October 27, 2016 | Tushar Tuliani, MD
Education 

In our quest to master disease processes and achieve academic glory, individual well-being takes a back seat. Medical education teaches us to be selfless and put others first. Can we provide quality care to our patients without taking care of ourselves? Numerous years of medical training kept me away from a daily routine of dedicated physical activity. As the years went by, I accumulated inches and pounds and, with it, increased the percentage risk of hypertension, dyslipidemia, metabolic derangement and cardiovascular disease to name a few. As I counsel my patients post-acute coronary syndrome event or in clinic for stable ischemic heart disease regarding healthy dietary etiquette, smoking cessation and regular exercise there is a feeling of guilt. Do I practice what I preach?

Balancing a busy work-life with healthy living is a challenge faced by many in the medical community. Our food industry provides us with easy access to calorie-dense albeit nutritionally-deprived sugar-laden foods. A quick glazed donut for breakfast, slice of pizza for lunch and vending machine paraphernalia for dinner and life is good. Using the following pointers, I would like to provide my two cents to every member of the health care team blessed with a professionally busy life. I hope this will help them make amends to their dietary and exercise habits, to positively impact their lives and most importantly the lives of our patients.

• Inspiration: A healthy present brings a healthy future. Life gets busier moving from medical school to residency/fellowship and I doubt this will change once we have a job. Work-out sessions, whether a form of sport or exercise, is your time away from the daily on-goings of the world around us. Inculcating this in a daily routine early in our career is important. Having trained at Loma Linda, there is no dearth of inspiration in my city where I regularly see nonagenarians working out at our community fitness centers or zipping around city streets on bike or foot. Some of the common features shared between blue zones (areas where individuals live measurably longer) around the world include lower prevalence of smoking rates, plant based diet, constant moderate physical activity and social engagement.
  
  
• Establishing a goal: Health care professionals are inherently goal-oriented. Bringing about changes to aid healthy living can be challenging due to lack of immediate results and continuous positive reinforcement. Individual goals could include longevity and vitality for a disease free old-age or preventing rupture of plaque. Depending on the established goal the degree of modification in diet and intensity of physical activity can be varied.
  
  
• The elusive 40 minutes a day!: One of my excuses for not exercising is the lack of time. In my case, I realized I can easily spare 40 minutes if I reduce my online social networking activities. Workouts can be combined with listening to podcasts, browsing through scientific journals or catching up on your favorite sitcom.
  
  
• Exercise: Daily exercise goals can be achieved by running /cycling to work or visiting the gym as a part of work transit. Tracking daily steps using fitness bands is a great way of objectively quantifying how active your day was at work. Depending on this daily work out regimens can be modified in intensity and duration, helping diversification thereby curbing boredom from repetitive workout routines. While taking the stairs at work instead of the elevator, parking at the far end of the lot, using stand-up desks and walking while talking on the phone helps you stay fit, but it should not replace a formal workout regimen. The same holds true for Pokemon GO!
  
  
• Cook your own food: Hospital cafeterias and outsourced food courts are not the best places to get calorie-lean food. Declining home cooking rates have correlated with the rising obesity rate world over. A recent study published in the ‘Special Focus Issue on Cardiovascular Healthy Promotion’ in the Journal of American College of Cardiology  found a significant association between social-business eating pattern characterized by increased consumption of red meat, pre-made food, snacks, alcohol, and sugar-sweetened beverages and frequent eating-out behavior with multi-site subclinical atherosclerosis. Packing home-cooked lunch helps save time at work and adds money to the bank. Replacing snacks with fruits, berries and nuts adds nutritious calories to a busy work day. Transitioning from a daily take-out routine to cooking frequently can be challenging. However, planning in advance can facilitate home cooking. Losing track of calories due to busy routine is easy. In this YouTube video, Michael Pollan brilliantly summarizes “How Cooking Can Change Your Life”.

At the end of it all, long work hours, submission deadlines, etc., are a handful. It is important to have time off away from work and daily routines. Healthy living and financial planning are two aspects that are lacking in our medical education curriculum. Investing while young in your health and finances pays big dividends later.

This article was authored by Tushar Tuliani, MD, a Fellow in Training (FIT) at Loma Linda University Medical Center.