foodnotmoralThree weeks have blown by since my surgery day.  I'm now eating soft foods and working on getting my protein and other nutrients from food instead of relying on protein shakes.  I still have a protein shake every day for breakfast to get a good start on the day with about 1/2 of my protein goal right off the bat.  But through the day I'm working toward small regular meals with protein to meet my nutrition needs.  It's a slow progression, but it's been steady, and I still have no complications.  (knock on wood)

One of the things I found when I researched the gastric sleeve procedure is that most people lose their hunger drives and cravings.  I was convinced, however, that I would be the one person this didn't work for.  I'm happy to report that this was not the case.  I have to set reminders on my phone to eat and drink because I just don't get the same hunger signals I used to.  This has caused a sea change in the way I see food.

I wish I had grown up with a healthy relationship to food.  For a number of reasons, I didn't.  I know I’m not alone internalizing moral judgments about food - vegetables are "good," ice cream is "bad" for example.  And of course, the biggie - if you're overweight you're lazy, have no self-control, and are "bad".  There are lots of theories as to why our society imposes and reinforces these moral judgments about food.  I don't really care why, I just need to get those voices in my head to shut up.

Here's where the beauty of this procedure comes into play.  The messed up food voices are still in my head, but I no longer confuse them for physical hunger or cravings.  After I was cleared for soft foods, the Mister and I went to the grocery store.  Immediately, I was attracted to this amazing smell from the produce section and tracked it down to the nectarine display.  I have HUGE food issues going back to childhood and have severe anxiety when trying to eat anything out of my comfort zone.  I can't tell you if I had EVER actually tried a nectarine.  We bought a couple, and they were pretty good.  (They'd be better with granola or in a cobbler than by themselves in my book, but really pretty good.)  This is something that would NEVER have happened before.  Then we walked past the Little Debbie display.  Now, Little Debbies, specifically the honey buns, have been my downfall for a long time.  I'd clear out a whole box of them in 2 days before.  The messed up voice in my head said "oooh, Little Debbies.  That would count as soft foods.  We should get some."  Then the part of my brain that imagined actually eating one went, "eh.  Doesn't sound that good."  Walked by with no issues.  Same thing happened with the Pop Tart section on the next aisle.  (Chocolate Fudge Pop Tarts were another gotcha for me in the past.)  It was incredible.

I don't know if this effect will last forever.  But if it lasts long enough to help me establish a different relationship with food, it will be so very much worth it.  I think I could have gotten there with enough time and therapy, and admit that surgery is a drastic solution.  However, it's working so much better than I could have wished for.  It's still too early to say "best decision I ever made" but the evidence is racking up pretty fast for it.

stuart_smalleyAs happens around my house, a conversation with my husband about a weird dream I had turned into a deep conversation about "imposter syndrome".  I've suffered from this most of my life and am only now starting to have any real confidence in myself professionally.

Anyone who knows me has heard tales of the multiple jobs I've had throughout my life.  My standing joke well into my 30's was that I didn't know what I wanted to be when I grew up.  The saddest part is that I know exactly what I wanted to be, and I didn't have the courage to do it when I could.  So instead I drifted through life, jumping at new opportunities when they presented themselves.  I'm lucky to be white, female, intelligent, and well educated.  These advantages opened up a lot of doors for me over the years.

Most of my working life has been spent in corporate IT working with databases, reports, and data warehouses.  While I was pretty good at it and learned new concepts and technology very quickly, I always felt that imposter syndrome.  I didn't have a college degree where many of my peers did, and no formal education in computers.  I spent most of my years feeling deep down that someone was going to figure out I was an imposter, and I'd get fired and wouldn't be able to take care of my child.  There's a constant anxiety level to deal with that makes everything stressful.  I still cringe when I'm asked to step into my boss' office (or worse, my boss' boss' office).

Once I got my initial nursing degree and moved back into the medical field, I started feeling more comfortable.  The hardest job I ever loved (before nursing) was working as a Paramedic.  I didn't do it long enough to get seasoned, but I knew I was reasonably competent.  I had the same training and certifications as my peers, the only thing I lacked was experience.  Nursing felt like coming home, and again I found myself with the same license and (mostly) training as my peers.  My comfort must have shown because I can't count how many times people I worked with were shocked to find I was a new grad nurse.  I was told many times that I didn't comport myself as a new grad, and they had assumed I had been a nurse for many years.  Having worked for some two decades feeling like an imposter, that was incredibly affirming to me.  I loved nursing and was sad when I had to leave.

Moving into healthcare informatics, I knew I would have more computer experience than a huge majority of my peers.  What I didn't expect was several rounds with recruiters essentially telling me I had nothing to offer because my computer experience was then three years old.  I started feeling the anxiety of imposter syndrome again.  I had just started my master's program in informatics and wasn't far enough along to feel like it gave me any credibility.  I'm very lucky to have found my current position because I'm reassured on a daily basis by what I accomplish that I can do this job, and do it well.  It's a small slice of healthcare informatics to be sure, but I have no doubt now that I can walk into an informatics job at any level and rock it out.

Interestingly, I thought it would be getting my master's degree that would help me get over the imposter syndrome.  I thought it would give me the informatics specific training as well as fill in some of the formal computer science education I missed.  What I'm finding is that higher education is more of an endurance test than actually teaching anything.  The professors in my graduate classes say that their job isn't to teach us any information.  That as graduate students, what they are teaching and evaluating is our ability to research and learn from existing materials and then translate what we've learned.  Hell, I've been doing that since high school.  I can honestly say I'm not learning anything in my classes about how to do an informatics job.  The best I can say about my incredibly expensive graduate degree is that I'm being exposed to sources of information I didn't know were available in the form of books and peer journals.  I know how to read and extract information.

I don't think I'm over the imposter syndrome completely.  I'm not sure if this syndrome is a function of misogyny in professional life or our overall culture.  I'm not sure if it's just something that people face when they're good at a lot of things and just "pick things up" along the way.  It could even be a function of age, and now that I'm getting closer to 50 (cringe) I'm just growing out of it.  I'll leave those questions to the social scientists.  What I do know is that I'm not alone in it and that it's an anxiety construct and needs to be dismantled as such.

So to quote Stuart Smalley,

I'm good enough, I'm smart enough, and doggone it, people like me.

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kitty_napThe radio silence has been due to my having surgery last week and being in recovery mode since. The short version of this article is as follows: surgery is never fun, it's weird not feeling hungry, and life is good. If you want the details, keep reading. Otherwise, have an excellent day, see you next time.

The surgery went very well. I have a history of having severe nausea after anesthesia, and considering it's the #1 post-op complaint about bariatric surgery, I was a bit worried. But my anesthesiologist gave me a drug beforehand, plus a scopolamine (motion sickness) patch, and gave me IV Zofran during the procedure. Whatever she knocked me out with caused me to lose a chunk of time, I don't even recall being moved from the pre-op area to the surgical suite, nor being in post-op recovery at all. I had absolutely zero nausea. I had filled a couple of prescriptions for dealing with it at home but haven't opened them up at all.

My post-operative pain was there, but it wasn't even comparable with the pain after my knee reconstruction. It was enough I couldn't ignore it and limited some movement, but it wasn't unbearable. Which is good, because I found out that Dilaudid doesn't do jack for me. If the pain had been much worse, I'd have asked to try morphine instead, but it was already lessening by Day 2. Tramadol took the edge off, so I didn't ask for Norco. Went home Day 2 and by Day 3 my unmedicated arthritis hurt worse than my stomach. At this point, it's slighty sore when I move certain ways, and that's it.

Recovering from surgery means a lot of sleeping and laying around doing nothing. Since my arthritis is flared up, I can't really do any knitting or crafting that I would like to when forced to rest for hours on end, so I've been watching a lot of Netflix. And drinking. Water, I mean. Well, and the protein shakes. My instructions are to drink at least 48 oz of fluids and get about 60 grams of protein in, with more being better and fluids being a higher priority than the protein at least to start. I didn't meet the fluid goal until Day 5, and still haven't met the protein goal, but I've been improving every day.

When researching the surgery, almost everyone I talked to said that their appetite completely went away after the surgery, and they had to remind themselves to eat. While I really hoped that it would happen for me as well (and worried that it wouldn't) it's been a huge adjustment. I'm really not hungry. My stomach can be empty, and I know I'm physically hungry, but I just don't feel hungry or interested in food. It's not quite a food aversion (though I am getting hellishly sick of protein shakes) but just a general disinterest. I'm using timers on my phone to remind me to drink and eat because I'll get involved in something and just not think about it.

I had arranged to work from home this week because of the surgery, and it was a good call. Today is probably the first day I think I could manage the office if I had to. My department has started offering part time work from home, and my days are Tuesday and Thursday, which breaks the week up well. I was on the fence about it, but after this week I will definitely take advantage of it.

I'm already down about 13 lbs from my weight on the surgery day, so that's awesome. Of course, the journey is just beginning, but I think I'm off to a great start.

kaizen

I used to love Tony Robbins, reading his books and watching his shows. I still think he's awesome, but hadn't thought much about him until this past week. One of the things he promotes is from the Japanese concept of 'Kaizen' which in simple terms is to commit to constant improvement in whatever you're trying to achieve. Never being satisfied with your performance, and looking for little ways to improve. This really resonated with me when I was younger, and I've worked to implement this in my own life.

What really got me thinking about it this week however, was a simple blood draw. With surgery upcoming, the surgeon wants to make sure I'm healthy and all that, and it's standard to draw some blood and run a few tests to make sure the system is operating within normal parameters. No big deal. I have zero issues with needles. Back in the day, we practiced on each other in Paramedic school, and since then I've let nursing students and other people training to start IVs and draw blood to practice on me. I don't have much pain with it, even though I bruise like fruit and sometimes come away from those sessions looking like a junkie.

I preface all of this by letting you know up front that I am an easy stick. My skin is quite light, and while some veins are not visible to the eye, they are easily felt and not very deep. My veins aren't particularly prone to rolling or blowing. I also have quite a bit of experience with both blood draws and IV starts. I am fond of telling people "I used to do this bouncing down the road in an ambulance with very little light." I am not a "vein whisperer" by any means, but I'm better than average, I would say. Working in the ER as a nurse gave me opportunity to regain my skills from years ago as a Paramedic and expand on them.

Drawing blood requires a slightly different technique than starting an IV, but they are similar enough that we tend to discuss the techniques interchangeably. It's a skill to be sure, so my next comment is not intended as a denigration of the people who do it. It is not rocket science. It doesn't take dizzying intellect or some special knowledge, nor is it an unachievable skill for most people. People who are particularly good at it usually are happy to give you tips and tricks they use, and with the advent of the internet there are dozens of places to go for information including videos about improving your IV skills.

So it always surprises me a little and seriously disappoints me when medical professionals who need to draw blood or start IVs regularly just throw their hands up and say "I'm not very good at this." It reminds me of a scene from one of my favorite movies where a hunky Viking throws Antionio Banderas' character a sword, and he complains that it's too heavy to use. The Viking's response? "Grow stronger."

So my surgical intake nurse this week was very nice, and seemed to be a very competent nurse. She wasn't a new grad by any means. As a surgical intake nurse, she probably has to draw blood on a dozen people or more a shift. I could tell she wasn't terribly comfortable with the draw, so I tried to reassure her by letting her know that I'm not a hard stick. She flat out told me that she can't really feel veins at all. This floored me a bit, since you can't see the veins on most patients due to skin pigment, tattoos, scars, hair, and more. We are taught to evaluate the veins by feel. Location, direction, valves, "bounciness", and size are all things we tell from feeling the arm.

One of the large veins that is almost a default for blood draws and often for IVs is the antecubital, which is on the inside of the bend of the elbow. You know the one I mean, some of you are cringing and pulling your arm in to protect it as you read this. Mine is fine, no issues with sticking it, pretty much ever.

She missed it. Clean.

Which I should be happy about, since that means it doesn't bruise. But there's no reason for it. I was hydrated and in reasonably good health. So she moved to my forearm wherebruise she could see the vein. Long story short, she went through the vein. Which is actually quite common with people learning to do blood draws, but they usually get better. It makes for a leaky IV and blown veins if you're trying to start an IV, but it doesn't usually screw up a blood draw. So she got the blood she needed. And I got this bruise:

I'm honestly not upset with the nurse. Like I said, I routinely let people practice on me. But I am disappointed that she doesn't seem to be trying to get better, she's just accepted that she's not good at it. In her position, that means that people who are harder sticks than I am get stuck way more than they need to. She did state that if she didn't get the second try, she'd get someone else. Which is good, because it at least limits the number of sticks and bruises. However, there are people for whom even this article is painful. They have a real anxiety about needles, and it's traumatic for them to have repeated sticks. Some people are truly hard to stick, and while they're usually patient, they need people who are working to improve their skills, not people who have given up.

When I was working ER, it was a point of pride that I was pretty good at IVs. I enjoyed having people come to me for help when they were having problems. I liked passing along the tips and tricks that worked for me and seeing my cohorts improve their skills as well. When I worked with honest-to-goodness vein whisperers (and I worked with several) I watched carefully how they did things, and asked questions. I sought out internet resources to find new information about ways I could keep getting better. I would ask for help when I was outmatched by a patient's veins, because I wasn't going to turn my patient into a pincushion. But it was my goal to be the person who, if I couldn't get a line, the patient needed a sonogram placement or a surgeon to place a central line. I wouldn't be satisfied with myself until that happened.

Kaizen isn't an obsession with perfection.  It's a commitment to becoming just a little better every day.  That's a healthy approach, and one we should all embrace.

Especially if you draw blood every day.  Just sayin'.

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1345951608-rocky-no-easy-way-out-400x400I'm lucky that I haven't actually had someone say to my face "you're taking the easy way out". Mainly because I'd likely have to contact my attorney about defending me against charges of battery, and that probably gets expensive.

Or assault. I used to think I had the distinction clear in my head (assault is the threat, battery is the actual touching), but I've had people tell me that it's just assault. (But I digress.)

Right now I'm on my pre-op diet. The surgeon calls it a fast, but I do not think that word means what she thinks it means. (Any opportunity for a Princess Bride quote should not be squandered.) She has me drinking protein shakes 2-3 times during the day, and having a "healthy dinner" and can have "healthy snacks" if needed. MyFitnessPal informed me after I closed it out last night that if I continued eating like that, I'd lose 15 lbs in the next 5 weeks. Well, heck. I should just do that, then, instead of having 75% of my stomach cut out, right? I mean, isn't this really just a way to get out of having to have discipline and self control?

One of the things we've learned about dieting and maintaining weight loss is just how freaking HARD it is. Some of us are genetically programmed to put on weight easier than others. That's not an excuse, it's science. Then our bodies adjust to the new weight and fight like a cat in water to keep it on. This is what's commonly referred to as "Set Point". Our brains use a bunch of hormone signals to make us crave salty, sugary, fatty foods in order to maintain the weight the body thinks is correct. When we successfully lose weight, our metabolism lowers and our caloric intake decreases, requiring us to eat even less, all the while fighting against this tide of hormones. Food manufacturers know this, and create convenience foods that are full of the salt, sugar, and fat our bodies are screaming at us to eat. Culturally, we don't expend as much energy as our ancestors, and cram our schedules full so that eating home cooked foods is a struggle. Worse, the more weight you pack on, the worse this uphill battle gets.

Whew. And that's without even touching the emotional and mental barriers we face. Talk about the deck being stacked against you.

Yes, some people do successfully lose a lot of weight. And some of those are able to keep it off for a long time. And some of those are able to keep it off (mostly) for the rest of their life. It's possible. Possible does not mean realistic, though. It's possible for me to become a concert pianist. However, starting at the age of 46, it's really really damned unlikely. Likewise, it's possible for me to lose the 120-140 pounds I need to and keep it off without the surgery, but it's really really damned unlikely. Seriously. A 5% chance I'll keep *any* of it off past 5 years. Surgery raises that chance to somewhere between 50% and 70% depending on the study reported. Commitment to the lifestyle changes can bump either of those estimates up, certainly. The starting line is a little better at 50% or 70% than it is at 5%.

Wait a minute, didn't I just make an argument for it being the "easy way out"? Depends, I guess, on how you look at it. If I am running a race, and it's uphill, is it taking the easy way out to ditch the 50 lbs of sand someone put in my backpack? Is it taking the easy way out to buy good running shoes with good ankle support, or should I just go ahead with the 3" heeled pumps because that's what I was given? I'm choosing to equip myself better for the long haul. To me, that's smart, not cheating.

Let me talk for a minute about how "easy" this is. Once I made the decision to move forward with this, I had to schedule a string of appointments. A seminar with the weight loss surgeon. A one on one appointment with the surgeon. One with my cardiologist. Followed by a stress test with the cardiologist. One with a nutritionist. One with a psychologist to clear me for surgery. Three months of a supervised diet with monthly lectures from the doctor supervising me. Another with my primary physician to clear me for surgery. An upper endoscopy with my surgeon to check for ulcers and hiatal hernias. A follow up appointment with the surgeon about the endoscopy. Another appointment for the final preparations once insurance approved me. Pre-op testing, though I can skip the EKG since my cardiologist had to do a stress test. All totalled, I have spent almost $900 out of pocket for co-payments and co-insurance. I'll spend another $1,000 out of pocket over the next couple of months. (I'm grateful to have excellent insurance, without it I'd have to go to Mexico and it would cost me on the order of $5,000 plus travel, or some $10,000 to $15,000 to have it stateside.) That doesn't count the $1,200 I've spent so far with a therapist facing some of the food issues that would derail this process if left alone, because I'd have that expense if I tried to do this with just diet and exercise.

Now I'm on a two week "fast" and it's hard. The snack machine at my office tempts me every time I walk by to refill my water mug or mix up another powdered protein shake. The fast food restaurants taunt me as I drive by them. I want to EAT ALL THE THINGS because I'm starving, I have a headache, and I'm groggy. Oh, and I have to be off all of my PsA meds for the surgery, so I also have pain in my hands, my feet, my back, and my knees. I can't distract myself with crafts because my hands hurt. I can't take a walk because it feels like spikes in my arches. I'm on day 3 of 14, and I'm fairly miserable.

After surgery, I'll be on a full liquid diet for 1-2 weeks. Then I get to have pureed food for another week or two. Then I get to "graduate" to soft foods like eggs and tuna. It'll be 4-6 weeks before I can have "regular" food again. Even then I'll have to add foods one at a time and be very careful because my tolerances and tastes will have changed, and any given food - or too much or to fast - can make me very ill. I'll very likely be on a fairly restrictive diet for up to a year. Once my system recovers, and I'm at or near my goal weight, I'll get to add foods to my diet in a measured way. 18 months after surgery, my diet should look fairly normal, though with slightly smaller than normal portions.

Meanwhile, I'll have to get creative in order to stay clothed during this time. People report changing a size or more every week or two through this process. I should count myself lucky that it's culturally acceptable for me to wear skirts, because I forsee many months in drawstring maxi skirts. If I were a guy, this wouldn't be as easy, and that might be the first time (and likely the only time) I'll ever say that regarding fashion. Oh, and a lot of my hair might fall out.

But some will still say it's the EASY way out.

No. The EASY way out is to keep doing what I've been doing and not make any changes in my life. The EASY way out is to keep trotting out the tired and worn excuses as to why I can't do better. Not trying, THAT is the easy way out.

Anyone who is out there making changes to improve their health and life is NOT taking the easy way out. Choosing different tools to help make those changes is not taking the easy way out. Dietary changes are a valid choice. Exercise is a valid choice. Surgery is a valid choice. Medications are a valid choice. Any combination of the above and more is a valid choice. Each has risks and benefits that are unique to each person. Not one of these (or any combination of them) is the "easy way out".

So do me (and my attorney) a favor. Don't tell me I'm taking the "easy way out".

convenient-to-bring-wheyI started my 2-week pre-op diet today. 2-3 protein shakes plus a "healthy dinner" each day. Doc said I could have "healthy snacks" if I needed. She's not as strict as some surgeons about the pre-op diet, and I am grateful for that. However, I really need to try and stick to the pre-op diet. The goal of a pre-op diet is to get a little weight loss and shrink the liver, which sits in front of the stomach and has to be moved out of the way for surgery.

Honestly, this phase has scared me more than the surgery itself or the post-op diet. After the operation, it seems the vast majority of "sleevers" lose their cravings for food, and actually have to remind themselves to eat. That effect is what keeps me from worrying overmuch about the post-op diet that progresses from liquids to pureed foods to soft foods to solid foods over the course of about a month.

Before the surgery and the loss of appetite though, I worry about my ability to do this. When I try to restrict, I get incredibly fatigued and headache-y with brain fog, and find myself craving all sorts of things that aren't on the plan. Add to the stress that because of the surgery I'm off my meds which means my chronic pain level has gone up from a 3 or so to a 5-6 and I'm finding the pain causes cravings for comfort food (aka sticky pastries, chocolate, and anything else super carb-y and super sweet).

In light of this struggle, I thought I'd take Monday and Tuesday and do some "dry runs". Breakfast isn't a big thing, since I already substitute SlimFast or something like it for breakfast periodically. It's the 11am hungries that start the problems. For my "dry run" days, I ended up eating a protein bar for lunch. By about 2pm though I was hurting, starving, brain fogged, exhausted... and hit the snack machine.

Today I'm thinking positive thoughts. Drinking lots of water, and I have plenty of protein drinks standing by. I can do this... I hope.

level10lifeAs part of my foray into bullet journaling, I ran across some people doing "Level 10 Life" in their journals. This intrigued me, so I started researching it. From what I was able to find, it started with the "Miracle Morning" by Hal Elrod. I've borrowed one of his books available on my Kindle and am reading it currently to see if the morning process he advocates will work for me. I'll report back on that after I finish it. One of the bullet journalers I follow has several posts about how she's implementing it, here and here.

Since I'm trying to digitize my bullet journal (at least for now) I wanted a way to put this into my OneNote, which means either hand drawing and taking a picture or doing an Excel chart. While expert Excel chart makers can do this wheel type chart, I don't have the time or expertise to do it. So I did a radar chart. I may change this later on, but thought it was a decent start. While the graphics are amusing, the heart of this is setting goals and tasks that will improve the self scores for each area. That's a little harder. I decided that I'll categorize this blog along the ten dimensions, and see how it shakes out. My OCD tendencies had me re-wording the categories as single words, but no single word seemed to work for Personal Growth, so I decided the OCD person in my brain needs to just shut up.

Companions - for me, this is about the people who mean the most to me. I blur the lines between "family" and "friends" enough to cause confusion. So the concept of companions on this journey of life seemed appropriate. My challenge is staying in closer contact with these people. I've come to rely on Facebook to update everyone on what's going on in my life, and it's very impersonal. My goal is to cultivate closer relationships with my core group of companions. I'm not quite sure exactly what that's going to look like yet.

Romance - I am so lucky to have a great guy who loves and understands me. My goal will be to spend more quality time with him, and less "veg in front of the TV" time.

Health - I gave myself a really low score on health. I know my health could be a lot worse, but I rated it in terms of how happy I am with my current state. I'm having bariatric surgery to start working on the weight. I will increase my activity level as I'm able post-op. Once I'm far enough post-op to get on the biologic treatments for my PsA I will. So my focus will be eating well and moving more for the time being.

Environment - This one seems a little odd in comparison with the others. It's about the physical environment we're in at work and home. I haven't been able to tolerate outside activities or do much in the way of clearing clutter and cleaning inside, so I also rated this one pretty low, but only because there's so many things I want to do as I have time, energy, and finances. De-cluttering, cleaning, landscaping, and decorating for starters. I'll refine this one as I go along.

Career - I think I'm doing pretty good in my career. Once I made the decision to go into Medical Informatics and landed my current job, things have smoothed out. I'm including graduate school in this category, since the only reason I'm doing it is to advance my career. All of my goals are long-term here, so I'll focus on school for now.

Finances - This area sucks for us, there's no way around it. All in all, we're very lucky. We make enough to support the family, and are comfortable. But the debt doesn't seem to budge, and we're not implementing much of a plan. I have loaded our data into YNAB (link) and the Mister and I have committed to reviewing it jointly every week, developing a plan and working the plan. First goal is to re-build our emergency cushion as recent unexpected expenses had reduced it. Then get rid of the debt as aggressively as we can. Oh, and buy a used truck sometime late summer or early fall for cash.

Personal Growth - All of the non-school stuff I want to learn and do falls into this category, except for Spirituality. So my bullet journal/miracle morning stuff will go here, trying to learn other languages, etc. My goal is to dedicate some time to doing these things on a regular basis.

Spirituality - I feel like I've really lost something here. I used to be active with the church I attended, even serving as a Board Member. I've worked with and founded non-traditional religious non-profits, and used to spend a lot of time working on my spiritual life. I feel like that completely flew out the window during marriage #2. I want to get this back, and I'm looking at a few ways to work on that. More to come.

Recreation - There's so many things I love to do: knitting, spinning, beading, reading, computer stuff, etc. Right now I can't do much of the craft work because of the pain in my hands, but hopefully this will change.

Giving - I wasn't sure what to do with this, at all. I volunteer time as a medic for a roller derby league a friend of mine skates with, so I counted that. I don't feel like there's a lot of 'giving back' in my life right now, and I don't know what that will look like, but I'm going to give it some thought.

This ended up being a much longer post than I intended, and a lot of it is "I don't know what this will look like, but I know I want it to be better." But it's a start, and one of the lessons I need to learn is that sometimes good enough is good enough.

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tom-Bathroom-scale-800pxLast week I got the insurance approval for my bariatric surgery which has been scheduled for mid-August. While I hadn't talked much about it before I started the formal process for approval, I've been thinking about and researching bariatric surgery for several years. There is a general attitude that the surgery is the "easy way out", and lots of people choose not to be public about their choice. While I respect that, I'm a "live out loud" kind of person, so I've chosen to share this with anyone who wants to know. (Kinda obvious since I'm posting it on the interwebs, LOL.) I'll write more about the "easy way out" in later posts.

I've been overweight most of my life, certainly since my teen years. I stayed pretty active though, sports and cheer-leading in junior high and activities like square dancing through high school. So while I was pretty healthy, it impacted a lot of things in my life. I always felt like the Ugly Duckling and didn't get a lot of male interest when I was younger. I never got cast as a lead in a play. I couldn't wear a lot of the fashion trends because they didn't make them in my size. I got teased quite a bit for my "thunder thighs". All in all, it wasn't as bad as some people have it, but things like that do change who you are as a person and how you see yourself.

My weight has been up and down throughout my adult life. I've had good success with diet and exercise for short periods of time - less than two years generally - but it has gotten harder to get the weight off with every lose/gain cycle. The time period after my second divorce and through nursing school is when my weight really got out of hand. I kept thinking that once I was doing nursing and on my feet for 12 hour shifts, the weight would start coming off. I didn't count on developing an auto-immune condition and the associated pain, or that night shift would make it incredibly hard to eat in a healthy way. I was able to stabilize my weight during that period, but I couldn't seem to make the changes needed to start pulling it back down. Then after I had to leave bedside nursing, my weight shot up and crossed the "shoot me if I'm ever that heavy" line.

I started thinking about surgery several years ago after a few friends of mine had gastric bypass and had good results. I was worried about such a drastic option - changing the way nutrients are absorbed didn't seem like a good option to me. I knew several people who had the lapband, their results were dismal and there were some serious complications. I didn't think much else about it until a few years ago when my sister had the vertical sleeve (VSG) done while she was living overseas. She encouraged me to think about it, but I wasn't ready for anything that drastic at that time. Every spring for the last two or three years, I've promised myself that I am going to change my habits and if I haven't lost some significant weight by my birthday in October, I would do the surgery. Needless to say, the weight remains. I still wasn't ready for the permanence of the solution.

Dealing with my auto-immune arthritis had brought the issue to mind again. I started researching it again in earnest after another friend had the sleeve and has had excellent results. I started working with a therapist about my odd food issues, knowing whether I had the surgery or not I would need to address those issues. In April, my diagnosis changed from presumed rheumatoid arthritis to psoriatic arthritis, and Dr. B started talking about biologics. I had done enough research to know that biologics create issues around surgery. Namely that the decreased immune system function caused to mitigate the auto-immune condition causes slower healing and more risk of infection. So I floated the idea to Dr. B, expecting her to say that surgery wasn't a good idea. She surprised me by being completely *for* the idea. What my research had not revealed is that the hormone changes that accompany the surgery - first with the loss of stomach tissue, then with the loss of fat cells - directly and positively impacts the inflammatory processes that are behind the damage with auto-immune. Later benefits of weight loss are less joint pain, losing the CPAP for sleep apnea, and a reduced risk of diabetes and other conditions that complicate auto-immune. The caveat was that sooner was better than later for the surgery, as once we started biologic treatment I'd have to have a much longer break from treatment in order to have the surgery than if we did it prior to starting.

That knocked me off the fence. I went the next night to a weight loss seminar with the surgeon Dr. B recommended, and started the process to get insurance approval. I've spent the intervening time with a series of appointments needed for a supervised diet period, my cardiologist's clearance, a psychiatric evaluation, and my primary physician's approval. My blood pressure has been steadily climbing since last year, but I hadn't considered it high enough to warrant treatment. My primary doc disagreed especially after it was found to be 160/110 in her office. So we had to get that under control before surgery. Being put on two blood pressure meds has only confirmed my choice in my mind. I'll likely be back off the meds by late fall, and potentially will be able to get off my CPAP this winter or next spring.

Two roads diverged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood
And looked down one as far as I could
To where it bent in the undergrowth;

Then took the other, as just as fair,
And having perhaps the better claim,
Because it was grassy and wanted wear;
Though as for that the passing there
Had worn them really about the same,

And both that morning equally lay
In leaves no step had trodden black.
Oh, I kept the first for another day!
Yet knowing how way leads on to way,
I doubted if I should ever come back.

I shall be telling this with a sigh
Somewhere ages and ages hence:
Two roads diverged in a wood, and I—
I took the one less traveled by,
And that has made all the difference.

-- Robert Frost

spoonie_explanation Christine Miserandino penned a story about how she shared with a friend what living with Lupus was like.  (http://www.butyoudontlooksick.com/articles/written-by-christine/the-spoon-theory/)  This metaphor gives language to the struggles people who live with chronic illness face, and a community of "spoonies" has arisen.  I joined the ranks of spoonies last year, and everything about my life has changed.

2014 was an intense year for me.  I'd spent a year as a nurse in the ICU at a long term acute care facility, and was thrilled to move on to my "dream job" as an ER nurse at a Level 1 Trauma Center.  I struggled with the intense patient load and unrelenting pace in that ER, and felt like I never really recovered from my working shifts.  I chalked it up to being in my 40's, out of shape, and unused to the pace.  When I felt something pop in the arches of both feet while pushing a particularly heavy patient up a ramp, I thought the pain would go away with some ibuprofen, ice, rest, and stretching.  I'd had plantar fasciitis before, but this time it didn't go away, and hard knots developed in my foot arches.  The doctor at the employee clinic insisted it was not an acute injury, but rather ongoing "wear and tear" fasciitis.  Little did I know it was a sign of something much more serious.

Between the pain in my feet and the unrelenting fatigue, I knew that I couldn't keep working at the pace needed by the ER I was in.  As hard as it was, I knew I needed to find a different environment.  I loved the people I worked with, loved the challenge, and really had a passion for the work.  I also knew if I continued, I would end up missing a lot of work, and putting more strain on my team through my absence and decreased performance.  I moved to an ER in my hometown, and it seemed perfect.  The pace was still brisk, but not as insane as the county ER, and I physically felt better for a while.  I loved working there, but my physical condition kept worsening.  A conversation with another nurse about kidney function being impacted by overuse of ibuprofen made me look hard at how much I was taking every week.  At 800 mg per dose for many doses per week, I realized I was taking almost 10,000 mg a week and had been for the better part of a year.  I decided my physician and I needed to start investigating what was going on.  (Luckily my kidneys were still working fine.)

My response to a round of steroids was the tip-off for me.  I knew my feet were hurting badly, what I hadn't realized was that many of my other joints had been developing an ever-increasing level of chronic pain.  A round of steroids brought my pain levels to near zero, all over my body.  Prior to that, I would have said my ongoing pain level, out of 10, was about 3.  What I realized once I didn't hurt anymore was that I'd been living at a 6 or better.  Many people feel like crap when they take steroids, but I felt human again for the first time in years.  My migraines completely went away, I had energy again, and my joint pain was almost completely gone.  My nursing reference books all pointed me toward an inflammatory process.  As auto-immune disorders run in my father's side of the family, it wasn't a far stretch to start suspecting rheumatoid arthritis (RA).  It took a bunch of blood tests and referral to a specialist (Dr. B) and many months, but it was confirmed as non-serologic RA in May of 2015.  Recently the diagnosis was changed to psoriatic arthritis (PsA) based on new information  Dr. B had after Munchkin started seeing her.  The treatment doesn't change significantly, as it's still an auto-immune arthritis.

I'll write more about the treatment of auto-immune disorders in future posts.  What became obvious to me is that bedside nursing was not going to be a viable option for me ongoing.  I couldn't stay on steroids because of the numerous side effects that make steroids problematic.  (There's a reason one RA blogger calls them "Satan's little tic-tacs".)  I couldn't leave the RA untreated, because the pain was becoming unbearable and I would start having degeneration in many joints.  But the treatment lowers my resistance to infection, and an ER is not a place to be working when I will pick up every cold, flu, and other communicable disease I come into contact with.  So I changed my career plan and moved to a job working in healthcare with computer systems.

It's been hard to change everything in my life, and many days I resent my illness for making it necessary.  But I realize how lucky I am that I have a mix of skills that is in demand and allows me to continue providing for my family and is not as physically demanding.  I'm still struggling with fatigue and pain, but I know I'm so much better off than many people.  I don't want to be defined by my illness, but it certainly is shaping my life at this point.  So for now, it's one spoon at a time and living life the best I can.

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When last we left our heroine, she was ranting about politics and getting settled in a new job.  Let's peek in and see how she's doing…

Things are good in the land of the AntiChick.  Work is going well, married life suits me, those in my family are all doing well.  I'm adjusting to living with a chronic illness, and grateful that it's been mostly manageable.  I'm working on insurance approval for weight loss surgery.  Graduate school sucks.  Well, to be fair, ONLINE graduate school sucks.  I don't know if there would be less suckage if I were able to attend physical classes.  I keep reminding myself that it's not forever, just until December 2017.

I've been considering a move to a Bullet Journal, which has been consuming more of my thought processes than it probably should.  (http://www.bulletjournal.com)  I am an office supply addict, and it appeals to me to have an analog system for capturing thoughts and notes.  However, I am completely digital with my calendar on Google and have a cool Galaxy Note 5 phone with a stylus, so I'm toying with the idea of doing something like it digitally.  I mean, I *always* have my phone with me, it seems silly to have to always carry around a notebook.  But there are things I prefer to scribble out, and they seem to get lost in the notebook I usually run around with.  I will need to find a system that allows me to blend analog and digital notes in a usable way.

One of the things I really need to keep up with better is my blogging.  I have a bunch of ideas I want to write and publish, but I need to get in the pattern of writing daily and updating my blog more often than I'm currently managing before that can become a reality.  The blogging landscape has certainly changed in the twenty-some years I've been on the internet.  I finally got a Facebook page set up, and I need to figure out what other social media needs to accompany my blog.  Instagram?  Snapchat?  Not really sure where all of that fits in, but I'll figure it out.

More to come.