Morbidly Obese & Morbidly Malnourished

Today, we did (6 moths ago) a fluoroscopic upper GI series on a patient, my age, who’s 700 lbs. I was so depressed when I saw her entire bare back with excess subcutaneous adipose tissue hanging in rolls behind her as she walks the hall into the fluoroscopy room. I rushed up to try to tie her hospital gown so she was not so exposed in public, but I was not very successful and she told me it’s alright. I looked down at her feet, and saw that her legs were red and scaly, likely from chronic venous insufficiency, and the flesh on her ankle literally spilled over out of her shoes. I felt so bad. I felt angry too. Angry at our government and schools for not educating us on healthy food and lifestyle choices.

Angry that our law makers are in the deep pockets of the big corn, big wheat, super processed food industries. Misinformation on what truly healthy diet is and purposeful lack and negligence on information against how harmful process foods are.


I’m certain that this 32 year old young woman has tried to lose weight, but how could she? When our government tells us that fat is bad and allowing all the food manufacturers to hide glucose everywhere in all the process foods from white bread, to chips, to sugary drinks.

Go to supermarket, notice how you are greeted with colorful boxes of food-like products (so processed that they are depleted of vital nutrients, and so enhanced that they are loaded with fatal toxic chemicals) that could last a lifetime with the amount of carcinogenic preservatives (some listed, some not even listed in ingredients, as FDA has allowed food companies to Not list ingredients < than a specified threshold percentage or weight.)

She is so young, she could have such a life. She did not become 700 lbs overnight. She must have tried, I know she did to shed weight. But she told me she thought fresh foods and vegetables are more expensive the than the ubiquitous process foods. It probably didn’t help her at all to have to walk to the every end of the supermarket just to buy some fruits and veggies, even when she was ½ her weight. She would have suffered quite a bit discomfort including joints pains from weighing 350 lbs and my height, 5’5”.

We modified the exam protocol for her because there is no hospital table that could bear 700 lbs. She had to stand while we use C arm to take images. She requested to sit down after standing for 2-5 minute interval. I felt her pain, only it wasn’t in my joints, it was in my heart.

After we finished the exam, I wished her good luck on her bariatric surgery and I shared that it would be great to watch a few food documentaries such as Food Matters, Fed Up. I told her how the food industry hooks us with sugar and use many toxic chemicals to stabilize their food-like products. I encourage her to go the fruit and vegetable sections and cook a few things.

I recently learned from the food documentary Hungry for Change that modern western people are not able to shed weight because they ingest so many toxic chemicals and their bodies natural response is store adipose tissue to buffer against the toxins and to protect vital organs from the toxins. Many of these preservatives, food stabilizers are fat soluble chemicals, in other words, fat can isolate the toxins from the blood (mostly water) and from the rest of the body. So when a human body is loaded with toxins, the body holds onto the fat or even make more fat whenever there’s an energy source, in order to store the toxins, away from the rest of the body.

So for those who try to work out really really hard, they are only burning some fat, against the body’s natural instinct to retain fat when there’s toxin around, and exposing themselves to toxins simultaneously.

Not only is it way harder to get the fat off, as one works against his/her body, but also the impact of losing some fat is not positive on one’s overall health.

So to achieve a healthy weight one should eat healthy, cleanse the body of the toxins from process, nutrition-less foods. When the toxins are gone, the body lets go of the fat it uses to buffer against the toxins. Additionally, when we stay away from the process foods and eat simple, wholesome fresh produce and protein sources, our bodies send signals of satiation as it gets the vital nutrients it needs. By switching from process foods to foods from Mother Nature, our body lets go of fat and let us know it’s happy and fed. Losing weight becomes a by-product of nourishing our bodies and protecting our bodies against toxins.


I hope the documentaries will empower her with knowledge to nourish her body appropriately. I pray that she will enjoy a full life as she is so young and has much to offer our society when she can get on her feet.


“There is in fact a stunning parallel between our physical morbid obesity and our financial morbid obesity.

We have expanded our lifestyle beyond control as a nation, 95% of sharing 5% of the national wealth,

and a great percentage of the 95% majority Americans are becoming the consuming poor,

forever buying, ever trapped in worsening poverty.”


It’s the same as the 700 lb 32 year old girl who was over-fed yet incredibly malnourished simultaneously. As a nation, we ought to start making healthier food, lifestyle, financial choices.

Don’t consume for consumption’s sake. Know the true value of what we consume, with our money and with our bodies. Our ultimate pursuit in life is happiness, joy, peace, of lasting qualities. Not fleeting sugar high followed by debilitating sugar crash, not the rush of endorphin from paying to possess a $500 purse. Let’s get back to our roots, create with our minds, help a neighbor out, gratefully take from Mother Nature, stop short-changing our bodies and ourselves with short cuts/processed food-like substances.

While we are conscious with our food choices and generally eat pretty healthy, homemade food from fresh produce and good protein sources, we give into our addition to process foods sometimes. We have lots of room to improve too. Will update you in a month on how we are doing.

4 Ways to Tax-Free Money Everyone Should Try

1.       Cash back from credit cards.
We all need to eat. Buy your groceries, and in fact all your necessities with a credit card with good cash back. While most people settle for cash back of 1-2%, with a little google search, you can easily find cards that will give you10%-30% cash back. I got 20% cash back from discover it + 10% off gift cards from Sprouts farmer’s market on 4k worth of grocery gift cards.
Right now, you can still manage 10% cash back from discover credit cards. Sign up or find an even better card yourself.


2.       Up your loyalty for even more cash back.
Banks like to have ALL of your money. So the more banking products you sign up and the greater your total assets reside in one bank, the more rewards you get such as better mortgage rates, faster turnaround time on your deposited checks, and greater % of cash back associated with purchases.
For example, when I get my measly 1% cash back from my BOA cash rewards VISA card, I can get additional 10% cash back on that cash reward by depositing it into my BOA checking account.
But when I have more than 20k in my BOA accounts, that additional 10% cash back jumps to additional 75%, which means each dollar I charged on my BOA VISA card, when deposited into my BOA account now earns me 1.75% cash back.
This can especially work to attending physicians’ advantage.


3.       Fund bank accounts with credit cards.
Some banks allow you to open new bank accounts and fund these accounts with credit cards. I used to open Citibank online checking accounts and then fund it with my BOA visa cash back reward card. Each time I open a Citibank and fund 50k from my BOA credit card, I make $550 tax free money (because it is cash back associated with “purchases.”)
In 2015, I made over 3k with just over 2 hours of my time by opening a few Citibank checking accounts.  What I love the most about this is that it’s completely tax free. Not because I did anything, just because BOA credit cards processed my action of “funding Citibank account” as a purchase and cash back associated with purchase are tax-free.


4.       Pay your high interest debt.
It’s tax free and guaranteed. I like being the bank and don’t like paying anyone interest unless I know I’m leveraging a debt for higher return on investment elsewhere. So if you have >6% interest rate debt such as student loans, I highly recommend that you pay it off.
When facing the pay down debt or invest, I’m somewhat of an extremist, I didn’t start my Roth IRA until I completely paid off my 6.8% student loans because I really liked the guaranteed ROI when paying such a high interest debt.


 If you like this article, you might enjoy other DWM articles on Personal Finance, Investing, Retirement, Practice Management, & Lifestyle.

All articles by DWM are for informational purposes only and not intended as a substitute for professional advice. Please consult a professional accountant, financial adviser or lawyer, before making financial decisions.

 

2017 New Year Gift to Self: Not Clothe-Shopping for 3 Years

I recently stumbled upon Mrs. Frugalwoods and was very inspired by her.

I thought that I had a ridiculously high savings rate, allowing me to retire by 2023, within 2.8 years of finishing fellowship. Most (soon-to-be) radiologists look at me like I’m some sort of weirdo who derives pleasure from “beneath-average-physician-standard-of-living” and obsessed with saving.

Reading Mrs. Frugalwoods articles produced as a stay-at-home mom on their 66 acre ($400k) homestead in Vermont reminds me why I am so happy and not the least deprived living the standard of living I enjoy today.


Furthermore, she inspired me to save more and cut out all the silly purchases.
Effective today 7/20/2016, I will not buy clothes for myself for 3 years. I’ll check in periodically and fess up if I falter for the next 3 years.
Here are 10 reasons off the top of my head why I think this vow is a natural next step in my life.


1.       I have all the clothes I need.
2.       Everything (other than food) I’ve purchased in last 12 months did not increase my quality of life.
3.       I only use 10-20% of what I currently own.
4.       I dislike clutter. I love space.
5.       I have no time to shop. I’m a resident/blogger/tutor/mom/author/lecturer.

For 5 more awesome reasons to my shopping ban, you may read the remaining article here, published on Physician’s Money Digest.

Then make comment or ask questions on this blog; I usually answer them within 24-36 hours.


 Personal Finance, Investing, Retirement, Practice Management, & Lifestyle More articles like this on Physician’s Money Digest.

3 Top Reasons Society Should Love Doctors More

 

Why do we rare hear of heroic cardiothoracic surgeon saving the life of patient with AAA rupture but we hear about doctor scandals with such as a M.D. overdosing from medication or another swindling cancer patients out of their living days and life?

Why do Hollywood celebrities in skimpy clothes make way more money than similarly attractive female doctors, NP, nurses?

Why do NBA players get so many fans and makes millions than doctors with equal caliber physical and mental stamina and prowess?

Since when do patients and the rest of the society turn against their very own health-care providers?

 

While we unfortunately get bad press as health care providers due to a few rotten apples, which happen in every walk of life/line of profession, I want to speak up for us and reveal some facts perhaps unknown to the non-white-coats.

 

  1. We chose medicine though it clearly is not the path of least resistance.

When I look around me, I am astounded by those surround me in medicine, from technologists, nurses, NP’s, PA’s, residents, fellows, to attending physicians. Any of them would be incredibly successful and wealthy if they had chosen a better paid career, NBA players, Hollywood, modeling, business.

With the exception to a few nerdy-looking people like myself, there are an overwhelming amount of good looking gals and guys in the health care profession.  Just scroll through the Staff/resident/fellow pictures at UA/BUMC, I’d say there are few girls who would have made it big in Hollywood if they chose so.

Ironically, the play doctors in Popular TV show “Scrubs” are much better compensated financially & socially than real docs and nurses. Yet look at these Hollywood material girls training and working so hard to be real doctors, working 80-100 hours weekly through their golden 20’s or 30’s, 4 of these years in medical school, paying 50k/year tuition for the privilege to work every day that ends in day.

Another example, have you ever wonder about the neurosurgeon who just finished a 18 hour surgery? Such physical stamina could fuel success and excellence in any line of sports. How about the work ethic of health care providers? Anyone with the dedication to study or work 16+ hours/ day and sustain this intensity for 10-20 years would have easily made it as a CEO of any fortune 500 company.

Turning down opportunities such as NBA players, Hollywood celebrities, or fortune 500 CEO’s, we strive and struggle our way to put on our white coats and to serve fellow human beings. We too are human, and we too need love and support.

We care about the well-being of another individual beyond our loved ones and ourselves. We pay our way, finically, physically, mentally, psychologically, socially, and relationally, for the privilege to serve.

  1. We make inhuman sacrifices.

Look around us, how many marriages, relationships are broken as someone go through their medical training, from medical school to residency, well into attending physician stages. The amount of stress from all fronts, physical fatigue, mental exhaustion, financial stress (with 300-400k of student loans snowballing at 7%), shaken confidence (from being tested/evaluated repeatedly in small and large intervals), is simply inhumane.

Now why would you treat the natural bleeding hearts of our society (those who care enough a stranger to serve them and to carry the weight of someone else’s life or death on his/her shoulders) with such inhumane demands and expect nothing less than bedside manner and stellar test scores?

Something’s ought to give.

Unfortunately, for those of us who chose to put another human being’s wellbeing above our own needs, we are taken for granted.  We are expected to not crumble like any other human being would under extreme pressure and run the code and bring an acutely dying patient back from the cold arms of death.

  1. We are tested and charged in every way possible.

When we signed up for medicine, we signed for a lifelong privilege to be tested, evaluated, and examined into our 80’s if we choose to practice until then. From pre-SAT, MCAT, DAT, PCAT, to USMLE step I/II/III, general medicine boards, specialty medicine boards, to interval recertification/licensure exams. We are the most tested profession on earth. What’s worse, the people who made the laws to test us throughout our entire career are not health care professionals. This makes little sense to me. Additionally, these examinations are incredibly expensive.

USMLE Examination Fees 2017

 

Step 1 $605* Three month eligibility periods beginning November 1, 2016 – January 31, 2017 and ending October 1, 2017 – December 31, 2017
Step 2 CK $605*
Step 1 and 2CK $70 Eligibility Period Extension (requests received starting January 1, 2017)
Step 2 CS $1,280 For completed applications received starting January 1, 2017.

 

COMLEX-USA Exam Fees

2015 & 2016 Fee Schedules

COMLEX-USA Cognitive Evaluation July 1, 2015 –
June 30, 2016
July 1, 2016 –
June 30, 2017
COMLEX-USA Level 1 $590 $615
COMLEX-USA Level 2 Cognitive Evaluation $590 $615
COMLEX-USA Level 3 $800 $835
(Exam fee is determined by the registration date)

 

 

 

 

 

How Doctors Can Stop Living Paycheck to Paycheck

I was inspired by Passive Income M.D.’s post on Why Doctors Live Paycheck to Paycheck (P2P) and would like to offer some suggestions to live the other end of the lifestyle spectrum of P2P.

I lived P2P once, in college and in medical school. These are times when my full time work is to study and learn while paying a hefty tuition to do so (50k/year for 4 years of medical school). I was able to pay off my student debt a few months after graduating medical school because I always had a plan and I was diligent and disciplined (mostly) about it, even though my cash flow was quite limited and expenses were high as a student in a Bay Area medical school with annual cost of attendance between 80-100k.

Now that I no longer pay 50k a year just to learn and study 80 hour week per week but instead enjoy a wage of 60k annual salary as a radiology resident, I continue to have a plan and stick with it.

What I have found is that not only am I not living P2P, but also, I’m accomplishing my financial goals much faster than what I had planned.

So here are some ideas on stopping the vicious P2P (paycheck to paycheck) cycle.

Set a goal.

In fact, data from the Harvard MBA program showed that the 3% of graduates with formal written goals earned 10 times as much as the combined 97% of those without.
A goal may simply be:

  • I will pay off my student loans in 5 years.
  • I will max out my Roth IRA, 401k, and my kid’s Roth IRA starting this year.
  • I will pay off my home in 15 years.
  • I will save $100 bucks more this month.
  • I will do everything I can to get my company match this year.
  • I will save 30% of my income this year.

 

 

Track expenses.

This may seem painful at first. But do it so that you know where you money goes. Identifying your expenses is the 1st step to evaluating whether these expenses are truly worth the money you spend.

 

Make a budget.

My rules for making a budget includes:

  • Pay myself first by making my saving/debt pay down goals as my #1 non-negotiable expense.
  • I don’t spend money on anything that doesn’t bring me joy.
  • Things usually don’t make me happy.
  • Experiences, learning, and serving others do.
  • Spend a little on things/causes that make me happy. For me, these include Mini wise money (my 8 year old)’s pilot and equestrian lessons, a little vacation fund for the family, and sponsoring Mariela in El Salvador.

 

Actually pay yourself first.

Do this by sticking to your budget where you commit to how much you want to pay yourself (build your net worth), either paying down debts, buying producing assets like index funds (low cost).

If you find that you’ve cut out all the fat in your budget but still in the red at the end of the month, then consider the following:

Do you have too much house? Too much car? Too much vacation funds? Eating out too much? Do you really need cable? (hint: you don’t.) Is your high speed internet really necessary? Can you use work internet and just stick with phone internet after work? (Why are you on the internet rather than spending time with your loved ones anyways?) Spending too much on mobile phone services? (check out FutureProof MD’s article on reducing cell phone bills)

Get out of the trap of paying everyone else first and give yourself what’s left. You deserve more than that.

 

Surround yourself with like-minded people.

It’s difficult to explain to my friend who’s ecstatic from her 5th coach bag why that doesn’t make me happy and why saving money for my family’s future make me happier. It’s difficult to quit smoking, no matter how much you know it’s bad for you, if all your friends are chain smokers.

You can still love and care for those who are not taking care of their finances and future, but definitely seek out those who have successfully practiced the way you want to live.

 

Passive income.

YouTube. Blog. Books. Share your knowledge, expertise, and experience via these channels where once you put in the time to create the product, you could be sleeping or vacationing while the product generates income for you. Passive Income M.D. has lots of great ideas on doing this!

 

Smart credit use.

Ever thought of making money with credit cards on your necessities such as groceries? How about lowering your interest rate to help you pay of debt faster? When you dedicate $2000/month to pay down a debt/liability, without increasing your payment dollar amount, you can pay off that same debt sooner if you switch it from a 7% student loan to a 0% interest credit card balance, right?


If you like this article, you might enjoy other DWM articles on Personal Finance, Investing, Retirement, Practice Management, & Lifestyle.

All articles by DWM are for informational purposes only and not intended as a substitute for professional advice. Please consult a professional accountant, financial adviser or lawyer, before making financial decisions.