Monday, June 30, 2008
This weekend was a scorcher...98 degrees and humid, ugh. Saturday was supposed to be a run day but it just was not going to happen. However, it was HoopFest, and we did walk downtown, and then back uptown, and all over...all told we walked 7 miles in 98+ degrees. So I didn't feel too bad about putting off my run until the following evening, when it had cooled down to a balmy 90 degrees. It was an evening in which I was glad that most of Spokane has not discovered buried irrigation for their lawns...I could run from one side of the road to the other, passing through the neighbors' sprinklers, to cool off.
It's still plenty hot, and humid. We had pharmacology class at our instructor's house today. It consisted of an hour or so of review for our exam, which is in 2 weeks, then pizza and beer. I did reasonably well, ate too many crackers, but just a small piece of pizza, and didn't even have an ice cream bar before leaving. Hot days just don't leave you hungry.
I have lots of studying to do this week. We are wrapping up our clinical orientation this week, then we are off for the weekend after class on Weds. Upon our return on the following Monday, we start clinicals. Scary! But before then, I'll spend about 5 days in Portland, which will be nice. I have some get-togethers planned with friends I haven't seen in a long, long time.
This afternoon one of my classmates asked if I'd lost weight since we started school. It's kind of funny, because my class knows I have had lap band surgery, but the idea of actually losing weight during anethesia school is really bizarre, I guess. I've lost 20 lbs since starting school, whereas everyone else has put on at least 5. I think I might have lost more if I hadn't been in school. It doesn't matter anyway, but it was nice that she noticed just the same.
This week I've been having the feeling that I'm forgetting or neglecting something. I can't quite put my finger on what it is. Do you ever have that feeling? Perhaps I just have a lot of things coming up and I'm trying not to forget any of them. I'm not sure. But it's unsettling. The hot weather tends to slow down time, and the afternoon slips away before I realize it. Maybe that doesn't make sense, but it seems right.
Friday, June 27, 2008
Hubby is driving here as we speak, and should be here by about 11. This is the third weekend in a row that we've been able to spend together, and folks, that is nice. Kiss your honey today and be glad you are able to see each other every day (if you are). I miss that, and it will be another 2 years before we have that luxury again.
Weight is holding steady...haven't gained, haven't lost. I had an awesome run on Tuesday that I thought would surely break some kind of distance or time record for me. I felt so strong and energetic. But when I mapped the route out, both my distance and time were just okay. Then yesterday's run, I felt like I was dragging, but I got out a much better distance (if not time). So, I don't know what to think of that. But I'm up to 13.5 miles this week and I still will run tomorrow, probably 3 miles. So I feel pretty good about that.
I'm starting to notice myself craving things that I haven't eaten in a very long time. Things like pasta. I've turned away from pasta without a glance backward for a long time now. I'm not on a super carb restriction, I just don't think there's a lot of nutritional value in pasta, especially yummy, white semolina pasta. But for over a week I've been getting these periodic cravings for delicious pasta. Don't know what that's about. I haven't decided if I'm going to fight the urge for a while longer or if it's better to just have the pasta and move on. I don't know if it's the kind of craving that goes away after you indulge it, or if it opens the basement door to let the Pasta Monster loose forever, destroying the landscape and smashing my best weight loss efforts like Godzilla.
I also notice that I'm not alone in slipping almost imperceptibly off the bandwagon after a year of weight loss effort. On a forum I visit, there is a group for people who were banded in the same month. My "Marchies" (March 07 bandsters) are a great group of supportive gals who have been at this the same amount of time and share many of the same experiences. About a month ago many on that group started reporting this kind of thing...a drop in their motivation, slipping up by letting more and more junk back into their diets. I can relate to that. Overall my diet is still not bad, but I definitely allow more junk in than I used to. Somehow I think we have to be able to learn how to have treats regularly without slipping back into old habits of eating them frequently. Who can live such an austere culinary life forever? I hear it said a lot, "If I could control my eating, I wouldn't have needed this surgery." But having this surgery is an opportunity to learn to control eating. Once the physiologic hunger is abated, that is one less thing to worry about as we try to control the heart of the issue: eating for all the other reasons besides hunger. Make no mistake, that is the hard part, and that's something I think most of us will spend the rest of our lives working on.
I think that has a lot to do with why many bandsters keep going back for fill after fill after fill, complaining that "I can still eat too much". That's looking for the solution in the wrong place. You CAN eat too much...you have to learn NOT to, somehow. Yes, it's not easy. I'm not suggesting that I've figured it out, either. But I do know that if the band is tight enough to force food out of your stomach after a few bites, it's too tight for your stomach to tolerate for long. We have to find a solution in our brain and our heart. That solution lies somewhere in connecting your brain back to your emotions, and learning to make treats occasional--but not rare--and keep our portions smaller. A small slice of cake isn't going to hurt you if it's not a regular occurance. But keeping your band so tight that you can only eat 2 bites of it WILL hurt you eventually.
Tuesday, June 24, 2008
The second is protein shakes.
Many banded patients swear by their protein shakes. Sometimes, their doctors tell them to drink the protein shakes--usually doctors that ask their patients to take in more protein than is physically possible with a diet of solid food, protein requirements that are generally agreed to be appropriate for patients with malabsorption only, such as gastric bypass or duodenal switch. Other patients are told at some point by their doctors not to drink "liquid calories", but perhaps not explicitly told that protein shakes could sabotage their weight loss efforts--yet they are afraid of not getting enough protein, so they rely on protein shakes.
Protein shakes seem to be a controversial topic among bandsters for these and other reasons. The idea of protein shakes is very reassuring to a lot of people--it must provide "complete" nutrition, right? And it's easy, and some people enjoy the taste. They provide lots of protein for your nutritional "buck". Protein shakes are good for weight loss, right?
To look at this, we need to separate the way protein shakes work in the general population from the way they work in the banded patient. There are compelling reasons to think that protein shakes don't benefit the general population who do not have lap bands. (In this discussion, I'm not including people who have had other bariatric surgeries that utilize malabsorption. These patients have special nutritional requirements--usually protein supplements are a necessary part of their diets.)
Let me briefly add the disclaimer that I am not a doctor or a nutritionist. I am commenting on this topic as a registered nurse, a student nurse anesthetist who has recently studied the physiology of the GI system (tested last week on it, at the cellular level), a bariatric surgery patient, and a frequent consumer of scientific journals. These thoughts are not intended as the gospel truth but as food for thought, so to speak. I hope my arguments seem logical and provide a jumping-off point for more research and questions on the part of my readers.
The argument for protein drinks is basically this: protein increases satiety, so drinking a protein supplement will make one feel full longer. This is a controversial idea, in and of itself. There is good evidence that SOLID protein does increase satiety (which is the feeling that one is not hungry, or does not want to eat), although it is not clear why. Satiety is controlled by many factors--the pressure that a volume of food exerts on our GI tract is one factor, the kinds of digestive hormones and enzymes stimulated are another, the amount of carbohydrate present, our levels (and stability) of blood glucose, the amount of thermogenesis that digestion produces, etc. There is also good evidence that liquid calories--any beverage that contains calories--do NOT affect satiety. It appears that our bodies are unable to recognize the calories contained in a beverage and as such, we tend to take in calories from food as though we had never taken in the calories in our beverages. This is the main reason that many diet experts have blamed the increase in soda consumption for our increasing incidence of obesity over the past 30 years. Beverages containing primarily carbohydrates are most commonly blamed, but the same effect has been seen with beverages that derive most of their calories from protein, like protein supplement drinks. One mainstream media article about this idea that was widely posted in April 2008 can be found here. Here is a clip from that article:
Why do liquid calories fail to elicit the same response as whole foods? Reasons include:
-high calorie density
-lower satiety value
-more calories ingested in short period of time
-lower demand for oral processing [e.g. chewing]
-shorter gastrointestinal transit times
-energy in beverages has greater bioaccessibility and bioavailability
-mechanisms may include cognitive, orosensory, digestive, metabolic, endocrine and neural influences (human appetite is a complex thing!!!)
Last but not least, nowhere in our history have our ancestors had access to large amounts of liquid calories. Alcohol may have been around as far back as several thousand years BC, but even that is a blip on the evolutionary calendar of humanity.
As a result, our genetic code has never developed the physiological mechanisms to properly register the caloric content in liquids the way it does when you eat, chew and swallow whole foods.
So, those are some proposed effects of liquid protein on the non-banded person. How is this different in people who have the lap band? Any liquid calories defeat the purpose of the lap band. The band basically turns your stomach into a funnel: the band creates a top portion to hold food in, which slowly drips through the banded portion (the "neck" of the funnel) and into the lower portion of the stomach. Once the food is in the lower portion of the stomach, it is no longer helping you feel full--it's the pressure that the food exerts on the walls of that sensitive part of the upper stomach "pouch" that helps us feel full so we eat less. Any liquid will just go right through that funnel. So any calories taken that way will not help us physically feel any more satisfied, even if it's protein--because it seems that when you turn protein into a liquid, its properties of increased satiety are negated. It seems that protein keeps us satisfied longer because it's harder to digest, but when it is turned into a liquid it is basically pre-digested, so we lose that benefit.
Many banded people swear that their daily protein shake helps them feel full longer, and they carefully keep their calories very low and make sure not to eat more than a certain level. I'm not really sure how to respond to that. If it works for you, that's great. But it's something to think about if your weight loss tapers off or stops--are you sure you aren't eating more than you would be if you replaced that protein shake with solid food?
Obviously, any time you are required (by your doc) to stay on a liquid diet when banded, a protein supplement is a good thing to have in your diet. This would include the post-op liquid diet, after a fill (recommendations vary, but my doctors have told me to have only liquids for 24 hours after a fill), or when an esophageal or pouch dilation is suspected, or when your fill is too tight and you are going to go in for an unfill. But if you are on a regular diet, it's best to stick with solid food. If you are relying on protein shakes because you CAN'T eat (or keep down) solid food, you are filled too tightly, and you need an unfill, at least a small one.
That's one other big problem with having protein shakes as a regular part of a lap band diet--it can be hard to recognize when you are nursing a too-tight fill when you should really be slightly unfilled. Some people report going for months without realizing that they've been eating only soft, "easy" foods and liquids because they keep barfing up solid food, especially protein. Then that too-tight fill that has quietly converted their diet starts to show obvious symptoms--reflux or heartburn, pain, inability to keep even liquids down--and they find out that they've damaged their stomach or esophagus by not getting the fluid out months earlier. It's easy to be lulled into complacency because you're still losing weight. Nobody wants to be hungry, and that tight fill keeps us from eating much at all, without being hungry, so who would want to mess with that? But that kind of thinking can cost you your band in the long run.
This isn't really about protein per se, but I think it's an interesting blog post about how many calories are right for safe weight loss.
Reference for this article: Effects of food form on appetite and energy intake in lean and obese young adults. International Journal of Obesity. 2007 Nov (11):1688-95. Mourao DM, Bressan J, Campbell WW, Mattes RD. Department of Foods and Nutrition, Purdue University, West Lafayette, IN 47907-2059, USA.
Monday, June 23, 2008
But let's assume the target weight is your perfect physiologic goal weight. When are you a success? When you "hit" it? When you've lived at it for a month, a year, 5 years? When you seem stable at that weight? Can you be a success before then? How about when your obesity related comorbidities are a distant memory, when you are off your BP meds and CPAP, when you are reasonably fit? The surgeons consider "success" at WLS to be 60% of excess weight lost--which I have already surpassed. So does your goal fall at 60% lost, or 100% lost? Is success before or after your tummy tuck?
I was just thinking about this because I've read several blogs by blog buddies lately who have reached their goal (or very close to their goal) and now are struggling with a few pounds regained for various, perfectly good (but I'm sure, stressful and scary nonetheless) reasons. It just drives home that point that we have never "arrived" really, it's always something we have to maintain, or re-achieve, and sometimes life interferes with that or makes it harder. I think that must be part of why so many people are subconsciously scared to reach their goal. What do you do then? How do you maintain? Most of us know how to LOSE weight and how to GAIN it, but have little or no experience with maintaining a healthy weight. Myself included!
I have glimpses of success frequently these days, although I remain 12 lbs above my (first) goal weight. I see myself in a store window sometimes and wonder who that slim person is. My hubby frequently asks me (mostly joking, I think) to stop losing weight. After all, this is uncharted territory for both of us--I weigh less than I ever have since he's known me. I wear sizes that I didn't even hope to achieve when I was first researching WLS. Like so many women, I "didn't want to be skinny, just healthy"--although skinny was definitely the cherry on top of the sundae that we all desperately wanted. When I check out my excess skin (yes, I have it), I realize that what's underneath is even smaller than I imagined. But I really, really want to reach my goal.
I've felt like I've been plateaued for the last 3 months, but when I look on the progress graphs on Fitday, it's been a slow, bumpy, but sort of steady decline. In 4 months I've lost 12 lbs--that's not great in Lap Band terms, but not bad for being near goal either, especially with anesthesia school factored in. My classmates were talking about having gained weight in the last 6 months, and I didn't say a word because I'm probably the only one who has lost weight the whole time. And when I found a BMI calculator that could figure my actual BMI at 5'3.75" (my real height, not the 5'3" I've been using) I discovered that I'm just overweight now, at 29.8. Woot! Those little decimals make all the difference.
Of course, there really isn't any answer to the question of when you are a "success"--it's a philosophical question, and I'm sure it means something different to each person. To me, I can't consider myself a success until I've reached my first goal. I'll know it's "real" when I've maintained it for a good long time. There are lots of places to post your "before and after" pics, and I just can't post an "after" until I feel like an "after". I wonder if that will ever really happen. Will I ever feel like I "arrived?"
Thursday, June 19, 2008
Yet we all know that we need to exercise for a number of reasons. The most recent research indicates that exercise alone doesn't cause weight loss for most people, and it's certainly possible to lose weight without exercise. But weight loss isn't the only, or best, reason to exercise. We all know the reasons--heart health, bone health, etc. I think the most immediate results that we get from embarking on an exercise plan are improvement in mood and energy level, a sense of accomplishment, and an overall sense of well being. It feels good to move.
When you're overweight, you might feel too conspicuous to start working out in a gym or in front of others. It's easy to feel like people are noticing you, your size, making judgements about you while you are feeling clumsy and doing something new. First off, you have to start realizing that people really aren't paying as much attention to you as you think. We all think that everyone notices our every flaw, but the truth is that most people are paying attention to themselves and how THEY appear to everyone else, especially when exercising. That can be enough to get your foot out the door.
The hardest part about exercise is starting when you haven't done it in a long time (or ever). We have preconceived notions about what we "like" to do or don't like, and we have a comfort zone that doesn't include exercise. Let me tell you a secret: Most people who have lost a major amount of weight (and kept it off) will tell you that it can't happen without making some major changes to yourself personally, psychologically, spiritually. We have to change our comfort zone. Our comfort zone is what got us and kept us fat! Your comfort zone is not your friend. Get ready to challenge it, if you are serious about making healthy changes in your life. You can make that your new mantra when you are exercising: "My comfort zone is not my friend!"
How much should you exercise? The USDA has made exercise recommendations for the first time. Here they are:
- At least 30 minutes of moderate-intensity physical activity, above your usual activity, on most days of the week to reduce the risk of chronic disease in adulthood. Greater health benefits, say the Guidelines, can be reaped with a more intense program or one that is of longer duration.
- About 60 minutes of moderate- to vigorous-intensity activity most days of the week to help manage body weight and prevent gradual, unhealthy body-weight gain in adulthood.
- At least 60 to 90 minutes of moderate-intensity physical activity daily to sustain weight loss in adulthood.
So the key there is "most days of the week", not 3 days a week. I find it's easier to just plan on doing something everyday, rather than the old 3 days a week recommendation. But, if you're just starting out, 3 days is better than no days. A goal of 5 days a week is good though. 30 minutes per session to reduce risk of chronic disease, 60 minutes to prevent gradual weight gain, and 60-90 minutes daily to sustain weight loss. That doesn't address the recommendation when you are trying to LOSE weight. But when you are just starting out, I think the best thing is to pick how many times a week you can commit to and start doing that. If it's 2 or 3, make that commitment and go from there.
Next you need to choose an activity that you will enjoy doing, that you feel relatively comfortable doing, and that doesn't present a lot of barriers against doing it every day, or almost every day. For a lot of people, walking is the best way to start out. It doesn't take special equipment, doesn't have to be done at a fancy gym, and can be done no matter where you are or no matter what the weather. You don't have to do it in front of people, and you don't have to drive anywhere to do it (although it's nice to pick out a variety of settings if you like--scenic parks, riversides, lake trails, whatever you fancy). For some folks, that doesn't do it for whatever reason. It's good to think about your personality for this--if you are competitive, maybe training for a 5k (walking or running or both) would keep you motivated. If you like variety or don't like to feel like you are "exercising", maybe taking a dance class or some other class. Or finding a gym with a wide variety of group exercises that you would like to try might be the thing.
If you are interested in the traditional gym setting, I recommend visiting a LOT of gyms before settling on one. I'm very particular about the setting because if it's too noisy or chaotic, or doesn't have any natural lighting, I won't go regularly. I'll pay a little more for a setting that is refreshing and recharging to me. One great thing that the YMCA offers is a program called the 12 week program. It's based on the idea that it takes 12 weeks to establish a habit. It's offered by most Y's, I think, and it's free to members. You meet with a trainer in the beginning and about every 3 weeks until you finish. They set you up on a weights and cardio program--very basic--and help you advance through it until you finish. At the Y in Portland, they had a special room set aside for the 12 week program so you didn't have to exercise in front of the 20 year old bodybuilder types--there were old and young, thin and overweight people there, and it was very comfortable and welcoming. It was almost set up like circuit training. That's a thought for you--and the Y doesn't have a hard-sell membership policy, each club sets their own monthly rates, and often you don't have to pay an enrollment fee, although that varies according to club. Furthermore, many of them offer childcare and other amenities for families. The Y is a very friendly place to start exercising, I think, and many of them are getting fancier these days, so go check yours out.
Another thing that lots of new exercisers enjoy is DVDs at home. You don't have to buy them--your local library has a selection, as does Blockbuster and Netflix. There's a service called Flickety Fit that is similar to Netflix but rents all fitness DVDs--dance fitness, martial arts, yoga, pilates, stretching, walking, step, aquatics, cycle, you name it. You can do a huge variety of things in the privacy of your own home. This is a great way to try something out before committing to a class or some equipment that you aren't sure you want to shell out a lot of money for.
You might decide to buy equipment for your home. This works for a lot of people. I didn't do this because I move a lot and I don't have space for big equipment. But I would make the recommendation that you look for used exercise equipment. People are always selling barely-used treadmills and other equipment, and frequently they just want it out of their house. You can get pretty nice stuff for dirt cheap this way. Check your local craigslist before you look to buy something new.
The most important thing about starting an exercise program is learning how and when to advance yourself in the intensity and difficulty of your workout. Many people start out with a program, but just keep doing the same thing over and over and no longer see any improvement in their fitness level or their weight loss. Your body is very smart and efficient, and will get used to whatever you throw at it in a surprisingly short amount of time. You'll have to keep working a little harder, or a little longer, every few weeks to keep seeing benefits.
About motivation: I don't really believe in it when it comes to exercise. When you are comfortable, or tired, or sleeping in your bed, you are not motivated to exercise. Doesn't matter--what matters is your decision. Most regular exercisers would tell you that many days they do NOT feel "motivated" to exercise until they've actually started doing it. I know that if I can get myself to change my clothes into my workout clothes, I will exercise, and I'll be glad I did. So all I have to decide now is to change my clothes. You might have to play tricks with your mind to accomplish it--like telling yourself that you're only going to walk for 10 minutes, or that you're going to put on your walking shoes and just check the weather outside. Once you've gotten out the door, you'll feel like doing your routine. And if you don't? Well, you can just do your 10 minutes. There are days that I'm just not feeling it and I do cut it short that day. Not very often, but if I've gotten midway through a workout and I'm still just slogging through, sometimes I just wrap it up for the day. Most of the time, you make the decision to do this, and you find a way to move your body until your brain catches up with it. Believe me, you'll feel especially good about yourself when you didn't want to go work out, but you did anyway and you felt great afterward. You'll feel like you found a secret that no one else has.
So, my biggest tips, in a nutshell:
1. Find the thing that you have the least excuses not to do, and something that you like, or at least don't hate
2. Find a way to get yourself out the door to do it--once you start doing it, you'll feel like continuing most of the time. Don't wait to get "motivated."
3. Know that most people aren't talking about how fat you are, or what you look like when you exercise--they are thinking those things about THEMSELVES. Get over yourself and go do it!
4. Challenge your idea of what you "like" to do, or your idea of what kind of person you are. You can be the kind of person who likes to exercise--or a person who does it because you have to--but either way, you have to challenge yourself to find out what you will like. The only way to find out is to do it.
5. While you are challenging yourself, do pick something that you are comfortable enough with that you will actually do it. You don't have to start running 5 miles a day, or taking spin classes, or going into a gym. You might find that you want to do those things later, so don't rule them out, but you don't have to start out there.
6. Be open to the changes in yourself that come with being healthier. We like to say that we will be the same person if we lose weight--but truth is, we aren't the same person. Few people are successful at major weight loss without experiencing significant changes in themselves personally. Almost always, this is for the better.
This was really long, but I hope it helps someone. You may shock the hell out of yourself one day, like I did, and discover that you enjoy running. Or some other crazy thing. You never know.
I'm hanging on at this weight--I gained about 1/2 lb, but have held steady for 4 days since then. I'm cool with that. I'm at almost 13 miles run for the week and I still plan to run on Saturday--my mileage goal for the week is around 14 miles but I doubt I'll stick to a 2 miler on Saturday. I never do. I went to the gym yesterday and did just upper body weights and core. I've decided not to lift with my legs anymore and see if it improves my running. From what I read it's not necessary for running itself, and I don't know that it benefits me otherwise. It certainly makes my legs more tired if I lift on my non-run days, and I never have time or energy to do it on my run days. So that's the plan for now, and we'll see how it goes. I'm still doing upper body and core and swimming at least one of my off days. The exercise plan is always a work in progress.
The eating is pretty good though. I feel that my fill level is appropriate even though I think I have a lot of room to go if I wanted more restriction. At this level, I'm getting hungry at an appropriate time, and I can be satisfied on 1 cup of food. I can definitely eat more if I don't pay attention. But I don't want to be in a position where the band FORCES me to stop eating, so at this point I don't see how more fill would benefit me.
I have one more post I want to make separately, then off to bed. Early rise in the morning--5:45. It's Friday!
Monday, June 16, 2008
We planned a class celebration after the exam, because the end of this class is a big milestone in our first year. When I got done with the test, though, I was so tired, I just went home and took a nice long nap. I spent the rest of the day reading a book (not a text book!) and then went for a nice long walk in Riverside Park. I took a lot of photos. I'll post some when I sort through them. It was a perfect day--maybe close to 90 degrees today at the hottest, but it was 83 at 6pm when I went to the park. I walked for about 90 minutes, then did some more reading, got some groceries and came home. I probably should have gotten back here sooner--I should really be asleep by now, as we start clinical orientation in the morning. But I definitely needed the day to recharge, after studying like a madwoman for the last 2 weeks.
Today I hardly felt hungry at all, and ate very conservatively. I'm at a good restriction point right now--hunger perfectly maintained for 3-4 hours after a small meal of about 1 cup of food. I've been making beans in the slow cooker lately and that has been working out great--lots of protein and fiber, and delicious and easy to reheat and have a quick little meal. This time it was Vegetarian Boston Baked Beans. Yum!
Sunday, June 15, 2008
Today was a beautiful, sunny Spokane day. Hubby and I got up and went to breakfast, then I did a bit of studying before we headed out to a sports bar to watch Tiger in the US Open. We enjoy watching Tiger on Sundays, it's a bit of a tradition for us. But we don't have a TV in Spokane (the giant TV lives in Portland, it's better that I don't have the distraction here) so on the rare occasion that we do want to watch something (usually a sports event) we go to a bar. Then, it ended quite late, so he had to leave once we got home. Not to worry, though, he'll be back later this week. :)
After he left, I went back to the People's Park by the Spokane River for a nice 3.9 mile run. It was still at least 75 degrees although the sun was going down by then. What a lovely day. The run was tiring, but since we had nachos at the bar I really needed the run! Now it's time to shower, look over my cards one more time, and go to bed.
Sometime this week, if the weather holds up, I'll go back with my camera and take some photos by the river. It's really a beautiful spot. And if my weight loss survives the nachos, I'll be a happy girl.
Anonymous, if you wanted a dialogue about the qualifications and competency of nurse anesthetists vs. anesthesiol0gists, the honest thing would have been to include a name or an email address. I have it all hanging out here--my name, my pictures, my city, all the details of my bariatric surgery and my schooling-- even my weight is posted on this blog. And you don't have the courage to include your name to make this an actual discussion.
Furthermore, you detail the ways in which the CRNAs in your (former) practice were unpr0fessional and unsafe. Yet your practice didn't do the obvious things, which would be to report the practitioners to their state licensing board, or fire their asses. Rather than go after unsafe practitioners, your organization would rather simply hold these people up as representative examples of the profession to the public, as a reason why the public should only accept MDs for their anesthesia. Yet, you continue to hire CRNAs in your practices, because you can "supervise" 4 of them at a time, and bill at 50% for supervising them. (Yes, folks, that's 200% billing at one time.) All this, and you earn at least 4x the salary of a CRNA.
If your complaint is accurate (and I've only heard your obviously biased side of the story), your practice hired some incredibly unpr0fessional nurse anesthetists. The practice shares the blame in allowing them to continue to work. We all know that your professional organization would rather replace all CRNAs with anesthesia ass1stants, who are under your complete control. However, unless you are going to make your salaries affordable for rural hospitals, there would be no anesthesia providers for most hospitals in the country, because they can't afford an anesthesiol0gist, let alone one plus an anesthesia ass1stant. CRNAs will always be around because a, you guys make money off us, and b, you aren't willing to work in Backwater Oregon's 100 bed Level 4 hospital for half of what you make in Seattle or San Diego.
That's great that you're moving on to an all MD practice--but if you feel so great about that, why do you feel the need to Google "crnas+inferi0r" and leave anonymous comments on some student nurse anesthetist's bariatric surgery blog?
That's all the space you get here. Back to my regularly scheduled WLS content.
Saturday, June 14, 2008
I finally lost 2 lbs. Yay! I'm hoping they don't come right back. I don't know what I did, except be more aware of what I was eating. I also haven't really eaten out in the last week or so, which probably helps (can't hurt).
I am inching soooo close to "overweight" in my BMI, after years in the obese (and morbidly obese) category. I'm looking forward to just being overweight. I figure my BMI with a height of 5'3", even though I am 5'3.75" (which if I rounded that to 5'4" puts me under 30, I think). But I try not to think about that difference. I started with this, so I'll finish with it. I can't believe I only have 12 lbs until I reach goal!
Today is a beautiful day, sunny and lovely. Hubby will be here in an hour. I'm off to do some studying, then enjoy his company for a while.
Friday, June 13, 2008
I got a new haircut, too...decided to go a bit shorter. Of course it will never look as good as it did after she styled it today, but I like it and I think it will be nice for the summer.
I decided to go for a new route for my run today. I was aiming for a 3 or 3.5 mile run today. I found a new route on mapmyrun.com, that looked like it went by the river...I ran and ran, but it just seemed to sort of go through the 'hood, though it was near the river...eventually, after about 2.5 miles, I discovered that I was in the wrong place. I could see the park where I was supposed to start, down below. So I drove my car down there, and ran another 1.5 or 2 miles in the riverside park, which was really pretty and has a lot of routes in there to explore at later dates. The first part of it is up a big hill, though. For me, right now, it's a barf-up-a-lung hill that I ran about 1/2 of. Maybe by the end of summer I'll be able to run it all. One of these times I'll bring the camera and take some pictures. My weekly mileage ended up at 14, which is about what I was aiming for. It felt great to finally run in shorts!
Below: my new haircut, and pics from the High Drive run I usually do, which is near my house.
Tuesday, June 10, 2008
Checking out her back-at-home pics in Seattle made me a little nostalgic for my years living in Seattle. I have reasons that I don't live there anymore...but still, it does hold a lot of good memories for me there. Her favorite coffee spot is just a couple of blocks away from my condo that I sold 6 years ago--gosh, has it been that long already?!? Truth be told, the condo wasn't a very good idea for me. It was more than I could afford, but I was just divorced and refused to go from owning a home to owning nothing--and so, it sort of sucked me into much more debt than I could handle, which necessitated my selling it a few years later. Turns out my ARM mortgage would have sucked me under even worse if I had kept it any longer, even though my home appreciated quite well in value--I frankly wasn't in a position to own that place. So I sold and started traveling, and I wouldn't give that back for the world, even if I could have afforded to stay in that little 1 bedroom condo in Fremont. It brought me to different cities and different work experiences, which helped me focus on what I wanted out of life and out of my career...eventually brought me to Portland, which I fell in love with, and someone else I fell in love with, my husband. And then, to this new adventure of anesthesia school. But it all started there, in Fremont. Ahh, the memories.
While I'm shouting-out, I saw another good post on Tulip's blog, The New Me (Thinspiration). Her title says it all: Motivation is what gets you started. Habit is what keeps you going. I had a similar conversation recently on LBT with some folks who wanted to know how to get motivated to start exercising. I responded that I don't think motivation is so much the issue as just making a decision. I didn't really find the motivation to start exercising--I just knew I had to do it, and I decided to do it. You are motivated by wanting to lose weight and be healthier--that gets you started. But you don't really find "motivation" to work out, you just put on your gym clothes and get out there. The beauty --and the curse, in a way--is that once you get your butt out there, the real motivation comes in the form of the positive feeling you get from exercising and moving your body. It's a curse because you have to overcome the inertia to get that positive feedback of endorphins and so on that brings you back. But I use that as my reason to work out. I know I will feel so much better if I move, than if I sit on the couch.
In Tulip's post, she talks about hitting a plateau (hi, me too) and just keeping on trucking because she's formed the habits. You do lose that motivation boost when you aren't actively losing weight, and you have to rely on your habits and your long term goals to keep at your new healthy lifestyle. I'm glad that my exercise habits aren't so easily derailed when I'm not losing weight, because I don't really connect the two in my head--but the eating habits are so hard to keep on track when you aren't seeing "results".
Ahh, results. Last week's plan to break my plateau did not work--I tracked calories and they were not terribly off track. I planned meals better, and cooked more. I couldn't find any major problem areas, just little derails here and there that I'm sure add up, but even when counting them into my days, they didn't seem to be the culprit. This week I am prepping for the big exam, and you know what? I think that's going to be my focus. I'll just keep doing what I've been doing eating wise, try to be conscious about not snacking or eating stuff that's going to sabotage me, and otherwise not stress it. I'll just spot this week to the Plateau--okay, Plateau, you get week 6 on me. I don't think a fill is the answer. I "can" eat a lot of food if I push it, but if I eat the right amount, I stay full for 3 or 4 hours, or more, so that seems fine to me. I can keep eating the right amount of food without too much stress, and I do, routinely. So no fill for now. Who knows what will happen? Maybe something good will come of easing off the (food) stress for the week. Will keep you posted.
Sunday, June 8, 2008
My run yesterday was good and I stuck to my 3 miles, almost exactly, which was also good. Then I went to the Y and did upper & lower body weights. Nice and sore today--not too much, just enough to know I did some good. I like that.
Mostly, I studied this weekend. Hubby is starting a new job this week, but hopefully will be coming to Spokane later in the week. I sure hope so! I have a big exam next Monday so all week and all weekend will be about studying for it. I can't really go to Portland until that's over, so hopefully he can come here this week. I sure miss him a lot.
I've been reading the boards at nurse-anesthesia.org this weekend. It's a great site, full of CRNAs, SRNAs, and wanna-be's...but it's also depressing hearing what things are like at other anesthesia programs. CRNAs who "pimp" the students in their charge (ask them hard, often esoteric questions designed to make the CRNA look good), MDAs who belittle or sabotage CRNAs and students, the political environment of anesthesia in general...it can be overwhelming. But we have a pretty good thing going at Gonzaga. Our program directors are supportive and so are the clinical staff. The environment is friendly and warm, not militant. The US News rankings came out for 2007 and our program came in 23rd place, which is a pretty good showing for a tiny program on the West Coast. 8 students a year is nothing compared to a lot of these programs. And we came ahead of programs like Duke, Vandy, all the East Coast schools that my friends are at... These rankings are subjective and don't really mean a whole lot, in truth, but still it's nice that at least our reputation gets us ranked fairly highly among all the programs in the country today. Sometimes I read about the political issues within anesthesia and I wonder if there is going to be a career waiting for me at all when I am out of school. Anesthesiologists wish to have CRNAs work, but only if we accept their "medical direction" and they can bill for our work. I could expound on all of the issues here, but I'm not going to...because this blog isn't about that, and because I'm tired. But this is going to be a major health care issue in the near future so watch and support your local CRNA!
Weight loss...not happening right now. The rhubarb pie surely didn't help, even if it was made with 1/2 Splenda. I'm still stuck in Plateau Land. This week, hopefully I can make some progress.
Saturday, June 7, 2008
But, alas, weather.com says it will rain all day. Do I want to run in the rain or on a treadmill? I'm going with the rain, I think. Just have to work myself up to it.
Yesterday was my run day, but I took the day off. Just wasn't feeling it. Today I need to run AND go to the gym and lift. I haven't lifted all week! Bad me.
I didn't do fitday yesterday either. Double bad! I'm thinking that when I don't track, my calories are in the 1600 range; when I do, closer to 1100-1200. I THINK if I kept it around 1100, I would probably still lose weight; so maybe the answer is more tracking? But this week is a hormonal weight-gain week anyway, so I'll look at this all again next week.
Wednesday, June 4, 2008
IV's sort of sucked...I missed a few, and we had to leave at 0630 instead of 0645, which got the charge nurse all bent out of shape. They are very used to having students there to start all their morning IVs now, and take every opportunity to call our program directors and complain when something doesn't go the way they think it should. Luckily, our PDs take it all with a grain of salt and know that we don't pay tuition to start IVs...that is a small part of what we do here. I have a feeling the charge will complain to John about us leaving early this morning, even though we leave early EVERY WEDNESDAY because we have airway on Wednesdays... Whatever. I finally figured out "who" this person is...she is exactly like a nurse that I used to work with in Portland who was difficult to deal with...and now I know how to approach her, so it doesn't really bug me anymore. At least I got my intubation, and had a pretty good OR experience.
I'm finding myself getting anxious as clinicals approach. I've pulled out every flash card I've made since January, and I'm reviewing and gathering info that I'll want in the OR, while also doing my current studying of course. I'm tense at school, too. It's impossible to overestimate how hard it is to go from being an expert nurse in the ICU to a complete newbie who knows nothing. Not only do I feel anxious about not knowing anything and looking dumb, but also about everything I have to learn, and being safe, and keeping my patients safe. I know I'll get through it, but the anticipation is killing me. To make me feel better, I guess, my CRNA today (Larry) told me not to worry, I'd always feel dumb in clinical! Even when I'm near graduation. LOL. I had to laugh. But he meant that in a nice way. It's okay to be new and to know nothing, that is what is expected of us and we have to learn to put our egos aside and allow ourselves to be novices.
The fitday logging continues. I had a day around 1000 cal, yesterday was about 1200 as today will be as well. I hope this is enough fewer than what I had been eating to stimulate some weight loss, because it will be more difficult to reduce it further than that. At some point I'll have to do that anyway, but I'd rather put it off.
I read something on the lapband board today that really irritated me. There's a thread for nurses, and of course there are many nurses who have been banded. (We have a reputation for being fat, and for availing ourselves of everything medicine has to offer, for better or worse.) It's kind of nice. But someone posted today about having been banded 2 weeks ago, and how the liquid diet was "killing" her so she advanced herself to solids. Okay, I did that too, for a day, until I read about WHY my doctor had required this (and why they all do, it really is for a reason) and then I went back to my prescribed diet. I was going to reply with the reasons for following the diet as prescribed, until I saw her ticker. Her STARTING BMI was 30--what mine is after losing 60 lbs! Her goal is a BMI of 19. Who the f*@! banded her? What is that? I considered myself a "lightweight", with a starting BMI of 42--which was high enough that Regence (BCBS) covered my surgery. A starting BMI of 30? I just couldn't be bothered with giving her advice. I'm sorry, maybe that's snotty or catty or whatever. I don't care. Is this like "gastric bypass light?" Do people think if they have a little extra weight--40 lbs or so--that they should just get banded? This is serious surgery. There are serious risks. The health risks of having a BMI of 30 are not sufficient to warrent having bariatric surgery. That really got me riled up. If she wants to go get a lap band and then ignore the prescribed aftercare, fine, have fun. Don't come crying to us when your band slips or you can't deal with figuring out fills and restriction and you're barfing all the time. Gack!
I can say this because I am one--Nurses are Crazy!
Monday, June 2, 2008
"Twice a month, TODAY will induct new members into nutritionist Joy's Bauer's Fit Club. These are determined people who have lost and kept off a significant amount of weight -- 100 pounds or more. Read their inspiring and motivating stories of how they lost the weight the good old-fashioned way, through diet, exercise and no surgery."
I look forward to reading about the latest member inducted every week. I love a good before & after story as much as anyone else. But some things about this "club" have always rubbed me wrong.
First, this program really touts losing weight "the good old-fashioned way." No surgery. The intent, outwardly, isn't to say that surgery is wrong, per se, but I think they want it to inspire people to try weight loss "the good old-fashioned way" before jumping to surgery. Unfortunately, they don't really mention this much. They do mention frequently when an inductee lost weight as a "last-ditch effort" right before having surgery, or to qualify for surgery, but then changed their minds and did it "themselves".
I think it's great that people can lose massive amounts of weight through diet and exercise. Fact is, most of us who have WLS actually HAVE lost massive amounts of weight before. That brings me to the second thing that bugs me: there is no focus on keeping it off, which is the hardest part. The club members supposedly have "lost weight and kept it off", but the clips I see on their website rarely, if ever, mention when the goal was achieved, how long they have been at goal, and how they maintain. Am I wrong, or is that the answer that obese people are really looking for here? We all know how to lose weight. But keeping it off is the hardest part, and this "plan" has no focus on that. To me, it's just setting people up for the inevitable regain--all the weight loss, plus an extra 10-20%, is the norm, because the body tries to compensate for the next time this famine occurs with some extra insurance.
Also, Joy Bauer takes a lot of credit for these peoples' successes. But as I mentioned before, most of the 100+ club members lost their weight through some other diet--the most frequent ones I see are NutriSystem, Weight Watchers, and South Beach, but I've also seen Atkins, Jenny Craig, etc. on the list. But not the Joy Fit Club weight loss plan. Yet she implies on the TV segments that she has helped these people lose weight, even though they only "join the club" AFTER they've lost weight.
It just rubs me the wrong way. She implies that having WLS isn't "natural weight loss" or "good old-fashioned work", and that the "good" way to do it is D&E. I think she could do a lot more good if she (A) focused more on maintenance, and (B) talked about how people who have had WLS can benefit from these methods too. Be a little more inclusive. Or at least make it clear that she's trying to provide inspiration and options for people who already don't want to have WLS. Perpetuating the negative attitude that there is something wrong with that choice only hurts people more. It's not a choice for everyone, but for many people it is ABSOLUTELY the right choice. And lumping all the procedures together into one big, bad "surgery" ball is also misleading. I can personally relate to a lot of these weight loss stories, having had lap band surgery--the methods for weight loss are exactly the same, but I have assistance with appetite control, and to some extent with portion control. In that sense, it's not the same, but it's not that different either, and the band is very different from a lot of the other things that they make sound so scary (which themselves are ALSO the right choice for some people).
I wanted to put today's video in here, but Blogger wouldn't accept the embedded video. So, here's the link. In it, "Kathy" says that she started NutriSystem in August of 2006 and it took about 11 months to lose 140 lbs. So she has been maintaining for less than a year--which is great, but I'm not sure it qualifies as "keeping it off" just yet. Check it out and let me know what you think.
Here's the MSNBC feature as well.
Sunday, June 1, 2008
That's not a crisis, but I'm tired of it.
So, I decided, since my exercise is clearly adequate, that I'm eating the amount of calories it takes for me to maintain my current weight. I need to reduce the calories. My plan for this week will be to track what I eat for the next 3-4 days (on fitday), and plan my meals. Then I'll figure out where to cut down my calories.
Today's eating has felt out of control. I woke up with an irritated stomach that has been making me feel hungry all day. I think my evening pills stayed in my stomach pouch all night and irritated it. Ugh. I tracked what I've eaten today and came up with about 1800 calories--which is clearly too much if I'm trying to lose weight, but not as bad as I expected it to be for today. Usually, I think I'm probably around 1600--but I'll track to see. I'm going to bed soon, because I have to get up at 4:45 for IVs in the morning--so that's my calories for the day, I'm not eating any more.
I think I probably need my calories around 1200 to continue losing weight. Probably not as hard as it sounds to me right now--but I want to do it without getting another fill. So, plan of attack:
Losing the last 15:
1. Track eating on FitDay.com
2. Continue exercise program (running, weights, swimming)
3. Plan meals ahead, following band rules.
4. Figure out new calorie target
5. Bike to school a couple times a week
6. If I do all this and am not losing weight or am hungry, then consider a fill.
It's summertime, which means grilling and doing outdoor things, so this should be doable. It's just back to basics, which I've done many times. Tomorrow I am done with school by noon, so I should be able to get in my run and get some studying done without much trouble (although it's supposed to rain in the midday, so I may go in the evening). Oh yeah, I'm going to go easier on my mileage this week--probably about 14 miles--and work back up slowly.
I'm going to get to goal before the end of the year, I swear!