5 Tips for Planning a Wedding During Residency

Shauna and Matey

My dear friend Shauna (who I met on an orthopedics rotation) recently married in the last month of her intern year. I asked her to share 5 Tips for those of you who are also planning your big day amidst the craziness of residency. This is what she writes...
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SHAUNA:
Planning a wedding during residency might not seem like the best
timing, but in medicine (especially in my field of Emergency Medicine) we know all too well that life can be unpredictable.  I met my fiancee in my fourth year of medical school, he proposed soon after, and we didn’t have much time to plan a wedding before our big move across the pacific ocean and to New York City for residency.

We wanted our wedding in Hawaii where our families still live and to have it in the summer (during my only vacation). The challenge was ahead... planning a wedding thousands of miles away during my intern year.  Sound impossible? I thought so at first, but it ended up being better than I could have imagined. Here are some tips that I picked up along the way...

1. OUTSOURCE, OUTSOURCE, OUTSOURCE.
As a doctor; you are probably accustomed to not asking for help and handling situations all on your own; however, this is not the time. There is no time to do it all, so I suggest you use your friends and family as much as possible. Get in contact with that friend from college who majored in communications, design or fashion and now, while you are working 80 hours a week, seems to somehow have all the time in the world. The one who is talking about the awesome art exhibit going on, or being FACEBOOK tagged while doing tequila shots at that new bar that you can never make it to.. This allows you to utilize your friend’s skills and at the same time creates an opportunity to see him/her . I had a friend who works in fashion help me scout out the best boutiques for wedding dress shopping, and she also did my alterations for free. Another friend, who majored in web design created our wedding website; and my chef friend designed our menu. Also, get your physically fit friend to be your personal motivator/trainer to stick to your wedding diet and exercise regime. Tell them that their help and time is the only wedding gift you will accept. Make sure to schedule any meetings about wedding details at that great new bar or restaurant they have been raving about so you can finally have a glimpse of their glamorous lifestyle while working on the wedding.


2. AS A PHYSICIAN YOU SHOULD KNOW WHEN TO CALL IN A SPECIALIST. 
It is essential that you hire a “day of” wedding coordinator. I initially thought I could get away without one, but I am so glad I eventually came to my senses. Most charge $1000-2000, which seems like a lot to spend for one day of work, but my day-of coordinator was worth her weight in gold. Talk to friends that have hired a day-of coordinator for their own weddings, or find a good one on yelp.com or wedding websites like theknot.com. My coordinator prevented many disasters from happening, and pulled together all the
details of the wedding day beautifully.

3. CHECK IN WITH YOUR FIANCEE AND DIVIDE THE TASKS. Often when wedding planning one person finds themselves taking the reigns, while the other partner may end up feeling left out or under-represented. You already have very little time with your fiancee as it is being a resident; don’t let the wedding become a third wheel. Even if your partner states he or she has very little interest in the wedding planning; give your fiancee free reign over aspects that they find most interesting. For instance, my fiancee could care less about place settings, or flowers, but he wanted to be in charge of the band, the play list, and the alcohol. Make sure that both of you are involved, and try your best not to let wedding details become a source of discontent on the home front.


4. YOU MUST SPEND SOME TIME NOT WORKING AND NOT PLANNING.
Balance is important; you don’t want to expend all of your energy on one day and hate the other 364 days in the process. Your free time is vital and limited; use some of it doing something totally unrelated to work, or
wedding planning to develop the other aspects of your life and relationships.


5. DON'T SWEAT THE SMALL STUFF.
Seriously, you work in an environment where people live and die every day, you have witnessed much more in the last few years than most people will see in their entire lives. Your experience in medicine gives you a unique insight that allows you to see beyond the minutia (to put the inner bridezilla at bay). Yes, you might be a type A personality; partially how you got through medical school, but remember your patient’s need your attention to detail, so let the wedding planning be the more relaxed and enjoyable part of your life.

In retrospect, the time I spent on insignificant details was not really worthwhile at all. I can’t recall what color the ribbons around my roses were. I don’t really remember what font I used for the program, or who sat where and how many forks each person had… what I do remember is the look in my fiancee’s eyes when I walked into the church, the words my dad whispered to me as he escorted me down the isle, and the crazy dance moves that my 90 year old great uncle bill threw out on the dance floor to “sexyback”.

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Congrats to Shauna and Matey!
Thank you for contributing to HOSPITALstyle.

(If you would like to write for HOSPITALstyle send me an email to HOSPITALstyle@gmail.com)

The Perfect Christmas Gift for a Doctor you know...

 It is that time of year again, the time between Thanksgiving and Christmas, filled with anticipation and holiday parties. Meanwhile, there are even more patients in the hospital and you are working extra hard with the hope that you will have at least one of the holidays with your family and not on call in an intensive care unit. What do you do with little time to shop? I think that for many of us, online shopping is really the way to go. And for the doctor-(friend, girlfriend, boyfriend, sister/brother, mother/father, son/daughter, fiancee, not really defined colleague) in your life I have the perfect no-fail HOSPITALstyle approved x-mas present.

Buy them a pair of TOMS shoes to wear with their scrubs!


The story behind TOMS (shoes for tomorrow) is that their founder Blake Mycoskie after a trip to Argentina decided to form a company that is socially driven by the concept ONE for ONE. He designed a shoe inspired by the traditional alpargata shoe in Argentina and decided that for every shoe he sells, that he will give away one pair to a child in need around the world.

I have had a pair of TOMS for 3 years and love wearing them with my scrubs. I have given them as gifts and they are always a BIG hit! We spend our lives helping people on a daily basis within hospital hallways, so why not help one more child while shopping for Christmas presents.

TOMS shoes website www.toms.com

TOMS shoes are good for the sole and integrate a great cause into your HOSPITALstyle. They prevent injury to feet, prevent disease, and allow kids around the world to go to school in shoes. The perfect Christmas gift for the doctor you love!

A 15 minute Workout fit for medical residents

We preach to our patients on a daily basis that an exercise regimen is an essential element to living a healthy life. I have partnered with my good friend and fitness model Amanda Russell to bring easy to do workouts to the medical community. Having competed in marathons and triathlons prior to residency, I know find that my workout is the first thing to go on an extensive to do list (on my days outside of the hospital). I no longer have time for the endurance workouts I have done in the past. Amanda's entire fitness message (The AR Program) is about achieving a runner's body without running all the miles.  Having worked out with her on many occasions I have come to agree with her vision of quality over quantity. Check out this video on a 15 minute rejuvination workout, that any resident can make time for. Also check out her website at http://www.amandarussellworkouts.com/. Glad to have a workout that can keep me and my HOSPITALstyle in shape. Thanks Amanda!

5 Tips for Marathon Day

It is marathon week in New York City. The banners are hung. The race route scouted out. The city of New York is ready to welcome thousands of international runners and spectators. I will be working the medical tent at mile 24, so if you are around please come say hello! Having run the marathon in the past I have 5 tips for a successful and healthy marathon.

1. Avoid NSAIDS (like ibuprofen) which can precipitate electrolyte imbalances during high endurance athletic events.

2. Drink no more than 1 cup of a sodium containing sports drink every 20 minutes to avoid hyer-hydration and hyponatremia (low sodium) see attached post: http://hospitalstyle.blogspot.com/2010/10/hyponatremia-in-athletes.html

3. Pace yourself the first 13 miles (run slower than you feel you can, the good race depends on the second half). There are often pace bands that you can keep on your wrist and check each mile marker.

4. Increase salt intake 3 days prior to race (unless you have high blood pressure). Bring a packet of salt to take around mile 20 to prevent muscle cramping. You can pick this up at any local fast food establishment, or deli around the city.

5. Keep warm before the race. There is an area to throw off your extra layers at the start and they then donate these items to charity. Stay warm. Help others.

On marathon Sunday in NYC the best parts of the city are on display. It's sense of community. It's energy. It's inherent value of achievement.  It's beauty.  Run hard. Run fast. I will be there cheering you on!

Why higher suicide rates in Medicine?

There was a recent article published in the NY Times about the increased risk of suicide in medical students and doctors. 

http://www.nytimes.com/2010/10/07/health/views/07chen.html

This article displays the EXACT reason why I started this blog about healthcare lifestyle. The truth is we need it. We need balance.  There is an interesting dichotomy that while we are devoted to others, we often forget to take care of ourselves.  The stressors we face on a daily basis constitute a psych consult for ourselves.  However, there are many colleagues who are experiencing the same situations day in and day out to whom we can turn if needed.

Ever since reading this article, I am not quite sure (having been/going through) the process of the cause of this increased risk of suicide in doctors.  I have seen burn out, but I have also seen some of the most committed, driven, and intelligent people I have ever met who meet obstacle after case after problem with a calm demeanor.  Perhaps it is not the type of people, but the process which entails hours of isolated study, numerous examinations and continuous evaluation until your 30's, lots of medical student debt that continues to accrue despite earning probably less than minimum wage throughout residency, meanwhile managing your patient's emotions, sickness, and death along the way. 

Medicine is a field in which we need to prove ourselves over and over day in and day out.  There is always a looming lawsuit around every corner.  Our hours are irregular and often offset from the rest of the workforce.  Despite all these things, the type A personality, who is achievement driven can escape victorious in having conquered all of the aforementioned demons along the way of becoming a doctor.  And I truly believe that it is worth it. Maybe that means I am crazy, or maybe it means that I believe in the true value and calling of what our profession stands for and strives for.  Maybe the arduous road is to weed out those who do not belong among us, but at what cost? I think that we must do more for eachother.  We as doctors need to figure out why our suicide rates are higher and we must do something about it. Now! We cannot spare another colleague's death.

The ART of saying Thank you.

If you are successful, it is because somewhere, sometime, someone gave you a life or an idea that started you in the right direction. Remember also that you are indebted to life until you help some less fortunate person, just as you were helped."—Melinda Gates  

Thank those who help you.  Receive thanks by those whom you have helped. And the cycle of gratitude will continue.

One of the joys of working in the healthcare field is that we get to have a real impact on real people and are blessed with the opportunity to make a difference on a daily basis. On the other hand there are many people who have had an impact on us.  Our journey is long and therefore our teachers are many. Our attendings. Our residents. Our nurses. Our patients.  In the era of Facebook, Twitter, and Gmail we are often so busy that the ART of saying "Thank you" has been somewhat lost, despite the fact that it is easier. 

The ART of saying Thank you is taking the time to write a personal note of gratitude to someone that unnecessarily went out of their way to help you (I prefer hand written, but an e-card will suffice). The acknowledgement of their efforts can be best displayed by taking the time out of your own busy day to give them a thoughtful note. With your style and in your own personal way.

Each time I get a Thank you in any form, my decision to pursue a career in medicine is validated. I feel useful. I feel appreciated. I feel valuable. It is in times like these that I can say all the hard work and sleepless nights have payed off.  If we could bring back the dying ART of a simple Thank you, our world would be a better place. A place of kindness, communication, and gratitude.  I hope you will join me and incorporate the ART of saying Thank you into your daily HOSPITALstyle.

xo Kristin

Hyponatremia in Athletes

HYPONATREMIA: The most serious cause of exercise associated collapse

 A potentially fatal condition that can be seen in endurance athletes when their sodium levels drop too low either from hyper-hydration or from dehydration.

Dehydration = a low blood level resulting in low sodium content

Hyper-hydration = diluting the level of sodium

NORMAL 135-145

MILD   131-134

MODERATE  126-130

SEVERE  Less than 126

Too much H2O (water intoxication) can cause a lethal physiologic reaction where water rushes into cells including brain cells. 

Doctors can misdiagnose it as dehydration and mistakenly treat with IV fluids

How it happens:

During high intensity exercise, sodium is lost along with sweat. Athletes can lose up to 2 grams of salt per liter of sweat.  An athlete who only replaces the lost fluid with water will have a decreased blood-sodium concentration. Sodium balance is necessary for transmitting nerve impulses and proper muscle function.   

Consider a full glass of salt-water. If you dump out half of the contents of the glass (as is lost in sweat), and replace that with water only, the sodium concentration of in the glass is far less and the water is more dilute. This can occur in the bloodstream of an athlete who only hydrates with water during excessive sweating. The result is …… HYPONATREMIA

RUNNER’S PROFILE: Mark Robinson

Completed Boston Marathon at age 27

Drank gallon H2O before race

A cup at every drink station

Drank H20 after finishing race despite vomiting

Collapsed in parents home

Air-lifted to a Boston Hospital

Misdiagnosed with Dehydration, Given fluids

Was in a Coma for 4 days before recovering.

SIGNS OF HYPONATREMIA

Headache

Confusion

Nausea/Vomiting

Cramping

Bloated Stomach

Altered Consciousness

Swelling in extremities (fingers and ankles)

Seizures

Lethargy

FOR ATHLETES: HOW TO AVOID HYPONATREMIA

Use a sodium containing sports drinks during long distance (more than 60-90 minutes long)

Increase salt intake per day several days prior to competition (except for those with hypertension)

Try not to drink more then you sweat

During a marathon a good rule of thumb is to drink about 1 cup of fluid every 20 minutes

Avoid use of NSAIDS (like ibuprofen) medicines that contain sodium during event.

FOR PHYSICIANS: HOW TO AVOID PITFALLS IN THE TREATMENT OF HYPONATREMIA

Do not misdiagnose Acute Hyponatremia as Dehydration and give fluids and cause CEREBRAL EDEMA

Do not use Hypertonic saline in patients that do not have signs of CNS involvement

Do not correct Na greater than 4-6 meq/L and cause central pontine myelinolysis.

ACUTE

When serum sodium concentration falls rapidly

Over 24-48 hours

The compensatory mechanism is overwhelmed which can lead to cerebral edema and brainstem herniation

CHRONIC

Develops over more than 48hrs

Experience milder degrees of cerebral edema for a given serum sodium level

Brainstem herniation has not been observed

The causes of morbidity and death are status epilepticus (when chronic hyponatremia reaches levels of 110 mEq/L or less) and central pontine myelinolysis when corrected improperly.

The distinction between ACUTE hyponatremia and CHRONIC hyponatremia has critical differences in proper corrective therapy.

Acute evolution of hyponatremia (as in marathon runners and high endurance athletes) leaves little opportunity for compensatory extrusion of CNS intracellular solutes.

Hypertonic saline (3%) on a rare occasion may be used to rapidly increase serum sodium level in patients with severe acute or chronic hyponatremia if manifested by severe confusion, coma, seizures, or evidence of brainstem herniation

An increase of 4-6 mEq/L over a few hours is sufficient. Further correction is dangerous and must be avoided unless necessary to correct continued seizures or other severe CNS abnormality

Equation for use of Hypertonic Saline.

Required volume = (Na desired - Na current)(TBW) / (Na Fluid- Na Current)