Mommy Wars

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

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

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

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

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

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

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

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

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

Socially Necessary Surgery: the debate rages

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

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

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

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

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

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

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

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

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

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

We're having a blizzard!

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

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

Snow Day

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

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

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

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

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

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

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

End of Semester!

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

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

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

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

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

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

So Productive

I drove to Portland yesterday afternoon, spent a nice evening with hubby, and fell asleep before he went to pick up his brother from the airport (sorry hubby). It WAS a day that started at 6am (4am if you count the numerous times I woke up between then and my alarm going off at 6) and had a 6 hour drive in the middle of it, so I don't feel super guilty for being so tired when I got here, but I know hubby would have liked it if I had come with him to the airport.

But today I'm feeling super-productive. I got up at 7:30, spent an hour relaxing then chatted for a while with bro-in-law, which was really nice. I went and had coffee and breakfast, organized my pharmacology notes, cooked half of Thanksgiving dinner (everything that could easily be made ahead), got a second giant binder for my pharm notes (they FILL two 3" binders), ran 4 miles, and now am out studying pharm. It's only just now 6pm. Feeling pretty good...

My new fave place to study in Portland is Staccato Gelato in Sellwood. The original Laurelwood location was my favorite gelato place in Portland (there are a few). This location opened in the last 6 months, and is only a few minutes from our apartment--conveniently just a block away from our favorite sushi restaurant. This one serves lunch and really good coffee, and the gelato is served in little tiny scoops, so I can have a scoop without feeling too guilty. Gelato is made with milk, as opposed to ice cream which is made with cream, and it has less fat than ice cream, plus it's so delicious. So, getting a tiny scoop of gelato is a pretty low-impact guilty pleasure. They also have free wi-fi here, and it's not very busy and quite spacious, so it's a great place to study.

When I'm adequately caffeinated and wishing to avoid buying something (or being tempted by delicious food that I don't need), I go to Reed College to study. It's also nearby, and the library is big and quiet and filled with studious Reedies, which helps me concentrate. The wi-fi is free there too, of course, and it has a sufficiently collegiate feel to keep me on task. But this week they are on limited hours because of the holiday, so I am at Staccato Gelato.

I am slowly getting my running miles back to where they were before the accident and subsequent curtailing of my running schedule. It feels good to be back on track (even if the weight loss still isn't happening--at least I'm not gaining). If anyone is considering taking up running, I'd like to encourage you in your interest. I always thought I was too heavy to run, and I felt like if I couldn't run a mile straight through, I shouldn't even bother. But here are some great reasons to take up running:

• It's free, except for shoes. Of course, you CAN spend lots of money on specialized running gear: clothes made of high-tech wicking fabrics, heart rate monitors, MP3 player, Nike + iPod sport kit, etc. And those things can make running more enjoyable--but are totally optional. All you really need are running shoes that work for your feet and gait and fit well. I swear by my Asics 2130s. Get fitted at a quality running store, it's worth it.
• You can do it just about anywhere. No membership required.
• You don't have to be able to run a mile, a half mile or even a block all the way. You can start out the Couch-to-5K way (many people start running using this method, and it works great): run 15 seconds and walk 45-60 seconds, repeat for up to 20 minutes.
• You don't have to be at or near goal weight. You should get clearance from your doctor, of course. You may have bad knees if you've been overweight for a long time, and that's one of many good reasons to check with a doctor first. But many, many people start running when they are significantly overweight, and most of them have nothing but positive results--as long as they don't overdo it. The key is not advancing too quickly (speed, distance, or intensity), and not outrunning your fitness level. (I highly recommend reading Jeff Galloway's Running: Getting Started. Also check out his website, jeffgalloway.com.)
• Runner's high is real. You won't believe how great you feel when the endorphins start kicking in. Plus, the sense of accomplishment and pride in actually being able to call yourself a runner--especially when you're like me, starting out morbidly obese, and having no experience running since junior high--will make you a believer.
• It doesn't take much time to have a great fitness effect. I get way more fitness benefit from running than an equal amount of time spent in almost any other cardio activity (the only exception that I've actually done lately is swimming laps). Run for 20 minutes (or walk/run) and ditch your 45-60 minute elliptical routine.

I know there are lots more reasons--which can be supplied by my running friends She Smiles, Thinspiration, Angie, and others. If you're thinking about it, I say go for it. You just might become one of those crazy runners, too.

A busy week

The weekend is here...and hubby is not. :( He had to work overtime this weekend. I have studying to do, and I plan on running today, but it's been nice to wake up slowly and relax. I've been getting caught up on my blogs.

This week was very busy. We all gave presentations on Tuesday and Wednesday. (Let me tell you, listening to powerpoint presentations for 6 hours is a bit much.) I had 2 presentations to give: one a case study presentation on multiple sclerosis and anesthesia implications, and one in pharmacology about the anticonvulsant (antiepileptic) drugs. That was about 30 minutes, about the cellular pathophysiology of seizures, and many of the drugs used to treat them, mainly about their pharmacology, drug interactions, and anesthesia implications. If you hadn't thought about it before, anesthesia has interactions with many drugs that people take routinely, and many underlying conditions that people have. So those presentations were big deals. Then we had a pharmacology midterm (on antibiotics) and got back out test on central line placement, so now we can place central lines--woot! (With direct supervision, of course, while we are students.)

I placed my second spinal block yesterday, too. That is a very satisfying thing to do--getting the needle placed correctly and getting that CSF back just feels like you've really done something, and then when the block works and the patient tolerates the surgery with just a little sedation--that is super cool.

I was reading in one of the other blogs about the idea that you can defeat your band by drinking while you are eating. This is the main basis for the no-drinking-with-meals rule--you'll render your band ineffective, basically, and eat way too much. But I have discovered that if I drink after I eat (and usually I don't) I actually get more full. Especially if what I have eaten is something that can swell with moisture, but it seems to happen with most things. I avoid drinking with meals now mainly to avoid overfilling my pouch and stretching it. There are times, though, mainly when I take a break from clinicals in the morning, and I want to eat my breakfast AND I MUST get some coffee in...and the coffee is too hot, but I only have 15 minutes...I drink the coffee after I eat. You know, it seems I don't get hungry any sooner than when I don't drink. (Ha, you thought a bandster couldn't eat in 15 minutes? You never met a bandster anesthetist!) I think many people can "wash the food through" their pouch with drinking, and I am not recommending trying it. I'm just noticing for myself, it doesn't seem to work that way. But then again, I never get food stuck or PB, and I still seem to have restriction. So it seems some of the usual band things don't apply to mine.

Okay, time to get my day going...

Rant for the day

Just got done with clinicals, and am heading out for a run. At the end of the day I had a baby patient (18 mos old) for a quick little anesthetic just to remove some sutures from her face. Often little ones won't let their doctors do stuff like that without deep sedation or anesthesia, so here she was. She was attacked a few months ago by the family pit bull. The child had a depressed skull fracture that punctured into her brain, plus the injuries to her face which thankfully will heal with minimal scars. She seems fine now, but she is lucky to be alive. This story, of course, prompted a round of exclamations about how a parent could have a pit bull around a baby. There are cities in the US that now make it a felony for a minor to handle a pit bull. There are insurance companies that won't give homeowner's insurance to people with pit bulls.

Of course, pit bulls aren't bad dogs, it's the bad owners, right? That sounds like the argument for another thing we regulate (a little) in the US--guns. Which got me thinking: Why don't we have similar regulations for owning breeds of dogs like pit bulls who are known to be dangerous, especially when improperly handled and trained? I don't think pit bulls are inherantly "bad" dogs. But I don't see why we can't have a law that requires potential owners to attend a safety course, have a background check, basically some of the same things we require of people who want to own a deadly weapon. You have to have a trigger lock and a lock box if you own a gun in a home with a small child--why is it fine to have your family pit bull hanging out with your baby, when we know that small children might be harmed if they pull the dog's tail or even just start crying and startle the dog? The arguement goes round and round about how these dogs are fine if they are properly handled and trained--but we as a society do nothing to ensure that the dogs are owned and handled by people who are responsible and educated in how to handle a dog like this. It's not okay to have a lion in your house with your baby--why a pit bull?

That's what I'd do, if I was Queen of Everything.

People who don't want to regulate things like that have similar arguments against helmet laws--both for bicyclists and motorcyclists. But as a former trauma nurse, I saw the public health implications of people who don't wear helmets, or seat belts in cars. They become a burden to the taxpayer. We can be all for personal freedoms and say it's our own business if we don't want to wear a helmet when riding a bike or a motorcycle. But when you get that head injury that you don't recover from, that you end up in a nursing home on a feeding tube instead of back out working at your job and being a productive member of society--all because you wanted the "personal freedom" not to wear a $40 bike helmet--that is a public health issue. I'd better stop there, because I can really get going on helmets! If it just affects you--do what you want. When it starts becoming a burden to taxpayers (to ME), or when it involves not protecting the weakest members of our societies (the very young and the very old), that is when we need to regulate. That's my opinion.

Ok, off to run now. Lost 3 of the 4 lbs...slowly getting there. Everything is slow. This is Hell Week for the semester--lots of stuff due in the next 2 days, tests and presentations and papers. I spent the whole weekend at the library, and I'll be going back once I finish my run.

Newly fat?

Well, I for one am feeling newly fat, again, although I know I'm not really. The past few weeks of sporadic, rare feats of running, and stretches of poor eating choices, plus Aunt Flo, has added up to an extra 4 lbs. I'm trying not to freak out about it, but it's making me feel a little worse than I already do, with family emergencies and dramas and my schooling winding ever tighter into a big ball of overwhelming stress.

But today, finally, I ran again, and felt better. It's harder now that it's getting dark so quickly. I'm putting together strategies for how I can run on days that seem impossible. Some days ARE impossible: I leave before dark, I get home after dark, and I still have hours of homework to do before going to bed for a few hours of sleep. But others aren't quite as bad, like today, and I could get in a nice 5 miler before the sun set at 4:30. I can't run in my neighborhood after dark, not because I'm afraid of being mugged, but because there are no streetlights and my neighborhood has dangerously cracked sidewalks. I'm pretty sure I'll end up with a newly flattened nose if I try to brave the roads in the dark. So I either have to find a lighted running path somewhere, or find a way to run during the daytime, or run indoors, which is my LAST resort, and which I'll eventually have to start doing anyway, when it gets too snowy and icy to safely run.

I really liked that article that I posted below because I think all of us who have gotten close to goal weight and stayed there long enough to know people who didn't know us when we were MO have had these experiences. It's so weird for people to assume that they can talk smack about fat people because you aren't fat. It's really bad in health care, because you can get badly hurt taking care of the morbidly obese, so a lot of providers have a hostility toward fat people. It's sad, because of course we all deserve dignity and to be treated as a patient who deserves good care, not a liability or a burden. But people are people, even if they are doctors and nurses. It's going to be more of a problem, and I hope that my fellow health care professionals learn how to do their jobs without getting hurt and without treating patients poorly as the population grows more obese and needs more health care. (Of course, I hope the trend towards rising obesity rates starts to reverse. But it hasn't yet.) But even just among friends, it is weird when you overhear someone talking amongst their thin friends or coworkers and realize that you are hearing things you never would have heard when you were MO. People would make sure not to say them in your earshot. (Or sometimes they wouldn't...ouch.) At first it's exhilirating to be thought of as someone who was never obese. But then it's sickening, to realize the way many thin people think of fat people. I know that just because I was MO didn't mean I was lazy, or refused to exercise (I exercised more than most normal-weight people), or ate buckets of greasy junk food (I ate a sensible, vegetarian diet, much like I do now...just with more cookies and ice cream). And people who knew me wouldn't have thought those things either, I don't think, but people who didn't know me probably did.

How It Feels To Be Newly Thin (Newsweek)

http://www.newsweek.com/id/74075

My Secret History
I may be thin now, but that doesn't mean I share your opinions about fat people.
By Megan Northrup Newsweek Web Exclusive
Dec 6, 2007

It's almost surreal how I find myself privy to the hushed conversations thin people have among themselves. I'm part of this insider group, but I carry a secret identity that renders me an impostor to some degree. I spent most of my childhood and the entirety of my adolescence overweight, and eventually morbidly obese (a very difficult health category to own up to). My core identity was once tied to being an outsider to this camaraderie of thin people. But my identity shifted rapidly in February of last year, when I underwent the kind of "medical intervention" that Star Jones recently acknowledged was the reason for her own weight loss. People I've met in the last year don't know me as I knew myself before I underwent gastric bypass surgery. They take for granted that my physical presence—I am now 130 pounds, having dropped 135 pounds after my operation—has always been this way, and I let them believe this myth because I see now, more than ever, how much judgment is directed toward the overweight and obese.

My best friend Bea places nannies in elite homes in Los Angeles, and more than once she has been explicitly asked not to send overweight applicants, no matter what their qualifications. Recently she had a candidate of the highest qualifications and glowing references, but this particular candidate wore size 16 jeans. When she found the courage to share this last detail with the client, the client immediately justified her prejudice by explaining that there were a lot of expensive antiques in her home, and narrow hallways. Fat, this woman believed, was simply unacceptable. If I had been there, I'm sure I would have simply nodded in quiet acquiescence.
I did as much recently when I went on a date with a young doctor. As I batted my eyelashes and enjoyed my newfound attractiveness, he recalled his morning spent helping in the delivery of a baby. "The woman was morbidly obese," he leaned over and whispered. Who, he wondered, would have wanted to have sex with that nine months ago? I said nothing and just let him buy into the illusion of me as someone who has only ever known a normal, healthy weight range.

I survived the day-to-day humiliations of obesity, the looks of pity and the "you have such a pretty face" compliments. In a moment I consider emblematic in the story of my struggles, I was once even stuck inside a dangling car tire six feet off the ground. I was 19 years old, participating in a ropes course retreat with my collegiate peer group. Somehow my assigned "bonding" group managed to hoist my 265-pound body up and into the challenge element (goal: get entire group through car tire) where my hips promptly announced themselves to be larger than the tire's opening. Bea (thankfully present for this ordeal) pushed from behind. The strongest male pulled from the front. Nothing. I was completely stuck. After a few more minutes of audibly difficult pushing and pulling by the group, I was free. Weeks later I still had the bruising around my hips to remind me of this embarrassment.

Two years ago Bea was also thankfully present when a nurse in the hospital yelled across the nurses' station, in reference to my need for a chair, "Has anyone seen the extrawide wheelchair? You know, the really big one?" Under her breath, Bea responded to her with, "Has anyone seen my friend's dignity?" We like to re-enact this moment from time to time, overexaggerating the extent of the nurse's yelling and complete lack of consideration for me as a human being. It's funny and we laugh, but we both know that this day, the day of my medical intervention, was the most difficult day of my life.

I've had nothing but success, healthwise, from the decision to have gastric bypass surgery. I've even run a half-marathon since then (not a superhuman feat by any means, but one almost unimaginable to that girl dangling in that tire). But every day I struggle with who I am and what this new membership to the normal-weight group means to me.

When you take on a new identity, and you've let others believe that this is your one true identity, it's easy to find yourself completely disowning your previous self. Recently my mother and I were going through old pictures of me—all those years of photographs and truths that I've hidden from new people in my life—and, picture by picture, my expressions of disdain and disgust grew louder. Fully acculturated to the thin insider group, it took my mother's tears to shake me out of my judgment. With wet eyes she said gently, "Be careful what you say about that girl. I loved her very much." And although my words could never carry the power of my mother's quiet admonishment, the next time someone leans over to me in the assumption of shared judgment, I can only hope that I will not remain silent.

Northrup lives in Charlottesville, Va.