Month: July 2019

How Debt Limits Our Potential

/ Jame A. Agapoff, MD, MS (she/they) / Leave a comment

When I turned 18, I could not wait to get a credit card. My culture taught me that debt was the path to greater things. I believed like so many others that affording payments was equivalent to affording the purchase. For this reason, I quickly added a few additional credit cards and a car loan to my list of lending acquisitions. None of this felt strange to me because everyone else was doing it too! As my debt grew and I began to feel the pinch, I learned about credit card transfers, personal lines of credit, and other strategies of managing my debt without actually doing anything.

At some point in medical school (I took out student loans too, lots of them), I was invited on a trip. In the past, I would have simply financed the little adventure with plastic, but as I began to plan, I realized I wouldn’t be able to go unless I received a credit line increase. At this point, I really began to look at my debt and think, “This is insane. This is going to take me years to pay off.”

Debt had been part of my life for so long, I really never considered the consequences of my behavior. I was fortunate in that I was on the heels of graduating medical school. But what if I didn’t get through residency? What then? The tightrope I’d been walking for years never felt more perilous, and I was one of the LUCKY ONES! Even if I finished residency, I would be in debt for years, and there was no one to blame but myself.

According to debt.org

  • More than 189 million Americans have credit cards.
  • On average, each household with a credit card carries $8,284 in credit card debt.
  • Total U.S. consumer debt is at $13.51 trillion. That includes mortgages, auto loans, credit cards and student loans.

According to the Association of American Medical Colleges (AAMC)

  • 75% of students completing medical school in 2017 had an average debt of $190,694 (median $192,000).
  • Public University $181,179 (median $180,000).
  • Private University $206,204 (median $202,000)

The biggest problem with debt is that it limits our potential. We are limited in our ability to build wealth and our ability to help others. We becomes slaves to banks and payments, and Gods forbid, debt collectors. Many of us wander into debt with the best of intentions, but there is wandering out of debt.

For me, the first step of conquering debt was to accept that I didn’t need to be like everyone else. I wanted real wealth that allowed me to bless others rather than the appearance of wealth brought to you by our consumer culture of comparison. I decided, if I couldn’t pay cash for it, I wouldn’t buy it. For the first time in my adult life, I put myself on written budget, and made a conscious effort to pay off my debt.

At first, restricting my lifestyle felt awkward. I was a physician, after all! My debt didn’t care and I decided I shouldn’t either. Now, several years later, I’m still paying off debt, but I’m starting to see a flicker of light at the end of the tunnel. It’s not always easy, but when I consider the freedom and opportunities being out of debt will bring me, I trudge on for the benefit of all.

I wish you the best on your debt free journey.

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Calorie Restriction. More Simple Than You Might Think.

/ Jame A. Agapoff, MD, MS (she/they) / Leave a comment

In a recent 2-year study published in the Lancet, Kraus and colleagues report on their findings that a calorie reduction of only 10% (200 calories if your basal metabolic rate (BMR) is 2000 calories per day) can result in weight loss and a reduction in cardiometabolic risk factors. This means that one choice a day such as not eating desert or skipping a snack can potentially result in dramatic long term benefits.

The first step is to determine your BMR. The BMR assumes sedentary conditions. There are many calculators online. BMR decreases with age. That’s why it’s harder to keep weight off as you get older. Caloric restriction itself can also decrease BMR, but regular cardiovascular exercise can increase BMR, making both essential for long term weight control.

Here is a link to a BMR Calculator. http://www.bmi-calculator.net/bmr-calculator/

Once you know your BMR, you can begin to devise your calorie count. You may be surprised to find your BMR to be less than 2000 cal/day. Mine falls around 1600 cal/day. That means for me, a 10% calorie restriction is about 160 calories (total calorie intake 1440 per day).

If 1440 sounds like a small amount, I would agree. That’s why exercise is so important. One hour on a stationary bike with modest resistance burns about 400 calories. A one hour jog around 5 miles burns around 450 calories. Adding activities to your daily routine will allow you to consume more calories and maintain your restriction.

Stay tuned for more information about calorie restriction and related research.

References:

Kraus, W. E., Bhapkar, M., Huffman, K. M., Pieper, C. F., Das, S. K., Redman, L. M., … & Holloszy, J. O. (2019). 2 years of calorie restriction and cardiometabolic risk (CALERIE): exploratory outcomes of a multicentre, phase 2, randomised controlled trial. The Lancet Diabetes & Endocrinology.

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The Problem Within

/ Jame A. Agapoff, MD, MS (she/they) / Leave a comment

When difficulties arise, our natural reaction is to look outside ourselves for the causes and conditions. This creates much suffering and unhappiness because we lack control over these external factors. In many cases, the actual problem is internal, arising from our thoughts, actions, and perceptions. However, to admit that the causes and conditions of our own happiness are within us is a terrifying prospect because with that insight comes the responsibility of change, which all of us resist.

If you doubt this, I recommend the following exercise. Choose a family member or coworker who is often unhappy. It is likely that they have told you the reasons they are discontent. For some, the causes may change from week to week or even day to day. As you listen thoughtfully to this person’s concerns, try to imagine how they would feel if they looked at their situation in a different way. Consider whether or not this new perspective would make them feel different. If the answer is yes, then the problem is internal rather than external.

Now that you can see this in others, try it on yourself. Next time something happens that makes you mad or affects your mood, consider whether or not you truly have any control over the situation. The causes and conditions for many of our problems cannot be prevented and simply must be dealt with as they arise. Therefore, try to change your perspective. Another strategy is simply practice acceptance. If we are mindful of our emotions, thoughts, and feelings, the more power we have over them and the less we will attribute them to external phenomena.

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The Positive Mental Energies of Nikola Tesla

/ Jame A. Agapoff, MD, MS (she/they) / Leave a comment

 

Many of you may know the name Tesla from Elon Musk’s Tesla electric automobiles. What you may not know is that Nikola Tesla (Not Thomas Edison) is responsible for the alternating current that powers modern day electric grids.

In 1899, inventor, scientist, and real-life wizard, Nikola Tesla, was interviewed in his laboratory in Colorado Springs by reporter John Smith for the magazine “Immortality.”  In this interview, Tesla talks about his accomplishments as well as his failures.

I always find it interesting and heartening when great minds like Tesla wax spiritual. His words about beauty and energies are truly inspiring. He dedicated his life to making the world a better place, and I am touched by his humility in the face of so many personal accomplishments. I pray that we may all aspire to be a little more like Nikola Tesla.

The following is an excerpt from that interview where he talks about positive mental energies.

TESLA: Yes, these are some of my most important discoveries. Yet I am a defeated man. I have not achieved the greatest of my goals.

JOURNALIST: What would that wish be, Mr. Tesla?

TESLA: I wanted to light up the whole earth. There is enough electricity to create a second sun. Light would appear around the equator, like a ring around Saturn. Humanity is not prepared for greatness. In Colorado Springs I have impregnated the earth with electricity. We can also water the other energies, such as positive mental energy, found in the music of Bach or Mozart, or in the verses of the great poets.

Inside the Earth, there are energies of joy, peace, and love that are expressed for example through a flower that grows from the earth, food that comes out of it and everything that makes it the home of man. I’ve spent years looking for ways that this energy could influence people. The beauty and aroma of roses can be used as a medicine and the sun’s rays as food. Life has an infinite number of forms and the duty of scientists is to find them in all forms of matter. Three things are essential in this regard. All I do is look for them. I know I will not find them, but I will not give them up.

The entire interview entitles “Everything is Light” can be read online at https://infinityexplorers.com/everything-light-incredible-interview-nikola-tesla-1899

If you are interested in learning more about Nikola Tesla I recommend the following comic about why Nikola Tesla is the greatest geek who ever lived. Enjoy! https://theoatmeal.com/comics/tesla

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Intention of the Heart

/ Jame A. Agapoff, MD, MS (she/they) / 1 Comment

To each of us there is a purpose.

Consider your reaction to this statement. Do you agree? Are you skeptical? Are you moving on to the next blog?

Each morning, I ask myself three questions. “Who am I? What do I want? Where am I going?”

These simple questions can help ground us in the present, reflect on what’s important, and motivate us plan a path to achieve our goals. I call this process the Intention of the Heart.

I believe practicing the Intention of the Heart can help us discover our purpose.

When I began to pursue a career in medicine, I reached a point in my training where I asked myself, “Why am I doing this?” The more I asked myself who I was, what I wanted, and where I was going, the more dissatisfied I felt by external rewards of achievement. I began to view the world as an impermanent mirage. This forced me to look within and that is where my true journey began.

Even a goal as noble as wanting to help others must be anchored to something. This may be an idea, a code, a God, or even a philosophy. You will know when you find this center/purpose because it will bring you peace when no other thing can. It may take an entire lifetime to find it, but if you choose to practice the Intention of Heart, eventually it will reveal itself to you.

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Food Journaling and Mindful Eating

/ Jame A. Agapoff, MD, MS (she/they) / Leave a comment

 

In a recent article in the periodical Psychiatric News, researcher Linda Richmond makes an argument that physicians need to model nutritional wellness to help their patients lose weight. The truth is overweight physicians tend to counsel their patients less about nutrition and research about tobacco smoking tells us that a doctor’s advice helps people change behaviors.

So let’s talk about some proven techniques to help us lose weight.

Journaling has shown to have many therapeutic benefits. It is a means of decreasing stress both subconsciously and consciously, and working through problems. Food journaling is a technique I personally use to help me be more mindful of what I eat.

Food journaling is simple. I personally use a pocket-sized, spiral-bound, note pad. At the top of the page I put the date, and throughout the day, I list everything I eat and the total  calories. If I’m having to “guesstimate”  the calories I always round up by 50 calories to make sure I’m not underestimating my count. There are a number of websites and apps to help with your count. The article below has a few that are fairly user friendly.

https://www.healthline.com/nutrition/5-best-calorie-counters#section1

I keep my calorie goal pretty simple (less than 2000 calories a day). At the end of the day, I subtract any calories from exercise. In my case I always “guesstimate” lower by 50 calories to not overestimate my loss. For example, if the stationary bike says I burned 350 calories, I record 300. If you consistently are taking in less than 2000 calories a day, you will see weight loss over time guaranteed. Regardless of what the media says, if you cut calories you will lose weight, no exceptions.

Mindful eating is a practice to help you eat less and enjoy food more. Mindful eating involves the thoughtful preparation and consumption of food. Food in many ways is about values and goals. What you eat is you. On my fridge I have a sign that says “Eat like that which you would become.” Things I value in my life are kindness and sustainability. For this reason, I eat a mostly plant based diet.

Being a mindful eater doesn’t necessarily mean you need to be a vegetarian like me. I know plenty of healthy people who are mindful meat eaters. When I prepare my food, I consider where each part of the meal came from, and all the people, time, and energy it took for me to get it. It’s actually pretty profound when you think about it. Another aspect of mindful eating is considering the textures and various tastes of what we are eating. This usually involves eating more slowly, which is good because it takes awhile for the gut to send the message to the brain that it’s full. If you practice these simple practices, you’ll not only eat healthier, you’ll lose weight in the process.

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Leadership in Writing is about Lifting Up

/ Jame A. Agapoff, MD, MS (she/they) / Leave a comment

As a supervisor of psychiatry residents, I have the opportunity to review the Curriculum Vitae (resumes) of graduating residents. One section of the Vitae includes publications (academic or otherwise). For a graduating physician, having at least one publication is important, especially when applying for academic positions in medicine. However, many residents whose CV’s I review do not have a publication listed. This can make or break their chance of getting a first choice position.

Academic writing comes in many forms. There are case studies where specific patient cases are reviewed and discussed. There are randomized controlled trials where some patients receive an intervention and others do not. There are commentaries and reviews of important topics. There are also reflective pieces that touch on the soul of the profession. In essence, there are many niches to publish academically.

Authorship order on academic papers is based solely on contribution. If you did the most on the project, your name is listed first. No exceptions. Contributions can vary widely between the first author and the last author on a paper; however, to be listed at all requires a contribution.

I would argue the most difficult part of publishing is getting your foot in the door. For highly motivated individuals, this step involves courting researchers and offering to help write up their work. When I was a resident, I lacked this particular level of motivation, but I was fortunate to have an academic leader approach me casually and ask for my assistance on a project. This led to my first academic publication Training Psychiatry Residents in Patient Handoffs Within the Context of the Clinical Learning Environment Review.

I owe much of my ongoing success in academic publishing to this leader’s gesture.

Leadership is about lifting up; leadership in writing is about cultivating talent and creating opportunities for publication. As I have moved forward in my career as a writer and a professional, I offer the opportunity of authorship to all residents under my supervision. This collaboration enriches the researcher, the student, and the profession. May all beings benefit!

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Investing in Your Writing Future

/ Jame A. Agapoff, MD, MS (she/they) / Leave a comment

Wealth comes in many forms. There is material wealth, spiritual wealth, and the wealth of knowledge and wisdom. When we think of investing, we often think of money. Those who have a plan tend to win with money, and this usually means spending within your means and sacrificing present wants for future dreams.

The lessons learned by effectively managing money are applicable to other forms of wealth building. As I have grown into a more efficient (and hopefully proficient) writer, I’ve learned a few things along the way.

Like investing money, all it takes is a little bit of writing each day to build a vast amount of material. Similarly, not all investments pan out, so it is important to diversify them. I have one academic paper that I’ve been trying to get published for a few years with lackluster results. I’m still revising it, but it is not my primary focus. Similarly, like a mutual fund, it’s important to weather the highs as well as the lows and be consistent with your writing. For example, after a string of rejections, I had several papers accepted within one month. Woohoo!

So,  learn from your mistakes and try not to carry them with you. Take the time to invest in your writing future every day. Learn from your mistakes but try not to carry them with you. You never know when you might be sitting on the next big thing!

 

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The Mindful Writer

/ Jame A. Agapoff, MD, MS (she/they) / Leave a comment

Mindfulness. You’ve probably heard about it. Mindfulness is about awareness. It’s about observing thoughts and feelings without attachment. For example, someone cuts you off on the highway. You feel anger, you acknowledge the feeling consciously, and let it pass. That is mindfulness. Mindful people are in complete control of their emotions and have the ability to focus their actions with intention and not impulsivity.

Sounds hard, right? Well, it sort of is. Mindfulness is like installing a new operating system in your brain. At first it takes some getting used to but after awhile you get the hang of it. In Buddhist cultures, children learn to be mindful before they are old enough to go to school. Mindfulness is the cornerstone of wisdom, and a useful tool for focus and motivation.

Mindfulness practice is the antidote for procrastination. A mindful person lives for actualizing the moment and extracting every ounce of potential from it. They see everyday as an audition and an opportunity. They recognition all things, including themselves, as impermanent, and that motivates them to action. The mindful person prefers failure to never having risked to fail. To be mindful writer means accepting critical feedback, always seeking improvement, and never giving up on your dreams.

The only real thing is now…so write!

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