Three, count ’em, Three meals a day!

NurseBob_1
Well, as of last evening, my cohort has progressed to three “actual food” meals per day, with consideration regarding the meal replacements, which can also be included depending on need.
For me, I’m still including a couple of the chocolate shakes (320 calories total per day) in my meal planning. They are convenient, and while not absolutely “tasty,” they are better than a mere “OK.”
Since I am hoping to continue to lose weight for awhile, I’m targeting a total of 1200 calories per day, and the old carpenter in me seems oddly attached to 3-4-5 (a handy right triangle for determining if a corner is “square” – 90 degrees). Of course, I need to adapt that to my current situation: Weight loss, and the multiplier of 100 for each digit. Thus, the reality of my plan is actually… Breakfast – 500 calories, Lunch – 400 calories, and dinner – 300 calories. However, I’ve broken away from the traditional “three meals per day” and am back to what I did as a child – grazing my way through the day. The variation? Now the first six hours of the day will be breakfast and a mid-morning snack – the first 500. Then lunch and a mid-afternoon snack that combine to the the next 400, and finally dinner and an evening snack that complete the plan with the last 300 calories for the day.

Perhaps the most significant change to my diet behaviors (this is, after all, a behavior modification program), has been to break free of my “addition” to milk, half and half, and white sugar. Like an alcolholic, I always made sure that there were sufficient supplies of all three on hand. And “sufficient” could be read as “lots.” I’ve not touched the unholy trinity for over four months, and attribute most of my weight loss success to that simple change. I do, at times, really miss the cream in my coffee, and that “white” concoction sweetened excessively. Happily, while missed, it’s not missed to the level that I can’t wait to get back to the pattern. Surprisingly, I really am OK for the vast majority of the time with keeping the new status quo – coffee “whitened” with unsweetened almond silk, then sweetened with a touch of stevia. While it tastes nothing like what I used to drink, it is surprisingly acceptable. And on those days when I need something more, I do a mocha instead, using the soy-based chocolate shake – though that does add 160 calories. The silk adds at most 15.

I’m off on a five day trip to Death Valley with my best friend. The challenge on the trip will be to make appropriate menu selections from the restaurant fare. I believe my friend can be easily recruited as a supporter for my continuing goal.

Well, time to post grades for my RN students, then pack and prepare for my 04:00 departure tomorrow. If all goes well, there should be some photos, and maybe a video or two, to share. Fingers are crossed; there’s a report of another “super bloom” in Death Valley. I had the good fortune to see a similar event in 2005.

Stay Well,

Bob

Hiking Backwards on the JMT

NurseBob_1

OK, I’ll be facing forward, but hiking the trail in the “wrong” direction, which I believe I mentioned in my last post. Why be the “wrong way Corrigan” of the Sierras? I find some strange comfort in the thought that the trail gets marginally easier each day when heading north. Of course, that leaves out one fact: six of the highest trail passes in the continental U.S. are in the first 100 miles when heading north, which is one reason most choose to do the trip in the traditional direction – hiking themselves into shape. (BTW – getting on a trail as rugged as the JMT without prior training and conditioning is a VERY BAD idea.)

Last year my wife pointed out to me a documentary: Mile, Mile and a half. The film features a group of artists hiking the trail and recording their experiences. It offers insight into both the beauty and challenges of the JMT.

I have gotten past my blister episode and am now doing 5-mile training hikes. Next, it’ll be time to add a light backpack, extend the length of the hikes, and start getting all my gear in place. I have mapped the trail from Horseshoe Meadows (about 30 miles south of Mt. Whitney) to Toulumne Meadows and have everything in place to upload the trek to my handheld GPS. I checked with the ranger station in Lone Pine today to confirm that I’ll be able to get wilderness and fire permits when the time comes. All that’s left is to get in shape and hike the trail. Oh, and make sure I can capture both still and video of the experience – my own JMT diary.

Stay Well,

Bob

221 Miles by Foot – The John Muir Trail

Bob at 240#

Bob at 240#

I’m at least 50 pounds lighter now, but still have a pair of unmet goals: 1) Drop yet another 20 pounds. 2) Repeat the trek I did in 2000 from Horseshoe Meadows (just south of Lone Pine, CA) to the Yosemite Valley – the John Muir Trail, but in reverse, just shy of 250 miles. Last time I lost some 20 pounds on the trail – then gained all back, and a bit more, after returning to a desk job with no plan to watch my diet.

Why south to north? Well first, I tend to be a contrarian, that, coupled with the “fact” that the trail gets incrementally easier each day when heading north is a significant psychological boost. Knowing each day’s effort may be just a smidgen easier is enough for me. Further, I know, from previous experience that I’ll meet a number of people worth talking with who are travelling in the “correct” direction, and few are heading my way; a solitary hike. 🙂

For now? I’m actively hiking in the local open space and Cal dept. of Forestry lands in and around St. Helena. Today’s plan was 5 miles in under two hours. However, a new blister on my right heel which developed at about 2 miles convinced me to bail at four miles. Tomorrow? Five’s the plan.
Ultimately, my goal is 3 – 4 ten mile practice hikes (with a 35 pound pack) each week, coupled with at least one, if not two 15 mile hikes per month. I know from past experience that to accomplish my goals I need to be able to do at least 15 miles a day, and at altitude, if I have any chance of meeting my goals.

Stay Well!!!

Bob

Medical Weight Management

NurseBob_1

My self-directed and self-managed attempt at a ketogenic diet this time last year was successful until… my wife and I traveled to Santa Fe, NM just after Christmas for just a week.  While on the road I went off my diet after having lost 20 pounds; upon our return home I was unable to resume the resume my plan, and, as happens to many, most? I had a “rebound” experience and gained back the 20, plus 5.  Argh!!!

I came to the conclusion that I could not do this on my own, and that my best bet was to enroll in a medical weight management program.  Last week I started in earnest with a Kaiser-based program. The program has demonstrated good results in the past, and I know from a personal contact who successfully did, and remains on, the program (officially 82 weeks, but apparently, a life membership for support meetings), that long term success is possible. Though a KP member, this program is outside of the KP benefits, so it’s out of pocket, about $800/month for the first four months, which includes weekly meal replacements.  After that initial period the cost drops significantly, but having not reached that point, I’ll hold off on any cost estimate for now.

My long term goal is to lose about 70 pounds. I have, in the first week, dropped 12 pounds.  Now, much of this is likely to be water, so I expect this weekly number to drop pretty rapidly to a more realistic 1-2 pounds per week.
Since weight loss tends to be physiologically sexist, I do expect to experience a more rapid rate of loss than most of the women in my cohort.  For now my diet is 960 calories daily, with a less than wonderful menu of two shakes, two soups and two nutrient bars per day.  To the credit of those at KP who designed the program I’ve not been starving, just had moments of elevated hunger.  I know that to get to sleep I need to have that last nutrient bar in the last hour before bed.

I will see if I can manage a weekly update on both the experiences and, I hope, successes of the experience.

The numbers:
Height: 5-10 – Hoping/expecting this won’t change over time… 🙂
Starting weight: 241 lbs
This week: 229 lbs
Goal: 170

Stay Well!

Bob

20 down, 40 to go

It’s been about six weeks since I decided a major lifestyle change was in order.  I mentioned that over the years my weight had increased by some 60 pounds over what matches my height and frame.

SOAPBOX ON
I’m not a fan of “fad” diets.  I’m careful to explore the basis for lifestyle changes, and especially in regard to diet.  There is such an overwhelming abundance of dietary advice and products, which in my view are mostly focused on generating profits for companies preying on the ill-informed, desperate, and unhappy segments of our population, which is a very, very sizable percentage.  Sadly, sound evidence-based, scientifically valid information is pretty much overwhelmed by the noise created by these unscrupulous purveyors of pseudo-scientific or mystical solutions to the real problems affecting many of us.  Further, on a similarly sad note, the level of education in this country leaves much of the population unable to see through these scams.
SOAPBOX OFF

However, someone I know and trust had recently experienced great success with a medically supervised Very Low Carbohydrate Ketogenic Diet (VLCKD).  Not only in successfully losing some 80 pounds, but also managing to make a lifestyle change in terms of diet for the long term which should aid in keeping those excess pounds off.

Given that, I decided to explore a similar diet.  Mine was started after an email consultation with my MD, and some six weeks ago I cut out all refined sugar, processed foods, and starches.  My goal:  under 20 grams of carbohydrates per day, and a target of 1000 – 1100 calories.  I’m basically on a moderate protein, higher fat and near zero carbohydrate diet.

The results so far: I’ve been steadily losing weight; I’m now 20 pounds lighter than when I began.  While I’m only about 1/3 of the way to my target of 160 – 170, I’m feeling pretty successful.

The experience:  To my surprise, and in truth, wonder.  I’ve rarely felt excessively hungry.  I do try to have a bite of something satisfying every 4 – 5 hours to forestall any sense of extreme appetite, but interestingly I’ve not had cravings for what I have cut out of my diet. And, believe me, I did like a lot of sugar in my coffee and cream, loved breads, chips, tortillas, pasta, etc.
Further, I’ve been sleeping better, have generally been in a better mood, and seem to be more stable in regards to mood swings (not that I experienced extremes)

Finally, I have a reasonable wardrobe which I’ve not been able to wear for the last several years.  I’m looking forward to having a “what’s old is new again” moment as I am once again able to pull some of those items from the closet, and hang them on me instead.

So, the experiment continues. As of this morning I’m on the cusp of transitioning from “Obese” to “Overweight” in the BMI table.  More in the future as I have more experience, and as I delve further into the physiology of this all.

Stay Well.

Bob

Other interesting resources:

Low Carb Dietitian:
Lipid Changes on a Very-Low-Carb Ketogenic Diet: My Own Experience

My Thoughts on Low-Carbohydrate Ketogenic Diets

My Thoughts on Low-Carbohydrate Ketogenic Diets, Part 2

I HATE the Mirror!

I’m in my sixth decade, and it seems I’ve gained close to a pound per year over my ideal body weight.  That translates into 35-39% excess body fat.  Now, I haven’t really done a slow one pound per year gain.  In my teens I was pretty much on track with what I should weigh.  Things first went a bit haywire when playing college football.  I had the luck (whether it was good, or bad is hard to determine) to be 1st string center.  Now, even in the late 60’s, a man at 5′-9″ is not exactly ideal, especially weighing-in at 170 pounds.  So, as the coaches wanted, I “bulked-up” – which really just meant, gain weight.  The quality of that weight gain was not supervised, so while I did spend time in the gym, I also spent a lot of time at the local Fosters Freeze consuming double burgers, shakes and fries…

Needless to say, I DID gain weight; ultimately I hit close to 220. And Then… I went on to wrestle.  Wrestling demanded a 180 degree turn-around.  Short and fat is distinctly disadvantaged when competing with tall and wiry.  Now, given my body type, I will never be described as “wiry” – I’m more of the fireplug in terms of my natural body type.  However, in a very few weeks I was down to 175, still a very challenging weight class for my height, but I did a reasonable job of competing.  That is, until I met a Stanford wrestler who’d taken second at nationals in the 191 pound weight class, who was determined to place first. He’d managed to get his 6′-2″ frame down to 175.  I think that match lasted less than a minute, and only a few seconds after I made the mistake of reaching to him to initiate a move…

In my 20’s I worked night shifts (11 pm – 7 am) in the psychiatric units of a general hospital in Berkeley, CA. This was the late 60’s and early 70’s.  An interesting time to say the least. But, exercise was limited, and normal metabolism disrupted by the night shift. Once again I found myself at 200, then 220.  I finally began a regimen of exercise, and then started working as a carpenter, so for my late 20’s and early 30’s my weight was elevated, but I felt OK as I hovered in the 190 – 200 range.

My next major transition found me in the role of a software engineer, long, sedentary hours in front of a terminal, but I did continue to exercise – gym membership a job benefit.  So, now I’m in the 200 – 210 range.  Then came nursing school and employment as an RN in the Intensive Care, once again on the night shift, but now 12 hour stints from 7pm to 7am.  Totally disruptive any form of normal metabolic activity.  My weight ballooned to 230, which is where I’ve hovered for the last 10 years.

So, I have a very nice wardrobe.  But it only fits the 190 – 200 pound version.  Instead, I’ve resorted to limited wardrobe of “acceptable” clothing, going for loose-fitting, which to some degree disguises just how over weight I really am.

Ok, so now you know the history, and how I probably look.  I can barely see the tips of my toes.  Bending over to tie my shoes requires exhaling and waiting til they’re tied before taking my next breath.  Arising in the morning I tend to roll out of bed since I can no longer just sit up.  My upper body weighs so much more than the lower portions. (I’m in the “apple” group of body fat deposition, not the “pear.”)

Well, last Sunday I decided I couldn’t wait any longer to address my weight, the associated unhappiness with my body image.  The solution?  Well, that’ll be in the next post.  This one’s gotten pretty long, and my solution isn’t going to be a brief post either.  However, I do plan to post my progress on a regular basis.  So, stay tuned!  Much more to follow.

Stay Well-
NurseBob

Mom’s Acting Crazy! – The Elderly and Urinary Tract Infections

NurseBob

Bob

Unexpectedly, your mom, dad, granny, is actingly strangely.  They seemed fine yesterday, but today they’re calling the police to find out why you’re not visiting anymore (you were there yesterday), making plans that make no sense at all (“I think I’ll drive across country to see all the sights I missed as a kid.”), accusing you of stealing from them (of course you’re NOT!), etc.  It’s not commonly known that seemingly minor infections, such as Urinary Tract Infections (UTIs), can cause profound changes in behavior for the elderly.
As our population ages, and as many of us find ourselves caring for our increasingly elderly and frail parents, we are faced with situations which we are neither trained to reconize, nor handle.  So, if you’re in charge of the care for an elderly parent, I have some thoughts on what to look for. Continue reading