The best kind of vacation

by Christina on March 30, 2014

It’s been a silent few months as I’ve been going through a lot of big transitions, but I am back and have a bunch of exciting updates to share!  Before I get into it all, I hope you enjoy this guest post from my superwoman younger sister, Jen… (she calls me Tina in case anyone is confused by that).

Healthy Trip to Napa, by Jen

 Tina and I had the most rejuvenating trip to Napa last weekend! Rather than focusing on the wine this time, we used the opportunity to be extra healthy: we got amazingly relaxing massages, soaked up some Vitamin D sunshine and strolled around the cute town.

And of course, to feel healthy, we had to eat healthy.  Like Tina, I eat a nutrient-dense, mostly plant-based diet—with lots of raw veggies, healthy fats, and plant protein.  I absolutely hate being hungry and having only less-than-optimal options around, so I do my best to make sure that doesn’t happen.  This time, we were driving, and there was a fridge in the hotel room, so it was relatively easy.  Here are my tips for eating extra healthy on a road trip vacation. 

1. Pack some meals.  

Going out to meals is definitely fun and can be the highlight of trips. But it’s not necessary every meal.  I packed four identical meals (and since I’m prepping for a fitness model photoshoot, I weighed everything and counted calories ahead of time).  My “Napa meal,” which I happily ate for 2 lunches and 2 dinners, was seitan, chickpeas, brown rice, avocado, raw beets and raw spinach.  I put some tamari and nutritional yeast on top.  At home, I might put some almond butter sauce on top, too, and I would vary up the protein (tofu, tempeh, Edamame), the legumes (pinto, lentils), the grain (quinoa, spelt berries, sweet potato), the healthy fat (nuts, seeds, coconut), and the veggies (endless).  But I was okay sacrificing variety for ease of prepping for this short trip.  

For Tina, I brought my leftover edamame salad, based on this recipe, which she loved!  And we shared a yummy chocolate protein bar for dessert a bit later on.

Packing all this was made much easier by my super nerdy cooler, which I tend to carry with me when I am out of my apartment for more than a few hours at a time.  It’s easy to throw in the trunk of the car and stays cool all day.  I also have been known to bring it to work with me, which can lead to some teasing, but totally worth it :)

 

2.     Pack raw veggies. 

This is so important for me that it warrants its own category!  You can snack on these anytime you want to!  I ate raw red cabbage, raw cauliflower, and raw beets while driving in the car.  This adds lots of nutrition, and very few calories, while keeping you feel satisfied. 

3.     Pack some snacks. 

I also pre-made 10 (green!) protein pancakes (protein powder, oat flour, almond milk, banana, spinach, wheatgrass powder), and put them in one tupperware with a bunch of teaspoons of sunflower butter and peanut butter.  They were something like this, with spinach and wheatgrass blended in.

This was quick and easy to grab when we needed a mid-morning, mid-afternoon, or pre-bed snack.  This snack/mini-meal worked well on this trip because I had my cooler for the car and the fridge in the hotel. 

4.     Pack some more snacks. 

It’s quick any easy to throw these in a bag: nuts, flax crackers, vegan seitan jerky, fruit (e.g., oranges, apples, bananas), and some more vegetables (e.g., whole red peppers and cucumbers).  These don’t add a lot of weight, and are easy to throw in if you are driving somewhere, and some of them would also work for flights. 

5.     Choose healthy restaurants and healthy meals at restaurants. 

When you do go to restaurants, you can check out the menu ahead of time and look for healthy options, e.g., may latest favorite, steamed edamame and sushi with brown rice and veggies.  Chipotle is another good option on the road.

6.     Exercise! 

To feel extra good, we did a little jog in the sunshine, and lifted weights at the local gym.  Always fun to be the only girls in the weight room.  And the weight-lifting helped some of the extra-carbs from our breakfast-in-bed from the delicious Sweetie Pies bakery…  We picked our splurges well! :)

We got back feeling healthier and happier than when we left—perfect vacation.

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Highlights from the Rez

by Christina on November 18, 2013

I just got back from living and working on the Navajo Reservation in Shiprock, New Mexico. I was grateful for the time to step away from residency, to live and breathe the beautiful Navajo land and sky, and to get to learn from such a beautiful culture and people. It’s hard to know where to start so here’s a mini photo journal from the month:

The Northern Navajo Medical Center, where I spent most of my days. As a family medicine doc there you are full-spectrum: inpatient, outpatient, ICU, labor and delivery.

 

A depiction of the Navajo land, bordered by their four sacred mountains. Almost 175,000 Navajo live on the reservation spanning New Mexico, Arizona, and Utah.

 

The Indian Health Service also runs school-based clinics and this teen clinic.

 

There’s a sweat lodge in the back of the teen-clinic where they do women-only sweats as well as co-ed family sweats.

 

A small community clinic open twice a week.

 

Shiprock: a historically and religiously important landmark for the Navajo. Geologically fascinating ancient volcanic plug.

 

Anasazi cliff dwellings from around AD 1200 at the Navajo National Monument.

 

One of many fast food signs on the Rez, this Burger King with the added benefit of a Code Talkers Museum. I realized the power of these advertisements when for the first time in >20 years I had cravings for fast food.

 

The Navajo Reservation is a food desert, with little access to fresh produce, easy access to fast food.

 

Navajo Frybread… had to try it. Ubiquitous on the reservation. Created in the 1860s out of rations given to the Navajo by the US government. Now viewed by many as a traditional food.

 

Navajo Nation Tribal Government Headquarters in Window Rock, Arizona. They have their own executive, legislative, and judicial systems, as well as their own law enforcement agency.

 

Inside the Navajo Nation Council Chambers where a committee was voting on a “junk food” tax, which would add an additional 2% tax on sodas/junk foods and eliminate the sales tax on fresh produce/nuts/seeds. It passed this committee vote and is now going to the full Council vote in the coming weeks. Beautiful mural on walls tells the history of the Navajo people.

 

One of my typical dinners as I lived on the hospital compound in government housing: boxed lentil soups heated with the vegetables that lasted in my fridge from the weekend’s shopping trip.

 

It was a great month!

I’m now back in San Francisco and gearing up inpatient nights. I’m actually looking forward to it in some ways… part of me misses that hospital.

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The Best Death Possible

by Christina on September 23, 2013

Reposting this great blog post that my dad just wrote. I love that my dad thinks and writes about this, and I really wish I had more time in my visits with patients to discuss what the best death possible would look like for them. It’s one of those things I always note to “discuss at future visit.”  Enjoy… 

 

 The Best Death Possible

By Chris Palmer

“The sobering fact is that there are worse things than having someone you love die. Most basic, there is having the person you love die badly, suffering as he or she dies. Worse still is realizing later on that much of his or her suffering was unnecessary.” So writes Dr. Ira Byock, a professor at Dartmouth Medical School, in his thoughtful and deeply felt book The Best Care Possible, published last year.

I’ve written before about Byock’s pioneering efforts to help us think more clearly about death and dying. In his new book, he asserts that we make dying a lot harder than it has to be and, as a result, we are “scared to death of dying.”

According to this physician and researcher, a large majority of Americans die in hospitals or nursing homes, suffering from poorly controlled pain and other physical miseries, and often enduring their final days feeling embarrassed, humiliated, lonely, confused, and a burden to others. Prolonged serious and chronic illness, physical dependence, extreme frailty, and mental confusion are now common facts of late life. It is not easy to die well.

Byock reports that hospitals remain the site of more than 50 percent of deaths in most parts of the nation; nearly 40 percent of people who die in a hospital spend their last days in an intensive care unit, where they will likely be sedated or have their arms tied down so they will not pull out breathing tubes, intravenous lines, or catheters. While acknowledging that dying is hard, the author asks if it needs to be this hard.

Too many people suffer needlessly at the end of their lives, he says. Indeed, Byock says that the way many Americans die is a “national disgrace.”

My wife and I had dinner recently with good friends, a lively couple who are in their sixties. Toward the end of a delightful evening, I brought up the topic of how they were planning for the time in their lives when they became frail and ill from old age. Our friends plaintively responded, “It’s so depressing” and didn’t want to talk about it.

They’re right of course. The topic can be depressing. It’s natural to want to avoid serious conversations about the end of life. Who wants to think about annihilation, pain, loss of autonomy, despair, vulnerability, physical dependence, and the excessive cost? A dying person’s identity, relationships, work projects, aspirations, hopes, and plans are pretty much doomed.

But we must think about the end of our life, plan for it, and talk to loved ones about it, especially while we are physically healthy.

Byock suggests that fresh approaches to discussing death and the decisions associated with it actually create a way to honor and celebrate our dying loved ones, as well as ease their pain and suffering. Writes the good doctor, “We can provide excellent lifesaving treatments, while respecting people’s right to determine when enough is enough, always ensuring that their pain is treated expertly, that they and their families are treated tenderly.” The 1997 book by Mitch Albom, Tuesdays with Morrie, is worth reading on this point.

Offering the best care possible in this way also means offering practical help and emotional support to the loved ones of a dying person.

Byock notes that not only patients and potential patients (all of us) are reluctant and afraid to talk about dying. Doctors themselves have “an aversion to talking about dying and death.” They dread it. Medical schools could change that reluctance by giving medical students more training in palliative care. Doctors need to know if elderly patients want to die gently and how to give them that option.

The Dartmouth professor justifiably grouses, “Most medical schools do not require hospice or palliative care rotations, many do not even offer them as electives. Medical schools generally provide a lecture or two on pain management and discuss the ethics of end-of-life decisions and palliative and end-of-life topics within other courses. The total course content of these topics probably amounts to fifteen to twenty-five hours over the four years of medical school curriculum.”

Byock emphasizes that there is no universally right way for a person to die. What constitutes dying well for one person might be entirely wrong for another. The key question is: How do we make full use of lifesaving medical science and technology while ensuring that people are comfortable and allowed to die gently when their time comes?

The big question is when does one acknowledge the inevitability of death? At some point in the course of illness and decrepit old age, more treatment will not equal better care. When you are dying, do you want to be gently released in order to relieve your suffering? If so, how will you make sure that happens when the doctors treating you may have a different goal? 

 

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