Monday, February 1, 2016
Monday, May 12, 2014
Now for the Who, What, How, Why, Where, and When of all this.
Changes in Health Care: While I enjoyed certain things about my nursing job, namely, working with the patients, nursing is an extremely stressful profession. Add many of the changes that health care is undergoing in this country, and the trend toward corporate mergers and huge health care conglomerates and their profit-focus, and it becomes even worse for those who do the actual work in the trenches, serving the public. All the money is being siphoned off directly to the top.
This is something you might want to keep in mind when you do go to a physician. Many of them are no longer in independent practices, they are being bought up and controlled by these huge so-called "health care" companies. Physicians are among the employees who do the work in the trenches, and their employers' profit focus also forces them to modify the way they see patients.
Additionally, the increasing use of the electronic health record, while advantageous for information sharing, has been co-opted by a multitude of regulations that essentially have changed the primary focus of the practitioner's time to documentation. It is very difficult to focus on the patient and a face-to-face conversation when there is this computer that demands input that can eat up to 80 percent of the nurse or physician's time.
Finally, some of the political maneuvers happening in my local hospital were apparent to me, and I wasn't going anywhere. I wanted to work with patients and make a positive difference in their lives for wellness, and that just wasn't going to happen inside of that box. It's not a good time to be in health care, at least not in the corporate world of so-called "health care". So I made a decision to take things into my own hands and move on.
Stress Reduction: As soon as I got out I felt better. I had gained a lot of weight, I was up to 132 pounds from 112 in 2007. I was drinking a couple of beers daily. I was running, but I felt horrible doing it, all the weight was a load on my body and mind. I had been eating too much, mostly just stress-related eating, not paying attention to portions, eating comfort foods (I have a weakness for ice cream), eating too many restaurant meals, and in general, just not doing well.
I strained my hamstring sometime in May or June of 2013. I believe it was a couple of weeks after a disappointing performance at a 24 hour race in Cleveland. I wasn't recovered and I continued to run for stress relief. I signed up for two marathons and a few 5Ks in the 6 weeks following the Cleveland race, and felt horrible, and somewhere along the way acquired this nagging hamstring strain that would not go away.
I ended up missing several races I had signed up for in the fall, most disappointing of all was the 24 hour national championships. But in retrospect, I wouldn't have been in very good condition anyway, so I'm glad I didn't go from a performance standpoint.
Once I quit the job my sleep improved dramatically, too. While working at the hospital I had been waking up during the night unable to go back to sleep, I was having hot flashes, and I felt tired during the day. I felt irritable and it was hard to focus or think clearly. My patience with everything was wearing thin. As soon as I quit, the tension melted away and I slept through the night most nights. That led to a much clearer mental focus and ability during the day.
Increased Activity: Having more available time and more energy from sleeping, I began to increase my physical activity to about two hours per day. it wasn't all running. First I needed to heal the hamstring. I took some time off, did some pool running and swimming, and spent time on the bike, which I mounted on a trainer over the winter in my living room. I was doing a lot of studying for some certifications for my new line of work, so I would sit on the bike and spin and ready my study materials. As of the first of the year my hamstring was much better and I began training for the spring racing season.
At the beginning of the year I also changed my diet dramatically, with the intention of dropping the weight I had gained in recent years. I was thoroughly disgusted and sick of carrying around weight, having a belly, having to go up in clothing sizes, and how it felt to be carrying a lead brick around with me while running. My TSH at the beginning of all this, by the way, was 1.0, with Free T4 and Free T3 at about the same place in their respective lab ranges.
One of my patients had told me about a new book that had helped her lose weight, and I am not usually one to pay any attention whatsoever to diets or popular fads. This particular book emphasized a lot of activity, and that alone made it more credible. I decided to check it out. Here's the information if you want to. State of Slim. 2013. Hill, James O. and Wyatt, Holly R. Rodale Press. ISBN 978-1-60961-491-1
It is broken down into phases: I, II, and III. I never formally got to phase III because I just incorporated my new changes into my regular (healthy) diet. Phase I, I did do religiously, and stuck pretty close to Phase II.
Besides the increased physical activity (keep in mind that I had not been doing typical ultra training for quite some time and I was not working out the way I normally do at the time I was reading this book)I found the following guidelines most helpful to me personally:
Portion Control and Keeping Track: I wrote down every thing I ate for about the first 6 weeks. It helped me track how much I was eating and how often. It kept me on track and was a reminder throughout the day that it was time to eat, and I could see what I'd already eaten and it helped me think of what else I could eat- more veggies, different recipes.
Eliminate Sugars and Most grain-based carbs: Within the first two weeks Phase I has you completely eliminate grain based carbs with the exception of oatmeal. There is no fruit in Phase I, either, and this helps you reduce both your sugar intake and consequently, your sugar cravings. Most of your carbohydrates come from vegetables. The emphasis on vegetables is another thing I liked about it.
Eat Frequent Small Meals: I ate 5 or 6 small meals a day. Each meal or snack contained a small amount of protein. I believe this frequency of eating was the single biggest contributor to my success, because I never was hungry, never had cravings, and sometimes it was hard to get to that 6th meal. It felt like I was eating all the time.
New Ideas: I came up with a lot of new, easy, quick, creative ideas for snacks and meals that were healthy and helped me stay away from those sugar cravings. There were some very helpful ideas regarding convenient foods without sugar. I love the powdered peanut butter, that has become a staple for me. I also am now addicted to their pumpkin chili recipe.
I was able to stick to Phase I very easily because it did eliminate the source of my problem: craving sugar. Eating sugar makes you crave more. The blood sugar spikes and crashes are eliminated if you simply eat a small amount of food with protein every couple of hours. I did not cheat at all in the two weeks of Phase I. The hardest thing for me to give up was beer. When you get to phase II you are allowed to have a "cheat" meal once a week. The thing I wanted was not something sugary or sweet, but a beer.
I was able to train intensely and the only thing I eliminated at first were the gels from my training run fuel. I ate some almonds but tried to stick to real food for my runs. I was in phase II by the time I started doing long runs, so I never had a problem fueling myself. I eventually added the gels back in. I also took sweet potatoes with me, and tried to avoid doing gels unless absolutely necessary. Even though the gels are sugary, I used them only while running and they never seemed to cause cravings.
I had a lot more energy all the time and was surprised, during my long runs I didn't seem to need as much fuel.
Does it last? Can you keep the weight off? I've always felt that two weeks is a good time frame for changing a habit, and that seemed to hold in this case too. Within two weeks I felt confident that I wasn't going to relapse.
I lost 7 pounds in the first two weeks, then quickly dropped another 3, until after two months I had lost 14 pounds. I weighed in at 118 a couple of weeks before my race, right before I started my taper. I did slack off a bit in the month leading up to my 24 hour race but I weighed in at 121 pounds a couple of days after the race. I slacked off really bad this past week following my race and I can already feel how bad sugar and overeating makes me feel. So I'm back to phase I to clean out the system again as I finish my rest and go into my summer training for the fall racing season.
I am pleased to say that I have proven to myself that it is possible to lose weight, eliminating the stress was the number one thing that made it easier. But sticking to a tightly regulated intake for a few weeks to re-establish healthy eating patterns, changing the things you eat and eliminating all those sugars and carbs, and getting enough physical activity, are the other parts of it.
Nothing we haven't heard before, but actually taking those principles and applying them in a disciplined manner and allowing them to play out, really worked. It did for me.
Running performance-wise, I ran 11 miles further in 24 hours and improved my 100 mile time by 2 1/2 hours. Earlier this spring I also ran my fastest 50 mile time in about 10 years. And, I turned 50 in March, so age is no excuse.
I'm not saying that State of Slim is the magic bullet, it has it's flaws, it does take a lot of planning, and it's not convenient for people with busy schedules, but it definitely has some good take home points, great ideas, and recipes. I highly recommend READING it.
Tuesday, May 28, 2013
This morning I had to forego my morning coffee and go over to the lab to get my blood drawn after a 12 hour fast. I was getting my lipids re-checked, and my TSH too. I went into the Express lab at 6:40 am and it was hopping in there. Everyone must have waited until after the holiday.
After that I went back home and had my coffee, and felt much happier. I took Iris for a brief run, and then went up to Horsetooth. It was my first hill workout in way too long. Can't even remember the last time I purposely ran hills. I'm slower than a snail, but at least I got up there and did it.
On my way home my phone rang and I didn't recognize the number, so I just let it ring. Plus I don't talk on the phone and drive, I have a hard enough time just talking on a cell phone...add driving to that and it would be a disaster.
When I got home I listened to the voicemail, it was my doctor's office calling with my lab results. Only 4 hours went by since I got the blood drawn. I was amazed, I thought I'd be able to see my results at work tomorrow before they'd ever call me. Then I thought, must be something really off, to call me back that fast.
But when I talked to the nurse who works with my physician, she told me my cholesterol was in the normal range now. I couldn't believe my ears. I asked her what it was. She said, "192." And that my triglycerides, LDL, and HDL had also dropped. The HDL I can understand because I haven't been running much, and that is very sensitive to exercise, but it's still 70.
When I had my labs drawn in March, my total cholesterol was something like 257. I remember the triglycerides were normal and the LDL was high-normal at that time. My TSH has actually dropped slightly, I thought maybe it went up because of the way I've been tired in the afternoons and gained weight so easily. Having a lower TSH might have something to do with the lowered cholesterol, but I sort of doubt it because I've been more on the hyper end of things before and never had my cholesterol anywhere near that low. So I'm pretty convinced it's dietary.
When I got my lab results back in March, my doctor mentioned that going gluten free had produced some dramatic results for other patients, and she knew I didn't have much room for improvements in my diet in general. I really do eat well, and I allow myself to indulge in bad things occasionally, but not regularly. Over the past 5 weeks I've been off the wagon somewhat, and over the last week I was extra bad with the sweets and ice cream, so I was a little surprised when today's labs showed what they did.
As we talked on the phone, I told her that I had only made two dietary modifications over the past 3 months: one was no longer putting half and half in my coffee and switching to soy creamer, and the other thing is that I've been avoiding gluten. I haven't been completely gluten-free, but I have been mostly avoiding wheat and sticking to corn and rice for the majority of my carbohydrates.
What I've done is avoid eating wheat. I'm not so strict about it that I scan labels of things like soy sauce, which I know has wheat in it, and I drink beer, which is not gluten-free either. I just avoid things that are made with wheat flour and have wheat as a major ingredient.
By avoiding things made with wheat I've found that helps me avoid the bloated feeling I get when I eat things like bread and pasta, and it also helps me eliminate a lot of bad foods from my diet: baked things, cookies, and other crap that I shouldn't be eating anyway.
I do eat dairy products, but not very much. I eat cheese and yogurt occasionally, and I do eat lean red meat more often than dairy. I eat a good amount of fat, but other than the infrequent red meat and dairy sources, almost all of my dietary fat comes from olive oil, avocados, and fish. Salads and fish are probably the most frequent things you'll find on our dinner table.
This is all really interesting. I'm curious to see what happens by next year when I get my annual labs drawn again.
It has never been my intention to promote a gluten-free diet, because if you're not celiac, and not gluten-sensitive, it can be an awfully inconvenient and expensive way to feed yourself. I think I might be a little sensitive to gluten, because I've noticed that when I eat certain things I get bloated.
Pizza and bagels are the worst offenders for me. I think they are often made with high gluten flour products. I don't know if it's wheat itself that's the problem, I haven't tried a lot of the other grains simply because I'm not a big fan of flour and baked things anymore.
I also have never been one to jump on the bandwagon with the latest dietary trends like Paleo or Atkins or whatever. I do like the concept of Paleo, and there are a lot of things wrong with the commercially prepared, processed foods abundant in the American food landscape. I probably eat closer to Paleo than anything, but I'm not strict about that, either.
One thing I want to avoid is going on medications for anything unless I absolutely need them. I already take two thyroid meds and I don't buy into the statin thing, being an athlete I don't want to cause muscular problems. Some drugs, for some people, are worth taking, but I'm not into tithing for Big Pharma when I don't need to.
But I was absolutely shocked and amazed at the results of my labs this morning. Time will tell if this is a lasting change, I probably won't have another lipid panel drawn until next spring. If this is a lasting change for me, worrying about cholesterol-lowering medications is not going to be an issue.
Time will tell and this case study will go on. I intend to stick to the dietary changes I've made, and see where that goes. Dropping my cholesterol by 65 points in 3 months without drugs, hell I should write a book...
Sunday, July 8, 2012
I found this fascinating.
Yesterday we saw a young family, the parents and two little girls probably 8 to 10 years old. The parents were noticeably overweight but not what I'd call obviously obese. I'd say average based on the majority of people I see these days. But the little girls were both fat, in my opinion, at least working on obese.
I wonder, what are these kids eating, how much are they eating and what, and what are they doing all the time?
Allow me to rant for a while.
Obesity is one of the most pressing issues we have to deal with not only here in this country but worldwide, as it's spreading. Pun not intended.
It caught my eye not only because I'm interested in the topic, but I used to work for this organization, Scottsdale Healthcare, it's a good hospital system and good place to work, doing some cutting edge work in certain areas like bariatrics.
I first saw this in one of the e-mail medical newsletters I read daily.
Diabetes is an extremely costly disease. The complications: cardiovascular disease, neuropathies, infections, organ dysfunction especially of the kidneys and eyes. Limb loss. Sepsis. Dialysis. Premature death.
We also need to attempt to stop it before it happens, like not letting people get to a BMI of 30 in the first place, even though some people are more likely to go there due to genetic influences. The video doesn't talk about changing behavior early on, intervening before a person starts to become obese and the metabolic signaling results in diabetes.
Years ago people were not so fat. They were more active. They didn't have the range of sedentary activities to keep them mesmerized. There wasn't the range of bad food, and the ingredients, and the portion sizes.
There is a huge genetic influence on obesity. But that doesn't mean we throw up our hands and say, wait until the person is diabetic then give them a sleeve gastrectomy.
We need thinkers like Dr. Blackstone to manage the medical approach to managing this disease, but we also need more action on the prevention end of things. We certainly aren't doing enough lifestyle interventions to help solve the problem.
Workplace habits, city planning, commuting time, work schedules, stress, availability of healthy foods, lack of leisure time, leisure time choices, lack of physical education that truly teaches kids how to develop healthy lifestyles, all of these things and more add up to what? Sleeve gastrectomies?
Exercise and nutritional screening, behavioral screening for tobacco and alcohol consumption, electronics use and TV watching. Simple things! Doctors aren't necessarily good examples at all.
I'd like to see total screening in preventive care as an ongoing intervention, education and practice throughout the lifespan. It doesn't belong primarily in the domain of preventive health care in a doctors' offices. The schools could play a huge role, along with the community organizations that sponsor youth activities. What to eat, how to cook, what to buy, what to avoid. How to increase activity, emphasizing less sedentary time.
As people get older, include thyroid screening. You wouldn't believe how many patients I see, when I look at their labs, I see elevated TSH and they're not on thyroid meds. When I ask about it, they look perplexed. Many cancer treatments can affect thyroid function but many of these patients are not getting treatment for cancer. They say they are tired.
The thing is, we already know all this stuff. We know what would work. But there's a lack of organized, coordinated societal effort. In the video, Dr. Blackstone acknowledges that some of the other medical disciplines such as oncology and cardiology have had a lot of success with combination therapies, including behavioral interventions and medications, in addition to surgery. It is a multifaceted problem and needs to be treated accordingly.
But when I see little kids who are well on their way to becoming obese adults, it makes me cringe, and I know we are setting them up for failure early on, before they ever get a chance to learn to make healthy choices for themselves.
And I think that's a major failure on the part of the adults in this country. We know better, and it's outright negligence to continue to allow this to happen.
end of rant, for now.
(cross posted at Journey to Badwater )
Tuesday, April 3, 2012
When this goes on for a period of time, it can make you question the meaning of your existence, and not in the philosophical sense. I've heard people say it feels pointless to go on living like this. That's another reason why we need to be vigilant about our physicians' handling of our treatment. They might not have ever experienced brain fog, but I bet if a doctor had to deal with their own brain fog, they would understand. Completely.
Being an oncology nurse, I am constantly hearing about chemobrain, a phenomenon that many people experience when going through chemotherapy, and for months to years after treatment, or even permanently. I have never experienced chemobrain but from the way patients describe it, it sounds just like hypothyroid brain.
One of the newsletters I subscribe to featured this article on concentration recently, intended to help people experiencing chemobrain to function better. When I read it, I found it perfectly applicable to hypothyroid brain.
I hope this helps. I'd like to hear your comments.
Monday, March 5, 2012
Doctors and pharmacists always say you need to take your thyroid medication on an empty stomach. Why? Because food, especially foods with calcium or iron in them, will interfere with thyroid hormone absorption from your stomach. Also, some medications, like antacids, can bind to the thyroid medication and prevent absorption. (Caution: If you do take other medications along with thyroid meds, check with your pharmacist to see if there might be any interactions between drugs or any reason that you absolutely need to take them separately from your thyroid meds.)
Here's the scenario: You're newly diagnosed with thyroid disease and need to start taking medication. Upon hearing that you need to take it on an empty stomach, you realize that means you won't be able to eat breakfast in the morning for an hour even if you tke the pill first thing when you wake up. That disrupts your whole morning routine. So you get this great idea: you'll wake up an hour early, take your pill, and go back to sleep. Sounds great, right?
WRONG! Not fun. Plus, how many times do you wake up out of a sound sleep and have to do something, and then can go right back into a sound sleep for another hour? (If you can, then you're either lucky, or not perimenopausal)
One of the biggest fallacies about taking thyroid meds is the waiting an hour until you eat. If you always do the same thing, and are always consistent, the absorption thing will work itself out in the testing and dosing. I take mine every morning with my coffee (which has milk in it) and I eat breakfast soon after. You need your sleep more than you need to be woken up every morning just to take a pill. I know so many people who think they have to do it that way and really, it makes no sense.
Here's what I learned from my old endocrinologist in Arizona. She had her thyroid removed and took thyroid meds every day. She took hers with her morning latte. She explained it like this:
If you always have the latte, then the test will be based on your thyroid med absorption with the latte. So whatever your TSH comes out to be based on thyroid meds with latte, you can be medicated based on thyroid meds with latte.
I never worry about it, and I've never had a problem. In races, like I said, just do it when it's the same time of day. One day doesn't make all that much difference in your overall TSH if it's done slightly differently due to a race. Especially considering you'll only be getting tested every few months at the most.
Enjoy your sleep! (And your coffee)
Thursday, January 12, 2012
Medical News: Older Surgeons May Not Be Better Surgeons - in Surgery, General Surgery from MedPage Today
Medical News: Older Surgeons May Not Be Better Surgeons - in Surgery, General Surgery from MedPage Today