Emergency! Emergency? (2014 Edition)

After only one trip to the emergency room in the last twenty years, 2014 was my year of emergencies for myself. I've had many trips during that time and recently to ERs with family and friends, but it's very different when it's you.

The killer tree and the telephone pole it brought with it.

First, in August, was the Attack of the Killer Tree, the 100-foot tall, 100-year-old oak that decided to come down on me. I ran, it missed me, but when I looked over my shoulder to see if I was clear, the dog kept going and over I went, backwards. (Good to know I can outrun a tree, too bad I was so clumsy.) I cracked the back of my head open on the curb and ended up in an ambulance. It turns out ambulances have protocols of where to take people, but some discretion on how they do it. Head injuries were supposed to go all the way across the county; I talked them into the hospital in my neighborhood, just a half mile away.

Good to arrive in an ER via ambulance. They look at you right away, no waiting for triage. On the other hand, once they figured out I wasn't going to die from it, I spent a total of FIVE hours there. Luckily, a helpful neighbor had taken my dog home for me, and scooped up my purse and got it to me before the ambulance left. My kindle lives in the purse. As it turns out, that was at least as useful as having my insurance card.  I read a complete VI Warshawsky novel. If you aren't familiar with VI, she is the original hardboiled female detective, by Sara Paretsky. It is not uncommon for VI, after having been beaten up or even shot, to get up and walk out of a hospital with doctors telling her not to. At once point, I considered doing likewise, but talked myself out of it.

Another helpful neighbor called my brother-in-law to tell him I was being taken off in an ambulance. I had texted him, something like "I'm off to get my head bandaged because I fell." But after the call, he came creeping into the ER, scared to death. This ER is fraught with pain for us. My sister died a few feet from where I was lying. He was reassured to talk to me, though the back of my head looked like I failed to outrun the zombies and they had some of my brains.  He assigned my nephew to await my call to come get me when I was released.

Four metal staples, a week's worth of bad headaches, two weeks of no running or jumping, an inability to sleep on my back for several weeks, and eight weeks before I could get my hair colored, was the only aftermath.

I had to go back to the ER to get the staples out, because it takes a special tool. (Of course, the family kindly offered to go to Office Depot and take care of it, but I decided to stick with the professionals.) I estimated 7 am was the deal - after 6 am shift change, but before most walk-ins would get there. BINGO!  One hour in -and-out, exactly.

The next adventure was much less exciting. I sliced a nice clean oval off my thumb the very first time I used a mandoline. (Thanks to my wood-working friend Jeff for the tip on the stainless steel mesh glove, which has enabled me to use the mandoline again, even though I twitch at the thought. Even more thanks to my girl for my new vegetti - like a pencil sharpener for vegetables. Still, I'll wear the glove when using it.) It's really hard to work your way into a first aid kit and sort through packages of bandages while blood is flowing freely from your thumb on your dominant hand.  Pretty much, my bathroom looked like a slasher movie by the time I was done. The next morning, I asked the nurse at work to help re-bandage it. She took one look, and ordered me off to the ER. (I have since decided this was unnecessary - this is actually what "urgent care" is for. I had thought of them as the flu clinic, but they do bandages.)  This time, I went to the downtown hospital at prime time. Still, they had two tracks, one for the easy things like my thumb. They talked to me and took my temperature, checked when last I'd been in West Africa, and had me back being looked at in about twenty minutes.  Two times, they unwrapped it and pulled off the bandage, which started it bleeding and hurt like billy blue blazes. Gave me a chance to practice my cowboy cursing, and to realize you have to ask for painkillers. Two hours later, and I had a high-tech bandage that could stay on for 10 days without pulling the scab off again.  I had to wear a waterproof finger cap over it during my sailing excursion, and I've got a nice scar now, but otherwise uneventful.

This last trip is the reason I actually started to write this.  Two weeks before Christmas, on a Tuesday, I woke up with chest pain. I got up and started doing my morning stuff. The pain got worse. It was like a pressure, and to the extent I could localize it, it seemed to be coming from between my shoulder blades.

I was terrified and skeptical, all at once.  I have a tragic family history of heart problems. My sister dropped dead at 46, waking up one morning with chest pain and declared dead two hours later. My older brother had a bypass operation while in his fifties. My grandfather died of a heart attack at age 52.

 I had felt something like this pain before, intermittently and for brief (< 5 minutes) periods.  I have had intense heart screening because of this family history, with no indication there is anything wrong. But I've read a fair amount about how women's heart trouble presents differently than men's. There was a recent article in the New York Times from a woman who wrote a book about her husband's heart attack and recovery, but who had a hard time believing she was having one herself a couple of years later.

I kept on getting ready for work. I drank some coffee. In the bathroom, I found myself with my eyes closed, leaning against the wall, feeling the pain and trying to push it away.  I remembered how good I felt in the gym last night, as I worked my upper body with very heavy weights. "That's it!" I thought "That's what is causing this!", and then I closed my eyes again from the pain. A deep breath, which hurt to do, I straightened up, and went to the computer. I googled "chest pain in women" and came to a website with short anecdotes from women who dismissed their chest pain.  "SECONDS COUNT!" was the theme between them. "I had a powerful pain between my shoulder blades and it hurt to take a deep breath" read the third narrative I read.  

That did the trick. I would have told anyone else to go to the hospital. I might have been dialing 911 for them. I knew I needed to go get this checked out. Still mostly convinced it was the gym, I thought of my family, and how my fragile girl shouldn't have to go through this again.  I might be embarrassed, but the embarrassment would be worth it.  I got dressed-I'm not sure exactly what I was thinking, but I put on work clothes, though especially comfortable ones, except for the ankle boots.  It was 44 degrees out, pouring rain, and 6:30 in the morning. I put on my foul weather jacket, grabbed my purse (the one with the kindle) and my car keys, rested my head against the door and tried to make the pain stop, and then headed towards the hospital.

Note to readers:  DON'T DO THIS!  Never drive yourself to the emergency room if you suspect you are experiencing something that could incapacitate you along the way. It is as bad as driving drunk. You may be endangering other people which you don't have the right to do. Always always call 911 for yourself or your spouse. The folks on the ambulance will start treating you when they arrive, saving some of those precious seconds that count.  This is true even if you live a quarter mile away from the regional cardiac care center's emergency room, with just two right turns  and one traffic light to get there, and you are already somewhat embarrassed about making a fuss about probably (but only probably) nothing.

I parked at the hospital visitor parking, and stood under the overhang just out of the rain and outside the door literally turning in circles,  "It's nothing", I thought. "I don't want to be here and I don't want this to be happening", I thought more honestly.  This place is fraught with tension for me.  My sister died right here. What is going to happen when I walk through that door?  One thing I know for certain, a chain of events is going to start that I won't be able to control.
I walked into the ER, and sat down at the intake window. "Why are you here?" asked the lady I recognized from my staple-pulling visit.  "Chest pains", I said, wishing I was anywhere else. She scooched her chair back, called "chest pain" to someone over the cube divider, scooched back, and asked for id and insurance cards.  I had them out, and requested she double check the address because of a mixup in the billing statements.  She asked who my primary care doctor was. "Well, my cardiologist is Dr. B" I said. "Dr. B!" She said with reverence.  She scotched back and said over the partition, "Dr. B's patient!"  A nurse came out and asked me to come back.  He took me into a little room and put those little electrodes all over my chest and did a quick EKG.  He said the doctor would look at it but but it looked fine to him. 

I don't know what I expected to happen but this was really low key. My mental images had been of the noise, confusion, and many many people surrounding my sister, overlaid with several seasons of ER on TV. This was almost bucolic, and certainly anti-climactic since I had worked myself into such a tizzy. I had on a hospital gown on top by now, but I walked behind my nurse to a work station, carrying all my stuff, thinking now I'll just get dressed and head on to work. 

Not so fast. I described my symptoms in more detail, first to the nurse and then to the doctor, how I'd been having intermittent pain for some days and then big pain this morning, continually adding that I'd worked out with heavy weight the night before and it certainly could be muscle pain. "But then why have you felt it before?"  I said I was fine and I wanted to leave to the doctor, and she said fiercely, "There is no place else you should be right now!"  I stayed.  I sent an email to work, "No Nan today" with no other explanation.

The rest is even more of an anticlimax.  I was there for some hours, during which time I was hooked to cardiac and blood pressure monitors, had two lines for blood draws/drug pushes put in my arms, given aspirin, nitroglycerin, a proton-pump inhibitor (for acid reflux, because the odds were growing it was not cardiac related), and an MRI. I resisted other stronger drugs that were recommended, and when the doctor talked about admitting me to stay overnight I really grew alarmed. At that point, my pain was less but not gone.  It's really hard to listen so closely to your own body and distinguish sensation from suggestion after a while. I took my own notes on my iPad about what was happening when, and what my symptoms were. I regretted the ankle boots, which I was still wearing, along with my comfortable work trousers. My own cardiologist, the important Dr. B, (who had done all those tests on me before) practices at that hospital, so the ER doctor talked to him on the phone. "Dr. B will be coming to see you himself" she told me with some awe. When he came, he looked through all the charts again and sort of apologetically told me he really needed to use his own stethoscope with his own ears to listen to my chest. The doctors agreed to let me go if I took the PPI and went for a follow up at his office for a stress test. 

So yeah, I'm fine.  I did an echocardiogram a week later, running on a treadmill at maximum effort then having an ultrasound of my heart while it was going fast from the exercise. The crew had to repeat the test because we didn't move fast enough. It turns out I'm in such good aerobic condition my heart rate dropped too fast for them to catch good video of it pumping hard.  When I reviewed the overall situation with the glorious Dr. B, he said every marker said I was very healthy, and he was impressed at how long and fast I was on the treadmill.  "Well, yeah, I ran some 5Ks this summer", I said, then very grandly, channeling our friend Chris, "it is my intention to go vigorously into old age". Quickly then, hearing the hubris echo in the room, sheepishly, "I'm going to be 60 this year. I have to think about these things."  "I'm right there with you" he said with a grin. He basically told me it appeared I won the genetic lottery, mitosis had favored me, and there was no reason to believe I had any cardiac problems, I should take the medicine for the acid reflux and follow up with my own doctor.

But I think I did the right thing. Here is something to think about during this red month of February -"just a little heart attack".

So that's my ER stories from  last year.  It's all over but the billing and insurance paperwork, which may last for some time to come.

Getting Things Under Control

I ate too much over the holidays - and didn't stop when the holidays were over. But homeostasis - my body's set point - resisted gaining the weight until mid-January. Finally, my indulgences caught up with me and I hit my highest weight in a couple of years.

Ding Ding Ding!  The alarm bells rang!

So back under control, which means following strict rules for a few weeks. I'm going to what has always worked for me so far - Atkins. I started a week ago last Tuesday (Jan. 21) - the day after my house guests departed. I had planned for this - happily postponing the work and the sometimes unpleasant beginning of the diet.  My guests left mid-day Monday, and since I was not at work I was able to lay in supplies and prepare for my back to work scramble.

As is my wont, I read some books. My two go-two books are the Beck Diet Solution which got me started back in 2010, and of course The New Atkins for a New You.  The Beck book is really a workbook of how to think about eating, and it has definitely helped me shape a new relationship with food. This Atkins isn't terribly different from the original Atkins, except it emphasizes vegetables more. But, like all these books, it has to start out with the science of how your body processes food and therefore why their way of eating is better. And, since it is part of the much-reviled Atkins approach, it has to justify why their approach to eating is not dangerous. The problem with re-reading these books is I've read them so much, they don't hold my attention. I think I know what they say and so I put them aside and just eat.  The problem right now is I need some rules on eating.

So for a change of pace, I got The New Atkins Made Easy.  This book pretty much covers exactly the same thing as far as eating rules as the more official book. It skips all the science, and in different words, tells you what to eat when. (And every rule is the same, just different style.) I needed different words to hold my interest, and the plain talk is great. The big point that is hammered into the first few chapters is:  VEGETABLES.  Not focussed on meat, butter, and eggs, as Atkins is rumored to be. Design every meal around greens. This book stresses the minimum amount of vegetables to eat each day, rather than talking about limiting carbs.  Yes, you have to limit carbs. No grains, no potatoes, no sugar, no beans, limited dairy at this stage. No fruit at this stage, which is the hardest right now. But eat your vegetables and you won't miss the carbs. Proteins are also subject ot portion control. Four or five ounces of meat per meal, max, (no pounds of ribeye), and average no more than an egg a day. No yogurt till later, but small amounts of sour cream are ok.  But eat your vegetables first!

So now here is a typical day:  Breakfast is eaten in the car while driving: no-carb chicken sausages wrapped in lettuce leaves to be finger food.  Usually each wrap is a single romaine leaf torn off the heart-of-romaine head.  There is my first cup of leafy greens. Lunch is a huge salad from the salad bar are work- spinach, lettuce, red onions, cucumber, mushrooms, (at least 3 cups) with my own salad dressing (so I know it has no sugar) and five ounces of meat from home. (I bring my own meat mostly because I care about farming practices used on animals).  An afternoon snack turns out to be crucial in giving me the energy to do dinner right. It's been a couple of celery stalks with hard salami, or just plain guacamole, or olives. (I'll add nuts next week, but want to keep the green vegetable side as well.)  Dinner on a week night is heating up something made in advance - roast chicken or grilled steak, with a couple of cups of cooked vegetables - broccilli or cauliflower or asparagus.  I've kept my evenings busy, so I can't reach for the sweets. This is my weakest time of day, and pretty much celery or a piece of cheese has worked for a bed time snack. It's also worked to not have a snack at all. I cook with olive oil and butter, and last weekend ate a bunch of bacon, but really, doesn't this look relatively healthy by almost anyone's standards?

I'm tracking my food in My Fitness Pal, and so I can say with confidence eleven days into this I've averaged 1300 calories a day, and hit the 20 "net" grams of carbs exactly on average. (Net carbs are total carbohydrate grams minus fiber grams, in my case that works out to 30 total carb grams and 10 fiber grams, so about a third of my carbs are fiber. More fiber would be good, but hard to find a food that isn't sawdust yet has more grams of fiber than other carbs.)  If you don't make your own food from scratch, it's very hard to make these targets. Bottled salad dressings, fruit condiments in salads, bread crumbs on cooked vegetables, all of these things add carbs. Meat and green vegetables, with oil and butter and vinegar is the only way to make sure there isn't corn starch in the gravy.

So I'm having terrific success in terms of what I see on the scale.

So the weight I saw on the scale two weeks ago, that went "ding ding ding" was six pounds more than today's weight!  Atkins says the first 4-6 pounds in the first two weeks are water, and then your body concolidates and starts losing fat.

We'll see. I've seen in the last five years that I can do this well for 2-4 weeks, and then I'm bored and want chocolate.  But it's also sustaining the effort to make food myself that derails me. For lunch, I can't stop at the food trucks for a sandwich (or even a curry since I don't know what's in the sauce). I've decided to buy step-saving foods, like cut up celery or romaine hearts. Eating off the salad bar at work is a huge convenience and almost totally eliminates any excuses there. One day I truly did not have time to go to the second floor and buy my greens, and so I just ate my meat for lunch, my celery and salami for snack, and ate more veggies at dinner. Another morning I was disrupted by teen schedules, but I was able to grab my meat and breakfast and stay on track when I got to work late.  But it is certainly a friggin' lot of planning and work.

Typically, there is a loss of energy a few days in, and a recovery a few days after this. I've had that "Atkins flu" very badly other times. To try to avoid it, I followed their advice and ate a teaspoon of salt (fleur de sel) for each of the first five days. I really didn't have the issues this time I've had other times. Today I started training for a 5K in March, so I can confirm the energy is back.

So I'm aiming to keep up this very restricted eating until President's day, then consider adding some carbs back. We'll see. I think I'm doing better at the planning and management this time around, and I pat myself on the back for not letting work or teens derail me in the first ten days.

Excelsior!

It's time to get going

I'm not entirely sure where, but let's go!

Should I be content or aim for more?

Happy New Year everyone!  Here is my report on the weight front:

My weight stayed constant last year, not so bad.  I reconciled myself to being in maintenance, and except for the detox period, it stayed phenominally consistent - three pounds change the whole year,

From Trendweight.com, terrific free site!

The graph above shows my actual scale reading in the light gray line, and the "trend", or underlying weight calculated by a moving average, in the red line. Here is the familiar chart from the beginning of time:

So the question that is consuming me, as I finish up eating the Christmas sweets, is whether I should make a try for blasting below the floor of my weight I keep bouncing off of. Should I try losing the last 10-15 pounds that takes me to the "goal weight" I've had in mind for 20 years? The weight that I actually saw for about 48 hours at the turn of the millenium?

The things I know I want to do:

• Get back into running (I've taken a vacation from running since the last 5K in November).
• Eat more fish (I realized I cooked fish during the detox diet and it was the first time I had done that in maybe 20 years - except for shrimp and salmon, which somehow don't count).
• Eat more soups (I made turkey soup out of the carcass, using my new slow cooker. I got really full and happy for not so many calories.)
• Keep eating vegetables (I haven't had so many in the house to choose from recently).
• Take my lunch to work more often.
• Cook more.

I'm scheduled in June to stand in front of a bunch of strangers and talk about my weight loss history. Wouldn't it be nice to have a new bit of success to talk about?  I think I'm going to go for it, but at the same time I'm wondering how committed I am. That's why I'm in the "contemplation" phase now.

Year of Adventures.... Sort Of

Looking back to the end of last year and beginning of this year, I didn't have much in the way of resolutions. I did, however, express one:  Try to have an adventure at least once a month. An adventure, defined loosely, was doing something I had never done before - something hard.  At least, hard for me.

How did I do?

I almost blew it right away.  In January, on the last day of the month, I went running on the mall, right from work. Pretty weak, I'd say, but it counts.  I did this a couple more times this year, but after my dog was cleared for exercise, I mostly have gone running with him.

February was Rocky liberation, and we celebrated with a hike in Greenbelt National Park. My first time to the park, and Rocky's first hike. It was splendid, and long enough to be really physically challenging for us both.

March was different. I did something social, and hard. I went to a "meetup group" - an event set up with an open invitation on the internet.  This was very hard for me, but actually I ended up doing a few of these this year. In March, I attended the Quantified Self group - the same group I gave my talk to in November. I also attended a Data Science DC group, where there was the author of Cool Infographics, something which I am very interested in.

In April, I did a "Meetup Group" hike, to see the cherry blossoms. It ended up with just a couple of us, but it was fun before work.  I also did the Detox Diet, (which I wrote about in May).  Not something I intend to repeat, but an interesting adventure, never-the-less.

May began the 5K circuit, starting with the Takoma Park 5K. It wasn't my first time, but it was the first race in two years, the first of the season, and I'm counting it as my adventure.

June, I went to the Congo with my family. Adventure enough for anyone.  Not your normal vacation destination. It was particularly good for me to be on a vacation where I could influence nothing, I was just along for the ride.

July was the Annapolis Women's 5K. My first race with a friend. Lots of fun.  I also did two other Meetup hikes, places I had never been before. I was not overwhelmed with the company, but it was good to get out and be at least a little bit social.

August was The Attack of the Killer Tree, and my first ride in an ambulance, my first metal stitches. Not an adventure I want to repeat, but it kept me from the Flee the British 5K I had been planning to run, so I have to count the ambulance ride as the adventure.

September I joined a new gym, and ventured out in public in workout clothes. Before then, I had only worn those clothes to my other, private gym, and only for the 6 am workout. Now, I'm strutting around running errands in my workout clothes downtown.

October was three adventures:  two 5ks and sailing on the Pride, as well as ER trip #2 from slicing off a piece of my thumb with a mandoline.

November was the last 5K race of the year, and my QS talk which was posted on the internets.

December - what have I got to show for the month? I'm doing new stuff at the gym - including bench pressing with the big weights! - and the rowing machine, and pull-ups.  I think that will have to count.  I don't want to count ER trip #3, the cardiac false alarm. I'm sorry I brought it up. Let's go back to the subject of planned adventures.

What will I plan for next year? I'm going to take a vacation to San Francisco for one, in June. I think I need more travel, will have to figure it out.  But I think I achieved my goal, overall, of pushing myself to new horizons this year. It is certainly NOT time to rest on my laurels, but instead move forward.

Excelsior!

Silly little goals

I've been trying to meet my step goals on the Jawbone every day (except for the days I blow it off completely because I'm so far from the end at night and it's raining and nasty out).  So last night, I checked it, estimated how far to walk the dog, and came in and got ready to go to bed. I finally checked it again just before climbing in -and I was 200 steps short!  So I decided to go for it-I strolled in a circuit around my kitchen, living room and office. The really amusing part was how the dog faithfully trailed after me every single step! I always hand him a treat after I climb into bed, and so he is especially velcro'd to me as I go through bedtime motions just so he doesn't accidently miss it. So about five minutes of the two of us strolling in a circle made the goal. The phone lit up and the goal bar did its little spectacular dance. 

I'm not at all sure 200 steps has any impact on my health. However, I think maintaining a baseline of activity does have an effect, and the little reinforcements from the phone encourage making the goal consistently.

Little Motivations

It's cold, it's dark, and there are special events every day. I need help getting moving. I like exercise, except for the getting-off-the-couch and the first-five-minutes parts. It takes a nudge to get me going.

Strategies I'm employing:

I have a dog!  He nudges, literally. And he is much better behaved (ie, sleeps more versus looking for something else to eat) if he is tired and not bored. I have a small part of my yard fenced, so I do NOT have to put on the leash and walk. But he really really likes it, and lets me know by inserting his nose between my hand and whatever I'm doing. So out we go.

I'm continuing with personal training, though now I have a new gym. It was good to change it up, and I like the more social scene at the big gym.I certainly would NOT have gone to the gym several times in the last couple of months, except that I have to pay if I simply no-show.  I am planning ahead and cancelling more often, though, on fairly flimsy excuses.  I know I work much harder for the trainer than I would for myself, but I need to get the trainer to push slightly less hard. I don't think she is used to working with old folks like me, and I know what my body is doing pretty well, so I will be speaking up some more.

Goals on my fitness tracker. This is silly and trivial, but it's part of what keeps me moving. I lowered my step goal to within reach, but not a slam-dunk:  9,000 steps a day. Now, the Jawbone app gives me kudos when I make it, and for making it several days in a row - a "streak". Getting that little message has kept me moving more. Last Friday, for example, I was less than half way there in the evening. I went out with the dog, in the dark and cold and light rain, and we took a circuitous walk through the neighborhood - two and a half miles, about 45 minutes. Without the quantitative goal, it would have been shorter. Without the dog, it wouldn't have happened (or else it would have been inside on the treadmill, I suppose, maybe with the ipad).

All those Norwegian genes in my body are expressing themselves by sending messages to every cell:  "Slow down and bulk up! Or else you won't make it to summer!".  I read recently a theory that depression is an adaptive mechanism, to get you through a cold, dark period with scarce food - there is an evolutionary advantage to wanting to lie in the dark and not move.  What makes us different from the animals is we so not have to behave the way our genes suggest. But it definitely takes more effort. It's good to have some immediate, little, nudges and feedback rather than have to rely on longer term, more abstract goals.