So for the past few weeks I've been struggling with how intuitive eating does or does not fit with weight loss surgery.  I don't have a healthy relationship with food to start with, so I'm admittedly at a disadvantage.  We grow up with certain foods being labeled as "bad" and "good", and some foods being held out as "treats".  Someone I know posted this week, "Treats?  What are we, dogs?"  It certainly made me think about how our society programs us for unhealthy attitudes about food.  I want to get away from that.

I agree that intuitive eating is a healthy approach to food.  Do I want chocolate cake?  If so, I should eat chocolate cake.  Thinking that I can't have the cake, or that it's forbidden or "bad" increases the likelihood that I'll binge on it.  Checking in with my body about what it wants and needs is certainly a good approach.  Food is not a moral issue.  Food is not good or bad, it's just food.

Most of the WLS community is sold on low-carb eating, many advocate a ketogenic diet.  The discussions on the boards frequently label anything with carbs as "bad" even including fruit and starchy vegetables.  Anyone discussing eating bread or rice is quickly informed that those foods have no place in our diets during the weight loss phase.  I find that kind of labeling problematic.  Especially given that I cannot eat low-carb.  Going into ketosis makes me incredibly ill for weeks, where most people get over the "carb flu" after 2-3 days.  So carbs are part of my diet, though I do try to eat mostly whole grains, fruits, legumes, etc. for my carbs and limit refined flour and sugar products.  But occasionally I want half of a bagel with cream cheese, dammit.  I refuse to start labeling food as "good" or "bad" just because everyone else does.

My sleeve actually is helping with part of the intuitive process.  My newly rearranged tummy has definite ideas about what it likes.  If I eat too much sugar, too much fat, too fast, or don't pay attention to when I'm full, I physically feel very bad.  Certainly reinforces the whole "listen to your body" thing.  My tastes have changed, and I'm having to re-learn what foods I do and don't like.  I am trying foods I would never have tried before this whole process started, as well.  Definitely steps in the right direction, I think.

Then there's the "have to" pressures.  I "have" to eat a certain amount of protein every day.  I "have" to drink a certain amount of water every day.  I feel pressure to eat vegetables and fruits, even the ones I don't like because they're healthy for me.  There are days I don't want another protein shake, or another chicken breast, or whatever.  There are days I just don't feel thirsty and the water just tastes awful.  Because I don't have much of an appetite anymore, if I practice completely intuitive eating, I can subsist on shockingly few calories and little hydration for several days before I'd feel the need to eat or drink more.  That doesn't seem healthy, but is it good to force myself to eat or to eat something I just don't want?  Is that any healthier?

Sometimes we have to hold our nose and take medicine that tastes awful.  There is a school of thought that food is medicine, and we should essentially hold our nose and eat what is healthy for us even if we hate it.  That school of thought is what has made me miserable for most of my life around the so-called "need" to eat vegetables.  While I see the logic, it's just not going to work for me.

So what am I supposed to do about the protein requirements and the fluid requirements?  My therapist asked me last time what the consequences were for not meeting the minimums.  If I don't drink enough fluids, I get migraines to start with, and other issues also arise.  So in order to stay healthy, I have to drink whether I want to or not.  All I can do is add flavorings to my water to make it more palatable.  With the protein, I suspect that missing a day here or there isn't a problem, but on an ongoing basis I'll start losing muscle mass.  So it's best if I strive for the protein goal every day in order to stay healthy and active.

As with so many things in life, I think that there's just no black and white answer.  I need to find ways to get all of my needed macro nutrients into my diet, most days anyway, to keep moving toward a healthier place.  Forcing myself to eat things I just don't want however, is going to push me back into an unhealthy relationship with food.  The best answer I have come up with so far is to start thinking of every food option for these macro nutrients so I can give myself options.  Like having different flavorings available to make the water more enticing, I need to have different options available all the time for my protein to give my tummy and taste buds plenty of variety to choose from.  Maybe the message my body is trying to send me is "enough with the freakin' protein shakes!!" and it's not about the protein per se because hummus or a nice bowl of lentils could meet the protein needs without forcing myself to drink another shake.  Maybe I'm just not listening ENOUGH to my body, even though I'm doing much better with it.

Food for thought.  (Pun completely intended.)

mri_anterior_cingulateI used to hate the term "cognitive dissonance."  That's because I had a guy one time use it as the reason to quit seeing me  when it was very clear to me at the time that the only dissonance was that I was smart and fun to be with, but I was also fat and the woman he had the hots for looked like a magazine model.

I'm starting to come to terms with the phrase, though, since I'm now going through it.  I find

myself trying to hold conflicting thoughts (or at least ones that seem conflicting) about body image and relationships with food.  I'm coming to understand just how frustrating a true cognitive dissonance can be as I try to tease out the layers involved.

It started when I read an article about a video blogger who had made the statement that you're not body positive if you're on Weight Watchers.  I dived into the rabbit hole of the internet, and ended up watching videos and reading articles from people in the body positivity movement for hours.  The vlogger that started it all for me had clarified that she was aiming that statement at people who are positioning themselves as leaders or examples in the body positive movement yet promoting ideas and products that are body shaming.  The statement made more sense in that context.  I agree that there is nothing body positive about the way WW does business or the messages they send.  That the WW program is healthier than most other commercial diet programs is not saying much, given that the evidence is pretty clear that diets make us fatter.

But I started wondering how she would see me and my choice to have weight loss surgery.  Can that choice mesh with a body positive mindset?  I brought the subject up with my therapist, and it started a very interesting and thoughtful conversation.  I'm still processing all of it, but want to share where I'm at in the hopes it helps someone else.

Some body positive activists clearly state that if you are trying to change your body shape, size, etc. that you are obviously not accepting it and that you are not espousing body positivity.  That was troubling to me because I do believe very firmly in many of the things the body positive movement is trying to promote.  I believe there needs to be a place in the movement for people who for whatever reasons want to change their size and shape, but know that it doesn't mean anyone else's shape or size is wrong or bad.

I can honestly say that my size and shape had little to do with my decision to have WLS.  Even though I've suffered bullying and a certain amount of discrimination over the years because of my weight, I had mostly come to terms with it.  I haven't looked in the mirror and hated what I saw for many years.  I don't feel pain when someone refers to me as "fat", because I am.  I'm also a strong, intelligent, sexy woman and my size doesn't alter that at all.

My decision was based on my health, which was in a decline for reasons not directly because of my weight, but certainly exacerbated by it.  The decision was made when Dr. B told me that the stomach tissue to be removed is directly responsible for a large part of the inflammatory factors that are driving my disease, and any weight loss after surgery would only serve to decrease the inflammation further.  The weight loss would remove significant stress from my screaming joints and could even render my medications more effective.  It wouldn't cure my auto-immune, but it held a great deal of hope for improving the condition.

Even clarifying this makes it sound like I'm bashing people who choose WLS because of aesthetic reasons.  I do not want to put forth that message.  Everyone has different priorities, and makes decisions based on them.  Those reasons are just as valid as others.  It's just not where I was coming from.

To make it even more complicated though, as I've lost weight I've found myself thrilled to be giving away clothes that are now too big for me and seeing some of the changes in my physical appearance.  Does that mean I didn't really love myself to start with?  Or that I cannot have a place in the movement because I'm liking the changes I'm seeing?  Or is that just playing into the societal expectation that only thin is pretty?  And since I’m trying to improve my health that I'm redeemed as a "good fat person"?

Health is a touchy subject in relation to body positivity.  One of the concepts that is hard for people to grasp, but is central to body positivity is that thin does not equal healthy.  That is very true.  Thin people get illnesses and fat people can be healthy.  You cannot tell by looking at someone whether they are healthy or not regardless of their size.  Did I have any guarantee that the surgery and weight loss would improve my health?  No.  However, other than reducing the stress on the joints, the weight loss itself isn't what's impacting my health.  It's the inflammation caused by the tissue that was cut away and the fat cells I’m losing.  It's a fine distinction, and perhaps it doesn't matter.  What about people for whom the weight itself has been shown to cause health problems, and losing it has improved their health dramatically?

I struggle with the health aspects of the body positivity movement.  I do believe there is a point - which is different for each person - at which the weight simply cannot be healthy.  When the weight itself prevents a patient from being able to move adequately to perform what medical professionals refer to as "activities of daily living" or ADLs (bathing, dressing, grooming, feeding are examples), then as a medical professional I simply cannot agree that the person is healthy at that weight.  I fear that the "health at every size" movement can go too far and give some people an incorrect belief that they are healthy when they clearly are not.

But even that definition - which I've been working on for months, by the way - fails when I properly expand body positivity to include more than just weight/size/shape issues.  Body positivity is also about people who are differently abled.  If a person is not able to do some ADLs because of a medical condition or injury, are they  then "unhealthy" because their condition keeps them from meeting my definition?

If a person who is unable to perform ADLs due to weight (or any other cause) is unhealthy, what does that even mean?  Here's where I converge again with the movement.  Because honestly, if I'm not their caretaker or on their medical team, absolutely nothing.  It is none of my business what anyone does in relation to their health if I'm not invited into that situation as a medical professional.  Doesn't matter if they're my best friend, my spouse, my child, or a stranger on the street.  It's not my business, nor is it my place to offer comments or advice.  Society treats fatness as a moral failing, and people seem to think it's their business to shame or confront people "because it's not healthy."  I think that's completely unacceptable.

Weight is a measurement of mass and gravity.  It is not a moral failing.  Our society needs to quit treating it like it is.  Our media needs to show many different kinds of bodies as "normal".  Our healthcare providers need to quit treating weight as the cause of every medical problem and shaming people who don't fit the "ideal" size and shape.  I read an account of a woman who went to her doctor with an ear infection and was told to lose weight and was not prescribed an antibiotic.  Another whose abdominal pain was dismissed for years because she needed to "be compliant" with weight loss and no testing done to reveal the invasive cancer actually causing the pain.  Absolutely unacceptable.  I'm on board with the movement about changing these things.

But then, I also participate in online support groups for WLS.  The people in these groups tend to be very focused on weight and BMI.  We gleefully post how many pounds or inches or clothing sizes we've lost.  We commiserate with people who are losing more slowly than others, congratulate the ones who are having "success", and share tips about our lifestyle changes.  We talk about caloric intake and carbs and "good" foods and "bad" foods.  How does that fit with the idea of body positivity?  It doesn't feel like it fits at all.  I can't (and shouldn't try to) change what other people are using as goals and benchmarks.  But perhaps I should take the advice I read today, and find different numbers than those on the scale and tape measure to gauge my success by.  I knew my health was declining when my heart rate was near 100 at rest and would jump to 150 walking from the parking lot to my physician's office.  Or when I couldn't even complete a cardiac stress test because I was too out of breath after 3 minutes on the treadmill.  I can judge the improvements in my health with numbers like these instead of my weight and my jean size.  I wonder how changing the language I'm using for myself would affect those around me?

So where's my place in the body positivity movement?  I don't know, but I found an article today that gives me hope that I have one.  The author talked about body positivity being about loving your body as it is right now, and taking responsibility for its care.  That can mean (but doesn't have to) making different choices about food and exercise and changing the size or shape, if it's coming from a place of caring for your body instead of hating it.

Perhaps, like most things in life, it's about the process and not the results.  I'm not trying to be a role model for anyone, or a leader in the body positivity movement.  Ultimately, it doesn't matter whether anyone in the movement accepts me and my thoughts and choices or not.  My actions are all I control.  I offer my thoughts and feelings with a small hope that it helps someone who's struggling, even if it's just knowing they're not alone.  My therapist (need a cute online name for her I guess) says that lots of people never even think about these things, and by examining my thoughts (even the dissonant ones) about it, I'm ahead of the game.

I'll have to think about that.


Wow. Over a month since I've posted anything. I plead life changes, grad school, work, and illness as excuses. Life is beginning to look a LOT different than it did pre-op. I'll post more on that later.

It's interesting to me how we define moments as life-changing. Life before this event and life after this event. There are the huge ones that everyone remembers as a frozen snapshot in time: JFK assassination, Reagan shooting, Challenger explosion, 9/11 attacks. The "where were you?" moments. We all have stories to share about where we were when we heard, how it's changed our life or society since then.

But then there are the personal ones. Some tragic, more that are joyful (hopefully), but each one marking a point in life where everything changed. Moving to another state, life-changing injuries or illness, graduation, marriage, ending relationships, forming new relationships, encountering the death of loved ones. Events that change the trajectory of your life, for better or worse.

It seems like I've had nothing but changes over the last few years. Back to school 3 times. 4 new jobs. Divorce. Remarriage. Chronic illness diagnosis. Weight loss surgery. Whew, and that's only the last 5 years. Needless to say, my life doesn't look anything like it did five years ago. I live in the same house and Munchkin is a constant as are friends, family, and the remaining cats. Nothing else is the same, and that's a good thing.

Some of these are certainly life changing moments. A clear line in the sand of time where something stopped or started or both. But many of them blend in like a wave of tiny changes that go almost unnoticed until in a moment of retrospection you look back and see how far you actually got moved.

I've been - mostly - a "go with the flow" kind of person my whole life. Especially regarding my career. Opportunities presented themselves, and even if it meant a complete shift from the prior plan I embraced those opportunities. That's resulted in an odd patchwork of job history and an interesting mix of skills. It's served me well overall. It meant that when a chronic illness diagnosis required me to leave bedside care, I only experienced some regret but no panic as I made the decision to move into Informatics. When changes come, I tend to roll with them.

The only things I tend to really regret are opportunities I've missed. Like when I was too scared as a 19-year-old to take a Paramedic job in Alaska (even though I "had people there") because it was so far from home. And leaving bedside care and a future as a nurse practitioner because I really didn't have a choice. I don't carry around a lot of regrets about life choices, and I think it may be because I did embrace opportunities and change when they came.

Since this has apparently become a "Wear Sunscreen" kind of post, I'll close with my advice for what it's worth. (And if you've never read "Wear Sunscreen", click the linky thing and read it now.)

Embrace the opportunities that come to you. Take the job that means moving across the country. Go to school (or even back to school) for the thing you've always wanted to be but didn't think you could. Go out on the blind date (but have a safe call set up). Travel every chance you get. Take that dance class that requires a public performance at the end. Life is about change, so buckle up for the ride and enjoy it.

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.


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'.


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.