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Wednesday, December 31, 2008

The end of 2008

The end of 2008 is here. 2009 will bring me a bit closer to finishing school, which is supposed to happen May 2010.

I made it through year 1! Unbelievable.

Hubby made it to Spokane on Christmas morning. He left Portland by train at 4:45pm, but the train was held up for 4 hours after it left the station--not due to weather, as was anticipated, but by commercial freight trains (Amtrak does not own its tracks, so it has to cede the right of way to the freightlines that own the tracks) which were presumably held up themselves by the storms of the previous several days. He finally made it to Spokane at 5am, and took a taxi as far as he could to our house, but ended up having to walk part of the way. Poor guy got to our house at 6am. We slept for a bit as the snow continued to fall, and spent the rest of the day overeating and watching movies. It was pretty nice, all in all.

Between him having to work overtime for 2 weekends, and then the weather preventing travel, we were separated for a whole month before Christmas Day. Not really something I recommend to anyone. Hopefully this won't happen again. We are hoping he finds some work in Spokane...

On Monday, we both took the train back to Portland. Our 2:45am departure was delayed to 10:20am, and we arrived in Portland around 6:30pm. It snowed here quite a bit, but by the time we arrived it had pretty much melted, except for some dirty piles beside the roads. Which meant that yesterday, for the first time in 2 weeks, I was able to go run. It really did more for me mentally than physically, even though it was great to move. I was going to go run today also..but didn't...so will head out tomorrow again. And probably every day I am still in Portland. Spokane isn't going to be run-worthy for a while. The snowfall for December was 62" the last time I checked. Most of the sidewalks are not shovelled, so there's nowhere to run but in the street, which is pretty unsafe with vehicles unable to brake. So...it looks like I need to find a gym again. Suck!

Last year I went through this process of trying to find a gym. I settled for the Y in Spokane Valley, but the hoardes of screaming children in the locker room make me want to avoid that this time. I am thinking of just joining my university gym. Gonzaga's facility seems pretty nice, and it's $150 for a semester (Jan to May) for graduate students. There are no gyms in walking distance of my home anyway, and pretty much all of the gyms in Spokane are lame.

I'll be joining millions of Americans tomorrow by vowing to lose weight, although it's not a New Year's Resolution, but the continuation of my plan for the past several months. I'm looking to lose about 12 more pounds and I don't have a timetable for it. I gained some weight during my time being snowed in over Christmas (9 days total), but nothing terrible. Considering that I couldn't exercise and had all these goodies baked that I was going to give as Christmas gifts (but never was able to see my family), it could have been worse, and shouldn't be hard to get rid of.

Happy New Year everyone.

Wednesday, December 24, 2008

All I want for Christmas is...my hubby!

Still snowed in...

Today I spent the day scanning some old photos, and watching movies, and cooking. My hubby has been trying to get to Spokane for a week now. The weather has foiled us at every turn. Finally, he got a train ticket for the 24th that wasn't cancelled. He got on...there was a 4 hour delay after the train left the station, but they are on their way. He should be here around 5am.

Like a lot of people this year, all of our normal Christmas plans have been cancelled. We already decided that we couldn't afford presents this year. Or, rather, giving gifts just didn't seem worth the cost. We already have everything we really need, we don't really want anything that you can get as a gift. And money is tight, as it is for everyone this year. My being an unemployed full-time graduate student doesn't help that situation any. So it made no sense to do the gift thing this year. We plan on doing something nice for each other later--whether it is exchanging gifts or planning a little weekend away or something, we haven't decided. I had planned on making gifts for my family, and we were going to see them--we planned to stay at my brother's house from the 24th to the 26th. But then the snow started, and soon it became apparent that we would not be getting to that side of the state under any circumstances.

So for me, Christmas this year is all about seeing my husband. We've been separated, not by our choice, for a month now. Getting him out here has been the number one priority. I will go back to Portland with him this weekend, but we really wanted to spend the holiday together here in Spokane. And it is very much a white Christmas...

It's actually really a relief not fussing over presents this year. First we asked everyone if we could either agree to not buy gifts for each other (of course we would for my nephews), or choose names out of a hat and buy for just one person, like a lot of families do. No dice. So we asked everyone to not buy us gifts, and I think everyone except my mom agreed to that. Next year, I'm going to ask everyone who can't stand to not buy us presents to donate money to charity for us. I know a lot of people do this already. But my family just doesn't seem to "get" the idea of not exchanging gifts, even though most of them agree with me that we don't really need stuff and the gifts we exchange are never really things that we wanted or needed. I think because we don't see each other that much, having that exchange means a lot to some of them. But I kind of convinced my mom tonight on the phone when she was talking about an animal rescue that she volunteers for, that she could donate to that in our names next year. She kind of warmed up to that idea a bit better...so hopefully I can make some headway by next year. We are very blessed, and we have what we need. I hate bringing home stuff that we don't need, and feeling guilty about it because I know my family gives it to us because they care. A present-free Christmas is actually pretty nice.

We'll have a low-key holiday by ourselves. I've made some of our favorite traditional Christmas foods, and we'll watch some movies and probably go for a walk in the snow. Hubby will get here so late (or early) that we'll definitely sleep in. I think it will be nice! But this is the first year I can recall that I won't spend with any of my family. That is pretty sad, especially after losing my grandparents this year. I'd really like to spend time with them. And they won't be seeing each other, although they all live within 50 miles of each other. The roads are just in no condition for that kind of travel right now. (Western Washington is not prepared for major snow like other areas that usually get it. When they get snow like they've gotten over the past week, things shut down, because there just aren't that many plows and there is no organized response, like there is in Spokane or other towns that usually get snow.)

Being stuck in the house with holiday food and no real prospects of exercise hasn't been good for my weight AT ALL. I can't wait until I can get back to some kind of exercise! Aack, it's driving me bonkers. But right now there's truly not much I can do about it.

Merry Christmas to everyone. May your holidays be as low-stress and low-guilt as possible, filled with love and family.

Monday, December 22, 2008

Winter Fun

Some days I just have to laugh at myself.

This is Day 6 since the Big Snow started to fall. We have somewhere between 2 and 3 feet on the ground, but the plows have been through most places, and the roads look ok, so I thought I would go venture out and pick up my glasses at Costco. It seemed like a good outing, entirely on major arterials once I got out of my neighborhood. I just had to dig my car out first.

I went out with a shovel, determined to get the car out of its snowy cocoon. I put my keys on the garbage can so that I wouldn't drop them, and dug and shoveled for about 15 minutes until the back was pretty well cleared, enough that I could start the car and not get carbon monoxide poisoning. Then I went to clear the driver's side so I could start the car and let it warm up and thaw. I grabbed my keys and shoveled once, twice...

...and dropped the keys.

The snow was all shoveled so there was no obvious hole where they went. I looked under the car and couldn't see them...looked beside the car...then started going through the piles of snow beside the car. It's perhaps worse than looking for a needle in a haystack, with that much snow to look through.

I didn't find them, though I looked for over an hour, and had help from my neighbor. The keyring held 4 keys: my car key, which I have no copy of (it's electronic, I lost my other one down an elevator shaft 4 years ago), my house key, which I have no copy of, my apartment key to the Portland place, and the key to our classroom at the hospital. My landlord came over and let me into my apartment and will get me another copy tomorrow. My car I'm just going to have to have rekeyed. All told, that will end up costing a few hundred dollars, and won't get done for at least a week--which is fine, I don't really need to drive anywhere for at least that long. But what an asshat thing to do.

Once I got inside and took a hot shower to thaw out (and looked to make sure that I really don't have another car key), I had to just let it go. What can you do? You really can't unlose your keys. They might turn up one of these times, when the snow melts in..April? May? I'll look again tomorrow morning, but the keys seem to have fallen into a black hole. It's not the end of the world, just a little annoying, and I'm lucky that I don't have to go to work this week and I'm in walking distance of the grocery store, which is all I really need while I'm on winter break. I can take a taxi to the train station, or could even walk if it got that bad. It's a little expensive and inconvenient, but it could be much worse.

So, I'll be confined to about a 1 mile radius for at least another week. Sweet!

Saturday, December 20, 2008

Clearly it's cabin fever...

Lookit all these posts. I've been stuck at home for too many days now.

I've posted about a lot of random things lately...evidence that I've been able to dedicate some thought to things other than school, finally. WLS blogs are funny things. We all seem to go through a similar process: first, we have this huge goal of weight loss, a scary prospect of major surgery to achieve it, and we start a blog to help ourselves, and hopefully others, through the process. We spend a year or more navel-gazing about our "Journey" and blogging about the smallest details of the process. Then something changes--we lose weight, we start to widen our view and our blogs change a bit. Some of us regain, and stop posting out of embarrassment. Others settle into regular life and post about everything but weight loss, because--guess what?--it's happened, and other things seem more interesting.

Major weight loss is a puzzle about life, and whether we have surgery or not, our Herculean task is to solve the puzzle. Over time, we come to realize that most of it is more dependent on us solving the riddle for ourselves than on the surgical procedure. And with a wider view afforded by achieving our goal (even partially), we come to see that the riddle applies to our whole lives, not just the number on our scale.

I'm not apologizing any longer for my blog not really being just about WLS anymore. If you are a reader who is doing research on WLS, I'd like to suggest that you see WLS blogs that shift focus after reaching goal or coming close as a sign of success. The success is not only losing weight or being thinner (or whatever the original goal was), but in sorting out our priorities and figuring out how to see ourselves in a greater context than our dress size. I'll always talk about the process somewhat, and I'll probably always have some health, fitness or weight-loss goal that I am working toward, just like everyone else. But thank goodness that I am no longer singularly obsessed with my lap band. I wish everyone the same success.

Interesting Link: End of Life Care

I have an interest in medical ethics and end of life care. Here's an interesting link I followed today, written by a hospitalist in his blog:
My Patients Are Dying...And I've Never Been Prouder.

This is a really well-written piece about the importance of planning for end-of-life care in the hospital, and the better-late-than-never shift of focus from "The Patient Must Never Die!" to a discussion of the viable options and possible shift of focus from "doing everything" to making the patient and family comfortable. We all die, sooner or later, and not many of us want to do it in the ICU, especially if there is no real hope for a positive outcome.

The one thing I would like to see more of is a focus on the nurses' role in palliative care. This doctor talks a lot about all the physicians he has worked with who have advanced the issue of end-of-life care, and mentions the multidiciplinary Palliative Care Team he works with. He mentions the social worker by name, but then refers to the "PCT-trained nurses" as a group, and never talks about the bedside nurses that not only carry out orders, but coordinate the efforts with the patient and family, and create the environment that families need and remember later. Nurses really make palliative care possible. Certainly the doctors who make the major treatment decisions are important, but there are a million intangibles that cannot occur without an educated, compassionate and willing nurse caring for the patient and family.

Snowshoeing Pictures

(That's my red Jetta under all the snow...see the side-view mirror?)

Mommy Wars

I am 35 years old, and I can relate to single women my age and the frustration and humiliation they feel when people offer them advice on how to get married and have babies--although I am married.

I am still childless, both by choice and not by choice. I think our lives are like big Jenga puzzles--you don't know which piece can be removed without making the rest fall down. I have wanted to be a mom since I was a teenager. That being said, I also decided as a teenager that I shouldn't marry before I was 30, and I assumed that meant I wouldn't have kids before then, either.

Despite that, I married for the first time when I was 24, and my plans were that I would have a baby around age 26. I had just finished nursing school and started my career as a trauma nurse. I thought 26 would be a great age to have a kid. Unfortunately, my marriage ended before I got there, partly because my husband decided really didn't want kids, after all. I usually blame my currently childless state on my ex-husband, because it's more fun to blame the ex than myself. The real truth is a lot more complex than that. I should have known that he wasn't really on-board with my desires for children, although he told me he had changed his mind and really did want them when we did get married. I wanted to believe that, and I didn't want to face the difficulties of ending that relationship, which was 5 years old by the time we married. So instead of having a baby at 26, I had a divorce.

What happened after that was just life, and I had about as much control over its flow as anyone else does. It's easy for me to look back now and guess at which Jenga pieces I could have taken out that would change my circumstances now, but less easy to decide if I really want my circumstances changed at all. I lost weight, gained it, lost it, regained it...who knows if that would have affected my ability to have kids between ages 26 and 35, because I wasn't in a position to try. I dated for many years, mostly not very seriously. I didn't want to get married again. I didn't really want to be a single mom either, but I never lost my desire to be a mom. I just didn't know how to realize it.

When I was almost 31, I met my current husband. We knew right away that we would get married. We married when I was almost 33. (Actually it was 2 years exactly after our first date.) By this time, I was fast becoming burned out in my career as a critical care nurse, and I knew I wanted to go to grad school and become a CRNA. We had some decisions to make--buy a house or not, go to grad school or not, have a baby or not. I decided that having a baby then would push out grad school too far for me to tolerate, and we both decided that I should pursue graduate school--which also meant not buying a house yet (a great decision, I think, given current circumstances). We both continue to second-guess these decisions, because the path we chose is not easy. I'm in grad school, pursuing a career that I'm excited about--but I'm also 400 miles away from my husband most of the time, which is very hard on both of us. At this time of year, travel between Spokane and Portland is very difficult. As I write this, I haven't seen my husband since the end of November, and he's trying to make arrangements to get here this weekend. The road conditions in the desolate areas of southeastern Washington and the central Columbia Gorge area mean that we are separated a lot more than we want to be. And of course, now I am 35 and my biological clock ticks louder each day.

The good news is that I am healthier than ever before, and I have no reason besides statistics to think I won't be able to have a child in a year and a half. I've already pretty much decided that extensive fertility treatments are not for me--if I find that I cannot become pregnant by the time I am finished with school, I MIGHT try some fertility drugs, but would not do anything more invasive unless for some reason I couldn't adopt. IVF and all those things are fine in certain circumstances and for other people, but to me, my point is to be a parent, not just to have my own genetic child. If I'm going to spend that kind of money, I may as well spend it on adopting a baby, and not risk my health so much. That's my personal philosophy, and I'm sure it's subject to change if I ran into unforseen difficulties along the way.

It's sad that people are so judgmental of others in the area of having children. At my age, people who meet me assume I must have children, and when I tell them I don't they tend to ask questions that aren't really their business or assume that I don't want them. It's a subject that is very emotional and uncertain for me, and I don't really want to talk to strangers about it. Then I get the comments about all the things I can't possibly understand because I'm not a parent. Whether that is true or not, it hurts to have it put in my face all the time. And it happens every day. The emotional part of me wants to tell the world that it's not my fault I am not a parent right now. That's how it feels, but of course it's as much because of my choices as it is because of circumstances beyond my control. And I'm usually able to see that my life would be very different right now, and not necessarily better, if I had kids. If I had kids right now, which things in my life wouldn't have happened? Would I have met my husband, traveled around the country? Would I be in grad school right now? For the most part, I am happy with where I am right now, but this one area of uncertainty does cause a lot of anxiety and sadness for me.

I was having breakfast this morning and thinking about this as I listened to Ani Difranco's latest album, Red Letter Year. One of the things I love about music is that moment when you are listening to a new album and it goes from being something unfamiliar to somethng that you really connect with and relate to. It's sort of a magical thing that happens with music. I've listened to Ani since I was about 21--which for those who are keeping track is kind of a long time--and have seen her career and her music change a lot over the years. (That's another thing I love about music, watching how artists change through the years and how their music changes with them. That drives a lot of fans crazy, but I enjoy it.) Ani has gone from being this almost militant young teenaged folksinger to a sort of artistic patron in her hometown of Buffalo, NY (she writes a lot of music about Buffalo, and has provided some jobs at her own record label that she founded as a teen, Righteous Babe Records, and recently refurbished an old church into a concert hall in the downtown area) to a new mom. Her latest album contains a lot of songs about being a new mom, and about love--topics a lot less political than her early work, but still with her unique perspective and voice. Ani is 2 years older than I am, and the fact that she had her daughter at my age now gives me a lot of hope--as do all of my friends my age who are having kids now. In this album she sings about having this incredible insecurity and self-loathing that a lot of women have and having to revisit that when she sees that her child looks so much like her and is beautiful. This is in the song "Present/Infant" ("so I'm beginning to see some problems with the ongoing work of my mind/and I've got myself a new motto/it says don't forget to have a good time/don't let the sellers of stuff have power enough to rob you of your grace/love is all over the place/there's nothing wrong with your face"). In "Landing Gear" she sings of her pregnancy and the arrival of her daughter with a tenderness and cheerful beauty that fits the topic perfectly. Her unique view of labor and birth in this song both lightens and elevates the moment: "the candles are burning down, the music is fading/your pinata is torn/it's time to be born...you're gonna love this world if it's the last thing I do/the whole extravagant joke topped in bitter sweet chocolate goo/for someone who ain't even here yet look how much the world loves you."

I don't often quote lyrics in postings, but the topics covered in this album have the potential to bring a whole new set of listeners to this incredible artist. Of course, there are still some controversial politics on this album, too, and she's definitely a liberal--it's not for everyone, but it's worth checking out. Listening makes me feel a little better about my place in the Mommy Wars--even if I'm not sure if I'm an insurgent or a casualty.

Friday, December 19, 2008

Socially Necessary Surgery: the debate rages

You may have read the news that a woman in Ohio recently received a nearly complete face transplant. I am sort of surprised that this is so controversial, but it is. Articles like this argue that doctors willing to perform a facial transplant must also offer the possibility of assisted suicide if the transplant fails. Others question the idea of surgery that is not absolutely medically (physically) necessary. There are a host of other questions that remain to be answered: what about the donor, for example?

(Note: I'm going to talk in detail about facial injury and disfigurement, and about the process of organ donation, in this post. I also talk about patients who are burned, and those who attempt suicide via gunshot. If this is too emotional for anyone, I suggest skipping this post. It's not really graphic, but it can certainly be emotional.)

I have worked with many patients who were severely disfigured by surgery, burns and trauma, who are the usually talked-about potential recipients of face transplantation. The idea that this surgery is not medically necessary is a lofty one for those who don't have to live with the consequences of having a devastated face. Take burns, for example. There is a lot of research going on to determine the best ways to prevent disfiguring scarring after burn grafting (especially to the face) and how to treat disfiguring scarring when it does occur. Scars continue to grow months or even years after a graft has healed. Some new specialized laser surgeries do offer some hope to people with horrific hypertrophic scars (like keloids) over their burn wounds, but these people live for years with a face that humans naturally recoil from, even if they have the best of intentions not to. And to lose what was once a normal face to a burn accident or trauma can be so devastating to a patient, they often withdraw from society altogether, unable to take the ongoing trauma of interacting with people.

I've also had many patients who disfigured themselves in attempting suicide. (Side note: gunshot to the head is not a surefire way to commit suicide.) I've had a few patients who blew off their whole face but left their brains competely intact. Imagine being so depressed that you try to commit suicide by putting a gun in your mouth, only to wake up in an ICU, on a ventilator, still depressed and now you have no face. (Aim too low, and you can blow off the top of your spinal cord, leaving you a quadriplegic with an intact brain.) Many people tend to blame these patients for bringing this on themselves. But depression is a disease, and the consequences they face after something like this happens are devastating.

The people who do research on treating facial disfigurement (I think the term deformity refers more to structural problems that tend to be congenital) see facial transplantation as a very viable treatment option to problems that our other surgical techniques just can't solve. The obvious downsides include the following: you have to take high-dose antirejection drugs for the rest of your life, which often cause cancer; the liklihood of a facial transplant being rejected over time is higher than for most solid organs; if the transplant is rejected, there is no second chance, and the patient is left with a face that will probably be worse than what they started with. In short, if it fails, the patient--who already could not bear to live with their original disfigurement--may not wish to live with the consequences.

All of this is, I am certain, covered in extreme, minute detail when the surgeon discusses this option with a patient. Unlike a lot of mainstream journalists opining on this subject, plastic reconstructive surgeons who consider this option for a patient think every day about the consequences of extreme facial disfigurement for their patients. Humans have a strong attachment to faces, and it's not just societal norms that cause people to recoil from disfigured faces--it's a very basic part of human nature. That's not to say that people should not make every attempt to counteract this instinct when interacting with someone who is severely disfigured. But look at the dance that occurs between that patient and one stranger with whom they are interacting: the stranger trying to treat the patient normally, being compassionate but trying not to make the patient feel bad, and the patient feeling the stress of knowing that their face is difficult to look at. And this is with people who are trying not to be cruel--some don't even try. Imagine having to do this dance with every single person you interact with for the rest of your life, and it's easy to see why doctors and patients consider taking all these risks to repair extreme damage to a face.

The donors are another matter. Some of the articles that quote Art Caplan, the bioethicist (whom I've seen on a number of forensics shows before, and who I think is kind of a tool) talk about this new world of organ donation, wondering if families get a choice in having their loved one's face transplanted when they agree to organ donation, or if we need to change the whole process so that people can make sure their loved one doesn't have to have a closed casket when they agree to organ donation. I think this is a bit of silliness that reflects a lack of research into the organ donation process. In my experience with numerous organ donors in several states (at least Washington, Oregon, Arizona and Illinois, the states I have worked with organ donors in), just having "organ donor" on your driver's license doesn't mean that you are obliged to donate your face when you have a devastating accident. (Or any other organ.) The declaration on your driver's license carries no legal weight, and at this point only serves to inform the organ procurement agency (OPA) of your wishes so that they can convey this to your family. Your family makes all of the decisions about organ donation--not your driver's license. This includes specifying what organs are transplanted.

Here's what happens after a patient is determined to be a possible candidate for organ donation. A donation coordinator from the OPA approaches the family and discusses the option of donation. This conversation happens very delicately and focuses on what the family wants and what they think their loved one wanted. If they sound like they want to pursue the option of donation, the coordinator lets the family know what kind of donation appears possible--i.e. full organ donation (heart, lungs, kidneys, liver, pancreas, plus tissues such as bone, tendons, corneas), donation after cardiac death (kidneys and pancreas only, plus tissues), or tissue donation only. The OPAs are very sensitive to the needs of their donor families, and of course to the possibility of being sued by a donor family, so they would never "slip" a facial donation into that process without being extremely clear about it. With all of the OPAs I have worked with, I am confident in saying that at least about those organizations. OPAs are not going to say to a family, "You consented to organ donation, so you don't get any say about what we take." With all the emotional weight that a face has, no one is going to use a donor's face without explicit and detailed consent from the donor's family. I think this is really a non-issue based on what I've seen. There is a choice. The consent process doesn't need to be changed at this early stage.

In all of the articles I have read about this issue, one thing that always comes up is the idea that this surgery isn't really "necessary" for life. This really bothers me. I think bariatric surgery patients can relate to this to a lesser degree. How often have people told us we didn't really "need" our surgery? These are people who haven't had to live the life we lived as morbidly obese people. They don't have to face all the social problems that the MO do. For candidates for facial transplantation, this is much more extreme because they don't also have the systemic health risks of morbid obesity, but their psychological necessity is even greater. The idea that a person's life should be fine as long as their heart is beating and they are able to feed themselves and get around is so simplistic. How can you say that transplanting a kidney is more medically necessary than transplanting a face? (After all, you can live a surprisingly long time on dialysis.) Transplanting solid organs is a fairly uncontroversial topic these days, since people aren't as emotionally attached to a liver or a heart as they are to a face. But I defy any of these journalists who say that this surgery isn't worth risking a patient's life for to tell that to a patient who can't eat or breathe normally, who is missing entire parts of their face and cannot go out in public without being stared at in horror.

I don't know if my readers find this topic as interesting as I do. But again, I think we all can relate to other people determining what is really "necessary" for us. For people who may be wishing that medical science hadn't been able to save their life at all, now that they have to live with the consequences of an otherwise healthy body and a horribly disfigured face, this can be the only hope for a reasonably normal life. The ethical dilemmas are real--I'm skipping entirely the question of offering assisted suicide--but they are best left for the patient and the physician to determine.

We're having a blizzard!

Well, we already did, but that's still what my friend Tami likes to say. We got a record 23.5" in 24 hours yesterday. Even for a city with a full fleet of plows, that is a lot. Yesterday I went snowshoeing in my neighborhood and I'm going to go again today. This time I'll wear my heart rate monitor though--I know going up the hill I got just as much aerobic workout as I do running. The state patrol is still telling people not to drive anywhere, while the plows are still trying to clear the streets, so snowshoeing on the streets is pretty viable in my neighborhood, and much easier than trying to walk in boots.

Snowshoeing, for anyone who hasn't tried it but wants to, is really just walking. If the snow is a little bit packed, the snowshoes will keep you from sinking much, but in the loose powder, forget it. The snowshoes I bought have much nicer bindings than the ones we rented last winter, and that makes a big difference since you don't want to have to take off your gloves to adjust the snowshoes when it's so cold out. These work well with big, clumsy gloved fingers, and they stay on much better than the rentals. I'll post a few pictures sometime today.

Thursday, December 18, 2008

Snow Day

Winter is here. It started snowing last Friday, but then we had nothing for the next few days. Now it has turned into something of a blizzard. We've gotten over 2 feet in 24 hours. At least it's a little warmer now--19 degrees, instead of 2.

We were supposed to have a year-end school brunch today, which was cancelled. OR tomorrow was also cancelled for us. As it stands, the hospital has cancelled all elective surgeries anyway so there wouldn't be much for us to do. Spokane is a city that is accustomed to snow, but this is an emergency even here. But as opposed to places I have lived closer to the coast, where people freak out and act a fool (like Seattle and Portland), in Spokane people just enjoy the snow. If it's an emergency, like this particular snowfall, they stay home and do snow things. Most people here have trucks or SUVs with 4wd (I do not, I have a Jetta and don't even have snow tires) so they are a little bolder about getting around. I am bound to the house for now, since I have the little car with no traction, but I am in walking distance to the hospital and the grocery store, so I'm doing okay. Just a bit bored.

I don't care for the cold too much, so it's hard to convince myself that I should get out my snowshoes and go up to the park. I know I should. I haven't been able to run since Friday. And I will...I'll go snowshoe and get some exercise. Lord knows there is enough snow for it. When the sidewalks are shoveled, and it stops snowing, we'll be left with packed snow and ice and I can run again, or so I hear. There are two ways I have heard of to get traction on your tennis shoes for running on snow and ice. One, buy YakTraks, which go on your shoes somehow (I've never seen them but many people swear by them). Two, buy a bunch of 1/2" screws and screw them into the soles of your running shoes. They are short enough that they won't go all the way through but they give you some "studs" to grip the snow. They come out, but they are dirt cheap. So I am sure sometime this winter I'll be trying these things out. I'm not really made for the snow and cold, though.

It will soon be time to try to tackle the last 10 pounds. I've been waiting for this semester to end. Here are some things I was thinking of doing when the new year arrives:

Food: Try the plateau-busting diet that Sandy R developed. (I would post it, but I'm not sure it's okay with her, so for now I won't.) That is 2 weeks max. It's basically the same as the liver shrinking diet that many surgeons put their patients on pre-op.
Then, see how my restriction is (like actually pay attention) and go in to see the surgeon and determine if I need a fill.
Eating is always about going back to the rules and the basics, which I haven't been sticking to very well this semester. Using FitDay again will help me out with that.

Exercise: My running is good, but I need to get back to something in addition to that. I haven't decided if it will be weight training again, or yoga, or both. If I have time next semester, both would be good. I'd love to do a weekly or twice-weekly yoga class, but weight training might be better for me. I haven't decided about that yet.

It's nothing earth-shattering, by any means. It's just a cluster of things to focus on again to see if I can lose 10 more pounds. But what is interesting to me is that right now I have maintained the same weight for 6 months. And that weight is exactly how much weight my surgeon initially told me he thought I would lose. Of course, it's about 70% of my excess weight (that's what they always predict) and I want to lose more than that. But I'm not going for 100%, I don't think that would actually work well for me and it would be extremely hard for me to maintain even if I could get there. I guess the lesson here is that on-going weight loss is not a mystery with the band. It's still calories in, calories out, more or less, no matter if there's WLS involved or not. If these things don't work, then I either need to regroup with my surgeon, or maybe just be okay with this weight. I'll keep ya posted.

Wednesday, December 17, 2008

End of Semester!

So, I am sorry that I have not blogged. It's not that I've fallen off the wagon or anything. I've just been studying for the pharmacology final ever since I got back from Thanksgiving break.

The pharm final is the big hurdle for the first year of my program. We have lots of midterms and exams through this big first year, when we do the bulk of the classroom work for the 28 month nurse anesthesia program. But this pharm final is a really big deal. It covers all the pharmacology that we have learned in our first 3 semesters of school. I realize that if you haven't had to study pharmacology, a lot of this is Greek, but I'll share with you anyway. The topics include:

Basic pharmacology concepts
Inhalation anesthetic agents
Anesthesia induction agents (paralytic medications, hypnotics used for "induction")
Opioids and benzodiazepines
Autonomic nervous system agonists and antagonists
Cardiovascular drugs: vasopressors, catecholamines, antihypertensives, drugs for congestive heart failure, diuretics, etc...
Local anesthetics
Antiemetics, prokinetic (GI) drugs
Antipsychotics and antidepressants

I might be missing something there. Anyway, that's hundreds of drugs to know what they do, what receptors they work on or what their cellular mechanism of action is, what are the drug interactions, how are they metabolized, how are they cleared, etc. etc....so that's why I've been MIA.

The final was today. Our instructor said he is spending the day correcting the exams and plans on giving us our grades tonight by email (there are only 8 of us in our class). I'm really anxious to hear how I did...the way he tests, it's very difficult to know. There are a total of 295 points possible in the class, and the final is 200 of them. The other 95 are everything else we did in the last 2 semesters (the first semester was graded separately, we get the same grade for summer and fall semesters): that includes 5 midterms, 6 or 7 quizzes and our big teaching project/presentation that we each did a few weeks ago. It's kind of unfair that so much is riding on this one exam, but that's how it goes. At least we are forced to go back through all the material and make sure that we know it (or relearn it, as we tend to forget everything after the exam). Then we'll have to do it again when we take our boards in 18 months. Each time you go back through the material, of course, you learn it a little better. That's the reason we do the big giant painful final.

So...sometime soon I'll find out if I passed. I'll try to blog more now that I'm on break. It's snowing like crazy here in Spokane. Hubby has been stuck in Portland for weeks because of overtime and weather. I'll be glad when we don't have to be so far apart.