Time for some PA Advocacy!

If you are a frequent flyer to my blog, you already know I'm a Physician Assistant. Given the recent passing of national PA Week (October 6-12, 2013), lets take a moment to spread the word about PAs!

Definition: 
A PA (Physician Assistant) is a member of a medical care team supervised by a physician. Depending on what part of the country you are in, and what medical setting we are discussing, this medical team can include multiple physicians, PAs, nurses, medical assistants, or it can be a two person team consisting of just the physician and the PA.

The details of physician supervision varies by state, but overall the term generally means that physicians oversea and delegate the activities the PA performs and assumes some level of responsibility for the medical care provided by a PA. The physician need not always be in the same vicinity as the PA nor does the physician always dictate each and every medical decision a PA makes. PA's are an extension of physicians. We are educated in the same model as physicians and we are licensed by the state in which we practice to provide competent medical care. We must graduate from an accredited PA program and pass a national board examination in order to become licensed.

What I do:
I work for a major medical center in the department of hospital medicine (we take care of all the patients admitted to the hospital under general medicine, as opposed to a specialty such as neurology, surgery, cardiology). A day in my life begins with reviewing lab work, test results, vital signs, rounding on 12-16 patients with or without the physician present, make a medical plan with the physician and carrying out that medical plan whether it be ordering tests, prescribing medications, or calling specialty consultants. The physician may physically be on the floor with me for as little as 2 hours, or as many as 8-10 hours a day depending on their practicing style. When they are present, we work together coordinating patient care, tests, consults, and social needs with the social work team. When the physician is not present, I not only continue to carry out the plan discussed with the physician, but handle any issues that may come up in the meantime. However, I am never completely on my own and can always reach the physician on call by phone, pager, or text if needed.


For links to more information: Click here!

F is also for Food

I seem to be starting a theme here for Fall -- first fantasy football, now food, perhaps I'll dedicate a whole month to "F" related posts in honor of Fall (then again perhaps I won't since this alliteration was mostly coincidental).

Anyway, the point of this post is to discuss food. Rather, its to discuss diet. I've written a post or two in the past about improving healthy lifestyle through diet and exercise, and since its something that is constantly on my mind you should expect to see this topic come up every now and then. Today I read an article entitled the Anti Inflammatory Diet from JAAPA (The Journal of the American Academy of Physician Assistants). I have an inflammatory condition so articles like this always intrigue me on a personal level to begin with so of course I read it.

The article touched on concepts we already know: whole grains are better for you than refined grains, excessive sugary and deep fried foods are bad for you, eat more fruits and vegetables. What was different was the extensive number of statistics the article posed with regards to the differences in inflammation within the body of individuals who eat "western diets" (low fiber, high refined grains, sugars, fried foods, red-processed meats) vs. those who eat a "prudent diet" (high fiber, fruits, veggies, fish, whole grains, legumes, etc). The article referenced several studies that showed significant results that should be quite meaningful to any medical practitioner.

Overall, the conclusions were that inflammatory markers (signs of inflammation in the body) were increased in those who consumed the "western diet". This not only meant that these individuals were more at risk for conditions such as cardiac disease from the high fat intake, or diabetes from the high sugar intake, but that they were more at risk for their bodies to be under a chronic state of inflammation, which wears and tears on your tissues over time. Unsurprisingly on the contrary, those with a "prudent diet" had decreased inflammatory markers = less inflammation, less damage, overall healthier and at lower risk for future health conditions. Yay for fruits and veggies!  

What's in a vitamin? (Vitamin B12)

Last summer I started this little segment about vitamins, so here's a lighthearted post about our next special vitamin. How do we really know what vitamins are actually worth the buzz? That's what I'm attempting to discover. We've already discussed the benefits of vitamin D and C, next up: B12.

Vitamin B12

B12, aka cyanocobalamin, is fairly well known as an energy booster and has been on trend for the past several years. Given is ubiquitously known name, lets just jump in and affirm that yes - B12 boosts your energy! This is mostly due to the fact that people with a B12 deficiency suffer from weakness and fatigue as a side effect. So when you replace what you've lost, you feel better! But what else can this little bugger do for you?

B12 is a vitamin only obtained via diet, whether it be fortified foods, OTC or prescription supplements, or naturally occurring in foods. Without it not only will you feel your metabolism slow (two of its by products are active in metabolism.. metabolism = energy), but you can also develop anemia and neurological deficits including abnormal sensations, such as pins and needles, and memory loss, which can contribute to a sense of weakness and fatigue. Deficiency can also lead to constipation, depression, weight loss, and loss of appetite. There are a few factors that put a person at risk for developing a B12 deficiency.

1 - being vegan or vegetarian. B12 is naturally found in the meat, fish, shellfish, chicken, and dairy... therefore if you are not eating any of those foods you put yourself at risk for developing a B12 deficiency, among other things. If you practice vegetarianism, be sure to see a nutritionist to make sure you are getting enough of the vitamins and minerals you might be missing out on. Side note: B12 can also be found in fortified cereals.

2 - being elderly. As you grow older, you GI system gets tired and doesn't absorb the nutrients in the foods you eat as well as it did when you were younger. In fact, many times older people may be misdiagnosed with early dementia if their chief complaint is only memory loss and therefore the practitioner doesn't think to check for B12 deficiency. NY Times wrote an article on Vitamin B12 with this scenario as their back story.

3 - having a gastrointestinal disorder. B12 is absorbed in the small intestine. If you have a GI disorder, such as Crohn's Disease, Celiac's, or another condition that affects the small intestine, it can lead to malabsorbtion of many things, including B12.

4 - having had GI surgery or bariatric surgery. If you are missing some of your pieces, then its fair to guess that your body is going to miss out on whatever it is those pieces do for you. You lose your gallbladder, you can no longer secrete the enzymes needed to break down fatty foods, therefore you can no longer eat those fatty foods you love or else they'll be coming straight out the other end the same way they came in... gross (sorry for the visual, it was the first example that came to mind and I was too lazy slash entertained to change it to something more benign like losing your uterus means no babies). Likewise, if you are missing part of your GI tract, you can bet you're gonna miss out on absorbing some or many of the nutrients your body needs.

So how does this affect you and what can you do about it? For most of the young American population, you probably aren't B12 deficient. If you are tired, its probably because you stayed up too late watching TV or going out with you friends or taking care of your kids all day. However, you should eat a well balanced diet including an appropriate amount of meats, fish and dairy, and you should still get an annual physical in which your doc does routine blood work to check for anemia and vitamin deficiencies. And if you are still worried you might be deficient - a little OTC B12 never hurt nobody (at least not that I can find in the literature...)

Another fun fact: along with folate and vitamin B6, B12 also contributes indirectly to overall cardiovascular health.

Where this information came from: 

Vitamin B12 Fact Sheet, NIH

Yoga: Why you should think about doing it

In my quest for health (which, if you have been a consistent follower, you will know from my commentary last summer I began taking my health and fitness seriously and *pat on the back* I've kept it up) I've recently stumbled upon yoga. My routine last summer was pretty consistent: running 5-6 days a week. Once the cold kicked in, however, I had to get more creative. I have reactive airways (my lungs act up like an asthmatic under certain conditions) and the cold is just not my friend. I kept up my running until the end of October after my second 5K and then it was time for a bit of recovery. I took approximately two months off from running busying my time with a few weight exercises and Kenpo X here and there.

{Kenpo X is a disc from the famed P90X series... up until recently it was the only disc I would indulge in - 45 minutes of cardio in the form of mixed martial arts, primarily boxing/kick-boxing like exercises}

Shortly after the massacre in Newtown, I learned of a 5K at the end of March to support the victims families and immediately signed up. This meant I had to jump back into running. I joined a gym in January and resumed my running with more vigorous weight training than I had previously been doing. I ran my 5K and then fell into a bit of a slump. With my new career it was very difficult for me to work out with the frequency I had previously been used to since I work an odd schedule, and now that I wasn't tied to an upcoming event I lost my motivation to run.

As if it was a sign from the heavens, my mom called me one day and said "I signed up for yoga!" My whole family was shocked since we had all been ragging on her for years that she needed to get involved in some kind of physical activity because her body wasn't going to get any younger or stronger without it. She told me about it and insisted that I would probably enjoy it too. I knew P90X had a yoga disc, but I had no idea what I was getting myself into when I decided to stray from my Kenpo X to attempt Yoga X.

The "X" I discovered really does in fact mean "intense". Of course I knew Kenpo would be intense since it is a full body cardio work-out, but I still felt the X was a silly name attached to all the discs for the sake of the series. However, Yoga X is freakin' hard, people!! The first time I tried it, I could barely make it through the first 20 minutes of the work-out... which is a whopping hour and 45 minutes long. However, I really felt like my inner core was strengthened by even that measly 20 minutes. So I continued to attempt, and re-attempt the Yoga X. While I still can't do the entire disc at once, I've significantly improved and I really feel like it has enhanced my strength and endurance. And while the P90X instructor really doesn't focus on the mental health aspect that yoga claims to also enhance, it really does help clear the mind if you focus on the breathing while timing the stretches with the breathing as instructed. It brings your mental awareness to yourself, your body, your breathing, and brings you to the present moment.

Basically, it all boils down to the following reasons why I advocate for this form of exercise: 1. It's challenging and gives you a real work-out, 2. It builds your core strength and flexibility - which will enhance your overall athletic ability, 3. It can serve as a fabulous form of "you time" to workout your body and mind. So if you are looking for an alternative work-out to add to your routine, seriously consider adding yoga! Ohmm.

As an extra tidbit, if you are curious about yoga, I recommend you purchase a $10 video on amazon before you decide whether or not its something you really want to commit to at a studio. Studio yoga classes are ridiculously expensive and you can get a well guided workout from a video.

Happy PA week!

The end of PA week has come and I felt it was time that I contribute to promote my profession. I'm a Physician Assistant, which means I am a trained graduate of a masters program in medical education, I've passed a national certification exam, and I am licensed by the state to provide medical care to patients in almost every medical specialty, including diagnostic testing, managing patient care, and administering treatment to patients. I work as part of a team with medical assistants, nurses, and supervising physicians. Want to know more about how PAs are providing necessary medical care in today's society? Here's a great video on PAs: I'm a PA

Here's a link to my page on PAs, Health, and Medicine where you can find even more information about this great profession. 

A step in the right direction, if you ask me

Saw this little article floating in my AAPA news-watch this morning. I bet all you ladies are hoping this gets taken to the next level:

Study in mice raises hopes for birth control pill for men

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By Julie Steenhuysen

CHICAGO | Thu Aug 16, 2012 1:17pm EDT

(Reuters) - U.S. researchers have stumbled on a compound that may finally lead to a birth control pill for men.

In lab experiments, male mice given the pill were rendered completely infertile during treatment as they produced fewer and less mobile sperm. The drug, originally tested as part of a broader cancer research project, does not affect the hormone system or sex drive, the team said on Thursday.

"There is no effect on the mouse's mojo. The animals exhibit the normal sexual behaviors and frequency of copulation," said Dr. James Bradner of the Dana-Farber Cancer Institute in Boston, whose study appears in the journal Cell.

What's more, the effect is completely reversible. Once doctors stopped giving the drug to mice, they were able to sire healthy litters, with no apparent side effects, Bradner said.

Scientists say the research is exciting because it applies a unique approach to the problem of male contraception, which is now largely comprised of less reliable methods like condom use, or more permanent procedures like vasectomies.

Bradner's lab focuses on developing new drugs to undermine the molecular memory of cancer cells that tell them to divide. Those memory markers are distributed throughout the genome, the DNA that makes up a person's genetic code, and Bradner likens them to post-it notes that give cells instructions.

The team was experimenting with a compound developed in Bradner's lab called JQ1, which was originally synthesized at Dana-Farber to block BRD4, a cancer-causing gene.

They discovered that it appears to target a protein specific to the testes called BRDT that instructs sperm to mature. Bradner said the compound does not appear to do damage to sperm-making cells, but they forget how to create mature sperm while under the influence of the drug.

DRUG IMPEDES SPERM PRODUCTION

Bradner reached out to reproductive health expert Martin Matzuk of Baylor College of Medicine, another author of the report, and his team tested the compound in mice.

What they found is that the animals began producing fewer sperm, and the ones they did produce were poor swimmers.

"When the drug is removed, these instructions return," Bradner said.

The finding was surprising because few drugs are able to cross a protective firewall known as the blood-testes barrier that protects the testicles from substances floating around in the blood stream.

William Bremner from the University of Washington in Seattle, who was not involved in the research, said in a commentary the finding was "a breakthrough new approach," noting that there has not been a new reversible contraceptive for men since the development of the condom centuries ago.

"It's exciting basic science that provides a new approach to think about how a contraceptive for men might be designed," Bremner said in a telephone interview. "At the same time, it's a long ways from being in clinical trials in men, let alone being on pharmacy shelves."

Other teams have developed hormonal pills that are effective, but they disrupt hormone balance in men, and drug companies so far have not picked up on this approach, Bremner said.

Professor Moira O'Bryan, head of the Male Infertility and Germ Cell Biology Laboratory at Monash University in Australia, said the study was "an exciting report that could have major scientific and social impacts."

O'Bryan said the strong similarity between sperm production in mice and humans suggest that a variation of the drug may ultimately result in a human contraception for men.

Bradner said his team is working to refine the drug so that it only acts on cells in the testes, and not on cancer cells.

And while there are many more tests ahead before it can be a drug, the researchers believe the new approach can be "completely translated to men, providing a novel and efficacious strategy for a male contraceptive."

(Reporting by Julie Steenhuysen; Editing by Michele Gershberg and Vicki Allen)

Ice Cream vs. Frozen Yogurt

I apologize for the hiatus, however, my posts will be fewer for at least another week or two for a multitude of reasons. With that said, here is a little treat to tie you over:

Frozen Yogurt Vs. Ice Cream

The debate on frozen yogurt vs. ice cream is catching on like wildfire! So which is better? This article dwells on the difference between frozen yogurt and ice cream. Read on...

How many ice cream lovers have shifted their loyalties to frozen yogurt, simply because they got weight conscious? Most people believe that frozen yogurt is a healthier choice as compared to ice cream. Today, frozen yogurt is being considered to be something like ice cream and is served in several flavors, with different toppings, etc. According to the USDA, 62.4% of US production was regular ice cream in 2007, with low-fat and non-fat ice cream at 25% and frozen yogurt at 4.4%. However, what's the truth? Which is better?

Ice cream

Ice creams are frozen desserts prepared from dairy products, such as milk, cream, fruits, flavors and other ingredients. Most ice cream varieties are made from sugar, however, there are some made with other sweeteners. Sometimes, instead of natural ingredients, artificial flavorings and colorings are also used. People with lactose intolerance symptoms have ice creams made from soy milk and rice milk as well.

Ice cream comprises milk fat (10-16 %), milk solids (9-12 %), sweeteners (12-16%), stabilizers and emulsifiers (0.2-0.5%), water (55-65 %), which comes from milk or other ingredients. All the ingredients are mixed and stirred slowly while cooling, thereby preventing formation of large crystals and conducing to smoothly textured ice cream. Today, ice creams are available in all parts of the globe and are sold in large cartons in grocery stores and supermarkets.

Frozen Yogurt

Frozen yogurt is a frozen dessert prepared from yogurt, rather than cream. In the 1970s, this dessert was introduced as a healthier alternative to ice cream, however, its yogurt like consistency and tart taste lead to complaining customers. In response to these complaints, manufacturers spearheaded the production of a frozen yogurt recipe that would pacify the palettes of the consumers. In 1980s, frozen yogurt made a comeback and reached sales of $25 million in 1986. By the early 1990s, frozen yogurt had captured 10% of the dessert market. In frozen yogurt, the cream of the ice cream is replaced by the yogurt, however, the other ingredients are more or less the same.

Frozen yogurt comprises yogurt culture, milk fat (comprises about 0.5-6% of yogurt), milk solids (form 8-14% of yogurt's volume), gelatin, sweetener, coloring, corn syrup and flavoring. The milk fat accounts for the yogurt's richness and the milk solids provide proteins for smoothness, increased resistance to melting and lactose for sweetness. Frozen yogurt can be prepared in an ice cream machine, however, major companies often use assembly lines, specifically designed for yogurt production. 

Ice Cream Vs. Frozen Yogurt

Today, frozen yogurt is available in several flavors and styles, just like ice cream. Both ice cream and frozen yogurt are known to be nutritious with large amounts of high quality protein, calcium, riboflavin and some other essential vitamins and minerals. While ice creams contain 10-18% of fat content by weight, frozen yogurt usually has lesser amounts of fat content. Fat-free yogurt also exist, however, they often have even more added sugar, as compared to other varieties.

While considering the difference between frozen yogurt and ice cream, people often tend to halt at the fat and sugar content present in them. It's true that frozen yogurt contain less fat content than ice creams and that certain organic frozen yogurt are low-calorie and non-fat, however, one cannot just stop here and draw conclusions. The major health benefit of frozen yogurt goes beyond the horizons of fat and sugar content and stretches to its probiotic content.

Yogurt is actually fermented food, which is made by adding live bacterial cultures to milk. These bacteria spearhead fermentation in the milk and release lactic acid. The acid thickens the milk proteins and causes them to form a thick substance. Consumption of yogurt causes these live bacteria to enter the body and assist various beneficial bacteria in the body. These live bacterial cultures present in frozen yogurt promote better digestion. Probiotic content means good bacterial content, which helps boost the body's immune system, enhances digestion and is also believed to lower cholesterol levels.

Moreover, the amount of lactose present in frozen yogurt is more digestible, as compared to the lactose present in ice creams. This is because frozen yogurt contains enzymes which assist in breaking down dairy products, thereby enabling people with lactose intolerance to ingest frozen yogurt with minimal or no ill effects.

Frozen yogurt, with its additional benefits over ice cream, of greater digestibility, low-fat content and presence of probiotic cultures has caused it to be favored over regular ice creams. However, it is important to note that a great amount of sugar is added in frozen yogurt, which does not make it as healthy as regular yogurt. It is best to view frozen yogurt (health wise), midway between plain yogurt and ice cream. It is best to maintain a balanced consumption ratio. Each is known for its own benefits, so enjoy them proportionately. Hope this article was informative and helpful!

By Priya Johnson
Last Updated: 11/2/2011

*Taken from Buzzle.com, original article linked in the title

What's in a vitamin? (Vitamin C)

Vitamin C

Everyone's favorite vitamin has to be vitamin C (also referred to as ascorbic acid). Probably the most ubiquitously known reason for taking vitamin C is to help your immune system in the winter to fight off those pesky colds. However, this is not the most important reason your body needs vitamin C, in fact, its an after thought. Vitamin C actually plays a pivitol role in maintaining the different types of body tissues that keep you functioning as an intact human being: ligaments, gums, skin, tendons, blood vessels, even bone. Vitamin C is key to helping wounds heal and forming scar tissue. With that said, the affect vitamin C has on the common cold is lack luster. There is no evidence that vitamin C helps in preventing the common cold, and some studies show that it mildly reduces the duration of the illness, though other studies show no benefit. 

Vitamin C is not produced by the body nor is it stored in the body. It is solely gained from diet and supplementation. If you take too much vitamin C, your body will eliminate the extra that it does not use immediately. So, there is no harm in taking a regular vitamin C supplement if that is what you fancy, unless you are eating them like candy (which like candy, you might get some stomach upset). However, too little vitamin C can lead to a serious disease known as scurvy. Scurvy is characterized by anemia, bleeding gums and gingivitis, weak tooth enamel, nose bleeds, painful joints, inability to heal wounds, decreased ability to fight infections, and easy bruising. This is extremely rare in the United States. So as long as you are eating plenty of the foods listed below, you're getting enough vitamin C. 

Foods Rich in Vitamin C:

• Guava
• Red bell pepper, Green bell pepper
• Kiwi
• Oranges and Orange Juice
• Grapefruit Juice
• Vegetable Juice
• Raw Strawberries
• Brussels Sprouts
• Cantaloupe
• Papaya
• Kohlrabi
• Broccoli
• Sweet Potato
• Tomato Juice
• Cauliflower
• Pineapple
• Kale
• Mango

Another fun fact: Vitamin C helps you absorb iron and it is classified as an anti-oxidant. 

Where this info came from:

CDC - Vitamin C

Medline - Vitamin C

Vitamin C for preventing and treating the common cold

Mega-dose vitamin C in treatment of the common cold: a randomised controlled trial

What's in a vitamin? (Vitamin D)

During my clinical rotations I had a preceptor who recommended over the counter (OTC) vitamins to almost every patient at each routine physical. At first, I followed blindly, but I decided I would do my due diligence and investigate some commonly recommended vitamins to see if there is actually any evidence that it is worth it to be taking them. I'm going to do this intermittently since it will entirely depend on my mood towards research when I sit down to write. Today, lets talk vitamin D.

Vitamin D:

This one is getting a lot of attention lately among health professionals. A significant portion of the American population is vitamin D deficient, and those with darker skin tones are more likely to be deficient. Vitamin D is naturally obtained through exposure to sunlight or in fatty fish, or egg yolks. Very few foods naturally contain vitamin D, and therefore, here in the USA many foods are fortified with vitamin D such as milk, yogurt, orange juice, and some cereals. 


The primary function of vitamin D is to help absorb calcium from the GI tract. Without vitamin D, we cannot absorb calcium, which affects bone growth and muscle function. Therefore, obvious reason to take vitamin D, if you are deficient, is to keep your bones and muscles function properly.  


However, vitamin D does more than just absorb calcium. Vitamin D has been shown to have effects on the immune system, particularly in regulating the inflammatory response. White blood cells (helper T cells) have vitamin D receptors which allows vitamin D to have an influence on their response to an immune threat. Vitamin D is thought to play a role specifically in respiratory infections - head colds, chest colds, flu, asthma attacks, etc. Several studies have been performed, especially in children and asthmatic patients, showing the positive effects vitamin D has on regulating immune system response and how deficiency can lead to poorer overall health.

Whats even better is that because of the research that has already been performed, more evidence is surfacing about the many roles vitamin D plays in decreased inflammation and increasing regulation of the immune system. It may even play a role in reducing risk of colon, prostate and breast cancer.

With that said, don't go crazy and overdo it. The benefits of vitamin D come only from having a normal level. Excessive levels of vitamin D can cause problems of its own, as with anything. Vitamin D deficiency should be treated, but if your levels are normal, you eat vitamin D fortified foods, and get some exposure to sunlight, there is no need to worry.

Where this info is coming from: 

Vitamin D Fact Sheet

The Vitamin D Connection to Pediatric Infections and Immune Function

Vitamin D and Mucosal Immune Function

23.5 Hours

My friend Megan (holla!) showed me this video and I think its great stuff to think about. Its advice you know, its common sense you've heard, but watch the video (the whole video) to find out why its something you've heard and should start doing now.

Tweaks to a famous life-stage theory

We're grown-ups, how did that happen? And how do we make it stop?
(Props to who can name where that quote came from)


This one is for all of you psychology geeks out there. I've been having jitters for about a month or two... Life is changing and I fear I'm entering a life-stage crisis as I like to say. The last semester of PA school is underway, I'm in the middle of planning my wedding, I've started to job hunt, my board exam date is booked, and my quarter century birthday is on it's way.

So lets talk psychology. Everyone has heard of a "mid life crisis" and ironically, when you Google search, there is also a quarter life crisis -- which refers exactly to the time frame I'm in right now. Furthermore, the famed psychologist Erik Erikson developed and proposed a sort of counter-theory to Freud's approach that describes life stages that correlate with certain ages and with specific psychological barriers that must be overcome to continue to the next stage. His 8 stages of development are as follows:

1. Trust vs. Mistrust: 0-1 years, highly related to the baby's relationship with the mother; separation anxiety usually starts during this stage and the baby must learn to trust the caregivers

2. Autonomy vs. Shame and Doubt: 1-3 years, coincides with toilet training, child learns that he/she has control over his/her body and actions

3. Initiative vs. Guilt: 3-5 years, associated with preschool, children learn to assert control over their environments

4. Industry vs. Inferiority: 6-11 years, associated with elementary education, children learn to how cope with new challenges independently, such as homework and responsibility at home

5. Identity vs. Role Confusion: 12-18 years, this coincides with middle school and high school when teens start learning about themselves and who they are/who they want to be, this is highly affected by social influences (peer pressures)

**6. Intimacy vs. Isolation: 19-40 years, young adults learn and need to form loving human relationships and bonds while also finding a sense of security in adult hood (via career, education, relationships, etc)

**7. Generativity vs. Stagnation: 40-65 years, adult lean and need to find ways to be productive, whether it be having and nurturing children or creating a positive change that will benefit others

8. Ego Integrity vs. Despair: 65-Death, older adults reflect and acknowledge their accomplishments to find a sense of fulfillment

The first word in the stage name, trust, autonomy, initiative, etc, is the attribute the individual attains if successful, and the second word, mistrust, shame, guilt, etc, is that which the individual learns if unsuccessful. I have written these descriptions in the positive light in which the individual is successful during that stage (i.e. in stage 2 if the child learns he has control over his body, he feels a sense of autonomy, if he fails and does not learn this self control he learns to feel shame and doubt).

Stages 6 and 7 have been starred and I bet you can guess why. Intimacy vs. Isolation (stage 6: young adulthood) correlates with a "quarter life crisis"... however, I personally like to call what I'm going through a "life-stage crisis" because over the span of 20 years, I'm sure individuals can feel a sense of uncertainty at multiple and various points along that time frame. Yes graduating and getting a job is one, but what about marriage? Or buying a house? Or having a child? All these can happen at different time points and still cause feelings of "crisis" because they are each big life changes. And while Erikson's theory doesn't specifically refer to crisis, his description of the stages account for the crisis by suggesting there is a certain conflict to overcome, in this case finding security.

Generativity vs. Stagnation (stage 7: middle adulthood), which correlates to "mid-life crisis," is really just a continuation from finding security, for after you gain security the next goal is to be productive in that role. If you have nothing to show for your hard work and effort at the end of the day, or if you feel like you have nothing to show or you don't know where your work is taking you, that can lead to feelings of crisis. Though I'm not at this stage in my life, its important to keep in mind now that I'm currently laying the foundation for what is to come, so I better give myself a nice set up so I can be successful in the future.

What does this mean for me right now? I guess I need to get some "security." Since I've identified the feeling, and now the problem/solution, the next step is putting it into action and continuing to keep my goals in mind while taking one step forward at a time. The important thing is to avoid letting the feeling take over and paralyze progress, because the feeling is simply a feeling - it is of no real value. To keep it simple: this too shall pass.

*Note: Any supplemental information about Erikson in this post is from my good friend wikipedia. 

A lovely letter to any patient

Since today I am busy studying for the last exam of my clinical year, I will leave you with a re-post to a lovely letter to every patient about the ever changing practice of medicine. I hope you can grasp something out of this because though we will not all work in the medical field, we all have been and will continue to be patients to our doctors.

Dear Patient

*Note: other bloggers have mentioned the concept of re-posting things to their own sites. I haven't done any investigation and don't yet know if that means linking or copy and pasting with a citation so I've simply linked this one for now until I discover if there is a better way of doing this...

More tips for healthier habits and a bit about fruits

Lets start with the bit about fruits. My world was recently shaken up a bit when I came to the realization cucumbers are fruits, not veggies. Shocker, I know. I was eating my healthful side dish of cucumbers, carrots, and left over pico de gallo (raw tomato and onion salsa) and was thinking about cucumbers being at the top of my fave veggies list. Then I thought, are they a veggie? They have seeds... To Google I went! The verdict: Cucumbers are the fruit of a vine plant, like tomatoes, pumpkins, and squash. So my side dish of veggies was really a side dish of fruit plus a rogue carrot.

With that I promptly went looking for nutrition information about cucumbers because the major fruits I actually think of as fruits are usually high sugar, which equals high carb, albeit the natural version. This brought me to a great link that gives nutrition information on almost anything you can think of. This link brings you right to the cucumber, but type in any food at the top search bar and it will give you a list of options of raw, peeled, cooked, sauteed, canned, etc. It even lets you pick prepackaged versions of foods, such as Campbell's tomato soup when you type "tomato." I definitely spent 10 minutes typing in my favorite "veggies" (read: cucumber, zucchini, tomato, rogue carrots...) right before I started writing this.

I also recently stumbled onto this great page that summarizes more eloquently the points I was trying to make in my previous posts about healthier habits. In addition to reinforcing the idea that healthy living is a lifestyle, not a fad only for bathing suit season, the author talks about the "paleo lifestyle." I'm not sure if you've stumbled on to this in your travels yet, but it is a lifestyle that seeks to imitate how a human would eat and what kind of activities they would partake in if they lived in nature. After all, our bodies evolved in nature. The focus is on free range, naturally grown meats, vegetables, and fruits. And while I don't intend on ever becoming strictly paleo (as evidenced by point #3 on my post about lunch April 30th)... it makes sense and after reading about it I'm starting to more consciously consider what I really want my food lifestyle to be.

So, with that, click here for some food for thought  if you are interested (pun intended :) )

A fresh start for forming healthier habits (Part 2)

Exercise is my nemesis.

I think the last time I enjoyed exercise was when it came under the disguise of "tag" when I was 8 years old. Well, I guess I somewhat enjoyed it to a certain extent in high school when I was a member of the swim team. I attempted to force myself to enjoy running in college. Running was very popular among my roommates. Sophomore year I even got myself running 3 miles about 5-6 days a week for a couple months. Senior year I went to the fabulous brand new gym on campus here and there, but never on a steady basis. Since then, I've done close to nothing in the way of physical activity beyond walking 2 blocks to where I park my car. So in essence, you can expect this next habit change to be a tremendously difficult one.

Don't get me wrong, there is a lot of value in exercise. It releases endorphins, it leads to better body image, it strengthens your heart and lungs, it improves your overall health, and so on. I'm not a fool, I'm just lazy. Apart from play time as a kid, I never developed a routine of exercise as being a part of my everyday life. And let's face it, exercise should be a part of everyone's life for their entire lives. As much as we pretend we don't need to be active, we are animals and we need physical activity to be at our best.

First thing to do is realize that this needs to be a permanent change. Some sort of physical activity needs to enter my life for the long haul. With that, I need to start with the basics. I know if I go out and pretend to run for the first time in 3 years it's just not going to happen. I won't be able to do it, I'll send myself into an asthma episode, and that will be the end of that. Two months ago I finally built up the motivation to stop thinking about exercise and to start doing some. That abruptly ended when I was hit with the most severe upper respiratory infection I've ever had: inhaler every 3 hours, prednisone, nebulizer treatments, unending cough suppressants, and so on. Since then this recent lull really set in. So it's time to start getting my act together.

Going off of my philosophy with diet, I've decided to start slow. What is manageable? What is something small I can add to my daily routine without feeling overwhelmed? 10 minutes sounds like a reasonable amount of time to start... what can I do in 10 minutes? How about 4 sets of 15 tri's and bi's? So that's where I started. I also told Howie to whisper in my ear every now and then about doing some activity since he was already in the routine of working out every day. After I decided working my arms was very manageable and not enough, I added 4 sets of 10 lunges. Then I added some ab ripper X (from Howie's p90x). See where I am going with this?

I went for my first run this weekend and to my delight I didn't die! I guess all those core things really do work! Unfortunately this week with the down turn of the weather and me not quite figuring out mentally how to make myself go do cardio after being at work all day, I haven't run again in 4 days.  Good news: I'm still doing my core.... The real improvement is that I haven't given up and I haven't completely reverted to my old ways. This is the first start to forming a habit - sticking with it. 

A fresh start for forming healthier habits (Part 1)

For a few weeks now I've been thinking about habits. I'll admit I've been feeling pretty down about myself with regards to body image lately - its one of those months where I'm just not feeling too great. We all have these moments. I've been half-heartedly considering diet changes I've been trying to motivate myself to live an overall healthier lifestyle. But man, it is so hard to do sometimes! So lets talk about a topic I have strong love/hate feelings for:

* Diet and Excercise! *

How many times have you heard or read about diet and exercise? I should ask how often you hear about these two things on a daily basis (Think diet food/beverage commercials and online ads in the corners of most websites).  It may seem repetitive and boring at this point to hear about, but these two sneaky little habits have been shown time and time again to influence major health conditions and overall health. Think about it: obesity, diabetes, high blood pressure, high cholesterol, constipation, colon cancer, depression, anxiety, osteoporosis, memory loss. These are just a hand full of conditions that can be aided by diet and exercise. 


I'm not the healthiest eater and I don't exercise regularly. I look healthier than I am, which you may think this is great, but it's really just a crutch to promote my bad habits. I'm at high risk for developing almost all of those conditions I listed above once I get older based on my genetic lottery and my poor health behavior, which means I need to change NOW. So how? Little by little. And with the help of a buddy: Howie. He motivates me on the exercise end (he runs so he's already in that routine) and I bug him about establishing better eating habits. So what do I do to start making healthier habits?

Disclaimer: this is not any formal, professional advice. This is what works for me when I'm in a slump to START getting me back on track. I start with one thing, and then once I'm back in a better routine with that, I add another little change.

Lets start with what I'm better at regulating: 
Long term goal: Better eating habits


With regards to lifestyle changes, my biggest suggestion is to start small with a task that is not overwhelming. So, yes we have one umbrella goal of better habits, but how do we get there? When I realize my sneaky bad habits have taken over, I start getting back on track with one of the following 3 options: 


Short term goal 1: 
Don't eat within 2.5 hours of going to bed for the night. If you go to be at 10:30pm, this means no more food after 8:00pm; very manageable. This is my favorite rule to start with. Over time, it even allows the flexibility of moving that stop time earlier depending on your schedule (this week I'm attempting no eating after 7:30pm). I also give myself the one allowable cheat: If I'm starving by bedtime to the point I won't be able to sleep I am allowed one healthy snack, such as a small carrot, a glass of milk, or a quarter of an apple. After even just a couple of days of getting in the mindset that I'm not going to eat after the designated time, I don't even consider the cheat anymore and I actually prefer going to bed being on the slightly hungrier side versus the slightly full side.

Short term goal 2: 
Revamp one meal. I usually start with breakfast. Lets say my bad habit is eating no breakfast or something not so healthy. My new small change is to eat a breakfast that contains protein and/or fiber while avoiding white carbs. Example: multi-grain english muffin (fiber) with an apple (fiber and the natural kind of sweet cheat) or yogurt (protein, dairy, calcium). Nothing extreme, a health freak could think this is nothing, but its what works for me and its a positive change from eggo waffles or bagels. Like I said, I start little by little and keep going until I get to a happy place; as long as you are making changes in a positive direction. Another alternative to the revamp rule that I like to do is make a rule to include a vegetable at every dinner (helps the boy be better, too). One of our biggest bad habits is to have a mostly carb with a little bit protein dinner, such as pizza or pasta, or chicken with mac & cheese (yum). By simply adding a vegetable, I automatically dish out less of the carb, but still get my fix. Over time, I find myself craving the balance of having more than 2 food groups represented in my big meals.

Short term goal 3:
Portion control by changing the size of your plates; instead of serving yourself on your huge dinner plate, use the small lunch plates from your set, regardless of what meal you are eating. The difference in portion size when you do this is astonishing. I find that if I put food on that big plate, I'm going to work to eat it all, (I'm not kidding when I say I love food). Whereas when I put food on the small plate, when I finish I usually find it was enough. And if I still think I'm hungry, it gives me the pause to really think about whether or not I really need seconds.

This method of starting slow and going little by little helps me stay on track, not feel overwhelmed, and I'm not tempted to jump off the wagon because the changes were too major for my body. Its no secret that the majority of people who jump into a crazy diet or exercise routine head-on easily fall off and end up right where they started. Remember, we are trying to change habits here, not go through a phase of good behavior only to fall back into our bad habits. Habits are routines established over long periods of time. They are deeply ingrained by the time you reach adulthood and they can't be changed overnight.

As an additional tidbit, a good friend of mine recently wrote on his own blog about keeping New Year's resolutions and staying motivated. His tips are excellent, but the best part is they don't just apply to New Year's resolutions, they apply to any goal or habit change you want to make. I'm always up for a good suggestion about staying on top of things! 

Droppin' knowledge on homemade dressings

Howie and I love food. We LOVE food. If you met me in high school, you wouldn't think I could possess a domestic side. I hated indoor chores, I hated outdoor chores, I didn't cook (my mom was a stay-at-home-mom and did all of the cooking), and I could only bake goods that came in a box (still my preferred method for brownies: holla Ghirardelli). However, once we became juniors in college, we graduated to the apartment life. Goodbye food plan, hello kitchen. Howie's upbringing was totally different. Both his parents worked so he had to learn to cook and get along on his own. At one point during the beginning of our junior year, Howie decided to make me a dinner. I was shocked and impressed. He seemed to have so much fun doing it and just whipped it up from memory. He taught me some of his tricks and I began watching the food network religiously. I love cooking, finding new recipes, and I've even started coming up with my own. Howie also has his repertoire so we split the cooking responsibilities about 60/40 depending on who is the most stressed  with school. 

Which brings me to the point of this post. Howie recently made a delicious meal which included a salad and lime-cilantro vinegarette. The recipe he used for the dressing made a large amount, so I saved it as left overs. If you know me, you know I'm not super germaphobic and I usually go by my nose when deciding if something is still good. This dressing I knew was super acidic (lots of lime juice and lots of vinegar) so I figured it would last awhile. Recently, I decided to make myself dinner with left over chicken and I decide to use the dressing to make a salad. Its been over a week now since it was originally made, but it still looks and smells good. So I'm chugging along and I'm wondering how long do homemade dressings actually last? To Google I went. 

Now, I would never claim to be any sort of advanced or even experienced cook. But I was in for a real surprise that definitely brought me back down to a feeling of "novice" status. I found this great post that asked the question "How long do home made dressings keep in the fridge." The first response explained very well how different ingredients in the homemade dressing make for different shelf lives. This made sense. The part that caught my attention was this one little sentence, however: 

"The classic is the homemade garlic oil: you can keep pure garlic and pure oil for months in the pantry, but once you combine them, you get a botulism risk."

At first I just re-read it and tried to wrack my brain to see if I could figure out what this meant. I've seen on the food network that some of the chefs make garlic infused oil and that it is a popular commodity among Italians. I also knew garlic was one component of this dressing, in addition to the oil. So I typed in a new search: "Garlic in Oil." As I read through a couple of the hits I became more and more nervous. Keep in mind, I'm still eating and am already about half way finished with my salad. Apparently, garlic in oil stored at room temperature is a breeding ground for the bacteria Clostridium botulinum, the bacteria that causes botulism. Botulism is a scary, progressive, and often deadly reaction to the botulinum toxin released by these bacteria. The toxin is a paralytic and in high enough concentrations gradually paralyzes the muscles of the victim eventually leading to paralysis of the muscles that keep you breathing. It may start with abdominal cramping, fatigue, droopy eyes, and weakness in the arms and legs. Over time symptoms progress, reflexes are lost, and if the diagnosis is not made, it becomes deadly. The problem is, its a hard diagnosis to make. In this day and age, botulism is uncommon enough that it is probably not at the top of a doc's list and the initial symptoms can mimic a variety of diseases. Once this diagnosis is correctly made, anti-toxin is given.

So, as I'm reading these articles about the risks of garlic in oil, I'm becoming increasingly nervous. I start researching botulism itself (like I said, its not a common condition and its not the top culprit of food poisoning). Symptoms may come on in 18-36 hours. I promptly tell Howie if I start acting weird and become weak, bring me to the ER and tell them to look for botulism. He thinks I'm crazy. And then the rationalization starts. Well, its not garlic alone in oil. Its got lots of acid to kill bacteria, and it was kept in the fridge. So, that's okay, right? As you can tell, I'm still living today so clearly I did not get botulism. But its an important point to take home since homemade dressings are delicious - once you start making them, you'll want to make more. Here are the tidbits I found out during my research. {I apologize for not remember what sources I got this stuff from to properly give them credit, but the general tips are ones I found repeated in several of the sites I visited}

1. Clostridium botulinum is a bacteria often found in dirt. Its spores can adhere to any vegetables grown in the ground, such as garlic. Botulism is often associated with canned vegetables. This type of bacteria can only grow in an environment without oxygen (something called anaerobic). Once ground vegetables are sealed into a liquid with no oxygen available and are not properly preserved, the spores "hatch" to life and the bacteria begin growing and producing toxin.

2. Don't ever store garlic in oil at room temperature, EVER. The oil seals in the bacteria and seals out the oxygen.

3. Some sites say garlic in oil stored in the fridge can last up to 7 days max. Attempt at your own risk.

4. There are a few ways to reduce risk if you want to store it, such as drying out your garlic completely before infusing it into the oil, or heating it up to a specific temperature for a specific amount of time before putting it in the oil, or pickling it in vinegar, or acidifying the concoction. None of these are sure-fire ways of eliminating all bacteria and their spores (the dormant form that only starts growing in the right conditions). My dressing contained large amounts of vinegar and lime juice, which is probably what made it safe enough.

5. Likewise, some sites say that it can be stored in the freezer to keep for longer.

6. VERY IMPORTANT: There is no way to tell if your dressing or garlic oil has gone bad because this bacteria and its toxins are colorless and odorless! 


So, best way to avoid the risk: make a small quantity of dressing you can finish fresh that day or that you will only have a small amount leftover to finish in the next couple of days.Always store it in the fridge, never on the counter. Based on the information I read, I would highly recommend against keeping any homemade dressing containing garlic and oil for more than one week, regardless of the other ingredients. Most importantly, if you don't make homemade dressings yet, don't be afraid to. They are 100% better than store bought dressing and I plan to continue testing them out. Note: everything I had to say was about STORING the dressing. Eating it fresh is absolutely safe!

For more information about botulism in general, the CDC has a great variety of information. Click here to go to their page on botulism. 

What a drag it is getting old

I had a high school teacher who once came into class flustered, clearly having a tough day, and sighed, "What a drag it is getting old." She then credited the Rolling Stones for their opening line of their song Mother's Littler Helper. Being my father's child, I knew the Rolling Stones, but I only knew their most famous songs. To this day whenever I stumble across this one on the radio I think of that teacher and that line. To be honest, I don't have a clue what the rest of the song is about.

Getting old sucks. Point blank. I'm not even old and I already have developed a rock solid, and possibly irrational, aversion to the thought of getting old. I know what my bad habits are doing to me now, and I know what my genes could have in store for me down the road: heart disease, colon cancer, and Alzheimer's. The first two I can fight, so I guess I'll just deal if those happen. Alzheimer's is the problem. The word alone irks me. The thought of the symptoms form a nice little ball of anxiety in the middle of my belly. I can hardly watch some of the scenes in Grey's Anatomy lately of Chief Weber struggling with his wife's Alzheimer's. It just hits far to close to home and it hurts.

My grandfather died fairly recently from Alzheimer's, among his many other physical ailments. It was devastating. If you have seen this disease, you'll understand how terrible, terrifying, and life altering it is for everyone close to the victim. My grandmother has now started with symptoms and it breaks my heart. Consequently, anytime I stumble upon information regarding progress in research about this disease, I gobble it right up. In one of my daily newsletters from the AAPA this week (American Academy of PAs) the top article was one about physical activity and Alzheimer's:

Daily Physical Activity May Help Reduce Alzheimer's Risk.

The CBS Evening News (4/18, story 6, 0:20, Pelley) reported, "It appears that daily physical activity may help reduce the risk of Alzheimer's disease." After monitoring some "700 elderly people," researchers found that "the least active were nearly two and a half times as likely to develop Alzheimer's as the most active."

        USA Today (4/19, Lloyd) explains, "A higher level of physical activity -- not just exercising -- is linked to a reduced risk of developing Alzheimer's disease even in people over 80," according to a study published online April 18 in the journal Neurology. "Protective activities include washing dishes, cooking, cleaning, gardening -- even playing cards. People who scored in the bottom 10% of physical activity were more than twice as likely to develop Alzheimer's."

        "Plenty of research has suggested that people who make a habit of exercising are less likely to get Alzheimer's, though scientists aren't sure how to explain the link," the Los Angeles Times (4/19, Kaplan) "Booster Shots" blog notes. "Other activities that have been correlated with a reduced risk for Alzheimer's include engaging one's brain in mentally stimulating activities, spending time in social groups and eating a healthful diet, according to the National Institute on Aging."

        Focusing on the study's methodology, MedPage Today (4/19, Phend) points out, "Highly active older adults in the 90th percentile on actigraphy were 2.3 times less likely to develop Alzheimer's disease during a mean 3.5 years of follow-up than their inactive peers in the 10th percentile." Specifically, "the analysis included up to 10 days of 24-hour actigraphy monitoring for 716 individuals without baseline dementia participating in the observational Rush Memory and Aging Project." Notably, "after adjustment for age, sex, and education, total daily physical activity was associated with incident Alzheimer's, with a hazard ratio of 0.477 (95% CI 0.273 to 0.832)."

        "Just how exercise may reduce risk of developing Alzheimer's is not known, but in general, what is good for the heart is believed to also be good for the brain," WebMD (4/19, Mann) reports.

For those of you who don't love science, studies, or statistics. This synopsis basically is saying that there is a correlation between increased activity of any kind, physical and mental, and lower risk of developing Alzheimer's. This does NOT mean that high activity levels prevent Alzheimer's; it means that there may be a relationship between increased activity and decreased Alzheimer's risk. As the last statement of the synopsis reiterates - this disease is not well understood, and in my opinion it probably won't be understood for quite sometime. The take home message for me is really you get out what you put in. Yes, the human body is mysterious and there will always be things to learn about it. However, on its simplest level, its pretty much just like anything else, if you take good care of it, it will take good care of you. This is true of almost any pathology (fancy word for disease). The trick is starting those healthy habits from a young age and sticking with them for a lifetime.

 Healthy habits aren't any more difficult to have than bad habits... they are habits regardless of how you look at it. And a habit is just that, its something you do routinely without thought. Whether its eating Eggo waffles for breakfast, or eggs with a glass of milk instead, washing your hands after using the bathroom, brushing your teeth before you go to bed, and saying "God bless you" after a sneeze.  Your routines become your habits, and habits set the tone for lifestyle and health.