Monday, April 28, 2014

Pushing buttons

Had a long Sunday at Immediate Care.  Seems that the people coming in were not interested in getting healthy, they were more interested in getting back to the way they were before getting sick.  (What they don't get - they are sick because of the unhealthy lifestyle....may not seem obvious now but I can wait, when ready, I can help)  So I buzzed through the walk-in patients....kept the wait to 15-30 minutes and handed out a lot of prescriptions.  Kinda easy to agree with a diagnosis of infection and just write a prescription.  Another symptom, another prescription; another trauma, another xray.  This is "cook book medicine", if your symptoms fit the ICD9 code, you will get the predetermined treatment algorithm for that code.  I detached myself from the need to educate and empower and just picked up charts and discharged patients.  After work, I was looking forward to spending the remainder of Sunday with my family so we took a walk at a local forest preserve then looked for a place to eat.  Son wanted Japanese food so we drove to a local place..  After reading through the menu, I asked to waiter about the portion size for some soup.  He said "it was big".   I wanted to make sure it wouldn't be too much to eat.  He said "I don't know how much you eat".  Finally I asked how many scallops come in an order/dish and he said it was "alot of scallops".....(perhaps his full time job was at a Japanese comedy club so I went on to decide my order by just reading ingredients and guestimating portion size by price point.  We all ordered and received our food....except for my scallop order which seemed to take a long time to come out.  I ended up having some of my wife's sushi order and asked for the check and some boxes.  He came with the check and the missing order.  He said scallops take a long time to cook and he mentioned it to me (of course it was probably between the fantastic descriptions he arduously built up of the menu choices when taking our order)  I took the price of the scallops out of his tip and left saying the food was good but service not appetizing.  Then it started raining on the drive home.  I usually drive the right lane and during downpour make sure I watch my periphery and rear since people underestimate wet stopping distance.  (dry = 1 car length for each 10 mph  or follow using the 4 second rule)  Regardless, if someone is tailgating me in the right lane, they have the option to use the left lane for passing.  If they don't take the option I slow down both of our cars and increase the distance to the guy in front of me so in the event of a sudden stop, I have ample braking distance and the tail gaiter will hopefully do the same.  So on this day with windshield wipers going full speed, the only thing I saw in the rear view mirror was a very 3D looking set of headlights.   I let up on the throttle to "gently" indicate that he should distance himself or pass (not sure if male or female -too much rain).  Headlights got even closer.  I continued to focus on the scene in front of the car while my son was making fun of me pretending he was the waiter from the comedy club/sushi place we just left.  (I didn't want to invite wife and sun into this movie that was taking place behind us -reminded me of a 70's film by Spielberg called Duel where Dennis Weaver was being stalked by a relentless big red 18 wheeler villain)  The narrow right hand turn into our neighborhood was fast approaching and he was intentionally getting closer so I had to slow to a crawl to navigate the intersection/the rain/his front bumper.....and while my son was laughing from the reenactment, the car behind me started wailing on his horn.  I did the civilized thing and made the turn waving my finger to him saying you are driving to close.  I couldn't make out if male or female as my eyes were on the road hazards during the peel off.  I always like to memorize the driver and license of reckless drivers thinking that one day I will be able to discover an amber alert fleeing vehicle.  My son immediately says this is the worst day ever, then my wife say poor Daddy "so stressed".   I then calmly say...I'm not stressed....that guy is.
This is one of the reasons why it is important to practice relaxation exercises daily.   To remain calm in a fight or flight situation will help with problem solving/be a beacon for others in the frenzy to emulate me /and I believe if you react to anger or a stressful event with more stress, the options for moving forward will be limited. Think of the typical ER star- cool calm and collected physician that runs the recusitation, leaning back against the wall, calling out orders, controlling the chaos erupting over the dying patient and having everyone work in unison to bring the patient back from death.  The human body can only exist in fight/flight or unity/procreation.  If the only way you know to live is fight or flight, adrenaline/epinephrine/cortisol will be the dominant hormones and inflammation will be the dominant reaction in every cell.  (FYI....inflammation = heart disease, autoimmune disease, Alzheimer's, diabetes and cancer.)     If you develop/practice a relaxtion response regime, you can choose to be proactive/calm before an event.....(the opposite would be reactionary to all events).   Having a healthy life practice doesn't guarantee immortality but at least you did what you could to shape the future.  

Monday, April 7, 2014

Multi Level Happiness Marketing

There is something about helping (contributing) that gives satisfaction.  Humans are hardwired to be a part of "the whole".  In it's most basic sense, we can generate a good feeling (high secretion of serotonin/oxytocin hormones) when we are part of something bigger.  Think of the rush you get to see how many Likes a post on Facebook gets.  Studies measuring hormone levels in people having an act of kindness done to them show highest hormone levels as expected.  Same study didn't expect high levels in the person giving the act of kindness.  Further studies went on to find out how far this extended and documented the same hormone levels in people witnessing the act of kindness being done!

Humans have a built-in brain pathway (like a service road) that certain electrical impulses get prioritized to go from the 5 senses witnessing the event straight to the pleasure center.  The end result is a reward system that makes you feel good if you are doing good.  It gives you such a great "high" that you want to seek out doing it again-even if you witness an act of kindness.  Just see what being in nature does to you.  No matter how stressed out a parent is while traveling with the family, when you get to the destination beach; stress just melts away.  Nature has it's own beauty that acts like a beacon to draw you to it and involve yourself with it.  You get to a pristine national park and notice trash-you pick it up to keep the memory pristine.  Louis Schwartzburg filming nature. The sum of energy in the universe is meant to be everlasting and all the lives that exist within the universe live in happiness when in harmony.  The opposite can be felt as well, when you live to destroy and not contribute- life is lonely, painful and unrewarding.   Witnessing bad energy also leads to an uneasy feeling.  When you watch the morning news and see deaths that occurred overnight, every new story ends with a feeling of fear or hatred (toward the bad guys).  Watching an uplifting movie, an act of kindness or the beauty of nature will bring a sense of calm and awe.  Nature in particular expresses itself to make lives want to "join in" and be part of "the whole".

For those of you stuck in a rut, trying to change with a push or detox......try to surround yourself with positive energy.  I remember buying paint at a local store (now out of business) and the guy mixing looked and sounded like a KKK member.  Every other work in his vocabulary was F@#$.  As I was waiting for my can to be mixed, I noticed when there was a new customer, the customer would acknowledge the conversation and answer in step to the KKK guy with F#%$.  (Kind of like joining in on the mob mentality topic which was all small talk about current hot button topics).  I paid my bill and didn't join in as he seemed to bait me when it was my turn to the counter.  The opposite also happens under rain sheds when in a national park, I was in the Grand Canyon solo hiking and needed a break from the elements.  The 7 mile mark of a 14 mile hike had a shelter and others were there.  I stopped, changed my gear, re hydrated and the conversation with 3 other parties was so cool.  The topics seem to be superficial but the people that day were sharing without fear of judgement.  Soon without an uncomfortable feeling of the conversation dwindling, we all wished safe journey and carried on.  One positive experience (received, given or witnessed) generates another positive experience and so on.  Like multilevel marketing, if your down line is strong and happy, you to will exponentially manifest strength and happiness.   Seek it out!!!

Friday, April 4, 2014

Happy (Unhealthy) Doctors Week!!!

Got a nice gift for Doctors Week this am with a bag of "goodies" from one of the hospitals I belong to.   It was a container filled with colorful decorations and snacks.  I opened the bag and started pulling out the snacks and wondered.....wheres is the gift? (Mama taught me to say it's the thought that counts).   Then I got to the bottom of the red paper filler and found some golf tee's.

So I just finished my morning loose leaf green tea (Genmaicha from Adagio Teas), toast and fruit (banana) and thought good thing I'm not hungry.  If I didn't have my morning ritual, I may have been tempted to pop open the Special K breakfast bar.  The design of the "100 calorie" bags is deceiving; packaging says 100 but it's flat, small and carries about 20-30 pieces of mini size edibles. (I would not be satisfied with 1 package unless I intentionally ate one at a time and allowed the wafer to melt on the roof of my mouth then worked it with my tongue-sounds sensual but this is mindful eating - (see Jon Kabat Zinn Mindfulness for Beginners-The Raisin Story) and allows for satiety with changing blood levels of ghrelin/leptin/cortisol/serotonin/oxytocin/IGF1.   Mindless eating comes when stressed, hungry, tired, thirsty, overwhelmed, sick....and I just described every American I see in clinic.  Obesity is an epidemic and it will carry heart disease, high blood pressure and diabetes along with it for 1in3 people -excluding Colorado.  (Cool to watch on my lecture link by advancing from slide 12-slide 39 and you will see the evolution of obesity in the US.)   I calculated the total calories from all these snacks

to be 1010 calories.  (This would be in addition to 2-3 regular meals in a day!)  The downside is the glycemic index for the snacks is very high and in 30-120 minutes I would crave more fast food due to the hypoglycemia response after fast food I refer to as the "insulin dump".

In comparison, the bulk of my packed food for the day is about 1300calories- good enough for me!  I am working a 14 hour shift today so in anticipation of hunger this evening, I will plan on a pre-emptive strike to cravings with an order from local veggie restaurant if necessary.  My food looks bland compared to what I ate 20 years ago but across the hallway is a physical therapy place.  My excitement/satisfaction will come in the endorphin rush from getting on the treadmill during down time and cranking out a mile or two.  (unless the physical therapy police tell me the equipment is only for patients).  Speaking of police, if an officer of the law is found doing anything illegal the news will chastise him/her and suspend without pay until decided by a judge. No one is above the law but I am sure some law enforcement officers break rules every once and a while.

So what should we do with health care workers that are unhealthy.  Or healers that don't know the law of letting "food be thy medicine".   After prescribing medicines, most doctors would apply some anecdotal stories of what they have tried personally which is honorable but not usually deep enough to build individual templates for the wide variety of people/diseases/ethnicity/tastes/ages.  In the 90's, insurance used to cover visits to a Registered Dietitian but not now.  With some insurance companies- after you have been diagnosed with Diabetes, you will get 2 visits to an RD in the first year and then 1 visit annually (lifechanging right?).  Most diabetics I speak with roll their eyes when I ask "how informative was your visit and why are you not taking advantage of what your insurance covers?"  Looks like patients are on their own when it comes to nutrition....unless you find someone locally on EatRight.Org.  A friend told me it would be better to see someone for counseling that you know versus a stranger, at least make sure they have been through credible training.  Be your own policeman!  (Or attend local lectures like mine at Advocate Sherman Hospital April 26th!)