Weight Loss

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Friday, February 29, 2008

little update

Just a quickie...

My pharmacology midterm was yesterday. It went pretty well, I think. I have another one in A&P on Monday and I've been procrastinating on studying for about an hour, so I gotta get back to it soon.

My weight is the same, no changes for about 2 weeks. I weigh daily, so it gets to feeling like I've plateaued for a month, but when I look back at Fitday, it hasn't been nearly that long. Anyway, I didn't exercise as much as usual while hubby was here, but now I'm back to every day. Last night I ran for 14 minutes in 3 blocks, so I'm getting much better. I had to get another pair of running shoes to keep at the hospital. I ran in bad shoes there the other day and that was a mistake. I think especially with my weight and my high arches, I really need good support to run. Yesterday during Principles class I took my resting heart rate and it was below 80! That's a first in many, many years. Usually when I check it's 84, though. I do notice that my heartrate recovers much more quickly now than it used to. Yesterday my max rate was 174 right after running for 4 minutes. In 60 seconds it had dropped to the low 150s and was down to 140 another minute later. Also, it's much harder to get my heartrate up to 130 when I start than it used to be. So I think my general fitness has improved a great deal in the last couple of months, since I started getting more serious with my cardio and restarted lifting weights.

I need to make an appointment with the new band doc to have my upper GI scope and make sure everything is going okay in my stomach. I don't think I need a fill. Maybe I do. But it seems like I just need to stop eating sooner, and make better choices about what I eat. I think the band is doing its job in keeping my hunger at bay. I really, really do NOT want to have it adjusted any tighter than absolutely necessary. So many people have late complications, 3, 4 years after being banded, and I do not want that. I think people get surprised by the fact that the band is as complex as it is and requires so much upkeep and vigilence. But any time you restrict a vital organ like the stomach, one that is so dynamic and moves so much, you run the risk of slippage, strangulation of blood vessels, and erosion, to name a few. Having a lap band is not a natural, normal thing, and we have to treat it with respect and do our best to baby it and keep our stomachs happy. And it seems like one of the surest ways to have late complications is to maintain too tight a restriction level, and challenge it often by overeating. I'm trying to avoid that so I can keep my band until I am old and gray and no longer need it.

Off to study....

Sunday, February 24, 2008


We went snowshoeing on Saturday on Mount Spokane. It was part of a class, which I took as part of another class, actually. Our Theories of Adult Education class has a project in which we take a 3 hour class and write a paper. It can be on anything--and I chose snowshoeing. The first part of the class was at REI and went over the basics of what to have/what to get before going to the mountain. The second part was the hike itself, which was a lot of fun. It's pretty simple, but it does make you sweat. At least me--I tend to sweat anyway. But we had a good time.
Here's the Picasa album.

Tuesday, February 19, 2008

Exercise, a Love Story

I was thinking of my exercise history today. To qualify for WLS, I had to submit a history of my obesity and attempts to lose weight and maintain weight loss. What I didn't have to document was my exercise history. It wouldn't be a bad idea to do this when preparing for WLS, because most people can't maintain weight loss without it. (Not all, though. And some people can't exercise after WLS, for various reasons.) Examining your relationship with exercise is a useful thing to do before undergoing something as life altering as WLS.

As a child, I never thought of myself as athletic. No one did, really; I was never an athlete, and no one ever pretended I was. I wasn't obese as a child--most of my childhood I was a normal weight, although I know I was always above 50th percentile, and below 50th for height. (This is a whole different discussion, though. I still deal with the fact that my ideal weight is going to end up being higher than the charts say it should be, because I have a very heavy frame. This is how it is on my dad's side of the family, and I'll never have a BMI less than 25, and I'm okay with that.) But I didn't like to run, I was very slow, and I preferred art and reading. I liked some sports, but wasn't good at them--I enjoyed volleyball and basketball, despite being a terrible shooter. In high school I swam a lot and toyed with the idea of joining the swim team, before I realized that my other extracurriculars--mainly music--wouldn't allow it. Late in high school, I was encouraged to join the gym with my mom, and I did--we went to "Living Well Lady" (remember them?), the all-women's fitness franchise from the 80s. I went, I did the same things over and over, without a lot of heart or enthusiasm. I hated it.

But, I was bulemic then, and did whatever I had to to keep weight off, and to "restrict" and "purge" as much as possible. I eventually outgrew bulemia, at about age 16 or 17. I just decided it was "dumb" and I was sick and tired of being sick and tired (that old cliche is pretty true) and I was going to eat. This decision was complicated by the fact that my mother has been anorexic and bulemic for her entire adult life--but I never turned back. I still had food issues, but I left that behavior behind. I had been pretty slim as a bulemic, through a lot of effort, but the weight came on fairly quickly after this period.

I continued to work out in the gym until I went to college. Then I stopped exercising altogether and continued to gain weight. I joined a gym sometime during nursing school, around age 21 or so, but went infrequently. I realized that I didn't like working out in gyms (I think now that I just didn't like the gyms I had been going to, but anyway) and decided to Never Do That Again.

Fast forward a bit. I graduated nursing school at my highest weight ever (even recently, I didn't get quite that high ever again, but almost). I started working, got married, lost a little weight and settled at a sort of set point for me for a few years. I got divorced, lost some more weight by going on phentermine, walking regularly, and being extremely stressed out. By the time 4 years had passed, I had gained about 30 lbs and went on Weight Watchers. On WW, I walked again as my exercise method, still thinking that gyms were not for me. I lost 35 lbs over about 13 months and stayed at my low weight, which was still 30 lbs from goal, for about a day before going back up. At that lowest weight I started running intervals, but not with much dedication--I was running in downtown Portland, which isn't very conducive to running effectively, and I didn't like it. I was too intimidated to run with my new boyfriend (now my husband) so we went on nightly walks together. But, the weight came back on over the next 2 years, and then some.

I started considering WLS in early 2006, but before getting too far with that thought, I decided to give one more gym another try, and I joined the YMCA in Portland in January 2006. I actually really enjoyed it. I started with the elliptical at a fairly slow rate, for 30 minutes 3 times a week. I didn't really advance it for long time. Then I joined the 12 week program, which is for new exercisers. It's a circuit, of sorts, of strength training, set aside in a special room. I enjoyed that, completed it and continued to do the program. By now I was up to about 40 minutes of cardio 3 or 4 days a week, at a moderate intensity. But, I found that I enjoyed it, surprisingly. I swam intermittently, although I couldn't do more than about 8 laps before getting worn out. My resting heart rate has always been high, and I maxxed out fairly easily then.

Then, the Y raised the dues, and my employer had just opened a new gym, called march wellness (no caps!). It was fancy and pricey, but with my employee discount it was cheaper than the Y. It was in our new Center for Health and Healing, which is a LEED building, very earth friendly, efficient, and peaceful. The gym is a marvel. I felt at peace there and loved being there all the time. So, I started going there in January 2007. But, since I left the Y and its routine of weight machines that I knew, I stopped with strength training. (What, you say? It's true. I never got around to getting a trainer at mw to get me a new routine, and I was too intimidated by the machines to start my own. I can't explain it, but strength training confounds me. I have to have someone show me a routine, then I can take it from there.) By the time I had my lap band surgery in March 2007, I was doing about 45 min of cardio, which included a 10 minute warmup of walking on the treadmill and a combo of elliptical and upright bike for the other 35 minutes, about 4-5 days a week. But now, my goal was 60 minutes of cardio 5 days a week. My primary doc had told me that the latest recommendations for exercise were 60 minutes a day of moderate exercise. I couldn't see any reason not to shoot for that (and still can't). So I worked my way up to that over the next 6 months. Still no weights.

Let me just add that during that year and 3 months between starting exercising again and having WLS, I continued to gain weight. I got in better shape and had more energy, but I gained about 20 more pounds during that time. Exercise alone might work for some people, but not most of us who end up morbidly obese. A lot of us are "fit fat", which is what I was. In fact, if I hadn't had obstructive sleep apnea, I never would have been approved for surgery by my insurance.

When I moved to Spokane to start graduate school 3 months ago, I had to find a new gym. Actually, I didn't find a new gym until December, since I was still mostly in Portland and was still going to march wellness. Leaving that gym was one of the hardest things about moving away from Portland. It was such a haven for me, I just loved being there. I took yoga there, I took pilates, I worked out, I relaxed. I just loved it. Spokane is not a very gym friendly town. I finally settled on the YMCA in Spokane Valley--there is a Y closer to me, but the facility is very old and run down. I've blogged more about the Y (aka McDonaldland), it's a pretty nice facility but overrun with small children. I had some fit-testing and body composition testing (which I doubt was as accurate as what they did when I started the WLS process) and discovered that while I had lost 45 lbs, I had only dropped my body fat percentage very slightly. Oops. Guess where I lost the weight? Guess why I was "plateaued"? Yeah, you need muscle, and quitting strength training right when you have WLS probably isn't a great idea. So I got a new strength routine and kicked it up.

Now, I work out 5-6 days a week. I do my whole strength routine in the same day, usually, if I have time. I take one day off afterward, but do cardio that day. It ends up being 3 days a week that I lift. I increased the intensity of my cardio workouts in the fall, and some more when I started going to the Y--faster elliptical at a higher resistance level, much faster walking on the treadmill. I started using the treadmill more, because you can't get "lazy" and go slower without thinking about it like you can on the elliptical, and I increased the speed of my walking.

Two weeks ago (for the sake of tracking my progress, I am going to say Feb 7) I started running intervals again. I walked about 20 minutes, at 3.0 to 4.0 mph at a 6% incline, then ran for 4 minutes, walked 5 minutes, and ran another 3, then walked the rest, ending up with about 45 minutes total. A total of 7 minutes running. I've now increased to 10 minutes running (3 min, 2 min, 3 and 2) and I'm just looking for slow, steady improvement. I don't run because I really like it, but because I want more bang for my workout time or "buck". I COULD just walk for 2 hours, but who has that kind of time? I will never consider myself a "runner". I won't do a marathon, or a half marathon, or probably even a 5k. But I will try to increase my running (on a treadmill, where my joints don't have to absorb all the force of my still-technically-obese weight) and see if I start enjoying it more as I get more fit. My resting heart rate has come down, from 110 (!!) a couple years ago to 84, and my heart rate recovers more quickly than it used to when I work out hard. I get up to about 175 when I run, so I can't sustain that for longer than a few minutes at a time, but hopefully it will continue to improve. Previously I've tried to keep my heartrate between 145-155 (higher than most people my age would, because my resting rate is higher than most) and hopefully I can eventually run for a longer period and not go higher than 160 or so. At some point I might get a heart rate monitor to keep better tabs on this.

But the biggest surprise to me of all of this is that I love to exercise. I don't love to run, and I don't always feel like working out, but what gets me there anyway is knowing that as soon as I dress down, I am ready to go, and I always feel great, during and afterward. My overall energy level is so much greater than it was a year ago. Sometimes I am afraid that something will get me to stop going and working out, and I think that actually motivates me to keep going. I don't ever want to go back to my life before exercising regularly. I just didn't feel like doing anything.

There is a quote that I think of often with regards to exercise, and it is from, of all people, Kate Hudson. I read an interview with her, and she talked about exercising whether she felt like it or not, and always feeling like it eventually, because "It feels good to move." She is so right. You have to move your body, and keep challenging it.

Recipe: My Own Kick-Ass High Protein Mac & Cheese

I really wanted some mac & cheese last night. I make it myself, no Kraft boxed death for me. If I'm going to go into a comfort-food carb coma, I'm going to have something good. But I'd been thinking for a while on how to make it better...get some protein in there.

What I came up with is very simple, so simple that it's probably out there somewhere under someone's name. But I didn't read this anywhere, I just thought it, and it turned out great, so I'm calling it mine.

Gwen's High Protein Mac & Cheese

1 box Mori-Nu Silken Tofu (the soft, silken stuff, NOT firm)
1 1/2 cup (more or less) cheese--sharp cheese, like sharp chedder, allows you to use less
1 tsp ground mustard

1/2 bag (7 oz) Whole Wheat & Flax pasta (I used Nature's Path Lifestream Organic Whole Wheat and Flax seed Rotini, see below for nutritional breakdown)

Serves 4 (2/3 c. servings)

Place tofu, ground mustard, and about 1 tsp salt in food processor or blender. Process until smooth. Pour into sauce pan and heat through on medium-high heat, stirring frequently. Add cheese, and continue to cook until sauce is smooth and cheese is evenly melted and distributed. Add salt so that sauce is just slightly salty--the noodles will absorb some of this.

Meanwhile, in a large pot of boiling salted water, cook pasta until done. Drain, add noodles into cheese sauce, stir and enjoy.

Some notes:
I used the cheese I had on hand: a little 2% medium cheddar and some swiss cheese, because I wanted to use the rest of these up. The rest of the cheese was 2% sharp cheddar and some part skim mozz. The mozz makes the sauce stringy, so if you don't like that, skip it.

The nutrition facts on the pasta is as follows: 1 serving of 2oz uncooked noodles (about 2/3 c. cooked, roughly) contains 210 cal, 3.5 gm fat, 700mg omega-3 FA and 200 mg omega-6 FA, 8 gm dietary fiber and 9 gm protein. That's quite a whallop for pasta, which is supposed to be a carb bomb.

When I ran the sauce and pasta through FitDay, I came up with about 375 cal per serving, 15 gm fat, 40 gm carbs and 21 gm protein. Now, it is not a low fat food (you can thank the cheese for 9 gm of fat, mostly saturated) and it's not really a low carb food, but it's MUCH better than any other mac & cheese I've ever eaten, or made, and that's a crazy amount of protein, thanks to the tofu and the pasta. I realize that some people cannot digest tofu, so this would not be a great recipe for them. But the sauce is SO smooth, and tastes great. Honestly. I don't know why I'd ever make it any other way again. And the pasta is good--if you like whole wheat pasta. I can't really justify eating white semolina pasta anymore, and I like whole wheat pasta, so this whole thing was a big win for me.

Bottom line: Tasty. Not an every day kind of food, but when I'm really craving some comfort food, I can eat this with a minimum of guilt. Portion control is a must, though. I could really hurt myself if I don't watch it.

Thursday, February 14, 2008

Genes Take Charge, and Diets Fall by the Wayside

From the New York Times:

Fred R. Conrad/The New York Times

It was 1959. Jules Hirsch, a research physician at Rockefeller University, had gotten curious about weight loss in the obese. He was about to start a simple experiment that would change forever the way scientists think about fat.

Jules Hirsch, a research physician at Rockefeller University, conducted a simple but groundbreaking experiment on obesity nearly 50 years ago, changing the way scientists think about fat.

Obese people, he knew, had huge fat cells, stuffed with glistening yellow fat. What happened to those cells when people lost weight, he wondered. Did they shrink or did they go away? He decided to find out.

It seemed straightforward. Dr. Hirsch found eight people who had been fat since childhood or adolescence and who agreed to live at the Rockefeller University Hospital for eight months while scientists would control their diets, make them lose weight and then examine their fat cells.

The study was rigorous and demanding. It began with an agonizing four weeks of a maintenance diet that assessed the subjects’ metabolism and caloric needs. Then the diet began. The only food permitted was a liquid formula providing 600 calories a day, a regimen that guaranteed they would lose weight. Finally, the subjects spent another four weeks on a diet that maintained them at their new weights, 100 pounds lower than their initial weights, on average.

Dr. Hirsch answered his original question — the subjects’ fat cells had shrunk and were now normal in size. And everyone, including Dr. Hirsch, assumed that the subjects would leave the hospital permanently thinner.

That did not happen. Instead, Dr. Hirsch says, “they all regained.” He was horrified. The study subjects certainly wanted to be thin, so what went wrong? Maybe, he thought, they had some deep-seated psychological need to be fat.

So Dr. Hirsch and his colleagues, including Dr. Rudolph L. Leibel, who is now at Columbia University, repeated the experiment and repeated it again. Every time the result was the same. The weight, so painstakingly lost, came right back. But since this was a research study, the investigators were also measuring metabolic changes, psychiatric conditions, body temperature and pulse. And that led them to a surprising conclusion: fat people who lost large amounts of weight might look like someone who was never fat, but they were very different. In fact, by every metabolic measurement, they seemed like people who were starving.

Before the diet began, the fat subjects’ metabolism was normal — the number of calories burned per square meter of body surface was no different from that of people who had never been fat. But when they lost weight, they were burning as much as 24 percent fewer calories per square meter of their surface area than the calories consumed by those who were naturally thin.

The Rockefeller subjects also had a psychiatric syndrome, called semi-starvation neurosis, which had been noticed before in people of normal weight who had been starved. They dreamed of food, they fantasized about food or about breaking their diet. They were anxious and depressed; some had thoughts of suicide. They secreted food in their rooms. And they binged.

The Rockefeller researchers explained their observations in one of their papers: “It is entirely possible that weight reduction, instead of resulting in a normal state for obese patients, results in an abnormal state resembling that of starved nonobese individuals.”

Eventually, more than 50 people lived at the hospital and lost weight, and every one had physical and psychological signs of starvation. There were a very few who did not get fat again, but they made staying thin their life’s work, becoming Weight Watchers lecturers, for example, and, always, counting calories and maintaining themselves in a permanent state of starvation.
“Did those who stayed thin simply have more willpower?” Dr. Hirsch asked. “In a funny way, they did.”

One way to interpret Dr. Hirsch and Dr. Leibel’s studies would be to propose that once a person got fat, the body would adjust, making it hopeless to lose weight and keep it off. The issue was important, because if getting fat was the problem, there might be a solution to the obesity epidemic: convince people that any weight gain was a step toward an irreversible condition that they most definitely did not want to have.

But another group of studies showed that that hypothesis, too, was wrong.

...read more here...

Wednesday, February 13, 2008

The sweet spot

I'm a little embarassed to admit this, but I have been reading the ENTIRE archive of Melting Mama's blog lately. (See sidebar for link, or one of the posts below.) Mind you, I have many things I am SUPPOSED to be doing instead, like studying pharmacology and physiology and anesthesia principles. But no, I just get sucked in. I'm totally fascinated. It's funny, almost a year after my surgery, and over a year since I started seriously researching it all (in the fall of 2006), I still read something about WLS every day, be it someone's blog, message boards, or the Yahoo group I subscribed to (Smarter Bandsters--shout out--the only group that really TELLS IT LIKE IT IS and keeps it real and accurate, and won't sugar coat a damn thing, especially when you need your arse kicked a little bit). Anyway, I love Melting Mama, because she is a really funny writer, tells her exact experience without being all navel-gazing about it, and puts in lots of interesting articles and links related to WLS, side effects thereof, other health issues, and whatnot. I came across this interesting link in her blog tonight to the blog of a Texas Lap Band surgeon. He and his partner only do Lap Band surgery, because they feel the safety profile is the best, and because of its adjustability and removability. (Most of us who choose lap band do so for these reasons, and because we don't want to deal with malabsorption issues down the road--that was probably the most important reason for me.)

Here's a great post that I saw in there that perfectly describes my experience:

In the Lap Band what we consider the 'sweet spot' is the ideal fill. If I had to think about a perfect sweet spot I'd have to tell you about a patient. One of our patients was 66 years old when he had his Lap Band surgery. Over the course of the first 9 months he lost over 90 pounds! But he was confused and every time we saw him he would say "Doc my Lap Band must be broken. I don't feel restriction, I can eat what I want, and I never have food come back up."

That is the perfect sweet spot. The Lap Band was adjusted to the point that he felt control of his hunger and was able to control his eating portion size, but he had no significant restriction preventing him from eating any particular food nor did he ever have any regurgitation of food.

Many people who had lap band surgery find the sweet spot elusive and some people end up with a fill greater than they need because they rely on the Lap Band for restriction rather than hunger control.

If you are having a tough time keeping many foods down or having more than a small number of PBs (productive burps) you might be too tight and need some fluid taken it.

To summarize, the Lap Band is meant to help you with hunger control. By limiting the amount of food you eat with smaller portions, you can reduce your caloric intake, and lose weight.

I often worry, sometimes on this very blog, about my possibly less-than-ideal restriction, because so many people can eat a lot less than me and have vomiting/PB/sliming and all the other common lap band experiences. I have not ever had any of these. In fact, I haven't vomited since having surgery, even 1 time. And I can eat a good 2 cups of food if I'm not careful or if I try. But my hunger has been satisfied ever since about my 3rd fill. I do have to be careful about how much I eat--I have to do some of the work too, I can't rely on the band to do it all. And of course this holds true for food choices as well, and grazing, and head hunger/emotional eating...all things the band can't control. But what this doc describes as the "sweet spot" is exactly where I have been, so I feel better about it all. Oh yeah, and I've lost 50 lbs in 11 months--can't complain about that!

The big breakthrough for me this week is that I have started RUNNING on the treadmill. No one was even chasing me. I have traditionally HATED to run, ever since I was a little kid (and not overweight at all). But I have been feeling the need to intensify my cardio workout a bit, and I already walk at a pretty brisk pace when I'm on the treadmill--about 4.1 mph at a 7% incline, which is pretty fast for my stubby little legs. So the other day I walked for about 15 minutes before doing some running (or jogging) intervals. I ran for 5 minutes, then walked for 5, then ran another 2 minutes, and cooled down by walking. It certainly gets my heartrate up. I did it again today, and ran a total of almost 8 minutes, doing cardio for a total of 43 minutes (I usually shoot for 45-55 minutes, and I do it 5-6 days/week). It's not as horrible as I remember it being in the past. And my weight lifting routine is going pretty well, although today for some reason my arms were pitiful--why?? I just don't know. But it's good to always keep changing the routine up, and keep challenging myself. I never would have expected to be exercising at this level even 4 years ago, the last time I was losing weight, on Weight Watchers.

Another interesting thing, speaking of Weight Watchers. I am lower now than the lowest weight I reached in 2004 after my 13 month WW diet. At the time, when I got to that weight, I was pretty satisfied. I did want to keep going to my goal, but felt pretty good where I was at. This time, I'm not satisfied. I do feel good and I no longer think losing any more weight will significantly improve my appearance, but I definitely want to continue to my goal this time. I don't know if it is because I got close and stopped before, or what, but I think my health and well being will be so much improved if I can just get there--and once I do, maybe set another slightly lower goal. I've wondered about that numerous times on this blog, where my real goal should be, so I'll just leave it at that tonight and go do some homework.

Sunday, February 10, 2008

OK, 2 rants

Before I go to bed... 2 things.

For some reason, I have been reading the boards a lot lately. I mean the WLS boards, of course. Here are the top two things that really yank my chain that people insist on posting about:

1. "I have XYZ health problem, my doctor told me this and that. What do you think I should do?"

Umm, I dunno, maybe not try to get medical advice from perfect strangers who have a very low likelihood of knowing anything about your health?!? I mean, if you don't like your doctor's advice, maybe get a second opinion. Or even ask someone you KNOW has some sort of expertise in the area, rather than random people whiling their time away on message boards. I know people like to get other people's opinions about stuff, but this is your health. Perfect example I just read tonight: the poster has a low pulse rate after gastric bypass surgery, accompanied by dizziness. She also has elevated liver enzymes. Her doc refers her to a cardiologist, and now she puts it up to the experts at oh-aych dot com to tell her what to do next. Am I missing something here???

2. "I/my mom/my son's teacher had surgery and this terrible complication (that I fully recovered from, in fact never had any untoward effect from it and my health is fine now) happened and now I don't know what to do?"

The answer to that question, on the boards, is always a resounding: "Sue the bastard! Get a new doctor! What an incompetent fool!" Now, I get very edgy about this particular thing. Often what has happened is so-and-so went in for surgery (elective surgery, mind you, for morbid obesity, that the person has signed INFORMED CONSENT for which details most of the complications that might happen because YOU ARE ASKING SOMEONE TO CUT YOU OPEN) and their surgery is not completed because the surgeon nicked something or made some mistake--they close the patient, let them wake up, tell them what happened, and the person wants to know if they should have the surgery as rescheduled for the next week with the same doc or not. There aren't any residual effects from the surgical error, except that they didn't wake up with the procedure they expected to be done. Yet everyone is quick with their chorus of "Sue the bastard" and "Don't let him touch you!" and "what an incompetent idiot!" etc etc. Am I the only one who gets annoyed by this? For one thing, EVERY SURGEON, every doctor, every health care practitioner out there, makes mistakes. They are made on patients. Good ones, bad ones, they all make mistakes because they are EFFING HUMAN BEINGS. I mean, all the world's administrators, teachers, postal workers, truck drivers, cooks, lawyers, database administrators--they all make mistakes every day. Yes, I realize that health care professionals are held to a higher standard because their mistakes can cost someone their health or their life, and we should be held to a higher standard, absolutely. But still, mistakes will be made. How lucky are you to be the one on whom the mistake that was made didn't cost you your life or your health? Maybe some inconvenience, an extra scar, some worry until you are sure that you are fine? Of course, some people make a lot of mistakes, and certainly some health care professionals of all breeds are truly incompetent. But people are so quick to assume that any mistake at all indicates that the person cannot be trusted, is not a professional, is clearly not educated or skilled enough to care for patients. Excuse me? How do you think it is possible to do ANYTHING as a human being without making some mistakes? The mark of a competent surgeon, in my opinion, is the one who will come to you in the recovery room or in your room when you wake up, explain what happened to you, tell you what was done and what will be done to make sure you are okay, and apologize for the error and worry. Unfortunately, most docs are trained to never apologize because that admits guilt, which invites malpractice suits. The research has shown that patients who were apologized to by their caregiver were far less likely to sue than those who weren't. But anyway. The other thing about it that drives me crazy is the suing thing. We are obviously very quick to litigate in the US, and especially in cases of surgical errors. People assume that a, surgeons are infallible, unless they are incompetent, b, they are loaded, and c, this is the time to cash out. What does this do? Clog the judicial system with frivolous lawsuits. Drive up health care costs for everyone. Drive competent providers out of business because of the insurance premiums after one of these (almost always) frivolous suits. Reduce available funding for valuable research. And most importantly, it doesn't do anything to change the outcome of what happened, and it doesn't change the fact that mistakes will happen as long as humans are practicing health care. It's simply wrong, all around. Lawsuits should be brought by people with legitimate cases: people who were harmed by true incompetence or negligence.

It's enough to make me crazy.

Readin', 'Ritin', 'Rithmatic....

Man, studying sucks sometimes. I just don't have the kind of concentration that I need to get all this materiel in my thick head. There are sooo many distractions, and I'd really rather do just about anything than draw diagrams of cell receptors. Or pictures of cellular mitosis. Or other stuff that I learned, oh, the LAST time I was in college, like 15 years ago. But here I am, and this is now my full time job, so it's time to suck it up and learn it all.

Today was a BEAUTIFUL day too, as long as you didn't look down at the streets full of mud and half melted snow. Sunny, blue sky, 40 degrees. Not an icicle in sight. I did end up going for a little walk in the slush around dusk, just to get some air, and I went to the gym in the evening, when I thought the crush of children might have died down at the YMCA. The Y I go to has this amazing pool, or pools really: a big lap pool and a big activity pool with a water slide and some other child friendly features. I'm sure it is busy year-round, but especially in the winter it seems every suburban mom in the Inland Northwest packs up her brood and brings them to the pool at the Y on the weekend. Which is fine. But what kills me is the locker room: filled with screaming, unsupervised children. Boy children, too old to be changing in the women's locker room (they have a "Family Changing Room" for moms who have boy children who are officially too old for the women's locker room--over age 5). And kids running, taking pictures while you are changing, and the Baby Jesus music playing...aaahhh. I try to avoid the locker room as much as possible. I realize that parents are used to this kind of cacaphony, but it is not a part of my daily life, and it doesn't really help my nerves any. Unfortunately, this YMCA is the only gym I could stand to work out in when I moved to Spokane. People apparently don't really work out here, or they aren't very picky about where they do it. So I went from my beloved March Wellness in Portland, which had a quiet atmosphere much like a giant yoga studio, to McDonaldland.

Ahem. That was the long version of the story. Maybe I shouldn't have kids.

Ok, off to study, then bed!

Thursday, February 7, 2008

Checking in

Life as a student is moving right along. School is busy, scary at times, but exciting. I can't believe that a year from now I will know as much as the juniors know now. It's amazing what can happen in a year.

I officially hit 50 lbs lost this week, about 5 weeks before the 1 year post op mark. (Or my first bandiversary, as some call it.) I only have to lose 2 more lbs to maintain the 1 lb per week average, which I mention because it seems likely that I might only lose 2 lbs between now and then. It's so up and down. Maybe if I fine tune my eating habits a bit, find the areas where I've been getting lax over the last several months, it will help. I do know that I am in a rebuilding phase right now, having just started strength training again in December after being away from it for a year. I lost about 40 lbs without strength training, and lost quite a bit of lean mass with that, so now I have to rebuild muscle so I can burn off the fat. That will take me some time. But, on a brighter note, I'm at the lowest weight I've been since I was about 19. I was thinking today about how happy I am to be wearing size 10 jeans now, and how we love certain sizes on the way down and hated them on the way up. I remember pretty clearly being a size 4 in junior high, a 6 in high school, and when I first had to go to a size 10--double digits--I was about 17 or 18 and was just appalled. Now it's been so long since I saw single digits, the size 10 is delightful. It's all about perspective.

So I officially have about 24 lbs to lose to reach my goal, but my goal gives me a BMI of about 28. I've always seen it as a long shot anyway, and only have a glimmer of a thought that I might be able to get lower than that. I don't know how I'll look or feel at that weight, but I suspect it might not really be overweight for me, despite what the BMI charts would say. That's the big mystery waiting for me at the end of the weight loss rainbow. But I need a goal before that, and I think my next one is just another 5 lbs. If I lost 3 more lbs before March 13, I'd be happy, and I would be just over 1 lb per week weight loss in my first year. Most people lose at a much faster rate than that, but I'm not most people, clearly. And I'm pretty much okay with that.

The snow tried to melt today, the temp got up to about 38 degrees and most of the icicles fell off the houses. The streets are wet and slushy. It's supposed to be in the 40s this weekend. But there is still plenty of snow on the ground. It will take a long time for all that to melt, especially since most of the storm drains are packed with snow from the snow plows. I think we are in for some more snow before this all goes away, but it can't happen soon enough for me. I'm over it!

Nighttime Eating

I think most of us with serious weight problems have trouble with late night snacking. I certainly do, although it's probably not the single biggest reason why I became morbidly obese. (Ice cream for breakfast might be.) Still, we all struggle with nighttime eating, it seems.

This is an excerpt of an article that I stole from Melting Mama's blog. It has some good tips that I wanted to include. Some of them are reminders of things we used to do...I know there are things on this list that I remember working on when I was getting ready to have surgery, and I've sort of forgotten about them. So this is a nice reminder on how to get back on track. Enjoy.

Why We Eat at Night

There are many reasons why so many of our total calories tend to be eaten during and after dinner, including physiological, emotional, cultural, and possibly evolutionary influences. They include: It's part of our culture to eat a large dinner. It's also customary in many homes to enjoy a large dessert after dinner. Some people, especially women, skip meals or undereat during the day. It can take quite a lot of food to satisfy the body's hunger after a day of undereating. Overeating at dinner or late at night may help to calm people from stresses that build during the day. Studies show that meals eaten with others are, on average, 44% larger than meals eaten alone. Since dinner tends to be the meal that is more often shared, this may partially explain why it's also most likely to be the largest meal. From an evolutionary perspective, nighttime used to represent the longest time period without food and activity. In modern times; however, artificial light allows people to remain awake and continue to eat, perhaps, contributing to obesity. Tips for Overcoming Nighttime Noshing But even with all this working against us, experts say, it is possible to avoid nighttime overeating. If you're a nighttime nosher, here are some tips to help you kick the habit:

1. Get in the habit of enjoying a hot cup of decaffeinated tea at night. Tea comes in so many great flavors that you'll never be bored. In the warmer months, have a glass of iced tea instead.

2. Many people snack at night because they're bored. Keep your evenings interesting, and you'll find it easier to refrain from mindless snacking. Take a night class, plan an evening exercise session, find a new and interesting book or hobby, etc.

3. If you've gotten into the habit of eating in front of the television, vow to eat only in the kitchen and only drink no-calorie beverages while watching TV. Or limit your TV eating to fruits and vegetables. Occupy your hands in other ways -- ride a stationary bike, do exercises with an exercise ball, take up knitting, pay bills, or write notes to friends.

4. Because evening meals and snacks tend to be the highest in fat, it's especially important to make healthy food choices at this time. Go for foods that are rich in nutrients, high in fiber, and balanced with some lean protein and a little bit of "better" fat (like olive or canola oil, avocado, or nuts).

5. Though you don't want to eat too many calories at dinner, for some people, a small dinner could lead to a late-night snacking tailspin. Eat a balanced, high-fiber dinner. If you get hungry later, enjoy a smart and satisfying evening snack like low-fat yogurt with a sprinkle of whole-grain cereal, fruit with a few slices of cheese, or whole-grain cereal with milk.

6. Have a balanced, higher-fiber lunch and afternoon snack to help avoid overeating at dinner.

7. Don't skip breakfast. "When people skip breakfast, they end up eating more calories by the end of the day, and we know that they end up compensating for this skipped meal with high-sugar, high-fat foods," explains Bowman.

8. People who eat small, frequent meals tend to eat fewer total calories and fat grams than those who eat larger meals less often. Try eating small, frequent meals to see if it improves the way you eat and feel.

9. If you're in the habit of finishing your day with dessert, try having a mini-portion. The first few bites of a food always taste the best, anyway. Experts say a petite portion is more likely to satisfy if you choose a dessert you truly enjoy, take your time and savor every bite, and accompany your treat with a cup of hot coffee or tea.

SOURCES: The Journal of Nutrition, January 2004. Physiology & Behavior, 1987, vol 40. Journal of the American Dietetic Association, December 1994. Body Mass Index New Research, 2005. Shanthy Bowman, PhD, U.S. Department of Agriculture's Agricultural Research Service. John M. de Castro, PhD, chairman, department of psychology, University of Texas, El Paso. Edward Saltzman, MD, energy metabolism scientist, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston.