MINDFUL OF MEDICINE

Hi everyone! I wanted to write at least one more blog post before taking my step 1 - study hiatus from the blog.

Anyone who knows me would tell you that I’m obsessed with skincare. Seriously, I love skin. I’m not much of a makeup person but that’s because I feel that the best makeup is actually just great skincare. My love affair with all things skin-related started while working as a clinical assistant in a dermatology practice during my last year of college. I had always taken care of my skin, but working there took my commitment and knowledge of skincare to a whole new level. It taught me a lot about mainstream “beauty” products and the false hope they give consumers. I also learned a great deal about a holistic-approach to beautiful skin - that means what you put in your body is just as, if not more, important than what we put on our skin!

It’s now Spring and that means more sun exposure and hotter temperatures in the months to come. That also means that the protection and nourishment we give our skin should be amped up accordingly. Naturally, avoiding unnecessary sun exposure is key to preventing DNA damage to our skin cells and photoaging. So that should be a top priority regardless of the season! I'm always thinking of new ways to improve my skincare regimen, and I've narrowed down my summer essentials to these 4-must haves.

Protect + Prevent. The best treatment is prevention. The environment can be quite harsh on your skin. And though resilient, skin is sensitive and needs to be cared for just as you would any other organ system - its the largest organ system, afterall! Damage to your skin can lead to obvious things like sunburns and aging, but also more insidious diseases like skin cancer. Basal cell carcinoma of the skin is the most common cancer in the world. The skin can also be affected by squamous cell carcinoma, and melanoma. The common factor behind all of these conditions is UV radiation from the sun.

Sunscreen. Make sunscreen your best friend and apply it to your entire face and neck every morning - even if you think you’ll be inside all day or if it’s cloudy out. Your skin will thank you now and in 20 years when you look younger than your peers. And if your activities require longer than minimal sun exposure make sure to re-apply accordingly! I make sure to apply sunscreen to my face, neck, upper chest and hands every morning. I’ve been using EltaMD UV Daily SPF 40 for the past three years and I love it. It’s light, moisturizing, and invisible under makeup or with a fresh face. It provides a physical UV block with Zinc Oxide, as well as a chemical block with Octinoxate. Whenever possible, try to find a sunscreen with a physical block, as chemical blocks can be irritating and unstable when exposed to UV. It is best to wear a sunscreen that is at least 30 SPF or higher to block both UVA & UVB rays.

C E Ferulic is an antioxidant combination that gives you an extra level of protection from photodamage by neutralizing free radicals. It also increases the firmness of your skin and erases hyperpigmentation (dark spots) over time. The really great thing about C E Ferulic is that it absorbs into your skin and remains effective for at least 72 hours. I try to incorporate this topical into my daily regimen as often as possible, but it is an absolute necessity in the summer months. The SkinCeuticals brand is super expensive, however. So I use a dupe by Skin Care Solutions which has the same formula and gives the same results.

Moisturize. No matter what your skin type, moisturizing is essential to maintain the integrity, firmness and health of your skin. Moisturizers increase the skin’s hydration by preventing evaporation. I discovered LUSH’s moisturizers last year and I couldn’t be happier. I’ve always had issues with moisturizers that sting or fail to soothe my face, and the list of ingredients on most products is overwhelmingly complex. My favorite LUSH moisturizer is Celestial. Vanilla water, almond milk, and dove orchid extract come together to keep your skin soft, soothed and glowing. LUSH is also a cruelty-free, vegan and fights animal testing - what’s not to love?

Correct. I get a lot of questions about skin from classmates and friends and the one thing I can’t stress enough is the importance of a retinoid. If nothing else, everyone should use a sunscreen and a retinoid. Topical retinoids pass through the cell membrane and mediate their effects by switching on genes that increase collagen production, increase vascularity and blood flow in the dermis (the deeper part of skin), and enhance the shedding of skin cells with excess melanin (fighting hyperpigmentation). The addition of a retinoid to your skincare regimen will correct past damage and make your skin more resilient to new insults. Ideally, people should start an anti-aging regimen at the age of 21, but it is never too early or too late to start protecting your skin appropriately. If you’re in the US, medical insurance will cover at least a portion of the cost for retinoid prescriptions up to age 30. If you’re over 30 or simply don’t want to get a prescription there are many high-quality retinoids on the market, like SkinCeutical’s. When starting a retinoid, begin with application once a week and work your way up to nightly applications as your skin starts to tolerate it.



A daily routine using these products looks a little something like this:

Morning

1. Cleanse face with cleanser of choice, I like Cetaphil’s Normal-Oily Cleanser


2. Apply 4-5 drops of C E Ferulic to face and neck, allow to dry for 2-3 minutes


3. Apply sunscreen or moisturizer+sunscreen mix


4. Optional: non-comedogenic foundation, like this one

Night

1. Cleanse face, pat dry


2. Apply moisturizer


3. Apply a pea-sized amount of retinol to face and neck

As with anything, make sure to read labels and instructions of individual products. Good things take time so don’t fret if you don’t see changes right away. If your skin is sensitive don’t try to add too many products at once, instead introduce changes to your routine slowly.

Have a great week  

Hello and happy Monday!

As I move into the last couple weeks of second year (crazy!) and prepare for my 6-weeks of board studying I’ve been really thinking about how I’m going to maintain my fitness goals. It’s somewhat of a med student inside joke that your body turns into a jiggly, out of shape blob during board studying. That doesn’t super appealing and so I’m committing myself to staying active, and not falling into that trap.

A meta-analysis in the Annals of Internal Medicine recently reported that sedentary behavior is not, in fact, completely neutralized by exercise. That means that intense exercise doesn’t make up for all the intense sitting we do all day! It’s more about maintaining a level of activity during the day on top of our dedicated “workout” time. It’s kind of scary to think of the damage we do to our bodies by sitting all day. It’s somewhat ironic that while I study and learn to be a healer, I’m simultaneously compromising my own health by being so sedentary. Luckily, there are so many ways to get around that!

I recently rediscovered Blogilates by Cassey Ho. Blogilates is an amazing fitness resource and it’s totally free - all you have to do is sign up for their newsletter in order to unlock the exclusive workout plan for the month. There are other features that don’t even require an email  like her meal plans, ab/thigh/arm challenges, workout calendars, before & after stories, and even recipes. I admire Cassey’s story  and her ability to bring something she is so passionate about to life! I personally love pilates, but classes can be really pricey. Cassey’s signature “POP pilates” style isn’t only free, but it’s pilates that you can do anywhere, whenever. All you need is a mat and some motivation!

One of my favorite workouts is her Pick-Me-Up Quickie Workout. I’ve been using it as a healthy study break!

[embed]https://www.youtube.com/embed/PySN5tabiLQ[/embed]

My typical workout regimen is composed of 4-5 60-minute sessions on my elliptical while watching lectures or occasionally some Netflix. Although using my elliptical at 100% incline and the highest resistance is a fantastic cardio workout, it can be hard to target other very important muscle groups including my core and arms. I’ve been sticking to my elliptical workouts and have seen some great results as far as getting leaner and having more energy in general but I’m excited to incorporate Blogilates to my routine. I’m going to start the April “Aprilates” schedule today after my elliptical workout!

Since coming off my meds I have a newfound motivation for fitness and wellness in general. I’ve been making some adjustments to my diet that I hope will be easily maintained long-term, and I look forward to blogging about it. Living a healthy lifestyle is just that - a lifestyle. That means making lasting changes and truly committing yourself to doing what is best for your your body, mind and soul. We are multifaceted beings and the care we give ourselves should be, too.

Have a wonderful, productive week!  

Two weeks ago I got a second chance, alhamdulillah (thank God). But in order to understand why that’s so important to me, I’d like to share some of my story.

Back in November of 2009 I was 18 and barely settling into my role as a college student. I was performing well in my courses and genuinely enjoying that new stage of my career. Except something wasn’t right. For a few nights I had stayed up coughing until one day I coughed up a handful of blood. My good friend and roommate was very concerned and told me that if I didn’t go to the doctor the next day she was going to call my mom. And so, I scheduled an appointment for later that month.

November 27th was a day I’ll never forget. After reviewing my xrays that showed a large, circular shape, my primary care physician nonchalantly told me it was likely not benign and I should prepare myself for a diagnosis of a tumor. When I asked what to do next, she said I should “probably find a pulmonologist”. I don’t remember anything else from the visit, my memory of it literally stops there. I was confused, scared, skeptical, sad. I had never been sick before and, being someone who likes to plan ahead, not knowing how to proceed was terrifying. I drove home with my mom in silence. I thought about all of the things I wanted to do and might not get to. I thought about my dream of being a doctor and the irony of getting hit with a possible cancer diagnosis. I thought about God. I thought about my family. I prayed.

The next day I was back in my dorm room, frantically calling every pulmonologist in town. They were all booked for the next several months and I felt hopeless, and frustrated. I decided to call one more office. When the receptionist picked up I told her my story and before I even realized, I was crying. Hard. I couldn’t help it. To my relief she said they had an appointment in February and I was so relieved. But it also meant that I had to spend the next two months in a state of absolute uncertainty, not knowing what was wrong with me all while feeling ill, fatigued and coughing up blood every time I tried to lay down or exerted myself.

Those two months were life changing, though. I finally learned what it means when God’s plans truly deviate from our own. Whether you are religious or not, we all must face the fact that there is a force greater than our own; and in order to get through struggles we must submit to it, accept our weakness, and grow. I remember sitting on a bench during final exams that December reading my favorite book of all time (The Shadow of the Wind, by Carlos Ruiz Zafon - check it out). It was sunset and it was quite chilly out. Campus was almost empty and the air was quiet. And so, I sat there. I’ve never felt more peaceful in my entire life. I had accepted that I had no control over what happened next. I was happy, really genuinely happy. I also began to understand the beautifully ephemeral nature of this journey we call life. As a gift to myself I decided I would finally do something I had planned to do for years: I embraced Islam and became a practicing Muslim on Valentine’s Day 2010, just a few days before I saw my pulmonologist. I figured whether I had 1 or 100 years left on this Earth I would worship in the way that best suited me, I would strive to become a better person, and generally work to maintain my inner peace.

At my appointment we reviewed my CT scans and almost immediately my pulmonologist said, “Oh, that’s cocci.” (Coccidioidomycosis, also known as “cocci” or Valley Fever, is a disease caused by the dimorphic fungus coccidioides). At the time I was relieved to hear anything but the word “cancer” come out of his mouth. Little did I know this new diagnosis would send me on a longer journey than I could have ever anticipated. After some confirmatory labs, I started antifungal therapy.

I spent the next two years coughing up blood almost daily while my body deteriorated into someone I didn’t know. I had always been active, playing competitive volleyball year round, running, and swimming. I had prided myself in how strong my body was. And to see myself transition from fitness to someone who couldn’t take 10 quick steps, or lay down without coughing up a bunch of blood was heartbreaking. Nevertheless, I pushed through my first two years of university and did really well. On the surface you wouldn’t know how sick I was. How worried my family was. If you met me you’d think I was an over-achieving, stressed out premed who went to school, worked, volunteered, did research and generally enjoyed life. And all of those things were true, but there was something insidious and inescapable beneath the surface. Most days, I didn’t let my sickness become an inconvenience. That was a good thing, but often it was bad. I didn’t take care of myself the way I should have. I didn’t rest enough. And I paid for it all. Meeting my husband, J,  a year into my diagnosis was a blessing in so many ways. In terms of my health, he really pushed me to rest, eat well and take it easy. Even though we were long-distance he would call to make sure I was going to bed on time, or make sure I was going to Urgent Care when I had a bad flare up. J was the first person I ever listened to in terms of taking care of myself. And even that was hard for me! Afterall I’ve never been one to admit weakness or let anything get in the way of my plans. But getting sick will make you question everything you know about yourself.

J was also the reason I decided to find a new pulmonologist. Dr. P was a genuinely kind person. He was also thoroughly confused as to why my condition hadn’t resolved with two years of antifungals (most cocci cases are self-limiting even without treatment, but I am part of a lucky 5% of cases that get a bit more complicated!). He sympathized with me and was a stark contrast to my primary care physician who had delivered an (incorrect) diagnosis of cancer in a cold, uncaring way. Dr. P was a hero to me, I remember him taking my hand and saying “I’m sorry you’ve been through so much, I’m going to make sure you get better.” He called his friend (an infectious disease specialist) and personally asked him to see me the next day. This was a positive change in my medical management. Together my two new doctors consulted cardiothoracic surgery to have the cavity in my lung removed.

On December 23, 2011 I had a large portion of my right lower lobe removed. The recovery was really tough but I felt infinitely better almost immediately. I remember my dad telling me, while I was still in the hospital, “Wow, you’ve already got your color back” - being hypoxic for two years will do wonders for achieving an off-green complexion!  Four weeks after surgery I was in the gym jogging for the first time in two years. That was also the same time I started studying for my MCAT. Even though I was still on medication and my scars were still healing from surgery, I could see my body returning to some semblance of what it once was before I got sick.

My disease has been a backdrop for the most important events in my life. In the two years that followed my surgery, I continued pushing through school, traveled, studied abroad, got married, and started medical school. Having being diagnosed with cocci when I was 18, I’ve grown into an adult with it by my side. It’s been a constant part of me and shaped my worldview. It has influenced the decisions I’ve made, inspired me, broken me, and challenged me. And, most importantly, it will always be a part of me.

And so, as of two weeks ago, I feel as if I have been given a second chance. I am no longer on my antifungals. Getting off my meds has been something I’ve wanted to do since my surgery, but my labs didn’t suggest that would be safe to do. My labs have been stable for a year and my doctor consulted with other Valley Fever specialists to come to the conclusion that it is worth trying to discontinue them given that I’ve been asymptomatic since my surgery. In reality, any symptoms I had experienced were all side-effects from high doses of my meds. From now on I’ll be getting labs drawn every 6 weeks to make sure it’s still safe.

I cannot explain how important and exciting it is for me to be coming off my meds. Taking my meds twice a day was a constant reminder that something was wrong. And when you do that for nearly six years, it becomes a part of your being. Physically, I’m looking forward to a few things: my hair growing back into it’s thick glory, my skin no longer being super dry, my nails getting strong, my hormone cycle getting back to normal, and giving my liver a much-deserved break. Mentally, I feel very blessed to have survived my worst days and look forward to making the most of my new healthy ones. Most importantly, I’m grateful to have a second chance to maintain my health and take care of my body. I am excited to start a new “healthy” chapter with my husband because he’s only ever known me when I’ve been sick or on medication. He pushes me to be healthy and make good choices, and I owe it to him and myself to live up to that.

Whether we are faced with difficulty or blessed with happiness, I’ve learned that everything is a temporary state and will end at some point. So it is important to recognize the lessons we are supposed to learn and use them as an opportunity to grow. Every chapter is a second chance at something, and I’ve learned to make the most of whichever one I’m in.

 

 

Happy Sunday!

I hope everyone had a wonderful weekend. I can’t believe it’s already mid-April, where does the time go? Recently I’ve been thinking of what pieces I need to add to my wardrobe to prepare for my third-year clerkships. I want to put together a more professional wardrobe so that can seamlessly transition from day to night. I’ve been sitting in lectures and studying for two years, and I’m so excited to be out and about!

So in order to add versatile pieces I’ve started shopping for one or two pieces every couple of weeks. Last weekend I found this nude shirt by Ro & De at Nordstrom Rack and absolutely love how flowy yet structured it is. It also drops down in the back for a more modest look. I picked up my pants at H&M a few months ago and they are my go-to professional pants for all my clinic activities. I love that they are full length and don’t stop above the ankles. This outfit can be worn with flats for a day in clinic or heels for a more dressy look. I wore it out for a friend’s birthday last night and loved how polished it all looked together!

 

 

Have a wonderful week  !

What I'm wearing:

Shirt: Ro&De , Pants: H&M, Purse: MK (color no longer available online, others here), Shoes: Chinese Laundry

Happy Friday, everyone!

I thought I would share my recipe for another quick, filling breakfast. Except this one you can take with you during your busy mornings! Most days I have enough time to make myself breakfast since I'm podcasting my lectures and studying for boards. But some days I have to run out of the house early in the morning and I need something quick to take with me. After doing some research I found this vanilla hemp protein by Nutiva back in December and I've loved it ever since. I had never bought any other protein shakes since I'm always a little skeptical of processing and quality standards. Nevertheless, I like Nutiva's mission statement and the ingredients of the protein shake itself. Plus I think it tastes wonderful and isn't too sweet! One package usually lasts me about 7 weeks if I use it three times a week.

 In order to get an added boost of fiber and some omega-3 fatty acids I throw in a bit of ground flax seed. Ground flax seed is flavorless and so versatile - you can add it to yogurt, smoothies or even thicken up some tasty sauces! As a base for my smoothie I use a one part almond milk and one part water to prevent it from getting too thick. Overall I've found that this combination of nutrients really helps keep me full and focused during my busy mornings. It's all about what works for you!

Things you'll need:

- some kind of blending device to get the mixture to a semi-homogenous consistency (I use a blender bottle)

- 1 cup almond milk {90 calories, 1 g protein}

- 1 cup water

-. 3 tablespoons hemp protein {120 calories, 5 g fiber, 10 g protein}

- 2 tablespoons ground flax seed {70 calories, 3 g fiber, 3 g protein}

Directions:

- join and blend all ingredients

Total protein - 14 g

Total fiber - 8 g

Calories - 280

   Enjoy  

Your daily life is your temple and your religion. When you enter into it take with you your all.                                 - Khalil Gibran

Hi everyone! I can’t believe I’ve taken a 5-day hiatus from posting here on the blog. I guess time really does fly when you’re busy. These days I’m finishing up my last block of second year while studying for boards. While my “dedicated” 6-week board study period won’t start until May 1st, I am still trying to get through all of the Step 1 material at least once before really diving in. Being in the midst of a crazy study schedule, it’s easy to get stressed without even realizing the toll your body and mind take. Self care is such an integral part of success but it is often overlooked. Learning to recognize high-stress levels and managing how you deal with it is a skill you learn only with experience. It’s all about knowing what works for you. So here are some tips on stress relief, prevention, and management especially for stressed-out students like myself!

Mindfulness. In our busy lives it is incredibly easy to lose sight of the bigger picture. Our exams and goals consume our thoughts, and though they are essential on our path to academic / career success, they are part of a bigger whole. And nothing is more essential to that “whole” than the integrity of our inner peace. Mindfulness is a state of being present and calmly accepting life as it comes while remaining conscious and aware. Stress is a motivating factor if directed appropriately. As students it is important to acknowledge when we are stressed, and be able to direct that energy in a positive way. Whether that means re-organizing your study schedule or taking a day off, the main goal should be to take care of yourself holistically.

Environment. Setting up your study space to include as few distractions as possible is so important. That means putting your phone or other entertainment outlets out of reach, turned off, or in another room entirely. Minimizing distractions helps you study more efficiently and prevents you from wasting time that will amount to stress in the form of extra studying or re-reading something you didn’t focus on the first time around. Your physical location is also a big factor. I personally don’t like to study at the library and only rarely do so. Nevertheless, regardless of where I am - library or home study space - I make sure I have natural lighting near a window. Feeling “connected” to the outside world relaxes me and reduces my anxiety while spending countless hours confined to my desk! In terms of auditory stimulation I have found two wonderful resources. When I’m doing my “normal” intensity studying I like to listen to the sound of rain, since even classical music distracts me. I’ve used ambient mood sounds since undergrad and it really works for me. You can find other ambient mood sounds here. When I’m really focusing, like when I’m going through practice questions, I like to block out all sound using ear plugs. This is to simulate the conditions of taking Step 1 (or the MCAT) where noise-canceling devices are offered.

Breathing. More often than I’d like to admit I catch myself feeling what I would describe as “clouded.” And then I realize I’m not breathing properly. Breathing is something we do all day everyday, but did you know that it is one of our - if not the most - potent tools against stress? Focused breathing elicits what The American Institute of Stress calls the “Relaxation Response.” This is described as a state of deep rest that changes the physical and emotional responses to stress including: decreased heart rate, blood pressure, respiratory rate and muscle tension. A list of mindful breathing exercises can be found here. My favorite is the 4-7-8 exercise, especially before bed when I’m trying to quiet my thoughts.

Exercise. We all know that exercise is vital to our health and well-being. On average you should be doing active, cardiovascular exercise for 150 minutes a week for maintenance of muscle mass and cardiovascular function. Engaging in exercises that you genuinely enjoy is key to maintaining a sustainable exercise regimen. Exercise can also be a wonderful source of stress relief, management and prevention! Our bodies are beautifully intricate machines that should be taken care of in order to function optimally. With my busy schedule I have found that studying while exercising is an excellent use of my time. Not only is it efficient but it actually helps me learn and retain things longer. I podcast my school lectures or watch Pathoma lectures on my iPad while working out on my elliptical for around 60 minutes Monday - Friday. Some days I don’t have to watch any lectures and I get to treat myself to Netflix while working out! If I had more time on my hands I would probably go to a few classes at the gym but since I don’t, this works for me and keeps me fit. It’s all about what works for you! Remember your body will only help you if you take care of it. Exercising meaningfully and regularly helps bring nutrients and oxygen to your brain and other organs, increases energy levels, and pushes you to make healthier choices everyday.

Hydration. If you’re ever feeling sluggish or just not well in general, chances are you’re dehydrated. Ensuring that you’re drinking enough water is vital to maintaining proper perfusion of your tissues - especially your brain! It will help you function better and think more clearly. Most of all, it will help you feel good and increase overall performance. Cutting out all non-water beverages is a great strategy. I’m not a coffee drinker myself but many students are. I personally drink lots...and lots, of green tea. But drinks like coffee and green tea contain caffeine, which is a diuretic (causes your body to lose water). One way to curb this is to drink an equivalent amount of water for every amount of coffee / tea on top of your required water intake for the day.

Nutrition. Your body functions only as well as the quality of food you nourish it with. I’ve always known that nutrition is the biggest part of maintaining a healthy body but it became even clearer after my first year of med school where I spent countless hours working on my group’s cadaver. I truly realized that the human body is strong, yet fragile. And it was absolutely astonishing to visualize the processed junk we put through our bodies expecting our tissues to bear such a burden without any consequences. Be mindful of the food you are putting in your body. Try not to eat things that are refined or have been extensively processed. I try to eat a more plant-based diet, high in protein, and low in saturated fats.

Quality time. I like to spend time with my husband whenever I can. Sometimes I’ll even take a day off from studying to hang out with him. He’s my best friend and spending time with him is always a stress reliever. I also get to vent about what’s bothering me or listen to him tell me about what he’s stressed about. Spending quality time with the one you love is a great way to get away from the stresses of studying and reminds you of what’s really important in life!

Limits.  Above all, preventing, relieving and managing stress is about knowing your limits. If you are feeling stressed, take a step back and assess what you could be doing to improve your situation or mindset so that you can deal with the stressful factors in a more meaningful, positive way. It’s all about giving yourself the best possible chance both physically and mentally.



 

It’s Wednesday and that means the possibility of mid-week blues. Fortunately there’s a remedy - delicious, quick homemade pizza!

Being so busy but also health conscious I’m always looking for quick, healthy, and nutritious recipes. That doesn’t always mean going out and buying things specifically for one recipe since that takes extra time and money. Instead, I try working with what I already have available.

During the week I go grain-free and on weekends I’ll allow myself to have 1-2 meals that have bread or other grains. And there are times, like this past weekend, where I crave pizza. I mean, who doesn’t love pizza? Delicious pizza doesn't mean it has to be overly greasy or unhealthy, however. So instead of going out for pizza, I decided to make it myself using pita bread and a few other fresh items.

Ingredients:

4 pieces thin pita bread (about 8” in diameter)

1 cup marinara sauce

1 cup shredded mozzarella cheese

½ bell pepper, thinly sliced

1 cup sliced green olives

1 cup sliced black olives

1 cup sliced mushrooms

2 sliced jalapeños

Directions:

1. Start with a clean work surface

2. Preheat oven to 350°F

2. Add ¼ cup of marinara to each pita and spread evenly

3. Add your choice of veggies and cheese

4. Place pizzas carefully onto a large baking sheet

5. Cook for 20 minutes, or until the crust is golden-brown

6. Add garnishments - I added some chili flakes!

The finished pizza will be crisp and deliciously thin.