Don't Skip the Good Stuff!

Today, I am a hypocrite. I am writing about what NOT to do...and I did it myself this morning..while waiting on a contractor for my office. Skipping breakfast. Sure, if you listen to what I have written in the past, less calories in= more weight off. But, in terms or breakfast, I tend to disagree with my own advice.

It is a well known fact that eating breakfast increases energy, mood and metabolism..yes, metabolism, throughout the day. But did you know that people who skip breakfast are typically heavier than people who don't? This is because people who skip breakfast are more prone to eat more food, and less healthier food at other meals. Sort of like "well, I didn't have breakfast, so I can have this cupcake with lunch" way of thinking.

There have been many studies published in relation to breakfast and weight. A study in Japan showed that those people who skipped breakfast were more likely to develop metabolic syndrome.  A study from the Dairy Research Institute found that people who skip breakfast weigh more and have more unhealthy habits than those who eat breakfast. Those who skip breakfast consume 40 percent more sweets, 55 percent more soft drinks, 45 percent fewer vegetables and 30 percent less fruit than people who eat breakfast. There has even been research showing that children (and we can assume adults) who eat breakfast have a better concentration level and do better on tests than those who do not.

Now THAT'S a healthy
breakfast!

The key here? A HEALTHY breakfast! My go-to breakfast is typically a protein-rich cereal like Kashi, oatmeal with bananas, or an egg-white omelet with veggies and whole-wheat toast. Around my neck of the woods, anywhere you go for breakfast offers healthy options such as egg substitutes, egg whites and whole-grain options. I'm sure your town does too. Also, remember a glass of OJ is fine, but not 3! (And yes..I'm going to say it again...replace your coffee with hot green tea!)

So, now I am off to eat. Is it too late to get breakfast still? Oh well. There is always tomorrow!

xo,

Why I Chose Concierge Medicine

In the face of this ever-changing world of health care, patients as well as doctors have many options. To have insurance or not have insurance? HMO or PPO?  For physicians, the decisions are not too far off from those of their patients. Private practice or employee? Accept insurance or do not accept insurance?

My company logo

These questions and decisions can provoke a large amount of anxiety on even those savvy in "health care lingo". Personally, I believe that the general public has absolutely no idea what they are getting into when they sign their insurance agreement. The vast majority of people assume (and you know what they say about assume) that because they have insurance, they have GOOD health care. Wrong. Way wrong. Listen up. Insurance companies are like any other company-they are there to make a profit. Period. If the public as a whole only knew what physicians know, I don't think half of the companies would be in business. Hey, medicine is like anything else-you get what you pay for (especially in terms of insurance). The same will likely hold true for government insurance, unfortunately.

What I spent a good portion of
my training doing. Terrible.

Let me give you an example. In Miami there are ACO's everywhere. ACO's are accountable care organizations. Read about them here. A very popular ACO here may quite possibly provide the worst coverage I have ever seen. Are the doctors good? Actually, the main doctor in the hospital is excellent. However, as an outpatient, getting any high-end medication approved is like have teeth pulled without an anesthetic. They pay for bottom-of-the-barrel medications. Getting a more effective blood pressure medication approved is like a 3 week process. Why? Because the less effective one is CHEAPER. Imagine you just had a heart attack. Your doctor wants to put you on the best medication to help your stent stay open but waiting 3 weeks for the approval is out of the question. So, instead of letting you suffer, waiting for it to be approved for the better medication, you'll get the older, generic medication instead. The list goes on and on. This includes radiological tests and procedures too! Could your doctor call the company, yell, yell again....argue and finally get something approved? Sure. But you tell me what doctor that is seeing 40 patients a day has time for that. Exactly.

Oh wait! One better. There are capitation or "risk" contracts that doctor's can be a part of. In layman's terms, this is a contract where the doctor starts off with x number of dollars, and those dollars get deducted for tests or treatments ordered by the doctor. It pays a physician or group a set amount of money for each enrolled person assigned to them per certain period of time, whether or not a patient seeks care. So, basically, doctors are given an incentive to consider the cost of care. Or, the way I think of it...they are given an incentive to save the insurance company money- which puts more money in the doctor's pocket. Luckily, all of the physicians I know are ethical, so they do all they can for their patients in terms of care.

Enter: me. Bluntly, I can't stand the way people are manipulated in regards to their health care. Just because you walk into a pretty building and get pastries at the door (don't even get me started on that) does NOT mean that you are getting quality healthcare. So, I decided to do something a little more....straightforward.

I do not want to see 40 patients a day.  I saw someone post on facebook the other day.."What a great doctor! I was in and out in 5 minutes with a prescription in hand for my COLD". What the heck? BUT, most doctors have to do this. And for some absurd reason it is perceived by the public as good care. We as practitioners are reimbursed so poorly nowadays from insurance companies that in order to make a good living (and pay off our ridiculous student loans) we are forced to see 30 patients a day. No thanks.

My husband and I have decided to go the concierge medicine route. Just hear me out and you may

One of our relaxed exam rooms!

understand why. I like people. A lot. I also like to talk...a lot. In order for me to be able to spend a solid 45 minutes with a patient (which is what they deserve), I have to charge extra. If not, I'd be barely breaking even after billing the insurance company for the services rendered and then paying for the office, supplies and staff. I do not like to be rushed, and I do not think that a patient should ever feel rushed. I want to have the time to talk about nutrition, weight loss, prevention of disease, family medical history..etc etc. I can't do that in 15 minutes. No one can do it in 15 minutes. I also believe that a patient should have access to their doctor 24/7. Cell phone and e-mail included. So, we decided to form a style of practice that is becoming more and more popular these days. We charge a flat annual fee (which comes out to a monthly payment equivalent to most people's cell phone bills) to be able to provide a SERVICE. The service is 24/7 access, cell phone and e-mail access, same or next day appointments in the case of an illness or emergency, extended office hours (evenings and weekends) and extended office appointments- 45 minutes to an hour. We still bill the patient's insurance company for services rendered (the office visit, labs, etc), but we have the TIME to actually call and get things approved, as mentioned above. So, basically, the patients pay a fee for a service, not the medical care.

Our calming, uncrowded waiting room. No need for 40 chairs when we are seeing only about 1-2 patients an hour!

Make sense? Well, I hope so. Thus far, we are doing well and we have patients that are so happy to walk into a nice, inviting office, free of a packed waiting room, people yelling or the smell of a "doctor's office". I am happy to be able to call my patients my friends...and I am even more happy that they are able to put their trust in me that I am ALWAYS 100% on their side...I am their advocate, no one else's.

www.ChoicePhysiciansSFL.com (website almost up..finally!)

Xo,

Heart Health Month....and Recipes!

Speaking at the Hard Rock on Go Red Day

I know. I have been a bad bad girl. I have kept you all waiting for a month for a new post! This month is heart month and I have been so busy with the American Heart Association and my regular schedule that things have just been too hectic for me to sit down and write a post. So, THANK YOU for being patient! :)

I have attached some photos from National Go Red Day, February 1st. That week was quite busy to say the least...but I was so happy to meet such wonderful, influential people, and also to spread the word about women's heart disease and health.

Being that we are still in heart month, I wanted to have a heart-healthy post! A lot of times I get asked for my favorite heart-healthy foods or recipes, so I thought that this would be a great time! I have included a list of my favorite heart healthy foods along with a few of my favorite recipes...ENJOY!

Go Red for Women Executive Board Cabinet

Myself and other Circle of Red members

Macy's Go Red for Women. Macy's is a national Go Red for Women sponsor!

 Favorite Foods

My husband picking from the trail mix!

1. Hummus! I even order this when I go out to dinner because every restaurant has such different variations. Enjoy with fresh raw veggies for an even more heart healthy snack.
2. Trail mix. I make my own because I can pick my own ingredients and its actually costs less to buy the products individually and mix together. I usually use raw, unsalted almonds and cashews, dried cranberries and cherries, banana chips (for some sweetness), and sometimes coconut flakes. It is healthy, yummy, and definitely filling! A handful goes a long way. Anyone who knows me knows that if they come to my house, there is ALWAYS a big container of trail mix! (See photo to prove it!)
3. Popcorn. Let me rephrase that...no butter no salt- popcorn..:)
4. Celery and low-fat peanut butter. Remember the ants on a log? Well, that but minus the ants. (I'm not a raisin fan).
5.Guacamole. I LOVE guacamole. For me, I have to watch my portions...I could eat the entire bowl. I have to have fresh guac though...not the kind you buy in a container. Yes, avocados have a lot of fat, but it is the good fat, and they are packed with vitamins, fiber and folate...so every once in a while, it is completely okay to enjoy this yummy green goodness.

Recipes!

#1...Salmon Burgers. Stop making that ugly "yucky" face! I PROMISE you..these are AMAZING! My husband is not even a big fan of salmon and asks me to make these all the time! SO GOOD!!!!

Yield 4 servings

Time 20 minutes

If you finely grind part of the salmon, it will bind the rest, which can be coarsely chopped to retain its moisture during cooking. The two-step grinding process means that those flavorings that you want minced fine, like garlic or ginger, can go in with the first batch of salmon; those that should be left coarse, like onion or fresh herbs, can go in with the rest.

Ingredients

YUM!!

• 1 1/2 pounds skinless, boneless salmon
• 2 teaspoons Dijon mustard
• 2 shallots, peeled and cut into chunks
• 1/2 cup coarse bread crumbs
• 1 tablespoon capers, drained
• Salt and freshly ground black pepper
• 2 tablespoons olive oil
• Lemon wedge

Method

• 1. Cut the salmon into large chunks, and put about a quarter of it into the container of a food processor, along with the mustard. Turn the machine on, and let it run -- stopping to scrape down the sides if necessary -- until the mixture becomes pasty.
• 2. Add the shallots and the remaining salmon, and pulse the machine on and off until the fish is chopped and well combined with the puree. No piece should be larger than a quarter inch or so; be careful not make the mixture too fine.
• 3. Scrape the mixture into a bowl, and by hand, stir in the bread crumbs, capers and some salt and pepper. Shape into four burgers. (You can cover and refrigerate the burgers for a few hours at this point.)
• 4. Place the olive oil in a 12-inch nonstick skillet, and turn the heat to medium-high. When the butter foam subsides or the oil is hot, cook the burgers for 2 to 3 minutes a side, turning once. Alternatively, you can grill them: let them firm up on the first side, grilling about 4 minutes, before turning over and finishing for just another minute or two. To check for doneness, make a small cut and peek inside. Be careful not to overcook. Serve on a bed of greens or on buns or by themselves, with lemon wedges and Tabasco or tartar sauce or any dressing you like. 

#2 Columbian Chicken Soup. I am a BIG soup fan. The only problem is that many soups are loaded with salt. Not this one!! So yummy. I thank my husband's 1/2 Columbian roots for this one.

Ingredients

• 4  cups  low-sodium chicken broth
• 1  pound  boneless, skinless chicken thighs (about 4)
• 4  frozen corn-on-the-cob pieces (sometimes called “cobbettes”)
• 1  tablespoon olive oil
• 1  small onion, thinly sliced
• 1  celery stalk, thinly sliced
• 4  garlic cloves, thinly sliced
• 2  medium russet potatoes (about 1 pound), peeled and cut into 1-inch pieces
• 2  tablespoons fresh lime juice, plus wedges for serving
• 1/4  teaspoon  dried oregano
• kosher salt and black pepper
• cut-up avocado, fresh cilantro sprigs, and capers, for serving

 Directions

YUMMY!

1. In a large saucepan or Dutch oven, combine the chicken broth and 1 cup water and bring to a boil. Add the chicken and corn and simmer until the chicken is cooked through, 10 to 12 minutes.
2. Remove the chicken and corn from the saucepan and reserve.
3. Strain the cooking liquid into a large bowl or measuring cup and reserve.
4. Wipe out the saucepan and heat the oil over medium heat. Add the onion, celery, and garlic and cook, stirring occasionally, until beginning to soften, 2 to 3 minutes. Add the potatoes and the reserved cooking liquid and bring to a boil. Reduce heat and simmer until the pota-toes are cooked through, 15 to 20 minutes.
5. Meanwhile, shred the chicken and cut the corn pieces into 1-inch-thick rounds. Return the chicken and corn to the soup. Add the lime juice, oregano, ½ teaspoon salt, and ¼ teaspoon pepper and cook until heated through, about 1 minute. Serve the soup with the avocado, cilantro, capers, and lime wedges 

#3 White Bean and Turkey Chili. A cousin of mine made a variation of this last week and it was so good! Heart healthy and yummy is a good thing! 

Ingredients:

• cooking spray
  
• 2 small onions, chopped
• 5 garlic cloves
• 2 tsp chili powder, to your taste
• 1 bay leaf
• 1/2 tbsp cumin
• 1/2 tbsp oregano
• 2 tsp red pepper flakes (to taste)
  
• 3 lbs 99% lean ground turkey
• 4 16 oz cans of cannellini beans, rinsed and drained
• 2 cups of fat free chicken broth
• 1/2 cup of fat free sour cream
  
• salt and pepper to taste

Directions:

Heat a large heavy bottomed pot over medium flame. When hot, spray oil. Add onions, garlic, saute about 5 min. Add meat and cook, breaking it up until white, about 5 minutes. Add salt, chili powder, cumin, oregano, red pepper flakes and cook for 2 minutes. Add beans, broth, cook uncovered about 10 minutes.

Lower heat and cover, simmer about 45 minutes mixing occasionally. Add sour cream and cook 5 more minutes. Adjust seasoning and salt to taste.

Top with chopped red onion, chopped fresh cilantro, light sour cream, jalapeños and reduced fat cheddar if desired.

Please let me know if you try any of these...!! 

Happy eating!

xo,

New Year, New Problems!

Although we all make these wonderful resolutions with the start of the New Year, it all too often seems that along with the New Year comes new problems and stresses. New job, new house, new baby on the way and new expenses all play into why we all may feel a little more "stressed out" in the beginning of the year...(on top of trying to stick to those resolutions!)

Recently, I was asked to write about ways to decrease stress, whether it be by holistic means or by medications. Also, what stress may due to the heart. I will defer the stress effects on the heart to by previous blog post here. All though there are other problems that can occur in regards to heart health with anxiety...I will focus on prevention and treatment today.

Preferably, I like holistic means of reducing stress. For me, the kryptonite for stress is simple. Deep Breaths. I find that it is very easy to get "worked up", but very difficult to come down. Sometimes, well, the majority of the time, a few simple deep calming breaths will do the trick. As you breathe, focus on the breath going into your nose or mouth, down your airway, into your lungs and throughout your body. Picture every single step.

Another simple tip is focusing on the things around you. Focus on details. On the color patterns of the flower outside, or the way the wind blows a piece of paper across a parking lot. Sounds ridiculous, right? Well, it's not. Simple focusing techniques have been proven to help reduce stress. If you are focusing so closely on the details, you will tend to forget about what you were stressed out about in the first place!

EXERCISE!! What better way to relieve tension than to sweat it out and pound it out at the gym? Exercise, beyond it's obvious physical health attributes, is wonderful for emotional and behavioral health as well. For me, there is NOTHING better than a good work out for some post-call stress relief!

There is no wonder why the music industry does so well. We turn to music for our heartbreaks, our romance and even our anger. Why not use music for it's healing capabilities as well? For this one, stick to classic music. Research has shown that listening to 30 minutes of classical music may produce calming effects equivalent to taking a 10 mg pill of Valium!

Speaking of Valium....

Are there instances where medication has to be used for anxiety? Sure, that's why they are made! I will say though, that these resources should only be used in special circumstances, and typically if more holistic trials have failed. As a whole, anxiety medication should be reserved for those patients with documented true panic attacks, and patients who have severe anxiety. Sometimes, they are also prescribed to patients prior to medical procedures to help them remain calm, or prior to flying, which is also understandable. In my opinion, these medications should only be used AS NEEDED and should not be a "crutch" for normal stressful situations. We, as a population, need to learn how to deal with stress better, without relying on these medications, which can become addictive and harmful to our health.

For more information about anxiety, please visit http://www.apa.org/topics/anxiety/index.aspx.

xo,

Here's to a New Year!

Well well....we all made it to 2013 with only a few scratches! I have decided that this is the perfect time to write about a few things that I am hopeful for in the new year...and I know how much everyone LOVES lists..so here is my list for 2013.

1. The cancellation of Honey Boo Boo. I'm not kidding. Since when did we allow such ridiculousness on television? And since when did it become okay and popular for an obese child to prance around and make jokes about how she and her family eats spaghetti and ketchup? I find it utterly repulsive. And we wonder why the majority of American's are overweight or obese? Well, we are entertained by it. There is part of the answer.

2. Old Habits Dying...Easy.  Nowadays, there are no excuses for cigarette smokers. There are endless options from cold turkey to help groups to prescription medication, such as Chantix. There is no reason as to why ANYONE should be smoking anymore. When I see someone smoking I just want to scream.  It is your responsibility too..if someone you know is a smoker, you must help them! Old habits no longer die hard, they die much easier.

3. Positive Attitudes. Look, I can get as ticked off as the next person, but in general, I have quite a positive attitude. Even when my grandmother in Georgia asks about me she says.."Is that Tiff still smiling?". It's true. I am always laughing, smiling or making a joke. If you can't enjoy life, what's the point? People that complain just to complain, argue just to argue, and are all around just negative...need to find their way out of your life. Me? Well, I just don't talk to those people. Simple.

4. Women's Heart Health. 2013 is the 10th anniversary of the Go Red for Women campaign...and it is OUR YEAR! My wish is that all women acknowledge that heart disease is their number one killer and they begin to do something about it!! Annual physicals, knowing your numbers, daily exercise..there are so many things that we can all do to make our hearts healthier..so get out and do it!

5. Animal Adoption.  Not kidding! If you don't have an animal..you should! Research has shown that not only do pets enhance mood, but that pet owners had less heart disease, less incidence of stroke, lower cholesterol, and even better immunity. If for no other reason...a furry friend can make a great workout partner!

Here's to hoping 2013 will be your healthiest and happiest year yet!

xo,

Movers and Shakers

Last year, I was surprised to find out that I was nominated (and chosen!) to be one of Broward county's Top 40 (people) under 40 for Gold Coast Magazine. We are called "the movers and shakers", innovators and leaders, in the January 2013 article...and I must say I feel honored to be a part of such a wonderful group of people.

Our goal as a whole? Change our community (and nation!) for the better. I was honored to be surrounded by other young adults who share the same drive and determination for making this world a better place... like me! Alongside myself were artists, attorneys, charity organizers, city commissioners, the youngest house of representatives elect, a CFO of a major hospital system, a bank vice-president, a dentist and a veterinarian...just to mention a few. Funny thing, is most of these talented people do not just have a special job, but are also volunteers for multiple organizations. The digital article can be found...here!

My goal? To continue to make you all proud! I will continue to strive to make sure that women's heart health is given the awareness that it deserves. More than anything, I will do everything I can to keep those hearts of yours healthy! I am a lucky girl, although I will admit what I do everyday is no easy task...but hey, someone has to do it! I wouldn't change the sleepless nights and tired days for anything in the world...because like I said on my facebook page, hearing "thank you for saving my life" makes it all worthwhile.

It's important for us all to realize that age is just a number...young, old or in between, we can all have a positive impact on this world!

For your continued support, I thank you all!!

xo,

Don't Play with your Pressure!

The most common primary medical diagnosis in the United States is hypertension, or high blood pressure. The most common question I get from my patients is "why do I have high blood pressure", followed directly by "how can I make it better"?

Believe it or not, you are most certainly not alone. 1 in 3 Americans has hypertension, which increases the risk of heart disease and stroke. So what causes it? Well, to be honest we are not quite sure. There are some cases that may be reversible, such as obesity, but typically there are no identifiable causes. In this case, it is called essential hypertension, and affects 90-095% of people. Patients that have essential hypertension are typically tried on diet correction (low salt) and exercise (leading to possible weight loss) prior to the start of medications. There are some cases however, which require medication first and foremost, if the pressure is just too high.

My friend learning her blood pressure.
It's never too early to learn your
numbers!

The second, and obviously more rare causes of hypertension are called...by what other name then "secondary" hypertension. The causes of secondary hypertension include kidney problems, some medications (such as oral contraceptives and pain relievers) and illegal drugs. Luckily, the majority of secondary hypertension cases are reversible with discontinuation of the causative agents or correction of kidney problems (not always possible, though).

So why is high blood pressure education so important? Well, it is called the "silent killer" because a typical patient does not feel anything. Currently, you may have a severely elevated blood pressure, and not even know it. High blood pressure leads to cardiovascular disease, which is the leading cause of death in the US. That's why it is SO important to be seen by a physician annually and get your BP checked. (This applies to everyone...even young adults and teenagers!)

What's normal? Less than 120/80. The first (or top) number is the pressure in your arteries when the heart is contracting/beating. The second (or bottom) is the pressure in your arteries when your heart is resting. There are various stages above this number that are pre-hypertension, stage 1 and stage 2 hypertension.

It you don't know your BP go find out now! It may just save your life!

Until next time,