LAURA LEWIS MANTELL, MD

Keep the weight off this season!

Most people gain between a 1/2 to 1  1/2 pounds over the upcoming holidays. It doesn't sound like a lot of weight, but the unfortunate thing is that people don't usually lose the weight they gain over that period of time.

Getting together and eating with friends and family are some of life's pleasures, so enjoy them! There are lots of things to do to fill your senses at this time of year: smell the ubiquitous evergreen branches, potpourri and candles; look at the creativity of store windows and other decor; listen to the sounds of holiday music and the feel of hustle and bustle.  Let food be just a part of a holiday experience.

Here are some useful ideas for helping you to wear the same size in 2011 as in 2010:

• buy a pedometer; work up to taking 10,000 steps a day - inexpensive helper.
• start walking regularly; it's what you want to be doing for your health anyway - 45 minutes of brisk walking burns 300 calories.
• don't have your lunch delivered - walk to pick it up.
• If you live in suburbia, continue or start to park your car as far from your shopping destination as you can - you can  build a 10-15 minute walk into the trip a few times a week.
• Consider a meal replacement drink with a green salad for lunch - these high-protein drinks are filling, and while tasty, won't tempt you to over-indulge.
• Does it have to be said?  Never go to a party hungry.
• No good choices?  Champagne is better than any mixed drink; a brownie is better than fudge; almost any cake is better than cheesecake.  These kinds of choices are the reason for never going to a party hungry.
• If you go to a gym, now is the time to shake up your work-outs.  Try a new group class or gift yourself a personal trainer for the next month.
• Make your sandwiches open-face, cut the pasta servings in half and add more vegetables to the bowl starting NOW.
• If you don't care about alcohol - skip it; t can add 300 calories to an evening.
• Try the Japanese art of hara hachi bu - eating until you are 80% full!
• Eat mindfully - that is, pay attention to every bite;  smell, chew, taste and enjoy!
• Refuse your friends if they want to send you home with yummy leftovers.
• Buddy up with a friend who shares your goal and exercise together; it's more fun, less lonely.
• Add 5-7 minutes to your work-out. 
• have an ounce of almonds or walnuts in your car, desk or purse for hunger emergencies: they're healthy, filling and boost your metabolism.
• Oh, and does it have to be said? NEVER go to a party hungry!

Each of has our own challenges at holiday time.  If the tendency to gain some weight between now and January 1st is one of yours, try some of these ideas, you've nothing to lose but weight.

 

My Abnormal Mammogram, Breast Cancer Screening and Prevention

I had a mammogram two and a half weeks ago. It was abnormal, a first for me. On the bell shaped curve, I’m on the right side in terms of anxiousness with this sort of thing; perhaps it's because I’m a doctor, perhaps it’s because my family is basically hysterical about the possibility that anything might go wrong physically with any of us.

I was sent for a biopsy under ultrasound, which didn’t show anything meaningful, so the next procedure was planned:  a stereotactic biopsy. For this, they figure out where the suspicious area is with coordinates on a mammogram, and send a needle in after it. I came back without a cancer diagnosis but my doctor, a true super star radiologist, both technically and as a human being, was still not certain the biopsy had targeted the problematic area.  Finally, an MRI, which is excellent for detecting cancer in the breast, was approved (after my physician spent hours on the telephone convincing the insurance company that it was necessary) and performed.

 No cancer.

I feel as if I have not fully exhaled for about two and a half weeks – the time it took to get this done. I've got my life back.  An anonymous quote kept going through my head and still does: “a man who has his health has a thousand wishes; he who does not, has but one”.  It is the truest thing I can think of today. Each time I looked at an entry in my calendar, over these past weeks, I thought “Ok, so that’s what I’ll be doing next Tuesday at 3:00 pm…or not”. I also reviewed my lifestyle and thought about the ways I altered it years ago in order to enjoy life more fully and reduce my risk of heart disease, high blood pressure, diabetes and cancer.  I wondered if I had started too late.

When my girlfriends complain about discomfort they experience during mammograms, the point is driven home to me that we forget to be grateful for modern medicine. Whatever discomfort a mammogram causes, it’s short-lived, infrequent and finding an early cancer could save your life.  Some of the greatest strides in medicine have been and continue to be our ability to screen for life-threatening diseases 

Screening isn’t prevention and we need both.  Prevention is adopting a lifestyle that promotes health. That means:  eating lots of vegetables, fruits, whole grains, and minimizing animal fat, maintaining a healthy weight, limiting how much alcohol you drink, not smoking, getting off your sofa and even out of your house and moving your body in some way, as many days a week as you can; learning how to manage your stress, savoring good things that happen and appreciating and nuturing the loving relationships in your life.

Prevention begins and ends with you; it doesn’t happen in your doctor’s office.  Every time you make a decision about what and how much to feed your family, whether to go outside or sit at your computer, talk to friends or watch TV, you’re making a lifestyle decision that, over time, can greatly impact your well being and actually make a difference in your health.

October is breast cancer awareness month. Make sure that you, and all the women in your life who should be getting mammograms, get them. That would be any woman over 40.  Let’s make every good use of this incredible screening tool we are fortunate enough to have available to us. 

Let’s also make October a month in which we embrace prevention; our genes are only one piece of the picture that is our health; we have enormous influence over what that picture will look like over time. Making lifestyle change that promotes health feels and looks great.  

My practice is devoted to Lifestyle Medicine - the scientifically-based practice of helping individuals and families to transform their health and well-being by adopting and sustaining healthy lifestyle choices. If you'd like some help along the way, give me a call or send an email: 212.734.2902; info@mantells.com.

 

Lifestyle Medicine: What's your Health and Wellness Vision?

I believe everyone wants to be healthy; it's just not always easy to see the path.  Once you've defined what your personal Health and Wellness Vision is, a key to success can be having an ally on the journey; someone in your corner who understands, supports, encourages and does not judge.  In my Lifestyle Medicine practice, I do just that. Lifestyle Medicine is a growing and evidence-based practice of assisting individuals and families to adopt and sustain behaviors that can improve health and quality of life. 

I help people make transformative lifestyle changes, not quick fixes.  Recognizing that everyone is in different stage of readiness to change, I make no assumptions. For some people, the starting point is simply to consider stopping smoking. For others, it may be helping them hold themselves accountable to a rigorous exercise program, reducing salt and fat in their diets and/or substantially managing their response to stress.  To be most helpful, I meet each person "where they are".  The qualities that make you "you", those special traits that have helped you thrive in other areas of life (work, parenting, etc.), we call them your "signature strengths", can be harvested and used to help you meet the challenges of making rewarding lifestyle change. This isn't "therapy"; we don't focus on deficiencies, but instead, use your values, dreams and strengths to power change.  

Everyone's Health and Wellness Vision is different.  If we are free of medical problems, we view our health and wellness differently than if we have cancer, diabetes, chronic pain or heart disease. Often our age affects our vision of what our health and wellness can be, as do our roles in life.  For example, if you are a care-taker for a sick child or parent, your Wellness vision might be impacted.  But what we all share is the desire to be as healthy and well as we can possibly be.

Some people define their health and wellness vision largely in terms of their weight, how active they are and whether they are eating nutritiously; many also include how well they manage time and stress, and others feel making sure they apply their core values to their everyday lives is necessary for health and wellness.  By bridging the gap between how well we are and how well we'd like to be, we can bring our health to new and exciting places and even expand what we mean by "health", which has conventionally meant the absence of illness. I think there is more to it than that, and I also think we can experience health even in the face of illness.

Try this exercise.  Toss aside your usual ideas about what health and wellness mean for the moment and picture:  it's a year from now and you are living your own vision of health and wellness. You are in an airport and you bump into someone who hasn't seen you in ten years. Who do they find? Take some time and have fun answering these questions for yourself:

-What do I look like? What am I wearing?

-What does my energy level feel like?

-What kind of health-promoting behaviors do I do regularly?

-What is my work or retired life like?

-How do I spend my free time? Do I have any?

-What are my connections to other people like?

-How much do I like where I am in life?

What's really interesting is that when you answer the questions, it reveals what your health and wellness vision is. And, you see the gap between how healthy and well you feel you are now and how healthy and well you'd like to be.  For some people, the difference is small, for others, it's huge.  Research shows that by helping people attach their core values to the new behaviors they seek to practice, motivation soars.  I work with people weekly by phone or live sessions to help them connect with the change that really matters to them. 

The most important point is that no matter how far you may be from your ideal of health and wellness, you can come to live it, one step at a time. If you'd like to know more about how we might work together to help you find health and wellness on and in your own terms, call or write (info@mantells.com).  I look forward to hearing from you!

 

On Time with Your Doctor

I recently accompanied my husband to a doctor’s appointment.  While he talked to the doctor about his reason for his visit, he spoke hurriedly, rushing to “get through”. I gently interrupted and told him to slow down and take his time, to which he replied “I don’t want to take up too much of the doctor’s time”.  Thankfully, the doctor agreed that he should relax and not feel pressured. 

 

When we left, I told my husband what I tell my patients, many of whom have indicated that they are concerned with how much time they are “taking”.  Think of your appointment with your doctor as your time instead of your doctor’s. You have put aside everything else aside in order to be with your doctor.  This is time you have reserved for his or her full attention, whether or not the appointment started on time or how many people are sitting in the waiting room. 

 

Doctors do not always make it easy.  One study reported that during patients’ their initial reporting, doctors interrupt patients 74% of the time.  Other studies have determined that physicians interrupt patients within 18 to 22 seconds during the first few minutes of their encounter.  No wonder you doubt that he or she is listening.

 

I became a physician, I am quite sure, because my father loved being a doctor and that feeling permeated my childhood.  He described solving the riddle of a patient’s diagnosis with the suspense of a Sherlock Holmes mystery. Equally interesting was his description of his patients as people.  He was compassionate, understanding and respectful.  That was my model for being a doctor.  So, it is always strange to me that doctors need to be taught to listen; liking to listen to people and learning their stories is why I became a doctor.

 

 As much as I value listening to patients, I interrupt sometimes, too, and when I realize I’ve done it, I apologize. Here are some things you might try to improve the dynamic with a doctor who does not seem to be listening well enough:

·         Remember that the time is yours; you “bought it”. Hopefully, however, there is  some kind of partnership between you and your physician, not just an exchange of services for money.

·         If you are interrupted by your doctor before you have said everything you feel is important for them to know, say so.  A comment such as “Doctor, I feel there are a few more facts I haven’t told you that may be important for you to know” should not offend any physician.

·         If you cannot establish a comfortable give-and-take with your physician and do not feel you are being listened to, consider changing doctors. It can be a very difficult thing to do, but not much is more crucial than your health.  If you cannot feel comfortable with the person you entrust it to, maybe it’s time to look further.