And now for Something Completely Different--Vaccine Preventable Diseases

Meningococcal Meningitis

The measles in a 2 year old.

German Measles (Rubella) 

Chickenpox in adults can spread to the lungs and kill adults and children alike

Cervical Cancer from HPV

 I have a friend who just had a stem cell transplant for CLL.  Please read this blog entry.  He put forth the need for vaccinations better than anything I’ve ever seen by making it personal. His whole blog rocks though...:  Journal from the Plague Year:

http://journalfromtheplagueyear.blogspot.com/2011/10/herd-immunity.html

The Diseases:
Influenza:

Influenza disease:  is a respiratory virus that causes a high fever, generally 102, although not all will get a fever,  severe muscle aches and pains,  stuffy nose, sore throat, fatigue, and cough.  Some people get vomiting and diarrhea, but that is more common in kids.
Complications which can occur include post influenza pneumonia, bronchitis, ear infections and sinus infections and death.
People with the following problems are at higher risk:   asthma or COPD/emphysema, Diabetes, those over 65, pregnant women, People with HIV/AIDS, people with cancer. children younger than 5 and especially younger than 2.


Measles:

There is an unexpectedly high number of cases in the US this year.  Measles had been declared eradicated in the US in 2000.  The cases are imported from abroad where the disease is still rampant.  These unvaccinated US travelers got sick and brought it back to the US and spread the disease in our communities because NOT ENOUGH people are vaccinated now.  Most of the people who got sick in the US from these people were unvaccinated or under vaccinated.

Measles causes fever with rash, cough, runny nose, conjunctivitis.  One out of 10 kids get an ear infection and 1 out of 20 get pneumonia.  For every 1000 children who get measles, one or two die.

Measles is preventable by taking a vaccine. From the following CDC.gov website:
http://www.cdc.gov/measles/vaccination.html#coverage

“Measles can be prevented by the combination MMR (measles, mumps, and rubella) vaccine. In the decade before the measles vaccination program began, an estimated 3–4 million people in the United States were infected each year, of whom 400–500 died, 48,000 were hospitalized, and another 1,000 developed chronic disability from measles encephalitis. Widespread use of measles vaccine has led to a greater than 99% reduction in measles cases in the United States compared with the pre-vaccine era, and in 2009, only 71 cases of measles were reported in the United States.
However, measles is still common in other countries. The virus is highly contagious and can spread rapidly in areas where vaccination is not widespread. It is estimated that in 2008 there were 164,000 measles deaths worldwide—that equals about 450 deaths every day or about 18 deaths every hour.”

Go to the CDC website to read about the vaccine.  It does not cause autism.

Mumps:
There is an ongoing outbreak of mumps in highly observant Jews in Orange County, NY and in NJ. This is a community where there was a high amount of vaccination with 1-2 doses of MMR.  Turns out the mumps vaccine isn’t as effective so in order to prevent person to person spread, you need to make sure even MORE people are vaccinated with 2 vaccine doses.  In this outbreak, they were giving a 3rd dose of MMR to increase the immune response in the schools affected.  It didn’t spread much outside the observant Jewish community.  Speculation includes that possibly the surrounding communities had a higher vaccination rate, or there just wasn’t much intermingling of the affected community with their surrounding non Jewish neighbors.
This article explains it well.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5905a1.htm

Mumps causes fever, headache, muscle aches, tiredness, loss of appetite and swollen and tender salivary glands under the ears or jaw on one or both sides (parotitis).  Most people fully recover. but boys who have reached puberty can get inflammation of the testicles, girls who have reached puberty can get inflammation of the ovaries or breasts.  Meningitis and encephalitis (brain infection) can occur.  Deafness can occur and may be permanent.  It is spread by saliva or mucous from the mouth, nose, throat.  It can be spread by sharing drinks, utensils, touching virally contaminated surfaces(counters, toys, doorknobs, toilet handle etc.).

HPV:
is the cause of cervical cancer in women and head and neck cancers in men.  It causes anal-rectal cancer in people who engage in anal intercourse.  It can cause throat infections through oral sex.  It can be passed through straight and gay sex.  Pregnant women can spread it to their babies during delivery causing warts to grow in the babies throats (Recurrent Respiratory Papillomatosis).  It also causes genital warts.  The types of HPV that cause genital warts aren’t the same as those that cause cervical cancer.
At least 50% of sexually active people will get HPV at some time.  In 90% of the cases, people clear the infection and are fine.  BUT there are over 40 HPV virus types.  Most people don’t even know they have an infection.
There is a vaccine available for boys and girls to prevent them from getting the types of HPV that can cause cancers.  Here is the link to the CDC website:
http://www.cdc.gov/std/HPV/STDFact-HPV.htm#common

Getting the vaccine does not mean that you are condoning premarital sex.  Where did that idea come from?  Would you deny your child Hepatitis B vaccine for that reason?  C’mon now.

DIPTHERIA:
Who’s ever heard of this?  You know why?  We practically never see it here because of immunization against it.  There are only about 5 cases a year in the United States.  It’s in the routine Tetanus vaccine.  In the 1990‘s, when they took it out of the tetanus vaccine in Russia  a while back, it made an amazing recovery and caused many cases and many deaths.  They used to call it the “strangling angel of children”.  It was a leading cause of death in children.
Diptheria is a bacteria that is spread by coughing and sneezing, or contaminated food or objects (milk, utensils).  It infects your throat and nose and causes a gray/black fibrous like covering which can block your windpipe and suffocate you.  It can cause skin infections like above.  Then, once it infects you, it makes a toxin (a chemical poison) that can spread to your heart and cause inflammation of your heart and other organs.  You turn blue, get a watery nasal drainage, have great difficulty breathing, get chills, a barking cough, drooling, fever, painful swallowing and skin lesions may occur in tropical areas of the world.


MENINGOCOCCAL MENINGITIS

Meningitis is an inflammation of the membranes which cover the brain and spinal cord.  Meningococcal meningitis is caused by a bacteria and occurs mostly in children and adolescents.  It is the most common cause of bacterial meningitis in children and the second most common cause of bacterial meningitis in adults.  It occurs in winter or spring and can cause epidemics in boarding schools, dorms, and miltary bases.
It causes sudden onset of fever and chills, altered mental status, nausea and vomiting, purple bruise like areas (purpura) and pinpoint red spots (petechiae), light sensitivity, severe headache, stiff neck, rapid heart rate, and rapidly progresses to death within 24 -48 hours.  The death rate varies from 5-15%.  Young children and adults over 50 are at highest risk of death.  It can cause permanent hearing loss, heart inflammation, seizures, brain damage, seizures, if you survive it.  It is preventable by getting the vaccine, washing hands before and after changing a diaper or after using the bathroom.
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001633/

TETANUS

Also known as lockjaw.  It’s caused by a poison made by a bacteria called Clostridium tetani.  The spores live EVERYWHERE and can remain infectious for 40 years.  When the spore gets into a deep wound where there is little oxygen (hence “stepping on a nail” being a risk), the spore releases the bacteria which then makes a poison.  The poison stops the nerves from working and the muscles all over the body go into spasms so severe that they can tear muscles and break bones, especially in the spine.  It starts with mild spasms in the jaw (lock jaw).  The muscles in the chest, neck, back, and abdominal muscles can spasm too. “ Opisthotonus” is when all the back muscles spasm causing the back to arch and to break the vertebrae.
The spasms can affect breathing.  Loud noises can exacerbate the spasm.  They can have difficulty swallowing, uncontrolled urination and defecation, irritability, foot and hand spasms  and drooling.  Often you need to be in a dark room, on massive doses of muscle relaxers (valium like drugs), and to be on a breathing machine.
One out of four will die if not treated.  Newborns with untreated tetanus is even higher.  WITH treatment, < 10% die.

I’ve seen this in a patient from Mexico after childbirth and cutting of the cord with an unclean knife.
This disease is completely preventable with TdaP vaccine, dT vaccine boosters every ten years.  after the primary series is finished as a child.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001640/

SMALLPOX

Small pox is a virus that only infects humans and has been completely eradicated by vaccination.
The disease was eradicated by 1980.  Without vaccination, millions would still be dying from this terrible disease.  It is believed that Pharaoh Ramses V died of smallpox because of scars found on his mummy.  In the 18th century in Europe, 400,000 people died YEARLY of smallpox and 1/3 of the survivors went blind.  20-60% of the infected died from it.  It was 80-98% fatal in London and Berlin during the late 1800’s.
Here is a great article on the history of smallpox:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200696/

POLIO
Polio is a virus that can cause paralysis.  It is spread by person to person direct contact, mucous or phlegm, or feces.  It grows in your gut and then spreads to your blood and lymph and then causes symptoms.  Children, the elderly and pregnant women are at the highest risk during an outbreak.
Polio has virtually been eradicated in the US.  Outbreaks still occur in other countries amongst those not vaccinated.  It only exists in a few countries in Africa and Asia now.
It has two forms, paralytic, and nonparlytic.  It involves the brain and spinal cord.
It can cause back pain, diarrhea, fatigue, headache, irritability, leg /calf pain, moderate fever, muscle stiffness or pain or spasm, neck pain and stiffness, stiffness in arms, legs, abdomen, or back, rash, vomiting.
Paralytic polio causes abnormal sensations in an area, bloating, breathing problems, constipation, difficulty urinating, drooling, headache, muscle contractions, spasms, pain, and weakness that is only on one side or worse on one side.  stiff neck and back and difficulty swallowing.
I remember my father talking about not being able to go out to the pool because of outbreaks.



 

Polio NOW

Small pox affecting the eyes. It was around up until 1967 in millions

Tetanus in a baby...muscles all in spasm

s

Plateau Formations

Plateaus, Plateaus Information, Facts, News, Photos -- National Geographic

I’ve reached a plateau.  If you read the above article by National Geographic, the definition of a geologic plateau is somewhat similar to my situation.  Over decades, forces have lifted up my adipose (fat) tissue and it’s been sculpted into mesas, buttes and canyons.  My butte has become quite massive.  My mesas are kind of lumpy, and my canyons, well, we’re in polite company here. 

The forces that cause a plateau seem to be enormous.  Magma erupts through the crust and forms large plateaus, like the Tibetan Plateau, or the Colorado Plateau.  I’ve just reached a previously unknown plateau (The Carlon Plateau) and the forces that have caused it are just as great.  Inactivity and Menopause.  Well, Perimenopause.  And the Internal Medicine Board.  I believe that the stressors to the plateau were definitely great. 

In the past, my buttes and canyons and mesas were easily worn down by decreasing my dietary intake and exercising.  I could lose twenty pounds easily.  I would lose at least 2 lbs a week and would be able to keep it off without any problems.  Unfortunately, the magma of menopause is fighting my metabolism.  (I always wondered why you got hot flashes-now I know!  It’s magma!)


According to the Mayo Clinic website: “In fact, some research suggests that gaining as little as 4.4 pounds (2 kilograms) at age 50 or later could increase the risk of breast cancer by 30 percent.”
 http://www.mayoclinic.com/health/menopause-weight-gain/HQ01076/NSECTIONGROUP=2

They stated that losing weight is definitely more difficult in the perimenopausal time frame.  Well, that just sucks.  I’ve reached 194 pounds and I’m stuck.  My clothes definitely fit better, and I feel better but I still am plagued by the American Board of Internal Medicine making me rush to finish a Patient Improvement Module or some such thing.  So, instead of free time to start exercising, I’m bringing home more and more work to do. 

The Mayo says that you have to become active.(needs improvement)  You need to decrease calories (done).  You need to have support.  (done--this blog is keeping me in line.  Thanks Guys!).  There is only one thing left to do. 
Damn.

Chinese Take Out and The Compost Cake

The Actual Cake!

Not Our cake.  Pictures of our compost cake to come...Stay tuned.

I succumbed to exhaustion last night.  I ordered Chinese Take Out. 

Today, Saturday, is my Number One Son’s birthday.  We have a tradition of making each kid a birthday cake ON their birthday.  It started out when the kids were really small and I had a book of cool birthday cakes to make.  Each kid would pick out a cake and we would make it.  Stars, hearts, alien spaceships, desert Island cakes, Monkey heads (that was for my husband), dinosaurs, etc., have been the subject of a cake.  This year, my son wanted a cake that looked like a compost pile.  He had been planning this for MONTHS.  He designed it and got some more ideas from an internet compost cake (Yes, someone had already done it!)  Last night we realized we had to go to the grocery store and buy the ingredients to make the cake today. 

We hadn’t eaten dinner, and I was exhausted.  I knew that venturing into the grocery store was a dangerous event on an empty stomach.  I fortified myself with some cheese and steeled myself to venture down the aisles I never visit at the grocery store. 

Off we went.  The funny thing is, the kids were AMAZED at how much candy and junk food the grocery store sells because we just skip the two or three long aisles of “crap” when we shop.  We really do shop the perimeter of the grocery store and venture down only the frozen food and dairy aisles, and the paper goods and cleaning items aisles.  We had difficulty finding the stuff we needed because we didn’t know what aisle things would be in. 

We managed to purchase the cake mix, the icing, the pretzel rods, the gummy worms, the oreos (to crush into “dirt”), the vampire and wolfman gummies (it’s an unorthodox compost pile), and some Hersheys “drops” which look like rocks.  The kids then realized THEY were hungry and so we went to the Chinese Take Out in the strip mall to order some food. 

I was not starving.  That was good. 
Previously, in my “Before the Phone Call from My Doctor” Days, when we ordered Chinese, we would order 3 or 4 things and have leftovers for  a few days.  Usually we ordered deep fried stuff, stuff with nuts in it (Kung Pao) etc.

I was able to look at the menu and remember that fried, breaded, coated, and sweet and sour stuff were probably not kosher to eat on my new regime.  My daughter wanted egg drop soup, my son wanted Orange Beef (definitely NOT on the list of good stuff) and so I got the tofu and vegetables Yu Shan.  (brown sauce and spicy). 

Usually the danger is that I will fill my plate and have seconds because it tastes so good.  This time, I used a luncheon plate for myself, measured out (eyeballing it) the rice and only took 2 pieces of orange beef and filled the rest with the vegetables and tofu.  I had 1/2 cup of egg drop soup.  Then I cleaned up.  You see, if the food sits out, then it is really easy to have seconds, and to snack on the crab rangoon or the egg rolls.  Fortunately, fortune cookies are only 25-45 calories apiece! 
My daughter set her alarm to 6:30 this am to help me make the cake.  We’ll wait for my son to wake up in order to decorate the cake because therein lies the fun!

 I feel really bloated from all the salt in the food last night, and I’ll skip the scale and be happy with the 195 I got yesterday.  I am six pounds down from the doctor’s office scale.  Now I’ve got to find a way to exercise.

The Best Laid Plans

The Triple Whammy

Yesterday was the Trifecta of bad days.  Poor sleep, stressful situation (the Boards Exam) and a short time to eat between sections.  Add the overwhelming exhaustion after I got home and didn’t feel like cooking and it could have been a disaster of a day for sticking to my new lifestyle modifications. 

I was absolutely exhausted before the test because I just couldn’t sleep.  Robert Burns Poem “To A Mousie” kept running through my head, “The best laid plans of mice and men often go askew”. 

I chugged iced coffee between the first and second parts of the test.  I was assailed by a food court of wonderful choices, some not so good for you.  I didn’t want to eat heavily and get post-prandial sedation, so I chose sushi.  I chugged another iced coffee.  On the way home, I stopped at an artisanal cheese shop and ordered goodies for the family to try (Camembert, 2 types of brie, a sheep's milk cheese from Wisconsin, some Spanish ham, and a baguette) but didn’t eat any until after dinner with the kids.  We ate leftovers while I stared at the wall and recovered.  I went to bed early. 

My husband is studying for the sleep boards.  He informed me that it is true that poor sleep causes weight gain.  Also, staying up late causes weight gain.  Many people snack when they stay up late.  Many eat to STAY awake.  Then, there are sleep eaters, more common on psychotropic drugs like ambien.  They eat but don’t remember it and they gain weight.  Sleeplessness slows down your metabolism, according to him, but I need to look that one up myself. 

In MY experience, when I’m exhausted, I just stop caring.  I will eat the easiest thing to eat just to get it over with.  Often, that means things which are easily attained, like ice cream, or take out.   If I hadn’t had the left overs from the weekend, I could have ruined my attempts quickly.

Tonight is my late night at the office.  Usually, I bring 2 lean cuisines, one for lunch, one for dinner, and some fruit or baby carrots to much on as a snack.  Unfortunately, my kids ate all the Lean Cuisines and there’s nothing to bring except left overs.  Juan will make shrimp tacos for the kids for dinner tonight.  I’ll probably bring the leftover flank steak in chili sauce and a couple of corn tortillas. 

But remember, The Best Laid Plans of Mice and Men....oft go askew.  Hopefully I won’t go askew. 


Here's a link to Robert Burns' poems:
http://www.robertburns.org/inenglish/extracts.shtml#toamouse

Potato Pancake Envy

Yesterday, the kids had Kasias’ Potato Pancakes for breakfast.  They looked and smelled really, really good.  I  wanted one.  I could have had ONE, but everyone knows you can’t just eat ONE potato pancake, and in addition, although they’re good with apple sauce, they’re GREAT with sour cream.  So, I walked away.  I had Potato Pancake envy. 

One small battle in the war won.  At least I haven’t insisted they eat brussel sprouts .

Today I'm taking my Boards Recertification Exam.  Think of me and wish me well.

The "Brussel Sprouts Incident"

My sister and I were talking yesterday about the time my mother got a bug up her butt that my sister HAD to eat the  brussel sprouts she’d served at dinner one night.  We think my sister may have been about six years old or so at the time of the “Brussel Sprout Incident”.  It was an early sign of things to come because my mother hadn’t counted on my sisters ability to be so obstinate.  Who feeds a six year old brussel sprouts and really expects them to LIKE them?  It takes introducing a food to a kid about 10 times before they like it, or so I’ve read. ( My kids will eat just about anything).  My sister refused to eat them.   Mom insisted.  Mom said she couldn’t leave the table until she’d eaten them.  Mom left her in the kitchen and turned out the light after we’d finished dinner, leaving her in the dark with her brussel sprouts.  “Even the dog wouldn’t eat them!”, she told me.  She sat there in the dark for 3 hours until my mother dismissed her to bed.  My sister still hates brussel sprouts.  (And she’s still obstinate).

 I suspect that brussel sprouts give her PTSD. 

Elastic Recoil

recoil /re·coil/ (re´koil) a quick pulling back.

"elastic recoil -- the ability of a stretched object or organ, such as the bladder, to return to its resting position."
Dorland's Medical Dictionary for Health Consumers. © 2007 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

One of the down sides of aging is that your body just doesn’t react the way it used to.  For example, it is a lot harder to get in shape, and to keep a shape. In other words, when we get older, our muffin top becomes a blob. 

When you are 20, your skin happily returns to it’s previous shape and maybe the only tell tale signs are some stretch marks.  Something really awful happens somewhere between 40 and 50.  Your elastic recoil, recoils. 

Suddenly, when you lose weight, instead of your abdomen and legs and arms going back to their usual normal shape, you have chicken wings, and loose wrinkly skin where you used to have a muffin top.  You look in the mirror and scream, “NO ONE TOLD ME ABOUT THIS!!!”   I look like my MOTHER!!!  What happened?

It’s like a pair of jeans getting fitted JUST for you , like a second skin, then suddenly you lose weight and they just don’t fit right.   That said, it’s much better to LOSE weight and get healthy if you’ve become overweight or obese as you’ve aged, and invest in “foundation garments” to hold it all in.  I’m just glad they don’t kill whales anymore for the “whale bone”  in said garments.


BTW, all of those lotions and creams and supplements do nothing for "cellulite" and lumpy skin.  The elastin is deep in the dermis where lotions and creams don't go.  So I guess the only thing to do is to exercise!
Boards are in 3  days.  Wish me luck.  I will start to exercise after the Board exams are done!  I need to banish my chicken wings and firm up my muffin top.  Oh let's face it, it's an entire muffin!

Boredom

Boredom is the enemy of anything worthwhile.

 I’m discovering that.  Beginning a healthy change in one’s diet (or “lifestyle modification” in medical parlance) is exciting, new, and at first, easy.  It’s like falling in love.  At first, every little thing about that person is new and cute and interesting.  You love being with that person, talking, touching, sharing.  Your friends will think you’re over the top because all you do is talk about that new special someone.  They don’t want to hear every single detail, but you tell them anyway because you’re excited!

Then you get married.  Life settles into a predictable routine and suddenly you discover that the cute little snort your partner makes when he laughs is really NOT cute, but annoying.  You feel annoyed sometimes and don’t want to talk.  You discover the WORK of marriage.  You realize it’s worth it (if you’re smart), and you learn to forget the arguments, overlook your loved one’s faults, and love them anyway. 

That’s what getting healthy is like.  At first, all the new habits you’re developing are new and exciting.  In diabetics, we talk about the “honeymoon period” where the diabetes goes from horribly, awfully, controlled, to unbelievably good.  The patient loses weight, eats right, and their labs come back fantastically good.  Three or four months later, the patients’ weight starts to creep up.  “I went on vacation, (a cruise is the worst) and stopped watching, stopped exercising, and when I got back I didn’t get back into my routines.”

Getting healthy is changing your routines.  At first, because they’re new, all your friends know you’re “on a diet” and cheer you on.  You do fabulously at it.  You do all the right things, exercise, eat right, etc. and then.....something messes up your routine. 

I’ve read in multiple places that it takes 30 days of doing some new habit to make it stick.  I belong to a group called “Flylady” who uses this idea to get people to clean their houses and their lives.  She adds a routine a week  and sends out emails of encouragement daily.  It works, but you have to do the routines daily.  She stresses that you need to just START.  She uses a timer.  The enemy is Perfectionism because you think you can’t get things done so you never start.  She encourages you to  just do 15 minutes, or 10 minutes and STOP.  It’s okay if you don’t finish.  Do 15 minutes of a new habit daily.  Clean up a “hot spot” (a messy junk collecting spot) for 10-15 minutes a day.  I plan to eventually use this plan to get off my butt to exercise.  I’m trying to use this also for writing the blog. 

I saw a patient the other day who has been with me for the 16 years I’ve been in Oak Park.  She saw me through both children being born, and all the ups and downs of our practice.  When she first started with me, she was morbidly obese.  She joined Weight Watchers, and started exercising every day.  That was about 13 years ago. She lost probably about 100 lbs, and has kept it off.  I saw her the other day and she was very disappointed because she wanted to work for Weight Watchers and they told her she needed to have a BMI of 25 to work for them.  I think that is so short sited.  She has a BMI of 27, but has KEPT IT OFF.  She is healthy!  Tom Cruise, I read somewhere, has a BMI of 30.  It’s because he’s muscular.  She’s not in Tom Cruise’s shape but she has managed to keep her weight off, keep exercising, keep eating right.  She has so much to offer to those of us who are trying to establish good habits.  The point of this whole thing is to get healthy, not to be a fashion model, after all. 

So, set your timer (thank you Flylady!) and make a menu and grocery list.  Set your timer and start dancing around your house.  Start a daily healthy habit. 
Appreciate the fact that you are alive and have a chance to change and STAY that way!

Weekly Menu and Weigh In

Weigh in and Menu Making Day:
So far I’m doing really well, but I was beginning to feel deprived.  Seems I didn’t pick out enough recipes and make enough food on the weekend for the week.  I was inspired
yesterday by one of my patients though.  She made up her mind in February to change her life.  She changed her diet, and began training for the marathon.  She came in regularly to see me for a weigh in and occasional waist circumference.  I saw her yesterday and found out she had run the  marathon this past weekend and FINISHED IT!!!! WooHOOO! 
I’m not sure I could do that! 
Congratulations to her.  I was so excited I could barely contain myself.  She’s lost a ton of weight, and has lost about 4 inches in her waist circumference.  Isn’t that cool?

Okay, so here’s my weekly weight, before breakfast in my PJ’s. Drumroll please.......
194!  Yea!!!

Menu for the week:

Slow Cooker Southwest Hominy and Turkey Sausage Stew
Slow Cooker Flank Steak
Fish tacos
Bulgar pilaf with pistachios and raisins,
No noodle Vegetable Lasagna

Broccoli, clementines, apples, 4oz nonfat yogurts, and baby carrots for snacks. 
(I’ve discovered snacks are really important so I am not ravenous on the way home from work).

The Poop Report

Doctors are a warped bunch of people.  We talk about poop and get excited about different types of poop.    Well, we call it “stool” and “BM’s” to sound cooler.  But let’s face it, it’s poop.  In the hospital, when someone has a BM after surgery, we all cheer because it means their bowels have woken back up.

I had a professor in residency who was an old GI attending from South Africa.  He had a saying which has stuck with me my entire career.  It’s simple and it’s true.  He said, “Michele, you can divide the world into two types of people.  Those who look, and those who don’t.” 

Of course he was speaking of looking (or not) at your stool.  In my personal experience, about 75% of people look, and 25% are appalled to be even ASKED to look.  That is until they’re 80.  Suddenly, 90% of people look (for their health) and 10% look ALL THE TIME and tell you every single detail about it!

Now I understand this is an uncomfortable subject.  In my husband’s family, no one EVER talks about poop.  I found this out after the kids were born and I would try to give him information about the kids stools.  He started calling it the “Poop Report” and making fun of me for even bringing it up.  You see, in MY family, well, poop had the potential to be something to be very proud of.  We got the poop report every day from my dad.  He had his own classification system too.  There were “Bowl Wrappers”.  These were “healthy” BM’s that looked like a cobra at the bottom of the bowl, ready to strike.  We would gather ‘round the toilet to admire it.  There were “Torpedoes”.  Self explanatory.    I can’t remember the rest, or maybe I’ve blocked it out.  We also had a separate classification for those who had the uncanny ability to sense that someone was just settling in on the john  (or the “throne” as we called it).  Dad would think that it was safe to sit and read the paper and enjoy a good poop.  I would come running in screaming that I “had to go,” and was crowned  a“radar butt”  usually with a few expletives thrown in for good measure. 

I bring this up not to gross you out but to explain that Doctors have a stool system too.
It’s called the “Bristol Stool Scale”.  I thought about putting in a picture, but I’ll let you google it. 

Why in the world am I talking about poop?  Well, anyone who has made a drastic change in their diet knows that your poop changes too.  I figured it was all the fiber I was eating, but MAN!  This was just too much. (I’ll spare you the full poop report).  Anyway, it got me to thinking about fiber.  I’ve been reading labels lately. I noticed that they had fiber broken down into “SOLUBLE Fiber” and “INSOLUBLE fiber.”  It was more confusing than helpful.  I’m embarrassed to say that I didn’t know the difference and figured other people reading this wouldn’t either. 

So here goes.  Soluble fiber is just that.  Soluble.  If you put it in a glass of water, it dissolves.  In your stomach it becomes a big gelatinous mass and soaks up fat and sugar and slows down digestion.  Foods that have lots of soluble fiber include oat bran, barley, apples (not the skin) and similar fruits,  and legumes. They bring down your cholesterol. (Cheerios anyone?)

Insoluble fiber does NOT dissolve in water and goes through your digestive tract unchanged.  (think corn).  (Again with the poop report)
Wheat, corn, oats, barley, nuts, flaxseed and the skins of some fruits (apples and pears for example) are a good source. 

Insoluble fiber is like a broom, and soluble fiber is like a sponge.  Insoluble fiber gives your stool girth and bulk.  It fills you up so you don’t feel as hungry, and helps you lose weight.  Soluble fiber helps reduce your risk for diabetes  and lowers your cholesterol because it slows down the transit of sugars and fats and makes it take longer to absorb. 

So, your poop tells a lot about how much fiber you’re eating.  If you have constipation and rabbit pellet poop, well, start eating more fiber!  If your LDL is high, like mine, eat more soluble fiber.  Apples, oranges, oatmeal (the long cooking or steel cut stuff is best), barley, etc.  Become a "looker"! 

This has been your daily Poop Report. 

Willpower

“The trouble with resisting temptation is it may never come your way again.”  ~Korman’s Law

“Most people want to be delivered from temptation but would like it to keep in touch.”  ~ Robert Orben

“There is a charm about the forbidden than makes it unspeakably desirable.”  ~Mark Twain

Abstainer, n.  A weak person who yields to the temptation of denying himself a pleasure.  ~Ambrose Bierce, The Devil's Dictionary, 1911

I’ve been thinking about willpower today.  Today was a rough day.  There were so many opportunities for me to really mess up. 

What I’ve noticed is that willpower is not intestinal fortitude.  It is not a character trait.  It is a series of choices in which you make in a split second each time.

Think about it.  You find a wallet.  Do you keep the money?  You know the thought crosses your mind.  You end up trying very hard to find the person it belongs to and returning it.  You’ve made a choice. 

Today, it was the choice between the stairs or the elevator.  The elevator was WIDE OPEN!  It was screaming to me, “Come into the bosom of my comfort and muzak.  I will whisk you up to the fifth floor and you won’t experience the discomfort of climbing the stairs.” 
I took the stairs.  The elevator doors closed in disgust.

There was a birthday at our office today.  There was some really delicious looking cake sitting on the counter all afternoon.  “You know you want me.  Look at me all dressed up in this slinky sugar glaze, filled with pudding so creamy that your very being will transcend into light!”

I walked away.  Like 5 times.  It was like a siren call in the kitchen.  I lashed myself to my chair in my office using the phone to drown out the sweet siren song and answered phone calls and filled prescriptions.

I have figured out that willpower  is just a series of daily choices.  Willpower isn’t  a moral compass which tells you what is good and bad.  Not having willpower isn’t a lack of character.  Think about it.  What if you followed the credo to live each day as if it were your last.  Would you give in to the chocolate shake’s frothy call, or would you say, “Oh no, I’m hoping to have a great body for the casket later today.” (Probably not the best example, hm?)
It’s just making choices. 

I’ve discovered that it is a lot more difficult to make the choices which are harder when you’re tired.  I almost succumbed to ordering Chinese tonight.  “C’mon Mom, Let’s order Chinese! or Pizza!  You know you want it!” 

I did.  I really did.  I was very tired and didn’t want to cook. 

I was close.  Hand on the receiver....looking up the phone number....AGGGHH!  NOOOOOOO!!!!!

I found a quick shrimp stir-fry with zucchini and I added some other vegetables and made some Israeli whole wheat couscous.  It took 30 minutes, and the kids cleaned up.  More importantly, they liked it and stopped clamoring for take out. 

I will leave you with this quote:

“I generally avoid temptation unless I can’t resist it”  ~Mae West

The Art of Cooking Part II

Part II Learning How to Cook in the 1970’s and ‘80s and Beyond


I learned from TV that cooking could be fun.  “The Galloping Gourmet” was always a hoot to watch.  He would be plastered by the end of the show because he drank wine while preparing the food.  To his credit, he made a 180 degree turn around and became an advocate for alcohol restraint.  His food always looked great.   Then there was Julia Child, but her voice was a turn off.  And her recipes were too complicated. 

When I went to college, I learned to cook in self defense.  We had an apartment on campus during Junior and Senior year.  I became adept at creating masterpieces out of really inexpensive foods.  (Macaroni and cheese in the box became a tuna noodle and pea casserole).  My roommates and I would occasionally pool our meager resources and put together a real sit-down dinner.  Anything was better than the cafeteria. 

Medical school was another place where I expanded my repertoire.  I was a poor starving medical student on a shoe-string budget.  I lived around the block from a Wonder Bread Outlet and ate peanut butter and jelly sandwiches for lunch every single day.  (I still love them and make my own jam now.) My roommates and I cooked all the time!  It was cheaper than eating out. It was challenging as one of my roommates didn’t eat any vegetables at all.  I really never understood that, but we accommodated her and made veggies for ourselves on the side.

So how is it that young men and women cannot learn how to cook now, in this age of the great international brain called the INTERNET?  There are zillions of cookbooks at the library, at second hand stores, at other peoples houses too, in the case of not having access to the internet. 

I would love to have the resources to pull a “Jamie Oliver” and open up a big “learning” kitchen.  I also would love to go into people’s homes and get rid of all of  the “crap” in the cupboards.  When I tell people that they cannot, under any circumstances, drink soda, they look askance at me as though I’ve asked them to amputate a finger or something.  It’s the same with chips and such, the same with asking them to stop eating at fast food emporiums.  I get this look of abject horror, followed by terror, followed by the, “I’m listening but you’re out of your mind” look. 

Yes, I know that look well.   Usually about then, I say, “So, honestly, I can see from the look in your eye that you think I’m nuts. Are you going to stop drinking soda?”  Usually they hesitate, hem and haw, and eventually respond that they’ll try.
Is soda so bad?  Well, it has no nutritional benefit to it.  It is extra calories you can use for other things which are better for you, like fruit, or vegetables. 

So back to cooking.  How hard is it to fire up the George Foreman, throw some spices on a chicken breast and cook it, zap some broccoli in the microwave and zap a small potato?  Put some salsa on the chicken and Voila! Dinner.  You’ve completely avoided the stove!

Look on line for cooking techniques and recipes.  Try out new grains and spices.  We have the “Green Eggs and Ham” rule in our house.  We all try new stuff.  If we don’t like it, we don’t repeat it and we don’t have to finish it.  Guess what?  We usually like it and finish it. 

Sometimes we cook real stinkers.  In fact, we did last night.  Into the garbage it went.  Oh well, live and learn.  Then there was the time I made the "Inedible Thai Chicken Curry".  It was EPICALLY BAD.  We put on a brave face and really tried to eat it.  Unfortunately,  there was so much pepper in it that we both started to sweat bullets and get chest pain, and laughed at ourselves for even trying to eat it as we threw it out.  It lives in the Annals of Bad Food History in our family. 

My Dad has a saying for foods he doesn’t like. It’s an attempt  to not insult my Mother.  You know never to repeat that recipe when he utters the phrase.  When asked if he wants more, he says, “Oh no. You shouldn’t have too much of a good thing.”  Out in the garbage go the leftovers!  Game over.  Failure.

The Art of Cooking, Part I

The Art of Cooking Part I

I was corresponding with a friend of mine and we hit upon one of the problems of eating healthily.  Many people do not know how to cook. 

Every day I will see a young man (or woman) who weighs a great deal more than he/she should.  I will take a diet history and inevitably find out that he/she eats out for almost every single meal.  Not only does he eat out,  but he eats at  McDonalds or other fast food restaurants.  When asked why, he inevitably tells me that he doesn’t know how to cook. 

This always blows my mind.  I grew up in a house where my mother cooked but also put Stouffers frozen sides up on a pedestal.  She made Stouffers sides all the time.  Most of them were not bad.  She did know HOW to cook, but often she was too busy to REALLY cook every night.  I remember at 14 years of age asking permission over the phone while she was at work, to make stuffed pork chops. Now, I had never cooked an entire meal before this. I wanted to learn how to cook, so I went to, (what else?) the Joy Of Cooking!   We had an ancient copy that was dog eared and stuffed with papers with hand written recipes in it from my grandmother.  My SOUTHERN Grandmother.  My NORTHERN (Irish) grandmother was not a fabulous cook.  She boiled things to death and always left an ingredient out of the recipe for the  few things she made well.  They were never quite as good as hers.  Infuriating.

Unfortunately, stuffed pork chops were a bit above my level as a novice cook.  I used twine to sew them closed.  I think my father was picking twine out of his teeth for a week after that.  I didn’t get too discouraged though, and kept trying. 

My Mother taught me the basics of chopping and slicing and sauteing and frying and broiling.  She was the QUEEN of broiling.  She was known to remind us daily that we needed a meat, a starch, and a vegetable with every dinner.  She also served up a quarter of a head of iceberg lettuce with tomatoes as our salad every night.  I still hate iceberg lettuce.  We also had milk with every meal. 

 I can still make a mean southern fried chicken and fried pork chops with white gravy.  I only do that once every couple of years because you can actually FEEL your coronary arteries close as you eat it.  Yum. 

I digress.

There is so much on the internet now.   There are even VIDEOS showing you how to saute, broil, fry, chop, etc. You don’t even NEED a mother to teach you how to cook!  I once found  a cookbook called, “Help, My Apartment Has a Kitchen In It!”  It was hilarious but had some pretty good recipes and taught techniques in it.  There was a lot of motherly advice in it.

I’m not quite sure what is causing this phenomenon of not cooking.  When I was a kid, there weren’t restaurants on every corner, and foreign food was Italian or Chinese.   You HAD to eat at home because there weren’t that many restaurants.  Fast food was a big treat. Is this why people don’t cook now?  Is it because they can walk around the corner and get good tasting cheap food? (Note:  I didn't say that it was good FOR you)  Is it the “food deserts” where there are no big chain grocery stores?   Is it that we are working longer hours and are exhausted?  Is it that Moms and Dads and their spouses are both working full time?  I think it is not a simple question.  I’m sure people smarter than I am are looking at this very question.  I hope they solve it.

Weekend Planning.

Menu for the week:

Indian Lamb Patties with peas
South Indian Chickpea Curry
Chicken Saagwala
Stir fry Shrimp with Zucchini
lots of fruits and veggies

Already made and tried the Lamb Patties!  Yum.  and the chickpea curry was delicious but fartogenic!  Beware of the chickpeas!!!
Today we prepare the chicken saagwaal and the shrimp for some dishes for the week. 

Yesterday, we went bike riding as a family!  Oh MAN am I out of shape.  I was surprised at how much, too!  I walk up to the fifth floor of the hospital every single day and am tired at the top, but usually make it.  My thighs were KILLING me yesterday  and I was slow.  So I plan on repeating the torture again! Fortunately we’re having spectacular weather and the leaves are the prettiest I’ve seen them in years.  Reds, yellows, beautiful filtered light, warm air, the smell of fall, all make the riding easier!  You wonder what you’ll see next! 
We rode for about 30-5 minutes.  I got exercise pumping up the bike tires to 60 PSI for two of the bikes.  Hey, you get it where you can!  I have to remember that ANY movement counts.

If You Eat THIS Food, You'll Live Longer

http://www.youtube.com/watch?v=HYng_oCaL3w&feature=related

Does anyone else remember the Dannon yogurt commercial with the old Russian guys? I put the link above.
At that time, in the 1970's, no one was eating yogurt.  Let’s face it, it was gross.  It was sour milk in a gel form.  Dannon made it cool.  “Look! The Russian guys are living a really long time just by eating YOGURT!  Maybe we should too!”

Only they didn’t tell anyone that the old Russian guys were eating RAW goat or sheeps’ milk yogurt and the ones that survived the Brucellosis  from raw milk were the ones you saw! 

I was thinking about all of the diet fads we’re exposed to.   Daily, I hear about a new fad  to lose weight either by completely eliminating some food group, or by eating only one specific food group.

Juicing is one of my pet peeves.  Juicing involves taking perfectly good, high fiber, crunchy, tasty fruits and  vegetables, and putting them in a grinder and “juicing” them.  One ends up with SUGAR water.  Granted, it tastes lovely, or so I would imagine, but REALLY? REALLY! You’ve eliminated all the fiber, the stuff that keeps you full, and turned it into instantly absorbed sugar water!  Where’s the “healthy” in that?


There's the "Avoid all white food” approach.  Okay, I can see the logic in this one.  Get rid of white bread, potatoes, white rice, white pasta which are high glycemic index foods.  That sounds logical.  The problem is, cauliflower is white. ( I know, I’m missing the point.)  It IS better to eat brown rice, whole wheat high fiber breads, and to eat yams instead of white potatoes.  Here’s the thing.  You can still eat some of the "white" foods, but in smaller portions.  MY problem is white rice  portions.  I used to think a portion of rice was half the plate.  I was sorely surprised when I read about  portions, and 1 cup is a serving.  One cup of cooked pasta is a serving.  I have to say, that is not a lot of pasta.  I would be STARVING if that’s all the pasta I ate.

Then there was the Cabbage Soup diet (EUGHHH! How did these people keep friends?), the grapefruit diet, (Prilosec anyone?), The Atkins diet (whose founder dropped dead of a heart attack), etc. 

I really think that as a foodie, I would have a very difficult time even considering eliminating any one food group.

That said, I’ve lost 5 lbs so far in one week.  Woohoo!  I’ve done it by eating a balanced diet, not giving in to temptation (another topic for another day) and not eating out at all.  (a HUGE accomplishment!)  I haven’t avoided any one food group.  I’m drinking a ton of water, and I’m writing down what I eat and doing the Points(TM) system religiously.

Eventually, after the boards, I’ll try to find time to exercise.....Yech.

Nonagenarians

 The Secret of Aging Well

Today I saw one of my favorite patients.  She’s 97 years old, spry, smart and funny.  It got me thinking about all of my nonagenarians lately. 
Once you get to be in your 90’s,  you can say ANYTHING you want. You lose the filter for political correctness and everyone thinks it’s cute!  My nonagenarians say the most outrageous things, often in a stage whisper.  They fart and laugh about it without embarrassment. 
I’ve been thinking about it because I want to be a nonagenarian like the one I saw today.   How did she get there?  What is the secret to her longevity?

Often, my very elderly patients are lovely, dotty, and hilarious.  They have absolutely no reverence for ANYTHING.  Sometimes though, they’re mean as a way to get the things they need to survive.  Often, everyone around them has died and they need help.  So, instead of honey, they use vinegar. 

I knew one lady who was always well dressed in high heel pumps.  The problem was, she kept falling.  Nothing I could say would get her to wear flat shoes, much less sneakers.  One day she said to me, “What type of shoe should I wear?”  Thinking I was FINALLY getting somewhere, I blurted out, “Well, something like mine!” 
Her response was a sneer and a contorted face and the words, “Those-are- UG-ly!” with the accent on “ug”!  I never did get her to wear flats. In fact, after that encounter, she bought a new pair of black two inch pumps!

One day, I thought I finally was going to hear the “secret” of getting old. 
Picture this, a petite, chubby, 95 year old with perfectly coiffed hair with erect  posture and no assistive devices for walking.   She sauntered into the office cracking jokes and laughing.  She sat down next to me at the desk and started regaling me with stories.  Absolutely nothing medical was going on. 

(Aside, sometimes with 95 year olds who are well, I do a lot of nothing.  First do no harm is the most important rule of medicine.  I figure if they’ve gotten this far without me, who am I to tell them what to do and cause side effects with medications? I make sure they’re okay and leave well enough alone.)

Now you must understand, this woman had a whiskey tenor voice from decades of smoking.  Her stories were punctuated by cackles of laughter.  She wore black plastic glasses with yellow lenses.  I never figured out why. 

Finally, she stopped talking.  She put on a serious expression, but had a twinkle in her eye.  She leaned forward as though to tell me a great secret. 
“Do you know WHY I made it this far without a cane or walker or lots of medications like all these ‘old’ people around here?”  (we were in a retirement home where I see patients).
 
I was afraid to ask and told her so. 

“Peanut butter, Scotch, and Cigarettes!”  was her response, and she cracked herself up laughing. 

She always wanted a late morning or early afternoon appointment because her habit was to sleep until 11 in the morning, get up and then to have coffee cake or a donut with her cigarettes.  Around 3 in the afternoon, she would have a tablespoon of peanut butter as a snack and cigarettes.  For dinner she had ice cream and a scotch. 

NOW do you see why I want to live to 95?  NO RULES!

The "S" Thing...

Day 6

I had to buy a new (dare I say the word out loud?) SCALE.  My old scale was just that. Old.  I loved it because it actually was woefully inaccurate. It was off by a full 10 lbs.  This annoyed my daughter.  “Mom, the DOCTOR’s scale was HIGHER than this one.” 
“That’s okay, dear. Don’t worry about it.  Just add 10 lbs in your head.”

For me, it was a false sense of security.  I figured, if I weigh on the SAME scale it doesn’t matter what the actual weight is.  I just need to follow the trend.  Except the trend started upward.  So, I just stopped using it. 

Also, when I put the weight data from that scale in the weight watchers on-line “weight tracker” section, I looked FABULOUS!  My BMI was NOT as high as it really was. 

Scales.  Lady Liberty holds a scale.  Scales are a measure of equinamity and justice. 
To me, a scale is a taunting, screaming panel of shame.  “See what you’ve done to yourself?” it screamed each time I got on it.   I just stopped stepping on it.  I believe in running away from the truth sometimes.  At least until I’m ready to deal with it. 

I went to Target’s and bought a new fancy pants digital scale.  It’s actually a Weight Watchers’ branded scale.  I bought it because I liked the color.  It is a very lovely striped opaque glass with seafoam green alternating with a pale beige. Quite pretty.  The clear glass one was too stark.  I needed something a bit more opaque.  Literally. 

Of course, I weighed myself on it fully clothed, just like at the doctor’s.  Then I decided that was really not accurate because I won’t be wearing the same clothes each time I step on it.  Naked.  That’s the ticket. 

Wait, shouldn’t I do it before my shower so my wet hair doesn’t add pounds?  How about after using the john?  YES, all these thoughts went through my head. 

There are rules about facing the SCALE.  Weigh yourself once a week. 
Yeah, right.  I want instant gratification!  That’s how I got here, isn’t it?  I’m hungry, shove closest sweet creamy food in my face. 
Your weight will vary from morning to night and day to day by as much as 5 lbs from water weight. 
Yes.   Yes it does.  Fortunately, I’m close to “that time of your life” when water weight is less of an issue. 

I’m trying to break fewer rules.  I’m not allowing the car to pull itself in to the closest Baskin Robbins for a chocolate shake, or to Taco Bells (yes, I know, I live in the city with the best Mexican restaurants in the midwest and I still frequented Taco Bells) for a burrito or some other creation of theirs.
I’m making a menu and shopping to it. 
I’m keeping the house stocked with fruits and veggies (we always did that anyway). 
I’m stopping myself from eating seconds and I’m allowing myself to experience hunger without panicking. 

Scales.  Truth.  Blech.

Day 1

Day 1:

My husband is in a panic.  What are you going to do?  I have certain things I like to eat!  You’re not going to stop me from eating what I like, are you? 

Fortunately, no.  We really don’t have such a bad diet at home.  There’s no soda, no chips, no cookies, no CRAP (as I call it) in the house.  We have a ton of fruit and high fiber snacks.  It’s the portions.  And lack of vegetables.  My husband likes crock pot all-in-one meals. On the weekends, we cook for the week.  He makes MASSIVE amounts of food but we all get sick of it on day 2.  So it rots.  Then we eat out, or eat other stuff. 

First thing to do --- Consult Weight Watcher’s web site and get up to speed on the new Points (TM) system.  It’s really different and perfect for me at this point in my life. 

Made a menu for the week.  Used the crockpot to make a pot roast yesterday, cooked some steel cut oats last night after soaking them, and this morning, added mashed bananas, brown sugar, and vanilla and milk to it just like the recipe on WW said to. 
Husband and kid both loved it.  Me too.

Made Salmon burgers for lunch for me and my daughter.  “These are the BEST SALMON BURGERS EVER, MOM!”  ( note: she’s never HAD salmon burgers before).  Used high fiber bread (Natural Ovens Whole Grain Bread), lots of mixed greens for lettuce, and dijon mustard.  Not bad, and I’m full. 

Now I have to get off my butt and start finding a way to exercise. 

I’m going to make a pasta salad  for the week and we should be all set for  the week.  I shopped to my menu.  I bought whole wheat Shredded Wheat for variety for breakfast, and Natural Ovens Blueberry Bagels.  More fiber. 
Hopefully this goes well.  I always do well the first week, then all my good intentions pave my way to , well, no where.  No, to a size 18.  NOOOOOOOO!!!!!!!


Shopping List:
onions, garlic, green bell pepper, zucchini, squash, potatoes, mushrooms, baby carrots to eat(snack) and for pot roast. 
apples, bananas,
dried cranberries
whole wheat high fiber bread and bagels, whole wheat pasta. 
canned crushed tomatoes,
dried black beans,
lean cuisines, milks for school lunches.  nonfat yogurts (6 oz)
high fiber snacks (TLC bars, fiber one bars)

Weight 201
LDL 202


I am a doctor and I am overweight and have bad cholesterol. 
There.  I said it. 

I have a million excuses.  I’m too busy to eat right.  I get up at 5:30 a.m. to be at the hospital by 7:00-7:30 a.m.  I eat lean protein (usually) before I go to work.  I rush to the office and grab a muffin on the way out of the hospital.  Then, I scarf it in the car.  At work, I’m sitting in front of a computer even more than ever now that we are on an electronic medical record.  My butt actually hurts from sitting so much.  I have been bringing lunch often, but every Monday we get a “drug lunch” from the drug reps who come to tell us about why we should use their drugs for our patients.  It’s usually “not so good for you” food, and worse, it’s not portioned, like the lean cuisines, or the food you bring from home.

I eat quickly, then work through lunch to catch up on phone calls and labs and charting, then start seeing patients again.  I finish at 3 and do more phone calls, and charting and I put out fires all afternoon.  At 5, I rush out the door to relieve my kids caregiver.  Then on Mondays, we rush to Boy Scouts.  Tuesdays, I rush to pick my daughter  up from volleyball, Girl Scouts, whatever.  Wednesdays vary.  Thursday is my late night.  I leave home later, using the morning to catch up on work I can’t do at  the office because everyone sees me and feels the need to tell me all kinds of stuff that has to be taken care of the minute I walk in the door.  So I stay home awhile and get things done.  I don’t get home until 10 p.m. or so at night because of all the paper work, although I’m done seeing patients at 7 p.m.
Fridays, I rush home and the kids and I have “FNO” or Friday night out.  Usually this involves food and movies. 

So, SEE!  I have NO TIME!   I’m also studying for the board exams.  Every 10 years we re-certify.  This is it.  I’m using every free moment to study. 

I saw my doctor.  He was super nice.  “You’ve gained 10 lbs in 2 years.  It’s not SO bad.  You’re overweight, not obese. Yet. “
The next day came the panicked phone call.  “Michele.  DO YOU KNOW WHAT YOUR CHOLESTEROL IS?  What the heck have you been eating? “

I was too embarrassed to tell him about the two bags of pistachios that I demolished in the car over a three day period. 

So, here I am.  A doctor who for the first time in her life has to take her own advice.
That’s what this blog is about.  Hopefully, it’ll spur my patients to do follow suit. 
I am a life long member of on-line Weight Watchers.  I really believe in it.  I just chose not to follow the plan for a while.  Then, menopause started creeping, in, and ice cream, and comfort foods, and no exercise, and too busy....  I want to be accountable.  I hope this helps me to succeed, but I also hope it helps my patients to see what it takes to succeed.