Wellness Rounds

It’s Saturday and I’m on call – and it’s going to be a busy day!  We have about 75 patients on the service, we already have 4 cases done and another 4 posted, and it’s still early (~4pm)   I have a fantastic resident with me today.  We just were chatting about what we are going to do for meals today.  He didn’t have breakfast and has only had a Coke and a “borrowed” bowel of Kix cereal from the recovery room so far.  I had whole wheat toast with some goat cheese before I left my house this morning, and I here’s what I have to eat today:

• Strawberries
• A handful of frozen cooked shrimp with cocktail sauce (they’ll thaw by the time I want to eat them)
• Frozen peas (I put them in the microwave for a minute but, like the shrimp, frozen would be fine because they’ll thaw) + goat cheese, olive oil, vinegar, salt and pepper
• Leftover whole wheat orzo, artichoke hearts, tuna and lemon pasta from last night
• An apple
• Lemon wedges for water

My resident’s Coke is probably more than I used to have as an intern… which is STUPID.   Eating well is important to feel well, perform well and do the right thing for your patients. There is one word that explains the difference between my resident (and what I used to do) and what I do now… planning.   “I’ll just get something from the restaurant across the street later…”, “There will probably be food leftover from the GI conference…” .. “I can always eat a bagel from the lounge..” … NOT.   When you finally have a minute to grab something to eat, you won’t usually have time to go look for the food.  It’s a lot easier if its’ there and ready to eat.

Here’s how to do this right:

1. Buy a good “lunch box” .

I like the hard plastic ones that fit in an outside, insulated carrying case.  It’s a lot easier to clean up if something spills than the usual “lunch box”.

You can use plastic (disposable) containers to carry your meals with you.  I’ve switched to glass containers because some of the data about heating the plastic containers in the microwave started sounding convincing.  It does mean you have to keep track of them and bring them home, but I suspect in the long run (if I don’t lose them) it will be cheaper than the plastic containers.   I particularly like the ones I bought because the seal is so tight that they don’t ever leak  (even for things like soup).

2. PLAN.

The night before call, figure out what you are going to take. Make it good stuff, too!  Call nights are not the “what I know I should eat” nights.  You need to have real food (i.e. not processed) but don’t skimp.  When you get to the “I really deserve those french fries” time of your call (which we all do) you will have really delicious and balanced food  in the refrigerator.

3. Pack your meals for the next day the night before (no matter how late it is or how tired you are).

It’s the only way you’ll actually do this.   None of us when we work this hard have the energy to put together meals for the day at 5am.  This takes a little effort but the payoff is real.  You will absolutely eat better, have more energy, maintain your weight and do a better job.  Don’t forget to throw some fruit in – and to make sure it’s washed so you can just pull it out of the refrigerator for a snack.

Here’s a few more recipes that meet the “pizza rule” (cooking in medical school and residency has to take less time than ordering a pizza).  Here’s the link to my post on cooking for yourself in medical school and residency if you need more info on the “pizza rule”: http://wellnessrounds.org/cooking-for-yourself-in-medical-school-and-residency/

Spinach, Feta and Tomato Quiche

http://www.vegetariantimes.com/recipes/10963?utm_source=Vegetarian&utm_medium=newsletter&utm_campaign=vege175

This is a really easy recipe that uses phyllo dough (which you buy in the frozen food department) as a crust.  Another alternative is to buy frozen pie crust (I prefer whole wheat). You can skip the sesame seeds, but if you choose to use them, make sure you toast them.  Put them in a hot pan and don’t turn away!  Keep shaking the pan and as soon as you smell the sesame dump them out (about a minute or two).  If you don’t have nutmeg, don’t worry about it.

I really try not to mention anything commercial in this blog, but I have to make an exception for spices.  If you like to cook, or are learning how to cook, spices are key.  I order mine online from a spice company www.penzeys.com.   They are fresher than what you buy in the store and about the same price.  More importantly you can buy little (half) jars which saves money and keeps fresher spices in your cabinet.  When you buy spices, whether online or in the store, write the date on the jar.  You should throw them out after 2 years.

21 Superfast Stir-Fries and Sautes

http://www.cookinglight.com/food/quick-healthy/20-20-superfast-stir-fries-sautes-00400000037729/page23.html

This site has 21 different recipes for stir fry dinners that take less than 20 minutes to prepare and all look delicious.  Stir-fries and sautes are always easy, and are going to make up a high percentage of your “pizza rule” dinners.  You’ll need a wok or a saute pan – one of the essentials of a student or resident’s kitchen.  Good cookware is a great thing to ask for as a present (and I just added it to the list of things to buy for someone graduating from medical school!)

If you buy a wok, you have to season it before you use it.  This is not hard, but you’ll look like an amateur if you don’t know about it (and one of my rules is that it’s important to look cool).  Seasoning just means getting a thin layer of oil to incorporate into the surface of the wok.  The key is “burning” it on the first time and then keeping it on by not scrubbing the wok.  After you cook in a wok, clean it with soap and water, but don’t scrub it – if it’s shiny you messed up.

http://thepauperedchef.com/2007/08/when-cheaper-is.html

http://www.asiarecipe.com/woks.html

I’m going to periodically add some recipes to the blog that meet my “pizza rule” i.e. if it takes longer to cook than it does to order a pizza it’s not going to work… http://wellnessrounds.org/cooking-for-yourself-in-medical-school-and-residency/

WHOLE WHEAT SHELLS WITH ASPARAGUS, PEAS, FETA AND MINT

This is a great vegetarian dish and would make enough for a lot of call nights!.  The recipe calls for garlic oil (which I’ve never heard of).  I’d skip it or, if you really want to add a little garlic taste, mash up a couple of cloves in some olive oil (like 2 tblsp) before you start and let it sit while everything else is cooking.  You can drizzle the olive oil over the pasta at the end.

http://www.vegetariantimes.com/recipes/10964?utm_source=Vegetarian&utm_medium=newsletter&utm_campaign=vege174

GRILLED FISH WITH FRESH PEA SAUCE AND PEA AND TOMATO RELISH

Here’s the original url for this recipe which is delicious (but a little fussy and violates the pizza rule)

http://www.foodista.com/recipe/4V8PPYZF/grilled-fish-with-fresh-pea-sauce-and-pea-and-tomato-relish

Here’s the resident friendly version:

GRILLED FISH WITH FRESH PEA SAUCE AND PEA AND TOMATO RELISH  (PIZZA RULE VERSION)

2 servings

• 2 filets of the freshest white fish in the store (Tilapia, snapper, etc)
• 2 tablespoons olive oil  (cut to 1 tablespoon or use Pam to save calories)
• 1 package frozen peas
• 1 cup chicken stock  (buy the 4 packs of one cup each)
• 1 shallot (if you can’t find one, use part of the red onion)
• 2 cloves of garlic (don’t cheat on fresh garlic)
• Salt and pepper

• 2  Italian Roma tomatoes
• ½  minced red onions
• 1/4 cup chopped black olives  (buy in bulk at Whole Foods – use Nicoise or herbed olives of Provence – can buy small jar, too)
• 2 tablespoons chiffonade of basil  (chiffonade = finely sliced.  Don’t cheat on the fresh basil, either)
• 3 tablespoons extra-virgin olive oil  (cut to one table spoon if you are watching calories)
• 2 Yukon gold potatoes cut into 6ths or 8ths

Start with the base of the sauce

• Saute the shallot (or onion) in the olive oil
• Add the garlic until you smell it (more and it will burn = bitter)
• Pour in the chicken stock
• Bring to a boil
• Add the potatoes – drop the heat to a simmer and cook until just fork tender (~8-10 min)
• Pour in the frozen peas – cook for 3 minutes
• Take the potatoes out and save

Take out a third of the peas with a slotted spoon and put in a bowl to use later

• Put everything else (minus the peas and potatoes you took out) into a blender until smooth.  (If you don’t own a blender, this is a critical tool for residents so go out and get one!  Smoothies are a key food item for medical students and residents and blenders are cheap!)

Make the relish

• Cut up the tomatoes, olives, basil, red onion
• Add to the peas you saved from above
• Add the olive oil

“Grill” the fish

• Use a grill pan or non-stick sauté pan (another important piece of resident equipment)
• Put olive oil in the pan (Pam if you are watching calories)
• Cook 3-4 minutes per side

Assemble the dish

• Pour the sauce into a bowl
• Put the fish on top
• Arrange the pieces of potato around the edges
• Put the relish on the fish

A variation (if you like Mexican flavors)

• Use tomatoes, corn, cilantro, jalepeno and onion for the relish
• Use frozen corn instead of peas

MLB’S EASY MEXICAN SOUP

8 servings

• 1 tsp olive oil
• 1 onion, diced
• 1 red bell pepper, diced
• 4 carrots, diced
• 4 stalks celery, diced
• 8 cups (two containers) chicken broth
• 1 roasted chicken (bought already cooked), skin removed and meat broken up into small pieces
• 10 oz frozen corn
• 1 can pinto beans
• chopped cilantro
• 2 avocados
• pico de gallo (buy at the store)*

Saute vegetables in olive oil until they are soft

Add chicken broth, bring to a boil

Lower heat to simmer and cook 10-15 min (until vegetables are mostly cooked)

Add chicken, corn and pinto beans

Cook another 5 minutes on simmer

Garnish bowls with chopped avocado (1/4^th per serving), cilantro and pico de gallo

Optional:  Add cooked rice and/or shredded cheese

* to make pico de gallo (if you can’t find it ready made)  combine 3 diced tomatoes, 1 diced onion, chopped cilantro, one diced (fine) jalapeno, salt and lime juice.  This is a great dip for chips or to put on grilled fish or chicken, too.

If you are not up to eating a big breakfast when you wake up, that’s ok.  Particularly in residency you may be getting up too early to be hungry.  As you are brushing your teeth make yourself drink a big glass of water.  Even if you are not hungry at all eat a little something  like a piece of fruit or a cereal bar.  (Set them out on the counter the night before to grab and eat in the car if you have to.)  There will be days that you may not get anything else to eat until the middle of the day, so don’t forego all nutrition in the morning.  Take a  ”real” breakfast to work with you and eat it when you can between 8 and 10.   

 

Easy breakfasts for doc’s on the go

 An energy bar (e.g. PowerBar)

Frozen breakfast taco (see recipe below!)

Last night’s dinner (such as rice and meat, rice and an egg, noodles)

A smoothie (you can put the ingredients in the blender the night before, then just put it on the blender in the morning)

Peanut butter and jelly sandwich

Frozen pierogies heated up in a microwave

Instant oatmeal (add nuts and dried fruit if you want)

Cereal and milk (add fruit to make sure you get fruits into your diet)

 

MLBs Breakfast Tacos

Buy 10-12 whole wheat tortillas, 1 can of refried beans, 1 bag of reduced fat shredded Mexican cheese.   Spread all the tortillas out on the counter and divide everything up between them. 

Add whatever else you want: 

8oz of cooked chicken or turkey (grilled in the deli is best)

Sausage (veggie soy sausage is good and tastes fine in the tacos)

Corn

Rice

Roasted red peppers (in a jar)

Chiles

 Put the tacos in the freezer in individual freezer bags (Ziplock,etc) .  (Put the individual bags in a big freezer bag if you want to further limit freezer burn). 

 2 minutes out of the freezer and into the microwave = breakfast.

I became aware of this book last week through one of the anesthesia residents at work (whose chairman made this book required reading for all residents in his department).  Dr. Gautam is a psychiatrist who has specialized in caring for physicians and is an expert in physician wellness.  She uses training for an Ironman triathalon as an analogy.  Physicians have to “train” for different roles (personal and professional) if we want to prevent burnout.  She proposes a training program that helps keep balance in the complicated life of a doctor. The book primarily addresses physicians already in practice, but the information is very applicable to trainees, as well.

Here’s her website if you are interested:  http://www.drgautam.com/gautam/books.htm

Most medical students and residents eat poorly.  It’s not really a surprise – the days are packed with work from sun-up to sun-down.  There are no planned meals because there can’t be.  Food is a quick bite when it is available.  It’s feast or famine.  On the far end of the scale, the stereotypical diet of a resident is no breakfast (but usually coffee), a doughnut and coffee grabbed on the run once you get to work, some mid-day meal of fast food, and pizza on call.  Food, particularly fast food, becomes solace.  In the stressful world of residency, this kind of “comfort food” becomes a “reward” for the hard work and tribulations. It’s not rocket science.  This kind of diet doesn’t give you the energy you need to function at your peak.  It is also a diet that is very likely to lead to weight gain.  In your 20s, your body can cope with this suboptimal fuel, but it’s not ideal.  However, what “works” in your 20s won’t work as you get older and could even be responsible for a heart attack, diabetes, or other medical problems in your 40s and 50s.  On a more philosophical level, you would never advise this kind of diet to one of your patients.  None of us want to be hypocrites.

The answer is to cook for yourself.  Not everyone likes to cook, and not every one knows how.   I’m going to make a case that you should learn.  Trust me – if you can learn to take out an appendix, or diagnose a pneumonia, you can learn to cook.   I’m going to assume that you are single for the sake of this description.  But, if you have a significant other, it’s even more important to cook at home.  He or she can participate in helping with the meal preparation, and, by doing this together and for each other, there is added benefit for your relationship.  Having dinner at home with a significant other will become an “anchor” to your day that will become very important to you.  As hard as it is to work around a busy schedule, if you can eat together, and have a real conversation, you will both benefit greatly.

Cooking is a wonderful therapy for the stress of medical school and residency.  If you’ve never learned how to cook, this is a hard time to learn complicated techniques, but it’s not hard to learn simple techniques.  There are several advantages of cooking for yourself that outweigh (on most days) the hassle of spending the time.  The act of cooking for yourself can be a time of “decompressing” from work.  Arranging vegetables, cutting them, smelling the odor of the food appeals to all your senses and is a moment in the day that you can intentionally slow down.  It’s very important that the recipes you choose are simple and quickly prepared.  No one wants to come home to a 2 hour task in the kitchen after a hard day.  Cooking for yourself has other benefits as well.  First, it is tangible evidence that you are taking care of yourself.  This is not a trivial point.  There are days during your training when it seems no one is taking care of you.  Having concrete evidence that you are caring for yourself is an antidote to that feeling.  Secondly, you will eat better.  By cooking from fresh ingredients, you will decrease the amount of pre-packaged and fast food.  Even without medical school, you know that this will result in better nutrition.  Thirdly, you will eat cheaper.  Other than the “free” pizza (ethically debatable, but financially clear), processed food is usually more expensive.  And lastly, you can share.  It isn’t any more work to make 4 or 6 portions of a dish than it is to make 2, and it usually isn’t that much more expensive, either.  If you can convince one of your colleagues that this is a good idea, you can cook for each other on alternate days.   Likewise, you can cook larger amounts and, using freezer ready containers, freeze portions for yourself for the future.  Doesn’t homemade pasta with a side of fresh vegetables really sound better than the greasy middle of the night food that is available in most hospitals?   It’s true that you can’t cook just anything with the kind of schedule you will have in medical school and your residency.  But, there are few key rules that will make it possible for you to do this, enjoy it, and eat well.

Rule 1:  Don’t cook anything that takes more than 30 minutes to prepare.

Let’s be realistic – you are not going to walk into your home at 8 o’clock at night, hungry, and spend an hour preparing something.  But – there are very nutritious dinners that take less than 10 minutes, so getting home late is no excuse.

Rule 2:  Plan ahead.

The first step in preparing dinner for most busy people is to open the refrigerator door and ask “What can I eat tonight?:  If you are anything like I was in residency, the refrigerator had some cheese, some vegetables (often way past their prime), and maybe some leftovers.  Not very appetizing.  There is an easy way to prevent this from happening.  On whatever day you have off and have time to shop, spend 30 minutes making a menu.  Start by making a table for the week with what is happening.

	Breakfast	Lunch	Snack	Dinner	Comments
Sun
Mon					On call – take Tues meals, too
Tues
Wed				Out	Out with friends after rounds
Thur
Fri					On call
Sat

Once you have an outline of your week, fill in the blanks with the meals.  Now, most of us can handle “hamburgers” or “Raisin Bran” as a menu item… but it’s more fun, and healthier to branch out a bit.  So, if you are not used to looking for new things to cook, how do you find recipes?  Cookbooks can be fun, particularly if you are looking for a particular ethnic food or a style (e.g. low-fat) of cooking.  If you like cookbooks, and bookstores, find the used book store nearest you and go to town!  There are also web sites for recipes.  Many of them also have “cooking lessons” on line.  Most cooking shows have a web based recipe site as well.   So, say you start by searching the web and find this recipe. (for this particular recipe, I’m assuming you have no concerns about calories)  It looks easy, and like it would taste good.   So you print it out.

NEW ORLEANS PASTA

ESSENCE OF EMERIL (FOODTV)   SHOW #EE123 – http://www.recipesource.com/main-dishes/pasta/11/rec1100.html

1 tablespoon olive oil

16 ounces chicken breast half, cut into strips (about 1/2 cup)

1/4 cup chopped chorizo sausage

2 tablespoons chopped green onions, plus extra for garnish

1/2 tablespoon chopped garlic

Tabasco and Worcestershire sauce

3/4 cup heavy cream

1/4 cup grated Parmesan cheese

1/4 pound shrimp, peeled and deveined

1/2 pound penne pasta, cooked al dente and tossed in oil to coat

Creole spice, salt and pepper

In a large saute pan heat oil, add chicken and sausage and cook 5 minutes, stirring often. Add green onions, garlic, 2 dashes each Tabasco and Worcestershire sauce or to taste, and cook for 1 minute. Add cream, cheese, shrimp and pasta. Cook, tossing, to heat through. Adjust seasoning to taste with Creole spice, salt and pepper. Serve garnished with green onions.

Yield: 2 servings

Now what?  First, cut and paste the ingredient list to a shopping list.  If you are compulsive, you can organize it into meat, dairy, produce, etc (it makes shopping easier, but it’s not essential).  You’ll need to add a vegetable or salad to balance this out nutritionally. (I picked broccoli as an example) If you can afford the calories, add a desert. (Ice cream in this case)  Then decide what night in your schedule this will work best.  This recipe will take about 12 minutes total so it would be great for a night you are getting home late.  You can either share the other portion with your significant other or you can take it with you the next day as lunch.  You can double the recipe and have it more than one night.   For example:

	Breakfast	Lunch	Snack	Dinner	Comments
Sun
Mon					On call – take Tues meals, too
Tues
Wed				Out	Out with friends after roundsThaw shrimp for tomorrow
Thur				NEW ORLEANS PASTA (CHICKEN, CHORIZO)Steamed broccoliIce Cream	Freeze one portion for later
Fri				NEW ORLEANS PASTA (CHICKEN, CHORIZO)Steamed broccoli	On call
Sat		NEW NEW ORLEANS PASTA (CHICKEN, CHORIZO)Steamed broccoli

Shopping list:

2 lbs chicken breast (16 oz x 2)

1/2 cup chopped chorizo sausage

1/2 pound shrimp, peeled and deveined

heavy cream   (need 1 1/5  cup)

Parmesan cheese  (need 1/2 cup grated)

Olive oil

Creole spice

green onions

garlic

broccoli (4 portions to steam)

One pound penne pasta

Ice cream

Rule 3:  Cook (or prep) today today to eat tomorrow

As soon as you get home from the grocery store:

• Freeze any meat that is for later in the week (and make a note to yourself to put in into the refrigerator to thaw a day or two before you are going to use it.)
• Wash the vegetables, dry them and put them away
• Wash lettuce for salads and dry completely (a spin dryer is the best).  Store in a zip lock plastic bag with a paper towel in the bag (which absorbs any residual water).  Make sure you squeeze out all the air you can before closing the bag.

Take advantage of days off to cook things that may take a little more time or effort.  While  you are watch the football game on Sunday, you can cook chili in a crock pot for Wednesday.  If you know that your vegetable stir fry on Tuesday is going to be after a long day, go ahead and chop all the vegetables and meat a day or two before when you have the time and have them stored in the refrigerator.   When Tuesday rolls around (and you are exhausted from work), you’ll have all the ingredients chopped and ready to throw in the pan.

This is the time of year when 4^th year medical students are winding down and preparing for the “big move” into internship.  Our 4^th year students take a special 3 week course to get them ready – a wonderful mix of small groups on professionalism, ACLS training, first night on call beeper emergencies…etc, etc.  It ends with a small group of senior faculty who talk about making the transition to residency.  I wish we’d recorded the talks – they were all really wonderful.  In addition to giving wonderful professional advice,  all of the faculty included advice on taking care of yourself.  It struck me that one of the specific issues that each of them mentioned (well, four out of five) was how much weight they had gained in their internship and residency.

Losing weight is not easy for those that struggle with this issue – but preventing weight gain is not as hard – and should be a goal for every intern and resident!   It’s not hard – you need to increase your activity (a little) and watch out for stupid food choices.   Here’s the “rules” I wish someone had given me before I started my residency (if you have rules you would add, please send a comment!)

1.  No junk food (doughnuts, pizza, hamburgers, etc)

2.  Take healthy food with you to work – especially for call nights.  Keep emergency healthy food in your locker i.e. high quality energy bars, dried fruit/nuts (in appropriate small portions).

3.  Make sure you get an hour of real exercise on days when you are not in the hospital

4.  Take the stairs instead of the elevators.

JAMA. 2010 Mar 24;303(12):1173-9.

Physical activity and weight gain prevention.

Lee IM, Djoussé L, Sesso HD, Wang L, Buring JE.

Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02215, USA. ilee@rics.bwh.harvard.edu

CONTEXT: The amount of physical activity needed to prevent long-term weight gain is unclear. In 2008, federal guidelines recommended at least 150 minutes per week (7.5 metabolic equivalent [MET] hours per week) of moderate-intensity activity for “substantial health benefits.”

OBJECTIVE: To examine the association of different amounts of physical activity with long-term weight changes among women consuming a usual diet.

DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study involving 34,079 healthy US women (mean age, 54.2 years) from 1992-2007. At baseline and months 36, 72, 96, 120, 144, and 156, women reported their physical activity and body weight. Women were classified as expending less than 7.5, 7.5 to less than 21, and 21 or more MET hours per week of activity at each time. Repeated-measures regression prospectively examined physical activity and weight change over intervals averaging 3 years.

MAIN OUTCOME MEASURE: Change in weight.

RESULTS: Women gained a mean of 2.6 kg throughout the study. A multivariate analysis comparing women expending 21 or more MET hours per week with those expending from 7.5 to less than 21 MET hours per week showed that the latter group gained a mean (SD) 0.11 kg (0.04 kg; P = .003) over a mean interval of 3 years, and those expending less than 7.5 MET hours per week gained 0.12 kg (0.04; P = .002). There was a significant interaction with body mass index (BMI), such that there was an inverse dose-response relation between activity levels and weight gain among women with a BMI of less than 25 (P for trend < .001) but no relation among women with a BMI from 25 to 29.9 (P for trend = .56) or with a BMI of 30.0 or higher (P for trend = .50). A total of 4540 women (13.3%) with a BMI lower than 25 at study start successfully maintained their weight by gaining less than 2.3 kg throughout. Their mean activity level over the study was 21.5 MET hours per week (approximately 60 minutes a day of moderate-intensity activity).

CONCLUSIONS: Among women consuming a usual diet, physical activity was associated with less weight gain only among women whose BMI was lower than 25. Women successful in maintaining normal weight and gaining fewer than 2.3 kg over 13 years averaged approximately 60 minutes a day of moderate-intensity activity throughout the study.

PMID: 20332403 [PubMed - indexed for MEDLINE]

Food is fuel.  It’s also solice if you are stressed, and face it – it’s fun to eat. Other professions that deal with stress and physical labor have learned the lesson about not paying attention to nutrition.  The culture of medicine demands a “selflessness” that borders on the absurd.  It is often a badge of honor that you can go all day without eating.  But, when you consider the consequences of such behavior, it is really crazy.  There is no benefit to the patients, and clear harm to the doctor.

Eat often and eat well

When you are physically and intellectually busy (an average day on call in the hospital) you need to plan to eat every 3-4 hours.  In general, you will have one “meal” (i.e lunch) in the middle of the day and two snacks.  It’s not always going to possible to stop for lunch at lunchtime, but you should be able to find 10 minutes at some point in between 11 and 4 to eat a meal.  Different rotations have different demands, and you can certainly take this into account when planning your meals.  A peanut butter and jelly sandwich on whole wheat requires no preparation, and no refrigeration (it can even go in the pocket of your white coat).  Alternatively, buy a loaf of whole wheat bread every week, and put the bread, a jar of peanut butter and a jar of jelly in your locker. It takes 2 minutes to make a sandwich to put into your pocket on the way to a conference or a brief break.  Bring leftovers from the previous night’s dinner to reheat and have for lunch.  You need to plan to include fruits and vegetables as part of every meal and your snacks.  Buy a bag of apples once a week and put them in your locker.. and then make sure you eat the entire bag every week.  The snacks don’t need to be elaborate, but you do need to watch the clock and eat them – even if you are not hungry!

Examples of easy snacks for the hospital

• “Meal replacement bars” (power bars, Luna bars, Kind bars etc)
• “Meal replacement drinks” (Ensure, Boost, etc)
• Skim milk with either graham crackers/peanut butter or a banana
• Cheese stick and an apple
• Melba toast or other crackers with sliced cheese plus some fruit
• Yogurt