Arthritis Magazine Cover Story


Aging is Reversible–If You Start Now

Blog Photo

I stood facing the aerobic room mirror dressed in my competition bikini and my high heels with 15 fellow fitness competitors flexing, fake smiling, and sweating all at the same time.  We were practicing our posing routines for the millionth time.  The goal was to commit these poses to muscle memory so we hit the perfect poses when these mirrors were replaced by competition judges.  Suddenly one of my teammates complained that the “tiny boppers” had it so much easier. She felt college students had a leg up just because of their age.  As a young medical student myself, I had no place to say she was wrong but I did wonder was this 40-year old female complaining or was there science to back-up her thoughts?  What can be done to reduce the effects of the natural aging process?


The Natural Aging Process

Time is one thing no one can change. Although the body is resilient, with time cells age and the ability to replace those cells with perfectly good ones becomes more difficult.  Muscle cells are greatly affected. Every decade after the age 30 you can lose 3-5% of your muscle mass.  Bone cells become more fragile and with age there is an increase chance for broken bones from falls.  Most of these changes can be attributed to various hormone changes.  In men and women there is a natural decrease in testosterone and estrogen which can cause a decrease in muscle mass, decrease in metabolism, and decrease in energy.*  One other mechanism of cell damage is an increase in free radicals. Free radicals are nasty atoms rampant in the body usually increased after a toxic trigger.  Triggers for free radical release are smoking, alcohol, drugs, medications, processed foods, air pollution, and ultraviolet (UV) sun rays.

Behaviors That Can Accelerate Aging

There are behaviors that can accelerate the aging process.   A lack of sleep has been directly correlated to poor memory and slow processing of information by the brain.  In addition, not getting at least 8 hours of sleep per night can increase medical problems such as cardiovascular disease and obesity.  Another behavior that will speed up aging is not working out.  A lack of exercise will promote muscle mass loss, body fat increase, and decrease energy levels.   Poor eating habits can also send negative messages to our bodies.  Eating very few, but large meals per day can create a slow metabolism which will push your body into “starvation mode” and cause weight gain.  A slow metabolism then makes it harder to drop those excess pounds.  And the final behavior to address is exposure to ultraviolet sunrays.  The amount of sun exposure needed to cause cell damage is variable dependent upon genetics.

How to Feel and Look Younger

What can you do to reverse the aging process?   How can you regain your ideal physique, increase your energy, and decrease your chance for medical problems?  You have to change your daily habits.  Fad diets, gimmick beauty products, and complex surgical procedures absorb lots of money with high probability for only short term results.  The earlier you start, the greater the affect you can have on the aging process.  Your daily habits should include 8 hours of sleep per night, exercise, and frequent, fresh and small meals.  If you suffer from sleeping difficulties consider talking to your primary care provider about proper sleep hygiene and consider a sleep study to assess for apnea prior to trying medications.  To protect your skin use sunscreen even on overcast days.  Try using products such as retinol and glycolic acid to trigger collagen production on your face.  Your daily vitamin should help you get sufficient vitamin C, vitamin E, and beta-carotene which are antioxidants to slow the free radical damage.  Although, the best way to decrease the free radicals in your body is to avoid the primary causes by limiting alcohol intake, avoiding tobacco products, using sunscreen to limit the effect of UV sunrays, and avoiding over processed foods.

After 13 years of competing with some of the most amazing athletes in the nation, I can say that I have seen a lot of older athletes win over younger athletes.  I think the reason for their wins is definitely not short of hard work and discipline, but their lifestyle undoubtedly plays a large role.  Whether your goal is to look hot in a swimsuit on the beach, to have younger looking skin, or to have more energy, you have to commit to some healthy habits.  Start with one behavior change and challenge yourself to do that one very well, and then take on another.  Over time these habits will become natural and your body will thank you for a lifetime.

Lady GaGa’s Natural Rheumatoid Remedies: Will They Work for You?


When I first saw Lady GaGa’s story title ‘Hip Pain Can’t Stop Me,’ on the cover of Arthritis Magazine, the doctor and long-time athlete in me assumed it was just a common over use injury.  As I skimmed through the article I quickly connected with GaGa – I had once suffered from debilitating  joint pain from rheumatoid arthritis (RA) too!  I’m one of the lucky 33% of patients who went into (what I hope to be is) remission without recurrent relapse.  But, being pain free did not come without a price.

While I was a cadet at the Air Force Academy, when my symptoms began, I would wake up an hour earlier  than everyone else because it took so long for my joints to become “unstuck” and simple activities were so hard.  Turning on the sink, holding a brush, opening my room door, tying shoes – all challenging tasks.  I found work-arounds but one thing was guaranteed with my RA – each day was unpredictable and I would complete as many tasks as possible before the sun set because that’s when my body would start to shutdown on me.  I was always tired.  I was depressed.  Undoubtedly these were the hardest two years of my life.  I refused to give up on myself.  I read everything about RA. What could I do for myself?  It’s no secret that autoimmune diseases have a very nebulous course.  I chose to make some healthy changes to limit my symptoms.

GaGa describes the benefits of heat and cold therapy to manage her symptoms.  While the research does not show a clear benefit in RA, every patient with pain finds different treatments beneficial and so did I.  I encourage anyone in pain to try different things to find what works best for YOU.  It’s simplest to start with natural ways.  I would say there are two goals when choosing natural remedies: 1) To optimize your daily function, and 2) To avoid prescription medications due to the serious side effects.  The classic RA patient experiences pain and swelling in multiple joints that worsens as the day progresses.  It can be very hard for busy, high-energy people to adjust to how much you have to slow down. Lady GaGa describes cancelling many concerts due to her pain.  I empathize for her.  While I’m not a Grammy-award winning singer/songwriter, I had my own lofty dreams.

I think a natural way to manage symptoms is to just listen to your body day-to-day. You have to know there will be days when bare minimum activity is okay. Then, there will be the good days! Oh, the good days!  These days you do EVERYTHING!  I also found that working out everyday was very beneficial.  If it was only 30 minutes of walking and stretching, I still did it.  Of course on less painful days I did more.  My ligaments became very prone to over stretching and injury so I avoided lifting heavy weights but used light weights and focused on increasing my heart rate – this was enough to keep me fit and keep me happy.  I found a lot of pain relief with massage, as well. I couldn’t handle deep tissue but gentle massage was very helpful.  In addition to heat, exercise, and massage I focused on changing my diet.  This meant avoiding foods that were known classically to illicit an inflammatory response: processed foods, refined sugars, salt, and dairy.  I already didn’t drink alcohol or eat fried foods but those are other things to avoid.  My final tip would be to get enough sleep.  It’s tempting to avoid it because you honestly feel tired all the time, but I found my symptoms definitely eased up after a nap or a begrudgingly chosen long nights rest.

Like Lady GaGa, you can surely pop in your infrared sauna and still be functional enough to kill it at the Super Bowl, but it’s important to understand keeping symptoms at bay requires commitment to a healthy lifestyle 365 days a year.  I’m lucky to be pain free for several years but I stick to these natural remedies in hopes of not triggering my disease.  Everyone’s disease severity and symptoms are different so you have to choose what is right for you.  Even if you currently take DMARDs and steroids, these natural remedies can ease your symptoms.  Speak with your doctor first as what I shared is my own person experience and not medical advice.

Motivation Monday, Motivation Everyday!

I was recently talking to my friend about the difference of successful people and those who are just waiting around for a miracle. After reflecting with him, I said “I think one of my greatest strengths that is not a talent, nor a skillable craft – it’s my perspective of who I am, where I fit in the world and how I can make an impact.”  I used to simply be a hard worker.  I don’t know where it came from.  But I can’t remember thinking any differently.  I always wanted to be the hardest worker.  The more I learned about the world and the possibilities the greater my dreams became.

It is simple:  Exposure to greatness will make you greater if you are ready to receive these opportunities.  I became more than just a hard worker.  I became a woman with a mission.  I may not be the smartest, the fastest, the richest, the anything-EST.  Words cannot deter me and either can previous statistics nor trends.  Other people’s successes have no impact.  When I learn of an opportunity to be better, do better–I do it.  I go after it for me.  I’m not worried about what hurdles are ahead.  It’s obvious all great things will have an arduous pathway – at least from my life experience.  Instead of thinking about the path, I focus on the end goal and pick a starting point.  I let the passion in my heart lead my steps. When I hit a hurdle, I expect it. I expect bad days. I expect to feel down and I cry.  I expect to feel alone.  No, I don’t have a crystal ball or even a sixth sense that failure is coming my way.  No, instead I just know that my selected goals will  be challenged. How bad do I want it? Do I need to re-address my strategy?  Do I need to ask for help?  These are the things I address to get over the hurdles.  I don’t change my goal.  After all, it’s a matter of time to success if you’re not a quitter.  I’ve never been a quitter.  I find where my passion fits.  And when it’s time to step-it-up, I adjust.  When I reach one point, I don’t think that’s the finish line, I see it as the new start.  After all, this is my story.

I encourage you to reflect on your position in the world. Where do you fit? How can you make an impact?  And for goodness sake, don’t mirror the life of someone else as that is truly not living.


Photo by Jay Farrell

Set Exercise Routines: Set Up for FAILURE

How often does your friend tell you about the hottest new {insert any group class here} or a crazy shoulder workout on a cool website! And you’re curious so you try it! You love it, then you promise yourself I’m going to do this three times per week!  I have my stuff packed! No excuses!

I love that! As a doctor and personal trainer, I want nothing more than for you to be excited about working out and have a plan!  But set classes are just like that one weight routine you have saved in your email or as a note on your smartphone — they are so INFLEXIBLE!

I don’t know many people who’s days go exactly as planned everyday. Ok, I don’t know anyone.  Let me tell you why very busy successful people have more than one exercise routine:

1)  Time.  You have to select workouts appropriate for different amounts of time you have available. It’s ok to workout only 25 minutes but some days you may really want to go for 60 minutes. You need a couple workouts to fit different time slots! (Don’t cancel your workout because you can’t do that one cycle class that started 15 min ago — Uhh, just do something else.)

2) Physical Adaptation.  Our bodies are very, very smart and they will adapt to a workout after doing it one time. The second time that workout is a little bit easier and also a little less effective.  I personally have never done the same weight routine one time in my entire life.

3) Mental Fatigue.  Your mind will get bored and you will be more apt to quit if you don’t have a workout to look forward to!

One of the top reasons I’ve been able to workout as often as I have is because I can adjust my workouts to my time available. Off late and gym closes in 45 min?!  Well, I can’t do a full leg workout and cardio. Oh well! Let’s knock out shoulders and triceps – that’s shorter for me. Who cares if you did it a few days ago. Just go workout. Sometimes you have to let go of the strict pre-planning and just get it done.  I would definitely not like working out as much if I didn’t mix it up either!  So, yes, have plans for a workout but have more than one! 


Forgiving Yourself for Failure

     It’s inevitable — sometime in your life you will fail.  Whether it be at a test, getting accepted to a job, establishing a successful relationship, or reaching a health or fitness goal.  If you have never failed, most likely you’re not really reaching for the best stuff.  In such case I’m not talking to you ‘min-shooters’.  Today, I’m talking to those I relate to who go after DREAMS with all the energy have!  You go so hard it’s painful to not see your dreams realized.  Your heart hurts.  

     The key to your eventual success is getting over your failures.  You have to forgive yourself.  You set your goals.  YOU decided it was what you wanted. YOU haven’t let anyone down — not like you tell yourself you have.  You ultimately did not get what YOU wanted within the time frame you set and possibly within the current conditions.  Sometimes the one thing holding you back from success if you’ve never forgiven yourself for your previous failure.  You hear negative whispers in the back of your head. Your failure has set the precedence — I don’t deserve this, I’m not good enough, or it’s just too hard.  You can relate to this in a deeper more complex situation such as a failed long-term relationship with someone you truly loved.  Or, more simply, you decided you were cutting back on sweets or alcohol to improve how you look!  Things didn’t go how you envisioned.  What now?  You move on.  

     You put your efforts toward a more valuable relationship that lacked what you both needed.  Or, you create a different strategy and make your food goals more reachable.  You need to admit your approach was wrong or the conditions were not right!  Change what you need to to reach happiness.  Every morning wake up and forgive your previous day’s failures.  Apologize to yourself for being so hard on yourself.  Put things in perspective and start again.  Finally, remember the greatest success is built from your failures. 

Swelling in Healthy Athletes

After competing as a figure athlete for almost 8 years one of the most common concerns I have heard from aesthetic athletes is at least one episode of random swelling somewhere on their body (not due to trauma).  I also have encountered this symptom many times in the hospital setting as a medical student.  In this setting we typically refer to it as edema.  If an attending physician or resident would ask me about causes or treatment my response would appropriately start with differentiating transudative vs. exudative causes.  I would talk about changes in capillary permeability and oncotic pressure.  Well, that is fine to show the docs I am not an idiot, but I try not to talk to my patients with the same language.  I try to relate and make sure they clearly understand their medical issue.  I would like to attempt to talk to athletes about this phenomenon the same way with an added twist that I am NOT going to address the serious illnesses/pathologies.
If an unhealthy person has swelling, my mind primarily rushes to which organ is damaged?  I have a complete differential for vascular/heart vs. liver vs. kidneys.  In a healthy person I think two things: salt/water imbalance or venous valve insufficiency.
First, let me share my definition of swelling.  Swelling is what happens when water gets trapped between the skin and tissues such as muscles and organs.  In healthy athletes it would most commonly occur in the legs, hands, belly/hips.
Now, let me address the two common causes in healthy athletes. 
Salt/Water Imbalance
Our bodies like to be balanced when it comes to concentration of salt.  Too little is just as bad as too much.  We have many sensors in our brain and kidneys to sense if this balance is off.  In a healthy person, the kidneys will not allow water to exit the body as urine if the salt in the tissues is too high.  This is because the body is trying to get that healthy concentration of salt and the only way it knows how to do that is keep the water inside.  So, let’s say you have been eating a very low sodium diet for several weeks in a row.  This does not mean you are necessarily hyponatremic (low salt in the blood).  You may be in the low-normal range which is healthy and fine.  If suddenly you intake a large amount of salt in one day, your body tries to adjust quickly to accommodate the increased concentration and urine output decreases and water starts shifting to the spaces between your skin and tissues for storage.  Even if you drink gallons and gallons of water, it takes time for the dilution process to take place, so you may STILL experience this swelling.  The amount of swelling is based on the amount of salt you intake. Water will help in the long run of course, but not as quickly as you might think.  The primary treatment for this type of swelling is to decrease the intake of sodium. 
Venous Valve Insufficiency
The second most common cause of swelling in healthy athletes is venous valve insufficiency.  This means the valves that help push the blood back to the heart from the veins in the body are not properly working.  Because the veins cannot pump the normal amount of blood back to the heart, this can cause swelling in the lower legs.  So, what causes this venous valves to not work?  With every step you take this helps the valves to pump blood inward and upward.  So during normal walking, the pressure in the venous system is about zero.  Right after you stop, that standing pressure is still pretty low.  The artery blood then slowly fills the veins.  Now the only pressure on the venous system is the hydrostatic pressure of a column of blood that really is only as high as the next competent valve.  If those valves fail, then the pressures do not change along this column from the head up to the heart.  So, now the pressure is high even when walking (remember I said it should be zero!)  This leads to venous congestion!
 It is important to understand that venous valves are made of collagen.  Just like collagen in other areas of the body, as you age you lose the ability to generate new collagen fibers which leads to a decrease in elasticity.  A decrease in elasticity in the valves equals more insufficiency.  And some people may genetically just have weaker collagen in the venous valves. 
There are a few more treatment options for this cause of swelling compared to the salt/water imbalance issue.  You can try compression stockings.  There are a variety of compression strengths.  For purposes limited to this discussion I recommend the ones that are about 30-40mmHg.  If those are uncomfortable of course get ones with less compression.  I do not recommend a higher level. Those are typically reserved for post-surgical purposes.  Another treatment option is to the raise the legs for about 30 minutes 3-4 times per day.  The legs need to be ABOVE the heart for maximum effectiveness.  For those that experience swelling while traveling I recommend the following tips:
– Drink plenty of water while in the air
– Get up and stretch/stand at least once per hour of flight
– Point and flex your feet, and bend your knees from time to time
– Wear loose-fitting clothing
– Wear shoes with shape and support such as tennis shoes instead of flip flops
– Do not smoke or drink alcohol before flying (doubt this applies to athletes, but just in case!) – even in celebration after a competition know it could increase your chances of swelling on the flight back home
– Do not take medications that knock you out when you fly so that you cannot get up to stand/stretch
-Try to sit in an emergency exit row for the extra leg space
Finally, understand that for the most part these two causes of swelling typically do not need medical attention and are self-limiting (meaning it goes away by itself).  There is no specific time it is estimated to go away.  Everyone is different.  Do NOT try to take over the counter diuretics.  This could make your situation much worse.  When you should seek medical attention: 
– Swelling is only on one side
– Swelling around the eyes
– Severe dehydration symptoms
– Experiencing any leg pain
– Experiencing any breathing difficulties
– Swelling that gets worse each day even after drinking plenty of fluids
Note:  I am a NSCA certified trainer and a third year medical student, not a M.D., yet.  The information I provided is based upon what I have learned and read from expert resources over the years combined with experience.  Please consult your physician before making any major medical decisions based on this article.

The dirty truth about the fit lifestyle

I can’t believe I just finished my first pro show of my IFBB career.  I’m just in shock of not only the weekend events, but how quickly things have turned since Team U.  I feel I just got off the New Jersey stage yesterday.  But I literally have gone a million miles a minute the last 5 weeks.  Trying to balance my internal medicine rotation while prepping made this the most difficult prep to date.  I hadn’t admitted that to anyone yet, because I don’t like to complain while in prep but I was down on myself so many days.  I would be disappointed I couldn’t do my cardio “fasted” (meaning on an empty stomach), even though it was because I had to be in extremely early.  It made sense logically to do it later at night, but I just didn’t like doing things not exact.  It felt weird, but I came to terms with this is how this is going to be this rotation if I wanted to get on stage.  Either it was going to be a struggle or I was going to quit.  I got over the things I couldn’t do perfectly and realized that for the next 6 weeks my #1 priority was  my education and my patients.  Fitness would be extremely important, but not #1 this time.  I’ve learned that to be successful at many things you need to be willing to shift your priorities.  I used to think I needed everything to be perfect ALL THE TIME – which resulted in anxiety attacks. :) So — you want to do lots of stuff and you want to do lots of stuff awesome??? – learn to spread out your awesomeness.  It’s OK!

Because I reprioritized I was able to balance my fitlife with my medical school and for that I am proud.  To me that is how I can call this a LIFESTYLE. I was so proud to stand on stage next to some of the best athletes in the industry on Saturday (Aug 10th).  That day my goal was to be my best and enjoy my first show and I did just that.  I approached a handful of the women I’ve respected all these years and I let them know the impact they’ve had on my life.  It felt good to talk to these professional female athletes in person.  Some of my conversations even confirmed that I wouldn’t change anything about my last 5 weeks of prep or how I managed to maintain my goals.

I can’t wait for the next one.  Luckily this next rotation I should have a day or two off :)

Ashley Maybin - Pro Bodybuilding Weekly Championships 2013

If you are too tired, too broken, or too poor – guess what? you need to find a way

Recently one of my friends asked me if I ever doubted I’d achieve my IFBB Pro Athlete status because I posted a comment about how “overwhelmed” I was still weeks after my competition.  I thought about her question for a  few seconds before I responded right away that of course I knew I would get my pro card ONE day.  I believed in my goal. It was the TIMING I could not control.  My goal was not only realistic according to the best in the business, but I was putting in the work.  I mean I was really putting in the work–excuse free.  Many people have “reasons” (if you don’t want to call them excuses) that they get off course of doing literally EVERYTHING it takes to achieve a goal.  I don’t complain about injuries, sore muscles, cost of food, prepping food, cost of competing, training to compete.  My coaches will tell you.  I have about 1 weak moment per prep and it’s usually an instance where I doubt myself.  They get me in check and we keep on rocking :)  But I can’t think of too many times I’ve requested ANY deviations. I just DO.  After all, I believe when you want to get to a certain level of success it’s not always about “doing your best.” Because honestly if my best is better than yours, I will beat you!  To be successful you must do WHAT IS REQUIRED.  If you can’t do it, you don’t get the success.  I know I make it sounds black and white, but that’s how I’ve approached all of my goals, so I can’t help it.  So for example if I REALLY want to get into a professional school, I take  a  standardized test, and I get a low-average score that means compared to the rest of the nation my chances of achieving acceptance are low.  So at that point I could decide to keep pushing to get the national average or better or I can say I just wasn’t good enough and move on.  In fitness competitions I believe many people “move on” in a different way by just not doing everything it takes to make it without deviations.  If you are too tired, too broken, or too poor – guess what? you need to find a way, but it’s still really in your control!  I’ve never blamed anyone for my shortcomings, because I know at the end of the day my succcess is up to me.  So everyday I try.  I push hard even though I’m not the best RIGHT NOW because it will eventually come together.  I have tenacity and that is my strength.  I hold on until it’s my turn to receive my blessing.  If I am not ready everyday though, those opportunities don’t just get thrown at you.  I have learned to be ready for any opportunity by being successful in my DAILY life.  Little by little the big goals come but if I’m not ready EVERYDAY, then oops there goes a great opportunity…

…the rest of the story…

Since competing at Team Universe, I’ve received an overwhelming amount of congratulatory statements from friends, family, and strangers!  I appreciate every single positive gesture.  After all, my determination to keep competing actually comes from that exact energy.  So while I am so humbled to receive compliments about my win and earning my pro card, what touches my heart most is when I see the words “you inspire me” come across my phone/computer.  Just today I’ve had two extremely driven women tell me I’m the reason they keep pushing to establish a healthy lifestyle.  Let me tell you, that really means more to me than any trophy, diploma, or money.  I desire to inspire. It’s not easy at all I will be honest.  To push through with this crazy schedule and make things happen that seem impossible…whew! But that’s why I had to share the rest of my story of making it to Team Universe a few weeks ago.

Not only did I have to select a rotation months in advance that actually would allow me to have a day off to get there, but I had to consider NOT being in the operating room the weeks leading up (you can’t eat and drink on a regular schedule). Then at least 6 weeks before I had to plan to work all day the day before I left just so I could catch a plane to check in on time.  All that week I was doing cardio sessions back to back due to not being able to workout early because I have to be at work so early!  I was pretty fatigued, but I kept receiving encouraging notes from people.  “It’s your time.” “Pro card time, baby.” Man, not only did I feel external pressure, but I already knew I couldn’t do any of the other NPC Pro Qualifying shows this year due to specific rotations I was scheduled for later.  This was my one and only shot for 2013.  So I kept pushing.  Tired, but pumped.  I felt ready..Best I ever looked.  By time I arrived to check in I had been up for about 36 hours straight.  I was concerned about holding water, getting soft… falling apart basically.  You know what? None of that happened.  I was able to stay on top of water, meals, and supplements while flying to minimize any issues!  When I checked in with my coaches I was a happy girl.  I got off of my feet and slept as long as possible before getting up to prep for Friday’s events.  Before I knew it…things were coming together…and the rest is history…