productivity

Wellness Wednesday: Reclaim your Summer ! 

Setting Summer Goals 

I write this post as the beginning of summer approaches. I look forward to each summer as though I were a school child with a summer break instead of a physician with a steady job. All the same it is a special time, when children are more available, and when people are happily vacationing. We get an especially big dose of this spirit since we host guests in a vacation rental. They remind us of what summer is all about: excitement family, relaxation and adventure. 

To make sure you get all you can out of the summer, I suggest you plan. I suggest this since I am doing the same thing for myself right now. 

No matter your job, no matter your income, you should make sure to refresh yourself in this most sparkling of seasons. 

 

 

 

 

Here’s how.

1. Make a list of your summer goals. Make sure to include your goals in the following areas:

  • Fitness- Set realistic SMART goals for fitness. Make sure to incorporate active summer sports into these goals. Likewise, plan ahead to get fit before that big hike, so you can enjoy it best. 
  • Nutrition and Culinary- Make dishes you want to cook, eat and share, especially with fresh summer produce.
  • People goals- Who do you want to see this summer ? Make time for reconnecting. 
  • Project goals

Home improvement, garden, artistic- Take a summer themed classes, like water colors. Do some gardening. I believe everyone should garden, even if it is a nice tomato pot on the porch. 

Activities- Take advantage of the out of doors and the company of your kids. 

Staycations and Vacations - You can make time special right where you live, or strike out on the trail, for all day or all month as your circumstances allow. 

2. Consider making use of a wall calendar that comprises the whole summer. Block out the time so your goals are realistic.  Leverage your available technology to communicate and coordinate with others in your group of family and friends. 

3. Document your summer so you can best enjoy your memories later. Use photo, video, journalling, paper and mixed media scrapbooking or even digital scrapbooking. 

 

No matter your job or responsibilities,

summer is not just for kids.

Reclaim your adult summer !

The first day of summer is June 21st.

Make it your best yet.

Wellness Wednesday: How to Tell if You’re a Workaholic

Most people say they are busy. But are they ? Americans are famous for being workaholics (fully 25 % of us). How busy is too busy ? 

I would like to present my thoughts on the issue. Then I would like to present some other sources which are more authoritative.

It is important to understand what is not too busy. If you work full time, but have no time to work out or see your spouse, and yet you have time to game, watch TV or get a professional pedicure, you are not too busy. 

You are not too busy if you find that working at your desk leads to hours of randomly surfing the web or checking social media. You can only assess yourself once you have cut all the unintended time wasting from your life. If you are mindfully watching a film, or checking specific things in social media for a few minutes, that is fine and does not count as time wasting. 

So let’s say you have optimized the way you work and spend your time (a topic for another day). Let’s say you have reviewed your schedule and have decided that everything on it is important and nothing can be cut. Then you have met the “ inclusion criteria” and can ask yourself these questions: 

  • Am I getting less than 7 hours of sleep on a regular basis ? 
  • Do I feel a constant sense of frustration at not getting things done ? 
  • Do I lack time to work out for 30 minutes per day ? 
  • Do I lack time to eat three healthy meals and snacks ? 
  • Am I getting sick too often ? 
  • Is the quality of my work getting lower and lower ? 
  • Am I neglecting important relationships ? 

 

If you met the inclusion criteria and you answered yes to any of these things, you should consider thinking about whether you are overcommitted. These would be the relevant endpoints for me, after 54 years of living with, working with and being an overcommitted person. 

WEBMD

http://www.webmd.com/balance/features/are-you-a-workaholic?page=2

This article places workaholism in its psychiatric context. It is a compulsion to go work, combined with discomfort when not working. So it is much more than working hard, or working a lot. They site signs like trouble delegating, thinking about work while on vacation, or neglecting one’s nonworking life. They indicate that cognitive behavioral therapy and support groups can be helpful. 

US NEWS 

http://money.usnews.com/money/careers/slideshows/17-signs-you-might-be-a-workaholic/2

This feature described signs you might be a workaholic. Noteworthy signs including having no hobbies, working through lunch every day, coming to work when sick, being accessible to work all the time, and consistently overbooking. 

The WORKAHOLICS ANONYMOUS site is a real eye opener. 

http://www.workaholics-anonymous.org/10-literature/24-twenty-questions

Surprises in their list of 20 questions include "Do you regularly underestimate how long something will take the rush to complete it ?” This is a more in depth read and I recommend it. 

FORBES 

http://www.forbes.com/sites/deborahlee/2014/10/20/5-signs-you-might-be-a-workaholic/#430847d833d1

Forbes showcases a very worthy article about work-life balance, citing some interesting statistics including the following : "Americans put in more hours than workers in other wealthy countries and are more likely to work nights and weekends.” They alsogive an introduction to Bryan Robinson’s book “ Chained to the Desk”, which is available on Amazon. 

The follow up articles in the same series 

http://www.forbes.com/sites/deborahlee/2014/10/20/6-tips-for-better-work-life-balance/#5ae8fd25dbc9

details 6 tips for a better work like balance. The two tops which appeal to me the most are “ Letting go of perfectionism” and “ Limit time wasting activities and people”. 

SCIENCE DAILY

https://www.sciencedaily.com/terms/workaholic.htm

This site highlights some more surprising aspects of workaholism including the observation that workaholics lose track of time. They also highlight some chilling aspects of workaholism including the problem in Japan, where early death related to workaholism has its own word, karoshi. We all know that workaholism takes a huge toll on mental and physical health, but death by karoshi is hard to fathom. 

I am going to strive in the next few weeks to make my posts more brief. I will feature more outside sources. It is my hope that these posts will be easier to write and easier to read. This is one step I will be taking toward a better work like balance. 

Send me your thoughts on the matter. I would love to see what you think. 

 

 

 

 

 

 

Wellness Wednesday: Healthy Boundaries

Boundaries are essential to our physical and mental health. And yet, they are rarely discussed in everyday conversation. This post is to put the concept of boundaries on your radar, and into your vocabulary and to encourage you to learn as much as you can about them. 

Boundaries can be physical, mental, emotional, or even functional. At essence, a boundary is the line between you and everything else. To have good boundaries means that you maintain a truthful view of yourself. You know how you are distinct from others and honor that. Additionally, you take responsibility for all that is yours, from the state of your body, to your thoughts, your emotions, your skill sets, and the way you perform in life. 

Bad boundaries allow numerous problems to occur. For example, weak boundaries allow one person to tolerate mistreatment from another. Another kind of weak boundary allows one person to blame others for their problems. Bad boundaries produce abuse, resentment, chronic victims, pleasers, controllers, bullies, the overcommitted, enablers, entitled freeloaders, martyrs and guilt trippers… The list is endless. 

Boundaries are established as we grow up and have life experiences. We may learn from experience that standing up to a bully causes them to leave us alone. Or we may learn that it makes the situation worse. We may learn from parents that misbehavior has clear consequences, or we may learn that we can get away with anything. We may learn that when we apologize, it is accepted and life goes on. Or, we may get a never ending stream of resentment. All these types of things can affect the integrity of our boundaries. 

Those who have suffered abuse have particularly damaged boundaries. They tend to tolerate much more mistreatment than they should. In fact they may not even know to classify mistreatment as mistreatment since they do not even know what healthy relationships look like.  To them, an abusive relationship is sadly normative. And since boundaries are like fences in that they have gates, abused people have trouble with gates as well. Is particular,  abused people often shut out those trying to help. 

Few people have perfectly healthy boundaries. To have healthy boundaries, one has to be aware they even exist, if only on an intuitive level. To really understand them requires examples. Having healthy boundaries is about setting limits for oneself. While it is not about setting limits for others, it is about setting limits on what one will tolerate from others. Likewise, it is not about reacting to others. Rather, it is about communicating clearly specifically directly and honestly from a first person point of view ( "I statements") and giving responsible feedback to others. 

We all need to be aware of our personal boundaries and how to keep them healthy.

 

  • First is to realize boundaries exist.
  • Second, we must realize we have an innate right to maintain our boundaries.
  • Third we must become self aware of our own thoughts and feelings regarding what we are comfortable or uncomfortable with in ourselves and others.
  • Fourth, we must be honest and realistic about our needs, and employ self care to meet them.
  • Fifth we must be willing to enforce our boundaries if they are violated. This is done for the long term good, but we must realize that in the short term it may cause conflict.
  • Sixth, we must reach out for support and knowledge as we strive for healthy boundaries. This is because we are trying to learn that which, by definition, we did not know before. It is also because we may encounter resistance from those who encroached on our boundaries before. Sometimes, this requires professional counseling or a supervised support group. 

 

Healthy boundaries are critical to our self respect, integrity and optimal functioning. Here is some great reading to learn more:

 

http://psychcentral.com/lib/10-way-to-build-and-preserve-better-boundaries/

http://tinybuddha.com/blog/how-to-set-healthy-boundaries-3-crucial-first-steps/

http://www.essentiallifeskills.net/personalboundaries.html

https://www.ipfw.edu/affiliates/assistance/selfhelp/relationship-settingboundaries.html

https://www.psychologytoday.com/blog/prescriptions-life/201311/7-ways-protect-your-energy-enforce-healthy-boundaries

http://www.loveisrespect.org/healthy-relationships/setting-boundaries/

http://www.huffingtonpost.com/jennifer-twardowski/6-steps-to-setting-boundaries-in-relationships_b_6142248.html

http://greatist.com/happiness/how-to-set-boundaries-in-relationship  

Wellness Wednesday: Healthy Stuff 

Wellness includes how you feel as you function in everyday life. How you function greatly influences how well you are. How you handle your material belongings in your home and workspace influences all of this. Today’s post is devoted to introducing the topic of  healthy relationship with your material belongings. 

The developed world has an unhealthy relationship with stuff. Many of us have more than we need. Our collective patterns of consumption strain the environment.  Our individual patterns of consumption strain our personal finances. Excessive objects clutter our spaces andmakes us miserable. 

How can all this be stopped ? Two fairly recent books have addressed this challenge. The first was written by two friends of mine, Joshua Millburn and Ryan Nicodemus. It is titled, “Everything that Remains”.  I met these two fine fellows at TEDxWhitefish where they gave a beautiful and clever presentation on Minimalism, or the art of mindfully curating one’s things and one's life down to that which is necessary and desirable. You can access their work HERE: 

http://www.theminimalists.com

and their TEDx HERE: 

http://www.theminimalists.com/tedx/

The second is a really trendy and fascinating set of books by a Japanese women named Marie Kondo. She has written The Lifechanging Magic of Tidying Up and its companion volume, Spark Joy. These books go into the concrete details of tidying up. However it is not done for its own sake. She makes it clear that it is to enhance quality of life and effectiveness in life. Ms. Kondo draws a clear connection from this tidying practice to clarity of mind and clarity of purpose. She speaks of improving relationships and clarifying life goals as by products of removing one’s clutter, and systematically determining which of one’s possessions “ spark’s joy”. Sparking joy is, in fact, her inclusion criteria. One should only keep an item if it “ sparks joy". Granted, joy is broadly defined to include traits like beauty or utility. She states quite plainly that curating and decluttering your space is a prerequisite to clarifying what is one’s own unique ideal lifestyle. 

I am no minimalist. In fact I derive great joy from textiles, colors, and various materials. I continually acquire new books. But I have come to understand that I should go through my things periodically, and that if I do there will be things which I can let go. Thus the quality of my items increases as their quantity decreases. 

I have also come to utilize alternatives to “ things”  more often. In particular, I am a magazine addict. My office overflows with them. I do not like the piles, even though I derive great joy from the individual issues. My solution ? I have gotten an app called Textile. For a small subscription fee, I can get many of the magazines I want in digital form. Additionally, I consume more and more material by Kindle or Audible. There are still some things, like cookbooks, which I like to have in paper, but this is the case less and less. 

I am interested in gaining mastery over my things so they are not master of me. I would like to edit and organize my things so they do not take up so much of my time. I am beginning to see time as a more tangible commodity. I am becoming more and more selective about how I spend this “ thing” called time. Your material possessions, you time, your lifestyle choices and your wellness are intimately related. Check out these two books, their insightful authors, and give a little more thought to how the space you inhabit influences the life you live. 

 

Wellness Wednesday: Healthy Architecture

Have you you ever noticed that you just feel good in some homes ? This might be because of the people who live there, or because of some happy memories. Or it could be the architecture ! It has been definitively shown that architecture influences our health and our sense of well being. In this post we will be examining what science and architecture say about healthy living space. 

Vitruvius, a famed architect and engineer of the Roman Empire, note that three elements were required for a well designed building: health, comfort and delight.

Cleary these requirements go beyond household air and water quality, lighting, waste management, and nontoxic materials. They go beyond shelter, privacy and safety as well. 

The AIA or American Institute of Architects has utilized a set of design principles to inform architecture not only for homes, but for schools and hospitals as well. They are as follows: 

  • Safety
  • Social Connectedness 
  • Environmental Quality
  • Sensory Environments
  • Physical Activity
  • Access to Natural Systems. 

This means that besides being safe, homes need to provide a space for people to comfortably gather. They need to be designed in such a way as to foster good air and water quality in the home. They need to provide pleasant sensory experiences of sound, sight, smell and touch. They need to foster the ability to be active. Finally they need to include or be able to interface with nature. 

According to Robert Ivy, CEO of AIA, these criteria for health fostering architecture can go even further. He highlights the following design principles: 

  • Biophilia
  • Educational design strategies 
  • Light as therapy

Biophilia refers to our innate love of nature. It even alludes to the fact that exposure to the natural world has measurable effects on well being. This can mean we keep indoor plants. It could also mean we keep a small garden outside the kitchen door. Educational design, means that our physical spaces ideally foster learning. This may mean something as simple as including space for an aquarium,. Or, it may mean including bookshelves, a tool shop, or a lego table in a child’s room. Light as therapy is a proven factor. Daylight fosters recovery in the hospital and good emotions at home. Daylight is ideally part of every room in a building. 

Designing for wellness is important whether you rent, own or are building your home. Small but well informed changes in your living space can have significant effects on wellness. 

To learn more: 

http://info.aia.org/AIArchitect/2014/1121/aia-interactive/index.html?utm_source=http://info.aia.org/AIArchitect/2014/1121/aia-interactive/index.html#

http://www.ncbi.nlm.nih.gov/books/NBK44199/

http://www.webmd.com/women/features/25-ways-create-green-healthy-home

 

 

 

 

 

Wellness Wednesday: The Art of Preparation 

Why discuss preparation in a health blog ? Preparation is an antidote to what ails us. 

Preparation is key to overcoming health challenges like obesity, poor nutrition, lack of fitness, chronic disease, and bad habits.

Tax day is April 15th and tax season has prompted my focus on preparation. There is a lot of stress going around associated with tax preparation, and not just because money needs to be paid. There is stress because some people leave their preparations for taxes for the last minute. 

The opposite of preparation is procrastination. Check out this older post on procrastination: 

Curing Procrastination

Procrastination increases stress, undermines self - confidence, and undermines relationships at home and work. 

It decreases performance and effectiveness at completing any goals, including those associated with health. 

There is a common misconception that preparation and goal meeting is about will power and discipline. On the contrary, preparation is about the realization that goal meeting is hard. Because goal meeting is hard, we need preparation which is easy. Said better, preparation is what makes it manageable. Preparation, not will power, is the key to success. 

Let’s dissect or “ unpack" preparation, so you can see what it really is:

  • Having optimism that your goal can be achieved.
  • Taking the time to fully define your goal. 
  • Frankly assessing where you are at the present moment, so that you can see how far you have to go.  
  • Breaking down your goal down into parts. These subsections of the main goal, and not the whole goal, get divided according to the SMART goal criteria. Each of these subgoals must be: 
    • specific 
    • measurable
    • attainable
    • relevant 
    • and time bound. 

 

That is what will make them, if not easy, then attainable.

To learn more about SMART goals, read here : 

New Years Resolutions

Three Ways to get Ready for the Week

The Importance of Inspiration

 

Sometimes preparation itself is daunting. However, when the ask of preparation itself is broken down into segments, it is easier to face. And, crucially, starting with plenty of time ahead will take enable you to spread the segments out so you don’t have to do too much at one time. With preparation the hard becomes easy and the stressful becomes empowering. Try some today !  

Wellness Wednesday: Wellness While Gardening

Gardening does not strike anyone as a particularly dangerous pastime. However there are a few tips and one critical point I’d like to share on the subject. 

I have been a committed gardener ever since I got married 33 years ago. It has been a soul feeding pastime for me. Gardening has gone hand in hand with family time, from the hands on science education for our kids to our present day culinary pursuits. 

I have gotten sunburns, rashes, cuts, scrapes, slivers and mosquito bites.  I have gotten dirty and dehydrated. I have lifted too much. I have risked heat stroke and frostbite. Thank goodness I have not gotten any ticks. But these are the concerns at hand. If you check the CDC (Centers for disease control ,they cover the list of precautions that would have prevented all these ills, and I will recoup them dutifully here. But there are a couple surprises, and at the end, one BIG POINT. 

  • Your clothing and hat should protect against weather, insects, chemicals (even organic ones) sun and yes, dirt. Dirt is full of pathogens like various fungi, tetanus and toxoplasmosis. This is of special concern to those who are pregnant or have compromised immunity. Play in the dirt with gloves.  
  • Make sure your every ten year tetanus shot is up to date. 
  • Your skin should be protected by sunscreen or insect repellant as indicated. 
  • Your hands should be gloved no matter what. Did I mention the gloves ? 
  • Your eyes should be protected from flying debris and dirt. You are not pulling enough weeds if you do not have dirt flying toward your face. 
  • Have water with you and hydrate throughout the day. Dehydration happens faster than you think. 
  • Know the fertilizers and supplements you are dealing with. Read all labels and follow all directions. 
  • Know your equipment, and make sure it is in good working order. If you are using sharp objects or powered equipment, keep your attention on what you are doing and keep small children out of harm's way. 

Here is the BIG POINT, and I will plead with you on this. Use organic methods. Please. The whole point of gardening is to get closer to nature and to produce something wholesome you can eat. Please do a little reading, and welcome yourself into the immensely gratifying world of organic gardening. If there is one thing that will save the world, it might be this. 

I am not even going to begin to address all the safety concerns of gardening any other way, such as with conventional herbicides, pesticides, or fertilizers. It would take too long and it would be depressing. So, get yourself one of the many excellent organic gardening resources, like maybe a book, the internet, or maybe your grandmother.  It doesn’t matter if you do container gardening in the middle of a cityscape, or if you have a farm. Chose this life affirming hobby, and do it in a life affirming way. 

 

Stay tuned next week for another Wellness Wednesday. 

Wellness Wednesday: Menstrual Wellness

At first I thought the #freethetampon movement was a bunch of hooey. However, now I am giving it a second look. What got me thinking was a Tedx talk given by Nancy Kramer featured here on this website:

http://freethetampons.org

This site has some hard numbers about how many girls and women have to interrupt their school or work day to improvise a solution to an unanticipated period (86 % of us !) This is because restrooms the world over are stocked with toilet tissue, soap and something to dry hands, but there are scarcely ever any tampons or pads.

Granted there is an additional cost to providing these supplies, but in terms of school or professional environments, there are also benefits: less time away, less workplace stress, etc. Supporters of the #freethetampon movement advocate that tampons and pads should become freely available in every public bathroom, much like toilet tissue or soap. They view it as a public good and standard of decency in consideration for the everyday realities of normal body functions in women. Most women prepare as best they can and carry adequate menstrual supplies most of the time. But, as a Gynecologist I can assure you that irregular cycles and uncontrolled menstrual flow happen once in a while to most women. Even the best prepared among us has most likely struggled with an out of control period at one time or another.

Back to the cost of menstrual supplies. Did you know that in most places there is sales tax on tampons and other menstrual hygiene materials ? Sales tax criteria vary by state. Montana, Alaska, Oregon and New Hampshire have no sales tax on anything. Beyond that, Minnesota, Pennsylvania and Maine tax the customary items of “ tangible personal property” excluding necessities like food and medicine. Most notably these states also exclude menstrual hygiene products from sales taxation! In these states menstrual hygiene products are classified as necessities rather than “ luxury” or “ tangible personal property” items. Every other state taxes menstrual hygiene products. Every other state has what is being called the “ tampon tax.” Critics of the tampon tax say that it unfairly discriminates against women. They point out that it is a tax that women have to pay solely by virtue of being women, which is sex discrimination.

The tampon tax issue together with the #freethetampon movement has catapulted the menstrual cycle into the public limelight. For most of history however, the subject has been totally taboo. Most generally menstruation has been looked upon as an “unclean" state. In many cases menstruating women have been set apart from their family during this time. Even until recently it has been considered a topic not fit for polite conversation. And for reasons which are still not clear to me, menstruation has been a source of embarrassment or shame.

Many contemporary women are interested in removing the stigma of shame associated with this normal body function. To do so, they have taken several tacts. If you search the web on such matters, you will find all kinds of art from posters, pins and jewelry which flaunt these taboos, and demonstrate menstrual pride. There are references to “shark week”, “riding the cotton pony” and visits from “Aunt Flo”, normalizing and humorizing the subject. In one instance at one American high school

(https://en.wikipedia.org/wiki/Tri-Valley_Central_School,)

a security guard’s public search of a girl’s purse also included questions about whether she was on her period. The incident was considered intrusive. The next day, boys at the school came to class with sanitary pads taped to their shirts in a show of solidarity for the girl. Girls wore tampon necklaces. Finally, most of you have heard by now how Kiran Gandi, a Harvard business school student, ran the 26 mile London Marathon on her period, without a tampon and with visible bleeding, to “ transcend oppression” and to publicize the plight of those women who lack adequate menstrual products.

You get to decide how you feel about your period. But you should know a few things about it. No period is comfortable or convenient, but some get downright bad. If you meet certain objective criteria, you should call your doctor and get checked. Abnormal periods are not healthy, and should be treated.

Here is a section from our page on on adolescent and childhood Gynecology which describes the beginnings of periods :

The mean age of menarche (first menses) is approximately 12 1/2 years of age, with a range of about 11 to 14. Menarche typically occurs 2 to 3 years after thelarche after the breasts are fully developed. Ninety eight percent of females will have had menarche by age 15. Any adolescent girl who has not reached menarche by 15, or within 3 years of thelarche should be evaluated. Additionally, any vaginal bleeding before the age of 8 is a concern and should be evaluated by a a gynecologist.

- See more at: http://drginanelson.com/childhood-gyn-concerns#sthash.ykiQ4Hoh.dpuf

 

More menstrual facts you need to know:

Periods should not last longer than a week.

Period intervals ( time from day 1 of one period to day 1 of the next period ) should not be less than 21 days or greater than 35 days.

Total flow should not exceed 80 cc (1/3 cup) in one cycle.

Period flow should not make you lightheaded or anemic.

Period pain should not keep you from school, work or exercise.

You can get pregnant on your period.

 

If you experience any of these things, you should call your doctor. Depending on your age and medical history, an evaluation may be done. Depending on the results, a treatment can be planned.

Tips for menstrual management:

You may pick from either pads, tampons or both. You may use menstrual cups as long as you wash them as instructions indicate. None of the internal methods should be left in longer than needed, or they can foster infection. Apparently there are now unisex tampon necklaces you can wear, to use yourself or to “help a sister". There is even an app, developed by a Harvard freshman, Olenka Polak, called “ Code Red” which alerts sympathetic users in your area that you are caught in a “ periodic emergency”.

Menstrual health is a physical and psychological challenge. Don’t feel like you have to meet this challenge alone. 

Food Friday: Easy Weeknight Meals

Most of us work during the week. All of of us are supposed to exercise sometime in the day. Between all this, children and other responsibilities, it is challenging to pull together a good dinner for the family. Here are some suggestions to help you with easy weeknight meals. 

People often suggest “ Make ahead” meals as the solution for busy cooks. However, I am going to assume that you, like me, have trouble thinking ahead and pulling those together. We will tackle those another day. Instead, today's suggestions will apply to “ on the fly” meals you make on the spot. 

  • Keep it simple. 
  • Keep it healthy.
  • Use fresh or frozen. 
  • Cut pieces small for fast cooking. 
  • Combine protein with produce. 
  • Serve three dishes - a protein based main dish, a salad, and an additional fruit or vegetable. 

The protein dish is usually the most challenging for people to devise. Consider meat fish chicken or eggs as a base.  Meat fish or chicken can be fresh or partially defrosted and cut into bite sited pieces and either broiled, sauteed or grilled with olive oil, salt and pepper. Eggs are quick and can be made any way. Serve your main dish with salsa, or another sauce. 

Vegetables can be washed and cut small and either steamed or sauteed in olive oil or stir fry sauce. Make sure and combine different kinds of vegetables after cooking for good color and varied nutrients. Remember to cook the longest cooking vegetables first. Toss with a healthy salad dressing or sauce and serve in large quantity with your main dish. 

Always have prewashed salad at the ready. Always include some color with the greens, such as tomato, carrot or even strawberry. Throw in some nuts, maybe some cheese, and even some hardboiled egg. 

These are simple preparation guidelines for a main dish, a vegetable side dish and a salad. Provided you have the right groceries in the freezer and fridge, you can whip up this kind of dinner in 25 minutes or less. Key points are the small size of the pieces, which cuts your cooking time, and the healthy sauces, salsas and dressings which you can buy or easily make. 

Have fun with this. See how fast you can get. I’d love to see you post some of your variations of this dinner prep format. 

 

 

 

 

 

Wellness Wednesday: Time and Goals

We each have goals. What would it be like to accomplish them ? What would it be like to accomplish a lot of them ? Some people do. These are people with good time management. 

It occurred to me that before I discuss exercise on this Wellness Wednesday blog, I should discuss the one thing my patients say they need before they can exercise: more time. We all have one lifetime of time. What matters is how we use it. Everyone knows this, so what is the problem ? 

Most people are not fully aware of how they spend their own time.

They are not as factually familiar with how they spend each hour as the think they are. I have found that everyone thinks they’re busy, and everyone thinks they're active. People are less sure if they are efficient in their day. This is the territory I suggest we explore at this point in the New Year. 

We are talking about time management. Have you ever had a class in this ? Few people have. It seems like it would be a good idea right at the beginning of high school. Or how about right now, in the blog post ? 

Here is your mini class on time management, complete with some handouts and homework. 

  • Obtain a notebook to document this process. 
  • Record your present schedule, down to the hour, for one week. Include everything from housework to Facebook. Wear a watch all week so you will have realistic estimates of time. 
  • Make a list of goals, for the week, month, quarter, year and five years. 
  • Order the goals by priority.
  • Assess your week long log and see where you are misdirecting or wasting your time. 
  • Realign your schedule with your priorities. Include a spot for 30 minutes of exercise 6 days per week. 
  • Record what happens the next week and repeat. 

Now this is a VERY simplified version of a time management class. It is, however, the essence of the process. It only works however, if you are absolutely truthful with yourself about how you spend you day’s time and absolutely truthful about what you really want. 

I hear so much about not “ having enough time” to exercise, or to shop for healthy food, or to prepare healthy meals, that I decided to address it head on. 

For those interested in more, there are really so many great resources on the web, from Lifehack.org, to books by Harvard Business Review. 

Here is a one page handout on the subject. Click on the title below to download. 

"Time Management" from the Stanford Center for Teaching and Learning

For extra credit, here is an awesome self assessment and time management tool from University of Kentucky. Click on the title to download. 

 

"The Successful Person's Guide to Time Management"

This should be be printed, filled out and used. 

Class is dismissed. Homework is due next week! I’d love to hear how you do. 

 

 

 

 

 

 

 

 

 

Wellness Wednesday: New Year’s Resolutions 

I have always been skeptical of the idea of  New Year’s resolutions. Did you know that only 8% of them succeed ? I am more in favor of a New Year’s PLAN. Plans can change things. 

I am all for establishing intentions and all for making lists. A resolution however, is more like wishing for something and expecting that the strength of your wish will make it come true. Research shows the desire or willpower alone is insufficient. If you are ready and willing to make changes, bring out the power tools. They are called SMART goals. 

SMART is an acronym for Specific, Measurable, Attainable, Relevant, and Time bound.

See more at:

Structure Sunday: Three Ways to Get Ready for the Week

So make a New Year’s list of the goals you would like to achieve, but apply this metric to each one. 

Here is more on exactly how this works : 

The Importance of Inspiration

For example, if you want to exercise daily, you must know what exercise you will do, and where. You should make a record of what you do. It should be something that is realistic at the present moment. You should know exactly when in the day and week it will take place and give yourself a date to reassess your progress. If you do not do these things for your exercise plan, then you are not serious about this goal. If you actually set yourself up this way, you will almost certainly be successful. It’s like Dorothy and the ruby slippers. You had the power all along. 

Meanwhile here is some additional fun and illuminating reading on New Year’s Resolutions : 

LIfehack: 50 New Year's Resolutions and How to Achieve Each of Them

Happy New Year ! 











Medical Monday: Breaking News from the World of Obstetrics and Gynecology 

This weeks news is all about the facts and figures. Statistics is like pie. It is all about how you cut it. That is to say, the real meaning of raw data is challenging to correctly interpret. A great deal of the message from a study depends on how the data is presented. Be wary about drawing conclusions from studies where none can be drawn. 

The CDC report indicates that the number of abortions in the United States has hit a record low compared to 1990. This is true for all ethnic groups.

A new study has hit the press indicating that use of SSRIs, common antidepressants, in the first trimester is NOT associated with increased risk of autism spectrum disorders. Nonetheless the study also showed babies whose mother’s took SSRIs were 75% more likely to get autism than than their peers. Whether this is related to the mom’s condition, the medication or something else is totally unknown and cannot be known from this study. 

In the strange, counterintuitive and questionable department, a new observational study published in the Journal of the American Medical Association shows more complications among those with a planned C section compared to those with an emergency C section done after labor. This is against what has been show before, and against common sense. Authors at the NYT Blog Well speculate that somehow the labor is “ good” for babies. You just as well might speculate that people who chose elective C sections are less healthy to begin with. No conclusions can be drawn, although many will be. 

New findings in the Journal Cancer Epidemiology show that while cancer rates are declining in developed countries, they are increasing in the developing parts of the world. With development comes smoking, and more obesity, which increase the risk for certain cancers. 

The now ancient Women’s Health Initiative, which gathered data on a great many things, has been mined once again. This time it has revealed an association between smoking and infertility. No surprises there. 

I guess I am not the only one who doubts the work of the USPTSF on the issue of breast cancer screening and mammograms. Over 60 lawmakers, headed by Representative Debbie Schultz of Florida, have included a provision in the new budget requiring that the US government officially recommends breast cancer screenings at age 40 rather than 50 as the UPTSF does. Looks like they feel American women are willing to undergo some increased anxiety and discomfort in exchange for earlier detection, longer life, and less mortality. 

A new study out of Britain once again raises the question as to whether the use of the Ca 125 blood test can help detect ovary cancer and save lives. The results are by no means conclusive, but they will provide an impetus for much needed additional study. 

Back to pie. This week I hope you have several kinds, pumpkin, cherry and whatever is your favorite. Merry Christmas week ! 

 

 

Wellness Wednesday: The Wellness of Being Yourself

My new T shirt 

My new T shirt 

As most of you know I recently returned from my alma mater, nerd nation, the mothership, Stanford University. Here is a group of misfits so diverse and enthusiastic that they just might save the world.

Wikipedia defines nerds as follows:

Nerd (adjective: nerdy) is a descriptive term, often used pejoratively, indicating that a person is overly intellectual, obsessive, or lacking social skills. They may spend inordinate amounts of time on unpopular, obscure, or non-mainstream activities, which are generally either highly technical or relating to topics of fiction or fantasy, to the exclusion of more mainstream activities.[1][2][3]

The Wiki goes on further to add the following:

"Nerdy" interests[edit]

Some interests and activities that are likely to be described as nerdy[by whom?] are:

Jane McGonigal writes convincingly in her book “Reality is Broken" that the gaming community is full of people with great capacity to focus, as well as a passion for adventure and righting wrongs. She proposes to harness this energy for good and not just for gaming. This nerdy passion for adventure and justice combined with an intense capacity for focus was just what I saw at Stanford.

I returned from nerd nation inspired and encouraged. However I also found myself with a number of questions. Have I had enough faith in myself and the world? Have I tried enough new things ? Have I developed myself to my fullest potential? Have I done enough to make the world a better place ?

There is the temptation for these questions to become very heavy. However, in nerd nation, there is the acknowledgment that everyone is unique and that everyone has something unique to contribute. It was provocative nonetheless to meet a considerable selection of people who are doing things that could actually change the world, and by change the world I mean things like discover life on other planets or cure cancer. It is even more provocative to consider that most of these nascent accomplishments were not that hard. Rather than coming from brute force of mind, they came from unencumbered creative thinking, an environment supportive of trial and error, and steady efforts in a collegial team environment. 

On balance the visit was more empowering than daunting. This is where the connection to wellness becomes evident. I have written before about the connection between wellness and creativity. I have also written about the connection between learning and wellness. There is clearly a connection between wellness and altruism. I write now to encourage all of us to have a little more faith, a little more creativity, maybe some continuing education, maybe a little travel to get us out of our own heads, and more drive to make the world a better place.

Get your nerd on people.

Structures Sunday: the Structure of Studying

I'm a perpetual student. You may not realize it but in certain circles this was considered an insult. I now realize it is good thing. Indeed life long learning is the only way to go.

I have already blogged about the importance of reading and creativity. Those of you who know me realize I have a number of serious creative pursuits, Since we are approaching Halloween, I am deep in preparation to sew a detailed costume. For these sorts of things as well as my work, I have to study. That's right, study.

For my costume I have had to research everything from specialized sewing machine feet to the thermal properties of craft foam. For my amateur photography I have had to research telescope eyepieces and how to connect a old school serial port to a USB port.

Tonight for example I am deep into my annual board review preparation. Every year we have to review research articles and take tests, But every 10 years or so we have to take a big test and that is what I am preparing for this week.

Additionally, I am aware of many of my friends and their adjustment to the new school year. Bottom line: all parents home school, even those parents whose kids go to public or private school. That's how I felt anyway when my kids were in grade school and high school. Every day when I would come home from work I would simply change hats and I would turn from OB/GYN to homeschool teacher. I would check in with each of my kids to see what they had to do for homework and upcoming tests. I would check in on how their classes were going. I might take a some time and give them a little supplemental information on a topic if I happened to know something about it. Finally I would monitor their study habits. As much as I think they found it irksome, I think even they would admit it has served them well. 

So what are good study habits? There are numerous books written on the subject which are beyond the scope of this blog post and well worth reading. I just want to emphasize that you should stay intellectually and creatively active as a part of your overall good health. I also want to empower you to get involved in your children's academic life. So here are a few basic tips for studying that will serve you as a parent coaching children, a student, or simply as an adult keeping her intellectual and creative life healthy.

  • Get an overview of the task at hand. Even grade school children should know that school goes in semesters or quarters. They should know when the tests and quizzes are given, and when their assignments are due. Both children and adults should have a simple clear system for writing this down. It can be either digital or paper. Their should be a daily and weekly routine for referring back to this schedule. That makes for no surprises and less procrastination. 
  • Prepare. It does not matter whether you are preparing for a book report in seventh grade or a board exam when you are a doctor, preparation is key. Learn to channel your anxiety and concern into an early jump start on your project. This is imperative because it alleviates stress and gets the job done.
  • Know how to study. Here is a general method for low stress, effective preparation. 
  1. Scan the material for an overview.
  2. Read the material thoroughly.
  3. Highlight the material thoroughly.
  4. Make your own handwritten notes from your highlights.
  5. Make index cards from your handwritten notes, using a brief description on one side and more complete details on the other.
  6. Quiz yourself on your index cards. Do it out loud. When you do, put the ones you know well in one pile and the ones you need to review in another pile. Repeat your index card quiz, this time only with the pile that you need to review. Again, put the ones you fully understand in the good pile and the ones you need to review in the bad pile. Repeat the process until there is nothing in your bad pile.

It turns out that getting as many senses involved in your learning helps. The technique described above involves several senses, sight, touch, and hearing. Reading, writing with your own hand, and seeing what your own hand has written or hearing yourself read what you're own hand has written reinforces the learning of information on multiple levels, indeed in multiple areas of brain.

This is all well and good if you simply need to learn facts. However, if you need to know how to work problems, that comes next. Work on all the problems you can two or three days before they are due. That way you have a chance to go in and ask questions well before the problems need to be turned in. If you are a parent supervising children with homework like this, be sure that they do their assignments at least two days before they are due. You will ingrain this kind of habit in them for the rest of their life, and that will serve them well. And don't forget to lead by example.

If you're working with older children who will be taking tests, coach them a little bit in test preparation. Emphasize early and repeated contact with material as well as working of every problem that the teacher has handed out. Encourage students to use practice tests that have been provided to them and that are available on the Internet. Encourage them to fill in their understanding with information they find on reputable Internet sites such as Khan Academy. Have them try finishing the test preparation the day before the test is given so that they can spend that day asking the remaining questions. Tell them not to be afraid of being like Hermione Granger and having their hand in the air all the time. 

Make sure you and your children have a good night’s rest before any tests. I realize this is easier said than done but it is sound advice. In fact, make sure they are well rested before any school day. This will maximize their ability to learn. Equally important is a good protein rich breakfast, especially before tests.

It is important that if you are parents supervising children in their studying or their homework that you be supportive not harsh. Regardless of what you may think of their teachers, encourage courtesy toward the teacher. To do otherwise is a disservice to your child. 

Is very important to remember that if you are helping someone with their work, you're principally helping them to understand how to do the work themself. Under no circumstances do you do the work for them. You may work a similar problem for them to see, since that is different.

A healthy creative and intellectual life has been proven to benefit health. This is true for both adults and children. I hope these tips help make your studies easy and fun.

 

Wellness Wednesday: Getting Real about Wellness Coaches

"Are health coaches a real thing? What do they actually do? Something like that sounds really expensive.” In our survey two weeks ago you said the most helpful thing for your health improvement would be a health coach. Here is the lowdown on this very real and up-and-coming service.

There are a lot of coaches out there. There are a lot of health and wellness coaches out there too. As you know, I have hung out my shingle as an "evidence based" practitioner. Accordingly, if I were to get a wellness coach, I would want one that practiced evidence based coaching. 

I have done a little homework on our behalf, and found that the American College of Sports Medicine certifies only one coaching program in the country at this time, wellcoachesschool.com. Lucky for me, the medical fitness center (health club) associated with my hospital utilizes wellness coaches certified by this school.

However, I too assumed this would be on the expensive side. Here's what I found out. First of all all, prices are cheaper if you are a member of the health club, which stands to reason. Secondly, they offered different packages. The cheapest package without membership was $200 and consisted of eight sessions over eight weeks. This would provide personal training in a small group. This sort of thing would be an out of pocket expense.

On the other hand, I was pleasantly surprised to find out that the more extensive packages involving weight management and wellness coaching for those with serious or chronic medical conditions might be covered by insurance. These programs range from $250-$750 and take place over several months time. Of course any coverage by insurance would have to be determined beforehand and would have to be based on documentation in the patient's medical record by a patient’s physician, someone like me. 

Although I was encouraged by all of this, I did come away from my fact-finding with the impression that my patients who need this most are simply not going to be able to have access to this, afford it or obtain coverage for it. 

This led me to the idea of being your own coach. This is not my idea or a new idea. A simple Google search revealed several reputable sites which deal with this topic. I will share them with you now.  

How to become your own life coach with 14 simple strategies

10 ways to be your own life coach

How to be your own life coach in four easy steps

And my favorite,

Tips from the pros: how to be your own life coach

 

I am thinking about getting wellness coach certification from wellcoachesschool.com. So much of what I do in the course of the day with my patients is wellness coaching. While it is true that I deliver babies and perform female pelvic surgery, I spend a lot of time and energy trying to get my patients to be well. I would like to be as good as this as possible.

I looked into the course curriculum, and I noticed they had two key textbooks, one you get when you register for the classes, and is rather costly. The other is available on Amazon.com for a modest amount of money ( At this time a used one is $0.43 plus $3.99 for shipping. ) It is called "Organize your Mind, Organize your Life” with the subtitle,”Train your brain to get more done in less time”, by Margaret Moore and Paul Hammerness. I think this is a great place to start for people who want to be their own life coach. I know I am going to crack open this book as soon as possible. 

Beyond that I am still going to be giving continued thought to what, in practical every day terms, could help people meet their basic health goals in nutrition, fitness, and stress management.

Stay tuned for more tips on achieving wellness on next weeks Wellness Wednesday. 

Structure Sunday: The Structure of My Reading List

Isn’t reading for kids in school ? Who has time for reading ? I hear these types of things all the time. Reading is immensely important to me. Stacks of books and magazines line my home office.

I have already blogged about the scientific evidence on the effect of reading on health in the following post: http://drginanelson.com/drginablogs/2015/2/28/structure-sunday-structure-your-mind?rq=reading

Now I am going to share how I divide my reading pie. 

  • Reading the news
  • Reading to indulge certain interests 
    •      Things that just pique my interest 
    •      Things I’m trying to do
  • Reading for self improvement 
  • Reading for Medicine
    •      To deal with a patient problem 
    •      To accomplish my annual board review 
  • Reading for business 
  • Reading for inspiration 
  • Reading for fun

 

Here are my current examples: 

 

Reading for News: 

I use Flipboard, a popular customizable news app, my Yahoo homepage which I have tailored to my interests, and News, the new Apple app included in the latest IOS operating system. I also sometimes look at two local paper newspapers. 

Interest Based Reading; 

I am always reading cookbooks, or on cooking sites. I love foodnetwork.com, and epicurious.com. My favorite cookbooks right now are” Paleo”  cookbooks like NomNom Paleo. Pinterest is the best pictorial cookbook in the universe.

I am working on a sewing project and have had to reread some stuff about free motion machine quilting. I am also reading about the work of Natalie Chanin, a designer who revitalized an Alabama community with her handmade heirloom pieces of organic cotton jersey. See alabamachanin.com. I am trying to use one of her beautiful instruction books to make a tunic out of old black t-shirts. 

I am doing quite a bit of reading about small smart energy efficient homes. My family is considering a project with these. On my desk right now is a small beautiful book called “ Convertible Homes”, by Amanda Lam and Amy Thomas. 

Reading for Self Improvement: 

I am about to dig into “ Superbetter”, by Jane McGonigal, a scientist and game designer interested in harnassing the power of gaming for self improvement and medical recovery. I am also excited to ready the giant book on my desk written by my old dorm mate Dan Levitan, The Organized Mind. Good on you, Dan. 

Reading for Medicine: 

The large stack of research articles for American Board of Obstetrics and Gynecology annual board review. I have to have them done by December 15th, but prefer to have them done by October 20th, when I go on vacation. 

Reading for Business: 

I am currently reading “Ask” by Bryan Levesque as an ebook on my Kindle app on my IOS devices. I regularly read Inc. and Entrepreneur magazines. 

Reading for Inspiration: 

I am still working my way through “ Becoming Steve Jobs”, by Brent Schlender and Rick Tetzeli. Wired magazine is a constant reliable source of inspiration. 

Reading for Fun: 

I just finished a new favorite, “ Seveneves”, by Neal Stephenson. I have ordered "Trigger Warning", a short story collection by Neal Gaiman, and just bought  paper copy of “The Martian” by Andy Weir, since I have a feeling I will want to share it. Finally I am savoring “ The Magician’s Land” by Lev Grossman, and author who I was pleased to once meet at a reading.  And yes, my favorite fiction genre is sci-fi. 

You might ask how I learn what’s out there to read. I live in an area THAT HAS NO BOOKSTORE ! I go to Amazon.com and check the recommendations. I also am a member of the online community Goodreads, where I get all kinds of ideas. I read book reviews such as the regular columns in my favorite magazines. I check the NYTIMES review of books, and the books award lists such as the Nebula Awards. Plus, I simply google things like “ The 10 best new cookbooks of 2015” or “ The ten best sci-fi novels of 2015”. 

How can I read so much ? Here’s the secret: I do it all kinds of ways. I read my paper books in the day, books on devices at night, and use Audible.com to listen to books when I drive, jog, cook, sew or do housework. Each method has a different effect and that is ok. Try them all and see what you think. 

Reading stokes the fire in my soul. So take page from this playbook and harness the power and joy of reading for yourself. And don’t be afraid to have a few things going at once. 

 

Wellness Wednesday: Survey Results for your Biggest Health Challenges

Don't you like getting survey results? It's like getting the punchline to a joke or solving a puzzle. Basically you get to compare your anticipation of the results with the actual results. It's even more fun when the results you get are unexpected. 

Many thanks to those who took the time to complete the survey. The number is small, but it is more than last survey I ran.

Here are the key results:

Personal trainer and fitness women.jpg
  • Approximately three quarters of respondents felt that their health was only somewhat where they wanted it to be.
  • The biggest health challenges were divided almost equally across nutrition, fitness, weight, and stress.
  • Most everyone who took the survey took the time to write a bit about the biggest obstacle to health maintenance. Time was the most common theme expressed in a variety of different ways. Some people referred to the time demands of their job, partner, kids, house and pets. I doubt very much that these things are ever going to go away. In fact, I hope all of us always have jobs, partners, kids,  houses and pets. It sounds to me that concerted improvements in time management would be helpful across the board.
  • Respondents were uncertain and vague when asked open ended questions about what would help them the most with there health. However when given a choice of specific set of health related products, they were able to clearly choose what would help them the most. This is where the surprise came. It wasn't a product at all. Far and away the most often chosen product was a "health coach." 

Fairly recently I ran into a physician friend of mine who I thought had retired. It turns out she had actually gotten certified as a health coach. She is loving it and and really feels like she's making a difference in her patients' lives. So after I saw the results of my survey I called her up to find out a little bit more. It turns out that health coaches are probably the next big thing in preventive medical care. 

It turns out that there quite a few health coaches out there and it turns out there are a lot of courses you can take in person and online by a great many certifying organizations to become one. However, only one organization is approved by the American College of Sports Medicine, the Wellcoaches School of Coaching. (wellcoachesschool.com) It is an evidence based program which uses up to date behavioral, exercise and fitness science to help people improve their life and their health. Luckily for us, my friend was certified in this manner. She works at out local fitness center. 

All well and good. But I called her later and grilled her about insurance coverage for such services. It turns out that, yes, many insurances do cover some health coaching, which struck me as a pleasant surprise. So I am going to start utilizing her and her team for my patients. I and many other doctors do a lot of office based health coaching, but in the setting of providing specialized medical care I can only give health coaching a limited focus. 

I wonder about those without insurance, those with high deductibles, and those with insurance that does not cover health coaching. I still would like to know what resources would be helpful to people who wish to, in effect, be their own health coach. What do you think ? 

 

 

 

Structure Sunday: The Structure of Your Process

How can we get done all that we want so that we can truly free up personal and family time ? The answer lies in our process. Here is a rough and simple set of guidelines that should help you improve any process that you do, from shopping for groceries, to generating a report, to buying a horse. 

Read More

Wellness Wednesday: The Benefit of Trying New Things 

Nutrition, fitness and good relationships can keep us healthy. But... trying new things ? Yes, being adventurous has physical as well as psychological benefits to our health. (1) 

Adventure is a relative thing. For one person it might mean trying a new cookbook (me) while another may need to paraglide to 5000 feet above sea level (my son). But in all cases it means doing something different than your usual, and, for best results, it means getting out of your comfort zone. Comfort zones vary considerably in size.  

Does adventure have to be dangerous ? Of course not. But it should expose you to a new environment and require you to do things you have not done before. So why does it have to be all that? 

Before I explain, lets take a look at the American vacation. It is an endangered species. We are one of the few developing countries without a national policy of paid leave. Those companies who do provide paid leave do not always encourage its use, even though research shows it greatly improves employee productivity and satisfaction. When the companies do provide leave AND encourage its use, employees are reluctant to take it. Why ? Forty percent are afraid of coming back to " a mountain of work" , a third feel no one can do their work but them, a third feel they cannot afford it, and about a fifth feel guilty.  Forty-three percent of adults do not remember the last time they tried to have an adventure. Reasons for avoiding adventure range from lack of money to embarrassment. (2) Fear of one thing or another plays a role in skipping vacations. Ironically, it should be the opposite, since skipping vacations is associated with a measurable and significantly increased risk of heart disease in men and women, according to the Framingham study. (3)

And yet, we bemoan our lack of time off and we make bucket lists all of the things we don't and won't do. We execute what Tim Ferris calls the " deferred life plan". (4) Moreover, we note how every year seems to pass more quickly. 

Enter adventure. If we do get around to it, here is what happens. First, our narrow view of the world opens back up. We experience different ways of living, and see ourselves and others in a new light. Novelty and some degree of challenge have to be a part of it. This way, our confidence and competence is enhanced. A 2015 Study on newly graduated nurses found that a nontraditional outdoors adventure leadership program increased feeings of competence and confidence. When they returned to work, their transformation was felt to have impacted their entire work culture. (5) 

Adventure may even be an antidote for the accelerated passage of time. Dave Engelmann, a neuroscientist, notes that the more familiar the world becomes, the less we remember, and thus the faster times seems to pass. (3). I deduce that novelty and adventure may help us savor the time we have. 

Check out these fun resources: 

30 New Things to Try by Lifehack.com

The Beginner's Guide to Trying New Things

Staying on Top of Your Game

References: 

  1. http://www.huffingtonpost.com/laurie-gerber/are-we-having-fun-yet_b_7948588.html
  2. http://www.huffingtonpost.com/2014/08/19/americans-vacation-days_n_5682576.html
  3. http://www.newyorker.com/magazine/2011/04/25/the-possibilian
  4. http://www.bothsidesofthetable.com/2010/01/10/what-can-you-learn-from-the-4-hour-workweek/
  5. http://www.ncbi.nlm.nih.gov/pubmed/25608096