Friday, September 20, 2013
A small-town radio reporter was interviewing an 80-year-old because she had just been married for the fourth time. The interviewer asked about her new husband’s occupation.
“He’s a funeral director,” she said. The interviewer paused for a few moments and hesitantly asked the occupations of her three previous husbands. She explained that in her 20s, she married a banker; in her 40s, a circus ringmaster, and in her 60s, a preacher.
The astonished questioner asked why she had married four men with such diverse careers.
She smiled and explained, “I married one for the money, two for the show, three to get ready, and four to go.”
Saturday, September 07, 2013
CHAPTER THREE: Why Spark People Worked for Me
Surprisingly I was pretty excited to join Spark and I spent a lot of time exploring the website. I set up my home page and posted some pictures. (Of course the first pictures were head shots only!) I read articles and was encouraged. I started tracking my food and my exercise. Actually, the exercise tracker was motivating to me because I wanted those points. Then I wrote my first blog and was encouraged and horrified when other sparkers responded. Horrified because I could no longer hide in anonymity, scared to death someone would actually want to talk to me and not sure at all if I wanted to do this. I was also nervous about being accountable. After all, that child inside did not want anyone to really know all the dark secrets of binge eating.
But…I continued. I read other people’s blogs and gave encouragement where I could and found doing this helped me also. I updated my status regularly which was posted to Facebook and in return I received encouragement from family and friends. I found updating my status with what my plan for exercise was for the day helped in keeping me accountable to do what I said I was going to do.
And yes, my weight started dropping as I ate more healthfully and particularly since I was exercising regularly. Those early days at the gym were eye-opening as I became fully aware of what bad shape I was in. In those beginning days I varied cardio between the elliptical, the stationary bike and the treadmill. I also did weight training with free weights using exercises I had seen in magazines. I remember my first work-outs on the elliptical were on level one and I could barely finish ten minutes. At about 8 minutes I was going so slow the machine would keep pausing and shutting down. But I read similar stories on Spark People and how persistence and consistency paid off in the long run and people gained strength and endurance. I’m not sure why I persisted, but I did and Spark People was there to cheer me on.
As I logged in daily, I began to notice a change in my attitude. After years of dieting and yo-yo weight loss and regain, I was starting to notice small, subtle changes occurring. One of the biggest changes was fully embracing weight loss/weight maintenance as a life long journey. Of course I had known this intellectually for a long time, but it wasn’t until I had a real gut sense for this that it became easier when I was less than perfect. So many things learned along the way…like that whole problem with perfection and learning it is okay to make mistakes and it is okay to forgive yourself and have a better day tomorrow.
I bought the ‘The Spark’ and found inspiration and hope. I was particularly interested in the goal setting sections. Setting goals and having dreams was intriguing as well as sad because I couldn’t recall having dreams or goals as a child, a young woman or as an older adult. For me life seemed to just happen and although I don’t have many regrets about how my life experiences have gone, it is sad I never dreamed about possibilities or reaching, stretching beyond what was comfortable.
In 1963, the year I graduated from high school, girls either got married, went to school locally to become teachers or nurses. Although I had a boyfriend there was something inside me that said he wasn’t marriage material and I was right. Twenty years later, I learned he was incarcerated in federal prison for white collar crime.
With the marriage option out, it was go to school to be either a teacher or a nurse. It was a very big deal when I left my little wide spot in the road called Mossyrock, WA and traveled to Chicago to go to nursing school. However, no one ever told me or suggested I be a doctor or a college professor or an engineer, or an architect or a dancer, or anything other than teaching or nursing. I’m very grateful for my nursing career and all of the opportunities it has provided, but what would my life have been if I dreamed of being a trauma surgeon, or a cardiologist or anything other than the expected?
I discussed this with my therapist and she said it was never too late to dream and asked what I would like to do and what goals I wanted to set. Those were very scary questions for me. Setting a goal meant being vulnerable in telling people what I wanted to do. It also meant the possibility of failure and OMG failure is not an option for me. After all, other than weight loss, I had been successful at most everything I had ever attempted. More about fear of failure later, but for now I was on the spot to pull something from very deep inside me about dreams.
And after some agonizing moments of really thinking about what was important to me, I blurted out in a frenzy of words what I wanted to do.
This blog will continue: Chapter Four: I Have A Dream
Monday, June 10, 2013
CHAPTER TWO: Finding Spark People
Okay, so losing 100 pounds could be done and I was encouraged. I started on my own without much of a program other than cutting down on portion sizes and trying to limit desserts. I didn’t think about losing 100 pounds as it would have been too overwhelming.
I struggled with deprivation; after all I was someone who wanted what they wanted when they wanted it and I looked at limitations as not getting what I wanted. I told myself I could have whatever I wanted but not all that I wanted all the time. I also used a physical mantra whenever I passed “casual food.” You know, that candy dish on someone’s desk, the Einstein bagels with cream cheese out in the break room, the birthday cake in the refrigerator…all those casual foods around me in my work area. Fortunately I had my own office so I could keep healthy food in my immediate area, but getting up and taking a break or going to the bathroom forced me to pass by all these foods. I struggled with the “one little bite won’t hurt” a lot until I started touching my middle finger to my thumb and saying, “It’s my choice.” The action that it took to do this seemed to stop me for a second and let me think if I really wanted what I was in front of me. That seemed to help with not feeling so deprived as it certainly was my choice and if I wanted to I could, but most of the time I stuck with what I had planned for the day.
Because I had been diagnosed with pre-diabetes, my doctor recommended I attend a Mayo program once a week for new diabetics (and pre-diabetics) taught by a dietician. The classes covered how to read food labels, the balance between protein, carbohydrates, and fat, exercise and how it affects blood sugar, meal planning, weighing in and a host of other beneficial discussions. I resisted. After all I was watching what I ate, making better choices, and losing a little bit of weight. AND, I was not diabetic!
My family history is very strong for death from stroke and heart disease. Of course as a nurse I knew obesity and lack of exercise are key risk factors for heart disease. But denial was a powerful component in making me think I was exempt from any heart disease issues. My blood pressure was low, and I didn’t smoke.
But when I got the diagnosis of pre-diabetes, I really swallowed hard and there was no amount of denial that would let me convince myself I was okay with my weight. I had to lose weight. I did not want to be diabetic! That was what prompted me to think about bariatric surgery and even though that was not an option, I was doing okay on my own. I was rather miffed that my doctor suggested a program for diabetes, because I was not one and I was determined to not become one.
Looking back on this time, I have to hang my head. My stubborn, hard-headedness can be my worst roadblock to good health. Here I was being offered a free program that would support me in losing weight, I would have support from a group and I had a chance to gain information on how to balance carbs, protein and fat. And I was resisting and giving every reason to my doctor about not signing up.
For the next month or so I stayed with my eating plan, I started exercising a little and I lost one pound in five weeks. Frustrated I hadn’t lost more weight, I realized at the rate I was going, I could be dead before I lost all the weight I needed to lose. I reluctantly signed up for the diabetic program.
I kept an open mind, attended the classes once a week for 6 weeks, learned a lot I didn’t know, (surprise, surprise, I thought I knew all there was to know about losing weight), and I lost 7 pounds over the six weeks.
The most important thing I gained from the classes was an introduction to Spark People. The dietician leading the class used the website regularly for herself touting the food and exercise trackers. In November 2009 I joined Spark People and a new journey began.
This blog will continue: Chapter Three: Why Spark People Worked For Me
Thursday, June 06, 2013
CHAPTER ONE: The Beginning
In March 2009 I was seriously considering bariatric surgery and pursued information at Mayo Clinic in Scottsdale, Arizona. I was morbidly obese, was using a C-Pap for treatment of sleep apnea, and had recently been diagnosed with pre-diabetes. And with at least 100 pounds to lose to bring my BMI into a normal range, I certainly met criteria for surgery. With a family history of stroke and heart disease, I felt I was a ticking time bomb ready to explode.
I attended several informational sessions on the lap band procedure. I was excited, thinking I could do this and it would be much easier than the lifelong roller coaster I had been on with my weight. My wishful, hopeful SELF whispered in my ear that lap band with the accompanying weight loss would be a magical cure and once the weight was off, I would no longer struggle day to day.
However, as a Mayo Clinic gastroenterology nurse, I saw patients regularly where bariatric surgery was not the answer. They came with serious complications, from short bowel syndrome to constant diarrhea and dehydration, to actual botched procedures. None of this really bothered me as I realized I was only seeing the failures and not the hundreds of patients who had successful results.
What bothered me the most were people I knew who had surgery and did lose weight, even 60 or 70 pounds and then gained it back. I saw the rolling eyes and heard the clicking tongues that talked in lowered voices behind closed doors. “Oh, did you hear, so and so, has regained all the weight they lost and then some.” That was my life story…losing, regaining, losing, regaining. It sobered me to think I could put myself at risk (all surgery, anesthesia has risks) lose weight and then regain it again. And I didn't want those rolling eyes and clicking tongues talking about me.
Somewhere in my deepest thoughts I knew as a binge eater, I would have trouble stopping when my stomach signaled it was full. After all, I had spent a lifetime denying my body signals. "No, I'm not hungry, I'm on a diet and I'm only eating 500 calories once a day." There were times I realized I was stuffed, but whatever was soooo good, and after all, I was starting a diet tomorrow, so I might as well get while the getting was good.
But the tantalizing thought of magic was very powerful and denial was very strong and I continued in the bariatric weight loss program.
It didn’t go well. Perhaps my rational self was working very hard underneath all the denial and wishful thinking, but when the program dietician told me I would never eat pizza again (not true) and explained the nutritional issues, how long it took to eat a simple meal, warning me about weight re-gain, I finally said, “This is NOT for me.” For me, it was a very good decision and I’ve never looked back. However, that being said, I do believe bariatric surgery can be very successful for the right candidates.
The next several months were difficult as I floundered in misery. I knew what to do, I knew that diets don’t work, I knew exercise was important, I knew what constituted healthy eating. BUT and I hate to say this, I’ve always wanted what I wanted when I wanted it and I’ve got a million excuses to justify whatever. “It’s too hot to go for a walk now, I’ll go later.” Of course later never comes. “One little bite won’t hurt.” And somehow the whole cake disappears.
And then the guilt, shame and self-beatings would come, spiraling me down, down, down onto the slippery slopes of the sugar-salt mountains. The more I berated myself, the harder it was to do anything positive.
I finally pulled myself out of my misery enough to call my endocrinologist for an appointment. Bariatric surgery was out, but what was I going to do to lose over 100 pounds. This very large amount of weight seemed like an impossibility. We talked for over an hour discussing how no food is really off limits, about portion control and frequency of treats, about exercise, and about my pre-diabetes. She told me she could practically guarantee I would become a diabetic if I didn’t lose weight now and begin eating healthfully. And she gave me hope! She told me losing 100 pounds on my own would be difficult, it would take vigilance to maintain a weight loss, but
IT COULD BE DONE!
This blog will continue
Chapter Two: Finding Spark People
Wednesday, February 20, 2013
Sobered and scared is the best way to describe the beginning of my dear husband’s day. This was hard for me because this is not how he has approached surgery in the past. Even though he said he knew everything would be fine, I believe he really knew the seriousness of the proposed procedure he was about to undergo and deep down was not sure what the outcome would be. He talked about his kids, his grandkids and me in a reflective sort of way remembering good times in the past almost as if time had run out and he would no longer make additional memories. I’m thankful God gave me peace and although I was nervous, I never once thought, “what if...”
As we drove down Pima Road making the right hand turn at Thompson Peak and then onto the 101 and Mayo Clinic Hospital, we both had a sense of deja vu. There have been so many other early morning rides to the hospital to have a surgical procedure. But this time was different and we both felt the gravity and weight of his upcoming procedure. Yes, in the past as there is with any surgery, there are the risks, but this time, his heart was going to stop beating while a mere mortal touched that stilled heart and did his work.
At 5:45 AM Andy passed the first registration point in the main lobby and then up to the second floor where he signed in at the surgical waiting area. He was called immediately and was taken back to the pre-operative areas where he was prepped for the upcoming procedure. Medical history was reviewed, consents were signed, IV’s were started, and his chest was scrubbed and shaved. At 6:30 AM daughter Barbara arrived and we were both allowed to go back to his pre-op bay. His shaved chest was a shock to me...not that I didn’t know they would do this, but after 20 plus years, it was strange to me to see him truly bare chested! It was hard for Barbara to see her strong “Poppo” in such a vulnerable state and the tears flowed, BUT she had tissues covered with red hearts and her Dad took her tissue and wiped his own eyes with the “love Kleenex.”
Andy also had a Bair Paws gown on which is a special gown with a forced-air warming system as part of the gown that helps patients avoid hypothermia during surgery. Most surgical patients lose the majority of their body heat during the first hour under anesthesia. This is not good as unintended hypothermia is associated with surgical site infections. Back in the mid-1990’s I used a very antiquated version of this system when I was recovering ambulatory surgical patients.
I was very relieved and happy to see Patti Certified Registered Nurse Anesthetist, who I worked with when I started at Mayo in Ambulatory Surgery in 1996. Under the direction of the anesthesiologist she would be putting Andy to sleep, monitoring him AND waking him up. The anesthesiologist visited and I was reassured when he told me they would be monitoring the oxygen supply to his brain with specialized equipment.
They took Andy to a procedure room where the anesthesiologist placed an arterial line which is a thin catheter inserted into an artery for the purpose of measuring blood pressure real time rather than by intermittent measurement. It is also used to obtain arterial blood gases throughout the surgery and then during the first few days of recovery. A Swan–Ganz catheter was inserted into the subclavian vein, passed through two heart chambers and then into the pulmonary artery for the purpose of measuring heart function during the surgery.
A quick chest x-ray to check placement of the lines was done and then he was ready to be rolled through those doors at the end of the hall with Restricted Area in big, bold letters written above. The time was 8:05 AM. We never know if the simple acts we do each day will be the last time and so as I kissed him and told him I loved him, I couldn’t help but wonder if this would be the last kiss. Patti looked me straight in the eye and told me, “I’ll take good care of him” and I knew she would.
This would NOT be the last kiss and with Patti’s reassurance, Barbara and I left the hospital. Back at home I watched mindless TV, cleaned out a closet, walked around the house aimlessly and did everything except directly think about my husband, but underneath it all were my prayers asking for God’s blessing on the surgical team.
At 12:30 PM Barbara and I were back in the surgical waiting area where now minutes became hours as we waited and waited and waited. At 2:10 PM we were called into a small conference room in the surgical area and Dr. D appeared. He looked tired and I thought this was a good thing. The responsibility of literally holding someone’s heart in your hands should make you tired. Everything went perfectly, his brain was well oxygenated, and once removed from the heart lung bypass machine, his heart re-started on its own and continued to beat in a normal rhythm. Isn’t that just truly amazing that medicine and God’s will allow this to happen?
He was moved from the operating room to his critical care bed where we were told we could see him at 3:00 PM. I was starting to feel a little anxiety when at 4:00 PM we were still waiting to see him. So at 4:40 PM when allowed to enter the critical care area I couldn’t get into his room fast enough. Sure enough, there he was, a little dot on the bed amongst hundreds of wires, cables, tubes, pumps, machines, monitors all flashing and beeping their messages to his nurse Allison who along with Patricia would be at his bedside continuously.
His eyes were closed, the endotracheal tube connected to a ventilator protruded from his mouth as well as a tube through his mouth and into his stomach. He had the Foley catheter in his bladder, three chest tubes draining excess blood and fluid from the cavity where his lungs reside. All of this expected, but yet it all contributed to how small he looked amongst all this technology. When I was a critical care and recovery room nurse for inpatient surgical patients in the early 1970’s, I probably used about one third of the technology now available.
I held his hand and I felt an almost imperceptible squeeze. I told him he was okay, he made it, surgery was over, he was okay, I loved him, he was alright, I loved him, he was okay. I asked him if he was cold as his feet and hands were freezing to my touch and he was able to nod his head yes. Warmed blankets were brought in to cover him. Thank-you Lord for getting him this far.
Then I started looking at all of the lines, the equipment, the drugs, the monitors, and the ventilator that was breathing for him. We were delayed in going back to see him because at one point the ability of his heart to produce strong contractions lessened to the point where he was given serious medication (dobutamine, and epinephrine) to make his heart contractions stronger and more efficient. I could see on the monitor the exact point where the dobutamine had been given and the spike it caused in the strength of his heart contraction. This was all noted because his NURSE was at the bedside constantly monitoring what his heart was doing. Dr. D was there through out because Andy’s NURSE called him and at the same time she had already prepared the necessary medications for infusion and once infused his heart responded immediately. God bless Dr. D, his brilliance, his skilled hands, his judgment, his absolute focus, his obsessiveness with his patients. Because of Dr. D, we can say the operation was a success, but God bless Allison his nurse because she’s the one who can say the operation was a success AND THE PATIENT LIVED.
I talked to the cardiology fellow who would be with Andy through the night and he was very reassuring all was going well. I didn’t know cardiac surgery is such an insult to the body that blood glucose levels and temperature rise during and immediately after the surgery. Andy who is not diabetic and whose fasting blood sugar was 93 (70-100 is normal) prior to surgery had a rise to 200 after surgery. He was on IV insulin with his nurse monitoring and adjusting the rate according to his blood glucose level. His temperature was 100.3, but as Patricia (his 7 PM to 7 AM nurse) told me, this was of no concern and was expected and would go back to normal as he recovered.
Barbara and I went to dinner at Pita Jungle. I had intended to go home after dinner, but decided to go back to see him one more time. He was more awake, nodding his head, sweating because now he was too hot, feeling like he needed to urinate (this is a common sensation with a catheter in the bladder), feeling the irritation of the tube in his throat, wanting to talk but unable to do so because of the endotracheal tube. Think about this folks, Andy unable to talk...
The next hurdle to cross was getting him to breathe well enough on his own, so the mechanical ventilator could be removed. Patricia called me at midnight to tell me he had been extubated (tube removed), was breathing on his own with 4 liters of O2 and maintaining his blood oxygenation at 96%. Once the tube was removed, he responded with his name and date of birth when asked. This is all good, very good.
I am so humbled by the absolutely amazing outpouring of love and support from all of our friends and family. Andy has read every one of the e-mails, cards, text messages and we both are so grateful. I’m especially thankful for the messages that came while he was in surgery. Thank-you seems so inadequate, but believe me; it is very heartfelt from both of us. We are blessed to have so many friends and family who have reached out to us.
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