“I don’t have time to work out.” Have you said this before? Do you say this on a regular basis? If you answered yes or “ain’t nobody got time for that!” please keep reading. I’d guess that most of us are “too busy” to (fill in the blank). Here’s the thing: if you want something badly enough, you’ll try to make it happen. Here are some tips to help you squeeze in a little bit of fitness into your busy schedule.

1. Push-ups. These can be done practically anywhere and become easier to do with practice. I personally like to do about 10 push-ups as a pick-me-up if I’m struggling. Is 2:30 pm rolling around and you feel like you need a nap? Skip the gimmicky 5 hour stuff and do some push-ups. You’ll thank me later.
2. Planks and side planks. Great core work can be done anywhere.
3. Take the stairs. Yes, I know, you’ve heard this before. So do it! Not only is it terribly lazy to take an elevator up one or two measly flights (pet peeve, sorry), but it’s a waste of time. If you truly don’t have time to get to the gym, at least walk up a few flights of stairs.
4. Walk. Oooh, groundbreaking! Seriously, think of ways to increase your walking. In a new city? Walk instead of taking a cab. Running errands? Park as far as you can from the store’s entrance.
5. Consider exercising at home. You can save a considerable amount of time (and money!) by sweating it out at home. Think about the time it takes to drive to the gym, change in the locker room, talk to people that think gym time is social hour, etc. I’m not going to advocate for particular workout, but there are some great workouts available on DVD. People commonly say they won’t have enough motivation to work out if they don’t leave the home. Again, if you want something badly enough…
6. If you’ve got a few free minutes, try any of the tips below. Doing something is always better than doing nothing. Or as my husband would say, “at least you’re not eating!”

Say you’re out of town and the hotel charges some ridiculous fee to use their fitness room, or maybe it’s just too crowded. I once attended an annual conference of a sports medicine society and had this problem. It’s no surprise that sports medicine docs are pretty active, but when they all get together, that makes for one crowded hotel gym. In that case, I recommend stealing your favorite parts from various workouts to make your own hotel room-friendly workout. So the hotel floor might not be the cleanest, but you’re going to shower afterward anyways, right? Here are some examples:

Toning:

1. Push-ups.
2. Planks and side planks. Length dependent upon your fitness level and experience with this.
3. Bird-dogs. On all fours, extend your right arm and left leg and pause before returning to starting position. Repeat.
4. Tricep dips. These can be done if you find a stable ledge or chair – be careful not to tip.
5. Tricep push-ups. If these are too hard for you, start with your knees on the ground.
6. Arm circles or pumps. If you don’t have free weights, it’s a little more challenging to work the shoulders. Performing multiple reps of arm circles or pumps (small up and down movements) will really get those deltoids going.
7. Squats. It helps to hold weight, but they are still effective if you don’t have weights. If they get too boring or easy, try adding pulses in the lower half of the squat. Also try turning your feet out and widening the squat to get the inner thighs.
8. Wall squats. Think high school volleyball or basketball practice. Sit with your back against the wall, ankles and knees bent no more than 90 degrees. Sit. Sweat. Curse.

Cardio:

1. Burpees. From a standing position, squat down and put your hands on the floor. Jump legs back to plank position. Jump back in. Jump up with arms overhead, land softly. Repeat.
2. Squat jumps. From a slightly squatted position, jump up with arms overhead, land softly. Repeat.
3. Lunge jumps. Start in a lunge with the right foot forward, making sure your right knee does not go past/over the right foot. Put your hands on your hips or over your head if you’re up to it. Jump while switching legs. Repeat.
4. High knees. Run in place, trying to bring your knees as high as your hips. Don’t lean back; use your core to raise your knees.
5. Jump. Simple, right? Mix it up by jumping side-to-side or forward and back over an imaginary line. Try incorporating jabs with your jumping. Jumping jacks are also an option.
6. Stairs. Walk or run. Try two at a time if you want. But first, make sure you won’t get locked into the stairwell J
7. Squat slides. Sit in a squat and shuffle 4 (or more, as room allows) steps to one side and 4 to the other. There is probably a better name for this, but whatever you want to call it, it works.
8. Add music! It will make a world of difference in your workout. Just try not to move when you hear this.

In an effort to combat obesity and all the health problems that are associated with it, New York mayor Michael Bloomberg recently announced a plan to ban the sale of sugar-sweetened drinks to 16 ounces or less. It also includes a $200 fine to vendors who violate it. If passed, the ban could take place as early as next March. The ban would not include diet drinks, juice-based drinks, or alcoholic beverages. It would also not include drinks sold at convenience or grocery stores.

So, my first reaction was, “Um, what’s the point? If I can’t get a large soda at the movie theater or the drive-thru, what’s stopping me from swinging by my local 7-Eleven to get my fill?” It didn’t make sense to me.  But the more I think about it, I applaud the effort. I mean, you have to start somewhere, right? And who needs 32 ounces of soda at the movie theater? It just disrupts the movie with bathroom breaks. Seriously, though, Mr. Bloomberg should be recognized for his public health efforts. He banned both smoking and trans fats at restaurants, in addition to requiring restaurants to post their health grades in their windows. For a city in which at least half of the people are overweight or obese, I think it’s a fair start.

The New York City Beverage Association is speaking out against the ban; its members feel that the beverage industry is being singled out. Beverage companies say that drinks alone are not the cause of the obesity problem in the US. Are they correct? Obesity is a HUGE problem (forgive the pun) in this country. It’s outright scary. But it’s multi-factorial. People don’t exercise enough. Physical education programs are being cut from school curricula. Fast food is cheap and convenient. Healthy food is more expensive and doesn’t come from a drive-thru. And yes, portion sizes are huge. Think about a regular cheeseburger at McDonald’s versus the size of a burger at your local sports bar. When was the last time you saw a burger on a menu that was made of less than 1/3 lb of beef? The size of a bagel has increased three fold in the last 20 years. I’m also pretty sure that when I went to the movies as a kid, the “small” drink wasn’t as big as my head.

Another common argument against such policies is in reference to personal freedom. Let’s be honest – people aren’t exactly making the best choices with their “personal freedom” these days. The obesity rate is rising at an alarming rate, and so is the percentage of Americans without insurance or depending on government programs for healthcare. It is clear that obesity leads to multiple health problems. Should we encourage “personal freedoms” that can, and do, exacerbate these conditions? Especially if our tax money is funding them? It’s a touchy area, I know. But as a taxpaying citizen and a physician who sees obesity and its consequences on a daily basis, I know that we have to start somewhere. And if it makes people a little angry, then so be it.

Shoulder pain is a common complaint. In fact, I’d estimate that it is one of the most common complaints I see. In most cases, the diagnosis is rotator cuff (not “cup”) strain or tendinopathy. The good news is, most of the time, it’s non-operative. That means it likely won’t require surgery. It also does not require an MRI for the diagnosis, contrary to common belief.

First, let me review the anatomy in basic terms. The shoulder joint is a ball and socket joint. The socket is very shallow, which allows for the great range of motion we have in the shoulder. However, this makes the role of the rotator cuff critical. The rotator cuff is made up of four tendons, and these tendons stabilize the humeral head (top of the arm bone) in the shallow shoulder joint. When these tendons as a group are weak or not working properly, other structures become impinged, causing pain. I must also mention the scapular stabilizers (trapezius muscles, rhomboids, etc.) here. In addition to the rotator cuff, these muscles are critical for normal shoulder motion because the glenoid, or the “socket” part of the joint, is actually part of the scapula, or shoulder blade. Often times scapular motion suffers as a result of shoulder pain, but it also commonly contributes to the discomfort. Over time the muscles and tendons can become weak or imbalanced as a result of overuse or poor mechanics. This results in a tendinopathy, or prolonged injury to the tendons.

When evaluating shoulder pain, I assess range of motion and strength of the rotator cuff, in addition to some special testing. The history, physical exam, and x-rays often tell me what I need to know, without having to rely on advanced imaging. Many of my patients think they need an MRI to rule out a rotator cuff tear, and sadly, some physicians will order one automatically when they hear “shoulder pain.” Here’s the thing: the likelihood of a rotator cuff tear increases as we age. And like I said, the physical exam can tell us a lot. So if I see a 25 year old male with gradual onset of pain who demonstrates good range of motion and strength on exam, I am not suspicious for a full-thickness tear. However, if I see a 65 year old female with severe pain after a fall or other trauma, I am more suspicious for a tear, and I will order the MRI to evaluate.

The good news is, young to middle-aged folks respond very well to conservative treatment and rehab (which usually involves physical therapy). Re-training the rotator cuff muscles and tendons, in addition to the scapular stabilizers, is critical to the treatment plan. This isn’t something that gets better overnight, but it should improve with time as the shoulder mechanics improve.

The treatment of rotator cuff tears is not always so simple. Full-thickness tears are quite painful and will not heal on their own, requiring a surgical repair. However, many partial-thickness tears can be treated conservatively. While they won’t heal, per se, they will “quiet down” and become less painful over time. Unfortunately, there is no way to predict which partial-thickness tears will progress to full-thickness tears and which ones will become less troublesome.

Of course, there are exceptions to the rule, and I won’t belabor those points here. It would require another post to address injuries specific to throwing athletes, another to address instability in the shoulder, and another to address injuries of the acromioclavicular (AC) joint. So that’s it for now. When in doubt, see a sports medicine physician who understands common pathology in the shoulder and can make appropriate treatment recommendations based on your particular problem.

Accountability.
According to Merriam-Webster.com, the definition is this: the quality or state of being accountable. especially : an obligation or willingness to accept responsibility or to account for one’s actions.

I feel as though society completely lacks accountability these days. I believe this to be true in many aspects of life – financially, socially, morally, among others – but since I’ve been involved with health care for my entire adult life, this is what I’ll address today. In my opinion, many American adults do not hold themselves accountable for their own health and well being.

I first saw it in medical school. I didn’t understand why patients with peripheral vascular disease or diabetes simply wouldn’t at least try to quit smoking or walk a few times a week for exercise. “I can’t afford Chantix (smoking cessation medication),” they’d say. “Well it’s less than what you’re spending per week on cigarettes,” I’d say. “But my husband loves donuts, so I have to buy them,” they’d say. “Well, try to eat something else,” I’d say. You can see why it didn’t take long before I was banging my head against the wall. The worst part about it was spending so much time and effort on patient education and lifestyle modification, only for the next question to be, “Can’t I just take a pill for that?”

Fine, I thought. I just won’t go into primary care. Sports medicine is where it’s at! Everyone loves treating athletes. However, going into sports medicine is more like going into musculoskeletal medicine. A lot of people, not just athletes, have knee pain or shoulder pain. And some of those people come see me. As time goes on I’m starting to realize that a significant percentage of those patients want one of three things: an MRI, a cortisone injection, or pain medicine. Sometimes all three. Problem is, they don’t know why! “I think I need an MRI.” Really? Why’s that? “Well, I don’t know… my sister-in-law had shoulder pain and her doctor ordered an MRI.” Gee, thanks. They didn’t teach me that part about doing what everyone else is doing when I was in med school.

I also have a “friend” with recurrent abdominal pain, cause unknown despite multiple lab tests and imaging. “The doctors have no idea what’s going on,” she says with disgust. She has a long-standing, skeptical view of medicine and doctors. Despite the fact that I am, in fact, a doctor, she asked for my advice. Should she see another specialist or seek another diagnostic test? “Well, that depends – can you tell me what tests have already been done?” I asked. “Um, I think a CT scan, some labs, I’m not really sure.” Here’s an idea – why don’t you take charge of your health, be accountable for what’s going on with your body, then we’ll talk. The first step in diagnosis is to get a good history, which is the patient’s account of what’s going on. It’s difficult to establish a diagnosis without a good history.

I think the finest example of this lack of accountability was in a middle aged female I saw recently for knee pain. She had seen one of my colleagues 6 months prior, at which time conservative treatment was recommended for her, including weight loss, as she weighed in at 300 lbs. We worked her into the schedule because she was having such horrible pain. I soon discovered that she had seen another physician the previous day, who had given her a cortisone injection. She had no relief, hence, her visit with me. I also discovered that she had in fact gained weight over the last 6 months, and had not done any of the recommended exercises for at least 3 months. When asked about this, I was given every excuse in the book about why this was the case. I was also interrupted several times by her husband, who took a defensive stance on the weight loss subject. Let me assure the reader that I was in no way hurtful with this conversation, but matter-of-fact. There is evidence to support the recommendation of weight loss for knee health. I emphasized the simple fact that her knee would not feel any better if she did not lose the weight. The visit ended with her asking me to give her pain medication and… wait for it… a note for bedrest!!
Why is it that so many patients just want a quick fix? If your (insert body part here) hurts badly enough that you took time out of your day to seek your doctor’s advice, why can’t you take the time out of your day to do what your doctor recommends? Are your health and well-being not worth the effort? And if I recommend physical therapy instead of a surgical consult, why are you disappointed? I’m so confused by this. I kid you not, I’ve heard a patient speak these words: “Are you kidding?!? Just physical therapy? I just want back surgery!!” Can’t make this stuff up.

Don’t get me wrong, most of my patients are very compliant and pro-active when it comes to their health. It’s just that subset of patients who want the easy way out, no matter what the diagnosis is. I think that as a society, we need to learn to be accountable for what we do, financially, socially, and personally. My recommendation for patients is to keep track of everything – if you had a cortisone injection, remember when it was and why it was given. Keep a list of medications. Obtain a copy of any imaging (CT scans, MRIs, etc.) for your own records. I also (strongly) suggest following the recommendations that are given to you by your physician. For example, try the physical therapy – just because it doesn’t relieve your pain overnight doesn’t mean it’s not worthwhile. You might find that when you participate in your own health care, it works out in your favor. After all, if you don’t take care of yourself, why should you expect someone else to do so?

As I mentioned in a previous post, I do not advocate for any one diet or another. I do enjoy most things in moderation, and I’m not a big fan of depriving yourself of things you really enjoy. However, I have recently been asked about the Mediterranean diet, and while I don’t adhere to it strictly, it has a good basis. I’ll explain why.

First of all, it’s not so much a diet as it is a pattern. It’s about choosing low-risk fats over high-risk fats, and it emphasizes exercise. There is also emphasis on foods that are rich in antioxidants – think anti-aging, anti-inflammatory, super troopers that have even been suggested to prevent brain aging. The Mediterranean diet has been linked with a significant reduction of mortality due to cardiovascular events, stroke, and cancer, as well as reduction in the incidence of diabetes, high cholesterol, metabolic syndrome, Alzheimer’s disease, and Parkinson’s disease.  Here are the highlights:

Fish – cardioprotective due to omega-3 fatty acids, and it’s a good source of protein. Red meats and certain dairy products are high in saturated fat, which has been linked to cardiovascular disease, especially in smokers.

Olives and olive oil – rich in antioxidants and monounsaturated or low-risk fats, as opposed to butter or margarine

Vegetables and fruits  – high in fiber and rich in antioxidants

Spices/herbs  – instead of salt, which increases risk of high blood pressure and stomach cancer

Nuts , seeds, whole grains – high in protein, fiber, and low-risk fats

As you can see, this does not include processed foods and carbohydrates, so it is not your typical American diet. I think what the diet doesn’t include is just as important as what it does include. You might be saying, “If I adopt this type of dietary plan, it’s going to cost me.” This is true.  But think about it this way – you could eat cheaper, processed foods full of carbs, fats and sugars NOW and then pay more for medications, procedures, and hospital stays LATER. Am I being dramatic? Maybe. But if your health isn’t worth the investment, then what is?

Recently, my fiancé and I went on a short cruise. If you’ve never been on a cruise before, let me just tell you – there are ample opportunities to eat. And that may be an understatement. I’m talking about pizza from 9 pm to 3 am. Cookies via room service at any hour of the day. Breakfast in the dining room from 7 to 9 am followed by a huge breakfast buffet from 8 am to noon. You get the idea.  I’d like to tell you about a family that was sitting at a table next to us at breakfast. There was a teenage girl who appeared healthy and fit, eating her 2 plates of breakfast. There was a mother who made repeated trips to the buffet, who continued to announce what she retrieved on her last trip. There was also a boy who was approximately 8-10 years old. He had a bowl in front of him, along with milk and an individual size box of Fruit Loops. He was about to dump everything into the bowl and looked pretty happy about it. However, his mother kept trying to feed him other foods. “Do you want some of my bagel?” “You should eat some eggs.” “I got some bacon for you.” “You need to eat something else.” My fiancé and I looked at each other, thinking the same thing – just give him the freaking fruit loops!

The point is this: why do you think forcing him to eat eggs and bacon will be better for him than letting him eat his Fruit Loops? Which is clearly what he wants anyways? Is sugar really that much worse than fat and cholesterol? Or is it just the fact that you think he needs to eat more? Which brings me to another question – Are we doing kids a disservice by continuing the “clean plate” motto? According to the CDC, approximately 17% of kids age 2-19 are obese, a number that has tripled since 1980. Pretty alarming if you ask me. But speaking of the 80s, I remember when my mother would make me finish my vegetables before I could leave the dinner table. The key word here is vegetables. When my parents made me finish my dinner, it wasn’t an adult’s serving of stuffed-crust pizza and breadsticks. It wasn’t 5 scrambled eggs with a ½ pound of bacon. Back then, we were still able to demonstrate portion control, and every meal wasn’t unhealthy. Back then, McDonald’s was a treat, not a regular stop on the way home from work.  And yes, back then, we were physically active on a daily basis. We enjoyed spending time (gasp!) outside. So much has changed in my lifetime, and I’m not even that old. Sad.

I don’t have all the answers. Heck, I don’t even have kids. But with 1/3 of American adults being obese and the kids not too far behind, I’m more than concerned.

Anybody with me?

After a recent conversation with my sister, I thought it would be a good idea to post some basic tips on weight loss. It’s not rocket science, but I realize some people might need to know a few basics to get going. Please keep in mind that I do not and will not advocate for any particular diet. If you know me, you know that trying to deprive me of any particular food for a period of time would NOT have a good outcome. First, here is the jist of the conversation.

Sister: “I’m really going to try to lose weight for your wedding. I’m going to be a new person when you see me next time.”

Me: “Really? That’s great. What’s your plan?”

Sister: “Well…I’m going to start working out again. And improve my diet.” (As we’re eating pizza at 10 pm)

Me: “So… pizza at 10 pm is probably not the best start.” I then suggest various products and foods.

The next day around 3 pm…

Me: “I see you bought protein bars. Are they good?”

Sister: “Yeah, pretty good. I had one earlier.”

Me: “What else have you eaten today?”

Sister: “Just the protein bar.”

Me: “Did you eat breakfast?”

Sister: “No.”

Me: “Well, there’s your problem.”

Sister: “Really?”

My sister’s lack of knowledge on effective weight loss (albeit with good intentions) made me realize that maybe what I consider to be common knowledge on this stuff really isn’t. So I’ve made a quick list of easy tips. Feel free to research more on your own; as I said, these are just the basics.

Eat breakfast

Most would recommend that you eat something within an hour of waking. No time? Protein shakes are super easy. But please, don’t let a donut or bagel be your breakfast. You need something with fiber and protein.

Eat often

I aim to eat a snack between meals, so I eat at least every 3 hours (some may say eat more frequently than that, but this is what my schedule allows). The idea is to keep your metabolism going.

Count your calories

First, make sure you’re getting enough. Ladies, you need to eat at least 1200 calories per day, to prevent your metabolism from slowing down. Secondly, to limit excess calorie intake, pay attention to labels. You’ll find plenty of calories that you consume here and there without even realizing it – salad dressings, lattes and mochas, condiments on sandwiches, etc. (more on this later). There are great phone apps with calorie info also.

Exercise!

You don’t really expect to lose weight just by diet alone, do you? Plus, it’s good for your mental health. Trust me. It’s hard to get going if you have been sedentary for a while, but once you make it a routine, you’ll wonder how you got along without your regular work out. TIP: get a heart rate monitor. They’re cheap and will help you stay in your target heart rate range, which makes for more effective workouts.

Weight train

Many reasons for this. Muscle burns more fat.  It’s good for your bone health. Your jeans will look better on you. Plus, as if I really have to state this, nobody likes jiggly arms.

Beware of alcohol calories

This is a tough one. I love beer. And I don’t mean domestic light beer. I’m talking 300 calories a pop, amber ale or brown ale or Oktoberfest or… you get the picture. But it all adds up. If you like margaritas, try the skinny margarita (lots of calories in the sweet and sour mix). If you like dark rum, try switching to a clear alcohol. There’s plenty of caloric info online if you want more ideas.

Drink water

I’m not encouraging you to indulge in those crazy “drink 100 gallons of water each hour” diets, but staying hydrated will keep you feeling fuller and will also benefit your workouts. Plus, your skin will thank you.

Mix it up

If you feel as though you’ve reached a plateau, try something new. For example, every now and again I’ll go “low carb” for about 5 days. It’s not “no carb” as I still eat fruits and vegetables and the occasional handful of crackers, but I’ll take a break from bread, pizza, pasta, etc. It’s not fun, but it works.

If you’re trying to slim down, and it seems that many of us are these days, good luck! Be patient but persistent.