Tag health

My Oldest Patient

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Shortly after I completed my residency training in family medicine in 2004, I worked briefly for a company which offered mobile physician home visits. Though I soon realized that driving to patients wasn’t my thing, I definitely met some very interesting people during that time.

My favorite and most memorable patient from my mobile medicine days was an elderly woman, aged 105. During my hospital days, I had seen and treated a number of centenarians, but this woman was the oldest. I was called upon to visit this woman’s home (I’ll call her Mary) to perform a blood pressure check and manage her hypertension. She lived in a charming duplex which was erected circa 1905. I knocked on the door and when the door opened, a friendly middle-aged man greeted me and introduced me as Mary’s caregiver (let’s name him Tim).

The interior of the duplex was a time capsule. I honestly felt like I had stepped into the 1920’s, because everything in the place was from that era: lamps, paintings, coffee cups, pens, furniture, curtains, pillows, etc. As my eyes scanned the room, I saw Mary sitting in a large chair with a walker in front of her. Mary’s face certainly was old and her body was frail, but she possessed fire in her eyes and a sassy attitude to match. I thought of how this woman, born in 1899, was witness to three different centuries, as a result of the year she was born as well as the longevity which extended her time on planet Earth far beyond that of the average person.

Mary smiled at me and motioned for me to come over.
MARY: “Well you’re a pretty young lady…what’s your name?”
ME: “Hello Mary, I’m Dr. Naito.”
MARY: “DOCTOR??? DOCTOR??? Tim, what have you tricked me into? Why do we have a doctor here?” Mary’s brow was furrowed.
TIM: “Well Mary, since you refused to take your blood pressure medicine, and since your blood pressure reading was very high today, I had to call the mobile doctor service to come see you. Now be nice to the doctor, will you please?”

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At this point I asked Mary if I could take her blood pressure again, and she consented. I took her blood pressure reading: 175/95. I began to ask Mary questions: was she in pain anywhere, did she have a headache, was she dizzy, was she nauseous, was her heart racing, was her vision blurry? I took her pulse: 78 and steady. Mary had no complaints. I then conducted a physical exam on her, which was completely normal. I then asked Mary if she would please take her blood pressure medication immediately, to which she also consented. Once Mary took the medication, I informed her that we would wait about 30 minutes to assess her response to it. She responded by saying, “Well I like you, young doctor! We’re going to have a nice chat!”

The next 30 minutes were incredibly fascinating and funny as Mary settled into a stream of vignettes about her life, focusing mostly on her days as a true flapper, wild and carefree, wearing short dresses, “necking” with handsome young men, hanging out in jazz clubs, and being a general troublemaker. One of those young men managed to steal her heart, and they married in 1922. She spoke about how she became an actress quite by accident when her husband, who was a Hollywood film producer, began to cast her in his films. Mary and her husband were more interested in traveling the world and investing their money than buying an expensive home, so they lived in their modest duplex from 1922 until his death almost 60 years later, and Mary refused to move into an assisted living facility when she became an invalid. It was the same duplex I was visiting that day.

After thirty minutes of hearing the most engaging stories about Mary’s life, I didn’t want to interrupt her. But I was working, after all, so I told her I needed to re-take her blood pressure. This time it was 138/72 and Mary was still completely asymptomatic. I told Mary that it was time for me to go and began gathering my supplies.
MARY: “Oh no you don’t! You’re going to drink a martini with me. It’s my nightly ritual. Been doing it since I was 20 years old.”
ME: “Every night since 20?”
MARY: “Yes indeed. It’s kept me sane all these years, and I enjoy it.”
ME: “But I need to drive over the hill, and it’s rush hour.”
MARY: “Oh please! Now stop complaining and just sit. Tim, make my usual times two.”

After several minutes Tim emerged from the kitchen with two double gin martinis. I don’t like gin, but I wasn’t about to complain or refuse to drink the martini. Mary and I (actually, she talked and I listened) continued to talk for another 30 minutes while sipping on our cocktails. The martini was STRONG but well made, so I continued sipping. Mary polished off her entire martini like the martini drinking expert she was, and motioned to me when she took her last sip. “Well, dear? You’ve got some left in there.” I had to finish the last couple of sips of my martini while Mary watched me, making sure I did so. Once I did, she smiled warmly. “That’s my girl!”, she beamed.

I gathered my belongings and said goodbye to her, and when she motioned for a hug, I walked over to her and wrapped my arms around her. She hugged me and patted my back with her hand.

I never saw her after that.

I Can’t Eat That! – Balancing Healthy Eating and Normal Life

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Original post can be found at: https://www.p28foods.com/i-cant-eat-balancing-healthy-eating-and-normal-life

Fast_Food hottie

There are countless challenges and roadblocks which can derail us from our efforts to follow a healthy meal plan, especially when we are faced with the indulgent foods that emerge during the holidays. Whether you are a seasoned competitor who is accustomed to following a strict meal plan, someone who wants to adopt healthier eating habits, or battling excess body weight, it can be very difficult to pass up regular restaurant meals, fast foods, and holiday treats. However, it IS possible to stay on track even in the face of such temptations.

The first and most important thing is to remember your GOAL, whether it is improved health, weight loss, or getting into contest shape for an upcoming event. Your goal should serve as a tangible mark which you are aiming for. I always tell my patients and weight management clients to post images of people who possess the type of physique they covet in a prominent place (such as a refrigerator) so that they can be reminded of their specific goal.

Here are other effective strategies to help you follow a healthy meal plan:

Keep forbidden foods out of the kitchen so that the temptation to eat something unhealthy is removed. This means that you need to avoid purchasing chips, crackers, cookies, ice cream, packaged pasta dinners and whatever other unhealthy foods you tend to gravitate towards. If unhealthy foods are not in your kitchen cupboards, you won’t be tempted to grab them and indulge.

Prep your meals at home beforehand. Meal prep can be tedious but it is well worth it when you consider the control you will have over what goes into your body. You can control ingredients, cooking method and portion sizes and maximize your chances of maintaining healthy eating habits. Once you have prepared your food, you can store single serving sizes in individual storage containers which are easy to pack when you need them.

Invest in a great food cooler bag. Trust me, you NEED one of these!

Make sure your meal plan is balanced. The best meal plans have lean protein, healthy fats and slow digesting carbohydrates. Do not fall into the trap of thinking that all fat is bad! You need certain healthy fats to maintain normal cellular function.

Avoid fast food restaurants. Fast food restaurants (and most restaurants for that matter) feature extremely unhealthy options which can completely destroy your efforts at reaching your health and fitness goals. You will also save a ton of money by avoiding the calorie and saturated fat laden options found at such establishments.

Don’t cave in to peer pressure. I don’t know what it is about friends and family, but it seems like they get some twisted thrill out of convincing others to eat forbidden foods. If you find yourself in such a situation, you need to ask yourself if it is worth unraveling your healthy eating habits in order to appease a relative or buddy. I have heard, “Awww, come on, a couple of bites won’t hurt ya!” from people who usually mean well but who are unaware of the psychological torture they might be putting me through. I honestly don’t want to be pressured into consuming something that will make me feel guilty or will not digest well . It isn’t worth it!

Work Out Like You Mean It!

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Are you one of those people who has had an active gym membership for a while, but just can’t motivate yourself to avail yourself of the services which your gym offers? Perhaps you are new to a gym environment, and though you are interested in transforming your body and your lifestyle, you are intimidated by all the weights and machines. If that’s the case, a knowledgeable certified fitness trainer with whom you have a good rapport will familiarize you with the equipment and how to use it, while also motivating you to show up and move towards your fitness goals.

If you already know how to navigate around a gym, but just can’t seem to lock down a consistent regimen, the best motivation is to establish a specific fitness goal and develop a strategy to reach it. If you then pursue that goal with intention, you’ve already won half the battle. Hitting the gym with no real plan of attack is like trying to drive a race car when you haven’t even learned to drive yet. I firmly believe in the power of specificity, structure and accountability, because all of those elements provide a blueprint for you to follow.

Here is a step by step guide to developing a successful fitness overhaul.

1. Convince yourself that you WILL reach your fitness goals.
2. Print out images of people who have the kind of body you want and put them on your fridge or another prominent place you will see daily.
3. Give yourself a deadline.
4. Make your goals REASONABLE. Don’t put down, “I will lose 60 pounds in 30 days”, but pick a more reasonable goal, like losing 3 pounds per week.
5. Develop a workout schedule and stick to it.
6. If you don’t have a clue what to do while at the gym, hire a personal trainer.
7. Take progress pictures every week to monitor your progress.
8. Follow a specific meal plan to keep you on track.
9. If you have a setback, pick up where you left off. We are all human and have “off” days.
10. Don’t be intimidated by seasoned gym members. Most people are willing to help you if you have a question about how to operate machines.
11. Learn gym etiquette. The pace of a gym is rapid, especially during peak hours, so you need to be aware of concepts like “working in” (people will ask you if they can take turns with you on a machine or station). Don’t sit on benches unless you are actually exercising on them. Wipe down equipment if you sweat on it.

Now get off your computer and get serious about your goals!blue-and-black-leaning-001

Don’t Bust Your Diet This Holiday Season!

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thanksgiving-turkey-dinner

Here is a repost of an article I wrote last November. It’s that time of the year again for holiday foods, so beware!

It seems that I will continue to uphold my yearly tradition of making my incredible (and incredibly UNclean) fudge for the holidays, as well as my signature turkey stuffing. Since the holidays come only once a year, it seems reasonable to indulge a bit, right? Well, if you’re a fitness fanatic and you have competitions coming up like several of my friends do, you can’t exactly throw caution to the wind and consume whatever you want. However, you CAN still indulge in small amounts of rich foods which are not considered clean as long as your other foods are healthy and clean. This means that your abs don’t have to hibernate during the holidays!

There are a few tricks to minimize the amount of bad foods which you may be tempted to devour.  You can consume a small amount of lean protein right before you have a carb cheat.  This will slow down digestion so that the carbs aren’t stored as readily.  Another trick is to drink at least eight ounces of water before you indulge in a decadent treat.  This will help to fill you up so you consume less food afterward.  When you are aware that you will be at a function in which tempting foods will be around, make sure your meals beforehand are kept clean and that you you eat every 2-1/2 to 3 hours to ensure that you won’t be ravenous come party time.

A newer tactic which can often work wonders for some people is to practice an intermittent fast the day before in which you consume a small number of calories, say 400-500, then go to town on turkey day, consuming your maintenance calories then. This seems to work better if you ramp up the week before with a series of intermittent fasts in which you consume your food (maintenance calories +10-20% on training days, then drop to -20% of maintenance on rest days) within a 4 to 8 hour window, then fasting the rest of the time. If you do this, crank up your protein intake so that it is at least 1 gram per pound of body weight. I personally love this diet approach and my body responds well to it, plus I can enjoy all the goodies on Thanksgiving without remorse.
turkey leg
There are food choices which are cleaner than others during the holidays. Though common holiday foods are rather calorie dense, here are a few food items which are lower in calories and fat:

  • Roast turkey breast
  • Green beans without butter
  • Mashed potatoes made with whipped butter and Greek yogurt instead of milk and regular butter
  • Pumpkin Pie

I know some of you are assuming that my cats join in with holiday feasts, but I always put them in my bedroom and lock the door. There are several reasons why I keep my felines away from the holiday table:

1. People food can often be hazardous for animals
2. My cats will run underfoot and probably trip people
3. My cats will suddenly forget the rule about not jumping onto tables and will create an unsanitary environment for guests
4. My cats will turn into pesky little beggars
Holiday-treats

Some of you may also be wondering what I am planning on cooking and eating, so here is my Thanksgiving menu:

  •  16-18 pound turkey
  • my secret stuffing recipe which has lots of goodies in it, but is relatively low in fat and calories compared to other exotic stuffing recipes
  • mashed potatoes made with light butter and sour cream
  • green bean casserole
  • my homemade fudge
  • whole cranberry sauce
  • turkey gravy
  • wine
  • store-bought pumpkin pie

Obviously there are some items on my menu that fall outside of my “clean food guidelines”, but since the holidays only come once a year, I have no qualms about it.   This is the time during which we should count our blessings and spend quality time with the people we love without getting anxious about what we are eating.  However, this does not mean you have free license to go nuts on bad foods for the next month!  If you end up indulging in other foods, don’t beat yourself up.  Instead, enjoy the feast and resume healthy eating the next day. 

Happy holidays!

Yes I AM a Doctor!

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doctor-bag2It appears to be a lifelong curse for me to have to deal with people who never seem to take the fact that I am a bona fide medical doctor seriously. Most recently, I was challenged by a hater who didn’t bother to check facts and find out WHY I had “board-certified physician” on my main Instagram profile. All she saw was B.A. in Exercise Science and stupidly assumed that I had no other credentials. I purposely left out all my medical certifications and titles because I had to include my fitness background, writing and modeling descriptions in a limited number of characters.

She attacked me by posting a challenging comment on MY Instagram post, so I wrote to her clarifying my background and then blocked her because her comment was rather scathing. She returned through a different IG profile and BLASTED me, hurling profanity at me via another public comment. So I threw all her filthy words back to her and blocked her again. I REFUSE to be bullied by haters, especially those who don’t bother to do some research before hurling false accusations and insults against people they don’t even know.

Even those who know me through social circles will exclaim, “Oh wow, you mean you’re a DOCTOR doctor? That’s amazing!”, as if my medical training and career are somehow not supposed to be taken seriously by those near and dear to me. I want to yell, “YES, I am a doctor! Why didn’t you believe me the first time I told you? Why do I have to somehow prove it to you?” What irks me is that I don’t see these people doubting the abilities of their friends who work in any other industry, be it certified public accounting, law enforcement, or any other respected profession. I honestly resent the insinuation that my credentials somehow don’t count because I don’t wear a white coat all the time (by the way, I can’t STAND wearing those polyester nightmares) or flaunt my professional title like a badge.

For those of you who question what my credentials are, I will be very clear. Several years after I obtained my Bachelor’s degree, I completed four years of medical school which culminated in a medical diploma. After that, I completed my internship year (which was also my first year of family practice residency training) and became licensed as a physician. Two more years of residency training in family practice followed, then I sat for my specialty boards and became board-certified in family practice. Eight years later I had to sit for board recertification, and that process will repeat itself every eight years until I retire from medicine.

I am not a nurse or a physician’s assistant (though those professions are highly respectable, and attract some of the smartest and most compassionate people on the planet). What I AM is:

Degreed.
Licensed.
Board-certified.
Physician…ahem, a.k.a. Medical Doctor.
Yessir.

I may not be conservative or conventional, but I expect the same amount of respect as a physician who chooses to fit the mold and wear conservative attire and a white coat. My patients refer to me as Dr. Naito, not as Dr. Stacey or Stacey. I have worked VERY hard to become a physician, and I also recognize how hard my colleagues work as well. That is why when I am around other physicians, I err on the side of caution and refer to them as DOCTOR and not by their first names unless they specifically ask me to refer to them on a first name basis.

My Video Review Of Flex Flavors By Devotion Nutrition

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Flex Flavors is a stevia-based, sugar-free, gluten-free flavoring system which is all-natural and incredibly delicious! There is an amazing variety of flavors available too!

Check out this flavor lineup:

Bananas Foster
Birthday Cake
Blueberry Sky
Coconut Biscotti
Creme Brulee
Fruity Hoops Cereal
Italian Cookie
Lemon Meringue
Maple Bacon
Monkey Bread
Peach Cobbler
Peanut Butter Crunch
Pumpkin Spice
Razzmatazz
Strawberry Fields

You can either choose a favorite flavor and buy a box (or 2 or 3…), or you can get the variety pack and try all 15 flavors!

To order, please visit http://devotionnutrition.com/store/flex-flavors/

Ibuprofen Has Its Merits

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ibuprofenOver the years, numerous medical studies have explored the idea that ibuprofen interferes with muscle growth, with conflicting conclusions. I know that there are some weightlifters who will take ibuprofen on a daily basis to combat numerous pain issues so that they can lift more comfortably, but this is something I would NEVER recommend. As a physician I am well aware of ibuprofen’s remarkable ability to shut down acute inflammation, but I am also aware of the risks of taking high dose ibuprofen over an extended period of time. I think it is also important to bear in mind that 1) there are different types of inflammation found in the body, and 2) some inflammation is actually necessary for optimal muscle growth.

The reason why I broach this subject is that I also know people who lift who stubbornly refuse to take ibuprofen under ANY circumstances, stating that it isn’t worth the impaired muscle growth. These people could be in agony from a muscle strain, bursitis, arthritis flare-up, tennis elbow or any number of conditions which arise from localized inflammation, yet will refuse to take anything. I will see them at the gym, struggling to move the weight that they are accustomed to lifting, only to cut their lifting regimen short or sharply reduce the weight lifted. Some of these people are so intent on pushing through the pain that they often make things WORSE and have to stop training completely until their injuries subside. Now that is just stupid. It makes far more sense to tackle the acute inflammation systemically with ibuprofen and rest the area for a few days so that one can return to full capacity, rather than risk even greater injury which essentially forces one to stop training.

I have recently dealt with a mild ankle sprain which I aggressively treated with ice, elevation, compression and high-dose ibuprofen for four days. Instead of being stubborn and refusing to take anything, I took 600-800 milligrams of ibuprofen twice a day with food, and also avoided any activities which required me to push off from my feet. I also refrained from doing any high impact moves which would aggravate my ankle. Was I concerned about adversely affecting my body’s ability to build muscle? Certainly not. Healing was my primary concern. Besides, there would have been no way that I could have trained the way I normally do while dealing with such outright pain, so it made sense to shut down the inflammatory process which was causing all the discomfort in the first place by taking the dreaded ibuprofen. I was smart about how I took it, and I did not take it for an extended period of time. Thankfully, it was a successful therapeutic treatment and I am glad I did it.

With all this said, I am still very cautious about prescribing high dose ibuprofen. The effects on the gastrointestinal tract are significant, so it is imperative to eat when taking this medication. I also caution people against taking too many doses throughout the day. A very real example occurred with a friend who was apparently taking high doses of ibuprofen (600-800 mg 4 times per day) without food for severe daily headaches. This practice resulted in a peptic ulcer which bled enough to cause her to pass out twice, landing her in the emergency room.

For those of you on the other side of the coin who have a habit of taking ibuprofen chronically, even if you are only taking 200 or 400 mg at a time, I highly recommend that you discontinue such chronic use. It is best to reserve ibuprofen for acute flare-ups.

Let Your Slow Cooker Do All The Work

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crock-potThere is a funny story about how I acquired my first slow cooker, and one which resulted in some resistance to using it for a number of years. I was living with a boyfriend who thought it would be a brilliant idea to give me a Crock Pot for Christmas that year. I am sure many of you know what a faux pas that was! I was so pissed that I refused to even unpack the item for several months, then finally relented and used it. I actually loved the convenience it afforded me, especially since I was expected to cook dinner for my man on a nightly basis. I made stews, soups, chicken, jambalaya, and didn’t have to make much of an effort to create these wonderful home-cooked meals.

Thankfully my resistance to using a slow cooker has passed over the years. Whenever I use my slow cooker I am always rewarded with moist, perfectly cooked meat with minimal effort. It’s a snap to throw meat into the slow cooker, add liquid, chopped veggies and seasonings, then allow the cooker to do its thing from 4 to 10 hours while I go about my day. I still prefer the awesome char that comes from broiling or grilling, but with my crazy schedule, it is often impossible to find the time to employ those cooking methods. So if you’re one of those people who never seems to have time to cook, but you prefer home-cooked meals, consider using a slow cooker.

One thing I have noticed is that whenever I cook chicken breast in the slow cooker, it tends to taste the same no matter what seasonings I use. At some point I may try a brine or marinade and put the mixture in the fridge overnight to infuse the meat with flavor, then cook it with the slow cooker the following day. Once I figure out a good prep mixture, I will share the recipe on my blogsite.

There is a favorite recipe which I have for beef (particularly beef shortribs) which is absolutely delicious and incredibly simple. Cover the entire surface of the beef shortribs or roast with medium grind black pepper and rub into meat, then place into slow cooker. Chop green onions to make 1/4 cup and one shallot then set aside. Mix 1/3 cup olive oil, 1/4 cup red wine vinegar, 1/3 cup water and 1 clove crushed garlic in a bowl, then add the green onions and shallots. Pour mixture over beef, place lid on cooker and cook for 8 to 10 hours.

You can even cook a whole chicken in the slow cooker with little effort. Simply season the bird, place in the slow cooker, add chopped vegetables, water, olive oil, garlic cloves, lemon juice and set the cooker on high heat for 4 to 6 hours. If you’re really pressed for time, you can set a rice cooker to cook brown rice so that both dishes are completely ready for you when you get home.

If you don’t have a slow cooker, you can purchase one for as little as $30 (get at least a 3 quart size). I have the 6 quart cooker which allows me to cook whole roasts and whole chickens without an issue. These gems also last a good, long time. The one that my old boyfriend gave me lasted twenty years before I had to replace it with a new model. Slow cookers will simplify your life in the kitchen!