Weird Foods

Weird Food

My kids are at a great age now.  They are interested in experimenting with new and unusual foods.  Until now, I thought it was just that they had open minds and were interested in expanding their palates.  Then the REAL truth came out.  It is the GROSS OUT factor. 
Now don’t get me wrong.  I completely appreciate the “gross out factor”.  One of my favorite songs to teach scouts and other kids is, “Great green gobs of Greasy grimy gophers guts...” and so on.  OR think of the song:

 “Did you ever think when a hearse went by, that you might be the next to die?  They wrap you up in a long white sheet, and lower you down for about 6 feet.  And all goes well for about a week, and then the coffin begins to leak.” 

After that, depending on what part of the country you’re from, the song varies tremendously in the gross things that happen to the body.   Let’s face it, kids love to gross each other out. 

What I’ve discovered is that the kids like to try new and interesting foods so they can one up their friends on the “gross out “ scale. 

Now, never one to miss an opportunity, I’ve discovered the usefulness of this.  When I want the kids to try new foods, I point out how they’ll be able to bring it up at school and disgust their friends.  It almost always works to get them to try what ever food it is. 

Gross foods vary from culture to culture though.  When I was growing up, octopus and squid were gross, brains were super gross, as were turtle soup and snails. 
NOW squid and octopus are normal fare for my kids.  I have to really up the ante to get them to be grossed out.  Fish eye balls, Jelly fish tentacles, beef heart,Crickets on a stick,   etc. 

Sometimes it’s the simple foods that families ate growing up that gross other people out. 
Consider banana and mayonnaise sandwiches on Wonder Bread.  That was one of my Mother’s “go-to” sandwiches when we were out of cold cuts growing up.  You would slather an amazing amount of mayo (not the other stuff) onto Wonder bread.  You then sliced bananas longitudinally, and piled them onto the sandwich.  YUM. 
We also ate bananas and milk for breakfast when we would run out of cereal. 

What odd foods did you have growing up? 

BTW, I passed my Boards Exam!!! whoohooo!

I

Momentum and Shame

Momentum:


mo·men·tum/mōˈmentəm/

Noun:
The quantity of motion of a moving body, measured as a product of its mass and velocity.
The impetus gained by a moving object.

shame/SHām/
Noun:
A painful feeling of humiliation or distress caused by the consciousness of wrong or foolish behavior.
Verb:
(of a person, action, or situation) Make (someone) feel ashamed: "I shamed him into giving some away".
Synonyms:
noun.  disgrace - dishonour - dishonor - ignominy - opprobrium
verb.  disgrace - abash - dishonour - dishonor



I am losing it.  No, I’m not losing my mind, although with Christmas coming up lightning fast and not one iota of shopping done, I should be.  No, I am losing momentum. 
I am having a hard time sticking to my resolve. 
I’ve established my routines of making a menu, shopping to it, and actually preparing the foods.

I am trying really hard to make sure I put all my food and drink into the Weight Watchers points calculator.  That is often a problem.  That is where I’m losing momentum. 

I’m also starting to have difficulty because this is the time of year where patients, specialists, lab representative, physical therapy companies, all drop by with goodies.  Yummy, over the top homemade cookies, shortbread, donuts, chocolates.  I do really well until someone TELLS me there are cookies in the back.  There were chocolate shortbread cookies today.  How in the world could I pass THAT up?  So, I didn’t.  I had one. 

In the past, I would have had 3 or 4. 

I don’t like Dunkin Donuts, thank God.  There were some in the kitchen today, too.  They have this weird artificial taste and some type of fat in it that coats your mouth leaving it feeling sticky/slimy. 

In order to combat this inertia, I’ve been telling more and more of my patients about the blog.  I am trying to ensure my resolve by increasing the number of people who can give me a hard time about failure.  I’m trying to shame myself into success.  Not sure if this is the best approach, but it seems to be working so far!

  Most of the conversations start with, “Hey Doc!  I like your new hair cut!”  Then I launch into the REASON for the haircut, my struggle, and the blog, and I invite them to follow along and cheer or jeer me on!  I tell them that I HAVE to succeed at this because then I’ll be giving them an excuse to fail, if I do.  BUT, if I succeed at this, then I’ve given them hope that they too can do it, and I can give THEM a hard time.  It’s kind of group therapy. 

So far, it’s been a success.  This lack of momentum thing is a temporary bump, I think.  Shame is a powerful motivator and I’m shaming myself into success every time I see my resolve weakening.  I think to myself, “THINK of this TEACHABLE MOMENT!  If YOU fail, you’ve failed your patients too!”  Then, I walk away from the temptation or  I  eat fewer of the tempting yummies. 

Keep me on the straight and narrow guys!  Help me keep up my momentum!
Help me avoid the SHAME!!!

Splurging. OR It's Not a Life Sentence

Splurging
I really thought I blew it. 
I was not the paradigm of virtue these last 7 days. 
There is something so tempting about going off the rails on Thanksgiving!  I had the most delicious time being alone for 3 days too!  I could eat anything I wanted and not worry about feeding any one else.  I actually had a milkshake for dinner one night!  (a small McDonalds chocolate shake is about a zillion points, BTW). 

I had TWO Thanksgivings.  One at my partners house on Thanksgiving Day (man is she a good cook!) and the second at my house on Sunday. 

I really tried to be good within reason.  I did splurge on a pumpkin pie and homemade whipped cream, but we decided to just make a turkey, dressing, and green beans on Sunday.  No other soft and squishy, high caloric foods like mashed potatoes, sweet potatoes, green bean casserole.  I made green beans almondine with fresh green beans, and I used lower fat sausage for my dressing this year.  We left the table full but not needing to unbutton.  I had 4 oz of white wine and stopped at that. 

Unfortunately, I also gave in to other temptations.  Chocolate.  I stopped at 2 small Ghiradelli squares though.  I was utterly convinced I was done in and avoided the scale for several days. 

I decided to get back on the straight and narrow two days ago.  I figured that this is a life style change, not a life sentence, so occasionally I could splurge, as long as I only did it occasionally.  So, here I am. 

I got on the scale today and held my breath.... 191.7.  WHEW!!!

SO, I got back into my routine and made a menu for next week, which I’ll shop to.  I’ll prepare most of the food over the weekend between kid activities and housework. 

To my patients who are following along...You don’t have to be a saint.  This isn’t a prison sentence.  Eating well actually tastes good most of the time.  I felt satisfied on both Thanksgivings without feeling overstuffed!  Christmas may be a challenge but I’ll try to be reasonable and stop when I’m full, taste the goodies and not gorge. 

Menu for next week: 
Spaghetti with broccoli sauce
roasted brussel sprouts with maple balsamic drizzle
Slow Roasted Pork in Mole Sauce
Chicken with Broccoli Rabe and White Beans
Maybe a chili or sloppy joe with bulgar wheat or ground turkey.  

Remember, it's not a form of suffering to eat well.  Unless you're this guy:

Thanksgiving Thanks....

What I’m Thankful For



I’m thankful that I have to actually worry because I get too much to eat.

I’m thankful that I have heat and electricity (especially in light of Connecticut’s recent outage)

I’m thankful that my friends are healthy.  (Yes, even YOU Steven.  He said that you’re doing BETTER than expected, not AS WELL as can be expected).
Read :
www.Journalfromtheplagueyear.blogspot.com and you’ll understand. 

I’m happy that I’ve lived long enough to say, “---BECAUSE I SAID SO!” to my children. 
By the way, I swore I never would say that. 

I’m thankful that I now understand the “Mother’s Curse” (I hope you have a child who is JUST LIKE YOU!). 
I’m happy that I lived long enough to learn it.  And to say to my Mother, “I’m sorry because I was a royal PIA as a kid”. 

I am thankful that my children are quirky and funny and smart. 
When Tom was five, he was sitting on the toilet and I was getting dressed.  I swear this is not edited.
“Mom, You know how I’m a ‘science kind of guy?’”(He was FIVE!!!)
Me, “yes”
“Well, I’m not sure if I can believe in God.”
“Why not?”
“Well, there’s no proof.  I believe in Santa because there’s PROOF,  but there’s no proof that God exists.”
(I had to run into my bedroom to keep him from seeing me crack up laughing). 

I’m thankful that my husband is the kindest, most thoughtful guy I’ve ever met.  He does housework, cooks, cleans, and is a fabulous father to our kids.  I cannot and never will complain about him to my friends.  I’m so lucky it’s ridiculous.  That said, He needs a haircut.

I’m thankful that my cat, Fuzzbutt, has lived to the ripe old age of 20.  When I say ripe, I mean it.  Old cats don’t groom themselves very well.

I’m thankful that I have a hobby.  Life would be so boring without some obsession to distract me.  Quilting is a great hobby because you leave behind a piece of you for others to keep themselves warm  after you’re dead and buried!  People will remember me and say stuff like, “Oh, there’s the quilt that Michele made for us.  Too bad she’s dead.” 

Mostly, I’m glad to have two days alone.  No one to cook for, no one to clean up after.  No one to put to bed.  No one else’s laundry to do.  I don’t have to say, “Hey, I’m in here!” while I’m showering.  (13 year old boys love to barge in and pee while you’re showering.  What is that anyway?)

Happy Thanksgiving!

Alfajores

Alfajores

Alfajores are a type of Peruvian cookie.  They are made of two shortbread like cookies made with ground walnuts, not too sweet, filled with a dulce de leche filling and gently dusted with confectioner’s sugar. 

One of my patients knows that I love them and made a whole tin of them for me yesterday. 

Alfajores are NOT easy to make.  They are delicate and dry and easily burned.  Getting the shortbread biscuit part just right is an art.  I have tried to make them myself.  Let’s just say they were not the most successful cookie I’ve ever made. 

Alfajores are also my husband’s favorite cookie, which was my saving grace.  Those cookies were in their tin in the car on the way home from the office.  I managed not to eat any at all until I got into the car.  There’s something about being in the car with forbidden foods that causes me to lose all hope of forbearance. 

As I bit into the cookie, my teeth sunk gently into the dry,soft cookie.  The powdered sugar fell onto my tongue with a tease.  The cookie was buttery, and walnut-y and coated my mouth.  Then, there was the sweet and creamy caramel  of the dulce de leche intertwined with the cookie.  I savored the sensations of the sweet, the creamy, the nutty and the buttery as they all combined in my mouth.  I let the cookie linger on my tongue so I could really enjoy it, knowing what a rare treat it was. 

I couldn’t stop at one. 

In the past, I wouldn’t have been able to stop at all, and would have eaten four or five of the rich cookies before I got home.  This time, I stopped at two. 

My husband and children were thrilled to have an entire tin of the delicate treats.  I haven’t had any more.  They just left to go to New York for Thanksgiving.  I haven’t looked to see how many are left because I’m trying to save my Weight Watcher’s Points for Cornish Game Hens tomorrow at my friend’s house. 

Happy Thanksgiving.  I hope you all have the opportunity to have GOOD alfajors at some point in your lives. 

11/17/11

It has been about six weeks since I started this experiment. 

I started out at 201 pounds.  This was a new high (or low) for me personally.  I don’t have time to go to meetings for Weight Watchers and I needed a way to stay accountable.  Certainly, my son telling me that he “loved my jiggly butt” was motivation in and of itself.  Or his saying that my “stomach is so soft, it’s better than a pillow.” 
It’s easy to block out what you really look like and ignore your children because they say obnoxious things all the time.  They have no filters. 

You know you’re in trouble when your patients start asking you if you’re pregnant.  That happened more than once.  I chalked it up to big shirts, or just plain obnoxious commentary. 

I figured that it is time to take stock of the experiment and to see how well this has been working.  I have invited many of my patients to view my blog.  They are surprised to find out that I too, struggle with some of the same problems they do.  Also, secretly, I think they hope I’ll fail because then they don’t have to succeed.  Put another way, I feel the pressure to succeed so I can show my patients that they can succeed at this too. 

Well, I have lost TEN POUNDS!!!! 

My new digital scale says I weight 190.4 lbs., so technically I’ve lost 10.6 pounds, but who’s counting?  (Kudos to Target, who took back the broken scale without a receipt or box and let me get a new one!  They are my new favorite store!)

I still have another 15 or so pounds to go.  I still have to incorporate exercise into this experiment.  I definitely understand my patient’s issues when it comes to weight loss and exercise and I hope they see this.

Here are a few tips. 
Don’t eat out.  Don’t eat out.  Don’t eat out. 
Eating out was my undoing.   I didn’t realize how often we were eating out or ordering in until we stopped. 

Try new foods. 
I am trying new foods and I’m trying old foods in new ways.  For example, I am making a type of chili with bulgar wheat instead of meat.  I love bulgar wheat but always had it in traditional middle eastern dishes, like tabouli, or a pilaf like dish.  I made eggplant rollatini  which is kind of like eggplant parmesan but with a lot less ricotta cheese, and with pre-roasted eggplant slices and with a homemade quick tomato basil sauce.  My daughter’s best friend told me she hates eggplant normally, but loved the eggplant rollatini  Get recipes from the “Cooking Light” magazine or it’s website.  They have great recipes.  Weight Watchers web site also has wonderful recipes.  If you are cooking for one or two, cut the recipes in half, or freeze half of the prepared food in single serving containers. 

Cut way back on salt. 
I didn’t realize how salty my food was until I stopped eating so much processed food.  My ankles don’t puff up at the end of the day like they did. 

Buy a leather punch.  (My belt is suddenly too big!  Hurrah!  I need to punch a new hole in it!)

Keep a sense of humor. 
Have a cookie now and then.
Realize that this is a lifestyle change and will take time to get used to. 
Develop a new habit of making a menu weekly and shopping to it.
Cook the foods you have on your menu instead of letting the ingredients turn into compost in your refrigerator. 
Keep plenty of healthy snacks handy.
Don’t let yourself get so hungry at the end of the day that you eat ravenously when you get home. 
Include the kids in preparing meals.  (They’re more likely to eat the food if they help to make it.)
Drink a lot of water. 

Most importantly, do something big to announce to everyone that THIS IS IT.  You’re making a BIG change.  For me, it was a drastic hair cut.  I went from a “below the shoulders” style (usually pulled back so my hair was not in my or my patient’s faces) to a short  bob.  People say they “like my hair cut” and I announce that I did it because Dr. Tong yelled at me to lose weight so this was my way to start the whole process...with a big change in my appearance. 

Let’s keep going!  Another 10 pounds is my next goal, as is incorporating exercise. 
Feel free to leave comments!

Shhh...The Secret To Hunger

I don’t know about you, but in my family, we are so busy during the week, that we have to do all the chores on the weekend, in between all the kid’s activities. 

Today, I did 4 loads of laundry in between cleaning the bathroom, straightening up the living room and yelling at the kids to clean the closet out.  I  vacuumed the living room and dining room, swept the kitchen, swept the basement stairs, changed the cat litter and cooked a roast chicken.  I made Pork Cacciatore, and Morrocan Slow Cooker Stew whilst harassing my kids to do their homework.  I stripped the bed and threw the garbage out.  Juan mowed the front lawn and covered the air conditioners and helped my son with physics homework. He helped me with the cooking and prep work and carved up and put away the chicken and did the dishes. 

Here’s a first.  I forgot to eat.  Therein lies the Secret!  You just have to have too much stuff to do and you’ll forget to eat. 

My house always looks like a tornado went through it.  For some reason, my children think the floor is a fine place to drop their coats, hats, gloves, candy wrappers, etc.  When asked to pick up, they don’t seem to see the mess. 

My family's inability to see clutter is my fault.  I am most definitely not a neat freak.  We have books and magazines and papers all over the house.  We are a house of readers.  I have been trying to convince my husband that if journals are over three months old, they must go out.  Most medical journals are on line now, too.  But with bifocals, it’s a bitch trying to read on the computer.  Also, he is sentimentally attached to paper.  It's the same with his New Yorker Magazines, and the Sunday NY Times Magazine and Book Review sections.  We also have at least 2 new history books a week from the History Book of the Month club that he was supposed to quit, oh, about 2 years ago.  We’ve run out of bookcases, and the books and journals are stacked up under our bed, alongside the bookcases, in the basement, and anywhere there is space. 

I have TRIED to maintain order.  I have instituted chores.  Theoretically, my children are supposed to do all the housework, but lately, with Science Fair, with incredibly huge amounts of difficult homework that takes hours to complete, with Boy Scouts and basketball, my Irish Work house has fallen by the wayside.  I have to do more of the chores myself now.

I am running out of time during the weekend to get everything done.  Hence, I forgot to eat.  Juan forgot to eat too.  We realized we'd forgotten to eat when Juan asked me, "I wonder why I'm so  crabby?"
I asked, “Have you eaten?”
“I’m not hungry,” was his reply.
I said, “Trust me on this, eat something!”  (When he's crabby, he's either tired or hungry, and usually doesn't realize either one!)

Juan ate and realized, he was hungry.  So I ate.  I was hungry too but just didn’t realize it.  How’s that for crazy?  Most of the time I eat even if I’m NOT hungry.  This is usually NOT a problem for me.

There it is.  The secret of appetite suppression is to have too much stuff to do in the amount of time you have to do it!

Uh Oh.  Maybe I shouldn’t tell my kids this, or they’ll make me thank them for being slobs.  They might even leave more for me to do on the weekends and plead homework as a way to get out of chores. 

Let’s keep this little secret between you and me. 

Scale Died. RIP

Once again I’m having issues with my scale.  You may recall that several weeks ago, I bought a brand new digital scale to record my weight as I go through the process of making big lifestyle changes.  I personally found this to be a difficult process.  My old scale was so much kinder to me.  It was like your husband.  When I’ve asked him, “Do I need to lose weight?  Am I fat?”  He always wisely and kindly said things like, “I love you just the way you are!”    Only once did he deviate from his usual non-answer and say, “You know, tight clothes aren’t flattering.”  My old scale underweighed me by ten pounds.  It was like a friend. It said,  “You’re okay!  You’re not THAT fat.”

My new scale was like a drill sergeant.  It was digital.  It was stark.  It had decimal points.   It screamed at me and said things like, “Your OLD scale would say you’d lost a whole pound, when in fact, you only lost 0.4 lbs.” 

My new scale died.  I can’t even believe it.  It was a month old and it died.  I put new batteries in it and it cannot be revived.  Is it because it was mean?  I think I’ll bring it back to Target and see if I can get a replacement.  I don’t have the box or the receipt, but the sticker is still on it that says, “Tap here and wait for the 0.0 before weighing”.  I hope they take it back. 

It’s so weird, but I feel lost without it.  I even have had the passing thought that I could CHEAT now and no one would be the wiser!  It’s like when your teacher leaves the classroom to answer a phone call or to go to the bathroom and the entire class erupts into a loud chattering which promptly stops when she returns.  I am in the “talking when you’re not supposed to “ phase of not having a scale. 

Measurements are SO important.  I had NO idea how much so.  Having that feedback is really important.  I COULD weigh myself at the office, but I think the staff might frown on me standing naked in the middle of the office on the scale.

My mission this week is to get a new scale and to stay on the straight and narrow path of eating well.  I had the kids hide the Boy Scouts Triple Chocolate Popcorn from me.  My son was taunting me this morning.  “Don’t you want to know where the popcorn is, Mom.”   
“No.”
“Oh, come on.  Guess where it is!  Just guess!”
“No.  I really don’t want to know.”
“Yes you do!”
“No I don’t.  You can dole out 1 cup of the popcorn for me and then I can stop.  If it’s out, I’ll just keep eating it.” 

I think he was disappointed.  The kids seem to want me to fail.  I don’t get it.  It could be because we’re not eating out much anymore. They’re going through pizza withdrawal. 
As long as the Triple Chocolate Popcorn is out of sight.....

Brownies

Yesterday was a  “fail” as my kids call it. 

It didn’t start out that way.  I was doing GREAT.  I ate a fabulous breakfast of shredded wheat with some granola and craisins and skim milk.  At lunch, I ate a salad with a tiny bit of lasagna on the side. 

Then----DUH, duh, DUH----I caved in to the brownies. 

This started a downward spiral.  I got home and had no time to really eat a meal before schlepping off to my son’s Boy Scouts meeting.  So I snacked on some yogurt (Fage yogurt is unbelievably good if you haven’t tried it) and pretzel chips with hummus. 

Okay-not bad, right?  If only I’d stopped there. 

I got home at 8:30 and instead of stopping, out came the leftover shrimp in lime and butter sauce and more pretzel chips and hummus.  I went WAY over my points yesterday.

This is what I like about Weight Watchers.  They KNOW you’re going to have epic failure days.  They build in extra points for the week so if you screw up, you haven’t really blown it.  They count on your being human and having bad days and add in a buffer zone of extra points for the week to “splurge” on. 

Normally, I only use a few of these extra points a week.  This week, well, I suspect I won’t lose any weight because I have used more.  But I’m still writing everything down and watching.  I figure that this is a process.  Mark Twain said that he thought quitting smoking was easy!  He did it thousands of times!  That’s kind of like making this change.  I’ll start over every single day.  If I mess up one day, Oh well!  I’ll just try again tomorrow.  There’s no sense making myself miserable because then I’m doomed to fail from a sense of overwhelming guilt.  Guilt will kill this whole project. 

One Day at a Time also applies to giving up alcohol amongst other things, and counting on your support group to keep you in line.  Thanks support group!

Prohibitions

Prohibitions

I began to think about this topic after watching Ken Burns’ special “Prohibition”.  In some ways, my being able to succeed (so far) in watching what I’m eating is because I decided MYSELF, to make the changes from my previous diet to the new one.  If I had been TOLD that I couldn’t have chocolate or other foods I like, I likely would have rebelled and gone out of my way to get some.  As it is, I have a little bit of less healthy foods, but self regulate my portions. 

It’s human nature to rebel against prohibitions.  At least in America, it is.  When people were told they COULDN’T drink at all, suddenly all sorts of criminal enterprises came about to supply the sudden increased desire for alcohol. 

Lately, it seems like our government is legislating a lot of things which deny people the things they think they want.  I think, in some cases, they’ve learned lessons from prohibitions’ failures.  Instead of outlawing cigarettes, they’ve regulated them to death.  You CAN smoke, but only in proscribed places.  No one has said you’re not ALLOWED to smoke.  I think if that happened, we’d see a boom in smoking and in bootlegging of cigarettes.  Already bootlegging from lower taxed states (and Indian reservations) is a problem.  But, this strategy has mostly succeeded and the rate of smoking has overall decreased. 


Dieting is sort of like that.  If I were told I wasn’t allowed to eat certain foods, I would crave them.   People have proposed to put higher taxes on junk food like soda and chips and cookies and such.  I think that people would self regulate if they had to pay more to eat at a fast food restaurant, or to buy soda or chips.  Part of their allure presently is that they’re cheaper than healthier foods.  Would we be able to subsidize farmers better with taxes on junk food and fast food so that healthier foods could be cheaper? 

I like high fat and high sugar foods as much as the next person.  I am not a food evangelist who goes out and says that these foods should be outlawed.  People would find a way to get them somehow if they were.  I do recognize the value of moderation though.  It turns out that after the repeal of prohibition, fewer people drank because there were laws with age limits, closing times for bars and restaurants, and laws about public drinking.  People moderated themselves because if they didn’t, they’d pay for it. 

I wonder if some of the plans larger corporations have started, with gyms at work, nutrition counseling and rewards for weight loss like better costs on health care are working?   They’ve made healthier foods at their cafeterias less expensive than less healthy foods. 

Would punishing people who have lifestyle related diseases with higher costs for health insurance work?  I kind of doubt it.  By that point, it’s too late.  The damage is done.  If you don’t cover those people with health insurance, someone will be paying for it, eventually.  Uninsured or poorly insured people delay care and then come in to the hospital unable to pay for the very expensive care they need. 

I think the trick is to make it seem like it’s not a prohibition against bad lifestyle choices, but to regulate those bad choices.  Making bad choices should be more expensive, and making better choices should be less so.  My husband has noted that our grocery bill has gone up a good bit since we’re shopping to a menu which includes a lot of fresh vegetables.  That’s okay for us, but I know it’s not okay for many people that I take care of in my practice.  They make choices between paying for food, medicine, rent, and utilities.  Cheaper food is often the only choice available.  Supermarkets are unable to survive in poor neighborhoods because their products are too expensive.  Subsidize the costs of healthy food with taxes on less healthy foods and I wonder if that would make a difference?  Has this experiment been done anywhere? 

I really hope they never outlaw chocolate.  I’d have to become a criminal. 

I'm BACK...The DoctorDiva talks about Osteoporosis

The Doctor Diva has been on a writing hiatus.  She has been very busy working on her “Practice Improvement Module”  (PIM) for the American Board of Internal Medicine in order to complete her Board certification.  In fact, she is not done...and she likes to refer to herself in the third person!  She keeps WRITING DOWN EVERYTHING SHE EATS IN THE WEIGHT WATCHERS POINTS TRACKER!  It really helps her.  Occasionally she thinks about lying.  Is that stupid or what?  Who is she lying to? 

Okay, I’ll stop referring to myself in the third person.  It’s just too hard, anyway.

I have made some progress on both the diet/weight loss and the PIM.  I’m down to 193.3 lbs.  Or at least I was yesterday.  I had a couple of Snickers minis yesterday so all bets might be off today.  I’m not checking though.  I earned those Snickers. 

SO, I thought I’d share with you some of the stuff I’ve learned about osteoporosis. 

Your bones are like a bank account for calcium.  You make deposits and withdrawals at different times of your life and for different reasons.  As a child and teenager, you need to build up your account and add calcium.  Most women reach peak bone mass at 18 and men by 20.  You can add bone density up to about age 30, and then, for women, you stay about the same until menopause.  Then you start to lose bone density pretty quickly for a couple of years after menopause. 

Girls who don’t get their periods until late, who are anorexic, who over-exercise or are underweight or don’t have regular periods, may never reach peak bone density.  Also, girls tend to stop drinking enough milk in their teen years and may not reach peak bone density.  African American children tend to have higher bone density for reasons unknown. Oral contraceptive use seems to improve bone density.

SMOKING.  Don’t do it.  It causes you to get osteoporosis, amongst other things. Same with alcoholism.

Calcium is key.  You need a lot more than you think.  You would need to drink 4 glasses of milk a day to get enough.  SO:  Premenopausal women should take Calcium 500 mg twice a day and postmenopausal women should take 600 mg twice a day plus.  You have to split dose it because your body can’t absorb it all at once.  And make sure you drink enough water to prevent kidney stones.

Vitamin D.  You need it, especially if you live in Chicago, where I do.  I have found that almost ALL of my African American patients are profoundly Vitamin D deficient.  I have found through trial and error, that to get to a level of 30, which seems, (despite the controversy) to be the number to get to to prevent secondary hyperparathyroidism, you  need about 2000 IU of Vitamin D3 a day in Chicago.

Other risk factors include: family history, taking certain medications  like steroids, dilantin or phenobarbital, breast cancer anti-hormone drugs, cancer chemotherapeutic drugs (a certain friend needs to consider this carefully), Lithium, heparin, drugs for ulcers like omeprazole, thyroid hormones in excess.  Remember, though, that calcium can decrease absorption of other medications, so take it separately from other medications! 
Also, don’t stop the  medications you are taking!  You SHOULD talk to and remind your doctor (including me) that you are at risk for osteoporosis and that we should CHECK! 

How does one find out?  Well, I’m glad you asked.  There are a bunch of tests you can get done to check.  At the malls or health fairs you’ll sometimes see a heel ultrasound set up to tell you if you are osteoporotic or osteopenic or normal. 
These are okay, but the gold standard is a test called a DEXA or “Dual Energy X-ray Absorptiometry”.  (Yeah, that’s why we call it a DEXA).  It is a quick, low dose X-ray that measures the bone mass in your lumbar spine and your hips. 

Osteopenia means that your bone density isn’t normal (T-score of -1 to -2.5), but it isn’t severely decreased (osteoporosis T-score -2.5 or less), yet.  You can’t do a DEXA in a child or very young adult because it will overestimate osteopenia because they haven’t reached peak bone mass yet.  It is recommended mostly for women over 65 and men over 70, but we do it after 50 if you have certain of the risk factors above, including a low impact fracture (broken bone).  If you have osteopenia with a T-score of -1.5, you may have a 16% chance of fracturing a hip and a 27%-33%  chance if you have at a T-score between -2.0 and -2.5.  Scary, huh?

Prevention:  EXERCISE!  Walk, bike, hike, play tennis, run!  Do weight bearing exercises!
Take Calcium and Vitamin D every day!  (I need to remember to do this too!)
Make sure your daughters and sons drink milk and get their Vitamin D!  (check with your pediatrician for dosing!)

Treatment--another whole topic!

I have also learned a bunch about fall prevention too...but I’ll save that for another day.

So AGAIN with the Damned Exercise.  I hate exercise.  I need to find a way to make it fun.  I’m thinking, maybe Zumba?  I tried it on my Wii, but my coordination is the pits and the kids kept making fun of me. 
I like to walk, but I live in Chicago and it isn’t always safe for a woman alone to go walking. 
I’m working on it.  I want Michelle Obama’s guns!  She is so cool.  That’s MY goal.

And now for Something Completely Different--Vaccine Preventable Diseases

Meningococcal Meningitis

The measles in a 2 year old.

German Measles (Rubella) 

Chickenpox in adults can spread to the lungs and kill adults and children alike

Cervical Cancer from HPV

 I have a friend who just had a stem cell transplant for CLL.  Please read this blog entry.  He put forth the need for vaccinations better than anything I’ve ever seen by making it personal. His whole blog rocks though...:  Journal from the Plague Year:

http://journalfromtheplagueyear.blogspot.com/2011/10/herd-immunity.html

The Diseases:
Influenza:

Influenza disease:  is a respiratory virus that causes a high fever, generally 102, although not all will get a fever,  severe muscle aches and pains,  stuffy nose, sore throat, fatigue, and cough.  Some people get vomiting and diarrhea, but that is more common in kids.
Complications which can occur include post influenza pneumonia, bronchitis, ear infections and sinus infections and death.
People with the following problems are at higher risk:   asthma or COPD/emphysema, Diabetes, those over 65, pregnant women, People with HIV/AIDS, people with cancer. children younger than 5 and especially younger than 2.


Measles:

There is an unexpectedly high number of cases in the US this year.  Measles had been declared eradicated in the US in 2000.  The cases are imported from abroad where the disease is still rampant.  These unvaccinated US travelers got sick and brought it back to the US and spread the disease in our communities because NOT ENOUGH people are vaccinated now.  Most of the people who got sick in the US from these people were unvaccinated or under vaccinated.

Measles causes fever with rash, cough, runny nose, conjunctivitis.  One out of 10 kids get an ear infection and 1 out of 20 get pneumonia.  For every 1000 children who get measles, one or two die.

Measles is preventable by taking a vaccine. From the following CDC.gov website:
http://www.cdc.gov/measles/vaccination.html#coverage

“Measles can be prevented by the combination MMR (measles, mumps, and rubella) vaccine. In the decade before the measles vaccination program began, an estimated 3–4 million people in the United States were infected each year, of whom 400–500 died, 48,000 were hospitalized, and another 1,000 developed chronic disability from measles encephalitis. Widespread use of measles vaccine has led to a greater than 99% reduction in measles cases in the United States compared with the pre-vaccine era, and in 2009, only 71 cases of measles were reported in the United States.
However, measles is still common in other countries. The virus is highly contagious and can spread rapidly in areas where vaccination is not widespread. It is estimated that in 2008 there were 164,000 measles deaths worldwide—that equals about 450 deaths every day or about 18 deaths every hour.”

Go to the CDC website to read about the vaccine.  It does not cause autism.

Mumps:
There is an ongoing outbreak of mumps in highly observant Jews in Orange County, NY and in NJ. This is a community where there was a high amount of vaccination with 1-2 doses of MMR.  Turns out the mumps vaccine isn’t as effective so in order to prevent person to person spread, you need to make sure even MORE people are vaccinated with 2 vaccine doses.  In this outbreak, they were giving a 3rd dose of MMR to increase the immune response in the schools affected.  It didn’t spread much outside the observant Jewish community.  Speculation includes that possibly the surrounding communities had a higher vaccination rate, or there just wasn’t much intermingling of the affected community with their surrounding non Jewish neighbors.
This article explains it well.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5905a1.htm

Mumps causes fever, headache, muscle aches, tiredness, loss of appetite and swollen and tender salivary glands under the ears or jaw on one or both sides (parotitis).  Most people fully recover. but boys who have reached puberty can get inflammation of the testicles, girls who have reached puberty can get inflammation of the ovaries or breasts.  Meningitis and encephalitis (brain infection) can occur.  Deafness can occur and may be permanent.  It is spread by saliva or mucous from the mouth, nose, throat.  It can be spread by sharing drinks, utensils, touching virally contaminated surfaces(counters, toys, doorknobs, toilet handle etc.).

HPV:
is the cause of cervical cancer in women and head and neck cancers in men.  It causes anal-rectal cancer in people who engage in anal intercourse.  It can cause throat infections through oral sex.  It can be passed through straight and gay sex.  Pregnant women can spread it to their babies during delivery causing warts to grow in the babies throats (Recurrent Respiratory Papillomatosis).  It also causes genital warts.  The types of HPV that cause genital warts aren’t the same as those that cause cervical cancer.
At least 50% of sexually active people will get HPV at some time.  In 90% of the cases, people clear the infection and are fine.  BUT there are over 40 HPV virus types.  Most people don’t even know they have an infection.
There is a vaccine available for boys and girls to prevent them from getting the types of HPV that can cause cancers.  Here is the link to the CDC website:
http://www.cdc.gov/std/HPV/STDFact-HPV.htm#common

Getting the vaccine does not mean that you are condoning premarital sex.  Where did that idea come from?  Would you deny your child Hepatitis B vaccine for that reason?  C’mon now.

DIPTHERIA:
Who’s ever heard of this?  You know why?  We practically never see it here because of immunization against it.  There are only about 5 cases a year in the United States.  It’s in the routine Tetanus vaccine.  In the 1990‘s, when they took it out of the tetanus vaccine in Russia  a while back, it made an amazing recovery and caused many cases and many deaths.  They used to call it the “strangling angel of children”.  It was a leading cause of death in children.
Diptheria is a bacteria that is spread by coughing and sneezing, or contaminated food or objects (milk, utensils).  It infects your throat and nose and causes a gray/black fibrous like covering which can block your windpipe and suffocate you.  It can cause skin infections like above.  Then, once it infects you, it makes a toxin (a chemical poison) that can spread to your heart and cause inflammation of your heart and other organs.  You turn blue, get a watery nasal drainage, have great difficulty breathing, get chills, a barking cough, drooling, fever, painful swallowing and skin lesions may occur in tropical areas of the world.


MENINGOCOCCAL MENINGITIS

Meningitis is an inflammation of the membranes which cover the brain and spinal cord.  Meningococcal meningitis is caused by a bacteria and occurs mostly in children and adolescents.  It is the most common cause of bacterial meningitis in children and the second most common cause of bacterial meningitis in adults.  It occurs in winter or spring and can cause epidemics in boarding schools, dorms, and miltary bases.
It causes sudden onset of fever and chills, altered mental status, nausea and vomiting, purple bruise like areas (purpura) and pinpoint red spots (petechiae), light sensitivity, severe headache, stiff neck, rapid heart rate, and rapidly progresses to death within 24 -48 hours.  The death rate varies from 5-15%.  Young children and adults over 50 are at highest risk of death.  It can cause permanent hearing loss, heart inflammation, seizures, brain damage, seizures, if you survive it.  It is preventable by getting the vaccine, washing hands before and after changing a diaper or after using the bathroom.
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001633/

TETANUS

Also known as lockjaw.  It’s caused by a poison made by a bacteria called Clostridium tetani.  The spores live EVERYWHERE and can remain infectious for 40 years.  When the spore gets into a deep wound where there is little oxygen (hence “stepping on a nail” being a risk), the spore releases the bacteria which then makes a poison.  The poison stops the nerves from working and the muscles all over the body go into spasms so severe that they can tear muscles and break bones, especially in the spine.  It starts with mild spasms in the jaw (lock jaw).  The muscles in the chest, neck, back, and abdominal muscles can spasm too. “ Opisthotonus” is when all the back muscles spasm causing the back to arch and to break the vertebrae.
The spasms can affect breathing.  Loud noises can exacerbate the spasm.  They can have difficulty swallowing, uncontrolled urination and defecation, irritability, foot and hand spasms  and drooling.  Often you need to be in a dark room, on massive doses of muscle relaxers (valium like drugs), and to be on a breathing machine.
One out of four will die if not treated.  Newborns with untreated tetanus is even higher.  WITH treatment, < 10% die.

I’ve seen this in a patient from Mexico after childbirth and cutting of the cord with an unclean knife.
This disease is completely preventable with TdaP vaccine, dT vaccine boosters every ten years.  after the primary series is finished as a child.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001640/

SMALLPOX

Small pox is a virus that only infects humans and has been completely eradicated by vaccination.
The disease was eradicated by 1980.  Without vaccination, millions would still be dying from this terrible disease.  It is believed that Pharaoh Ramses V died of smallpox because of scars found on his mummy.  In the 18th century in Europe, 400,000 people died YEARLY of smallpox and 1/3 of the survivors went blind.  20-60% of the infected died from it.  It was 80-98% fatal in London and Berlin during the late 1800’s.
Here is a great article on the history of smallpox:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200696/

POLIO
Polio is a virus that can cause paralysis.  It is spread by person to person direct contact, mucous or phlegm, or feces.  It grows in your gut and then spreads to your blood and lymph and then causes symptoms.  Children, the elderly and pregnant women are at the highest risk during an outbreak.
Polio has virtually been eradicated in the US.  Outbreaks still occur in other countries amongst those not vaccinated.  It only exists in a few countries in Africa and Asia now.
It has two forms, paralytic, and nonparlytic.  It involves the brain and spinal cord.
It can cause back pain, diarrhea, fatigue, headache, irritability, leg /calf pain, moderate fever, muscle stiffness or pain or spasm, neck pain and stiffness, stiffness in arms, legs, abdomen, or back, rash, vomiting.
Paralytic polio causes abnormal sensations in an area, bloating, breathing problems, constipation, difficulty urinating, drooling, headache, muscle contractions, spasms, pain, and weakness that is only on one side or worse on one side.  stiff neck and back and difficulty swallowing.
I remember my father talking about not being able to go out to the pool because of outbreaks.



 

Polio NOW

Small pox affecting the eyes. It was around up until 1967 in millions

Tetanus in a baby...muscles all in spasm

s

Plateau Formations

Plateaus, Plateaus Information, Facts, News, Photos -- National Geographic

I’ve reached a plateau.  If you read the above article by National Geographic, the definition of a geologic plateau is somewhat similar to my situation.  Over decades, forces have lifted up my adipose (fat) tissue and it’s been sculpted into mesas, buttes and canyons.  My butte has become quite massive.  My mesas are kind of lumpy, and my canyons, well, we’re in polite company here. 

The forces that cause a plateau seem to be enormous.  Magma erupts through the crust and forms large plateaus, like the Tibetan Plateau, or the Colorado Plateau.  I’ve just reached a previously unknown plateau (The Carlon Plateau) and the forces that have caused it are just as great.  Inactivity and Menopause.  Well, Perimenopause.  And the Internal Medicine Board.  I believe that the stressors to the plateau were definitely great. 

In the past, my buttes and canyons and mesas were easily worn down by decreasing my dietary intake and exercising.  I could lose twenty pounds easily.  I would lose at least 2 lbs a week and would be able to keep it off without any problems.  Unfortunately, the magma of menopause is fighting my metabolism.  (I always wondered why you got hot flashes-now I know!  It’s magma!)


According to the Mayo Clinic website: “In fact, some research suggests that gaining as little as 4.4 pounds (2 kilograms) at age 50 or later could increase the risk of breast cancer by 30 percent.”
 http://www.mayoclinic.com/health/menopause-weight-gain/HQ01076/NSECTIONGROUP=2

They stated that losing weight is definitely more difficult in the perimenopausal time frame.  Well, that just sucks.  I’ve reached 194 pounds and I’m stuck.  My clothes definitely fit better, and I feel better but I still am plagued by the American Board of Internal Medicine making me rush to finish a Patient Improvement Module or some such thing.  So, instead of free time to start exercising, I’m bringing home more and more work to do. 

The Mayo says that you have to become active.(needs improvement)  You need to decrease calories (done).  You need to have support.  (done--this blog is keeping me in line.  Thanks Guys!).  There is only one thing left to do. 
Damn.

Chinese Take Out and The Compost Cake

The Actual Cake!

Not Our cake.  Pictures of our compost cake to come...Stay tuned.

I succumbed to exhaustion last night.  I ordered Chinese Take Out. 

Today, Saturday, is my Number One Son’s birthday.  We have a tradition of making each kid a birthday cake ON their birthday.  It started out when the kids were really small and I had a book of cool birthday cakes to make.  Each kid would pick out a cake and we would make it.  Stars, hearts, alien spaceships, desert Island cakes, Monkey heads (that was for my husband), dinosaurs, etc., have been the subject of a cake.  This year, my son wanted a cake that looked like a compost pile.  He had been planning this for MONTHS.  He designed it and got some more ideas from an internet compost cake (Yes, someone had already done it!)  Last night we realized we had to go to the grocery store and buy the ingredients to make the cake today. 

We hadn’t eaten dinner, and I was exhausted.  I knew that venturing into the grocery store was a dangerous event on an empty stomach.  I fortified myself with some cheese and steeled myself to venture down the aisles I never visit at the grocery store. 

Off we went.  The funny thing is, the kids were AMAZED at how much candy and junk food the grocery store sells because we just skip the two or three long aisles of “crap” when we shop.  We really do shop the perimeter of the grocery store and venture down only the frozen food and dairy aisles, and the paper goods and cleaning items aisles.  We had difficulty finding the stuff we needed because we didn’t know what aisle things would be in. 

We managed to purchase the cake mix, the icing, the pretzel rods, the gummy worms, the oreos (to crush into “dirt”), the vampire and wolfman gummies (it’s an unorthodox compost pile), and some Hersheys “drops” which look like rocks.  The kids then realized THEY were hungry and so we went to the Chinese Take Out in the strip mall to order some food. 

I was not starving.  That was good. 
Previously, in my “Before the Phone Call from My Doctor” Days, when we ordered Chinese, we would order 3 or 4 things and have leftovers for  a few days.  Usually we ordered deep fried stuff, stuff with nuts in it (Kung Pao) etc.

I was able to look at the menu and remember that fried, breaded, coated, and sweet and sour stuff were probably not kosher to eat on my new regime.  My daughter wanted egg drop soup, my son wanted Orange Beef (definitely NOT on the list of good stuff) and so I got the tofu and vegetables Yu Shan.  (brown sauce and spicy). 

Usually the danger is that I will fill my plate and have seconds because it tastes so good.  This time, I used a luncheon plate for myself, measured out (eyeballing it) the rice and only took 2 pieces of orange beef and filled the rest with the vegetables and tofu.  I had 1/2 cup of egg drop soup.  Then I cleaned up.  You see, if the food sits out, then it is really easy to have seconds, and to snack on the crab rangoon or the egg rolls.  Fortunately, fortune cookies are only 25-45 calories apiece! 
My daughter set her alarm to 6:30 this am to help me make the cake.  We’ll wait for my son to wake up in order to decorate the cake because therein lies the fun!

 I feel really bloated from all the salt in the food last night, and I’ll skip the scale and be happy with the 195 I got yesterday.  I am six pounds down from the doctor’s office scale.  Now I’ve got to find a way to exercise.

The Best Laid Plans

The Triple Whammy

Yesterday was the Trifecta of bad days.  Poor sleep, stressful situation (the Boards Exam) and a short time to eat between sections.  Add the overwhelming exhaustion after I got home and didn’t feel like cooking and it could have been a disaster of a day for sticking to my new lifestyle modifications. 

I was absolutely exhausted before the test because I just couldn’t sleep.  Robert Burns Poem “To A Mousie” kept running through my head, “The best laid plans of mice and men often go askew”. 

I chugged iced coffee between the first and second parts of the test.  I was assailed by a food court of wonderful choices, some not so good for you.  I didn’t want to eat heavily and get post-prandial sedation, so I chose sushi.  I chugged another iced coffee.  On the way home, I stopped at an artisanal cheese shop and ordered goodies for the family to try (Camembert, 2 types of brie, a sheep's milk cheese from Wisconsin, some Spanish ham, and a baguette) but didn’t eat any until after dinner with the kids.  We ate leftovers while I stared at the wall and recovered.  I went to bed early. 

My husband is studying for the sleep boards.  He informed me that it is true that poor sleep causes weight gain.  Also, staying up late causes weight gain.  Many people snack when they stay up late.  Many eat to STAY awake.  Then, there are sleep eaters, more common on psychotropic drugs like ambien.  They eat but don’t remember it and they gain weight.  Sleeplessness slows down your metabolism, according to him, but I need to look that one up myself. 

In MY experience, when I’m exhausted, I just stop caring.  I will eat the easiest thing to eat just to get it over with.  Often, that means things which are easily attained, like ice cream, or take out.   If I hadn’t had the left overs from the weekend, I could have ruined my attempts quickly.

Tonight is my late night at the office.  Usually, I bring 2 lean cuisines, one for lunch, one for dinner, and some fruit or baby carrots to much on as a snack.  Unfortunately, my kids ate all the Lean Cuisines and there’s nothing to bring except left overs.  Juan will make shrimp tacos for the kids for dinner tonight.  I’ll probably bring the leftover flank steak in chili sauce and a couple of corn tortillas. 

But remember, The Best Laid Plans of Mice and Men....oft go askew.  Hopefully I won’t go askew. 


Here's a link to Robert Burns' poems:
http://www.robertburns.org/inenglish/extracts.shtml#toamouse

Potato Pancake Envy

Yesterday, the kids had Kasias’ Potato Pancakes for breakfast.  They looked and smelled really, really good.  I  wanted one.  I could have had ONE, but everyone knows you can’t just eat ONE potato pancake, and in addition, although they’re good with apple sauce, they’re GREAT with sour cream.  So, I walked away.  I had Potato Pancake envy. 

One small battle in the war won.  At least I haven’t insisted they eat brussel sprouts .

Today I'm taking my Boards Recertification Exam.  Think of me and wish me well.

The "Brussel Sprouts Incident"

My sister and I were talking yesterday about the time my mother got a bug up her butt that my sister HAD to eat the  brussel sprouts she’d served at dinner one night.  We think my sister may have been about six years old or so at the time of the “Brussel Sprout Incident”.  It was an early sign of things to come because my mother hadn’t counted on my sisters ability to be so obstinate.  Who feeds a six year old brussel sprouts and really expects them to LIKE them?  It takes introducing a food to a kid about 10 times before they like it, or so I’ve read. ( My kids will eat just about anything).  My sister refused to eat them.   Mom insisted.  Mom said she couldn’t leave the table until she’d eaten them.  Mom left her in the kitchen and turned out the light after we’d finished dinner, leaving her in the dark with her brussel sprouts.  “Even the dog wouldn’t eat them!”, she told me.  She sat there in the dark for 3 hours until my mother dismissed her to bed.  My sister still hates brussel sprouts.  (And she’s still obstinate).

 I suspect that brussel sprouts give her PTSD. 

Elastic Recoil

recoil /re·coil/ (re´koil) a quick pulling back.

"elastic recoil -- the ability of a stretched object or organ, such as the bladder, to return to its resting position."
Dorland's Medical Dictionary for Health Consumers. © 2007 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

One of the down sides of aging is that your body just doesn’t react the way it used to.  For example, it is a lot harder to get in shape, and to keep a shape. In other words, when we get older, our muffin top becomes a blob. 

When you are 20, your skin happily returns to it’s previous shape and maybe the only tell tale signs are some stretch marks.  Something really awful happens somewhere between 40 and 50.  Your elastic recoil, recoils. 

Suddenly, when you lose weight, instead of your abdomen and legs and arms going back to their usual normal shape, you have chicken wings, and loose wrinkly skin where you used to have a muffin top.  You look in the mirror and scream, “NO ONE TOLD ME ABOUT THIS!!!”   I look like my MOTHER!!!  What happened?

It’s like a pair of jeans getting fitted JUST for you , like a second skin, then suddenly you lose weight and they just don’t fit right.   That said, it’s much better to LOSE weight and get healthy if you’ve become overweight or obese as you’ve aged, and invest in “foundation garments” to hold it all in.  I’m just glad they don’t kill whales anymore for the “whale bone”  in said garments.


BTW, all of those lotions and creams and supplements do nothing for "cellulite" and lumpy skin.  The elastin is deep in the dermis where lotions and creams don't go.  So I guess the only thing to do is to exercise!
Boards are in 3  days.  Wish me luck.  I will start to exercise after the Board exams are done!  I need to banish my chicken wings and firm up my muffin top.  Oh let's face it, it's an entire muffin!

Boredom

Boredom is the enemy of anything worthwhile.

 I’m discovering that.  Beginning a healthy change in one’s diet (or “lifestyle modification” in medical parlance) is exciting, new, and at first, easy.  It’s like falling in love.  At first, every little thing about that person is new and cute and interesting.  You love being with that person, talking, touching, sharing.  Your friends will think you’re over the top because all you do is talk about that new special someone.  They don’t want to hear every single detail, but you tell them anyway because you’re excited!

Then you get married.  Life settles into a predictable routine and suddenly you discover that the cute little snort your partner makes when he laughs is really NOT cute, but annoying.  You feel annoyed sometimes and don’t want to talk.  You discover the WORK of marriage.  You realize it’s worth it (if you’re smart), and you learn to forget the arguments, overlook your loved one’s faults, and love them anyway. 

That’s what getting healthy is like.  At first, all the new habits you’re developing are new and exciting.  In diabetics, we talk about the “honeymoon period” where the diabetes goes from horribly, awfully, controlled, to unbelievably good.  The patient loses weight, eats right, and their labs come back fantastically good.  Three or four months later, the patients’ weight starts to creep up.  “I went on vacation, (a cruise is the worst) and stopped watching, stopped exercising, and when I got back I didn’t get back into my routines.”

Getting healthy is changing your routines.  At first, because they’re new, all your friends know you’re “on a diet” and cheer you on.  You do fabulously at it.  You do all the right things, exercise, eat right, etc. and then.....something messes up your routine. 

I’ve read in multiple places that it takes 30 days of doing some new habit to make it stick.  I belong to a group called “Flylady” who uses this idea to get people to clean their houses and their lives.  She adds a routine a week  and sends out emails of encouragement daily.  It works, but you have to do the routines daily.  She stresses that you need to just START.  She uses a timer.  The enemy is Perfectionism because you think you can’t get things done so you never start.  She encourages you to  just do 15 minutes, or 10 minutes and STOP.  It’s okay if you don’t finish.  Do 15 minutes of a new habit daily.  Clean up a “hot spot” (a messy junk collecting spot) for 10-15 minutes a day.  I plan to eventually use this plan to get off my butt to exercise.  I’m trying to use this also for writing the blog. 

I saw a patient the other day who has been with me for the 16 years I’ve been in Oak Park.  She saw me through both children being born, and all the ups and downs of our practice.  When she first started with me, she was morbidly obese.  She joined Weight Watchers, and started exercising every day.  That was about 13 years ago. She lost probably about 100 lbs, and has kept it off.  I saw her the other day and she was very disappointed because she wanted to work for Weight Watchers and they told her she needed to have a BMI of 25 to work for them.  I think that is so short sited.  She has a BMI of 27, but has KEPT IT OFF.  She is healthy!  Tom Cruise, I read somewhere, has a BMI of 30.  It’s because he’s muscular.  She’s not in Tom Cruise’s shape but she has managed to keep her weight off, keep exercising, keep eating right.  She has so much to offer to those of us who are trying to establish good habits.  The point of this whole thing is to get healthy, not to be a fashion model, after all. 

So, set your timer (thank you Flylady!) and make a menu and grocery list.  Set your timer and start dancing around your house.  Start a daily healthy habit. 
Appreciate the fact that you are alive and have a chance to change and STAY that way!

Weekly Menu and Weigh In

Weigh in and Menu Making Day:
So far I’m doing really well, but I was beginning to feel deprived.  Seems I didn’t pick out enough recipes and make enough food on the weekend for the week.  I was inspired
yesterday by one of my patients though.  She made up her mind in February to change her life.  She changed her diet, and began training for the marathon.  She came in regularly to see me for a weigh in and occasional waist circumference.  I saw her yesterday and found out she had run the  marathon this past weekend and FINISHED IT!!!! WooHOOO! 
I’m not sure I could do that! 
Congratulations to her.  I was so excited I could barely contain myself.  She’s lost a ton of weight, and has lost about 4 inches in her waist circumference.  Isn’t that cool?

Okay, so here’s my weekly weight, before breakfast in my PJ’s. Drumroll please.......
194!  Yea!!!

Menu for the week:

Slow Cooker Southwest Hominy and Turkey Sausage Stew
Slow Cooker Flank Steak
Fish tacos
Bulgar pilaf with pistachios and raisins,
No noodle Vegetable Lasagna

Broccoli, clementines, apples, 4oz nonfat yogurts, and baby carrots for snacks. 
(I’ve discovered snacks are really important so I am not ravenous on the way home from work).

The Poop Report

Doctors are a warped bunch of people.  We talk about poop and get excited about different types of poop.    Well, we call it “stool” and “BM’s” to sound cooler.  But let’s face it, it’s poop.  In the hospital, when someone has a BM after surgery, we all cheer because it means their bowels have woken back up.

I had a professor in residency who was an old GI attending from South Africa.  He had a saying which has stuck with me my entire career.  It’s simple and it’s true.  He said, “Michele, you can divide the world into two types of people.  Those who look, and those who don’t.” 

Of course he was speaking of looking (or not) at your stool.  In my personal experience, about 75% of people look, and 25% are appalled to be even ASKED to look.  That is until they’re 80.  Suddenly, 90% of people look (for their health) and 10% look ALL THE TIME and tell you every single detail about it!

Now I understand this is an uncomfortable subject.  In my husband’s family, no one EVER talks about poop.  I found this out after the kids were born and I would try to give him information about the kids stools.  He started calling it the “Poop Report” and making fun of me for even bringing it up.  You see, in MY family, well, poop had the potential to be something to be very proud of.  We got the poop report every day from my dad.  He had his own classification system too.  There were “Bowl Wrappers”.  These were “healthy” BM’s that looked like a cobra at the bottom of the bowl, ready to strike.  We would gather ‘round the toilet to admire it.  There were “Torpedoes”.  Self explanatory.    I can’t remember the rest, or maybe I’ve blocked it out.  We also had a separate classification for those who had the uncanny ability to sense that someone was just settling in on the john  (or the “throne” as we called it).  Dad would think that it was safe to sit and read the paper and enjoy a good poop.  I would come running in screaming that I “had to go,” and was crowned  a“radar butt”  usually with a few expletives thrown in for good measure. 

I bring this up not to gross you out but to explain that Doctors have a stool system too.
It’s called the “Bristol Stool Scale”.  I thought about putting in a picture, but I’ll let you google it. 

Why in the world am I talking about poop?  Well, anyone who has made a drastic change in their diet knows that your poop changes too.  I figured it was all the fiber I was eating, but MAN!  This was just too much. (I’ll spare you the full poop report).  Anyway, it got me to thinking about fiber.  I’ve been reading labels lately. I noticed that they had fiber broken down into “SOLUBLE Fiber” and “INSOLUBLE fiber.”  It was more confusing than helpful.  I’m embarrassed to say that I didn’t know the difference and figured other people reading this wouldn’t either. 

So here goes.  Soluble fiber is just that.  Soluble.  If you put it in a glass of water, it dissolves.  In your stomach it becomes a big gelatinous mass and soaks up fat and sugar and slows down digestion.  Foods that have lots of soluble fiber include oat bran, barley, apples (not the skin) and similar fruits,  and legumes. They bring down your cholesterol. (Cheerios anyone?)

Insoluble fiber does NOT dissolve in water and goes through your digestive tract unchanged.  (think corn).  (Again with the poop report)
Wheat, corn, oats, barley, nuts, flaxseed and the skins of some fruits (apples and pears for example) are a good source. 

Insoluble fiber is like a broom, and soluble fiber is like a sponge.  Insoluble fiber gives your stool girth and bulk.  It fills you up so you don’t feel as hungry, and helps you lose weight.  Soluble fiber helps reduce your risk for diabetes  and lowers your cholesterol because it slows down the transit of sugars and fats and makes it take longer to absorb. 

So, your poop tells a lot about how much fiber you’re eating.  If you have constipation and rabbit pellet poop, well, start eating more fiber!  If your LDL is high, like mine, eat more soluble fiber.  Apples, oranges, oatmeal (the long cooking or steel cut stuff is best), barley, etc.  Become a "looker"! 

This has been your daily Poop Report. 

Willpower

“The trouble with resisting temptation is it may never come your way again.”  ~Korman’s Law

“Most people want to be delivered from temptation but would like it to keep in touch.”  ~ Robert Orben

“There is a charm about the forbidden than makes it unspeakably desirable.”  ~Mark Twain

Abstainer, n.  A weak person who yields to the temptation of denying himself a pleasure.  ~Ambrose Bierce, The Devil's Dictionary, 1911

I’ve been thinking about willpower today.  Today was a rough day.  There were so many opportunities for me to really mess up. 

What I’ve noticed is that willpower is not intestinal fortitude.  It is not a character trait.  It is a series of choices in which you make in a split second each time.

Think about it.  You find a wallet.  Do you keep the money?  You know the thought crosses your mind.  You end up trying very hard to find the person it belongs to and returning it.  You’ve made a choice. 

Today, it was the choice between the stairs or the elevator.  The elevator was WIDE OPEN!  It was screaming to me, “Come into the bosom of my comfort and muzak.  I will whisk you up to the fifth floor and you won’t experience the discomfort of climbing the stairs.” 
I took the stairs.  The elevator doors closed in disgust.

There was a birthday at our office today.  There was some really delicious looking cake sitting on the counter all afternoon.  “You know you want me.  Look at me all dressed up in this slinky sugar glaze, filled with pudding so creamy that your very being will transcend into light!”

I walked away.  Like 5 times.  It was like a siren call in the kitchen.  I lashed myself to my chair in my office using the phone to drown out the sweet siren song and answered phone calls and filled prescriptions.

I have figured out that willpower  is just a series of daily choices.  Willpower isn’t  a moral compass which tells you what is good and bad.  Not having willpower isn’t a lack of character.  Think about it.  What if you followed the credo to live each day as if it were your last.  Would you give in to the chocolate shake’s frothy call, or would you say, “Oh no, I’m hoping to have a great body for the casket later today.” (Probably not the best example, hm?)
It’s just making choices. 

I’ve discovered that it is a lot more difficult to make the choices which are harder when you’re tired.  I almost succumbed to ordering Chinese tonight.  “C’mon Mom, Let’s order Chinese! or Pizza!  You know you want it!” 

I did.  I really did.  I was very tired and didn’t want to cook. 

I was close.  Hand on the receiver....looking up the phone number....AGGGHH!  NOOOOOOO!!!!!

I found a quick shrimp stir-fry with zucchini and I added some other vegetables and made some Israeli whole wheat couscous.  It took 30 minutes, and the kids cleaned up.  More importantly, they liked it and stopped clamoring for take out. 

I will leave you with this quote:

“I generally avoid temptation unless I can’t resist it”  ~Mae West

The Art of Cooking Part II

Part II Learning How to Cook in the 1970’s and ‘80s and Beyond


I learned from TV that cooking could be fun.  “The Galloping Gourmet” was always a hoot to watch.  He would be plastered by the end of the show because he drank wine while preparing the food.  To his credit, he made a 180 degree turn around and became an advocate for alcohol restraint.  His food always looked great.   Then there was Julia Child, but her voice was a turn off.  And her recipes were too complicated. 

When I went to college, I learned to cook in self defense.  We had an apartment on campus during Junior and Senior year.  I became adept at creating masterpieces out of really inexpensive foods.  (Macaroni and cheese in the box became a tuna noodle and pea casserole).  My roommates and I would occasionally pool our meager resources and put together a real sit-down dinner.  Anything was better than the cafeteria. 

Medical school was another place where I expanded my repertoire.  I was a poor starving medical student on a shoe-string budget.  I lived around the block from a Wonder Bread Outlet and ate peanut butter and jelly sandwiches for lunch every single day.  (I still love them and make my own jam now.) My roommates and I cooked all the time!  It was cheaper than eating out. It was challenging as one of my roommates didn’t eat any vegetables at all.  I really never understood that, but we accommodated her and made veggies for ourselves on the side.

So how is it that young men and women cannot learn how to cook now, in this age of the great international brain called the INTERNET?  There are zillions of cookbooks at the library, at second hand stores, at other peoples houses too, in the case of not having access to the internet. 

I would love to have the resources to pull a “Jamie Oliver” and open up a big “learning” kitchen.  I also would love to go into people’s homes and get rid of all of  the “crap” in the cupboards.  When I tell people that they cannot, under any circumstances, drink soda, they look askance at me as though I’ve asked them to amputate a finger or something.  It’s the same with chips and such, the same with asking them to stop eating at fast food emporiums.  I get this look of abject horror, followed by terror, followed by the, “I’m listening but you’re out of your mind” look. 

Yes, I know that look well.   Usually about then, I say, “So, honestly, I can see from the look in your eye that you think I’m nuts. Are you going to stop drinking soda?”  Usually they hesitate, hem and haw, and eventually respond that they’ll try.
Is soda so bad?  Well, it has no nutritional benefit to it.  It is extra calories you can use for other things which are better for you, like fruit, or vegetables. 

So back to cooking.  How hard is it to fire up the George Foreman, throw some spices on a chicken breast and cook it, zap some broccoli in the microwave and zap a small potato?  Put some salsa on the chicken and Voila! Dinner.  You’ve completely avoided the stove!

Look on line for cooking techniques and recipes.  Try out new grains and spices.  We have the “Green Eggs and Ham” rule in our house.  We all try new stuff.  If we don’t like it, we don’t repeat it and we don’t have to finish it.  Guess what?  We usually like it and finish it. 

Sometimes we cook real stinkers.  In fact, we did last night.  Into the garbage it went.  Oh well, live and learn.  Then there was the time I made the "Inedible Thai Chicken Curry".  It was EPICALLY BAD.  We put on a brave face and really tried to eat it.  Unfortunately,  there was so much pepper in it that we both started to sweat bullets and get chest pain, and laughed at ourselves for even trying to eat it as we threw it out.  It lives in the Annals of Bad Food History in our family. 

My Dad has a saying for foods he doesn’t like. It’s an attempt  to not insult my Mother.  You know never to repeat that recipe when he utters the phrase.  When asked if he wants more, he says, “Oh no. You shouldn’t have too much of a good thing.”  Out in the garbage go the leftovers!  Game over.  Failure.

The Art of Cooking, Part I

The Art of Cooking Part I

I was corresponding with a friend of mine and we hit upon one of the problems of eating healthily.  Many people do not know how to cook. 

Every day I will see a young man (or woman) who weighs a great deal more than he/she should.  I will take a diet history and inevitably find out that he/she eats out for almost every single meal.  Not only does he eat out,  but he eats at  McDonalds or other fast food restaurants.  When asked why, he inevitably tells me that he doesn’t know how to cook. 

This always blows my mind.  I grew up in a house where my mother cooked but also put Stouffers frozen sides up on a pedestal.  She made Stouffers sides all the time.  Most of them were not bad.  She did know HOW to cook, but often she was too busy to REALLY cook every night.  I remember at 14 years of age asking permission over the phone while she was at work, to make stuffed pork chops. Now, I had never cooked an entire meal before this. I wanted to learn how to cook, so I went to, (what else?) the Joy Of Cooking!   We had an ancient copy that was dog eared and stuffed with papers with hand written recipes in it from my grandmother.  My SOUTHERN Grandmother.  My NORTHERN (Irish) grandmother was not a fabulous cook.  She boiled things to death and always left an ingredient out of the recipe for the  few things she made well.  They were never quite as good as hers.  Infuriating.

Unfortunately, stuffed pork chops were a bit above my level as a novice cook.  I used twine to sew them closed.  I think my father was picking twine out of his teeth for a week after that.  I didn’t get too discouraged though, and kept trying. 

My Mother taught me the basics of chopping and slicing and sauteing and frying and broiling.  She was the QUEEN of broiling.  She was known to remind us daily that we needed a meat, a starch, and a vegetable with every dinner.  She also served up a quarter of a head of iceberg lettuce with tomatoes as our salad every night.  I still hate iceberg lettuce.  We also had milk with every meal. 

 I can still make a mean southern fried chicken and fried pork chops with white gravy.  I only do that once every couple of years because you can actually FEEL your coronary arteries close as you eat it.  Yum. 

I digress.

There is so much on the internet now.   There are even VIDEOS showing you how to saute, broil, fry, chop, etc. You don’t even NEED a mother to teach you how to cook!  I once found  a cookbook called, “Help, My Apartment Has a Kitchen In It!”  It was hilarious but had some pretty good recipes and taught techniques in it.  There was a lot of motherly advice in it.

I’m not quite sure what is causing this phenomenon of not cooking.  When I was a kid, there weren’t restaurants on every corner, and foreign food was Italian or Chinese.   You HAD to eat at home because there weren’t that many restaurants.  Fast food was a big treat. Is this why people don’t cook now?  Is it because they can walk around the corner and get good tasting cheap food? (Note:  I didn't say that it was good FOR you)  Is it the “food deserts” where there are no big chain grocery stores?   Is it that we are working longer hours and are exhausted?  Is it that Moms and Dads and their spouses are both working full time?  I think it is not a simple question.  I’m sure people smarter than I am are looking at this very question.  I hope they solve it.