Shout Out to OBs

This week is the American College of Obstetricians and Gynecologists annual meeting in Chicago.  Knowing the meeting is happening made me think about my time in the specialty.

Speaking specifically on OB, it is so difficult to express honestly to patients what we do.  The role of the OB is to keep moms and babies from dying and being damaged.  That's the job!

Everything else we do (deliveries, ultrasounds, routine prenatal care, chatting about breast pumps) is in service of that goal.  Bringing new life into the world is a big part of the job.  That's what's worth enough to keep us doing it, but it's not the real job.

People who downplay the role of the OB focus on uncomplicated deliveries.  They are correct in saying there doesn't need to be doctor at every delivery.  The OB is there to decrease the chance of death or damage when other birth attendants don't have the skill to do so.  When a home birth goes awry, the patient comes to us.  That's what we do.

I don't mean to be morbid, but now that I don't take care of patients anymore I am less censored on this issue.  It worries me to see good doctors be burned out by the real job all the time.  I just want to tell my fellow OBs I know and I appreciate your efforts.

You don't have to like your OB (or even have an OB), but at least give him/her the credit for what the job is.  If you do like your OB, tell him/her.  It really does make a difference.

WISH VS. DESIRE

What do you want?

I am a fan of semantics.  I believe in using the proper words to convey the intended meaning.  One word whose true meaning befuddles me is want.  The Merriam-Webster definition of the word want is - “have a desire to possess or do (something); wish for.”

Personally, I’ve always used want in the pre-semi-colon denotation.  If I want something, I have a desire for it.  That desire is expressed by effort on my part to obtain it. 

It seems we as a society use the definition after the semi-colon more often.  When folks say "I want" they mean "I wish I could have".  It’s a subtle distinction but it makes all the difference in how successful we are at getting what we want.  

As a life coach and personal trainer, I hear people say they want to have a better job, to be better managing their money, or to be in better shape.  Many times, in reality, they wish for those things because they recognize they could be beneficial. 

There is not actually a real desire to make these things happen.   This is why the choices they make can seem inconsistent with what they claim to want. 

One complicating factor is not wanting what we think we want.  We focus on a red herring instead of what we actually desire.  Then, we aren’t pleased when we get what we wanted. 

Having struggled with this issue myself, I enjoy helping people clarify what it is they truly want in order to figure out how to achieve it.  Everyone is unique but there are some general truths about fulfilling one’s true desires.

Desire is just the first step.  Eventually we have to take action to achieve what we want.  

We don’t always take children seriously when they claim to want something.  This is because we know kids are apt to think verbalizing a desire is all that is required to get what they want.  They don’t realize there is work necessary to satisfy a wish.  

As adults we know action must be taken to get something worthwhile. 

It is possible to stroll pleasantly along in life without much effort.  However, that type of unintentional living leads to a place that is fine, but not particularly fulfilling.  Getting something we truly want usually involves combining desire with purposeful actions. 

We will probably have to give up something we like to get what we want. One of the difficult parts of being mature adults is recognizing we may not be able to have everything we want at the same time. 

This is not to say we have to sacrifice everything we enjoy for the sake of one goal. 

However, the morning mocha latte may have to be swapped for home-brewed coffee while credit card balances get paid down.  Cupcakes may have to be put on hold in order to get the body fat percentage under control. 

We have to establish priorities.  Even if it is only short-term, some discipline is required to get what we want.

Everything we have to do to get what we want is not going to be fun. Gaining proficiency is somewhat humbling on the front end. 

When we were in grade school learning to play instruments or to speak foreign languages we expected to stumble over those first scales or mangle the conjugation of some verbs. 

Somehow once we become adults we forget about the learning curve.  We figure we should be immune to having to struggle to do anything we want because we have already acquired so many other abilities. 

Learning to manage money or to establish a consistent workout schedule is a new and challenging skill for some of us.  Getting better means sticking with it.  Commitment is what carries us through the moments that aren’t so fun.

Getting what we want is awesome.  It is remarkably satisfying when effort, discipline and commitment get us what we really want. 

We often put limitations on what we want because we worry the up-front investment isn’t going to pay off.  This is where faith comes in. 

We have to believe in ourselves and our capabilities to get what we want.  We also have to trust what we are striving to achieve has value.  When we do and it all works out, it is amazing.

Now think about it again…what do you really want?

WHAT'S THAT YOU'RE DRINKIN'?

I will preface this post with the admission that my recent discovery of the joys of Bikram yoga has made me very conscious of hydration.  For those who don’t know, Bikram yoga is a 90 minute session of 26 postures done in 105 degrees Fahrenheit and 40% humidity.  It’s really hot and it’s impossible not to sweat…A LOT!  That being said, I feel the need to comment on the fact many Americans don’t drink enough water.

When I went to a natural hairstyle I remember reading a lot of blogs about the best way to maintain moisture in coarse hair.  There were all sorts of concoctions involving oil of this and butter of that.  The most easily applicable thing I remember reading was the best ingredient to provide moisture to hair is water.  All the other stuff is just to make sure the water remains there.  I feel the same principle applies to hydrating one’s body.  Start with water.  In the USA, we have the clean drinking water for which a lot of the world literally dies.  We should use it. 

Here are some things to consider:

Dehydration makes you feel bad.  The human body is composed of 60-70% water.  When we don’t have enough of it, normal physiological processes take a hit.  We feel fatigued.  We get headaches.  Our toes go numb when we exercise.  Our urine looks crazy!  The recommended amount of fluid to drink per day varies depending on who you ask.  The Institute of Medicine says roughly 3 liters of beverages for men and 2.2 liters for women at baseline.  This should be increased when engaging in vigorous, sweaty exercise.  I personally think that most of the beverages should be water.

If you never exercise vigorously, just drink water.  The best way for most people to hydrate is to drink plain water.  Not all physical activity requires a post-exercise electrolyte infusion. Sports drinks are designed to replenish carbohydrates and electrolytes lost during vigorous exercise.  Gatorade was developed to help football players in Florida stay hydrated during practice.  Drinking some after a stroll through the neighborhood where we barely break a sweat is a bit of overkill.  Water will do the trick.

Don’t overestimate the hydrating effects of non-water beverages.  Coffee, tea, and alcohol do provide water to the body.  However, both caffeine and alcohol have diuretic effects.  This increases the body’s elimination of water.  No matter how watered down the drink tastes it’s not as hydrating as a glass of water.  I personally love coffee and have a large mug every morning.  However, I don’t give it full credit in my hydration equation since I know the effects on my kidneys make it almost a zero sum situation.

Rethink the legitimacy of the excuses you are using to explain away drinking too little water.  A complaint I often hear is that adequate water consumption causes frequent trips to the bathroom.  Not to be obnoxious, but that’s a pretty lame obstacle to such a simple wellness habit.  Another excuse I’ve heard is that water has no flavor.  This was an issue for me until I started squeezing lemon juice into water to make it less bland.  This got me into the habit of hydrating.  Nowadays I always have a water bottle with me that I refill throughout the day.  This enables me to avoid the cost-of-bottled-water issue.  Despite the propaganda of the bottled water industry, most of us can drink the tap water where we live and work.

Drinking water helps avoid a lot of unnecessary calories.  Pretty much everyone I know who has significantly decreased or completely cut out soda and alcohol consumption has lost at least 10 pounds.  That little anecdote is completely unscientific but I believe in it.  Weight loss is a multifactorial endeavor but this is something I have seen be effective a number of times.  Drinking calorie-free diet soda is not without weight gain issues either.  Recent research suggests artificial sweeteners increase appetite.  The body is expecting to receive calories when it tastes something sweet.  When it gets the sweet without the calories the brain gets confused and you get hungry.  Again, just drink water.

I understand it can be challenging to maintain adequate hydration consistently.  My method is to keep track of fluid intake throughout the day.  I try to drink at least three containers full of my 24 ounce bottle each day.  If it is 2 pm and I haven’t finished the first bottle I know I am behind.  I also start each day with at least eight ounces of water to prevent getting to midday without having anything but coffee.  That typically works for me but everyone is different.  Try to figure out what system works best for you, especially as we enter the heat and humidity of summer.  Once your kidneys adjust to the hydration program, you’ll feel better overall.

IDENTITY CRISIS

I spent the vast majority of my life wanting to be, training to be, then working as a physician.  This made it very difficult to separate who I am from what I do when I stopped practicing medicine.  The struggle was especially great since I had no particular new identity to embrace at the time.  The doctor mantle never fit quite right but it least it gave me covering.  Now I had to go out and define myself.

Leaving medicine the way that I did presented another interesting situation.  People thought of me as this brave person.  However, I never felt I lived up to the cool courageous woman people conjure when they hear my story.  Brave people do things that scare them.  I wasn’t scared.  I just didn’t want to be miserable anymore.  Quitting medicine seemed to me like a common sense decision more than an act of valor.  I was pretty sure the brave persona was not going to work for me either.

Eventually I accepted my identity comes from within, not what others think of me.  Once I determined what was important to me, the rest was about being true to that.  How other people perceive it tends to be as much a factor of what they need to see in me as what I am exhibiting.  Figuring myself out is a never-ending process but here are some general principles I’ve learned so far.

The key is to be genuine.  Regardless of circumstances, my life tends to stay on the rails when I am honest with myself.  At my basic level, I love God, I love exercise, and I love helping people.  I love God because He loves me in a way that models how I should love others.  I love exercise to relieve stress and stay fit.  I love helping people to feel useful and of service.  These core aspects of my life combine to allow me to like who I am and how I treat other people.  The best version of me will always involve a manifestation of all these whether it is as a physician, a wellness consultant or some profession to be named later.  Neglecting any one of them would be creating a false identity for me.  It is important to figure out what is essential to being you.

Don’t be what someone else thinks you should be.  Many well-meaning, yet misguided, people offered me suggestions on everything from how to remain in medicine to how to build my wellness business.  They didn’t necessarily value what I value, so their ideas didn’t really apply to me.  Trying to conform to what other people think is best for you means being defined by external influences instead of your own heart.  It only leads to frustration and resentment for all involved.  Being a better version of yourself may require some adjustments in the way you do things.  However, improving yourself never means losing the essence of what it means to be you.  If that is happening, it’s not really a better you. 

Don’t be afraid of what you can be.  One challenge I faced in forging my new identity is distinguishing whether it was lack of interest or fear keeping me from trying something different.  Especially for those of us who have charted out our lives since our teens, it is natural to be nervous about the unknown.  However, fear should not be the only thing holding you back.  This is where being responsive to your intuition is important.  For instance, I don’t run marathons because I have no desire to run for more than one hour, not because I don’t think I am capable.  On the other hand, I started my own business.  It is a completely novel and challenging experience, but it does not frighten me because it is in line with my authentic self.

Stay close to the people who love you regardless of your identity.  One thing that has become evident to me through all this is who is in my corner.  Someone asked me recently if my family supported my decision to leave medicine.  The best way to explain it is they gave me space to determine what I need without judgment.  I am very fortunate.  My family and closest friends don’t totally get what I am doing, but they know I am happier than I used to be.  They are concerned about my welfare but never push me to do anything or be anything I am not comfortable being.  They trust me and my process to lead me where I need to be.  Whether it is changing careers, ending a relationship or starting a new fitness regimen, sometimes you just need someone to be kind to you while you define it for yourself. 

I still don’t have a succinct answer for my new identity.  That pleases me.  It means I am not letting myself be put into a box.  Like every human being I am a complex individual who manifests differently to different people.  What is important to me is that through whatever lens people view me, they see truth.  That is the most anyone can ask.

LESSONS FROM MY CONVALESCENCE (AKA NEW YEAR NEW UTERUS)

By nature I am not an oversharer.  If anything I tend to keep my personal business completely to myself.  However, I do not feel I can adequately convey the message I want to share without exposing myself a bit.  That is why I am about to put my medical history on blast all over the interwebs. 

In December I had major abdominal surgery to remove fibroids from my uterus.  Because I am an obstetrician-gynecologist by training, I knew way too much about what was going to happen. It was quite a challenge to not be “that patient”.  The one thing I requested was some sort of visual representation of what my diseased organ looked like.  Because we live in the 21st century and I had surgery at a hospital where I used to work, I was able to obtain an actual photo.  It surprised me how disturbed I was by the appearance of my pre-surgical uterus.  It was a nightmare! 

As I reflected on the fact I had strongly considered deferring surgery or not having it at all, I determined my uterus was a metaphor for my life.  I have a self-limiting habit of convincing myself horrible things are not that bad.  While staring at the photo of my fibroids I made a decision not to let that happen anymore.  In more ways than one 2014 was going to be New Year New Uterus.  Here is what the process of preparing for and recovering from that procedure taught me about being true to myself.

Sometimes you have to choose the best of all the bad times. As an independent contractor, taking a prolonged leave of absence from work is never an easy choice.  If I do not work, I do not get paid.  Unfortunately, there was not a way for me to receive appropriate treatment for my fibroids without taking at least one month off.  I had to pick a time, and December was the least bad.  In many areas of the life, there is not always going to be a good time to make a necessary move.  In fact, every change is going to come at a bad time for someone involved.  Waiting for the best time is one way we responsible types camouflage procrastination.  Sometimes we just have to make the hard choice now and allow everything to fall in place after that.

It can be tough in the immediate aftermath of a right decision. Every good decision does not reap immediate benefits.  For instance, I like to exercise.  The circumstances of my recovery were such that it was around two months before I got back to working out.  It only takes about two weeks for the body to lose fitness conditioning.  My first post-op run was one of the more uncomfortable workouts I have had in recent memory.  There was literally a burning sensation in my chest for the first five minutes of jogging.  It was a reminder I had made a decision for my overall health that caused a short-term negative impact on my conditioning.  I knew it was reversible, but it was quite awful in the moment.  The important thing is knowing I can work through it and get back to a comfortable level.  The new perspective I have on coming back to fitness from medical leave also helps me to be a better personal trainer.  Preventing a limited period of discomfort is not a legitimate excuse to avoid making the correct choices for our lives.  If we allow it, the education we get from those tough times only serves to improve us.

Ignoring obvious signs may be hampering your ability to fulfill your intended purpose.  By design the uterus is meant to be a womb that gestates offspring.  I did not have my surgery with the expressed intention of preparing my body for child-bearing.  However, finally treating my fibroid symptoms made my uterus a much less hostile environment for any embryo that may reside there in the future.  I have cared for plenty of women who had fibroids and babies without issues, but pregnancy tends to be easier when the uterine wall is not housing numerous golf balls.  Downplaying my medical signs and symptoms was just the latest in a lifetime of rationalizing bad feelings.  Ignoring the significance of those signs can keep us from moving on to the satisfying and fulfilling existence we are meant to have.

When you make a tough decision other people will be scared on your behalf.  In their own loving ways, lots of people expressed their nervousness about my potential for post-operative complications.  Of all the concerns I had with regard to my operation, medical misfortune was not particularly high on the list.   I was confident God had a plan that would work out for the best.   Since others’ worries were manifestations of their experiences not mine, I chose not to embrace them as my own.  It reminded me of when I decided to stop practicing medicine.  While I found the decision to be remarkably liberating, many people in my life were worried about all the impending badness.  I could sense them trying not to freak out as they mentally calculated how I would maintain my mortgage, my school loans, and my prestige without a “doctor job”.  I had to learn to respect their opinions but not be unduly influenced by them.  The fact I was not scared by an objectively scary situation helped me to know I was making the right call.  When we make choices that are honest and authentic, we can be fearless.

My motto for 2014 is “New Year New Uterus”.  I never want to allow myself to get to the old uterus state again so I keep a copy of it on my phone.  It is a reminder to me of what can happen if I maintain the status quo when a change needs to be made.  It is not always necessary to know exactly what the result of a decision will be.  The important thing is honoring the instinct to make the decision in the first place.  Here’s wishing you all NYNU!

MOVE IT OR LOSE IT

I watch people move all the time.  As a personal trainer, I instruct clients on how to perform specific movements for improved fitness and function.  In general, I find it fascinating to observe how individuals get from one place to another.  It troubles me that many people seem to have difficulty moving while performing their normal activities of daily living.  Sometimes it is obviously due some injury or chronic impairment.  However, many times it looks like the body is just not used to moving.  This gives me some insight into why exercise can be such a daunting prospect.  If walking from the car into the grocery store is a challenge, getting on a treadmill would be completely unappealing.  Even those who regularly go to the gym are often culprits of being too sedentary for the rest of the day.  That is still a problem.  The human body is designed to move.  Here are some easy ways to add more motion to your day.

Take the stairs instead of the elevator or escalator.  You can ease into it by walking down the stairs for a week.  Many stairwells are located at inconvenient places in buildings which gives the plus of added steps to actually arrive to the head of the stairs.  Once you have gotten accustomed to walking to and down the stairwell you can add the anti-gravity portion of the movement.  If your destination floor is higher than you have the stamina to traverse, just get off the elevator a few floors early and walk the remainder.  This is a great way to move your body and strengthen your heart.

Park your car at the end of the aisle.  Those few extra steps must be of some value since everyone is always seeking out the closest spot.  It actually saves time looking for parking to just aim to be far from the front door.  This tip also makes it easier to find your car sitting by itself at the end of the aisle.  The fact that you now will have to carry your purchases a few more feet is just an added strength-building bonus on the back end.

Get up from your desk every hour.  Prolonged sitting in one position, especially hunched over a computer, is terrible for the body.  Backs get sore.  Hips get tight.  Bums spread out while the muscles get weak.  I’ll speak another time about the travesty that is the increasing size of the buttocks in the face of decreasing strength of the gluteus muscles with sitting.  Even if you just stand up for a few seconds and sit back down that is an improvement on the standard.  It is difficult to ask bodies to move effectively on demand when we keep them still all day.

Walk to your co-worker’s office/cubicle.  I must confess to have never worked in a typical office environment.  As I understand it, many people call/e-mail/text/instant message their officemates to communicate during the day.  That was not an option when I worked in a medical office.  You had to walk to where the person was with whom you wanted to speak.  There were a lot of steps accumulated over the course of a day.  I grant you it is not the most time-efficient way to communicate.  However, a walk to the other side of the office is probably a reasonable use of a few minutes for the sake of overall well-being.

None of these suggestions is groundbreaking.  The general principle is to try to incorporate more movement into your normal routine.  Even paralyzed individuals get physical therapy to keep their bodies from developing the complications associated with being still at all times.  Those of us with the power to put ourselves in motion ought to take advantage of the ability.  Your body will feel better for it.    

Dear Stress, Let's Break Up

The Merriam-Webster dictionary defines stress as a physical, chemical, or emotional factor that causes bodily or mental tension and may be a factor in disease causation.  Most of us, particularly my fellow healthcare professionals, have an intimate knowledge of stress and do not need a formal definition.  Some level of stress has been our constant companion as we have acquired both formal and practical life education over the years.  Now that we have moved past school and training into the world of careers and parenthood, the sources of stress have changed but the level remains constant if not increased.  Since the reality of life stressors is not going away any time soon, the important thing is to learn techniques to deal with stress effectively.

Stress is not always a bad thing.  The body’s reaction to acute stress leads to what we know as the flight or fight response.  In the short term, this makes us more alert and prepared to take on necessary survival functions.  The type of stress that causes problems is chronic stress.  The same chemicals that allow one to be ready for oncoming danger in a crisis situation can cause a breakdown in the body’s maintenance activities when present for too long. 

Many times the effects of chronic stress are so insidious they are not recognized immediately.  Most of us are so perpetually wound up we do not realize this is not a healthy state of being until some medical professional indicates we have a hypertensive disorder.  The physical manifestations of stress can include headache, chest pain, fatigue, musculoskeletal pain, and dysfunction of the gastrointestinal tract.  The psychosocial ramifications can be sleep disturbance, anxiety, depression, irritability, rage, disordered eating, isolation behavior, lack of focus and substance abuse.  The best way to counter these effects is to identify sources of stress and develop methods to manage it.

The National Institute of Mental Health (NIMH) website suggests the following tips for coping with stress:

o   Note what you have accomplished at the end of the day rather than what you have been unable to do

o   Set priorities for what must get done now and what can wait

o   Recognize signs of your body’s response to stress

o   Stay in touch with supportive people (family, friends, community groups, religious organizations)

o   Avoid dwelling on problems

o   Look into stress coping programs

o   Have regularly scheduled healthy and relaxing activities

o   Exercise regularly

o   Get proper health care for existing or new health problems

o   Seek help from a qualified mental health professional if you feel overwhelmed and unable to cope without using drugs or alcohol

             

Managing stress is important part of being well.  Finding balance in life helps modify stress.  Work/life balance is a popular 21^st century phrase.  However, it implies there are only two aspects of being that need to be considered to achieve wellness.  It conjures the image of a scale where work has to be balanced with everything else on the other side.  True life balance involves putting work, kids, partners, finances, emotional health, physical health, and spirituality all in their proper places.  I think of it more like a hanging mobile where some items have to occupy a higher location or a larger space in order for everything to keep spinning.  Figuring out for ourselves where everything goes on that mobile is the first step in stress management and overall wellness.