I am still reading "The End of Overeating" and it is quite fascinating. The premise is pretty simple--that the food industry has contributed greatly to the obesity epidemic in the US by creating "hyperpalatable" foods that (some of) our brains basically can't resist--and most of the book is describing the science behind it, which those in research and development within the food industry most likely weren't even aware of, at least at first.
One thing this book states over and over is that people who have a tendency towards obesity have different brains than those who tend to be thin. This is both genetic and environmental, and it can be enhanced by childhood experience, i.e. eating a lot of these hyperpalatable foods as a kid, learning eating habits from our parents, etc. One interesting thing about the book is that he writes from a first-person perspective; the author is in the entire book, which makes the whole thing seem a lot less judgmental of "us fat people". He describes the development of several foods, like Oreos, Cinnabons, and certain milkshakes, going through the characteristics of each one that make them so hard to resist. I realized through reading this that all of these things are things I, too, find impossible to resist, and so I simply never eat them, or buy them. If they are around, I know I will eat them. But even so, avoiding these strongly triggering foods hasn't meant that I don't still overeat, or that I no longer have a weight problem.
But, I don't drink milkshakes, because I don't go to places that sell them. Just the idea of going through a drive-through or into a restaurant that sells them (the good ones) is enough to stop me. Okay, there is an exception: I will go to Burgerville USA (in Oregon) and have a shake while I am driving a long distance. There are lots of subconscious cues and triggers that make it very hard for me to resist it in this circumstance.
I think it has been several years since I bought a package of Oreos. I can't resist them. I haven't had a Cinnabon in at least 5 years, because HELLO! And I've changed more things too. I almost never watch TV, because the commercials are too triggering for me. We do watch some shows on DVD, without commercials. Even so, some of the shows themselves contain a lot of food triggers. I rarely go out to eat anymore, because even though I eat a lot less than I used to, I still eat too much, and it's better and cheaper to cook at home. Also, my hubby is a great cook and likes making dinner. We go out for breakfast once a week, because I love breakfast so much. That's about it, and it's a vast improvement from a few years ago.
Our brains are different. That is one thing that the past year of my 2 1/2 years post op has really taught me. There are people who can sit in front of a whole plate of Oreos, and if they aren't hungry they won't eat any. If they want a snack, they might eat a couple, but not the whole plate. Many others of us aren't like that. Even if we are full, we will eat them until they are gone. Period.
Having surgery did what I wanted it to do: it took away my physical hunger, which was real. It left me with all the other reasons that I was overweight, including compulsive overeating and emotionally conditioned eating. This past year has really opened my eyes to this reality.
This book doesn't make the food industry into the big excuse for obesity. It simply shows how the foods that were developed because consumers like them and buy them and can't resist them have contributed to our drive to eat highly caloric foods, too much of them, and too often. It's one more key to understanding how to get control of our eating, our weight, and our lives. It also points to one of the reasons that WLS is not a magic bullet, and without attention to all of our habits that contribute to the problem, we will not reach and stay at our goal long-term.
Sunday, June 28, 2009
Friday, June 19, 2009
The End of Overeating?
My weight is coming down a bit. I've been able to be a bit more intentional about my eating lately, which surely has helped. Oddly, I've taken the last 2 weeks off from running because my right Achilles tendon was sore. Last night was the first time I had run in over 2 weeks, and my weight was already down 2 pounds by then. It's encouraging, but I want to see more movement than this.
I am reading a new book called "The End of Overeating" by David Kessler. It's a promising title...too promising, of course, but the premise is basically that America's overeating problem is (at least partly) caused by the manipulation by the food industry of the proportions of sugar, salt and fat in foods we commonly eat. The author argues that certain proportions of these basic ingredients trigger our brains to eat beyond our satiety. The book seeks to explain how we lose control over our eating, and promises to reveal how we can regain it. (I am thinking the answer will be in preparing more of our own foods, from scratch.) It is interesting. I'm not sure it's going to tell me a lot that I didn't already know, but even reading about overeating helps me be more conscious about what I do, so even that helps.
From the outset, this book reiterates what recent research has confirmed over and over: that we gain weight because we eat too much. It's such a simple idea, but we have fought the idea for a long time. I fought it, before I had WLS. Now I realize that I did eat more than I realized, even if the amount I ate might not cause another person to gain weight. It wasn't massive amounts, but it doesn't take much of a calorie excess to cause a lot of weight gain over time.
The book also talks in the beginning about the "setpoint" theory, that our bodies naturally maintain a certain weight range and somehow that setpoint gets messed up in people who are overweight. In fact, the author states, the setpoint, or homeostasis range, is only one factor in our weight. A lot of other things happen that override our body's weight homeostasis, and when we gain a lot of weight and then try to lose it, our setpoint often gets moved a little higher than it was before. We've all noticed that in our yo-yo cycles in the past. We blame it on dieting. It might be the actual weight gain that causes it, not the diet that revealed that changed setpoint.
I'm still fighting this seeming "setpoint" that I have reached of about 170 pounds. My body seems to want to stay here. Interestingly, it's exactly where my surgeon said I would land. But I could easily stand to lose another 20 lbs, and even 10 would make me happy. As tempting as it is to try to get there quickly through a "diet", I am resisting this urge, partly because I was always a terrible dieter, and partly because I want a more lasting weight loss. So I still work on this every day.
On the school front...I have 10 1/2 months left and I am very happy about that. The hardest part is behind me. It's nice to realize that by this time next year I will be graduated and will already have taken (and hopefully passed) my boards. We are finishing up our bioethics class next week. It's been a very interesting class. Then we will take Law and Medicine in July. Meanwhile, we are working about 30 hours/week in the OR. Tonight I am on from 3-11, which should be in OB rather than the OR--placing labor epidurals and providing anesthesia for C-sections. I enjoy OB anesthesia, and I also enjoy not getting up at 5am.
I am thinking of making an appointment to see the surgeon sometime this summer, just to check in and make sure everything is okay. I don't know if I need a fill or not. Sometimes I think I do, sometimes I don't. Since it's been over a year since my last appointment, I should go in either way.
Hope everyone is enjoying the summer!
I am reading a new book called "The End of Overeating" by David Kessler. It's a promising title...too promising, of course, but the premise is basically that America's overeating problem is (at least partly) caused by the manipulation by the food industry of the proportions of sugar, salt and fat in foods we commonly eat. The author argues that certain proportions of these basic ingredients trigger our brains to eat beyond our satiety. The book seeks to explain how we lose control over our eating, and promises to reveal how we can regain it. (I am thinking the answer will be in preparing more of our own foods, from scratch.) It is interesting. I'm not sure it's going to tell me a lot that I didn't already know, but even reading about overeating helps me be more conscious about what I do, so even that helps.
From the outset, this book reiterates what recent research has confirmed over and over: that we gain weight because we eat too much. It's such a simple idea, but we have fought the idea for a long time. I fought it, before I had WLS. Now I realize that I did eat more than I realized, even if the amount I ate might not cause another person to gain weight. It wasn't massive amounts, but it doesn't take much of a calorie excess to cause a lot of weight gain over time.
The book also talks in the beginning about the "setpoint" theory, that our bodies naturally maintain a certain weight range and somehow that setpoint gets messed up in people who are overweight. In fact, the author states, the setpoint, or homeostasis range, is only one factor in our weight. A lot of other things happen that override our body's weight homeostasis, and when we gain a lot of weight and then try to lose it, our setpoint often gets moved a little higher than it was before. We've all noticed that in our yo-yo cycles in the past. We blame it on dieting. It might be the actual weight gain that causes it, not the diet that revealed that changed setpoint.
I'm still fighting this seeming "setpoint" that I have reached of about 170 pounds. My body seems to want to stay here. Interestingly, it's exactly where my surgeon said I would land. But I could easily stand to lose another 20 lbs, and even 10 would make me happy. As tempting as it is to try to get there quickly through a "diet", I am resisting this urge, partly because I was always a terrible dieter, and partly because I want a more lasting weight loss. So I still work on this every day.
On the school front...I have 10 1/2 months left and I am very happy about that. The hardest part is behind me. It's nice to realize that by this time next year I will be graduated and will already have taken (and hopefully passed) my boards. We are finishing up our bioethics class next week. It's been a very interesting class. Then we will take Law and Medicine in July. Meanwhile, we are working about 30 hours/week in the OR. Tonight I am on from 3-11, which should be in OB rather than the OR--placing labor epidurals and providing anesthesia for C-sections. I enjoy OB anesthesia, and I also enjoy not getting up at 5am.
I am thinking of making an appointment to see the surgeon sometime this summer, just to check in and make sure everything is okay. I don't know if I need a fill or not. Sometimes I think I do, sometimes I don't. Since it's been over a year since my last appointment, I should go in either way.
Hope everyone is enjoying the summer!
Monday, June 8, 2009
Food Junkie
I never used to believe in food addiction. I didn't understand how anyone could be addicted to something you need to live. Isn't that like being an oxygen addict, or a water addict?
Well, no, I am realizing. It is not. We don't become addicted to the stuff we actually need to live, like whole grains and protein. Too bad! It is not very different from becoming addicted to gambling, or sex, or anything that produces a "high" in your brain. We actually aren't addicted to the food (or sex or gambling), we are addicted to our own brain chemicals that make us feel good. It is a pattern that we learn from childhood, for most of us. That is what tends to make it addictive: early on, we learned that certain foods make us feel good, comforted, loved. Our parents gave them to us to reward us, or we would eat them when we heard our parents fighting in the other room, or we observed other family members compulsively overeating and learned the behavior. Early on, eating certain things became associated with positive feelings, and they become our most powerful coping mechanism.
I know this isn't news to anyone reading this who has had WLS, or who has ever had a weight problem.
I am doing my own recovery work, unrelated (so I thought) to my eating, because I am married to a man with addictions. I'm learning that it was no mistake that I married an addict--wonderful person though he is. I was raised by parents who were at least food addicts, and I don't mean that in the sense of people who claim to be "addicted" to chocolate or Coach purses or Carmex. I realized when I first started goint to Al-Anon that the families people were describing were alcoholic families, and they were exactly like mine, except no one in my family drank or did drugs. They did, however, have an exceptionally unhealthy relationship with food, so much so that I believe they acted like any other addicts, and we all learned to respond to the addiction like any other codependent does. It sounds crazy if you haven't lived it. But I am certain that some of my readers have experienced the very same thing.
It has been through working my own recovery that I have realized how much I use food to cope with stress. STILL. Now that the blush of new WLS has worn off, 2 1/2 years after surgery, I don't have that "high" to keep me strictly adhering to my food plan. Like I described before, my days go pretty much according to plan, but I get home and I am "hungry" and foraging. Where I used to be able to listen to my stomach and stop if I wasn't physically hungry, now I am finding that to be much harder. I can actually notice now that eating sugar calms my anxiety and stress, something I didn't used to really be aware of. It is scary to observe this happening, and feel powerless to stop it.
I am undecided on how I want to try to get a handle on this. I feel pretty sure that I am not going to get to my goal weight (or really lose any more weight at all) if I don't get some better way to handle life than overeating. If it weren't for my band, I would be eating much more than I do now, and would have regained more than the 5 pounds I do have. I know the usual strategies, like exercising more, drinking tea, journaling, seeing a counselor etc. But I feel like this problem is much more core to who I am as a person than these simple behavior changes. I feel like something much deeper has to change if I am going to have a lasting way of maintaining my weight. It may involve going to OA meetings, although frankly OA scares me, with their Gray Sheets and eating soberly. And I don't know what their relationship with bariatric patients is like: are they accepting? Surely there must be many WLSers in OA meetings. I will probably just start by talking to our counselor about this and getting an idea from there on how I want to deal with this problem in a real and lasting way.
How have you all dealt with these kinds of issues? Any suggestions?
Well, no, I am realizing. It is not. We don't become addicted to the stuff we actually need to live, like whole grains and protein. Too bad! It is not very different from becoming addicted to gambling, or sex, or anything that produces a "high" in your brain. We actually aren't addicted to the food (or sex or gambling), we are addicted to our own brain chemicals that make us feel good. It is a pattern that we learn from childhood, for most of us. That is what tends to make it addictive: early on, we learned that certain foods make us feel good, comforted, loved. Our parents gave them to us to reward us, or we would eat them when we heard our parents fighting in the other room, or we observed other family members compulsively overeating and learned the behavior. Early on, eating certain things became associated with positive feelings, and they become our most powerful coping mechanism.
I know this isn't news to anyone reading this who has had WLS, or who has ever had a weight problem.
I am doing my own recovery work, unrelated (so I thought) to my eating, because I am married to a man with addictions. I'm learning that it was no mistake that I married an addict--wonderful person though he is. I was raised by parents who were at least food addicts, and I don't mean that in the sense of people who claim to be "addicted" to chocolate or Coach purses or Carmex. I realized when I first started goint to Al-Anon that the families people were describing were alcoholic families, and they were exactly like mine, except no one in my family drank or did drugs. They did, however, have an exceptionally unhealthy relationship with food, so much so that I believe they acted like any other addicts, and we all learned to respond to the addiction like any other codependent does. It sounds crazy if you haven't lived it. But I am certain that some of my readers have experienced the very same thing.
It has been through working my own recovery that I have realized how much I use food to cope with stress. STILL. Now that the blush of new WLS has worn off, 2 1/2 years after surgery, I don't have that "high" to keep me strictly adhering to my food plan. Like I described before, my days go pretty much according to plan, but I get home and I am "hungry" and foraging. Where I used to be able to listen to my stomach and stop if I wasn't physically hungry, now I am finding that to be much harder. I can actually notice now that eating sugar calms my anxiety and stress, something I didn't used to really be aware of. It is scary to observe this happening, and feel powerless to stop it.
I am undecided on how I want to try to get a handle on this. I feel pretty sure that I am not going to get to my goal weight (or really lose any more weight at all) if I don't get some better way to handle life than overeating. If it weren't for my band, I would be eating much more than I do now, and would have regained more than the 5 pounds I do have. I know the usual strategies, like exercising more, drinking tea, journaling, seeing a counselor etc. But I feel like this problem is much more core to who I am as a person than these simple behavior changes. I feel like something much deeper has to change if I am going to have a lasting way of maintaining my weight. It may involve going to OA meetings, although frankly OA scares me, with their Gray Sheets and eating soberly. And I don't know what their relationship with bariatric patients is like: are they accepting? Surely there must be many WLSers in OA meetings. I will probably just start by talking to our counselor about this and getting an idea from there on how I want to deal with this problem in a real and lasting way.
How have you all dealt with these kinds of issues? Any suggestions?
Monday, May 25, 2009
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.
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.
Sunday, May 10, 2009
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!
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!
Sunday, May 3, 2009
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.
Monday, April 27, 2009
Home,again, home again....
I've been out of town for the last week-plus. I spent 5 days in Washington DC, then came home for 12 hours and left for Seattle for 4 more days. The trips were great, but I am glad to be home. DC was our Mid Year Assembly for the national organization for nurse anesthetists. There were a couple days of conferences, mainly prep for going to Capitol Hill. Then there were a couple of days of each state's delegation going to visit its legislators and discuss various issues with them. It's about visibility for our profession, especially in light of health care reform that is happening as we speak. It was very enlightening to see how Congress actually works, and see that senators and representitives are actual people and there is no need to fear contacting them and telling them how you, their constituent, feels about issues. They actually do listen. In between all of that, we met lots of CRNAs and student nurse anesthetists, went to lots of fabulous dinners, and saw the sights in DC. It's a lovely city, and I hope to return someday and see more of it.
The Seattle trip was for our state organization. They had their spring conference this past weekend. I wouldn't have gone, except that I am the student representitive from my program for this year, which meant I needed to go to their board meeting. It's an honorary thing; no vote, and no responsibilities, just mentoring really. The conference itself was interesting, lots of good speakers and topics. I also saw some friends in town, which was great.
Now I am back into stress-mode for school. I feel like I've fallen behind in my studies; I've been away for over a week, and we have an exam tomorrow in OB. We are going to 2:1 supervision next week and becoming "seniors" which is a big deal and marks the final 12 month sprint to graduation. For our first year in the OR, we are supervised on a 1:1 basis, meaning that there is a CRNA in the room with us at all times. When we go to 2:1, we are supervised by the docs, and one doc watches a student nurse anesthetist in 2 different OR rooms. It's great experience because we get to develop our skills and our style of delivering an anesthetic, make more decisions ourselves, but the MD is present for induction and emergence, and if we have questions or problems at any point during the case. But it's a big shift, and it's a bit scary.
On my run tonight, I realized just how much negative self-talk I still have. I was telling myself how much work I have to do, how much studying, how I'm not ready for Bloomsday, how I'm not doing well enough in my recovery, I still haven't lost the 10 pounds I want to lose...and then I finally stopped and realized what I was doing. Learning to be kinder to myself doesn't come easily. I've got a lot going on, and I'm keeping my head above water. I'm very tired, and stressed, but really I'm doing okay. I've got to learn that a bit better.
I gained a few pounds while gone. But between all the restaurant eating, and no running all that time, I think I got off easy. Here's hoping it comes off without too much struggle.
The Seattle trip was for our state organization. They had their spring conference this past weekend. I wouldn't have gone, except that I am the student representitive from my program for this year, which meant I needed to go to their board meeting. It's an honorary thing; no vote, and no responsibilities, just mentoring really. The conference itself was interesting, lots of good speakers and topics. I also saw some friends in town, which was great.
Now I am back into stress-mode for school. I feel like I've fallen behind in my studies; I've been away for over a week, and we have an exam tomorrow in OB. We are going to 2:1 supervision next week and becoming "seniors" which is a big deal and marks the final 12 month sprint to graduation. For our first year in the OR, we are supervised on a 1:1 basis, meaning that there is a CRNA in the room with us at all times. When we go to 2:1, we are supervised by the docs, and one doc watches a student nurse anesthetist in 2 different OR rooms. It's great experience because we get to develop our skills and our style of delivering an anesthetic, make more decisions ourselves, but the MD is present for induction and emergence, and if we have questions or problems at any point during the case. But it's a big shift, and it's a bit scary.
On my run tonight, I realized just how much negative self-talk I still have. I was telling myself how much work I have to do, how much studying, how I'm not ready for Bloomsday, how I'm not doing well enough in my recovery, I still haven't lost the 10 pounds I want to lose...and then I finally stopped and realized what I was doing. Learning to be kinder to myself doesn't come easily. I've got a lot going on, and I'm keeping my head above water. I'm very tired, and stressed, but really I'm doing okay. I've got to learn that a bit better.
I gained a few pounds while gone. But between all the restaurant eating, and no running all that time, I think I got off easy. Here's hoping it comes off without too much struggle.
Wednesday, April 15, 2009
Doomsday
I ran Doomsday Hill tonight. It's actually Pettit Drive, but the organizers of the Bloomsday Race I think were the ones to christen the hill, perhaps for a little more publicity for their very popular race. Anyway, I was concerned about it. The race is in 3 weeks.
It's funny, I started running a little over a year ago. I have never had any desire to race. I still don't. I haven't done a 5K or a 10K and I have no plans for a half or a marathon. I just wanted to do Bloomsday (12K) because it's here in Spokane and it's a huge event: it used to be the largest footrace in the world, until last year when I think Dubai or someplace got 80,000 to run in their race. Bloomsday still attracts around 50,000 runners (and walkers) every year.
I'm going to be starting in the slowest group, with my hubby and some friends from school (I think). I have no plans to run without walking, or beat any particular time. I really just wanted to be part of the event.
Doomsday turns out not to be that terrible. I did walk a little midway through. It isn't much steeper than the hill I normally train on. The only terrible part is that it's almost a mile long and it's a steady grade, so there is no respite until the top. And it's around mile 5, so you're already pretty tired by then. But I was pretty pleased with the run anyway.
I didn't run the entire route; I only ran 4 miles today. I heard a long time ago that it's not great to run the race course while training for the race because it's a letdown on the day of the race--you've already run it--and you'll have adrenaline to carry you through the unexpected rough patches. I don't have any idea if that is true or not, but it does make sense. I KNOW I can walk 7.7 miles, so it's not a question of finishing. And I know I get a boost when I am running with other people around; I do have a tiny bit of competitiveness in me.
I'm looking forward to it!
It's funny, I started running a little over a year ago. I have never had any desire to race. I still don't. I haven't done a 5K or a 10K and I have no plans for a half or a marathon. I just wanted to do Bloomsday (12K) because it's here in Spokane and it's a huge event: it used to be the largest footrace in the world, until last year when I think Dubai or someplace got 80,000 to run in their race. Bloomsday still attracts around 50,000 runners (and walkers) every year.
I'm going to be starting in the slowest group, with my hubby and some friends from school (I think). I have no plans to run without walking, or beat any particular time. I really just wanted to be part of the event.
Doomsday turns out not to be that terrible. I did walk a little midway through. It isn't much steeper than the hill I normally train on. The only terrible part is that it's almost a mile long and it's a steady grade, so there is no respite until the top. And it's around mile 5, so you're already pretty tired by then. But I was pretty pleased with the run anyway.
I didn't run the entire route; I only ran 4 miles today. I heard a long time ago that it's not great to run the race course while training for the race because it's a letdown on the day of the race--you've already run it--and you'll have adrenaline to carry you through the unexpected rough patches. I don't have any idea if that is true or not, but it does make sense. I KNOW I can walk 7.7 miles, so it's not a question of finishing. And I know I get a boost when I am running with other people around; I do have a tiny bit of competitiveness in me.
I'm looking forward to it!
Monday, April 13, 2009
Good News....
3 pounds decided to leave. Don't know why they suddenly left, but I hope they stay gone. 3 more to go...then I can get back to losing the last few to goal. grr, regain sucks!
But, I've managed to stay within an 8 pound range for almost a year now, and very close to my goal, which could only be possible with the Band. Even though my eating habits are far from perfect, I've been able to do it for longer than I have EVER done it in my entire adult life. I've never stayed at any weight this long, really. So it's still a victory. I'll feel a lot better when I'm back down a little lower, though.
Today I planned on a run after clinicals, but was greeted by a real hail-storm. We've had several hail-storms this year, but usually it's just tiny hailstones. This time they were up to the size of a Gobstopper, like a centimeter or more in diameter, which is VERY unusual around here. Luckily they weren't that hard, and they didn't do any damage that I have seen. But they did dissuade me from running Doomsday Hill today. So I am off to the gym, to the Dreadmill. Hopefully tomorrow I can get in some outdoor mileage.
I'm trying to structure this week effectively. I am doing a 2 week rotation at our local VA hospital, which is an all-CRNA practice, and has a much slower pace than our usual clinical site. As such, I'll have a little bit more time, so I'm making an effort to get caught up on studying OB and finishing my portion of the lit review for our research project before leaving for DC on Friday morning. I have not studied nearly as much as I would like to have done this semester...my head hasn't been in the game, and there isn't as much pressure to do so, which is good and bad. But today I've been pretty good, spending some hours in the library studying (and very little of it on Facebook!). Tomorrow should be even better, fingers crossed...
But, I've managed to stay within an 8 pound range for almost a year now, and very close to my goal, which could only be possible with the Band. Even though my eating habits are far from perfect, I've been able to do it for longer than I have EVER done it in my entire adult life. I've never stayed at any weight this long, really. So it's still a victory. I'll feel a lot better when I'm back down a little lower, though.
Today I planned on a run after clinicals, but was greeted by a real hail-storm. We've had several hail-storms this year, but usually it's just tiny hailstones. This time they were up to the size of a Gobstopper, like a centimeter or more in diameter, which is VERY unusual around here. Luckily they weren't that hard, and they didn't do any damage that I have seen. But they did dissuade me from running Doomsday Hill today. So I am off to the gym, to the Dreadmill. Hopefully tomorrow I can get in some outdoor mileage.
I'm trying to structure this week effectively. I am doing a 2 week rotation at our local VA hospital, which is an all-CRNA practice, and has a much slower pace than our usual clinical site. As such, I'll have a little bit more time, so I'm making an effort to get caught up on studying OB and finishing my portion of the lit review for our research project before leaving for DC on Friday morning. I have not studied nearly as much as I would like to have done this semester...my head hasn't been in the game, and there isn't as much pressure to do so, which is good and bad. But today I've been pretty good, spending some hours in the library studying (and very little of it on Facebook!). Tomorrow should be even better, fingers crossed...
Saturday, April 11, 2009
Time Flies
I've been working away, and now it's already the middle of April. Where does the time go?
Here it is, Easter tomorrow. I used to celebrate it in high-church style when I was growing up. I grew up an Episcopalian, so High Church meant "smells and bells:" incense, 3 choirs singing, trumpets, lots of acolytes and priests in their finest regalia. When I was a girl, my mother would make me a new Easter dress every year. Usually she would play violin at church, as she did for most holidays and other Sundays, and when I was a teenager I often played with her. Of course, we also did the usual Easter things like baskets full of candy and dyeing eggs, and the occasional Easter egg hunt at church. In the afternoon, we'd go to my grandparents' house for dinner, which was pretty traditional.
These days, I get back to Easter's more pagan roots, celebrating the beginning of spring and the end of winter. And eating a lot of candy, of course. I try to do some of those little things for my husband, who grew up not celebrating holidays and never had those little things growing up. So we have Peeps, which I love but he does not. (Mmm, crunchy sugery outside, marshmallowy inside.)
This seems like an appropriate time to mention that I've regained about 6 pounds. They seemed to show up mysteriously over the last 6 weeks, or more like over 4 weeks, and have hung on the last 2 weeks, despite cleaning up my diet and running more. I don't know if it's the low-level chronic stress I'm now living in, or if I just haven't done as well as I thought. But there it is, staring at me every morning.
Still, I plan on running Bloomsday in about a month, even though I haven't run more than 5 miles in 6 months and it's a 12k. I won't end up running it all (I always walk/run anyway) but I'd like to kick things up over the next month, and hope it improves my weight as well.
That's it, not much exciting going on around here. Oh, wait...I am going to DC next week, that's pretty cool. Anyone know what the weather's going to be like?
Here it is, Easter tomorrow. I used to celebrate it in high-church style when I was growing up. I grew up an Episcopalian, so High Church meant "smells and bells:" incense, 3 choirs singing, trumpets, lots of acolytes and priests in their finest regalia. When I was a girl, my mother would make me a new Easter dress every year. Usually she would play violin at church, as she did for most holidays and other Sundays, and when I was a teenager I often played with her. Of course, we also did the usual Easter things like baskets full of candy and dyeing eggs, and the occasional Easter egg hunt at church. In the afternoon, we'd go to my grandparents' house for dinner, which was pretty traditional.
These days, I get back to Easter's more pagan roots, celebrating the beginning of spring and the end of winter. And eating a lot of candy, of course. I try to do some of those little things for my husband, who grew up not celebrating holidays and never had those little things growing up. So we have Peeps, which I love but he does not. (Mmm, crunchy sugery outside, marshmallowy inside.)
This seems like an appropriate time to mention that I've regained about 6 pounds. They seemed to show up mysteriously over the last 6 weeks, or more like over 4 weeks, and have hung on the last 2 weeks, despite cleaning up my diet and running more. I don't know if it's the low-level chronic stress I'm now living in, or if I just haven't done as well as I thought. But there it is, staring at me every morning.
Still, I plan on running Bloomsday in about a month, even though I haven't run more than 5 miles in 6 months and it's a 12k. I won't end up running it all (I always walk/run anyway) but I'd like to kick things up over the next month, and hope it improves my weight as well.
That's it, not much exciting going on around here. Oh, wait...I am going to DC next week, that's pretty cool. Anyone know what the weather's going to be like?
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