Your Doctor's Dilemma

Doctor is a word that historically is synonymous with Hippocrates, Caduceus, men in long white coats and an evolving field of new wonders.  Today people fear the profession for the financial costs and distrust of the industry, but do so with respect for practitioners who went through 4 years of college, 4 years of medical school and up to 10 years of residency just to be able to provide specialized care.  Though still greatly appreciated by patients, the relationship has eroded over time to a point that physicians nowadays could call their patients customers. I will explain why and how medicine is no longer in the control of the people and healthcare with the help of the Affordable Care Act (Obamacare/ACA), Tea Party, and health insurance companies cannot work to benefit the people.  The problem is threefold and in the end patients will be the ones to pay for it.

Business Models

The number one reason most physicians joined the exclusive profession of as a Medical Doctor (M.D.) or Doctor of Osteopathic Medicine (D.O.) is to help people. The downside of this is that sacrifices must be made in order to provide our services.  These sacrifices as with a lot of professional jobs require additional years of schooling, increased personal stress, a substantial financial debt, increased time to marriage, less time home with family members and a high suicide rate.  This dedication and time has also lead to an unforeseen problem, and that is the business of medicine being taken care of by someone other than the doctor.  During the Nixon Administration, at the behest of Kaiser Permanente’s Founder, the great HMOs came into existence and the decline in health care began.  As a fan of capitalism I believe in the ability of private and public shared entities to make their shareholders the most amount of profit possible.  In the past couple of years health insurance companies have seen greater than 20% increase in their profit margin.  These companies make money solely if they can claim more than they spend, with the profit margin going to shareholders, bonuses and into new funds to help fight legislation they see as a threat to their profits.

This story and tale has been said many times, but how does it affect your physician?  First and foremost if the goal is to make money, a company should find ways to not spend money while getting the most amount of benefit.  Here in lies the billing structure of today.  There are many crafty ways in which your doctor can perform services and insurance companies can try and not pay us for these services.  An industry of coders on both sides of the row now exist, documentation far more important than time consumed seeing patients, and the turnaround time in some cases is up to 90 days.  A pregnant woman may see her doctor three times before being paid for the first visit, and if there is something in the documentation the insurance company does not like, well that can delay the process even longer.  This burden has made it easier for hospital systems to buy up small offices as they cannot afford the staff needed just from the billing aspects to keep a practice running.  By creating a higher barrier to entry or to maintain their business, the American Hospital Association (AHA) and Private Health Insurance companies have waged a war against each other, where administrators win and consumers and the workers that actually see the patient lose.

Barrier to Entry

Let us understand how physicians have lost the way and were taken over so easily by the administrative world.  As I stated earlier, those in medicine go through a tremendous amount of schooling to learn how to take care of their patients with little desire to learn about the business side of the field. They naively assumed that their valued care giving would be compensated.  Flattery, arrogance and a false sense of altruism have been a great downfall to the profession as well.  If someone were to get in any legal trouble, they would immediately call a lawyer, and when physicians are being told that some sort of change is beneficial overall, a private consultant who is a J.D. /M.B.A. should be consulted.  Why? Because doctors and are not capable of understanding savvy or cunning language that is used to allow someone else to make us work longer hours, produce more work or see additional patients for the same price or more.  This can be done at various levels, from hospital wide policies that create new rules that make physicians answer countless emails for free or reduce benefits such as a hospital lunch of soup and salad deemed too costly for the hospital to maintain.  All of this is done underneath the guise of increased patient care and hospital proficiency.  A simple change as not providing a soup and salad, however, can create a non-charitable loss in hospital morality and increase segregation of physicians of various practices who will not intermingle as before. 

This is what can hurt physicians in the hospital, but what about while they are in medical school?  A medical student in four years can be required to pay or obtain a loan for the sum of $150,000 to $200,000 for the total time of their education.   Undergraduate and Graduate school educations are on the rise, but what about the USMLE, the organization that charges for STEP 1, STEP 2 CK & CS and STEP 3 tests that doctors must take?  STEP 1 is comprised of Basic Science classes that for those not going into research are foundational, and costs $550+ to take the computerized exam.  STEP 2  has two parts, the computerized question format which asks clinical questions and costs an additional $550+.   I am not dumbing this down, but the english practice portion that was initially only for international students costs $1,200+.  This exam for foreign graduates had a pass rate of 77% in 2011 and the pass rate for US students is 95%.   This test was not always required of U.S. graduates, but when the pool of 2,000 plus students paying over $1,200 a person to take the exam was taken into account,  it was an easy choice for National Board of Medical Examiners (NBME) to make.  The end result is money from the masses to fill a few pockets.  Charging a one time fee to take an exam such as the Bar Exam that lawyers take would reduce the cost of medical school and would still ensure a physician is qualified to take care of your needs.

Infighting

Physicians are proud people, but pride often comes with foolish admirations and goals that make people lose sight of what is important.  Previously living in Washington DC, I learned about the many different associations that exist in the medical field.  The relatively small field of Physical Medicine and Rehabilitation has 3 different organizations: the AAPMR, AAP and the ABPMR.  Each of them claim their value from Board Certification exams that are $3,000+ and have never been proven to produce a higher quality practitioner when compared to Uncertified Physicans.  Aside from these physician created organizations, there are also lobbying groups that are aimed at going to Washington DC and fighting for “our rights.”  Per a lobbyist, the various organizations won’t even work with one another.  Surgical groups feel as if their cries are more valid than internist problems and issues and psychiatry groups think their special circumstances outweigh the problems of emergency physicians.  This profession has inherently decided to try and divide and then conquer while the American Hospital Administration (AHA) has always had one voice. 

As reported in the Times Magazine, the AHA has outspent the defense industry over the past several years.  One of the provisions they were able to get included in the ACA was to make sure that Medicare and Medicaid finances would not be given to a hospital that has physicians investing in that hospital.  Therefore a Cooperative Hospital , where the ratio of income from CEO to janitor is the lowest, waste is reduced and each employee has a vested interest in the competitiveness and efficiency of the company, would not be able to receive reimbursements.

Another ingenious trick that has been used for some time to promote Health Insurance, but helps keep physicians at odds with each other, centers around billing practices.  As the Times article referred to above noted, each hospital can bill at different rates for the same service being provided, and insurers from Medicare/Medicaid to Private Health Insurances pay a portion of this allotment requested.  Every time a customer receives a bill, they see the hospital/physician requested amount, the amount the insurance company has agreed upon, and the amount they are paying based on your deductible and percent coverage.   This only will provide a fodder to feed the fire of insurance companies and show practitioners as overbilling thieves.  In this case the field has unwittingly been divided and conquered.

So what’s the Solution?

I started writing my blogs to present a view that would be positive, informative and hopefully shed a light on the humanity of the world.  The good news is that physicians and medical students alike still care about patients and want to spend their time taking care of them, and answering phone calls and emails as they are able to without adversely affecting their time to spend with their family members.  Working a little overtime and getting in early to get things done is part of our hard work ethic and long years of studying, but these compassionate traits were seen as weaknesses and were capitalized upon.  The SGR fights with congress, to Centers for Medicare & Medicaid Services (CMS) systematical reduction of payments for procedures that physicians perform does not promote patient care.  Physicians historically and currently want to be the voice of their patients and do whatever is right to help them out.  Doctors for the most part do not understand business well, are not cunning,  and prefer not to waste time on anything apart from what they have been trained to do.  The field is here because to help people, but because these interests do not make companies money and doctors have a hard time understanding why someone will not pay them for what they did, it remains an uphill battle.  The savvy ones are able to find some loop holes that allow them to continue making money with a reduced level of stress, but the majority of physicians want to simply help everyone out and do what’s best for you.  Our healthcare system where patients face high premiums, outrageous deductibles that are hard to reach unless something catastrophic affects us, and physicians that spend more time with paperwork than with patients is not sustainable.  The only hope is for people to simply say no more, and to reject our current system and ask for a new one, but if history has taught us anything this will not happen in my lifetime.  The only other solution is to give this current system a heavy enough push that a revolt in the other direction is the only thing possible.

As the late Nelson Mandela said, "A good head and a good heart are always a formidable combination."  I only hope we have someone who is of this caliber to help with an issue that in the end is to the benefit of the people.

Till Then.

God's Greatest Gift

Thank You! These are the two words that every man should say to those who have sacrificed themselves to better our own lives. These unintended positive externalities most likely were not important to this population of people, but men around the world benefit from their lifestyle. Whether you’re a Republican, Democrat, Atheist or Conservative you should treat these gay men with the gratitude that they deserve and I will tell you why. So, thank you to the homosexual community that everyday makes sure that us heterosexual men do not have to compete with you.

Disclaimers:

Before I go any further, for those of you in Uganda or Russia you may want to share this with your friends via an anonymous email account as your legislative branches have in the past made it quite clear that they are not fond of homosexuality.

For the women out there that may be disappointed in this article because I fail to tell you the benefits you'll receive, I hope this satirical argument makes you smile a little bit and is a helpful reminder to men that you chose them despite our clear inability to be the fairer species.

The Past:

Conservative individuals, or those who think being conservative means making up a fictitious timeframe in the 1950s after World War 2 when America was “perfect.”  I would agree with them if it wasn’t for segregation, gender inequality, carving up of the Middle East and Africa and many other atrocities that history tells us about. If we were to go back further we would find that each decade there were themes or ideas that nowadays we would find fault. From the pedophiles of the Greek and Roman Empires to the Tibetan dictator like punishments subjected to their people. Even Mother Teresa’s belief that all those who were dying should suffer like Jesus, or Mahatma Ghandi’s articles published in many languages that the local Indian population in Africa was not like the indigenous Africans who were one step removed from animals.  Before I go off on a tangent, let me explain why even if you believe that men should not date other men you should embrace this idea.

My Argument:

Let’s take a hypothetical individual, we will call him Jimmy. Jimmy is a normal man of unflattering characteristics with a boring yet stable job. He doesn’t have much fashion sense and his desire to explore the world and be adventurous is best labeled as non-existent, but if you ask him he would say “I would love to travel someday.” Ashley, Jimmy’s date for tonight, is a well accomplished independent woman who took full advantage of the women’s suffrage movement and has earned herself a respectable job. Due to her believing she would be subjected to an unfair advantage in the work force, she worked diligently and networked better than the best of her male counterparts. She dresses well, enjoys putting on make-up and maintains her fitness level in the mornings so that she can have a good productive day. In a fair world and environment, this date never would have happened, but due to them both living in Washington DC the gayest city in the United States, Jimmy has the opportunity of dating Ashley. The selection bias has skewed results to Jimmy’s advantage.

I’m not a fan of prejudging others, but many men in the homosexual community prefer a better fashion sense, eat finer cuisine, enjoy cooking, like to shop, are extroverted, love to laugh and keep themselves in shape, while some of their heterosexual counterparts sit on the couch watching football, eating unhealthy take out, drinking cheap beer and peeing on the toilet seats. Of course women would prefer them over you, and if you blind idiotic men continue to force this issue and prevent them from being together in your ideal world, you will have many more nights to spend Harry Palmer Jr. Though you make think that homosexuality is a choice, or you may believe that it is an innate desire, these reasons are unimportant. What is important is that us single men have an advantage and our sons and son’s sons will reap the benefits for many years to come.

So next time you are out and you see two gay men at a bar, send a drink their way to thank them for all that they have done to make sure us heterosexual men don’t have to compete with them and their fancy clothes and emotional awareness. At this point the ladies maybe thinking, why in the world should we be thankful?  Sadly, there is no silver lining or easy way to say this, or as James Brown sang, “It’s a Man’s World.” According to Lesbian Life,1.3% of women think of themselves as homosexual and 2.8% of women think of themselves as bisexual. Though you have the right to vote, express your feelings, be respected in your workplace (though not financially), your pool of selection ranges isn’t that great these days, so if you find a good one, I’d keep him because good old Jimmy is out there looking for you.

In All Honesty:

On a serious note, this author firmly believes that everyone should have the right to do whatever they please as long as it does not adversely affect anyone else.

Till Then.

Ignorance Isn't Blissful

“Country roads, Take me home, To the place I belong” are the immortal words sang by John Denver, and artist I refuse to listen to days before any plane ride due to his untimely death.  That said, his lyrical ability to create beautiful sceneries is something that I’ve always appreciated as I’m stuck indoors under florescent lights with pseudo flooring as ill, damaged or dismembered patients await my service.  Though I love what I do for a living, my favorite hobby for which I spend most days thinking about is traveling and exploring the world’s various wonders, valleys, mountains, lakes and cultures that I’ve failed to educate myself about.

But traveling is expensive, out of my reach and just not doable for someone in my position.  This is the lie that people constantly tell themselves especially here in the United States.  I would say there are 3 main false barriers that people feel they are not able to circumvent.  Breaking down these walls will allow you to travel with confidence that you can open up your world from the small dot that is represents.

 

NUMBER 1:
First being the financially daunting cost of traveling as foretold by the Travel Agency Gods.  My roommate - and, yes, I have a roommate so that I can save money to travel -  came to me this year and explained to me that her school was having a trip in Italy to Rome and the Tuscany region.  It would only be for 8 days, would include food and accommodations, and tours all for the low price of $6,500 USD if at least 20 people went on the trip.  This would be for double occupancy and you would have to book your own flight of course.  For those that haven’t had the chance to travel much, that price is ridiculous!  It is taking advantage of students and a culture in which people are most likely unaware of the costs of traveling abroad and assume Europe with its Euros is expensive.  For Thanksgiving 2012 I went on an 11 day vacation from Dallas to Venice, from there I went to Croatia for a few days, then Slovenia for a couple of days, then trained to Florence and ended up my last few days in Rome.  Including my flight, hotel, transportation, food and miscellaneous expenses I spent under $2,500 and that includes the cost of flying my friend in from Turkey.  If you use websites like AirBnB or VacationRentals you can rent your own apartment or home and have all the comforts that a home offers.  For those of you who are students Hostel World, and if even more adventurous, Couch Surfing can assist you in finding affordable accommodations.

 

This is not all done without sacrifices, well what appear to be sacrifices to others, but for me it is simply a well thought out calculation.  By cutting out a cable bill, but keeping internet and switching to a phone service without a contract, I’ve reduced my expenses per month by about $100, which equates to $1,200/ year.  Now add in not eating out that often or my abstination from drinking out, since a bottle of wine for $9 is usually marked up to $36 when going out.  That alone can save you $100-$200/month.  Add in with other savings, such as sharing rent, and we are talking about $2,400 to $3,600/year or more. That amount of savings is enough to fly to Belize, eat well, stay in a nice place and return with gifts for far less than $2,400 for two people.  I only know because I did that trip last year during the high season.

 

NUMBER 2:
I don’t know if it is safe for me to travel.  My friends are hard to organize to go on a trip and I won’t go by myself.  Do they have all-inclusive resorts there?  Though I may understand one’s insecurity when it comes to going abroad or visiting a new place, and sometimes irrational thoughts and behaviors have an innate reason for existing to be protective.  But I do not believe that ignorance is bliss and there is a lot more to learn about the world and oneself than there is to lose.  If you have not traveled a lot, or have never ventured abroad I would choose a developed country over a developing country to begin.  The infrastructure, information, assistance from agencies and footprints of previous travelers are well ingrained in developed countries allowing you to travel with much ease.  There are developing countries like Costa Rica, Belize, Peru, Ecuador and Thailand that have a robust travel industry that also makes them an easy destination to plan from abroad. 

 

When traveling the only way to make sure you are alone, is to go stay in a hotel.  These are boring, dry and usually possess no inherent character of the local culture as they were most likely designed by a “creative” team in another country that read some books on the local culture, if at all.  While I was in San Carlos De Bariloche, Argentina a family of four from France were staying in the same hostel as I was, they did not share a room or bathroom with anyone else, just a room for themselves and another one for their children.  This allowed them to travel on a budget, retain their comforts and mingle with locals at the same time.  The worst hostel is no different than the worst hotel and I would never recommend them, but by using Hostel International or Hostel World you can travel alone, but as anyone who has stayed in a hostel knows, you’re never alone.

 

For my female readers I shall solely refer to my friend, let’s call her EB who amazes me with her various adventures.  At this moment she could be state-side, still working in Afghanistan or finishing up her trip up the East Coast of Africa before it was interrupted with her job opportunity in the Middle East.  She has lived East Asia, North America, Western Europe and now the Middle East all by herself as a confident woman who takes all the necessary precautions that are needed.  As previously stated, I would choose a location that is easily traveled to for your first trip, but there are many women out there who have conquered the world alone and their hard work should not be forgotten.

 

NUMBER 3:
This complaint really is the silliest of them and it saddens me people consider this to be a real reason to remain ignorant of the world.  Even here in the States I’ll hear people making fun of the fact they cannot do this task as well as locals.   English is the most widely spoken language in the world and only the second most spoken language to Chinese (Mandarin and Cantonese).  Through my experiences I find Spanish to be the second most beneficial language to understand as those two languages can easily help anyone conquer North and South America.  The moment I stepped off the plane in Argentina I could only say hello and goodbye.  When I left I was holding conversations and well immersed in the culture and to this day still miss it.  If you are not able to speak the language that is okay, since you’re reading this, it means you speak English and in most countries English is the form of communication for the travel industry.  From the cabs of Cyprus to the Train Stations in Budapest, English is well accepted and present on every ATM machine around the world.  It is one of the United States greatest exports via music, movies, and sports stars.  People love the fact they can practice with you, so dare you try to speak the local language they will probably insist on speaking English instead.  Don’t let that prevent you from learning the local language though, a friend of mine let’s say MF, did the same in Honduras for 3 years and to this day she has retained friends she has made there and is still interested in the news coming out of the country.

 

Final Thought
On this last note I would like to remind you of a man who not until his job forced him to travel, remained in the United States and never visited another country.  He was wealthy, well connected, famous and could easily have hired his own plane to fly him around the world, yet he stayed state-side.  He left office as Africa’s most favorite President, and ended up spending his 67th birthday there. President George W. Bush waited what was almost a lifetime before experiencing the wonders of traveling, and we all should learn that most of the time, it is the mind that holds most of us back, never the actual challenge. Live for the journey, since the destinations have always been there awaiting our presence.

Till Then.

Pigmentation's Useless Importance

African-American is a relatively new term given to a group of people who “historically” were brought over to the Americas via vessels and were assimilated against their will to live and become today’s generic African-Americans.  But like all things, the farther back you go the more you’ll realize that these people are not the original people from Africa to have made it the Americas.  To be factual about our origins and generational diasporas that have occurred since we could ambulate on two legs, all of us that now reside in the United States of America have our origin in Africa and are now living in America.  That uneducated term is reluctantly, if at all applied to White/Caucasian people who have moved to the United States and are simply labelled by whatever perfunctory term best suits them.

This post initially was born to explain the wonders and dynamics of traveling, but as “way leads on to way, I doubt if I ever shall come back.”  A favorite quote of mine, from Robert Frost in The Road Not Taken, is how I wanted to illustrate the beauties of opening your mind. But as I went on my tangent, I realized there was a more poignant and interesting post that could be written first.  

Race, as defined by the authoritative Merriam-Webster is, “a group of persons who come from the same ancestor.”  How far back must the ancestral line be? Could it define tribes or groups of people in the Amazonian regions as belonging to a separate race or are they simply just, “Natives” or “Native Americans?”  I travel not to visit the Turkish Race, or the Swedish Race nor the European Race, but it is to eat and learn about another culture.  Webster’s defines this word as being, “a particular society that has its own beliefs, ways of life, art, etc.”  Let’s take myself for instance, for those that simply will look at my photo, and the brief synopsis of my past would classify me as an African-American, my parents on the other hand would consider me to be a West Indian, and my Turkish friend simply calls me an Arab.  What’s the truth?  Wikipedia probably has the best definition of what I am, a Third Culture Child, but the true story is I’m a West Indian national who was born in the Middle East and raised there till I went to high school in the United States.  My educational yearning years took place in Connecticut, my early dating years were influenced by the Orlando area, but my educated and refining years took place in Washington DC.  And now, my professional lifestyle is gaining some influence from the Dallas area.

So, do I think I’m special?  No, I don’t think anyone is special or has a particular characteristic that is unique, the characteristics that we are comprised of does however make us special.  Race is no more important than a person’s height, eye color or weight.  These are features that may help us find a mate, or someone who you would enjoy doing like activities with, but they do not tell you anything about the person.  History tends to repeat itself as do sayings, such as “don’t judge a book by it’s cover”.  I challenge all who read this to listen to yourselves and friends when they make uneducated comments about another person’s race to correct themselves or their friend’s comments.

It is in this author’s opinion that one could be understood by the cultural traits they exemplify if defining an individual into a large group is necessary.  This could range from the Portenos of Buenos Aires to the hip hop culture portrayed by many different races.   Some of the fears of the late 70s and 80s were that a little white boy may listen to the hip hop music and be influenced and moved by it and be drawn “down” to that level.  I believe a Mr. Marshall Mathers would disagree with that theory, as would the many Producers, DJs, and Corporate Executives whose wealth is based on that industry.  Cultures are rich, full, unpredictable and for the most part they do not make any sense at all.  They do things in a certain way for a reason that may be outdated or silly, but it helps define that particular culture.  Whether they are characterized as German or American cold or Hispanic and Italian warm it is fascinating to see what these people of one race have become as individuals.  

I leave with this note that is geared towards my current hometown and many in America; just because his last name is Cruz, he may not be an undocumented illegal immigrant living under the radar and driving without insurance.  Then again, there are many things about Senator Ted Cruz that would not surprise me.

Till then.

The Worldwide Indisputable Way to Lose Weight

This morning I was reading an article in the BBC which stated, “Obesity rate in developing countries has increased 4 fold.” This is not only a developed world problem. It is a worldwide problem that most of us have ignored or tried to explain away through excuses for far too long. Government intervention has recently surfaced from NYC's former mayor in an attempt to ban enormous sugar drink sizes to the FDA indicating an intention to ban Trans Fats, and has not surprisingly but disappointingly faced much backlash. Yet, the rise of health care costs is affecting everyone one of us whether through the newly started Affordable Care Act or from your state's tax dollars that get funneled into health care at public/county hospitals. This isn't a forest fire but it is time people take responsibility for their actions and future repercussions, and hopefully those reading this will share this valuable message to others.

As it should be with my profession, I must first disclose if I have any external factors that may contribute towards the information I will be presenting in this blog.

Legal Disclosure: Those with health ailments or disease should first see their primary physician, or better yet a PM&R Physician (yes this is my biased opinion as it is my field of medicine) if they would like to become healthier individuals.

Personal Disclosure: I have nothing to disclose, and actually anyone listening or heeding this advice will cause the health industry to crumble upon itself as chronic diseases and problems such as Cardiovascular disease, High Blood Pressure, Diabetes, Depression, Sleep Apnea, Anxiety, Osteoarthritis and a plethora of other diseases and disorders can be better treated and cured in some cases if you and your family members simply follow this method of treatment.

For this section I want everyone to take a nice deep breath in and back out and leave your mind open to this suggestion. We, as an organism, are inevitability looking towards conserving energy. This may be done emotionally or physically. Emotionally we may ignore the fact that we are overweight or that a loved one continues to live an unhealthy lifestyle. Physicians may not reiterate that a patient is overweight and patients may ignore our words or most often provide us with prevaricated goals of future endeavors. This all leads to us physically conserving energy as fat or emotionally as guilt.

So, what are the excuses that people make for themselves and others? “It must be a thyroid problem” -- that’s one of the most popular. Let me include that Hypothyroidism is a real disease that affects 4.6% of the population, women more than men and is clinically evident in 0.3% of the population per the Cleveland Clinic. So for those overweight, obese or morbidly obese who think it is hypothyroidism, 99.7% of you are wrong.

As many friends have claimed they have lost weight with the Atkins Diet, Low Carb Diet, 5:2 Diet and even the Cabbage Soup diet. Is this so? Is it actually possible lose weight with these diets? The answer is a resounding YES! So doc, what is the best diet for me to follow and which one will make me lose it with the least amount of effort possible? That answer is an even easier one -- whatever diet you think you will actually be able to follow. WebMd agrees with me on this particular point. The reason is quite simple why every and any diet you partake in will work, it is all based on an input and output algorithm. It takes about 3000 kcal to gain or lose a pound of adipose tissue (fat). If your body, just to make the number easy, can maintain its current body weight without any form of exercise or movement on 2000 kcal per day, then reducing your dietary intake to 1800 kcal per day will cause you to lose 1 pound in 15 days. Any diet, no matter what the content of it being, from organic to toxin laden will cause you to lose weight depending on how much lower your calorie intake is compared to your normal metabolic rate. Don't know yours, then check Here.

Other excuses: “I don’t have time to exercise” or “I don’t like exercise.” The American College of Sports Medicine, NIH and other bodies of medicine recommend that children above 6 years of age perform 60 minutes of exercise per day, while adults perform 150 minutes of exercise per week or 5 days of 30 minute workouts per day at a moderate intensity. If you're not tired, sweating, or have an increased heart rate after 10 minutes working out you probably are not at a moderate intensity. Pick your favorite activity, from cycling, running, swimming, dancing, rowing, wrestling, boxing or whatever gets your heart rate up and do that for at least 30 minutes and you will burn calories. Unless you have a health ailment, are elderly or are in the category of obese to morbidly obese, walking will most likely be an unsatisfactory form of exercise.

Why, should you exercise besides the benefits I eluded to earlier? Not only will this enhance your level of happiness, alertness, confidence and perception of things in the world, it will reduce your healthcare costs, food costs, stress, anxiety, and provide you with coping skills for future ailments and challenges. I say this from my own experience when I lost my baseball career my senior year of college to an injury and gained 40+ pounds thanks to not exercising, drinking and feeling down. When I started medical school in 2006, I couldn't cycle 12 miles without taking a few breaks, let alone run a 5k. Was it easy to have now completed a couple half marathons and 7 years later to still have a personal best in a 5K.....No. Was it worth it? Yep, it was worth all the headaches, vomiting, pain, aches, tears and tribulations that are now fond memories.

The biggest failure people can make is to think that when monitoring their diet and exercising that they "deserve" a treat, cheat or break from that habit. This failure is not fatal as long as the treat or break is done in moderation. Dessert after every meal or dinner is not a treat, it is a habit, and should be modulated. Every time you increase your caloric intake or fail to exercise is another day in which you have taken a step backwards and though this may be warranted and per some data can help in preventing your bodies mechanisms from ascertaining a new metabolic rate, it is vital that these treat and rest days are few and far between. And if you can, choose greek yogurt with fresh fruit over a milkshake.

For those nitty gritty folks who will want the data necessary to plug it into their Fitbits, MyfitnessPal, or any of the other various websites that exist. Here is the individualized plan that can help you lose weight and attain greatness: 6-10g/kg/day of Carbohydrates, 1.2-1.7g/kg/day of protein and 20-30% of your diet should be from fats. If you're not used to calculating your weight in kilograms then simply divide your weight in pounds by 2.2 and you will have how many kilograms you weigh. Now I must say I didn't do any of this research myself and the numbers and additional information can be found at my the American College of Sports Medicine website. That's the direct link to the full article which is full of many treasures including some information on the magical gems that can be found about vitamins and minerals.

So we all in some way are muses, advisers and consultants to friends, family members and our associates. You may even feel fearful of starting the conversation with someone and feel as if it will hurt their feelings or strain the relationship. The sad part is if you really care about your neighbor, country or the future in general you will heed some of this advice and make a change now -- not next week or when you can easily forget it -- to either become a healthier individual or alert a friend and try and help them out.

I'm very adamant about this message, so if you or your friends want help or advice on the matter, email me at Ronald.Baptiste@phhs.org and I will personally answer the questions I receive.

Till Then.