Saturday, March 29, 2008
Here is an article she wrote in 2006 about the source of her strength, her mother, who died in 1999. As her husband did, Mariane writes a compelling story and illuminates its message of optimism perfectly. Enjoy.
To misquote David Mamet's Glengarry Glen Ross, it takes brass balls to do anesthesia. Any one of the drugs we give during a case can easily kill a person if the dose is miscalculated or even if it's given at the wrong time. In fact, if you think about it, we have to get a person as close to dead as possible for surgery to even occur. Patients have to hover just above death in order to tolerate someone cutting into them and doing what are often fairly violent procedures on them. (If you have any doubt, watch any orthopedic procedure, especially joint replacement surgery, which is usually performed on elderly patients. The pounding and drilling that goes on is vigorous to say the least.) It sounds dramatic but it is actually the truth. This wouldn't make a very good PR campaign for anesthesia providers, though: "Nurse Anesthetists: Keeping Your Other Foot Out Of The Grave." So, it's good that we learn all that we do. But it is a daunting task.
I tried to drive back to Portland yesterday, thinking perhaps I could get ahead of the snowstorm, but I was unable. I drove about 40 miles before it became apparent that I would have to turn around. This morning there are maybe 3 inches of snow on the ground, and the DOT says I-90 is still covered in snow, so I will wait a few hours before heading out. The Groundhog promised another 6 weeks of winter, but he apparently didn't check the calender. That 6 weeks was up a couple of weeks ago.
Weight loss is at a standstill. I'm frustrated, but still working out and trying to be patient. I need another fill.
When I handed in my exam yesterday, Maggie and John were in the office to receive it. I haven't seen Maggie (program director) in a few weeks. She is in the midst of preparing the documentation for the program accreditors, who come every 3 or 5 years (I can't remember which). In addition, she injured her neck somehow and has been having a lot of pain. Her older daughter has a severe seizure disorder, having about 6-10 seizures per day. She went to Harborview about 6 weeks ago for extended EEG monitoring to try to locate an area that can be operated on to reduce her seizures, and they are waiting for those results still. So poor Maggie is under a lot of stress right now. But she and John and I chatted for a while and they commented that they really like our group a lot. I think our group is really good, too. No overwhelmingly strong personalities in the group (all nurses who are drawn to this profession are strong personalities, I think) and everyone gets along well and has a good attitude. I've really gained a lot of respect for all of my classmates in the last few months. It's sort of amazing to remember the group of interviewees last year and remember that I found them all to be so capable and qualified. It was definitely intimidating. And now this is the group of students that came from that larger group, and everyone belongs here and seems to have what it takes to be successful. It's really an honor to be part of this group.
Monday, March 24, 2008
Now, I'm just being provocative. I don't believe carbs are bad. They are necessary for life as are other macronutrients. Simple carbs--sugar, the tasty stuff--aren't so good, especially in excess. I love sugar and sugary things, and getting away from them has been a necessary part of my weight loss. Most of us swear off "carbs" at the beginning of weight loss, especially via WLS. Eventually they creep back into our diets and we have to get rid of them all over again. But ridding our diets of the evil carbs is not really the point. The point is more that we need to eat a fair amount of protein, and our caloric intake is (supposed to be) restricted enough that you just don't have space in your diet for "carbs". Also, the carbs most of us eat just don't have any nutritional value. But, there's always room for carbs....and that's the thing about the band, sugary things just slip down so easily. Few of us can avoid them without really trying hard.
I've been eating more sugar, and I need to cut it out. Sugar makes you want more sugar.
I saw "the new surgeon" last week, Dr. John Pennings of Post Falls ID. He's a nice guy, reminded me a lot of Philip Seymour Hoffman actually, with longish scraggly balding hair and a goatee, looks like a graying redhead. I almost didn't see him, actually; just as I was leaving for my appointment, his office called me and told me that they had a new policy for patients of other surgeons, that I had to have a letter of referral from my other surgeon and all my records before he would see me. This policy has been put in place in the past few weeks, long after I made this appointment. I strenuously objected to this, since it's hard for me to make appointments in the first place with my schedule and I was on my way to the appt. The surgeon who took over my care from Dr Hong when he moved to Canada, Emma Patterson, is a colleague of Dr Pennings and she told me that he would definitely see me if I told him she sent me. I think they trained together at Emanuel Hospital in Portland. Anyway, I told the office coordinator this and she checked with Dr Pennings and he agreed to see me without all the extra documentation. Sheesh.
So anyway, I see Dr Pennings, at last. He didn't seem super impressed with my weight loss at 1 year, but he saw I was within 20 lbs of goal. He liked how much I am exercising. They did a Tanita body composition thingie and determined that I had 120 lbs of lean mass, and he used that number with his personal number of 1.5 gm protein per kg lean body mass to determine that I need 90 gm of protein per day now. Um, what? How am I going to do that, without protein shakes? I think 75 gm might be more doable. My "people" at the Portland office told me 45-52gm, which I have been going by for the past year. Pennings believes that my weight loss will pick up again if I get 90 gm protein in per day. I believe he might be full of crap. But anyway, I'm trying to increase it some.
One useful tidbit he did give me was the calories-per-protein-gram rule. He told me to check labels on foods, and "gravitate" towards foods that have a ratio of 15 calories or less per 1 gm of protein. This seems reasonable and simple to do.
It kind of sucks having to see a different surgeon. This guy is nice, and seems to know his stuff. He does a lot of bypass; I didn't ask how many of his patients are banded. But I'm not sure if his 1.5 gm rule might be more bypass-oriented. A lot of bariatric surgeons take their RNY guidelines and just give them to band patients, which doesn't really work because the surgeries are so different and the requirements are really different, too. If a RNY patient takes in 90 gm of protein, s/he won't actually absorb all of that, because of the bypassed intestine. Honestly, I've never heard of a banded patient being told to eat more than 60 gm of protein per day. But, he was quite interested when I told him I am in anesthesia school. He told me he only uses CRNAs for his surgeries, he likes working with them better, and told me to come work at their hospital when I graduate--which I won't do for a few reasons, one being that we don't want to live in Idaho, another being that I need a much busier practice when I am first starting out. But it was nice to hear anyway.
He gave me a fill before I left, and here is another bit of discrepancy between what the office staff told me and what he did. They told me he always does the first fill on a patient that he didn't perform the surgery on under fluoroscopy. Well, he did a blind fill, just like everyone else has always done. Honestly, my port is quite easy to find, and he had no problem hitting it on the first try. I don't believe I was charged for fluoro, based on what they told me the charges are. But it was kind of interesting. Another interesting thing: he withdrew the fluid from my band and I had about 1.5cc LESS than I should have had in there. I really have only been noticing a reduced restriction lately. But he just gave me a 0.5cc fill and said to come back in 6 weeks if I need another, which I think I might. I notice the reduced restriction much more now that I know my band was a lot less full than previously believed. Interesting how the mind works. I didn't get the 1 year followup upper GI that I need. I have to make a separate appointment for that. It's going to be expensive, and cash, and I don't really feel like doing it right now.
So that's the lowdown with the band. I need to keep working on reducing sugars and increasing protein, and keeping the amount of food down. I ran today, was more tired than yesterday when I was able to run 20 minutes straight. Today I did 12/6/6 (24 minutes total) while listening to This American Life on podcast. The topic was "The Ghost of Bobby Dunbar." It is a fascinating tale of a family's response to learning the truth about their ancestor's kidnapping 80 years ago. The podcast itself isn't available for free any longer (the website for This American Life only allows free download for about a week, after that it's 99 cents, and iTunes only keeps 1 episode at a time) so if you don't want to pay to download the podcast I recommend reading this article about it. Great story.
Friday, March 21, 2008
Top photo: Kimberli and Tana work on a trach; Mark readies himself.
Middle photo: Me manhandling the trach
Bottom: Class of 2010: Connie, Mark, Kimberli, Tana, Brett, Corey, Cat, me. Most of the trachs have safe surgical airways established, but you can't really see that here.
Tuesday, March 18, 2008
This morning I woke up to a nice treat on the scale: a 3 lb loss, which makes a total of 56 pounds lost! I was very excited, needless to say. I'm also another "decade" down...from the 180s to 170s. (I know I've been vague about what my weight actually is on this blog...which I think is fine...but the longer this goes, the less concerned I am about it.) So, hooray for Lap Band, and running, and me.
That's all I got today.
Saturday, March 15, 2008
For one thing, I am older now and more experienced in losing and gaining and losing weight now than I was back then. I was experienced then, but I did learn a lot through my WW experience. So one thing has to be simple experience.
But the rest is a little nebulous. I think just the constant reminder that I HAD SURGERY and that I am succeeding so much more this time than ever before has an impact. A "binge" now (and they rarely happen) is so much smaller than before, it seems managable to me. I never have gotten that totally out of control feeling that I could get in the past, since my surgery. My mental dialogue seems to help me more than it used to: that figuring out if I'm physically hungry or emotionally hungry, deciding what would really help my current emotional state, etc. Doesn't work every time, but usually. And I think I'm just fed up and weary of the never-ending cycle that emotional eating becomes. It makes me feel worse, not better. It begets more emotional eating. It doesn't do anything about the original feelings or problem.
In other words, I think this is more a function of where I am in my life, than it is a function of WLS.
Now, IN NO WAY am I trying to imply, or do I believe, that I am in any sort of blissful food-issues zen, or that WLS is the way to get to this super happy place where you no longer binge. And my food issues aren't over by a long shot. And I still do, and will, have days when I am convinced that I need some particular binge food, and will have it before I stop to realize that I want something MORE than food, that it doesn't help and makes things worse. But I do notice, especially when I read things like Pasta Queen's wonderful post, that it's different for me now than it used to be. I don't feel so desperate.
Maybe part of that is that before when I was emotionally eating, I was usually ALSO physically hungry. I was hungry, physically, a lot, and lived in terror of being hungry because it seemed so hard to make that go away. Now I'm not afraid of being hungry, because I know it quickly passes, and if I do eat, the small amount of food will keep me satisfied for a long time. So in that way, WLS certainly helps. And especially when I was dieting, it was really hard to avoid binging when I was emotionally hurting AND physically hungry, plus feeling guilty for breaking my diet.
I'm not dieting anymore. I'm eating like a normal healthy person. And I can't "cheat" on life, so having occasional treats doesn't bother me as long as they remain "occasional".
WLS gives me a bit of help here, as it does in a lot of areas, but it isn't the cure for emotional eating by a long shot. Pasta Queen knows this. And most WLS patients know this. But while I want to give myself credit where credit is due, I also don't want to come across as glibly suggesting that it has nothing to do with my lap band. Making healthy choices is much, much easier for me with my band. No doubt about it. Resisting the emotional demons surrounding my obesity is much easier, although it is still tough at times.
Now if only I could apply these kinds of "healthy choices" to studying rather than reading WLS blogs online....
Today (okay, yesterday; it's around midnight on Sat morning now) was my first studying day of the weekend...and I did study, but not as much as I intended. It sort of fell apart in the afternoon. I did my minimum stuff I had to accomplish, then went to Costco, and Old Navy...then worked out...then went to the grocery store. Cooked dinner, which was nice: catfish, sauteed swiss chard and mushrooms. Settled in to do some more studying, but surfed the Web instead. It is amazing how easy it is to suck me into the Internets.
I washed the dishes and got ready to go to bed when I discovered that our landlords have rented the downstairs apartment and someone has moved in: hence, the amazingly loud TV sounds. So I had to go introduce myself and ask him to turn it down. I hate meeting new neighbors that way. But you have to do this first noise request properly. It might degenerate later, but it must be polite and friendly to start. I hate noise, and this building is old and very loud. We hear everyone who lives here, literally, in their apartments and tromping up the stairs, which go through the middle of our living space, although it is separated out by some thin walls and doors. This building is loud, and it's not insulated, hence the enormous heating bills. (Obscene, really, but that's for another post.) But, the location is good, and it's pretty quiet during the day, so we'll stick it out until I graduate, unless things take a turn for the worse before then.
I did some studying and now am just getting ready to go to sleep. I love the weekends--it's the first time in 11 years that the weekends are all mine, like normal people, without having to work every other one. Of course I have lots of studying to do on the weekends. But I don't have to get up at any particular time or be anywhere in particular. It's lovely. And the odds are good I won't have to work weekends anymore, unless I work where I have a lot of OB call. ORs don't generally run on the weekends, unless you are in a trauma hospital.
I ran today at the hospital gym. It's where I prefer to go on my non-lifting days, because I don't have to contend with hordes of ill-behaved children in the (OMG SO LOUD) locker room. It jangles my brain and I can't spend any time in there. So, the hospital gym is small, located in the basement. It's rarely empty, unless I go very late, like 9pm. It is open 24-7, so in theory I could be there right now, although I can't imagine a parallel universe in which that would happen. I listened to more Dan Savage podcasts and ran a total of 22 minutes out of 42. I warmed up, then ran 11 minutes consecutively, a new record, then walked 5, ran 9, walked 3, ran 2, and cooled down. Once I get my running time up a bit better, I'd like to incorporate some sprints again. I feel a lot more energized when I run faster, but I think if I train at that faster speed right now I am asking for trouble. Only bummer was that I brought the wrong gym bag, and didn't have my HRM with me. :( I had to wing it. I like playing with the new toy, so tomorrow I must use it!
Thursday, March 13, 2008
I'm in a very different place than I was on this day last year. Literally: I'm in Spokane, WA, in anesthesia school. But obviously it's much more than that.
I've always been a person who identified problems that I could solve and made plans and solved them. Sometimes the solutions might not have been the best ones, or might have caused their own problems. But inaction has always been my greatest fear, and usually I do pretty well with the plans I make. Deciding to have WLS wasn't much different. I identified that my weight was an ongoing problem that wasn't getting better, that losing weight seemed to be a problem I wasn't able to crack on my own, and that repeated cycles of losing and gaining were going to be harder and harder on my body in the long term. At the same time, I had images of my own father fresh in my mind: probably 200 lbs overweight, and barely able to walk on joints that are giving out, partly from trauma but mostly from supporting his frame for most of his life. He has lost and gained weight repeatedly, which I'm sure hasn't helped his body with his history of chronic hypothyroidism. I did not want to be his age, which this year will be 64, barely able to walk, and double my ideal body weight.
So WLS became another project for me. I was approved for surgery and scheduled it as soon as I could after that point. I had just interviewed at OHSU and Gonzaga for anesthesia school and decided to go to Gonzaga; my life was changing dramatically. I think I chronicled the details pretty well last year in this blog.
I don't think I really knew what to expect for my one year post op results. I hoped I would have lost ALL of my excess weight by now, but I knew that I probably wouldn't. I think I would have been surprised to learn that I would get as far as I have by now.
A lot happened in the course of this process that I didn't expect, but which I have all but forgotten about by now. I lost about 22 lbs initially but gained 10 back within the first month, as my post op diet progressed. Then I started getting fills but didn't have any noticable change in my hunger until July, which was my 3rd or 4th fill. So that time in between, I did lose weight, but very slowly. And I was hungry for a lot of it. I experimented with ignoring my post op diet, progressing to soft foods early, but learned soon the reasons that it's a bad idea, and slapped my hand. I sort of sweated the time ticking by, when I was losing in spurts. I've lost in spurts and then stalled during the entire process, which I think is pretty normal. The body isn't as simple as we like to think it is when it comes to weight loss.
Now my focus is more on exercise and general health. I'm continuing to advance my fitness level, trying to keep it interesting and challenging. I am still losing weight--I lost 3 pounds in a few weeks, then have hung at the same weight for the last week. I am an advocate for daily weighing, at the same time in the same conditions each day. I think this is the ICU nurse in me, wanting to track trends more than absolute values (although when it's your weight, and you're trying to lose weight, you are definitely interested in the absolute value too.) I weigh every morning, after I pee and before I drink or eat, as soon as I wake up. Naked, on the same scale. Doing this every day has kept me on top of things, knowing when I've been stalled for a while, and most importantly, knowing my pattern of weight loss intimately. I don't get discouraged by seeing the exact same weight for 5 mornings in a row, because I know that happens before I lose weight. I also know that after 5 days of that, it might go up a pound or more before it drops 2 or 3. That's how my body loses weight. I wouldn't know that if I weighed once a week or once a month. It doesn't work if the scale has the power to ruin your day, but it doesn't for me. Research shows that people who weigh every day keep their weight under better control, so I like establishing this habit so when I am in maintenance I can continue.
My health is a gift I partially gave to myself, but I have to thank my genes too--and of course, my lap band. I'm an advocate of treating it well so it will stay with me for the long term. That means not challenging it, by overeating, and not keeping any more fill than I absolutely need in it. I've never needed an unfill, never vomited or had any food get stuck, never "slimed". I'd like to keep that record intact, to keep my stomach under the band as happy as possible. I'm also curious about the effects of intraabdominal and intrathoracic pressure on the band--I have been noticing, when I do the leg press, that if I follow the recommendations and exhale when I press up, it creates a lot of intrathoracic pressure, and I think that might cause a very slight risk of prolapsing my stomach through my band under the right circumstances. So I let my breath out passively when I press, and try to minimize intrathoracic pressure to keep from that happening. (I thought of this after one woman lost her band when she lifted very heavy furniture and immediately had symptoms of a slip--when she finally had emergency surgery her stomach was ischemic, although they were able to save it--but not the band.)
On an unrelated note, I finished my third "orientation" day of IV starts in the surgical admit unit this morning. I'm so glad we will only be doing IVs once a week. Getting up at 4:30 am kills the rest of my day. I took a nap after class today and I feel a lot better now. I have a lot of studying to do this weekend. There's no class tomorrow, so I can start yet another fun weekend of nothing but studying. Of course, hubby is supposed to be coming here this weekend, which will be nice. But I have a lot of work to do, too. Anyway, the IVs, I missed 1 patient entirely this morning, and another one I got on my second attempt. I got 3 more on the first poke after that. But I hate sticking people more than once. Yesterday I had 5, all on the first poke, which was fantastic. One was even particularly difficult--very tiny, fragile veins, on a dialysis patient who said she'd kick me if it hurt! (She was sort of kidding.) But we are required to use lidocaine for IV starts in SAU, which is technically more difficult because it obscures the vein underneath it--and because of the lidocaine, she didn't even know I was done as I got ready to leave. IV in place, fluid dripping in just fine. So that was a nice success. I enjoy starting IVs, actually--I'm pretty good at it, after 11 years of nursing, and it's always a good challenge and very gratifying to get a difficult line. But I don't really enjoy getting up at 4:30, or the sleep disruption that goes with it. I've slept really poorly this whole week. Anyway. Next week: we start intubating! I'm excited for that.
Okay, I'm outta here...gotta go run, and study after that.
Tuesday, March 11, 2008
It's right on. I kept my HR no higher than mid 160s and was able to run 9 min straight and 19 min total. I don't feel quite as fab as I did when I ran faster, but I was able to run longer, and probably am less likely to hurt myself. So, right on there.
The HR monitor: Awesome. Love it. I got a Timex, it was about $50. Totally enlightening in my workout.
OK, bedtime. Just wanted to add that to my other posts below. Another thing: running to Dan Savage's podcasts is a totally different, engrossing way to work out. I heart Savage Love.
I'm a weenie about losing sleep. I have to get my 8 hours, or at least 7, if I'm gonna manage. I do have fibromyalgia, which is entirely controlled if I take my medication and get enough sleep. I'm a chronic insomniac (a topic for another blog post someday) and the only real way to manage that is to have good "sleep hygeine" meaning you do whatever it takes to have a regular bedtime and get the correct (for me) amount of sleep. So I have just a couple hours to figure out how I'm going to spend the rest of my time before winding down for the night. I think I'll just go to the hospital and run there. I only did my arms yesterday at the Y (after my run) and planned on doing legs today. I don't usually split them up but I was feeling a little tired and crunched for time. But I can do legs tomorrow after class. It won't kill me.
I do have my new Timex heart rate monitor. It's pretty fun. I posted all that stuff about training and figuring out heart rates because I really want to know what is MY max heart rate. When I run I hit 176 regularly. I recover quickly, but with running it's hard to get my heart rate to stay lower. So I don't believe my training zone is as low as 130, but at the same time, the heart rate monitor will help me adjust in real time, rather than trying to grab the treadmill handles after I am done with my sprint and hope it actually reads my heart rate (sweaty hands, faulty equipment, etc...I know they aren't very accurate). So, let's go take this bad boy for a spin!
Do you want to get the most out of those 30 minutes on the treadmill, or any kind of cardio exercise? You maximize the benefits of cardiovascular activity when you exercise in the zone of your target heart rate (THR). In general terms, your THR is 60-80% of your maximum heart rate. The Karvonen Method of calculating THR is one of the most effective methods of determining target heart rate because it takes into account resting heart rate. Here's how to find your THR.
Find your resting heart rate as soon as you wake up. You can do this by counting your pulse for one minute while still in bed. You may average your heart rate over three mornings to obtain your average resting heart rate (RHR). Add the three readings together, and divide that number by three to get the RHR. For example,(76 + 80 + 78) / 3= 78.
Find your maximum heart rate and heart rate reserve.
Subtract your age from 220. This is your maximum heart rate (HRmax). For example, the HRmax for a 24-year-old would be220 - 24 = 196.
Subtract your RHR from your HRmax. This is your heart rate reserve (HRmaxRESERVE). For example,HRmaxRESERVE = 196 - 78 = 118.
Calculate the lower limit of your THR. Figure 60% of the HRmaxRESERVE (multiply by 0.6) and add your RHR to the answer. For example,(118 * 0.6) + 78 = 149.
Calculate the upper limit of your THR. Figure 80% of the HRmaxRESERVE (multiply by 0.8) and add your RHR to the answer. For example,(118 * 0.8) + 78 = 172.
Divide the values obtained in steps 3 and 4 by the number 6 to obtain your THR in beats per ten seconds. For example,149 / 6 = 25 (lower limit)172 / 6 = 29 (upper limit)
- When you take your reading for your resting heart rate, make sure to do so the morning after a day where you are rested, as trying to do this after a day of a hard workout can affect your results.
You should ensure during your workout that your heart rate falls within your target heart rate zone to maximize cardiovascular fitness.
A rule-of-thumb is that if you're able to sing, you're not working out hard enough. Conversely, if you're not able to talk, you're working out too hard.
One of the most common ways to take a pulse is to lightly touch the artery on the thumb-side of the wrist, using your index and middle fingers. This is called a radial pulse check.
You may also place two fingers below the jawline, along the trachea (windpipe) to feel for a pulse, again using your index and middle fingers. This is called a carotid pulse check.
When taking your pulse for ten seconds during a workout, stop exercising. Do not allow yourself to rest before taking your pulse, and immediately resume exercise after the ten seconds. Multiply by 6 and you'll have your heart rate.
If you are serious about working out and becoming more cardiovascularly fit, you may want to consider purchasing a heart monitor for accurate readings during your workout sessions.
You can calculate your THR using the Karvonen method by online calculators, but if you take five minutes to do it yourself, then you will better understand the meaning of the numbers.
Running or jogging is one of the best ways there is to lose weight fast. It burns tons of calories and gets your body burning fat. Running strengthens the heart, lungs and can be done just about anywhere at anytime.
The problem is most people don’t know where to begin and usually do it wrong.
In this article I am going to show you an effective way to start a running or jogging program without killing yourself.
The first mistake people make when they begin a running or jogging program is that they run too fast. This will leave you out of breath and spent in about 5 or 10 minutes. When this happens people generally think to themselves that anyone who runs is crazy or likes punishing themselves.
This simply is not true. Once I found out how to run properly, I was able to run a few miles with ease and comfort.
I had been running for about a month and was up to two miles. But at the end of these two miles, I felt as if I was going to keel over and die. My legs hurt. My lungs hurt. Everything felt wrong.
I thought I would just keep running these two miles until it became easier, but it never did. It got harder, if anything.
Then I heard about a guy named Stu Mittleman. This guy had run from San Diego to New York in 56 days. Basically Stu ran two marathons a day for 56 days. So I bought his book called Slow Burn and it completely changed any negative feelings I had about running.
The first thing I did was bought a heart rate monitor. This cost around 100 dollars and was the best purchase I have ever made. It allowed me to monitor my heart rate and stay at a comfortable running level, even while running up hills.
What I did, was started running at 50 to 70% of my maximum heart rate. At first, I felt like I was going too slow and not getting a good workout. But within a week, I was able to run 4 miles without any problems. The best thing was that after the four miles, I felt incredible. Instead of feeling like I was going to die before, I actually felt better.
To find your targeted heart rate zone, do the following:
Subtract your age from 220. Then multiply this by .50 and .70 and that will give you your targeted zone.
Example: Age 28
220-28 = 192
192 x .50 = 96
192 x .70 = 134
By this example, if you are 28, then you should be running in the heart rate zone of 96 to 134. To make it easier to remember, just round it up to 100-135.
If you are running in this zone, you will probably be very comfortable and be able to run a good distance.
You see, the problem people usually face is that they start off running too fast. You just need to slow down. It isn’t necessarily how hard you run, but that you are moving as much as possible, as often as possible.
Once you begin to add mileage, you will get in better shape and be running faster anyways. You just won’t be working any harder. Your body will adapt, and you will begin to move more efficiently, without more effort.
This program worked perfect for me, and has turned me into a runner for life. I hope it does the same for you.
About The Author
This article was written by Jason Barger. Jason has been helping people lose weight with his breakthrough book, Primal Weight Loss. To learn more about his philosophy and programs you can visit http://www.primalhealth.com
Monday, March 10, 2008
I had to leave Principles early to go to an appointment with a new nurse practitioner that will be my primary care provider in Spokane. She was fantastic. Her name is Teresa Colley and she was very thorough and personable and kind. I was impressed by the level of her knowledge and she treated each of the problems I presented (just two) with a good mix of practicality and thoroughness that I liked. Her clinic is Grace Clinic in Spokane, and it is a ARNP-only practice that she appears to own. (A relative of hers is the office manager, I think it might be her sister but I'm not certain.) I like the seriousness and concern for exhausting all avenues that I get from nurse practitioners, and I like supporting advanced practice nursing, especially since I am working towards that goal myself. It is tough being a licenced independent provider in a world owned by doctors, especially in a town like Spokane, which is surprisingly unfriendly to advanced practice nurses, given the number of masters programs it has.
So, after all of that, I went to the Y to do my run, at minimum. I'm still sort of making all this up as I go along. I do know that I want to continue to increase the amount of time I can run in a stretch, and eventually the speed, and I want to avoid injuring myself in the process. I make little deals with myself as I go along. Today my deal came at the start of my third running interval: if I did 5 minutes consecutively for the last one, I was done. If I only did 4, I would have to do another 2 minute interval to finish. I was proud that I ended up doing the first one of 7 minutes, walked 5, ran 5, walked 4, and ran 5. 17 total minutes I have done before, but that 7 minute initial stretch was great. I felt a little emotional after it was over. I thought about where I was last year at this time, waiting for surgery and worried that it might not work at all. I was working out already and had been for a year, and frankly I thought I was doing pretty well. I was doing 45-60 minutes of cardio 5 days a week. But it was at a much lower intensity than I am doing now. Today I marveled that I am able to run at all, and I don't want to die at the end of it. I felt grateful to my lap band, and grateful to myself for improving my life the way I have in the past year. I thought about it a little bit in terms of a dharma, or lesson of wisdom, about running from pain versus accepting it and running anyway. Pain and pleasure are opposites that rule our lives these days, and obsession with both--avoiding pain, seeking pleasure--only causes more suffering for ourselves and those around us. Here I was, running when I could be sitting on my couch (I could even be reading my many textbooks and making myself feel good for the decision), and while I can't say that I was loving every minute of it, I was certainly loving the fact that I could do it at all, that I didn't want to die the whole time, and that it was changing my body and helping me become healthy enough to do the things I want and need to do with my life. I thought about my life today versus 6 months ago--I am out of the ICU forever, in graduate school, much thinner, and really relishing my life, as frustrating as it can be sometimes in its circumstances. I'm sure endorphins had something to do with all of this gratitude, but maybe that's part of why people get addicted to running in the first place.
Sunday, March 9, 2008
I did get outside briefly today, went to REI to look at clearance snowshoes. I found a pair for myself and they are quite nice. The price was reasonable, not earth-shatteringly low but good enough, and comparable to what is being found used on Craigslist. And they are Atlas, the good kind. Nice bindings. I HOPE that we don't have more snow this year, and I can just leave them in the closet until about November or so. But they are real purdy.
Here are the pics.
Friday, March 7, 2008
Found a new blog (during a study break...I'm allowed, ok?) called Half of Me. Link is in the sidebar (under Other WLS). It's not really new, she's already lost 200 lbs so the ship has sailed, really. But it's interesting, she's a good writer, and she likes to run, so I find that relevent. Here's a comic stolen from her blog, which she borrowed from xkcd.com. (Here's the really neato Creative Commons Attribution-NonCommercial license that makes it all okay.)
Tasty vs. Easy, an illustrated fruit graph:
Wednesday, March 5, 2008
Please. They all succeed, they all fail. It's more dependent on how you use it, how much personal responsibility you take, and how closely you matched your own (honestly assessed) personal situation with what the surgery can do. Also there's a little bit of luck in there. People don't ask to become reactive hypoglycemics, or for their lap bands to slip while lifting heavy furniture. That stuff you can't really plan for or avoid.
The worst is on Obesity Help, or I suppose on any board that throws all the WLS players into the same playpen. It gets ugly. My god, does it get ugly. WTF is that about? My personal take is that each of the available procedures is right for someone, and none is right for everyone. They all have their own drawbacks, their own advantages, their own particular quirks and risks. None of them are really proven in the real long term--like 40 or 50 years--and this is generally considered okay, because the morbidly obese won't survive very long if they don't change anyway, right? (That's a trick question. There are lots of pretty healthy MO people out there, despite what the weight loss industry, including medical and surgical weight loss, would have you think. And there are a lot of people who were healthier BEFORE their WLS than after.)
So don't quote me anything about what "the research shows" because the jury is not back yet, and there are dozens of contradictory studies out there. And the research doesn't really matter if you don't do your own part with your own surgery. This has a chance of failing for everyone--because, well, this is life, and nothing is certain, or permanent. Especially not "permanent weight loss."
1. I have a crazy memory for numbers. I remember numbers forever. I can still remember my childhood phone number (588-1317), my college apartment phone number (545-3837, hello 1993) and my house phone from my first marriage, 10 years ago (762-6258). I remember the 16 digit number of my last 3 ATM cards and my Visa card... and some other credit card numbers that I haven't used in a couple of years. In fact, it took me over 2 years of having a new Master padlock for the gym to stop trying my old padlock combination on it, which I haven't used since about 1995. True story.
2. I am the first member of my generation in my family to get a college degree. I might end up being the only one in my generation to get my master's. My father and his mother both have masters' degrees, and my maternal grandfather had a doctorate in botany. In fact, all four of my grandparents graduated from college, which is fairly unusual for their generation, especially for both of my grandmothers (one is 87 and the other would be 101 this year) and my paternal grandfather, who is a farmer.
3. I had a sister who died before I was born. She had severe birth defects from a medication my mother had been prescribed for severe morning sickness, and died at 11 months old.
4. I lived in Washington state for the first 29 years of my life, and I have never been skiing.
5. I met my husband on Match.com. Thanks, Match!
6. I do not let go of relationships with people I care about easily. I am still friends with most of my ex-boyfriends, and still maintain contact with my former mother-in-law (ex's mom), with whom I always had a wonderful relationship. This has nothing to do with keeping any flame alive, but everything to do with valuing the good people that I have come in contact with in my life.
7. Along the same vein, I still have a penpal that I first started corresponding with when we were both 8 years old. Her name is Nancy, she grew up in Brooklyn when I was growing up in Tacoma WA, and we are about 2 weeks apart in age. She is now a PhD and works in the field of economics of developing countries. We have only met in person one time, when we were in college in the early 90s.
8. I went on my first diet when I was 11 years old. I lost 25 lbs. Within 2 years, I was bulemic, but I outgrew it in high school.
9. When I was in nursing school, I also sang in my college concert choir, which had 80 members. I was an alto II. We recorded two CDs while I was in the group, and they still make me teary sometimes when I listen to the recordings.
10. When I was a teenager, I planned on being a violin performance major. I changed that to music therapy when I was a senior in high school, but after getting a scholarship and graduating, I decided (wisely) that I wasn't ready for college yet, and ended up taking a year off before completely switching gears to nursing. It was a good decision, both the year off and the nursing degree.
Tuesday, March 4, 2008
I found the same cut as the 10s, finally, and they fit. They were a little snug, but after wearing them around the house for a couple of hours, they fit perfectly. Score!
I have weird rules about deciding when I have actually dropped a size. I have to be consistently buying clothes in that size, at several different stores, for me to consider myself "that size". And not just the Gap store brands either, they are notoriously kind to American women. So I don't really consider myself an 8 just yet. BUT, usually I fit into the lower size skirt long before jeans of any brand or cut. And I really haven't tried on size 8 skirts, because A, my 10s seem to fit fine still, and B, I don't need any more skirts. I don't need any clothes, really, except that the baggy 10s were really bugging me. I don't like a saggy butt! Incidentally, I tried 10s in the cut that I had bought before, and even they didn't fit in the thighs. But I can buy size 10 at pretty much any store now, and it will fit. So I don't really think it's so much that I am copping out on the jeans. I am not REALLY a true size 8 yet, but I do think I am close, and since these jeans fit NOW, I will take it! :)
I must go run now. Toodles.
Monday, March 3, 2008
WTF?? So all I can think is someone hijacked it, and changed the email address on the account. Either that or I'm in trouble for some reason.
Today was the big Physio (A&P) test and it sucked. We studied ALL weekend, all 8 of us. I studied with Cat and Connie, and made the biggest stack of index cards ever. Felt as ready as I ever would. Well, the things I know I got wrong, I just wouldn't have known. I don't remember her lecturing on them or reading them (do YOU know what terminates the reaction of a G protein ligand bound receptor??). Just flat out don't know. I am pretty sure I passed, but not 100%. We'll see...I think next Monday??? Argh!
Hanging at the same weight. Did my full 45 min cardio (including 16 minutes of running) and full weight set. Felt very good to do it all, especially since I did no exercise yesterday, opting to use the time to study instead. (Unless you count walking 2 miles total to get to/from Connie's apartment...that doesn't count.) Did I mention I only have 22 lbs to goal? And that I STILL can't fit in the size 8 jeans? LOL.
I have other things to focus on, though. Connie was looking into a Buddhist temple here in Spokane, which is exactly what I've been looking into, too. So we're going to go, there is 1 Buddhist temple (and a Zen Buddhism center, as well) in Spokane, and they have an Intro to Buddhism series that we want to go to, when the next one starts up. It looks a lot closer to whatever I believe about life and the universe than anything else I've seen so far. I am reading about Impermanence and the Worldly Dharmas --the Eight Worldly Dharmas, which are pairs: Pleasure and pain, loss and gain, praise and blame, fame and disgrace. And lots of other very Buddhist things. It all sounds very intriguing. In Spokane, especially if you are white (like the other 99% of Spokanites) it is assumed that you are Christian. Especially in my program, which is based out of a Jesuit school and a Sisters of Providence hospital. They don't assume you are Catholic, but at LEAST Christian, gosh! Sometimes it's humorous, sometimes it's more maddening. I was raised in a Christian (Episcopalian) tradition, actually pretty devout for Episcopalians. The road has been winding and long, but now I just can't come up with any more convincing reason to consider myself Christian than habit and guilt. And friends, that just ain't good enough for me anymore. Nothing wrong with Jesus, but I get a little crazy around his followers.
Sunday, March 2, 2008
Yesterday in my perusals of the LBT board, I came across a thread started by a relatively new bandster who wanted to know how to get better nutrition in liquid form. It seems she likes to be very, very restricted, and had posted another thread about how she never talks to a doctor or even her fill nurse about her weight loss, eating habits or anything, just plunks down the cash and gets filled. And she felt this was very empowering, being in charge like that and getting fills whenever she felt like it--every day, if she wanted, according to her posts. So here she is on another thread, clearly overfilled since she can only get liquids down. I don't think she is a bad bandster, but I do think she is misinformed and the rapid weight loss only encourages the misinformation. Who would want to go back to eating solids and slowing her weight loss if she can take liquids all the time and not be hungry and lose weight rapidly? Never mind the fact that the band is supposed to be a healthier way to lose weight than the pure starvation of the malabsorptive procedures.
It's easy to see how people end up with eating disorders after bariatric surgery.
There is a reply on her thread from another member who I believe is less than a year out and lost over 100 lbs and is below her goal weight. She said she liked that kind of restriction too, and spent "months and months" sliming every day. She found it "helpful". And when she got hungry...Peanut M&Ms. This member posts frequently and I've never read anything this alarming by her before. But it goes to show the boards can be a dangerous place. People offer advice like this frequently. Anything that works to lose weight is fair game. They avoid the Complications section of LBT...don't want to hear about people losing their bands after slips and erosions. And more and more it seems people are accepting daily vomiting as normal for bandsters.
The nutritionists at my surgeons' office give a pretty convincing speech about how vomiting every day is NOT normal and is a reason to get in to see the surgeons ASAP. But this positive reinforcement thing is very hard to combat: why change what you are doing when you are losing weight? Well, the reason is, vomiting makes your stomach twist and collapse itself pretty violently. Most of the force of vomiting is produced by the skeletal muscles of your chest and abdomen and by the diaphragm, but the stomach makes deep twisting movements (I want to say they are beta reflexes...where is Bob Martindale when you need him?) that can move a lapband out of place and prolapse the stomach through the band. Add to that the risk of Mallory-Weiss tears, mucosal erosion and other problems associated with frequent vomiting...there is a long list. But it seems pretty sensible to say that anything that forces your stomach to move a lot when you have a piece of plastic around it that you don't want to move, probably isn't a good idea. Plus, wouldn't it be nice to keep food in your stomach and get nutrition from it?
Saturday, March 1, 2008
The more I read posts on this site, the more I see that patient results are all over the map. In the end, your actions will determine your results. Your level of activity and your self-discipline / self-control will seal your fate. It's a lot of work, no doubt about it.I sometimes feel disappointed or dumbfounded when I see a post such as this - one bandster was consoling another bandster by saying, 'it's ok if you haven't lost any weight because I had my surgery 8 months ago and haven't lost ANY weight.' This is NOT good advice. That individual clearly has issues.
My former therapist once gave me some advice that I will never forget. Now, I don't remember his exact words, which were quite eloquent, but this was basically what he told me. We are made up of three persons - our inner child, our adolescent, and our adult. In any given situation, you can ask yourself, "Who's in charge?" I'm finding that sometimes I'll use his advice when I have to choose between something like a cookie or a sugar-free Jello cup. If I choose the cookie, I know my adolescent is in charge. If I choose the Jello than I know my adult is in control.
For what it's worth, I hope my post will reach someone who needs it. We put our bodies through the lap-band surgery process, and it's a shame to see folks still eating whatever they damn well please. (I don't mean to sound like a bitch there. I'm really a very nice person.)
Who's in charge today for you?
As of this morning, I am officially down 52 pounds. My bandiversary is on March 13, so provided that I maintain this most recent loss by then (or hopefully, add to it) I will have averaged 1 lb per week weight loss this year. That doesn't sound like much to a lot of bandsters, or even to most people researching WLS. But to me, that is a big deal. I've never lost more than 1/2 lb per week, let alone maintain that loss. And if I am within the low average weight loss for the first year after band surgery, that makes me happy! And I am within 22 lbs of my goal, which makes me very happy.
At this time last year I had just scheduled my surgery and sorted out my medical leave. I felt huge, miserable, and desperate, but also saw some light at the end of the tunnel. I had just found out that I was accepted into school, and had all but decided to go to Gonzaga no matter what the outcome at OHSU. (And now that I look at my calendar, today was the day of my OHSU interview last year.) I didn't really allow myself to think too much about where I'd be today, back then. I just wanted to get through surgery and see if it would work for me. I certainly didn't think I'd be running by now, by choice! :)
Speaking of running, last night I did a total of 16.5 minutes running over a total of 45 min on the treadmill. I felt good, and was able to do 2-5 minute sprints (I ran for 5 min, and alternated with walking-next 4 min, 5 min, 2.5 min). My resting HR seems to be hanging about 80-84 bpm. My max HR when I finish a running stretch is 164-176, and it recovers quickly. Things are going well, and my legs can definitely tell they are getting more of a workout these days.
Now I just want to get into those size 8 jeans I bought. It's funny, the 10's I am wearing are getting baggy, but I bought the same brand and style of size 8 and I can't get them over my hips. What's up with that? So I'll try them again in another 3 lbs.
OK, this weekend is all about studying, so I am outta here. Big test Monday.