Liberated by Repetition

Thomas Keller, the only American chef to have earned three Michelin stars at two restaurants, spoke to the Wall Street Journal about habits. He said that he was most comfortable in situations where repetition is the norm.

“In order to be great, you have to be consistent.” Habit doesn’t interfere with inspiration – it allows it to happen. At first, Keller needed to pay close attention to cleaning a salmon, but after a couple of years the task didn’t require so much concentration. The habit of always cleaning a salmon the same way allowed him the freedom to think about what he would do with the salmon after cleaning it.  “You become liberated by repetition.”

Set a routine to take medication the same way every day – it will free the mind to think of more interesting things than “did I take my pill?” Make the next blood pressure appointment when leaving the physician’s office – no need to worry about schedule conflicts and medication shortages. Prepare a brown-bag lunch the night before – the time saved by not looking for something to eat will free up time for a daily walk.

An Expensive Rash

An excellent treatment for early poison ivy is a topical steroid cream. Low dose steroids, such as over the counter strength creams, not only are not helpful but can lead to exacerbation of the condition.  The continued itching and subsequent scratching can lead to infection and patient frustration.

There are a couple of often used products that safe and effective. These creams have been around forever – so long that only the generic product is still available. Imagine my shock when a patient told me that a small tube was more than $400! My database lists the average cost to be $25. I immediately called the pharmacist who said that the patient actually got an insurance discount and the full retail price is nearly $600.

It turns out that the ever increasing cost of dermatologic medications is a huge problem. For a variety of reasons, the manufacturers are leaving the market, resulting in shortages and prices that escalate in the face of demand. Those patients lucky enough to have insurance have greater out of pocket expenses – but one case of poison ivy can put a big dent in the deductible.

Fresh Corn

One of my favorite summer foods is fresh corn on the cob. I always get two ears per person: in my opinion that’s one serving and if by chance one ear is not so good there will still be a delicious ear to eat.

The fresher the better and a farmers' market is the ideal place to buy. Not only is the corn fresh but also it’s an opportunity to support local agriculture. I never spoil the corn by partially peeling the husk. Keeping the corn tightly sealed in the husk will keep it fresh. Once the husk is opened the farmer can no longer sell the ear. Choosing a good ear is simple: go for fat, firm and heavy. The process of sugar converting to starch is exothermic so if the corn is cool there will be plenty of sugar in the kernels.

Don’t remove the husk until the water is boiling. Peel the ear and remove the strings. Put the ears into the boiling water, cover tightly and turn off the heat. The corn will be perfectly cooked in 5 minutes and can be left in the closed pot for as much as 30 minutes without overcooking.

Buy corn the same day you plan to eat it. And while at the farmers’ market buy other local produce. Ask what it tasty – there might be something new to try.

The Farmers' Market Trail has year-round activities. 

Retirement

There are many tasks as one prepares for retirement: where to live, take a lump sum or monthly payments from the employer, how to spend the many newly available hours. In addition to the visits to HR, the real estate agent and the financial advisor I suggest one more stop: to your physician. It’s time for a frank conversation about how long you might live and in what shape.

If you have fifty pack years of smoking, an elevated blood sugar, untreated hypertension and a cholesterol greater than 300 I have a suggestion: take the lump sum and plan to live somewhere that your spouse will be happy as a widow(er). Fit in that one really great trip since you probably won’t have a long retirement. If you have never had a colonoscopy, can’t remember the last mammogram and think that immunizations are just for kids I suggest you relocate near a major medical center. You might need a good oncology team. The crystal ball is cloudy as to how long you might live – roll the dice to determine lump sum versus payout.

If you are in good health at age 65, take all your medications as directed and follow simple guidelines for weight, exercise, preventive care and immunizations you can reasonably expect to be in good health at age 85. Plan accordingly.

The most important preparation for retirement: keeping mentally sharp. Remember: you are not retiring from, your are retiring to.

Heart Attack Beginnings

Heart attacks have beginnings – and if recognized in time, these “beginnings” can be treated before the heart is damaged. People may experience mild chest symptoms, such as pressure, burning, aching or tightness. These symptoms may come and go until finally becoming constant and severe.

 Early symptoms may include:

            Nausea
            Jaw pain
            Pain that travels down one or both arms
            Fatigue
            Shortness of breath
            Back pain
            Chest pressure, squeezing or discomfort
            Shortness of breath
            Feeling of fullness
 

85% of heart damage occurs within the first two hours of a heart attack. Knowing the subtle danger signs and acting upon them immediately could prevent heart damage. 

Heart disease causes one out of every six deaths in the United States. 

In 2011, about 785,000 Americans will have a first-time heart attack and about 470,000 will have a repeat heart attack. Every minute someone will die of a coronary event.  

Take the Early Heart Attack Care Oath.

Gluten Intolerance

Famous Philadelphia restaurateur Marc Vetri wrote about the gluten  (GI) conundrum that he faces when designing his menus. “When someone has a shrimp allergy, I don't make them something that looks and tastes like shrimp, but isn't. I make them a great meal based on foods and flavors they can actually eat. Why would they want something "shrimpy" if they don't eat it? So, when someone doesn't eat gluten, I assume they don't want something "wheaty." With so many other choices available from our kitchen, why would they want faux pasta anyway? With Italian cuisine I can make anything they want to eat. Making them a gluten-free pasta--one that's most likely going to be crumbly at best, or chewy, but bound with some sort of chemical that mimics what gluten does to pasta--is the very last thing on my mind.”

Chef Vetri prefers another definition for GI: grossly ill-informed. About 1% of the population has celiac disease and truly gets sick from gluten. “Wheat is nutritious. In its truest form, the wheat berry has so many nutrients. It has protein, fiber and minerals such as zinc, iron, magnesium and potassium. How can a grain that is a basis of human civilization be bad for us? Wheat itself is not bad for us, but how it's used is a big part of the problem. Wheat nutrition depends entirely on the form in which you eat it, and weight gain is actually inversely associated with the intake of high-fiber whole grains.” It is what we have done to wheat that is the problem: over-processing and stripping out all the nutrition.

I am a fan of eating a wide variety of food and not excluding any one group. We should strive to eat minimally processed food and consider the source. Food comes out of the ground – not wrapped in plastic from a factory. If someone has reason to think that GI is a problem, consulting a physician is appropriate. Blood tests can be helpful and the definitive diagnosis is made with a small bowel biopsy.

The original Marc Vetri post.

A discussion about food allergies and intolerances.