Thursday, December 21, 2017
'Watching Your Toddler Drink Bathwater From a Hotel Tub', and other sordid tales of OCD exposure therapy
Now, this has always been sort of quirky and cute to most that know me, and those that may have thought otherwise have largely been kind enough to at least refrain from open mockery. "Oh, that TheUnluckyPath, she sure is hilarious, over there picking microscopic lint fragments off of her dinosaur print Boden top". But let me tell you, shit got real when Punky arrived four weeks early. I had what turned out to be straight up post-partum OCD/anxiety that might blow your mind. I had no idea that this was even a thing. You learn some (but not near enough) about post-partum depression in med school. But I swear I had no idea that you could get heightened OCD associated with the perinatal and/or post-partum period. It was absolutely heinous. I've never been so terrified in my whole life. I spent the first eight weeks of my daughter's life expecting to find her dead, in any and all manner of common and/or obscure/tragic/horrifying/violent ways, every single time I left her for a snooze. And, presumably because I've seen some serious things in my life, I could picture in excruciating detail every single aspect of the fictional scene. I became nearly-paralyzed by stairs, where I would clutch her to my body and get an iron-grip on the banister like I was free-climbing Half Dome every time I walked out to the garage (down four steps.....just four). I would imagine that she, at four weeks old, had somehow freakishly developed musculature, climbed out of her crib, and rolled underneath only to suffocate on a blanket that she had carelessly wrapped herself in. I visualized her tiny electrocuted body lying next to a wall outlet, no joke. My heart was repeatedly broken day in, day out, every time that I left her and cautiously returned to see what I would find. Because, even though she was perfectly fine every time I came back(if not sometimes poopy), I imagined her dead in more ways than anyone could ever believe, and it felt so real to me each and every time. And a little bit of me mourned her faux death, so many times a day.
But that actually wasn't the worst of it. The worst of it was that, in the majority of instances, when I imagined her death, it was me inflicting it. It was me hurting her in all of those ways every time. In the bath tub. In the kitchen. In her nursery. It was so, so shocking and terrifying to have these scenes playing through my fractured, sleep-deprived mind. The shred of myself that I was still clinging on to still knew that I did not ever want to hurt a single tiny spiky hair on my perfect little peanut's head, but it was so, so hard to reconcile this with the visions that I was constantly having. I was beyond terrified. I was so afraid to tell my husband about any of these things, for I didn't know if he would be afraid to leave me alone with her. A few weeks in to this guilt-and-shame-filled struggle, I remembered an episode of the podcast Invisibilia that I had listened to the year prior. It was called The Secret History of Thoughts, and it had made quite an impression on me at the time, especially the story about a young, just-married couple. They had a relatively carefree and easygoing life, until one day out of the blue the guy started having obsessive thoughts of his wife being stabbed to death in their kitchen. And he was the one doing it. On one hand, he just *knew* that he had no desire to harm his wife in the least. But on the other hand he was terrified that he must want to kill her, on some subconscious level, else why would he have such terrible visions?
Turns out, he had a specific subtype of OCD called Harm OCD, in which "an individual experiences intrusive, unwanted, or distressing thoughts of causing harm, and this is inconsistent with the individual's values, beliefs and sense of self. These obsessions typically center around the belief that one must be absolutely certain that they are in control at all times in order to ensure that they are not responsible for a violent or otherwise fatal act." (that's a nice definition provided by the website of the OCD Center of LA)
So, I went back and listened to the episode again, and I felt an immediate sense of relief. I remembered identifying with it to some degree the first time around, and feeling so deeply sorry for the poor bastard experiencing this terrifying thing.......but now I was was reasonably sure that I had become that poor bastard. However, at least I had some hope that perhaps I could fix this somehow. So I committed right then and there to myself that I would admit that I was having these thoughts to my lovely, compassionate therapist at my next appointment. And, I did. And doing so was the first step in my journey toward recovery from my post-partum Harm OCD. And now that Punky is 2.5 years old, I'm back to my slightly more than casual OCD, right where I'm comfortable.
And that brings me to watching my daughter drink hotel bathwater in a borderline sketchy extended stay motel during our cross-country move a few months ago. Having a toddler is a long-haul treatment course of exposure therapy for OCD, which turns out to be very effective for me in dealing with my issues. Identify the intrusive thought, analyze it and decide if it's valid and why/why not, then accept it or dismiss it as it's happening. Gives me the sense of control that I need to feel comfortable and safe. And then I can go about my quirky day.
Watching a toddler eat peanut butter off the floor of an airport. Standing idly by while my daughter puts her hand in the toilet to retrieve a toy that needed a quick and refreshing swim. Suppressing a scream as the kid covers the wall in crayon, grinning and singing with unabashed joy. It's a constant barrage of borderline-horrifying acts of depravity, packaged in an adorable little bundle of cuteness and light. And on that day a few months back, as I sat back on the yellowed and cracked tiles of that supposedly clean bathroom, I forced myself to let her be a toddler, feeling her way through the world around her and delighting in the new experience. It was a super gross experience, but she thoroughly enjoyed it nonetheless. And the reason that I finally got around to writing this five months after the fact is that it dawned on me a couple of nights ago that I haven't checked my pillow for stray hairs before falling (mostly happy and always exhausted) into bed at night since we moved to this new job and house. There are tons of other stressors in life, including some new ones about kind of hating this new city, but overall life is pretty damn good. And the older I get, the better of a handle that I have on my weird brain. It's actually pretty interesting in here most of the time......... :0)
Saturday, November 25, 2017
I remember one year, I was on the consult service the week of Thanksgiving and while I had Thanksgiving Day off, I had to come in on the Friday. A nurse asked me while I was making my way down the hospital hall whether I was okay. I didn't realize exactly how debilitated I appeared. Just walking a bit slow today *shuffle, shuffle, shuffle*!
This year, it has been no different. I should be more prepared after the same sequence of events every year for the past 4 years but, no, I stepped out of bed on Friday morning and was like - WHOA: IS THIS RHABDO? HOLY CRAP IT HURTS. If I wondered whether I pushed it hard or not, there was my answer. Yet, something about the pain with every step (all day and all night) is nice in a weird way. It's proof that I did something hard.
Thursday was my fifth race this year. I've realized that training for a race keeps me motivated in a way that plain old hopes and goals don't. With my work schedule and everything going on, it used to be so easy to make excuses why I couldn't run:
- It's too late
- It's too early
- I don't want to do my hair again
- Everyone else is hungry
- I'm hungry
- I have low energy (related to the above or separate)
- or almost anything else
|Not pictured: heavy labored wheezing/breathing|
Tuesday, May 24, 2016
This is my first post, so I will introduce myself. Thank you so much to KC and all of you veteran MiMs for this opportunity. I've been a reader for years, since residency, and found MiM so helpful when thinking about my future career. I'm a family physician in a mid-sized Canadian city. I've been in practice for seven years, which still feels very "early career" to me. I work full time - 35-40 hours/week counting clinical plus admin time. I call it full time but always somewhat sheepishly around other physicians! I have a three year old son and one year old daughter, and a work-from-home husband. I'm involved in refugee health work and am community faculty for our medical school. For me, some amount of "big picture" work has always helped me maintain enthusiasm and appreciation for the clinical work. I look forward to reading your stories, and sharing mine!
A few months ago, I was getting bogged down by excessive self doubt and perfectionism at work. The main way it manifested was in ruminating and worrying over decisions once I'd made them, but there was also over-thinking clinical choices, triple- (quadruple?) checking, and asking for advice when I really didn't need to. I try to take a pretty balanced approach to life, accepting the "good enough" principle and refraining from placing unrealistic expectations on myself. But "good enough" never seems to fit with medicine. I can accept vulnerability and imperfection in other areas in my life, but medicine? There's no room for it. I think our patients and society echo this as well; after all, it's comforting to think that physicians are the ultimate authorities in health and it's disconcerting that we are inherently flawed humans. We are socialized and trained in this mindset as well. Of course, we must be conscientious physicians. I'm not talking about being sloppy or less than thorough. But, recognizing that we are human, even when we are conscientious, careful and keep our knowledge and skills up-to-date, we'll falter.
During this time, I came across an excellent article on the topic of Overcare, written by the late Dr. Lee Lipsenthal and adapted from his book "Finding Balance in a Medical Life". Overcare was a new concept for me, and a useful one. Dr. Lipsenthal talks about overcare as a chronic emotional state that physicians can get into, and it involves agonizing over decisions we have made, and at the core of it, wondering "Am I a good enough doctor?" There are several factors at play. Our personalities tend to be perfectionistic, and we do carry a lot of responsibility. He talks about our addiction to being needed and how the intermittent positive reinforcement we get from patients can lead to us doing more and more, hoping and waiting for the "reward" of a satisfied patient. The perfectionism expectation in medicine is often instilled into us during training, and also informs how we judge others; we in turn also fear being judged harshly by our colleagues. This is especially true for me as a family physician. Any time one of my patients is seen in the Emergency Room or by a specialist I've referred them to, my care will be under scrutiny. I find that Impostor Syndrome often tags along with this overcare and perfectionism. If your expectation is that a "perfect physician" is the default, yet you witness your inherently imperfect self, impostor syndrome can creep in.
How can we counter overcare? Personally, it helps to remind myself that I am competent and doing the best that I can. And that I am human. I try to consciously make a decision, and make peace with the inherent uncertainty. I ask myself a useful question from cognitive-behavioural therapy for anxiety: am I problem-solving, or worrying? If the latter, move on. Do I think about patients after hours or change my mind about decisions? Of course, but I have a better sense now of what qualifies as being conscientious, and what is actually overcare.
Do you struggle with overcare? Are there any strategies you've found helpful?
Friday, January 1, 2016
Thursday, December 10, 2015
Friday, January 2, 2015
I just completed a 6 day holiday shift working what our residency program has deemed WARS (working at reduced staff). You work up to 6 shifts in a row and get either the week of Christmas or New Years off in addition to your 3 weeks of vacation. I gladly got one of my favorite inpatient services with the Division Chief that I most admire. However, after morning 3 of waking at 5am to arrive for sign out by 6am, I was tired, my feet hurt, and I was forgetting what sunlight felt like on my face.
Three years into residency, our family knows to plan for rough stints like this and to have extremely low expectations for how our house will look (though I am so ashamed about how cluttered our bedroom is and bemoan its state daily with apologies). My in laws came into town on day 1 and are staying for 4 days after.
My day of work ends with O calling and making some silly joke about my “Princess Service”. The staff members here call being picked up or dropped off from work “Princess Service” and O has added it to his lexicon. I don’t think he quite knows that it is one of the highlights of my day.
I have arrived home daily to Zo playing on the floor with his grandmother with blocks or making Playdoh cookies, a glass of wine waiting for me, and delicious vegetarian fare cooked by my in laws or my husband. By around 8pm I can be found in my pajamas nodding off on the couch while someone else does the dishes. I somehow make it through story time and have been in bed by 9:30 or so every night. O and I watch our new favorite on-line miniseries, this month it’s American Horror Story, and I pass out.
WARS has ended and I begin the next part of the end of this year, applying for my medical license in the 2 states that we would love to end up in, and preparing for my next interviews.
Here’s to all of the Princess-Mommy-Doctors out there. I hope during this holiday season you feel the joy I feel each time I hear “Your Princess Service has arrived.”
Thursday, November 20, 2014
Unused vacation days. Not us!!! We use them all up. Zo travelled with us for the first close to 2 years of his life. However, once he was weaned and could no longer be lulled into a breast milk-induced-coma, we began planning trips without him. Many thanks to my parents and in-laws. And thanks to my cousin for letting us use her timeshare to enjoy fabulous, affordable vacations.
Here is my chronicle of our delectable and delightful second Vacation Sans Bebe, New Orleans style. I will focus on the food because New Orleans has to have some of the most amazing, creamy, luscious, sinful, gluttonous food around and there is just too much to write about (the wonderful people, the outstanding architecture, the cultures, the alcohol).
Best brunch ever - I can’t tell you how much O and I love an excellent brunch. My Sorority Sister B and her husband R who work for a major oil company in Louisiana met us at Slim Goodies. The french toast below was the best I have ever had; crispy French bread crust, fluffy middle, dusted with powdered sugar, and drizzled with syrup! Paired with mimosas that you prepare yourself (orange juice from Slim Goodies and prosecco from a neighboring restaurant they have an arrangement with), it was amazing!
|(scrambled eggs, french toast, and large mimosa from Slim Goodies)|
Best lunch - oooooh oooooh oooooooh. Gumbo and crawfish at Cafe Reconcile. Amazing nonprofit organization that trains local teenagers and young adults for careers in the restaurant business. Wonderful staff. Delicious food. The crawfish sauce was so complex yet not overwhelming. The grits were soft but had some substance to them and were perfectly seasoned.
And the tie for best dinner - Bacchanal Wines and Houstons.
Bacchanal had to be one of the most fun experiences. We took a taxi into the Ninth Ward past factories and train tracks and end up in a cute neighborhood. You see a line on the corner entering a house with a big fenced in yard. You enter what may have previously been a living room, but has been converted into a wine and cheese shop. You purchase a bottle of wine, get a cheese plate (we unfortunately didn’t order one and the line was too long by the time we wanted some cheese), and go find a table. There are at least 100 people sitting and standing around. There is a live band playing in the courtyard. It is magical.
My husband and I failed on our first attempts to find a table, finally separating while he waited in the 20 person long food line and me making googly-eyes at folks with finished wine glasses taking up space. Finally, a very nice retired couple took pity on my and told me to pull up an empty chair. We sat at a candlelit table talking and drinking until they left.
And then the CHICKEN arrived.
Notice how I put that sentence on its own line. I had confit chicken that literally melted in my mouth with bok choy and a yummy carb I can’t remember. I did a little research on what confit means; it is to cook meat in oil at a low temperature (it’s not fried, it like melts away, oh goodness, soo yummy). That chicken was soo freaking good I am hungry just writing about it; the skin was crispy and perfectly salted and the chicken literally fell off of the bone and just melted in my mouth. O had a grilled tilapia that was equally divine. For dessert we had dark chocolate drizzled with olive oil and sea salt with even more wine.
Our recommendations for excellent food in NOLA:
Slim Goodies, Cafe Reconcile (weekday breakfast and lunch only, nonprofit that does job development and career training for teenagers and young adults in the Garden District), Cafe DuMonde, Houstons, and Bacchanal Wines (get there early and just go ahead and get the darn cheese plate!).
Of note, I have no conflicts or disclosures, we went everywhere based on recommendations from friends and paid for everything ourselves. All pictures were taken by me and O unless otherwise mentioned and cited.
An Assessment of Paid Time Off in the U.S. Implications for employees, companies, and the economy. Accessed Oct 16 2014.
Center for Economic Policy Research. No-vacation nation revisited. 2014. Accessed Oct 16 2014.
Work-life balance. Accessed Oct 16 2014.
Thursday, July 3, 2014
Over the years, I have felt like I have come to personally know many of our regular contributors and even a few of our regular commenters. I hope that someday there will be a big Mothers in Medicine Conference or maybe just a gathering at a bigger annual professional conference. When I read Cutter’s posts I said, hmmmm, I think we work in the same hospital! Flash forward to several months later (and many thanks to KC) and Cutter and I had our first MiM meet up at a local museum. Her daughter is super duper cute and Zo was smitten at first glance. He quickly followed her to the slide and then he began chasing her around the exhibits.
Play dates are always good times to reflect on the joys and vent about the struggles of motherhood, but when the other parent is a MiM, it is especially cathartic. Cutter is amazing. Chief Resident, Super Mom/Wife, super hair braider (from Youtube videos nonetheless). We spent hours talking and it was so nice to have someone who understands the doctoring and the mothering because it makes for a really unique life.
I have had a few other play dates with women Doctors including several with a beloved Attending who has young children. These times are equally amazing. She has the wisdom of being several years out of residency and fellowship. The first time I asked her and her kids out for a play date, she gladly accepted. We met up at another local museum and the next time at a park. Each time there was a lot of her being a cheerleader, saying “You’ll get through this.”
Play dates with stay-at-home mothers usually involve looks of pity and many exclamations of “I can’t believe you work that much.” Play dates with 9 to 5 working non-physician mothers usually involve less pity, but still many “I can’t believe you work that much” looks. There was none of that at our MiM playdate and I liked it!
Here’s to many future play dates, MiM style!
Monday, February 24, 2014
The students were engaging. The high school students asked silly yet endearing questions. One absentmindedly asked another resident and myself our specialties three different times because he kept forgetting what we said. He was sweet, but goodness, I hope his focus and attention span increase before starting college.
Several of the medical students asked very educated questions, ones that showed they knew where they were going. One particularly prepared medical student, dressed smartly in an off white blouse, flattering pencil skirt, and pearl necklace asked a series of questions that we answered. She thanked us and left. Then she came back later to chat some more. She began her new string of questions with “I don’t mean to sound, ummmm, superficial or anything, but even though I’m interested in all types of medicine, I am worried that if I go into Family Medicine instead of Internal Medicine that I won’t be able to pay off my loans.” I shared a quick, knowing smile with the Family Medicine resident sitting next to me and we began to talk to her about following ones passion. We also reminded her several times, indirectly and directly that regardless of what type of medicine you practice, each of us will be in the top 1% of US income-makers. The top 1%.
Yes I know $120,000 instead of $200,000 (in a surgical subspecialty) seems like a huge deal, but honestly, every single Family Medicine Attending the other resident knew and every single Pediatric Attending I know is living very well. Yes, they may have a ton of debt they are working to pay back, but every single one has a family that is well taken care of. Everyone I know has a nice house (mostly owned and not rented), a decent if not really really nice car. And none appears outwardly to be struggling to afford their basic needs. I apologize if these are material things, but that’s what she was asking about and we answered because it’s a very real concern.
And that’s the Attendings, not the Residents. Every Resident I know, including myself, lives in a nice apartment. Many Residents in my program own houses, not rinkey-dink jacked up houses, but really nice grown-up houses with nice yards. We can afford to go on vacations and we buy what we want at the grocery store including at Whole Foods (which my father-in-law refers to as Whole Check). My husband and I budget our limited money well and hope to buy a house in the first several years out of residency. And we are already well on our way to having my student loans paid off within 10 years using the income based repayment straight out of medical school. Don’t get me wrong, if we didn’t have my husband’s graduate school scholarships, our family of 3 with a single working adult (me), we would be very close to being eligible for public benefits (Section 8 housing, food stamps, WIC, you name it); some of our neighbors are on assistance now.
So, seriously, I know many of us including myself are in debt. And I know we need to do things to overhaul “the system” so that serving patients and saving lives is compensated in a common sense and equitable way. One that values innovative, smart approaches such as preventative care and comprehensive services. One that doesn’t cause very capable and compassionate students who are interested in our field to go running the other way as they eye the ever-mounting price tag. But even at the lowest-paying end of the spectrum, we all will make more money than the majority of our country. And if we help each other to become more business-savvy, we should never have to struggle to live well.
The medical student left smiling. I left more inspired. Hopefully we encouraged her to pursue what will ultimately make her the happiest so that she can bring her “best self” to work every day; she owes it to herself and to her patients. Yes, it’s a daunting task and the realities of practicing medicine in our country are scaring the crap out of many of us and our future colleagues, but again, we are still positioned in one of the best fields that exists. I am committed to reminding myself, my colleagues, and the “fresh meat” that this is the reality we find ourselves in. A bit daunting, but not too scary.
Thursday, December 6, 2012
Since then, I've maintained a basically low-carb diet (with the occasional celebration/ feast), and a basic exercise routine (with the occasional lazy week), and I've continued to slowly burn fat and build muscle.
Now, I've gone from 163 pounds to 121 pounds. At 5 foot 2, this puts me at BMI 23!
I am not yet at my goal, which is for 50 pounds lost, back to my pre-pregnancy weight of 113 pounds. I'm trying not to feel like a failure because I'm not there yet. (How Type-A is that?) But I am proud of what I have accomplished so far, and I offer myself as an example to others, including my patients.
Here are some take-away points and tips:
GET SUPPORT: Last January, I stated my intentions to my family, and they were enthusiastic to help me. I work part-time, 5 clinical sessions of primary care, which really is a 40 hour week at least. My husband works as a writer and broadcaster so works from home alot but also travels alot. My mom helps with childcare, and we have a babysitter. So, in short, though I work alot and intensely, and hubby works, I have alot of support to help me with logistics/ kid care. But more importantly, my family has been all-in behind my efforts. My husband shares the grocery shopping and cooking; he buys healthy groceries and cooks good food. He eats and enjoys the healthy food I cook. Our family gatherings tend not to be laden with "bad" stuff. So that helps. Everyone is happy to let me have some "me" time to exercise. This is key!
SLOW AND STEADY: I'd go many days of staying consistent on my diet and then have a slip-up day. That's OK as long as you get back on the horse as soon as you have your senses back. Like, when hubby was hospitalized with a diverticular abscess; when both kids and us got sick with some nasty fluey virus; and when we went out of the country on vacation, and several other times, I did not pay much attention to my diet. But as soon as I could get back into any semblance of a routine, I started eating healthy again. So, over time, I had many more low-carb calorie-restricted days then I did "bad" days.
PICK A DIET YOU CAN LIVE WITH: I'm doing a South-Beachy-Style diet where I eat 3 meals and 3 snacks a day, so I eat SIX times a day. I aim for 1200-1600 Kcal daily. I like my eat-six-times-a-day-low-processed-carb diet because I like eating every two or three hours, and I like fruits, veggies and lean proteins. I don't miss cake, bread, pasta, cereal, cookies etc. because I feel pretty good on berries, yogurt, apples, cheese, big salads, grilled veggies, seafood and chicken, and nuts. It also makes the occasional really good hot bread slathered with butter that much more special.
WRITE IT DOWN: I got a 79 cent spiral bound notebook and write down everything I eat over the day, aiming at 3 small meals and 3 snacks, eating 6 times/ day, and calculated out to about 1200-1600 Kcal total per day. At first this involved looking up calories a it, but after awhile, I had all the calorie counts memorized. Clementine or small apple, 50 Kcal. Yogurt, 150 Kcal. 2 small hardboiled eggs, 160 Kcal. et cetera. I didn't stick to 1200-1600 Kcal all the time, and I didn't write it down all the time, but doing this most days really helped me stick to it. It also felt SO good to flip back over the pages after a few months, with the occasional weigh-ins recorded, and see the pounds just going down, down, down.
EVERYTHING IN MODERATION: It's OK to have the occasional slice of hot buttered good bread. A diet is not "ruined" by a big treat, or even a week of treats. You're in it for the long haul.
GET IN ANY EXERCISE YOU CAN WHEN YOU CAN: You don't have to go to the gym to get exercise. In the beginning, there were many nights when all I did was some core exercises on the floor by the side of my bed. I've worked up to at least two days a week of either running, or a gym workout, like Stairmaster and light weights. I try to walk with the kids, or even take one or the other out with the baby jogger. I try to use a basket instead of a cart at the grocery store, and switch arms like I'm lifting weights. I try to get out and rake, or shovel, or just fill the birdfeeders. Whatever, whenever.
GIVE IT TIME: Quick results tend not to be lasting results. The goal is fitness and health for life!
Saturday, March 31, 2012
But today, this is a simple update on my own journey back to my own body. Two babies in less than two years (plus a bit of an addiction to really dark chocolate) put alot of extra weight on me. I fell off my own fitness wagon. My runner's body gave way to... Obesity.
At 4 weeks postpartum with Babygirl, I realized I was at BMI 30. I kind of freaked out. I started a modified South Beach Diet. I lost alot of weight really fast, I think because I was breastfeeding. Then, when Babygirl was 6 weeks old, my husband was hospitalized with diverticulitis for a week. My plan went by the wayside. There were many days of like, Cheerios for dinner. My breast milk dried up. We went into Survival Mode.
Now, he's fine, I'm back at work, and life goes on, I picked up the free weights again. I started running: 1, 2 miles. Today, I ran 3 1/2 miles. Whoo-hoo!!!
And, even with my schedule and the kids, I have managed to lose 20 pounds in 2 months. I am now at BMI 27 (I'm pretty short.) It's hard, damn hard, but I can't give in to excuses or laziness. (Well, maybe sometimes...)
But if I expect to see change, I have to do the work. That means making myself get up at 5:30 a.m. on a Saturday to go for a run BEFORE the kids wake up. And taking the time to do abs work before going to bed. And planning meals: buying the healthy food, packing it up for myself the night before an early office day. It means resisting desserts. Most of the time.
So, while I am not perfect at all of this, I am persisting. My goal is to lose 20 more pounds, to get back to my pre-pregnancy weight. I find myself empathizing with my patients. Commiserating. Coaching.
So much of my work with patients is in trying, desperately trying, to help people help themselves to get fit. If I can use myself as an example, I will. I know how it is, I'm living it.
I can share with patients about how it's tempting to declare "Diet over!" after giving in to a little indulgence. But this is a HUGE pitfall. I'll talk with patients about how, for me recently, one chocolate-dipped strawberry led to another... and could have led to more and more, but I physically got up from the table and got it back together, and now am seeing results. I'll talk about the merits of hot herbal tea after dinner in lieu of dessert; the handiness of packaged mozzarella cheese stick snacks; the necessity of Truvia.
I can share with patients how hard it is to get in exercise when you work and have kids. How I need to make it a priority, and stay on top of it. Can't go to the gym? Me neither. I haven't re-joined my gym, because I'm not sure I would ever get there. Try running. Jumping rope is excellent exercise. I also discovered hundreds of free fitness videos On Demand. I do abs work at night before bed. I run after my toddler and lift him like weights. And there are stretches of days when I don't move much, and that's OK. It's tempting to declare, Game Over. But that's a common error. Just Keep Going, I tell people.
And I will keep going. Persisting, Resisting. Eyes on the prize.
Next week: 4 miles.
Wednesday, January 25, 2012
Who here hasn’t needed to lose a few pounds? Well, I am a bit beyond needing to lose a “few”…
Babygirl is officially a month old, and I am officially a month postpartum. For two pregnancies now, my usually healthy diet slid into more of a “everything in moderation, and I mean EVERYTHING” diet. I don’t binge, and I don’t even like junk food or fast food… BUT I love me some dense whole wheat toast with tons of butter for breakfast, and high-quality dark chocolate for snacking, and a cup of premium ice cream after dinner, and… you get the picture. Two years of this kind of snacking, and I was bound to gain some weight.
Especially since I used to be very active. Like, distance-running, cross-country-skiing active. BUT for two years, that whole part of me has been on hold. During my pregnancies, I maybe did some prenatal yoga, and took some walks here and there, but basically, I became a slug. I did hire a trainer after Babyboy, and I did lose 15 pounds then… But as soon as I was pregnant with Babygirl, I slid right back into snacky-snacks and slugginess.
So, this week, I finally stepped on the scale to see what the damage was. Ouch!
I am a full 40 pounds above my normal healthy weight, with a BMI of 30. That means, I am obese.
And so, horrified, I decided to take action.
I have NEVER in my life been so fat. Sure, I gained a lot of weight during med school, and then residency, due to lack of sleep/ time/ stress/ poor diet. But never THIS much. Both of those times, I shed major pounds by eating low-carb and exercising.
Now, I am a huge fan of diet and lifestyle changes towards better health. I counsel all my patients over and over again on the merits of a diet high in fruits and veggies and lean protein, combined with regular vigorous exercise. I ask my obese patients to come back every 3 months for weigh-ins and blood pressure checks, and I spend a lot of time with them, describing what is a healthy diet and what is real exercise.
In our practice, we have a diabetes nurse who helps counsel patients, and I send her my pre-diabetic patients, as well. If I were my patient, I would probably send me to her. Diabetes runs in my family, and I did have a sort of high-normal glucose tolerance test in this second pregnancy.
And so, because I recognize that without some major changes, I may be headed towards a bad health outcome; and because I need to follow my own advice; and because I really don’t want to have to buy a whole new wardrobe (!) I got started right away.
As soon as hubby got home that day, I asked him to watch the kids so I could go running. Luckily, he is also really into fitness and eating healthy, and he was totally supportive. Shocked, but supportive.
I found and pulled on a (very tight) jog bra OVER my nursing bra, laced up some stiff sneakers, and headed out the door. There was about 4 inches of slush on the ground, and it was drizzling. YES! I love this. I imagined that drivers saw me as the intrepid warrior, determined to run in spite of the elements. Really, they probably saw a mooselike creature in ill-matching baggy pants and her husband’s rain jacket toodling up the hill like a manatee on land. BUT, I pulled down my baseball cap and ran harder.
I had not run in almost a year. I made it maybe a few blocks, then walked. Then ran, then walked. I did this for about a mile and half, total-- a laughable distance for me who has run three marathons. BUT, it is a start, and it’s better than nothing!
Hubby also dutifully went to the grocery and bought me my list of South-Beach-Diet-Style foods. (I don’t get any money from them, BTW, the diet just works for me is all). He came home with my veggie juice, Canadian bacon, eggs, cheddar, ricotta, almond butter, and tons and tons of veggies.
That was three days ago. Since then, I have been sticking to the diet, albeit with probably bigger portions and more snacking than is intended (I am breastfeeding, after all).
The late nights up breastfeeding are very tough. I HAVE to eat something when I am up feeding Babygirl at 3 am. Just, now, it’s less likely to be a huge bowl of Cheerios, and more likely to be a cup of plain ricotta sweetened with Truvia.
And that’s OK. The diet, plus exercise- with the goal of getting back to my previous level of active—WILL work.
The diet is meant to stabilize blood sugar swings and reduce craving for carbs. It’s amazing to me how I feel when I drop the carbs and go to this type of diet. At first, for a few days even, there’s a slight woozy feeling, and some intense carbs cravings. After a few days, the wooziness is gone, and there’s almost a buzz of energy as my body starts to burn fat. It feels really good, especially after exercising.
And so starts my effort to get healthy—and slim down.
Now that I’ve blogged about it, I really have to stick to it!
Friday, August 29, 2008
In college, it was more of the same; harder classes in a biology major, more studying, way more partying, leadership positions in extracurricular activities and my sorority (again, hush), the (required) volunteer work and physician shadowing in preparation for applying to medical school, and a long distance relationship. I bemoaned the woe of having 8 am classes, keeping me only able to go out 4 times a week instead of 6. When I found I had gained the dreaded "freshman fifteen," I dutifully trudged to the gym every afternoon after my 3 pm class, and found the will power to decline dessert with my meals. I lived in the sorority house where meals were cooked three times a day during the week, there was a housekeeper, and my idea of shopping was sneaking in a box (yes, I said box) of contraband wine to hide under the bed and drink with my roommate on the balcony. "A body in motion tends to stay in motion!" I would chirp, and be on my merry little way, padding my resume for medical school applications.
In medical school, things got a lot harder. The classes weren't easy any more. I actually had to go and study, a lot more than I ever had. I was living on my own for the first time in a really big city. I doing all of the chores, laundry, cooking for myself (lots of ramens, rice, and pasta), shopping for myself, and really starting to live like a responsible adult. All of the sudden, all of the extra stuff just wasn't so appealing. I dodged requests to join the AMA, and AMSA, and more volunteer work, and med school committees. I was too busy! I joined the note service for the benefit of not having to take notes during class, but dreaded my transcriptions. It was all I could do to keep my clothes clean, my brain plugged in, and my fledgling relationship thriving. I still made an effort to get to the gym, but the nearest one was a 30-45 minute drive in traffic both ways. This coupled with the pasta, after exam parties, and late night study snacking packed on about 20 pounds. In the last year of medical school, I planned a wedding, got married, interviewed for residency, matched, moved across the country, and bought a house. All of the sudden, I didn't feel like I could do it all.
Then came residency, the mother ship of having no healthy life at all. No sleep, terrible eating habits, 120 hour work weeks, and the *pressure* of being a neophyte physician. Hobbies outside of surviving residency? Surely you jest! It was all I could do to stay awake long enough to speak briefly with my new husband, eat a piece of pizza (cooking just didn't happen any more), and maybe occasionally bathe. Fortunately for me, the 80 hour work week was passed 2 years into residency. I celebrated my new found "time off" by getting pregnant...immediately. Then it was triple the laundry, triple the chores, and triple the responsibility. I began to lose who I was, other than doctor, mother, and wife. I stopped taking care of myself, in order to get everything else done. I was constantly in motion, and constantly wishing to rest. During this time an additional 50 pounds of weight crept on gradually, then not so gradually.
So here I am now, still working ridiculous hours. Still eating like I did when I was in medical school and residency. Still not quite keeping up with the chores. The focus of my life has completely shifted from myself to everyone else *but* me! I stop to look around, and I realize that with as much motion as I have experienced in my life, I have been standing still for years. During a recent interview, someone asked me what I did for "fun" when I wasn't working, and I couldn't come up with a good answer! Um, reading? Blogging? Trying not to pass out whilst my children crawl all over me in the evenings after work? I was shocked to realize that I am not really living, I am merely surviving. In all of my constant motion, that once started out so self-centered, I have lost contact with what exactly it is that I would *want* to do, should I have the time.
I want to cultivate in my children a love of something that makes them uniquely them, be it sports or music or dance or chess or reading. I realize that it is my responsibility to be an example for them, and I don't want my legacy to be only a strong work ethic and keeping very slightly ahead of chaos. I want my children to live in motion, like I got to do, once upon a time. I now realize that to help them live in motion, I've got to find a way to get some rest.
How do you take care of you, and still take care of your families and patients? I welcome your advice.
Saturday, June 14, 2008
One of the standout presentations, and there were many, was Pauline Chen, MD. Dr. Chen's first book, Final Exam: A Surgeon's Reflections on Mortality, is a New York Times Bestseller. She shared with us her Top 10 Pearls about writing in David Letterman style.
- 10. Study for your boards - attend writing programs and conferences. Dr. Chen went to the UCLA writing program
- 9. Practice your knots - write. write, write
- 8. Go through rotations with an open mind - be prepared to be surprised about where this writing journey takes you
- 7. See a donut/Eat a donut - Eat for free - Read as much and as widely as possible especially in your own genre
- 6. Better is the enemy of good (Voltaire) - Make the jump! Sometimes you have to stop writing and try to publish
- 5. Don't apply to just one program - Find someone with similar interests and meet them (personal thank yous to Fat Doctor and KC for getting me started)
- 4. Make a list of 10 most important things in life - sometimes it takes reestablishing priorities to write/blog - For Dr. Chen: Sleep when you can, eat when you can, write when you can and don't mess with the pancreas applies
- 3. Remember your residency - You survived/are surviving residency - you can write a book/blog
- 2. A good senior resident is a good team player - publishing requires same set of skills: be polite (give credit where credit is due), be prepared, be punctual
- 1. Trust no one - trust only your voice and find it by reading and lots of writing.
And in case you think I've lost my mind and forgotten that this blog is supposed to be about mothers in medicine, writing makes me a better parent and I hope a better physician. Maybe it's the political climate, maybe it's too much JennyMcCarthy's rant on vaccines and autism, but medicine seems to be taking a beating. It's important for those of us in the medical trenches to have an outlet to be heard. Honor and integrity still exist in medicine, and we are uniquely positioned to tell that part of the story by wearing our mom and doc hats simultaneously. Write with abandon!