Dinner of Champions/ Freebies From My New Book

Genmedmom here.

Yes, this lovely photo of walnuts, dark chocolate, and red wine against the backdrop of Christmas was my real dinner.

This was several weeks ago. Hubby was traveling. I'd worked a long clinic day, and had just picked the kids up from my mother's. My school-age kids ended up with yogurt, fruit, and cereal, while I ended up with this dinner of champions.

But it's not a bad dinner, from a nutrition standpoint. Actually, I was rather proud of what I'd put together, for cardiovascular reasons.

After all, I've done my research: I've just published a book on this! Healthy Habits for Your Heart is a behavior change focused evidence-based diet and lifestyle book for heart health. I was a bit insane about including the supporting science, so the references section is way larger than the publishers wanted. The first section of the book is all about how our behaviors impact our heart health, and how to approach habit change. Then, for each suggested diet and lifestyle habit, I've included tips to make it stick.

Want a free preview? Here you go! Pasted directly from the book, to you!

I hope folks find it helpful for them and for their patients.

From Chapter 5, Eat For Your Life: Nutrition Habits, here is the lowdown on nuts, chocolate, and wine:

#34: Eat Four Servings of Nuts Per Week
Nuts are good for your heart and your life. Research shows that eating four servings of nuts per week was associated with a significantly lower risk of having coronary heart disease (19 percent) or any type of cardiovascular disease (28 percent). ere was also a significantly lower risk of dying from coronary heart disease (22 percent), cardiovascular disease (22 percent), sudden cardiac death (75 percent), or anything at all (19 percent). e studies looked at tree nuts (which include almonds, walnuts, pistachios, and hazelnuts) as well as peanuts (which are technically a legume but nutritionally similar to tree nuts).

Another study found that for every one serving per week increase in nuts, there was a 10 percent lower risk of having coronary heart disease. is may be due to the fact that nuts are a rich source of healthy oils. Nuts also are great sources of both soluble and insoluble fiber, as well as vitamins and minerals. Nuts are an important part of the classic Mediterranean diet, which we know is a very good diet for heart health. (Allergies are a consideration here. For people who are allergic to nuts, this habit doesn’t apply. As a doctor, I’m going to remind you to update your epinephrine auto-injector and carry it with you at all times!)

What Does One Serving Size of Nuts Look Like?
Per the National Heart, Lung, and Blood Institute (NHLBI):

• 1⁄3 cup nuts (equal to 11⁄2 ounces)
• 2 tablespoons nut butter 

Tips to Make the Habit Stick:

• Regularly stock up on nuts, but keep budget in mind. Nuts are cheaper when bought in larger quantities or ordered online. Shop around for your favorite sources.
  
• Nuts can go rancid. Store them in airtight containers. Glass is ideal.
  
• Make a portion of your favorite nuts a regular go-to snack. Have
  some in your bag or desk at work at all times.
  
• Get in the habit of adding a handful of nuts to your meals, be it
  yogurt, oatmeal, salads, or stir-fries.
  
• Try these recipes: Apple Cinnamon Walnut Overnight Oats; Fill-
  ing Fruit and Nut Bowl with Greek Yogurt; Nutty Tabbouleh Salad (in Appendix A). 
  

#35: Enjoy Two To Three Servings of Dark Chocolate Per Week

Research has consistently shown that people who regularly eat chocolate have lower blood pressure, blood sugars, and less heart disease. Chocolate comes from the toasted seeds of the cacao plant, which is rich in healthy plant chemicals called flavonoids, specifically cocoa flavanols. Cocoa flavanols have beneficial effects on our blood vessels by neutralizing toxins, which helps prevent stiffness and plaque buildup, as well as promoting healing.
The darker the chocolate, the more cocoa flavanols it has. Milk chocolate sometimes has barely any (it can range from 10–50 percent) and also tends to have more unhealthy fat added. For this reason, I recommend only dark chocolate (at least 60 percent cacao, though the darker the better) and only a small amount. One serving is two small squares (about 50–60 grams total), and science suggests that two or three servings per week provide the most benefit.
Do you like chocolate, but not dark chocolate? It is less sweet but definitely much better for you than milk chocolate. e intense cocoa taste is what can help prevent us from overeating this calorie-dense treat. Start with a small amount and build up over time. The less milk chocolate you eat, the more dark chocolate will begin to taste like normal chocolate to you. 

Tips to Make the Habit Stick:

• Add a teaspoon of pure unsweetened cocoa powder to your co ee in the morning for a mocha treat.
  
• Use only dark chocolate chips or chunks (60 percent or higher cacao) in baking and cooking. 
• Try these recipes: Dark Chocolate–Dipped Strawberries; Orange Pistachio Dark Chocolate Bark; Cherry Chocolate Overnight Oats (in Appendix A).
• Use pure unsweetened cocoa powder in your savory cooking as well. Try the Antioxidant Chili recipe in Appendix A.
• If you have a tendency to eat more than a serving (two small squares), consider buying only small amounts at a time or dividing what you buy into serving sizes as soon as you get home. 

#42: Limit Alcohol, Although A Small Amount Daily Can Be Heart-Protective

People who drink a small amount of alcohol every day tend to have lower risk of coronary heart disease when compared to people who don’t drink or to people who drink heavily. Research shows that light drinking can lower the risk of developing heart disease a great deal (between 40 and 70 percent) and also lower the risk of related diseases such as strokes, aortic aneurysms, and peripheral arterial disease. Wine (red wine especially) seems to be the best choice, though the protective e ect is seen with all types of alcohol. e active component in red wine is thought to be an antioxidant plant nutrient called resveratrol, but studies that have isolated this compound and given it to participants as a supplement have not shown any promising results to date. (Of note, that seems to be the case with all supplements.)

But this doesn’t mean it’s advisable to pick up a drinking habit. Alco- hol won’t erase the risk brought on by other factors. Drinking any amount over what’s recommended will actually increase the risk of heart disease by causing high triglycerides (a form of cholesterol), high blood pressure, and weight gain. Alcohol can also be directly toxic to the heart and is asso- ciated with arrhythmias like atrial brillation. Drinking too much—even just a little too much—also increases the risk of cancer (particularly breast cancer), liver disease, and, obviously, alcohol addiction.
For all of these reasons, the American Heart Association recommends that people do not start drinking alcohol as a means to lower their heart disease risk.
For people who can safely drink, and who partake regularly, here is what is recommended:

Men: No more than one to two drinks per day 
Women: No more than one drink per day 

Definition of a Drink: 

• 5 ounces of wine
  
• 12 ounces of beer
  
• 11⁄2 ounces of 80-proof spirits
  
• 1 ounce of 100-proof spirits 

Tips to Make the Habit Stick:

0. Hydrate well before you have any alcohol. If you’re thirsty, you may unintentionally drink too much too quickly.
   
1. Measure out your drink (5 ounces of wine, 12 ounces of beer) and then put the bottle or six-pack away.
   
2. If you’re having mixed drinks, specify how much hard liquor you want and watch the bartender measure. Some bartenders are a lit- tle heavy-handed with the bottle.
   
3. If you’re entertaining, mix up a pitcher of a tempting mocktail and have plenty of healthy and delicious appetizers on hand. It’s good for you and everyone else as well.
   
4. Try the Bubbly Minty Mojito Mocktail recipe in Appendix A.
   

References: 

Research shows that (nuts)... A.J. Mayhew et al.: “A Systematic Review and Meta-analysis of Nut Consumption and Incident Risk of CVD and All-Cause Mortality,” e British Journal of Nutrition 115(2), 28 January 2016, pp. 212–225.
Another study found... Y.Q. Weng et al., “Association Between Nut Consumption and Coronary Heart Disease: A Meta-analysis,” Coronary Artery Disease 27(3), May 2016, pp. 227–232.
Research has consistently... E. Higginbotham and P.R. Taub, “Cardiovascular Bene ts of Dark Chocolate?,” Current Treatment Options in Cardiovascular Medicine 17(12), December 2015, p. 54 and S. Yuan et al., “Chocolate Consumption and Risk of Coronary Heart Disease, Stroke, and Diabetes: A Meta- analysis of Prospective Studies,” Nutrients 9(7), 2017, p. 688
and C.S. Kwok et al., “Habitual Chocolate Consumption and Risk of Cardiovascular Disease among Healthy Men and Women,”
Heart 101(16), August 2015, pp. 1,279–1,287.

Research shows that... and Drinking any amount (alcohol)... S. Bell et al., “Association Between Clinically Recorded Alcohol Consumption and Initial Presentation of 12 Cardiovascular Diseases: Population Based Cohort Study Using Linked Health Records,” e BMJ 356, 22 March 2017, p. j909 and
P.E. Ronksley et al., “Association of Alcohol Consumption with Selected Cardiovascular Disease Outcomes: A Systematic Review and Meta-analysis,” e BMJ 342, 22 February 2011, p. d671.
Alcohol can also... C. Tangney et al., “Cardiac Benefits and Risks
... UpToDate, updated March 2018, https://www.uptodate.com/ contents/cardiovascular-benefits- and-risks-of-moderate-alcohol- consumption.

The Devil You Know - A Book Review

I get really annoyed by those people who declare, "I only read non-fiction." And it's ok, if that's you, but don't say it snootily at a party when someone asks you if you've ever read this great fiction book. That's left me speechless and a bit shameful on more than one occasion - the person acts like fiction is non-fiction's red-headed bastard stepchild. And really, if I could go back in time - let's do that right now - I'd tell that person off. Fiction, I'll argue, is way more difficult to pull of than non-fiction. And I'll be damned if you can draw a straight line between the two. Fiction authors often weave autobiography into their own work, but instead of just spitting out what already happened they birth a new child. And that's pretty impressive, in my opinion.

I met Fizzy on Mothers in Medicine years ago when I first started. We became e-mail friends, she supported me through my divorce, I learned a little about her life. She is a very private person. I've met her for dinner once and I still don't know her last name. I respect that, and it comes with mystery and intrigue. We don't e-mail as regularly as we used to, but when she asked for me to read her new book a few months back and let her know what I think I felt like I had received an e-mail from Madonna (that's a nod to the book, by the way). I read it in one afternoon. Well, it bled into the evening a bit.

I read the first book, The Devil Wears Scrubs, years ago. I loved it, and talked about that here. What I loved about that book was how it captured the angst of medical school and training. What I love about this more is it captures the angst of mothering and working as an attending. It is a stand alone book - you don't have to have read the first one, but it was fun for me to reminisce about old characters as they were brought up again throughout the book.

Warning: This book will make you laugh out loud. A lot. Fizzy has always had a great sense of humor and in The Devil You Know she doles it out constantly. There was this one part about glitter - I almost put in a quote but I don't want to ruin it for you - where I was laughing so hard I had to put the book down. She perfectly combines the mayhem of being a doctor and a mother and a spouse - and doing it very imperfectly perfect. If you are taking yourself too seriously this is the book to pick up. I read it again to make this review better and it was a bunch of fun the second time around. One of the best things about it for me was I got a great big glimpse into my very private friend's - one whose blog - A Cartoon Guide to Becoming a Doctor - I've followed for years - life. No one can write a book like this without experience.

I could go on and on about the hilarious patient interactions and bumbling cast of characters at the VA (one of my favorite places on Earth where I trained) but Fizzy herself would stop me - I tend to get long-winded. JUST GO GET THIS BOOK ALREADY: HERE. You won't regret it!!

Side note to Fizzy - who ribbed me years back for never having read a book on a Kindle etc. - I have now read one book on my computer and phone exactly twice - yours.

Summer Book Recommendations

Ah, summer. There's nothing like the joy of sitting with an iced tea and a book on the deck... or waiting in the dentist's waiting room reading tiny print from a reading app on your phone.

1. Vaccinated by Paul Offit. It was completely fascinating to learn about the early days of immunization. Even if you've learned the science before, reading about the social context is so interesting.

2. Overdiagnosed by H. Gilbert Welch. This book changed the way I look at my practice, every day. Welch is an epidemiologist and explains the principles in a very accessible way.

3. Crazy Like Us: The Globalization of the American Psyche, by Ethan Watters. A must-read, especially if you work in mental health. I see a lot of refugee and newcomer patients, and do some element of cross-cultural mental health most every day. It's challenging because our entire mental health assessment is rooted in the culture in which it was created, and the very definitions of mental illness vary so widely in different contexts.

4. When Breath Becomes Air by Paul Kalanithi. I know you are hearing about it everywhere. It is beautifully written and helped me reflect on medicine in a different way. "But if I did not know what I wanted, I had learned something, something not found in Hippocrates, Maimonides, or Osler: the physician's duty is not to stave off death or to return patients to their old lives, but to take into our arms a patient and family whose lives have disintegrated and work until they can stand back up and face, and make sense of, their own existence."

I was on a female memoir kick last year, and thoroughly enjoyed the following:

5. Julia Child's My Life in France. Transport yourself to France and witness the early days of her love affair with French cuisine.

6. Nora Ephron's books of essays, I Feel Bad About My Neck and I Remember Nothing were, of course, hilarious.

7. Laughing All the Way to the Mosque by Zarqa Nawaz. Zarqa Nawaz is the creator of the TV show Little Mosque on the Prairie. She diverted from her parents' expectation for her of a career in medicine and found her way to journalism and the arts instead. As a fellow Canadian Muslim woman, I loved hearing her always-funny perspective on issues she faced along the way.

8. I Was a Really Good Mom Before I Had Kids by Trisha Ashworth and Amy Nobile. A down-to-earth book about the real issues we face every day as mothers, I found it totally affirming to read.

Fiction:

9. On Beauty by Zadie Smith. "And so it happened again, the daily miracle whereby interiority opens out and brings to bloom the million-petalled flower of being here, in the world, with other people. Neither as hard as she had thought it might be nor as easy as it appeared". Filled with breathtaking passages but also dry humour and wit, On Beauty was captivating.

10. Everybody Has Everything by Katrina Onstad. Following years of infertility, a young professional couple takes guardianship of a young child when their friends suffer a terrible accident. The struggles of being thrust into parenthood of a unique sort; with the same truth that we all live with - the uncertain future.

What books would you recommend?

Book Review: Burning The Short White Coat by Eve Shvidler, M.D.

I love reading books written by other doctors. Especially when I actually have time to read them. When I read the P.R. blurb on OB/GYN Eve Shvidler's Burning The Short White Coat: A Story Of Becoming A Woman Doctor, I knew I HAD to make time to read this book:

"What happens when Sex and the City meets Grey's Anatomy?… A medical chick-lit novel, Burning The Short White Coat exposes the personal battles that single women must overcome in balancing a demanding profession and the desire to find a trusting and loving relationship…"

I've been waiting my whole life for the female House of God. I was very excited to know: Could this be it?

Well, not quite. But, this light read is definitely engaging, funny, and fun.

The story follows relatable Elle Gallagher (and BFFs) through four years of medical school, and much romance. The action of the prologue draws in the reader (Overnight call! Crash c-section!). The first chapter, "The Gross Lab", is so gross, it's great. I was having formaldehyde flashbacks, myself. There are such nice touches here: the dissection of the penis by the retired surgeon is worth the price of admission.

But, the issues that plague this book also begin here: spelling and grammatical errors. Lots of them.

Now, I also write for publication, and I hate when some reader expresses extreme annoyance over a couple of typos. But there are ALOT of typos, misspellings, and incomplete sentences throughout this book, so many that even I was extremely annoyed. If I wasn't almost at the end of the book, I would have put it down at "introidus". Which appears twice. These errors make the book read more like a rough draft.

There is also heavy use of clichés, which I can forgive because at the same time, there is also plenty of fresh, unique material.

The chapter titled "Psych" is a fascinating little story-within-a-story featuring one of the creepiest cases I've ever heard. If what is described really happened, that's crazy disturbing. If it didn't, that's crazy good imagination.

One surprise for me is that my favorite character in this book isn't one of the female protagonists at all, it's the slightly immature but lovable surgeon Samy. We all know that attendings who hang out with medical students… well, that's just wrong. But this guy, he's complex, and he has some great lines. His advice to Elle on booty call vs. relationship girls is right on, and I'm not sure I've seen it done so well in a book that wasn't intended for teenagers.

The best part by far, though, was the chapter titled "Good Vibrations". I believe I had a similar hilarious conversation with my medical school BFFs. I would never have dared to write about it, though. I'm impressed!

In the end, I thoroughly enjoyed what was overall a refreshing, real-deal, feminine take on the modern medical school experience. (Yes, people, med students DO party that hard.) I just wish someone had run a spell check and an editor's eye over the text prior to publication.

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Hot off the presses! Addendum! As of 6/27/15 I have just heard from the author that she had already realized there were many errors in the original manuscript, and she put the whole thing through a copyediting process. There will be a new release in about 2 weeks from now, sans errors.

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As an aside, I have to say, the author's blog on Wordpress (https://burningtheshortwhitecoat.wordpress.com) is VERY good reading. Her articles and essays are enormously informative and entertaining. Moms in the audience, do yourselves a favor and read her post Where's My Orgasm from June 8, 2015.

Brain Candy

I met Fizzy here years ago, and long ago posted one of her first cartoons on my blog when she spun off this blog to create her own space at The Cartoon Guide to Becoming a Doctor.

I was amazed by this cartoon. It spoke to me about my experience as a resident/mom in such a good way. She made light of the angst and agony that I had recently been through, and made me laugh about it. I was already hooked to her writing here on MiM, but that cartoon drew me in to her blog and made me an avid follower to this day.

She's funny. She's droll. But most of all, she's unrelenting. I have periods in my blogging where I lag and shut down. She never stops. She's like the Energizer bunny of blogging, and her constant wit and presence amaze me. Not just me - she has built up an enormous following of readers that also recognize her talent. I like to secretly pat myself on the back for being one of her first readers. It doesn't surprise me in the least that she has come this far.

I bought her first book (see above) and it sat on my coffee table until I caught my daughter reading it and asking me questions I wasn't ready to explain. Now it's tucked away in the reading cabinet for easy access. And I had the privilege to beta read her first novel - The Devil Wears Scrubs. Do you read brain candy? I do. I don't watch brain candy on TV, but I read it religiously during stressful times in my life. Chic lit - it takes the edge off. The Devil Wears Scrubs is the best kind of chic lit. It draws you back into that horribly abusive space in time of training when you have no control and you are at the mercy of warped personalities. It allows you as a reader, like the viewer of her cartoons, to make lemonade out of lemons. Her razor sharp wit and her sarcasm brings a new element to the genre. She's a pioneer.

If you haven't read her book, you're missing out big time. I hear there's more coming down the pipes. I remember standing in line for hours waiting to see Guns N' Roses at the Memphis Pyramid (I had to pee really bad - good training for OR cases). I remember camping out all night in front of BeenAround Records to get my college boyfriend Metallica tickets (his band not mine). I remember pre-ordering the next Harry Potter book during residency and counting the days until it was released. Here I am again at 40 dying to read Fizzy's next book. I hope there's lots more to come. I can't wait.

*This post was based off of one I wrote last week on my blog.

Book Review: The Devil Wears Scrubs by Freida McFadden

I love to read books written by other doctors. I think doctoring can be kind of isolating sometimes, but reading about the experiences of our colleagues can be so... validating.

This book, which was written by Mothers in Medicine blogger Fizzy McFizz under the second pen name Freida McFadden, is a humorous account of an intern's first month in an internal medicine residency. It's light, it's a quick read, and it really is funny.

The story follows newly minted Dr. Jane McGill as she tries to figure out how to survive and thrive on the floors at a county-style hospital, with little to no instruction or guidance on what, exactly, to do (sound familiar?), and all the while being picked on by a seemingly sadistic senior resident. The senior, however, has a human side as well, and a few good lessons to teach.

While this fun little book is fiction, I get the sense that it's House Of God-style fiction, meaning, alot of it is likely sort of true. I don't know this, I'm just guessing, and it made the book so much more interesting to me, as this intern's experience is largely miserable, and it reminded me of my own miserable intern experience (and I blogged about those memories in a post titled "How a fun little book dredged up buried memories of my intern year" ).

I was again reminded of this book at a recent medical conference, a Virginia Mason seminar (all about running a more humane, efficient practice) and one of the speakers was describing how setting basic work protocols and standards is so key to a positively functional work environment. She asked us how we can expect people to do tasks if they have no formal instruction in how to do them, saying: "Asking people to do things that they have not been trained to do is an exercise in frustration: theirs, and yours. Most people want to do a good job, and if you repeatedly put them in a position where they are likely to fail, they become demoralized, angry, and difficult."

I sat there thinking: Well, that's medical residency in a nutshell.

And Dr. McGill's experience in this book exemplify this: An experience so miserable, it's funny.

The book is available on Amazon.com, here is a link.

The Devil Wears Scrubs

I did it! I wrote that book about my intern year!

It's fiction. But it kind of isn't. You know? In any case, if you enjoy my writing, I feel certain you'll really enjoy reading it. Here's the blurb:

Newly minted doctor Jane McGill is in hell.

Not literally, of course. But between her drug addict patients, sleepless nights on call, and battling wits with the sadistic yet charming Sexy Surgeon, Jane can’t imagine an afterlife much worse than her first month of medical internship at County Hospital.

And then there’s the devil herself: Jane’s senior resident Dr. Alyssa Morgan. When Alyssa becomes absolutely hell-bent on making her new interns pay tenfold for the deadly sin of incompetence, Jane starts to worry that she may not make it through the year with her soul or her sanity still intact.

Please buy it!

It's available for the Kindle. For now, I've kept it at the low, low price of only $2.99, although that is subject to increase in the future.

Also, you can get it in paperback!

It's short, it's fun, it's deliciously evil, and if you buy it, you'll make me really happy. And it also does involve a mother in medicine. What other incentive do you need?? :P

If you're not sure, you can read an excerpt.

(Cross-posted to my blog)

MiM book giveaway: In Stitches, by Anthony Youn

5/3/11 1:30 pm update: The two winners were randomly selected and emailed. Will keep working on SpaFinder...

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It's been two years since our first book giveaway (Remember "Match Day" by Brian Eule? Fizzy and I reviewed it here and here.) That was fun, and we're ready to do it again with the newly released memoir by Detroit-based plastic surgeon Anthony Youn. Why? Because Mothers in Medicine deserve free things.* And to read. And to win free things to read. (Also, mani-pedis, but haven't worked out that deal for you all yet. SpaFinder, call me.)

A little about the book from Amazon.com:

Tony Youn grew up up one of two Asian-American kids in a small town of near wall-to-wall whiteness. Too tall and too thin, he wore thick Coke-bottle glasses, braces, Hannibal Lecter headgear, and had a protruding jaw that one day began to grow, expanding Pinocchio-like, protruding to an unthinkable, monstrous size. After high school graduation, while other seniors partied at the shore or explored Europe, Youn lay strapped in an oral surgeon’s chair as he broke his jaw, then reset it and wired it shut for six weeks.

Ironically, it was this brutal makeover that led him to his life's calling -- and the four years of angst, flubs, triumphs, non-stop studying and intermittant heavy drinking that eventually earned him an M.D. Thanks to a small circle of close friends and an obsessive drive to overachieve, Youn transformed from a shy, skinny, awkward nerd with no confidence and no clue into a renowned and successful plastic surgeon.

In Stitches is a heartfelt, candid, and laugh-out-loud memoir of one man's bumpy road to becoming a doctor and learning to be confortable in his own skin.


To score your copy, just send us an email (mothersinmedicine@gmail.com) with the title "In Stitches" between now and tomorrow (5/3), noon EST. We'll randomly draw 2 names to receive a copy of the book. There are no risks to entering besides the normal risks associated with everyday life.**

For more info, you can read an excerpt on KevinMD.com, visit the In Stitches Facebook page, or see Amazon.com.



* You don't need to be an actual Mother in Medicine to enter! Any reader is welcome.
**That line was for anyone who has had to submit something to the IRB.