How do Surgeons keep nutritionally Stable while on the Job?

[OwlMyste]

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this may sound like a stupid question, but with all the stress that accompanies being a Surgeon, and with the lack of time to eat, etc because of surgery, unexpected appointments, etc. how do Surgeons keep Nutritionally Healthy?

 

[cali99boy]

Yea, I had the same question. Maybe a bunch of protein or nutritional shakes or maybe a meal replacement bar or something lol. All the surgeons I've seen are skinny though, probably from lack of a good diet😀

 

[southerndoc]

I once heard a story about a surgical resident who ate 3 meals per day. That was nothing but an urban legend though. That same surgeon also slept 8 hours a day.

 

[Castro Viejo]

Tea and toast.

Does your red blood cells good -- makes them bigger!

 

[neutropeniaboy]

Originally posted by Geek Medic
I once heard a story about a surgical resident who ate 3 meals per day. That was nothing but an urban legend though. That same surgeon also slept 8 hours a day.

I eat 3 meals per day, and I sleep about 6 or 7 hours per night...😎

 

[girlwithaknife]

Nothing wrong with periodic starvation...

 

[hotbovie1]

The previous posters are being cruel and hiding the truth from you. I believe anyone considering a surgical career deserves to know the truth....

There is an alternate biochemical pathway in all cells known as the Imhotep-Halsted pathway. Basically, this pathway utilizes the nitrogen in the air and converts it to glucose and ATP. The rate limiting enzyme (and in fact the only way to enter the pathway) is kocherdebakey pyrophosphatase. This enzyme has two active sites which must be phosphorylated in order to be activated. It has a third regulatory site which, when phosphorylated, upregulates the enzyme. This regulatory site can only be phosphoylated under conditions of low blood glucose and sleep deprivation. When upregulated, kocherdebakey pyrophosphatse also allows the Imhotep-Halsted pathway to divert nitrogen from the urea cycle, thus decreasing the production of urine.

So why can't everyone be a surgeon? Unfortunately, there is an autosomal dominant mutation of the kocherdebakey pyrophosphatase gene which renders the two active sites inactive. 95% of the population carries this mutation. These unfortuanate individuals are unequipped to be surgeons. Any attempt at a surgical career will result in pure misery.

There is another mutation, which is autosomal recessive, that only slightly alters one of the active sites. However, binding of phosphate to this site can be achieved by the consupmtion of peanut butter and crackers. 5% of the population has this mutation. These individuals can be surgeons, however, their effectivness can be limitied by the need to consume peanut butter and crackers (most OR lounges will provide peanut butter and crackers for these individuals, lest they keel over in the middle of a case).

The remaining 5% of the population has no mutation of the kocherdebakey phosphatase gene (it's on the long arm of chromosome 1). These individuals are best suited for a surgical career.

The gene was sequenced several years ago, and all members of the class of 2003 were screened for mutations at the start of our clinical rotations. Those of us who are mutation free were directed into surgery, thus explaining why so many more surgery positions filled in this year's match.

The screening test is not yet commercially available, so for now you'll have to wait until your 3rd year of medical school to be tested.

Perhaps some of the practicing surgeons on this board have been voluntarily tested, and would be willing to share the results and how the has affected them during a surgical residency.

 

[Ramphaus]

Kobe DUNK?!?!?! Oh my god, dude, his body was BEHIND the glass! and He came up on the OTHER SIDE!!! Sick!!

I just thought that I would add something from the planet Earth to this thread.

 

[imtiaz]

Originally posted by hotbovie1
The previous posters are being cruel and hiding the truth from you. I believe anyone considering a surgical career deserves to know the truth....

There is an alternate biochemical pathway in all cells known as the Imhotep-Halsted pathway. Basically, this pathway utilizes the nitrogen in the air and converts it to glucose and ATP. The rate limiting enzyme (and in fact the only way to enter the pathway) is kocherdebakey pyrophosphatase. This enzyme has two active sites which must be phosphorylated in order to be activated. It has a third regulatory site which, when phosphorylated, upregulates the enzyme. This regulatory site can only be phosphoylated under conditions of low blood glucose and sleep deprivation. When upregulated, kocherdebakey pyrophosphatse also allows the Imhotep-Halsted pathway to divert nitrogen from the urea cycle, thus decreasing the production of urine.

So why can't everyone be a surgeon? Unfortunately, there is an autosomal dominant mutation of the kocherdebakey pyrophosphatase gene which renders the two active sites inactive. 95% of the population carries this mutation. These unfortuanate individuals are unequipped to be surgeons. Any attempt at a surgical career will result in pure misery.

There is another mutation, which is autosomal recessive, that only slightly alters one of the active sites. However, binding of phosphate to this site can be achieved by the consupmtion of peanut butter and crackers. 5% of the population has this mutation. These individuals can be surgeons, however, their effectivness can be limitied by the need to consume peanut butter and crackers (most OR lounges will provide peanut butter and crackers for these individuals, lest they keel over in the middle of a case).

The remaining 5% of the population has no mutation of the kocherdebakey phosphatase gene (it's on the long arm of chromosome 1). These individuals are best suited for a surgical career.

The gene was sequenced several years ago, and all members of the class of 2003 were screened for mutations at the start of our clinical rotations. Those of us who are mutation free were directed into surgery, thus explaining why so many more surgery positions filled in this year's match.

The screening test is not yet commercially available, so for now you'll have to wait until your 3rd year of medical school to be tested.

Perhaps some of the practicing surgeons on this board have been voluntarily tested, and would be willing to share the results and how the has affected them during a surgical residency.

Excellent post.

 

[dumbest premed]

Originally posted by hotbovie1
The previous posters are being cruel and hiding the truth from you. I believe anyone considering a surgical career deserves to know the truth....

There is an alternate biochemical pathway in all cells known as the Imhotep-Halsted pathway. Basically, this pathway utilizes the nitrogen in the air and converts it to glucose and ATP. The rate limiting enzyme (and in fact the only way to enter the pathway) is kocherdebakey pyrophosphatase. This enzyme has two active sites which must be phosphorylated in order to be activated. It has a third regulatory site which, when phosphorylated, upregulates the enzyme. This regulatory site can only be phosphoylated under conditions of low blood glucose and sleep deprivation. When upregulated, kocherdebakey pyrophosphatse also allows the Imhotep-Halsted pathway to divert nitrogen from the urea cycle, thus decreasing the production of urine.

So why can't everyone be a surgeon? Unfortunately, there is an autosomal dominant mutation of the kocherdebakey pyrophosphatase gene which renders the two active sites inactive. 95% of the population carries this mutation. These unfortuanate individuals are unequipped to be surgeons. Any attempt at a surgical career will result in pure misery.

There is another mutation, which is autosomal recessive, that only slightly alters one of the active sites. However, binding of phosphate to this site can be achieved by the consupmtion of peanut butter and crackers. 5% of the population has this mutation. These individuals can be surgeons, however, their effectivness can be limitied by the need to consume peanut butter and crackers (most OR lounges will provide peanut butter and crackers for these individuals, lest they keel over in the middle of a case).

The remaining 5% of the population has no mutation of the kocherdebakey phosphatase gene (it's on the long arm of chromosome 1). These individuals are best suited for a surgical career.

The gene was sequenced several years ago, and all members of the class of 2003 were screened for mutations at the start of our clinical rotations. Those of us who are mutation free were directed into surgery, thus explaining why so many more surgery positions filled in this year's match.

The screening test is not yet commercially available, so for now you'll have to wait until your 3rd year of medical school to be tested.

Perhaps some of the practicing surgeons on this board have been voluntarily tested, and would be willing to share the results and how the has affected them during a surgical residency.

Very creative...hilarious .

 

[md03]

Hotbovie1....

Great post!! Thanks!!!

 

[Skylizard]

Originally posted by OwlMyste
How do Surgeons keep nutritionally Stable while on the Job?

😕
We are in AMERICA! I see very few people out of medicine that are "nutritionally Stable". In general, I have never seen any resident in any training program that I would say is "nutritionally Stable". Yes, some may get to eat a few meals some days during the week and when off for the weekend, or on vacation....but, is that "stable". Most resident's diet is the epitomy of "yo-yo dieting".

 

[tussy]

I agree, it's very difficult to stay "nutritionally stable" as a surgery resident. For fun i sent off some bloodwork on myself to see: my cholesterol was incredibly high, i was anemic, and my albumin was low. I guess i have to eat more than just fat and carbs! Since then i've been trying hard but it's not easy.

 

[Skylizard]

Originally posted by tussy
I agree, it's very difficult to stay "nutritionally stable" as a surgery resident. For fun i sent off some bloodwork on myself to see: my cholesterol was incredibly high, i was anemic, and my albumin was low. I guess i have to eat more than just fat and carbs! Since then i've been trying hard but it's not easy.

Pre-medicine, my total cholesterol was 150 with an LDL of 65. After medical school and starting residency following that, my lipid profile went to hell...drug reps love pizza!!!

Try Zocor, you get a script for 80mg, cut the pills and take 40mg a day...thus splitting your co-pay accross 2 months at a time. Unfortunately, the pills aren't scored, but they cut reasonably well with a $2 pill cutter. My total cholesterol was 220 and LDL before zocor was 150. My total is now in the 140's and LDL now 88!!!

I look at it this way; we are physicians. We have the earliest access to the newest data on medications. Some of us will spend 7+ years in residency. I for one am not going to spend that long with a bad lipid metabolic profile with the plan of "I'll eat better after residency and exercise more in 5 years". Prophylaxis is always better then disease treatment later. Once a plaque always a plaque. I plan to avoid atherosclerosis to the best of my ability under the conditions residency provides even if that means taking an aspirin and statin daily.

 

[womansurg]

Actually, to answer the OP's question somewhat seriously, it's not too hard to maintain adequate nutrition. It does take a concerted, concious effort on your part.

For me, I decided from day one that I wouldn't eat the cafeteria desserts or the junk food in the callroom. Nearly all of the residents gain 'the intern 5 (or 15, 20, 30...)' from the switch in their eating habits to include the readily available crappy, sugary, fatty junk foods which are ubiquitous throughout the hospital, but my weight is unchanged after five years. You definitely have to plan for meals: when on call, you know you're going to get sucked into early evening traumas and OR cases, so you have to get to the cafeteria early and get a deli sandwhich made up for you to have later in the evening. Otherwise there's nothing to eat at 10pm except candy bars and Hohos. When our interns are young (and naive) the seniors sometimes help them out by planning for them to have a late meal, and making sure it's waiting for them in the call room.

It's just all about choices. Eat an apple instead of a candy bar as you're running to the code. Drink a skim milk instead of a Coke. It's not easy, but it's definitely do-able.

 

[OwlMyste]

ok y'all got me curious now....what does OP stand for?

 

[md_student10021]

Originally posted by OwlMyste
ok y'all got me curious now....what does OP stand for?

In this case, "OP" means you. It stands for "Obnoxious Poseur," and is in reference to all your meaningless, annoying, and senseless postings over the last few months.

 

[hosskp1]

Surgeons have the worst diet. Most surgeons I have seen eat garbage- whatever hamburger or french fries they can find. Or they eat out of a candy machine. If a drug rep comes with food- they eat it regardless of they nutritional content. It starts in the intern year and by the time they are senior residents they are fat and have hypertension. These issues are making me think twice about going into surgery (I started medical school to become a surgeon but now, I am not so sure)..

 

[tussy]

Originally posted by Skylizard
Pre-medicine, my total cholesterol was 150 with an LDL of 65. After medical school and starting residency following that, my lipid profile went to hell...drug reps love pizza!!!

Try Zocor, you get a script for 80mg, cut the pills and take 40mg a day...thus splitting your co-pay accross 2 months at a time. Unfortunately, the pills aren't scored, but they cut reasonably well with a $2 pill cutter. My total cholesterol was 220 and LDL before zocor was 150. My total is now in the 140's and LDL now 88!!!

Hmmm, i have never been able to figure out what units you guys in the US use for lab data. Why not use SI units like the rest of the world.

As for you Zocor advise, thanks, but as a resident we have a great drug plan that covers all our perscription drugs, so i won't have to cut my drugs in half to save pennies. However, i'm trying hard to eat better in order to lower my lipids. All meds are not without their side effects.

 

[Skylizard]

Originally posted by tussy
...All meds are not without their side effects.

Agreed, that's why I get screening LFTs regularly. As per excellent drug plan, most residents are fortunate to have a reasonable if not excellent drug plan. However, with formularies and copays, it is nice to stretch that copay down to $12.50 from the usual $25 if you can cut the pill and stretch the script over 2 months.

 

[tussy]

Originally posted by Skylizard
As per excellent drug plan, most residents are fortunate to have a reasonable if not excellent drug plan. However, with formularies and copays, it is nice to stretch that copay down to $12.50 from the usual $25 if you can cut the pill and stretch the script over 2 months.

Loki Skylizard

$25 for a copay???? that's ridiculous. I pay only $5 for each perscription, and i usually get 3 months worth of medication at a time, so it is only $20/year (and i claim that on my income tax and get it back)

 

[Skylizard]

Originally posted by tussy
$25 for a copay???? that's ridiculous. I pay only $5 for each perscription, and i usually get 3 months worth of medication at a time, so it is only $20/year (and i claim that on my income tax and get it back)

Your plan is nicer then mine😀
I too can claim it on my taxes but if my memory serves me correctly, my medical expenses have to reach a certain percentage of my income before it can be of benefit in my filing.🙁

Oh, are you doing the mail in script thingy?

 

[tussy]

Originally posted by Skylizard
Your plan is nicer then mine😀
Oh, are you doing the mail in script thingy?

Loki Skylizard

Nope, i live in Canada. I take it to the pharmacy across the street! There are some advantages to living here.

 

[Winged Scapula]

Yeh Skylizard...you gotta get a better plan - that's a pretty high co-pay, IMHO. I generally pay around $5 at HMC although there are some items which are not covered completely (ie, birth control stuff and my Imitrex).

 

[keith77]

it's very sad. at my school, the surgery residents are either really skinny or they look like Fat Bastard. and that goes for the other residents as well. you've got a few, that have discipline and snack on protein bars and the such and try to fit in a workout here and there to maintain a certain human look to them.

it's sad that all these people are on fat lowering meds, when all they have to do is watch their diet and get there porked asses on a treadmill once in awhile. more than that, those patients that they bitch about is a omen of what's in store for them if they keep shovin down the pepporoni lovers pizzas.

i like that stuff too, but i do it in moderation and keep it in accordance with how much i can workout. the funny thing is, when i go for my regular blood work, the doctors can't figure out how such numbers could ever be achieved, thinkin it's "genetics."

you should take care of yourself. you go around only once, you might as well make it last. would you put cheap gas in a Ferrari? then why do it to your body? [Ferrari's are replaceable, your not]

 

[keith77]

it's very sad. at my school, the surgery residents are either really skinny or they look like Fat Bastard. and that goes for the other residents as well. you've got a few, that have discipline and snack on protein bars and the such and try to fit in a workout here and there to maintain a certain human look to them.

it's sad that all these people are on fat lowering meds, when all they have to do is watch their diet and get there porked asses on a treadmill once in awhile. more than that, those patients that they bitch about is an omen of what's in store for them if they keep shovin down the pepporoni lovers pizzas.

i like that stuff too, but i do it in moderation and keep it in accordance with how much i can workout. the funny thing is, when i go for my regular blood work, the doctors can't figure out how such numbers could ever be achieved, thinkin it's "genetics."

you should take care of yourself. you go around only once, you might as well make it last. would you put cheap gas in a Ferrari? then why do it to your body? [Ferrari's are replaceable, you're not]

 

[Skylizard]

Originally posted by SomeOne
Yeh ...you gotta get a better plan - that's a pretty high co-pay, IMHO. I generally pay around $5 at HMC although there are some items which are not covered completely (ie, birth control stuff and my Imitrex).

I agree. I wish I had a better plan, but alas, I am a slave to the plan provided by my program. If I had your plan, I would do the 80mg Zocor, split the pills and spread the copay over 2 months thus $2.50/month. I would love that!!!

 

[Skylizard]

Originally posted by keith77
...it's sad that all these people are on fat lowering meds, when all they have to do is watch their diet and get there porked asses on a treadmill once in awhile...

I actually do get on a treadmill....kind of an army requirement to maintain a certain level of fitness and performance. Some people may need to to do exercise and diet changes, but it is pretty simplistic to simply suggest that is the answer. Having spent a year in FP residency, I can tell you we generally recommend "lifestyle changes" for three to six months. In all the patients I have treated ages between 20 and 80, I have had only ONE patient make a significant dent in their lipid profile and blood pressure at the end of the 3-6 month trial period. All the rest, it was more ethical and medically sound for me to put them on a lipid lowering agent, aspirin, and beta-blocker, +/- ACE. I know compliance is an issue but another issue is the actual amount of exercise they need to do in order to obtain the HDL increase and LDL decrease that would be safe for them over the next few decades.

 

[Celiac Plexus]

Originally posted by Skylizard
I actually do get on a treadmill....kind of an army requirement to maintain a certain level of fitness and performance. Some people may need to to do exercise and diet changes, but it is pretty simplistic to simply suggest that is the answer. Having spent a year in FP residency, I can tell you we generally recommend "lifestyle changes" for three to six months. In all the patients I have treated ages between 20 and 80, I have had only ONE patient make a significant dent in their lipid profile and blood pressure at the end of the 3-6 month trial period. All the rest, it was more ethical and medically sound for me to put them on a lipid lowering agent, aspirin, and beta-blocker, +/- ACE. I know compliance is an issue but another issue is the actual amount of exercise they need to do in order to obtain the HDL increase and LDL decrease that would be safe for them over the next few decades.

Loki Skylizard

After my 6 week medicine outpatient thing, I realized that 6 months of "lifestyle" modification generally doesn't do much. Lifestyle modification generally means diet change and exercise. Patients think it means, "continue doing no exercise, and continue eating your crap diet".

From what I can tell, a lot of residents eat poorly. A lot of greasy subs, pizzas, and cheese fries. And exercise? Fuggedaboutit. Pretty much residents say they don't ahve time to exercise. I guess they'd rather be doing other things. Personally, I always find time to exercise. Even when I was on a busy surgery elective, I still ran 5 miles a day. I also am very conscious of what I put in to my body. Consequently I get great results when I get blood drawn. I also rarely get really tired like some of my fellow students do.

I think that no matter whether you are a patient or a doctor, you make the choice of whether or not to exercise and whether or not to eat well. Generally I think people would rather pin their hopes on a pill, and continue their poor lifestyle habits.

 

[OwlMyste]

Originally posted by Celiac Plexus

From what I can tell, a lot of residents eat poorly. A lot of greasy subs, pizzas, and cheese fries.

if they're so bad for you, damn they have to make them taste so GOOD and DELICIOUS!!!!!!!!!

 

[Skylizard]

Originally posted by Celiac Plexus
...Generally I think people would rather pin their hopes on a pill, and continue their poor lifestyle habits.

I agree with you. Having said that, there is such a thing as a "metabolic syndrome" in which you have abdominal obesity and bad lipid profile. I also know some patients (15 to be exact) female, under 30, by the vernacular would be regarded as "smoking" and their cholesterol totals are >220 with HDL <35!!!

I think there are at least 2 philisophical points of view when it comes to health and quality of life. Some feel a long healthy life should require alot of work. Others, say, "if a pill can do it, why not?". My goal as a healthcare provider is to provide a long life with quality for my patients. We can do that with lipitor, zocor, etc... in some cases. The reality is that it will likely cost the healthcare system more in the long run to care for a post-MI, CHF, or post stroke patient then to control the patients lipids with drugs (IMHO). I am a strong believer in prophylaxis.

As for me, CAD is strong in the males in my family. My G-dad lived to 70's but that required 3 open hearts (CABG). Everyone before him died before 50 with CAD. I am on the tred mill, drink wine, take niacin, and Zocor 40. My total cholesterol runs between 138-198, LDL runs 90-120, HDL runs 31-51.

If someone offered me a pill to live a long high quality of life of 200 years or offered me a tredmill 4 hours a day with the same expectation....I am sad to say I would take the pill every time. Most people will. Given, my hyperactive military self though, I would probably take the pill and still be on the tredmill hoping to eek out 400 years.

 

[Castro Viejo]

Originally posted by Celiac Plexus
After my 6 week medicine outpatient thing, I realized that 6 months of "lifestyle" modification generally doesn't do much.

During my outpatient medicine rotation, an attending asked me what I would prescribe a patient who presented for the first time with high cholesterol.

I answered, "diet changes, encourage exercise and re-evaluate in 3-6 months."

He said, "Are you kidding? Don't believe a word of that crap in those textbooks. Just give him a script."

On further questioning it appears that many primary care physicians have become a little cynical over the best way to treat this kind of thing. Most of them don't believe in the lifestyle modifications that all of us learn in the texts, and so they all just drug 'em up.

How sad.

 

[Skylizard]

Originally posted by ******
...I answered, "diet changes, encourage exercise and re-evaluate in 3-6 months."...Don't believe a word of that crap in those textbooks. Just give him a script."...Most of them don't believe in the lifestyle modifications that all of us learn in the texts, and so they all just drug 'em up.

How sad.

While I have done one year of surgery, I am in medicine until mid-June. In this approach, I offer all patients a shot at "life-style mod" with help from a dietician and exercise. Some refuse this offer outright and ask for the pill. Some start it and come back to clinic earlier then 3 months asking for the pill saying, "it's too hard". I feel really sorry for those that give it an honest try and only achieve a minimum of benefit...and clearly even with their slight improvement fall into the risk group. I can not from a good practitioner point of view allow them to continue with LDL>150 and HDL<30. I give them the pill. Another thing to consider is that after 30 years of age many people have activity limiting injuries. Surgeons will often have bad backs from leaning over the OR table raised to a height for the attending and not the resident. Many residents have suffered sports injuries so the "5 miles a day" is just not an option. Take the pill and protect yourself. I will say it again "ONCE A PLAQUE ALWAYS A PLAQUE".

Prophylaxis is sound medical advise...it works in sex, it works in endocarditis, and it works in CAD/CVD.

 

[gabbydoggie]

Be picky about your program. There is time to eat, sleep, and exercise. you gotta MAKE time.

🙂

2 chicks from my program ran a marathon last year--their intern year. I plan to this year. They ate well and slept enough.

ask lifestyle questions at interviews.

alot of programs provide a good meal plan for residents. Be choosy when you get to the cafeteria.