MINDFUL OF MEDICINE

Last week I had orientation for obgyn (obstetrics & gynecology) as well as several days of lectures from attendings and fellows on a broad range of topics. They were all fascinating but one stood out in particular: gynecologic oncology. We discussed the pathophysiology, treatment and patient counseling involved in uterine, ovarian and cervical cancers. While discussing ovarian cancer, we came across the topic of ways that patients cope and how they become involved in their own care. The one thing that really resonated with me was when the gynecologic oncologist commented that many of her patients, after their diagnosis, have a new-found passion for their lifestyle and general approach to wellness - often indulging in the newest cleansing trend, trying alkaline diets, etc. This really got me thinking - why do we wait so long, often after we've been dealt a bleak outlook, to change or do something about our health? Procrastination is arguably human nature, but shouldn't we be more proactive about health? One would think so, but that's not always the case.

Since it is January, I know we've all seen the social media pictures poking fun at the fact that gyms are all of a sudden teaming with new attendees. That's not to say that this isn't a real thing that happens every year after people have formed their new years resolutions à la "new year, new me." To me, this makes me reflect on two big points: waiting too long to change, and discouraging others from making a healthy change.

As a soon to be physician and someone who is passionate about my health and that of my loved ones, I consider myself an ambassador of health. This is a role I hope to embody throughout my career. I am not perfect, and though I've always striven to live a healthy life, I have certainly had my own struggles with optimizing my nutrition and lifestyle. This was especially true during my toughest years of my battle with Valley Fever. For example, during those years I would fluctuate between 100% commitment to avoiding gluten, dairy and any excess sugars while trying to keep my liver healthy; and sometimes I would indulge and inevitably feel guilty and resentful. I was lost in a vicious cycle that caused me a lot of grief when I really should have focused on eating clean, whole foods and staying active.

In our world, we're constantly bombarded with messages that immediate satisfaction is the key to happiness. These marketing strategies exploit our collective social tendency toward ignorance of one simple fact: short-term satisfaction does not build long-term change. But we have to be better than that, and not wait until it's literally too late to make a change. That means preventing disease before it happens, and one of the greatest tools we have is ourselves, equipped with both a mind & body. Through proper nutrition and lifestyle we can prevent, cure, and manage disease and that's very powerful, at least to me.

One other idea I've been thinking about is why we discourage others from making a healthy change, whether unintentionally or deliberately. I often see fitness trends marketed as exclusive movements that require some kind of acceptance into the larger group. This takes me back to those pictures I mentioned before, while they might make us giggle they are actually alienating many people who are genuinely trying to make a change but might feel like they're not welcome. The truth is, we all start somewhere. And the purest place we start is from within. That's why it's so important to encourage others in even the smallest of ways without being proud or aggressive and showing them that you truly care. No matter where someone is in their health & wellness journey, you can help encourage and motivate them. That might mean starting at the ground floor, like encouraging someone you care about to stop smoking; to applauding a friend's long-term commitment to exercise & even joining them.

I know this sounds like a bit of a soapbox but it's something I'm really passionate about. It's 2016, and even though we have incredibly advanced medical technologies and sophisticated treatments some of the most potent therapies we have are on our plates & our physical activity levels. We can all make a change, and we don't have to wait until it's too late.

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 Thursday everyone! I’ve recently been really into breakfast foods and have been looking to spice things up a bit. My mornings usually consist of walking Melo, followed by a an hour of studying on Firecracker with a hot cup of green tea. After that, I like to do some fasted cardio on my elliptical for an hour or so. That means that by 10 am I’m pretty hungry! Usually I just drink a vanilla hemp protein shake - which i’ll discuss in a future post! - but some days I like to indulge and cook breakfast for myself.

Anyone who knows me personally knows that I love eggs. Seriously, I love eggs for any meal, anytime of the day. I can honestly go through a whole carton of hard-boiled eggs a week - egg whites only, of course. They’re just such a simple, protein-packed snack that is so satisfying and low in calories. So of course I’m going to share a quick, healthy, egg-centered breakfast that I personally love. Enjoy!

Ingredients:

2 eggs*

1 cup chopped spinach

1 cup sliced mushrooms

1 tsp basil

1 tsp pepper

Directions:

1. Using 1 whole egg + the egg whites of the other egg, cook over medium heat until they are “over medium” - or desired consistency

2. In a separate pan, sauté the spinach and mushrooms over medium heat until mushrooms are soft. Add pepper and basil.

3. Serve and enjoy!

*This recipe calls for two eggs, though you will only be using 1 whole egg + the egg whites of the other. You will be discarding the second egg-yolk.

Nutrition Facts:

Calories - 221

Protein - 11.6 grams