May 16, 2018

Wisdom from the ER: 

• A patient told us that a very angry 5-foot-4 bald man would be looking for her. She was in a bad accident and she was thinking about her frantic husband. Minutes and even hours can fly by in the hospital, and this time feels like eternity to family members who are not informed. Usually the chaplain makes sure we get out to update the family, but it is always highly appreciated when we inform family as soon as possible. • The discharge order can wait, your coffee can wait, get out and reassure them.

Fasting wins again:

• Researchers found that a 24 hour fast in rats induces intestinal cells to begin using fatty acids instead of glucose for fuel (not newsworthy). Via the PPAR receptor, this action increased intestinal stem cell regenerative capacity. No reason to doubt this would take place in humans. Humans begin to use fat as fuel when the sugar runs out. In true American fashion, they also found that a drug acting on PPAR could induce these effects. • But why take a pills? Just skip a couple meals and burn some fat. 

Unilateral exercises:

• Dan John is full of practical, simple ideas. See this brief article related to one-arm versions of olympic lifts. They are easier than the two arm versions. You use less weight and get very tired. Instead of benching a barbell, go grab a dumbbell and try to push it up with one arm. Be prepared to fall off the bench. • One arm overhead press with whatever you have around the house. Or try suitcase carries, waiter’s carries (just what they sound like). Work on your balance and symmetry. 

Circadian:

• Eating at night is not optimal. Humans didn’t have cafeterias in caves. But sometimes you just need some calories for energy or morale. When you do, keep the meal small. • This study looked at an 840 vs 2100 calorie meal overnight and metabolic parameters the next morning. No surprise, the smaller meal subjects did better. Very important note: both meals were high carb. Would be nice to see equal calorie high carb vs low carb overnight meals compared. • But for now, keep the overnight meal small. 

This is Water:

• Will leave everyone alone this week on a deep lessons from dense nonfiction. But please listen to this commencement speechby David Foster Wallace. We should all probably listen to this once a month. • Don’t go through life on automatic mode. Choose where to focus your attention. Be appreciative. You are not the center of the universe. Here is a transcript. 

Quote:
Because here’s something else that’s weird but true: in the day-to day trenches of adult life, there is actually no such thing as atheism. There is no such thing as not worshipping. Everybody worships. The only choice we get is what to worship. And the compelling reason for maybe choosing some sort of god or spiritual-type thing to worship — be it JC or Allah, be it YHWH or the Wiccan Mother Goddess, or the Four Noble Truths, or some inviolable set of ethical principles — is that pretty much anything else you worship will eat you alive.
– David Foster Wallace

Martin Huecker, MD, is co-editor in chief of the free, open access Journal of Wellness. He is an Associate Professor and Research Director in the Department of Emergency Medicine (EM) at the University of Louisville. He is a member of Phi Beta Kappa, and the Alpha Omega Alpha medical honor society. Dr. Huecker graduated from UofL’s EM Residency Program and (Chief Resident in 2011). He works full time seeing patients and teaching residents in the UofL Emergency Department. His diverse research interests include substance use, accidental hypothermia, and healthcare professional wellness. Dr. Huecker is also a Certified Lifestyle Medicine Physician (DipABLM). He loves books, (cold) trail runs, dogs, and coffee. His wife is an OB/GYN and they have 4 children with cool names.