My Balancing Stick

I have hit a lag in my posting.  I appreciate all of you who have noticed.  Sometimes it is hard to know if it is being read.  Part of the reason for my lag is that I am running out of ideas.  I would love some feedback.  What would you like me to discuss?  I have had one request for migraines, so I will be thinking about that topic. Another reason for my lag is due to a consuming project that has been taking up almost all of my free time for the last six weeks.  In fact, it is the topic of this post.

The premise for "Simply Healthy" is just that, to keep health simple.  My four pillars are watching what goes in, to keep moving, maintaining balance and to ask your doctor about the rest.  I haven't touched too much on maintaining balance and will do so today.  As I talk to my patients and ask about their lives I have come to appreciate that we all have stress.  It comes in different forms.  It may be family related, work related, money related and often healthy related.  We all have times when it is worse than others.  How we manage it makes all of the difference.  Taking our mind off of the cause of our stress is essential.  Exercise is one of the best ways of doing that.  Another great way is to have a hobby or special interest.  Mine turns out to be wood carving.

As a young boy scout I was introduced to "whittling."  I loved using my pocket knife to make spears and arrows.  Making a chain out of a stick was more difficult but quite rewarding.  I never thought about doing more until about eight years ago when I decided to try and carve the nativity scene on a walking stick.  It was my first attempt to carve a human form.  I got hooked after that.  I started to find myself looking at arms and legs in a new way, paying extra attention to where the muscles came together and fit in with the body.  I would look at all the noses that came my way to try and decide which one I would use on my wise man.  At first, I used a simple exacto knife. I finally found a friend who also carved and he introduced my to "real" tools.  I started to collect not just knives but gouges, and bits to fit on my rotary tool and an electric chisel.  When I am working on a project my whole focus is centered on that piece of wood.  It is a great way to take my mind off of the stress of work.  I love the feel of the grain and get great satisfaction when a piece turns out well.

My recent project is for my wonderful parents.  They recently completed fifty years of marriage.  We have four children in our family.  Each of us are married and we all have four children. My oldest child married this April so that makes a total of 27 people in our family.  About a year ago I decided to carve something for my parents but couldn't come up with an idea.  One night I literally woke up with the idea for my project.  A verse in the fifteenth chapter of John came to mind where Jesus declares, "I am the vine and ye are the branches."  I envisioned creating a walking stick with vines wrapping up the stick, each leaf representing a member of our family.  I love working with cedar which has a red inner core.  I thought the stick would look great if I carved down to that red core and making the branches and leaves out of the outer white wood.  This symbolizes our family, tied together, centered on Jesus Christ.  With that in mind, I went out in the woods on my in-laws property and found a cedar tree that had been knocked over but was still alive.  I cut it down, sawed off the many branches and stripped the bark.  I let it sit in the basement for about six months prior to working on it.  I decided that I wanted each leaf to be centered on one of the knots in the wood, which would tie it to the red core.  I traced out my leaves and vines, counting over and over to make sure I had all twenty seven of them on the stick.  I would like to say the project then started in earnest but I didn't do much on it for many months after that.  I tend to work better when I have a deadline.  As the summer approached and the anniversary date started getting near I got more serious about the project.  At times in the beginning I nearly gave up on it, feeling it wasn't turning out as I had envisioned it but I kept at it, modifying the details as I went along.

I took it to every outside event that I went to, using the time at camp-outs, soccer games, and cross country meets to work on the project.  Several weekends ago, in its nearly completed stage, I took it to a scout retreat.  I was mostly sanding at this point.  Being around hundreds of scouts and leaders, many of whom had made walking sticks in the past, made me feel like a rock star.  I was pleased to see the response of those that wanted to see it and ask about how it was made.  The final task was the most rewarding of all.  After finally completing the many hours of sanding it down to a smooth sheen, I applied teak oil to the wood.  As I had hoped, it made the red core jump out of the wood, bringing out the grain and the knots.  I love how it turned out.

I know that this is not too "medical," but thought that many of you would enjoy seeing and hearing about my project.  It truly is a stress reliever.  We all need to have a stress relieving outlet besides the television set.  If you are feeling overwhelmed by life, pull out that old guitar, paint brushes, knitting sticks or whatever else it is that you love to do but may have put aside for awhile.  It is not just good for the mind, it is good for our health.

Safe in the Summer

We work all year long, saving our pennies to go on that family trip.  This is the time of year when we break with routine, let loose and just have fun.  We may not be thinking of our health when we are packing our suit cases and on our way but we all have likely experienced a vacation gone bad due to illness.  This week I offer three simple suggestions to ensure a healthy happy vacation.

First is likely the most obvious.  Beware of the sun.  Many of us spend a great deal of time inside all year long.  We work in offices, not fields.  Our body is not used to the sun.  I have seen my son turn into a swollen red lobster before my eyes.  He is old enough to give him the tube of sun screen and allow him to take care of himself.  Too often, the excitement of the beach, mountains or other activities overwhelms him and he doesn't take the time to prepare.  No, we don't need to use a truck full of sunscreen but it really does work.  Preparing before hand is helpful as well.  Plan to be outside on the weekends at least.  Some sun exposure is good and needed.  I do not recommend tanning beds.

It is not just the sun's rays that can affect us.  It's heat can cause us to dehydrate through sweat and evaporation.  Out of our routine, we usually do not drink as much precisely at the time when we need to drink more.  I find it interesting that the time of year with the highest rate of kidney stones is September and October.  The reason is that it takes on average three months for a stone to form and those who don't drink enough water in the summer time pay the price in the fall.  If you travel by plane, bring an empty water bottle with you. Fill it up when you get past security.  If you will not be near a drinking source, make sure you plan to bring plenty of water with you.  Staying well hydrated will keep your energy level up, prevent headaches and muscle soreness.

One of the most common reasons I see patients in my office after they have been on vacation is for foot pain.    Many spend a lot of time on the feet when on vacation.  Make sure that you are preparing before you leave. It is just one more good reason to stay active and to exercise.  Make sure you bring footwear that will help, not hurt.  If you are staying at a place that has a freezer, take one of those water bottles mentioned above and freeze it.  When you get back at the end of the day, roll your feet over the bottle on the floor.  It will help cool off inflammation and stretch out the tissues in the feet.

Have a great summer time.  Hopefully by taking a few minutes to prepare for the sun, by staying well hydrating and by taking care of your feet you will be able to both enjoy your vacation without having to pay unnecessary consequences later.

What's Your Number?

I participated in a sprint triathlon today at Innsbrook, here in MO.  It was a beautiful day, sunny and warm and not too hot. What a blessing!  I had some time to think during the race and came up with a few questions.  All of the participants in the race are marked with two numbers.  One is the race number we are registered under.  The other is our age, on the back of the left calf.

The first number doesn't say much to a general observer, other than how committed we were to the race.  The numbers are ordered by when we signed up.  I was number 595.  There were only about 610 participants, so that tells everyone that I committed to this race quite late in the process.  The other number seems to garner more attention.  It is our age.  The race is started in several heats or waves according to age and gender and which course is being competed in (there was a long and a short course).  The start is in the lake swimming.  No one is really paying any attention to the numbers of others in the water.  Most of us are trying to just not drown.  However, on the bike and on the run portion of the race most of us will glance at the person's age that we are passing or who is passing us.

I notice that if I am passed by a man with a 55 on his leg, I tend to push a little harder and try to stay up with him. I don't pretend that I am going to win the race, but I would like not to be passed by someone older than myself (though that did happen twice today!).  Here's my question: If we all walked around with our blood pressure and cholesterol numbers on our forehead, would it change our behavior?  I think it is worth a thought or two.

Many of us are rather competitive at heart, but not all.  Some tend to be more fatalistic and feel that it is all out of their control.  It doesn't really matter what someone else's numbers are, does it?  I guess if that other person were a loved one we might be more inclined to try and assist and support them if we saw that they weren't so good.  Would seeing other's numbers spur us to better habits?  It might.  The most obvious benefit to me is that it would ingrain in all of us what the normal ranges are.  I know what they are but I do this for a living.  I deal with these numbers every day.  These are numbers we should all know.  It is most important to know our own numbers but it doesn't do much good to know just one number without having a value attached to them.

Here are the ranges:

                          Optimal         Borderline               Bad
B/P:                   <130/80     130-140/80-90        >140/90

Cholsterol:
Total                  <200 (depends on the breakdown though)
HDL (good)      >45                35-45                     <35
LDL (bad)         <130              130-160                >160
LDL (for those with diabetes or heart disease:
                         <70                70-100                  >100
Triglycerides      <150              150-200                 >200

So look at these numbers closely.  What are your numbers?  If you are not in the optimal range, talk to your doctor about how to improve them.  In the race of life we win by being healthy.  We can all be winners.  It is easy to get discouraged.  One of the greatest things about participating in a triathlon is that there are many spectators who cheer loudly for all of the participants.  It really gives a boost.  Let's all cheer for each other. Don't give up if you are discouraged.  Keep running and keep trying.  Your health is worth it.

Super Size This!

We live in a day of convenience and ease.  Have you ever seen the process our pioneer fore bearers went through to just make soap?  It took about a week of stirring pot ash over a fire, separating impurities and repeating the process over and over.  Think about the work to eat a piece of bread.  The wheat was often grown by the family itself.  Fields had to be seeded, crops had to be cut.  The grain was taken into town to be milled into flour.  The rest of the ingredients had to be procured.  The dough needed to be kneaded and allowed to rise.  The oven had to be heated by a fire until the correct temperature was achieved.  We don't even think twice about such things now.  We walk down an isle, plop items in our cart, wave a piece of plastic and go on our merry way.

Not long ago, most professions in our country required physical labor.  This is not the case any more.  Even farmers are not as active as they once were.  Vast tracts of land can be plowed from an air conditioned cab on large equipment.  A farmer patient of mine recently told me that in ten years he suspects that most farms will be worked by unmanned equipment.  Many of us spend a large part of the day sitting in front of a computer screen.  Our cars take us right to the doorstep of almost any destination.  If we have to walk more than 100 feet after parking, we get cranky.  I know because I hear it from my patients all the time.

My point is this, most of us cannot live our lives and expect to be active enough to stay healthy.  Obesity is a huge problem world wide and especially in our country.  My patients ask for pills and hope beyond hope that the latest dietary supplement will truly help them lose weight.  I talk to them about diet and exercise and most people recognize that what I am saying is correct.  It is one thing to know it; it is another to do it.  Let me share with you, two ways to view your day to maximize your health.

First of all, you must move.  The reason why we eat is to provide fuel for our muscles.  If we don't use our muscles, there is no reason to eat.  Here's my offer: you only have to exercise on the days that you eat.  Now of course we all eat every day, but every time you open your mouth for a bite you should think about how much activity you have done for the day.  I have a daughter that was a swimmer up to and all four years of college.  While in training, I have seen her and her friends eat more calories than I can imagine eating myself. That is OK, they needed those calories.  Conversely, I have seen her bypass a dessert, saying "I didn't swim today, I can't eat that."  She has figured out that we must earn every bite that we take.

The last point I want to make is this:  eat all the fruits and vegetables you want.  Even if there was no exercise  in your day, you can sit down to an all-you-can-eat buffet with fruits and vegetables for all three of your meals.  No one ever died from super-sizing their fruits and veggies.  It is recommended that we get 4-5 servings a day.  Not a week, a day!  More is even better.  Use it for a snack.  A banana or other piece of fruit in the morning is a great way to start your day.  A salad will often be 2-3 servings of vegetables.  If you get the munchies before bed, eat a few grapes.  Sure it takes more effort to buy the fruit.  I know that it is more expensive, but it is worth it.  Go ahead, super size it!

The Hippocratic Oath for You

It is customary for medical school graduates to take an oath as they graduate from school and enter the profession of medicine. This practice stems from Hippocrates, widely consider the father of western medicine.  There are many facets of the oath ranging from answering to deity, providing free medical education, practicing confidentiality, not working beyond our expertise, proscribing abortion and avoiding personal relationships with patients.  The most widely known tenant is in regarding doing no harm.  The original version states:

I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice (www.pbs.org).


I recently saw a patient who told me she was trying to apply the Hippocratic oath to her own body, meaning she was trying to first, do no harm to her body.  As I thought about that concept, it sat rather well with me.  I spend much of my day as a physician preaching the admonition to first do no harm and second do your body right.  Harm comes in many forms.  The human body is an incredible organism capable of self repair and growth.  For most of us, if we give it the chance to work right, we will have the means to live a long, healthy life.  If the body is forced to deal with self inflicted damage, it's defenses will wear down and it won't have as much energy to spend on normal processes to keep the body going strong.  


The easiest form of harm to conceptualize comes from that which we ingest.  This ranges from that which we eat as food, the medicine that we take and the supplements that we consume.  I have discussed all of these previously in earlier posts (see categories: watch what goes in).  Illicit drug use, cigarette smoking and alcohol consumption are the most important toxins to get a handle on.  Each is truly a poison and will only lead to harm.  Other chemicals such as caffeine and artificial sweeteners are less dangerous and not as well understood but should be avoided or limited at least.  The more food we eat off of bushes, picked from trees or dug out of the ground, the better off we will be (God's food).  The less processed food (that which comes out of cans, boxes and wrappers) we consume, the less toxins we have to process (Man's food).  Keep it simple and keep it healthy.  


Harm also comes in the form of exposure to infectious diseases.  Those we do not follow safe sexual practices may harm themselves for the rest of their lives.  Good hand washing skills are important to limit exposure. Simple measures such as coughing into the crook of one's elbow instead of the hand may not keep us from being ill but it may for our close contacts.  Using helmets on bikes and motorcycles and seat belts in cars can be life saving.  Being smart about sun exposure and using sunscreen is another simple measure to avoid harm.  We can do harm to our bodies by getting too little sleep.  Stress, likewise, can adversely affect our health.  


Lastly, there is sometimes a need to experience short term harm for beneficial long term effects.  Avoiding a prescribed medication due to possible side effects, while ignoring a serious health condition can cause serious harm in the future.  Exercise also falls into this category.  Muscles and bones get stronger, only after first being broken down, thus the adage, "no pain, no gain."  Again, our physical body is a marvelous structure.  You are the steward of this great gift.  Will you take the oath?  Will you accept the challenge?  First, do no harm.

Using "E-Cigarettes" to quit smoking

As part of my duties as a volunteer teacher at Washington University, I periodically have medical residents (doctors in training) spend a month with me at the office.  I have been fortunate to have Dr. Seema Mahale with me this month.  She will be entering the practice of medicine in a few weeks and has been wonderful to work with.  I invited her to write a post for my blog.  She graciously accepted.  I hope you enjoy!

Dr. Mahale's post:

As I was walking by a kiosk at the mall, I was approached by a salesperson selling E-cigarettes.  While I didn’t buy into the man’s pitch that I will look very sophisticated and cool with an e-cigarette, I couldn’t help but wonder if and how this new device could be used to help people stop smoking. 

First I needed to find out how e-cigarettes work. It turns out there are several different styles available, but the main idea is there is a network of metal filament heated by a rechargeable power source that heats a liquid reservoir. A vapor then is created that the user can inhale. The liquid is made up of water, flavorings and nicotine.

Unfortunately, there have not been many studies done to see the potential beneficial use of E-cigarettes and there are differing opinions. The FDA looked at many different brands of E-cigarettes and studied the content. They found there were traces of tobacco specific impurities that are associated with adverse health effects. Their report also notes there is no way to predict the amount of nicotine actually delivered when inhaled. The FDA also feels E-Cigarettes may even promote younger generations to start smoking since it is a new device. Based on this, the FDA does not feel E-cigarettes can be used for smoking cessation.

However, a small study done by Boston University School of Public Health found that E-cigarettes are much safer than real cigarettes. While E-cigarettes do contain carcinogenic components, the amount is 1000 time less than real cigarettes. The study goes further to suggest that E-cigarettes can be used as an aid to stop smoking as it mimics motions that one does while smoking.

There is no doubt that smoking is bad for you. It increases the risks of several disease such as cancer most notably lung cancer, heart disease, emphysema and poor circulation. However, it is very difficult to stop smoking, as it is one of the most addictive substances available.  Therefore, I feel it is important for one to realize all the different modalities available to help kick the habit. Some combination of counseling, support from family and friends, medications (such as Chantix and Wellbutrin), and nicotine replacement (patches, gums, etc.) are needed for one to be successful to be become smoke free.

I feel E-cigarettes can help people stop smoking and most importantly by using E-cigarettes people are not exposed to such harsh chemicals. The bottom line is a person should pick the method that works for them the best. While it may take multiple attempts, quitting smoking is the most important things you can do for your health. 

In Memory..

As hard as I work, as hard as I study and learn, as much as I want to do what is best for my patients I know that every last one of them will die.  Does that make my efforts futile?  Of course not. Promoting good health enhances life now, each and every day.  It helps us function well in our older years.  It is not my goal as a physician to make some live as long as absolutely possible but it is for them to live as well as possible.  There comes a time when added minutes and days do not add to added quality of life.  Even when we understand that a love one is suffering and lingering, it is still hard to say goodbye.  It is in these heart gripping moments when we achingly say goodbye to the ones we love that we grieve the most.  These goodbyes are especially hard when life is cut short unexpectedly.  Grief may turn to despair and even depression.  While we must go on with our own lives, I am grateful to have a day set aside to reflect on those who have passed before us, a time to celebrate the memory of their lives and the impact they have had on our souls.


As a physician in training, I always figured that as I became more experienced, handling the death of my patients would get easier.  Having now been in practice nearly fifteen years, I can testify that the opposite is true, it is exceedingly more difficult.  To sit at the bedside of a patient that is now a dear friend, look them in the eye and say good bye for the last time is heart wrenching.  To be someone's physician is an honor and a privilege.  I always hope to say goodbye with no regrets, having done the very best that I could.  


As difficult as it is to say goodbye as a physician, I recognize that it is immeasurably more so as a family member.  Even when the loved one is clearly suffering, their departure leaves a void in our lives.  My own personal belief in a God and of the resurrection takes the sting out of death to some degree.  I am not sure how I would feel without such beliefs and am grateful for them.  Dr. Russel M. Nelson, a notable cardiothoracic surgeon, now a leader in my church recently said the following, "If the body’s capacity for normal function, defense, repair, regulation, and regeneration were to prevail without limit, life here would continue in perpetuity. Yes, we would be stranded here on earth! Mercifully for us, our Creator provided for aging and other processes that would ultimately result in our physical death. Death, like birth, is part of life" (April 2012).  Granted, it would be easier if God would just take us up in a twinkling of an eye, but that is not the way of life.  There are lessons to be learned at the end of life, both for those who leave as well as those left behind.


I would, therefore, like to pay tribute to my dear friend, patients, who I have grown to love and are no longer with us.  Each in his or her own way has taught me life lessons.  I am grateful to have been their physician and hope that the happy memories of their lives will sustain their loved ones who still miss them dearly.  Happy Memorial Day!


Editor's Note: I would like to acknowledge Daniel Pearlmutter, a patient friend and professional illustrator who graciously offered to provide the art for this post.  I am thrilled that he has taken an interest in my blog and know that you will enjoy his work.