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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.

Christmas

Cozy room with Christmas tree and decorations

This Christmas, I received a surprise gift, one that I definitely wasn’t expecting. No, it was not in a neatly wrapped box beneath the tree, nor did it arrive in a colorful envelope in my mailbox. Moreover, the person who gave it to me remains anonymous. What is this mystery present? Well, I got COVID for Christmas. I was also kind enough to pass it along to my older son.

I am so thankful that our symptoms have been mild. My experience has been fever, body aches, sore throat, cough and congestion. I am very fortunate that I was not affected more severely, and I pray for those that have suffered worse symptoms.

It seems as though the worse part of this is being isolated in our spare bedroom. My son feels the same way, as he is isolated in another room. I now know what I am sentencing all my patients to when I tell them that they must self quarantine. On the bright side, though, I had lots of time on my hands (a rarity) and thus had ample opportunity to catch up on things that I had been meaning to do.

I am most definitely blessed to have my wife, Mayra, by my side (not literally next to me). She has been taking care of everyone in the house—the humans, the dogs, the fish and the plants. She brings all of us our meals and ensures that our needs are met. Besides mother and wife, she is also doctor, making sure that my son and I have obtained a near full set of vital signs for ourselves everyday.

A few days into quarantine, it seems as though I was getting a bit moody. Out of concern and love, Mayra was telling me about many of the things she had been reading about COVID. She was doing a lot of research and informing me of items that I should be cautious about. For whatever reason, I decided not to listen. I figured that I knew enough about this horrible virus from working in the Emergency Department and I did not not need any additional information.

Mayra, always perceptive and astute, inquired as to why I was distancing myself. I initially resisted continuing the conversation (yes, I can be stubborn). But I quickly decided to do the right thing and open up (I also eventually figure out when I am not being my best self).

We spoke and I listened to everything that she wanted to say. I apologized for being inflexible and agreed that she had indeed learned many intriguing and important facts in her research. I felt much better after that conversation.

I enjoy being friends with Mayra. As a bonus, I also have a wonderful teacher. She keeps me open and honest with myself. Furthermore, in this instance she taught me that I was not practicing humility. I am grateful that she helped me to see myself as I truly was, and how I needed to make myself better.

Yes, it was an atypical Christmas with an unexpected gift. However, I did receive something else, something that is actually present in my life everyday—the love and friendship of a wonderful woman. 🧡🎁

Kindness

White Printer Paper With Be Kind Text on Plants

We are often assaulted by negative news stories. Although factual, stories of murders, terrorism, political scandals and natural disasters saturate the airwaves. While there are anecdotes detailing acts of kindness, in my humble opinion, it seems as though the stories recounting acts of malice are much more ubiquitous than those describing deeds of goodwill.

            Despite this overwhelming amount of pessimistic narrative that enters our lives through newspapers, radio, television and our phones, I sincerely believe that there are more acts of benevolence than there are gestures of hostility. Kind acts occur every day around the globe, and when I learn about things that people do to add something positive to the lives of others, it motivates me even more to do the same.

            While in the middle of a busy shift in the Emergency Department last year, I witnessed such an act. We were busy to the point that we ran out of rooms, so there were many patients on stretchers in the hall. I had cared for a middle-aged woman, and after some testing, deemed that she was safe to be discharged home. I cannot recall all the details, but apparently she lived about an hour away from the hospital and she had no way of getting home. The clerk in the department had offered to call a cab, and it turned out that the fare was going to be $100. My patient said that she could not afford to pay such a large fare and she stated that she had no other way of getting home.

            After a short conversation at the desk with the clerk, the woman appeared despondent. Only a few minutes had passed when the man approached. He was an older gentleman, probably in his early seventies. He was a family member of another patient who had overheard the difficulties that my patient was experiencing. He took $100 dollars out of his wallet, handed it to my patient and told her that he wanted her to have it.

            My patient responded by saying something like, “I can’t accept this money from you,” and then, “Why are you being so nice to me?”

            I still remember the gentleman’s response. He said, “You’ve got it backwards. You’re actually doing something nice for me by allowing me to help you.”

Giving away $100 seemingly without thought to a total stranger appeared to be an effortless thing for this man to do. I believe that showing love and compassion is quite easy most of the time. Admittedly, it can sometimes be a challenge. However, the more you do it, the easier it becomes. Moreover, kindness can be quite infectious, and it will be paid forward over and over again.

A Backwards Society

Sliced Avocado Fruit and Green Vegetable on White Chopping Board

While at work in the Emergency Department a few weeks ago, I saw a young man in his early forties who had come to the hospital because of neck pain. It turns out that he was concerned because he had just suffered a heart attack the prior week for which he had a cardiac catheterization and a stent placed in his heart to open up a blocked blood vessel. A few months ago, I took care of a woman in her fifties that was admitted to the hospital and ended up needing open heart surgery due to extensive heart disease. 

I realize that the above is not the most uplifting opening paragraph for a blog post. However, it is factual nonetheless. My intention is not to be discouraging, but rather to create awareness and inspire change. Diabetes, high blood pressure, obesity, high cholesterol, cancer, heart disease and stroke are chronic diseases that are very often related to lifestyle choices—especially diet and exercise. These horrible conditions are frequently preventable. When they do occur, many are often reversible. Moreover, these maladies are oftentimes created by the afflicted individual. 

Although I could be mistaken, I believe that I have a fairly unique perspective on the healthcare system in this country. I would like to preface my thoughts by stating that our healthcare system is miraculous. We have an armamentarium of pharmaceuticals, procedures and surgeries that are life saving. I know this because I’ve seen it first hand. Amazing things happen in hospitals every day. 

Having said that, I believe that our society has it all backwards. We eat an abundance of processed foods containing sugar, white flour, salt, oils and artificial chemicals. These lifestyle choices unquestionably cause people to become sick with one or more of the aforementioned chronic diseases. How do we currently fix this? We turn to doctors, pharmaceuticals and medical device companies. We use pills to control the symptoms of diseases that we ourselves have often created. This. Is. Backwards. We need a paradigm shift. Why eat poorly, become ill and then take pills to put a band-aid on your diseases?  Instead, why not eat a nutritious diet and greatly decrease the risk of sickness in the first place? Do this and you can feel vibrant, focussed and well.

Which option sounds better? The choice belongs to you. Have a conversation with your doctor. It is my sincere hope that we can have a paradigm shift. I know that we can be better. Are you with me?