Wellness Rounds

We all know the basics about how to be healthier and how much that can influence our risk of cardiovascular (and other) disease in the future.  Knowing is easy.  Changing is hard.

There is no doctor who wants to be fat, smoke, or eat poorly.  If you smoke, don’t exercise, eat poorly or are significantly overweight you already know

a) you have a higher risk of premature death and, worse, disablility

b) you’ll have decreased energy and generally feel worse than people who are fit

c) it’s going to be a lot harder to counsel patients about what to do for their health

It would be fantastic if we were all issued a magic wand as part of our medical supplies.  It would be so much easier to make changes in our lives and our patients lives by a wave of a magic wand.  There is no magic wand, but we (and our patients) can make changes using what is known about behaviors and changing behaviors.

The American Heart Association has recently published a review of the literature and recommendations on how to sustain changes that improve health.  I’ve put the link below to the entire article but here’s my summary (and slight translation) of what they found worked to change behaviors:

1. Set goals
2. Use a system to monitor the change
3. Create or discover a support system you can use on a frequent and regular basis
4. Establish a way to get regular feedback on your progress
5. Believe you can do it (and work on strengthening this belief)
6. Reward yourself when goals are achieved
7. Find role models for your new behavior and spend time with them (or what they have written)
8. Brainstorm to use your innate ability to problem solve.  Don’t accept “I can’t”
   or “never” in your vocabulary of change – find creative ways to move past these obstacles.
9. Learn from the times you fail (which is normal). ‘Try again. Fail again. Fail better.’  Samuel Beckett

Interventions to Promote Physical Activity and Dietary Lifestyle Changes for Cardiovascular Risk Factor Reduction in Adults. A Scientific Statement From the American Heart Association Artinian et al, Circulation. 2010;122:406-441

Do’s and Don’ts of Goal Setting from www.sparkpeople.com

Elements of Change from zenhabits.net

I recently found an easy breakfast idea for busy docs.  “Hungry Girl” is a website with interesting (and usually humorous) advice for people trying to lose weight – including recipes.  If you are trying to lose weight (or avoid weight gain), follow the recipe as written.  If you aren’t trying to lose weight, use whole eggs, real sausage, butter, etc.

One word of advice – if you are using whole eggs, make sure you scramble them before putting them in the microwave (unless you want an egg explosion and a huge mess to clean up!).  Even for egg whites alone, stop the microwave to stir every once in a while!

http://www.hungry-girl.com/week/weeklydetails.php?isid=1784

http://www.hungry-girl.com/week/weeklydetails.php?isid=2063

http://www.hungry-girl.com/week/weeklydetails.php?isid=1957

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.