WARNING: Overuse can be hazardous to your health.

As a New York Times reporter put it so well, “This is your body on chairs” (insert provocative CSI-style zoom-in to body): The assault on your metabolism begins as your calorie use dwindles to around 25 percent as compared to walking. Several researchers have published the sedentary body’s decline in sugar uptake, as insulin sensitivity drops by up to 40 percent. Several studies also show that our means of vacuuming fat from the bloodstream are also diminished after long periods of inactivity – particularly an enzyme called Lipoprotein Lipase (LPL). Increased levels of triglycerides and lipids and lower levels of HDL (the good cholesterol) have been measured in multiple studies. The combined harms of excessive sitting, especially over a lifetime, leave one with an increased risk for type 2 diabetes and cardiovascular disease.

This whole time many of you have been thinking, “Surely my exercise routine of 40 minutes, four times a week, protects me from these problems.” Experts would tell you that this is like excusing a cigarette a day with some time on the treadmill – the health effects take their toll regardless of your fitness level. Intense exercise is simply not enough to burn off the calories equivalent to our daily intake, even though it may boost our metabolisms throughout the day. Think of your metabolism as a car on the freeway – and for a frame of reference, Lance Armstrong is an Indy 500 car. The goal is to keep your engine running to maintain a high speed. When you are inactive, you are pressing the brake pedal, and your relatively short bursts of exercise are punches on the accelerator. Put the time difference into perspective, and you can imagine how slowly this car would be moving.

The silver lining in all of this is that there may be a way to ease up on our brake pedals, according to Dr. James Levine, a physician at the Mayo Clinic who is pioneering solutions for our “chair-based lifestyles.” This is where things get so simple! All it takes are minor activities, and more of them, such as standing or pacing while studying or on the phone, taking the stairs, cooking more – simple alternatives to long-term inactivity. He has coined this type of activity as non-exercise activity thermogenesis (NEAT), which realistically accounts for most of our caloric burning throughout the day. He and other researchers have demonstrated these interruptions of inactive time directly decrease health risks. Study subjects had increased insulin sensitivity, lower triglyceride and lipid levels, and long-term studies had smaller waistlines and BMI’s.

Students and those with desk-based jobs should be especially aware of the risk factors and their individual solutions to their inactivity. So next time you hear about treadmill desks, or the use of exercise balls as office chairs, consider the benefits of these solutions. I’m gyrating on an exercise ball right now, and it’s fantastic! If you need baby steps, perhaps start by avoiding the elevator.

In Physical Diagnosis class we have to learn not only the difference between a McMurray’s, McBurney’s and a Murphy’s, but how to properly test them. It’s usually in a high-stress situation that the school fondly calls Standardized Performance Assessment Lab, or SPALs. In SPAL we go through the tests we learn during class with a “patient” and a faculty in the room grading us. The faculty member looks at our finger placement, how we handle the equipment and how we interact with the “patient.” The SPAL patient is a very nice community member who doesn’t mind a bunch of inexperienced students poking them, sticking things in their ears, and trying to perform other uncomfortable diagnostic tests. We learn these tests by watching a video circa 1980s and then try to imitate what we see on the screen on each other during Physical Diagnosis lab.

Lucky for us, we are also taught by excellent faculty members. They show us different ways of doing tests and what works for them. Some of my classmates seem to really get a grasp on the different tests. Some were really good at the eye exams and others were really good at the orthopedics exams. Some were good at everything. The more I watched them and imitated them, the more I was able to correctly perform the test (or correctly enough for the SPAL).

We just finished our Physical Diagnosis class and I can now add about 100 pages to my book of tests that I know how to perform (depending on how big your font is). It did not come overnight. I had to fall. Watch my classmates. Get a big cut. Watch my teachers. Get a Band-Aid for my boo-boo and watch my classmates again. Now I think I can take the training wheels off, but I think I’m going to keep the pink basket and bell for now.

Also, I think it is fine to try to imitate someone else to learn how to do a new task. They say imitation is the most sincere form of flattery; however, I don’t think you should force someone to imitate you (cough, cough, Mom).

Why you should make friends in grad school:

10. School is now your life. You go to class. You study. You sleep (some) and repeat. Every once in a while when you get a five-day break between tests, it’s nice to have someone to complain to about school or make a “no talking about school” rule and attempt to follow the rule for five minutes when out to dinner.

9. You don’t know what to talk about to your friends and family back home because of number 10.

8. It is nice to have someone wish you “happy birthday” other than those Facebook people from high school you haven’t seen in years.

7. If you want to drink adult beverages, doing it alone can be a sign of alcoholism.

6. It is more comfortable getting up close and personal during Physical Diagnosis class. Well, no, actually it’s still awkward.

5. You learn more about Iowa sports. Since I am not an Iowa native, I thought I would impress one of my classmates with my knowledge of their sports teams. She said she graduated from Iowa State. “Ah ha,” I said to myself. I know their team name. “Go Hawkeyes!” Well, my friends let me know my mistake before I got beat up.

4. It’s nice to have someone who will share their locker for your backpack during test days when you can’t remember your combo or your lock is like mine and only works when you don’t actually need in your locker.

3. You might not be athletic enough for one-person volleyball.

2. If you are laughing in public with a group, people think you are having a good time. If you are laughing in public by yourself, people think you are schizophrenic.

And the number 1 reason is…

1. It’s better to cry on a friend’s shoulder after a bad test than on a stranger’s.

I can understand why they ask this question, as many people have an aversion to feet. My first response is to chuckle inwardly and think about the specialties I could never see myself practicing. I certainly don’t say that to put down other specialties, but we each have our specific areas of interest and strength. While I knew in undergrad that I wanted to go into medicine, I had no idea what area of medicine I wanted to pursue. To learn more about my options, I spent time shadowing physicians in several different fields: family practice, otolaryngology, dermatology, urology, ophthalmology, etc. I found things in each specialty that I liked, but nothing seemed to jump out at me.

While I knew I didn’t have to know exactly what I wanted to do going into medical school, I did want to have a better direction. I just couldn’t see myself waking up every day and looking forward to going to work in each of these other specialties. So as my time in undergraduate was coming to a close and applications for school were coming out, I decided that the next doctor I wanted to shadow was a local podiatrist. I had gone to see him before and also knew him outside the doctor-patient relationship. To be honest, before I went to shadow him I didn’t know that podiatry was a separate degree (D.P.M.) rather than a residency post-M.D./D.O. degree.

DMU's podiatry students learn ways to improve patients' quality of life.

After shadowing him, it was like a lightbulb flipped on in my head. Podiatry had many of the things I wanted in a practice. One of the things I found most appealing is that it focuses on improving one’s ability to move about without pain. To be able to help someone walk with less or no pain is an incredible feeling. You get to walk (no pun intended) through the whole process with the patient, from seeing them come in with pain and walk out at a later visit pain-free. That is awesome. Whether this is done by conservative care or surgery, helping a patient to be able to ambulate easier drastically improves their quality of life.

The practice even has a lot of flexibility with how much office time/surgery one does. Honestly, one isn’t going to know which side of practice they will like better until they get first-hand experience in the office and the OR. Personally, I take a lot of comfort knowing that when I graduate residency, I have a choice of how involved I want to be in both. If I decide that surgery isn’t my thing, I don’t have to do a lot of it. Or, on the other hand, if I absolutely love it, I can do more.

Another one of my desires for a medical practice was to find a specialty that had a wide range of patients not only in age but in background. I didn’t want a practice that was all of one group, e.g., pediatrics, ob/gyn, etc. Podiatry does have a focus on diabetic care (which tends to lend itself to the geriatric population), but it also has an array of other groups such as the pediatric population, adults and athletes. You really get it all. So those of you out there who are still contemplating what you may want to do, go check out a local podiatrist and see what it is really about!

Quinoa: versatile, protein-packed goodness in every bite

Now, coming from a guy’s perspective, I can tell you that the first thought that comes to mind when I hear the word soup is “watery and not filling.” Well, not this one. Fear not, gents, this one is for you as well!

This soup was “accidentally” invented when my fiancée was preparing another soup with a similar broth and realized that she didn’t have anything the other recipe called for. She substituted quinoa for barley and added whatever vegetables she had on hand, and it turned out great!

Quinoa vegetable soup

• 3 tablespoons olive oil
• 5-7 cups of vegetables (normally whatever is in season; corn, green beans, potatoes, mushrooms, onions, carrots, celery, zucchini and kohlrabi have all worked well)
• 1 tablespoon dill
• 8 cups chicken broth
• 1½ cups milk
• 2 tablespoons soy sauce
• ¼ teaspoon pepper or to taste
• 1/3 cup fresh parsley or 1 tablespoon dried parsley
• 1 cup quinoa

In a large saucepan or pot, heat olive oil for about 2 minutes. Add vegetables and sauté for 6-7 minutes until soft. Add dill and stir to coat vegetables. Add 2 cups of chicken broth and heat to boiling. Add remaining broth, milk, parsley, pepper and soy sauce. Simmer for 20 minutes.

Add quinoa. Simmer for 15-20 minutes or until the white spots in the center of the quinoa grains disappear completely.

This music festival was just one of Des Moines' fun summer offerings.

Of course, I was certainly able to pull myself together in time to visit the 80/35 music festival that took place downtown last weekend. For those who missed it this year, definitely mark your calendars for when it comes around again. I could post a whole series of blogs on the events of those two days alone, but suffice it to say that they involved robotic fish wearing gas masks and famous rappers autographing bottles of antipsychotic medications. I leave it to your imagination, my reader, to fill in the details. For those who are feeling left out having missed the chance to lose your voice and hurt your neck at a concert (I’m sure some of you know what I’m talking about), the 515 Alive event on August 6 will simply have to do in the meantime.

Now, all these wonderful tales of excitement, adventure and mishap shouldn’t detract from how productive my summer was. I’ve enjoyed the opportunity to participate in DMU’s mentored student research program, which concludes with a symposium this coming week. For my work with DMU Associate Professor Dr. Simon Geletta, we’ve been researching the timeframe of complications with diabetes, though our unfinished project will continue into the fall to serve as the capstone for my MPH degree.

Lastly, it pains me to report that this summer also saw the death of Caroline, my 1998 Pontiac Bonneville, after her brake line rusted through and burst (which I take to be the car equivalent of a ruptured aneurism). Fortunately, Des Moines is an incredibly bike-friendly city, and my apartment sits squarely between the DMU campus and a grocery store. Add to this the fact that DMU students can ride the city bus system for free, and I haven’t suffered much at her passing (aside from the emotional scarring at her unexpected demise, of course). I trust I’ll have fast-tracked through the five stages of grief and landed in the “acceptance” phase in time for the start of classes on July 20, when yet another year’s worth of the med school adventure is sure to unfold.

The T.O.U.C.H. program is recognized across the country. Most osteopathic medical schools have one, and most residency programs (D.O. and M.D. alike) are at least familiar with it. DMU, however, presents some interesting opportunities for students looking to receive a T.O.U.C.H. award in order to gain the upper hand in applying to residencies. For one thing, a unique aspect of the DMU curriculum is the fact that our physical diagnosis class is relatively early in the program. That means that by the end of our first year, we’re already able to conduct a thorough history and physical. Even if we aren’t yet familiar with all the clinical medicine or treatment options from the second-year systems courses, we can at least provide valuable assistance to local free clinics or health fairs. Oftentimes, the attending physician will give us modest autonomy in being the first to see a patient, take vitals, ask the right questions and begin the physical exam. Some medical students don’t get such opportunities until their third-year rotations (when they’re being evaluated).

Providing OMM treatments to athletes is just one way DMU students volunteer.

Another nice feature of DMU is its prime location. Des Moines is, after all, Iowa’s capital and most populous city. This means that most of the Iowa chapters of major health-interest groups have headquarters in or around our neighborhood. Furthermore, whenever there’s a need to raise political awareness with a major outreach event, Des Moines is a prime target. So what does that mean for us? Well, when the Iowa chapter of the American Lung Association hosts its “Fight for Air” stair climb, it’s right here in Des Moines. When Iowa’s branch of the American Diabetes Association launched its first “Tour de Cure Bike Race” this year, it was right here in Des Moines. And whenever there’s a “race for the cure” for AIDS, cancer, emphysema or whatever else you can think of in Iowa, guess which city it’s in? And with all these runs/bike races/stair climbs, of course, there’s an obvious need for medical personnel and dedicated little osteopathic medical students to provide first aid or OMM treatments (as in our famous Osteopathic Finish Line events – OFLs for short). We are, to my knowledge, one of the only (if not THE only) medical school in which students are able to perform OMM treatments on actual patients in our first two years (and my first OFL was in the first month of class). There are almost always two or more such events every month in Des Moines.

Additionally, Iowa has always been known for its famous educational system. Notice that the back of the Iowa state quarter features a school house in testament of this fact. Additionally, even back home in Pennsylvania, I too took “the Iowa Test of Basic Skills” in elementary school. A guest speaker from Iowa State University summarized it thusly (to a group of high school students visiting campus): “Based on standardized testing scores, it’s often said that America trails much of the world in terms of education…but if you were to remove Iowa from the U.S. and treat it as an independent country, its educational system would place #2 in the world by the same standards.” I don’t know how he got such numbers, but I knew he was right after hearing the high school students’ responses. One inquired: “Wait, on what data was that conclusion based?” Others piped in with “Yeah, I’d like to see the primary literature” and “What was their sample size?” (Seriously, I wish I was kidding.) Now, with all this excellent preparation for higher education and career placement, these students pay lots of visits to local colleges and professional schools early on in their schooling. And who, you might be wondering, will eagerly open their doors to educate such bright minds about the virtues of a career in medicine? Why, DMU, of course, with our “Exploring Post 141” program and “Community Ambassadors Program,” in which DMU students are actively involved in representing our respective programs. When they don’t come to us, we often visit them (as in our “What’s in a Doctor’s Bag?” program for explaining medical instruments to elementary students).

Now, as delightful as it is to have that T.O.U.C.H. certificate hanging on the fridge, or our gold and silver pins affixed to our white coats, working in the community is its own reward. It gives us a chance to remember where we’re headed – a reminder that there will indeed be a life after medical school. Sometimes, when you’re memorizing microbes or chemical pathways for hours on end, you may often ask yourself, “Now, why is it that I’m here, again?” or “Why was it that I wanted to be a doctor in the first place?” Then, after you help an impoverished man at the free clinic get payment assistance for his hypertension meds, you find your answer.

Ahh, it's time to take a break. For some DMU students, anyway.

While I still intend to fritter away a good part of my summer reading drab pharmacology notes or preparing well in advance for boards, I could hardly turn down a chance to do something pointless and unproductive for a change. I’m particularly delighted that this week marks the Electronic Entertainment Exposition (E3) in LA, the High Holidays for videogame nerds everywhere in which our favorite developers unveil their latest creations for the coming year. I haven’t had time to spend on gaming for quite a while now. The expectation that Nintendo will reveal the successor to the Wii this week is one reason why I elected to repair my old Wii console instead of buying a new one when it stopped working last month (turned out to be a broken laser lens – I was able to find a suitable donor and perform a transplant with minimal complications, thanks to the contributions of my talented first-assist during the risky surgery).

I’ve also taken to spending more time volunteering at the Science Center of Iowa, where the “Body Worlds Vital” exhibit continues to be on display for a few more months. Thanks to those of you who attended my dissection demonstration on Friday, btw – I had never cut up a dead sheep in front of an audience before, but we certainly had a great crowd for the occasion. Myself and several other DMU students will be providing guided tours of the exhibit throughout the summer. If you’re in the neighborhood, be sure to come check it out.

Also, when the oppressive heat dissipates and it’s safe to go outside again, the farmers’ markets are an obvious staple for the local Des Moinkers (a term which Dr. Mueller proposed as the demonym for people in Des Moines at our orientation last year). Now, coming from out East, I had sworn that the Strip in Pittsburgh had the best edibles in the world, but the foods sold at these markets give it a run for its money. They have pies that will basically come to life in your stomach, climb up to your ear, and sing you enchanting melodies with their flavor. Yeah, I don’t even know what that’s supposed to mean, but there’s no other way to describe the phenomenon that they evoke. Just try one already, and you’ll know exactly what I’m talking about.

In an entirely unrelated note, good luck in Anatomy to all the first-year PAs. Just remember, it eventually ends. Just like everything else.

*SPALs are sessions for DMU clinical students in the Standardized Performance Assessment Laboratory, which uses people trained to play the roles of actual patients in a physical exam setting.

Okay, now bear with me for a minute here. Long ago, it was thought to be good practice that the best way to get someone to quit smoking was to make them smoke an entire pack of cigarettes at once until they were sick of them. No, I’m not proposing we do this in a clinical setting, but I think the basic concept can be generalized to other situations. The reasoning, essentially, was that the easiest way to make someone stop using something was to give them as much of it as possible until they hated it. So the other day, I thought to myself, “Hey, what if we adapted this logic to fix excessive health care utilization?”

So here’s the genius idea: In my new “StWP” plan, doctors will respond to office visits for simple and uncomplicated illnesses by providing every possible service remotely associated with the complaint. For example, a patient who visits the doctor for an uncomplicated headache need not be charged a co-pay. They will, however, have a head CT, a spinal tap and every single blood chemistry drawn. Conversely, if they have a cold, they won’t actually need to pay a dime for their visit. Instead, they’ll simply have to undergo a full-body MRI, a lung biopsy and an ELISA test run for all viruses known to man (exotic viruses will not be excluded, of course). For men over 50, every office visit will also include a colonoscopy.

The message we sent with the old system was “You want health care? That’s fine, but this stuff ain’t free.” The message we’ll send with the StWP plan is “You want health care? Oh, we’ll give you health care…but careful what you wish for.” Insurance companies thought that a little $20 check was enough to scare people away from booking too many appointments with their physician. But what they didn’t realize is that the only thing that really scares people away from the doctor is the prospect of a colonoscopy. Best of all, unlike traditional disincentives, the StWP leaves no opportunity for small and uncomplicated illness to go unaddressed. After all, if a patient comes in for so much as a splinter in their big toe, the doctor will have tested for everything from a case of the sniffles to the black plague before treating them. Sure, they won’t go to the doctor as often, but when they do…they really mean business.

So that’s my grand idea – the product of a sleep-deprived medical student with too much time on his hands who had one too many feverish dreams following his last health administration exam. But hey, every truly genius idea comes in the disguise of madness. And I think we can all agree – this one has a pretty convincing disguise.

Students, we’ll see you on Saturday. Study hard!