Being a Hospitalist


As a hospitalist my main weapons are not scalpels or catheters or ET tubes. I’m not pulling 13 hour days in the OR or performing back to back intubations in the ICU. My arsenal relies on my knowledge, my communication skills and my documentation skills.

Hospitalist medicine is still a rather new area of practice, having been around only for a few decades. It may be frustrating as a patient to know you won’t see your personal physician in the hospital, but that also frees up your doctor to devote more time to his or her office patients. Since we are all trained in general medicine in either Internal Medicine or Family Medicine, our job is to know a little bit of everything. I love being able to take a global view of my patients and their health, as opposed to specializing in any one arena. One of my favorite aspects of being a physician is sorting through a complex patient and trying to bring the entire picture into focus. There isn’t anything like the feeling you get when you clinch an elusive diagnosis and get the patient stated on the right path.

Documentation is the lifeblood of hospitalist medicine. We weave the stories of our patients lives and maladies into electronic records. Our words determine how sick someone is considered to be by the insurance company and if they will pay for and reimburse the hospital for our treatment. A simple turn of phrase and semantics can lead to a major reconfiguration of someone’s severity of illness. You learn very quickly the power of your words and how they can alter the shape of your patients’ lives.
Our profession as hospitalists really comes to life at the bedside. At the bedside I’m able to use my words to comfort, to heal, to reassure, to clarify and explain, to make the difficult to understand simple and accessible. In a few short minutes I can go from never having met a patient to gaining their trust, easing their anxiety, and providing them a clear course of action. It’s not always easy. Sometimes there is no answer for the patient’s complaints. Sometimes the tests come back with unexpected, life- changing results. Sometimes the answers we find are not what the patient wants to hear. In its these moments at the bedside that I always remember why I chose to become a physician. That connection you make with a patient, whether you’ve known them 5 minutes or 50 years, it transcends science and data and medicine. It simply goes back to human connection. That connection is the root of everything I do. I am so grateful for the opportunities this job provides me to do it again and again, day after day.

365 Days Of Exercise EVERYDAY!!!


Ok party people, this one’s been a long time coming… 365 days in fact!!!
Every day. For 365 days. I exercised every day. It wasn’t easy, in fact it’s mostly been pretty damn hard. There were days I was sick or tired or had a migraine and all I wanted to do was sleep or veg out on the couch. It took everything I had those days to drag myself off my ass and do yoga or go walk the dogs for 20 minutes. Those days didn’t burn any significant calories, but they were so meaningful to me because I still did SOMETHING.

It starts with doing one little thing. 14 months ago when I started to exercise the most I could do was walk my dogs or do the elliptical for 20 minutes. I remember the first time I took my dogs to my favorite local park, I got about a half mile and then had to stop and turn around. I was so short of breath and drenched in sweat. Families with small children and those little baby papooses strapped to their chest were practically blowing past me. I went home feeling defeated, but the next day I got up and I did it again. And again. And again. Just start small. What seems insurmountable at first will soon become habit. It doesn’t get easier, you will just get stronger and stronger.

I have exercised through pain, sleepless nights, stressful days. I can touch my toes! I have climbed to the top of mountains! I have run 5ks and 10ks and 10 miles! I am organizing and planning a 5k/10k run for my hospital. I went skiing! I am training for my first half marathon! Above all, I have learned to believe in myself. To stop doubting myself and putting limits on what I can accomplish. It’s a whole new world out there, and I can’t wait to experience as much of it as I can!

Day 365


Failing Forward


There is a great # going on instagram right now called #failforwardcampaign. Reading about the obstacles other strong women have overcome really got me thinking about myself. What does it mean to fail forwards? To me, it means taking the worst moments, events, and mistakes in your life and using them as a catalyst to change for the better. We are not defined by our failures, but how we respond to them in the face of adversity. I culled through my own life and these are some of the moments that stood out to me.
1. Growing up, no one but my immediate family believed I would become a physician. I spent so much time believing them that I put limits on myself and never really gave anything 100%. I couldn’t shake the notion I might be what everyone thought I was- flighty, inconsequential, and average. I rarely even talked about wanting to be a doctor, even though I knew since I was 5 years old that’s what I wanted to me. I think that when we buy into other people’s negative perceptions of us, it has a scary ability to change the course of our own lives. It wasn’t until I was on my own in college I found my belief in myself and really came into my own. I believed that I was smart enough, strong enough, and that being a doctor was well within my grasp.

2. Until getting to med school. Yikes. I nearly failed out of medical school. I hated med school so much. The first two years were torture. I was crippled by severe anxiety and rarely left my house. I would only go to school for tests, and was withdrawn and isolated from my classmates. I felt like I was letting down everyone who believed in me and fulfilling the predictions of all those who said all along that I could never do it. It was on of the lowest points in my life. I ended up taking an entire year off and then choosing to repeat my second year of school. It was only after I got away from medicine I realized how much I loved it and that it was the core of me.

3. I let a physical injury set me back in all areas of my life. In residency I suffered a terrible knee injury that required multiple surgeries. I was despondent and gave up trying to ever get better. It would take me several years of chronic debilitating pain and my weight ballooning to 275 pounds for me to change. I stopped letting my injury and pain be the whole of who I was. I think it’s so easy when you have chronic pain to let that be the only thing that defines you, so that everything in your life revolves around the pain. I pushed through the pain and slowly got better with regular exercise and weight loss. I’ve lost so much of the weight that was physically a barrier to my health and happiness. I did not cure my pain, but I have found ways to minimize it and make it into an afterthought instead of the main event in my life.


When I was living through each of the moment above, I was miserable. It is only now in hindsight that I can see how clearly those events shaped who I am today. Has it been a smooth easy ride? No! Would I be the same person I am now if it was? No! Going through these struggles has given me the fortitude to overcome the challenges life has will continue to throw at me.


How Tracking my Food has Helped me Lose Weight and Stay on Track


I first started tracking my food daily a year ago. It was a eye opening, life changing experience. I had tried it before but given up because it was so depressing. When I first tried it I was eating 2500-3000+ calories per day. Was it any wonder I weighed 275 pounds and was morbidly obese? When I finally got the motivation to try again, I made so many changes to my diet. From the obvious like getting rid of Taco Bell and Fazoli’s to much more subtle changes like how many grams of sodium I eat a day. I use My Fitness Pal to track, but there are all kinds of apps out there so find what works best for you.

Here’s what I learned:

I eat way too many carbs. I’ve been vegetarian since I was 16 and the entire basis of my diet was not in fact vegetables, but pasta. So much pasta. But not just pasta- bread and tortillas and chips. I had such a carb heavy diet I was not getting enough protein or fats. I also eat way too much salt. Especially if I eat out, salt finds its way into everything. I for sure wasn’t drinking enough water, either.


So how has tracking helped me make changes that I can stick to?

Well first, I made small changes over time, I didnt just cut  anything out. I still got fast food but maybe only once a week. I still ate popcorn and candy and cookies, but much smaller serving sizes. I started to measure my food so I would know exactly what a serving looked like.  I started to cook meals intentionally knowing what the calorie count and macronutrient ratios would be.


Today I made a meal which perfectly exemplifies my new way of eating. And yes, it’s a new way of eating, it’s not a “diet”, it’s a lifestyle change. I had been trying Purple Carrot out and one of the meals was Vegetarian Pad Thai. Their recipe used rice noodles and had 730 calories per serving with 108 grams of carbs, 27 grams fat, and 21 grams protein.  Well that didn’t sit well with me. I added baked tofu to the dish and subbed in daikon radish “noodles” for the rice noodles. New stats: 384 calories, 24 grams carbs, 20 grams fat, 27 grams protein. How much better is my version!!!

I always recommed my patients track their food for one week if they are trying to lose weight. Even if you just write it down on a piece of paper, keeping track helps you stay acccountable and will really open your eyes to what you need to change in your diet. Give it a try.

Trail Running In the Snow


About a year ago, I was just starting to get serious about working out. My favorite early exercise to do was hike with my dogs. I had first tried hiking in my local park with them over the summer. I could only go about a half mile before I was drenched in sweat, out of breath, and exhausted and had to turn around. Winter is my favorite time to hike because the cold and snow keeps most people away. I love the serenity and peace that come with being alone in the woods (well not too much alone! I’m a chicken and and like knowing civilization isn’t too far away!).

On this particular hike last year, I was coming down these stairs and I fell. I was basically inching down them holding on the to rail for dear life, and I still fell. Right on my ass. My muscles were so weak and atrophied they couldn’t even help me keep my balance and keep upright coming down some slippery stairs. It was humiliating (of course that was the time we saw the only two other people in the park that day), but also a turning point for me. I knew I would do whatever was needed to make sure I could protect myself against falls and injury.

Being strong and healthy is the best way to prevent falling. So instead of feeling sorry for myself and beating myself up over a recent spurt of middle of the night binge-eating, I got myself up and went running in the gorgeous cold and snow. In one year I’ve come from falling on a simple stroll in the park to running 6.6 miles in the snow. What would you be like if you lived without fear and limits on yourself? Wouldn’t it be amazing to find out?


Skiing at Perfect North


So you guys, I hadn’t skied for over 10 years until a couple weeks ago. It was something I gave up on. The most physical activity I was routinely doing this last 5 years was walking. Skiing again seemed like an impossible goal, so it wasn’t even on my list. With my past ACL tear and surgeries, skiing seemed like a huge risk not worth taking.
Well here’s the thing… sometimes we sell ourselves short. Sometimes we let fear dictate our hopes and dreams. What I needed was some momentum to realize that I could dream bigger. As I started meeting my weight loss and fitness goals I had the chance to reevaluate myself. I realized I was stronger and healthier than I had thought possible.

I was so nervous strapping into my skis again for the first time in so long. It felt strange and off-kilter, I couldn’t get the hang of gliding along. I hesitantly went down the bunny slope and got my feet steady under me. Soon, I felt my confidence increase and went down the nicest trail at Perfect North, The Far Side. A gentle long sloping mile-long trail, it felt like freedom. I felt weightless and effortless, and so ecstatic with myself. Again and again back up the hills and down again. There is such an exhilarating feeling when you fly down the slopes with the wind blowing in your face. I am so happy that I have taken back up this sport again and look forward to many gorgeous winter days spent outside skiing.

The Migraine Curse


Guess what guys, migraines suck. Part of the reason I began my epic weight loss journey was my unrelenting and chronic migraines. I’ve been afflicted with migraines since soon after I hit puberty. Fun fact: being a woman and having hormonal surges also sucks! Migraines affect about 3 million people per year, and 75% of those people are female. Migraines can be difficult to treat and debilitating. 2% of people will have chronic migraines, defined loosely as migraine headaches more days of the month than not.
Historically, migraines have been treated with suspicion and degradation in the medical field. They fall into that nebulous category of diseases that we don’t understand the pathophysiology well and that don’t have a lot of objective findings. Prior migraine theory has postulated that the underlying cause was vasospasm and vascular dysregulation; this theory has not been outright disproven but more current information is leading towards a more neuronal driven model based on abnormal trigeminocervial afferent nerve activation. This obviously is still an area of much research, and hopefully with time we will gain a better understanding of the underlying process.
Treatment for migraines falls into four main categories:
1. Identifying and avoiding triggers
2. Lifestyle changes
3. Abortant medications to stop active migraine
4. Preventative medication to help stop recurrent migraines
In my lifetime I have had hundreds of migraines. Some last a day, some have lasted for more than 2-3 excruciating weeks. On and off I’ve qualified for the diagnosis of chronic migraine over the years. I’ve tried many many different treatments including multiple different abortant medications and preventative ones. At one time I was taking 3 different prescription meds and two herbal supplements to try and prevent migraines.
The thing is, none of it was working well. These medications work well and help many people, but it wasn’t a solution for me. Over time I gradually weaned myself off all my meds and have been using a much more holistic approach. I started to focus more on lifestyle changes and triggers to help manage my headaches. This is not an approach for everyone, and in fact I still get debilitating headaches, but overall the quantify and duration has been improved in the last 18 months.

So what are the most common migraine triggers?
1. Stress
2. Sleep
3. Caffeine intake
4. Diet: anything from processed food to alcohol to cheese to food additives can be a trigger. Note that chocolate had not been proven to be a trigger food, but cravings for chocolate are a warning sign a migraine is coming your way.
5. Environmental/weather changes
6. Dehydration
7. Over-exertion
8. Drugs
9. Oral contraceptives
10. Teeth grinding
11. Medication overuse
It’s not hard to see how many of us can check nearly every trigger box on here. I set out to work on what I could most easily control and change. Starting with my diet, I eliminated caffeine and cut way back on processed foods. I think this has been the biggest help to me. I now only drink caffeine at the start of a headache, and it helps to reduce my symptoms.
I also cut back on taking medications when I have an acute headache. I rely on more multimodal therapy, using an ice pack, caffeine, sunglasses and dark quiet rooms to help my symptoms. In the past would be chugging ibuprofen all day and night and ducking into the bathroom between patients to give myself toradol injections. I found that didn’t really help things improve any more rapidly. What I really need to get better is sleep and time.
As you can imagine, when you are a busy working physician, those things are hard to come by. I struggle with sleep so often and my stress levels are chronically high due to my line of work. It’s been a battle to try and get more sleep and learn to relax and meditate and stop perseverating on every single little thing.
So if you see me rocking my headache hat ice pack and sunglasses around the hospital, no it’s not an awesome new fashion trend.., just one woman trying to feel better, get through the day, and overcome the migraine curse.


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