What I Am

A happy Memorial Day to you all, especially those who serve in our armed forces. I extend this to everyone, not just Americans.

I'm enjoying a lazy Monday holiday. Hubby is still sleeping, I have coffee, and most of a day yet to determine how it will be spent. We went out to see my brother's family on Saturday and came back last night. I haven't seen anyone in my family in a very long time; we were supposed to go there for Christmas, but then the Great Blizzard happened and I couldn't go anywhere, and my hubby barely made it to our home from Portland, at 10am Christmas morning. So it has been a long time. It was nice seeing everyone, especially my nephews, who are getting big and sassy. It's a long drive, about 5 hours if you take the correct freeway and don't misunderstand the street name on the phone. My brother moved last year so I hadn't been there yet. But the drive was beautiful and enjoyable. We spent yesterday afternoon playing frisbee in the park with 4 kids, 3 frisbees and several adults. My legs are mysteriously sore today.

My weight remains undeniably higher than the beginning of the year. I have some good reasons/excuses, but still, I want to get it under control before I am writing here about regain and complaining that the band doesn't work. I am approximately 5 pounds higher, on average, than I was six months ago. Looking at my stats (which I keep on my running log), it seems that it started around March. This isn't terribly surprising given all that has happened this year, but again, time to fix it. The crisis is past, we are living our lives the way they are going to be for at least the next year, and I want to get closer to goal, not further away.

There are some obvious things I need to fix. My eating is great in the morning and during the day, especially when I am at the hospital for the day. I rarely have anything I didn't pack, and I pack well for the most part. The trouble comes when I get home. I tend to graze for sweets. I've tried my old tricks: have a protein snack, have tea, brush teeth. Sometimes they work. Unfortunately my hubby has been eating sweets in the evening as well, which he never used to do, so we often unravel each other's intentions. I know on my part it is emotional eating, stress relief from the day or the like. Because it isn't only my own behavior and a lot of it is subconscious, it's not easy to fix this. My hubby tries to support my efforts to get back on track by trying to block me from eating something, which just pushes my buttons and makes me angry. I know he is trying to help, but I feel parented and it makes me feel worse. So it's something we'll have to work on together.

I think probably increasing my running mileage again could help. I'm running less than 10 miles per week, as opposed to last summer when I was running 12-15. This could help some, but isn't going to be the magic bullet here.

I have tended to think that the answers lie in my own "working the band" rather than in getting a fill, but now I am starting to think that I do need a fill. I haven't had one in a very long time--maybe since last September or so? I don't even remember. No, I just checked my stats: it's been since early May of last year. Over a year. I have ALWAYS been able to eat more than I should be able to, and have never tried to get such a tight fill that it forced me to eat a tiny amount. But I tend to get hungry in about 3 hours after a good band meal--solid protein, then veggies or fruit, no liquids. This is especially hard in the OR, when I don't get a break for a long time (or like last Friday, at all). My original band surgeon told me that often when you find yourself grazing a lot or thinking about food when you aren't eating, it can be a sign that you need a fill. I'm paying out-of-pocket now for fills, so I have to have about $200 to get one, and we still have no source of income other than unemployment and student loans, so I do hesitate to spend money on a fill. But it's probably a good idea to do it, and check in with the surgeon since I haven't in over a year. While I am at it, I should go back to my NP and get some labs done--nutritional status, esp Vit D which I am sure is low.

What I really notice more than anything is that my old eating habits have come back since my stress level has increased this year. I eat less mindfully, and I eat more foods that produce good feelings for me: mostly sugary stuff, which triggers endorphins and such. When I talk about stress being higher this year, I am not only talking about my hubby. Yes, his difficulty in finding work, his legal troubles, his recovery as well as mine and ours together as a couple, have been stressful, but school has been at least as stressful as that as I became a senior. I have more freedom in the OR, but with that comes a constant level of stress that wasn't so great or noticable when I was being directly supervised. I don't know the docs as well as I knew the CRNAs so I don't really know what to expect, and I'm in a lot more situations where I'm out of my comfort zone. This is how it is supposed to be, and I'm learning a lot, but it really ratchets up the stress. So when I talk about "stress" that is not code for my personal life. It's interesting to me how old coping mechanisms get triggered by emotional situations, and we don't realize it consciously until it has been going on for a long time.

I guess I'm still on the WLS journey, and while I've done pretty well so far, at 2+ years out I'm still not at goal. I am a few pounds less than this time a year ago, a few pounds more than six months ago, and I'm right where my surgeon predicted I would be after my surgery. But I think I can do better, and I know what to do. I just need to do it.

Moving on...

Well, it's been a week since Bloomsday, and I planned on running after a few days' rest. But then I got sick, and I've been out ever since. I'm hoping to get in a short run today, if I don't cough too much.

School has been busy, and the scene is changing for my class. This week we became "seniors" which means that instead of being with a CRNA for every case all of the time, two of us are supervised by one MD, which of course means that we spend most of the case by ourselves in the OR. It differs from program to program how this is done. Some programs have this kind of supervision (2:1) from early on in the clinical rotation. Many others never go to 2:1 at all. I like how our program gets us a good clinical foundation before giving us an entire year at this supervision level. Our graduates are always able to start working right away upon graduation, with no lag-time for getting used to working on their own. Still, at 2:1 we have the MD there at the beginning of the case and at the end, and they come in periodically to check on us and if we call them with a problem. They are generally pretty vigilant about making sure we are supported, especially in the beginning. And it's the only way to learn how to administer an anesthetic on your own, making those moment-to-moment decisions without someone behind you putting in their 2 cents.

We've also been in OB, placing epidurals and doing anesthesia for C sections, which is pretty fun, and in pediatrics, which we have been doing for a little while now. The class above us just graduated on Friday, and we had a big banquet and ceremony for them, which was a lot of fun. My hubby helped put together a nice slideshow presentation for them which was a big hit, although he couldn't actually attend with me. And now we are the senior students at school. It's hard to believe, and yet I don't really feel like the last 17 months have exactly flown by.

I am struggling with about 7 pounds still that I can't seem to lose. I gained a few more in DC but have managed to shed a couple of them. I'm trying to get my eating back where it should be--less sweets, more protein. It's the snacking that kills me. This far out post-op, I think it should be about having a daily maintenance plan for eating, not going on a "diet" to lose weight and then changing our eating back. That's the kind of thing that caused the overweight in the first place. So I'm trying to just cut out the sweets and snacking. It's difficult, especially when stressed. But it's something I have to conquer if I want to maintain my weight loss, and reach my ultimate goal.

Yesterday I worked my first Saturday shift, and we were quite busy. Saturdays we do mainly emergency/urgent cases. My last case was a man with an incarcerated hernia, that is, an opening in the muscle wall of his abdomen that created a pocket for his abdominal contents to leak into. He was having pain because part of his bowel was in there, and starting to have its circulation compromised. I calculated his BMI at about 59. This presents a problem for his safety both in having the surgery itself--it's a much more complex surgery at this level of morbid obesity--and in receiving the anesthetic. I was unable to intubate him (the anesthesiologist could though) despite doing everything I've learned to do to optimize my view of his airway. Once anesthetized and in position, he was very difficult to ventilate. The surgeon who performed the surgery was on call for general surgery, but most of his day-to-day practice is bariatric surgery (mostly RnY). One of the techs asked if he'd be doing a RnY on this patient later, but the surgeon said that the patient seemed to have no idea that his weight was even a problem. Of course, we know that if the patient doesn't accept any ownership of the problem of morbid obesity, bariatric surgery isn't going to help in the long run. He reported having excellent health, even though we discovered that his blood pressure was quite high and he almost certainly should be sleeping with CPAP at home, at the very least. I am sure he doesn't see a doctor very often if at all, and if he's anything like many of us who had bariatric surgery, it is at least partly because he doesn't want to hear them lecture him about his weight. The patient seemed like a really good guy, and I thought about all the reasons he might not be taking care of his health, and felt really badly for him. Surgery went fine, though, and he was starting to recover well when I dropped him off.

Today is a lovely day, and I'm hoping to go for a run. Happy Mother's Day, everyone!

I'm a 2009 Bloomie!

The race was today. It started off cold and cloudy, but at least yesterday's wind was gone and conditions were not bad for running 7.46 miles. Well, I'm overstating a bit. I probably ran about half of it.

Bloomsday is a fun race. They had over 30 live bands along the route, so there was always music to run to, no need for an iPod, and every genre from rock to country to bluegrass. There was more than one group with an accordian. People line up along the way just to be a part of the event. Parents bring their kids out to slap hands on the side of the route. Some of the bands were middle school age kids, which was fun (and they were pretty good, too). This year, as part of their effort to make the race "greener", they plan to compost the water cups; they expect to haul over 500,000 to the composting center.

I got shin splints in the beginning for the first time in over a year. I think that's because it was early in the morning, earlier than I run anyway, so my legs weren't very warmed up. They eased up by 2.5 miles or so. I ran off & on, pacing myself by my heart rate. It's a big race; there were close to 50,000 participants, and 8 starting groups (timed with RFID chips), so you can't always run when you want to, and you have to be careful of people cutting you off as they pass you. I walked a bit more around mile 4 than I had been, leading up to Doomsday Hill since I wanted to run as much of that as possible. And I ended up running more than half of the hill, which I felt pretty good about. I hit a nice stride at the top but then made the mistake of stopping for water, which totally threw me off (and which I didn't need anyway). The last mile was long, but the final turn is on top of a hill so the coast to the finish line is easy. I finished in a little over 90 minutes, which is slow, but faster than I expected to do it.

Lessons learned from my first race: 1. Wear sunscreen. I didn't think about it, because it was so cloudy, but I know I got a little burned. 2. If I wear a headband again, I'll clip it on with something. I lost it by mile 3, which really bummed me out, especially when the sun came out and my forehead felt warm and vulnerable. 3. Put the chip on my laces instead of my ankle. More comfortable. 4. Bring a jacket that I want to donate, instead of wearing one that I have to tie around my waist when I get too warm. I forgot that they have a tradition of collecting all the discarded jackets and sweatshirts and donating them to Goodwill. (Although many of the ones I saw were not worthy of donation. What are people thinking?)

One thing I did right was leave my wedding ring at home. My fingers were puffed up like little sausages by the time I finished. They always swell when I run, I assume because I have them sort of dangling and all that blood is pumping around. I never would have gotten that ring off if I was wearing it today. The fingers are starting to look more normal now, but they are still a bit swollen.

Another thing was taking the bus: good move! Very easy from where we live, better than walking home would have been, and parking would have been a mess.

So there's my wrap-up, Bloomsday 2009 is in the can, and I have next year to look forward to. Racing isn't really something I'm compelled to do, but when it's an event that I really want to participate in, it's good to know I can do it.