Health

April 12, 2017

EM and Fitness

Being a doctor means being an advocate for good health.

As an Emergency Medicine physician, I care for multiple patients with a variety of complaints, everyday.

Whether I’m evaluating a patient with chest pain, high blood pressure, anxiety, or who is pregnant, I counsel them all about important lifestyle factors that I believe can help prevent worsening of current or future disease risk. One of the most important of these lifestyle factors is regular exercise. It is well known that regular aerobic activity can increase energy level, improve mood, and decrease risk for many medical conditions. Despite knowing this association exists, throughout the United States in particular there is a heavy focus on using medications to prevent and control disease, and less focus on actually teaching patients how to incorporate various lifestyle changes.

There is scientific literature available on the relation of exercise to improved disease outcomes.

It is very well understood that exercise can reduce the need for medications in type II diabetic patients by improving their glycemic control. Some patients even have reversal of their diagnosis of type II diabetes after making a healthy lifestyle change. The American Heart Association has official recommendations for the amount of time each person should be undergoing aerobic activity per day, based on extensive research. Cardiac rehabilitation programs have been created to help those patients recovering from a heart attack, and have shown improved outcomes of mortality, decreased recurrent cardiac events, and increased exercise capacity. Some clinical trials have even shown that exercise may be associated with decreased symptoms in patients with psychiatric disorders such as anxiety and depression.

With clinical studies advancing in this area, I would love to see the focus of medicine turn towards preventative strategies, as opposed to clean-up strategies.

In regards to my personal story… as I went through my training I realized that all these encounters during which I was counseling my patients on fitness and regular exercise, my own health and fitness routine seemed to be on the back burner.

Medical school and residency more so, is a grueling process. Studying or working for more hours than I ever knew existed in a day, left me little time to do the things I enjoy such as fitness and healthy cooking.

Patients will ask me what my favorite exercise routine consists of, and how I manage to stay fit with such a busy lifestyle. I found myself thinking, “I am a total hypocrite for teaching all of these health principles and not practicing them myself”.

The schedule of an Emergency Medicine physician varies greatly, and involves night shifts. With a schedule that is completely variable, and goes from days to nights and then back to days, it is a significant challenge to even function in the world, let alone exercise regularly. I know that there are many individuals who are not in the medical field, but struggle with the same schedule restraints whether it is secondary to work, family life, or other personal reasons.

Well, a couple of years ago I set out to make fitness and exercise a regular part of my routine forever.
It meant that I had to get a little bit creative, and accept that I wouldn’t always have control.

I realized that this was the problem with many of my patients being able to maintain an exercise routine. They didn’t know where to start; they didn’t have someone to educate them on the variability of fitness and what exercises and routines could work for them based on their lifestyle and disease process.

Hopefully the above layout of my life helps patients, and other individuals see that fitness and exercise IS possible, no matter how busy your schedule may be. By truly living and practicing what I am recommending, I know my patients have more trust in me, and motivation after hearing my suggestions.

I am an Emergency Medicine physician by day (and night of course), but my true overall goal is to teach preventative principles and strategies to help avoid Emergency Department visits and progression of disease as a whole. I truly believe that this starts with a well-balanced lifestyle that implements regular exercise and fitness.

Scrubs in photo found here (https://www.benefitmedical.com)

Nutrition

March 28, 2017

To cleanse, or not to cleanse?

Let me start by saying that I don’t regularly do cleanses.

My job is stressful; I work long hours, and I HAVE to eat, in order to make it through a shift in the Emergency Department. When I learned about this new Rejuvenation Cleanse, I was excited because it wasn’t just juice… it was soups and a small snack as well.

Now that’s more like it! Not to mention, I could always use a post-holiday diet clean up! So I decided to try the cleanse, instead of cookies!

projectjuice.com

As a medical professional, I live by the motto, “everything in moderation”. Therefore, I support maintaining a well balanced diet that includes both solids and liquids. I do however, maintain an open mind regarding cleanses, especially if it incorporates products that support adequate calorie intake.

I always recommend you keep in mind, however, that your body doesn’t NEED a cleanse. The body is perfectly capable of “detoxing” itself. That’s what your liver is for! If you maintain a well balanced diet that is tailored to your needs, you don’t need a cleanse at all! And just because a product is marketed as a cleanse, doesn’t mean it’s good for you. I educate all of my patients on reading labels, and ensuring they understand what they are giving their body. Some of the juices and “cleanses” out there are very high in sugar and carbohydrates, and may not be fit for YOUR diet.

The Rejuvenation Cleanse included some of my favorite juices, such as the Green Ginger and Green Lemon flavors. I also really enjoyed the Spiced Carrot soup, which in my opinion is better warm, but can also be eaten chilled, straight out of the bottle.

Project Juice consistently impresses me with their delicious organic and non-GMO juice flavors made from local farms. I am very particular about ingredients and flavor of the juices I drink. I won’t drink juice just to be “healthy”; it has to taste good! Project Juice delivers great flavor amongst great ingredients.

In the end, it was tough to complete this cleanse on a workday. I am so busy in my role as a physician that I often go long periods of time without eating or drinking. I then found myself behind on the juices, and starving! It was definitely easier to be successful on my day off, but I still had trouble with the amount of liquid I had to drink, to get the calories in and feel satisfied. At the end of the day however, I did feel significantly less bloated and I really enjoyed the taste of the juices and soups.

Overall, I love to supplement my regular diet with Project Juice products. Although I really liked this cleanse, I have to admit that I prefer my regular solid diet, with a juice or two in between!

Lifestyle

March 28, 2017

Travel Must-Haves

Let’s talk travel must-haves, Dr. Majestic style.

Whether I’m traveling locally or international, I always try to stay prepared.

For me, that means taking preventative measures to ensure I am healthy on my vacations, and carrying along emergency products for those “oops” moments.

My favorite vacation spot includes a beach, pretty much any beach!

With the beach hopefully comes sun, and with sun comes the risk for skin cancer and wrinkles/aging.

Who is a fan of skin cancer or aging? That’s right… no one.

I carry along a plethora of sunscreen, with an SPF of at least 35, even higher SPF for my face. Luckily Banana Boat makes a yummy-smelling men’s scent, for that male companion on your trip!

With the sunscreen has to come coverage. I’m all about the look of that bronzed glow from the sun but let’s be honest, the exposure required to get a real glow is not good for the face. I carry along a fun, fashionable hat on all of my vacations. Not only does it shield my face from the sun, but also I love that I really feel like I’m on vacation when I wear the floppy hat!

My favorite recently has been the Panama Jack-style hat.

Healthy living in medical school

Medical school may set you up for a successful living in the future, but let’s be honest; it doesn’t set you up for healthy living in the “now”. For all you medical students out there, I know you know where I’m coming from. From class to class, hours upon hours of studying, quick and easy dinners, short workouts (if any), and sleepless nights cramming for that next test; medical school can prove to support a very unhealthy lifestyle.

So what can you do about it? A lot! But it takes a conscious decision to make time for YOU, on a regular basis. Sure, becoming a doctor involves a lot of studying and hard work, but being successful in medical school also requires a healthy student!

Step 1: Schedule YOU time. Daily. And don’t deviate! This means setting aside a specific amount of time to do whatever you please, no guilt, and no books (unless it’s for pleasure, of course)!

Step 2: Exercise. In any way, shape, or form. This could mean squats in the trauma bay between patients, taking the stairs to your clinical floor, walking to and from class, or a living room high intensity interval training workout (HIIT) in your apartment living room. When I was in medical school, I utilized the gym regularly for workout classes. If I was really feeling stressed about studying, especially during my boards exam preparation, I would listen to podcasts while on the treadmill. It may not be the most ideal situation, but you CAN make time for exercise, and it will in turn keep your metabolism high and provide energy to your body.

Step 3: Feed yourself! GOOD meals and snacks. Remember the college days of ramen noodles? No more, my friends. You are about to be a doctor! And those high sodium meals will not provide high energy for those long clinical shifts. Keep snacks everywhere; I mean everywhere- your car, workbag, gym bag, and white coat pockets. Eating small snacks regularly is better than going hours without eating. This can lead to poor energy, brain function, and even syncope (passing out). No one wants to be the medical student that passes out during rounds! Make time to cook dinner regularly. It won’t happen everyday, but meal prep as much as possible! I started to look at my home-cooked meals as a treat, something I would look forward to regularly. In addition, clinical rotations were even better when I knew I had delicious leftovers in my lunchtime future!

Step 4: Surround yourself with only those who bring you positivity and happiness. Whether this is your family, or friends, keep these people in your life regularly. It is so easy to go weeks or months without communication to family/friends who are not in medicine. Signing up for medical school may mean missing weddings, funerals, birthdays, etc. However, if you keep your supporters close and cut out ALL drama and negativity from your life, you will start to notice that you have MORE time for those that really matter. It is important to prioritize in medical school, since you can’t say, “yes”, to everything. Save your precious time for those that bring you only joy and that contagious positive vibe.

Step 5: Keep your mental health at the forefront of your priorities. Making a life out of studying can lead to serious depression and anxiety. Be aware that medical students and physicians, in particular, are at great risk for these conditions. Evaluate where your mind is, on a regular basis. Do not wait to get help, if you notice persistent feelings that are impeding your success and well being as a student. I highly recommend finding a counselor or therapist to talk with, regularly. Remember YOUR health is the most important. If you don’t care for yourself first, you can’t care for patients!

Now that you have a little insight into how I incorporated health and wellness into my medical school experience, hopefully you will reflect on and evaluate your own health and wellness! Remember your well-being IS a priority, and you should be taking daily steps to ensure you live healthy and happy!

Career

March 28, 2017

Extracurricular Activities for the Undergraduate

No one expects you to go to college and not have any fun! Sure, it’s about education in the end, but life itself is all about balance and college is YOUR time to do YOU! I spent a great deal of my time in college having fun, and I would not trade it for anything. College is all about investigating who you are as an individual, and figuring out what you love and want to do for the rest of your life.

Trust me when I say, it is NOT all about studying, all of the time.

Most pre-med students forget that extracurricular activities are not just about looking good on paper. They are what will make you well-rounded, help you learn about yourself and others, and provide a source of fun and balance.

Here are some of the extracurricular activities I chose, in case you are stumped:

Volunteering

I did a TON of volunteer work in college and gained so much experience in the medical field, while having a ton of fun. I volunteered in two different emergency departments, on a pediatrics unit doing child life activities, and in a neurosurgery office. I also loved helping with annual races such as Relay for Life and various marathons as a medical volunteer.

Think about what you truly love and then figure out how to get involved! Some examples include working at an animal shelter, serving the poor at a soup kitchen, teaching/tutoring children, cleaning up the community, or building a new facility or home.

Work

Of course it still counts as an extracurricular, even if you are getting paid! I chose to be a nanny for a few different families, during my first two years of college. I then transitioned to a general chemistry teaching assistant position for my last two years of college. If you’re going to work in college, I advise you to choose carefully and wisely. Combine an interest with a job that will benefit you and your resume. Believe it or not, it is easier than you think to combine your interests with a job that will dually benefit your future, even at this early stage of your education.

School-related activities

This could include anything from sports clubs, student government or policy work, a sorority/fraternity, or special interest clubs. I personally loved being a part of a dance club and French club. These are great ways to meet other students with interests similar to yours, AND beef up that resume!

Research

Let me start by saying that I am not a fan of basic science research. But… I did it. Consider what your areas of interest consist of, and pursue research there, if possible. I chose a basic science research position in college because I knew there would be a publication opportunity. The trade off? I was learning about basic science concepts I had no interest in, and I had to work with mice. NOT my cup of tea. Alternatively, a clinical research position can include interaction with physicians and patients. Many medical schools do like to see research under a student’s belt.

Career

March 27, 2017

Applying to medical school

This is one of the most common topics I am asked about, on a daily basis. Although it has been quite some time since I applied to medical school, I remember being curious about the process. I also remember having had a difficult time determining the expectations of various medical schools. What do they look for? Am I good enough? Where should I start?

If you are looking into applying for medical school, and having some of these thoughts, you are NOT alone.

The process is tough, and stressful, but it IS manageable in the end. The key?? Start early.

I personally believe the process should start the second you begin undergraduate college.

Start with a plan for your curriculum, a timeline for standardized tests, and start to form and maintain relationships with mentors who may pose as recommendation letter-writers in the near future.

The resources have changed since I was in the midst of applying, but the AAMC website has always been an excellent source for up to date information. When I was a young pre-med, I also purchased a book that listed each medical school in the United States, all of the statistics and expectations of the applicants applying to each medical school, application deadlines, and contact emails.

Where should your focus be throughout undergraduate school?

Grades (duh)- both science and overall GPA
Everyone knows your GPA is very important.

MCAT

Extracurricular activities and leadership roles

Letters of recommendation

Most medical schools here in the United States use a centralized application called the American Medical College Application Service (AMCAS). Keep in mind some schools may use a separate application service.

After your initial application is submitted, you may be invited to fill out secondary applications.

This may include additional writing in essay format, letters of recommendation, and likely more fees. 🙁

Then come the interviews… interview prep is extremely important!

See my separate blog post on The interview checklist and What NOT to do on interview day.

Once your interviews are completed, you can expect to receive correspondence with your acceptance, rejection, or wait listing status. This process typically happens within a month of the interview, however each school is different.

Now that you know where your general focus should be, it’s time to get down to business. Learning HOW to be successful in each of the above- mentioned categories is key.

Learn your most efficient and successful early on, in undergrad. Practice and use trial and error, to ensure you have your favorite personalized study techniques down, before medical school If something isn’t working, CHANGE. It is so important to avoid making the same mistakes over and over. Doing so can truly affect your overall GPA.
When it comes time to take the MCAT, assess your test taking strategies and study schedule. Do you do better learning in a class format? If so, consider the Princeton or Kaplan reviews to prepare for the exam. Maybe you’re more of an independent learner, in which case you may be able to purchase some study books and learn the material on your own. Regardless of learning style, I recommend taking practice sessions (that mimic the real test), and doing regular questions.
Start early with extracurricular activities and leadership roles. Your course load and schedule will likely become busier as you progress in school, and this will lead to less free time. Build that resume as soon as possible and stick with the activities that you really enjoy, long term. This shows consistency and motivation.
Make as many personal connections as you can, early on. This is VERY important in medicine. Meet your undergraduate premedical studies advisor, and get to know your professors in office hours. Help them understand who you are, and what your goals consist of, so when it comes time to ask for that letter, they aren’t surprised. The medical community is surprisingly small, and one connection may open doors for endless opportunities.

Remember, although this seems like a huge checklist that can lead to stress and sleepless nights, it doesn’t have to be this way. Start early, and you will see yourself breezing through this process, before you even have time to notice stress.

Career

March 27, 2017

Getting into college

It has been quite some time since I applied for undergraduate school. However, I remember it like it was yesterday! I came from a school without much college preparation, and I ended up choosing the schools in Michigan (where I grew up) that were either prestigious, or that I knew other students from my high school attended. I definitely looked into Ivy League schools; I thought it was something I should be doing because of my GPA and goals of being a physician, but it wasn’t really where my interest lied.

On a last minute whim, I decided to apply to Arizona State University because I have family in the area, and I wanted to experience another side of the country. It ended up being the best decision of my life!

For those of you out there thinking about applying to college, ask yourself this-

“What is most important to me”?

For some of you, that may be location. For others, it may be a specific program or academic track.

If you take one thing from this post, just remember that the name of your college will not predict your success. Only YOU hold the key to your success.

Take me for example. Arizona State University is definitely not the most prestigious school out there, but I still made it to medical school and a very successful residency program! My biggest piece of advice is to follow your heart and choose a school where you feel comfortable and happy.

It may be a good idea to purchase a reference that lists each college along with their statistics and requirements for matriculation.

Before you make your college prospect list, consider these things:

GPAThis number is of course an important part of your application, but it does not define you. I repeat… it does not define you! It may determine which schools you are a competitive applicant for, but that can be widely variable. Advanced placement classes can be a good idea depending on your future career goals, but keep in mind that these classes will always affect your GPA, whether good or bad. Some applicants may have a fabulous GPA, but with an easier set of classes. Colleges will look take this into consideration.

SAT/ACTDepending on your high school or preference, you may be taking the ACT or SAT. They are both college entrance exams. I took the ACT when I was in high school, but many of my friends from different schools took the SAT. This score may or may not be strongly considered when evaluating a college applicant. It would be within your best interest to discuss these tests with your guidance counselor, and research the importance of test scores at the colleges you are interested in. I am showing my age with this topic unfortunately, as I do not have much up to date information!

Personal referencesHere is your chance to shine! Choose your letter writers carefully. Schools will typically state the specifics required of these letters. They may request at least one come from a teacher, or mentor, sometimes a personal friend. It would be a good idea to discuss your expectations with your letter writer. Sometimes you can even consider writing your own letter, and then asking your letter writer to modify as they see fit. You definitely want to highlight your strengths in these letters!
Not all undergraduate schools require letters of recommendation*

Extracurricular activitiesI have always heard that schools care about much more than grades and test scores. Well now that I’ve been through a few years of school myself… I can tell you that it’s true! My biggest piece of advice here is to choose the extracurricular activities that you love! There is no reason to spend your free time on an activity, just because you think it will look good on your application. Take my advice and spend that precious free time happy and doing things that you love. It will come forward in your applications and the most important thing is showing that you can do more than just school. 😉

Remember that this should all be a fun and exciting process! Try to focus on your goals and where you really see yourself. This process is about YOU. There will be a lot of opinions thrown around; don’t be intimidated!

Career

August 22, 2016

Tips for shift workers

I have to give a shout out to my good friend, Rupy Aujla, otherwise known as @doctors_kitchen, who took part in this blog post, and who understands the true meaning of night shift work!

Before and after shifts, people often complain of abdominal pain, bloating, nausea, low mood and increased susceptibility to common viruses. Studies looking at brain waves show that sleep rhythms are incredibly important to health. Proper alignment influences metabolism, inflammation pathways and stress hormones. So it’s no wonder us night shift workers (I’m afraid to say) have a significantly shorter life expectancy than our 9-5 colleagues.

But someone’s got to keep the streets safe at night, bake the bread or take care of the emergency department right?

Keeping your body awake when it naturally wants to sleep raises your cortisol. You’ll be working off adrenaline, so the last thing you want is sugary food to spike your glucose and insulin levels. Stick to low GI, nutrient dense and high quality fat foods to keep you going:

I tend to have a low carbohydrate, high quality fat and protein rich meal before my shift starts. My favorite is avocado toast with an egg on top.
Graze on nutrient dense, quality fat foods to keep you satiated.Toasted nuts and seeds – experiment with spices, I like using caraway and cumin seeds that are great at settling your tummy as wellKale chips – easy to bake a whole batch to keep snacking on, your colleagues will love you for them
Baked avocado – cover some slices in flaxseed crumb with cayenne and you’ve got a great high fat snack

Nut butters – I’m addicted. I like this one and this one

Crudités with hummus/guacamole – experiment with carrot, asparagus or whatever is in season. My favorite hummus can be found here

Dark berries – low sugar, antioxidant rich and tasty

Popcorn with spices – even though popcorn has low nutritional value, sometimes you just need to graze on anything that tastes good. My favorite can be found here and here

Dried coconut strips- in moderation due to sugar content. Shop at Trader Joe’s for these

Greek yogurt bites or yogurt-covered fruit- to curb the sweet craving when everyone else is eating cake. This is one of my current favorites here
If you find yourself desperate for caffeine hit, stick with tea. I aim for my tea fix about halfway through my shift. It’s enough to keep my energy level up for the rest of my shift, yet still allow me to sleep when I get home. Coffee raises your adrenaline levels that are already elevated, leading to high cortisol and insulin that leads to weight gain. Matcha tea naturally contains L-Theanine, an amino acid thought to be responsible for mitigating the anxiety promoting effects of caffeine. It’s also been shown in controlled studies to improve concentration… so drink up!
Foods to avoidSugary snacksProcessed foods
High Carb – pasta, rice, bread

Soda, chocolate bars … Cake (please stop eating cake at night)
Preparation is key to making sure you don’t reach for that cake somebody always brings in with the best intention! Before you get your last sleep in, make sure your food is ready. I plan for my favorite snack to be eaten halfway through my shift; it gives me something to look forward to.
Exercise. I always make sure I exercise before a shift. Even if it’s something as simple as stretching, yoga or a short HIIT session. It gets my blood pumping, endorphins running and I find it refreshing before a shift. But it completely depends on you!

Night shifts are not ideal, let’s be honest… but you CAN make it through a job that includes night shifts, with a little bit of preparation and a lot of discipline.

Good luck to you night shift workers out there!

Health

March 14, 2016

The truth about naps

Who’s ready for a nap? Did you know there is a National Napping Day, in the United States?

Let’s talk the truth about naps.

Research shows that taking naps can reduce stress and fight fatigue. A short nap can improve performance, alertness, and can help increase your ability to stay awake longer, if necessary.

Some tips for proper napping:

Nap in the afternoon, if choosing to do so

Timing is important; there are many resources out there, but 10-30 minutes seems to be the best length of time to nap and still enhance instead of harm performance later

Set an alarm- no one wants to worry about waking up from a nap in time, so just set an alarm and stick to it

Night shift workers (that’s me!) should anticipate their first night shift with a midday nap to help enhance wakefulness over the next 12-24 hours
Don’t lose sleep at night! Insomniacs should not depend on napping during the day. This will not help the night time sleep cycle

A caffeinated beverage can also help increase wakefulness. Some resources suggest a “caffeine nap”. This includes drinking something caffeinated BEFORE taking a nap, since caffeine takes about 20 minutes to kick in. This definitely doesn’t work for everyone.

Discuss your nap strategy with your doctor. It’s very individualized and dependent on your work/lifestyle balance.

Happy Napping all!

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