JMT-J

NurseBob_1
JMT-J??? I’ve decided to keep a journal of my John Muir Trail planning, training, prep, logistics, etc., and then the trek itself. Actually there will be a couple of journals – this one is text-based, the other one will be video-based and posted on my video blog). So, if you’ve any interest in the logistics, etc., as well as the trek itself, stay tuned-in. Otherwise… 🙂

For now my biggest challenge has been figuring out how to incorporate the time required for training hikes into my daily/weekly schedule. The time demands of teaching for a nursing program and tracking 150 students are challenging, and it’s very easy to put off the excercise and focus on trying to stay abreast of the work, the students’ needs and expectations, as well as managing my own expectations about the quality and quantity of my work.

Today’s goal: Start this blog journal, capture and edit related video to post on my vblog, and most importantly, do at least a 3.5 mile hike with pack and camera(s).
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Well, it’s post training hike. Shot some video; met a PUC Business Major student who expressed an interest in hiking the JMT and had two brief but enjoyable conversations. Video needs a little post-processing, so Friday??? 🙂

Want to know more about the JMT?
Very enjoyable video on Netflix: Mile, Mile and a Half

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

Fifty, and counting…

 

Bob at 240#

Bob at 240#

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

NurseBob_1

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,

NurseBob

Educating Future RNs

A new semester begins…

Bob at 240#

Bob at 240#

This is my 4th semester teaching in the classroom, and the first where I’m not doing a clinical rotation. Last Fall I discovered that the challenges of six lectures and a clinical rotation coupled with 150 students. It was definitely a “live and learn – don’t do that again” grind. I find as I age that coupling two days of arising at 0400 with 12 – 14 hour work days is exhausting, especially when the rest of the week is spent in front of the computer for 8 – 10 hours reading papers, writing and proofing lectures, reading and responding to countless emails, trying to keep up with current research and trends in healthcare… I hate to admit it, but I’m getting too old to maintain that level of effort. Further, and this I freely admit, I don’t want to work that hard, nor do I want to work my life away; I have outside interests which have zero connection to nursing, and about which I am easily as passionate.

Yesterday was, and will be for the next 15 weeks, my “long day.” Up at 0400, on campus by 0700 (traffic depending), and then lecturing from 0800 to 1800.  My morning and late afternoon Nursing Pharmacology III classes were spent with the senior nursing students who I had in Spring of 2015 as second semester nursing students.  It was a joy to see them again, observe the increasing maturity and confidence.  Especially I enjoyed their increased willingness to ask questions; they were much more reticent a year ago.

Sandwiched in between were my latest wave of second semester students in Med Surg. It’s intriguing to see the different “group personality” each cohort seems to exhibit, as well as the individuals within the groups. One of my personal challenges, life long, has been recalling names. I’m always a bit embarrassed, but I am perpetually challenged to remember names. As one of my other acquaintances noted just the other day, I can be introduced, shake hands, turn and find I’ve already lost their name. As I approach the middle of my sixth decade, I don’t know if I’ll ever get this aspect of my brain to work properly. Sigh…

What’s new?  I’ve become both increasingly demanding of rigor in their work, and better prepared and organized myself. I think, for the first time, I will have all of my lectures, quizzes, case studies, and tests in place before I’m fully engaged in delivering that content.  Last semester I had the opportunity to take on a couple of new courses and found myself writing lectures and creating presentations in the morning for use in the afternoon.  Not efficient, and part of the reason I found myself continually playing catch-up.  This semester looks to be different.  Not to say the work is done; it’s never done. Just like software development, there’s always a new, improved, enhanced version.  But, just the same, I’m anticipating having time to pursue some of my other interests AND be a better instructor.

So, off to tweak Nursing Pharm II (same students in Med Surg with me), which happens on Mondays.  I look forward to offering them all the support, information, and tools to become the best RNs they can be.  After that, it’s up to them.

Stay Well,

Bob

Mom’s Stroke – My Dilemma

Bob

On Christmas Eve, about 0900 I took a call from a nurse at the Alzheimer’s/Dementia facility where my mother now resides. At her current age, 94, I was not surprised by the news: “Your mother’s in her bed, unresponsive; her left side is flacid, and she’s not following commands.”

Before diving into the emotional challenges this presented, I want to reassure you that as of now she’s exhibited a near miraculous recovery, with only a minimal residual left-sided weakness, which has left her a bit more at risk for falls.

So, back to the story… Ok, of course if she’s “unresponsive” she’s not following commands, but as a nurse, I saw no conflict in the report. It’s similar to what I’ve reported to physicians regarding patients in the ICU under my care. It’s the jargon…
My in-the-moment analysis – she’s had a stroke, and a significant one. What’s unknown – is it a clot blocking the blood flow to her brain, or is it a ruptured vessel bleeding into her brain.

My sister and I are both designated as decision-makers for her health care if she’s not able or competent to attend to her own needs. And, importantly, my sister and I are in agreement regarding our understanding of how Mom wants life-threatening events dealt with if she’s not able to answer for herself. She wants no heroics; no last-minute efforts to stave off the inevitable as long as possible; she’s DNR – that is, Do Not resuscitate. Further, no intubation (breathing tube driven by a machine to breathe for her), no artificial nutritional support – that is, no tube feedings.

As I dealt internally with the likely impending demise of my mother, I busied myself in gathering and confirming the documents regarding both her health care, and how she wanted to be buried – well, cremated – and her ultimate resting place next to my father. And, of course, I sent off an email to family regarding the turn of events.

For those of you who may not already know, my mother has suffered a profound loss of both long-term and short-term memory, and while not diagnosed with Alzheimer’s, she exhibits many aspects of that condition. For the last two years she’s not recognized me, nor does she remember her marriage to my father. When I last introduced myself as “Bob, your son.” She commented, “How can I have children? I’m not married.” She has, at times, identified me as her late brother, but there is no recognition beyond that.

So, I’m ok. No last-minute life-saving efforts; let nature take its course… Then comes the real-life turn of events. Late that afternoon I get a report: She’s up and walking with assistance; not following commands; and is exhibiting an expressive aphasia – that is, she speaks, but it’s a jumble of words in a non-sensical order – “word salad.”

Prior to this report I was clear about my options, responsibilities and decisions. However, her condition at this point is something unanticipated and damn challenging. She is conscious but unable to understand incoming information and unable to communicate her needs and desires. My dilemma? She’s unable to express her desires; she can’t feed herself and likely won’t submit to any type of external feeding strategies (Intravenous, or, a tube in her nose, or directly into her stomach).

Now what? If I follow her expressed desires there is no feeding by staff, by tube, or intravenously. But… She’s going to potentially experience both thirst and hunger. Furthermore, she can’t say what she wants – remember the expressive aphasia (word salad), nor can she understand any explanation as to why she’d be denied water and food. And, she can’t understand an explanation – the evidence being her inability to follow simple commands.

Back to the present.  As I noted above, she’s back to her baseline.  She still doesn’t remember who I and my sister are, but she is able to feed herself, make her needs known, and move about without assistance.

I remain unsure about what how I might handle a repeat of her event.  What to do for someone who’s unable to understand incoming information, or express their desires, but with a previously laid-out plan for “no heroics” – no rescucitation; no life-extending measures.  We really never covered the scenario briefly experience over the Christmas holiday.

Stay Well

Stroke Resources:

F.A.S.T.
is an easy way to remember how to
recognize a stroke and what to do. Spot a stroke
FAST.
Face drooping.
Arm weakness.
Speech
Difficulty.
Time to call 9-1-1

Stroke – Stanford Health Care

 

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42… :)

Bob
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. 🙂

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!!! 🙂

Stay Healthy

Teach Nursing in NorCal!!!

NurseBob_1

I have to take a break from the clinical instruction I’ve been doing for the last 2+ years at the NorthBay Medical Center in Fairfield, CA for Dominican University of California. If you have the basic qualifications (active California License, BSN) and would like to take a once-a-week clinical rotation with a group of Dominican BSN students, please drop me a note!  The semester runs from Jan 17th to mid-May (approximately 15 weeks).

Previous experience teaching clinical nursing is not a requirement, but is certainly desirable. NorthBay is a great facility for teaching. The computer system is very functional, and the facility is committed to teaching future RNs.  In short, the RN staff take on the role of teaching their assigned student the tasks and skills for their case load, and rarely ask you to do the work for them.

This Spring the student cohort will be second semester BSN students. Thus, they have basic knowledge, but are stepping into the world of actually using their knowledge of pathophysiology and pharmacology to determine their plan of care and what their primary concerns are (or should be! – your experience and guidance is a fundamental aspect!)

So, at some minor risk for junk mail:  robert.dunlop@dominican.edu

Teaching Nursing is a unique and deeply fulfilling experience.  I do love the opportunity and experience, but am overloaded.  My perspective?  These are the RNs who will be caring for you.

What do you want them to know???

🙂 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

NurseBob and Politics

NurseBob_1I have avoided talking about the political aspects of health and health care on this blog, and will continue to do so; I don’t want to have discussions regarding peoples’ health get bogged-down in side discussions.  However, I am launching a new website in the near future – www.powerofpeopleunited.org. The site is a work in progress at the moment as I sort out the initial design, along with what the focus should be.  For now, I’m considering an approach similar to a news magazine, where the focus is on success stories of united groups addressing social issues.  I also believe it should serve as a resource and clearing house for groups in the process of organizing.

To give credit where credit is due:  I heard the phase as a closing comment from Gayle McLaughlin during her interview with Bill Moyers on his Moyers & Company program.

If you have thoughts, projects, stories to share, etc.  Please drop me a note, or comment on this post.

Stay Well

NurseBob

 

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