Our feet take a lot of punishment each day.  It’s amazing that they can support our body weights with each step we take.  My mother always said that you can save money on clothes, but never try to save money on shoes.  A good pair of shoes can prevent you from foot pain, injuries, back pain, and knee pain. In my practice, I see that “flip flop” sandals are being worn in more places than the beach or around the pool.  They are being used for walking to work and strolling on city streets.  Not surprisingly, I am also seeing a number of injuries directly related to the wearing of these flimsy plastic sandals.  Here are some examples about why you should save them for beachwear only.

• They do not provide support for your feet.  This is particularly true for people with “flat feet”.  In fact, walking in flip flops can increase your chances of getting a condition called “plantar fasciitis” which causes severe pain on the bottom of the foot often lasting for months.  Because of the instability, you are also more liable to twist or sprain your ankle.
• They are usually poorly made.  Many of them have a small knob that is threaded through a hole in sole.  This can often pull through the soft rubber and cause you to trip and fall
• Having your toes exposed and low to the ground puts you at risk for getting cut by metal or glass that may be on the street.  The thin rubber in these sandals is also vulnerable to punctures from nails or tacks that may be in the street.  If you had a thick soled shoe, this would be much less likely.   I have pulled many small shards of glass from peoples feet in New York City.  Even worse, a lot of times cuts on the feet can easily get infected.  Think about all the grime, animal urine, and bacteria that fill the streets.  If you get cut with a piece of glass that’s been sitting on the street you can bet it will be dirty.
• You are more likely to be stepped on by others and have serious injuries to your heels, toes and toenails.  These areas are completely exposed and leave your feet vulnerable.

Right now, I am seeing a large uptick in flu cases in my office.  As the weather gets cooler and we are gathered indoors with friends and relatives for the holidays, I think it is imperative that people get protected against the flu.

Here are some reasons why:

1. Getting sick with the flu means 2 or more weeks of feeling miserable and usually happens at the worst possible time (your long awaited vacation, wedding, Christmas holiday, etc.)
2. The flu shot is widely available right now (December 2018).  In previous years, people waited till January when there was a shortage and a terrible flu season to get the flu shot.  You can get your flu shot from your primary care provider, nurse, or local pharmacy.
3. It is covered under all insurances and medicare.  If you don’t have insurance, some community health centers can provide it for free.  Check with your local public hospital.
4. It’s quick!  A typical flu shot takes 30 seconds.  Make sure you wear clothing where you can roll up your sleeves to the deltoid muscle.
5. It hurts for only 1-2 days.  Yes, most flu shots can cause some local pain, but that’s temporary and pales in comparison to the body aches when you are getting the actual flu.
6. The flu shot takes 2 weeks to become effective.  Getting a flu shot now will ensure that you are protected before the holiday season.
7. By getting the flu shot, you are not only protecting yourself but also your family.  If you got the flu you could spread it to your children or elderly relatives.  Unfortunately, people are contagious up to 2 days before feeling sick with the flu! So you may spread it even without knowing that you have it. Wouldn’t it feel awful if you got the flu and gave it to your child or parent?  Worse yet, many children and elderly people are hospitalized each year for complications from the flu and some even die.

The words “vegetarian” and “vegan” for some people brings to mind food that “is missing something” or “not filling” or even “bad tasting”.  Other people have told me they could never imagine themselves not eating meat in any one meal, or that they couldn’t stand the taste of tofu, which they believe to be the basis of all vegan/vegetarian diets.  I think many of us have also been influenced by media and even the notorious “food pyramid” we were taught as kids, remember those giant chicken legs and steaks pictured in the middle of the pyramid?  (BTW, the pyramid is no longer promoted and has evolved into a food plate which does not require animal protein!)  In addition, we all have the memory of that one vegetarian/vegan friend who during dinner is forced to eat the green garnishes on the meat-filled plate or has to dig out the veggies from the chicken stir fry.  Sure, they look sad and miserable, but that’s because their selections are limited.  In the past, we have not made it friendly for people with food preferences different from our own, but as you read further, this is changing fast.

First, let’s define these terms.  Vegan is the stricter diet which leaves out all forms of animal protein including eggs and dairy.  However, some vegetarian diets can incorporate one or both of these exceptions.  There is also another type called pescatarian (which allows fish and seafood to be eaten).  For the purposes of this post, I will use vegetarian as it is more encompassing.

In my own life, while I am not completely a vegetarian/vegan, many of my meals during the week do fall into this category.  This has happened very gradually over many years, mainly because I just feel better afterwards.  It is a misconception that you must be “vegetarian/vegan all the time”.  Some people even feel intimidated walking into a vegetarian restaurant because they feel they would be vilified for being a meat eater, like in some Hollywood thriller movie scene where there are a group of cult members who find out that there is an imposter in the group and attacks that person.  Trust me, the vegetarian community is generally very open and accepting!  While many Eastern religions follow plant based diets, vegan/vegetarian does not equal religious cult (another common misconception).

Are there health benefits?  I would say, even a few plant-based meals can improve your health.  Many studies have shown that reducing animal protein can lower LDL (bad type) cholesterol.  I think part of this comes from “cost-avoidance”.  For every vegetarian meal you are eating, you are not eating cholesterol-saturated fat-laden meats.  Also, we often prepare meats with extra salt and fats.  Eating more vegetables is also a main component of the DASH diet, which has been shown to lower blood pressure.

I have compiled some ways that you can adopt some elements of a non-animal diet into your life and pointers.

• Remove preconceptions of what meals should taste like.  Ever wonder why we think that cereal, toast, eggs, milk and juice make us think of breakfast?  Mostly it’s the influence of culture and advertising.  In other cultures, such as Japan, breakfast is rice, pickles, and soup!  When we’ve been eating a certain way for a long time (e.g. meat and potatoes) it can be difficult to imagine eating something different.  We should be open to change and trying new things.  Unfortunately, the lucrative meat industry has literally “force-fed” the concept that you must have meat to have a complete meal.  Remember the beef commercials, “Beef, it’s what’s for dinner”?  Sadly, there was never a similar push by the carrot or mushroom industry!
• Remove your past experiences with vegetarian meals from memory.  Having lived in New York City my whole life, I have seen the plant based food scene literally blossom.  Twenty years ago, you couldn’t really find really high quality vegetarian food restaurants.  Most of them would be small diner-type restaurants with modest selections of salads and noodle dishes.  I think for some people who shudder at the word “vegetarian”, they had tried these in the past and have allowed those memories to cloud their view on the vegetarian food scene ever since.  These days, there are a wide array of amazing vegetarian restaurants some decorated with white table cloths, good wine selections, locally-sourced fresh organic produce and sometimes, prices to match.  If you live in the New York City area, here are some restaurants that I recommend:  XYST, Red Bamboo, Terri, Village Natural, Peacefood Cafe, Blossom, and Dirt Candy.  You will certainly realize how tasty plant-based food can be!
• You will not be suddenly anemic (low blood levels of iron) or have low protein levels by reducing your meat intake moderately.  A good example is the country of India.  In some parts of India, over 70% of the residents have eaten completely vegetarian for thousands of years and most of them are not and could not possibly be anemic.  I’m not one for conspiracy theories, but I think we have been ingrained at an early age with the thought that eating meat equates with proper nutrition.
• You will not be hungry.  Vegetarian food is both filling and nourishing.  Plants contain fiber which helps you to feel full.  Many times, I actually felt more full eating a vegetarian meal than a meat based meal!
• If you like desserts, try vegan desserts.  By not having eggs/milk/butter, they are often much healthier (fewer calories) for you and can be great for people with lactose intolerance.  Moderation is the key as they still contain sugar.
• Try vegetarian for lunch.  Since we often eat less during the mid-day meal, this could be a good opportunity.  Here is my recipe for a savory healthy veggie wrap.
• Because the focus is not on meat, which is generally more expensive, vegetarian/vegan establishments will invest money on higher quality ingredients.  For example, instead of mass produced mushrooms, they may use local, organic, and pesticide-free mushrooms.  In general, these will taste far better.  Also, since most vegetarians are health conscious, they will use healthier ingredients such as canola or olive oil instead of corn oil.
• You may save money eating vegetarian.  Generally, vegetarian options are less expensive, but no less tasty.  I’ve been to many top restaurants (that serve meat) with very high quality vegetarian dishes.
• Be selective with vegetarian food.  I often tell people that vegetarian food doesn’t always equal healthy, just as meat is not always bad.  For example, french fries with ketchup would be considered vegetarian technically, but of course are not healthy. Some vegetarian food will have extra salt added to enhance their flavors.  I find that certain Indian vegetarian dishes will use clarified butter, called ghee, which can cause increase in cholesterol.
• Vegetarian food is not just tofu.  Beans, mushrooms, root vegetables, and whole grains are often used to complete meals and are quite filling.  Some places will use “mock meat” which is soy protein that is seasoned and textured.  While some people have an issue with this as they believe it is trying to pander to the concept that we must eat meat, I find it helpful for people who want to transition.  I have not eating beef for over six years for health reasons and every so often I miss classic beef dishes such as stir-fried beef with broccoli.  I am often amazed at how amazingly similar it tastes with the meat substitute!
• If you enjoy cooking, use internet searches to find recipes.  I love using Google to find vegetarian versions of foods I love.  Try Googling your favorite foods and put the word “vegetarian” or “vegan”.  For example, “vegetarian meatloaf”.  You will be surprised how delicious they can be!  Try my Tofu Caprese Salad.
• As in all my blogposts, my recommendation is to be open to trying new things and to make changes gradually.  Ask yourself, how do I feel after I eat this food, how do I feel after I exercise, how do I feel after I meditate.  If your answer is “I feel great”, keep going!  Every little bit counts.  Good health is a marathon, not a sprint!

We all recognize some of the healthy things we should be doing, but something I see people frequently leave out is meditation.  I think we sometimes associate this relaxation practice with something exotic, spiritual, or that it can only be done hours at a time in a far away mountain temple.  I would propose that meditation should be accessible and an integral part of our daily lives.  Did you ever daydream when you were a child, staring out the window while sitting in a classroom?  Sit on a beach watching the waves crash upon the sand?  “Zone out” with your favorite song while on an airplane?  All of these are variations of meditation!  It is no surprise that children will daydream without any formal teaching.  Meditation is our mind’s way of “clearing out the clutter” of thoughts in our minds.

As with anything, it takes practice and commitment to change.  Here are ways that you can incorporate meditation into your life:

• Dedicate time (5 minutes is a good start) to meditate.  I like meditating to separate the different phases of my day.  For example, you could meditate for 5 minutes after arriving at work in the morning, and meditate for 5 minutes before heading home at the end of your workday.  In this way, you can leave behind “home” issues before you start working, and work issues at work so you don’t “bring them home”.  Ever have a tough day at work, then find yourself annoyed at everyone at home?  Meditation can help you so that you won’t bring the stress home.  This may sound a little obsessive-compulsive, but I find that setting a Microsoft Outlook reminder or physically setting an alarm on your phone for a certain time each day, helps me to be disciplined.
• There’s an APP for that!  Headspace is an app that you can download which you can listen to while commuting.  It generally guides you through breathing meditation and they have different lengths of time to fit into your schedule.  They offer a free trial which is great to see if it is right for you.
• Put a picture on your desk of your last vacation where you felt pure joy.  We all have tons of pictures from vacations, sunrises, sunsets, beautiful flowers, etc.  I recommend selecting a photo without any people or words.  Now when you feel stressed, imagine yourself in that place and immerse yourself with all the senses and focus on the details.  For example, I imagine myself on a beach in Cape Cod.  The temperature is 80 degrees, I can feel the sun on my face, shoulders, I can feel the warm moist sand between my toes, I can hear the waves crashing on the shore, I can hear the birds in the distance, I smell the salt in the air with a light breeze.  I don’t have a care in the world…  In 5-10 minutes, you’ve mentally left where you are and gone on a mini-trip to your “happy vacation place”.
• If you subscribe to a religion, reciting prayers can be meditative.  Poetry can also be soothing.  While I am not Christian, I like reciting what is commonly known as the Serenity Prayer, “God grant me the serenity to accept the things I cannot change, the courage to change the things I can and the wisdom to know the difference.”  I feel the words are very meaningful.
• Dedicate a space in your home for meditation.  Set up a comfortable chair in an area with a pretty view, or in front of a painting or picture that you enjoy.
• It is not surprising that most religions have a “mantra”, which is series of repeated words or phrases.  In Catholic tradition, it is the rosary. In Hinduism, it’s “Om Shanti” and in Tibetan Buddhism, it’s “Om Mani Padme Hum”.  By reciting a set phrase over and over, sometimes hundreds of times, your mind is able to break free of distressing thoughts.  I call it the “Etch a Sketch” effect, referencing that famous magnetic childhood toy that would erase any designs if you shook it rapidly for a few seconds..  By focusing on something else intensely, like pronouncing syllables, you “erase” other thoughts that were present before.
• Try, try, again!  Don’t lose heart if you can’t get the hang of meditation.  No one gets it right the first time!

This past week, the New York Times reported that NYU Medical School announced that they will be making tuition free for all their students.  This is a bold step for a prestigious medical school and their realization that medical school debt has led to proliferation of doctors in specialized fields and a shortage of primary care physicians.

As a primary care physician, I understand the current dilemma all too well.  Primary care (aka general medicine, internal medicine) does not pay nearly as well as other specialities.  For many medical students who graduate with debts in excess of $200 thousand dollars (even more, if they took loans out for college), it may take years to repay this debt.  Meanwhile, their peers in finance, law or accounting would have been debt free much earlier.  This lost income in the early years can have devastating repercussions.  I don’t blame medical students for wanting to choose specialties, where they could be making triple or quadruple the income of primary care providers.  Insurance reimbursements simply pay more for procedure-oriented fields such as orthopedic surgery or gastroenterology.  This will not likely change in the near future unless health care is reformed.

I think NYU has taken a revolutionary step that I hope will be copied by other institutions.  Primary care is a much-needed specialty and needs more attention.  For the aspiring medical students, I would like to say that primary care is one of the most gratifying fields of medicine.  In my over 15 years of practice, I cherish being able to care for my patients and their families.  Over the years, many of them know me as their personal doctor and not just the dermatologist they see every few years or their gastroenterologist they see every 10 years for their colonoscopies.  This is also a field that keeps me on my toes and is always exciting and interesting.  Rather than just learning one set of organs, you have to know a little of everything.  Each day, I have to use my knowledge of dermatology, ENT (ear nose throat), gastroenterology, cardiology and even psychiatry!  Sometimes, I find myself being more of a confident in my interactions with patients than a prescriber.  I do hope those current and future NYU medical students will reflect on the amazing gift they have just been given and understand that the door is open for them to pursue a rewarding career in Primary Care.