This weekend we took our firstborn to TreeTop Adventure, a climbing and zip-lining experience in Canton, Massachusetts 👦🌲. He took the yellow course last time, but this time he went for the more challenging green course, so dad had to take it with him (site policy)👨‍👦. As someone who, to put it mildly, doesn’t enjoy bungee jumping and rollercoasters, the first high climbing and zip-lining were pretty challenging. But we ended up having a good time, and I have a couple more years to prepare myself before he’s allowed to take the even more challenging blue course. I will eventually find myself missing the green one…

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So this week, we’ll crank up a notch and discuss squeezing physical activity into a busy schedule.

Number 8, let’s do this!

Table of contents

1. Main Article - Physical Activity for Busy People

2. OMFS World

3. Stuff (Book, Gear)

Main Article - Physical Activity for Busy People

🏃🏻‍♂️A few weeks ago, I started jogging again. Jogging is a top priority of mine, but not the highest. It means that if putting time and effort into another project will dramatically affect me in the long run - that project will take precedence over jogging. If I had more free time, I wouldn’t have to make this choice, but between my family, fellowship, and until most recently, the USMLE, jogging got cut out. 

STORY TIME!

🥔 My long-term relationship with jogging (and with intensive physical activity altogether) began at the age of 15. Until then, I was a couch potato: I wasn’t overweight by no means, but just thinking about physical activity sent shivers down my spine. Then I started high school, and I vividly remember my first physical education (PE) class: We waited quietly in a row and thought we were about to meet our gym teacher. Wrong! Instead, one of my classmates, who received training over the summer, ordered us to form a line behind him, and we all started running🏃🏃🏿‍♂️🏃🏽🏃🏽‍♂️🏃🏼🏃🏻‍♂️. Shortly after, I was short of breath and transitioned to a walking pace. From the corner of my eye, I caught my gym teacher watching us, but we had no direct communication with him. The first PE ended, and we returned to our regular school schedule.

🚶🏻‍♂️So we went on with this routine, twice a week, PE. Waiting quietly in a row, starting exactly on time (and not a second later), following our classmate’s lead, me running for 2 minutes and then transitioning to a walking pace while most of the others continue to run, the gym teacher watching us, and so on.

👩‍🚒But then everything changed. It was three weeks into high school. We had a 12-minute run during which the number of laps was recorded. Mine was 7 and ¾, which is low. At the end of the class, as we waited quietly in a row, our gym teacher approached us for the first time. I don’t recall everything he told us, but I clearly remember him referring to a group of students who expect others to do all the hard work for them (I paraphrased that, his exact wording was not as delicate). I took it to heart. We went on a ten days holiday vacation, and I decided this would never happen again. I started jogging daily around the neighborhood while a group of kids I’d never seen before sat on a bench and made fun of me. I didn’t care.

“When a rude person offends you, he can’t really make you unhappy, unless you turn the event into a thought, then allow it to linger in your brain, and then allow it to distress you.” - Solve for Happy, Mo Gawdat

💪Eleven days later, we returned from vacation, and instead of walking during the run, I kept the same pace as my classmates! Then we had the same 12-minute run, and I completed 9 and ¼ laps, significantly improving from my previous 7 and ¾ laps. At the end of the class, my gym teacher singled me out in front of everyone and asked: “Sharon, what was your previous result?”. “7 and 3/4”, I replied. “So today you scored 9 and ¼. See everyone? This is the kind of hard work that promotes results.” 

Throughout my life, I was lucky to know people I refer to as mentors until this day. My high-school gym teacher is one of them.

👟So, 27 years later, how do I do it with a busy schedule? We already discussed time management and prioritization in previous issues, so you might want to brush up on these before we continue. Also, I don’t think we need to go deep into “why physical activity is good for you”. I will say that although physical activity may seem time-consuming, it is essential even if you don’t have time. A 20-minute brisk walk can improve your mood, increase energy levels, and reduce stress. It is also a great way to improve cardiovascular health and strengthen muscles. If you are short on time, try brisk walking for just 10 minutes every other day. You will be surprised how much of a difference it makes, and soon enough, you will see that doing it for 12 minutes, 15 minutes, and 20 minutes is not that hard. But enough with common knowledge and stating out the obvious. I want to introduce you to my state of mind with running, so I’ll break it into three: 1. Be who you want to be 2. Minimize friction 3. Make it enjoyable.

“The Goldilocks Rule states that humans experience peak motivation when working on tasks that are right on the edge of their current abilities. Not too hard. Not too easy. Just right.” - James Clear, Atomic Habits

🕺First, BE the person you want to be. Instead of “I want to be a runner,” say, “I’m a runner”. It only takes one short run to define oneself as such. I know it sounds fluffy, but this small change in how we perceive ourselves will immediately bring internal and external motivation to do the work for us (see issue #5, where I discuss motivation). Let’s take this newsletter as an example: Immediately after sending the first issue, I started referring to myself as “a writer”. I’ve only done so in my mind, and I haven’t gone out and told everyone: “hey, I’m a writer now”. But that’s just me. Some of you will want to publish your new definition on social media, some will share it during a family dinner, and some will keep it to themselves. As long as it works for you, it doesn’t matter how you do it. Remember: instead of “I want to start swimming,” say: “I’m a swimmer”. So, why don’t you take a walk or a bike ride RIGHT NOW? Just 5 minutes, I’ll wait.

Here’s some energizing music for your workout - the mother and father of trans music:

Welcome back! So you’re a brisk-walker / biker now! Congratulations! Now we’ll discuss how to make this habit stick:

🚣🏾Second, minimize friction. Scenario: You’re sitting on the couch, enjoying the silence, exhausted from the long day you had. You’ve finally caught up with your chores (or: the kids are finally asleep), and you only have an hour before bedtime. So let’s isolate the friction points between you and your gym workout: 1. You’re tired. 2. You prefer spending one hour doing something else. 3. You need to take several steps before starting your workout. To make our new habit stick, we must REDUCE FRICTION. To reduce friction caused by lack of energy and time, we can workout first thing in the morning, during work (run up the stairs in our workplace for 5 consecutive minutes), or on our way back home (just get off a couple of stops away from home and walk/run it). To reduce the friction between us and our workout, we can prepare all our running gear the night before or start wearing clothes suitable for brisk walks daily. If we want to go to the gym, but it’s a ride away and it’s raining, we can store rubber bands and small weights in our car and work out in the parking lot right after work. I’ll stop here, the options are limitless, and you get the picture.

🎧Lastly, make it enjoyable. The more we engage in our physical activity routine, the more we’ll enjoy it. However, until we achieve it, we might not enjoy it at all. So we just need to find something we enjoy doing and COUPLE it with our exercise. For example, we can walk with our significant other, talk to our friend over the phone, or listen to an audiobook. We can also take it a step further and allow ourselves to do things we normally perceive as a waste of time or feel guilty for doing them. For example, we can treat ourselves to our favorite drink or snack at a place on our route or listen to our favorite Netflix/YouTube show (listening without watching is actually very nice). Our physical activity will be our guilt-free ticket as long as we do those things ONLY during our physical activity. The sky is the limit, so do whatever is enjoyable to you. Once we start coupling physical activity with an enjoyable activity, we’ll do it more, enjoy it more, and our minds will start looking forward to the physical activity itself. Let’s take advantage of our basic human psychology; it’s so primal and ingrained in us, it can’t fail :-)

🏋🏻So this is how I do it. By now, I had turned my running into a habit, so after not doing it for a while, I looked forward to restarting it. My motivation is mainly driven by improving my VO2 back to 50 after its most recent plunge to 45. Do I define myself as a runner? Yes. Do I minimize friction? Yes. My running gear is right next to the front door all the time. Do I make it enjoyable? Yes. I listen to audiobooks or just enjoy the silence of Brookline streets at 10 pm, a huge bonus at the end of a hectic day.

Am I the only one who was scared as a kid watching Mickey in this?

OMFS World

👩‍🎓For the student - This one won’t be easy, but once you do it, you’ll get addicted. I’m referring to preparing yourself and studying BEFORE class. I assume that getting a hold of last year’s notes is not an issue, and even if it is, the reading material provided by your professor can serve you well. All you need to do is to read it BEFORE class. No highlighting, no notes, not even staying focused. If you don’t have time, just skim through it. Once you’re done, your mind will be primed during the lecture, and you will absorb much more information without putting effort into it. It will suddenly seem interesting, it will be easier for you to stay awake, and the Professors will adore you :-)

🥼For the OMFS resident - When you give presentations, simplify everything! Simplify your language, simplify your slides, and simplify your explanations. Our audience will always prefer to be engaged, but often we give them too many reasons to get lost or just get bored. We tend to worry that some individuals in our audience will think that our straightforward presentation stems from our lack of intelligence. But the truth is that most of our listeners, if not all of them, will appreciate a talk that taught them something that they can relate to. Just think, have you ever seen a complicated TED talk?

🩺For the non-MD medical professionals - Uncomplicated urinary tract infection (UTI) in a non-pregnant woman may be diagnosed based on history, physical exam, and urine analysis (urine stick). The stick will show high leukocyte-esterase (for high white blood cells) and nitrites (for the presence of bacteria). There’s no need to obtain a urine culture to diagnose a UTI. Moreover, if a culture shows bacteria, but the non-pregnant woman is asymptomatic, there’s no need to treat her!

It is a whole different story in the pregnant woman: Even if she’s asymptomatic, a positive urine culture (i.e., more than 100,000 colony-forming units/mL) is enough to start her on antibiotics. It stems from the increased risk for maternal pyelonephritis and fetal complications such as preterm birth and low birth weight.

Stuff

📚Book I read - In “The Obstacle is the Way”, Ryan Holiday shows us that every challenge we face presents an opportunity to become stronger and smarter. By using concepts from the ancient Greek philosophy of Stoicism he teaches us that by embracing our obstacles, we can turn them into stepping stones on our way to success. At times I felt held back, this book proved to be practical and beneficial. Highly recommended!

💡Gear I use - Mobilo Smart Business Card 🪪- A business card says a lot about a person. It is the first impression a potential client or employer gets of you. However, paper business cards can be easily lost or forgotten, and they’re really bad for the environment. I recently transitioned to this smartcard with both an NFC chip and a QR code (barcode). A single tap immediately stores my contact details on the other person’s phone, which may be pulled up when needed. I can decide what to share, and I can change my info and contact details as much as I want. No more fumbling around for a pen and paper to write down someone’s information, and no more ordering new ones whenever I change my job description or contact information. 

Epilogue

That’s it for this issue.

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Stay tuned for next week’s newsletter - New York, Special Edition. I’m taking a week-long microvascular course in Columbia University, and it’s a perfect opportunity to try a new angle for this newsletter. I’ll reminisce about past experiences in New York and see what has changed since my first visit to the city 20 years ago. 

So go out there for a workout, and have a great weekend!

Shay