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Why Tuesday?

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

Tuesday, December 24, 2013

Oh Holy Shit

Tis the seasons my sisters and nothing says Winter holidays like minus 40 degree Celsius. Yes, as I write this, I am in the coldest place on earth. I am working for the weekend in Fort McMurray, Alberta.

Fort Mac, as it is affectionately called is an interesting part of the world. A sweet little town born of the oil sands and mostly made up of young families a men from everywhere else in Canada who have come here for work.

I imagine that this is a bit of a modern day version of Gold Rush towns. If you are in need of a visual frame of reference, think HBO’s Deadwood meets The Wire. Yes, my sisters, I’ve been spending some time watching “boxed set” series…. A Zentner holiday tradition.

I should say that indeed, I thought I was brave to the cold. Afterall, I was a little girl on the prairies. Having been born and raised in Winnipeg, I was indeed the girl who walked to school in 4 feet of snow.

Prairie kids are tough as shit; made of  steel and the salt that rusts it. We are proud of the ice water that runs in our veins and eager to claim a new member to our tribe. We are born of mothers who send us out to play in unzipped parkas in minus 40 (minus 80 with the windchill) and tell us to come inside only when we REALLY can’t feel our faces. We grew up knowing that we came of strong, proud stuff. We shared the same hallowed snow banks as Joni Mitchell and Neil Young.

I continue to take pride in my prairie girl status. Somehow I knew it grounded me to the plains that “raised me good”. No matter where I would call home someday, I was a prairie girl and that was as solid as the ground beneath my feet.

So imagine my surprise when I stood outside the Air Canada airbus 8566 on the tarmac in Fort Mcmurray on Friday with the wind teaching me who was really in charge.

Was I dressed appropriately? Hell, yes. Did it matter? Fuck no. If you must know, I had on winter boots. Yes, gone were the heels. I was in those big unflattering winter monstrosities (fine… they were Prada, if you must know- I have not lost all civility) and a wool double layer winter coat. I had a hat, two scarves and a decent set of gloves. This was purely for show as nothing could have saved me.

Never mind that I had played in this weather for many a formative years. My years spent in the snow of the 1970’s and 1980’s was immaterial. For there, on that tarmac in Northern Alberta, I realized in an instant what I had become. Eight years on the west coast had undone years of prairie training…. I had grown soft. I had lost my edge. And as I waited for my Sky-check baggage to arrive (damn you Air Canada)- the minutes seemed like hours. My prairie girl pride slipped from my freezing gloved fingers as one thought ran through my brain…

“They should pay people for populating this area”.

Make no mistake. I love the north. The Northern lights are something one must see at least once in a lifetime. I love the uncomplicated kindness that one is afforded in any town across this great nation that does not take itself too seriously. Fort Mac is such a place. People often turn their noses up at the rural communities in this country.

They praise the likes of Toronto, Montreal and Vancouver. They feel sorry for Saskatchewan and the misunderstand the Maritimes entirely.

But if you look closely in the smallest places of this great nation you will find the wonderment that really does make this land a magical place.

Make no mistake- I did not find wonder in my first moments on the first day of winter at the 60 parallel. I received my rental car with a smile and an extension cord and instructions to “plug it in all the time, or it won’t start”.

And so my weekend adventure began. I split my time between the hospital and the hotel, grateful for “auto-start” and underground parking; a woman who does not own a car now spending hours worrying if this one would start.

After two days in a deep freeze, I have taken to running on the hotel treadmill and wearing leggings, cashmere sweaters and winter boots… everywhere. I was not taking off these boots for love or money. I was freezing and my prairie girl core was buried under a glacier. She was not coming out till the thaw. The mighty had fallen. I I missed my bike and my “fit bit” (more on this in a future post) was calling me names for being such a lazy shit.

Three days in minus 40 had reduced me to the human equivalent of a hibernating grizzly. I could not help but wonder what this kind of weather does to anyone calling places like this a permanent home.

Was there an adaptive process to this freezing pain or does it indeed get the best of us all?

According to the Canadian Death Survey from Stats Canada, (2006) there is indeed an increase in death rates in winter months in this country. An average of 656 Canadians died daily in January compared with 546 daily in August. What’s even more interesting is that this phenomenon also applies to the USA, Australia and New Zealand. Does temperature have something to do with it? Sure enough… it’s only a small factor.

One theory is that winter months do indeed place an extra stress on body physiology. The theory is that the cold adds added physiological factor on a body’s usual functioning. Other factors to consider are what tend to do in winter months. Many of us are far more sedentary and we then only get active when we need to shovel snow. We fall more in winter and break things and well… you get the picture.

But some of this does not explain the fact that this phenomenon is even present in warmer states and countries. Sure this might be the case for Northern Alberta, but Florida? What about Florida?

Yes, my sisters- I could ponder this all day long. Perhaps subtle temperature changes are indeed the issue, perhaps it’s a post Christmas hangover… perhaps January is just a good month to die. Sometimes a pattern is just a pattern… sometimes it mean so much more.

All I know is that I spent the weekend in the ice age and lived to tell about it. My hard-hearted prairie girl is a bit of a wimp and I hate driving cars- especially ones that need to be plugged in.

Sure, I learned that the freezing cold on the tarmac in Fort Mac won’t indeed be the death of me any more than my winters spent playing in a prairie winter with my parka undone.

But on Tuesday as you read this- think of me back in Vanlover running the seawall in the rain, blissful once more on a winter day that I can indeed handle.

I am weak my sisters but I am all yours. Merry and Happy sweet girlfriends of mine…. Bundle up, wherever you are… it’s cold out there. 

Tuesday, December 17, 2013

Just in Time

Forgive me dear sisters if the following dwells a little too much in the heart and not enough in the head. But I’ve been thinking lately about the steps we take in this world and how all too often we live less in the moment and more in a future that may or may not be.

Let me explain.

10 days ago I did the Honolulu Marathon. Yes, insert cheer here.

This was my fourth marathon to be exact but I am not one to keep score. Indeed however, it was the first marathon that I have ever WALKED. Yes, my girlfriends, I’ve ran marathons before. Indeed I RAN the Honolulu Marathon last year. But this year, I walked it…. All 42.2km of it.

Am I injured you ask? Did I have a bad race? No, none of the above. I am injury free and the race was indeed glorious.

You see 18 months ago I started a walking group for my patients. Every Tuesday and Thursday we meet in my office after work and we walk the seawall in West Vancouver. Rain or shine we huddle up and soldier on. At first it began as a means for people to meet with their doctor and ask any question they wanted. They would come for the “doc talk” and stay for the walk so to speak. But over the year and a half it has grown into a community of its own.

Each night these brave souls come one and come all with or without me

Ah, what can I say about my Seaside Walkers?

They have become a group in and unto themselves. For the last 18 months we have seen members come and go. We have many faithful each night and many a “drop in”. But overall- these people are a community where fitness is king and the rest of the world’s troubles fall away if only for an hour.

This is a group of people who have come together by chance and are now bonded together by a common sense of friendship and a pursuit for better health. 

I know you think I am being a romantic about all this- but they really are remarkable.

I’ve learned a lot in my almost 20 years in medicine. Yes, Its been almost 2 decades since I stepped foot into my first medical school class (and thanks to my fabulous dermatologist – it only seems like 1 decade). I’ve learned a lot in that time- about the science of the human body in sickness and in health. I’ve learned about the bravery of the human spirit and the importance of maintaining one’s own connection to the human condition.

Some may say that walking with patients is not very “doctorly”. I could not disagree more. Truth be told, when it first began I was a bit unsettled. I was unsure if I could maintain a sense of professionalism while “out and about” on a seawall and not in an office.

But indeed my fears fell away as the weeks went on and I watched my walkers, those brave and fabulous souls grow stronger and faster before my eyes.

Truth be told- nothing makes me feel MORE effective as a physician than those moments on the sea wall.

That is until I crossed a finish line with a patient.

She indeed gave me permission to share a bit of our adventure as it went down, two Sundays ago on a perfect day in Honolulu.

The weather was a glorious 28 degrees celcius. We met in the lobby of the hotel at 4am, I was half asleep and drinking a coffee she was excited and a bit nervous.

My patient’s name is Elizabeth (no I’m not using her real name, duh) and she is a superhero. Now 70 pounds lighter since the day I met her two years ago, she has trained for this moment for the last 10 months. She has walked countless hours and given up months worth of Sundays all in pursuit of this goal. She has logged anywhere between 30 km/week to 70km per week all in pursuit of a dream.

And on Sunday, December 8, 2013, the dream became a reality. No matter that she was nervous. I knew she would be glorious. 

She wonders in the lobby if she has what it takes. Will all that she has trained and prepared for be enough? Will the heat get the best of her? Will she finish strong?

I don’t let a doubt enter my mind. Not because it is 4 am and my coffee has not kicked in but because I have seen what determination and resilience looks like and it bears an uncanny resemblance to Elizabeth.

We head towards the start line and find our place among the 30,000 people. The energy is amazing and the gun goes off. Our race has begun. Not a race against time- but a race of the human spirit.

We start out strong and she is a beast. We are making amazing time. We had hoped to finish at 8 hours and I check my watch after the first 10km to find that we are on track for 7:30. Elizabeth takes the hills like they are flat land. I am having to pick up my pace to keep up with her.

I give instructions at each water station on how much water and Gatorade to drink and she follows like a trouper. This is a woman on a mission with a quiet grace in a quest for glory. 

The miles fall away as do the hours. 

We talk about the weather, our stay thus far. I ask periodically how she is feeling asking her to assign a number between 1 and 10 as to how "full is the tank"; how much energy she has. we check in from time to time but mostly we just walk. I play my music on my playlist on little speakers to motivate her and move her on. 

At 35km she shows signs of wear. There is fatigue in her step but determination on her face. When I ask her how she is, she smiles and tell me “tired, I want this over. Let’s go”.

We round out 41km as we make our way into Kapaioloni Park. The finish line is now one long stretch of road ahead- and we can see it in the distance.

We begin the 900 metres or so long walk home and I start to cry. Yes, me.

And then as if on cue, Elizabeth turns to me and says,
“Oh get it together Zentner, Let’s go.”

And so we do. As we walk across the finish line I grab my patients hand and raise it in triumph. They announce her name and I look at my watch 8:03:23. We are just 3 minutes off our goal time. Considering we stopped to pee twice, (Too much information?) that’s pretty much a goal met.

I lead my weary soldier past the finish line where I place a finishers medal around her neck. She gives me a hug and begins to cry.

I have spent many nights sitting at patients’ bedsides in hospitals across this country. I have slept in ICU’s more nights than I can count worried for the safety of my patients. I have spoken the best and the worst news a person can say to another. I have relieved pain and caused it. I have uttered thing to patients that could make their day or ruin their lives.

I am very aware at how fortunate I am do be THIS close to the human experience every day.

I often worry about how my patients will do in the future. I wonder about the ones who have made such amazing changes in their own lives; those who have lost weight, found fitness, or fought a disease and won. How will their futures play out? Will they continue to be healthy? Will all the effort be for not?

On that glorious Sunday in December, I placed a medal around a very brave lady’s neck and the worry for the future was banished. For in that moment I was the best doctor I could be. In those 8 hours I learned that sometimes in life, as in medicine, it is indeed about THIS moment, right hear and right now.

We can not fix everything in this world. There are sometimes when the disease is too great and the will is just not willing. I think I’m a pretty good doctor, most days. I try my best, I really do care more than enough. I hope beyond all things that I don’t do any harm and that the benefit of everything will outweigh the risk; the good outweigh the bad.

But there is no better day than the one where as a doctor a patient inspires you with their grace and their courage; Whether it’s a bedside or a finish line.

Last week I stepped out of the doctor’s office and onto a marathon course to escort a patient across 42.2km to glory.

For in those hours I learned that medicine comes in all forms and life is not about the breaths you take…. It’s how you breathe. 

Tuesday, December 10, 2013

I know, I'm late... I suck. Best we all learn to live with a bit of disappointment. Sorry my sisters.... the day got away with me. Promise to be up and brilliant in the next 48 hours.....

Tuesday, December 3, 2013

Do They Know It's Christmas?

Merry and happy dear girlfriends and welcome to the most stressful time of the year. Make no mistake, my cybersisters… I do love me a good retail festival but even I lately have found myself avoiding the shops as if they were a small screaming child. (sorry, I don’t like screaming children- on further thought- I don’t like screaming anything- unless there is a PRADA sale and then- well who can’t help themselves.)

The past few weeks have gotten me asking myself, who but bitchy in the water? No one holds doors open for anyone any more. Walking down Robson street lately is like playing a real life version of retail WHACK A MOLE where people come at you with parcels and packages and you have to avoid being hit by them regularly.

Yes, I know Christmas is an emotional hardship of a holiday. Shopping is polarizing sport. People love it or hate it. That coupled with the judgments of families and friends. It’s a challenging time. Who wants to defend their life choices at a table full of family members for hours on end?

I’m not being a Grinch when I say that perhaps we could tone down the nasty for the next few days? I know we live in a materialistic society- and I’m not suggesting we turn it around- hell I love my closet; but can’t we all, I don’t now… just get along?

Do you remember when we were little and times were so much simpler? Your handbag HAD to match your shoes and your nail polish HAD to match your lipstick. “Please” and “Thank-You” were a given and people were always happy around the holidays. Life was simpler, air was cleaner, and people were nicer, no?

Maybe I just remember it that way. I remember being mesmerized by Charlie Brown Christmas Specials and big trees in malls. I remember how the days always had a little bit more sparkle around their edges. We never celebrated Christmas (and no Hanukah really is not the same) but as an outsider looking in I always thought December was a special time where people seemed more hopeful, and quite frankly… nicer.

Was I just a victim of the marketing ads? Was there really no PEACE ON EARTH, no GOOD WILL TOWARDS MEN? I never paused to ask my parents if the times in fact have changed. Maybe it’s just that I’ve grown up and grown a bit cynical. Maybe times in deed were as stressful back then as they are now it is just that I no longer have Charlie Brown to keep me hopeful?

Magazines everywhere talk about the “Christmas Depression” and how the holidays are more stressful and people more likely to have mood disorders and even suicides around this time of year. My VOGUE magazine had always been a source of knowledge but could it finally be speaking my medical language as well? Was CHRISTMAS DEPRESSION in fact a true disease? I wondered....

If in fact this were true than perhaps I was being too hard on my fellow shoppers. They were bitchy for a reason! They had Christmas depression? Mankind was in peril trying to find the perfect sweater set/iPod/perfume gift set for their loved one.

And then I went in search of a real scientific answer.

According to an article published in the JAMA in 1982- this idea of CHRISTMAS DEPRESSION is scientific bullshit. Although anecdotal notions are all about us suggesting that the stress of the holidays impacts peoples' mental well being, the science just does not back it up. There is no such thing in the medical literature as CHRISTMAS DEPRESSION. There is in fact a CHRISTMAS DISEASE but this is a form of hemophilia that has nothing to do with the holiday itself.

Several meta-analysis show that hospital admissions and suicides around this time of year are actually down. Less people visit Emergency rooms and doctors offices around this time of year. Sure you could say that they are all too busy but in my experience as a physician diseases don’t usually wait for you to get your “to do” lists in order before they rear their ugly heads.

Interestingly hospital admissions dramatically climb AFTER the holidays either suggesting that all the self indulgence over Christmas eventually catches up with us or in fact that people now have “the time” to be sick. Not really sure how to navigate that one my girlfriends but I will leave it to you to ponder.

Make no mistake- I do love me a good festive time. But medically speaking there’s no reason to be bitchy especially when gifts are involved. So on this holiday of holidays I say let's just all take it down a notch my sisters… pour yourselves a glass of mulled wine, settle down and let the joy begin.