Weight Loss

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Thursday, July 31, 2008

Water, water everywhere

Confession: I am the worst water drinker. Ever.

I KNOW that I'm supposed to be drinking 64 oz. a day, or oz. of water that equals my weight in kilos (you know, if you weigh 80 kg, you are supposed to drink 80 oz. I don't know how to say that), or any number of other formulas for the perfect amount of water we are supposed to drink. Drinking enough water is supposed to help weight loss, constipation, dry skin, and a hundred different biological things. I know this. I also know that as a bandster, I get less food than most people so I get less water in my food, thus a greater need to drink water.

But. In my defense, for unbanded people, the whole 8-glasses-a-day thing has been debunked as a myth, and the proper amount of water is now considered drinking until you are not thirsty. We probably have a greater need for drinking water than unbanded people, but I honestly don't think it's as major as people make it out to be, especially since I eat more food than most bandsters seem to. (And more moist food, I would venture to guess.)

It's not that I don't LIKE water. I have nothing against water, not even city tap water. I just can't carry it with me, and if I don't, I don't think to drink it. Even if it's with me, if I'm not thirsty I don't drink it. I've tried to change this part of being me, but I have failed. I have never been a Coke, juice, or anything else drinker, either. I'm just not that into beverages. (Unless it's a good wine or a Guinness, that is. But I rarely drink alcohol, either.)

I have considered posting on this topic in the past, and have always hesitated because there are a lot of people in the WLS community (if we can be called a "community") who are water Nazis, or at least water zealots, and I didn't want to stir them up. I also don't want to make this a recommendation to other people, because it ain't medical advice. I don't know if it's better or worse to drink water--I don't think drinking 100 oz a day can hurt, unless you have renal failure or certain endocrine or electrolyte disorders and are being water restricted. So I don't say this as a recommendation. I'm just confessing that I have discovered that I cannot maintain a water-drinking habit. I drink water when I am thirsty. I can't carry a water bottle everywhere I go. It's not gonna happen, people. I know this by now.

All of this being said, now that I am officially an anesthesia provider (in training), drinking water the WLS way is impossible. There are 3 major reasons for this:
1. You can't bring water, or outside food or drinks, into the OR.
2. You can't leave a case to go pee, unless another anesthesia provider is there to relieve you.
3. The turnover between cases is too fast to gulp down the water you didn't drink during your 5 hour carotid case.

(Also, while I'm on the topic, it's fortunate that I am not so restricted that I can't eat a meal quickly if necessary. If it took me 30 minutes to swallow 4 oz of gruel, I wouldn't ever get lunch.)

For this reason, I have essentially given up coffee as well. Can't risk having to pee an hour after my coffee, which will certainly come at a fairly inconvenient time as far as patient care is concerned.

My weight loss seems to progress on, despite my naughty water habits. I doubt my slow-down in the last 10 lbs has been due to not drinking enough water, but maybe it is. I am in good health--no, great health. I do drink water, when I'm thirsty and I think of it and I have time. (Usually after clinicals are over and I'm at home, and I always drink plenty before I go for a run, and afterward.) But I'm not a water-bottle-carrier, or a frequent bathroom-visitor. I've had a nurse bladder for years (can go 12 hours and only pee 1 time) as it seems to be an evolutionary requirement for bedside nurses, whether working ER, OR, med-surg or critical care (or elsewhere).

I will offer this caveat: If you are on liquids for any portion of your prescribed band diet (pre-op, post op, post fill, post unfill, waiting for revision, whatever), please make sure you drink the required amount of water. It is too easy to become dehydrated in this situation.

Beyond this, I offer no recommendations or advice. I'm just saying that this is me: a naughty bandster who drinks water only when thirsty. Sue me!

Wednesday, July 30, 2008


People, can you believe it's almost August? I cannot. Time flies when you're sweating bullets in the OR every day. LOL.

Today I turned in my last exam for the summer, which felt great. We have clinicals 5 days a week until classes start again in September (I'm not even sure when that is). BUT, I am on vacation for 2 weeks after next week...and I am so excited! The first week I don't have much planned. The second week we are going to the coast for the week. I have gotten a 2 piece swimsuit for this trip and it is flattering. I am pretty excited about it. But I am mostly excited to spend a week on the beach not thinking about school.
The low weight has stuck around...no regain yet! Woot! It's so weird, but so exciting too. I can't believe I only have 8 lbs to goal.

I'd better go for my run so I can get to bed at a reasonable hour. I scanned some old photos today. It was nice to do something not school related. Here are a couple goodies from the 80s, enjoy.

Monday, July 28, 2008

I don't understand

Don't ask me how it happened, because I drank too much this weekend, ate out and ran half of the mileage I usually do...but I am in the 160s today.

No, I can't explain it, and I'm sure I won't stay here for good (for now), but there it is.

I spent the weekend in Seattle visiting friends whom I see rarely, and it was really nice. I slept a lot less than I planned on, and couldn't sleep at all last night for some reason. I didn't get to see hubby as planned :( but will see him this weekend, and I have vacation in less than 2 weeks!

Off to the OR. Carry on...

Wednesday, July 23, 2008

Of Watermelon, and PMS

The 160's won't happen this week. I am foiled again by PMS. Ah, well. I can feel that the 160s are near! Maybe next week.

I am surprised by how tired I am since clinicals started full time. It's not just the early mornings--although I don't know many people who can get used to getting up at 4:30 every morning, much less following that by doing something stressful that you're just learning how to do and being critiqued all day long. The early mornings are tiring. But the learning curve is very steep, which is mentally exhausting. And ending the day by coming home to more homework and having to make out a plan for the next day's patients--which takes more time and brain power than I feel up to devoting to the task--and having to exercise, and get to bed at a reasonable hour (ahem, like right now) is quite tiring.

My runs have been very sluggish since clinicals started. I guess it's good that I'm able to keep doing them. Tonight my bed nearly tempted me to skip the run (and go to bed at 7:30!) but then I was afraid that it would become a habit. Besides, I had planned the run in my day. So I went--I had little excuse not to, it was 70 degrees and perfect by then.

I am obsessed with watermelon this week. It is the best--I've been getting the little sweetheart watermelons and I can eat it all day long. Plus it is very hydrating. And did you know it's been found to have a chemical that is good for erecti1e dysfuncti0n? Not that I have to worry about that. But just an interesting tidbit to put in your fact file.

Clearly, it's time for bed.

Monday, July 21, 2008

Run, Baby, Run

Today I made it to the official 10-lbs-to-goal mark. Woo hoo! I want to see if I can SEE the 160s this week. I only have to lose 0.1 lb. I'm not good at short-term weight goals--my body seems so unpredictable--but I am bicycling to work this week, plus running, so I hope to see a little more scale movement and a peek at the 160s. That would be so cool!

Today I was thinking about my goal weight, for about the millionth time since my surgery, and realized something that now seems like a big DUH. At 160, I'll be smaller than I was at 160 in high school. How can that be? Well, I have at least 10 extra pounds of skin. That's how. (I guess there's another thing too: I'm a couple inches taller than I was in HS.) WLS women who get tummy tucks usually lose a minimum of 5 lbs of skin during the procedure; people who have massive PS after massive weight loss can lose well over 25 lbs of skin (sometimes more than that just off the pannus). So even though I'm pretty lucky in the loose skin department--I have less than many folks do, and I don't look like a melted candle--and even though I will never have PS to remove ALL of it (just the tummy, some day, maybe), I really am smaller under all the skin. It makes more sense to me now.

I just got back from a short-ish run this evening; it's still over 80 degrees, and I was running in new shoes (breaking in the spoils from the sale at Portland Running Company--my same Asics 2130s that I LOVE), and I biked to work today, a route that includes lots of hills that I'm not buff enough for yet, so I didn't go crazy. But I was thinking about the idea that running is more mental than physical. Much of it is convincing yourself to go, and to keep going once you've started. Not unlike most exercise for those of us who aren't usually exercise-inclined. How do you keep at it? (I wonder this, because I don't want to get tired of this exercise--I enjoy it, and it works for me--but I know people get burned out.) Here's what I think:

1. Like any exercise, make a commitment to yourself to do it--you're less likely to back out. For me, this means set running days (every other day). Also planning it into your day--at the beginning of the day I know I'm going to run in the evening. If I know I have a late start in my morning, I'll run early.
2. Give yourself an out--on the days you aren't feeling it, it's okay to say "I'm just going for 10 minutes, and if I don't feel like going further I'll go back." Usually 10 minutes is enough to keep you going anyway.
3. Give yourself a lot of praise, even if it's what you do every day. This means more on the days that you would rather just go to bed, like today was for me.

I hope this works for me in the long run. I think also changing things up helps--changing routes, changing mileage, adding in other exercises, like my walk and bike commutes to the hospital. Running regularly makes it easier for me to be more active in general--like going to play frisbee with my hubby, or going for a hike.

Ok, off to shower, then bed. I'm hoping to see 169.9 this week! Fingers crossed...

Saturday, July 19, 2008

From the Head of the Bed

I had a good experience in the OR on Thursday. I got to administer the anesthetic for a lap band, my first one. I've never seen the surgery live, so it was pretty neat. When I met the patient pre-op I told him and his wife (briefly) that I had had the surgery and a little about what to expect post op. I think it helped them feel a bit more at ease. You have to be careful when telling patients about your personal experiences though. First, you want to keep everything about THEM--it's not about me and it's not my time to share, so everything should be focused on what might help put them at ease. Second, just because I had a good experience doesn't mean he will, so I didn't want to provide any blanket reassurances--just briefly what my experience was. Third, you don't want to give enough info about yourself that you cross from the professional to the personal.

The surgeon was one of two band surgeons in the Spokane area. I had considered both of them when looking for someone to do my follow up care when I moved from Portland. I ended up going with the other one, because my Portland surgeon knew him and referred me to him. The doctor I see is friendly, is no more pompous than the average surgeon, and looks a bit like Philip Seymour Hoffman. The surgeon who did my patient's band surgeon is younger, and a bit more arrogant. He seemed like a good surgeon, though.

One thing I didn't realize about the surgery is that most of the instrumentation is done through the port incision. They make the incision, put the end of the band on an instrument, and insert it into your abdomen. I always assumed that the reason the port incision was the most painful post-op was because of the port, but it's actually because most of the instrumentation is done through that incision; the port just gets added on at the end, and sutured over.

My patient did well, but I had to leave before he woke up (the CRNA I was working with finished his case.) I would have liked to see him post-op, to see how his recovery was going, but I had to hit the road and get to Portland.

Aside to Blair: I'll put another response in the comments.
Everyone: have a great weekend!

Thursday, July 17, 2008

Watch Lap Band Surgery on the Web!

Got this notice in my email. It is the Realize (Johnson & Johnson) band, but the procedure is the same for the Inamed band, if anyone is interested in watching.

ORLive Presents: Adjustable Gastric Band Laparoscopic Weight LossSurgery for Morbid Obesity
Webcast: From The Hospital of Central Connecticut: August 6, 2008 at6:00 PM EDT (22:00 UTC)
Last update: 3:57 p.m. EDT July 14, 2008

NEW BRITAIN, CT, Jul 14, 2008 (MARKET WIRE via COMTEX) -- The first webcast of weight-loss surgery using a new gastric band will be presented by The Hospital of Central Connecticut and OR-Live on Aug 6 at 6 p.m. The procedure, utilizing the REALIZE(TM) Adjustable Gastric Band and the latest laparoscopic techniques, will be performed by Dr. Carlos Barba. Narration will be in both English and Spanish. Weight-loss surgery has been demonstrated to greatly improve health for the morbidly obese. Recent studies have shown that, in many cases, gastric banding can eliminate Type II diabetes, and improve or eliminate other conditions including sleep apnea and asthma.The Hospital of Central Connecticut offers bariatric surgery and a full array of weight loss programs through its Weigh Your Options(R)clinical weight loss center.REALIZE(TM) is a trademark of Ethicon-Endo Surgery

******* To learn more and view a program preview visit OR-LiveVNR: www.OR-Live.com

Wednesday, July 16, 2008

School's out for summer....

Sort of. Today was the big CV exam for pharmacology. So glad to have that out of the way for a couple of months. We had our last classes for Principles of Anesthesia and our computer class, so now we are 5 days a week clinicals for the rest of the summer. I have 2 weeks off in August to relax and not think about school. Woot!

This afternoon I am heading out to a baseball game. A classmate had tickets to see the local minor league team play, so I'm going with another classmate. Should be fun!

Weight is down a little bit, hovering there. I didn't run last night ( my normal running day) because I was studying so much and worried about not having enough time. I got up early this morning (which was sleeping in really, since I normally get up at 4:30 now, but only had to get up at 7 today) and ran about 2.5 miles, because I didn't have that much time, but did want to get in a little bit of a run before it got too warm. It was pretty good. I try to avoid running in more than 80 degrees heat (27 deg C) if I can. When it's over 90, I bag it altogether, and usually wait until evening when it cools down a little. It's a challenge these days, when I want to be in bed early because I have to get up early, but it's still 92 degrees at 8:30.

Thank you, everyone, for the nice comments on my last post. I know trolls and negative anonymous commenters are a part of a blogger's reality, but it sucks. Why are people so hateful? If you're gonna be that way, at least grow a pair and sign your name. Oh yeah, and if you're gonna be anonymously hateful, get your facts straight. That is all.

One commenter wanted to ask about loose skin after being banded. I find it kind of oddly amusing, because you are the same weight as me now, and less than 1 inch shorter than me. So, I consider myself a success at this weight even if I don't lose another pound, but someone else wants to get banded at this weight/BMI. Ah well... I have loose skin, without a doubt. But my BMI was 42 when I started. With your BMI at around 30 right now, I kind of doubt you'll have much loose skin to worry about. That depends on a lot of things, of course, like your age, your skin's elasticity, and your body composition, how you carry your weight etc. There isn't much you can do about loose skin; either you have a lot of elasticity and it will rebound, or you don't and it won't. You do get a little more of it with rapid weight loss, but that is less with banding than with the faster-loss surgeries. But I would hesitate about pursuing lap band surgery at that weight. Assuming you can find someone who is willing to band you (my surgeon doesn't for a BMI less than 35, even self pay), I don't know that it would be worth it. Bariatric surgery is considered successful when the patient loses 60% of her excess weight. You really only have about 30 lbs of excess weight (you want to lose 40, but that gets you to about a BMI of 23, which is beyond your excess weight), so if the surgery worked for you as it does for people who are morbidly obese, you may only lose 20 lbs or less. Would it be worth it to have surgery for that? Also, for the morbidly obese, the weight loss really works because it enables the person to eat far fewer calories than they are currently eating. When we get closer to goal, our bodies don't burn as many calories, so our calorie restriction no longer causes such a big deficit of calories, and the weight loss slows down dramatically. At your size, your basal metabolic rate isn't as high as it would be at a BMI of 40 or 45. The calorie restriction caused by a lap band at an optimal restriction level might not be significantly more than it would be if you went on a mildly restrictive diet. I guess what I'm saying is I'm not sure it will work for someone with so little weight to lose. The person to ask, of course, is a band surgeon. You usually can't make an appointment with one without going to a seminar first, and you'll get some funny looks from the other participants since your weight looks more like an "after" than a "before" to most of us. I have heard of people your size being banded pretty easily in Mexico, though.

Believe me, I understand the panic and frustration of feeling helpless to control gaining weight. And I also understand that diets are almost impossible to make work, especially long term. I get why anyone would love to take advantage of the appetite suppression and satisfaction with small meals. But with any surgery the risks must be outweighed by the benefits, and most band surgeons say that the risks of surgery are too great for someone who is not morbidly obese. (And I know that BMI doesn't even come close to telling the whole story. But it is a good ballpark to work with.) I am your weight now, and I am losing just a pound or two a month right now. I'm at a good restriction level, I eat according to the rules, I exercise a lot. But my body isn't using a lot of calories now, so even though I'm not taking in that many calories, it just doesn't create enough deficit to lose weight like I did before. Starting out at that point, I don't know if you'd do better or not. But I think there is a "lightweights" forum on LBT, or something for lower BMI bandsters. They would be able to give you an idea of how successful you can expect to be. Personally, I wouldn't have surgery at that point. But that's my choice.

Perhaps some of the other bandster readers would "weigh in" on this topic?

Saturday, July 12, 2008

Oh, for chrissakes...

Some kindly troll came by and anonymously "suggested" that I was giving medical "advice" and I can't do that on a website. Well, actually, I CAN put whatever I want on my blog. It's my blog, none of the information is copyrighted, and it's obvious to anyone of reasonable intelligence that I am not your doctor. But just to be clear, I'm not giving anyone any specific medical "advice" here. I answer questions based on my experience and knowledge as a registered nurse, a nurse anesthesia student, and an experienced bandster. It doesn't replace the assessment, diagnosis and treatment of a licenced practitioner, i.e. your doctor or nurse practitioner. I'm making no diagnoses or treatment suggestions to anyone. I think that is enough of a disclaimer.

People are dumb, aren't they?

Weight is just hanging in its same place. I think this is going to be the norm for a while. It's interesting, I do lose weight when my husband comes to town--although I don't lose weight when I spend the weekend in Portland. It doesn't seem to work both ways. I was up 1 lb yesterday and this morning I am down 2 lbs. So, whatever. A pound a week isn't going to be happening this close to goal--not even 1/2 lb per week right now. I've been losing a couple pounds a month for a couple of months. I try to be cool with it, but sometimes it does drive me a little nuts. But I have other things to worry about, so now I'm just trying to eat like a normal person, keep up my running, and hope my body cooperates with me eventually. Losing 20 lbs in the first semester of anesthesia school is a pretty good accomplishment, I try to keep that in mind.

Thursday, July 10, 2008

Anesthesia Concerns

Okay, I'm coming up for air. My first week of clinicals is over, and it went very well. It was even fun at times! It's definitely terrifying, but it should be at this stage of the game, and that's why there's a CRNA with me at all times for the first year in the OR.

I do have to get up early tomorrow morning but only for an hour, and then I can get some more sleep, so I wanted to answer a reader question (or questions) about band surgery and anesthesia. I don't want to portray myself as an expert by any means, but being in my nurse anesthesia program, I do think I can answer some of these questions at least to some extent.

The questions, to summarize, were basically these: is it easy to detect a reaction to anesthesia, and how dangerous is it; does recent inflammation of airways increase risk during anesthesia; how common is it to wake up during surgery; and does coughing affect the band? These are all great questions, and I'll answer them as best I can.

First, about reactions to anesthesia: it depends on what kind of reaction you mean. Some people describe a reaction to anesthesia as something that happens while you are being anesthetized, during your surgery, that happens as a direct result of the anesthetic medications or procedures. Others would include things like post operative nausea and vomiting, which can be due to anesthesia but happen afterward, and are rarely life threatening. Most reactions that can occur during surgery are fairly easy for an experienced anesthesia provider to detect and treat. As far as safety is concerned, anesthesia has become extremely safe in recent years, due to improvements in technology and medications as well as the high degree of skill required by practitioners.

I've heard anesthesia risk described by an anesthesiologist this way: It's sort of like driving a car. It's very unlikely that anything will happen at all, but if something does go wrong it's usually fairly minor, say a flat tire or even a fender-bender. There is the risk that you will get in a big accident and die, but that risk is very, very low--we drive cars every day, all over, and that rarely happens to any one individual. That's a pretty good description of anesthesia risk (for most people, in most situations)--the likelihood of something going wrong is low, but it can, and on very rare occasions it can be life threatening or fatal. That's not meant to scare you at all, but just let you know that it's possible, but unlikely.

A recent cold or bronchitis can make your airway more reactive during anesthesia. The risk of having a "reactive airway" (one that doesn't respond favorably to having a breathing tube inserted) goes up if you have preexisting pulmonary problems (like emphysema or asthma) or if you are a smoker. I believe the current recommendation is that upper respiratory infections should be cleared up for 2 weeks prior to having anesthesia, but your anesthesia provider may tell you something different based on their own experience and their assessment of you. You might want to ask your surgeon about this now if you are within 2 weeks of your surgery date. (You probably won't have an anesthesia provider assigned until the week of surgery, probably the day before, and they usually visit with you just prior to surgery, although you might go see them a day before.) Especially if you have bronchitis right now, I would want to make sure that is completely cleared up before having anesthesia.

For lap band surgery, which is laproscopic, you have to have an endotracheal tube inserted in your trachea--often called a breathing tube. This happens after you are put to sleep, but if your airway has recently been inflammed by bronchitis or a respiratory infection, you may be at more risk for spasms in your airway during or after surgery, which can impair your ability to get oxygen. Obviously that isn't something you want. In addition, obesity makes intubation more difficult, and we often have other problems like sleep apnea that make our anesthesia more difficult when we have bariatric surgery. When an anesthesia provider prepares to care for a patient undergoing bariatric surgery, the first concern they have is usually the airway, because it can be very difficult to manage an obese person's airway. When you add to that a recent bronchitis, the anesthesia provider's red flags go way up. So my recommendation, based on what you've told me, would be to talk to your surgeon and be prepared to delay your surgery by a week or two, to ensure that your bronchitis is completely recovered. This is elective surgery, after all, and you want to optimize your health so you can be successful and recover quickly. It's not like you have to have an emergency triple bypass right now, and can't take the time to make sure you're as healthy as possible. (Of course, most of us don't really feel like this surgery was THAT "elective"...but in terms of surgery, it is.)

Next, waking up during surgery, or "anesthesia awareness" as we call it...Yes, it is very rare. It happens mostly during surgeries in which the patient can't be very deeply anesthetized with gas or IV drugs, like traumas or vascular surgery where the patient has a very low blood pressure and can't tolerate very deep anesthesia. Even in those cases, it is very rare. We have a lot of ways to make sure that you are asleep and will not wake up during surgery. During this surgery, you will most likely receive IV anesthesia at the beginning and gas during the surgery (some people do an entirely IV technique), plus you will get a lot of narcotic medication during the surgery to ensure that you are not in any pain. You'll also get at least one medication for nausea during the surgery, probably more than one, to reduce any chance of post operative nausea or vomiting. (You might have some anyway, because of the band being placed on the stomach, but most people with the band don't seem to report it, and I didn't have any nausea after my band surgery.)

Finally, coughing with the band. I haven't had any problems since being banded last March. I suppose that it is possible that the band could move with very vigorous coughing, but the stomach is stitched over the band itself, and it usually doesn't move unless there is too much pressure from INSIDE your stomach--like when you have a too-tight fill and are barfing up food, that creates a lot of pressure in your stomach and can cause a band slip. I haven't heard of anyone having a band slip from coughing, but I heard of one woman who had her band slip and had to have it removed after she lifted a very heavy trundle bed (like over 400 lbs, with someone else of course!). They weren't totally sure that was the cause but it happened right before her slip. That is very rare. The best way to prevent having a band slip is by never allowing your fill to be too tight--meaning that you are always able to eat solid lean protein without barfing it back up (or "PBing" as the slang is in the lap band world). Right after surgery, they will ask you to cough and deep breathe frequently--at least 10 times an hour--to make sure your lungs stay healthy after your anesthesia. You'll be coughing right after surgery, and it won't affect your band at all. If you do get very sick and your coughing is so much that you are really concerned about your band, you can always call your band surgeon and ask if there is a problem, or if you should take some cough medicine--although in general, it's best not to suppress a cough with medicine, as that is how your body is trying to fight an infection.

I hope this helps answer some of your questions. Good luck with your band surgery! Do talk to the surgeon about whether it should be rescheduled due to your bronchitis. And let us know how everything goes when you are all done!

Wednesday, July 9, 2008

hang on...

I have to get to bed now, but there is a comment that I am planning on responding to...so hang on, Penny Lane, I'll try to answer it tomorrow. It's early to bed and early to rise for me.

Tuesday, July 8, 2008

In the Bag

First day of clinicals is behind me! I was very nervous. It might not make that much sense to people who know me and know that I have a lot of experience with very sick ICU patients. In my previous life, I was a trauma ICU nurse with 11 years of experience. I worked in highly-regarded academic Level I trauma centers, and was very competent. I could resuscitate a critically ill patient, and recognize signs of danger before it happened so I could prevent it. I was responsible for trauma patients both in their initial resuscitation phase in the ER and when they were admitted to the ICU. I could run a code, and direct new residents when needed to get what a patient needed done. I was trusted by all of my coworkers and known as level-headed and highly competent.

But now I am in an entirely new environment. There are a lot of new rules in surgical areas--about how to maintain the sterile field and not contaminate it, which means you have to learn where you can and cannot walk, and learn subtle cues about what the surgeon and other OR staff are doing so you know what you can do (or should do) at that time. There is, of course, an entirely new staff of people to learn, and a lot of these people feel it is their duty to administer a trial by fire to every student. Plus, there are very high expectations of what we should come to the OR knowing ahead of time--every drug we give, every procedure we do, every aspect of managing an airway--making sure we can adequately breathe for the patient, making sure any breathing tubes are correctly placed so we know the patient is really getting oxygen (it's easy to place a breathing tube in the esophagus because the anatomy is very close togther, and of course a patient can die if that happens). So many things to know. Plus, nearly every drug we give in the course of an anesthetic has the potential to kill someone. So it starts to make more sense why learning how to administer anesthesia is nerve-wracking.

Today, my first day of clinicals took place in the ECT lab. I think I blogged about ECT before, when I was there for airway management a few months ago. ECT is electroconvulsive therapy, which is used to treat depression that doesn't respond to antidepressant medication. It sounds archaic and brutal, but it is very helpful to patients who can't get relief otherwise. It is always voluntary, and the patients are anethetized for the treatment so they don't have any memory of it, and aren't hurt. That's why I was there, to learn how to do this anesthetic.

ECT is very fast and short. Each case takes 30 minutes or less from start to finish. We had 7 patients today and were done by 11am. That makes it sound easy, but short cases are difficult in a lot of ways for the anesthetist. A lot of things need to happen in that short amount of time. It's a good place to be a student, though, because you are doing basically the same thing for each patient, and because we don't use a breathing tube, but we do give a muscle relaxant (aka paralytic medication, which temporarily paralyzes all the muscles), we have to learn how to properly ventilate the patients since they can't breathe. There are a lot of medications given for this short treatment--one to prevent the heart rate from dropping too low, one to sedate the patient, one to paralyze, and we usually have to treat high blood pressure with at least one IV drug, often 2 or 3. In addition, patients often get an anti-inflammatory drug to prevent sore muscles after the treatment, an anti-nausea medication, and more sedation at the end if they have woken up combative in the past. Some patients receive IV caffeine to induce a better seizure--it is actually a seizure that is induced by the electrical impulse, and the goal is a seizure that lasts about 30-60 seconds, for the maximum benefit to the patient. In addition to all of this, many patients are on a lot of other medications which can interact with the medications we give for this treatment, so you have to be very careful to check everything against each other and make sure the patient will be safe. After it is all over, the patient slowly wakes up and has no memory of the treatment. They often go home that day, but patients typically have about 8 treatments, 3 per week, before they are done, and then often will come back every month or two for maintenance treatment.

I was working with a really nice CRNA named Marcus today. He was very understanding that I was nervous and new and didn't really know how to do any of this yet. He did the first case and let me watch, and ventilate the patient after she was induced, then I gradually did more of each case until I did the last one from start to finish myself. Having a kind CRNA makes all the difference--I was less nervous, and able to actually learn. By the last few cases I felt like I was actually getting the hang of properly ventilating a patient with a mask, which is often a difficult skill to gain. It will take a lot more practice, but I did start to notice a difference.

Setting up the room was very hard for me this morning because it's been so long since I was in ECT last time, and I wasn't certain of which drugs to draw up. Checking the anesthesia machine also takes me a long time, since I've just learned how to do this. We get to the hospital about 45 minutes to an hour early, to set up the room and check the machine before we see our first patient. This meant 0545 this morning, to be ready to see the first patient at 0630. (Tomorrow I will actually get there at 0530, because I felt a little rushed this morning.) I had my careplan ready, for the most part, but Marcus didn't ask to see it and we didn't really have time to go over it at all--which was fine with me.

Someday, I'll feel like I know something about this whole business. Not yet, though.

Now, I am off for a run before it gets too warm. I have to go back to the hospital at 2:30 to check tomorrow's assignment, and then make a care plan for that. I also have to study pharm today--but once my run is done, I'll be a little more relaxed and better able to focus, I think. I'm glad this first day is behind me, though, and that it went well.

Monday, July 7, 2008


This is a quick one. I had a lovely weekend of parties with friends and family. My SIL came to stay for a night, which was nice. And I drove back to Spokane yesterday.

I'm supposed to run tonight, but tomorrow is our first day of clinicals and I've spent the whole evening working on my care plan. I'm not going into details. But I decided that I need the sleep more than the run. I am out of clinicals tomorrow at noon, so I should be able to get a run in without trouble tomorrow, when I'm less freaked. So, I'm off to bed.

Friday, July 4, 2008


Happy 4th, folks. Despite the hot, muggy weather yesterday in Portland, today is our typical 4th of July weather: nothing but clouds. It's in the low 70s, and doesn't look like the clouds are going anywhere, making for a typical foggy fireworks show.

I made the mistake of going by Great Harvest yesterday and buying a fresh loaf of honey wheat bread. Doh! I've eaten a few pieces today, a few yesterday...hmm. Knock it off!

I did manage to run yesterday, in the heat and mugginess. It wasn't that fun, but I got it done.

Today we celebrate Independence--from being a colony, ostensibly. But these days, I prefer to celebrate independence from chub rub, from bemoaning the need to diet (tomorrow), from being too big to enjoy the simple pleasures like running around, throwing the frisbee, and playing in the sun. Independence from the big girl stores. Independence from constant worry over this one small area of life--and freedom to worry about all the other things that remain. Losing weight doesn't release one from worry, but it does put life into a little more realistic perspective. To my US friends, have a safe and happy holiday--and to my friends and readers elsewhere, happy independence to you too!

Wednesday, July 2, 2008


One of the blogs I really enjoy reading is Jeanette Fulda's Half of Me. It's not a WLS blog, but it is about weight loss...Jeanette took on the task of losing half of her body weight, starting at 372 lbs and working her way down to about 160. Her writing is witty and insightful, and her story is honest and devoid of mushy sentimentality and excuses.

Jeanette published her first book recently, called Half-Assed: A Weight Loss Memoir. She fills in all the blanks about her history of obesity and her impressive weight loss, and tells a simple, yet interesting and relatable, story. I recommend checking it out. (The link above will take you to her own website to sell the book. You can also buy it from Amazon.com, but I think she gets more of the proceeds if you buy it directly. Also, she'll sign it for you. And you can use PayPal.) It's breezy, not too serious, but shares her very real perspective on losing weight. One thing I love about Jeanette is that she has never displayed a lot of self-loathing about being fat; she is supportive of fat-acceptance, even though the movement doesn't support her. Another thing I love about her is that she isn't all judgmental about WLS or about "losing weight naturally" like a lot of folks are. She simply hadn't seriously tried losing weight before, and wanted to at least try before thinking about having surgery to do so. I applaud her for that.

One of the last paragraphs in her book talks about her former fat self, and how that fat girl will never go away, no matter how hard you try. Losing weight doesn't change your past or any of the experiences we had, no matter how painful or sad they might have been. I find myself, now more than ever before, referring to my former fat self quite a bit. I tell my hubby that I couldn't have done this or that last year, when I was 63 pounds heavier. I think it might bug him a bit, although he is terribly proud of me. But I think it's part of the process of wrapping my head around the changes that have occured and getting used to who I am now. I try to "kill" that fat girl, but she's still in my pictures and my memories, and those of my friends and families as well. She's in all my wedding pictures--happy, but definitely obese. That's who I was, and losing weight doesn't change that fact. It's hard to get used to seeing a different person in the mirror. It takes a lot of time and mental energy to figure this new self out, and I'm not quite there yet. I can only imagine how much harder that is when you've lost 200 lbs.

Tuesday, July 1, 2008

Thunder Only Happens When It's Raining...

Turns out, that's not true. I went out to run this evening, just before 8pm, because the big thunderstorm was coming and I didn't want to get stuck before dark. It had just gotten down to about 85 so it was more tolerable to run in, and it was fairly windy which helped a lot, especially since it's been so humid the last few days. I briefly considered my chances of being hit by lightning. Even being on the road up on a cliff, I figured my chances were still pretty slim--there are trees there, taller than me right? So I headed out.

The storm was pretty cool. Lots of lightning, lots of thunder--NO rain. I could have used a little rain, actually. I felt pretty sluggish with the heat and humidity, but got in 4.5 miles. I stashed a bottle of water about 1 mile into the run, so I had some on the way home.

(Image shamelessly stolen off the Interwebz. Cool, huh? It is from 4th of July, Spokane's Riverfront Park...seemed appropriate, being so close to the 4th. Might happen again this year...)