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The Girlfriend's Guide to Health will be updated every Tuesday.... Stay tuned dear readers and let me rock your world.

Tuesday, April 30, 2013

I Gotta Be Me

I am told by those “in the know” that we indeed live in the “GENERATION OF ME”. Yes, my sisters- welcome to it- the age of the self. Never before has the world been such a personal place. Facebook pages, Twitter handles and personal blogs (ahem). We all have officially been seen. Today’s world is one where everyone- and I do mean everyone has their name on things.

Don’t believe me? Go to a Starbucks. Yes, my sisters- their coffee is not the greatest but in a caffeine deficient pinch- a girlfriend can’t be picky. And so there I was….. this past weekend. Two coffees into my day and desperate for a third. No judgement on my caffeine consumption- pay attention to the story.

I found myself in a Starbuck’s Coffee Company. I ordered my “usual” Grande mild in a Venti cup when the woman at the counter asked my name.

“I’m sorry?” I asked
“Your name…. you know for the cup”
“Lola”, I lied. It’s my standard tag name for all coffee orders. When pushed to identify myself to a barista- I cave and give my dog’s name. Why? I don’t know…. I’m an asshole.

But in the next moment, I watched the man behind me go through the same ritual. There he was, apparently a regular whose name was “Glen”. Glen proudly said hello to the barista behind the counter who by the way she greeted him clearly identified him as someone who “came there often”.

“Hey, Glen…. What would you like?’ she asked.
“I’ll have the usual”. He said.
And then…. This cute little barista committed a coffee felony. She could not remember Glen’s “usual”.
“Uh, Sorry,” she sputtered…. “I forget. What’s the usual”?

Glen was clearly not happy. This was his version of that scene in Cheers where everyone knows your name and sure enough someone did not know who the hell he was. Well, they knew he was Glen… but that was only part of the story. And so, I watched Glen shamefully slink back from the land of the familiar as he ordered his coffee just like the rest of the nameless faceless masses.

I took my coffee cup labeled LOLA in big black Sharpie letters and headed towards the condiment bar. And there I stood for what seems like a while watching Glen and Shari and Janice and Sienna all wait for their lattes and americanos and half fat, no fat foams. They stood there in coffee land wanting to be seen or not wanting to be seen and I got to thinking…..

My generation has no problem having their name engraved on a coffee cup on a regular basis, but my mother still won’t give out her credit card number on the Internet. Was this progress or retreat?

Was this the ultimate mixed message? We talk about identity theft as though it were a social case of bird flu- heaven forbid it fall upon us. But here we are one generation after another throwing our names and witty banter around like its oxygen- waiting for anyone to inhale and exhale it at whim.

Could this be the ultimate mixed message?

Here it is 2013.  Personal Identity is something we guard so closely but give away so freely. We post pictures of the food we are about to eat and what we did twenty minutes ago without a thought in the world. But here I was unable to give my real name for a coffee and here Glen was unsettled by the fact that some random stranger could not remember that he indeed like his latté extra hot and with no foam….

Incidentally Glen- lattes don’t come with foam- that’s a cappuccino, my friend, but I digress.

What is it about our sense of being that makes it so precious to some and so transparent to others? Here I was somewhere between Glen and my mother. I was unwilling to give my real name at a Starbucks but I will shop for Canada on the Internet.

I could not help but wonder what the proper course of action could be…. In short when it comes to identity, what’s the proper course of action?

There is of course another facet to this whole identity issue that we have not even thought of. Amidst our need for being seen is the concept that we indeed all crave for that spice of life known as authenticity. Yes, my sisters… we girlfriends, we can handle the truth. In fact, we demand it. Whether it is in our online profile or in the mirrors at Holt Renfrew- we want a degree of honesty that reflect who we are.

But at the same time- we all want to protect that level of privacy. SO how to maintain an authentic, personal relationship with the world while still maintaining your privacy?

The answer is…. You don’t. Make no mistake my sisters- I do indeed believe we can have it all but I’m not sure where the personal meets the private that we should. When you want the world to see you there will come a time where putting yourself out there really is too revealing.

I have thought about this a great deal as a physician. Here I am a doctor by day and once a week I lay it all out there (expletives and all) in a loosely based medical blog that no doubt some of y patients will read.

When do I stop being a doctor and just become a regular citizen? Has the Internet indeed limited this ability to separate medical church from state so to speak?

Indeed the American College of Physicians just recently released a position paper on medical conduct and the Internet. In this position statement published on April 16, 2013 in the Annals of Internal medicine the ACP acknowledges the power of the Internet to educate and inform patients and to indeed improve quality of care. However, the ACP states:

To protect patients and the public and promote quality health care, it is critical to strike the proper balance to harness opportunities while being aware of inherent challenges in using technology. But as others have pointed out, “Connectivity need not come at the expense of professionalism”

And so as a sister, I do what I do best. I walk a very fine line in four-inch heels and I hope for the best. I put myself out there every day in my practice and here and there in the media. Judge away my girlfriends…. But not until you’ve walked a mile in these heels. And indeed, thereafter do be kind. When I find myself in a Starbuck’s ordering my coffee…. That’s when I draw the line. Yes, I’ll be real in almost every place in my life, but when it comes to my “Grande mild in a Venti cup”, well, that’s indeed when you can just call me Lola.  

Tuesday, April 23, 2013

I Run for Shoes

Yes, I am a runner. Fast or slow, long and steady…. I am a runner.  May be I’m in it for the shoes, maybe I’m in it for the health benefits… hell maybe I just run from brunch. But indeed, I am a runner.

It has dawned on me in this year of running that indeed there is a rhythm to the sport of lacing up ones shoes and pounding pavement or trails or treadmill or a flat surface of any kind in the pursuit of…. The pursuit.

So this past Saturday there I was with my last long run before my taper in preparation for my next race.  

Yes, my sisters- in just 2.5 short weeks I will run the Vancouver Half Marathon. This is not my first 21.1 km race. I’ve been running for about 7 years now. My first half marathon was in 2007 and I’ve been running them ever since.

I do love a good half. It’s just the right distance to allow me to eat brunch without guilt while still allowing me to walk upright the following morning.

And so it dawned on me somewhere along my recent 20 or so km run that indeed there are stages to a run.

Humans love to keep track don’t we? We love to record the passage of time and the stages of life. We have stages of  growth, we have stages of life and yes, even in death we have stages of grief. Indeed, one such girlfriend, Elizabeth Kubler Ross even documented such stages of grief in her world renowned work ON DEATH AND DYING.

As an aside- the book is a fabulous piece of work. I would argue it has become an iconic reference in our grief nomenclature.

So I could not help but wonder if the lessons from Kubler Ross could be applied to  other stages in life…. Perhaps the stages of running?

Let’s be clear my sisters- I am in no way poking fun at grief in general or a personal grief in particular. I myself have had my fair share enough to know that once in a  while a good laugh is mandatory. If you find the comparison between stages of grief and the following offensive, please accept my heart felt apologies in advance and feel free to boycott my blog for at least, shall we say, the next calendar year?

But if you are a runner or indeed you dare to try it, might I say in advance (and I’m not over-reaching) that I think you may identify with my following little rant.


Denial usually begins the night before the run. Maybe you are eating a little too many carbohydrates, maybe not.  But somewhere along the way you think to yourself…. 20km? No big deal. If you are training for an even longer distance you lull yourself into a false sense of security of some kind. There’s no way running 38km is a bad idea? I’ll be able to handle it. This kind of blind disconnect continues into the next morning and perhaps even well into the first five or six kilometers of your run. I suspect its how a mother feels when giving birth to her fourth child. As the kid is ripping through her body with no apologies and no morphine she thinks…. There is no freakin way this is going to hurt that much.

Anger in running typically manifests itself in what I like to call ATHLETIC TOURETTE’S SYNDROME. This is where I swear profusely somewhere around 12 kilometres into the run and usually while on an incline. Anger is your brain’s way of bitch slapping your body for even thinking that 3 hours or more of exercise was anything but a shitty idea. Anger can also be directed at the skinny sister in front of you who is indeed the size of your left thigh and is running (and chatting) without a care in the world. She typically has a perfect ponytail that sways back and forth, rhythmically mocking you while your hip begins to throb.

Rest assured anger can indeed be a useful stage in running. It often propels you faster on your run and is a creative outlet for all those expletives you wanted to say in your everyday life but could not. When else in your life can the rubber meet the road while you scream MOTHERFUNSHOUSE for all to hear?

Fortunately, anger tends to pass as the run progresses. It must. Runners are a pretty happy group. If anger does not pass you will likely give up running all together and take up golf. Why golf you ask? Golfing by its nature is a very angry sport.

Ah, the runner loves to bargain. Half way through he run you make deals with the road and with yourself.
“I’ll run to the next bridge and then I’m done”
“I’ll eat another energy gel and then I’ll run for another 45 minutes”
“I’ll walk for 60 seconds until I can feel my left foot and then I’ll start to run again”

As for me? I bargain with retail rewards. If I finish this marathon I will buy myself a new pair of shoes. How extravagant these shoes are directly correlates to the amount of suffering I am currently feeling in this race or training run.  In short? I trade my pain for something pretty. I bargain back and forth in my brain on how much I will run and nothing is for nothing. Yes, it is juvenile. But both my body and my shoe closet have benefited for some time.

 Bargainers often bargain well before the run…. If I eat this chocolate torte, I will run that 10km race…. Bargainers are everywhere and they do indeed drive the sport.

Most people would think running is a great cure for one’s mood. In fact in many large scale randomized trials exercise has been shown to be an excellent treatment for depression. Here’s the thing…. Somewhere after the first hour of a three hour run you realize that you are only 1/3 of the way through. Heads up? That’s where the sadness begins. Some of us cry, some of us look at our watches and wonder why is it our body can’t go any faster. Some of us just settle in to the sadness and get ready for the next stage. Which is of course….

Yes, my sisters…. Here it is. This is where you sit back and resign yourself to the fact that you are indeed a lunatic. I say sit back only figuratively of course begin stage 5 usually comes somewhere near the end of your run and by this point you can no longer feel your hips. Sitting down is not an option. Why? Not because of the will of a woman but because you physically can no longer sit down. And so like any good girlfriend with the will of a woman you just keep on running.

There you have it my sweet sisters. We are full into running season. The Sun Run is past, the Vancouver Marathon around the corner. The London Marathon safely complete and my love for Boston swells as that city begins the healing.

On this lighter note I leave you with the five stages of running that all of us go through in the pursuit of our own physical excellence as we strive to push the limits of human abilities.

As for me? I continue to push my own boundaries of fitness when the rubber meets the road. Should I fail to meet my own limits? I will always have my shoe closet to fall back on and remind me of the real pursuits of excellence.

Have a great week my sisters. Run safe and run strong. 

Monday, April 15, 2013

A Word

It's Tuesday my sisters. And I feel that today begs a different commentary than my girlfriends may usually expect from me.

As I write this my heart is heavy. I try in vein to make sense of the events of Monday, April 15.

As  runner, I feel a special connection to those who were affected. Runners are a community and a family. A marathon commemorates the triumph of the human spirit. It is a demonstration of what we do as human beings when pushed to our limits. It is indeed the best in all of us.

Such an attack is a violation under any circumstances. The fact that it was done during a marathon tries to vilify what should be the ultimate celebration of the goodness in all of us.

As a person- my heart hurts for the victims and their families. We all have the right to feel safe in this world and to have that taken away from us- is the ultimate tragedy.

I'm not sure what to do with this unsettled feeling inside- with the hurt and the anger and the sadness of it all. I tried, in vein, to write some sort of statement about it all in the hopes that I would indeed find a place to put these feelings.

Unfortunately, I don't think that this blog is the place for me to heal. And so, my sisters, I will refrain from a classic post this week. Rest assured I'll return next week with the usual wit and wisdom. Instead- my sisters.... I'm going for a run. It may not be the right thing to do- but for today, it feels appropriate.

Monday, April 8, 2013

Measuring my life in coffee cups

Girlfriends- let’s face it.

Life is about the numbers….

The first question we ask a toddler is… “How old are you?”
(Well that and “Sweetie, can you get your little dirty fingers off Mommy’s friend’s Prada bag?)

At work, I’m often asked about the numbers…

How long will I have to take this medication?
How high is my cholesterol?
How much weight did I lose?

In my everyday life… It too comes down to a numerical game…

How many pairs of black patent pumps does a woman need?

How many eggs could I sell to pay for the new fall lines?

Then there are the questions of my patterns of behaviour.

How many hours of sleep do I get a night?

How many cups of coffee do I drink in a day?

Truth is we all deserve some answers.

So here goes…

A woman’s right to shoes knows no bounds. A pair of black patent pumps is the fashion equivalent to knowledge. … Keep searching and the universe will provide.

I do get 8 hours of sleep a night and I drink 3 shots of espresso every morning and two cups of coffee throughout the day.


I am told I drink too much coffee. This is often by people who don’t drink coffee and like to pass judgment.

Back in the 1970’s there were studies that suggested an increased risk of heart attacks among coffee drinkers. But the debate in the literature was never clear…

Remember my cybersisters…. The 70’s were the era when smoking was encouraged and spandex was king.

In response, researchers at the Harvard School of Public Health decided to look at coffee consumption, heart disease and stroke risk among more than 45,000 healthy men enrolled in the school's ongoing Health Professionals Follow-Up Study. Their analysis, published in the New England Journal of Medicine in 1990, found that coffee drinking had no effect on the men's risk of heart attack or stroke.

A 2008 study of more than 26,000 male smokers in Finland found that the men who drank eight or more cups of coffee a day had a 23% lower risk of stroke than the men who drank little or no coffee.

Results from an even larger study of coffee drinking and stroke risk were published in the journal Circulation in 2009: Among the 83,000 women enrolled in Harvard's ongoing Nurses' Health Study, those who drank two to four cups of coffee a day had a 19% to 20% lower risk of stroke than women who drank less than one cup a month.

A further meta-analysis in the New England Journal of Medicine in May, 2012 showed that coffee indeed does lower cardiovascular risk. During 5,148,760 person-years of follow-up between 1995 and 2008, a total of 33,731 men and 18,784 women died. In age-adjusted models, the risk of death was increased among coffee drinkers. 

However, coffee drinkers were also more likely to smoke, and, after adjustment for tobacco-smoking status and other potential risk factors, there was a significant inverse association between coffee consumption and mortality. IN other words- drinking coffee improved the risk of death (insert yippee here). Adjusted hazard ratios for death among men who drank coffee as compared with those who did not were as follows: 1% reduction for drinking less than 1 cup per day, 6% reduction for 1 cup, 10% reduction for 2 or 3 cups, 12% reduction for 4 or 5 cups per day.  

SO yes… my girlfriends…. It is about the numbers.

I’m a 42-year-old woman with far too many shoes. I brush my teeth twice a day. I have 4 credit cards, 2 dogs and never enough Prada handbags.

Some of my numbers don’t make sense… others will never add up…

But as far as my coffee consumption? I’m just right…

Tuesday, April 2, 2013

Foot Note

As far as body parts go, safe to say my girlfriends that my feet are not my best feature. Great hair, yes and a descent brain but my feet? No, it is safe to say that I was not blessed in this department.

Might I pause for a moment my sisters and ponder the fact that most of us do not have great feet. As a doctor I have the opportunity to see a lot of fingers and toes and let me tell you- a good pair of feet is not a common sight.

I bring this to light my girlfriends for just this past weekend, I had my first pedicure in easily 5 years.

Let me say that I am not a fan of the spa experience. I realize this surprises people when they hear this about me. One would think that a girlfriend such as myself would love the whole pamper and primping. Yes, I have been known to be a bit of a diva, shall we say? But here’s the thing…. I am high maintenenacen…. But I am happiest when maintaining myself.

Sure I love a good day of champagne and shopping. But stick me in a robe and put shit on my face and I am in a word- in hell.

Firstly there is the whole zen environment of the spa. I inevitably get in there and think of the million other things I could be doing with my time.

But there I was at the Ritz Carlton in Toronto with a $200 hotel credit and toes that looked like they had been through a war. What could it hurt to have some perfect stranger pumice my callouses for an hour or so….

That and they offered me champagne during the procedure.

Let me set the scene….

I arrived for my pedicure the recommended 10 minutes early to be handed a special form to fill out. The form asked my name, date of birth and my entire medical history. No joke. It asked for the name and address of my family doctor and a list of all my previous surgeries and medical information.

Like any good client…. I lied. It was a pedicure for heaven’s sake. I had no communicable disease. Hell, I’d never even had a cold sore. My family doctor was leaving her practice anyways and I reasoned that as a doctor myself- I knew what was medically relevant for a good foot soak. So I wrote down my name, my date of birth and left the rest blank..

It was then that I was called aside by one of the attendants and asked if my form was indeed complete.

“Are you sure we have everything accurate?”
“Yes” I smiled back confidently. This was a pedicure after all- not a pap smear, COME ON.

And then I waited. I sat on a lovely bench and read my New York Times and I waited.

Half way through the style section, Nadia, my lovely pedicurist arrived with a glass of bubbly and steered me towards what she called,  my “THRONE”. This is a large Barker like lounger with a bunch on buttons and an attached tub at the bottom where you put your feet for soaking and slothing.  

“Do you want to change into a robe?” she asked.
“No, I’m good,” I replied, “I’ll just take off my shoes and my tights.

Lets talk about the whole robe thing for a minute my sisters. I was not putting on a robe and some slippers all to have my feet done. I was in a perfectly good dress that would easily allow for access. Make no mistake- I love a good costume change- but I was NOT getting undressed for a robe and rubber slippers.

There’s the Basic pedicure, the Champagne Pedicure and the Spa Pedicure. Mine was clearly the Reluctant Pedicure.

And so it began. I stuck my newly naked feet in the tub at the end of my “THRONE” and let Nadia do her damnedest.

For the next 60 minutes she pushed cuticles around and pumiced callouses and lathered and massaged until my ugly ass feet looked a bit less ugly.

Here’s the thing about feet- mine in particular but most in general- they are indeed pretty nasty looking.

Years of running and wearing high heels and running in high heels has pretty much taken their toll on my little piggies.

On the toe nail front- I’ve lost every toe nail I own at one time or another. I like to think of them as badges of honour. I lost the big ones on Kili and the others in various races. As I describe this right now I see myself as a bit of a war veteran talking about the scars of battle.

I have a small benign tumour on my big toe- that can apparently be removed for cosmetic reasons should I find the time. Unfortunately the surgery involves not being able to wear heels or cycling shoes for at least 4 weeks so I will live with this tumor forever. Fret not- it’s benign. My addiction to four inch stilettos or a good bike ride is not.

So as I sat there in that “THRONE” looking up from my NY Times at my feet in the soapy water, Natalia reached for a cuticle cutter and I wondered about what kind of risk I was indeed taking putting my best foot forward. Perhaps I should have filled out that medical form in better detail? Could this pedicure really be a risky business?

According to the Toronto Public Health website- there are a variety of health issues associated with a pedicure. The website itself warns against contracting everything from a bad ass bacterial infection to Hepatitis C.

No I should say that I am anything but neurotic about the whole germ issue. As a doctor who spends their days around bodily fluids- I have no time to be neurotic. Yes, I wash my hands repeatedly and without fail- but no, I don’t obsess about the risk of various pathogens around me.

As such, I did not ask Natalia if the items she was using to gouge at my feet were indeed sterilized before use. I just assumed. And then I went to the medical literature to see if indeed I was at risk of contracting Hepatitis C from my Ritz Carlton Champagne pedicure.

Turns out…. I’m pretty much safe. As far as the literature goes, there was a small outbreak of Hep C in Turkey- associated with nail salons. In North America- we have bacteria infections to worry about far more than viral hepatitis.

According to an article published in Clinical Infectious Diseases Journal in 2011, Mycobacterium infections are quite commonly associated with pedicures. These of course are the NON-Tuberculosis variety.

It turns out that non-tuberculous Mycobacterium species colonize water systems and that exposure to them is quite common. The risk of infections, however from these bacteria is not so common. A recent outbreak in North Carolina saw 110 cases of bacterial infection from Mycobacterium fortuitum. This little sucker also called an outbreak in Oregon and California. People present with boils on their legs called furuncles.

The risk is much higher in people who have just shaved their legs prior to the pedicure. The problem is that the bacteria live in the water system and then infect the water being used for soaking. If you’ve shaved your legs recently you have microscopic cuts in the skin that allow the bacteria to get in.

Overall the risk of these types of infections is about 1 case in 100,000.

Safe to say- I have been remiss in the leg shaving department for a little bit. I was after all wearing tights that day, so lay off with the lecture. At one case in 100,000, I felt pretty safe indeed.

Nadia finished up her shaping and trimming and sure enough after a couple of coats of polish, my feet were indeed a new set of limbs.

Before saying good bye she suggested that I have a “touch up” of my feet in the next 4 weeks. Will I return, I thought? Will I, once back in Vancouver, find my own little salon to go to every few weeks to soothe my barking dogs?

The jury is still out my sisters as far as my need to primp my toes. I am safe in the knowledge that I’m not risking my infectious health to a great deal should I decide to add pedicures to my grooming regimen.

Has this recent pedicure changed my life, you ask? Not so much. Except to say that I have had an extra “foot confidence” this past week, that had indeed previously eluded me…. I have spent the last week wearing open toed shoes whenever possible. Far be it from me to hide Nadia’s hard work from the world.