MINDFUL OF MEDICINE

Happy Father's Day, everyone! Though J is a daddy-to-be (or a baba-to-be as we like to say), I know he'll be the best father in the world and I can't wait till our little guy is here. I can't believe that our baby shower was just a few weeks ago, time has been flying by these days. I wanted to share some pictures from the shower as I felt so loved and special that day!

J and my two best friends worked secretly for months to put together the baby shower of my dreams - I'm so grateful! My day started off with a prenatal massage (a gift from my wonderful mother-in-law) which was amaaaaazing - seriously, they even had a special prenatal massage bed where I got to lay on my belly (if you've ever been pregnant you'll know that this is a luxury since you can't sleep on your belly without feeling like you're squishing your baby and crushing your insides ;). After my massage I could've taken a 6-hour nap from how relaxed I was, but, alas, J wanted me to feel beautiful and had me scheduled to get my hair done - rough life, I know. By the time I arrived home, I was expecting to see the finished product of the baby shower I had been waiting for, but there were still things to be done before guests arrived! It was actually fun to be part of the pre-party decorating frenzy, including a helium tank without enough helium, balloons that wouldn't stick to the walls, and a sad attempt at filling metallic balloons with a bicycle pump. Oh the drama! Nevertheless we managed to get everything in order and the most wonderful baby shower started right on time :)

[caption id="attachment_879" align="aligncenter" width="960"] These balloons refused to stick to the wall so J had to perform some of his engineering magic. I also finally got to try sangria which always looks so tasty but usually has alcohol, boo.[/caption]



 

[caption id="attachment_878" align="aligncenter" width="960"] So many future female doctors in one picture![/caption]

 

[caption id="attachment_876" align="aligncenter" width="6000"] This cake was, hands down, the most delicious cake I've ever had at a party.[/caption]

 











[caption id="attachment_868" align="aligncenter" width="6000"] J got us a copy of Love You Forever, only the saddest book ever :)[/caption]

 

 

Hello! It's been a little bit since I've posted. I feel like peds was even more busy for me than internal medicine, hence the slacking in the blogging department - oops. I'm now on family medicine and I can't believe I've only got 5 weeks left until the first half of MS3 is over!

I've wanted to share a post on being married in med school since it's one of the most frequent questions I get. Every marriage/partnership is unique so I'm not declaring myself an expert on the subject. But these words are from my own perspective and my hope is that they might apply to other couples out there as well! But first, a little background.

J and I met back when I was a sophomore in undergrad in February 2011. After just a couple of weeks of talking (we were long distance) we knew we wanted to spend our lives together. But, more importantly, we wanted to build a life together from the bottom up. He knew my vision, I knew his and soon they became one. That summer that followed we were married religiously (also known as a katb kitaab) at his parent's house in beautiful North Lebanon. A year later, we had our wedding and we moved in together right before I started med school and he started his masters program. I guess I'm sharing all this to give some background and to give an example that a marriage isn't built overnight, and that it takes years to achieve things; whether that's finally getting to be together after years spent half a world apart, or goals like higher education, career building, and even surviving med school.

As a couple, we are each other's best friend / support system / biggest fan / you name it. We are equal partners in life and have always tried to approach challenges and blessings in this way. Our approach to medical school has been no different. Since starting my first semester of med school, J has always encouraged me to do my best while going out of his way to help me find time to study. To be honest, he's a super competitive person (and pretty brilliant I might add!) so he's often more intense than I am, lol. First and second year were pretty relaxed in terms of time commitments, though I did have to study a lot. Still though, I made my own schedule (should have enjoyed it more when I had the chance!) leaving us with plenty of free time for ourselves. Then came Step 1, also known as a the most mentally brutal and intellectually challenging time of my life. J did his best to ensure that I had time to study and less things to worry about like cooking, cleaning, and running errands. And now I'm almost 6 months into my third year which has been a totally new dynamic for us. Third year entails a lot of hours, on good weeks that means 40 hours. That has forced us to accommodate two work schedules while keeping up with our other responsibilities. There's also less time for ourselves, which makes "us" time more special. Considering that my days of passively learning in a classroom are over, I'd say learning to juggle demanding schedules while maintaining balance has been valuable and will continue to be so for the rest of our careers. Through these years I've learned a few things about being married in med school, and so I'd like to share a few key thoughts.

- Foundation. A strong foundation is the basis to any relationship and even more so in a marriage. I think that it's crucial to talk about your goals early on and how you plan on getting there even if you don't have an exact plan. Even more important, however, is having common goals in the first place. Communication is absolutely vital in this area. Establishing yourselves as a strong duo early on is the most important thing about married in medical school. There will be hard days, weeks, and months but being there for one another no matter what is a beautiful thing. For some of us med students, medical school is the most challenging thing we've ever gone through. Having someone who makes it easier on you by supporting you, cheering you on, and helping you out is priceless.

- Priorities. This is something that will depend on your personal beliefs and desires in life. For me, second only to our faith, my little family is my highest priority. That means that just as I set aside time to study or figure out my rotation / study schedule I also make sure that there is "us" time set aside. It honestly keeps me grounded and is my happy place. I think it's important to discuss priorities early on so there are no surprises.  As a woman in medicine, the idea of priorities is a deeply complex and challenging concept. There are already so many expectations placed on women that adding the responsibility of a medical career may seem daunting. A supportive partner can make all the difference. Another issue that may arise in the realm of "priorities" is that of whose career is more important at any given time. This can be especially challenging when a couple has two high-powered careers. I think it's important to respect and admire each others accomplishments and make space for them. While medicine is a life-long commitment, so are other careers and they are no less important to those in them than medicine is to us.

- Balance. Medicine can be consuming; it may take more than you would expect from your mind, body, and soul. Going through something like that can be taxing, but it doesn't always have to be. That being said, the stress and difficulties you experience as a med student will inevitably be shared with your partner. Expressing how you feel and getting through it together is not only cathartic, but makes you stronger as a couple. Do not feel that you must give 100% of yourself to medicine, your partner, your responsibilities, your children, etc at all times because it is simply not possible; and while the areas you are focusing on thrive, others will suffer. Your focus and energy will often be shared among many things but remember that you have the power to choose which parts get the most of you. Self-care is often forsaken in medicine, but how can we heal others if we ourselves are withering? Taking care of yourself is so important, and will help keep your relationship healthy.

- Reward. How special is it to become a doctor alongside the person you love? It is a privilege and should be treated as such. Being able to tell my husband about all the cool and fascinating stuff I learn, the memorable patients I meet and my ever-changing specialty interests is pretty special. Med school is hard, but it is temporary. And, as in life, there are hard times. But try to appreciate them,  they often teach us more than the easy ones and let us learn new things about ourselves and our partners. Celebrate your successes with your partner, recover from your failures together and appreciate the little rewards along the way, there are many.



I've learned so much in these last few years in med school that goes beyond facts and clinical pearls and I'm grateful to go through every step alongside my husband. In the end, a partner should make the hard things in life easier. Med school is a big feat, but it's not the impossible mountain for relationships that some make it out to be.

Happy Friday!

One of my all-time favorite dishes is my mom's green chicken enchiladas, and they've quickly become one of J's favorites too! I don't know what it is about tortillas, chicken, and salsa verde blanketed with cheese but when they come together it's magical. Top the fresh-out-of-the-oven enchiladas with fresh onion and sour cream and you have yourself a bonafide flavor explosion. I also love enchiladas for breakfast with an over-medium egg. I just love enchiladas, can you tell?

Since I find myself craving my mom's enchiladas more often than I'm proud of, I started experimenting with my own salsa verde recipe. My mom doesn't write down any of her recipes so she just gave me some basic instructions and told me to play around with the ingredients. Sounds easy right? Well it wasn't. I'll be honest, the first two..or three times the salsa didn't turn out very good (something J wasn't afraid of pointing out, lol!), but I think I've finally figured it out.

What you'll need:

12 tomatillos (medium-sized) - remember to peel them and wash them well if this is your first time working with them

1 jalapeño or serrano (add more if you want it spicier!)

1 hatch chile

1/2 white onion

2 cloves of garlic

1 bushel of cilantro - chopped

1/4 tablespoon sea salt

A saucepan, an oven & a blender

Directions:

1. Turn the oven to broil and place the hatch chile on a baking sheet. Make sure to turn it every two minutes. Don't let it burn! When it has toasted, pull it out and let it cool.

2. While the hatch chile cools, add tomatillos and jalapeño/serrano peppers to a saucepan and cover with water. Turn the heat on high and wait until the tomatillos turn from their original green to a lighter color. As soon as this happens remove the pan from the heat and drain the water - if you cook the tomatillos too long the skin will burst and you'll end up with a sour salsa.

3. Peel the hatch chile once it has cooled.

4. Add the cooked tomatillos & jalapeño to a blender along with the onion, garlic, cilantro, and salt.

5. Blend the ingredients until the mixture is an even consistency.

6. Serve and enjoy!

All in all, preparing and making the salsa verde takes less than 15 minutes. I use it on enchiladas, for dipping tortilla chips, on eggs, and even as a sauce for chicken breast.

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!  

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  

My husband J and I were lucky enough to have met each other four years ago. Within a month we fell so in love and decided to pursue a life together. Sure we were only 20 and still in college, but we were absolutely certain that we couldn’t live without each other. And now we’ve been married for nearly three years. After two-and-a-half years of being long distance we finally moved in together right before I started med school & he started his masters program. Living together and starting the “adult” chapter of our lives was really exciting. I mean, who wouldn’t want to see their best friend all day every day?

It was during that first semester of living together that it hit us: we want; No, we need a baby. Of course it was somewhat of a silly idea. After all, we were only 22 and definitely didn’t want to compromise our future, or the well-being of a baby by not being able to provide all the things a child needs & deserves. Nevertheless we couldn’t shake the desire to have a baby of our own. We had openly discussed the topic of children since the very beginning of our relationship - how many, when, girl names, boy names, what sports they’ll play, will they be a doctor like mommy or an engineer like baba? And hopefully one day that dream of ours will come true.

At that time in our lives we knew a baby wasn’t a responsible choice for us, but we knew that we had so much love to give and we wanted to be able to care for and love something together. It was also a spiritual decision in that, religiously, there are good deeds for showing kindness toward any living creature. So one day during my second semester I was searching local dog breeders when I came across a listing that sold mostly yorkies. I thought a yorkie would be practical, small and easy to care for so it seemed like a good place to start. I sent J the link and he suggested we go check them out. That weekend we drove up to the breeders house. Under a pile of loud yorkies laid a shih-tzu* puppy with the sweetest face in the world. He was so meek amidst 5-6 crazy little yorkies and seemed to not mind that they were jumping on him and using him as a stool. I knew immediately that he belonged with us. Funny enough, I found out later that my husband had seen a picture of him on the breeder's site and wanted him but didn't mention it because I had been so insistent on a yorkie, lol. But this little puppy was so calm and sweet that the name we had chosen for him before even meeting him was perfect: Melo, short for Carmelo...specifically, Carmelo Anthony. At 2.5 lbs, Melo was the smallest thing we have ever fallen in love with.

[caption id="attachment_128" align="alignright" width="300"] The day we brought Melo home[/caption]

I knew having Melo during med school would be challenging. Up until we brought him home I had been attending lectures in the mornings instead of podcasting. But that all changed. I knew he needed to be potty trained and taken care of. At only 8 weeks old he was basically an infant. I decided to stay home and podcast all of my lectures so that I could spend more time with him. I still attended my required lectures, clinical sessions and other club / research meetings, but most of my days were spent studying from home with Melo. It kills me to leave him at home alone and I honestly would not have gotten him if I had not been absolutely sure that I would be able to give him the attention and love he deserves. It took Melo about 2-3 months to be fully potty trained. And though he had a few accidents here and there, the hard work of training him really paid off.

[caption id="attachment_129" align="alignright" width="156"] Potty training is tiring[/caption]

Switching from attending lectures to podcasting was probably the best thing I did for my time management goals and I wouldn’t have done it without Melo. My current day-to-day schedule with Melo goes a little something like this. At about 7:45am I take Melo on a 1 mile walk which is just enough activity to get him to nap for a few hours in the morning while I do my most intense studying. That means doing my daily firecracker questions (~200) for about 2 hours followed by 1-2 hours of podcasting at 2x speed while I’m on the elliptical. In the afternoon I typically review first aid and flag some more topics on firecracker. In the evening I review topics from previous weeks. I think having Melo has made me more efficient and more conscious of how I’m spending my time. It has also taught me to take breaks and relax, usually by taking him out to the yard to walk around or play fetch for a bit while I get some fresh air. On days when I have to be gone for a few hours I make sure to tire him out before I leave so that he can sleep. If I have an extra-long day ahead, which doesn’t happen often, J will come home during his lunch break and walk Melo.


Balancing med school with having a dog is doable and has brought me so much joy and balance overall. When I begin my third year rotations in June I won’t be able to be home as much as I’d like so we will be getting a new puppy to add to our family so that Melo has a little buddy to play with!

It is crazy to think how much Melo has grown in the year that we’ve had him. He has such a big personality and is truly the love of our life. He’s taught us so much about what it means to love a creature so much that you would do anything for them. He has also taught us a lot about ourselves as partners and valuable lessons about patience, being observant and being present. We hope that these lessons will make us better parents to Melo and to our future children.

* Melo later turned out to be a pekingese / shih-tzu / lahsa apso mix which we discovered through DNA testing. We are actually relieved to know he was a mix and is healthier because of it. The breeder was, surprisingly, cooperative and we resolved the issue financially. Later I googled her name and it turns out there were many fraud claims against her business so be sure to do your research before buying a puppy!