Wednesday, June 26, 2013

Promoting Healthy Change: Stress Management

Just like how everyone knows that exercise and healthy diet is good… we all know that stress is bad. It is intuitive... but we also got presented with conclusive scientific proof! So I’ll break it down and summarize.

Conditions caused or exacerbated by stress include:
  • High blood pressure
  • Cardiac arrhythmias
  • Chronic Pain
  • Insomnia
  • Anxiety
  • Hostility
  • Depression
  • PMS
  • Infertility
  • Side effects of Cancer treatments
  • Side effects of AIDS therapy
  • Preparation for surgery and xray procedures
So if we can reduce stress, not only will it improve our health but there is even evidence of it affecting the aging of our cells! Apparently, our telomeres become more stable and degrade less.

Right... so how to accomplish this? One may have to take inventory of all the things on one's plate and rearrange to intentionally decrease the amount of stress that one is exposed to. Of course this is easier said than done... but if you truly believe it is a priority, you can make it happen. There are many websites out there offering self help guides to stress management. There are also professional therapists who are trained in helping one cope with stress... they use techniques such as biofeedback, cognitive-behavioral therapy, or even hypnosis. Ask your physician if you need help in this area.

The conference talked about a "relaxation response" that you can induce. You can read more about it here.

Two steps necessary to evoke the Relaxation Response:
  1. repetition of a word, sound, prayer, thought, phrase, or muscular activity
  2. passive return to the repetition when other thoughts intrude
Physiologically this is what happens to your body when you evoke this response:
  • decrease oxygen cosumption
  • decrease respiratory rate
  • decrease heart rate
  • increase slow brain waves
  • decrease blood pressure

Many Christians probably induce this response without fully realizing it. I can recall back to times growing up... whether it was before piano competitions or exams when I'd get nervous and stressed. Praying before hand would always help me calm down and perform better. Now as a mom, I need to evoke this response more intentionally especially when feeling at wits end with my preschoolers and toddler!

I think it is neat to know that God programmed this biological response in our bodies when we turn our minds to Him and lift up our needs. They didn't address this part at the conference... but I think it is comforting to know that we have a powerful and loving Father who knows our needs and will respond. This is in addition to the physiologic calming effect that "praying" or "meditating" evokes.
Turn your eyes upon Jesus,
Look full in His wonderful face,
And the things of earth will grow strangely dim,
In the light of His glory and grace.

Promoting Healthy Change: Nutrition

So here is another topic that is extensive to cover, but I’ll try to summarize the key take home points I got.  Just like the lack of counseling on exercise, we physicians do not adequately counsel our patients on nutrition.  Some sobering facts:
·      58% of adult obese patients do not report receiving any prior advice from physician about weight loss
·      patients who were told to lose weight were 3 times more likely to attempt weight loss
·      7 out of 10 patients would like to discuss diet
·      2/3 of patients would like to discuss weight loss
·      > 90% say they would make a change if advised by their primary care physician
Tops reasons why physicians neglect to address this topic:
·      time constraint
·      fear of offending
·      lack of medical school training on nutrition counseling
Well so let’s get talking!  I may have to come up with some brochures or fact sheets  or something because a 15min office visit is going to be tough to get into all the nitty gritty.  In a nutshell here are some simple tips…
Tips for Eating Better
·      Eat fruit before snacking
·      Use small plates
·      Never eat form a package (transfer food)
·      Eliminate the cookie jar and replace with fruit bowl
·      Control your environment
I also found these food rules amusing.  It is from Michael Pollan’s, FoodRules: An Eater’s Manual:
·      Eat food
·      It’s not food if it arrived through the window of your car
·      Don’t get your fuel from the same place your car does
·      Shop the peripheries of the supermarket
·      If it came from a plant, eat it; if it was made in a plant, don’t
·      Cook
To expound on that last point:
·      The average American spends 27 min/day on food preparation and another 4 minues cleaning up (less than half the time spent in 1960’s)
·      What are we doing with the extra time?  Watching cooking shows!
To see what is the current recommendation for food go to
I also like Harvard Public Health’s slight variation at Healthy Eating Plate

Tuesday, June 25, 2013

Promoting Healthy Change: Physical Activity

The bottom line is we all need to get moving!  There are so many benefits to exercise.  Everyone probably already knows this but the evidence is so compelling that I’m recommitted to stress this more with my patients.  In fact, I’ve grown complacent and lazy myself and plan to start becoming more intentional about exercise myself.
Now when I use the word “exercise” everyone is probably imagining going to the gym to use the machines or treadmill or join an organized sport.  Those are all great but physical activity does not necessarily need to be time consuming or expensive.  Simple things we can do during the day can increase the amount of physical activity or “steps” we take in a day.  For example:
·      Park farther out to increase walking distance to a building
·      Take the stairs instead of the elevator
·      Take a 10 min break during lunch and just walk
·      Try walking meetings instead of just sitting and talking meetings with friends
·      Get up and walk to the tv instead of flipping with the remote
·      Etc!
Goal is 10,000 steps a day.  Get a pedometer and start keeping track.  In fact, the fitbit is gaining popularity.  The nice thing about it is you can do this with a bunch of friends and keep one another accountable.
So what are the specific benefits?
Physical activity will affect:
·      Strength and power
·      Cardiorespiratory fitness
·      Balance
·      Flexibility
·      Agility
Here are a few medical conditions exercise will help:
·      Decreases heart attacks
·      Decreases strokes
·      Decreases high blood pressure
·      Decreases diabetes
·      Decreases osteoporosis
·      Helps with sexual functioning
·      Helps with depression and anxiety
·      Decreases total morbidity and mortality
Now here is a sobering fact for us, physicians:
·      1/3 of patients with high blood pressure received counseling to engage in physical activity
·      71% of those patients who were counseled to exercise actually followed the recommendation and lowered their blood pressure
So what is the amount of physical activity we are to aim for?
·      150 minutes of moderate intensity physical activity per week
·      75 minutes of vigorous physical activity (in bouts of at least 10 min)
For more extensive health benefits aim for:
·      300 minutes of moderate intensity physical activity
·      150 minutes of vigorous physical activity
·      resistance (muscle strengthening) at least twice per week
Here is how you can differentiate how intensely you are exercising:
·      Light = can talk and sing while exercising
·      Moderate = can talk but cannot sing while exercising
·      Vigorous = cannot sing and cannot talk for prolonged time
Couple more important facts:
·      Cannot really lose weight by exercise alone but it is important to maintain weight loss achieved
·      Need to fuel appropriately before and after exercise
·      Hydrate!  Hydrate!  Hydrate!

Monday, June 24, 2013

Promoting Healthy Change

I attended a conference in Boston this weekend called Lifestyle Medicine: Tools for Promoting Healthy Change.  Here is a short summary of some of the stats shared with us that I want to share with you.
  • our country now spends $2.92 trillion on health care costs
  • 78% of healthcare expenditures are for management of chronic disease
  • 2/3 of all diseases are lifestyle related
Take home points which we all know intuitively... but have lots of stats and research to back it up include:
  • modifying lifestyle choices can prevent/alleviate disease, death, and health care cost
  • it makes a difference for physicians to counsel on lifestyle changes
Therefore, I plan to make be more intentional in counseling my patients on these lifestyle changes.  The challenge will be to do so in the time constraints of the clinic model we are currently under.  It is stressful enough trying to stay on time and minimize patient wait time while delivering empathetic and thorough medical care.  I can only imagine the volume of patients we have to see per work day increasing as more folks get access to health care insurance with "ObamaCare".  Nevertheless... try we shall.

So the three key areas to modify one's lifestyle for positive health outcomes are:
  • Physical Activity
  • Nutrtion
  • Stress Management
I'll expound on these in the next few posts.

Monday, June 17, 2013

Happy Fathers Day

Happy Father's Day to all you dads out there!  

I want to dedicate this post to my husband and to my dad.  I was commenting the other day about how my dad is so much more mellow now than when I remember him to be growing up.  My husband made a comment that made me pause and think that maybe my dad was so stressed during those early child rearing years because those are stressful times.  And perhaps... I wasn't an easy kid.

Special kudos especially during this physically and emotionally challenging time when our kids are all so little (five and under!)... AND we're going to add another.  Yep.  Looks like it will be a boy so our little man will have a brother to tumble with.   Now we're even... and now we're done!  So according to this new survey... we're about to decrease the stress level in our life!

So... here's a little father's day tribute.  Thanks, hubby for partnering with me during all the momentous moments.  I especially appreciate it when you...
  • change and wash throw up on bedsheets in the middle of the night
  • change and wash throw up on bedsheets in the middle of the night after already doing so once
  • change and wash throw up on bedsheets in the middle of the night after already doing so twice (this truly happened with our first daughter... hard to forget that exhausting night.  So special kudos to hubby because he usually gets the job of cleaning up the gunk while I bathe and soothe my little one)
  • change poopey diapers (hard for me during the nausea period of 1st trimester... though the nausea improves 2nd trimester, certain strong smells can trigger my gag reflex... so again... thanks hubby)
  • take the glorious job of wiping poopey bottoms  (same goes here... gag reflex...)
  • cut up all sorts of fruits so there's plenty for all to eat (I'm dangerous with a knife so daddy does most of the fruit cutting whether it is mangoes or watermelon or honeydew... you name it, he cuts it!)
  • put up the pack n play if we ever have to bring it somewhere (it always takes me longer to figure out how to put all the sides up before pushing that bottom down...)
  • pull out and swap carseats if we need to (those darn straps that hook the seat to the car are a pain to figure out and remove... hubby just does it so much better and faster)
  • show the kid cool reptiles and bugs to help them learn to not fear them (was a turtle one day, a frog the next... just don't bring home a snake...I could never do this...)
  • bathe the kids, brush their teeth and read to them at night before bed (especially during the late nights I work or when I just need a break...)
  • act like "robot daddy" to bring a smile to their faces..

Monday, June 3, 2013

Comparing Royal Carribean vs Disney for Small Kids

Well, it may be hard to compare because we went on one of Disney's smaller ships... but at the same time we also went on Royal Carribean's smaller older vessels.  So here are some comparings between the Disney Magic and Grandeur of the Seas:  

Kid Program
So here you have Disney themed characters roaming the ship vs no characters on the Grandeur.  I believe some of Royal's larger ships will have Dreamwork characters but we weren't on that boat and my kids aren't as familiar with those characters (like Shrek).  So from my daughters point of view... princesses win.  

The actual kid program on both ships are very good in my opinion.  I was pleasantly surprised at how organized Royal Carribean's kid program was.  They had plenty of activities and crafts and my kids seemed to have lots of fun every time they went.  The actual play area where the activities were held was much smaller on Royal.

Going off season was a plus for both ships since the programs were less crowded.

Our family of five had to squeeze into one small room with a balcony for both ships.  Royal's room was slightly larger as there was slightly more walking room once all the beds were pulled out.  However, since my girls were not used to sleeping in the same bed and kept kicking each other and keeping each other up, we ended up having to split them up and each slept with a different parent instead.  Whereas on Disney Magic, they had two separate pull out type beds so each child had their own space.  Plus Disney had a curtain to divide the kid section from the adult bed section, so it almost felt like two rooms.  

The other plus on the Disney ship is they have tiny bathtubs in the bathroom so you can bathe little ones.  Based on that, I can tell they definitely cater more to families with small children.

I loved the wave phone on the Disney ship.  Since you can't really use your mobile phone once out to sea if in international waters (unless you want to pay a fortune), it was super convenient to be able to call one another on the wave phones provided in each stateroom.  I used it to communicate to my husband as well as other family in other staterooms that we were travelling with.   You get two phones per room... so huge huge plus!  I'm not sure if any of Royal's other ships have this feature.

I think Royal wins in this category overall but only by a slight margin.  Royal had more options in the buffet dining.  However, overall quality of the food during the regular sit down meals were probably about the same on both ships in my opinion.  Disney's Magic did have more variety in ambience since they rotate you through three different sit down dinings which had different themes.  That made things more interesting/entertaining.

Other Ship Activities
Both ships have pools for kids as well as for adults only.  The kid pool on the Disney ship had more fun elements like a slide and fountains for little ones etc.  Royal has a climbing wall which my husband loves.  Now Grandeur was one of the smaller and older ships in the Royal Carribbean line and they did not have a movie theater which is usually where I go after the kids are asleep.  So I was disappointed at that.  Disney Magic did have a theater and they were playing fairly new movies like Brave and Avengers on there back in Sept 2012 and you can watch it in 3D.  No casinos on Disney which in our opinion is a plus...  don't have to walk through a really smoky area just to get to another part of the ship.

My kids loved the Disney shows.  I don't think we let them watch any of the Royal shows since they seemed more interested in just going to the kids clubs for the activities they had there.  Personally, I also really enjoyed the Disney shows and found only some of the Royal Carribbean shows very entertaining but I suppose it depends on your taste.

Disney costs a whole lot more.

So overall??  Both were good experiences... when I ask  my kids, they liked the Disney cruise better. However... for the value and and the difference of price.... is it worth it?  Would we cruise with Disney again?  Maybe just to try one of their bigger ships... but will have to plan and save for it... and will likely be a while...