Monthly Archives: January 2010

Five years ago, Dr. Paul Farmer was invited to be a guest lecturer for my Social Analysis course at Harvard College. The course opened my mind to the needs of the world with respect to public health and medicine. While my primary demographic interests in medicine are more oriented to domestic, urban, inner-city populations, one sentence in Dr. Farmer’s talk with respect to international medicine bothered me for quite some time. In an effort to call upon our sympathy and recruit motivation to support efforts to bring first world medicine and people to third world, resource-poor settings as Partners in Health was doing with Haiti, he said that in the end, it all comes down to one thing: mercy. At the time, my skeptical mind wondered, “Is this pseudo-religious/spiritual talk of mercy really going to convince a cynical, selfish human race to help those in need thousands of miles away?”

That was the year of Hurricane Katrina. Even in the chaos and the demonstrations of the worst part of human nature, the vast majority of humanity on display was that of grace under fire-and mercy. The past four years of my life as a listener of stories is filled with anecdotes like an easy-going counselor at my school jumping in his fishing boat to ferry neighbors and strangers from rooftops to safety, the sending of food to my parents and other survivors stuck in a flooded hospital from people all over the country, and the rapid response of firemen and policemen who flew down from New York City who felt they owed something to New Orleans, one of the cities that donated fire trucks and equipment to NYC after September 11, 2001. Despite the cynicism, so many people around the U.S. and around the world helped New Orleans rise out of the ashes to the city it is today: as fun-loving, free-spirited, and full of life as before.

Now, another group of people is in desperate need. To the vast majority of humanity that recognizes our oneness as a people, as one human race united by an everlasting desire to grow and find a better future, ignore the cynicism and skepticism and do what you can to help those suffering in the wake of a terrible natural disaster.

Stand with Haiti – Partners in Health

Drawing from the old Chinese traditions of hand reading and face reading, my father used to say that one can determine how well one manages financial resources by looking at the spaces between one’s fingers when they are held together. Unfortunately, my finger joints are rather knobbly. Whether it is because Chinese traditions are based in wisdom and evidence or it is that my dad gave me a complex, I have approached the need for diligence in financial matters in my adult life with a level of intensity swinging rapidly between lackadaisical and fanatical. This has been in part due to the wavering financial fortunes of my family, dating back to the various wars in China during the twentieth century that reduced a wealthy family to poverty, followed by the relatively meteoric gains in political and financial freedom by my parents which was cut short by my mother’s untimely death to cancer and my father’s loss of a job to Hurricane Katrina. My perspective is also deeply affected by the growing burden of medical school loans. With all of these pressures and the additional cost of traveling back and forth between New Orleans and Boston during these past four years to visit my fiancée, one of my goals has been to develop a sustainable way of life.

As a physician, my aim will not only be to save lives from the catastrophic outcomes of disease but also to help my patients improve their lives and make them more sustainable. Ultimately, everyone has their own individual constructs for what constitutes happiness, but the ways we try to achieve happiness come with associated costs and benefits that must be weighed together. A major component of a physician’s job is to help patients recognize the costs of their behaviors and the benefits of change: the financial and health costs of tobacco use, the potential benefits to an individual’s health of prescribed medications or a particular surgery, or the return on investment in time spent on regular exercise and weight loss. Developing this skill set has also affected my own pursuits for a better lifestyle, primarily in the areas of refining a healthier diet and developing a regular exercise regimen.

In these two realms, the following are my lifestyle modifications, experiences, and current approaches (which will continue to evolve based on new information and changing needs). Costs in money and time are weighed against benefits to health and enjoyment:

A Healthier Diet
• New Orleans can be a hard place for healthy eating: there is too much food that tastes so good yet is very unhealthy! The local Cajun-French cuisine, especially in the more tourist-oriented restaurants, often involves heavy cream sauces, fatty cuts of meat, and a relative paucity of vegetables (and virtually no strict vegetarian options). Nonetheless, I have found it possible to enjoy the vast range of New Orleans cuisine by maintaining a high level of conscientiousness about what I am eating and aiming to keep a balanced diet.
• With the success of Starbucks, coffee and coffee-infused drinks have become a staple of American fast food. While coffee is often a regular part of medical student/resident/physician life, it is worth knowing what you are drinking because many coffee drinks are not as light as you might expect: Caffeine and Calories by Information Is Beautiful. For me, I only get regular coffee or lattes/mochas, only use Splenda, and never have whipped cream added.
Dietary supplements has and always will be a hot-button topic for physicians to address, and I have encountered many medical students and physicians who have widely different recommendations and self-imposed regiments based on their fields of interest. First, it is important to note that dietary supplements (vitamins, minerals, etc.) should not be used as a replacement for eating a balanced diet (hence the term “supplement”), but it can be used to help fill in the gaps where one’s regular diet might not always meet the recommended amounts of individual nutrients. For example, I am pretty certain that my regular diet does not give me the recommended daily intake of calcium, so I take a calcium supplement to bring it up to 100%. As for other dietary supplements beyond the basic recommendations, I am inclined to take the “family medicine” approach: instead of focusing on the latest individual trial data, I instead rely more on the larger reviews and the whole body of available evidence to inform personal health decisions in the context of being a relatively young, healthy individual with few comorbidities (that is, I don’t perceive my health status as being overtly different from the majority of the population). For example, should I be paying $15-20 per month to buy omega-3 fatty acid supplements (or eat more expensive fish, or eat omega-3 fatty acid-infused eggs despite the high cholesterol content)? Based on the overall body of evidence, my current answer is no for me as omega-3 fatty acid supplementation only has a level A recommendation (supported by the strongest evidence) for individuals with high blood pressure, high triglycerides, or a previous history of a heart attack. Similarly, cardiologists are constantly talking about Vitamin D these days: should I supplement my diet with more? This question is trickier since Vitamin D has effects in a wide variety of disease. At this time, I obtain about 1400 IU of Vitamin D through my multivitamin and calcium supplement, so I do not plan to add more (unless there is a stronger consensus suggesting a substantial benefit for relatively healthy individuals).

The U.S. Department of Health and Human Services has a decent website offering guidelines and recommendations for a healthier diet.

A Regular Exercise Regimen
• During college, my main form of exercise was martial arts (free, no equipment required): approximately 90 minutes of moderately intense activity three times a week. I continued exercising in this way during my first two years of medical school, but it simply is not fun to practice martial arts alone.
• In November 2008 during my third year of medical school, my fiancée and I purchased running shoes ($90) and resolved to start long-distance running together. At best, I was able to run 3-4 times weekly for 15-30 minutes anywhere from 1.8-3.5 miles. Unfortunately, despite the beautiful routes I have available for running, I found it hard to keep up a regular schedule due to discomfort from weather changes (mostly extreme heat and humidity in the summer in New Orleans) and also due to my increasingly busy clinical rotation schedule.
• During the month I spent studying for the Step 2 CK exam, I spent 40-90 minutes each day in the medical school gym using the elliptical and weight machines. I enjoyed having the opportunity to have (free) access to a relatively uncrowded gym, and my overall level of fitness improved during that time. Shortly thereafter, I was able to start a gym membership ($60/month) in Boston with my fiancée while I was there for away rotations; at best, we used the gym 1-2 times per week. However, when we started going on interview trips that did not overlap and as the weather became chillier, my gym use ceased.
• This is by no means an ideal solution, but in an effort to address the inability of my level of motivation to surmount these barriers, I finally invested in a Wii Fit ($99 including the basic Wii Fit Plus program and Balance Board) and the well-received EA Sports Active Personal Trainer ($60, resistance band included; note it is possible to get EA Sports Active without the $99 balance board). I have only had the setup for a few days, but so far my plans to exercise daily seem to be easier and more enjoyable to implement. The included Wii Fit Plus game primarily focuses on balance exercises and yoga (an “Eastern” approach) while the EA Sports Active program focuses on cardiopulmonary exercises and strength training (a “Western” approach). Many articles have noted that the number of calories burned is generally less using any of the Wii programs than with conventional exercise (e.g. I might burn 150 calories running 5 mph for 20 minutes but only 110 calories doing a variety of exercises on the Wii for the same amount of time), but I am hoping that the immediate feedback, motivational tools (awards, progress tracking, etc.), and enjoyment of the games (cardio boxing, tennis, skating, etc.) will help me exercise more consistently. When I start feeling more fit again, I hope to obtain stronger resistance bands ($10) and weighted gloves ($12-16) to increase the intensity of the strength training.

I previously neglected to mention my reasonably successful quest to improve my quality of sleep which is helping improve my perceived quality of life as well as helping me start each day better rested.

A Better Sleep
• Drawing from advice given by one of our medical school instructors, I replaced the light-penetrating Venetian blinds covering the windows to my bedroom with thicker cloth curtains ($25) that block out most of the light. This, in addition to covering the blinking lights from the various electronics in my bedroom, has drastically reduced sources of light that would otherwise trouble my sleeping brain and prevent me from easily entering deep, restorative sleep.
• To address my cranky neck and shoulder muscles, I finally invested in an IsoCool memory foam side sleeper pillow ($42) which (at least for the past week) has successfully reduced the number of nights I would otherwise wake from with a sore body.

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