Dynamic Balance and Beyond

Homeostasis is a biologic process that is self-regulated. It is a key concept in physiology that helps our bodies adjust to conditions in order to maintain survival. It is the human body’s way to remain in balance amidst change. However, unlike a scale, of which the destination is stillness, homeostasis is a dynamic equilibrium. There is fluidity and continuous change in order to adapt and evolve with feedback and integration. It is an amazing natural engineering of our human bodies. But when it comes to the art of living, why is homeostasis and balance so hard to realize and achieve?

Wanting It All

My friend Cathy has always told me: “You can have it all, just not all at once.” I understand that – to a degree. When I first embarked on a career as a medical doctor, I knew sacrifices would have to be made. Working part time was never a thought on my mind. Medicine is life’s work. But after being in practice for just over five years, I wonder, is all life meant to be work? Or should doctors really maintain more of a work-life balance?

Burnout is characterized as a syndrome of symptoms such as fatigue, decreased enthusiasm, and increased cynicism with waning job satisfaction. It is not an uncommon phenomenon. This is especially true in medicine. Recent Medscape surveys note ranges of burnout amongst physicians to be ranging from 30% – 65%, depending on specialties. Most vulnerable populations include critical care, emergency medicine, and primary care. This response is unfortunately not unique but a serious upward trend over the last decade. This not only leads to an increase in job turnover, which can cost healthcare systems millions, but if left unrecognized and untreated, can lead to a decrease in the quality of care for our patients.

Beyond the Bottom Line

Recognizing burnout early to prevent further physical and mental sequelae is important for rehabilitation. Moreover, it is important to consider breeding a culture that is able to focus on balancing dedication and self-preservation to provide excellent care to patients, as well as providing impeccable care to ourselves. It is hard to educate, counsel, empower and engage patients about their health when many physicians are nearing if not at burnout or compassion fatigue. How can we help achieve greater balance when the demands of healthcare continues to rise?

Here are three tips to consider to improve balance while preventing burnout:

  • Reflect on what is important in your life daily. What relationships, hobbies, experiences matter to you outside of your work? Write these things down. Keep them handy. Let these things help root you in times of stress. Next time it is a busy day, consider this: two feet, one breath. Read your list. Feel your feet on the ground. Take a breath. Reset and go.

 

  • Set your priorities. Being a physician means you are going to have to have to have flexibility to adapt to the unpredictable demands of our patients. It is important to note that some days are going to demand you work outside your requested schedules in order to provide the best care possible to our patients. However, it is critical to also respect the same dedication to your other priorities. So mark those family events on those calendars. Take that trip with you have always wanted. You are more than your job.

 

  • Saying “no” is not a bad thing. You have to consider saying “yes” to your life. Helping and serving is the essence of why many choose a path of medicine. However, your value is not enhanced by being a martyr and constant sacrificing. It is important to help out when you can and able, but consider saying “no” with a smile. Resentment from always stepping up and stepping in can creep before you know it.

Patient Centered Care

The art, science and career of medicine has always encouraged the patient to be put first. And this is demonstrated through value based care models that emphasize decreased cost of care while improving outcomes and patient satisfaction. It is important not to forget the importance of physician health and satisfaction in that equation. It is known that job satisfaction improves employee engagement while decreasing costly turnover. However, what directly impacts patients more is the fact that decrease in satisfaction of physicians may ultimately lead to less medical errors. It is reported by Andel et al in 2012, medical errors cost the US healthcare system approximately $19.5 billion. This amount is not trivial when considering the out of pocket costs continue to soar in the US. Despite many proposed models of cost containment have been developed, the concept of work life balance, improved physician engagement, and avoid burnout has not been largely recognized as an opportunity to not only improve quality of care but improving value to the healthcare system. It is in my hope as the population continues to grow, we all demand the wave of the future to embrace this challenge and find dynamic balance amidst the struggles in order to teach the importance of thrive and resilience.

 Dr. Joanne Wu is a board certified physician in Physical Medicine and Rehabilitation and Integrative and Holistic Medicine. Her background extends beyond traditional medicine to encompass training as a medical acupuncturist, an experienced yoga and fitness teacher, and holistic health coach. She has passion in integrated wellness and value based medicine for both patients and practitioners.

Fitness trackers get people moving

Are you obsessed with your Fitbit? I was happy to share some thoughts on the fitness trackers.

Read the whole article in the Democrat & Chronicle. 

Tabouli Quinoa Salad with Turkey Remix

Whether you call this Tabouli, Tabbouleh, or Tabbouli, this hearty, filling and refreshing salad is sure to help you detox from your filling Thanksgiving meal. Aside from the clean Mediterranean flavors this dish can offer, it celebrates freshness, wholesomeness, and diversity. There are so many ways to keep this strictly raw, vegan and gluten free, but I like to propose this recipe as a nice alternative to that turkey casserole, turkey chili, turkey sandwiches or turkey shepherd’s pie recipe to use up that wonderful lean bird you may eat with your family for Thanksgiving.  It is filled with fiber, flavor, and fabulous nutrients to help you stay lean into the holiday season. Enjoy!

(Fit2bWell Tip: Try substituting quinoa with other high protein, high fiber seeds or grains for some texture and earthiness like chia, bulgur, farro. None of the above? Brown rice can be considered as well! Don’t have leftover turkey? Don’t worry. You can make this meal with any protein you desire)

Serves 4 (approx 1 3/4 cup)

1 3/4 cups water

1 cup uncooked quinoa

1 cup coarsely chopped tomato

1 cup chopped fresh mint or parsley

1 cup chopped cucumber

1 cup leftover diced turkey, reheated

½ cup fresh lemon juice

2 tablespoons chopped green onions

2 tablespoon extra-virgin olive oil

Salt, pepper, red pepper flakes to taste

Directions

Combine water and quinoa in a medium saucepan. Bring to a boil. Cover then reduce heat. Simmer for 20 minutes or until liquid is absorbed. Remove from heat; Stir in tomato and remaining ingredients. Cover and let stand in fridge for 20min. Re-heat your leftover turkey from Thanksgiving. Dice it and stir the warm meat with the cold salad just prior to eating. Delish!

 

Vegan Spicy Spaghetti Squash 2014

It used to be very difficult to eat or cook vegan. A vegan is one who does not eat or use animal products. Many think that a tasty vegan dish is limited to some salads or cooked vegetables. I was challenged by one of my health coach clients to help find dishes that have roots of being vegan but can have animal protein added simply in a pinch. This time of the year, when fall splashes cold and the trees are robust in colors, I like to look for squash dishes that can often spice up our palettes and warm our bellies.

I love Mexican food flavors, and I just love the color of spaghetti squash, so this recipe adopted from wholefoodsmarket.com was a treat to taste test.

(Fit2bWell Tip: There is vegan protein such as seitan and tofu that would be good additional “toppings.” But be mindful, seitan is not gluten free. Feel free to also explore many type of vegan cheese on the market and sprinkle it on last minute for a nice finish to this tasty meal)

Vegan Spicy Spaghetti Squash (serves 2 for dinner)

Ingredients:

• 1 medium spaghetti squash, halved lengthwise and seeded

• 2 teaspoons extra-virgin olive oil

• 1/2 onion, chopped (any type)

• 1 jalapeño pepper (can be more if want more spicy)

• 2 cloves of garlic diced

• 1/2 cup red bell pepper, chopped

• 1 cup of tomatoes, chopped

• 1 cup cooked black beans

• 1 cup corn

• 1 teaspoon chili powder

• 1/3 cup fresh cilantro, finely chopped

• 1 tablespoon lime juice

• 1 teaspoon salt

Directions:

Preheat the oven to 375°F. Arrange squash in a large baking dish, cut-sides down. Pour 1/2 cup water into the dish and bake until just tender, 30 to 35 minutes. Rake with a fork to remove flesh in strands. Yes, it looks like spaghetti! Don’t rake too deep as to puncture your squash as that will now serve as a dish for your meal.

For the filling, heat oil in a large skillet over medium heat. Add garlic, onion, jalapeño and bell pepper and cook until soft. Be careful not to burn the garlic. Add beans, corn and chili powder; cook, stirring frequently. Add cooked squash, cilantro, lime juice and salt, cook a few minutes until heated through. Try using tongs to fill squash halves with filling, mounding mixture in the center. Tongs will help protect the fragile root vegetable, while maintaining its integrity as you lay it into the “bowl.”

(spaghetti squash photo credit: www.skinnymom.com)

Get Motivated: Finding What Moves You and Sticking to It.

Real goals are simple if we harness our motivation and visualize success. But it is not that easy, most of us who are innately highly motivated can feel unmotivated at times. In fact, sometimes we get into such a slump that even thinking about positive change can be overwhelming and even hopeless. And when failure sets in at attempts to get started again, we find excuses to be at the forefront of delay of unlocking our potential to get out of our slumps. Here are some tips to take it one step at a time and set you up for success to dream for reality once more:

1.)   Set one goal: establish focus

Don’t let too many things pile in your life. De-clutter your physical space. Harness your energy and find focus. You can do your other goals, when you have finished this one.

2.)   Inhale inspiration

I draw my inspiration from my community, my travels, and my experience. We build on connections and we seek to understand and be understood. Learn from those who have triumphed and you too will find extra in your ordinary.

3.)   Get excited with positive thinking

Recognize negative self-talk. What is really going on? Try squashing that energy like a dead bug. As Zig Ziglar said it best: “Your attitude determines your altitude.”

 4.)   Build anticipation with daily intentions

The power of daily intentions in conscious living is often misunderstood. The more you are able to visualize your success by acknowledging your goal, the more you are able to lead yourself there.

 5.)   Post your goal: Commit out loud

Nothing sets in reality like saying something out loud and sharing it with others. Hold yourself accountable and you will feel more responsible. So go on, say it with pride!

 6.)   Lean on support: you are not alone

This road to success is not easy without friends to lean on. Don’t isolate yourself, learn from each other. Be stronger as you garner strength from your community. Ask people for advice. Trust me, many people are not just eager to help, but are honored to be asked.

7.)   Dynamic stability: life is a flow

Trend towards improvement is better than large leaps of fluctuations. Don’t expect your growth to be linear. Life is a flow so expect turbulence. Root down on your strong foundation and you will find strength once again to head towards your goal.

8.)    Start small, dream big

Rome was not build in a day but there was a dream of its existence. Allow each step you take towards the picture of great success help push you forward and onward. Want to run a marathon? Start with a two minute run, and then add two each day. Build on your small steps and the leap will happen.

9.)    Stick with it:  learning how to gracefully step back

Don’t give up. Motivation will come back if you just let your slump be a bump. Don’t just steer yourself completely onto a new goal or a new fad. There is no instant gratification. Take step back, be patient, and re-examine your big picture goal. Let that fuel you and help you stick with it.

 10.)Celebrate success, no matter how little it may seem

We all need a pat on the back. Acknowledgement is positivity. Don’t’ let your intentions, your practical breakthroughs, go amiss. You deserve rewards to remind you that you are doing the best you can and you are worth it.  It doesn’t need to be celebrated with champagne or a party, but smile, look at yourself in the mirror and say “good job”! It matters.

Eggs and Tomato Pie

Gluten free is no longer becoming a trend. It is a way of life. It has been known that a gluten-free diet can be anti-inflammatory. It is a diet that excludes the protein gluten. Gluten is found in grains such as wheat, barley, rye.

A gluten-free diet is also used to treat celiac disease. Gluten causes inflammation in the small intestines of people with this disease, making them really sick from malabsorption.  Eating a gluten-free diet helps people control their signs and symptoms of this disease and prevent complications.

This recipe is delicious, similar to many GF recipes on Simply Gluten-Free.com.  Check them out!

(Fit2bWell Tip: Many healthy and delicious foods are naturally gluten-free such as beans, seeds, nuts, fresh eggs, fresh meats, fish, poultry, fruits and vegetables. Most dairy is also gluten-free! It’s important to make sure that they are not processed or mixed with gluten-containing grains, additives or preservative)

Gluten Free Eggs Baked in Tomato Sauce Recipe (serves 4)

Ingredients

1 tablespoon olive oil
1 medium onion, diced
1 clove garlic, minced
1 (15-ounce) can of diced tomatoes
1½ cups tomato sauce
Salt
Black pepper
8 large eggs (can substitute out four whole eggs for four egg whites)
¼ cup parmesan cheese, grated – optional

Directions

Preheat oven to 350 degrees.

In a large skillet, heat the olive oil over medium-high heat. Add the onion and cook for 5 minutes or until softened. Add the garlic and cook for 30 more seconds. Add the canned tomatoes along with the juice and cook for about 10 minutes or until the liquid has evaporated. Add the tomato sauce and cook for another 5 minutes. Season to taste with salt and pepper.

Divide the sauce among four 12-ounce oven-proof ramekins, bowls, or mini skillets. Crack two eggs on top of the sauce in each ramekin, and sprinkle the eggs with a little salt and pepper. Sprinkle the parmesan on top and bake for 10 minutes or until the whites are set and the yolks are still soft.

Movement of the Month: Hula Hooping

Hula Hooping is no longer an activity for kids. I fell in love with this sport the last couple years when I spent my time traveling to festivals and dancing in the great outdoor summer son. Since then, I have become a certified Hoopnotica Fit and Flow teacher. The way the hoop flows the body really enhances our natural curves. It is a dance with our consciousness. You can’t help but laugh as you explore new moves with a hoop. Hooping has been helping many lose inches off their waist over the years and build cardiovascular endurance and improving balance.

 Check out this article I commented on in EveryDay Health!

 (Fit2bWell tip: Talk with your doctor about your desire to hoop. Seek out a fun but experienced teacher Make sure that foot, knee, hip and back problems are cleared before attempting any rigorous training event to avoid injuries. Consider doing this as a family activity, outdoors, and listening to a tune that moves you!)

Ten steps to hula hooping:

1.)   Wear comfortable clothing. Recommend no backless sandals or shoeless when you first start

2.)   Put the hula hoop on the ground and choose a hoop that reaches your chest or waist. The larger the hoop, the heavier the hoop (to a certain point) tends to be better for beginners due to its slower spin.

3.)   Step inside the hoop

4.)   Reach down and pick up the hoop with soft knees. Ensure hands are at a comfortable distance apart

5.)   Bring hula hoop to waist level. Step one foot in front of the other (approx 1-2 shoe lengths) with soft knees

6.)   Hold on to hoop but place on side of your body near top of pelvis

7.)   Spin the hoop clockwise or counterclockwise. Many feel comfortable with one side better than the other, so explore

8.)   Start to think about points of contact with the hoop. Those would be your push points. Push your stomach forward as the hoop comes around. Push back with the back as it goes around the other way. Sometimes circular motion with push points on side to side feels better. So see what works for you!

9.)   Keep breathing, keep smiling and keep the hoop spinning

10.) Expect the hoop to fall, and when it does, keep trying and have fun!

Fluffer Date-Nut Cranberry Oat Energy Balls

With my activity level beaming strong as the summer rays, I look forward to creating snacks that pack a punch in deliciousness and nutrition. These energy balls helped nurture my run club after our sweaty date.

As many of you know, dates are wonderful fruits. They are however often high in sugar, so I do not usually snack on them as a whole. So using them as a natural sweetener and binder in raw energy balls is a delicious option to integrate its high antioxidant properties into an invigorating boost to the end of your workout!

These energy balls remind me of my love of Rice Krispies treats as a child. Nostalgic with a nutritious adult spin. Enjoy!

 (Fit2bwell Tip: Feel free to substitute any other dried fruit or nut into this snack!  Play with this recipe for creative variations. Enjoy your food!)

August2014Foodglutenfreeballs

Ingredients

  • 1 cups rolled oats
  • 1 cup dried or roasted almonds
  • 1 cup 70-80% dark chocolate pieces
  • 1 cup cranberries
  • 1 cup dates
  • 1 cup dried cranberriess
  • 1 cup of Fluff
  • Cinnamon dusting

 

Directions

  1. Use food processor and blend almonds and oats until crumbly. Place in a bowl.
  2. Use food processor and blend chopped dates. If it is too thick, add a couple of teaspoons of warm water. Remove and place into another bowl.
  3. Chop dark chocolate pieces into slivers. If you are using small chips, no need to chop.
  4. Combine almonds/oats mixture with dates mixture. Use your hands and don’t be afraid to get messy
  5. Add Fluff. Don’t be afraid to get messier
  6. Add cranberries
  7. Roll into 20 equal sized balls. Place on parchment paper
  8. Let it set in fridge for 30min
  9. Dust with Cinnamon before serving.

 

Movement of the Month: Running

Summer fun is enjoyed best outdoors. Running is a sport that not only frees your soul but also improves your health. I am thankful this year to join my run club at Lululemon Athletica Rochester to share joy outdoors with a fun run every Monday night. Community bonding through sweat dates not only brings accountability, but also nourishes socialization in an otherwise very independent sport. Here is small list of health reasons to start running!

(Fit2bWell tip: Talk with your doctor about your desire to run. Make sure that foot, knee, hip and back problems are cleared before attempting any rigorous training event to avoid injuries. Consider looking up free run clubs in your area that can motivate you to start something new. And sign up for charity race to set sights on goals that can bring a new dimension to your exercise routine.)

Augrunning1

1.)   Runner’s High

  • No matter how tired, a small dose of exercise can make anyone feel better. This rush of endorphins can instantly boost mood. In fact, exercise has been demonstrated  in many studies to help treat depression, and improve concentration and sleep.

2.)   Running slim

  • It is no secret that exercise burns calories during a workout. But did you know that cardiovascular exercise like running, can strengthen your muscles including your heart and lungs that will help you burn calories even when the workout has stopped. Now that is a good investment return!

3.)   Running strong

  • Running is a wonderful way to tone and strengthen all muscles. By strengthening your muscles, you can take stress off your joints. Excessive running can add stress however to joints that already have significant arthritis however. A balance of intensity, duration and frequency of running can keep you strong and pain-free! This strength extends to your heart and your lungs as well. This translates to more efficient and powerful oxygen delivery to your muscles and your brain!

4.)   Running sharp

  • Aging gracefully is a desire for all. Studies show that not only can exercise extend your life, but there are studies that demonstrate improved attention, memory, judgment and thinking (ie overall brain function). So stay sharp, get your sweat on!

Dark Chocolate Cherry and Chia Energy Bars

Chia seeds is a good source of omega-3 fats, calcium, and fibre.  It can be eaten whole or milled. It is tasteless and can be easily added to many dishes. I love adding it to salads or blended into smoothies. It comes from the mint family, and transcends from native countries. It can improve your health by improving your metabolism, stabilizing blood sugars, and regulate your digestive system.

I have to thank this recipe from Shaina Olmanson, from Foodformyfamily.com. Inspired by her story, I tried this as I prepare for my race season this year. I tweaked a bit for my taste. I spend so much money on bars, and love many of them, but I am quite motivated to make this one regularly. It is simple and encompasses one of my loves: dark chocolate. Thanks Shaina!

(Fit2bwell Tip: Quality dark chocolate is rich in Fiber, Iron, Magnesium, Copper, Manganese and  Antioxidants. When consumed in moderation, it can have heart healthy benefits. When choosing nut butter, do not choose low fat! Nut fat is healthy for you compared to additives they replace the fat with in those alternatives. )

Ingredients

  • 2 cups rolled oats
  • ½ cup chia seeds
  • ¼ cup chopped dark chocolate
  • ¼ cup pumpkin seeds
  • 1 cup organic peanut butter (explore other nut/seed butters)
  • ½ cup coconut palm nectar (honey was in the original recipe)
  • ¼ teaspoon salt
  • ¼ cup dried tart cherries (feel free to substitute dried strawberries)

Directions

  1. In a large bowl, mix together the oats, chia seeds, dark chocolate, and pumpkin seeds. Stir to combine.
  2. In a separate bowl, mix together the peanut butter, nectar, and the salt. Stir until smooth. Pour the butter and nectar mixture over the oat mix and stir until evenly coated. Then stir in the cherries.
  3. On a baking sheet using a 2-3″ cookie cutter, press the energy bar mix into the cutter and press firmly. Continue until the mixture is gone.
  4. Place the energy bars in the refrigerator until firm and then transfer to an airtight container and store in the refrigerator.