Friday, May 18, 2007

A Cat's Life: Weight Management

Uly on the couch

Today Ulysses has gone to the vet for some dental work. Trust me he hated it, but I was also a little worried about it because he has gained quite a bit of weight over the last year. When I got him, he was 14 pounds and looked well. Now he is almost 19 pounds and is a fat, slow-moving cat.

Psychologically, many people tend to see the obese as people who lack brain power. The train of thought goes like this: if they were smarter, they'd make better food choices or at least do something so that they wouldn't neglect themselves and look like that. For doctors, we tend to cringe even more as these patients have more medical problems, come to see us more, hear us talk about weight loss, and often have a hard time getting anywhere with the root of their medical problems. As a pediatrician, at least I can often talk about weight maintenance, since your average overweight Caucasian 10-year-old really should weigh more than 140 pounds in a decade, and they just have to hold the fat until they grow into muscular adults. I hope.

Anyway, with Ulysses, he's not smart enough to understand that he needs to diet, and he's obviously failed to self-regulate his own intake. He loves food, and I can certainly empathize with that. I've tried a few different regimens involving a mix of canned food, AKA “wet” food, and kibble, or “dry” food. I used to give him a lump of wet food (1/4 of the can) in the morning and let him snack on as much dry food as he wanted through the day. Then, after a significant weight gain, I tried limiting the dry food. Then I tried halving the dry food and increasing the wet food. Last week he was on wet food only and ate about 1.75 cans a day, begging for more.

Ulysses Experiences Snow I've done some reading. First, there's the problem that cat food packaging, which unlike people packaging, does not necessarily list the absolute calories it contains, and how much of those come from fat, protein, and carbohydrates. Instead it lists percentages, without stating how those percentages were calculated. Because of this, you cannot compare the percent protein on a kibble package (33%) to the protein on a can (10%) and conclude that kibble has more protein, which it doesn't. Secondly, cats' metabolisms are geared to protein and a mostly meat diet, though Ulysses likes some grass now and then. Thus, a high carbohydrate diet gives them a metabolic state similar to adult diabetics. To give you an example of the health risks of that, an adult human diabetic has the same risk of getting a heart attack as the risk of a second heart attack in someone who's already had one. Not good.

To complicate it further, I can't bear the thought of him starving, so I can sympathize with those moms of obese kids who don't have the heart to make their kid diet. That won't stop me from doing it, but I really hate it. It also drives me up the wall when he begs too.

So the solution? The ideal solution would be to feed him only wet food a few times a day. It is not ideal for us because I work so much and there's often no one around to feed him more than once a day. I really hate to give him dry food again, but we may have to go back to it. The vet is going to give me the number of calories he needs (I tried to estimate using the formula we use for premature babies…obviously wrong), and I've written our current pet food supplier to ask them just how many calories are in their products. Based on that, I'll be able to calculate how much food he really needs. It still won't be the correct percentage of protein, fat, and carbohydrates, but at least I'll stop overfeeding him for a time. Ulysses gets grumpy when he's hungry. I'm afraid I'll have to wear thick socks this summer or risk getting attack kitty marks on my calves.

Pediatric Check-Up: Mom's Quote 1

Doctors, especially doctors in training, like to bemoan that "no one understands" just what we go through other than our allied medical professionals. Now I don't agree with that completely, but I do agree that a large percentage of people do not understand the training pathway or just what our training consists of. So here's a funny quote from my mom this week while I was visiting Reno (translated): "So now that you're out of school, you're less tired, right?"

Er, that didn't sound as funny, but please reference my previous blog post from this January:

Current total hours worked: 101.5!
Current days working on this part of the job: 7 days

Here's a picture of a fellow intern that same month. Can you tell that we were delirious?

Matt Carter in Transformer gearMatt Carter in Transformer gear

Thursday, May 17, 2007

Philosofiend: Wealth (And Gifts)

Everyone knows a person it would be hard to shop for: a colleague with everything, in-laws with odd tastes. I've got a mother who doesn't make decisions on her own. How do you find a Mother's Day gift for someone without an opinion, especially if you detest insincere holidays such as Mother's Day? Luckily, my mother in-law is very "girly" and into various scented sundries as well as cosmetics, so I picked up a spa kit from my favorite, moderately Earth friendly boutique chain. Of course, most perfumes and colognes make me want to puke, so I chose something with very neutral scents and not puke-o-genic. Additionally we went to a spa for massages together once we arrived in her city, and made her a mixtape of music she likes and may like.

Now this course of action may seem very simple, but it is still philosophically driven. In giving a gift, we are not limiting ourselves to find something material that the person may like. For instance, there's a lot of souvenir kitsch that my mother enjoys and that I refuse to buy for her. Instead, we've expanded our idea of gifts to giving something that will enhance the person's enjoyment for the moment but also broadens the giftee's perspective or introduces them to a whole new skill set or set of experiences. We've given mixtapes, how-to gift books, de-virginized sushi eaters, and taught origami. It's a lot of fun for both parties in the exchange, and it suits our value system while also allowing us to spread something that we enjoy.

Of course sometimes it's still a case of "you can bring a horse to water, but you can't make him drink." I've bought a few different "how to use your Mac effectively" books for my dad, and also spent some time introducing my mom to computers, but there's still a beautiful G5 water-cooled Mac desktop idling in my parent's dining room using maybe 5% of its computing potential. But I digress.

I was thinking about the concept of wealth in our country. Currently, many (though not most) people enjoy a relatively decent quality of life. On home visits in the more disadvantaged neighborhoods in Albuquerque, people have heat, clean water, shelter, clothing, enough food calories, and preventative health care. In better neighborhoods people enjoy more consistent heat, greenspace and parks, safe neighborhoods, and better food. In my neighborhood, it's quiet, mostly safe, there's lots of young families nearby, and there's a good elementary school three blocks down the road.

So what does wealth mean in the context of Albuquerque, NM in 2007? For myself, what works is similar to an idea my father learned in wartime Vietnam: "they can't take what's in your head." In my context, where personal safety is less of an issue, I'd revise that to say "what's in your head makes you wealthy." In this context, the wealth I enjoy encompasses multiple skill sets, many wonderful experiences, and the ability to acquire more. Sunny and I have gone to Amsterdam, Saigon, New York, San Francisco, Hong Kong, and a really nice spa. I garden, and he codes. I troubleshoot medical instances, and he's made all of our house's doors fit in their jams. We're healthy and safe enough to continue all of that and more in a context of love, respect, and mutual values subject to discussion and tinkering. I think that even in less prosperous circumstances, this method of conceptualizing wealth would serve us well.

Monday, May 07, 2007

Being Whole: Training And Development

Recently, one of the testier attending physicians in the department was speaking with another intern who appeared to be at least five years older than me. In reference to this intern's increased life experience points and presumably more focused and ambitious career plans, this attending linked them together and rather casually derided “the folks who go to medical school and don't know what they want and halfway through decide that they don't want all this [waving at the hospital].”

Now I resemble this remark because I do not intend to find a job as a usual pediatrician or go into subspecialist training when I finish. I intend to chart my way off the beaten path that leads from medical student to practicing physician. I love the work some days, and it's a valuable body of knowledge that I can master. Yet I am looking for work that will allow me to use many of the skill sets I have, and also to continue to be a generalist, learning new skills as I go. Incidentally, I will also be looking for work that is more conducive to family life and to pursuing my wide range of non-career interests. Therefore, I disagree with the implication that I've wasted the seven years I'll have put into the medical career at the end of my residency.

In the gaming world a player's character gathers experience points in each battle, whether the beast is slain or not. I can stretch a simile and suggest that each endeavor, each moment in life, garners myself experience. Though I do occasionally regret a choice, usually I get over the unnecessary emotion and view the moment as a learning experience. Similarly, while I could have chosen to take more of a risk and just moved to San Diego with Sunny to look for a job instead of going to medical school, and perhaps been happier finishing a Ph.D. program in English, I made the best decision I could at each step of my path between entering medical school and finishing my intern year in a pediatric residency. Thus, I am now endowed with one of the rarer professional degrees one'll see in academic research, and I also have a large body of knowledge on how children might be raised, though not the experience of course.

I have always pictured myself as a person who constantly evolves and develops herself. Though this stage in my growth may seem very masochistic to others, it still serves as a stage of dramatic growth. It is very narrow-minded to consider it a waste of time despite the fact that the outcome is not the expected one.