Monthly Archives: July 2016

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.