Perspectives from living many places in a few short years – Part 3: A few healthcare issues I have noticed

Living the life of a nomad for the past three years has exposed me to several healthcare issues around the US.  Here are two issues I discovered.

In Jackson, Mississippi, there are a lot of premature babies being born, and a lot of babies born to young teenage moms.  I remember one mom was 13 and her sister was 15 with 2 kids.  Mississippi has high rates of teen pregnancy and obesity.  Obesity goes along with malnutrition, both of which are contributing factors to the number of premature babies being delivered.   Being able to save these babies is a modern day medical miracle, but usually (though not always) it is safer for the baby to be delivered at term.  We need better nutrition, education, prenatal care, and medical access to care if we want prematurity and teenage pregnancy rates to decline.  Easier said than done.  What suggestions do you have?  Please post comments with your thoughts.

In Chicago, over the course of a few months I watched a woman deteriorate: she had asthma and she liked to drink.  In January she was admitted under our care for asthma attacks; her asthma was very poorly controlled.  Our attending doctor told her how severe her asthma was and how necessary good control was.  He spoke with her about her drinking, and we made sure she went home with her asthma medication.  Again in March she was admitted for an asthma attack.  Again, we made sure she had her medicines and that she knew she must stop drinking.  In June, when I was in the ER rotation, she was being seen for chest pain.  I remember noticing how thin, anxious, emotional and sick she looked.  Her chest pain was due to asthma, and how she looked was due to months of not taking care of herself. I can’t forget how she cried while admitting to continuing to drink.  She had literally wasted away; we stopped her asthma attacks, sent her home with her medications and instructions to stop drinking with resources for how.  I felt sad in seeing her waste away; I only imagined what was to come.  This isn’t a story particular to Chicago and it isn’t a pediatric story.  Medical problems and mental health issues, complicated by poor self-care, plague people of all ages everywhere.  Certain areas of the country have limited health care follow up.  People are seen when they are sick but often there is no continual care to ask, “How are things going?”  We need more medical follow up to really help people of all ages with chronic medical and mental health issues.  Are there medical follow up issues in your area?  Please post comments to let us all know.

Perspectives of a doctor becoming a patient – Part 2 – Doing nothing option

One day, when I was 27 years old, suddenly, out of the blue, I noticed a breast lump.

I went to the doctor, who sent me to get an ultrasound to determine if the lump was solid or cystic.  It was solid.  Again, the same worry…what if??  I was really scared and it didn’t matter that I knew the facts, that the doctor and medical texts told me the facts, I was panicking inside.  It was the first time in my life I had something physically wrong and I did not like the unsettling feeling.

Still, I had my wits about me enough to go see a surgeon.  At the appointment he told me I could decide if I wanted surgery or if I wanted to wait and see what the lump did.  Because of all my fear, I jumped at the idea of what seemed to me the “doing nothing option.”  I went home telling my husband and family that if a surgeon says he doesn’t want to operate that means I don’t need surgery.

Now I realize that this isn’t want the surgeon meant at all.  He was saying the lump did not have to come out right away and that observation was a safe option provided we continued to watch it clinically and with ultrasound; but I interpreted it as “ignore the problem so it goes away” and used the excuse that “the surgeon doesn’t want to operate” as my scapegoat.  The reality was I was afraid of the surgery and because I had never had one I did not want to deal with it.

I continued to ignore the problem, until I noticed one or two weeks later that the lump had changed and it was more visible under the skin.  This was my triumphant moment when I finally conquered my fear and realized that for me and that point in time the only thing to do was to be proactive and to take it out.  Now, that isn’t to say that I made the right decision.  As a doctor I know there are many decisions.  Things are not necessarily absolutely right or absolutely wrong; things are just right and wrong for that particular person and that particular clinical scenario.  For me it was right to take it out.  Fear was the only thing stopping me from surgery, not sound medical judgment.  Once I realized that it was only fear prevented me from making the right decision, I called the surgeon back and told him I wanted surgery.

The happy ending is the surgeon removed the lump and the lump was diagnosed as a fibroadenoma by pathology.  The tumor was benign!  The surgeon did an excellent job and I as a patient did an excellent job in conquering my fear.  As a doctor, I would recommend not panicking, not ignoring the problem and not letting fear decide what is best for you; but as a patient I understand—it’s not that easy!  What we can strive for when we are patients or when our loved ones are patients is to have an eye of calm that allows us to be cool, composed, and rational.  Together with doctors we can make the best medical decision once we realize that “the worst thing to fear is fear itself.”

Perspectives of a doctor becoming a patient – Part 1

One day, when I was 27 years old, suddenly, out of the blue, I noticed a breast lump.  Since I am a doctor, my initial reaction was to wait a few weeks to see if it changed with my menstrual cycle.  It was pretty easy for me to ignore the problem once I chalked it up to fibrocystic change (changes the breast undergoes during the menstrual cycle).  This is probably rationalization, a defense mechanism.  Unfortunately, the lump did not change at all, and suddenly I felt something I wouldn’t have felt if it was my young patient who told me about a breast lump—fear.

Now, if my 27 year old patient told me about a breast lump, I would tell her that the most common solid tumor of the breast in women under 35 is a fibroadenoma.  These tumors are simply removed surgically and then forgotten.  They are not cancer.  But honestly, I remember being very afraid of what the lump contained.  And do you know what my reaction was?  To ignore it.  I just simply did nothing.  I didn’t tell anyone and I didn’t think about.

Now this is not the advice I would give to my patients; if you have a breast lump, you don’t panic but you don’t ignore it.  You simply make an appointment with a doctor in a reasonable amount of time to address it.  But you have to understand that I was scared, and being scared meant I needed to address the issue when I was ready.  Luckily it didn’t take me too long to get out of the fog of denial and realize I needed to do something.

The next thing I did was look up breast lumps in my medical texts, because I wanted to find out what was wrong—worst case scenario first.  Yes, rationalization helps me.  The medical texts confirmed what I knew and I felt relief….

More to come with tomorrow’s blog post!

Part 2: Exercise and various cities in the US

Living in lots of cities recently has made me aware of the fact that the amount of exercise I get depends on where I live.  In LA, walking is out of the question unless you are walking inside a mall.  To quote the movie Clueless, everywhere in LA is 20 minutes away, but you have to be driving.  Miami and Jackson are driving cities as well.  Chicago has great public transportation and so you walk to and from “L” stops.  Palo Alto is a biking town, which as an Angelino has been hard to get used to.

So America, a lot of what influences your health has already been decided for you.  If you live in an area that encourages walking, you will walk.  If you live in San Francisco, you will walk up hills and you will walk down hills.  If you live in Boulder you’ll likely bike, hike, ski, or snowboard – and that’s on a workday. If you live in Chicago you’re going to spend a lot of time trudging through and shoveling snow.  If you live in a town like LA though, you will spend lots of time in your car.

My point is simply to point this out to you, so that you can discover ways to keep yourself fit.  Hopefully you won’t have to move, no pun intended.

What is the transportation style where you live? Does it impact how much exercise you get? Can you come up with a strategy to get more exercise in your locale?

For my medical training, over the past 3 years I’ve lived in 6 cities.  Now as I plan to live in Palo Alto for the next 2 years and have time to reflect, I realize this travel has shaped a simple opinion in my mind: health is linked to environment.  Diet, weather, way of life all influence our health and are dependent on where we live.  There are healthcare disparities that also depend on where we live.  Therefore, come with me to revisit the places I’ve lived over the past 3 years to further understand why health is determined by the area in which you live.

Part 1:  Health and diet and various cities in North America

Decide for yourself if the area you live in decides the foods you eat, healthy or not.

Health is linked to diet.  Eating less salt, fat, and sugar is healthier.  In saying that, a lot of what we eat depends on what is available to us.  Cost, local produce as well as local cuisine and culture all determine what foods are available.  Personal taste has a role in what we eat.  So which has more of an impact on our health?  In my opinion, diet is determined by where you live and it’s up to the individual to pick out healthier foods.  Let’s see what my diet was like in all those cities to see if I was able to eat sensibly.

Los Angeles, my hometown and a good starting point for my journeys, for the simple reason that everything I would find abroad was already here in my home city.  I eat everything when in LA, but one thing consistently I eat here that is lacking elsewhere are all the salads.  Salad is such a part of the culture that places like Souplantation are commonplace—a whole restaurant around the idea of a salad bar.  Obviously having healthy foods as part of the culture makes it easier to choose healthier options.  And luckily my taste aligns well with all the salad available in LA.

Next is Chicago.  Most common meals were fish/chips/peas, milanesa (breaded steak), and meatballs—it was so cold in the winter we wanted comfort food.  By far the best meal was the pizza!  If you haven’t had the pizza pie, you must!  But something I found in Chicago but not elsewhere was the best-sliced bread I’ve ever had: Arnold Flax and Fiber with 4 g fiber per slice.  This brings me to a point: despite all the tasty junk food I was eating, I was getting basic nutrients daily in my bread.  It is possible to choose a healthy option despite the availability of a lot of unhealthy options!

I lived in Guadalajara, Mexico for around 2 years.  Food I often ate: bread plus beans/cheese/salsa, milanesa, sushi (usually rolls with cream cheese), fresh cut up fruit with lime and chili powder.  The best thing about food in Guadalajara is carne asada, thin delicious steak cooked well done…yum!  Next best thing chorizo and melted cheese—queso fundido con chorizo.  Another yum!  It is more obvious living in a foreign country that culture dictates the kinds of food available even though this is a phenomenon common to everywhere.  Largely it is the Tapatio culture (a Tapatio is a person from the area around Guadalajara) that has determined what kind of foods you eat in Guadalajara; it is up to individual taste to pick out the healthier options.  For instance, the fruit was available, but it was up to me to include it in my diet.  As always, there is a choice.

Miami—I only stayed for 3 months and honestly all I remember eating frequently is the  Cuban sandwich (ham, roasted pork, cheese, pickles, mustard) which is so good.  No great conclusions can be made from this statement; I just thought you’d want another suggestion to try!

Jackson, Mississippi in the Deep South has amazing food, with fried chicken, fried catfish, crawfish, and BBQ pork ribs as common and delicious foods.  Meals at home included our usual staple (spaghetti, milanesa, chili, chicken or beef curry).  My drink of choice was sweet or un-sweet tea—I like both when people usually like one or the other.  Learning from my experience in Jackson, the foods you choose to make for yourself at home can and should be at odds to the ones you choose when you are dining out: splurge on fried foods when out, and rely on baked ones when dining in.   Note, this is a biased, salad eating California girl’s observations; and often, culture and availability and taste all align on foods that are not traditionally considered healthy, i.e. fried, in which case it requires a concerted effort to eat differently out of the home from inside the home.  After saying all this, I left Jackson 10 pounds heavier than I arrived.

Last but not least is Palo Alto, California, my new home.  I’ve noticed my lunch on a daily basis has been burritos, and sandwiches often with alfalfa sprouts (no joke).  My restaurant dining experience has been with sushi, noodles, fish, and steak.  New foods we have tried since coming to the area include Quinoa.  So yes, culture and availability have dictated me eating healthier options, but what about taste?  I must confess I have eaten at the fast food chain closest to my new home: jack in the box, simply because I miss eating fat!

Conclusions, I ate a lot of milanesa no matter where I went!  So yes, although there are differences regionally and a lot of what you eat depends on what is available—there is definitely a hunger/taste factor!  I suspect the key is to enjoy in the first place healthy, cheap foods that are found everywhere…carrots!?!   This might be wishful thinking for a lot of people, in which case it comes down to the basics.  Reducing empty calories from the drink you most often consume (choosing un-sweet versus sweet tea) and increasing the nutrients in the bread you most often eat is much easier than forgoing the delicious local cuisine.  Choosing healthy options while cooking for your self is less tempting than “eating healthy” when going out and missing out on the fried pickles in Jackson or the pizza pie in Chicago.

Where we live influences our diet.  It’s up to us to make the right choices!