Affirmations

I have used affirmations in the past to help me become something I wanted to be. I used affirmations about being a good student and ended up receiving the Distinguished Student of the Year award when I graduated with my Bachelor's Degree for the College of Health Sciences at the university I attended. I used affirmations to lose 15% body fat and get to a svelte 14% body fat in 12 weeks. Why is it that I find something that works... and then stop doing it?

Affirmations and visualization go together and are powerful tools in our brains. Think of the advertisements you know for Coca Cola, Toyota or Taco Bell. I can come up with slogans for all of these and I haven't had cable or local television stations for over three years. Advertising is powerful. Repetition works.

I am guilty of allowing other people to advertise in my brain and not intentionally putting things in that would help me or those around me. Listening to the radio on the way to work may seem like an innocent pass time, but it really is not. I am allowing someone else to put thoughts in my head. Rather than allowing this, I will go on a 30 day morning media break. During this time, I will learn a language or play the affirmations I have recorded.

Affirmation 1 "I am a strong, flexible, healthy woman and love to work out. I love the way my body feels when it is strong. I love the sense of flow I get from working out every day."

Affirmation 2 "I am intentionally adding things to my life that make it deeper and richer. I also intentionally free myself from things that could shrink my life by creating fear or protectiveness. I give all I can to others and find that my joy is full."

These may change a bit over time as I find the things I need help motivating myself to do. I will try to update them in real time. I will use my affirmations twice a day along with visualizing the thing I am trying to create. Do you use affirmations? If you do, what has been your experience?

Intention and FLOW

In the last few weeks, I've been going on about my goals and how I want my health and future to go. But, sometimes things are not under our control. Like getting sick. It was certainly not in my plan, nor my intention to get sick this week. You would think in health care, that I would be sick a lot. But, the opposite is actually true. After the first year of getting everything every patient brings in, you tend to get sick a pretty average amount. This is the first on my back sickness in about 4 years other than headaches.

When you are sick, you can't remember what it was like not to be sick. This week has been horrible for goals and for all things health related. I did not get anything done on my goal list. It makes me grateful for my health. I realize that I may have a stroke at any moment, but it is easier to deal with than being sick in the here and now. I also realize, upon review, that every time I have improved my health, it has followed an illness. What does this say about me?

Perhaps like anyone, I have to have something tangible to remind me that I could, indeed, feel worse than I normally do. This year is going to be about INTENTION. I want to do things that improve my life intentionally. I want to be well intentionally. I want to create a space here to gather and disseminate knowledge that will help people with great intention.

Health is about more than the absence of disease. Health is about living my best life, in the best way I can. Not only about being the best for myself, but about giving away the best of me. Helping others to become better helps me.

In order to become the best I can, I have to confess a huge source of anger. I am angry at the Affordable Care Act. I think it has been a dismal failure. It has horribly increased costs for many hard working people including me. I don't want to be angry. I can't be angry every day as patients come and tell me of the failure of this law, but I have been. It exhausts me to reach out with compassion and not have any answers for them. I would like to channel the anger to something more helpful. Creativity and helping to show the way toward healthier people. We can no longer afford to be sick. So, let's decide to be well. Starting with our focus.

Happiness. The entire country of Bhutan is striving to increase the gross domestic happiness, rather than the gross domestic product. How great is that? (From the documentary Happy) In the same documentary, the research showed people who experience FLOW, that state of being immersed in an activity, feeling energized and clear, the most often are the happiest. I think that is why I write, I find FLOW in the action. I remember feeling FLOW with running, which is why it calls me. Once upon a time, I felt FLOW in my job. Before the ACA. I will work to find a place I can experience FLOW in my work again. I am going to strive to be intentional about the activities I engage in this year to increase how often I feel FLOW. Flow will help me to be a happier person, and increase the reserves of energy and creativity I have and can use to better the world.

So, the plan for this week is to come up with some recipes and a shopping list for the next 1-2 weeks. I will write out my affirmations and find a space and time to meditate.

Long term thinking and Visualization

Well, it has been quite the week! I did finally get some exercise, but not before being called on my lazy butt-itude by Ron. Thanks, Ron. 

I cleaned the house on Saturday morning in preparation for the homecoming of my wonderful child, who has been gone for 2 years. I love that kid. He has truly grown into a man and I am overwhelmed at the intelligence and amazing maturity he is showing every day. He constantly amazes me and I am grateful to have him around. I will be sad to see him off to college when he has to go. In the meantime, I will hoarde every moment I can with him. Short term, I hate that I can't spend every minute with him, but long term, that would not be so good. We are, after all, in the business of raising adults. He is wonderful despite environmental screw ups, for we all damage our children in our own unique fashion. Hopefully, he knows how much he is loved. Said house-cleaning left me quite sore. Legs especially, arms from all the scrubbing and oh, my feet! I am so out of shape, it is probably criminal. Today, we went shopping and walked extensively around Best Buy and Costco, which I am totally counting. So, two out of three days down, and I just have to get on the treadmill tomorrow to make the movement goal for the weekend! Small steps to lead to toned body parts and greater physical stamina. 

Next on the list was planning the meals. That will be a difficult one this week due to the kid being here and Christmas, but I am going to take a shot at it tomorrow evening. I am fortunate to be off work until the day after Christmas, which is great, I think my brain needed a break. I had a blind spot again this morning. Stupid head and headaches. That's the second one this week. I need to go back to Mayo clinic and see Dr. Meyer, the Neurosurgeon who did my sister's bypass surgery. She has a quarter sized hole in the side of her skull because they used a scalp artery to feed into the middle cerebral artery in her brain so that she did not have any more strokes after the two she suffered. It worked, so far so good. He discussed doing this with me if a different type of brain scan was not showing good blood flow to my brain. Short term, it is a scary thought, but long term, it could prevent serious damage. I wonder if getting active again and eating right will reverse the narrowing. I don't know, and it would probably be a miracle if it did, but a girl can hope.

I was thinking of working a bit, but I don't think I will until after Christmas. I am on call Christmas Day and my wonderful colleagues have split the week up with me so that I can spend some quality time with the kid. I can't tell you how amazing it is to work in a place that has such an optimistic and team-work-inspiring atmosphere. I have spoken to so many people who struggle every day with politics and difficulties with colleagues. Mine are wonderful to work with. Maybe I am the difficult one? Oh, I hope not. Short term, I remember how difficult school was, I have struggled at times with staffing and with difficult challenges in my work, but I would not change a thing. I love the shape the clinic is taking. I love the teamwork and camaraderie that is building. We have worked hard and it is paying dividends.

So, short term struggles and long term successes. I guess it comes down to what Dori said in Finding Nemo, "Just keep swimming." So much of taking care of my own health comes down to being able to see the long view. It will pay off. It is like sowing a field, though. It can't be done overnight. Slowly, day by day, I have to make the choices that lead me to the place I need to be in one year, in five years, in ten years. It is like a course correction in an airplane. One tiny little difference, ten minutes on the treadmill, not drinking fake sugar (headache trigger), eating more vegetables, make a huge difference when you add it up over ten years of days upon days. 

So, I am actively looking into the future to see what it looks like. Since I am not actually clairvoyant, I will create a vision for what I want it to be and then create the habits I want to get there. Will you come with me? What habits must you create to get to where you want to be in a month? A year? How about ten years? VISUALIZE what you will look like. Create a real experience. What will it look like, sound like, taste like. How real can you make it? See it? VISUALIZE twice a day. Professional athletes do it before a match, a contest, a race. There must be something to it.

No Plan, No Gain and finding your WHY

I haven't done something this week and it has stopped me from being successful. I have a need to obsess a little. I know, that is an oxymoron (a little obsession?). But, if I am going to get in shape, I have to plan my meals and workouts every day. Every time I have done a transformation, I have had a plan.

So, I have to take this week to start thinking about how I want this planning to go. Shall I add it to the journal I use for everything else, writing, drawing, complaining, rejoicing? Will I hate later that I have to see boring lists of food and workout plans? Or is it a good idea because it will keep the goal in front of my face? I am thinking this week that I may plan in my regular journal. There is plenty of room. I bought a beautiful Italian made journal with slightly heavier paper that I can write in with ink, paint with watercolor if I'm careful, and even glue things into without getting the paper too wrinkly. It does wrinkle, but I like a little wrinkling. It makes me feel like the journal is truly mine. My old journal was about 144 pages. This one has over 400 pages. Lots of room to plan workouts and food.

During my last successful health transformation, I had a monthly calendar that I marked every day. One part of the x was for exercise, the other part for food and the third, a straight line through the middle, was for affirmations. All three were imperative to keep me going.

Many times in my life the concept of finding my why has come up. The thinking is if you find a big enough why, the rest is easy. I think that is right. The why is the big motivator. Why do I want to be healthy? Why do I want to eat better? But it isn't quite enough when it comes to getting the healthiest you can be. You have to sort through the piles of information and misinformation and then through some trial and error find out what works for your body.

So, this week is about finding the why. Getting it front and center whether that is in a journal like it will be for me, or maybe a goal poster would work better for you. That is a powerful way to give messages to your brain about where you are trying to go. Put pictures of what you want on the poster and then put it where you will see it often. Advertise in your own brain. Heavens knows everyone else is there often enough!

Thanks for coming on this journey with me. It has been a week without the gains I wanted. But, I tried to start in the middle and I know better. This week I will obsess a little, I will PLAN and I will write my WHY so it is clear and motivating.

Coping and finding a reason to live healthy

We went to a party on Friday, and I asked my husband what Mike's wife's name was.

"What's my microwave's name?" asks my deaf husband. "Sharp, I think." He also answers. With a straight face.

Oh boy.

So, this week is not a great one. I had bad news. The Neurosurgeon I saw at Mayo last summer looked at the recent MRI of my head and decided the narrowed vessel was worse and I need to go back to Mayo. For some people this would not be a big deal, but I live in Montana and Mayo clinic is in Minnesota, about a 1300 mile trip. It's 20 hours of driving. Boo.

The good news is that my husband does not have a hernia, so no expensive operation for him. Yay! And, I am finding that writing and the movie Despicable Me 2 are both good distractions from the troubles of bad health. Weirdly, it is not the health I am worried about, it's the damn money. The insurance is much worse in 2014 than it was this year, so it will be much more expensive. How will we do it?

How? I will write and write and write... to take my mind off of what I can't change. I will go to the doctor and let him do bypass surgery in my brain if that is what he wants to do so that I don't have a stroke... at forty two. And I will write. I will write to cope, I will write to live and I will write so that I don't disappear from the earth... at forty two.

So, it may be expensive, but it's better than waiting around to have a stroke. What I don't understand is why I went so long without having any trouble and suddenly I have more narrowing and more trouble. So, my goals this year are to eat better, move more, get back to being the in shape girl I was before I went to college and learned to sit around and think for a living, and learn to have less stress. 

I know that I did better while journalling, which habit I have kept and continue. So, I will start keeping a food journal and planning my exercise in it. It worked in the past. That which I obsess over, I succeed in doing. Strange but true.

If you want to come with me on this journey, I'll be checking in a couple of times a week. Come get healthy with me! Find your why. Mine is easy. I get healthy or I have a stroke. What is yours?

What do you want?

I hear so many people say they just want to be rich. Really? Think about this for a moment. It takes a lot of training, learning and worry to be rich. You have to learn how to make the money, then how to protect it. Then you have to worry about how to store it. You can't put more than $250,000 in a bank because if the bank fails, that is all that will be insured by FDIC. And understanding how and when you will get it back is another story.

The stress that would follow "a lot" of money would be, well, not small. You have to know enough about how to read a profit and loss to know if your bookkeeper is taking some off the top. You have to trust people who understand money. And on, and on. You can see where this could get pretty sticky.

I heard a story once and I am making up my own version because it is so powerful:

A couple of American capitalists went to an island in a warm climate and were vacationing on the beach. They watched a man emerge from a small hut close to the shore one day on a beautiful warm morning and get in a medium sized boat and row away. They were enjoying their time on the beach and frittered the morning away relaxing and discussing world politics as the capitalists are wont to do.

A few hours later one of the men noticed the man from the morning returning in his boat with some fish. He watched the man tie the boat up, take the fish, walk down the beach and disappear. A few hours later the man reappeared and his family came out of the hut. They frolicked on the beach, spent time playing music and dancing and went in when the darkness fell.

For the next few days the men watched him as he had basically the same routine. Saturday came and he followed the same routine even on the weekend. They couldn't believe it. He was such a slave to the fishing he had to do every day! One of the capitalist men thought that he would help the fisherman before he went home. He walked over to the fisherman when he came in from the vast sea the next day, Sunday, and asked if he could have a word with the man. The fisherman grinned widely and nodded.

They sat on an old log and the capitalist asked the fisherman why he did not buy another boat and hire some others to work for him so that he would not have to work so hard. The fisherman looked at the man for a moment and smiled. He said, "I do not work hard, sir. I go out in the morning and commune with the fish, I catch a few. I come back to the shore and sell a few of my fish to my friends. Then my family and I spend the rest of the day together. Why do I need more?"

"But sir, don't you see, you could have lots of money." The capitalist plead with him to open his eyes and see that he was missing out on the good life.

"What would I spend it on?" the fisherman asked him.

"More boats. So that you could have more employees and have to work even less than you do now. You could have lots of money and a big house."

"But sir, someone would have to make sure those employees were working. They might not like to fish the way I like to fish. They might be lazy. Then I have to work harder than I do now. And a big house would mean that my children would not play with me the way they do now. They would want video games and television."

The capitalist looked at the fisherman and realizing that he would never be able to convince him of the power of capitalism, went back to join his friends. He shook his head and told them the incredible story of the man who didn't understand capitalism and didn't want to have money.

Meanwhile, the fisherman went home after selling his fish to his friends. He told his family about the man he had met. The one who didn't want to be happy. The one who didn't know what it meant to understand yourself. He shook his head and was sad for the man.

I LOVE this story. The fisherman had everything he wanted. Maybe you are close to retirement age. Maybe retirement to you is spending time with your grandchildren. If they are close to you, great. If not, could it mean that you move closer to them? Maybe that doesn't take a lot of money. Maybe that takes courage. And planning. Design your life. What do you want? Then... how do I get there from here?

A little disclaimer. I think capitalism is grand. I really do. It built America. A lot of people really enjoy the challenge, the thrill and the chase of capitalism. But sometimes we get so caught up in "making money" that we forget the purpose. We forget to decide what we want. That money is just a means to an end. Design your life. Decide what you want. Don't get to the end having made money but having had no life. Having never enjoyed any of it except the two weeks every year that you got to spend backpacking when you had some time off work.

I want to write a novel. I have about 4 first drafts and am still working on more. I want to feel like I contribute and my job allows me to do that. I have had to learn not to let my job take up too much of my life. But I am slowly designing the life I want. My challenge to you is to design the life you want. Start today.

The Reason I Wanted to Get Healthy

So, back in February things changed a little at work. I got some help, we got in a groove, things changed for the better. It was wonderful. I was able to get some of the stuff that I was struggling with trying to get done because, well, because I'm only one person. I had stopped waiting for the ability to clone myself about a year ago. So, after this horrendous year of stress and barely hanging on, I could breathe again.

Being able to reflect once again, I realized I was tired of feeling like I had no energy. Tired of having my brain and body protest every time I looked in the mirror and wondered who that fat girl was and where the fit girl I had always prided myself on being had gone. I was tired of secretly hoping that every patient with an appointment after three o'clock EVERY day would just not show up because my brain did not have anything left. I was tired of being behind all the time even though there were others helping to share the load, and I should have felt the burden lighten.

I have been married for about three and a half years to a guy who knows how to make potatoes, steak, lasagna, fried anything, and pretty much any bachelor food known to man...and known to make woman gain weight... he he. He cooks every day. I know, I am the luckiest... and I admit it. But, aside from the stress at work, I also had to find a way to discover the healthy girl that I used to be and do it in a way that would work for my husband, too. So, I couldn't eat salad every meal, or eat 2 teaspoons of food at each meal, or not eat. None of these would fly with my hiker, hearty-eating, feeding-me-because-it's-his-way-of-taking-care-of-me husband. And, I couldn't work out for three hours a day. No possible way. Even though my stress level is lower, I still leave at 7 am and get home around 7 pm daily. Twenty MINUTE workouts are hard to fit in that schedule.

As a health care provider I know I need to manage my stress. Check. I need to move every day. Check (mostly). And I know that I need to eat healthy. How would I go about doing this?

Six years of college dedicated to health care with another two in business and I still had only vague ideas about where to start. I knew that I was eating too much and that I was definitely eating poorly. So, first change was to eat less. Starting there, ten pounds came off in about three months. Starting at thirty pounds over where I have lived most of my life, that ten pounds wasn't as miserable as I'd feared it might be. Unfortunately, I still didn't feel much better. Still having headaches regularly and still looking at an unhealthy girl in the mirror. Aaargh.

Lots of patients have come to me with the same complaints and I have given them the same advice. Move more, eat less, more veggies, avoid the 5 whites (bread, pasta, potatoes, rice, and pastries-anything sugary). These are great starting strategies but they aren't the whole banana. And I wanted more.

The benefits of my journal

My sister has a disease called Moya Moya which caused her to have two strokes. One was when she was 28 and the other was when she was 32. She has had bad headaches her whole life. It wasn't until I was in my early 30s that we talked about our headaches and realized how similar they were.

We both have auras, the "warning sign" that there is a headache coming. Unfortunately for both of us, the aura is worse than the majority of headaches. Usually, it starts with a blind spot and some mental scrambling, and I have had some difficulty speaking in the past. The speaking difficulty is the thing that took my sister to the ER and ultimately was the sign that she had indeed suffered a stroke.

In February, I started having headaches after 8 years virtually headache free. Yes, I have gained 30 pounds of happy weight since getting married to my husband, my blood pressure is borderline and my stress level is about 3 times what is was before my great professional support system changed. All of those things had a part in my headaches, but when I had a headache that included a numb left arm, I got worried. So, I went in for an MRI. Which showed some narrowing in the blood vessels in my head. Moya Moya? After lots of tests, I saw a Neurologist and he sent me to a Neurosurgeon to get advice about whether to have surgical intervention. Thankfully, I do not have Moya Moya.

My journal was a huge help in my week long marathon of visits at Mayo Clinic in Rochester, Minnesota. I saw the Neurologist and when she asked me when something happened, I could look back and see. When the headache Neurologist asked which medication helped, I could look at a calendar I created to keep track of headaches. I could look at my "headache watch" section of each day and tell the headache specialist what made a difference. I could also tell him what did not make a difference. I had a list of questions for the Neurosurgeon and was able to be sure all of them had been answered before I left the room.

Until health care changes so that there is less waiting around, a journal is also a great way to pass the time while you are waiting. My first journal was boring and not too fun to read again, but the more I do it, the more fun it is to go back and read.

I am almost to the end of my third journal of this type, it has taken me about two years to fill three. I use a journal that is about 7.5 by 10 inches a softcover Moleskine. I can't use a digital journal, it doesn't call to me the same way that a real, paper journal does. I paint in it, I glue things into it, and I feel like I live a little more every day because I keep track of important, and sometiemes not-so-important things. I am happy to report that this, my third, journal started with a health scare and ended with the good news that I do not have a progressive blood vessel disease. I can't wait to see what the next journal will help me to discover.

Health care is too expensive

I spend a lot of time with patients trying to get them healthy. I don't mean just prescribing medication, although I do that. I mean talking about other things they can do to stay or to get physically, mentally, and spiritually healthy.

One of my common recommendations is journaling. There are a ton of good books about journaling and the benefits you can get from the practice. I recommend The New Diary by Tristine Rainer. I love the tone of the book and I feel like it is inspiring without being preachy or weird in that touchy-feely, free-love sort of way that it is easy to fall into when talking about accessing your inner wisdom. 

Journaling is an inner wisdom thing; you try to find the answer you know but can't identify because you are too hard on yourself. Your best friend loses something and you say, "Don't worry, you did the best you could." But if you lose the same thing your inner voice calls you stupid, dumb, loser, insert your inner voice put-down here. It isn't pretty.

I've recently had some patients unhappy about the cost of their visits. Three out of 80 patients isn't a bad ratio, but it still bugs me. Unhappy patients, no matter what the reason, trigger my need to journal. It took a migraine headache and 4 journal pages to realize that my frustration came down to agreement. The cost is outrageous…and I have no control over it. 

Nationally, the average support needed in a healthcare clinic is 2.5 full time staff per provider (or up to 5.8 staff depending on the resource you use). At least one of those is dedicated to billing. Every insurance company wants something different. The same problem may have to be coded in 3 different ways for 3 different insurers to cover. This means that every patient that walks into the clinic has to pay for at least 3.5 staff positions. It's not fair, but that is the reality. It isn't the only reason for the cost, of course, but I wish more people understood it. 

I also wish people understood that I don't choose what they pay. All I do is see people, treat them the best way I know how, and chart what we did. There is some complicated way that the price is figured. I don't know how it works, and it is one reason I am not self employed. I would prefer if no one had to pay for health care. But that would mean that the system would not exist. It's a catch-22. Hospitals and clinics have to charge for services or they can't pay providers. If providers don't get paid, they can't eat. I like to eat. Eating allows me to see patients.

So, I apologize in advance. It is certainly not more expensive to see me than it is to see anyone else, but I apologize for the state of the entire system. It isn't perfect, but it's the one we are stuck with. The best I can offer you is advice; find a provider that you like and who helps you get and stay healthy and see them as rarely as possible because you are following the advice they give you.

Pets for longer life

I am nearly a 40-year-old woman and I have never had my own pet. I couldn't have just any pet because we already have a very large doberman named Madonna and most pets could be eaten by her. Madonna barks at cats and bullies other dogs; she is a little high strung. So I chose a pet that lives in a cage…and happens to  require temperature control, a light schedule and hours of bonding time.

My baby, Persephone, is a three month old hedgehog, and is a lot of work. She has an exercise wheel that she uses every night and does most of her pottying on it. Yes, it's as messy as it sounds. She huffs at you when she is scared and jumps with her quills standing up so that you get poked. Hedgehogs are nocturnal and are prey animals so they take a lot of time to get used to you because they think you are going to eat them, most likely.

My husband had a Doberman when we got married. She was his baby. He took her with to worksites, she slept at the foot of his bed and she ate about everything that he ate. He covered her up when the house was a little chilly and even had a doggy coat specially made for her. I thought she was spoiled rotten. I guess she was, but he was happier for having her in his life.

Now, I understand that a pet is not just a pet. We spend a lot of our time with our pets. Dogs will follow you around and make you feel like a hero every time you come home, even if you were only gone for 10 minutes. Persephone has stopped huffing at me and trying to poke me with her sharp quills. It makes me happy. Even taking care of her hedgie house, aka cage, makes me happy. Research shows that people with pets are happier and healthier. I get it.

Last night, I had a dream that Persephone died. I realized the attachment I have to her when I woke up crying and went to be sure she was okay. The death of a pet for some can be more traumatic than the death of a human family member. I have patients that cry over a pet's death and then apologize because "it was only a dog." I believe that pets are worth the mourning that we do when they die.

I am going to enjoy my baby and all the work that goes into caring for her. I am going to feed her mealworms, no matter how icky, so that she has a good, comfortable and long life. She is making my life longer and happier. Oh, and pokier, too!

Searching the internet for heartburn

Sarah came to see me the other day (not a real person). She was having some problems with reflux, or heartburn, and had some information from the internet with her. She told me that she tried some things she found on a medical web site, blocking her bed up so that she was sleeping on a slight incline, not eating or drinking for at least two hours before going to bed and cutting out spicy foods. She wanted to know from me if there was anything else that she could do before she tried medication to help with the heartburn. 

I asked her some questions about her symptoms to be sure she was not experiencing a heart attack. She was not having any alarming symptoms, so we talked about heartburn and reflux.

TREATMENT: We talked about cutting out alcohol and caffeine, which can make heartburn worse by loosening the muscle around the top of the stomach (the lower esophageal sphincter or LES). She drinks coffee in the morning and decided to cut back to half decaf. We discussed not overeating at any meal, especially dinner, to decrease mechanical pressure on her LES. She doesn't smoke, so that is not an issue, but it can be for some people, as it also loosens the LES. Sarah was surprised to learn that peppermint can also loosen the LES. So she said she would avoid the after dinner mint sometimes served at her favorite restaurant. She also had been drinking peppermint herbal tea before bed and decided she could change to some other kind.

THE POINT: This was a perfect internet research story. She looked things up on reliable sites and let me know what she already tried. She was open to more ideas and help. She had good questions and she had tried nothing dangerous. She looked the information up on a few medical sites with good reputations, to compare what she found. In short, she did her research, but didn't try to diagnose herself.

The internet is wide open. Just as I can say anything I want in this blog, people can say anything on the internet. There are no internet police, no editors, no peer review, no reins. When I was a child, we were taught that gossip was like blowing the seeds off a dandelion. You can't get the words back. The internet is a lot like gossip. Once something is on the internet, it can take on a life of its own. And it doesn't have to be right or true.  There is no filter.

There are some really good medical sites that are peer reviewed. This means that one person can't say whatever they want. There is consensus behind the information and usually backed by research. This is the filter. Two good places to start to get more information or do research on the internet are Medical Net Top 20 and The Medical Library Association. They both have lists of sites that would be good places to start for reliable information. 

Eat right and exercise?

What is your health goal for this year? We all want to "eat right and exercise" but what does that even mean? Chances are, last year you vowed to eat right and exercise but nothing changed. Or maybe it did…for a week. I am guilty of this, too. I gained about 30 pounds two years ago and haven't taken it off. And I, like you, know exactly what I am doing wrong. 

Here are my whys: In order to be good at my job, or any job, physical health is imperative. I'll be more efficient and be better at sleuthing if I am taking care of my physical health.  Staying healthy for me is imperative. My family history includes heart attacks before age 50 and strokes.  I have been in good shape. I remember how good I felt. The energy level, the clarity of thinking, the decreased need to sleep my life away "catching up" on the weekends. (Which doesn't work. It just makes it harder to get up on time for work.)

Eat right. There are about a zillion different ideas about how to eat out there. Low carb/high fat, high carb/low fat, vegetarian, vegan, fast food…oh wait the last one isn't actually a diet. But wait, if you are regularly consuming fast food, it is your diet (food and drink regularly provided or consumed- Merriam Webster). Do you really think that fast food diet is healthy? Really? So, start your healthy goal by eating less fast food. You know where to start making changes. Start there. And you can go here for help http://www.webmd.com/diet/myths-vs-facts-10/lose-weight-safely.

Fad and extreme eating is all the rage, the names and foods change a little, but the concepts don't. If the diet you are contemplating has you eating fewer than 1200 calories a day, you will not maintain your muscle mass and be unable to add exercise. And you will be going the wrong direction. A loss of muscle mass means that your body is burning fewer calories and it's just not sexy to be all baggy and floppy. There are a lot of current celebrities who are very thin but what my friend, Dr. Willey, calls skinny-fat, higher in body fat and with very low muscle mass. It is not healthy to be so weak that you are unable to pick up your kids or run a mile or ride a bike. The idea of this whole healthy thing is to be, well, healthy. That means you want your body to do anything you want. Run, walk, swim, move furniture, whatever you desire. 

Exercise. How? You already know how to exercise. Move more. Find something that you love to do and then do it. Every day. The only thing I will add is to be an underachiever when you begin. Most of us, especially in January with New Year's goals, will start out by working much harder than we should. Why do we do this? We don't trust that we will follow through with our goals. So, make small goals every day. Start by getting started, but leave something in the tank so that you don't get so sore you can't move. That will derail you. And measure. Keep track of what you are doing, the amount of time you spend, the weight amount if you are lifting weights, the difficulty level. The gains you make will be your inspiration on the day you don't want to do it. 

What do you say we get started? There are so many reasons to get healthier this year. Find your why. What makes your toes tingle when you think about it? What will really get you started toward creating healthy habits? Today I ran one mile. Not much, but it's a start.

Time is slippery

Time is a great two faced monster. In between patients, when I am charting and composing letters, time sits on my shoulder and breathes in my ear…hurry, hurry, hurry. During phone calls, he is less insistent. As soon as I walk into an exam room where a patient is waiting, time leaps from my shoulder and waits to pounce as soon as I come out. 

Asking questions and getting to the bottom of the problem are my favorite things. When did it start? How long does it last? What does it feel like? Have you ever had it before? What do you think it is? I am allowed to be nosy. In school we learn that the diagnosis is 90% history. That means you tell me what is wrong before I ever lay hands on you. If you ever notice a frustrated health care provider and you happen to answer in one syllable, this is why. 

While sleuthing for answers is usually fun, there is one phrase that will kill it. "You're the doctor, you tell me." The human body is not a stereo. You cannot open it up and look into the back, solder something back together and be done. There is no jiggling it to see what is broken. When I started school I thought it would be easy. I thought that a patient would come in and tell you the symptoms they were having, you would reach back into your memory and say ahh, those symptoms equal this problem. Here's your prescription. Yeah. Not. I need you to tell me all of the pertinent details to figure out whether you have a horse or a zebra (I will explain the zebra thing later).

For lots of reasons, patients are sometimes trained not to give all the pertinent details. When you have a provider that has been seeing patients for 20 years, they often figure out what is happening in the first few minutes. And they are usually right. I have found that being a relative newbie is helpful because I have to ask more questions. Sometimes, one answer changes everything. You may get cough syrup…or you may go to the Emergency Room. I will spend more time getting there than my learned and experienced counterpart.

So, time stops in the room with a person who is hurting. It starts again when I step out into the hall. Unfortunately, I have sometimes spent too much time with one patient at someone else's expense. I feel bad for that. But I feel very good when I can look back at the end of the day and know that I did all I could for each patient. I hope that the people who come to see me feel supported and are willing to wait around just a little bit so that everyone gets what they need. It isn't the most efficient way, but it's the most caring way I know to do the job. One day, I will kill the two faced monster. Probably right before I die.

What I do

Hi and welcome to Health Care Insights!

Why would you read my blog? I am going to attempt to give you some insights from behind the white coat. 

I am Rebecca and I am a Family Practice Nurse Practitioner, also known as FNP. I work in a clinic in a small town in Montana and absolutely love my job.  I take care of patients on a daily basis and teaching them anything makes me love my job. I love to teach.

What is a Nurse Practitioner? It isn't an easy question to answer. The short answer is I am the person you see when you go to the "doctor's office" and don't see a doctor. Another short answer is that I am like a PA, if you know what a PA is.

The truth is, I can't tell you that I am like a doctor because I work with doctors every day. They have a lot more education and training than I do and it would be presumptuous of me to say. I do similar things to a family practice doctor. I see patients and examine them, order tests and prescribe medications. It fits well with my personality because I do well with new challenges daily. I can tell you I had no idea how challenging it would be when I started!

The most challenging thing about being a FNP is time. I worry about giving each patient enough time so that they get what they need, and I worry about the next patient who may have to wait if I take too long. I don't wear a watch, which helps me to be attentive to the patient I am with. I don't have to leave the watch at home, but I like the symbolism.

Before I was a nurse,  I had a surgeon who was 4 hours late for my family member's surgery. He told us when he came in that he had been with a woman with newly diagnosed breast cancer and she needed him. That impressed me. When I became the one "in charge" I wanted to be sure to rise to that level of care and compassion.

My pet peeve of the day is when a doctor of any kind doesn't know what a FNP is. I had a physician call me once when I was on call for the clinic (which includes me, two family practice physicians and an internal medicine physician). He told me if I couldn't find someone to make a decision about a patient, I should send them to the Emergency Room. The gentleman was very condescending and rude. He was not aware of my position, training or responsibility and treated me like a staff nurse. Unfortunately, the staff nurse is the most picked on, disdained,  and undervalued position in medicine. The good ones are good because they are fearless. They stand up for the patient no matter who challenges them. I decided it wasn't worth fighting with the physician since I sent the patient to the ER anyway. Rant over.