Food Friday: Grocery Store Reverie

I am back in Palo Alto, California for reunion and I hardly have time to think about food. But, in the course of my travels, I have come across some of the most beautiful grocery stores ever. 

I have never been to Italy. But I have been to France. In these places, people care deeply about food in a way most Americans don't seem to. However, here in Palo Alto, these are my people. I watched in the stores how twenty something men would converse over the quality of fruit. Or how professorial types moved about with one meal's carefully chosen foods in a basket. I saw others asking questions about cheese, and the butcher explaining a fine point or two to some prospective buyers. I saw bakers, hatted in white,  displaying desserts for the evening's customers. Even the checkers would comment on the items in my basket, like a Sommelier complementing my choice of wines. 

I enjoyed this throng of like minded people. The beautiful displays of foods engendered conversations all around the store. Many people had phones to their ears, checking with companions elsewhere about what to purchase. These were not just grocery lists. They were menus that were being executed. Several were doing what I had been doing earlier in the day, holding a phone out in front sending a live video to another who would look over the wares and voice their preferences. 

There were thoughtful conversations here and there, but at the same time, the group had a bit of hustle and bustle as if they all had somewhere to get to. People were expecting them. Within the hour, so many well considered tables would be set. 

This would be my wish for every one on this evening of travel. The food you buy and the place you buy it should mean something. Moreover your dinners should be special in some way.  Finally, do what you can to have special dinners with special people, in a special place.  

Wellness Wednesday: Being Proactive

I found myself a little out of my comfort zone this week. I was working on a little app for the App Store, and I am new to developing. I had done my due diligence, reading, and going through the tutorials. And yet, things were just not working out how they were supposed to. I got a little down about it. I got a little mad about it. Tech support sent me a lame email back not really addressing the questions I had clearly asked. I put the project aside for a couple days. I thought, maybe this is just not my thing. Then Monday morning rolled around, and thought, I am going to wend my way through the phone networks of Apple Computer and find someone who can help me. Three layers deep, I did. The person I reached was amazing. She agreed that I had done all that I should have; She took on my cause and bumped it up the chain of command. Ultimately the advice she gave me worked. I looked back on the incident and realized how silly I was to have gotten discouraged. Only when I got proactive and reached out, did things get better. 

Proactive is the opposite of reactive. To be proactive is to be psychologically healthy. It means being the one who takes the steps to make your life what it is. It means to be responsible for one’s self, one’s thoughts, actions and circumstances. It means to be self-determined. 

To be reactive, on the other hand, is to be a victim of life. You life is determined by other people and other factors. What you do is a reaction to other factors which have happened “to” you. You may feel out of control or like a victim. 

Wouldn’t anyone want to be proactive ? You may want to become a proactive person. And yet, until you adopt the mindset and behaviors of being proactive, it would be very difficult. 

How do you become a proactive person ?

Responsibility

The first step is to realize that you are responsible your own well being and success.  Life hands people circumstances which range from good, to bad to ugly, and yet, mindset is the main determinant of how people feel and how they do in life. Remind yourself you are empowered in your life. Pin a pin, put up a poster, or do what you need to do to train yourself to remember this. 

Honesty

Also central to the process of being proactive is to understand your starting point. This requires honesty with one’s self about one’s present state. It is like talking a good hard look at the balance sheet of your life. What are the assets, and what are the liabilities ? Only then can you realistically plan for going forward. Train yourself to honesty. 

Accountability

To be responsible is to be accountable for yourself. In literal terms, you are the accountant of your life. You have the ability to set a budget, or a goal, and work backward to meet it. You are more than dreams and talk. You have real steps to realize your plans. You may even use the so-called SMART goals. (Click HERE to learn more.)You are reliable to others and to yourself. Train yourself to take regular inventory or your life. Train yourself to use SMART goals. 

Action

When you use SMART goals, you will get used to the idea that big goals are achieved with small steps. Furthermore, you will get used to taking small steps. Many people who haven’t realized their goals are simply not used to taking steps outside their normal routine. Being proactive means training yourself to get used to taking new and different steps as part of a larger, realistic plan. It also means training yourself to get used to the fact that meeting goals proactively takes time.  

Resilience 

When you become proactive in your life and start to take steps toward realizing your life goals, you usually encounter obstacles. These may derail or discourage you temporarily. This is natural. However, the proactive person must have resilience. This is the trait which embodies the best response to adversity. With resilience, the problem is acknowledged, analyzed and the steps of the plan are reworked. They are iterated, and reiterated.  With resilience, one has to train oneself to keep a flexible positive attitude, along with the idea that continual reiteration is part of the process. 

Communication 

In everyday life, being proactive is easier said than done. Everyone feels pressured, angry or frustrated at times. These are small everyday examples of being reactive. Sometimes even bigger situations like peoples' jobs or relationships are the result of being reactive rather than proactive.  Learning the emotional and communication skills associated with being proactive is no easy task. 

During challenging encounters, the natural reaction is fight or flight. Proactive communication requires acknowledgement of these reactive feelings, but not acting on them. Simply pausing, and breathing is an essential first start. In that moment, the feelings of anger, frustration or sadness are acknowledged and set on the back burner. Then a constructive response can be proactively made in accordance with the speakers highest and best ideas.

A proactive person also knows she has the right to defer. She can take time to think about things, calm down, or gather more information. She knows how to say these things the right way. She uses responsible closed loop communication. Responsible communication uses "I statements”, i.e.“ I think”, ,”I feel”, or “I need” or “ I want”.  In this way, you speak for yourself. You may not be listened to, but at least you have spoken up for your self, and your statement has the weight of authenticity which may well continue to sink in after the conversation. 

Closed loop communication has to do with listening well. When you speak, you are obliged to listen. Listen with full attention until the speaker is finished. Then use another “ I statement” , which is “ I heard….” then repeat back a nutshell version of what you thought you heard the speaker say. This is especially useful for challenging or complex conversations. It honors both the speaker and the listener and greatly reduces the chances of misunderstanding. 

Train yourself to breathe, pause, use "I statements", and closed loop communication. 

So you see that being proactive is a training process. Nobody has a charmed life. But everyone can use the methods of responsibility, honesty, accountability, action, resilience and communication to be more proactive and move toward the life they want. 

Wellness Wednesday: Fitness Redux

Wellness Wednesday was originally conceived as a place to post about fitness. While I am glad it has morphed into a space about all kinds of wellness, I’d like to take this moment to focus back on the one thing that is the

best illness prevention,

best mood enhancer,

best fat burner,

best strength builder,

best beauty treatment of all: 

exercise, of course. 

I don’t think it gets the press time or the limelight it deserves in the the halls of modern medicine, or in our public media space. There are studies are out there to support exercise for both prevention and adjunctive treatment for disorders from A to Z. These studies are not glamorous and not really media worthy, because in many cases they are confirming things which we already strongly suspected. So the results of these exercise studies are not sensational in any way. So the media is partly accountable for not continuing to remind us of the central importance of fitness. Medical caregivers are to blame since their focus is elsewhere and they themselves have insufficient knowledge and experience with fitness. Most importantly, the public is to blame. They would much rather read about a pill to cure obesity than read about how a consistent regimen of 30 minutes of daily exercise can reverse diabetes and heart disease.

I would like to take this opportunity point you back to my website pages on fitness, and encourage you to read through all the links.

Fitness

That way, in about 5-6 minutes you can get the important points in a short period of time. But for those of you who are not link clickers, I will give you the nutshell version here: 

• Those with medical problems should obtain medical clearance to exercise. 
• Exercise should be engineered and planned into your day like an important meeting. 
• Start with brief easy sessions 6 days per week to build a habit. 
• Determine why you need to exercise.
• Resolve to make exercise fun. 
• To begin, pick at least 3 easy fun routines or an exercise which requires little thinking on your part. Do not go over about 30 minutes per session on your first 3 months of exercise. DVDs or a class are ideal. Chose workouts that include concurrent cardio and resistance. Until you know what you are doing, go with a professionally designed workout which is safe, effective, balanced and includes warm up and cool down. My favorite library of workouts is Beachbody on Demand. I also love Jillian Michaels workouts. 
• Pick a place of exercise that is time and weather independent. This could be a 24/7 gym, the outdoors, or a DVD in your living room. 
• Arrange accountability through an app, a log, or a friend. 
• Arrange self tracking through an app or a log. Include, weight, waistline, type and duration of workout. Do not measure your weight and waistline more than once per week. 
• Have comfortable and flattering exercise wear. 
• In the first three months go mellow to let your body begin adjusting. After that ramp up in intensity to your tolerance, provided you are tired but refreshed afterwards, rather than wiped out. 
• Hydrate well all day long and have water during every workout. 
• Remember that it takes 3 months to build a habit. 
• Focus on how good you feel when you are finished. 

Medical Monday: Breaking News from the World of Obstetrics and Gynecology

It turns out that Dr. Peter Hotez, the Dean of that National School for Tropical Medicine has been thinking about the interplay between Hurricane Matthew and the Aedes mosquito which spreads Zika. His informed speculations were that the Hurricane could provide an initial respite from the mosquitos, being essentially blown away by the tremendous winds. However, the enormous amount of standing water afterwards would provide ideal breeding ground for the virus carrying mosquitos. 

Though the Federal government has passed a limited Zika funding measure, the bulk of the costs have fallen on States. The 1.1 billion dollars recently approved requires the development of a spending plan which the Department of Health and Human Services are required to complete by the end of the month. One hundred and fifty two million will go toward vaccine development. The rest will go to local labs to speed up testing, as well as for prevention efforts like mosquito control, and education campaigns. 

Much of the press about Zika focuses rightly on its effects on pregnant women, namely microcephaly and other severe effects on the fetal and neonatal brain and nervous system. However, Zika virus effects non- pregnant women and men by increasing their chances of Guillain Barre Syndrome, post viral paralysis. In the recent new wave of such patients, 97% of these patients had symptoms of Zika 4 weeks prior, further cinching the relationship of the virus to the syndrome even further. 

At least 808 pregnant American women have Zika. It is likely that there are many more since the infection can be asymptomatic, and testing results are much delayed. Physicians and Institutions are trying to ready themselves for the increase in special needs children which will come as a result of the Zika epidemic. 

New Zika recommendations indicate that both men and women wait six months to get pregnant after Zika exposure. 

In other virus related news, studies have shown that parents are more likely to ask for HPV ( Human Papilloma Virus) vaccine to be given to their children if their child’s caregiver discusses it with them in a certain way. In particular, if caregivers highlight the parent’s role in preventing HPV infection, parents are more likely to agree to the administration of the vaccine. HPV vaccine is grossly underutilized. Researchers and physicians are trying to increase HPV vaccine utilization rates by funding the vaccine with others and by giving it in school based programs. HPV is a virus which causes serious and sometimes fatal disease processes ( cervical cancer)  for which there is an effective vaccine. Yet many will not utilize it. Once we are fortunate enough to have a Zika vaccine, I wonder if some will decline that too. 

Speaking of inadequate utilization of vaccine, over half of millennials do NOT plan to get the flu vaccine this year. Half of these people do not believe it is effective and 29% think it will give them the flu. The data do not bear out these concerns. 

Here is some bad news that is, at the same time, interesting and useful. First, people in most modern countries gain weight during the holidays. The amount and time frame varies by country. In the US, our weight is at its lowest in October, right after summer, and increases in the ten days preceding the holidays. It appears that holiday related weight gain, regardless of country, takes about FIVE months to lose. That’s right people, gain it in ten days, lose it over five months. 

In other bad but fascinating and hopefully helpful news, stress contributes to aging in a very particular and profound way. A large human DNA study has demonstrated that “ adverse events in childhood ...hasten …telomere tear down." I once read telomeres are the protective shoelace tips to our DNA shoelaces. Telomeres keep DNA from fraying as it were, and this prevents premature aging. They were able to determine that each significant stressful event in a person’s life increases the risk of shorter telomeres by 11 percent. DNA codes for what we are… in a very immediate tissue sense of the word. Damaged DNA leads to all kinds of diseases including cancer, and basically the failure to heal and renew properly. We have to start taking the prevention of childhood stress much more seriously. 

State Medicaid expansions are most costly than previously anticipated. This is because more qualifying patients have signed up, and they are sicker than had been anticipated. This should be cause for increasing the funding to the expansions, says this fiscal conservative. Why ? It is because preventive care and treatment that is earlier rather than later ALWAYS is cheaper in the long run. Never mind that it is more humane and the ethical thing to do. 

Stay tuned for more fascinating news from the world of Obstetrics and Gynecology, next week, on Medical Mondays.

Wellness Wednesday: Wellness in Dying

I generally shy away from this topic. But a few things have happened recently causing me to realize that there are some issues that can make the process better. 

I did say process. I have observed a range of situations, from a young person with a couple of years to plan, to a middle aged person who died suddenly and unexpectedly, to an elderly person whose passing was entirely anticipated. In all cases it was a process. They were all hard, and they were all different. As an inexperienced observer, I did notice that several things had a big impact on how the whole process went, for the patient and the friends and family. 

Wellness in dying comes from wellness in living. It comes from the most basic of things.

• Get along with those around you. Resolve your issues and express all your affection. 
• Stay out of debt.
• Obtain life insurance to cover any debt that you have and to provide for spouse and children through college.
• Clear out your household clutter so your family and friends will not have to do it.
• Have a clear paperwork system.
• Have computer backup and passwords entrusted to someone.  
• Establish a will if you have assets and or children. This can prevent bad feelings after you are gone.
• Establish a living will (advance medical directives)  including instructions for any organ donation with your primary caregiver. 
• Arrange your life and work so you are not always postposing special experiences. 
• Arrange your everyday life and work so you have good experiences routinely. 

These are the Days of Return and Repentance in the Jewish Calendar, a time of self examination. It is the week between Rosh Hashanah and Yom Kippur, the High Holy Days. The liturgy refers to the Book of Life. It refers to those whose names will be inscribed for the coming year and those that will not. The traditional blessing reflects this imagery. The whole service is very much a contemplation of mortality and the need to be mindfully present in the time we have. 

May you be inscribed in the Book of Life for the coming year. May you have a good year and a sweet year. 

Wellness Wednesday: Travel Insights

I am in black and with me is Kyra Bobinet, MD, MPH of drkyrabobinet.com

Although travel is often arduous, it has the capability to be really invigorating. Travel is meant to refresh both the body and the spirit. 

I travel seldom. Often, when I do, it is for a specific reason such as a conference. Nonetheless, it gives me perspective on the destination and on home. I also learn things about myself. Here is a sampling of my insights from a recent trip to Stanford Medx. 

• I worry before a trip and invariably come to find that my worries were largely unfounded.
• Every time I travel, especially the day I’m supposed to depart, I'm reluctant to leave home and have strong feelings of missing home. However, by the time I change planes, I am very glad I went and I get excited for the destination. Toward the end of the trip, I'm anxious to depart, and love arriving at home.
• I romanticize my destinations yet ultimately find that they, like all places, have advantages and disadvantages.
• I sleep more when I am not at home since I do not engage in the endless list of things to do at home.
• I feel better when I sleep more as many people have told me I would.
• I am becoming increasingly selective about what I eat.  I am therefore becoming more careful about bringing food, especially snack foods, with me.
• I am more determined than before about finding new ways to keep up on my workout while I travel.
• I drink more and hydrate better when I am away and I feel better because of it.
• I am still reserved at the beginning of a big interactive conference. I then realize partway through the conference that there is no reason not to approach anybody, including the main speaker, that I find interesting. When I do approach people with reasonable points or questions, they are uniformly receptive and share generously.
• I never bring enough business cards. And in a related vein, my business cards are boring. I need some new ones.
• I sometimes get the “ I am not worthy“ feeing when I meet people of towering brilliance and accomplishment. It does not take me too long to realize that this is a waste of energy. However, it still happens. Thankfully, this feeling does not paralyze me, and it makes me want to do more. These negative feelings are eclipsed by my gratefulness at getting to meet such people.
• I am afraid of “ losing” the cool people I meet on my trips, so I have become more thorough about getting their complete contact information, often including pictures. The funny thing is, everyone else seems to be doing the same thing.
• I used to disdain Twitter, but now I get it. I don’t know if this was one of the original intended uses, but I quickly learned to do as others were doing and tweet out key points from the lectures, including helpful hashtags and relevant twitter handles. The twitter stream from the sometimes concurrent presentations in one conference could thus be shared by all who were interested, regardless of what presentation they attended or, regardless of whether they were present at the conference at all. I was enthralled by the idea that we were creating a crowdsourced collective impression of the conference available live in the twitter sphere.
• When I travel to places where I have lived before, I feel a pleasant sense of continuity from past to the present. I also get a sense of longevity, as though life is reasonably long, and that you are free to do many different things over the decades.

Traveling inspires me to do more and be more. It makes me appreciate both home and the destination better. If I go back in time by going back to a place I’ve lived before, I gain understanding and compassion for my younger self.

Traveling can be expensive and challenging to arrange. However, I believe that it is worth it.

Here are some older posts I wrote about travel: 

Travel Wellness

Travel Food

The Structure of Travel

Food Friday: The Travel Food Tour

Food always factors greatly in my traveling. First, I am concerned about healthy snacks that are allowed on the plane. It ends up being nuts, chocolate, and dried meats like jerky. I buy fruit, veggies and drink as soon as I get past security. 

On the plane I either get a club soda with a splash of cranberry juice, or a bloody mary mix with no alcohol: a Virgin Mary. 

For layovers, I like to keep it light but ethnic. My favorite in Salt Lake is the Greek place, since I seldom get this kind of food. In Seattle, it is Asian of some kind, usually Japanese or Chinese. 

 Once to my destination, I had the good fortune to be hosted some lovely people who came originally from the south of India. She, a Biology professor at Stanford, and he an engineer with a company, they were both a bit older, and had freedom in their schedule. They used this time in some part to putter around in a lovely cottage garden that they both maintained. Big sweet oranges were falling off the trees, while diverse peppers, tomatoes and strawberries decorated their respective bushes. 

We shared similar sensibilities in everyday foods, which took my worries away. Additionally we went out a couple times, once to a traditional Indian restaurant and ate family style. It was so much fun since each new dish was a discovery. The second time we went to a old style steakhouse with clients. The dinner was spiced with political conversation. 

The most amazing use of food was at the conference itself. I laughed when I saw the schedule. As there were not one, but two or three breaks between breakfast and lunch. Tables were set all over the place amidst and some times in auditoriums. The food at morning break might be poached pears, or filled croissants. Lunch was often salmon with several vegetables. Mid afternoon, tea with something on the sweet side was served, from strawberry shortcake to cups of fresh fruit. Fruited ice water was everywhere. 

All of this abundance encouraged a relaxed attitude. People sat with each other ate short frequent meals or servings. Before long another session would be called, and then another break, so it kept people mixing in a very genial fashion. The food was entertaining as well as delicious, so it was an instant conversation starter, fostering very positive feelings.

Finally my travels usually include some exotic purchases. This time I headed to an Indian grocery store which we lack, and picked up some very fresh spices. Small and light, they were easy to bring home. 

I have long advocated that my patients pay more attention to their food. If you do, you will enjoy it more and it will be of a better quality. This fits my vision that enjoyment of good food, good social life and good health go together. 

Wellness Wednesday: Stanford Medx

I just knocked something off my bucket list. 

Stanford Medx is a multi-day conference on innovation in health care. The conference is akin to it’s older and more popular cousins TEDx and TED, programs which are available online to everyone and which deal with topics in technology, entertainment and design, really all the big issues. 

Medx brings together people interested in moving medicine to a new and better place. It’s themes are people, technology and design. I would like to share with you some of the material that I encountered and the people that I met, together with a few images. 

On Wednesday my first day, I travelled. It is always an entertaining shock to change biomes so quickly, going from the alpine to the sonoran in little more than a couple hours. From cool pine I went to warm eucalyptus. After getting settled, I attended presentations and a workshop at the D school - The Design School on the Stanford Campus. There I met designers, architects and medical people all coming together to make buildings, objects, and even procedures which would make getting medical care more effective and pleasant for patients and caregivers. I met a women who is involved in renovating the Women’s and Children’s hospital at Stanford, just as I am at my hospital. I also met the grandson of Charles and Ray Eames who reviewed principles of design though a survey of his grandparents’ work. I also met the mother of an unexpectedly premature baby who had struggled with expressing colostrum. She had, as a result, developed a clever and inexpensive device to modify existing pumps to make them more effective. We expect its use to become widespread. 

Day two was a workshop on shared decision making. This was meant to be decision making between anyone and anyone else: doctor-patient, doctor-nurse, and family member to family member. Shared decision making was a key theme which dovetailed into one of the main themes of the conference, EVERYONE INCLUDED.

Decisions from the top down can be problematic, and partake of hierarchy. Hierarchy for its own sake is to be banished from medicine. Effective communication, and therefore better results, satisfaction and even safety grow out of shared decision making. This was amply explained an demonstrated across all the varied content of the conference.

Communication needs more than clarity. To be optimal, it is two way, and involves empathy. EMPATHY was another key theme echoed over and over again. As physicians, engineers and designers, we must employ empathy in all our thinking. We need to ask the patients and the users for input at all stages of development. Such a process creates more user satisfaction and better results. 

On day two, we partnered up. Our group was composed of the professionals I mentioned, but also of special “ e-patient scholars”. These were medically sophisticated patients with serious chronic medical conditions who could speak to us about their long experience in the medical system. They were there to help us see through their eyes. I was paired with an older woman in a wheelchair with end stage MS and lupus. Since I have lupus we exchanged notes about that. But it was her MS that was making the critical problems. She spoke about her end of life plan. Even so, she was as pleasant and sparkling as a person could be.

On days three four and five we had presentations from morning until evening, often rapid fire. That is when the conference really took on a life of its own. The conference designers were smart. They had substantial breaks every hour or two, and provided food, and tables, and encouraged everyone to live tweet the conference. The session to break ratio was optimally dialed for stimulation and interaction. All the speakers made themselves accessible, so not only did you hear these phenomenal stories, you met the phenomenal people. Bread was broken and contact information was exchanged. 

Key themes were as follows: 

• open medical data, especially genetic data
• open research data 
• the quantified self 
• gamification of healthy lifestyle goals
• getting patients, doctors and researchers together, often through the internet
• patient education, often self education, through apps and the internet
• collaborative and integrative medicine
• collaborative end of life planning

A lot of this came together under the topic of PRECISION MEDICINE. This means care tailored to one's precise condition, down to the genes if possible. It also means giving exactly the right amount of medical care, not too much, and not too little. It also means care tailored precisely to the patient’s wishes. Finally it means oversight so that care dollars are used optimally. 

By far the most stunning presentation was that of Dr. Lucy Kalanithi, the widow of Dr. Paul Kalanithi, Stanford neurosurgeon who wrote “ When Breath Becomes Air”. Her presentation detailed the reality of love and connection despite suffering and death in a way that I have never imagined. Her presentation had more power than any I have ever heard. I recommend the book. 

Besides being stunned, I was also charmed. I got to meet so many delightful people who were also talented beyond measure. The same people were uniformly willing to share their insight and experience. Noteworthy among these was Dr. Wendy Sue Swanson, Seattle Mama Doc. She is a Pediatrician, mom, and writer extraordinaire. Check out her website, blog, and book " Mama Doc Medicine".

It was also great to meet Dr. Kyra Bobinet, who shares my interest in helping patients realize their goals in fitness, nutrition and health in general. She told me that everything she knows is in her book, " Well Designed Life". I didn't believe her but I can't wait to read it. 

Medicine is moving forward folks, and you will want to come with it. Medicine needs your input to be what it needs to be. Monitor yourself. Get your health data. Try to connect with your caregivers. Tell your story. Listen and see an alternative point of view. Have a discussion.  This is the basis of the future of medicine, medicine 2.0. 

Not nearly everything from the conference is uploaded, but a Stanford MEdx youtube channel exists. Check out the link below and I know you will be inspired. 

https://www.youtube.com/channel/UCK1chhgXNHf7iB5mlqzXODA

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Well Designed Life: 10 Lessons in Brain Science & Design Thinking for a Mindful, Healthy, & Purposeful Life

$12.00

By Kyra Bobinet MD MPH

Buy on Amazon

Mama Doc Medicine: Finding Calm and Confidence in Parenting, Child Health, and Work-Life Balance

$13.12

By Wendy Sue Swanson

Buy on Amazon

When Breath Becomes Air

$15.00

By Paul Kalanithi

Buy on Amazon

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Travelling !

I'm on my way to Stanford MedX conference and I'm very excited. My usual blogging format will give way to posting as I go, so you can experience some of the amazing things that this trip will bring. Our journey starts in just a few hours ; )

Food Friday: Feeding the Recovering

Last week on Food Friday we looked at "Feeding the Unwell". We talked about patients who were quite ill or in the early post op phases. This week we will go on to pleasanter things and talk about the time frame when patients are feeling better, but still are unable to cook healthy attractive food for themselves. 

Nutritional requirements are increased while recovering. In particular, nutrients and protein needs are particularly increased, similar to that for pregnancy. There are other special needs. For example, the need to avoid constipation is key. Those recovering from surgery or whose mobility has been limited are prone to constipation, and this can be a significant source of discomfort. Strategic food choices can help avoid this. 

Those who are recovering may have had antibiotics. They may benefit from probiotics such as yoghurt, kefir, sauerkraut, and kombucha. 

Appetite is often diminished in the recovery period. Foods need to be especially appealing and tailored to the patient’s preferences. It also is best to foster a small frequent meals type schedule. 

Between all this, you as the caregiver or helpful friend have several options: 

• Bring freshly made food which can be portioned out over time.
• Bring frozen food which can be heated up.
• Bring ziplock freezer bag “ Kits” of food for use in slow cookers or fast cookers ( pressure cookers like InstantPot) which the patient might have. 
• Make sure the patient has enough healthy handy beverages. Consider herb tea, probiotic Kombucha, milk if tolerated and lightly sweetened drinks. 
• Bring frozen “smoothie kits” containing yogurt or kefir, fruits, and veggies. 
• Use the secret weapon of some wholesome sweets, .i.e. dark chocolate, or a slice of fruit pie to kickstart a recovering person’s appetite. 
• Use the secret weapon of salty foods like pickles, salsa or sauerkraut to induce someone to drink more water. 

Here are some of my Pinterest Boards with recipes which may inspire you. 

Instant Pot Tips and Recipes

Paleo Nutrition

Pick dishes with ample protein, fruit, veggies, and fiber. Include healthy fat such as avocado, nuts, olive or coconut oil. For specific information on these, see below: 

Protein

Fiber

Healthy Fat

Smoothies

Here are some tips to make your culinary caregiving experience more manageable and satisfying. 

• Visit your patient first to see how she really is doing. 
• Make sure you know her allergies, intolerances, preferences and level of hunger. 
• Check in regarding who else will be helping, and whether someone else has organized a meal schedule. 
• Organize a meal schedule yourself using Google Docs or another method of your choice. 

Your patient will not just be well fed; She will have the pleasure of seeing you and the knowledge that you care.  

Wellness Wednesday: The Importance of Neighborhood

Right now I am in the middle of something big with my neighborhood. We are rallying and banding together to prevent the development of a huge water bottling plant in our agricultural and research oriented riverside neighborhood. Yeah, I know ! Outrageous isn’t it ? More on that later. 

I am learning what good people I have around me. I have truly been blessed. My neighbors are educated, considerate, flexible, and well spoken. They are from old to young. They come from a variety of economic and social backgrounds. They have a wide range of politics. But one thing’s for sure, we have some shared values. Those include feelings of stewardship for good soil and our pristine aquifer. 

It goes deeper. I have a sense of having a neighborhood of people who would help me if I had a flat tire. I have seen random busy people stop their cars to help shoo someone’s cows back into a pasture. I would never worry about my kids walking to school. But not everyone has these types of advantages. 

A Rand foundation report called “ Neighborhoods and Health”  indicates the following:

“ Just as conditions within our homes have important implications for our health, conditions in the neighborhoods surrounding our homes can have major health effects. Social and economic features of neighborhoods have been linked with mortality, general health status, disability, birth outcomes, chronic conditions, health behaviors and other risk factors for chronic disease as well as with mental health, injuries, violence and other important health indicators."

reference:

http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2011/rwjf70450

Did you know, for example, that heath habits or disease habits are contagious ? That’s right, things like obesity, smoking, or on the other side, jogging and gardening are contagious too ? Neighborhoods can influence health in this way. 

Even the physical layout of a neighborhood can have its effects. Are there sidewalks, playgrounds and good lights ? A “ bad neighborhood” where it is not safe to walk or play outside severely constrains people’s ability to be active. It keeps people inside with the shades drawn, and bad behaviors like drinking can potentially go unchecked because there is no social accountability.  Such a lonely hostile environment greatly contributes to people’s stress, and of course stress truly contributes to many disease processes. 

Green spaces in neighborhoods turn out to be especially important. These serve as places to congregate and places to play. They also expose people to nature in places where it may be scarce, and research tells us that exposure to nature is beneficial to health in specific measurable ways. Please see my 2015 post on Nature and Health HERE. I remember being delighted with the particulars of what I unearthed when I did the research for this post. 

Here is a strange, wondrous and reproducible statistic:

An increase of ten additional trees on a city block on average, increases self reported health equivalent to a $10,000 annual increase in income or being 7 years younger. That’s right, adding ten trees to your block will add seven years to your life, at least from your perspective. The health they are talking about here is “cardiometabolic conditions” such as heart disease and diabetes. Several studies have tried to determine how this works. It seems to start by getting people outside, more active, with lower stress and lower blood pressure. More green space also seems to help reduce aggression and crime. 

What about the food environment of a neighborhood ? Is there local food ? Is food grown and sold ? Are there bars, grocery stores or convenience stores ? There is such a thing as a “ food desert” and I don’t mean dessert. A food desert is place which has nowhere to easily get healthy affordable food. The food environment has a huge obvious effect on food choices and health. 

Have you ever heard of a Ciclovia ? A Ciclovia is a open street programs that closes major roads to motor vehicles so they can be used exclusively by bicyclists and pedestrians. Ciclovias are being studied in large urban centers like Los Angeles in an effort to increase physical activity and sense of community in urban areas. 

What about sense of community ? What does that do ? This goes back to my original description of our neighborhood. It involves trust. There is trust and accountability in the continuity of these neighborhood relationships. Dan Beuttner, in his book Blue Zones, speaks of the decade-spanning friend groups of Japanese women, the “ moai” and their role in promoting the extreme healthy longevity of these women. The trust and connection of these long relationships provide a basis for the best things in life, such as celebration. 

These neighborhood relationships also uphold us when the going gets tough. I can remember nearly 27 years ago, I was between med school and residency, when I was pregnant with Forest. I had preterm labor and was put on bedrest. I was living in this same rural neighborhood, but in a tiny aging cottage which has since been torn down. I had a four year old, and my husband worked long days. Neighbors I barely knew, from newly married young women to aging matriarchs arrived with casseroles and pies. When it snowed, the drive just got plowed. These people became friends, and some have since passed. But their kindness left a permanent mark. 

In my search of Pub Med, which is the US National Library of Medicine at the National Institutes of Health, I found a fairly recent article stating “ The study of neighborhood health effects has grown exponentially over the past 15 years. “ Do not think for a minute that this is not real science nor that there are not real monetary and human resources being devoted to it. 

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Neighborhoods affect the physical and mental health of their constituents. One study from the Archives of Psychiatry introduced me to some useful terminology as they highlighted the effects of neighborhoods on health. “ Concentrated disadvantage” was strongly associated with mental health problems for children. On the other hand, collective efficacy (the ability of neighbors to work together) and organizational participation mediated the effects of concentrated disadvantage on the effects of children. 

My neighborhood is demonstrating collective efficacy and organizational participation at its best. We have got our Facebook and Twitter pages for our cause and a great many of us plan to show up at the County Commissioners’ Office  to register our thoughts on the matter. I anticipate the group will bring some scientific and oratorial firepower to bear. 

It turns out that bad neighborhood environments generate their own vicious cycle and good neighborhood environments generate an even stronger virtuous cycle. Understanding this dynamic gives people a handle on how to make things better, no matter where they are starting from. 

How do you make things better ? Twenty two years ago I purchased an unconventional poster to decorate my office. It was shrink-wrapped, and backed in cardboard. When my practice got going, we had it framed and glassed. I still see its message every day. It is by an artist named Karen Kerney, and I will share it with you through an Amazon link. It is titled, “ How to Build Community”. It is for everyone who does not yet have a nice neighborhood to live in. It was ahead of its time. The folk wisdom it contained has now been largely validated by the science on neighborhoods and health.  I hope you enjoy it. 

Wellness Wednesday: How to Visit Someone in the Hospital

On first glance this seems self-explanatory. However, a few tips may make things easier. 

If you are uneasy about visiting the hospital, figure out why. Are you afraid of embarrassing the patient ? Do you not like hospitals ? Do you fear illness yourself ? Figure out your reasons and decide if they are reasonable. Remember that the visit is for the benefit of the patient, and that it is an act of care. People in hospitals can very easily feel isolated, as though everyone else is out there living life to the fullest…but them. 

Call beforehand. Based on circumstances, call the patient, her significant other, or perhaps the nursing station of the ward that she is on. Find out the visiting hours, if there are any, and whether or not a visit is appropriate. When you call, ask if the patient needs anything from home or from the store. Sometimes little things can make a big difference, i.e. gum, or their iPad. 

Consider bringing a small gift of your own. However, when considering gifts of or drink, make sure you know the patient’s dietary limitations. In the hospital, dietary restrictions are common, such as during the time before and after surgery, or stroke. When considering flowers, make sure they are permitted. Some units cannot have them because of infection risk. If the patient can do things to pass the time, consider bringing activities that he or she will like, such as card games. 

When you arrive, check in at the nursing station and with the patient’s nurse. Wash your hands. Once in the patient’s room, it is important to suss things out. It may be a time for visiting and joking, but it also may be a time to just be present in silence. Either way, it is a comfort. Even without a lot of conversation, just being there is very beneficial. On the other hand, patient’s still like to hear about what is going on in their friend’s lives as they would normally. If the patient is too tired to read, they might like having the paper read to them. Do remember that hospitalized patients are almost always tired. Watch carefully so that you do not stay too long, to that there are so many guests that the patient feels overwhelmed. 

Do not ask prying or personal questions about the patient or the illness. If the patient wants to talk about them, be a good listener. Even then, do not pry. Do not ask the nurses, doctors or other staff about the patient’s condition. They are not permitted to discuss the case without the patient’s permission, and asking right then might be uncomfortable. 

When you are there, consider offering material help to the patient or to her helpers. She may need kids shuttled, dogs walked, or lawns mowed. You could even offer to set up a google doc or some equivalent to coordinate the helpers if the need is extensive. 

Consider helping your friend after they transition back to home. Getting around will not be the same even if they are stable enough for discharge. Plus, hospitalized patients get a lot of attention to help them through. To have that come to a screeching halt upon discharge would not be all that fun. Connection, not isolation, is essential to healing. 

Most major religions, certainly Judaism and Christianity, include visiting the sick as a formalized duty. It represents the best of society, and embodies compassion. The secret is, it blesses the visitor as much as the visited. 

Wellness Wednesday: Back to School

Parents all over the world are experiencing one of the biggest transitions of the year: back to school. Whether you have grade schoolers, high schoolers or kids bound for the university, it is bound to have a big effects on your routines of daily life. And that in turn, has effects on your health and the health of the family. 

Summer can be a relaxing time when people are more physically active. Or it can be hectic with guests, vacations, and the routines can go out the window. Take a moment to assess your summer. Determine how you would like to capitalize on the transition back to school. 

For families with kids of any age, getting back on a good sleep wake schedule is key. Start at least a week early. Get back on a good meal and snack time schedule. You should be on that schedule anyway ! 

Sit down with kids of any age and go over their school supplies. Let kids have as much independence as possible in picking their supplies. These are important expressions of individuality. 

For university students, sit down and discuss finances. Establish a realistic budget regardless of where the money is coming from. Make sure they know how to balance a bank account and look up any card balances. Discuss expectations well in advance. 

For school clothes, don’t go crazy. Start by asking kids to tidy up their room and go through their things. Younger ones will need help with this, but let them do as much as they can by themselves. Encourage them to get rid of as much as they can, but go through it later yourself for things you might need to keep for younger children or other kids whom you know. Establish a habit of giving to Goodwill, and likewise, regardless of your finances, teach kids that it is reasonable to check second hand stores for things they might need. This should be given a air of boho environmental cachet, as well as frugality. After that, establish a budget and go shopping, but just get basics until your child reinvents themselves again for that year. 

Make it easy for kids to stay organized. Have an area such as a mudroom with hooks and cubbies for kids to put their things. Additionally, each child, whether large or small should have a desk area of their own if at all possible, even if they have to share a bed. This can be organization central for them. Consider having a family wall calendar, so everyone can see what family activities are coming. 

Teaching kids early on to have a routine will save them tons of stress. There are routines for sleep, eating, exercise, homework, after school activities, family time and play. Teach kids by example. Make sure you have good habits yourself. Then everyone will have a productive, low stress, enjoyable school year. 

Wellness Wednesday: Unpacking the Seven Principles

Last week in the post entitled “ Couple’s Wellness “ I referenced the work of Julie and Stuart Gotten of the esteemed Gotten Institute and the Seattle Love Lab. I introduce their book entitled “ The Seven Principles for Making Marriage Work”. However we didn’t really go into what those principals really are. This week I will give you a thumbnail sketch of each in the hopes that you will be interested enough to pursue more study. They are as follows: 

1. Enhance Your Love Maps
2. Nurture Your Fondness and Admiration
3. Turn Toward Each Other Instead of Away
4. Let Your Partner Influence You
5. Solve Your Solvable Problems
6. Overcome Gridlock
7. Create Shared Meaning 

Enhance Your Love Maps

The love map is a term for the area of the brain which holds all the information about your partner. The Gottmans propose that having a detailed love map of your partner enables you to love better, and weather challenges more easily. This is done by concerning yourself with all the things that are important to your partner and keeping up to date with what is going on in their life. 

Nurture Your Fondness and Admiration

Fondness and admiration usually exist at the beginning of any relationship. However, as time passes and life’s difficulties are encountered, they may diminish. Expending effort to deliberately keep these past memories and present feelings of fondness and admiration alive will prevent bad feelings from developing in their place. In particular, the Gottmans state that fondness and admiration are the antidote to contempt. 

Turn Toward Each Other Instead of Away

A couple’s connection is built of many small connections throughout the course of everyday life. When one partner reaches out even slightly in speech or gesture, the Gottmans call this a bid. If the other partner turns away from (disregards) the bid, the bidder is slighted and some degree of detachment or irritation takes place. However, if the partner turns toward the bid responsively, their connection is strengthened. The Gottmans teach that a tendency to turn toward your partner’s bids build trust, goodwill and emotional connection. 

Let Your Partner Influence You

The Gottmans have found that partners who share power are more likely to have happy and long lasting marriages. Part of sharing power is allowing influence to flow back and forth. In these marriages conflict prompts a search for common ground. 

Solve Your Solvable Problems

This sounds hard at first but the Gottmans break it down as follows: 

1. Soften your start-up. 
2. Learn to make and receive repair attempts.
3. Soothe yourself and each other.
4. Compromise.
5. Prices any grievances so they don’t linger. 

These are the features that an effective problem solving session needs to have. They liken good problem solving to that done between respectful professionals or esteemed guests. 

Overcome Gridlock

The Gottmans assert that gridlocked issues in a marriage touch on deeply held beliefs or wishes, or each partner’s dreams for their life. If partners sit down with each other and try to discern the real basis of the tightly held position, then perhaps a common ground can be found. 

Create Shared Meaning 

The Gottmans assert that a real marriage is more than the sum of its parts. By parts I mean living or loving each other, raising kids competently, and having sex. Instead, they argue, the couple must create a their own unique culture, which incorporates both partners' closely held beliefs and dreams. The Gottmans have identified four aspects of creating shared meaning:

1. Rituals of connection, such as a family sit down dinner 
2. Support for each other’s roles
3. Shared goals 
4. Shared values and symbols.

This will give us all a lot to think about until next week on Wellness Wednesday. 

Wellness Wednesday: Couples Wellness

This last weekend our adult kids cross examined us about when we had last done something with just the two of us as a couple. As a result we ended up taking our own hike in Glacier Park, something we had not done in years. This got me thinking about the ever increasing amount of evidence demonstrating how critical relationships are to health. I put two and two together. 

More attention should be given to relationships in the context of health. Primary care physicians including Ob/Gyns should include relationship assessment in their broader health history. They should be able identify serious problems and refer patients for couple’s counseling or whatever it is they need to correct the problems. 

All this can happen in the context of the doctor’s visit. But discussion about the health of our relationships should be a common one, because it is important. We talk about kale, yoga, cardio and even mindfulness. Why shouldn’t the conversation extend to interpersonal skills and healthy relationships ? 

I have spent the last few days reviewing material on the subject of relationships and what can be done to make them healthier. This extends beyond partner relationships to friendships and family relationships. The core skill set in all cases is the same, with variations depending on the relationship. 

Two particular sources were the most helpful. 

The first is an article in Psychology Today which pointed me toward a sweeping review out of UCLA on the effectiveness of couples' therapy. The conventional wisdom in the lay press seems to be that couple's therapy does not work well. This research study served to shed light on this question. It was a major review of the past 40 years of research on couples therapy. It turns out that certain therapy worked, and certain therapy did not. The conclusion of the study was that couple's therapy does demonstrably work IF it follows 5 particular principles : 

1. The therapist must be willing to ask both partners to step back and look more objectively at the facts and patterns of the relationship and actually be willing to change how they each think of the relationship. (The individual partner’s views are not sacrosanct.) 
2. To be effective, a therapist must be wiling and able to change actual behavior in the individuals. They must be able to take concrete steps to prevent one partner from harming the other. This includes psychological services, anger management, or substance abuse treatment. (The therapist must have teeth.) 
3. Effective therapists must bring out the emotions of each partner. 
4. Effective therapy must include the teaching of good communication skills. This includes active listening and responsible “I statements”. 
5. Effective therapy must focus on strength and build resilience. 

In brief, therapy can be effective if it

1. Fosters objectivity
2. Changes behavior
3. Handles emotions
4. Teaches communication
5. Enhances strengths

My second source led me to the famous Gottman Institute founders John and Julie Gottman. They provided a piece in the recently published " Time Special Edition, The Science of Relationships" . As lay reading goes, it is superb. I picked mine up in Costco. In it, they discussed their work and the “ Seattle Love Lab” where they evaluate and treat couples. They also referred to their most recent book, "The Seven Principles of Making Marriage Work”. In this book they present the distilled result of their observations of hundreds of successful “ emotionally intelligent” marriages. They too identified the common patterns in these relationships and have presented them for our consideration. 

They seven principals at work in successful marriages are as follows: 

1. Enhance Your Love Maps
2. Nurture Your Fondness and Admiration
3. Turn Toward Each Other Instead of Away
4. Let Your Partner Influence You
5. Solve Your Solvable Problems
6. Overcome Gridlock
7. Create Shared Meaning 

You could map each of these lists uno the other and find that they line up pretty well. I find it interesting that both research groups chose to study what worked, and that the features held true over large numbers of couples and long periods of time. Finally, it seems that the social sciences are catching up to the medical sciences in prescribing evidence based treatments. 

I encourage you to delve into this literature, regardless of the type or the state of your relationships.

Check these valuable resources out at your local library, your local booksellers, Amazon.com, or even Costco.

The Seven Principles for Making Marriage Work: A Practical Guide from the Country's Foremost Relationship Expert

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By John Gottman Ph.D., Nan Silver

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TIME The Science of Relationships: Better Romance-Modern Families-True Friends

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By The Editors Of Time

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Medical Monday: Breaking News from the World of Obstetrics and Gynecology

About 1.6 million pregnant women are at risk for Zika virus infection in South and Central  America. Now, health officials are concerned that local transmission of Zika virus has begun in southern Florida. This means the virus was acquired in Florida, instead of being acquired elsewhere while a person was traveling. This means that some of the mosquitos in Florida carry the virus.

In related news, the blood supply in South Florida is now considered to be potentially contaminated with Zika virus. The FDA ( Food and Drug Administration) has asked that all blood donations from South Florida halt until all donations can be screened for Zika virus.

In even more striking news, the CDC ( Centers for Disease Control)  is recommending that all pregnant women be screening for the Zika virus. 

As most of you know, Congress left for its seven week vacation without coming to an agreement on Zika funding. The President of the American College of Obstetricians and Gynecologists has written a strongly worded letter to Congress on this matter. 

http://www.acog.org/About-ACOG/News-Room/Statements/2016/ACOG-Statement-on-Congress-Failure-to-Take-Action-on-Zika

Proceedings from the National Academy of Sciences include research that indicates that women who enter menopause early age faster than other women. They were able to quantify this, saying that menopause speeds up cellular again about 6 %. They also indicated that poor sleep can trigger similar aging type changes. 

In related news, women who start menstruation late and who have menopause late compared to average are more likely to achieve 90 years of age. Information like this is useful in that it helps identify factors tied to longevity. 

Research from the Journal Circulation has indicate that only 2.5 hours of moderate exercise per week has measurable effects on heart disease risk in women. Let’s see, taking one day off per week leave six days for exercise. Divide that into 2.5 hours to get the time per day needed for exercise. Only 25 minutes per day needed to reduce cardiac risk ! 

Stay tuned next week for more breaking news from the world of Ob/Gyn and women’s health.

Wellness Wednesday: Sleep Hygiene with Sketches

It is summer in the far north and the days are long...so long they stretch into the night. Farmers work until 11 pm and dinner is at about 9pm in broad daylight. Then the evening comes, and by 11 pm you feel the evening is just getting started. A movie is chosen and whoops, you are up way too late, especially since the sun comes blazing in shortly after 5:30am. 

So I though I would take this opportunity to share with you some sketches I did for my wellness reminder cards that pertained to the importance of good sleep hygiene. Each card will hopefully remind the user of a key principle, with the image on one side, and the reminder on the other. 

1. Adequate Restorative Sleep 

With few exceptions, adults need 7-8 hours of sleep. You should wake, almost spontaneously, and feel rested. That is the meaning of restorative sleep. 

2. Consistent Wake Time

Having a consistent wake time actually helps you fall asleep properly at bedtime. 

3. Consistent Sleep Time

Once you get in a routine, you will start to get sleepy at the right time. 

4. Correct Sleep Environment

The room should be dark, quiet and cool, without electronics or snoring people. 

5. Medical Evaluation of Necessary

Most major hospitals have a Sleep Center or Department of Sleep Medicine. There is now the recognition that sleep health underscores all health. Rigorous studies can be done to assess sleep problems, and treatments are available. 

To learn more see our webpage on sleep HERE. 

Next week on wellness Wednesday we will continue with more wellness reminders. 

Nighty Night !

Wellness Wednesday: Healthy Habit Formation

Healthy habits are the basis of peak wellness. Heathy habits are something we can develop. Whether the healthy habit is taking vitamins, being grateful, exercising, or eating fiber, the practice only works if it is done over and over for extended periods of time. This repetition is achieved through habit formation. 

What does science say about how habits are developed ? 

The brain is designed to form habits.  New behaviors or tasks can be challenging. Over time, the brain “chunks” small possibly difficult behaviors into automatic routines which becomes easy or even effortless. This is a habit. Habits are adaptive and have helped us survive. Habit formation is our brain’s way of automating certain key behaviors, so more conscious attention can be paid to novel situations.  If we understand how this works we can form new habits at will. 

What do we need to form new habits ? 

In simple terms there are three steps: 

1. Cue
2. Routine
3. Reward

This is called a habit loop. These are well explained in Charle’s Duhigg’s book "The Power of Habit”.  The cue triggers the routine, and the routine triggers anticipation of the reward. For example, my exercise routine is cued by changing into exercise clothes. From there, I go downstairs to workout, and the reward is the endorphins and the satisfaction. There is no doubt that at first, it is hard to link the steps. But it becomes easier with each cycle. To be realistic, it takes somewhere between 6 weeks and 3 months to form a new habit. 

What about bad habits ? They too have cues, routines and rewards. Basically, they have to be understood in terms of their rewards, namely, what you get out of it. In many cases, smokers smoke to get a moment of peace in a busy day. This is obviously legitimate. However, the cigarette is unhealthy and chemically addictive in addition to being behaviorally addictive. It turns out we should not exactly delete bad habits since this leaves a void. Instead we are better off to overwrite them with good ones. To illustrate, a smoker could use patches to wean down on the addictive nicotine, while overwriting her smoking habit with a healthful tea drinking habit. Perhaps to make it more engaging, she would brew the tea from loose leaves. Her reward would be the moment of peace, the taste, smell, and mental clarity that followed. 

My subject in this post are the cues. In simple terms, they are reminders of health habits. I decided to expand my set of reminder cards to include not only the subject of nutrition, but also the subjects of sleep, exercise, communication, and creativity. I believe these are some of the elements in total peak wellness. Here are my cue phrases so far. 

Sleep 

The Power of Habit: Why We Do What We Do in Life and Business

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By Charles Duhigg

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•      Adequate restorative sleep 
•      Consistent wake time 
•      Consistent sleep time 
•      Correct sleep environment 
•      Medical evaluation if necessary 

     Exercise 

•      Start easy and short 
•      Warm up
•      Cool down 
•      Value initiation over endurance 
•      Good gear 
•      Eat for exercise 
•      Hydrate for exercise 
•      Tunes for exercise 
•      Podcasts for exercise 
•      Exercise daily 
•      One break day per week 
•      Stretch after exercise 
•      Buddy exercise 
•      Track your exercise 
•      Explore HIT 
•      Include yoga 
•      Mix it up 
•      Use good form 
•      Consult professionals 

Creativity 

•      Get inspired through people travel and media 
•      Find your styles 
•      Express creativity in your personal space 
•      Make a space for your creativity
•      Take time for hobbies 
•      Take time for Travel
•      Take time for recreational reading 
•      Pick a hobby and learn it well
•      Share your creative work

Work 

•      Always work
•      Honor work in and out of the home 
•      Chose meaningful work 
•      Become expert at your work
•      Give work boundaries in time, space, and thought
•      Do you best at work 
•      Communicate effectively at work
•      Reach out often at work
•      Play as a team 
•      Ask for appropriate compensation

Communication 

•      Breathe and think before speaking 
•      Use Honesty 
•      Use courtesy
•      I statements
•      Precision of speech
•      Closed loop communication
•      Listen more than speak 
•      Listen actively
•      Repeat back clarification 
•      Acknowledge others’ point of view
•      Build common ground

You can find nutrition reminders HERE discussed in a prior post. I plan to devote a few wellness Wednesday’s to the development of these reminders or cues. 

For more reading : 

http://jamesclear.com/three-steps-habit-change

https://www.psychologytoday.com/basics/habit-formation

https://www.sciencedaily.com/releases/2014/08/140808111931.htm

http://www.scientificamerican.com/article/power-of-habit-excerpt/

Food Friday: Family Dinner

It’s summer and the kids are home. Why not take advantage of their company and get serious about some awesome family dinners ? Sounds like fun, right ? But it’s much more. According to a considerable body of research on the subject, family dinners are important to well being. (Reference: thefamilydinnerproject.org)

Family dinners are associates with the following findings: 

• Better academic performance 
• Higher self esteem
• Greater sense of resilience 
• Lower risk of substance abuse 
• Lower risk of teen pregnancy 
• Lower Risk of depression 
• Lower likelihood of developing an eating disorder 
• Lower rates of obesity 

Let’s think about why. 

The family dinner is a testing ground for the performance of a family group as a team. And yet, pulling it together to make a family dinner is not all that hard. It is within most every person's or every family's reach. Engineering the family dinner is an exercise destined for success. Most people are grateful when someone makes them something to eat, no matter how simple. It is a primal act of caring, usually free of strings, that one person does for others. Thus a dinner is easy to produce and easy to accept. 

Children and teens can and should help prepare the dinner, even if is just setting the table. They learn preparation and cooking skills, and they learn to pitch in. They also learn that if they don’t pitch in, they will stand out. 

The family dinner is a time when most families put aside conflict, since conflict at the dinner table just doesn’t work. The ritual and the food cause us to make a deliberate change in our behavior for the better. We cease to be isolated individuals and come together to make something more, a family or a even a social group. Thus, it is very hard for someone to be lonely at the table. At the table, it is graphically obvious that you come from somewhere, and that you have a place. 

Our family table has extended into the adulthoods of our children and to the younger cousins and their friends. We are very lucky in that regard. Most of them have gone off to college and have come back, bringing spouses, girlfriends, friends and grandchildren in tow. They have each developed family table specialty skills. Echo bakes and is an award winning amateur chocolatier. Forest is lately enamored of our Instant Pot, a cool pressure cooker, which enables you to make impressive meals with little planning or tending. Geri does veggies and my son in law does smoked meats and salads. Vale is smoothie man. Hanna my niece is a cake decorating expert. They are all serious students and professionals, but they have all come to be serious foodies too.

Stepping back, I see that no matter what their fancy, the whole thing is one big shared hobby, and when we do food, everyone is pretty happy. A happy hobby. Moreover, while it was simple and easy when they were little, they have, on their own, leveled up, as the gamers say. They relish the acquisition of skills needed for their culinary hobbies, and that gives them social confidence. Finally, they relish the presentation of their dishes to others. The “ breaking of bread” has always been a bonding experience and in a family this is nothing but good. 

Think about all this this summer, when your kids are around more, and hopefully you have a little more time. All you have to do is start something fun in the kitchen. Put your heart into and it and invite others to join in the process of creation. It will take on a life of it’s own.  

Wellness Wednesday: Reclaim your Summer !

Setting Summer Goals 

I write this post as the beginning of summer approaches. I look forward to each summer as though I were a school child with a summer break instead of a physician with a steady job. All the same it is a special time, when children are more available, and when people are happily vacationing. We get an especially big dose of this spirit since we host guests in a vacation rental. They remind us of what summer is all about: excitement family, relaxation and adventure. 

To make sure you get all you can out of the summer, I suggest you plan. I suggest this since I am doing the same thing for myself right now. 

No matter your job, no matter your income, you should make sure to refresh yourself in this most sparkling of seasons. 

Here’s how.

1. Make a list of your summer goals. Make sure to include your goals in the following areas:

• Fitness- Set realistic SMART goals for fitness. Make sure to incorporate active summer sports into these goals. Likewise, plan ahead to get fit before that big hike, so you can enjoy it best. 
• Nutrition and Culinary- Make dishes you want to cook, eat and share, especially with fresh summer produce.
• People goals- Who do you want to see this summer ? Make time for reconnecting. 
• Project goals

Home improvement, garden, artistic- Take a summer themed classes, like water colors. Do some gardening. I believe everyone should garden, even if it is a nice tomato pot on the porch. 

Activities- Take advantage of the out of doors and the company of your kids. 

Staycations and Vacations - You can make time special right where you live, or strike out on the trail, for all day or all month as your circumstances allow. 

2. Consider making use of a wall calendar that comprises the whole summer. Block out the time so your goals are realistic.  Leverage your available technology to communicate and coordinate with others in your group of family and friends. 

3. Document your summer so you can best enjoy your memories later. Use photo, video, journalling, paper and mixed media scrapbooking or even digital scrapbooking. 

No matter your job or responsibilities,

summer is not just for kids.

Reclaim your adult summer !

The first day of summer is June 21st.

Make it your best yet.