Fifty, and counting…


Bob at 240#

Bob at 240#

Actually, this image is closer to where I am now…


While it is some 15 years older, it’s closer to my current look. The weight is right, but I am MUCH more grey… As Billy Pilgrim would say, “So it goes.”

For the first time in the better part of a couple of decades, when I walk towards the mirror in the bathroom, I don’t cringe; in fact, I’m pleased with what I see. While not at the goal I’d set, I’m on the right side of the curve, and feeling I just may make it back to what I weighed back when a college student. FWIW, that’s still heavier than what the BMI charts indicate are “correct” for my height. However, those charts have wide error ranges. If I get down to 170+, I will be ecstatic. As it is, I am able to see parts of my anatomy that have been hiding for quite some time. And, more importantly, my wife is very, very pleased with my new, reacquired physiogonmy.
In short: On Track.

Stay well,


T Minus 45 and holding…

Bob at 240#

Bob at 240#

Well, if your memory of “T Minus… and Holding” has you recalling NASA’s missions to land a man (uh, person) on the Moon, then you’re likely in my age cohort. If not, well you’re likely a bit younger than I.
Then again, from my current perspective the phrase has nothing to do with Space, NASA, or astronautical adventures. Once again it’s a weight reference. In this moment it’s my hovering around 193 lbs (87.72Kg or 13st 11Lb – I LOVE Scotland and the Scots!!!), which is a couple pounds away from 50 pounds lost. Fifty is neither my goal nor a magic number, but has become significant since I’ve been feeling stuck.

What’s up? Well, I’ve been hovering at that weight for most of the last week. And, “Why stuck?” you ask… Well, I’m struggling to stay on plan; struggling to increase my level of exercise from sedentary to not sedentary. Did I mention struggling to stay on the plan and not exercising enough?

’nuff said. The short, insight-less vision: some weeks are harder than others. This week has been one of the more challenging. In my last group meeting we were all to select a partner we could confide in. While there is an individual I would like to add as an understanding “sponsor,” he’s out of town. Hell, he’s out of country in Patagonia. So, I’m opting to use my other connections as part of my support network. Those would be all of you on FB, Twitter and Linked-in. I appreciate all the wonderful expressions of support I’ve received from all of you. While I may not always adequately acknowledge the support and comments, they are deeply felt and appreciated. Setting out on a more beneficial and insightful path, I have come to realize it’s time to use other additional resources and help. This is not something easily accomplished in state of emotional or social isolation, which is where I tend to go in times of stress.

Thus the work continues. Currently my greatest food/feeding challenge is when I have engagements that have me traveling in the greater Bay Area during business hours. I find I’m near OCD in my newfound desire to eat in places, and have dishes, I don’t normally care much about at all.

Where do these near-overwhelming urges and desire originate? Who knows? Is it just my physiological being, my body, saying, “Eat More! I need FAT! I need SUGAR! Oh, and a bit of protein would be OK too. Then again, is this related to my gut bacteria, my microbiome , calling the shots? Who’s in control, or out of control, here?

Short answer: I don’t know. All I “know” is, at times I am very hungry, and if I’m out and about, the temptation is overwhelming. On the other hand, and perhaps most importantly, I know you are out there on my side; rooting for me; and whether I want it or not, reminding me of the goal.

So, the story, and challenges of my weight loss journey continue, but not without a massive “Thank YOU!!!” to you all. You have no idea of how important and effective your support has been, and will continue to be… ūüôā

Stay Well,


42… :)

42? Why does that get a smiley? Well, ask Douglas Adams, or read his book… According to his fictional characters, 42 is the answer to to life, the universe and everything. If only…

For me it’s a milestone in my quest to return to a smaller, former self. As a result of my medically managed diet, and my adherance to the diet (well, 98% of the time), I’ve now lost 42 pounds. More than halfway to my goal of 70 pounds. If/when I get there, I’ll be back to my high school weight, which is where I was supposed to stop, but didn’t/couldn’t.
Coupled with that happy achievement my wife and I took a Christmas/New Year’s vacation to Santa Fe, NM, whereupon I not only did not gain any weight, but managed to lose a couple more pounds. Not bad for both a vacation and the Holiday Season.
Other benefits: New/Old wardrobe: Clothes I’ve not fit into for years (maybe decades?) now fit. ūüôā

Thus, while I did not strictly adhere to my meal replacement diet while out of state – my cousin’s wife’s New Year’s roast beef dinner with poached and caramelized pears for dessert was too inviting to ignore, it did not stop me from returning home lighter than when I left!!! ūüôā

Stay Healthy

Medical Weight Management


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… ūüôā
Starting weight: 241 lbs
This week: 229 lbs
Goal: 170

Stay Well!


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.

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.

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.


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-

Let Them Eat Dirt?

In the U.S. we are increasingly obsessive when it comes to cleanliness.¬† Just take a moment to analyze the T.V. ads, if the subject isn’t cars, food, or booze, it seems they’re focused on¬† killing those damn germs; OMG, they’re everywhere!¬† Ahhhg!!!¬† I swear, many of the ads remind me of my college roommate’s mantra:¬† When in danger, when in doubt, run in circles, scream and shout.
I know the marketeers are shouting to push danger and doubt regarding those ever-present microbes to increase sales, but I believe the true danger lurking in the shadows resides in not allowing our immune systems, and more importantly, our childrens’ immune systems to develop as nature intended –¬†learning which microbes are benign, which are our allies, and fighting the good fight against pathogens.
Not all germs are BAD; in fact, many are beneficial and most are neutral. We each have more microbes in our gut than there are stars in the Milky Way. Increasingly, current research points to a possible link between the health of our internal microbiome and our physical and mental health.  There is also a growing body of evidence that the increase in allergic conditions and autoimmune diseases may be connected to our near-obsessive efforts to kill-off all the invisible organisms in and around us.

I know you wouldn’t wish these maladies on yourself, and¬† most certainly not on your children.¬† I’m even willing to guess you wouldn’t wish them on your enemies.¬† So, what to do?¬† I’m not actually encouraging you or your children to eat dirt; I don’t really believe that¬† pica, which has a somewhat negative reputation, is the solution.
What we need to accomplish is to let go of our compulsion for attempting to sterilize our environment; it’s neither a healthy nor healthful practice.¬† Of course, in the kitchen, if you’ve been preparing any meats or eggs, a cleaning of the work surfaces and hands is in order.¬† For the hands, just a thorough wash with plain soap and water.¬† By thorough, I mean a vigorous effort for a minimum of 15 seconds and a rinse under running water.¬† As to the work surfaces, following a wipe-down, use of a spray bottle filled with a dilute solution of bleach is an excellent choice, it’s effective, inexpensive, and doesn’t lead to the creation of superbugs.¬† And, a weak bleach solution can be used in the bathrooms as well for the final pass.

My point is to use common sense.¬† While it’s not true that if it looks clean, it’s clean. It is true that the effort used to clean the kitchen, dining areas, and bathrooms doesn’t need to be excessive.¬† Furthermore, I believe the use of anti-bacterial hand soaps and cleansers is detrimental to both the environment and public health.¬† These products put sub-therapeutic levels of antibiotics into the environment, and can contribute to the creation of antibiotic resistant bacteria.¬† So, stay well, stay clean (reasonably so), and enjoy.

NurseBob – Stay Well

Disclaimer: This information is not intended to diagnose or treat any condition, or to replace the advice of a doctor. NurseBob  disclaims any liability for the decisions you make based on this information.

A Healthy Low-Carb Diet Contains Lots of Plants

The following is reposted with permission from Franziska Spritzler, RD, CDE, of

One of the things I see time and again is¬†people going heavy on the protein and fats while avoiding most vegetables and fruits when following a low-carb diet. While you’re ¬†definitely minimizing carbs¬†by only eating meat, fat, and¬†leafy greens, you’re also missing out on the benefit of including a large variety of plant foods in your diet.
Continue reading

Food and Water at the End-of-Life – What’s “Normal”?



Before I can talk about possible problems with TPN at the End-of-Life, I need to lay a quick foundation describing what the “normal” components are in the blood when we’re healthy, and how those components function to help maintain the balance of fluids in the blood and in the tissues. The scientific term for this is “osmolarity” – which in the most general sense, refers to the concentration of the various components dissolved in water. But in addition to their concentration, it also is related to how big the molecules are that make up these components. The reason that “osmolarity” is so important is that it plays a very significant role in determining whether the blood is loosing water to the surrounding tissues, or pulling it in. If the blood is loosing water to the tissues it can result in dehydration, edema, or in severe cases, anasarca.
In this blog entry, I’ll give you both some definitions of the terms I just introduced, as well as some examples.¬† In my video blog, I will be showing how these processes work using both some animation, and a short time-lapse video.
So, what are the major players among the blood components? Well, of course there are inorganic salts (primarily table salt)¬† and sugar (glucose), as well as a number of other organic components and proteins.¬† When it comes to managing the amount of water in the circulatory system, all of the components just mentioned play a role, but one of the more important components is a protein called albumin (which is manufactured by the liver).¬† When the level of albumin in the blood serum drops, the water normally contained in the blood and blood vessels begins to leak out of the blood and into the tissue.¬† The “why” for this leakage is due, in part, to the change in the balance of osmolarity between the blood and the fluids in the tissue surrounding the blood vessels.

Osmolarity is one of those “scientific” terms, which as I mentioned earlier, generally refers to the concentration of various substances in water.¬† The Wikipedia entry for Osmolarity is too complex for the purposes of my blog.¬† The very high-level explanation I’ll offer is that it’s a way of determining the total concentration of multiple substances in a sample of water.¬† If there are two samples with different osmolarity, the one that has a higher value will tend to draw water from the lower value.
This flow is called osmosis – and the direction is determined by the osmolarity.¬† In short, water moves from the lower to the higher concentration in an attempt to make the two samples equal. (Remember the old adage:¬† Nature abhors a vaccuum?¬† Well, Nature “hates” any imbalance!).¬† Another way to think of osmosis is that if there are two samples with water, each with different substances dissolved, the water will tend to flow from the sample with more water to the one with less water.¬† Think of it as water flowing “downhill.”
Well then, when we have blood in the circulatory system with fewer dissolved substances in it than the fluid surrounding the cells in the tissue – the water will migrate from the blood, through the walls of the blood vessels, and into the fluid in the tissue.¬† The net result is that you end up “dehydrated” from the perspective of the circulatory system, but swollen from the resulting increase in water in the tissue – this is edema.

Stay Well -NurseBob

visit my video blog for other health information

References Researched

Do We Require Food and Water at End-Of-Life? NurseBob Discusses Nutrition and Hydration for the Terminally ILL



Today I’m starting a new series on my video blog:

Force Feed Your Dying Loved-One? Nutrition and End of Life – Part 1 – An Overview

In concert with that effort, I’m going to be noting the important points here for those who prefer, or need, a text version rather than video. As the references noted below indicate, I’ve been doing my homework. I am in the process of adapting and summarizing the information for this medium.
While I have some strong feelings and opinions on whether we should do tube or intravenous feedings and hydration with someone who’s near the end-of-life, my focus here will be to provide sufficient information so that you can choose the path you believe is best for you or your loved-one. There can be significant issues with adding hydration and nutrition for someone who’s near death, and research indicates that there is little or no benefit to balance the risks and potential loss of quality of life in the last days.
I don’t know any health professionals who want to cause undue suffering for those they care for, but I have seen situations where they find themselves challenged to deal with the needs of the living, who don’t realize the full consequences of their requests – which usually boil down to: “Keep my loved-one alive as long as possible.” It’s very hard in that situation not to try to offer some lifeline, some hope, to the family, and in those circumstances, last-ditch medical technology can be offered, but without necessarily noting all of the potential risks for the patient.

It’s my goal to provide sufficient resources so that you can ask the right questions, and get the answers you need. Choices made in ignorance are dangerous to both the patient and the survivors, the negative outcomes may impact not only the patient’s health and comfort, but might also leave lasting psychological issues for the survivors.

This topic is complex, and requires some understanding of physiology, pathophysiology, and even some chemistry. Thus my choice to do the text and video blogs in segments, and where practical on the video blog, show some demonstrations of what happens when our body chemistry becomes deranged due to the disease processes involved. I hope you find the information both useful and interesting. And most importantly, if you should find yourself in the position of having to make decisions about some else’s nutrition and hydration at the end-of-life, you will have sufficient information to ask all the right questions to aid you in your decision.

References Researched: References

Stay Well -NurseBob

Visit my Video Blog for more health information.