Dr. Julie, Author at Weigh Different

July 15, 2023July 16, 2023

When in Rome

As a high school Spanish teacher, Elena is continually looking to advance her knowledge and expertise. This time she signed up for IB (International Baccalaureate) training at the end of June in Madrid. Madrid, Spain.

The Madrid part was not surprising as she loves to travel and has completed several immersion courses in Spanish speaking countries over the years.

What was surprising was her invitation for me to accompany her for all or part of her trip.

“It will be a great way to celebrate my birthday!” she explained enthusiastically during a phone conversation one Saturday morning in mid-March. Despite my usual early bird gets the worm mentality, it had been drizzling for days and I was still in bed.

I sat up and looked through the window sheers at the emerging gloom outside. It was the kind of day that made one forget all the beauty and abundance of the Willamette Valley and question their sanity for ever having moved here in the first place.

I switched Elena to speaker phone and tapped the weather app. It showed no hope of letting up.

“Will it be sunny there?” I replied, not even attempting to match her level of excitement, fighting the urge to crawl back into bed. I closed my eyes and transported myself to June. In Madrid. With Elena. And sunshine.

It was interesting for me to observe myself becoming anxious the weeks and days before our trip. I gave myself grace. After all, it had been years – twelve years to be exact – since I had traveled outside the country. My last several trips were to West Africa for medical missions. Those were rewarding but grueling treks. We would travel for days then hit the ground running, treating hundreds of people. And when you thought you were finished for the night, one more person discovered your presence and came knocking at the door. How can you say no. Reality overcomes you with the enormity of the need and your complete lack of ability, resource, or strength. But even a cup of water in His name, right? Anyway, that’s how you console yourself. The recovery took weeks.

I think my biggest fear was that someone would need acute medical care on the plane during the flight, like a chest tube or urgent delivery, and I would be inept to help because I don’t practice that kind of medicine anymore. That and the jet lag. Oh, and travelling standby.

Elena and I arrived early at the airport Sunday morning and set up “standby camp” near the gate of our intended flight. Elena scrolled feverishly on her phone while discussing with Jacob the myriad of ways we could get to Europe. Jacob was behind the scenes in Atlanta, staring at his computer, examining the loads on the various flights, and calculating the statistical probability of getting two seats on the same plane considering the weather patterns, the higher than usual travel season, all the connecting possibilities, etc.

I sat a few feet out of earshot of their intense conversation, people watching, and remained blissfully ignorant of all the empty seats that were there and then gone,vanishing into thin air at the blink of an eye. Leave it to the experts, I thought. I don’t need to get involved. I contemplated digging out the seven-hundred-page novel from my backpack that I stowed for leisure reading (and that Elena cringed at the weight of…. “are you sure, Mom?”)

A family parked their gear in the seats next to us. I recognized the dad immediately. It was a colleague of mine who was with his wife and children. We exchanged greetings and travel plans.

“You are very brave,” he commented when I explained we were traveling standby and what that entailed. “You don’t know exactly how you are getting to your destination or if you even have a seat on a plane? I don’t think I could give up that much control.”

Elena interrupted with some urgency, trying to figure out who I was talking to and trying not to be rude. “Mom, excuse me, Mom, she said abruptly, “what do you think of going to Ibiza instead of Galicia. We would fly into Amsterdam, pop into the city, then hop on a plane to Ibiza. Probably get there by noon. What do you think?”

I looked at my friend and then at her and shrugged my shoulders. “Sure,” I said, feeling a little smug, having no idea Ibiza existed before that moment. “Ibiza. Why not?”

I smiled inwardly. Yes, look at me, not having to be in control of everything all the time. I am footloose and fancy free. At least for the next nine days, que sera, sera.

After all, even if I could not control seats on a plane or weather patterns or travel arrangements, I could still be in complete control of maintaining my healthy habits during the trip. Of that I was certain. I had been practicing healthy habits for several years now and they had become ingrained. Stay hydrated, even if it means buying water. Fast on the plane (because I am not using any energy and I know that my body can manage without food for even a day or two at a time. I would not starve. I packed raw pecans and walnuts just in case.) Stick to my normal meal and sleep schedules. Choose whole food. Enjoy the wine because we are in wine country, but don’t overindulge. Have a treat but save it for the end of the trip. I wasn’t even concerned about activity. I knew we would walk everywhere we went. So, I didn’t even bring my AppleWatch to track my steps.

a delicious plate of greens, tomatoes, and yogurt

I was so confident that my habits were part of me that I toyed with the idea of writing about it before I left…at least a friendly email to my patients as a way of leading by example.

It’s a good thing I didn’t.

April 15, 2023April 15, 2023

Purpose

It’s days like today that make me wonder what on earth am I here for.

I woke up and drank my ritual coffee, talked with my husband, got ready for work, then realized I had a late start so decided to bake cookies for Zeke whose birthday is in 2 days. I kicked myself for not thinking about doing that last night when my day finished by 6:30 and I literally had nothing to do but laze around on the couch waiting for my husband to come upstairs and watch Palau, a movie about a great evangelist who did something great with his life. When am I going to do something really great with mine.

Ok, ok. I have. Done something great. I don’t discount any of that. I overcame a difficult childhood, performed well at college, made it on my own for a year before heading to medical school, graduated at the top of my class, then managed to make it by the skin of my teeth in residency and began the practice of medicine. I married, had three children, grieved the loss of one, struggled through a rough marriage, navigated muddied waters with a nanny brought on a short-term visa which expired at the inconvenient time I was raw from grief and fighting for my life, literally, having to tell myself the truth to drown out the ugly voices of worthlessness and self-doubt.

Then I met Kenny, and we started a different life. I scaled back; he worked all the time. We blended two families and birthed child number four. Life was not perfect, but it was beautiful. We home schooled successfully. I went back to work. Our kids started to fly the coop and blossom. I dug deeper and learned more about nutrition and obesity, started a clinic, had the rug pulled out from under me, so started another clinic with the support of Kenny and friends. I navigated challenging waters, outside of the machine of medicine, outside of the influence of insurance, and now I am operating out of my home.

I don’t negate any of what has happened. It was for a purpose, on purpose. I want to do more.

And now, as I am waiting for my next patient, I am wondering: .What else is there for me to do.

I don’t want to wish Monday into Tuesday. I don’t want to rush through the week to come to Friday with nothing to do. I don’t want to fill my days with busyness because I am not comfortable with seemingly empty moments. I want to be in this moment.

And I don’t want to go back to the frenzy of working every waking moment.

God, what do you want me to do. What do you have for me to do. What on earth am I here for.

What is my purpose when You are my resource. How do I love You and love others in this moment.

I think I know what I don’t want.

I don’t want to be unequally yoked.

I don’t want to run ahead.

I don’t want to do nothing.

I don’t want to move further in the practice without shared partnership.

I don’t want to chase and fret and worry and talk about money like it’s the only thing that drives me.

I don’t want to compare myself to others or be jealous of where they are.

I don’t want to rehash the mistakes of the past.

I want to press on to the goal to win the prize.
I want to figure out what the prize is.

The prize is Jesus.

I want to encounter Jesus in every interaction I have with another person or show them Jesus in me.

I want to stay strong and available for my kids.

I want to play with my grandkids.

I want to have energy for the rest of my days.

I want to use my mind and create and support others.

I want to figure out how to create a retreat center.

My dream is to see people set free from our culture’s unhealthy relationship with food.

My dream is to see people set free from entrapment by big food, big pharma, and big health care and insurance.

My dream is to see people have access to healthy foods they enjoy, take time to lovingly prepare food to nourish their friends, family, and themselves.

My dream is that life would slow down so we could enjoy the arts and the activities AND enjoy eating whole, real food.

My dream is for healing of deep wounds that have been filled in and covered up by food and weight gain which only causes more wounds and feels like a never-ending cycle.

My dream is to run a retreat center that would wrap around care for doctors, teachers, nurses, leaders. who struggle with obesity, with all its physiology, psychology, and spirituality.

I want to invite people to come together, share, prepare food, learn, let go, grow, stretch, walk, pray, cry, heal. And be renewed.

Today, I am writing this in the Define Your Dream section of my daily journal. Let’s see what happens!

March 1, 2023March 1, 2023

S.L.O.W. Foods

assorted variety of vegetables on basket

Lately I have been adopting and teaching the mantra: “Eat S.L.O.W. foods slowly.”

What are SLOW foods?

S stands for SEASONAL so your circadian rhythm and the foods you eat or the foods the animal you eat, eats, stays in sync with the sun. Plants eaten in season are at their peak nutritional value. Nutrient dense foods taste better. Think about your home-grown tomatoes in late August vs a hot house tomato in February.

L stands for LOCAL to be in sync with the soil microbiome of your area which is important for and improves your gut health. Local foods grown in local dirt.

O stands for ORGANIC which maximizes nutrient density. If the minerals are not in the soil because of our modern farming practices, they cannot get into the plant. Choose organic foods (I follow the EWG guidelines) to avoid pesticide residue which can disrupt the body’s signaling systems.

W stands for WHOLE as in minimally processed. You want to give your stomach work to do. You want your gut to be your food processor.

When you eat SLOW foods, your gut signals your brain that you have the nutrients you need for your body to work well and then your gut tells your brain to stop eating. SLOW foods have fiber to provide the bulk for the stretch receptors and SLOW foods have nutrient density to signal the nutrient receptors which via the vagus nerve, signals the brain: STOP EATING, WE HAVE WORK TO DO AND WE HAVE WHAT WE NEED. The macronutrients take time to digest and release the hormones into the blood stream to go to the brain, turn off the hunger pathway and turn on the satiety pathway.

Eating SLOW foods SLOWLY allows your brain to hear the signals from your gut and you are able to feel full and satisfied.

When you are eating, you only want your brain to do one thing and be fully engaged in that one thing, which is eating. You want your brain to notice the colors, the textures, the smells, the tastes of the food you are eating. When your brain is fully engaged and not distracted, then your brain can hear the satiety signals your gut is providing.

If you eat in a distracted way, while driving, in front of a screen, walking down the hall, you are asking your brain to do too many things at once. You are activating the Sympathetic nervous system which overrides the rest and digest Parasympathetic nervous system. This leads to indigestion, and you can’t hear the satiety signals.

Americans eat F.A.S.T. food FAST.

F stands for FIBERLESS. Food without fiber goes through the GI system too quickly. The stomach sees that there is no work to do, empties quickly, and as a result produces ghrelin again, and you get hungry and eat.

A stands for ARTIFICIAL INGREDIENTS the majority of which increase hunger and disrupt gut bacteria balance.

S stands for heavily sugared, salted, seed oiled which disrupts blood sugar balance, drives fat production in the liver, and increase inflammation.

T stands for TOO TASTY, bypassing the gut signaling system and activating the reward/dopamine center which screams eat more, more, more because you cannot be satisfied. The food industry works overtime to get you to fall into their trap.

You want your food to taste good but not be hyperpalatable so you are not driven to over eat.

This is what we teach at Oregon Weight and Wellness. Eating SLOW food SLOWLY takes time and practice and three steps forward, two steps back. It’s sometimes more expensive short term. It’s not always fun or easy, but with grace and patience with the process, it becomes your new way of life and you feel so much better, you won’t want to go back.

February 11, 2023April 17, 2023

On Her Wings and a Prayer

Though many of my family members had chosen the medical field as a vocation, Grandpa Rosenburg a doctor, Grandma Del a nurse, Dad an army medic, I suppose my desire to go into medicine was most heavily influenced by my mom.

Mom worked in several capacities as a registered nurse over the years and juggled her work and family life well. Home Health for a stint, then as a floor nurse at our local hospital, then in their emergency room where there were no doctors on staff. In whatever way she could flex her work schedule around her five children and husband, she would, sometimes working nights and weekends, sometimes swing shift.

I have fond memories of her coming home after her 3-11 ER shifts. Even after a long day’s work, she’d always look in on us kids, climbing the stairs to our bedrooms, the two boys bunked in the smaller room on the left and we three girls piled in the larger room on the right. I was a light sleeper and woke easily to the sound of her footsteps, the creek of the door opening allowing entrance to the tiniest ray of light. “Who did you save tonight, Mom?” I’d inquire about the red stains on her white dress, imagining all kinds of scrapes and skirmishes skidding through our small-town ER.

Having a mom as a nurse had its downsides, though. We kids knew we had to be on death’s door to get out of chores or school or homework. “You’re not that sick,” Mom asserted, pressing her palm against the forehead of whichever one of us was claiming to be sick and rebuking any illness back into the dark abyss from whence it came. Late one night during one of her shifts, my dad carried me up the three cement steps through the back door of that small town ER. I was a wilted flower limp in his arms, my temperature having escalated to over 104 degrees Dad’s alarm met nurse Mom’s experience and composure. “She’ll be alright,” Mom assured him after a thorough exam, and gave me Tylenol with a glass of water and sent us out the door. “I’ll check on her when I get home.” And she did.

Our family outgrew the small house on Eastbrook Drive and we moved across town a few blocks away from the hospital to Vernon Avenue and a larger but older home in need of a few repairs and fresh paint. With our family’s changing needs, Mom’s job changed too. Eventually she worked for Dr. Charles Warne, a General Practitioner, whose office was housed in a professional building in the same block as the hospital.

Dr. Warne was a mountain of a man. He stood over six foot tall and I’m guessing weighed all of three hundred pounds. Complete with booming voice and commanding personality, he was not only mom’s employer, he was our family’s doctor. I made sure I was really sick before ever complaining to Mom.

“She has the bronchitis again,” he’d pronounce distinctly into the Dictaphone which sat on the desk in the efficient exam room. He could hear my coarse breath sounds wheezing their way out of my lungs; he hardly needed to use his cold stethoscope. He’d dart out of the room and my mother would dart in with a syringe full of penicillin aimed right at my left thigh.

His waiting room was always packed. Dr. Warne would see upwards of forty, sometimes sixty patients in a day. Mom would make haste to fill the six exam rooms, everyone dressed down to the waist, gown open in the back, no matter what their chief complaint was, a puncture wound on their index finger even. And he would start down the line, weaving in and out of the exam rooms one through six, then back to one, like the carriage on an old-fashioned typewriter. He had a method to his breakneck madness, dictating while taking a history, then a perfunctory but skilled exam, then barking out orders to his two nurses who moved like whirling dervishes to keep pace with him. I’d come home from softball or tennis practice in the early evening to find Mom sprawled on the living room couch, unwinding from the day’s dizzying work.

But there were the occasions when Dr. Warne would slow down and give all his attention to one patient for thirty minutes, even an hour. A nurse would call from the hospital to clarify orders for an inpatient and Mom would have to put her on “hold heaven.” Dr. Warne had a strong foundation of faith. And when his patients needed it, he prayed with them. Apparently, no one minded the imposed longer wait at these times because they knew if they ever needed more than the usual five-minute visit with Dr. Warne, they would get it.

When I was old enough, Mom arranged for me to clean Dr. Warne’s office to earn extra money and learn the importance of work ethic. One Saturday afternoon when I arrived, he was there in the back office sitting behind his big oak desk catching up on paperwork. He called me into his room.

“Take a seat,” he said nodding his head toward the chair in front of the desk, not really looking my way.

I complied.

“Your mother tells me you want to go to medical school,” he began matter of factly, raising only his eyes over his glasses, his head staunchly perched over the piles of paper.

“Yes,” was all I could muster, startled by the personal nature of his question.

“I’d like to pray for you,” he said as more of a statement than a request.

“Ok,” I must have said, having no idea what to expect. Prayers to me at that time were rote, responsorial, before meals, mostly at church.

Dr. Warne rose from his chair as I shrunk in mine. He proceeded to call on God as if he knew Him personally. He laid his hand on my shoulder as he spoke inviting a calming presence that pushed my fears away.

I had been watching Mom living her life fully as a nurse and a mother, but I saw her sacrifice too. I dreamt of going to medical school and having a family of my own one day; but I had no idea how I was going to make it happen, or what it took to make it happen really, only that the road ahead would be a long and challenging one. Would it be worth it. His prayer conferred a reality to my dream which made it seem like a worthy struggle which would ultimately come to pass.

I am not sure I spoke to Dr. Warne much after that. I was off to college and Mom changed jobs again, this time working as a charge nurse in a new nursing home on the outskirts of town. One winter break, I volunteered at the nursing home to get some practical experience now that my course seemed set. For the first time, I got to really work alongside Mom, observing her carrying out her duties with great skill and caring for her patients with even greater compassion.

My family moved away from that small Ohio town to Texas. I soon followed and applied to Texas medical schools. In time I attended UT Houston and completed a Family Practice Residency in Kentucky.

I am who I am today because of my mom and her consistent example of hard work, resilience, and kindness. And my thanks to Dr. Warren,too. I will never forget his empowering prayer.

January 12, 2023January 12, 2023

Just Being Honest

Winter is usually the most difficult time of the year for me for various reasons: the short days, less sunshine, more rain, anniversary of my son’s death, the façade of festivity highlighting all the reality of our imperfect world. But you do the best you can, right?

This year I am faced with an additional challenge of medication shortage. And I thought I was so clever.

Weight loss is challenging. Obesity is a multifactorial disease with aberrations in many hormones: insulin, glucagon, hunger and satiety hormones, thyroid hormones, leptin, adiponectin, dopamine, to name a few. All these mixed and messed up signals drive hunger and eating behaviors and it is not due to lack of will power as anyone who has ever tried to lose weight knows.

Along came GLP1 agonists. These medications increase the effect of one of the satiety hormones which in turns leads to slower stomach emptying time so people feel fuller with less food. They press the satiety brake in the brain and turn down the main hunger pathway in the brain. They help balance blood sugar which decreases sugar cravings. All this adds up to weight loss.

The medications have been life giving, hope restoring, miracles for a lot of my patients. Not because they help with weight loss but because they get to the root of the problem of insulin resistance and hunger/satiety hormone imbalance. The medicine slows the hungry gut, calms the hungry brain, balances the hungry blood, so a person can identify their hungry habits and have half a chance to stand up against a hungry society that pushes Frankenfood 24/7. Eat all you want all the time whenever you want whether you are hungry or not whether its good for you or not. That’s what the culture pushes.

And now these very expensive medications have been hijacked for various reasons (maybe by people who really don’t need them but can afford to pay for them out of pocket?) The demand is high. The supply is limited. So the manufacturers’ and insurance companies’ solution is to require a diagnosis of type 2 diabetes in order to get them covered by insurance. I understand this is trying to limit them for people who have DM2.

This is not solving the problem, however. The people who have been buying them for the wrong reasons (to lose the 5 pounds) will continue to buy them because they can afford them. Meanwhile, my patients and I are back to the drawing board, fighting with insurance companies for coverage with an endless back and forth with pharmacies.

My apologies to the pharmacist on the other end of the phone a few weeks ago. I felt exasperated to the point of rude honesty. “What do you mean semaglutide is not being covered with for insulin resistance anymore!!??!!” All in defense of my patients, of course. Convicted, I ended up calling him back to apologize. He was not the problem. My rudeness does not solve any problems either.

Recently a syndicated news show highlighted the ways obesity is a medical condition just like diabetes or hypertension or hypercholesterolemia and deserves coverage by insurance companies the same way they cover diabetes, hypertension, and hypercholesterolemia. If those latter conditions are not lifestyle related, I don’t know what is. And that’s the justification for non-coverage of obesity treatment and anti-obesity medications. It’s all lifestyle. So it’s all on the patient, exempt from insurance realm. Even if you accept that logic, alcohol and tobacco and drug use/abuse all get covered. What about food?

Short sided is what it is. Unjust. What’s the old adage? Life is not fair.

Shoulder shrug. Big sigh right here. So now what?

That’s what I have been ruminating about lately and that’s what I am encouraged about, even in my frustration.

At Oregon Weight and Wellness, we teach how to eat in a way your brain can hear your satiety. We teach how to do what the medications do, bringing hormones back into balance.

Eat in a way your brain can hear your satiety.

Eat seated. At a table. Without distraction. Put your fork down. Breathe between bites. Eat with someone you love. Don’t try to solve the world’s problems. When you sit down for a meal, just eat. And pay attention. Eat what takes time and energy to digest. Like high quality protein from fish or beef or eggs. Protein takes time to digest so you feel fuller longer. Eat veggies with fiber. Fiber makes you feel full. Add a little natural fat. Fat with fiber. Like avocado, or walnuts, or pumpkin seeds.

Determine to be a person who values health. Then do what healthy people do. Eat whole foods, not in a hurry. Let your gut do the processing and tell your brain you are full.

It takes practice. It’s not easy. It takes stepping out of the current crazy culture. It often requires support. And with grace and time you will think and eat weigh different.

October 4, 2022October 8, 2022

In Honor of Dr. Lisa Wipf

You’ve been gone more than two weeks now.

Your dad must have been there to welcome you. Have you met my son, Sammy, yet? Or my cousin, Kevin? How long was the line to meet QEII?

Have you found out that I tricked you into giving me the Wordle answer that one day? Or that I watched Downton Abbey before you? Or that I secretly liked my sour dough bakery better than your sour dough bakery? Or that I did not read every tweet or listen to every podcast you sent my way?

I can see your eyes roll mocking me for going to that Christian concert. Yes I cried when Casting Crowns sang Scars in Heaven. But those were hot, don’t rush me tears. Don’t rush me through this sadness. Through this anger. It will be some time before I can turn over in bed, ignoring the 3am haunts of unspoken words and unprayed prayers. Joy will come, I suppose, with the mourning.

Did you hear my tongue lashing as you lie there, paint still wet on your fingers, cold, silent in that sterile ER room roughly tidied of its crash cart shrapnel. With all the miracles of modern medicine, you were too stubborn or too anti-establishment to let them bring you back.

Julie, Jeanette, Sarah, Shon, Shannon, Margaret, Lisa, Kathryn and grandchild at P and Q for a quilt show

And I can picture you showing up at the Pearly Gates and Saint Peter checking his book, scratching his head, confused. “You are not on my list today. You were not due here for quite some time. We will have to put in a rush order for your room.” I see you yanking the clip board out of his hand, scribbling your name at the top, shoving it back into his chest, grabbing a hammer and some nails and going to work. “I’ll do it. How hard can it be?”

How hard can it be? You said that often and conquered whatever you put your mind to.

How hard can it be? To build your own dental practice and then to make your patients your friends. How hard can it be to develop a non-profit dental ministry and relieve a little human suffering. Dream it, raise funds for it by selling the paintings you painted and quilts you quilted,. Then gather your friends and go.

How hard can it be? You’d visit a local artisan, observe him at his craft, then try your hand at it, like stuffing sausage, or making cheese, or pasta or sour dough bread. You’d get the hang of one thing, then move on to the next. Fermenting pickles, sour kraut, kombucha, always inviting friends to learn alongside you. See one, do one, teach one.

How hard can it be to refurbish a rundown printing press you uncovered on an overnight to Ashland. The deceased owner’s now aging son had housed the dinosaur for years in an old barn just as dusty and dilapidated as the printing press was. Junk to him was treasure to you. All the attention to detail seemed exhausting to me, but you evidently enjoyed painstakingly setting the blocks, and the ink, then sending the same card through, one, two, and three time to recreate nostalgic remnants of the past.

But then you liked old things and old ways of doing things, preferring a reverent liturgy with hyms and head coverings over a contemporary church service, or an old-fashioned high tea with scones and lemon curd over a chic cocktail party. You preferred supporting local businesses over buying from box stores. And never on a Sunday.

For all your love of tradition, though, you broke the rules. Once you mastered conventional quilting, you made it your own with free style piecing and free hand quilting on your very own long arm. I marveled how you could see strips of fabric at random angles, yielding uneven sized pieces, eventually sewing them together to create beautiful tapestries that told a story.

We were friends for a reason. You to sharpen me as iron sharpens iron. “Faithful are the wounds of a friend,” comforts Solomon. You called me out like no one else could. I did not always appreciate the curt execution of your exhortations, like when you ripped the mask off my face as we entered that estate sale late August last year. You walked right past the sign, head held high with a clear conscience, completely resolute in your truth. You could not abide with my seeming inconsistency.

“Be brave” your note read arriving by snail mail, supporting my nonconformist practice of medicine in this crazy mixed up world at this crazy mixed up time.

You know I forgave you when you got me in trouble at the grocery store. You thought you were so clever, strolling in nonchalantly, knowing you were going to create a scene, then standing on your soap box to deaf ears. It was my license plate they took a picture of; it was I who was accused of stealing. The smug look on your face, like the grin of a Cheshire cat. You could be exasperating at times.

But your yes was yes, and your no was no. You were willing to stand up for what mattered and tell others why. I respected that about you. The way you defended the rights of the unborn and the mothers of the unborn. And the widows. That’s true religion says James.

I must correct you on one thing, though. You once called me a sycophant. First of all, I had to look up what sycophant meant. You were always throwing out fifty cent words, trying to best my vocabulary. But I was not. A sycophant. When I gave Kristen Kimball that glass of water to soothe her dry throat, it was out of compassion. I knew she was overly fatigued from farming, family, and unwanted fame, and had just flown cross country to give the keynote address for the OSU small farms conference. I could tell she had a head cold and was not feeling well. Yes, I got my book signed. Yes, I talked to her longer than anybody else in line, but my heart was genuine. Hopefully, you know that now.

And what was my role in your life? To soften you, perhaps. You surrounded yourself with friends who softened you with their gentle ways and their kind hearts. Jeanette and Peggy and Shon and Shannon. Your sisters. Even Steven. And I did see a softening over these last several years as you honored your mother by moving in with her and caring for her. Where you once were impatient with tardiness, you gave grace. Where you once were annoyed when things did not go your way, you were more at peace. I was almost shocked at how immediately contrite you were when I scolded your rude interruption of an office visit gone overtime. And I could see you slowly letting go of your deepest held hurts.

You were determined to give your mother her heart’s desire, which was to live in her home of fifty years, where the majority of her old memories resided because her aging brain could not easily create new ones. You gave your mom more and more of your time, more time than you gave your friends and siblings in the end. Time was your love language. And we knew it.

“Don’t hate me” you texted, begging off our annual Coburg trek. Of course, I didn’t hate you. I knew you were tired. Weary of well-doing, perhaps, not able to see more fruitful service. I saw it in your slow pace when we walked from my office to Bush Park to the art fair late July. You had to stop three times to catch your breath. “Heartburn,” you feigned. I knew it wasn’t heart burn. For your sake, I will resist my catholic, self-effacing tendency to kick myself for not insisting one more time you go to the ER. The fact is, I didn’t. For whatever reason. Respect. Futility. Distraction. It wasn’t because I didn’t care.

And I saw it in again in your face at breakfast on Labor Day. The fatigue. The food wasn’t great but that’s not what kept you down cast. I could see you were tired. Tired of contending. You always wanted more. More common sense from your country. More cohesion from your church. More commitment from your friends. More consideration from your family. You even wanted more cooperation from God. Maybe that’s why you barged in ahead of schedule. You believed in prayer, but you wanted God to do more, and you had to get right in His face.

I don’t remember our entire conversation at that belated birthday breakfast. I am racking my brain to remember. I know we talked mostly about how my home office was going. You thought I wore my dog shirt to counter the cat cards you sent me three days in a row. I don’t know if the conversation turned to you with your customary, “now let’s talk about Lisa” line. Did I even ask you about your how you were feeling, if you had any more episodes. I’d like to think I did. But I have to accept that maybe I didn’t.

All of life is a competition, you’d say. You beat me in fast Scrabble. You beat me in Settlers. You were stronger, more talented, more stalwart. You prayed more than I did, and you prayed for me more than I prayed for you. I know it. You were the better friend. And you beat me going home.

You were not afraid to die, and you proved it. “Absent from the body, present with the Lord.” You believed it and so will l.

What I really want to know, though, is what was it like hearing Jesus say, “Well done. Well done good and faithful servant. Enter into the joy of your master!”

To live is Christ. To die is gain. You win, Lisa. You win.

September 15, 2022September 16, 2022

Bus Rides and Bullies

School is back in session. That reality set in hard yesterday morning on my way to work when I found myself coming to a screeching halt behind two other cars and glaring at the red stop sign sticking out the side of a yellow bus, flashing lights and all. I glanced at the clock realizing I had not left time for this slice of Norman Rockwell’s Americana. Adjusting in my seat, I took a cleansing breath and melted into the familiar scene.

Grade school children lined up single file, climbing up the big bus steps and down the rows to find their seats. It was somewhat orderly, like ants at a picnic. A few young mothers stood safely at the roadside, waving enthusiastically as the bus lurched forward, hauling their children away, some of them presumably for their first day of school. One mom clutched her chest and blotted tears from her eyes with her shirt sleeve, maybe from the bittersweet reality that her child was growing up and moving on to the next stage of life, or maybe from guilty relief that summer was finally over. Or maybe from a little of both.

I remember taking the bus as a kid when we lived more than the obligatory mile away from school. Under a mile and you had to walk which we did when we lived on Vernon Avenue. Up hill, both ways, I tell my kids. But when we lived farther out on Eastbrook Drive, we rode the bus. My brothers and sisters and I attended St. Edward’s, a Catholic school located a few short blocks from Ashland Junior High for our grade school tenure. Apparently, St. Ed’s had an agreement with the public school that we parochial kids could ride their buses to the Junior High and walk the rest of the three blocks to our school. We got out earlier than the Junior High kids and were always the first ones on the bus at the end of the school day. I usually sat in the second seat behind the driver, not wanting to appear too eager. And I saved a seat for Justine.

That’s all I knew about her. That her name was Justine. And that she was teased. A lot. She had short, dark, wavy hair. Her body odor was noticeable, even by me at the naïve age of eight, and she was heavier than the other kids her age. No one wanted to sit by Justine. So, she ordered me to save her a seat. She was not nice about it at all. I figured probably because she was teased so cruelly. Hurting people hurt people, I later learned. I obliged her, dutifully placing my books and lunch pail next to me on the other half of the bench seat and then picking them up when I saw her climbing the bus steps. What was it to me? Nobody seemed to want to sit up front anyway. We sat in silence most of the way home.

Admittedly, the vast majority of bus rides home are a positive experience for kids. It’s fun to sit in the back of the bus and goof off with friends, throw paper wads, eat the rest of your lunch, or get started on your homework right away so when you got home you could play. And I know that every negative comment does not cause lasting emotional trauma. Sticks and stones and words, however, can hurt. Deeply. I have no idea what happened to Justine, whether the school bus bullying went on to negatively impact her in adulthood.

I know a lot of Justines now though. I talk to people every day who were teased mercilessly as children because they carried extra weight, through no fault of their own. They were called Fatso or Porky or Tub-o-lard or worse. And by parents and grandparents even. They were passed over on the playground, never being chosen to be on a team. They were compared to their string bean siblings, as if they were in control of their own genetics or grocery shopping or the school lunch menu.

At Oregon Weight and Wellness, we screen for this kind of childhood trauma as well as other physical and emotional trauma. We know that childhood trauma correlates with adult obesity. Not to say that the damage is irreparable or people who experience trauma are hopeless. But sometimes we must address that deep limbic woundedness to understand patterns of behavior, to get to the root of the barriers that sabotage people’s success time and time again. We try to make a change and it works for a time. Then something happens, and we find ourselves back to our tried-and-true coping mechanisms. Like turning to highly palatable foods not because we are physically hungry, but because we are lonely or tired or anxious or bored. The hurts can be so hidden and so deeply rooted, it seems like we don’t even want to succeed.

Recognizing our past traumas, giving space for them, perhaps reframing, and forgiving, can bring healing to those limbic memories so they no longer interrupt the progress of the present.

At OWW, people find hope and restore their health. We not only build a strong foundation on the lifestyle pillars of nutrition, activity, sleep, and community, we build the indispensable skills of resilience. And then those long forgotten but ever so painful bus rides truly become a thing of past.

August 24, 2022August 26, 2022

It’s in the Genes

Ruminating on all the minutiae of my move and wondering how a home office for my medical practice will work out, I have been thinking lately about how and why I was drawn to the medical profession in the first place.

My mom was a registered nurse, my father a medic in the army, my grandmother a licensed practical nurse, and my grandfather a general practitioner. Maybe it’s in the genes?

I don’t know that I inherited any medical DNA, nurture vs nature and all, but I did inherit my grandfather’s old desk that he used in his office. Ironically, he practiced out of his home too.

I can see plain as day my grandparents’ sprawling ranch house, complete with a screened in porch and an in ground pool. The property’s expansive yards backed up to a deep, wide ravine on Sylvania Avenue at the outskirts of Toledo, Ohio. The red brick house had two doors off its front porch entrance, the north facing grander door for the main house, and the more modest door to the east for Grandpa Doc’s office. It must have been a bedroom, repurposed, now that I really think about it; but at the time it seemed built in, natural, like it never was any other way. “Doc” as he was affectionately named, accepted chickens and tomatoes and beans as payment from his loyal patients. And conveniently, Grandma served as his nurse.

Grandma and Grandpa were the epitome of “opposites attract.” Reserved and unassuming, Grandpa mostly stayed in the background, listening from afar. He always wore a starched white shirt, pressed black trousers, and grey leisure shoes. Maybe he only had one set of clothes. Grandma, quite distinctly, was flamboyant, even eccentric. With her bright red lipstick, costume jewelry, and bellowing singing voice, she created a party (or a commotion) everywhere she went.

Grandpa Doc and Julie (me) on the orange tractor

We spent lots of time at that Sylvania house, baking huge sugar cookies the size of saucers, swinging on a myriad of plastic swings hanging from towering oak trees in the grand yard and then climbing all over them like monkeys. And that’s what Grandma called us, her “little monkeys.” We piled in her white Cadillac convertible with its red leather interior (in our pajamas no less and as late as 8pm!) for a trip to McDonalds (the first one in Toledo I am sure), then choked down cod liver oil the next morning. Grandpa did not join in that fun, but he was there, and his presence was felt. He never denied us a ride on the old orange tractor. I can still smell the damp, musty mix of gasoline and dried grass wafting from the tool shed where he parked the old workhorse after mowing the back forty.

Grandpa died when I was seven years old. I remember driving past his childhood home, a tradition in the Jewish faith I am told, before laying him to rest. Grandma soldiered on, but she was never the same. She took us “Termites” on her travels to the Smokey Mountains. She stayed at our house for a week, sometimes two, darning socks, making Favorite Casserole and bolagna sandwiches with butter and mayonnaise, and played Kings on the Corner, Crazy Rummy or Euchre with us till the wee hours of the morning. We accompanied her on visits to her five sisters and their kids. TheToledo Zoo, Cedar Point, a local fishing hole, and Frischs’ Big Boy became our stomping grounds. Sometimes she would take us to the Holiday Inn down the road for the weekend just so we could swim in the pool.

Grandma spoiled us with love and laughter, but her “fun tank” could run dry. Or so it seems when you are a kid. There were times where we stood knocking at her door for an eternity, begging her to come out and play. But she stayed hidden in the safety of her home, lights off, blinds pulled low, and doors locked tight. Many years later I learned she suffered deep, prolonged bouts of depression and agorophobia.

Grandma was of Polish descent. A tall woman with a larger frame, she had curves in all the right places and carried her weight well. But during these bouts of depression, when she turned to the all the latest fast and highly processed food for emotional support, the inevitable happened. She gained weight and developed multiple chronic diseases including endometrial cancer which ultimately led to her demise. Her genes were like a loaded gun as far as energy storage was concerned, and the food environment as well as the medications she was taking pulled the trigger. Even though I was completing my residency in Family Medicine at the time, I had no knowledge of epigenetics, insulin resistance, or binge eating disorder. Not even a clue.

Now I understand that weight regulation is genetic. There are over 200 genes that we know of today that tell our bodies when to store, how much to store, and where to store energy. We come in all shapes and sizes and that’s in our genes. Unlike the genes that tell our eyes to be blue or green or black, these weight regulation genes are modifiable by our environment. Changes in our environment affect the expression of these genes beginning with our formation in our mother’s womb. Things like illness, injury, antibiotics, surgery, allergy, emotional trauma, medications, can all effect how these genes are expressed. And just like a rheostat where gene expression for energy storage can be turned up, it can also be turned down. Environment plays a crucial role.

So how do we set our genes up for healthy expression. At the risk of sounding like a broken record: Eat real food. Go to bed. Get moving. Manage stress with strategies that don’t involve food. Eat to feel well, not to be good. These are the lifestyle pillars that set you up for healthy gene expression and healthy weight regulation, that decrease the risk of the diseases you inherited from your parents, like type 2 diabetes and certain cancers and heart disease that you don’t have to get.

These are the habits that we want to help you build and pass on to your children and grandchildren. It’s what we do at Oregon Weight and Wellness. And its how we live. And now we are doing it from home.

August 10, 2022August 10, 2022

Herculean Tasks

During the initial conceptualization phase of my start up business, I considered housing my office in my home. Several naysayers brought up reasons against: Location.Liability.Limitations. I stumbled upon my current office one day after a meeting with my CPA and that was that. I signed a lease at 1265 Waller Street in Salem.

These last two and a half years have been a blessing. The Waller Street office was a place of small but great beginnings. Now it seems it is time for a change. And the concept of home office these days is very much the norm, one of the silver linings from the recent past.

I have been talking about change for several months with patients as my sounding board. I made the final decision in May while visiting my cousin in Ohio.

Change talk sounds like this: Can I do it? Will it work? Is it worth it? Who is in charge? And Who is my support?

Is the change to a home office feasible? Will patients follow me? Do I have the time and energy and resources to convert our mother-in-law suite to a viable office? Will it be the overhead reducer I hope? When will the change take place? Is four months enough time to get everything in place? Who do I have to consult with for questions and counsel?

After thinking through these questions, I decided that even though I could not predict the future, I had enough confidence and motivation and support to move forward. Besides, my husband, who has always been my biggest advocate, would be doing the lion’s share of the work. #gokenny!

Then started the mission of breaking down the herculean task to small, manageable steps, taking one day at a time, one challenge at a time. First, tell people. Then design. Then choose colors. Then buy fixtures. Go through stuff I had accumulated at the office. Take only what is necessary home, a few things at time. Do one thing every day that will move me toward the September 1 goal.

It’s twenty-one days until Go Time. How am I doing?

If the dream I had last night is any indication, I am feeling very anxious. (I was sitting, naked, in the disorganized waiting room of my new clinic watching the first patient walk up the drive). But wait, maybe that is not just anxiety working itself out. Maybe that is foreshadowing that people will indeed show up, and that I am creating a vulnerable, honest, and safe place for my patients. OK, maybe I should keep my day job and not switch my career to dream interpretation, but I am choosing to think positive.

And seriously, we are 85% complete. Fresh paint. Done. ADA bathroom. Done. Ramp. Done. 75% equipment moved. Done. And, in the meantime, I have secured a Salem office location for most Wednesdays for people who are not able to come to Jefferson.

The goal is in sight. One day at a time. One tiny step at a time. Then there will be new goals to create and new dreams to be dreamt. Wait till I tell Kenny about phase 2!

Change starts with asking questions and talking it out. Can I do it? Will it work? Is it worth it? Who is in charge? Who is my support? This is a big part of what we do at Oregon Weight and Wellness when helping people envision better health. We give you the support and the knowhow you need to break that herculean task of weight loss, whether its twenty pounds or two hundred pounds, into manageble goals.

Give us a call to get your health vision started. 971-273-7143.

July 9, 2022August 24, 2022

…As Yourself

I was asked to give a talk to a group of church women attending a conference on Loving Yourself Well.

At first glance, the topic seemed somewhat selfish to me . I am supposed to talk about self-love? to a group of Christians? Aren’t we Christians taught to deny ourselves, pick up our cross, endure suffering, trials and tribulations of many kinds.

Then I thought about Mark 12 when “one of the teachers of the law came and asked Jesus, Of all the commandments, which is the most important? The most important one, answered Jesus, is Hear O Israel, the Lord our God the Lord is one. Love the Lord your God with all your heart and with all your soul and will all your mind and with all your strength. The second is this: Love your neighbor as yourself. There is no commandment greater than these.”

And it occured to me that we often gloss over the last part of the commandment. “as yourself. ”

Jesus did not say instead of yourself, not yourself, forget yourself, at the expense of yourself. He says love God. with every thing that is in you, both spiritual (heart and soul) and physical (mind and strength). And Love your neighbor…. AS YOURSELF.

We are commanded to love ourselves; but what does loving myself look like?
A spa day with my BFF? Perhaps.
Taking a vacation to Hawaii?Maybe.
Buying a new outfit? My personal favorite.

Occasionally pampering myself may be part of loving myself, but I noticed another verse that put “as yourself” in a more practical way,
In Ephesians 5:29, Paul is talking to husbands and wives. He says “husbands ought to love their wives as their own bodies. He who loves his wife loves himself. After all, no one ever hated his own body, but he FEEDS andCARES for it. Just as Christ does the church.” Another version of the bible says NOURISHES AND CHERISHES.
So part of loving myself is FEEDING AND CARING for myself. Nourishing and cherishing myself.
Maybe not the whole thing, but a part of it anyway.
How am I doing?
How are you doing with feeding and caring for yourself?

How did Jesus, feed and care, nourish and cherish his body?

To answer this, I looked at the beautiful story in John 4 about the woman at the well. You may know it well. It tells the story of how Jesus, in meeting a woman, breaks through so many barriers including polictical, religious, ethnic, cultural, and gender barriers to speak to her and love her into the Kingdom.

I posed my questions to this story and noticed a few things I had never noticed before: Fully human, Jesus had physical needs. He embraced his humanity and he met those needs in a way that nourished his physical body. Jesus kept himself healthy so that he could meet others’ needs.

1 – Jesus drank water. Jesus got thirsty and he went to the well to drink water. Not juice or pop or Starbucks mocha latte with an extra shot of espresso. Water.

Water is so important to the body over sixty percent of which is comprised of water. Water purifies our bodies. It protects our nervous system. It provides energy. Sugary beverages (even artificially sweet) do the exact opposite and toxify the body and hijack hormones to make us think we are hungry. They de-energize by causing a sugar spike and then a sugar crash. They intoxicate. Jesus cared for his body by drinking water.

2 – Jesus ate real food. “He sent his disciples to buy food.” I don’t hink they went to McDonald’s or In and Out or Chick Fil-A. Jesus ate real whole food, minimally processed, like fish and whole grain breads and cucumbers and leaks and figs and dates and olives. He ate foods that provided his body the nutrients he needed to be strong and stay healthy.

3 – Jesus walked. The journey from Judea to Galilee was forty miles. He did not Uber there. He walked. I don’t know how long it took him but he walked. Walking was so important to him, in another bible story, he walked on water. But he moved his body. A lot.

4 – Jesus rested. The bible says “wearied from his journey, he sat down.” Jesus took a break. He did not go 24/7 365. He took breaks. He respected and honored the fact that he had to reboot, restore, recharge. He rested.

And while tending to these physical needs, while feeding and caring for himself, he met the Samaritan woman and connected with her in a way that met her greatest need and broke through her biggest barrier, shame. He did not ingorne her. He saw her. He was patient with her. He was kind to her. He did not manipulate or judge or condemn her. He simply asked her for a drink of water.

Jesus loved his neighbor as he loved himself.

WWJD? Jesus would drink water, eat real food, walk, rest. He would keep himself physically healthy and mentally strong.

We need to do the same.

Loving yourself by nourishing and cherishing your body is not selfish. Embracing the fearful and wonderful way God created us, with physical needs, we can love ourselves well, motivated out of obedience to God , out of reverence to Christ, as our spiritual act of worship. Then we can truly love others.