I have had a Netflix copy of A Mighty Heart at home for weeks, perhaps even months. It is the story of the kidnapping and murder of Daniel Pearl, the journalist who was beheaded in Pakistan in 2002. I finally watched the movie last night, and it was deeply moving. The idea that Mariane Pearl could remain hopeful and loving throughout such an ordeal is unimaginable to most of us. She remains so to this day, and still writes. She is now raising her son Adam, with whom she was pregnant when her husband disappeared. Her writing is beautiful, and she appears to be one of those extraordinary people whose courage and strength are greatest at moments which would fell the best of us. I don't believe it is a coincidence that she is a devout Buddhist.
Here is an article she wrote in 2006 about the source of her strength, her mother, who died in 1999. As her husband did, Mariane writes a compelling story and illuminates its message of optimism perfectly. Enjoy.
Saturday, March 29, 2008
Where is Spring???
The big Physiology exam was yesterday, and I'm now on spring break. I can't believe we are already to spring break. It's been an interesting few months. We have learned a great deal, and are glimpsing how much we have yet to learn.
To misquote David Mamet's Glengarry Glen Ross, it takes brass balls to do anesthesia. Any one of the drugs we give during a case can easily kill a person if the dose is miscalculated or even if it's given at the wrong time. In fact, if you think about it, we have to get a person as close to dead as possible for surgery to even occur. Patients have to hover just above death in order to tolerate someone cutting into them and doing what are often fairly violent procedures on them. (If you have any doubt, watch any orthopedic procedure, especially joint replacement surgery, which is usually performed on elderly patients. The pounding and drilling that goes on is vigorous to say the least.) It sounds dramatic but it is actually the truth. This wouldn't make a very good PR campaign for anesthesia providers, though: "Nurse Anesthetists: Keeping Your Other Foot Out Of The Grave." So, it's good that we learn all that we do. But it is a daunting task.
I tried to drive back to Portland yesterday, thinking perhaps I could get ahead of the snowstorm, but I was unable. I drove about 40 miles before it became apparent that I would have to turn around. This morning there are maybe 3 inches of snow on the ground, and the DOT says I-90 is still covered in snow, so I will wait a few hours before heading out. The Groundhog promised another 6 weeks of winter, but he apparently didn't check the calender. That 6 weeks was up a couple of weeks ago.
Weight loss is at a standstill. I'm frustrated, but still working out and trying to be patient. I need another fill.
When I handed in my exam yesterday, Maggie and John were in the office to receive it. I haven't seen Maggie (program director) in a few weeks. She is in the midst of preparing the documentation for the program accreditors, who come every 3 or 5 years (I can't remember which). In addition, she injured her neck somehow and has been having a lot of pain. Her older daughter has a severe seizure disorder, having about 6-10 seizures per day. She went to Harborview about 6 weeks ago for extended EEG monitoring to try to locate an area that can be operated on to reduce her seizures, and they are waiting for those results still. So poor Maggie is under a lot of stress right now. But she and John and I chatted for a while and they commented that they really like our group a lot. I think our group is really good, too. No overwhelmingly strong personalities in the group (all nurses who are drawn to this profession are strong personalities, I think) and everyone gets along well and has a good attitude. I've really gained a lot of respect for all of my classmates in the last few months. It's sort of amazing to remember the group of interviewees last year and remember that I found them all to be so capable and qualified. It was definitely intimidating. And now this is the group of students that came from that larger group, and everyone belongs here and seems to have what it takes to be successful. It's really an honor to be part of this group.
To misquote David Mamet's Glengarry Glen Ross, it takes brass balls to do anesthesia. Any one of the drugs we give during a case can easily kill a person if the dose is miscalculated or even if it's given at the wrong time. In fact, if you think about it, we have to get a person as close to dead as possible for surgery to even occur. Patients have to hover just above death in order to tolerate someone cutting into them and doing what are often fairly violent procedures on them. (If you have any doubt, watch any orthopedic procedure, especially joint replacement surgery, which is usually performed on elderly patients. The pounding and drilling that goes on is vigorous to say the least.) It sounds dramatic but it is actually the truth. This wouldn't make a very good PR campaign for anesthesia providers, though: "Nurse Anesthetists: Keeping Your Other Foot Out Of The Grave." So, it's good that we learn all that we do. But it is a daunting task.
I tried to drive back to Portland yesterday, thinking perhaps I could get ahead of the snowstorm, but I was unable. I drove about 40 miles before it became apparent that I would have to turn around. This morning there are maybe 3 inches of snow on the ground, and the DOT says I-90 is still covered in snow, so I will wait a few hours before heading out. The Groundhog promised another 6 weeks of winter, but he apparently didn't check the calender. That 6 weeks was up a couple of weeks ago.
Weight loss is at a standstill. I'm frustrated, but still working out and trying to be patient. I need another fill.
When I handed in my exam yesterday, Maggie and John were in the office to receive it. I haven't seen Maggie (program director) in a few weeks. She is in the midst of preparing the documentation for the program accreditors, who come every 3 or 5 years (I can't remember which). In addition, she injured her neck somehow and has been having a lot of pain. Her older daughter has a severe seizure disorder, having about 6-10 seizures per day. She went to Harborview about 6 weeks ago for extended EEG monitoring to try to locate an area that can be operated on to reduce her seizures, and they are waiting for those results still. So poor Maggie is under a lot of stress right now. But she and John and I chatted for a while and they commented that they really like our group a lot. I think our group is really good, too. No overwhelmingly strong personalities in the group (all nurses who are drawn to this profession are strong personalities, I think) and everyone gets along well and has a good attitude. I've really gained a lot of respect for all of my classmates in the last few months. It's sort of amazing to remember the group of interviewees last year and remember that I found them all to be so capable and qualified. It was definitely intimidating. And now this is the group of students that came from that larger group, and everyone belongs here and seems to have what it takes to be successful. It's really an honor to be part of this group.
Monday, March 24, 2008
Nutrition recommendations, and a new doctor...
Carbs are bad.
Now, I'm just being provocative. I don't believe carbs are bad. They are necessary for life as are other macronutrients. Simple carbs--sugar, the tasty stuff--aren't so good, especially in excess. I love sugar and sugary things, and getting away from them has been a necessary part of my weight loss. Most of us swear off "carbs" at the beginning of weight loss, especially via WLS. Eventually they creep back into our diets and we have to get rid of them all over again. But ridding our diets of the evil carbs is not really the point. The point is more that we need to eat a fair amount of protein, and our caloric intake is (supposed to be) restricted enough that you just don't have space in your diet for "carbs". Also, the carbs most of us eat just don't have any nutritional value. But, there's always room for carbs....and that's the thing about the band, sugary things just slip down so easily. Few of us can avoid them without really trying hard.
I've been eating more sugar, and I need to cut it out. Sugar makes you want more sugar.
I saw "the new surgeon" last week, Dr. John Pennings of Post Falls ID. He's a nice guy, reminded me a lot of Philip Seymour Hoffman actually, with longish scraggly balding hair and a goatee, looks like a graying redhead. I almost didn't see him, actually; just as I was leaving for my appointment, his office called me and told me that they had a new policy for patients of other surgeons, that I had to have a letter of referral from my other surgeon and all my records before he would see me. This policy has been put in place in the past few weeks, long after I made this appointment. I strenuously objected to this, since it's hard for me to make appointments in the first place with my schedule and I was on my way to the appt. The surgeon who took over my care from Dr Hong when he moved to Canada, Emma Patterson, is a colleague of Dr Pennings and she told me that he would definitely see me if I told him she sent me. I think they trained together at Emanuel Hospital in Portland. Anyway, I told the office coordinator this and she checked with Dr Pennings and he agreed to see me without all the extra documentation. Sheesh.
So anyway, I see Dr Pennings, at last. He didn't seem super impressed with my weight loss at 1 year, but he saw I was within 20 lbs of goal. He liked how much I am exercising. They did a Tanita body composition thingie and determined that I had 120 lbs of lean mass, and he used that number with his personal number of 1.5 gm protein per kg lean body mass to determine that I need 90 gm of protein per day now. Um, what? How am I going to do that, without protein shakes? I think 75 gm might be more doable. My "people" at the Portland office told me 45-52gm, which I have been going by for the past year. Pennings believes that my weight loss will pick up again if I get 90 gm protein in per day. I believe he might be full of crap. But anyway, I'm trying to increase it some.
One useful tidbit he did give me was the calories-per-protein-gram rule. He told me to check labels on foods, and "gravitate" towards foods that have a ratio of 15 calories or less per 1 gm of protein. This seems reasonable and simple to do.
It kind of sucks having to see a different surgeon. This guy is nice, and seems to know his stuff. He does a lot of bypass; I didn't ask how many of his patients are banded. But I'm not sure if his 1.5 gm rule might be more bypass-oriented. A lot of bariatric surgeons take their RNY guidelines and just give them to band patients, which doesn't really work because the surgeries are so different and the requirements are really different, too. If a RNY patient takes in 90 gm of protein, s/he won't actually absorb all of that, because of the bypassed intestine. Honestly, I've never heard of a banded patient being told to eat more than 60 gm of protein per day. But, he was quite interested when I told him I am in anesthesia school. He told me he only uses CRNAs for his surgeries, he likes working with them better, and told me to come work at their hospital when I graduate--which I won't do for a few reasons, one being that we don't want to live in Idaho, another being that I need a much busier practice when I am first starting out. But it was nice to hear anyway.
He gave me a fill before I left, and here is another bit of discrepancy between what the office staff told me and what he did. They told me he always does the first fill on a patient that he didn't perform the surgery on under fluoroscopy. Well, he did a blind fill, just like everyone else has always done. Honestly, my port is quite easy to find, and he had no problem hitting it on the first try. I don't believe I was charged for fluoro, based on what they told me the charges are. But it was kind of interesting. Another interesting thing: he withdrew the fluid from my band and I had about 1.5cc LESS than I should have had in there. I really have only been noticing a reduced restriction lately. But he just gave me a 0.5cc fill and said to come back in 6 weeks if I need another, which I think I might. I notice the reduced restriction much more now that I know my band was a lot less full than previously believed. Interesting how the mind works. I didn't get the 1 year followup upper GI that I need. I have to make a separate appointment for that. It's going to be expensive, and cash, and I don't really feel like doing it right now.
So that's the lowdown with the band. I need to keep working on reducing sugars and increasing protein, and keeping the amount of food down. I ran today, was more tired than yesterday when I was able to run 20 minutes straight. Today I did 12/6/6 (24 minutes total) while listening to This American Life on podcast. The topic was "The Ghost of Bobby Dunbar." It is a fascinating tale of a family's response to learning the truth about their ancestor's kidnapping 80 years ago. The podcast itself isn't available for free any longer (the website for This American Life only allows free download for about a week, after that it's 99 cents, and iTunes only keeps 1 episode at a time) so if you don't want to pay to download the podcast I recommend reading this article about it. Great story.
Now, I'm just being provocative. I don't believe carbs are bad. They are necessary for life as are other macronutrients. Simple carbs--sugar, the tasty stuff--aren't so good, especially in excess. I love sugar and sugary things, and getting away from them has been a necessary part of my weight loss. Most of us swear off "carbs" at the beginning of weight loss, especially via WLS. Eventually they creep back into our diets and we have to get rid of them all over again. But ridding our diets of the evil carbs is not really the point. The point is more that we need to eat a fair amount of protein, and our caloric intake is (supposed to be) restricted enough that you just don't have space in your diet for "carbs". Also, the carbs most of us eat just don't have any nutritional value. But, there's always room for carbs....and that's the thing about the band, sugary things just slip down so easily. Few of us can avoid them without really trying hard.
I've been eating more sugar, and I need to cut it out. Sugar makes you want more sugar.
I saw "the new surgeon" last week, Dr. John Pennings of Post Falls ID. He's a nice guy, reminded me a lot of Philip Seymour Hoffman actually, with longish scraggly balding hair and a goatee, looks like a graying redhead. I almost didn't see him, actually; just as I was leaving for my appointment, his office called me and told me that they had a new policy for patients of other surgeons, that I had to have a letter of referral from my other surgeon and all my records before he would see me. This policy has been put in place in the past few weeks, long after I made this appointment. I strenuously objected to this, since it's hard for me to make appointments in the first place with my schedule and I was on my way to the appt. The surgeon who took over my care from Dr Hong when he moved to Canada, Emma Patterson, is a colleague of Dr Pennings and she told me that he would definitely see me if I told him she sent me. I think they trained together at Emanuel Hospital in Portland. Anyway, I told the office coordinator this and she checked with Dr Pennings and he agreed to see me without all the extra documentation. Sheesh.
So anyway, I see Dr Pennings, at last. He didn't seem super impressed with my weight loss at 1 year, but he saw I was within 20 lbs of goal. He liked how much I am exercising. They did a Tanita body composition thingie and determined that I had 120 lbs of lean mass, and he used that number with his personal number of 1.5 gm protein per kg lean body mass to determine that I need 90 gm of protein per day now. Um, what? How am I going to do that, without protein shakes? I think 75 gm might be more doable. My "people" at the Portland office told me 45-52gm, which I have been going by for the past year. Pennings believes that my weight loss will pick up again if I get 90 gm protein in per day. I believe he might be full of crap. But anyway, I'm trying to increase it some.
One useful tidbit he did give me was the calories-per-protein-gram rule. He told me to check labels on foods, and "gravitate" towards foods that have a ratio of 15 calories or less per 1 gm of protein. This seems reasonable and simple to do.
It kind of sucks having to see a different surgeon. This guy is nice, and seems to know his stuff. He does a lot of bypass; I didn't ask how many of his patients are banded. But I'm not sure if his 1.5 gm rule might be more bypass-oriented. A lot of bariatric surgeons take their RNY guidelines and just give them to band patients, which doesn't really work because the surgeries are so different and the requirements are really different, too. If a RNY patient takes in 90 gm of protein, s/he won't actually absorb all of that, because of the bypassed intestine. Honestly, I've never heard of a banded patient being told to eat more than 60 gm of protein per day. But, he was quite interested when I told him I am in anesthesia school. He told me he only uses CRNAs for his surgeries, he likes working with them better, and told me to come work at their hospital when I graduate--which I won't do for a few reasons, one being that we don't want to live in Idaho, another being that I need a much busier practice when I am first starting out. But it was nice to hear anyway.
He gave me a fill before I left, and here is another bit of discrepancy between what the office staff told me and what he did. They told me he always does the first fill on a patient that he didn't perform the surgery on under fluoroscopy. Well, he did a blind fill, just like everyone else has always done. Honestly, my port is quite easy to find, and he had no problem hitting it on the first try. I don't believe I was charged for fluoro, based on what they told me the charges are. But it was kind of interesting. Another interesting thing: he withdrew the fluid from my band and I had about 1.5cc LESS than I should have had in there. I really have only been noticing a reduced restriction lately. But he just gave me a 0.5cc fill and said to come back in 6 weeks if I need another, which I think I might. I notice the reduced restriction much more now that I know my band was a lot less full than previously believed. Interesting how the mind works. I didn't get the 1 year followup upper GI that I need. I have to make a separate appointment for that. It's going to be expensive, and cash, and I don't really feel like doing it right now.
So that's the lowdown with the band. I need to keep working on reducing sugars and increasing protein, and keeping the amount of food down. I ran today, was more tired than yesterday when I was able to run 20 minutes straight. Today I did 12/6/6 (24 minutes total) while listening to This American Life on podcast. The topic was "The Ghost of Bobby Dunbar." It is a fascinating tale of a family's response to learning the truth about their ancestor's kidnapping 80 years ago. The podcast itself isn't available for free any longer (the website for This American Life only allows free download for about a week, after that it's 99 cents, and iTunes only keeps 1 episode at a time) so if you don't want to pay to download the podcast I recommend reading this article about it. Great story.
Friday, March 21, 2008
Pig Trach Day
Quick note on my way to a pharm test...
The predictions about the snow came true. We are getting quite a bit of snow right now in Spokane. I don't think it will stay for long, but there is about an inch accumulated. I'm hoping it stays warm enough to keep the roads from freezing. Right now it's about 34 degrees at 8am. Today is supposed to be the first day of spring (for leap year) and it's my younger brother's 32nd birthday. So, Donald, thanks for the snow.
Yesterday was pig trach day. We had fresh pig trachs flown in from somewhere back east, and learned to perform emergent cricothyrotomies on them. They made a whole day of it; we had 2 hours but the juniors and seniors did theirs earlier, and CRNAs and MDs, not just anesthesiologists but ER docs, pulmonologists, intensivists and others also came to practice crics. It was a lot of fun. Our class went after everyone else had left, so we had a nice low pressure environment to practice in. My personal best time was 29 seconds. We even had photos....
Top photo: Kimberli and Tana work on a trach; Mark readies himself.
Middle photo: Me manhandling the trach
Bottom: Class of 2010: Connie, Mark, Kimberli, Tana, Brett, Corey, Cat, me. Most of the trachs have safe surgical airways established, but you can't really see that here.
Tuesday, March 18, 2008
Hubby in town!
My hubby is here for the whole week. What a treat! It's really a drag living in separate states most of the time. We can't find a better solution--my school is in Spokane, and his work is in Portland. He couldn't find work in Spokane in his field that paid more than a barista in Portland. When you have children you support, AND your wife is in graduate school and you are the sole breadwinner, that won't work. So he works in Portland, and comes to Spokane every other week, more or less. I try to come to Portland once a month. I'm putting it off a little bit this month because I have spring break in 2 weeks and a lot of exams until then...it made more sense to just come out there when it was all done. We aren't the only couple separated by a lot of distance in my program. But it is very hard. We are going to get some webcams, and see if maybe we can eat dinner "together" and see each other a little more when we are apart. We have to get creative here, because I am only starting my 3rd month out of 28 months. But for this week, we get to spend a lot of time together, which is great.
This morning I woke up to a nice treat on the scale: a 3 lb loss, which makes a total of 56 pounds lost! I was very excited, needless to say. I'm also another "decade" down...from the 180s to 170s. (I know I've been vague about what my weight actually is on this blog...which I think is fine...but the longer this goes, the less concerned I am about it.) So, hooray for Lap Band, and running, and me.
That's all I got today.
This morning I woke up to a nice treat on the scale: a 3 lb loss, which makes a total of 56 pounds lost! I was very excited, needless to say. I'm also another "decade" down...from the 180s to 170s. (I know I've been vague about what my weight actually is on this blog...which I think is fine...but the longer this goes, the less concerned I am about it.) So, hooray for Lap Band, and running, and me.
That's all I got today.
Saturday, March 15, 2008
Zen....or not
I was reading this great post by Pasta Queen and thinking about how the desire to emotionally eat, or binge, was different between now and the last time I lost weight, on Weight Watchers. The urge, and the response to the urge, is different now than it was before I had surgery. How is it different?
For one thing, I am older now and more experienced in losing and gaining and losing weight now than I was back then. I was experienced then, but I did learn a lot through my WW experience. So one thing has to be simple experience.
But the rest is a little nebulous. I think just the constant reminder that I HAD SURGERY and that I am succeeding so much more this time than ever before has an impact. A "binge" now (and they rarely happen) is so much smaller than before, it seems managable to me. I never have gotten that totally out of control feeling that I could get in the past, since my surgery. My mental dialogue seems to help me more than it used to: that figuring out if I'm physically hungry or emotionally hungry, deciding what would really help my current emotional state, etc. Doesn't work every time, but usually. And I think I'm just fed up and weary of the never-ending cycle that emotional eating becomes. It makes me feel worse, not better. It begets more emotional eating. It doesn't do anything about the original feelings or problem.
In other words, I think this is more a function of where I am in my life, than it is a function of WLS.
Now, IN NO WAY am I trying to imply, or do I believe, that I am in any sort of blissful food-issues zen, or that WLS is the way to get to this super happy place where you no longer binge. And my food issues aren't over by a long shot. And I still do, and will, have days when I am convinced that I need some particular binge food, and will have it before I stop to realize that I want something MORE than food, that it doesn't help and makes things worse. But I do notice, especially when I read things like Pasta Queen's wonderful post, that it's different for me now than it used to be. I don't feel so desperate.
Maybe part of that is that before when I was emotionally eating, I was usually ALSO physically hungry. I was hungry, physically, a lot, and lived in terror of being hungry because it seemed so hard to make that go away. Now I'm not afraid of being hungry, because I know it quickly passes, and if I do eat, the small amount of food will keep me satisfied for a long time. So in that way, WLS certainly helps. And especially when I was dieting, it was really hard to avoid binging when I was emotionally hurting AND physically hungry, plus feeling guilty for breaking my diet.
I'm not dieting anymore. I'm eating like a normal healthy person. And I can't "cheat" on life, so having occasional treats doesn't bother me as long as they remain "occasional".
WLS gives me a bit of help here, as it does in a lot of areas, but it isn't the cure for emotional eating by a long shot. Pasta Queen knows this. And most WLS patients know this. But while I want to give myself credit where credit is due, I also don't want to come across as glibly suggesting that it has nothing to do with my lap band. Making healthy choices is much, much easier for me with my band. No doubt about it. Resisting the emotional demons surrounding my obesity is much easier, although it is still tough at times.
Now if only I could apply these kinds of "healthy choices" to studying rather than reading WLS blogs online....
For one thing, I am older now and more experienced in losing and gaining and losing weight now than I was back then. I was experienced then, but I did learn a lot through my WW experience. So one thing has to be simple experience.
But the rest is a little nebulous. I think just the constant reminder that I HAD SURGERY and that I am succeeding so much more this time than ever before has an impact. A "binge" now (and they rarely happen) is so much smaller than before, it seems managable to me. I never have gotten that totally out of control feeling that I could get in the past, since my surgery. My mental dialogue seems to help me more than it used to: that figuring out if I'm physically hungry or emotionally hungry, deciding what would really help my current emotional state, etc. Doesn't work every time, but usually. And I think I'm just fed up and weary of the never-ending cycle that emotional eating becomes. It makes me feel worse, not better. It begets more emotional eating. It doesn't do anything about the original feelings or problem.
In other words, I think this is more a function of where I am in my life, than it is a function of WLS.
Now, IN NO WAY am I trying to imply, or do I believe, that I am in any sort of blissful food-issues zen, or that WLS is the way to get to this super happy place where you no longer binge. And my food issues aren't over by a long shot. And I still do, and will, have days when I am convinced that I need some particular binge food, and will have it before I stop to realize that I want something MORE than food, that it doesn't help and makes things worse. But I do notice, especially when I read things like Pasta Queen's wonderful post, that it's different for me now than it used to be. I don't feel so desperate.
Maybe part of that is that before when I was emotionally eating, I was usually ALSO physically hungry. I was hungry, physically, a lot, and lived in terror of being hungry because it seemed so hard to make that go away. Now I'm not afraid of being hungry, because I know it quickly passes, and if I do eat, the small amount of food will keep me satisfied for a long time. So in that way, WLS certainly helps. And especially when I was dieting, it was really hard to avoid binging when I was emotionally hurting AND physically hungry, plus feeling guilty for breaking my diet.
I'm not dieting anymore. I'm eating like a normal healthy person. And I can't "cheat" on life, so having occasional treats doesn't bother me as long as they remain "occasional".
WLS gives me a bit of help here, as it does in a lot of areas, but it isn't the cure for emotional eating by a long shot. Pasta Queen knows this. And most WLS patients know this. But while I want to give myself credit where credit is due, I also don't want to come across as glibly suggesting that it has nothing to do with my lap band. Making healthy choices is much, much easier for me with my band. No doubt about it. Resisting the emotional demons surrounding my obesity is much easier, although it is still tough at times.
Now if only I could apply these kinds of "healthy choices" to studying rather than reading WLS blogs online....
The Ides of March
You know that's just an old way of saying the 15th of March, right? It's not as complicated as it sounds.
Today (okay, yesterday; it's around midnight on Sat morning now) was my first studying day of the weekend...and I did study, but not as much as I intended. It sort of fell apart in the afternoon. I did my minimum stuff I had to accomplish, then went to Costco, and Old Navy...then worked out...then went to the grocery store. Cooked dinner, which was nice: catfish, sauteed swiss chard and mushrooms. Settled in to do some more studying, but surfed the Web instead. It is amazing how easy it is to suck me into the Internets.
I washed the dishes and got ready to go to bed when I discovered that our landlords have rented the downstairs apartment and someone has moved in: hence, the amazingly loud TV sounds. So I had to go introduce myself and ask him to turn it down. I hate meeting new neighbors that way. But you have to do this first noise request properly. It might degenerate later, but it must be polite and friendly to start. I hate noise, and this building is old and very loud. We hear everyone who lives here, literally, in their apartments and tromping up the stairs, which go through the middle of our living space, although it is separated out by some thin walls and doors. This building is loud, and it's not insulated, hence the enormous heating bills. (Obscene, really, but that's for another post.) But, the location is good, and it's pretty quiet during the day, so we'll stick it out until I graduate, unless things take a turn for the worse before then.
I did some studying and now am just getting ready to go to sleep. I love the weekends--it's the first time in 11 years that the weekends are all mine, like normal people, without having to work every other one. Of course I have lots of studying to do on the weekends. But I don't have to get up at any particular time or be anywhere in particular. It's lovely. And the odds are good I won't have to work weekends anymore, unless I work where I have a lot of OB call. ORs don't generally run on the weekends, unless you are in a trauma hospital.
I ran today at the hospital gym. It's where I prefer to go on my non-lifting days, because I don't have to contend with hordes of ill-behaved children in the (OMG SO LOUD) locker room. It jangles my brain and I can't spend any time in there. So, the hospital gym is small, located in the basement. It's rarely empty, unless I go very late, like 9pm. It is open 24-7, so in theory I could be there right now, although I can't imagine a parallel universe in which that would happen. I listened to more Dan Savage podcasts and ran a total of 22 minutes out of 42. I warmed up, then ran 11 minutes consecutively, a new record, then walked 5, ran 9, walked 3, ran 2, and cooled down. Once I get my running time up a bit better, I'd like to incorporate some sprints again. I feel a lot more energized when I run faster, but I think if I train at that faster speed right now I am asking for trouble. Only bummer was that I brought the wrong gym bag, and didn't have my HRM with me. :( I had to wing it. I like playing with the new toy, so tomorrow I must use it!
Today (okay, yesterday; it's around midnight on Sat morning now) was my first studying day of the weekend...and I did study, but not as much as I intended. It sort of fell apart in the afternoon. I did my minimum stuff I had to accomplish, then went to Costco, and Old Navy...then worked out...then went to the grocery store. Cooked dinner, which was nice: catfish, sauteed swiss chard and mushrooms. Settled in to do some more studying, but surfed the Web instead. It is amazing how easy it is to suck me into the Internets.
I washed the dishes and got ready to go to bed when I discovered that our landlords have rented the downstairs apartment and someone has moved in: hence, the amazingly loud TV sounds. So I had to go introduce myself and ask him to turn it down. I hate meeting new neighbors that way. But you have to do this first noise request properly. It might degenerate later, but it must be polite and friendly to start. I hate noise, and this building is old and very loud. We hear everyone who lives here, literally, in their apartments and tromping up the stairs, which go through the middle of our living space, although it is separated out by some thin walls and doors. This building is loud, and it's not insulated, hence the enormous heating bills. (Obscene, really, but that's for another post.) But, the location is good, and it's pretty quiet during the day, so we'll stick it out until I graduate, unless things take a turn for the worse before then.
I did some studying and now am just getting ready to go to sleep. I love the weekends--it's the first time in 11 years that the weekends are all mine, like normal people, without having to work every other one. Of course I have lots of studying to do on the weekends. But I don't have to get up at any particular time or be anywhere in particular. It's lovely. And the odds are good I won't have to work weekends anymore, unless I work where I have a lot of OB call. ORs don't generally run on the weekends, unless you are in a trauma hospital.
I ran today at the hospital gym. It's where I prefer to go on my non-lifting days, because I don't have to contend with hordes of ill-behaved children in the (OMG SO LOUD) locker room. It jangles my brain and I can't spend any time in there. So, the hospital gym is small, located in the basement. It's rarely empty, unless I go very late, like 9pm. It is open 24-7, so in theory I could be there right now, although I can't imagine a parallel universe in which that would happen. I listened to more Dan Savage podcasts and ran a total of 22 minutes out of 42. I warmed up, then ran 11 minutes consecutively, a new record, then walked 5, ran 9, walked 3, ran 2, and cooled down. Once I get my running time up a bit better, I'd like to incorporate some sprints again. I feel a lot more energized when I run faster, but I think if I train at that faster speed right now I am asking for trouble. Only bummer was that I brought the wrong gym bag, and didn't have my HRM with me. :( I had to wing it. I like playing with the new toy, so tomorrow I must use it!
Thursday, March 13, 2008
Bandiversary
Happy bandiversary to me!
I'm in a very different place than I was on this day last year. Literally: I'm in Spokane, WA, in anesthesia school. But obviously it's much more than that.
I've always been a person who identified problems that I could solve and made plans and solved them. Sometimes the solutions might not have been the best ones, or might have caused their own problems. But inaction has always been my greatest fear, and usually I do pretty well with the plans I make. Deciding to have WLS wasn't much different. I identified that my weight was an ongoing problem that wasn't getting better, that losing weight seemed to be a problem I wasn't able to crack on my own, and that repeated cycles of losing and gaining were going to be harder and harder on my body in the long term. At the same time, I had images of my own father fresh in my mind: probably 200 lbs overweight, and barely able to walk on joints that are giving out, partly from trauma but mostly from supporting his frame for most of his life. He has lost and gained weight repeatedly, which I'm sure hasn't helped his body with his history of chronic hypothyroidism. I did not want to be his age, which this year will be 64, barely able to walk, and double my ideal body weight.
So WLS became another project for me. I was approved for surgery and scheduled it as soon as I could after that point. I had just interviewed at OHSU and Gonzaga for anesthesia school and decided to go to Gonzaga; my life was changing dramatically. I think I chronicled the details pretty well last year in this blog.
I don't think I really knew what to expect for my one year post op results. I hoped I would have lost ALL of my excess weight by now, but I knew that I probably wouldn't. I think I would have been surprised to learn that I would get as far as I have by now.
A lot happened in the course of this process that I didn't expect, but which I have all but forgotten about by now. I lost about 22 lbs initially but gained 10 back within the first month, as my post op diet progressed. Then I started getting fills but didn't have any noticable change in my hunger until July, which was my 3rd or 4th fill. So that time in between, I did lose weight, but very slowly. And I was hungry for a lot of it. I experimented with ignoring my post op diet, progressing to soft foods early, but learned soon the reasons that it's a bad idea, and slapped my hand. I sort of sweated the time ticking by, when I was losing in spurts. I've lost in spurts and then stalled during the entire process, which I think is pretty normal. The body isn't as simple as we like to think it is when it comes to weight loss.
Now my focus is more on exercise and general health. I'm continuing to advance my fitness level, trying to keep it interesting and challenging. I am still losing weight--I lost 3 pounds in a few weeks, then have hung at the same weight for the last week. I am an advocate for daily weighing, at the same time in the same conditions each day. I think this is the ICU nurse in me, wanting to track trends more than absolute values (although when it's your weight, and you're trying to lose weight, you are definitely interested in the absolute value too.) I weigh every morning, after I pee and before I drink or eat, as soon as I wake up. Naked, on the same scale. Doing this every day has kept me on top of things, knowing when I've been stalled for a while, and most importantly, knowing my pattern of weight loss intimately. I don't get discouraged by seeing the exact same weight for 5 mornings in a row, because I know that happens before I lose weight. I also know that after 5 days of that, it might go up a pound or more before it drops 2 or 3. That's how my body loses weight. I wouldn't know that if I weighed once a week or once a month. It doesn't work if the scale has the power to ruin your day, but it doesn't for me. Research shows that people who weigh every day keep their weight under better control, so I like establishing this habit so when I am in maintenance I can continue.
My health is a gift I partially gave to myself, but I have to thank my genes too--and of course, my lap band. I'm an advocate of treating it well so it will stay with me for the long term. That means not challenging it, by overeating, and not keeping any more fill than I absolutely need in it. I've never needed an unfill, never vomited or had any food get stuck, never "slimed". I'd like to keep that record intact, to keep my stomach under the band as happy as possible. I'm also curious about the effects of intraabdominal and intrathoracic pressure on the band--I have been noticing, when I do the leg press, that if I follow the recommendations and exhale when I press up, it creates a lot of intrathoracic pressure, and I think that might cause a very slight risk of prolapsing my stomach through my band under the right circumstances. So I let my breath out passively when I press, and try to minimize intrathoracic pressure to keep from that happening. (I thought of this after one woman lost her band when she lifted very heavy furniture and immediately had symptoms of a slip--when she finally had emergency surgery her stomach was ischemic, although they were able to save it--but not the band.)
On an unrelated note, I finished my third "orientation" day of IV starts in the surgical admit unit this morning. I'm so glad we will only be doing IVs once a week. Getting up at 4:30 am kills the rest of my day. I took a nap after class today and I feel a lot better now. I have a lot of studying to do this weekend. There's no class tomorrow, so I can start yet another fun weekend of nothing but studying. Of course, hubby is supposed to be coming here this weekend, which will be nice. But I have a lot of work to do, too. Anyway, the IVs, I missed 1 patient entirely this morning, and another one I got on my second attempt. I got 3 more on the first poke after that. But I hate sticking people more than once. Yesterday I had 5, all on the first poke, which was fantastic. One was even particularly difficult--very tiny, fragile veins, on a dialysis patient who said she'd kick me if it hurt! (She was sort of kidding.) But we are required to use lidocaine for IV starts in SAU, which is technically more difficult because it obscures the vein underneath it--and because of the lidocaine, she didn't even know I was done as I got ready to leave. IV in place, fluid dripping in just fine. So that was a nice success. I enjoy starting IVs, actually--I'm pretty good at it, after 11 years of nursing, and it's always a good challenge and very gratifying to get a difficult line. But I don't really enjoy getting up at 4:30, or the sleep disruption that goes with it. I've slept really poorly this whole week. Anyway. Next week: we start intubating! I'm excited for that.
Okay, I'm outta here...gotta go run, and study after that.
I'm in a very different place than I was on this day last year. Literally: I'm in Spokane, WA, in anesthesia school. But obviously it's much more than that.
I've always been a person who identified problems that I could solve and made plans and solved them. Sometimes the solutions might not have been the best ones, or might have caused their own problems. But inaction has always been my greatest fear, and usually I do pretty well with the plans I make. Deciding to have WLS wasn't much different. I identified that my weight was an ongoing problem that wasn't getting better, that losing weight seemed to be a problem I wasn't able to crack on my own, and that repeated cycles of losing and gaining were going to be harder and harder on my body in the long term. At the same time, I had images of my own father fresh in my mind: probably 200 lbs overweight, and barely able to walk on joints that are giving out, partly from trauma but mostly from supporting his frame for most of his life. He has lost and gained weight repeatedly, which I'm sure hasn't helped his body with his history of chronic hypothyroidism. I did not want to be his age, which this year will be 64, barely able to walk, and double my ideal body weight.
So WLS became another project for me. I was approved for surgery and scheduled it as soon as I could after that point. I had just interviewed at OHSU and Gonzaga for anesthesia school and decided to go to Gonzaga; my life was changing dramatically. I think I chronicled the details pretty well last year in this blog.
I don't think I really knew what to expect for my one year post op results. I hoped I would have lost ALL of my excess weight by now, but I knew that I probably wouldn't. I think I would have been surprised to learn that I would get as far as I have by now.
A lot happened in the course of this process that I didn't expect, but which I have all but forgotten about by now. I lost about 22 lbs initially but gained 10 back within the first month, as my post op diet progressed. Then I started getting fills but didn't have any noticable change in my hunger until July, which was my 3rd or 4th fill. So that time in between, I did lose weight, but very slowly. And I was hungry for a lot of it. I experimented with ignoring my post op diet, progressing to soft foods early, but learned soon the reasons that it's a bad idea, and slapped my hand. I sort of sweated the time ticking by, when I was losing in spurts. I've lost in spurts and then stalled during the entire process, which I think is pretty normal. The body isn't as simple as we like to think it is when it comes to weight loss.
Now my focus is more on exercise and general health. I'm continuing to advance my fitness level, trying to keep it interesting and challenging. I am still losing weight--I lost 3 pounds in a few weeks, then have hung at the same weight for the last week. I am an advocate for daily weighing, at the same time in the same conditions each day. I think this is the ICU nurse in me, wanting to track trends more than absolute values (although when it's your weight, and you're trying to lose weight, you are definitely interested in the absolute value too.) I weigh every morning, after I pee and before I drink or eat, as soon as I wake up. Naked, on the same scale. Doing this every day has kept me on top of things, knowing when I've been stalled for a while, and most importantly, knowing my pattern of weight loss intimately. I don't get discouraged by seeing the exact same weight for 5 mornings in a row, because I know that happens before I lose weight. I also know that after 5 days of that, it might go up a pound or more before it drops 2 or 3. That's how my body loses weight. I wouldn't know that if I weighed once a week or once a month. It doesn't work if the scale has the power to ruin your day, but it doesn't for me. Research shows that people who weigh every day keep their weight under better control, so I like establishing this habit so when I am in maintenance I can continue.
My health is a gift I partially gave to myself, but I have to thank my genes too--and of course, my lap band. I'm an advocate of treating it well so it will stay with me for the long term. That means not challenging it, by overeating, and not keeping any more fill than I absolutely need in it. I've never needed an unfill, never vomited or had any food get stuck, never "slimed". I'd like to keep that record intact, to keep my stomach under the band as happy as possible. I'm also curious about the effects of intraabdominal and intrathoracic pressure on the band--I have been noticing, when I do the leg press, that if I follow the recommendations and exhale when I press up, it creates a lot of intrathoracic pressure, and I think that might cause a very slight risk of prolapsing my stomach through my band under the right circumstances. So I let my breath out passively when I press, and try to minimize intrathoracic pressure to keep from that happening. (I thought of this after one woman lost her band when she lifted very heavy furniture and immediately had symptoms of a slip--when she finally had emergency surgery her stomach was ischemic, although they were able to save it--but not the band.)
On an unrelated note, I finished my third "orientation" day of IV starts in the surgical admit unit this morning. I'm so glad we will only be doing IVs once a week. Getting up at 4:30 am kills the rest of my day. I took a nap after class today and I feel a lot better now. I have a lot of studying to do this weekend. There's no class tomorrow, so I can start yet another fun weekend of nothing but studying. Of course, hubby is supposed to be coming here this weekend, which will be nice. But I have a lot of work to do, too. Anyway, the IVs, I missed 1 patient entirely this morning, and another one I got on my second attempt. I got 3 more on the first poke after that. But I hate sticking people more than once. Yesterday I had 5, all on the first poke, which was fantastic. One was even particularly difficult--very tiny, fragile veins, on a dialysis patient who said she'd kick me if it hurt! (She was sort of kidding.) But we are required to use lidocaine for IV starts in SAU, which is technically more difficult because it obscures the vein underneath it--and because of the lidocaine, she didn't even know I was done as I got ready to leave. IV in place, fluid dripping in just fine. So that was a nice success. I enjoy starting IVs, actually--I'm pretty good at it, after 11 years of nursing, and it's always a good challenge and very gratifying to get a difficult line. But I don't really enjoy getting up at 4:30, or the sleep disruption that goes with it. I've slept really poorly this whole week. Anyway. Next week: we start intubating! I'm excited for that.
Okay, I'm outta here...gotta go run, and study after that.
Tuesday, March 11, 2008
Quick update before sleep
About the post below on training and heartrate...
It's right on. I kept my HR no higher than mid 160s and was able to run 9 min straight and 19 min total. I don't feel quite as fab as I did when I ran faster, but I was able to run longer, and probably am less likely to hurt myself. So, right on there.
The HR monitor: Awesome. Love it. I got a Timex, it was about $50. Totally enlightening in my workout.
OK, bedtime. Just wanted to add that to my other posts below. Another thing: running to Dan Savage's podcasts is a totally different, engrossing way to work out. I heart Savage Love.
It's right on. I kept my HR no higher than mid 160s and was able to run 9 min straight and 19 min total. I don't feel quite as fab as I did when I ran faster, but I was able to run longer, and probably am less likely to hurt myself. So, right on there.
The HR monitor: Awesome. Love it. I got a Timex, it was about $50. Totally enlightening in my workout.
OK, bedtime. Just wanted to add that to my other posts below. Another thing: running to Dan Savage's podcasts is a totally different, engrossing way to work out. I heart Savage Love.
I've got 2 hours...
...until bedtime! I doubt I will really be in bed by 8pm, especially since I am contemplating going to the gym. But today was my first of 3 days starting IVs in the surgical admit unit. This starts at 5:45 am, which means I get up at 4:30 to be dressed, fed, caffinated, at the hospital, changed into scrubs and in the SAU by 5:45. After these 3 days, I'll have about another month's reprieve while everyone else in my group gets oriented, then it's once a week until this time next year. This is our program's way of making sure we get our minimum of 100 IV starts by the time we take boards. At least half of us are proficient in IVs, but a couple people worked in hospitals that had IV therapy teams, which means you don't ever start your own IVs. The juniors say they've gotten about 350 IVs this way over the past year. That doesn't count the IVs you start during your own OR cases, so we get plenty. The juniors are very anxious to hand this baton over to us for the next year.
I'm a weenie about losing sleep. I have to get my 8 hours, or at least 7, if I'm gonna manage. I do have fibromyalgia, which is entirely controlled if I take my medication and get enough sleep. I'm a chronic insomniac (a topic for another blog post someday) and the only real way to manage that is to have good "sleep hygeine" meaning you do whatever it takes to have a regular bedtime and get the correct (for me) amount of sleep. So I have just a couple hours to figure out how I'm going to spend the rest of my time before winding down for the night. I think I'll just go to the hospital and run there. I only did my arms yesterday at the Y (after my run) and planned on doing legs today. I don't usually split them up but I was feeling a little tired and crunched for time. But I can do legs tomorrow after class. It won't kill me.
I do have my new Timex heart rate monitor. It's pretty fun. I posted all that stuff about training and figuring out heart rates because I really want to know what is MY max heart rate. When I run I hit 176 regularly. I recover quickly, but with running it's hard to get my heart rate to stay lower. So I don't believe my training zone is as low as 130, but at the same time, the heart rate monitor will help me adjust in real time, rather than trying to grab the treadmill handles after I am done with my sprint and hope it actually reads my heart rate (sweaty hands, faulty equipment, etc...I know they aren't very accurate). So, let's go take this bad boy for a spin!
I'm a weenie about losing sleep. I have to get my 8 hours, or at least 7, if I'm gonna manage. I do have fibromyalgia, which is entirely controlled if I take my medication and get enough sleep. I'm a chronic insomniac (a topic for another blog post someday) and the only real way to manage that is to have good "sleep hygeine" meaning you do whatever it takes to have a regular bedtime and get the correct (for me) amount of sleep. So I have just a couple hours to figure out how I'm going to spend the rest of my time before winding down for the night. I think I'll just go to the hospital and run there. I only did my arms yesterday at the Y (after my run) and planned on doing legs today. I don't usually split them up but I was feeling a little tired and crunched for time. But I can do legs tomorrow after class. It won't kill me.
I do have my new Timex heart rate monitor. It's pretty fun. I posted all that stuff about training and figuring out heart rates because I really want to know what is MY max heart rate. When I run I hit 176 regularly. I recover quickly, but with running it's hard to get my heart rate to stay lower. So I don't believe my training zone is as low as 130, but at the same time, the heart rate monitor will help me adjust in real time, rather than trying to grab the treadmill handles after I am done with my sprint and hope it actually reads my heart rate (sweaty hands, faulty equipment, etc...I know they aren't very accurate). So, let's go take this bad boy for a spin!
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