Both... And

At 89 years old, my Grandfather ("Pappy") died this week. For him and for me, his death was a welcome end to the suffering he had endured. With a myriad of health issues, he had been completely dependent on others to feed, dress, bathe and move him. He spent these years living in my Dad's house and, gratefully, was surrounded by family and remained a constant presence in our lives.

Pappy was very special to me, and as the first Grandchild, I enjoyed all of the magic of being the apple of his eye. My response to every quandary was, "My Pappy will fix that" and so I believed without ever a doubt. I am very fortunate to have had nearly 44 years with him and am ever grateful for the example he set: be kind, help anyone in need, have some fun, go on any adventure you find, and meet every challenge head-on. He was my hero.

As we live life, we are often faced with situations accompanied by utterly conflicting emotions. Peacefulness comes from learning to accept what is. Learning to accept what is comes when we learn how to "dance" with two opposites pulling on us at the same time.  Embrace life and live in a world where "both... and" can exist at the same time.

I am very sad my Pappy is gone. I am so very glad he is free.

Chemistry for Dinner

One of my favorite summer recipes is Spinach Quesadillas from Vegetarian Suppers by Deborah Madison. This is a quick dish and as long as you don't use too much cheese and sour cream, a pretty healthy one. With the fresh salsa and corn from the Sunday Farmer's Market in Baltimore, the meal is something we look forward to every time it appears in the weekly menu plan.

When it was almost time to prepare dinner last night, I suddenly realized we didn't have any tortillas so I made a quick trip to the local Giant and given the array of tortilla choices presented to me, I started turning over the packages and looking at ingredients. I was about to buy a chemistry concoction with which to cushion my fresh farm spinach, onion, jalapeno pepper and cilantro. What has happened to our food?

A rhetorical question, of course, as I know what happened to our food and it makes me angry. I was angry last night and I'm still pretty angry about it this morning. Why is it impossible to go to the local grocery store and buy something without subjecting my body to this list of garbage:

Flour tortillas require a very short and simple list of ingredients: Flour, fat (some type of oil), water (or milk), baking powder and salt. I didn't make the tortillas last night - I bought this package and stewed about it all night. Yes, dinner was tasty but I can't help but wonder about the global impact of this kind of systematic and prolific poisoning that happens every day. I wanted to cook a healthful dinner. I wanted to do some thing simple and fast for a Monday evening. I wanted to enjoy the bounty from the weekend farmer's market while it was still fresh and bursting with flavor.

Why is it so darn difficult, if not impossible, to avoid ingesting chemistry for dinner?

Is our healthcare system making us fat?

The growth in healthcare costs and the growth in America's waistlines follow the same path. Up. Yesterday, I asked the question, "Is our healthcare system making us fat?"

Today, I will explain. To be clear, I don't blame the healthcare system for the growing obesity epidemic. I do blame the healthcare system for not making dramatic changes in the 1990s when we realized the managed care revolution wasn't actually helping people get healthier. I blame it again in the year 2000 when the trend was clear. By 2008, we have no excuse. We are spending more and more money for less and less health. We have more healthcare. We do not have more health.

The scary part, to me, is there is no end in sight. Much like the dual-eligibles that are plaguing state budgets all across the country, the obese and extremely obese are expensive. As they age (assuming they get a chance to age), I can't begin to fathom what it will cost to care for the extremely obese elderly. My Grandfather is nearly 90 and completely dependent on my Father and a team of aides for everything he needs. He is too skinny, honestly, as he continues on his slow journey toward death. If he were 200 pounds, my Dad couldn't care for him at home. A nursing home would costs thousands and thousands a year and we'd have no choice. 

The system is broken. We cannot continue to spend more and more money on worsening outcomes. We can't afford to give gastric bypass surgery to 40% of our population. We can't afford the risks and costs of whatever promised weight loss pill a drug company will come up with. While we have the Affordable Care Act (health reform), it will not fix the problem.

The problem, dear people, is all up to you and to me. To our neighbors, to our families, to our communities. We, the people, are the only ones with the power to "bend the curve" on healthcare costs.  We, the people, have to stand beside one another and help each other lose weight and get healthy.

We the people, when we work together, can do anything we set our minds to. Now is the time.

When Called to Help...

Do you know basic first aid? What about CPR? I happen to think both should be taught in all high schools and if you have not learned how it is a life skill worth having. And, I fear it might not be enough anymore. 


Yesterday, there was a gentleman doing some work in my neighborhood and he fell ill. Granted, it was very hot here in Maryland so any outdoor work was unpleasant for the youngest and healthiest among us, but this man was overweight and 64.


He looked to be having a heart attack (with which I'm very familiar) but he said he wasn't in any pain. Clammy, shortness of breath, could barely speak and was clearly in distress. We got him inside in the cool air and called 911. I learned from his co-worker that the man was diabetic so I asked him if he had eaten today. He said yes. Instant oatmeal. I asked if he needed something to eat, thinking his blood sugar was low and he said no. I asked if he had been drinking water and he said yes and that he had also had a gatorade. Gatorade? Odds were he wasn't suffering from low blood sugar with that in his system.


The best I could do while waiting for the paramedics to arrive was to try and cool him down with a cold compress, reassure him help was on the way and he was going to be fine. In the back of my mind, I was reviewing my CPR instructions just in case. The paramedics arrived and I reported to them what I knew. They immediately took his blood sugar and it was nearly 350. I knew that was very high based on my Grandfather's diabetes. I later read that a blood sugar reading over 180 is considered hyperglycemia. This man was very sick and needed insulin. He told us he only took medication which he had taken that morning and wasn't on insulin shots.

I likely won't find out what happened to him. Last I saw he was in the back of the ambulance being well cared for by the Baltimore City paramedics. I am sure he made it safely to the hospital and I hope his poor wife - who he had tried to call at the start of all of this - was able to calmly get to the hospital to be with him.

After my adrenaline subsided, I couldn't help but think... instant oatmeal and a gatorade? For a overweight, 64-year old diabetic going outside to work in 100 degree temperatures? Other than a box of donuts, I would have a hard time picking something more harmful for him to have for breakfast.

Today, I am still wondering about him. I know his name but won't share it to protect his privacy. I wonder if he had insurance... somehow, I suspect no. I wonder if he knew how to care for his health and eat the right things for his diabetes. Again, I don't know that he had ever been told. Or maybe he simply cannot afford something healthier for breakfast. Granted, the American Diabetic Association website actually suggests instant oatmeal as a quick meal-to-go option. It baffles me, but they do. The gatorade is almost entirely sugar and the same website says 1 cup of gatorade is okay for a diabetic who has the cold or flu. I don't think he had either and what are the odds he would have only had a cup anyway? Next to none, given the common bottle sizes. And, let me go on record to say neither option should be suggested by the ADA. 


The health coach in me wants to help this man change his diet and lose the 50+ pounds he needs to banish. The Granddaughter in me knows helping an older individual understand what they can and cannot eat requires a great deal of patience and creativity (I made a special "food count whiteboard" for my Grandparents when Pappy was first diagnosed as diabetic so they could easily keep track of his food). 


There are currently 350 million people worldwide with diabetes. The number of cases continue to grow exponentially. This impacts all of us - our economy and our healthcare system. It also impacts us as people in a community. Along with basic first aid and CPR, we need to learn what to do when someone with diabetes falls ill. I could have very easily given that man a piece of orange or candy thinking his blood sugar was low. I could have killed him.

Health happens in community. Unless you decide to lock yourself away and not venture outdoors, you and I, and all of us, need to come together to answer the call, and be able to render the right aid, when someone falls ill. We also need to come together and stop the growth of diabetes. Otherwise, we'll need Diabetes Care Stations next to the AED machines hanging on walls in airports and malls. 

The Power of Small

Loki and I rounded a corner on our walk through Druid Hill Park yesterday and we were suddenly overwhelmed by a sweet, flowery smell. Yes, even Loki raised his dog nose into the air for a few sniffs. It was remarkable. I peered around and didn't see any large flowery bushes or flower beds which would explain the aroma. Then, I looked down.

Spanning in all directions on both sides of the path were these tiny little white flowers. I will rely on any botanists to correct me, but I believe they are the flowers that come with clover. In many suburban expanses of perfect green lawns, the clover is much maligned as a weed. Yes, some people coat their lawn in chemicals in at attempt to banish this "weed." I'll spare you my feelings on lawn chemicals and the pursuit of the perfect green lawn - for now anyway - as I have another message.

The power of very small things. One of these flowers alone would not have the ability to create the amazing aroma we encountered yesterday. The hundreds and thousands of them together did something amazing.

In our pursuit of health, the ultimate body and the purist diet, sometimes we look for THE ANSWER. The big flowery bush in the garden of life, if you will. Maybe we can learn something from the lowly clover bud. Maybe we can finally recognize our real power really lies within the tiny, small choices we have each and every moment to better our wellbeing.

Crowded Exam Room

How many people are in the exam room when you visit your Doctor? You may be able to count one other individual, a nurse, though that doesn't happen so much anymore. 

What about all the other people you can't see but are there in force? Several people from your insurance company, at least. Maybe a human resources person from your work and your boss wondering when you'll get back to the office. There is usually a person or two from the state medical board, maybe someone from the AMA, an auditor. Could be a few Government people in there - Medicare, Medicaid. Maybe the front desk clerk from the doctor's office wondering why your doctor is running late. Again. There must be a lawyer or two - malpractice insurance. I bet you could count at least five or six local drug reps all with free pills to give away. Perhaps a few specialists, all thinking you now need to visit them for a test or two. Honestly, it is getting so crowded in there you might not even be able to see them all.

Who "owns" the relationship in that room? The trust between a doctor and his or her patient should be sacrosanct. It isn't very often anymore. It can be...

I've recently had a very different experience. Me and my doctor. He is different both in his practice of medicine and his approach to the business of medicine. He doesn't have front desk staff. When you arrive at your appointment time - you simply knock on his door and have a seat until he is ready. He is always on time. Your initial visit with him is 90 minutes. The follow up visits are 30 minutes. He actually takes your blood pressure, checks your pulse, eyes, tongue, heart. You actually talk and explore things in a collaborative way. He doesn't seek to mask symptoms, in fact he welcomes them as clues. He seeks to resolve problems. He has telephone consult hours each morning. He gives you his cell phone number for emergencies. He types up notes and instructions while you're sitting there - he prints them asks you to read them to be sure you understand. You both keep a copy. He doesn't take insurance. You write him a check when you're through. He writes the receipt by hand.

My Doctor practices medicine the way most people who go to medical school want to practice (based on my conversations with many physicians). I don't know any physicians that welcome the involvement and influence from the dozens of people all sent there courtesy of our current healthcare system.

What if healthcare could be like my experience? What if the relationship between patient and Doctor was an actual relationship versus a transaction? We wonder why there are reports of up to one-half of patients not following their doctor's advice (for diet, exercise, medication, physical therapy, rest). Who will listen to someone you spend an average of 7 minutes with? Who can possibly trust someone you don't even know. We have a populace that is very sick and getting sicker. All of the medical transactions in the world aren't going to make people healthier. And the cost pressures continue to mount which we still attempt to resolve through faster, easier, cheaper medicine.

When will we learn? Slower, meaningful, collaborative medicine could be the answer. When a Doctor and patient own the relationship together, good things happen.

Axis of Wellness

HBO debuted "Weight of the Nation" last night and the conversation continues today about the impact of obesity on people and our country. If you didn't get a chance to watch last night you can watch online now. Parts 3 & 4 will be on HBO this evening. It is worth watching.

Our challenge, as individuals and communities, is to find a way to lose weight and get healthy. It matters not if you are overweight, obese or of a normal weight today - this epidemic impacts all of us. Only 1/3 (or less) of people in this country are able to maintain a healthy weight. This is a community problem and it is very complex.

What is certain? Our healthcare system and economy cannot survive the pressures levied by the obesity epidemic.

Now here is the good news: there is no magic bullet - which means you can do something about it right now.  And, here is the bad news: there is no magic bullet - which means the only way to solve this problem is for you (and me and our friends, family, colleagues, neighbors) to do something about it and start right now.

What to do? Here are three things you can do today:

1. Drink plenty of water (and give up any drink containing sugar)
2. Move your body every day and several times a day (even 5 minutes a few times per day is better than nothing)
3. Cook at home more (using real food) and eat less processed food (which is most things that come in boxes)

Your goal is to get into the upper right quadrant of the Axis of Wellness. You can get there by making good choices each and every day. 

You can do it. I believe in you.