I have vivid memories of my father being fixated on the family's exercise habits. He would come home muttering to himself that he had to walk 3km tonight or...I am not totally sure. He would then fixate on getting my brother to go shoot hoops in the backyard, something my brother didn't really need to be encouraged to do. He would then shift his attention - which definitely bordered on nagging - to my mother who did all she could to rebel against this external pressure. I was usually on my way to or home from some practice or another so I rarely needed encouragement.
My dad just had this urge to push himself and push others to move. But his efforts usually felt coercive - of no one more than his own self - as opposed to empowering.
In Day 3 of Bust Through Your Barriers, Dr. Carla Cupido shares her husband's voice. On days of overwhelm, he calls on his interest in her welfare and just simply makes her aware that she is welcome to exercise. Usually outdoors. And that it might be the antidote to her overwhelm. "This is not pressure," she says, "but a reminder of my own goals." And this is the tightrope of accountability. It's a fine line between dragging someone along with shame and lifting them up with wishes of self-efficacy.
And that's it. My dad's efforts to raise a healthy family were sabotaged so often by the ridiculous demands of two small family businesses that he was always playing catch up with our health. There was never enough time for a real talk session around goals. It just always seemed that the minute there was a free second to think about healthy living, it was swallowed whole by the stress he imposed on himself to get out there, pound the pavement, usually in the pursuit of weight loss. And it all felt so tiring, so punitive, even as I think about it in the rear view.
This is one of the reasons I am really excited to take The Realization Project's Movement module once I am finished with the introductory course. I need some time to set some pragmatic goals and figure out what exercise means for me now, so then I can be intentional and purposeful about how it becomes a part of my life again.
This is so deeply personal. I can't do this for my husband, or my friends, or my colleagues. I can only do it for me and you can only do it for you.
But we can help the special ones in our lives by mirroring their own goals in their own words back at them in a gentle, positive and encouraging light.
Instead of, "I thought you were going to jog every day!" try "I know that your goal was to jog more this week. Is there anything standing in your way that I can help with?"
We cannot afford not to move so we have to find the mental frames that allow us to put one foot in front of the other. These come in the form of accountability tools, and I hope you take advantage of those available in The Revitalization Project, which is on sale now. I sure will and I will let you know how it goes.
I am not in the worst shape that any 31 year old has ever been in. This is a cute, if dangerous, spin on the reality that I am in the worst shape that I have ever been in.
In Dr. Carla Cupido's Bust Through Your Barriers video course I am taking right now, she writes "The worst part about denial is that it's a lie that you tell yourself."
I have heard myself explaining to my brain that it is ok that I am in terrible shape in my 30s. I have taken on the demanding task of becoming a doctor and my body is tired and my mind is overwhelmed about 110% of the time. I will use my 40s to get it back.
Denial is a lie I am telling myself.
I will get back into shape in my 40s. When I have small children. And aging parents. And a full practice. And night shifts.
Denial is a lie I am telling myself.
But creating change feels so huge right now. So I continue to deny the reality that I am losing muscle mass daily, my knees have started to creak which is a precursor to degenerative changes that will absolutely hit me in my 40s and prevent me from exercising.Read More
Carla Cupido is an athlete, mother, chiropractor, partner, author and entrepreneur. Yes, she is all of these things.
But the reason I think people should know about her is because she infectiously interrogates this human experience, from an angle of holistic, compassionate wellness.Read More
The last time I visited Las Vegas, my good friend Melissa and I took an ambitious detour towards the city on our route from Edmonton to San Francisco. We arrived at 11am, her car way overheated and packed to the brim with everything I owned. We stopped at a mall somewhere and the city looked burnt up, like it wasn't built for daylight. People looked sad and wandering lost. We left after a few hours.
We both preferred the desert terrain and glorious, whipped crimson sunsets.
He sat back, exhausted. “I am so worried about where we go from here. I am so worried for how my wife will do without me. We get 70 or 80 years here,” he said, looking at me, “But I know I’ve got an eternity left in Heaven.” He went on to share that he is worried about money, his children and his home. Norfolk General is a bucolic terra firma for faith, fellowship and farming. The idea of an eternity in Heaven crosses cultural divides between the Mexican and Jamaican migrant farmers, the farming families of European descent, the Mennonites and the First Nations. Of course we face the same economic and social challenges as the rest of rural Ontario but it seems these challenges are weathered with stirring self-reliance and closeness.
I am technically an outsider. I am not a woman of faith. I am from the country too, but a different kind, farther north. My Low German is about as good as my Mohawk and my Spanish, which is to say non-existent. I don’t know anything about farming. But despite all of that, each of these communities has made space for me through my role as a provider of care. When I drive to work every morning, I drive through the Norfolk County hamlets, villages and fields, past the side roads, around the tractors and other slow, wide loads, to a new kind of home. Each one of my patients asks me if I think I could stay.
I am prone to Facebook tirades and lengthy arguments with people who think about things differently than I do, and with people that are just trying to get my goat.
These arguments are typically about issues of justice or equity, as I see it. In that sense, the issues are of great import. But in another, the tiresome back-and-forth with Internet acquaintances is not important because it doesn't accomplish anything. I also leave them feeling angry and incomplete.
I am a social media crusader and I don't particularly like it. I like the thrill of the argument, but no one ever wins and a lot of time gets wasted. So there's that kind of social media user.
Then there are these kinds of social media users who produce a whipped cream version of their lives for the Internet. They have pretty faces and wear pretty things and go to pretty places. And it makes me smile.Read More
In northeastern Afghanistan, there is a province called Badakhshan. In Badakhshan, there is a capital city called Fayzabad. In Fayzabad, there is a provincial hospital. In that hospital, there are dozens of women who came from far away to have their babies. They are Pamiri women and women from the Wakhan corridor. They are women from everywhere in between.
In 2011, I took my very best shot at helping out. I was 27 years old and I moved from Ottawa, Canada to Kabul, Afghanistan for a job with a well-known and well-respected global non-profit. I thought I would do some good. I thought I would learn a lot.Read More
As someone training in family medicine, I covet the opportunity to teach young women, and men, about their nether bits and how they work. Young women and men sort of know how the bits work and high school health classes do a decent job covering the very basics.
But when it comes to caring for the vulva and vagina, a little advice can go a long way.
I am so fortunate to be working with a great OB\GYN generalist. I watched him discuss genital hygiene with a patient this week and was really quite pleased to know that a lot of the advice he gives is stuff I've figured out on my own. But that same advice is rarely discussed in routine primary care visits with family doctors. Let's talk about it now!
First, grab a hand-held mirror and follow this tutorial from Women's Health to get your bearings.
Seriously, go. I'll wait. My guess is that less than 25% of you reading this sentence take a regular gander at your anatomy. So, really, no time like the present.Read More
America's Test Kitchen: YEAH PLEASE.
A few years ago, I got the America's Test Kitchen Cooking School Cookbook for my wedding shower. It has all of these great image-based tutorials for classic meals like roasts, turkey, gratin and other important cultural 'meal'stones (ha!).
So then I started looking around to see if they had a podcast because my podcast game has been a little blah lately.
And they do!
Two women led us through the oldest residential school in Canada this afternoon. One was a survivor. People who spent part of their childhood in a residential school are known as survivors. The other had a grandfather who lived in this residential school in and around 1899. They both generously took us - seven Canadian family medicine residents - through one of this country's darkest legacies....Read More
A new nutrition book hit last week: Always Hungry?: Conquer Cravings, Retrain Your Fat Cells, and Lose Weight Permanently.
I listened to the audio version and have tried a couple of recipes. My thoughts? I love it. It's really reasonable in its presentation of the evidence. And the recipes are not aspirational. They make sense.Read More
I think about the years and years of play I sacrificed for my education and my career. And finding space for play - to enjoy my life - is now a spiritual imperative. If I was to die of a rare cancer next year, like Dr. Kalanithi or my friend Jen Young, it would all feel so profoundly unfinished. And it would feel like that because I have a lot of banked play time that remains unused in my esoteric life account.
Over the last several years, I've had a voyeur's view into the lives of people confronting terminal illness. The hoops of medical training dropped me squarely into the existential sorrows of perfect strangers as they realize that these days or months are their last. It feels great to help where you can, and utterly, outrageously sad when there is nothing to do.
But just before Christmas, I found out a truly adored member of my family has two large tumours, likely representing an aggressive cancer.Read More
Yesterday, was talking to a woman who has experienced a great deal in her life. She said to me,
I want to taste peace.
I want to taste joy.
I need to taste my food.
I need to taste my kids.
The past needs a great hug.
I just spent four weeks in a training program for visual literacy at a local art gallery, a program designed to help residents with the art of noticing in the clinical setting. If I pick and chose charitably from the program, the things I loved were the things that helped me see forms of human life more vividly.Read More
Coffee is a warm friend in the winter, a gentle nudge towards alertness on an early morning and a toasted ode to having grown-up tastes. I love it.
But the health consequences?
It's great for you. It's terrible for you. It will make your baby fat. It will give you never-ending youth. It will give you malaria.Read More
It’s just about time to leave the office for the day and you’ve got a choice to make before you step outside the door. Are you going to put your running shoes on and head straight to the gym? Or are you going to open your to-do list and be persuaded to skip the self-care because you’ve got homework to supervise, groceries to buy and a house to clean? Or maybe you’re tempted to nap? On certain days, one of these choices is going to make more sense than the others. But going to the gym, or wherever you like to move your body, requires the greatest investment of self-regulation.
How we understand willpower is shifting. Willpower is the conscious self-control we use to resist impulses. The prevailing idea in studies of willpower is that our supplies are limited and reduced by fatigue, hunger and stress. Research from the past five years has introduced some new features to this core idea.
I began my recovery from anorexia nervosa in July of 2008. I had just returned home from Vienna, where I was a UN intern for 6 months. I was sitting with my parents in their backyard. I had a jar on my lap of green sludge. It was a concoction of spinach and water and a few berries which, with the correct blender and a healthy mindset, would be a perfectly fine snack. In that setting, however, it was a bitter metaphor for deprivation and rammed home an awareness that my life was shrinking.
That jar of spinach water was the only thing I had eaten all day. I ate the stringy, leafy mess with a spoon because the blender was a dud. It was not even close to the grossest thing I had ever eaten in the name of calorie restriction.
I told my parents that afternoon that I thought I needed some help. I needed some help because I was passing out all the time. I was growing hair all over my body and losing it on my head. I was freezing cold all of the time, even in the hot summer sun. I was also struggling to control my bladder. I could feel my body falling away.
But the scariest thing was the thought tumor.
This is the name I use to describe the cloudy, racing, repetitive thoughts that characterize the most treatment-resistant part of an eating disorder. The thought tumor - the compulsion to restrict, in my case - is a most dangerous invisible ailment.
I owe my life to the books. This is not an exaggeration.
We went to the internet. Was there anything available for a 24 year-old with a first time eating disorder presentation, with no co-morbid mental illness? Nothing free, that's for sure. There was a private place in BC - where I was supposed to be going back to graduate school in the fall to finish up my Master's degree - but it was so expensive. It would require a re-mortgaging of my childhood home. The psychiatrist I spoke with during the telephone assessment was pretty insistent that I agree to inpatient therapy. I could tell I was getting close to needing medical attention.Read More
Everything I have ever learned about nutrition, healthy living or lifestyle changes has come from self-directed learning outside of medicine. Everything I've ever learned about why obesity can be - but not in every case - so toxic to the body, I learned in medical school.
I learned about the solution in one place and the biophysiology of the problem in a completely different place.
This doesn't make any sense. But this is how it is.
When I was a student at the Institute for Integrative Nutrition, we mostly learned about coaching practices and self-care. When I was a medical student, and now also as a resident, my learning sits squarely in the disease model. I felt like the basic premise of my training was: Obesity is a disease and we treat the consequences with pills. Exercise and eating well are awesome but we don't really know how to get people to do that. We realize the problem is much bigger than any one person, but that's how medicine works.
Sound cynical? It is.Read More
My supervisor and I were working with a patient last week and he said "hey, have you heard about this new weight loss drug that just got approved?" The patient said no. I also said no, because I had no idea what he was talking about.
I went home to look it up - Liraglutide - and I realized that I did actually know about the drug. It's a diabetes medication that tries to squeeze as much insulin as possible out of the pancreas, keep the pancreatic cells alive and reduces hunger at lower doses.
At higher doses, and for the same reasons, it is helping people lose weight and it is being marketed as Saxenda for these purposes.Read More