June 2009 NOAH NY Medical Mission to Fort Liberte, Haiti from John Grace on Vimeo.

That summer I took a trip to India with my family and I remember thinking that none of the pictures of me from the trip were any good. Maybe they were all taken at a bad angle, or they didn’t catch my good side, or maybe I just wasn’t photogenic. All I knew was that I didn’t like them, and I couldn’t put my finger on it.

I couple months later while I was down in Auburn during football season, someone was playing with my iPhone and somehow snapped a picture of me inadvertently (shown at right, cropped). When I found the picture, I was floored. It was probably the worst picture of me that I’d ever seen. The fact that I was unaware it was taken didn’t help, but the image was burned into my mind because after seeing it, I couldn’t rationalize away the fact that I was fat. Not just a little over weight, but fat. It took a couple of months to process that because I didn’t gain a ton of weight all at once. Instead it was just a slow culmination of eating whatever I wanted for 20 years. Around December 2007, I stepped forward and started with an old business adage – you can only change what you can measure, and I bought a scale.

On my first weigh-in, the scale tipped 220 lbs. For context, I am 5′7″ tall. This equated to a Body Mass Index (BMI) of 34.5, and while I didn’t know it then, I was medically classified as morbidly obese. 220 scared me a little because I was always used to being in the 210 – 215 range whenever I previously got on the scale once in a blue moon. I knew it wasn’t great, but it had been consistent for a long time. Now I was on the verge of gaining even more weight, and I was already wearing pants with a waist size of 40. Any larger, and it’d be much harder to find pants at most normal stores.

I knew I had to lose weight, but I really didn’t have a clue as to how I was going to do it. Most dieting plans never seem to work, and few of them are sustainable in the long run. There are also thousands of dieting plans out there in the first place – I had no idea which one I should follow. So I did the only logical thing someone who didn’t know anything about dieting would do – I created my own.

The Stewart Grace Plan (or “The Plan” for short) was created devoid of all medical advisement to be based on one premise, and one rule. The premise is that deep down we are not morons, and that we all know what we should and should not eat, it’s just a matter of having the willpower to do it. The one rule in The Plan is that if you don’t think you should eat something, then you’re probably right. I guess it’s really a form of eating by process of elimination.

The initial purpose of The Plan was really more of a lifestyle change than a diet. When I first started, my goal was to eat healthy for a little bit and just see what happened. I didn’t want the expectations or the pressure of a full blown diet in case it didn’t work out – I didn’t want it to be a “New Year’s Resolution” that ended up with a one month shelf life. So I started making little changes in my eating habits. I switched drinking coke to coke zero, and tried drinking water whenever I ate out. I stopped eating out except for when it was for social occasions, and then actually tried eating salads every once in a while.

After seeing a little success with The Plan, I started building on it. I still didn’t know much about nutrition, but I knew that all of the labels on food were based on a 2,000 calorie diet. I figured that ultimately, losing weight is a math equation: Starting Weight + Food Consumed – Exercise = Ending Weight. Every day, this equation stays the same. So if I ate less than 2,000 calories, I’d probably lose weight. While I never religiously counted calories, I started looking at the labels of things I ate to stay informed. Just being aware of how many calories were in what types of things made choosing the right things much easier. I also never told myself that I couldn’t eat something, only that what I ate had consequences. A cheeseburger today, meant salad the rest of the week.

It was a slow process, but I kept losing roughly two pounds a week for about six months from mid December 2007 through June 2008. In total, I lost 50 lbs, six inches on my waist, an inch and a half on my neck, and dropped from an XL to a L. As you can imagine, I had to replace my entire wardrobe! I even probably weigh 20 lbs less now than I did when I graduated high school!

What I’m proud of most though is that about two years after starting to lose the weight, I’ve kept all of it off. There’s still a little more work to do, but I don’t plan on the weight ever coming back.

CHEATHAM, Dr. John M., Jr. Dr. John M. Cheatham, Jr., 68 A Life without Furniture Dr. John Cheatham passed away Monday afternoon, November 2nd. He succumbed to a heart attack while climbing Kennesaw Mountain. Hiking was a favorite recreational pastime and an important part of his profession. He recently climbed and summited Mount Kilimanjaro and had made multiple trips to the Grand Canyon. Just this year, he completed a 50 mile hike from the canyon’s south rim to the north rim and then back again with his brother and hiking partner, Jackson.

John was born in Griffin, Georgia, on November 29, 1940. He graduated from high school at the Westminster Schools in Atlanta. He completed his undergraduate work at Georgetown University, after serving his country as a sergeant in the Army Special Forces with a tour of duty in Vietnam. Not content with traditional career patterns, however, he earned a commercial pilot’s license and then set out to travel the world. John worked as a bush pilot in Africa and New Guinea and then there was a stint in the Amazon rainforest. While in the region, he amazingly persuaded his sister, Elizabeth, to accompany him on a 2,500 mile trip down the Amazon River in a non-motorized dugout canoe. The trip started at the river’s headwaters in Peru and finished in Manaus, Brazil, where civilization then began. Along the way, there was a particularly troublesome encounter with an anaconda longer than the boat.

Briefly giving in to conventional pressures, John returned to the United States and attended Columbia Business School where he received an MBA degree. Then followed a financial career abroad, but one in which he never felt fulfilled. Business was never John’s passion and he was a person who simply refused to live life without passion.

Though John was never one to be imprisoned by what others thought he should do, it was not until his late 30’s that he identified his life purpose and set out to become a medical doctor working with the poor in the underdeveloped world. He decided upon ophthalmology as a specialization as he considered cataract surgery to be the most effective medical procedure for the poor world. He saw an opportunity to give sight to those who were blind but who lived in areas too remote to be helped by others. At that time, however, no one John’s age was ever admitted to American medical schools and for years he was rebuffed in his attempts to study medicine. However, John refused to give up his dream and spent ten years struggling to overcome obstacles before finally getting his degree. Early on, he simply bought medical books and self-taught himself enough to pass Part 1 of the National Medical Boards before ever enrolling in medical school.

Then there followed years of multiple schools in multiple countries, with his study of medicine including elements in French, Spanish, English, and Portuguese. Eventually, two influential people recognized what John had to offer the world and took up his cause. They managed to have others bend rules to have him admitted to the Medical College of Georgia where he excelled. Quite likely, John is the only graduate of that school who did so without ever completing a single premed course. One of these men described his efforts on John’s behalf as the best investment he ever made.

John went on to practice ophthalmology for 20 years in the undeveloped world. During that time he never received a dollar of salary nor charged a single patient for either the surgery received or for the all important logistical support that made that surgery possible. John took the time to learn the needs of the poor; he walked among them. He understood how difficult it was for the blind in remote areas to find their way to medical facilities. So he went looking for them, always contending that the surgical aspect was the S easiest part of the process. John knew that the work takes a lot of mud on the boots as well as good medical skills, and he was prepared to give both. Though he certainly never kept score, it seems safe to say that over 20,000 people regained their sight due to his efforts and those of the dedicated team that he led at the Mathis Eye Foundation, an organization named in honor of his mother and uncle.

John’s other interests over the years included flying, parachuting, judo, SCUBA diving, travel (people would try to name a country that he hadnít visited), languages (he studied eleven and spoke many of these fluently), hiking into remote areas to locate the blind poor, and reading. He studied history that he might learn from the past. In June of this year, he embarked on his greatest adventure of all when he married his long-term companion, and often co-worker, Dr. Anne Schlueter. Many have said how John strongly influenced their lives. We know that his example inspired others into medicine. Some considered him to be their mentor. All who crossed his path found him encouraging, as just being around John left one with the feeling that they could do better in their own lives. He inspired them to try.

Throughout it all, John lived a simple life. He did not own a home, a car, or a cell phone. His possessions consisted only of a closet full of items at his mother’s home and that which he carried with him when he traveled. Yet with so few accessories, he accomplished so much. People often marveled at John’s life and asked if he would ever write an autobiography. This question he would laughingly dismiss, saying that too many people write books while too few read books. However, he did recently say that should he ever change his mind, the book’s title would be A Life without Furniture.

In accordance with John’s wishes, he will be cremated on Friday, November 6th and his ashes scattered without ceremony or memorial. He wanted no flowers to be sent or donations made on his behalf. The family certainly intends to respect his wishes, but we also feel the need to make a request of those who cared for John. We want to recognize that he spent his life giving sight to the poor. He quite literally brought light into areas of the world that desperately needed it. As such, we can not let the day pass without honoring his efforts. So we ask all who knew John or those who simply identify with his life’s purpose to light to a candle on Friday in memory of a life well spent and to take a few moments to reflect on how we, too, can bring light into the world. A single life produces much radiance when that person follows his dreams, tries to do what is right, and refuses to let obstacles stand in the way. John Cheatham did all that. The world is better for his having lived. We are better for having known him. Though his life may have ended too soon, it was a life complete in so many ways. John is survived by his wife Anne, mother Elizabeth, sister Elizabeth, brothers Jackson and Harvey, nieces Lizzie and Anne-Marisa, and so many here and abroad who called him friend.

Tort Reform – This is the biggest reason that health care costs have skyrocketed. My job is to make sure that doctors are competent, and fit to practice medicine, and while there are some bad apples, they do get tossed out. People have to accept that there is risk in life, and that life isn’t always fair. While we should do everything we can to right wrongs, making the entire health care system pay the price for those bad apples exponentially increases the cost for everyone. This would single handedly provide the most help to easing the cost of health care.

No denial for pre-conditions – this is included in the government health care plans, and is a good idea.

Tie health care insurance to individuals not to employers – most people switch jobs 5-7 times in a career, therefore they also switch health insurance carries that much too. Insurance companies have no incentive for doing preventative care and treating you for the long term, because in the long term, they won’t be insuring you! So instead, they only focus on fixing (read: paying for) immediate needs. Any study shows that preventative care is a little more expensive up front, but will save tremendously on the back end, but the insurance companies won’t be insuring you then, so they aren’t focused on that.

Reform health care education standards – other countries allow pharmacists to dispense certain types of drugs. In the same way, we need to reform the medical education system so that simple health care professionals (call it a nurse-lite) can diagnose 80% of common health issues from a clinic in Wal-Mart. This would be the second biggest impact to the health care system because we could then train these professionals and have them practicing without forcing them to spend 7+ extra years in school and saddle them with 200K+ in personal debt before even starting to practice. Then they wouldn’t need to charge insane prices in order to make a living. This would also give most people (especially the poor) a place to go (instead of the emergency room) that wouldn’t break their bank just to clear up a bacterial infection. I already get frustrated when I have to see a doctor to get a prescription for cipro. That’s insane.

Legislate transparency in hospital pricing – If your leg is broken, and you’re sitting in the ER, you don’t care how much fixing that is going to cost. That being said, a couple of months ago I went in for an ultrasound on my thyroid and even though I have health insurance, I got stuck with a $250 bill. If there was transparency in what I was being charged and had the option of selecting the site that offered the best price/service combination I might have gone somewhere else that would have been cheaper. That would also force hospitals to compete in pricing, thus lowering the costs. You don’t go to a restaurant, order and eat before knowing the price of anything, and then get surprised with a bill, but that’s how hospitals operate now.

Allows health plans to compete across state lines – more competition always drives down cost. The fact that insurance companies can’t do this already is ludicrous.

Tie the cost of health care insurance to the risk of the individual – if you’re middle age, 50 lbs over weight, and smoke a pack of cigarettes a day, your healthcare costs should be dramatically higher than a healthy, non-smoking 25 year old’s because you’re much more likely to have major, expensive medical issues caused by your own behavior. America is fat, and that’s a huge problem – if given a financial incentive to get healthy, I bet a lot of people would!

Institute health savings accounts – This is what I want to do. Allow people to put pre-tax money into a health savings account that allows me to decide how to get to spend my health care money – instead of giving it to an insurance company month after month whether I get sick or not. If I’m healthy, I get to keep all the money until I actually need it, and not pay ridiculous premiums. You would then also buy a high deductible (in case of cancer) insurance policy just in case something major happens.

Ultimately, I just have very little faith that the government can run ANY large program effectively – mainly because I’ve yet to see them do it.

———————————————–
On the Road

Many Americans who regard their roadside landscapes as a wilderness of neon-lit motels and fried-chicken stands may or may not be cheered to learn that two wandering Russians have found these same roadside landscapes to be a paradise of—well, neon-lit motels and fried-chicken stands. The two wanderers—Boris Strelnikov, Washington correspondent of Pravda, and Vasily Peskov, a visiting journalist from Komsomolskaya Pravda—spent six weeks driving 10,000 miles from coast to coast and discovered all manner of things to be praised and emulated.

“We should learn from America how to build such highways,” they wrote, impressed that even minor arteries on their road map were paved.

They found the highway restaurants “faultlessly clean” and staffed by “smiling waitresses,” and the motels inspired them to say, “We can and must learn a lot from the example of the American ‘overnight industry.”” They found that Cokes “really did make things go better,” so they drank 300 of them. As for catsup, they claimed that it turns “every meal tastier.” They added: “What happened to catsup in the Soviet Union?

The recipe is not an American military secret.”

All these wonders might seem strange to the pair’s 40 million readers back in Russia, where roadside restaurants are hundreds of miles apart and gas stations are scarce, but some of the Russian discoveries are strange to Americans too. Colonel Sanders, they reported, “was given his title for the merits” of his fried chicken.

http://en.wikipedia.org/wiki/INTJ:
“INTJs are strong individualists who seek new angles or novel ways of looking at things. They enjoy coming to new understandings. They tend to be insightful and mentally quick; however, this mental quickness may not always be outwardly apparent to others since they keep a great deal to themselves. They are very determined people who trust their vision of the possibilities, regardless of what others think. They may even be considered the most independent of all of the sixteen personality types. INTJs are at their best in quietly and firmly developing their ideas, theories, and principles.”

The article went into other interesting areas, accurately pointing out flaws in INTJs, but I won’t go into that here… Fascinating still!

Third world travel is tough. Things just don’t work the same way they do in the States. No matter what you do, or how you dress, you stick out like a sore thumb. Because of who you are, you are treated differently. A lot of times, this is in a bad way. You are sought out by locals looking for money – by either trying to sell you something, or by just sticking out their hand and begging. Because there are so many of these people, as soon as you give in to one, you can be surrounded by others looking for their sale or handout too. It can get so bad that it feels like all you can do is to run away from the crowd.

Sticking out like a sore thumb has its advantages too though. Outside of major transportation sites (airports), security measures don’t generally apply to you. Where any other local is stopped and questioned intently before being allowed through (if at all), the color of your skin allows free passage without question, and without even the need to stop.

Because you’re an American, people assume you’re made of money. There are different prices for you, apparently because you can afford it. After leaving an Egyptian temple, we tried to buy 12-oz cans of Coke. We were told the price was 25 Egyptian Pounds for each drink, which translated into roughly $5. When we left without buying anything, the store owner was honestly surprised. He then started negotiating as we walked away, but it was too late.

Negotiating the price of everything is a way of life in these countries. It is the local’s job to extort the most amount of money possible from you in each sale. As tourists, it is your job not to get screwed. This task is actually much more difficult than you’d expect, even for an experienced traveler. You’re on their home turf, you’re trying to convert the foreign currency to your own for comparison, and you don’t always know what’s reasonable to pay for something anyways. On the other hand, the locals are expert salesmen (con artists), they don’t let you walk away easily, and they pull on your heart strings about their own poverty to close the deal. Some tourists enjoy the challenge of negotiating. My brother will take great pride over negotiating an extra 50 cents of the price of a $4 item. Personally, I pay whatever I’m comfortable with. To the chagrin of my brother (liberal), I (conservative) rarely negotiate as hard as I could, and always pay a little more than I maybe should. I guess you could call it my own personal form of wealth re-distribution. Ironic, huh?

As different as things are in third world countries from the United States, I still love traveling there. You get a perspective on life that would otherwise not even be possible to experience, and you are reminded that life in the United States is the exception to the rule. We really are different. Very different. It’s humbling to be reminded how good we have it here.

I had an ultrasound on my thyroid about a month ago (everything’s fine btw…that’s not the point here). Eventually I got a bill from the hospital. The hospital bill was for ~$800, and it showed that insurance was responsible for ~$600, leaving the remaining ~$200 for me to pay out of pocket.

So, I call my health insurance just to see what’s up, because like you, I love getting unexpected bills for $200.

After talking with the rep, I find out the deal:

The hospital sets an arbitrary price ($800).

The insurance company negotiates how much the procedure actually costs, and claims they “paid” the difference ($600), but no money changes hands.

I get stuck with the bill ($200) as part of my “deductible” – the only cash the hospital actually receives for the procedure.

Here I thought the money I spent on health insurance actually went to paying medical costs. I can’t possibly imagine how much debt you would rack up if you had medical issues while being uninsured.

Health insurance is a scam. Here’s an idea – hospitals charge the end game amount up front, and I’ll set up a pre-tax health care savings account (unless Obama wants to tax that too…). Then I’ll just pay for all health care expenses from the health care savings account. Add in a small “in case of cancer” insurance policy, and we’ll call it a day. Is that too much to ask?