A Food-Borne Illness

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As an Emergency Medicine physician, when I hear the term “food-borne illness,” it immediately conjures images of people with vomiting and diarrhea secondary to consuming undercooked or spoiled food contaminated with bacteria or their toxins. However, I recently learned of a new usage of this term. In his article, “Is the Present Therapy for Coronary Artery Disease the Radical Mastectomy of the Twenty-First Century?” Dr. Caldwell Esselstyn ascribes a new meaning to the phrase “food-borne illness,” referring to coronary artery disease as this type of illness. According to the CDC, coronary artery disease (CAD) is the most common type of heart disease in the United States. It is the narrowing and blockage of blood vessels supplying blood to the heart, which can eventually lead to heart attacks. The CDC also states that in the United States, over 20 million adults over age 20 have CAD and that someone has a heart attack every 40 seconds.

Those are some pretty frightening statistics. But luckily, doctors have treatments for heart disease. We have an armamentarium of medications as well as procedures such as coronary stents and coronary artery bypass surgeries. These are remarkable advances that are lifesaving for those that are having a heart attack. However, as Dr. Esselstyn states, “…none of the present therapies targets the cause: the Western diet.” Yes, our Western diet—filled with processed foods, fried foods, meats, oils, and dairy. He describes cultures that consume a plant-based diet in which CAD is almost non-existent. Moreover, the converse is also true. When plant-based cultures adopt a Western diet, guess what? Yes, that’s right, they develop CAD. Thus, it seems as though heart disease really is a food-borne illness. 

History also teaches us this lesson. Between 1939 and 1945, Norway was occupied by Nazi Germany. During this time, the Germans removed all animal livestock, forcing the population to subsist on whole grains, legumes, fruits, and vegetables. Following this, deaths from heart attacks and strokes fell. When the war ended, and animal products became available again, deaths from these illnesses rose to prewar levels. Thought-provoking, isn’t it?

In his article, Dr. Esselstyn mentions a study he conducted on very ill patients with CAD that he placed on a plant-based diet. These patients have thus far been followed for twenty years, and the results are fascinating. A plant-based diet not only stopped the progression of heart disease but even reversed it! Yes, reversed it. Furthermore, this study and its follow-up showed that people with CAD would stick with dietary changes for decades. If provided with an understanding of the link between diet and disease, I believe that people will want to take control of their own health and give themselves the opportunity to be better.

Running a Mile in Less than 4 Minutes

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I love the story of Roger Bannister. He was a runner that ended up becoming famous. You see, for the centuries that track and field records had been kept, nobody had ever run a mile in four minutes. It was deemed impossible for a human to run so fast for such a distance. It was an obstacle that no person could overcome. That was, until May 6th, 1954. Roger Bannister had resolved to be the first person to run a mile in four minutes, and on that day, he ran a mile in three minutes and fifty-nine seconds, breaking through barriers that had stood for centuries. 

However, the truly incredible part of this story is that his record lasted for only forty-six days. Moreover, within the following ten years, 336 other runners had also broken the four-minute mile record. 

How could it be that no human could run a four-minute mile for centuries, and then suddenly, over 300 people can do it within ten years? The answer lies in the fact that the barrier was not a physical one—it was a mental one. It existed only in the minds of runners, and it crumbled as soon as Mr. Bannister proved that it could be done.

Often, our own barriers do not exist outside of us but within us.

What Goes Around Comes Around

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 “What goes around comes around.” 

I’ve heard that phrase my whole life. However, it wasn’t until later into adulthood that it took on greater meaning for me. 

Some days, I “wake up on the wrong side of the bed.” I don’t give my wife a smile or a good morning kiss. Sensing something amiss, she distances herself. I may be impatient with my boys. As my morning progresses, I can’t seem to find paperwork that I was planning to work on. I try to do some work online and discover that the computer has “frozen.” Other small things seem to go wrong during the course of the day.

Conversely, life seems much easier when I am in a good mood. My day is pleasant when I choose to have feelings of gratitude and cheerfulness towards those around me. I wake up with a smile and take a moment to make coffee for my wife. She smiles and hugs me. My boys laugh with me. Whatever tasks I have planned usually go well. And if they don’t, it’s okay because I’ve already chosen to be happy and thankful.

So, “what goes around” does indeed “come around.” Hostility begets hostility. Kindness begets kindness. What we send out into the world will come back to us.

The Balance of Nature

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If you’ve been reading my posts for any length of time, you know that one of my interests is wellness and the importance of healthy lifestyles. I wanted to share that I am also vastly interested in sustainability and our environment. I developed this fascination several years ago, and it has continually grown. 

We are blessed to have a beautiful planet to call home. It provides us with the resources necessary for survival and inspires us with nature’s miracles. There are times when I leave my home for work in the mornings and stop my car to admire the orange-tinted sky as the sun makes its way above the horizon. Forests, mountains, rivers, and oceans are teeming with an abundance of life, with each of the thousands or millions of individual organisms going about their daily activities without disturbing the overall balance of their ecosystems. Left to its own intelligence, nature will maintain equilibrium across the globe. 

Unfortunately, that picture changes when human beings enter the equation. With our superior intellect and reasoning capabilities, we have built civilizations and developed technologies that have allowed us to become the dominant species on Earth. However, in the process, we have disturbed the balance of nature. Please don’t misunderstand me—I am a fan of progress. Over the past decades, advancements have allowed innumerable people to live better lives. More people now have clean water, electricity, mobile phones, and internet access. As a matter of fact, according to Hans Rosling in his book “Factfulness,” over the past 20 years, the proportion of the world population living in extreme poverty has almost halved. These are remarkable achievements, and I am elated that we have come so far. 

My hope is that modern societies will learn from nature. We have figured out ways to care for our growing population, which is wonderful. However, we must maintain balance. We are not the only species living on this beautiful blue and green sphere—we share it with trillions of other beings. We have already begun moving in the right direction, as countless dedicated people are working on solutions to the many environmental imbalances that we have created. In the meantime, I know there are so many seemingly small things that I can do to help out. A few things that come to mind are planting a garden, picking up litter, turning off the lights when I leave a room, and not leaving the water running continuously while washing dishes. I have faith, and I look forward to a better and healthier planet in the future. 

A Bandage Culture

It’s a typical busy day in the Emergency Department. Physicians, nurses, and other staff members are bustling about doing their best to care for those that came through our doors. I walk into the room to greet my next patient and find an uncomfortable appearing man sitting up on the stretcher holding his chest. 

“Hi, I’m Dr. Piriano. How long have you been in pain?”

“Hi, doc,” he replies after a long exhale. “For about an hour.”

“What exactly are you feeling?”

“It feels like someone is standing on my chest.”

“Do you have pain anywhere else?”

“Yeah, my left arm is kind of aching.”

“Any other symptoms?”

“I’m having some trouble breathing, and I’m also a bit nauseous.”

Before I have a chance to speak again, a technician rolls an EKG machine into the room and begins placing stickers onto the patient’s chest. 

“We’re going to take care of you,” I tell him. “We’re going to do our best to make you feel better.” 

I start my physical exam while the technician enters the patient’s information into the EKG machine. 

After the EKG prints out and I review it, I note some worrisome findings. Although the EKG does not reveal evidence of a heart attack, it does raise concerns about a possible blockage of a blood vessel supplying his heart with oxygen and essential nutrients.

An IV is started, blood is drawn, and medications are given to my patient that help to alleviate his discomfort. He is eventually admitted to the hospital for further monitoring and evaluation by a cardiologist. 

As I sit down at my computer and reflect on my patient, I have a bittersweet experience. I am happy that we were able to make him feel better and admit him to the hospital so that he may receive further care. I am also sorrowful that he had this experience. Thinking about him more, I feel that this episode could have been prevented. 

He is fifty-three years old. He also takes five prescription medications as “treatment” for diabetes, high blood pressure, and high cholesterol. Given his underlying conditions, it was likely only a matter of time before a complication manifested itself. 

The truly unfortunate thing is that the gentleman with chest pain is not alone. He is representative of so many patients that I care for in the Emergency Department. I see patients with conditions such as diabetes, high blood pressure, high cholesterol, heart disease, stroke, and cancer many times in a shift. These individuals have lists of prescription medications numbering three, five, ten, or even more. 

Is this really what we have come to? We appear to be a society where so many of us take poor care of ourselves and subsequently develop lifestyle-related diseases. We then take multiple prescription medications to “treat” our illnesses. Many times, of course, the medicines do their jobs and help us manage our afflictions. However, are they addressing the actual underlying cause of our condition? For instance, if you have diabetes due to a poor diet and being overweight, are prescriptions correcting the underlying cause of your diabetes? If you have high blood pressure secondary to obesity, physical inactivity, and excessive salt intake, are your blood pressure medications fixing the root causes? Are medications truly healing you, or are they just bandages attempting to prevent things from getting worse?

There is an abundance of scientific research telling us that living a healthy lifestyle can help to prevent and even reverse many of the diseases mentioned above. Wow!—eating wholesome foods, including an abundance of fruits, vegetables, whole grains, and legumes, and getting adequate physical activity can prevent and reverse diseases. This is remarkable knowledge. Believe me, I appreciate that it is so much easier to take some pills than to change your lifestyle. I also understand that many people are trying to change, and that’s fantastic. I applaud you, and I know that we can all be better. 

My one parting thought is this: Is your wish to give your wounds the opportunity to heal, or are you satisfied with keeping them as they are and just covered up with a bandage?

***As I said, living a healthy lifestyle can help to prevent and reverse many illnesses. However, it is essential that if you are a mostly sedentary person or are currently under a doctor’s care, that you speak with them about your desire to change and do it under their guidance. Furthermore, never change or discontinue any prescription medications without your doctor’s approval.

My Hope for the Future of Healthcare

Medical stethoscope with red paper heart on white surface

As I walk into the Emergency Department at the beginning of my shift, it seems like it will be another day typical of the new era of health care. Over the past few months, I have been treating fewer and fewer people for complications of chronic diseases. I rarely encounter patients suffering from the acute effects of illnesses such as hypertension, diabetes, heart disease, and cancer. Most people are coming to the hospital seeking treatment for injuries and infections.

Since the COVID pandemic ended a decade ago, so many more people have been genuinely focused on taking better care of themselves. It seems as though there has been a major paradigm shift. Almost everyone I speak with has told me that they have changed their diets for the better. So many people are eating increased amounts of fruits, vegetables, and grains and much lesser amounts of processed foods. In addition, people have become so much more physically active. Countless individuals I have encountered during my shifts in the ER have told me that they have been able to discontinue several, if not all, of their medications because their conditions have been cured or stabilized. Perhaps the best thing, though, is that they feel great. People are always telling me how energetic and focused they are. I am loving this. 

Moreover, I am overjoyed to know that these wonderful improvements in the health of so many are not just localized to my little corner of the world. Reviewing statistics from the CDC and medical journals confirms that this has become a near-global phenomenon.

Health care has shifted from a predominantly symptom and disease management model to one that emphasizes the importance of promoting and maintaining excellent health. Providers of health care spend significant amounts of time counseling their patients on the importance of good nutrition, regular exercise, adequate sleep, and coping well with stress. Rather than prescriptions for drugs and procedures, patients receive guidance on eating well and giving themselves sufficient physical activity. 

Not only are innumerable people grateful for this new era of health care and the wonderful feeling of vitality that they experience every day, but governments have been reaping the benefits as well. Health care spending has been spiraling downward. I’m no economist, but I think that’s a good thing. Lost workdays due to illness have remarkably decreased, and productivity has consequently increased. These factors have proven to be an excellent boon for economies worldwide. 

I had hoped for such a world for many years, and it has finally come to be. I am delighted to be taking care of such a healthy population in my professional life as an Emergency Medicine physician. Even many of my older patients are less frail and more energetic than I remember. In my personal life, I am thrilled to be part of a healthy family whose members I know will live not just long lives but energetic and joyful ones.

Consequences

Ham Burger With Vegetables

Cheeseburgers and chocolate cake are delicious. Eat a cheeseburger for lunch, and you will likely feel really good. And that piece of rich chocolate cake—definitely mouthwatering. The same goes for pizza dripping with cheese, juicy porterhouse steaks, hot dogs with all the fixins, moist frosted creme donuts, and many others. Undoubtedly tasty and gratifying. 

Eating such foods on infrequent occasions is pleasurable and will probably cause no harm. However, filling your plate with these types of foods on most days of the week is an entirely different story—one whose ending is difficult to visualize in the present moment. 

Many of us are probably aware that foods high in sugars, fats, and cholesterol are not the healthiest options. They increase the risk of developing many chronic diseases, including heart disease. Moreover, this risk increases the more often these foods are consumed. I’d bet that countless people who understand the dangers of eating these foods consistently still do so. Why would this be?

The likely answer is that the consequences of regularly eating unhealthy foods do not occur right away. As a matter of fact, the results of these actions will typically take years to manifest. If you knew that eating cheeseburgers a few times every week would increase your risk of suffering a heart attack ten or fifteen years down the road, it might not bother you too much. However, if you knew that eating a cheeseburger on Monday would cause you to have a heart attack on Tuesday, I’ll bet that you’d think twice about it. 

The converse is also true. Eating a vegetable salad on Monday will not turn you into a picture of good health on Tuesday. But eat lots of fruits and vegetables every day, and you will undoubtedly see and feel the difference in the following months and years. Again, when there is a lot of time separating actions and consequences, people will oftentimes only care about the immediate or near-term results without giving much regard to the long-term effects of their choices. 

This concept was explained very well by Ray Dalio in his book Principles. He refers to near-term effects as first-order consequences and long-term effects as second- and subsequent-order consequences. As Mr. Dalio says, “Quite often the first-order consequences are the temptations that cost us what we really want, and sometimes they are the barriers that stand in our way.”

The next time you are about to order that cheeseburger, don’t just think about how it will make you feel as you’re eating it. Consider how it may affect you a few years into the future. After all, it is still you that will bear the consequences.

Choices and Action

Red Racing Car on Race Track during Daytime

Consistent choices and action over time are the two things that will determine what types of results a person achieves in every area of his or her life.

Regarding health, eating the right foods each day and exercising regularly are the foundations of maintaining good health.

This lesson is important for adults, but also for children, who have an opportunity to begin making good choices from an early age.

Following is an excerpt from a children’s book I wrote entitled “The Lost Ugew”. It is a story and activity book in which I also wanted to instill the importance of healthy living to the young readers.

“There are many great ways to take care of yourself,” says Pogavat. “You can learn about them from different places–such as grown-ups, books and the internet. However, it doesn’t have to be complicated. Just eat lots of fruits and vegetables and not a lot of junk food and be active. However, even if you do learn a lot, the most important thing is taking action. And action, like everything else, is a choice. How about a quick lesson on choices?

“Imagine that you have a nice, shiny sports car,” says Pogavat.

“Wow, very fancy car,” says J-O

“Imagine if you put soapy water into its gas tank,” Pogavat continues. “How do you think your car will operate? Well or badly? Pretty badly, right? But what if you give your car the right kind of fuel? How do you think it will operate? Well or badly?

“So, if you give your car the wrong kind of fuel, it won’t operate well at all,” Pogavat says. “But if you provide your car with the right type of fuel, it will run very smoothly. Choices, right?

“OK, young buccaneer, how about I give you some choices of fuel to use for your body–which ones would you pick?”

I hope you enjoyed this small excerpt. It is from a children’s book, of course, but it does contain an important truth. Until next time…

Canine Lessons

When I get home from work, all three of them are there, staring at me with tails wagging. “I’ll be right back,” I tell them. Since the pandemic began, I still take off my clothes in the garage and shower before saying hello. After ducking into the bathroom and cleansing myself, I am ready to greet everyone. It’s usually the furry members of the household that welcome me first, and I become the recipient of an abundance of dog kisses and snuggles. There is also the rhythmic rapping from their tails striking the walls and chairs as an expression of their exuberant joy. I’ve begun to refer to this as the “happiness noise.” Being greeted by Rocky, Buddy and Bailey when I return home from work is a wonderful feeling that I look forward to after every shift. Mind you, this exuberant display of affection doesn’t only occur after being gone for the entire day. Even after running a quick errand, I am welcomed home in the same way.

            Yes, dogs easily become true members of our families. Moreover, not only are they part of our family, in many ways they have also become my teachers. I have learned that it is important to live in the present. Although my dogs were not the first to demonstrate this to me, they emphasize its importance each day. Unlike humans, they do not appear to dwell on things that have already happened nor to be concerned about future events. They are always right here, in the moment. If they do something naughty, such as stealing someone’s dinner, they enjoy their bonus treat and seem to be done with it. By the same token, when they are reprimanded for an act of bad behavior, they hold no grudges. A moment later, they are back to their usual playful selves. Several years ago, we had taken home some burritos for dinner. The memory is still so clear. One of the meals was sitting on the counter and my attention had been diverted. As I turned my head, I saw Rocky slowly climb the chair, gently and quietly grab the burrito, and then slowly jump down. Even though someone’s dinner was at stake, it was comical nonetheless. We managed to salvage some of the meal, but Rocky did end up getting a share, after which he went on with his day as if nothing happened.

            As I alluded to, dogs treasure their families, provide abundant amounts of love, and seek the same in return. Even as I type these words, I hear light scratching on the door. Not recognizing the “Do Not Disturb” sign, Buddy wants to be here with me. It isn’t long before Rocky and Bailey follow, their tails gently wagging.

They consistently maintain their positive outlook. There have been times when they are sick or injured. When these unfortunate incidents occur, they don’t sulk. They may be a bit more calm than usual, but they will wag their tails, lick us, and still radiate happiness. As long as they have kind people in their lives, happiness is their dominant emotion.

I have learned a lot from my furry friends. If I could sum up the wisdom they have bestowed upon me in one sentence, it would be the following: Live joyfully in the moment and always be affectionate to those you care about.

The Empty Space

From above of unrecognizable female holding book with blank pages while sitting near stone stairs

Everything we do in life is a choice. From what we eat, to checking our email, to making coffee for our spouse in the morning. Our choices are manifested as words and actions (or inactions). If we wish to explore the idea of choices further, we can contemplate the fact that our choices arise from our thoughts and emotions. A thought or feeling will lead to the next decision we make. Thinking about a looming deadline may prompt us to begin working on a project. Happiness may lead us to hug our spouse. Anger may lead us to shout expletives at the driver that just cut us off on the highway.

Over the years, I have learned some rather interesting truths about these concepts of thoughts, emotions, and choices. These teachings came through people much more insightful on this topic than me. It was through their words in books as well as in person mentorship that I  came to reflect on the idea that I might be ignorant of something critical.

What was I missing? The empty space. I was missing the small segment of time that exists between thought or emotion and choice leading to eventual action. That space is there, and, with practice, we all have the ability to recognize and utilize it. In circumstances of heightened negative emotions, such as anger, instead of just reacting, this space will give us the power to respond with thoughtful consideration.

I have experienced this many times over the years. A few weeks ago, I was out running with my two larger dogs, Rocky and Bailey. It happened that they both decided to do their business (#2) at the same time and about ten feet apart. I was stretched out between the two of them, wondering who was going to finish first. When they were done and I was cleaning up, their leashes became entangled, and I became a bit flustered trying to separate them. Almost as soon as we got going again, Bailey decided to misbehave. He was biting on his leash and pulling. I became impatient and angry. I was about to react and loudly scold him. I then became aware of the empty space. It was seconds, but it gave me the opportunity to respond rather than react. I calmly regained his attention, he stopped pulling, and the crisis was over.

Practicing awareness of this space has helped me a lot over the years. Of course, I am a fallible human and there are still many times when I react rather than respond. However, I strive to be better every day. It’s amazing how a few empty seconds can have such an impact.