Talked about the vegan diet and intermittent fasting. Here is a Keto Diet Review by Dr. Vero. So I thought today I’d dive into the ketogenic diet, aka the Keto diet review. There is a lot of hype surrounding this type of food, and there has been a lot of talk about the benefits. So let’s talk a little bit more about what this kind of diet consists of and what you’re allowed to eat. Everything from the benefits to the side effects is covered! ✓ First things first: Keto Diet Review All diets consist of certain macronutrients, aka macros. Believe it or not, I didn’t start counting my macros until recently because my fitness coach asked me to track them during my 1-month fitness plan. In general, all diets consist of 3 macros: Protein, Fats, and Carbohydrates. A healthy diet is said to consist of: 20% protein 30% of fats 50% carbohydrates is quite different from a keto diet, in which your primary source of energy comes from fats and protein. ✓ 30-35% protein 55-60% fat 5-10% carbs You are basically limited to up to 50g of carbs PER DAY, and some even go beyond to 20g max. So what happens to your body when you decrease your carb intake this much? Here is the direct link to the video about the Keto Diet review by Dr. Vero. Check it for a quick review. GLUCONEOGENESIS This is yet another outstanding method for producing glucose (sugar) from the ground up. Your body can get glucose (sugar) from your diet, like carbohydrates, or it can make its own in the liver through this process. Sugar primarily triggers the release of insulin, which in turn drives the storage of fat and glucose. This low-carbohydrate state reduces fat storage and helps lower blood sugar. KETOGENESIS When the body cannot produce glucose quickly enough to meet its energy needs, it begins to generate ketones. The term “keto diet” simply refers to the process of generating ketone bodies. These ketone bodies produce more energy than regular sugar, so it has been called a kind of super fuel. So what are a few of the Keto diet BENEFITS? The Keto diet can lead to fat loss while preserving lean body mass. It can improve symptoms in patients with Polycystic Ovarian Syndrome (PCOS), including mental health-related signs. Low-carb and low-protein diets may reverse diabetic neuropathy (diabetic nerve pain). Low-carb diets can improve glycemic control in obese patients with type 2 diabetes. Low-carb diets can also improve blood pressure. What about some SIDE EFFECTS? Well, it can include mild symptoms known as the keto flu, which usually get better within a few days or weeks. This includes: ✓ Headache Difficulty in exercise tolerance Nausea Vomiting Dizziness Fatigue Constipation Other side effects include: Diarrhea Insomnia Backache If you have type 2 diabetes, it can lead to hypoglycemic events (low glucose), especially when taking sulfonylureas such as metformin. Be sure to consult your doctor before starting this type of diet. Your glycemic control and medication type may affect your response to this diet, so consult your doctor before starting. Those were just some short-term effects. What about more long-term effects? Fatty liver Kidney stones Mineral deficiencies LDL (bad cholesterol) might increase (which is odd because another study showed it might improve; we can’t be too sure). Questions you might ask yourself: What happens if you stay ketogenic long-term? There was a study where obese participants maintained a keto diet for 24 weeks. It turns out that there were significant benefits to their BMI, with total cholesterol and bad cholesterol decreasing, while good cholesterol increased. Blood glucose decreased too. DISCLAIMER = Since the study was done among obese participants, we cannot extend these results to non-obese participants. Is this diet right for you? If you only have these side effects for a short time or react well, then why not? If you are considering this diet, what steps should you take? Go see your doctor for your proper checkup. If fatty meals exacerbate your medical issues, you should probably avoid adopting a high-fat diet. If you’re an overall healthy person, should you do this diet? If you would like to try it and observe the results, feel free to do so. If you have medical conditions, consult your doctor first! Actually, consult your doctor anyway whenever you’re starting a new diet. Fun fact: Did you guys know that colostrum, the first milk that is let down in breast milk, is ketogenic? This means that all newborns can survive and be well-nourished on a ketogenic formula, but remember that colostrum production switches to regular milk production about day 4. Definitely nothing like a longer-term ketogenic diet, but still a fun fact, in my opinion. ✓ Summary: Like any lifestyle change, it can be difficult to sustain this kind of diet. It is safe for otherwise healthy patients to try this type of diet for 2–3 weeks or even up to a year. Just make sure you follow up with your doctor so he can monitor you and your health while you’re on it. Also, remember that tapering OFF the diet is important. What does that mean? Don’t be keto for weeks and suddenly start eating foods high in carbs again. Make sure you gradually transition from keto to a regular diet. The bottom line is, we know the short-term effects of this type of diet, but the long-term effects are less well-known. Doctors don’t recommend it because we don’t know if it helps with anything else, but it can help with glucose control in type 2 diabetics, reverse diabetic nerve pain if protein is restricted, and help with rapid weight loss that can be maintained for up to 2 years. ✓ Whether or not you have followed or will follow a keto diet, I hope you learned something new! If you have any questions, feel free to comment or just follow me on IG and let me know! I currently don’t have
Flexibility, Balance, Cardio, and Strength Training This past week, I got to see how you function well-rested. But it’s a brand new week! So here’s a brand new topic: Benefits of flexibility! We’ve already covered two types of exercises: ✓ Cardio and strength training. Previous weeks have even given you some tips on food swaps, what a balanced meal is, why sometimes you just want to eat everything, and also why sleep is so important to your health. ✓ Today, we cover our last topic. ✓ To bring it full circle, what’s one of the first things you do in the morning after you wake up? How about a big long stretch of your whole body? That’s right…today we’ll be focusing on stretching and, more specifically, flexibility and balance. Let’s begin by discussing the recommendations, benefits, types of exercises that improve flexibility and balance, and how to perform them. First, let’s talk about the recommendations on stretching. Currently it’s recommended to do some stretching exercises about 3 times a week. But how do you do that??? Well, there are a variety of ways. You can just hold a position for about 30 seconds at a time, release, and repeat for a total of 60 seconds. This form of exercise is called static stretching. Or you can do some dynamic stretching that involves movement while you also stretch your muscles. Now, what about types of exercises that count as flexibility and balance? If YOGA comes to mind, then you’re right!! YOGA does give you the best of both worlds. Not only are you using your muscles and stretching through movements, BUT you are also holding certain positions (static) in both power poses and stretching poses. Must love yoga! The good thing is that you don’t even need to enroll in a class. You can find excellent yoga classes on YouTube and do them from the comfort of your home! How do I know? I’ve used them!!?? Another great exercise for balance is Tai Chi. The slow, guided flow from each movement makes use of each of the muscles that help you with stability. More stability means fewer falls. The older you get, the more critical these balance exercises become. Okay, so yoga and tai chi, but what are the benefits of doing these flexibility and balance exercises? Are you ready?? Stretching and flexibility improve your range of motion. This means that your joints can move the way they are supposed to. Like a well-oiled car! You want proper motion so you can get the most use out of your muscles. For example: If you were to trip over something and you’re pretty flexible, then your hip muscles have room to move to their extreme position and prevent a fall. Hopefully. Now, if you are less flexible, think about trying to break your fall while your shoes are tied together. You won’t be able to take the wide-open step to prevent your fall because your range of motion is restricted. The same is true of your arms and other body parts. It also improves your athletic performance! Let’s put it this way. Your muscles need to stretch a little so they can use their full potential to move. If you’re flexible, then you can use your entire range of motion, and your muscles can use their full potential too! Such flexibility is great not only in sports but also in daily activities. Could you please explain what occurs when you need to carry groceries to the car? Or move a few things around the house? You may also need to transport your books from one class to another. MUSCLE USE! Sports or not, it’s good for your strength and power. Decrease the risk of injury! This is both in sports injuries and injuries in daily activities. For example, if you’re playing a sport and you fall on one of your joints in a weird way, if your bones are okay with that kind of stretch… no injury. Conversely, when engaging in routine tasks such as climbing stairs, moving boxes, storing dishes, or preparing the bed, flexibility plays a crucial role. Thus, being flexible is an excellent way to do these activities without pain, without strain, and without injury. Why? Well, because you can bend that way! So it’s no biggie! But what if you’re trying to lift a heavy box? What if your hips aren’t flexible enough to bend widely? Chances are you will raise the box with your back rather than your buttocks, and you guessed it… You “pulled your back.” Now you’re lying there in pain, hoping someone will come and help. How do I know this? Based on my experience, of course! Like Rome, flexibility doesn’t come in a day! So what do you do? Like all other exercises… start somewhere… and little by little, push for more. Stretching to the point of pain is no longer more beneficial than stretching to the end of discomfort. so don’t aim for pain… just feel uncomfortable, and you’ll benefit from the stretch. I know… Who wants to feel uncomfortable? Oddly enough, it starts to feel beneficial, and you find your body loves it! A lot of people say, “Stretch before a workout.” But you should WARM UP your muscles first before you go and stretch them. A mild time before a workout is okay, but don’t try to do a full stretch before you’re warmed up. Here’s an example. Think of your muscles as cheese. I know; now I’m hungry too. If I give you a piece of cheese straight from the fridge, you won’t be able to stretch it and pull it, right? Or maybe you will, but then you’ll just rip it apart and nom nom nom if you warm it up a bit. Like in a microwave… You get all the stretch and melt you want without the rip! And then you can still nom nom nom! Muscles are the same, okay. You don’t wish for
B eing from Miami, I have my fair share of experiences with category 3,4, and even five hurricanes. They are not pleasant. They are quite scary. And everyone must know how to prepare for a hurricane. Your emotions can overwhelm you, particularly when you lack family support. Currently, yes, at this very moment, as I write this post, I am without electricity because of Hurricane Sally. Hurricane Sally, a category two storm, unexpectedly struck Foley, Alabama, and this town was unprepared, leaving me without power. And AT THIS VERY MOMENT, I realised how important it is to learn how to prepare for a hurricane. Southeast FL is very well prepared for hurricanes. The cable lines, building structures, and emergency services are all well-prepared. Foley, AL… not so much. Although this hurricane is classified as a category 2, it has felt more like a category 3 or 4 due to the nearby damage, loss of power, and severe floods. This post is not research-based, and it is the first post I will write, which is based purely on my experience with hurricanes. So, if I forget something or you had a different experience than I did and found better ways to prepare, by all means, share them with me. Until then, read some tips on how to prepare for a hurricane from Dr. Vero, an experienced survivor of multiple hurricanes. So let’s get right down to it! Here are 16 tips on how to prepare for a hurricane. Put up your Shutters early. Whether you have actual shutters or purchase plywood to hammer over windows, make sure you start early. The winds are the most dangerous early on. Their speeds can go up to 140mph, depending on the strength of the hurricane. Debris will be thrown around. So, protecting your windows with shutters or plywood is very important to protect your home and everyone inside it. Not to mention it’s also labour-intensive and time-consuming. DO NOT underestimate it. Buy drinking water. Dehydration is very dangerous. Make sure you buy and have enough water to last at least a week, but plan for more. I know it sounds excessive. But when the electricity goes out, you won’t have A/C or fans to work. You will sweat, and you can get dehydrated. You also don’t know how long you will be without power. Buy Food that doesn’t spoil. Buy food that won’t spoil easily and can be quickly cooked without the need for electricity, and if you have a BBQ grill, have extra gas tanks. In Miami, most people have BBQ grills out back. This helps because you can still cook things. My family did. ✓ So, make sure you have extra gas tanks. BUT, if you don’t… then you depend on electricity to cook. This means that anything that needs the stove, pressure cooker, or oven will not be useful. Buy foods that you can eat without having to cook them and foods that don’t spoil easily. Cereals are a good option. Certain fruits are great! It will help you eat healthily, even if it’s unintentional! Bananas, Oranges, Mangoes, and peaches are a few of my favourites. Peanut butter, Nutella, and bread are also good options. ✓ Cans of tuna are also great! Peanuts, mixed nuts, almonds, raisins, and prunes are great snacks, too. You can also get seeds: pumpkin, sunflower, flax, etc. These are just a few ideas. You can also get unhealthy but yummy potato chips, cookies, doughnuts, etc. But don’t overdo it. Stress can make you change your eating habits. Hurricanes are no different. Get a flashlight and batteries. When your electricity goes out, it will get very dark. With dark skies and no power, it can get pitch black. So have flashlights and plenty of batteries. If you have kids at home, the darkness is sometimes the scariest part for them. They hear all this noise outside, but they can’t see what is happening around them, giving them light. Those battery-powered hallway lights are great. You know, the ones you press down on, and they turn on and off. Fill up your car with gas. Even if you don’t plan on going anywhere… Have your car tank full! You never know if you will need to go somewhere to get extra food/water or help a family member. We had to drive to my sister’s house to get water and extension cords. Not a far enough drive to fill out the gas tank, but you never know. Get extra gas in those red containers. This gas can be used for the car but also as a generator if you have one. Powering a refrigerator with a generator eats up a lot of gas. So make sure you pack plenty. Especially if you don’t know how long the lack of power will last. We had to pull gas from our car because our extra fuel ran out trying to power our refrigerator. ✓ Buy a small generator if you can afford it. Lucky for my family back in Miami, we had one. During one hurricane, our power was out for five days. The refrigerator was full of food. But we had our generator and gas to keep it running and keep all our food fresh. Besides, my nephew is asthmatic, and he started having anxiety attacks thinking that he had no power to use his nebuliser. Some medications also need to be refrigerated, so plan for that as well. Buy one or more fans. When you’re out of power, loss of A/C can be very dangerous for certain people, such as the elderly. Our wiser generations cannot tolerate heat well. Having portable fans will help keep a room cool and prevent heat exhaustion and heatstroke. Buy extension cords. Since the generator uses gas, it throws off fumes. You do not want the generator inside the house! Extension cords will allow you to power your refrigerator safely. You can also plug in lights and charge your phones. We were
Importance Of Glucose Control In Diabetes: Depending on how high your A1c is, your doctor may try “lifestyle modifications” first. It includes all the preventive things I discussed in my post, “The Sweet Tea for Diabetes.” Next comes the glucose control. Why is glucose control important for diabetes? Maintaining a healthy diet, engaging in regular exercise, and getting enough sleep are crucial, and it’s likely that you’ll have a follow-up in three months to assess your A1c levels. But sometimes, your doctor will know that even if you do your part, your A1c is too high to start with to reach the goal with just lifestyle changes, or you may have tried the lifestyle modifications without enough of an effect on your A1c. So, they will likely recommend medical therapy. There are many treatment options available, but the most common first choice is a medication called Metformin, provided you do not have any contraindications. As long as you don’t have any contraindications. I’ll think about writing a post on different treatment choices for type 2 diabetes, but let’s put that on hold. Could you please explain the concern regarding elevated sugar levels? Why do you need to control so much? Well, it’s because you want to prevent complications. Let’s go over them. Now, this does not mean everyone with lower blood sugars will experience these complications. It does mean that if you control blood sugar levels for a long time, your chances of experiencing these complications increase. COMPLICATIONS—Glucose Control: These can be divided into an effect on small blood vessels (microvascular) or Large blood vessels (Macrovascular). Effects on large blood vessels include stroke, heart attack, and reduced blood flow to the lower legs. In contrast, effects on small blood vessels include the kidneys, eyes, and nerves. Let’s go over each of these and why they occur, and then I’ll even throw in some complications of uncontrolled Gestational Diabetes. Increased risk of Stroke (Large Blood Vessels) On its own, reducing blood glucose due to diabetes is a considerable risk factor for stroke. There is a 4-fold increased risk of stroke in people with uncontrolled diabetes. This risk is due to the effect of high sugar on blood vessels. Many people who have diabetes don’t know ways of controlling glucose levels, and this results in high blood pressure and high cholesterol. This situation further increases the risk factors associated with having a stroke. Not only is the risk of stroke higher, but so are the number of days in the hospital, the risk of more significant disability after the stroke, the risk of another stroke, and the risk of stroke-related dementia (memory issues). Coronary Artery Disease (Large Blood Vessels): Increased risk of a heart attack. Your heart has its blood supply, called the coronary arteries. Since diabetes affects blood vessels, damage to these blood vessels can lead to decreased blood flow to the heart muscles. Less blood flow means less oxygenation in the tissues. Your muscles need oxygen to stay alive. Significant damage to the blood vessels can lead to chest pain and, in severe cases, a heart attack. Peripheral Artery Disease (Large Blood Vessels) As I mentioned above, your coronary arteries are affected. But you also have arteries that feed your arms, hands, lower legs, and feet. These are referred to as peripheral arteries. At the periphery, get it? Your hands and feet are the most distant from your heart. Your feet are even farther away than your hands. So it takes extra power to supply these areas with blood. If your heart is not getting enough blood because of damaged coronary arteries, it will have a difficult time working well. It means that less blood will be pushed out to your peripheral arteries. If you also have damaged peripheral arteries, your feet will get even less blood. Good healing requires good blood flow. So this can lead to decreased wound healing, therefore, chronic ulcers and infections. It can even lead to amputations. Besides, sometimes walking too much can cause pain or cramping in your lower legs. It is termed ‘claudication’. It sometimes gets better once you sit and rest. It’s kind of like a ‘chest pain’ in your legs. It happens because when you perform an activity, your muscles need more blood, but they don’t get it because of your affected blood vessels. Diabetic Neuropathy It happens when the sugar in your blood coats your nerves. Short term, this is not too bad. But, in the long run, it causes nerve damage and nerve death. Your entire body is full of nerves. Your body contains nerves that sense sensations on your skin, stimulate your stomach for digestion, and even play a crucial role in erections. You might experience sensations such as tingling, similar to the feeling of ants crawling on your feet or hands. You may have issues with erections or impotence. Moreover, you might even notice you have slow stomach emptying, called gastroparesis. It can lead to feelings of fullness after a meal, nausea, vomiting, or acid reflux. Diabetic Retinopathy The long-term high sugar in your bloodstream leads to damage to both the nerves and the arteries that supply your eyes, leading to progressive blurry vision and loss of visual acuity. Diabetes is known to be the most prominent reason for damaged vision in people aged 25–74. Your doctor will likely schedule an annual ophthalmology check to make sure your eyes remain healthy. Diabetic Nephropathy Nephro means kidney, yes, that’s right. Long-term uncontrolled diabetes can lead to kidney damage. One of the leading causes of chronic kidney disease and end-stage renal disease is diabetes. Many of these patients require dialysis to help filter their blood because their kidneys can’t do it anymore. You might experience changes in your urinary frequency and amount. You might also notice swollen ankles or lower legs and even puffiness under your eyes. Remember that some of these symptoms might occur with many other medical conditions. They are not specific to kidney
D iabetes is such a broad topic! I have personally noticed that the general public doesn’t know much about it, other than “you have to be on insulin.” Or, “you got it because you’re fat.” Both are incorrect. Do you know about Mellitus and Type 1 & Type 2 Diabetes? So, I have chosen to write this post to give you all the ‘sweet tea’. We will go over what it is, some of the risk factors, symptoms of diabetes, and things you can do to prevent it. I would add that even if it is a disease, it does not mean that you have no control. There are ways you can help manage your diabetes aside from any medications. Like many others, including high blood pressure or high cholesterol, the beauty of this chronic illness is that your lifestyle and daily habits play a massive role in its progression and control. Despite receiving a diagnosis of a chronic disease, you have the power to take action. So don’t let that keep you down! With the combination of your effort and your physician’s help, you can lead a very healthy life without complications of the disease. It takes a partnership for anything to work, and this includes your health. ✓ Types Of Diabetes: Listed below are the two types of diabetes, but I will be focusing on the signs and symptoms of type 2 diabetes. Type I Diabetes Mellitus Insulin-dependent diabetes mellitus Previously: Juvenile-onset diabetes. Type 2 Diabetes Mellitus Insulin-resistant diabetes mellitus Previously: Adult-onset diabetes. Both types of diabetes involve problems with insulin regulation. Insulin regulates the amount of sugar in your bloodstream. Having too much sugar in your blood for too long can lead to specific health issues, which I will discuss in a different post. The most notable difference is that in type 1 diabetes, the pancreas produces little to no insulin. In contrast, in type 2 diabetes, your pancreas makes plenty of it, but your body is just not responding to it, AKA resistant to it. The treatment of these two types is, therefore, quite different. If your body isn’t making it, such as in diabetes mellitus type 1, treatment would be to give yourself insulin. It is the reason why it’s called insulin-dependent diabetes mellitus. In type 2, your body makes it, but it’s not sensitive enough to respond, so it’s treated with other meds. If blood sugar levels remain uncontrolled, insulin may eventually be necessary, but this is not always the case. DEFINITION OF RISK FACTORS Before I discuss specific risk factors for diabetes, I just want to make you guys aware that there are different “classes” of risk factors. In medicine, risk factors are divided into those you can change and those you cannot change. We refer to them as modifiable vs. non-modifiable risk factors, respectively. Things you can change include your diet, your sleeping patterns, your level of physical activity, and whether or not you smoke or drink alcohol. These are the things you can change. Things you cannot change include your family history (genetics), age, height, race, and ethnicity. Further still, some can be a combination of the two: it can include your socioeconomic status, which can affect your access to health care or even healthier food options. It affects your neighbourhood, which can affect how safe it is for you to exercise outside. Some of these factors can change over time, but in some cases, the changes may take longer than expected, or they might remain unchanged indefinitely. We call these determinants of health. These things can hinder your healthy lifestyle goals, but they don’t affect your motivation. So let’s get started on this sweet topic! Pun intended. Family history of type 2 diabetes If your family members have type 2 diabetes, it increases your risk of developing it in the future as well. ✓ Even though type 1 diabetes can be caused by autoimmune disease, which can run in families, type 2 diabetes has a more robust “hereditary” pattern than type 1. The past medical history of gestational diabetes (GDM) is important to consider. Did you know that being diagnosed with diabetes during pregnancy increases your chances of retaining it or developing it later, even after delivery? Gestational diabetes is a whole other topic for another day, but for it to be called Gestational Diabetes Mellitus (GDM), you must develop it after 20 weeks of pregnancy. Sugar issues during pregnancy are due to glucose intolerance, and most resolve after delivery. But did you know that your risk of developing diabetes is about 3–7 times higher than the average person, even 5–10 years after delivery and the resolution of gestational diabetes? Additionally, infants born to mothers with gestational diabetes mellitus (GDM) face an increased risk of obesity and diabetes throughout their lives. So there is a higher risk of diabetes in both mother and child later in life. Obesity, current or in youth Excess adipose tissue (fat), and in particular visceral (abdominal) fat, increases your risk of insulin resistance and, therefore, type 2 diabetes. Why? There are a few theories on that. It’s believed that visceral fat might cause two things. One, the accumulation of fat in the liver and muscle causes insulin resistance in both organs; and two, visceral fat releases cytokines and proteins that help with signalling in the body, affecting your whole body’s response to insulin. Your liver is responsible for sugar creation (gluconeogenesis) and sugar storage (fatty acids, glycogen, and triglycerides – energy for later use). Insulin stops gluconeogenesis because it is a signal that there is enough sugar in your blood; there’s no need to make more. Insulin also promotes the creation of fatty acids (building blocks of triglycerides). If your liver is resistant to insulin, it won’t be able to stop gluconeogenesis, which contributes to high sugars, while still promoting fatty acid production and deposition as triglycerides. It is the reason why diabetes can also cause high cholesterol and triglycerides. Your muscles are involved
Congrats! You’ve matched. What should you expect as a First-Year Family Medicine Resident? Resident family medicine! Welcome to the best position in the world! You must be thrilled! But right about now, you begin to have questions. First-Year Family Medicine Resident What should I expect? What is expected of me? Is there more than just medicine? One of the most haunting questions I ever had was: “Will I kill someone?” I had the same questions. Except I never got any of the answers. This hasn’t happened yet. Now I know. So I’ve decided to share them. I hope this post helps all of you who are about to start your first year of FM. This post aims to alleviate your concerns or potentially spark new ideas. So what is it like to start a family medicine residency? And what are the hours like? I will say this. To be completely transparent, the hours vary based on your current rotation, the attendings you work with, and the specific program you matched into. This is the experience I have had during my program. Ours may differ. On average, expect to work between 8 and 13 hours a day. You get weekends off during outpatient rotations. And, on inpatient rotations like ICU, Inpatient medicine, which my programme calls adult medicine, and Emergency medicine… You will work six days a week, between 10-13 hours per day. On outpatient rotations, you have clinic hours, 8 am-5 pm. There will be days when you have a clinic for half a day, usually in the afternoon. You are in inpatient medicine, so you must go to the hospital in the morning and return after the clinic to do your PM rounds, finish notes, check on patients, and prepare for the next day. These days are the toughest because you have inpatient notes AND clinic notes to finish. It takes time and practice to get better at time management. You’ll get there. WHAT IS EXPECTED OF YOU? ✓ Punctuality: If you are on the dot…you are late. Be in places 10-15 min early to allow yourself time to set up, turn on computers, and sign on. Etc. Moreover, it shows you respect your position and respect those you work with. Their time is as valuable as yours. ✓ Accountability: Hold yourself accountable for the commitments you make, especially if you forget, make a mistake, or write something incorrectly. Hold yourself accountable. Admit your mistakes and doubts. This allows others around you to trust you and depend on you to follow through. ✓ Honesty: If it’s in your notes, please ensure you have completed it. For example, if you say “no lymphadenopathy” in your physical exam, make sure you’ve palpated the lymph nodes. Trust is not only essential but crucial. While defensive medicine may not be ideal, it’s crucial to ensure that your chart accurately reflects your actions in any legal situations. The chances of you remembering what you’ve done at each patient encounter are low. You will one day refer back to these notes to remind yourself of what you saw, felt, and observed/appreciated. So be honest. ✓ Respect: Be courteous to everyone around you, including cafeteria staff and cleaning staff. The environment you foster will benefit you in the long run. You want to come to work in a pleasant atmosphere. Respect others’ privacy as well as their boundaries! Don’t demand things or “order” them. Request, and then say thank you. You are a team. ✓ Read up on your patients: The best way to learn is to read up on your patients. This includes treatment plans, options, side effects, and benefits, among other important information. This knowledge will benefit your patients in the future and enable you to assist them more effectively. Also, it will make sure you know how to answer questions if you’re ever pimped. WHAT TO EXPECT ✓ Long hours: As mentioned above, some days run as long as 12-14 hours, and if you’re having fun, you may stay later. I’ve done it. The average workweek is about 70 or more hours, with a limit at 80 hours a week. This means that if you reach the 80-hour mark, You must go home. ✓ Some weekends off, You get one day off a week during inpatient rotations and two weekends off during outpatient ones. Make the best of them. Do what helps you keep your sanity! Whether it ‘s the Gym, outdoor activities, family time, etc… Regardless of the activity, engage in it. Do it and be present. ✓ Vacation days: Each programme is different. I have about 21 vacation days, including sick days, so I plan wisely. I haven’t used a sick day yet, but let’s not jinx it. Oh, and no vacations during inpatient services (ER, inpatient medicine, and ICU). ✓ Fatigue: You will get worn out. Very. Personally, when I get worn out, I get emotional and sensitive, and it takes me a bit longer to finish notes and documentation. Know yourself! Know how you react to fatigue, what you need to help it with, and adjust your workday and workflow to account for it. At times, I need a hot bath with candles and meditation music; at other times, I just need a good cry; and sometimes, a quick workout session is exactly what the doctor ordered. Depending on my level of fatigue, I adjust accordingly. I know what I need. It is essential to know these things so that they do not interfere with your work and patient care and that you don’t burn out. So, recognise your fatigue and do something early to help it. ✓ Support: Lean on those around you. You can rely on your co-residents and your family for support. Your attendings. You are keeping things bottled up, which leads to BURNOUT. Don’t let yourself get to that point. You will be surprised how quickly you bond with your class. You will have a village supporting you whether you ask for it or
Now that we’ve given you the basics on the benefits of Cardio exercise, the three different types of exercise you should engage in, and the recommended amount of exercise you should do a week, why don’t we get a little more into what Cardiorespiratory exercise means! If you are unsure about what I mean, do not worry! Just take a quick peek at the video from week 2 to get a brief reminder! Don’t forget that we have an awesome challenge for the week, so keep watching so you don’t miss out on those reward points! So let’s get right into what CARDIORESPIRATORY exercise is. Benefits of Cardio The word tells you what it does: It gets your heart pumping faster and makes you breathe faster. It is considered an AEROBIC exercise. You will break a sweat! Those jumping jacks are right for you! Sweat is good! If you look like you just stepped out of the shower, my friend, it means you did a job well done! Cardio is broken up into two types of exercises: The MODERATE intensity and VIGOROUS intensity. Moderate intensity includes things like Cardio has two types of exercises: – The MODERATE intensity and VIGOROUS intensity Benefits of Cardio Activities such as dancing, hiking, riding a bike, and walking fast are considered moderate-intensity exercises. Vigorous-intensity includes things like Jumping rope, Running, Swimming, Basketball. Burpee, I know those dreaded burpees! And if you’ve never heard of these before, it’s okay! We’ll show you what they look like and how to do them. and in time, you’ll see why they are “dreaded.” ✓ But it feels so good when you’re done. And they work so well to get your heart pumping like crazy! It’s why I mention them here among the benefits of cardio. ✓ Quick thing: Any of the above exercises can be either moderate or vigorous depending on HOW you do them. ✓ Take dancing; depending on the kind of music, dancing can be moderate, like a slow romantic song like boleros, or it can be very vigorous too. Merengue, Salsa, and even vallenatos can be so quick-paced, they will make you break a sweat. Even after just one song, you might end up begging for a CHAIR and a GLASS OF WATER. Not to mention your LEGS CAN GET SHAKY from all that Benefits of Cardio. Been there, done that. CHECK! Then there are those non-typical exercises that you don’t even consider exercise because they are daily activities. These activities include mopping, sweeping, washing dishes, and gardening. Have you ever started sweating while you clean your room or clean your house? Oh, and don’t even get me started on the stairs. If you use stairs instead of an elevator, Up and down the stairs sounds like cardio to me! And it feels like cardio too! You just give that a try and let your family know how you feel! You could even add some music and dance while mopping, which would give you a complete cardio workout! If you’re cleaning your room, do the same! Adding your favorite tunes encourages exercise. Have you ever walked through a gym? Maybe you’ve seen a spinning class happening even on TV shows. The music is so loud! Everyone is sweating; the leader is screaming! It’s almost like a club! But the only thing people are drinking is water! So…how is it that any exercise can be both moderate and vigorous? How do you know which is which? Easy!? If you can gossip with a pal and talk about the latest telenovela or girl or boy problems, then it’s MODERATE… if you can sing… Well, then you’re on your way to joining the turtle club… so pick up the pace! If you can’t gossip because you’re gasping for air and can’t even hear yourself think, it’s VIGOROUS. MUST KNOW In cardio, breathing fast is okay, especially during high-intensity exercise. BUT if you ever feel PAIN in your CHEST or your JAW… stop. Listen to your body! It is smart! If you get dizzy, stop. Rest. Sit Down. Be safe. Exercise is all about being SAFE, having FUN, and being ACTIVE. BUT let’s get back to food. Because I love food, don’t you? Have you ever had one of those days where it feels like your stomach is what we would say in Spanish, “un barril sin fondo”? You eat and eat, and still, you don’t feel full! Ugh!!! It’s so frustrating. I know! And you end up eating very unhealthy things, and then you regret it, and you feel gross, and the next day your pants don’t fit. I know the feeling! Well, how about the obvious! You’re hungry!!!! DUH! Who would have thought that you feel hungry because you actually are? It is clearly normal to feel hunger, so if you are hungry, feel free to reach out for some wonderful healthy snacks. Emphasis on HEALTHY, hello! Okay, but what if you’ve already had an enormous meal and a few snacks, and you just ate a few minutes ago, and you feel the urge to eat everything? Here are a few other reasons why you might feel this way, and trust me. I have been through them all, so you are NOT alone. 1: Boredom: Have you Ever been sitting around with nothing to do, and so you instinctively walk over to the fridge to see what might “entertain” you? So what do you do? Find another distraction! Exercise is pretty distracting, so I would say to do that, ha! But if that’s not what you have in mind, call a friend and meet up with them. See what happens to that natural urge to reach for food when you’re feeling a bit bored. 2: You’re eating less filling food: Foods like refined rice or bread, even cereals, can fill you for a bit… until the energy you get from them disappears, and you understand that sudden need to feed again! Ay! “But I just ate!”
Potassium of Potassium Everyone always says, Health Benefits of Bananas: Eat your bananas to get potassium. But do you know any of the reasons why potassium is vital? I’ll give you a few. A lower risk of strokes lowers the risk of congestive heart failure and overall cardiovascular disease. Potassium is good for? Health Benefits of Bananas in Muscle Building! It helps maintain body growth. Overall, bananas impact the electrical activity of the heart (arrhythmias). Potassium plays a crucial role in maintaining overall health, and bananas are an excellent source of this nutrient. Bananas are a good source of vitamin B6. A deficiency in vitamin B6 can lead to several harmful effects on your body. These include scaling at the mouth (cheilosis for those Curious George types out there!), anemia, swollen tongue (glossitis), depression, confusion, and even lowering your immune function. In children, it can cause seizures (convulsions), among other things. This is why bananas are delicious! Bananas provide 20% of the daily recommended intake of vitamin B6! Might help with Migraines! A study was conducted to evaluate the effect of magnesium on migraines. Infusion of magnesium during a migraine attack resulted in immediate and prolonged relief. Continued oral magnesium may even help prevent frequent migraines. But what does this have to do with bananas? Well, bananas have an 8% daily value of magnesium needed. According to the NIH, low magnesium has been linked to a few chronic disorders, including high blood pressure, cardiovascular disease, type 2 diabetes, osteoporosis, and migraines. Does it serve as a nutritious snack before or after exercise? A study compared the effects of Gatorade versus banana ingestion in a group of cyclists. When cyclists received equal amounts of Gatorade and banana, the results remained similar. However, although bananas had higher antioxidant activity, there was no change in oxidative stress in the body. There was also a higher increase in dopamine levels in the body after banana ingestion, but no effects on the heart. Usually, dopamine increases the amount of blood pumped by the heart (cardiac output), increases heart rate, and increases blood pressure. Still, the levels in the banana after it’s metabolised are too low to have any effect. Overall, even though it doesn’t have a significant impact on oxidative stress from the exercise you do or increase heart function during exercise: It is just as effective as Gatorade for replenishing your energy after a hard workout and can also be consumed beforehand to provide fuel. ????? Benefits of Bananas for Intestinal Health Bananas contain fibres called Pectin and Starch. One of the lesser-known Health Benefits of bananas is that unripe bananas contain more pectin and resistant starch, which helps them stay longer in your intestines and reach your colon—great news for your digestive health! Fibre attracts water and encourages healthy bowel movements. Furthermore, a study found that pectin has some anti-cancer activity and might, therefore, help protect against cancer, and more specifically, colon cancer. ???? It may help with weight loss! For all those calorie counters out there, bananas are your friends! A banana only contains 107 Kcal! Both pectin and resistant starch stimulate feelings of fullness. In fact, resistant starches have proven to promote satiety and weight loss. ???? It lowers fat storage in fat cells (adipocytes) and preserves lean body mass. According to the study from 2014 by Higgins, “retention of lean body mass during weight loss or maintenance would prevent the decrease in basal metabolic rate and, therefore, the decrease in total energy expenditure that occurs with weight loss.” What does this mean? Weight loss usually slows your metabolism by retaining your lean body mass with the help of resistant starches; your metabolism stays the same, promoting more weight loss! Resistant starch is now thought of as a ‘wonder food for weight loss’ because of these properties. Studies also show that people whose diets are high in soluble fibres, like resistant starch, have lower body weights. Meals high in fibre are also lower in fat and calories, which promotes weight loss and maintenance. This is why bananas are often considered a great fat- and weight-loss food! BUT! If you have bowel issues such as constipation, it is best to steer clear of bananas. Some studies show that whether they are raw or ripe, bananas may induce constipation. ???? If a child is already constipated, eating bananas might worsen their condition. It is recommended not to give bananas to children with constipation. Additionally, the FDA advises that people taking diuretics (such as furosemide or triamterene without hydrochlorothiazide) or ACE inhibitors (like captopril) should avoid consuming potassium, which is found in bananas. Why? These medications cause your body to retain potassium. Is having too much potassium just as harmful as having too little potassium? Like I always say! Moderation is the key! Always communicate with your doctors if you have any concerns. SIDE NOTE: Underripe bananas are the best! Especially for diabetics While exploring the Benefits of bananas, it’s important to note that ripe bananas contain more sugar and soluble starches, which is why they may not be the best choice for people with diabetes. However! Under-ripe bananas have a low to moderate glycaemic index, which means that they do not significantly raise your blood sugar levels. Underripe bananas have a glycaemic index of 30, while ripe bananas have a glycaemic index of 60, resulting in an average glycaemic index of 51 for all bananas. A study in 2014 showed that daily consumption of bananas is harmless to both diabetics and patients with high cholesterol. The NIH even includes bananas in the groups of foods diabetic patients should eat to have a healthy diet, and they don’t specify whether they should be underripe or ripe. In summary! Bananas are wonderful! Granted, you eat them moderately! Excessively eating or drinking anything is just as bad as never doing it! Find the balance! And if you have diabetes, don’t hesitate to ask your doctor about seeing a nutritionist. They can help you learn what
Tips For the First Year Of Family Medicine Residency: Congratulations! You’ve graduated from medical school and MATCHED into a Family Medicine Residency Program. You made it! You’ve worked hard, taken your exams, and broken your booty to get to where you are now. ✓ Tips for first-year family medicine Dr. Veronica Rodriguez Family Medicine Resident You can now introduce yourself to patients as DOCTORS! This is the moment of pride you’ve been eagerly anticipating. However, at that moment, you may start to feel as if your body doesn’t belong. Your mind tricks you into thinking, “there is no way I’m a doctor,” “I don’t know what I’m doing,” and “How can I possibly call myself a doctor?” This is all normal. Imposter Syndrome is a real thing. Imposter Syndrome can hit you intensely and linger for an extended period. Cling to it… It will encourage you to read more, pay closer attention, listen more intently, and retain information better. It will force you to become better. So why do we all feel this way? Because We’re Not Wrong. Let Me Explain. When I think of the life cycle of a medical professional, I very much believe it is like that of a frog. ???? Undergrad = eggs. Medical student = embryo. Intern = tadpole. 2nd-year resident = tadpole with hind legs. 3rd-year resident: looks like adult frogs but still has a small tail Attending = frog???? All interns are similar to tadpoles in nature. They lack legs and are still in the process of growing. They’re not yet ready, but they’re on their way. That’s right. I am a tadpole, but I’m about to sprout my hind legs soon! It will be just a few months away. So naturally, you don’t feel ready. Yet, you are. Intern year is a combination of 3rdand 4thyear of medical school on steroids, and then throw in a significant splash of responsibility. ✓ Each patient is yours; their outcomes are yours. It becomes your responsibility to care for them. Has the fear set in? Good. And now, let me reassure you. Despite the fact that you are thrown into this situation completely unprepared, there is a robust safety net in place to catch you if you stumble. Although you are making every medical decision, you have guidance if you don’t know what to do. The key is to recognize when you are unsure about your actions. Believing you know more than you do is more dangerous than admitting you don’t. Your attendings will fill in the gaps in care, add things, take things off, increase or decrease meds or doses, and add diagnoses you missed or just alter them a bit. These patients are yours, but they are also your attending’s, but don’t let that make you lazy now. Family Medicine has the beauty of being all-encompassing, as you already know. We say that Family Medicine encompasses care from birth to death. And although it’s beautiful that we have the opportunity to care for men and women, young and old, pregnant and just born, it means we need to know about everything. This can be intimidating, particularly when you begin seeing patients in the clinic independently. From day 1, You see your patients in the clinic. You start with two a day and gradually increase the number you see. This exercise will help you not only get the hang of clinic flow but also find your rhythm, learn time management skills, and realize how difficult it is to see a patient, examine them, diagnose them, treat them, and counsel them in only 15–30 minutes. But you will get here, I promise! I am already seeing 5-6 patients, and honestly… it took much longer when I only had 2 HA!’ Let’s not forget that although family medicine has all the above-mentioned, we also focus on preventive services. This includes colonoscopies, mammograms, pap smears, AAA screening, Hep C screening, diabetes screening, depression screening, alcohol use screening, smoking, flu shots, pneumococcal vaccines, and beyond… and eventually maybe a coronavirus vaccine too. It can be difficult to discuss every one of these items in one visit, and it’s not because of the time constraints. It’s because they should all occur in different age ranges, different demographics, earlier for special reasons, or not at all because of age. Additionally, you must access all of these elements simultaneously to ensure your clinic operates smoothly. It takes PRACTICE! You will eventually become adept at it. One tip I have learned from my attendings is, “Don’t wait for tomorrow; what can be done today?” This means that even if the patients are there for a sick visit, you should mention these screening tests and offer referrals so they can stay up to date and schedule return to the clinic (RTC) visits for procedures. Think ahead. Keep your patient’s health up to date. ✓ It is not their job to know what they should be getting done, although it would help if they did. It is YOUR job to know and to offer it at every visit, even if it is declined every time. And don’t forget to DOCUMENT the offer and the fact that they declined it every single time. Code Furthermore, learn your coding. Huh? Each clinic visit needs a code. It is how patients are charged, so your clinic can bring in the money. New patients and established patients get different codes. Well-child visits get different codes. Procedures have different codes. Modifier codes show you did something not covered in the first code. It can be daunting. But you will get it, I promise. Ask your upper levels for guidance or if you’re attending. The last thing about the clinic is this: At times it feels as though you are out there on your own. It is scary to be responsible for a patient. What if you forget to mention something is important? What if you forget to ask a question that is pertinent? What if you forget to talk about a screening test? Etc. Your mind will race. Fortunately, it’s mandatory to discuss every patient
As I was working in the ER, I honestly did not have enough time to truly evaluate how social distancing affected people. Now that I am out of the ER, I have had some time to think. ???? And another thing that makes me think about this term is “Social Distancing During COVID-19”. Social Distancing During COVID-19 I’ve realised a few things. Although social distancing is a way to reduce the spread of coronavirus, it is also affecting people in multiple ways. We are social beings. We thrive on social interactions. There is a reason why premature babies who are put together in the same crib have better outcomes than those who are in their personal ones. And as much as some of us enjoy alone time, that time is usually optional. Social distancing can lead to social isolation, and perceived isolation has been shown to increase a person’s morbidity and mortality. It means it affects your health in more ways than one. So when you hear the word social distancing, I’d like to make a change. Let’s change that to Physical Distancing. I don’t want any of you to perceive yourselves as isolated or alone, because you’re not. The rest of the world is with you, living through the same thing. ???? Despite the need for physical isolation, you DO NOT need to be socially isolated. But that is not the only thing happening this time. There are no restaurants, concerts, ball games, or social gatherings at places like churches, synagogues, or temples. The shutdown also means GYMS are closed and public pools and beaches are closed. What activities might you consider engaging in during this period? Unfortunately, the fast-paced nature of life has stifled our creativity. We never had the time to find new ways to spend our time, what with our jobs and bills and social media/technology, Netflix, video games, etc. Time was never in our favor. Now, it seems time is standing still for a brief moment. So what can you do? Consider the obvious first, followed by the less obvious. Exercise This information probably does not come as a surprise: I promote exercise. But I do it because, as you may have already read in my other blog posts, the benefits of exercise are NOT ONLY physical. They are also emotional. They reduce symptoms of depression. It can be an excellent outlet for anxiety, fear, and anger. Get endorphins roaming through your bloodstream and making you feel “good”. And we all need a little bit of that, especially now. Does it matter what kind of exercise you engage in? NOPE. As many of you follow the orders to stay indoors and stay 6 ft from others, here are a few awesome choices to get that blood pumping: You can engage in yoga, go for a run, use an at-home gym, engage in YouTube workouts such as High-intensity interval training (HIIT), or even play video games like Wii Fit. How about playing some music at home and just dancing? (I did this recently… felt so good!) Retrieve your old DVD workout videos, such as P90X or similar titles. If you have a pool, go for a swim. Walk your pets! Play with your kids! Do laundry, clean the house, etc. Seriously! You will benefit from working out and having a racing heart. Eat Right A balanced meal is the best way to stay in shape. Exercise helps, sure, but we all know that staying fit is 70% diet and 30% exercise. SO, eating the right thing is a wonderful way to keep your energy levels high, avoid the midday crash, and make sure you don’t need to go on a shopping spree for a new wardrobe that fits properly. Why do I say this? I know…that with boredom comes so many other things, including walking over to the fridge multiple times a day to then sit back down on the sofa or lie back in bed. It happens. This explains the prevalence of TikTok videos featuring people frantically running from their beds or couches to their fridges and back. The best way to maintain your true self during this time is to eat plenty of colorful, fresh foods. The brighter, the better. They should make your mouth water! You’ve nailed it! That’s right… veggies, fruits. Stick to your healthy eating habits as much as you can during this time. What you eat can affect your energy, your mood, and your self-esteem (especially if it changes your physique). Overeating can also lead to acid reflux, indigestion, and abdominal discomfort. A diet low in fruits and vegetables results in low-fiber intake, which can lead to constipation; this condition is uncomfortable, particularly for those who are typically very regular. Explore the coronavirus impact on media and changing communication trends. Get Enough Sleep If you haven’t had the chance yet, I invite you to read my post on sleep deprivation and its effects. If not, feel free to do so. However, allow me to provide a brief overview. Sleep affects your energy level, but it also affects your mood, your appetite, your concentration, your ability to multitask, and your patience. Insomnia can cause depression and vice versa. Your body and mind are connected. Disturb one, and the other is affected. This is why getting adequate sleep will be so crucial for not only your physical health but your mental health as well. But why am I even mentioning this? You used to have a schedule. Be up at a certain time; be somewhere at a specific time. So naturally, you went to bed at a particular time. BUT…now there is none of that. No schedules for many of you, so there is no reason to go to bed early or wake up early. This affects your sleep, and it will affect all the above-mentioned things too. Stay Social How? Technology is a two-sided sword. Although it can alienate you from active life, it can also keep you connected even when you’re not. Consider downloading a few applications to keep you
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