Bust a move(ment).

Dude.

If I had a dollar for every time I counseled a patient about their sluggish bowel habits, I'd be a gabillionaire. For reals.

Bowels. There is not a day that goes by where I don't talk about them, ask about them, and make plans for them. Seriously. Because if I don't know ANYTHING else, I know this:

People do NOT like it when their bowels aren't moving.

When I'm rounding in the hospital, that's always a question I ask. And if they aren't moving, I make sure to do something to fix that. I do, because bowels that don't move make people unhappy. And that isn't just an issue with hospitalized patients.

No, 'tis not.

So, yeah. In the hospital, I know there can be tons of reasons for bowels going on strike, but outside of the hospital? That's a different story. Usually it's the person with the typical Western diet. Low on fiber, high on refined sugars. They ramble off a recall of foods they've eaten for the last few days, and you understand why things aren't moving and grooving.

So what happens next? Well. I do everything I can to avoid having them take a bunch of pills to soften their movements. I talk all about adding fiber and all that stuff which is usually met with a slightly hairy eyeball. OR it's met with a whole soliloquy about how they ARE eating a ton of fiber.

Then, I started realizing how many conversations I've had with people who aren't my patients but who have locked up innards. And to them I say the same thing. Eat the right things and your bowels will be a no-strain zone.

Yup.

So they ask me for specifics and I tell them. And you know? If they follow what I told them, those suckers get to pumpin' in know time. And let me tell you, there's no gratitude like poop gratitude. Seriously. Okay, so. .  .over time, I've gotten to be a bit cocky about my ability to get things going. And since I am 100% sure that at least one person reading this either lives with someone who STAYS constipated all the time or personally is a once-per-week pooper who get's super miserable by day 6, I will bring my fool proof, stealthy non-pharmacologic bowel program straight to you for no charge.

Okay. You ready?

Step one:  Drink plenty of water. Soft bowels have lots of water in them. Duh.

Step two:  Eat more fiber.

But how is that supposed to happen? Or better yet, how can I get this stubborn person I live with to eat more fiber?

Bwwwwah ha ha haaaaaa! Guess no more, people. That's what you have ME for!

For you non-lactose intolerant people, one of the easiest ways to get your fiber on is through cereal. And no. Not just any cereal. The real, true high fiber ones.

I bring you exhibit A.

Let me be clear on something: All raisin bran cereals are NOT created equal. I personally think the Post brand not only tastes better, it has a crap-ton (no pun intended) of fiber in it. And what constitutes a "crap-ton?" Well, I'd say anything that gives you more than 30% of your daily allowance of fiber in one fell swoop totally meets that criteria.

This alone might do the trick.

I'm also a big fan of Frosted Mini-wheats. I actually suggest them to people as a midmorning or midafternoon snack. They're tasty and super high in fiber. I regularly pack these in my kids' lunchboxes. It keeps them moving and grooving--and does so inconspicuously.

I pack them for myself, too. Although as "the regulator" it is for less urgent reasons than some others in my household.

Ah hem.

Mini-wheats do a solid job with 23% of your daily allowance of fiber. That combined with a piece of fruit in a lunch box on whole wheat bread? Chile please.

And for those who are concerned about the crap-ton of sugar that can be found in these? Another great consideration is this:

 

 

I added this part in for Sweet Jo who made that very good point in the comments. Everyone isn't ready for Grape Nuts. I personally love them and am happy to sprinkle them on salads, in yogurt or in just about anything. But my feeling is that for this to work, it has to be something that the person will actually eat. I am the only one in my house willing to eat this. So as for the sugars, I recommend remembering that moderation is the key and that the likelihood of your BMI skyrocketing because of Raisin Bran alone is virtually zero.

Hmmm. What else?

Oh. This.

 

You've got to move to move. For reals. One of the biggest reasons (I think) that people have sluggish bowels is because they have sluggish bodies. The gut is lined with MUSCLE. Muscles need oxygen and blood flow and all that good stuff to work their best. People who exercise are less likely to have issues with regularity.

Yup.

Dark green leafies go without saying. We know that those are great sources of iron but also fiber. So mix some spinach and kale into that salad. Do it people.

And now for my ace in the hole. . . . . which I say is non-pharmacologic but I guess you could consider this like a med of sorts. . . .

The clear, soluble fiber supplement. 

OH. EM. GEE.

This stuff is genius. It's tasteless. It's odorless. It's not grainy or gritty. And it works.

The brand names ones are things like "Benefiber" or "Fibersure." I'm too cheap for that so I just get the Target brand. It's all the same.

You know how that Frank's Red Hot lady says, "I put that SH*T on everything!"

Well, I need to be on a commercial saying, "I put that SH*T in everything!"



It dissolves best in hot things. So I throw a few tablespoons in spaghetti sauce, chili, chicken and dumplings. . .you name it. If it can be stirred, I've made it into something higher in fiber. Oh and boo-ed up people? If you are kind like me and prepare your husband, wife, girlfriend, boyfriend or partner's coffee for them in the morning?

BBBAAAAAA-DDOOOOWWWW!

And all I will say is that any loving significant other who prepares meals and such in their homes should make no apologies for putting their loved ones on "a little plan" as I like to call it. And "little plans" are more than just about moving bowels. It's nothing for Harry to be like, "Damn, did you put the food up already?" And I say, "Yep." Then he says, "Dang. Am I on a little plan or something?" To which I reply, "Yup."

Ha.

Surely do.

And so. I say to you all. Who needs laxative pills? I'd say it's the person who isn't doing the things mentioned above. This plan gets even the most stubborn innards going.

And YES the caveats are things like taking iron or chronic opioid medications. But MOST people who are constipated DO NOT fall into this category. So there.

Eat fiber. Drink water. Get up offa that thang. Move your bowels. And then repeat.

Come on, people! Let's start a movement!!! Let's start several of them!

Bwwah ha ha ha.

That's all I got this morning. How you doing?

***
Happy Friday.

Team S.J.G.R. Thursday Huddle #11: Your Primary Care.

What's up, team? Sorry to be getting this up so late. Back-to-school night and a full work day trumped blogging earlier. But better late than never, right?

Riggggght.

So check it. Today I did one of my least favorite things on the planet. I went to see my primary care doctor.

Terrible, right?

First, let me be clear: My PCP is amazing. She's smart and thoughtful and empathic and decisive. She remembers things that I tell her and floats effortlessly between my care and things like how my kids are doing in school and how things are going at work. Her eyes were so caring when asking questions about how I've been coping with Deanna's transition that, despite my best efforts, I did that thing that I'm usually on the other side of. Yeah, man. I broke down and cried for a few moments. And she was awesome, man. She listened -- like FOR REAL listened -- and never once made me feel like all of it was some part of a giant psychoanalysis but instead just one human being caring about another one. She even makes things as unpalatable as lady-part examinations not so daunting since her bedside manner is so tremendous.

Yeah. My PCP is rad.

So. I'm sure you're all like, "Then why is seeing your primary care provider one of your least favorite things on the planet?"

Is it the blood letting? Is it the paperwork? Nope. It's not any of those things. It's actually something quite simple, really. Here's the confession: I simply hate being a patient.

Dude.

I hate it. Everything about it. And yes I said "hate"-- a word that is a bad word in my house. And since my kids won't be (at least not right now) reading this, I need to use that word for emphasis. Hate.

Sidebar: I told the kids a few years back, "There's just no reason to say 'hate.'" And Isaiah replied, "But what are you supposed to say when you just really, really don't like something?" I quickly shot back, "Easy. You just say you really, really don't like it." And Zachary said, "But wouldn't it just be faster to just say you hate it?"

Uuuhhh, yeah.

Anty who. I hate being in the patient role. The exploration. The investigation. The suggestions and thoughts. Even when they make perfect sense like my doctor did today. Like her asking me about this stress fracture I had back in the winter and then wondering if that had anything to do with the low Vitamin D level that I may or may not have had in 2009. Sure, it's a good--no, a great thought--but still. I hate it all.

Here's the thing: I am so used to being the doctor that I would mostly prefer to have my lip glued to a car bumper and then be dragged over broken glass to slipping into a paper gown and dropping a sheet over my lap. And I use that metaphor to emphasize how much I don't like being on the other side of a primary care appointment.

For reals.

But that? That doesn't really matter. Because on November 15, 2012, shit just got real. The reality kicked me straight in my two front teeth and screamed in the loudest voice possible that "JUST BECAUSE YOU FEEL FINE DOESN'T MEAN YOU ARE FINE." Because you can be hanging out with family and friends at your kitchen table on one night and gone the next. This I know for sure. Something discoverable and potentially reversible could be brewing and needing to be assessed. Or even if it isn't reversible altogether, it could be something that's at least treatable. But none of that can happen if you don't GET UP OFFA THAT THANG and see your PRIMARY CARE PROVIDER.

Yes. Your PRIMARY. CARE. PROVIDER. Not the person who delivered your babies and who has agreed to write your birth control or replace your IUD and listen to your heart and do your Pap Smear while you're there. No.

Wait. I take that back. If you're super young and without any health problems then that's mostly okay. But if you're over 40 and you have anything running in your family or personally, you cannot BS when it comes to getting yourself under a doctor's care.

Even if you hate it.

Your overall health needs to be your primary care. See, me? I have always gone to doctors with a CLEAR agenda. That agenda being: "Hello, I'm pregnant and you need to do the things pregnant ladies need." Or "Hello. My ankle is 'flicted and you need to do the things 'flicted ankle people need." But PRIMARY CARE? Geeze. That's altogether different. It's like putting your car on that diagnostic machine, man. And saying, "Hello. I'm mostly okay outside of my crappy eating habits and muffin top. Now you get to look at me and find shit even if it scares me to death."

Pretty much.

But let me be CONCRETE. Primary Care Providers--are ALL about preventing heart disease. ALL about it. Like, for real? That's like 87% of everything we do. For real. Like, we bug you about salt intake and blood pressure readings. Why? Because it hurts your heart. We sweat you about exercise and body mass index. The big deal? Cardiovascular health, dude. Our diabetics get stalked about their high blood sugars and the smokers get nagged to death about lighting up. That's not rocket science either. Those things take you quickly from one ticket to five in the heart attack lottery.

So serious business? That should be your primary care. Why? Because heart disease is the thing most likely to take your life or disable you. More than ANYTHING else. And no, I am not trivializing very important things like cancer diagnoses--I'm not. Of course those with family histories and personal histories should be thinking about those things. But they should also be concerned about heart health. We ALL should.

So that's the deal. I tazed myself in the back until I got to my PCP to be seen. And I stuck out my arm and let that lady plunge that needle with the Vacutainer on the end of it deep into the crook of my arm. I let that same lady schedule my mammogram which perhaps is another thing I'd exchange for that same broken glass trudge--even if doused afterwards with rubbing alcohol.

Umm, yeah. Hate those cold metal plates smashing me, too. Yes, hate.

So yeah. I took my lumps today. And since things were cool, I don't need to take more for another year. You know what else? I got to tell my doctor all about you guys. About us all moving for 150 minutes or more per week and about me running two 10Ks since she saw me last. I also got to beam when she was examining me and told me that my resting heart rate was slower and that she could tell I was exercising. It felt good not to fudge the facts about how much how often.

"I run. About four times per week for 45 minutes or more."

Which is TRUE, man. TRUE. So yeah, that was good.

Okay. So here is your clarion call. Have you seen a doctor this year? Did you see one last year? Was that doctor a PRIMARY CARE PROVIDER? If not, you need to rectify that.

Real quick: Caveats include people who are under the care of, say, a Cardiologist or Endocrinologist who is serving as a primary (or rather principal) care provider. Or people with HIV seen by an Infectious Disease trained HIV PCP provider. Otherwise? You need to GET UP OFFA THAT THANG and see a PRIMARY DOCTOR.

YES.

Make it your primary care to see about your heart health. Let go of only seeing doctors for your minor agendas because you're afraid. Stop being defensive and listen. Set some goals and let your PCP hold your feet to the fire. But especially look into the eyes of the people who love and count on you and try to justify not taking care of yourself. You won't be able to.

I know. The cost can be oppressive without insurance. But as a person who works in a setting where over 90% of the patients lack insurance, I know for certain that there is a way to see about yourself and your heart health even if you aren't covered by private insurance.

YUP.

Marching orders:

1. If you don't have a PCP, pick one. Even if you hate it, make up your mind to go.
2. Call by TUESDAY and make you an appointment for a PHYSICAL if you haven't had one.
3. Pick somebody you feel comfortable with.
4. Get the most out of the visit by being honest.
5. Set a goal to improve you're weight or some other parameter before your next visit.
6. Take all meds exactly as prescribed. Not "as needed."
7. Fight the urge to retreat to hypothetical la-la land.


That's all I got.

***
Happy Thursday, Team!

 Now playing. . . .the Team S.J.G.R. theme song. . . and JAMES BROWN singing it live. . . all while GETTING UP OFFA THAT THANG. OMG love this! Could watch it all day. Hell, I burned 200 calories just watching. . .LOL! (BTW....the funniest part about this is how LAME the audience is. They are TOTALLY just sitting there while JB is getting after it! Hilarious!)

It's all about the Benjamins, baby.

This is Kristi. She's one of the amazing hospital pharmacists at Grady Hospital. She is smart and diligent and empathic and generous with her knowledge. I stopped in her office today along with one of the residents because I needed her help.

The question wasn't about the pharmacokinetics of some drug or even about some kind of drug-drug interaction. Nope. This was question about what is, unfortunately, one of the most common things that gets discussed at public hospitals: Cost.

Okay, so check it. Grady Hospital and the handful of other safety net hospitals in the U.S. that turn no one away due to limited ability to pay has programs in place specifically for our poorest patients. That is, if you are at 200% of the U.S. poverty line or below, you qualify for a significant amount of assistance with whatever it is you need. And that? Now that is wonderful thing.

Now. If you are like me, you probably have no idea what 200% of the federal poverty level is. And maybe you are one of those people who just walks around with that kind of information in your head, but I'm not. So me? I had to look it up today. And I'll tell you why.

I saw a patient today who was sitting in front of me in a work uniform. Had worked some crazy oddball shift in order to get out in time to make this appointment with us for management of high blood pressure and diabetes. And really, this patient was super motivated, kept appointments, and went through great effort to make it over to see us.

Okay, so we check the lab results from the most recent blood draw and things look horrible. Like for real, horrible. The blood sugars are out of whack and the patient is clearly not doing what we asked at the last visit. And so we asked the patient straight up:

"What's up with your blood sugars? Is everything okay?"

"No," our patient replied, "I only take my insulin here and there because I can't afford it. I can't afford the blood pressure pills, neither."

And that was weird because this patient wasn't new to us. I mean, this patient had been coming to Grady in that same work uniform for many years. Why was this suddenly an issue?

My resident blurted out a question before I could. "Don't you have a Grady card?"

What she was speaking about was the sliding scale card given to patients with limited ability to pay. The patient gave a hard head shake.

"I used to. But my job gave me just a little bit more money so now I don't qualify no more."

And let me tell you. This patient was a hard worker. I also know that uniform was not one worn by a person who makes stacks and stacks of money. And so we talked about it and the patient said, "Essentially, I am now just over the line." Which was later clarified to be 201% of the federal poverty level. I agreed to look into what we could do to assist by talking to Kristi and also our social worker.

And so. I also looked to see what that all meant in concrete language.

Household Size	100%	133%	150%	200%	300%	400%
1	$11,490	$15,282	$17,235	$22,980	$34,470	$45,960
2	15,510	20,628	23,265	31,020	46,530	62,040
3	19,530	25,975	29,295	39,060	58,590	78,120
4	23,550	31,322	35,325	47,100	70,650	94,200
5	27,570	36,668	41,355	55,140	82,710	110,280
6	31,590	42,015	47,385	63,180	94,770	126,360
7	35,610	47,361	53,415	71,220	106,830	142,440
8	39,630	52,708	59,445	79,260	118,890	158,520
For each additional person, add	$4,020	$5,347	$6,030	$8,040	$12,060	$16,080

It gets cut off on this chart, but just know that $22,980 was the 200% marker for a single person and $31,020 for a two person household. Yeah. So my (single) patient was making like $24K per year up from like $22,500. And you know what? That patient was working hard for that little bit of money. Hard.

And so. I talked to all of the people that you talk to about these kinds of things and heard the same answers. Which essentially is that in order for us to help the very least of these, we have to draw the line in the sand somewhere. Unfortunately, our patient landed right on the wrong side of this and pretty much, there wasn't much we could do to help in the way the patient wanted.

And so. I stood in front of Kristi's desk talking about all of this and picking her brain about what to do. And she was at least able to locate some patient assistance programs on the blood pressure meds and lists of a few medications at pharmacies with fixed prices. But then we talked about the diabetic supplies that the patient would need for things like testing blood sugars and injecting insulin.

Okay.

So I took this picture of Kristi right in the moment where we all realized just how little slack people with low incomes get when it comes to something like diabetes. I mean. . .it already sucks to have diabetes, but this? This just makes it suck monumentally more. See, Kristi was looking at a screen that compared costs between certain diabetes test supplies and others. And it was dismal.

Even with "the hookup" from a special coupon, all of the supplies would run close to $100 dollars per month. $100. A straight up Benjamin Franklin one hundred dollar bill. Seriously? How in the HELL is this patient supposed to come up off of that much money for that AND eat? How.

Now. Can I just say that I don't have any prescriptions that cost me that much -- but when I did briefly take Nexium and it cost me like fifty-something bucks, I was LOSING MY MIND about it for an entire month? You'd better believe I was. And every single time I go to get some allergy medicine, I spit a little fire at the counter, too.

Man. A HUNDRED BUCKS? Dude. $100 is a lot of money. Especially for some strips and some syringes, man. So how you blame somebody for doing rock, paper, scissors when it comes to something like this? Like seriously, how can you? And, real talk, how can you even blame somebody for saying "bump it" when it comes to testing blood sugars since the strips cost a grip?

Answer: You can't.

Yeah. So here was the moment where we were all frozen in this sobering reality. Staring at that screen and wishing for a pop up with Oprah saying, "YOU GET INSURANCE! YOU GET INSURANCE! YOU GET INSURANCE!" Uuuuh, but yeah, it never happened. And the look on Kristi's face tells it all. I swear to you that right inside this moment every person there felt so helpless and discouraged. I am certain that I am not the only one who wanted to cry. I know that for certain.

Man. Here is a person who is putting on a uniform and working with greasy food all day. Someone who is dealing with demanding people and attitudes and anything else you can think of. All in an earnest effort to make a dollar out of fifteen cents.

So the very, very best we could do was this:

• Patient assistance meds through a pharmaceutical company 
• Medications off of the "four dollar list" at WalMart and similar places.
• A suggestion for the least expensive testing supplies based upon our research. 

And you know? It was still dear (in price,) as my mom says. Otherwise, it wasn't dear at all.

Yeah. I'm not even sure what my point was in telling you about this. I guess I just want to shine a light on the every day struggles of people who are out here slugging it out and trying to make it happen, man. And how many things stand in the way of them going to their full potential.

"I asked for them to keep my salary where it was, " the patient said, "but they won't do it. When you been there a certain amount of time, they got to raise you up some." And honestly, all I could say to that was one word that I kept to myself.

Damn.

"Seem like you better off quitting and getting disability," the patient added.

Which broke my heart even more because, in this instance, it almost was completely true.

Look, man. All I'm saying is this. It's people out here struggling. And they are not lazy or shiftless or any such thing. A lot are just resource poor or folks who made it as far as tenth grade without being able to read--meaning someone looked to the side and just nudged them on ahead. Like my patient today. Which is a whole separate issue, but still an issue. I'm just saying. It's rough out there, man.

Damn.

***
Happy Monday.

Now playing on my mental iPod. . . . .



And check this out. . . I haven't seen it but TOTALLY want to. This is the reality that we see every single day.

Feeling 42 (even though today I'm 43)

 It feels like a perfect night to dress up like team moms
And sign up for sports teams, uh uh uh uh

It feels like a perfect night for red wine at midnight
To covet shoes on Zappos, uh uh uh uh

Yeaaaah
We're happy tired and in debt at the same time
It's miserable and magical oh yeah
Tonight's the night when we forget about the dishes, it's time uh uh

I don't know about you but I'm feeling 42
Everything will be alright if you keep pick up these damn shoes

 

You don't know about me 'cause I'm not on YouTube
Everything will be alright if we just keep dancing like we're 42, 42

42. . . 42

It seems like one of those nights
This table's too junky 
for dinner and homework uh uh, uh uh 

It seems like one of those nights
We ditch the whole thing and end up singing instead of reading

Yeaaaah
We're dieting and sexy in the best way

We're training for a 10K, oh yeah
Tonight's the night when we forget about the Spanx lines, it's time uh uh

I don't know about you but I'm feeling 42
Everything will be alright if you just do what I told you

You don't know about me ('cause I'm not in your carpool)
Everything will be alright if we just keep dancing like we're 42, 42

I don't know about you, 42, 42

It feels like one of those nights
Don't know if I'm snack mom!

It feels like one of those nights
When Mom won't be sleeping

It feels like one of those nights
I don't need no bad news 
I want some new shoes, I want some new shoes

I don't know about you but I'm feeling 42
Everything will be alright if there's no calls from school

Yeah, I know about Wii, and I'm nice on X-box, too
Everything will be alright if we just keep dancing like we're 42, 42

42, yeah, 42, yeah yeah

It feels like one of those nights
We need a girls' night!

It feels like one of those nights
The dads won't be sleeping!

It feels like one of those nights
The kids aren't up, dude . . . .

I gotta have you, I gotta have you. . . . .

***
Happy Saturday. And Happy Birthday to me. And to you, it yours is today or coming up.

Even though I'm technically 43 today, all of it blends together at a certain point. Plus, "43" didn't work for the song. Ha ha ha. Oh yeah! All of the pictures are from my year as a 42 year-old so that counts. It totally counts, man.

Lots of good 43 year old shenanigans planned for tonight. . . . . . .

Now playing on my mental iPod -- but with my revised lyrics!

Team S.J.G.R. Thursday Huddle #10: Rage against the machine.

Yesterday, I missed my sister terribly. I was inside of one of those moments where everything quieted in my head and life just sort of moves around me in slow motion. Maybe that doesn't make sense to you, but it's the best way that I can describe the most searing grief I feel sometimes when it comes to Deanna's death. I see her laughing and smiling and saying things like, "Hey Pookie!" And usually when that happens, I simply reach for a tissue to pat the few tears that leak out of my eyes, take a deep breath, and then carry on.

For some reason, though, yesterday was different. The little voice started niggling at me and I started in on the "if only" tirade. If only I'd gotten her into a doctor's care. If only I'd thought of creative ways to motivate her to move more and get into some kind of weight loss program. If only. . . . and then another voice said what has become my dad's new favorite phrase:

Cut. It. Out.

And so. I waved my hands in front of my face and shook my head furiously to get the thoughts out. Then I imagined Deanna scrolling through that Team S.J.G.R. Facebook page and seeing all of your beautiful faces in places near and far. Speaking of all of these brave steps that you are taking towards escaping the hypothetical la-la land that keeps people bound up inside unhealthy lifestyles. That? That made me super happy. It did because I know that all of this would please her. Knowing that all of these people are connecting and feeling inspired to take control of something that is often so, so complex and elusive yet so simple at the same time would make her glad. This I know.

I also think about when my friend Jill J-B said to me over a simple comment on this blog that she had a feeling that Deanna's influence would be even more powerful from this position than from her position on earth. And I liked that idea because some part of it feels divine and gives me marching orders to carry out the parts that she can't.

I miss my sister. Terribly, terribly, still. I wish that she did not have a heart attack more than anything I have ever wished in my life. Damn, I do.

But.

I also trust the process. I am still more glad than sad and more determined than ever to continuously look for ways to inspire not only myself but others to prevent themselves or their loved ones from succumbing to heart disease. And let's be clear:  I fully recognize that people die every day of heart attacks who aren't overweight or who do triathlons or whatever it is you can think of that is super healthy. I know that a will and a power greater than my own called this shot and that some parts of life can't be chalked up to simple cause and effect but instead divine appointment. Yes, I believe those things but I also know that all of the knowledge that we have is a gift that we've been given. And there has to be something divine about us being empowered about taking that knowledge and raging against every weapon that tries to prosper against our bodies.

Was that confusing? Gosh. I'm sorry. Feeling a bit rambly. But really all I'm saying is that I am not walking around in a "woe is me" fog. Instead I'm just ripping the covers off of any and all bullsh*t that holds the people I love back from at least trying to prevent themselves from death or disability from heart disease.

Did you catch that part? The part where I said "or disability?"  Remember, a WHOLE bunch of people are left disabled by heart disease and strokes every single day. I see them and treat them, so I know. I admit that I am glad that I didn't have to see my sweet sissy severely disabled from this event and I know in the back of my head that it is something that absolutely could have happened.

Let's make this super basic, shall we?

The same thing that causes heart disease is the same thing that causes strokes. Arteries gummed up with plaques of goo from a myriad of factors. But the good news is that we know a lot about the "myriad of factors." We have good data that tells us which things are in our control when it comes to modifying risk of heart disease.

Team S.J.G.R. has been talking about them a lot. But I want to be sure that we never, ever get away from those simple things in the midst of being wrapped up in a feel-good whirlwind. And so. Those of us who are seriously looking to lower our artery goo levels need to make certain that every so often, we check back in to make sure that we're doing the things that matter.

So let's get back to the basics.

• A minimum of 150 minutes per week of physical activity. Yes, you can add it up by doing fifteen minutes here and thirty minutes there. But remember that when your physical activity exceeds 30 minutes, that's when you really start getting the good fat burning.

• Know your family history of cardiovascular disease. If someone in your family has had a heart attack or stroke, know that your chance of having the same is higher. And real talk, there's just not much you can do about family history. So what does that mean? It means that you MUST and I do mean MUST go even harder when it comes to the things you CAN control.

• Get under a doctor's care. I can't emphasize this point enough. You need to know FROM YOUR DOCTOR (not CVS pharmacy) what your blood pressure is. You need to be okay with doing what it takes to get it to an appropriate level, which varies depending upon what other medical problems you have. And, if you're like a lot of people, you need to NOT make a single excuse when it comes to NOT doing these things. Because the artery goo keeps on goo-ing whether you accept this reality or not. So if you are one of the many, many, many people out there who tricks yourself into believing that "borderline" hypertension and "borderline" diabetes don't cause heart disease? Cut. It. Out. The damage these things cause to our hearts isn't "borderline." And if you also have a family history of heart disease (like most folks do) then that's all the more reason to go EXTRA hard and get a doctor.

• Think about every single thing you eat. Good or bad. Think about it and never let it be mindless. 

• Stop thinking that exercise directly counteracts what you eat. IT DOES NOT. You ate a bowl of ice cream? Okay, fine. Just pull up with your next few meals to make up for it. But don't go saying to anyone that you're going to "hit the gym" or "go on a walk" because you've been eating so bad. No. Don't. We lose weight in the kitchen. We get fit in the gym. Separate these things. Think of exercise as something for your heart and for building lean muscle. To lower the scale, put down the fork. 

•  Get someone to help you be accountable. Sometimes I leave notes in the kitchen at night that say things like "YOU ARE NOT HUNGRY." Or worse "STOP. DON'T EAT ANYTHING UNLESS YOU WANT TO GAIN WEIGHT." And those obnoxious notes are mostly for Harry, but they do keep us both accountable. Harry is good about saying to me, "Hey, you need to chill on that dark chocolate." And me? Well, since he's the late night snacker, he gets the wrath of my post it notes. Sometimes we fuss at each other about these nudges. But mostly, it's appreciated.

• Don't smoke. Period. End of story. It's horrible for your body. Horrible. So don't. Not even casually if you want to protect your heart.

• If you are depressed, get help. I never mentioned this before, but there is very good data to support untreated depression as a risk factor for heart disease. YES. Are you blue? Feeling blah? Never want to go anywhere or do anything? Crying all the time? Dude. Get some help. Or your heart will be more than just heavy.

• Aim for the real goal. Even if you are several pounds overweight, don't count yourself out when it comes to a healthy BMI being attainable. Don't. Yes. You should absolutely give yourself credit for every step along the way but don't aim for a size 18 as your ultimate weight loss goal. I know. It sounds insensitive to say but it's true. If you are at a size 18, there is likely a good bit of unhealthy visceral fat working against your heart. And since, for me, shit just got real on November 15, 2012, I refuse to pretend like saying "you go girl" and "some people are just always going to be curvy and fine, girl!" is going to make that a reasonable endpoint. Nor is a big discussion about how you "love yourself" and have a healthy self image. Because if loving yourself, being awesome and having a healthy self image prevented heart disease, I wouldn't have had anything to cry about this morning. If that were true, my sister would have lived forever.

• Don't let anyone or anything stop you. Not a hating-ass person near you. Not a saboteur. Not a bad day or a break up. Not a NOTHING. Because this heart is the only one you have. And nobody can do this but YOU. So when you are deciding whether or not to get up off your butt to move, don't think about that ice cream. Think about your HEART. Hell, think about me with my arms around Isaiah this morning as he cried about missing his auntie so much that I almost didn't want to send him to school. But then, you make up your mind to GO HARD. 

I'm sorry to unpack like this today, y'all. I really am. But heart disease pisses me off. I want us to be an army that goes up against it and fights like hell. I want us to stop being okay with obesity as something that "runs in the family" and all of the other things that have tricked so many of us into not doing what we need to do. In other words, I love you guys and I love myself enough to give this tough love that must be spoken from the mountain tops. Our kids and the people who love us deserve nothing less. And dammit, they need to get caught up in our health rapture in the process. They do!

S.J.G.R. Matter of fact, it's been real all along but now we recognize it.

These our are marching orders. We are an army and we will not live in hypothetical la-la land for another moment. We WILL NOT. Our angel Deanna will nudge us to keep going and will use her power from that position to motivate us when we feel down. Yes. YES.

I hate heart disease.

I miss my sister. Bad.

***
Happy Thursday, y'all. If you aren't keeping it 150, what are you waiting for?

Don't look now there's a monkey on your back.

Why can't you do it?
Why can't you set your monkey free?
Always giving into it
Do you love the monkey or do you love me?

~ George Michael

_______________________________________

A fellow Grady doctor-friend sent me this really great article from the Harvard Business Review a few years back. It was a short read geared toward business leaders and managers called "Who's got the monkey?" Honestly, I'd skimmed it back then and had forgotten about it. Then I haphazardly ran across it again a few days ago and reread it. This time, it really resonated. The idea behind it was one I know well but hadn't really thought of this way.

Until pretty recently.

Okay, so check it. You run into someone in the hallway. They tell you of a problem or an issue. And you listen and nod and make a few suggestions. Then you agree to "check on a few things" or "look into it." And the minute you do, according to the author, you have taken the monkey off of their back and placed it squarely upon your own.

Yup.

The author goes on to make a few suggestions that help with not taking the monkey. Or rather, how to close the loop and make a plan that leaves the person with the full understanding that this monkey is theirs and not yours. Or, at least, it's mostly theirs and you are not the primary caregiver of the monkey--they are.

So that. Yeah, that got me thinking. Thinking about how many monkeys I take on and also how many of those pesky little critters I try to put off onto someone else without even thinking. George Michael said it best:

"Watch out! Baby who's that? Don't look now--there's a monkey on your back!"

Of course these monkeys aren't only in the work place. Of course not. They're dangling off of cell phone calls and leaping between emails and swinging from text message to text message. Sometimes it's in the form of someone just "running something by you." Other times they come with a clear declaration of what it is:

"Dude. We've got a problem."

"We do?"

And just like that, out jumps the monkey. So you listen. Then you tell yourself that it's okay to take on one more very small and well-behaved monkey. I mean, taking care of such monkeys is what you do, right?

Right?

See, that's the hard part. For a lot of folks, taking on monkeys is what they do. And my hand is raised high because, Lord knows, I've been known to even solicit my share of back monkeys--especially in the work place. And all of it is a struggle because some part of not only my job but my life involves this. Not to mention it's also just a part of who I am.

Then there are the emotional monkeys. Other peoples' personal burdens and mental blocks that they have chosen to discuss with you on a regular basis. Now. I'd be lying if I didn't say that I, too, am guilty of this. Because emotional monkeys can be the hardest and most exhausting to care for.

Yup.

You get a call. It's a friend who is flying on one wing about something or maybe you are the one doing the calling. You talk and one person asks the other what they think. One person says reassuring words that make the other feel better. And, after a while, that becomes a regular occurrence. Which means that the monkey has now just found a new home.

Recently, I was talking to friend. And that friend began telling me about an issue shared in confidence with them (not me) about another mutual friend. And there was true concern in this conversation and not one drop of gossipy-empty-messiness. No there was not. So I listened and I nodded. I asked a few questions and explored what this all meant. Then, this friend said:

"So what should we do?"

And just as I parted my lips to answer, I heard George Michael warning me in my ear. Watch out! Baby who's that? I pulled my shoulder to the side quickly to keep that monkey from jumping onto my back.

Surely did.

The person had spoken to my friend, not me, about this problem. And yes, I imagine that the person of concern likely could ask my thoughts on this but, as of right now, they hadn't. No they had not. So this? This was someone else' monkey for now. That they were trying to give to me. Despite the very best of intentions, I recognized it for what it was.

"I need you to get involved," my friend said. "I suggested they talk to you."

"But they talked to you. What did you say?"

"I wasn't sure what to say so I just listened. This is the second time they talked to me about this and last time I encouraged them to get your insight."

"My insight?"

"Yeah. Your insight."

"Dude. You're trying to give me the monkey."

"The what?" my friend replied with a laugh.

"The monkey. The one that's on your back. You're trying to give it to me. But it's your monkey. Not mine."

And my friend just paused for a moment and tapped their fingers on their lips while staring at me. We faced each other down. And eventually we both had to just laugh out loud.

"Dude. I'm tired. Like, I'm out of things to say," my friend finally admitted.

"Yeah. This sounds heavy. And I agree that we both care about this person but let me suggest what I think you should do. And then you can take or leave that advice."

And so. I employed the business guru approach. We identified the issue and what is needed. We explored a plan of action. Then we agreed to revisit the concern later -- and not in the hallway. That follow up will be a dedicated discussion because formality puts the monkey under a spotlight. Those hallway pow wows lead to some of the stealthiest monkey relocations.

Yup.

I have thought of this a lot. And I'm not saying that this means that you should just shut any and every person down who comes in your direction needing your help. Not at all, actually. Sometimes, it's good to take on another monkey. Like, sometimes it's the absolute right thing for you to do and not doing so would be wrong on several levels. But sometimes? Sometimes the smarter thing is just to pet that monkey where it is and send it home with its rightful owner. I don't always know which is which. And therein lies the problem.

Yeah.

So me? I'm just trying to pay attention. Especially when my life is super busy like it is right now, I want to be careful with taking on monkeys but equally thoughtful about the monkeys I try to pass on to someone else. Because I know that feeling of relief that comes with pushing a metaphorical monkey--emotional or work-related--off onto another person. Yet I also know all too well the feeling of being that other person, banging the heel of my palm into my forehead and asking myself why, why, why or how, how, how did I become responsible for this random monkey? And don't even get me started talking about the whole pride issue that comes from being the "go to" person. You know--the kind that leads to boundary crossing and getting swirled up into things that are way, way out of your lane.

Sigh.

So me? I'm prepared to shock the monkey, man. (Yes, the answer is in yet another 80's Billboard hit.) Shock the monkey, people. No, not shock him by never allowing him to ever get on my back, but instead only bringing him on with my permission.

Yeah.

"Don't you know you've got to shock the monkey?"

~ Peter Gabriel

***
Happy Tuesday. This could make perfect sense to you. Or none at all. (If it's the latter, blame it on me being up late.)

Now playing full volume on my mental iPod. . . . wisdom of the '80's!

First. . . . . ."Monkey" by Geo. Michael.



and then this little gem. . . . Peter Gabriel rocks out to "Shock the Monkey."

Still listening.

 Would you hold my hand
If I saw you in heaven?
Would you help me stand
If I saw you in heaven?
I'll find my way, through night and day
Cause I know I just can't stay
Here in heaven 

~ Eric Clapton

 _____________________________________

"Good morning, my friend."

"Buenos dias, mi amigo!"

My sing-songy greeting was interpreted into Spanish as it had been every single day that I cared for you. Complete with the happy intonation.

I was happy to see you. In fact, I was always happy to see you on those days that you were there. Your gentle and brave smile and, especially, the way your eyes danced every time I asked about your wife and son, made every visit a joy. Even under these circumstances.

I took a seat directly in front of you as always. On this day, you were sitting on the bedside chair. You couldn't go too far from the bed with so many things connected to you. I was glad that you didn't let this stop you from getting out of bed.

"How are you?" I asked. I emphasized the word "are" and appreciated it when the interpreter did the same in Spanish.

You shrugged and told me that you were as well as could be expected. "You just try your best to be positive, you know? To get out of bed and tell yourself to keep on going." After that, you pressed your lips together and inhaled through your nose. You gave your right shoulder a tiny flick upward as you focused your eyes on mine. "All I can do is just hope and try."

And this? This is precisely why I always waited those fifteen minutes for an interpreter just about every single time I saw you. Not because you spoke no English. Your more than a decade in the U.S. had helped your conversational use of this second language along quite well, actually. But some things just couldn't be expressed by your basic English skills. Your heart emoted en Espanol. And without someone there to cross that divide, all of that part would be lost in translation.

Or just lost altogether.

It was so tempting to see you without those interpreters, too. Mainly because you understood nearly all of my questions and, with careful thought, could reply in short, logical answers. And sure, if I was just popping in for the umpteenth time during the afternoon to check on your pain management or to see if you'd made it back from some procedure, I was relieved that you could express what you needed and I could help you without much of a delay. But mostly, I called someone when I needed to talk to you. A person to knock down the wall of words standing between the kind of relationship I knew you deserved to have with your doctor.

And so. Day after day, sometimes multiple times in one day, in I walked with a blue-smocked interpreter by my side. And I'm so glad that they didn't just fold my English words over into the language you understood on those days. They put all of the emotion into it, too--a part that I didn't want to get lost in translation either.

Or lost altogether.

"When you have a child, everything that you care about changes. Like, all I can think about is what this means to my son. I've been sick since he was in kindergarten. It's just so much on him. And my wife." When you said that part about your wife, you balled your hand into a fist and pressed it to your lips. Again you sucked in air through your nostrils and this time your eyes squeezed tightly. "She is very, very strong. You know that."

I did know that. I knew it because, on a different day, an interpreter spent nearly an entire hour with me at your bedside as I talked to your wife and you. While your young son sat criss-cross-applesauce in the bedside chair while reading Diary of a Wimpy Kid. 

That hour was a pivotal one. Her English was far more limited but she had this way of smiling and nodding as if it were much better than it was. During that discussion, we got to address all of her concerns--and her concerns were many. And all of that took an hour because the first half of that time was simply spent trying to convince her that I wanted to hear what she had to say and that she wasn't inconveniencing our team by wanting to know what was going on with her husband.

"I really, really want you to feel comfortable asking for an interpreter, okay? Like this is very important," I recall telling her.

"A lot of times my son helps me. I just don't like to bother anyone." This was her response. Her honest response.

"Su hijo?" I said in my rudimentary Spanish. When I said that, I remember your son looking up from his book and resting his brown eyes on me. His expression was so complex that it was impossible to read. I softened my face in his direction and smiled. Then I shook my head hard. "Let your son be your son. He should never be the interpreter."

The interpreter with me that day repeated my words in Spanish. I could hear a tiny bit of emotion in those words that came more from her own feelings than what I said.

"Nunca." I said that part in Spanish for emphasis. And for some reason, that made your wife start crying. I walked over and gave her a big hug. Wrapped my arms around her, still in her housekeeper uniform, and pressed my hands into her back as she wept and wept.

That part required no interpreter for her to understand. Or you either.

So, yes. I knew that your wife was strong. As were you.

"Yeah. Your perspective does change when you have children. I agree."

"So really, that's all I think about. Wondering, like, what is best? Like should I keep taking the treatments? Because, you know, I looked up the word 'palliative' on the computer and I know it means that it's something that can't be cured. So, then I ask myself what's best?" You paused to allow the interpreter to tell me what you said before going on. And I was glad you did--not because I didn't understand what you said, but more because I needed to wrap my mind around it all. "Like, do I go back to my country with my family? Now? And even when I think of this, I feel bad because of my son and his education. Education there is just. . . it's just different."

I nodded because that made sense to me. And that's about all that I did because I knew that these questions were yours to answer, not mine. But I did feel glad that you trusted that moment enough to feel safe sharing them with me.

"What are you thinking that you'll do?"

"I just don't know. I don't. My son is everything in this. I want the whole world for him and I feel afraid that if we take him there he won't come back.  Like, for money reasons, he won't because it will cost too much to make it back here. I worry about that. And that he just won't have the same kind of life that he could have if he gets an education here."

"Hmmm."

"So this is what I mostly do all day between the procedures and treatments. I think of these things and pray about them. And I ask God what to do."

"You do? So. . . . what has been revealed to you? From God, I mean."

"I'm still listening," you said.

I nodded. "Good."  I narrowed my eyes and repeated that word again. "Good."

And the interpreter behind me said it just the same way. "Bien. Bien."

We finished up the obligatory parts like examining your body and discussing the treatment plan. Then I stood up to leave.

"What questions do you have for me before I go?"

"I'm okay," you responded.

"You sure?"

"I promise. I'm sure."

I nodded hard and then reached out to shake your hand. "Okay. I'll see you later, my friend."

"Okay. And thank you so much for always taking time with me. And my family."

I pressed my palm into my chest and smiled to keep myself from crying. "You know?" I finally said, "I guess I just want you to know that I'm still listening, too."

I glanced over at the Spanish interpreter when I said that part because some part of saying that made me feel like it should include her, too. 

Bien.

Bien.

***
Happy Sunday. Or rather Feliz Domingo. Or Domingo Feliz? Hmmm.

But especially thank you. To Carmen. To Ana. To David. And to our entire interpreter services at Grady Hospital most of whom I know but some of whom have names that escape me at the moment. And also to every single interpreter out there for helping people like me to see more of my non-English-speaking patients for the beautiful human beings that they are.

That just reminded me of something. It isn't always heavy, you know? Like it doesn't have to be heavy or life-threatening to warrant an interpreter. Sometimes it's something as simple and as silly as los dedos azules. Remember that?

Ha ha.

 Now playing on my mental iPod. . . this classic by the great Eric Clapton. . . .for every person who helps to create a little piece of heaven for our patients at Grady Hospital.