Reflections of a Grady Doctor

If you scurred, say you scurred.

getting to the heart of the matter.

The words I imagine our hearts sing to our bodies and minds ~ and vice versa:

"I've been learning to live without you now

But I miss you sometimes

The more I know, the less I understand

All the things I thought I knew, I'm learning them again

I've been tryin' to get down to the Heart of the Matter

But my will gets weak

And my thoughts seem to scatter

But I think it's about forgiveness

Forgiveness

Even if, even if you don't love me anymore

All the people in your life who've come and gone

They let you down, you know they hurt your pride

Better put it all behind you; cause life goes on

You keep carryin' that anger, it'll eat you up inside

I want a happily ever after

And my heart is so shattered

But I know it's about forgiveness

Forgiveness

Even if, even if you don't love me anymore

I've been tryin' to get down to the Heart of the Matter

Because the flesh gets weak

And the ashes will scatter

So I know it's about forgiveness

Forgiveness

Even if you don't love me anymore

Even if you don't love me anymore."

~ Don Henley (as covered by India.Arie)

__________________________________________________

Hey there. First let me just say thanks for reading and for being here at this very moment. The very fact that you are here means something.

Okay.

Welcome to Team S.J.G.R. Or, better yet, consider this your introduction to Team S.J.G.R. Joining will be up to you. No pressure. No cost. No nada. Perfect, right?

So what is it, you ask? Simple. Team S.J.G.R. is a movement of people who have decided that they will stop ignoring the obvious things happening around them and to them when it comes to health and wellness. It is not a guilt trip. It is not about outward appearance. Although, the outward appearance may be an indication of how things are coming along sometimes. But with Team S.J.G.R. it will not be the primary focus.

At. All.

Because outward appearance as a goal is not sustainable. It is not. But what I am learning is that life is not sustainable when we ignore our health. So together, we will stop being afraid and start taking steps toward opening our eyes and wrestling down reality.

Why?

Your why will be different than mine. But I will tell you some of my own -- some of which you will know and others which you won't.

S.J.G.R. simply stands for "shit just got real." Or "stuff" if you are uncomfortable with the expletive. But for me, that expletive is necessary so I'm sticking with it.

First, this:

In December of 1999 I was upset because I didn't have any fancy party plans for bringing in the new millennium. I had imagined myself partying like it was 1999 until it wasn't anymore. But lame me in Cleveland, Ohio had time off but no idea of what I'd do with said vacation time.

But then plans were made for me. On December 30, my father had a massive myocardial infarction. And if you don't know what that is, know that it is a heart attack and that having a massive one is usually not good. So on December 31, 1999, I was on an airplane flying to Los Angeles as my father had his chest emergently cracked open on an operating table. He was 56 years old.

Shit just got real.

My father had always exercised for as long as I could remember. But his father had both a heart attack and a stroke. As did his mother. Which meant a penchant for heart disease was in in his DNA. He grew up on traditional Southern fare and regularly ate "the big piece of chicken" -- BUT he saw doctors and did his part through exercise. But shit got real enough to let us all know that this wasn't enough. It wasn't.

Then this:

About seven years ago, a very close friend of mine called me and said she had just been diagnosed with breast cancer. She was young and beautiful and vibrant and everything that I always thought breast cancer patients weren't. Then right after her, another close friend had the same diagnosis. Both required major surgeries and chemotherapy. And we were all the same age.

Shit just got real. Super, duper real.

And of course, this:

As many of you know, on November 15, 2012 my sister Deanna succumbed to a cardiac arrest. "Massive heart damage" the autopsy report told us. She was wonderful. Funny. Lively. Supportive. Talented. Amazing. Inspiring. And every other word you can think of to describe the kind of person that you want in your life. But it wasn't a secret that my beloved sissy struggled with her weight. And she had for most of her life. I admit that I made a decision long ago to not give her grief about it. So I didn't.

I didn't.

But in the last days of her life, I remember thinking about her weight and feeling a little worried. I did. In fact, I will even confess that on the very last time I saw her and wrapped my arms around her to hug her, this crossed my mind. It did. And I wasn't sure about how much exercise she got and most of what she ate wasn't in my presence. So I sort of worried. But, you know? I wasn't worried in the way I should have been. Like, I was worried in that hypothetical way that we all worry. That far, far away way that we read about in papers and magazines but that doesn't touch our immediate family. In that James Gandolfini "oh, how awful" way but not in that way that means YOU or your family will be the ones sitting across from the funeral home director signing off on papers for death certificates.

But then? On November 15, 2012 shit just got so damn real that I could no longer ignore it. It hit home. Deanna. My 44 year old beloved sister left us. A cherished daughter, auntie, sorority sister, and friend--gone in the twinkling of an eye. We are all still probably more effed up about it than even we realize. And perhaps it could not have been prevented at all. But sometimes I lie in bed and wonder if some shifts in life and thinking and . . . I don't know. . . stuff. . .could have given us more time together. Because even though it feels like lightning has struck and hit my family, heart disease isn't like lightning striking someone. That occurrence is rare and without much real warning. Most people don't know anyone or even of anyone who was literally struck by lightning. And definitely not a family that experienced it twice.

But coronary heart disease ISN'T like lightning. So it's time for us to stop treating it that way.

And so. That is what this is about. The fact that heart attacks aren't like lightning strikes even though they feel that way. This? This is something I'm writing because shit just got real.

Look, man. My sister Deanna is proof that being awesome, talented, fun, and loyal does NOT prevent heart disease. Because if it did, I assure you, she'd still be right here, right now.

And the breast cancer part? Well, I mention that because there is clear evidence that regular exercise reduces the risk of breast cancer. Recurrent and otherwise. So that, I think about, too.

Now.

Deep breath. The realness can make us hyperventilate, but please, don't. Because hyperventilating doesn't prevent heart disease. It doesn't. So instead, make up your mind. Today. Now.

Heart disease is the reason I never met my father in law.

Okay. So feel free to stop reading here if you aren't ready to be a part of Team S.J.G.R. It's okay to not be ready for this. It is. In fact, just bookmark it until you are because I get it. I'm not here to scold you or to make you feel bad. Just to shake your shoulders in the way that mine have been shaken by the loss of someone I loved and cherished.

Now. If you are feeling like you might be ready, read on.

First ask yourself: When did I think those four words from a health perspective? When was I taking a big drag of air and saying, "Damn. S.J.G.R!"

Was it related to your own health?
Was it when Tony Soprano passed away?
Was it when Bill Clinton had to have his bypass surgery?
Or was it something in your own family?

Even if you are young and can't think of one, let me tell you this. The NUMBER ONE cause of death and disability in the U.S. is cardiovascular disease. Peep that second part -- "AND DISABILITY." Death sucks. But disability sucks, too. Factor that into the realness. Not just fear of death.

Now. Ask yourself this: What is putting me at risk for heart disease? Do I even know?

Is it a family history? That is, a family member who has had cardiovascular disease under or around the age of 55?
Is it obesity?
Are you thick in the middle--which carries greater risk?
How much weight have you gained in the last ten years? The last twenty?
Are you diabetic? Are you pre-diabetic? Does it run in your family?
Is it high blood pressure? Or a family history of it?
Do you struggle with tobacco addiction?
Do you drink a lot? Or more than you care to admit?
Is your cholesterol in the nose bleed section?
Do you eat whatever is in front of you?
Are you connected to people who don't care about their health or weight?
Are you in denial?

Ask these things. For me, it's family history--of heart disease, hypertension, diabetes, cholesterol--all that. My weight isn't much of an issue. But I do know that slim people have heart attacks every single day. And strokes, too. I also know that several of my family members once were small but over time with slower metabolisms and unrestricted eating they caught up with the rest of the family. So I can't be in denial about that. I cannot. But what I can do is fight the things I can modify. That I can do.

Me with my Mudear (Poopdeck's mom) -- who also had heart disease.

And it starts with letting go of the fear and denial. Remember. This isn't a guilt trip. This is simply an acknowledgement of the realness that exists all around us. I prefer to deal with it myself before it deals with me.

Okay. Let's start with exercise.

The first thing that we will do as members of Team S.J.G.R. is separate exercise from weight loss. Yes, exercise burns calories, which creates a calorie deficit, which aids in weight loss. But. To have a substantial calorie deficit, that happens when we put down the fork and make better choices.

But more on that later.

Let's do this. Let's imagine our hearts. Pumping blood to our bodies and brains so that we can do the things we need to do. Imagine every step, jump, leap, jog as aiding in that. And see it all as a gift that you are giving to every single person who loves and needs you. In other words, envision your heart not your butt when you exercise. Because your BUTT does not sustain you. Your HEART does. And your BUTT won't take your life or disable you. I mean, not directly, it won't.

And so. Do your best to envision your heart health at the center of every single physical activity that you do. This is critical for you to sustain this. Because if you focus on your behind and your skinny jeans, the minute you get into them, you'll drop the ball.

And sure. For some people who are uber-disciplined, that works well. But those aren't the people who need Team S.J.G.R. We are.

So what does it take to protect your heart, you ask? Well. Here is the minimum that the American Heart Association recommends:

150 minutes or more per week of moderate physical activity (like walking, jogging, taking stairs, doing an elliptical, biking, etc.)
OR
75 minutes or more per week of VIGOROUS physical activity (like running at a "mean mug" pace, biking on hills, running stairs, doing that crazy "Insanity" workout with Sean T.)

Not bad, right? So really, the easiest way to do it is to do a minimum of 30 minutes of moderate exercise five days per week. And what's really cool is that you get the same benefits if you break it up into two 15 minute blocks. Cool, right? So basically, you can take a vigorous walk in the morning for 15 minutes and then another 15 minutes later that evening for five days per week. And that, my friends, has been shown to reduce your risk of heart disease.

But. That won't add as much to your calorie deficit as exercising for longer. But 30 minutes for your heart on a regular basis is better than one random 90 minute session for your butt. Multiple 90 minute sessions? Two thumbs up. The key is to just do what is SUSTAINABLE. Start by envisioning your heart and how vital it is to you being around for the people you love. Let that get you into your sneakers.

Not self-hate about a dimple in your thigh. (Because that's genetic half the time anyways. Hello?)

Okay. So Team SJGR members commit to a MINIMUM of 150 minutes of moderate physical activity per week. Because this is what the AHA recommends we do for our hearts. We also commit to this because the American Cancer Society tells us that this same exercise reduces breast cancer risk.

Of note: VIGOROUS exercise at longer durations for women in their reproductive years has an even GREATER impact on breast cancer reduction. So those who have a family history of breast cancer may want to use this data as a part of their mental focus when "turning up" the exercise. In other words, think of your heart for the first thirty minutes and your heart and your boobies for anything after that if you decide to go hard.

See? This isn't so bad, is it? No, my friends. 'Tis not.

Okay. And now for the part we hate. Weight and food.

Sigh.

You heard me say it before. We lose weight in the kitchen and we get fit in the gym. Period. End of story. Signed, sealed and delivered.

Now comes some really tough questions. But since shit has gotten real in our lives, we need to tackle them. So let's do it.

Ask yourselves:

Am I overweight?
If so, how overweight am I?
What is my BMI?
What is my waist circumference?
What do most of the people of my gender in my family look like?
What about as they get older?
Were any of them built like me when they were younger?
How much weight have I gained in the last five to ten years?

Do NOT focus on body image or how you FEEL about your appearance when answering these questions. This is about our hearts. Not our looks. So let's just keep it there for now. Next ask these questions:

How often do I think about what I eat?
Do I dine out a lot?
What foods are off limits for me?
Are any foods off limits?
Do I drink beverages with calories?
Do I drink alcohol? If so, how much and how often?
Do I drink water? A lot or a little?
Do I have children?
Are my children overweight at all?
Am I a snacker?
Do I prefer sweet snacks or salty ones?
Is my spouse or partner overweight?
Does my spouse or partner have a good food relationship?
Am I depressed?
Do I eat late at night?
Do I reward myself with food?
Do I reward my children with food?
Do I cook?
Do I cook with real butter?
Do I care if bread is wheat and rice is brown on most days?
Do I roughly know how many calories I consume each day?
Do I roughly know how many calories I consume with each meal?
What do I regularly eat or drink that I know I really shouldn't?
What do I eat that is worth every single calorie and fat gram? How often do I eat it?
Have I always been overweight? Like since childhood?
Do I envision myself as anything other than overweight?
Do I believe that being overweight is a part of my identity?
Am I afraid of being smaller?
Do I believe that some people are just "meant to be big" or are "just big-boned?"
Would it make me happier to weigh less? If so, why?
Do I believe I am capable of having control over what I am eating?

and most importantly, these questions:

How will losing or better managing my weight help my heart?

Do I really believe that my weight could be working against my heart enough to actually disable me or abbreviate my life?

Perhaps the second of those last two questions is the most important of them all. Getting beyond the idea of it all being "hypothetical." Let me tell you something: I miss my sister Deanna every single day. Intensely, deeply and consistently I miss her. And there is no shit that is realer than wanting to talk to your sister who wasn't even two years older than you and not being able to because of heart disease.

This shit is real. It is not hypothetical or rare like lightning striking. It is not about how you look or your class reunion or some big party or vacation you have coming up. It is not about your baby weight or homecoming or your wedding or your child's wedding either. It is about being here. And being present and able while you are.

Now.

Let's be clear: Sometimes shit gets real and bad things happen even when you ARE doing your part. But very, very few of us can say that there isn't something that we can modify to cut those chances down.

Okay. So if you are overweight or have been picking up pounds, to protect your heart, you need to lose weight. And remember--we lose weight in the kitchen. NOT at the gym.

So go to your pantry. Look inside of it and start making some decisions about what you find. And before you do, make a declaration to your family that you have a long term goal. Not to oppress the family but to be here. So some things can't stay. Even if your rail thin teenager loves it. Your reply needs to be:

OH. WELL.

Now. It's okay to have a few treats. But what is your will power like? Do you have no power over Key Lime Pie from Publix? Does your hand have a mind of its own when it comes to trailmix, potato chips and Chee-tos? If so, then they must go.

And if your KIDS are getting thick in the middle, that's all the more reason to get that stuff out of your house. Oh, and even if they are slim kids, watch them to see how they eat. Do they eat when they are bored? Do they have carte blanche to the pantry? Do they drink a lot of calories? Remember: Kids follow our leads. They don't really have jobs to be doing the grocery shopping so whoever does the Krogering is in control. So it's futile to be "tough" on a little kid who's gotten a little chunky when the parents are sabotaging them with the groceries.

Yep.

Now. For me, I love dark chocolate. I allow myself a square or two in the evenings. I also like red wine. I have a glass every couple of days, too. I like those things but can restrain myself. But if someone brings a Key Lime Pie in here or some Graeter's Ice Cream? Forget about it. I'm chowing down until it's GONE. Same for chips and salsa. They don't come into my house.

Me eating Key Lime Pie: Danger!

Will I enjoy them outside of it? Sure. But if they are IN my house, I eat five times more. OH, and beware of the potluck at your house--where things like Key Lime Pie and chips 'n' salsa get left behind. Keep your eyes open and send it right on out with either the person who brought it or someone else altogether. But it CANNOT stay in your home. No, ma'am. No, sir.

Whew. This is a lot. Sorry, y'all.

Next, do the same thing with your fridge. Decide what's necessary and what isn't. Decide what's good and what's not so good. And then think about how much restraint you have for whatever is in there that is mostly a treat. If you have no restraint for it, let it go.

And what about you folks who love to cook and bake and all that? Or who live with someone who does? Just be aware. You must. And even if those people are young and still in hypothetical la-la land, it's up to you to tell them that you AREN'T. Keep in mind that a lot of damage is done to the heart when we are young. So the earlier you start being nice to your heart the better.

You probably noticed that I don't have a lot of specific rules on what is "good" and what is "bad." That's because Team SJGR isn't about guilting you into not eating things. It's about respecting you and your own limits and simply being aware. Aware enough to get out of hypothetical la-la land for good.

Yes, I had to say that again for emphasis. Hypothetical La-La Land. This is the place where you keep on doing shit not taking care of yourself because you don't *actually* think that you could have a heart attack. But remember: The thing most likely to take your life or disable you is HEART DISEASE. Not big butt, self hatred disease.

Making sense?

So check it. It's simple. Getting out of la-la land means being aware. Aware that your heart is at the center of it all. So when you get ready to eat something that is likely to cause weight gain, think for a moment. Have the dialogue with yourself:

What am I either eating or drinking (or thinking of eating or drinking) right now?
Am I hungry or just bored or being social?
Is this high in calories? If so, do I have any idea just how high?
Is it delicious? Like really delicious?
What else have I had already?
What am I willing to interchange or cut out to enjoy this?
Is this worth it?

So let's do this exercise with something I had the other day:

What am I eating or drinking (or thinking about eating or drinking) right now? Some guacamole and salty tortilla chips.
Am I hungry or just bored or being social? Hungry and being social.
Is this high in calories and/or fat? Yes. Super high. If so, do I have any idea just how high? Yep. The guac has a ton of fat, albeit good fat, and the chips are fried and full of salt, fat, and calories
Is it delicious? Yes. Like really delicious? Well, this isn't the best guacamole I've ever had. But I do love guacamole. But maybe I can enjoy a little bit then stop since it isn't like the guac from El Azteca or Rosa Mexicana or somewhere like that.
What else have I had already? This is the first thing they put on the table so nothing else.
What am I willing to interchange or cut out to enjoy this? I am going to have tortilla soup instead of the steak tacos that I really want. And a light beer instead of a margarita.
Is this worth it? Yes. But only a little bit so I won't have as much as usual.

And how about this:

What am I eating or drinking (or thinking of eating or drinking) right now? Thinking of drinking a mojito or a mint julep at my friends' cocktail party.
Am I hungry or just bored or being social? This is purely social.
Is this high in calories? Very, so I'm told. If so, do I have any idea just how high? Per Google: mojito has ~300 calories and mint julep up to 450.
Is it delicious? Like really delicious? I am not in love with either drink.
What else have I had already? Some pasta salad and some bar-b-que.
What am I willing to interchange or cut out to enjoy this? Probably will find an alternative drink like white wine or a glass of red.
Is this worth it? No. I don't like mojitos and mint juleps enough for that many calories.

And that's how it works.

The other thing I do is tell myself that every mile I run is 100 calories. So I ask myself if what I'm about to have is worth that. And many times it's a yes. And many times I am in hypothetical la-la land and try my best to ignore it. But now that we are Team S.J.G.R., that has to stop. It must.

This is a six mile Funnel Cake.

Oh yeah! And also the thing about socializing only with food and alcohol. Cut. It. Out. One of my BFFs and fellow Grady doctors Lesley M. and I run together. We talk and laugh and share but while getting exercise not eating. And now, I don't even associate us being together with food. I also have a student that I advise that wanted to meet with me and she suggested we take a walk which we did. It was genius. Instead of eating or even drinking a latte or something we moved our bodies.

Try that if you always eat when you meet.

Lastly, I am not sure if my big sissy had a primary care doctor. I am pretty sure she didn't. So all I will say about that is that if you don't have one, get one. And I will go on the record confessing that I DETEST being a patient so it's been a little too long since my last appointment. Yes, me. But since we are Team S.J.G.R., I have contacted my primary care physician and have an appointment coming up this month.

And so. Joining Team S.J.G.R. is simple. It just means you agree to the following things:

I will get out of hypothetical la-la land.
I will do my best to focus on my heart when exercising.
I will try my best to do 150 minutes per week of moderate exercise and will be aware that I am being unkind to my heart when I'm not.
I will not trick myself into believing that exercise is the best way to lose and maintain weight.
I will not insult my body image as I move toward being kinder to myself. Especially around my children, but period.
I will be realistic about the direct relationship between my weight and my heart.
I will be realistic about the direct relationship between the food I put in my mouth and my weight.
I will accept responsibility for the relationship my children have and can have with food. (Especially small kids.)
If I am a woman, I will be realistic about the direct relationship between weight/exercise and breast cancer risk. And heavy alcohol, too. (Even though I didn't really mention that.)
I will not bring the enemy home. (That is, I won't bring bad and tempting foods into my home no matter how bad my family wants it.)
I will eat and drink with full awareness of what I am doing.
I'll drink water.
I will see a doctor and know my risk factors for cardiovascular disease such as blood pressure, cholesterol, etc.
I will accept that I am a work in progress.
I won't make any more excuses nor will I let others make them for me. Because now that I am out of hypothetical la-la land, I won't let others imagine me and my heart health as something hypothetical either.

Oh, and a couple of last ones that I am working on that continue to be VERY hard for me:

Getting more sleep. Sleep deprivation increases hormones that make you feel less satiated. People who get more sleep weigh less. True dat.
Refusing to eat something--even if I ordered it and have to pay for it--that isn't good enough for what it does to work against my heart. Like, the other day I was at IHOP and ordered a short stack. And for whatever reason, they just weren't as good as I'd imagined they'd be. And so I stopped eating them right then and there. I ate my eggs and turkey bacon instead. It's up to you to decide if you want to send stuff back. I didn't. But I also didn't just eat it because it was there. Pancakes must be perfect and delicious to be justified. These weren't.

I want to add stuff about weight training, food trackers, and fitness trackers, too, but this has been long enough. I will stop here for now. If you are ready to get on board, make your mark here:

X___________________________________________

Or just quietly join inside of your own head if you're the shy type.

(There are no age, gender, or geographical restrictions to joining Team S.J.G.R.)

I hope you are still my friend after reading this. But remember, any message I write here is a message for me more than anyone else. Like Toni Morrison said about writing "The Bluest Eye" -- she wrote it so she could read it.

Me, too.

By the way, Team S.J.G.R. is a team approach. So your additions are welcomed as are your thoughts. But best of all, if this has you thinking differently about your health and weight than you have before, we have done something good. Ultimately, I agree with those song lyrics. I think it's about forgiveness, you know?

Yeah.

That's it for now. Love y'all. And I mean that literally, not hypothetically.

***
Happy Monday. We can so, so do this. We can.

Now playing on my mental iPod. . . . India.Arie sings Don Henley's classic "The Heart of the Matter." I love this cover more than the original. Beautiful.