Favorite Posts of 2010

This has been an amazing year!  It’s a good time to say thank you to the medical students and residents I work with who inspire and teach me every day.  As this year ends, I thought I’d look back and pick some favorite posts.  Happy New Year to everyone!  May your new year be full of joy, health and success!

Starting Medical School:  Rules of the Road

How to Choose Your Specialty

White Coat Ceremony Faculty Address

How to Study in Medical School (Basic Sciences)

Studying in Medical School: Making it Relevant

How to Study During Your Residency

Learning Clinical Medicine:  Tips for the Hospital and Clinic

How to Exercise Despite Your Busy Schedule

How to be the Best Intern in the Hospital

Failure

Cooking for Yourself in Medical School and Residency

Religion and Spirituality

Clean Eating

If you want to lose weight, or just to eat “better” you might want to consider looking into the concept of “clean eating”.

Although eating clean works to lose weight, it’s not really a “diet” in the usual sense of the word. Clean eating is a lifestyle and way of eating that is medically very sound.  It’s getting rid of the junk food, eating often enough to maintain your energy and  “shopping the periphery” of the grocery store.  (Think about it – the food being sold on the periphery of the grocery store is mostly non-processed.)

Everyone has had the (horrible) experience during a call day of not eating anything all day, having a big meal in the evening  (often McDonald’s or an equivalent) and then being brain-dead from lethargy for 2-3 hours. In addition to helping you control your weight (and preventing weight gain during medical school and residency),  “eating clean” will prevent the on-call lethargy you get from eating junk food and can give you sustained energy during long work days.

In a nutshell, here are the “rules” for eating clean (Revised from lists published on ehow.com and cleaneatingonline.com)

How to Eat Clean

1. Eat 5-6 small meals a day: breakfast, lunch, dinner and 2-3 snacks – and don’t skip meals! This means taking a cooler with you to work and/or having choices like meal replacement bars in your pocket. It’s important to eat every 3-4 hours to keep your insulin levels (and energy levels) from waxing and waning too much. It’s really important to never skip breakfast!

2. Eat a serving of complex carbohydrates at every meal (about the size of your fist). Grains should be unprocessed as much as possible (more fiber = more satiety) like brown rice or quinoa .

3. Minimize or (preferably) completely eliminate processed food, soft drinks and alcohol.

4. Eat fruits and/or vegetables at every meal.

5. Eat a serving (about the size of your palm) of lean meat, chicken or fish at (almost) every meal. Vegetarian options are fine, too (beans, tofu, etc).

6. Read labels. Try to avoid foods with white flour, sugar and sugar substitutes, saturated fats and trans-fats.

7. Take good snacks (like premeasured servings of nuts) with you to work so you don’t get tempted by vending machines and breakroom junk food.

8. Don’t beat yourself up if you cheat – in fact, you’ll probably need to have a cheat day (on purpose) every once in a while. But recognize it’s a cheat day and not a permanent change from your new way of eating.

9. Keep things interesting by checking out recipes and cooking for yourself. You can subscribe to Clean Eating Magazine or at least pick up an issue to check it out.  The Diet Rebels Cookbook: Eating Clean and Green, Clean Food: A Seasonal Guide to Eating Close to the Source with More Than 200 Recipes for a Healthy and Sustainable You and Tosca Reno’s Eat Clean Cookbook: Delicious Recipes That Will Burn Fat and Re-Shape Your Body! are cookbooks with good recipes for clean eating. Here’s some websites with recipes, too: cleaneatingonline, eatcleandiet, cleaneatingmag

On Losing Weight – Part 2 (The Roadblocks)

Part 2 of a guest post from Jenny Scoville Walsh with wonderful advice on losing weight.

Losing weight should be seen as a way to take better care of yourself, NOT torture yourself!  But  everyone I know realizes they want more food than their body technically needs.  How do you handle that?

If you’re hungry, then you might want to spread your calories out.  Are you eating something with high fat?  Try the reduced fat version and you can have a larger snack for the same calories.  Instead of eating French fries, you can eat TONS of carrots for the same calories.  Instead of microwave butter popcorn, try the lowfat version or an airpopped version with a controlled amount of butter.  Instead of a cinnamon roll for breakfast, try cereal and non-fat milk.  Try drinking water while eating oats or other grains, which will absorb the water and make you feel full longer.  Choose fiber—which also makes you feel full longer.  So, choose the orange over the orange juice.  You get more bulk, and therefore more fullness for the same amount of flavor.  If you’re looking for something sweet, try fresh fruits instead of candy.

What if you’re craving flavor?  I recommend sugar free gum.  It comes in tons of yummy flavors.  Try herbal tea with sugar substitutes.  Diet soda is tastier than it used to be and may help you beat that crave occasionally.  Maybe you could take tinier bites and savor a small amount of a favorite flavor, instead of eating a full serving of it.  Maybe you need to smell yummy things, like perfumes and candles—smell and taste are closely related.

What if you’re looking for comfort, endorphins, fun, friends?  Well, Flylady shared a quote with me, and now I guess I’ll have to look up where she got it, that said “If hunger isn’t the problem, food isn’t the solution.”  And Mary Ellen Edmunds shared:  “You can never get enough of what you don’t need.”

Looking for comfort?  Get a comfy sweater, snuggle with a favorite blanket, watch a favorite movie, light a scented candle that you love, get a hug, get massage, talk to a friend, take a hot bath, read a favorite book, play your favorite music, look at favorite pictures, call a family member that can offer support, etc.

Looking for endorphins or fun?—exercise, cuddle, dance, do a favorite activity, listen to a pumped up song, use a talent (decorate, write, paint, draw , knit, design, build, remodel), clean an area of your space, smile at yourself in the mirror, doing something fun with an energetic friend, compliment someone, help someone, tell a joke, watch something funny and laugh your head off, etc.

What if you’re lonely?  Get involved at school, church, community organizations, sports groups, dance groups, groups that explore the natural and manmade environment (they go skydiving one weekend and explore the underground tunnels in the city another weekend, for example).  Look in your neighborhood for people close by to befriend.  Try looking for people more shy or lonely than you and reach out to them.  There are people at work that you may be overlooking.

What about leftovers and wasting food?  Are you a garbage disposal or are you a person?  If you’re not hungry and something is worth eating, save it for when you are hungry and need more energy.  Refrigerators and freezers are wonderful things.  If it is not worth saving, throw it away.

What about people that offer you food and even cajole you if you turn them down?   If you suspect someone will offer your food later and you want to say yes, save up calories for the occasion.  Then, take wise portions of the various foods so it adds up to the amount you intend to eat.  If you have eaten enough, it’s ok to say no to food. Say, “No thank you.  I’m full.”  Or “Thank you, that looks delicious.  Maybe some other time.”  Or, “I’m trying to keep my girlish figure.”  Or, “That smells AMAZING!  I would love to try that when I’m not so full.”  Or, “Thank you for offering. You are such a great hostess.”  Or, “That really was delicious.  I’d love to get the recipe!”  I doubt your host or hostess (or relative) is trying to fatten you up like in Hansel and Gretel. They want their efforts to be appreciated and to know you had a good experience.  And they may not want to have a house full of food left when their guests leave.  If that’s the case, maybe a bag of offered food for later may meet your host’s needs and your desire for a tasty snack (but when it would be wise to eat again).

Hopefully, this helps you on your own journey to losing weight.

On Losing Weight

A guest post from Jenny Scoville Walsh with wonderful advice on losing weight.

A lot of people are planning on setting weight loss goals for the New Year.  I set that goal this year and I’m succeeding!  Over this year, I not only lost all the weight I gained in med school (all that sitting to study and munching to stay awake did a number on me—we just won’t discuss WHICH number), but I also lost some beyond that.  And so next year’s goal is “keep up the good work.”  I’m going to tell you what is helping me and maybe it will help you.

First, whenever people talked about metabolism (pre-med school), it sounded like this nearly magical thing that if you were lucky it was fast, if you were unlucky it was slow, and if you weren’t careful you could ruin it.  However, metabolism is simply the sum of all of the processes in the body that build (anabolism) or break down (catabolism) things in the body.  (see my video on Metabolism on Youtube.  I’m Englishgalmd)  It isn’t magic and you can’t break it.  It is something you can understand well enough to make better lifestyle choices and lose weight.  It IS true that you can have a faster or slower metabolism based on a lot of things (like thyroid hormone levels, for example).  If you’re losing hair, getting fat, feeling weak, tired, and depressed, have dry skin  and brittle nails, experience constipation, cold intolerance, or loss of the outer 1/3 of your eyebrows ( you  can Google “hypothyroidism”) get that checked out!

If you’re overweight, you probably hope you have hypothyroidism, because it can be treated and as a result, it will be easier to lose weight.  However, most people who are overweight do not have hypothyroidism.  They have a math problem which is causing their weight problem.  This is the math problem:

(Calories in-Calories out)/3500 calories per pound=change in weight

Let’s break that down.

Calories in-Calories out=change in calories

If you take in more calories than you use, your body with have extra calories to store as fat.  If you take in LESS calories than you use, your body will have to use extra calories from fat (I’m saying this with caveats attached—see later) and you will have smaller fat stores.

Now, let’s examine the other part of that math problem.

Change in calories/3500 calories per pound=change in weight

If you take in an extra 3500 calories, (and a pound of fat is 3500 calories), then your body is going to store 3500 calories, or you will gain one pound of fat.  Even if you are eating only protein, you will still store extra calories as fat, because fat is the storage molecule.

There are ways to make this math problem more complicated, like you could exercise or live in a very cold climate or have a higher percentage of muscle.  And you may, if you’re building muscle, WANT to gain a pound of muscle which you’d do by working that muscle and then providing the proper amount of protein so when it rebuilds itself, it can be larger.   You might temporarily change your weight with extra bulk in your intestines or being very hydrated or dehydrated, but your body will normally balance those things out.  You might be retaining water somewhere if you have swelling at your extremities or have a sudden change in abdominal size.  That’s not a calorie problem and you should get that checked out by a doctor.

You could decide to not eat at all and live off your fat, but DON’T DO THAT!  Living only off your fat causes a lot problems, since your body still needs some glucose (it is your brain’s preferred food and the only food red blood cells can use), and fat can’t convert back into glucose.  The only way your body can make glucose once the glycogen stores are gone (after 24 hours of not eating glucose sources) is to break down protein in your body.  Protein is not a storage molecule.  You are using all of your protein for muscles, carrier molecules, enzymes, coating your nerves, etc.  So basically, you need some source of glucose to at least feed your brain and keep a few processes moving properly in your body.  However, you can use fat to fuel many processes in your body.  In addition, you need various vitamins and minerals.  Take a multivitamin, but realize that food sources are usually MUCH better than taking a vitamin pill, so please don’t starve yourself!

So, the equation can get really complicated, but fundamentally, it can help to think about how to manage the calories taken in or calories used.  Excess calories (the stuff you don’t need to build your muscles, repair things, move, maintain your body temperature, and perform all of your normal body processes) will get sent to fat cells and stored as fat.  And, as long as your body has enough glucose to do its job and enough protein to repair itself, then eating less calories than you use will lead to weight loss (mostly from fat).

The next thing I learned is that one part of the equation is actually a lot more important than the other.  Calories IN can change a lot faster than calories out.  If you don’t believe me, go check out how many calories various exercises burn in an hour.  Then compare that to how much junk food you could eat in an hour.  You can easily outeat your exercise capacity.  So, be wise with what you put in your body in the first place.  Don’t get me wrong.  Exercise is great!  You tone your muscles and help your heart and lungs function better.  If you do weight bearing exercises, it can make your bones become stronger.   It can release natural endorphins.   It can even give you 200-400 extra calories to play with in your calorie equation.  However, it cannot undo an extra 2,000-3,000 calories every day unless you also run a marathon every day.   And I notice if I work out VERY strenuously, I am ravenous afterward and also take it easy for the rest of the day.  That doesn’t help my cause, you know?

So, how many calories ARE you taking in a day?  You can get some pretty good estimates with calorie counters.  There are TONS of them online.

Calories out is trickier.  There are estimates on line for different exercises you do and your general activity level and how tall you are and your gender.  If you don’t want to mess with that, just weigh yourself every day and then see if you are going up, going down, or staying the same.  If you can maintain your weight on 1800 calories, then you know how many you are burning daily, right?  If you’re gaining weight on 2200 calories, then you already know you need to back off on your food intake because you don’t need as much as you think you do.

Now, here’s how to use the equation for good.  Let’s say you know you maintain your weight taking in 1800 calories.  You don’t have to do anything super drastic (especially if you’re nursing a baby or pregnant or still growing up).  Just try USING 1900 to 2100 calories.  How?  Move a little more. OR, you could TAKE IN 1500 to 1700 calories by eating less food at lunch or dinner and fill the rest of the way up with water.  Eat half the dessert you normally eat.  Cut out a splurge a week or chew sugar free gum instead of pretzels when you want something to munch.  You could cut out more, but if you cut out too much (like going down to 1 meal a day, or taking in less than 1200 calories a day) first of all, you start bringing in some of the more complicating parts of metabolism which I glossed over (getting enough glucose to make your brain function properly without using up all your body protein, being nice to your kidneys by not breaking down too much protein a day, etc.).  But, second of all, you’re setting yourself up for an unworkable long term plan.  If you’re planning on losing more than just a few pounds, it’s going to take a while.  I’ve been working on weight loss since January and I will be working on it for at least several more months.  There is NO WAY I could do it if I were starving myself, eating only the foods  I hate, or working hard to always bring limited foods I’m allowed to eat with me.  My perspective is, do it in a maintainable way.  If you do something really drastic (even if you somehow aren’t hurting your muscles and kidneys), you won’t be able to stand it for very long and then you’ll revert.

New Year’s Resolutions

Why not take advantage of the first of the year to follow the tradition of making changes?  It’s a good opportunity to take stock of where you are and where you’d like to be a year from now.  Here’s some ideas to think about if you are planning to make some New Year’s Resolutions.

Eat real food. You may not be able to follow all of Michael Pollan’s rules all the time, but you should at least know about them.  Make a resolution that fits your life, but start with a) decreasing processed foods and b) increasing fruits and vegetables.  If you aren’t familiar with the principles of good nutrition, resolve to learn more by reading textbooks, information on line or books like In Defense of Food by Michael Pollan, Food Matters by Mark Bittman, or Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating.

Eat breakfast. There are a lot of reasons this is a good thing to do!  This is an easy resolution for the new year.

Lose weight to a healthy BMI. If you are in the group of people (like many of us) who struggle with weight this is a hard task!  Do not “diet” – it’s doomed to failure.  Instead, find small changes you can make on a consistent basis that will decrease your calories by 250-500 calories a day.  For example, if you drink soft drinks (150 calories each), eat a bagel in the OR lounge  (300-400 calories), or eat at McDonalds on call (1000-1500 calories), change to diet sodas, cereal and bringing a sandwich from home.  If you think having the support of an on-line or real group would help, consider Weight Watchers or Spark People.

Exercise (almost) every day. Consistency is more important than quantity, so find something you like to do and “Just do it!”  It’s not easy to fit exercise into a busy schedule, but deciding to try is the first step!.  Another strategy is to increase your activity at work, especially on days you can’t actually work out.

Love what you do. You can decide to be a “romantic scholar”– to find enjoyment in difficult work and awe in learning.  It’s really easy to get caught up in how hard this work is and forget how amazing what we do is… and what a privilege it is to do it.  Make up your mind to cultivate a sense of awe about your work.  Keep a notebook, and write down what you learn from and about your patients.  Read more than you are asked to read, learn more than you are expected to learn – not to be a “gunner” but because you love medicine.

Nurture relationships with family and friends.  It’s easy to get caught up in the hours and hours we spend learning and practicing medicine.  Resolve to spend one night a week as a “date night” with your significant other, call close friends on a regular basis, keep in touch with relatives you don’t see very often.

Develop ways to deal with stress. Learn how to meditate and start a practice.  Spend time playing a musical instrument (or learning how to play).   Take yoga classes.  Join a church, synagogue or other religious community. Get a massage once a month.  Develop an exercise program which is one of the best ways to decrease stress (another reason to make this a New Year’s resolution!).

Tackle your debt.  Financial issues just add more stress to an already stressful time.  Assess where you are financially and develop a plan for dealing with the debt that all medical students and residents have to deal with.

If you need help with a personal issue, make an appointment. If you drink too much, use legal or illegal drugs inappropriately, suffer from depression, or have significant anxiety, please call and make an appointment with a health care professional.

Best wishes to all for a New Year filled with joy, health, success and happiness!

Holiday Gifts for Medical Students and Residents

  • A maid or housecleaning service once a week.  No one in medical school or residency has time to clean (or likes it)!  This will be one of the most appreciated gifts you’ve ever given someone.
  • Along the same lines, a highly functional laptop computer is a critical piece of equipment (i.e. not the cheapest you can get).
  • An iPad.  There are a lot of uses for the iPad in the hospital… and even more personal uses!  This is a great gift for any medical student, resident or practicing physician.
  • Membership to a gym.  Working out is important both for physical and mental health during medical training.  But – unless you know for sure which gym is the closest to where they live, it might be better to create a homemade “gift certificate” and let them decide.
  • Anything to help promote more exercise.  A bicycle to commute to school or the hospital?  A gift box with exercise equipment?  Yoga classes?
  • A gift certificate to Whole Foods (or any grocery store that makes take out food), or a healthy prepared food service.  In Houston, we have My Fit Foods, Snap Kitchen, Diet Gourmet, Real Meals 365 and several other services.  These types of businesses exist in almost every major city and can be easily found with an internet search.
  • How Doctors Think, by Jerome Groopman. I’ve recently read this book (and will probably be posting more in the near future about the great observations he makes).  This is a great read for anyone in medicine, but especially for students and residents.

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Easy Fast Recipes: The Six O’Clock Scramble

One of the keys to eating well as a resident is to plan your meals.  I’ve posted before about how to cook for yourself in medical school and residency (i.e. how to plan) but came across a site this morning I thought I should share. The Six O’Clock Scramble is a service you can subscribe to that sends you recipes (with shopping lists) for the week.  Most importantly, the recipes follow my “pizza rule” i.e. they take less time to cook than it takes to order a pizza.   You can customize it for vegetarian or other specific diet needs and also for the number of meals you want in the week.

logo_scramble

For those of you that “don’t cook” – here’s a FAQ from the Website:

I am not a very good cook and I actually hate cooking!  How can the Scramble® help someone like me?

 

Scramble® recipes are designed to be EASY with all instructions clearly spelled out and few, simple ingredients.  Most importantly, the Scramble® takes the stress out of planning for meals by designing a week’s worth of balanced menus complete with healthy sides.

I have used this site myself in the past – the recipes are good and they are easy!  They also come with complete nutritional information, so if you are trying to control calories, limit fat or increase protein, you will have the information.   This service is a good compromise for students and residents that want to plan their meals, but don’t have the time.

The main reason I am posting this today is I came across a deal to subscribe at a discount if you do this before December 25th: http://www.snack-girl.com/snack/healthy-dinner-recipes-six-oclock-scramble/ This would also make a great holiday gift for a busy medical student or resident!

Why You Should Eat Breakfast

Most of us start very early in the morning and have a variety of excuses why we don’t/won’t eat breakfast, most often “I’m never hungry this early” or  “I’m in too big a rush”.  You don’t have to go to medical school to realize that your blood glucose levels will be low after 8-10 hours of no food.  It’s why things like donuts and sweet cereals are so popular for breakfast  But a quick infusion of sugar to spike your serum glucose leads to a spike of insulin which leads to hypoglycemia.  Not a good idea if you want to stay awake in class or be sharp when seeing patients.

It’s much better to eat a breakfast with carbohydrates, protein and little fat if you want to sustain your glucose levels.  There are a lot of other advantages to eating a good breakfast.

No one with a busy schedule is going to spend time preparing a “fancy” breakfast in the morning.  But there are many, many good options that don’t take any time at all.  I’ve listed some great websites and recipes below – but don’t limit yourself to these.  Look into typical breakfast choices in other countries, eat the leftovers from last night’s dinner…. Just don’t skip breakfast!

15 ways to eat a beautiful breakfast

18 Quick Breakfast Recipes for Busy Mornings

12 Smart Ideas for Breakfast On the Go

Thanksgiving Gratitude

Gratitude is not only the greatest of the virtues but the parent of all others.”  Cicero

Gratitude is a powerful tool.  There is good evidence that being grateful leads to a greater sense of well-being and less stress.   Practicing gratitude on a regular basis can be as simple as “counting your blessings” every morning, or listing things you are grateful for on your scut list, in a journal,or on your smart phone.  Another useful practice is to write letters (to send or not) to your parents, teachers, friends or mentors to thank them.  If you aren’t convinced that practicing gratitude can have a profound effect on your well-being,  take the “2 minute challenge”.  Get a piece of paper and for two minutes write down everything thing you are grateful for.  Don’t lift the pen off the paper and keep writing (non-stop) for the entire two minutes.

Today, as I am spending time with family and friends, making our Thanksgiving feast and counting our blessings, I am reminded that all over the United States, there are physicians, residents, nurses, therapists, and support personnel who are spending this holiday taking care of patients.  Along with the patients and families in their care, I am thankful for their sacrifice and their compassion.  It is a blessing to have the skills and the heart to care for others, and we are grateful for that privilege .

“If the only prayer you say in your whole life is “thank you,” that would suffice.  Meister Eckhart

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