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.