How I am Losing Weight and Getting Healthy

I get a lot of questions about what specifically I have done to lose weight and get fit… I’m going to write up a few pieces to give the details

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This one is about nutrition, first in the series
Getting started:
At the start of this journey in August 2016) when I topped out at 275 lbs I estimate I was eating 3000-3500 calories per day.
Most of that was at the end of the day and a large portion of that was snacks.
At that time my metabolism was slower than a tortoise, and I would often go 10-12 hours at work all day without eating.
I would binge eat when I got home usually shoveling in some animal crackers or chips while getting dinner together.
Dinner itself was fairly often take out from Q’Doba (nachos), Taco Bell (nachos and bean burritos), pasta (Fazolis or homemade), restaurant size salads with bread (Doubledays), pizza (Dewey’s or Papa John’s) or just going out to eat at any number of places around town.
You see what isn’t on that list? Fresh home cooked food full of fresh veggies and fruits and whole grains and nuts and beans.
So the very first thing I did was to cut back on snacks- eating one bag of animal crackers instead of two for instance. I also started to watch my portion sizes- eating a single portion or at most two portions instead of 2-3 routinely. And I started to make sure I was drinking at least 80 ounces of water per day.
With just these changes, no other diet, no exercise I lost the first 20 pounds. It was losing that first weight that made me realize I could do it and I needed to step up my game!

What It’s Like To Be A Doctor In the Heroin Capitol of the US

I am a practicing Hospitalist physician in Dayton, OH. Dayton has emerged in the last year as the city with the highest per capita death rate from opioid overdoses. When we measure the number of deaths here we talk about how many there are per DAY, not per week or per month. We have been inundated with heroin and other products laced with fentanyl or carfentanyl. Every other drug including, marijuana, is laced with an opiate in this city. Dealers stand on street corners and throw baggies of heroin into passing cars who have the windows open- free of charge- to get new customers hooked. A routine dose of narcan to revive someone here is not the standard 0.4 mg dose, but a minimum dose of 10 mg. Many people die and cannot be revived despite maximum narcan doses.
Our hospitals are overrun with opioid dependent patients. They take up a staggering amount of the healthcare community’s resources. When you are an IV drug user, there are many acute and chronic medical illnesses that come with it:
Hepatitis C
Bacteremia
Endocarditis
Abscesses of the skin and bone
Osteomyelitis
Pyomyositis
Rhabdomyolysis
And that’s if you are lucky enough to survive an overdose. Many of these conditions takes months to treat and will cost hundreds of thousands of dollars.
In hospitals and clinics in Dayton, the medical community is being tested. We do not have enough resources to help patients get clean- and even if we did the number of patients who achieve remission then relapse over and over and over is staggering. Instead we spend our days putting out fires. Reviving opiate users and patching them up so they can leave against medical advice only to return day after day in an endless cycle.
What you will see throughout the city is a community exhausted by opiate abuse. Our job is to take care of all patients, but you can clearly see over time a degradation of empathy and willingness to keep endlessly helping drug abusers. When day after day you are constantly verbally abused and threatened, and sometimes physically as well, it is very hard to maintain any kind of positive outlook and caring bedside demeanor. It wears on us day after day to be abused and mistreated by our patients and to even fear for our safety in caring for them.
Because the truth is that most of these patients we take care of are going to die of an overdose or a complication of their drug abuse. Right now things look bleak and a solution seems unreachable.
All I can do right now is keep trying to fulfill my duty to “do no harm” and treat each patient to the best of my abilities, but I’m not going to pretend that doesn’t get harder and harder for us healthcare providers each day. I hope we can work within the healthcare and the larger community to find solutions and help those many patients in need.

Southwest Sweet Potato Mash

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I’ve never been someone who has been really into sweet potatoes. I don’t get them, I guess. Many of the vegetarian recipes I’ve been seeing lately will feature this ingredient, so I’m trying to wrap my head around it and eat it in a way that tastes good to me. I get meal delivery services and this recipe started off as a Plated dish that I didn’t quite like, so I tweaked it for my own taste. You can eat this as a side or a main dish, make sure you have the chipotle peppers in adobo sauce- that is what makes this dish!
Makes 6 side servings or 3 full meal servings

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Ingredients:
3 sweet potatoes
1 can no salt added black beans
1 red pepper
1 yellow onion
1 can chiles in adobo
3-6 cups spinach (your preference)
1/2 cup Colby jack cheese
1 tablespoon mayo
1 tsp cumin
1 tsp cayenne

Instructions:
1. Poke holes in your potatoes and microwave until soft, about 10 minutes.
2. Assemble and prep ingredients. Rinse black beans. Chop red pepper and onion. Take 2 chipotle peppers out of the can and mince.

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3. Put 2 tablespoons olive oil in sauté pan on medium heat
4. Add bell pepper and onion to pan, cook about 5 minutes (my oil was too hot hence this face!)

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5. Add black beans, cumin, cayenne, and chipotle peppers to pan and cook another 5 minutes
6. While cooking bean mixture, scoop out the middle of the sweet potatoes and mash in a bowl. Add the mayo and the cheese and stir until soft.

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7. Add spinach to pan until wilted, take off heat

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8. Add bean mixture to sweet potatoes and stir
Serve and Enjoy!!!!

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Basic Nutrition Information
For one side serving (1/6 of total):
235 calories
7.8 grams protein
29.8 grams carbs
9.2 grams fat

Special thanks to Rob for the pictures!

Recipe adapted from Plated (initial recipe for twice baked sweet potatoes)

Meal Delivery Services- Ranked!

So I am lazy and hate grocery shopping and cooking! I just don’t have enough hours in the day to devote to that! Over the last year or so, I have sampled pretty much every meal delivery plan there is! I like the ones that deliver fresh food you have to cook (precooked or frozen are just not very good, so I won’t discuss them!). So yes, you still need to do some work, but having them delivered and prepped is a big help! Most of them cost about the same- between 10-14 dollars per person per serving. Cost difference wasn’t a factor when I chose a plan, the food and variety matters to me more.  When I think of all the groceries I waste from never having time to cook, it makes financial sense to do these meal plans!

Here’s my list, best first:

1. Plated and Marley Spoon. I like these two the best overall for one simple reason- choice! I am vegetarian and my husband Rob eats basically only meat, so we never eat the same food. These two services both let you choose your meals from a range of foods including meat and vegetarian options. They also have a lot of choices each week, so finding something you like is a lot easier! We currently subscribe to both of these and each week we can pick and choose what we like the most to be delivered, and skip if nothing looks good. Plated recipes are designed by different chefs, and Marley Spoon is tied to Martha Stewart.

2. Sunbasket, Green Chef, and Purple Carrot. I tied these three together because they all focus on organic clean food. Sunbasket and Green Chef offer both meat and vegetarian options. However, you can only choose one type, so I can’t mix my meals with my husbands. Not cool. Purple carrot is vegan. Great in theory, but I just didn’t like a lot of the food! If you are less picky it would likely be perfect for you!

3. Blue Apron and Hello Fresh. These are both kind of mediocre to me. I don’t like a lot of the recipes, you can’t mix and match veggie and non-veggie, and I feel like a lot of the meals are very similar over time. If Blue Apron offered more choice in options, I would try them again. They do have all their recipes online, and I’ve made a few of them myself at home. Hello fresh has some recipes by Jamie Oliver.

4. Home Chef, Terra’s Kitchen.These both offer meat and veggie options but again, I just didn’t like a lot of the recipes. Home Chef seemed overly boring and Terra’s kitchen didn’t offer enough variety for vegetarian options. Terra’s kitchen had this crazy little refrigerator that they use for meal shipping- it is less wasteful!

5. Hungry Root. This one offers vegan options but consists mostly of veggie noodles and sauce. I do like their snacks- vegan cookie dough, brownie dough, and carrot cake bites.

Local to Dayton Ohio only

Kates Plate. This is a place in Centerville that offers both pick up and delivery service. It is a great little business. If you eat meat I suggest you try this! But the menu only rotates every season, and there were not enough vegetarian options. So unless that changes I personally wouldn’t try it again. Great for people doing Paleo, too.

 

 

 

 

 

 

 

My Weighty Story

I am a Hospitalist doctor at Miami Valley Hospital. I trained as a family doctor, and then decided to work only in the hospital treating acutely ill patients. I am putting myself out here to talk about about an epidemic problem: obesity.
I myself am obese, and I am trying to make positive changes in my life so that I can lose weight and keep it off. I think we all have a different story of our weight and how we became obese, so I wanted to share mine with you.

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I was a tall and skinny kid, spending everyday out running around the woods and playing a bunch of sports all the time. That all changed hugely when I hit puberty, and that was a big adjustment! With all those hormones flooding in, I magically had thighs and a butt! I started to gain weight even when I was rountinely olaying sports and exercising. Throughout high school and most of college, I was an avid athlete playing a different sport every season. Towards the end of college, I stopped all my regimented exercise, but did not change my caloric intake… a perfect recipe for weight gain. As I ended college I was creeping up towards 200 pounds.
And then… medical school hit me hard. Med school was a generally terrible time of my life. I hated it so much in the beginning that I even took a whole year off of school and thought of switching career paths permanently (I had aspirations of being like Jo before Fixer Upper was a thing).

It was during this awful time that all my bad habits caught up with me. I favor quick and easy meals and hate to cook because I ruin many recipes! Even though I have been a vegetarian since the age of 16 I was relying on carbs and cheese and processed food for the majority of my calories. I also, like so many others, eat for bad reasons- stress, boredom, anxiety will all send me running for a nutty bar (or 2 or 4 or a whole box).
During this very stressful time in my life I retreated into myself, did no exercise and my diet deteriorated. I got up to about 225 pounds at first and then I developed severe anxiety about going into medical school because part of our classes involved examining each other in order to learn. I was ashamed and terrified of my body and became reclusive. during my time away from school, I got a job working for a small company in Yellow Springs. My weight ballooned to 270 pounds.
The one bright spot of this period is that my hiatus from medical school made me realize I could never give up on becoming a doctor. I missed everything about it, and reenrolled in school and proudly got my degree.
From here I went into my residency training in family medicine. I loved this part of my life very much. It was stressful to be working so much, but I was surrounded by amazing colleagues and blossoming into a true physician. I was able to get back on track with my weight, exercising regularly and reigning in some of my bad diet habits. I was back down to 225 pounds and feeling much better than I had in a long time… and then I fell. Playing indoor soccer of all things. Five minutes into the game. Disaster struck.
Instantly I knew it was a severe injury. I heard a loud pop and my knee immediately swelled to the size of a melon. I had torn my ACL, my lateral meniscus and had a tibial plateau fracture. I had to have surgery, and I was out of my residency training for months.

What followed the next two years was a horrible time of surgery, rehab, and more surgery. I didn’t sail smoothly through recovery and had a very difficult time. For part of my treatment my injured leg was  forced straight by two people pushing down on it, and then put in a cast to keep it straight. I have never sworn do much in my life as during that grisly and barbaric treatment! I was using crutches to walk for a year and a half, and I missed 6 months of training and had to extend my time in training.
It was hard; the hardest time in my otherwise privileged life. I felt weak, helpless and out of control. I didn’t know if I would be able to finish my training to become a physician; I was at risk of losing everything I had worked for. I was also in pain every minute and could not even stand or walk to be able to properly do my job. I was a patient instead of a doctor for the first time in my life. I experienced first hand what it is like when your doctor is not listening to what you are saying, and gives you the brush off. It was a harsh reality, and very humbling. Again all the weight I had lost piled back on.
At this time, I had to advocate for myself as a patient to get the correct treatment and get my life back. And I am so grateful to say that, eventually, I did. I can now walk, kneel, and have only minimal residual pain in my knee. I graduated from my residency training and started to work at Miami Valley Hospital, where I have been ever since.
Becoming a full fledged doctor came with its own challenges. When you are a resident you think you work all the time, but you have no idea how much more work you will do as an attending physician. I love my work very much, but I tend to be a workaholic. There have been many times I will be too busy working to take care of my own health.
The bad habits of not exercising and eating processed junk escalated. I have been able to lose weight, but invariably something will come up that keeps me from finding the time to go back to the gym or eat right and I backslide. I’ve had another lesser injury of my Achilles’ tendon in this last year and I was so frightened to injure it further I just stopped doing anything. I was living a veal-like existence with very little exercise. My weight spiraled more out of control than ever, up to 275 pounds. That means my BMI was over 40- I was morbidly obese. I went in to my primary care doctor and had a fasting blood sugar test. I was pre-diabetic.
That was a real wake up call for me. Until then I had been obese for a long time, but I had been otherwise healthy. When you are obese it will eventually start to cause health complications, and I didn’t want that to be my fate.
I have had enough. Enough of yo-yo weight going up and down 50 pounds in one year. Enough of hating myself for binge eating junk. Enough of feeling tired all the time and hurting all over my body from the physical stress the weight has on my joints.
So I come to you trying to make lasting changes in my lifestyle that will carry me forward for years. As soon as I found out I was pre-diabetic, I started on the medication Victoza- but that isn’t enough. Our first instinct as doctors can be to throw medication at every problem (because we like to fix things!), but making lifestyle changes is the single best treatment for many chronic medical problems.
The thing is… it’s really hard to be obese, damnit!!! And it’s even harder to change your lifestyle and keep the weight off! It’s hard to make time to eat right. It’s hard to shop and cook. It’s hard to get up early or stay out late to find time to exercise. It’s hard to own clothes in 3 different sizes because your weight is more fluid than quicksand. Its hard to not have that second helping. It’s hard to explain to well meaning people that no, you aren’t pregnant, just fat. It’s hard to look yourself in the mirror and not recognize who you see. It’s just hard!
But change is worth it. We all have the ability to be a healthier version of ourselves. It isn’t going to happen overnight; it’s going to take time, dedication, and work.
I’m ready to try, and I’m going to give it my all.
I hope you will join me!

Veggie Lasagna

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I’ve long been on a quest to make good vegetable lasagna. The basic ingredients are usually the same- it just usually never seems to taste as good as when I get it at a restaurant. This version is pretty tasty- a classic marinara and ricotta style.

Ingredients

For the sauce (or buy 2 jars)

8 Roma tomatoes

1 white onion

5 carrots

4 cloves garlic

1 tablespoon crushed red pepper

2 cans San Mariano plum tomatoes

2 large handfuls basil, finely chopped

salt and pepper

olive oil

I will say this: as often as I have now made homemade marinara sauce, I just don’t think it is worth the payoff here. So save some time and buy a nice jar brand; it will taste just as yummy

For the Ricotta

30 ounces ricotta cheese (can sub tofu)

1 handful basil

1 lemon, juiced and Zested

Vegetables

2 zuchini

2 yellow squash

spinach

lasagna noodles

Directions: takes 2-3 hours, will serve 8-10 good sized portions

To cook the sauce, place a pot of water to boil. Separately, chop your onions and carrots into small pieces and put in pot of olive oil on medium high. Cook down for about 15 minutes. Add the garlic and cook another 5 minutes.

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While that is cooking, cut a very thin slice into the skin of your Roma tomatoes and drop into the boiling water for two minutes.

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Remove and place in an ice bath. Peel and set aside until your sauce base is ready. Then add the tomatoes to the pot. Let soften and then mash up and stir. When well blended together add the canned tomatoes. Continue to simmer and stir for about 30 minutes. Add the basil, salt, and pepper and finish off for about ten minutes.

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While you are simmering your sauce, prep the rest of the dish. Cook and let your lasagna noodles cool.

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Chop your zucchini and squash and place on a pan with some olive oil and salt. Place in the oven on broil for about ten minutes.

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Finally, mix together the ricotta with the lemon zest, juice, and basil.

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Alright- it’s been about an hour and a half and all the fixings are ready- time to assemble. In a 13×9 pan start layering. Sauce first then noodles, ricotta, veggies, spinach and then sauce again. Keep going till you pan is full (I got two full layers veggies and the top one just ricotta) and top off with sauce and either grated mozzarella or Parmesan cheese.

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Bake at 350 degrees for 30 minutes, then enjoy!

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*** Adapted from Green Kitchen Stories

World’s Greatest Vegetable Lasagna!

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