Movember / Men's Health: Week One

11 days

Summary of Movember posts:

11/4/13 November is Movember, when you may notice some of the men in your life sprouting mustaches to draw awareness to men's health issues. While the growing of facial hair may seem silly as an awareness movement, men's health issues remain quite serious. Despite that medical science has long had a bias towards how problems affect men, men still have a lower life expectancy than women. Simply put, we need to start taking better care of ourselves. While the official Movember charity focuses on prostate and testicular cancer, I plan to highlight issues that are relevant to my own practice.

11/5/13 Hand-washing! 'Tis the season for common colds, stomach bugs, and the flu. The best preventive measure a guy can take is regular hand-washing Studies have shown that proper hand-washing (with regular soap) reduced respiratory illnesses by 21% and GI illnesses by 31%. Unfortunately, other studies show that guys are much worse than the ladies when it comes to hand-washing Grab the soap, men, and wash those hands!

11/6/13 Zinc. There is often a lot of talk about zinc around this time of year, as it is often used as a treatment to shorten the common cold. Zinc is often touted in supplements as a prostate panacea. While there is some evidence that zinc can support prostate health, too much zinc has been associated with prostate cancer. Most men get adequate amounts of zinc from their diet and should only supplement it if they are known to be deficient.

11/7/13 Ankylosing Spondylitis. Everyone should take care of their back. However, proper specific diagnosis of back pain is critical to order to guide specific treatments and obtain good results. This is particularly true for young men. Ankylosing spondylitis is a form of arthritis which predominantly affects the low back. Men are 2-3 times more likely than women to have this disease, which commonly manifests from the late teens to early 30's. Stiffness is a major symptom, often even more so than pain. While it is important to address the pain, it is critical to recognize and treat ankylosing spondylitis early in its course to prevent deformity and other complications.

11/8/13 Osteoporosis. Age related osteoporosis tends to occur later in men than women; with increasing life expectancy, we are seeing more and more osteoporosis in men. Osteoporosis can occur in younger men as well, often due to medical problems or medications. Men are more likely to die in year following an osteoporotic hip fracture than women. The best "treatment" is prevention: adequate amounts of calcium and vitamin D and regular exercise.

Generalist vs. Specialist

Years ago, I was conflicted when choosing my medical specialty. I had always imagined myself as a primary care physician, as a generalist, but none of the specialties that fit that description really resonated with me. Even when I finally chose Physical Medicine and Rehabilitation, I was drawn to it breadth. I felt that it's principal difference from the primary care specialties was philosophical, focusing on function instead of disease. Since starting practice, I have struggled to maintain that breadth. I want to remain a generalist within PM&R, though frequently I have been pushed to subspecialize. In my first job, I was shunted into caring for pelvic pain. In my current position, at various times I have found myself sucked into orthopedic rehabilitation, spinal cord injury medicine, musculoskeletal medicine, adult cerebral palsy care, and medical acupuncture. Recently, I have been delving into performing arts medicine. Through this all, I have struggled to maintain my identity as a general physiatrist.

 Early on in medical school, I heard a joke that went something like this, "A generalist is someone who knows less and less about more and more until he knows nothing about everything; a specialist is someone who knows more and more about less and less until he knows everything about nothing." The dangers of both approaches are evident in medicine. I have seen generalists who can only manage the most basic conditions and end up referring their patients to consultants for almost everything. I have also seen subspecialists so focused that they cannot or will not manage anything beyond the one disease or body part of their focus. Not all physicians fall under these characterization, but it is disturbing how much of medicine has shifted to such specialized care.

My experience thus far in design has been different, though admittedly I am not far enough into it to make sense of it yet. I did go into design with a strong opinion regarding specialization, beyond choosing the discipline of interior design. However, soon after entering the masters program, we were encouraged to start thinking about the specialization for our thesis work. Being a physician, I was naturally pushed towards healthcare design. However, I was surprised how much we needed to learn about graphic design, landscape design, experience design, and urban design. So as I was becoming broader in terms of other disciplines of design, I was becoming more focused within my chosen discipline.

I do not feel that being either generalized or specialized is necessarily better. In both medicine and design, there is room for both. There needs to be constant assessment and adjustment as to the balance between them.

Conference Geek

This weekend I am in Snowmass, CO for the 31st Annual Symposium on Medical Problems of Performing Artists sponsored be the Performing Arts Medicine Association (PAMA). This is a fascinating conference, not just because of the content, but also because of the attendees. So many of the conferences I attend are populated entirely by physicians. The PAMA conference is attended by physicians, therapists, musicians, and music educators. It is so refreshing to see collaborations and to hear different points of view.

As a physician, there is a constant need for continuing education. Some of that need is internal. I enjoy learning. I feel an ethical obligation to keep learning. There are also external requirements, from the state, from the hospitals where I have privileges, and from the specialty boards to which I belong. Physicians are required to get a certain numbers of continuing medical education (CME) credits; the amount for a given time period varies by who is doing the requiring. A certain percentage of the credits need to be in the physician's specialty. This tends to focus continued learning on achieving depth of knowledge in a specialty. I'm in a very luck situation. Working at an academic hospital, I can achieve all of my required credits within my specialty just be attending weekend noon-time grand rounds. Since it is so easy for me to meet my requirements passively, I am able to direct further efforts towards areas of interest or towards building breadth of knowledge.

Medical conferences can be a great source of both education, as well as CME credit. However, they carry a reputation of being excuses for doctors to go on fabulous vacations, with a little education thrown in for good measure. While there is more regulation now, often these educational junkets would be funded by pharmaceutical or medical equipment companies. This could certainly bias the attendees towards the funder, and in worse case scenarios even bias the content of what was being presented. Even at more reputable conferences, the presence of various interests in an exhibit hall and underwriting of some activities are potential sources of bias.

Since I use conferences as a supplementary education source, I have the luxury of being a little more picky in which I select. I try to focus on topics that I want to take a deep dive into, or on areas that I feel a pressing need for further knowledge. Even when the locations are fabulous, I tend to be a bit of a geek. I actually love going to the presentations; it is so nice to be able to show up rested and be able to stay awake for an entire lecture! I also feel guilty about skipping lectures to go off and do something fun; I could miss good learning or networking opportunities. I enjoy the opportunity to be able to focus on learning, without the distractions of work and home life.

Book Freak

I am a self-acknowledged book geek. I love books. I love reading them. I love holding them. I like the feel of the paper. I don't mind when the ink of cheap novels smear all over my fingers. I love fiction, non-fiction, poetry, science fiction, and fantasy. I love graphic novels, I look cookbooks and design picture books.

I get the current fascination with e-readers like the Kindle and Nook, though I haven't felt the urge to buy one. I know an e-reader would be a lot easier for reading on the bus or train. An e-reader would also allay one of my great fears: running out of books while on vacation. However, that would also deny me a great pleasure, namely exploring great bookstores while on vacation.

Last evening, we had some time to kill before dinner and happened upon Explore Booksellers in Aspen, Colorado. Rob needed a new book, and we both love independent bookstores. The store is in a cute, little house. All of the tiny rooms were filled to the ceiling with shelves packed with books. I've been in similar stores in the past, and they often have an chaotic, musty sense to them. Explore was organized and very neat, which made exploring the extensive collection so much more enjoyable. While they did have a cafe upstairs, I was happy to note that the smell of the books completely outweighed any aromas that might have come from the cafe.

Of course, I left with a new book. I have so little control in a bookstore. I love wandering around, picking up books based on their title or cover. I like reading the backs or jackets. I appreciate when the staff highlights books by making little displays on tables or shelves. In one of my favorite bookstores, Unabridged in Chicago, the staff write up little reviews of their favorite books and tape them to the shelves. After a while, you learn which of the staff has taste most similar to yours and you seek out their reviews. It's like having a personal book shopper. I don't get the same experience shopping online; I will buy through Amazon if I know there is a specific book that I need. However, there is no joyful experience. I love browsing for books and getting suggestions from staff, and I will almost always leave an bookstore, especially an independent local store, with a few books.

There Is Nothing Like A Broad?

"There is nothing like a dame
Nothing in the world
There is nothing you can name
That is anything like a dame"

  --There Is Nothing Like A Dame

"My doll is as dainty as a sparrow
Her figure is something to applaud
Where she's narrow, she's narrow as an arrow
And she's broad, where a broad
Should be broad..."

  --Honey Bun

South Pacific (1949) Rodgers And Hammerstein

As I go traipsing down the street, as often as not the soundtrack in my head is as likely to be provided by a Broadway musical as it is my current pop music. I have a particular fondness for South Pacific for two reasons. My parents frequently played the original cast recording, featuring Mary Martin and Ezio Pinza. Along with Mame, Showboat, and Fiddler on the Roof, these formed some of my earliest musical memories. In college, I sang with the University of Florida Men's Glee Club, and music from South Pacific was a staple of our repertoire. On the way to work last week, I was humming through South Pacific and the word "broad" got stuck in my head.

I love words. I truly do. I love how English freely accepts and morphs words from so many different sources. I love how words can have contradictory meanings. I love how words evolve in form and meaning over time. I love when I get to struggle with a word.

I am not a prescriptive (or proscriptive) linguist. Throughout my degree in English, I prided myself in being a descriptive linguist. I find the self-proclaimed grammar experts/snobs to be tedious. Languages evolve or they die. It is far more interesting to see how languages are actually used, or even abused, in the real world. I am capable of using "correct English" for formal writing or speaking; the rest of the time, I oft choose not to.

I tackled "broad." The origins of the word as a noun referring to a woman are a bit murky. A brief internet search provided reams of contradictory information from experts who state the validity of their "research" with absolute certainty. I have learned that "broad" is associated with "woman" because it used to mean:

• playing card. Later, in the gambling scam Three Card Monty, the player would need to select the card/board with the queen.
• entry or transportation ticket. Somehow, that got associated with a prostitute being a pimp's meal ticket.
• the widest section of a ship. As ships were often referred to as "she," this term was transferred to women.
• a shortening of "abroadwife." This was a woman separated from her husband, often by slavery.

Some of these definitions came with references, of varying levels of quality. I followed the trail for a while before I got bored.

For my current inquiry, the etymology really doesn't matter that much. I more curious about the current connotations. As always, a quick check over at Urban Dictionary proved to be entertaining but ultimately unhelpful.

My own sense of the word is that there is something vaguely negative associated with the word, that it shouldn't be used for some reason, but that the reasons are at a meta-level. When I think of "broad" I do not associate any specific negative meanings. In fact, most of the uses that come to my mind are fairly positive. I think of "tough broads," "tough old broads," "classy broads," and "sexy broads." I would envision a broad as being secure, powerful, resilient, middle-aged to senior, and refined without being overly sophisticated. Women who spring to mind would include Bea Arthur, Margaret Thatcher, Hillary Clinton, Bette Davis, Bette Midler, and Whoopi Goldberg. For me, the meanings attached to the word are admirable, but I still struggle with a sense of disapprobation in using it.

Of course, what it means to me is only relevant in my head. From a use standpoint, how other people consider and react to the word is what is important. So I welcome discussion. Is "broad" permanently tarnished or has it evolved to become a useful term for a particular type of woman? Is the shift in meaning I talk about due to evolution or due to an active reclamation of the word?

How Much Is Too Much?

There is joke among doctors, "What is an alcoholic?" "Someone who drinks more than his doctor."

Recently, a friend was injured when he fell following an evening of drinking. While his injury was fairly significant, thankfully there shouldn't be any long-term physical sequelae. This isn't about him.

What has been fascinating [is that the right word? Interesting? Challenging?] has been the ripples of responses within our circle of friends. There are all varieties of drinkers amongst my friends. Some barely drink at all. Some drink fairly impressive amounts on a regular basis. A few have discriminating tastes, and they take pride in their knowledge of variety of wines, crafted cocktails, and high end beers. Others have palates which are not so picky. Equally diverse has been the reactions following our friend's injury. Some barely acknowledge that anything happened. Some have considerably curtailed their own drinking, whether consciously or not. It seems like a few have even doubled down and picked up the pace.

Which leads me to the question I posed in this post, "How much is too much?"

As a physician, I've often struggled with this question. In rehabilitation, we often care for people who have had serious injuries caused by alcohol, as consequences of their own drinking or someone else's. I've care for people with head injuries, spinal cord injuries, severe fractures, liver failure, and burns. With each patient, I am stunned how quickly a life can change in a moment of bad judgment. After such an injury, however, my role is fairly clear cut.

What to say to people who haven't (yet) been affected? In my outpatient practice, it is fairly routine to ask people about smoking and drinking habits during an evaluation. These are people who may be coming to me for neck pain, tendon problems, sports injuries, or arthritis. What should be my flag to act on the information I collect and express concern about alcohol?

One might think that there is consensus among the healthcare professions about guidelines for alcohol consumption. I'll be the first to acknowledge that I am not an expert. There are guidelines which indicate amounts that may be beneficial for one organ systems, but often they conflict with guidelines for amounts that could harm a different organ. There is disagreement about how guidelines should be adjusted for gender or body weight. Genetics can influence how well people process alcohol, and they seem to influence who is at risk for addiction. Honestly, even if I knew how to weigh all of these different factors, I don't think I could effectively do that during a clinical encounter when I'm supposed to be treating knee pain.

I have equal confusion in a social context. There often is not a good correlation between the people who drink a lot and the people who suffer consequences from drinking. That makes it hard to rally support to intervene, when the people needed to help with an intervention may actually drink more than the person who really has a problem. Then, there is not even great agreement about what constitutes the best help: programs that advocate abstinence or ones that focus on harm reduction? Programs that are professionally based or community-volunteer led?

I really struggle with this both professionally and personally. I want to be a good physician and a good friend. I want to be an effective resource and advocate. How do I distinguish who needs help from those who are simply enjoying a vice responsibly? Then, how do I help? I know there are no easy answers to any of this. I have been struggling with the questions of how alcohol (and other substances) fit within a social milieu since college. It just feels more acute, more emotional, right now having had a friend get hurt.

Revisiting Degrees Past: Embracing the Bard

Between my recent immersion into design and my ongoing endeavors in medicine, I sometimes forget that I have scholarly interests beyond those domains. My undergraduate degree was in English. My focus within the major was linguistics, though getting an English major does require a fair amount of reading and writing. When I dabble in my language interests, I still tend to gravitate towards linguistics. I love learning about the history and structure of our language. As a descriptive grammarian, sometimes I smugly snicker at how wound up people get at perceived lapses in grammar.

While I still fancy myself an avid reader, I haven't delved much into the classics lately. That has changed in a wonderful way. I have become reacquainted with the Bard. In the last few weeks, I have had four exposures to Shakespeare, and once again I am hooked!

Part of my job involves caring for performing artists. I have had the pleasure of working with some of the actors from the Chicago Shakespeare Theater, a regional Tony winning company that is one of the gems of the Chicago theater scene. A few weeks ago, the company manager gave me a behind the scenes tour of the theater. What a thrill to see how all of the elements of a great production are pulled together, from concept to details. That evening, I returned to see Henry VIII. With all the recent fascination with Elizabeth I, it was great to see a glimpse into her father's life, from the perspective of a piece written so soon after her reign. While I knew the story from history, it is so much more raw on stage.

One of my neighbors is an actor and comedian, and he has been encouraging us to join him to see the Improv Shakespeare at the Improv Olympic. Generally, I'm not a huge improv fan, but I do love doing things with this neighbor. From a title thrown out from the audience, the five member troupe fashioned a Shakespeare-esque play. The language was remarkably similar, including long stretches of rhyming couplets. There were many characters; even the minor characters were distinct. I was amazed at how well they adhered to the typical structure of the acts, with multiple storylines woven throughout and coming together. I loved it so much, I plan to return next week with an out-of-town guest.

Last night, we returned to the Chicago Shakespeare Theater to see Othello: The Remix. This was Othello retold in a hip-hop setting, using hip-hop language and verse. Again, I'm not a big hip-hop enthusiast. I was blown away. While the story was set in the hip-hop recording industry, it was instantly recognizable. The story structure stayed true to the original, but it still felt fresh. It was some of the most innovative theater I have seen in a long time.

I'm itching to see more. However, I need to remind myself that it is not just Shakespeare that has me so excited. I adore having my love of the liberal arts awaken in me. It is one more side, one more world, for me to continue to explore.

Lovin' the (Indigo) Girls

A few weeks ago, I had the opportunity to see the Indigo Girls at Ravinia Festival. I think this was the fifth time I've seen them. The first time was about 25 years ago, while I was still in medical school. My cousin Debbi, who also lived in Nashville at the time, took me to a concert in the gym at Vanderbilt. It was love at first sight. I bought Strange Fire and Indigo Girls right away and drove my roommates nuts as I listened to the albums over and over. I was outraged in 1990 when the tone-deaf morons at the Grammy Awards gave the Best New Artist to Milli Vanilli (as if anyone considered them an 'artist') instead of the Indigo Girls...only to strip MV of the award months later when it was discovered they didn't actually sing.

The Indigo Girls, however, saved their outrage for more important things. It makes it so much easier to lay down money for an album or a concert when you know that the artists are tirelessly working, both on and off stage, for important causes.

What has kept me a fan for all these years has been the music. Songs like The Wood Song, Watershed, and Get Out The Map have been compasses for me, both for staying on track and appreciating hardships and detours. I've pulled wisdom about relationships from Power of Two and Keeper of My Heart, among others. Above all, I have learned to maintain a balance between heartfelt earnestness and the ability to step back to smile and wink at the self-same earnestness.

So, thank you Indigo Girls. I look forward to continuing our journey together.

A Magic Drop of Coffee

I love coffee. I truly do. While I definitely have some preferences about region and roast, I am nowhere near as picky or snobby about coffee as I am about other delectable beverages, such as beer or gin. Hot or cold, just add a little dash of cream and I'm good to go. I love the taste. I love the aroma. I love the pick-me-up.

This, however, is not a post going into all the ins and outs of coffee. There are tons of posts all over the internet which could provide a much better education. Whole books are written on the subject. There is no way I could add to that knowledge. Frankly, I don't even care that much about it.

I just want to acknowledge that there is something magical about coffee, especially that first drop. I am amazed how I can be plodding through a morning, still in a daze, and that first sip of coffee just perks me right up. I am more alert. I am enchanted by its appeal to my senses. My attitude is adjusted. My world is realigned. All of that comes with the first sip. I know that the caffeine cannot already be in my system. Even if it did absorb that quickly, the dose from one sip would be homeopathic. Something in the mystical nature of coffee, wrapped up in its complex history and mystique, alters me each morning.

I do love coffee.

Balcony Design

Rob and I used to have our balcony set up with a cute bistro table, but winters took their toll, forcing us to get rid of the table a few years ago. For a variety of reasons/excuses, we never got around to fixing up the balcony. This year, we were determined to use the balcony again.

I decided to take it on as a small design project. We wanted a seating area, but agreed that a table for dining wasn't a must. Rob wanted flowers for gardening, and I wanted to grow herbs for cooking. So plants became an important part of the design, both aesthetically and programmatically. I wanted the balcony to feel like an outdoor room, so it was important that the design of the balcony fit with the design of the adjacent dining room. I used the plantings to focus the line of sight to nearby trees and the sky. A rug pulled the space together. We now feels like we have an additional 50 square-foot room in the condo!

Unused balcony

Plan and Elevations

Proposed Layout

Proposed Design - View from Dining Room

Proposed Design - From Outside

Dogs helped with the planting.

Furniture and rug in place.

 Ricky is welcoming the Buddha.

Adding a second tier of planting.

 Training vines up the walls.

The balcony is ready.

Linner Beats Brunch

Earlier today, I posted on YouTube a video extolling the pleasures of linner (and the subsequent drunk shopping that often occurs, afterwards).

Today was a fairly typical Sunday for us. Rather than rushing to meet anyone for brunch, we slept in and had a leisurely morning. We walked the dogs. We finished laundry. We took care of groceries. We made plans for linner.

Getting to brunch takes way too much energy. You must either get up early or rush through the morning. I used to delude myself in thinking I could complete my chores after brunch, but who was I kidding? Once I got a few Bloody Marys in me, all productivity was gone.

Linner is so much more civilized. Everything has already been accomplished. You meet friends in the mid-afternoon for a lovely meal with cocktails or beer. If you meet around 2pm, you might still be able to take advantage of the brunch menus. If the mood strikes, you can also partake in drunk shopping as you stagger on home.

We met a friend for linner at Hopleaf. We love Hopleaf. It features an overwhelming selection of beers on tap, mostly Belgians. The menu, while not extensive, is quite good. I focused on the Belgian IPAs (Houblon Chouffe is my favorite) as I enjoyed a Duck Reuben. We had great seats at the bar and attentive service from the bartenders. It made for a perfect Sunday afternoon.

...And We're Live!

I finally made and edited my first video for YouTube. It was a steep learning curve. I had to learn to get my new camera (Samsung HMX-F90) set up properly. I had to figure out how to get the video transferred to the computer. I learned the basics of my new editing program (Pinnacle Studio) and edited the video. I now transferring it to YouTube for the final tweaks and then posting it live!

During the last two weeks, I have been feeling the excitement that would go along with a new design project. I'm trying to approach this venture as a redesign of my life. In addition to defining the specifications of what I want to accomplish, I've been laying out the plan. I've even started becoming active again on Twitter, Google+, and this blog, as well as signing up for Instagram. I've spent time getting familiar with YouTube and setting up my channel. However, the launch of the channel with my first video feels like the official start to my venture.

I plan to spend this next month building the habits of regular posting on the different social media platforms, and engaging people on them as well. Once these habits form, the platforms can stop being an end unto themselves, and start being an opportunity to explore what I want out of my life and career(s).

It is time to figure what I want to do and be when/if I grow up!

Social Media Relaunch

I am in the process of relaunching myself. I am taking a hard look at what I am doing in various aspects of my life, so I can find ways to move myself out of a status-quo. Over the last few years, I have envisioned myself "living full-time in many worlds," and I started this blog as a forum while I was in grad school. It felt like I was stretched thin, juggling 80% time at work, 75% time at school, and full time at home. I felt tired. I felt stressed. But I felt alive. When school ended a year ago, I enjoyed the feeling of only living in two worlds, work and school. I enjoyed the work/life balance. I had less stress, but I was complacent.

It is time to move forward! As I look at my life, I am relaunching myself in social media to express myself creatively, to process my progress in evaluating my life, and to share my journey. The initial phase will focus on four platforms (links in the sidebar):

1. YouTube - vlog covering my journey and sharing my geeky interests in life, design, and health.
2. In Many Worlds - blog to discuss topics related to what I am covering on my YouTube channel.
3. Google+ - sharing content relevant to topics from YouTube and my blog.
4. Twitter - sharing what I'm doing and links I'm enjoying.
5. Instagram - sharing what I'm digging visually.

I may progress to other venues, but these will allow me a good start. To pull things together, I am trying to consolidate everything with one brand. The In Many Worlds (#IMW) title will be seen across the different platforms, as will variations of the logo and banner, shown below.

I am excited to start this new journey and can't wait to share it with you.

Please look for my first YouTube video on Friday. I look forward to your feedback!

Join my journey - subscribe to this blog by clicking the button in the sidebar.

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Fighting for Footing

I run. I do exercise in other ways, but at the heart of my fitness, I run. I feel fit when I run. I feel refreshed and energized when I run. I feel psychologic release when I run.

At least, usually I feel these things when I run.

After the marathon in January, I had a annoying pain in my right foot. At first, I thought it might have been from an ankle twist early on in the race. However, in consulting with one of my colleagues, we think it is a tendinopathy, likely from some of the long (low grade) inclines...something I was completely unprepared for as a Chicagoan. I took some time off from running, and the pain is mostly gone.

Unfortunately, so is much of my running endurance. I'm not back to square one. I can still do 3-5 miles without problem. My speed is actually quite good. I am having problems pushing up in distance. I know that will improve, even though I am frustrated by it.

The thing that bothers me the most is the loss of the effortlessness and joy. I fully expect that these feelings will return, but I am saddened by their absence. It is hard to look forward to my runs. It is hard to motivate myself to lace on my shoes and go.

This affects the rest of my life, too. When I am not running, I find it hard to remain focused and enthusiastic about the rest of my life. It is also harder to maintain healthy eating.

Running....I miss you. Please come back to me.