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rx4living, 1830 Plaza Drive, Winchester, VA (2025)

04/18/2023

When I see patients in the outpatient world, I often ask them, “What has your movement been like since I last saw you?” More often than not, they repeat back to me, “You mean, how many times did I exercise?” No, I really mean have you intentionally put movement into you daily life?

There is a role and purpose in exercising for exercise sake, but equally important is just moving. What’s the easiest way to do this? Steps!

Multiple studies over the years have shown that the more simple movement you intentionally put into your life on a regular basis, lowers your risk of dying regardless of age, s*x or race. Just this year, Circulation published an article that analyzed eight different studies that included 20,000 individuals in 42 countries (including the USA). The data analysis showed that walking between 6,000 and 9,000 steps daily is linked to a dramatically lower risk of cardiovascular disease for older adults. Not as much benefit was seen in younger adults, but heart attacks and stroke are also less common in those under 60. Even as few as an additional 1,000 steps taken daily marks a substantial reduction in cardiovascular risk -- as much as 40-50%! That is huge, more than most medications!

This does not mean that you shouldn’t be exercising and getting your heart rate up. We also know that being physically active, especially before the age of 60 benefits many of the precursors of cardiovascular disease, such as high blood pressure, obesity, and type 2 diabetes. These conditions are more likely to develop in younger adults, and are important for early prevention of disease. While it is true that the more steps, the better – the most important thing is to increase one’s step count.

I have a mostly sedentary job with a small office space – if I don’t move intentionally, I often only get in 2,000-3,000 steps (per my phone’s built in tracker). So to try to increase my daily movement, I specifically add in more steps in my daily life by parking farther away from my destination or march in place while waiting for an insurance company to take me off hold (each minute = ~ 100 steps!). How have you moved today?

04/11/2023

Hello! It’s been a while since I have posted. My apologies, I have been suffering from imposter syndrome. Here's the back story: I often tell my patients, especially my weight loss ones, that if you fail to plan, you plan to fail. And for the last two years, I have failed to plan. All my life I have set goals and reached them by planning….. need to ace an exam? plan my study sessions, unexpected expenses? plan the repayment, want to go to medical school when you majored in English? plan your personal post-bac strategy. My confidence as well as success in achieving my goals, started to falter as my family planning ran into major roadblocks, but really started to unravel during pregnancy with my youngest son. He had a rocky start from day 1 when my bHCG levels didn't meet goals and my self-preservation plan with another predicted fetal loss was that I stopped planning on expecting a live child as the end result. I started living in the moment, letting life happen to me, including an emergency delivery and NICU stay. Totally unprepared to have a live child, especially at 28 weeks, I rallied and was able to focus on short-term goals of getting him home, financial recovery (since I had not planned a maternity leave), helping him meet his milestones, etc., but I was still faltering in my planning capacity. Then my mom almost died from flu and I rallied a plan for convincing her to get appropriate medical care and she lived, then COVID-19 happened and I rallied as part of multiple efforts to help save the world, but then in early 2021, I stopped even rallying. To be honest, I could barely stay awake and go to work, but I brushed it off to anxiety and pandemic life, busy working mom life, not taking enough vacation, burnout, etc. Then my husband almost died due to a complex aortic dissection. I rallied yet again -- didn't sleep for days between visiting him in the hospital, taking care of my family and keeping up my regular work schedule -- but a week later, I went into shock due to profound anemia and accompanying lack of iron.
What is the point of this somewhat sad story and series of unfortunate events?

The point is that I could not figure out a way out of my new pattern of thinking, climb out of grief for what I had lost and build hope again. Life was still happening as I went through treatment and recovered, my children grew, I started two new jobs all the while helping my husband navigate his new life fraught with setbacks and limitations. But I was unable to rally for myself and plan how to reach my goal, as much as I wanted it to happen. And to be frank, quite a complex goal. The life that I once recognized with fondness and pride in what I had planned and worked towards had been replaced by a painful uncertainty with little that was predictable or foreseen. Time was passing and my cyclical thinking of "what's the point?" -- as I kept a side eye out for the next disaster to hit me -- kept rounding the corner. With a new year and a birthday in January, the time was ripe to apply something I say almost every day in work and at home -- a plan can be simple or a small change, but the important part is consistency and accountability to make it happen, thus creating big changes.

Every day, I planned to focus on completing one task, ideally a very discrete yet proactive choice (e.g. planting bulbs, completing a set of pushups, etc.). I posted on social media for the first 28 days to hold myself accountable; for it takes about 28 days to set a pattern, 100 days to make it a habit, and another several months to have the habit stick and feel natural. So today, being the 100th day of the year, my self- assigned task was to write about my own journey to start planning again. Has it felt natural? Not always, but it is getting easier. Have I set a 6 month plan or set a long-term goal yet? Nope. But it is a start: I now have pretty flowers and am able to do 100 pushups as well as 100 choices that have broken my cycle of passivity. What do you want to change in your life? Start to gain traction by setting small and specific tasks, but be consistent and accountable to yourself. You will start to see bigger changes and reach your goal.

07/05/2022

The more I learn, the more I need to learn. Humbling and frustrating to learn that standard of care for iron replacement (oral supplementation) is ineffective and not tolerated 80% of the time. Iron deficiency can be effectively treated in 45 min with an IV infusion but is often denied by insurance companies or not even recommended by physicians until months later, when oral supplementation has not worked. #1 population that needs this treatment? Pregnant women, followed closely by menstruating women!!

05/21/2022

Sun’s out! Learn how to let your skin be its best and do the job for which it is designed. Not too late to join me for Walk with a Doc this am! Meets at Valley Health Wellness Center at 9 and we walk around the VH Cancer Center lake.

05/13/2022

Wi******er area — join me next Saturday for a little education, some exercise and good company!

05/13/2022

Virginia folks — tune in next Thursday to hear my story of walking the walk of lifestyle medicine through the pandemic.

05/13/2022

Virginia folks — tune in next Thursday to hear me talk about how running away to the circus kept me (relatively) sane in the last two years!

04/09/2022

Data has shown again and again that doctors who have an understanding of lifestyle medicine and make it part of their own lives are more successful at motivating their patients to change. It has also been said that the best physicians take care of their own health first and not just tell others what to do. This month has been just that for me.

Many of my patients ask me to tell them how to be healthy — often with that wishful light in their eyes that I will pull my unicorn wand out and make it happen by the end of our meeting. Good health is such a complex issue that I try to break it down into things we have to acknowledge and accommodate because we cannot change them and those things we can change by the choices we make, which I help them form.

I don’t like being the patient or getting tests done, but a little knowledge goes a long way when it comes to assessing risk. Here I am pictured in front a CT scanner for my recent coronary artery calcium score assessment. This is not a routine test (not covered by insurance, unfortunately) but after discussion with my own physician, we made a shared decision about the best way to evaluate my risk of heart attack, stroke or death from heart disease. This test is considered the best measure — comparing risks and benefits as well as cost (only $99!) — of the extent of asymptomatic heart disease for adults at risk.

I can’t change my age or gender or family history or my past medical history but I can make the best choices for me today with the right knowledge. Knowledge of risk and what to do about that is the key to health but remember it is still a tool not a destiny.

03/08/2022

This month, you may spot more than the usual number of medical folks (or their offspring!) wearing blue for colorectal cancer (CRC) awareness. CRC is the 3rd leading cause of cancer death for both men and women in the US, with an estimated 53,000 deaths last year. Not only does CRC pose a serious health risk to our population, it is one of those cancers that has very effective screening tools as well as actions that can reduce our personal risk.

Types of cancer can be placed into two rough camps: things we can control, and others that we can’t. CRC falls mostly in the former, we can reduce our risks by specific actions such as changing our lifestyle. Many environmental factors have been studied, with imbalanced diet, alcohol consumption, to***co use, obesity, lack of physical activity, and sleep deprivation being identified as the main causes behind CRC.

For example, just 30 g (less than 1/2 class) of alcohol per day results in a increased risk of CRC of 1.16, whereas consumption of more than 45 g (1/2 glass) of alcohol per day increases that risk to 1.41x more than average risk.

Unfortunately, CRC also falls in the latter category of things we can’t control such as high risk conditions and random changes to our genes or chronic conditions as we get older. By their nature, there’s not much we can do about these risks. But for CRC, we have an excellent screening tool - the colonoscopy.

The recommended age for screening colonoscopy for the general population was recently lowered from 50 to 45 because CRC cases are on the rise among young and middle-age people. The upside of these unfortunate statistics is that colonoscopies not only detect the disease, but prevent cancer because precancerous polyps can be removed during the procedure.

Of note, taking these actions isn’t about guarantees or absolutes, it is about reducing the chances of fatal disease. With both the things we do have some control over, such as what we eat as well as following recommend screening guidelines, there’s a potentially life-saving chance to act.

💙

02/18/2022

After a pleasantly warm December in Virginia, when I was able to exercise outside with minimal adjustment, my favorite outside exercise was suddenly curtailed by ice and subzero temperatures. Although I gave up regular, intense sessions in the air, I have pivoted to maintain regular exercise with 10-15 minutes of high intensity calisthenics every morning (inside) with occasional stretching sessions at night.

It may seem like an uneven exchange but the importance is that I keep going, even in the winter months. I am bolstered by increasing data that shows that the more sitting I do, the more my health risks equal that of a smoker.

Additionally, a recent US study in the Journal of the American Medical Association (JAMA) suggested that even 10 minutes per day of moderate to vigorous physical activity for adults could have significant measurable benefits, including extended life.

Per his CNN interview, the study’s first author, Pedro Saint-Maurice, reports, "We know exercise is good for us. This study provides additional evidence of the benefits at the population level: if all adults in the United States (over age 40) were to exercise just a bit more each day, a large number of deaths could be prevented each year,"

Just 10 more minutes of activity can make our nation healthier! Although this study’s results are focused on the level of the population, putting this information to use in our daily lives has great significance.

I regularly counsel patients about making small changes on a daily basis that can lead to big results. Instead of seeing exercise as the means for balancing bad eating habits or once we have more free time or the weather is better — we should think of exercising — even in small amounts — as the means to live a longer, healthier and happier life.

02/09/2022

At just past the halfway mark of winter, the darkness may be creeping up on all of us and affecting our mood. I have seen my fair share of darkness this winter and I can feel some seasonal affective disorder (SAD) creeping up on me. This syndrome, characterized by “the blues” during winter months, typically affects 10 million Americans every winter. But did you know, that a healthy lifestyle is the first step in preventing and treating this mood disorder?

As a physician, we know that we need to address deficiencies in norepinephrine, serotonin, dopamine, glutamate, histamine and epinephrine to regulate our mood. There are a fair amount of pharmaceuticals designed to address these exact needs. But with a significant amount of these key players produced in our gut, why not power the brain through our diet?

This means finding foods that are filled with the following:

Omega 3: seeds (flax, chia, h**p); nuts (walnuts); soy beans, kidney beans, Brussels sprouts, wild rice, firm tofu

Folate: leafy greens, beans, oranges, almonds, asparagus, avocados, beets, cashews, kelp, legumes, spinach

Flavenoids: most fruits, vegetables, tea, coffee, & cocoa

Sulforaohanes: broccoli, cauliflower, arugula, kale, cabbage

How do these nutrients work? Some work by increasing brain blood flow, protect against neuronal stress through anti inflammatory and anti oxidative effects or stimulating production of the happy chemical, serotonin.

For example, pistachios are an excellent source of vitamin B6, which your body needs to make serotonin. Refined foods and processed food with excessive fat sugar and food additives destroy gut microbiota and increase susceptibility to depression or anxiety by limiting absorption of these needed nutrients.

Just like most pharmaceuticals, consistency is key and over time. For diet to have meaningful impact — one may need to consume 7-8 servings of fruits and vegetables each day. We, as physicians often overlook the power of a whole-food plant based diet.

As rumor has it that winter is staying for a bit, let’s hibernate and whip up some brain food!

01/07/2022

One week into the new year… how is everyone doing? With all of the sparkly fresh New Year energy comes the perfect opportunity to set goals and become re-energized by your dreams and ambitions for good health! The shine of a new year may be a bit less sparkly this week but hopefully new intentions and goals are still shining bright.

My intentions for the new year include:

- [x] Keeping my brain and knowledge active and up to date
- [x] Doing my (and my family’s) best to dodge Omicron — although we were already hit by Flu A 😷!
- [x] Moving my body in a way that feels good yet challenges the status quo
- [x] Manifesting health, healing and happiness through my work and my life

According to statistics, only 8 percent of people actually keep their new years resolutions. That’s discouraging, isn’t it? Often, even with the best of intentions, we are derailed by small set backs or procrastination.

How then can we go about setting ourselves up for success with our broad resolutions?

1. Start small. Make promises to yourself that you think you can keep and set a date for completion of each step.

2. Change one behavior at a time, but be consistent. Unhealthy eating and other lifestyle habits develop over the course of time and we need to be patient and focused in order to undo our patterns and habits.

3. Be accountable — talk about it or share your goals with trusted family and friends (or social media 😳).

4. Don't beat yourself up. Progress is made in the process.

5. Stay focused and don’t give up, no matter how many times you fail or falter initially, keep striving for your goals!

Overall, keep up the focus and break it down to achievable steps. We are all living our own life each day. Wherever this new year has found you, I wish you peace, health, and your best life possible.

rx4living

04/18/2023

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