Monday, October 29, 2012

Palliative Care

Our ethics small group professor often shares sad stories of patients she has had to witness pass. After all, the heart of many ethics discussions turns to that fine thread of life and death. It seems that every physician collects a couple of these. Today she choked up during the discussion and was living the entire experience over again. I never even knew this person and I had to fight tears.

You never really know what to say or do in those situations, as someone's story unfolds. So I hugged her after class.

Her body, so small; I, the awkward giant.

Sunday, October 28, 2012

1st week lessons learned on a primal diet.

Things I've learned over the last couple of days. There's a lot to say so I'm putting it out there shot gun style.

1. Poached eggs without toast aren't worth it. They need to sit on things. I'm sticking to boiled eggs covered in hot sauce. Which I like better anyway.

2. I can make my own pesto! My crop share came in with a load of basil and a recipe. Easy enough to remember. Enough basil to fill a colander, juice of 1 whole lemon, 1 cup choice of walnuts/pine nuts/sunflower seeds, 2-4 cloves of garlic, 1 cup olive oil. Put in blender and go crazy. It's good.

3. I came across a miracle to save myself from my candy cravings. Chop up an apple, then cover it in cinnamon and cocoa powder. After a daze of chocolate cravings that I was just barely able to ignore, eating this was wonderful. I could feel a wash of relief over my entire body. And when I was done, I just sat there in the calm and soaked it in, savoring the last bit of bitterness on my tongue. Which is a bit screwed up in terms of reactions and leads me to my next bit of education.

4. I am most certainly addicted to chocolate. Specifically, the cocoa powder. I'm willing to make this a sometimes food for myself. It seems like the more militant paleo people like to throw around that cocoa powder (along with coffee and alcohol) didn't exist in paleolithic times, I'd like to throw out that neither did the great array of spices we use. Cocoa powder is a spice. Then again, you never see anyone jonesing for oregano or cumin, so I guess the their point stands on a different angle.

5. Last Thursday and Friday (Day 4 and 5 respectively) I was in a terrible, depressive mood. Completely overwhelmed by socialization, and had a very low tolerance for any sort of crap. This is very unlike myself. My tolerance for crap is quite high, and I like people. I skipped my last lecture on Friday I was so miserable and burnt out. Also very unlike myself. I'm one of those people who shows up rain or shine, and plunks my butt in the same spot every time. The mood went away after spending one on one time with my boyfriend but I don't have any explanation for it that makes a ton of sense to me. Maybe it was the stress of a new diet change, maybe it was being burnt out with yet another nonsensical microbiology information dump delivered by a monotone lecture, maybe I was just feeling lonely. But I'm much better now.

6. Starting yesterday I was done with the yogurt. The dairy is gone from the fridge. I found out there was a name for that as well in the community. Paleo + organic whole fat milk products = Primal. The more I look into this way of eating, the more you realize you're learning about an entire subculture, complete with the self righteous weirdos that have to take it to religious levels. You know, like vegetarianism.* Along with the food, there's an entire life style connected to paleo. Paleo is the white rabbit hole. Painfully simple on the outside, but with an entire wonderland inside it, driven by a variety of personalities. And really, it all depends on how deep you want to go. I've already decided that I'm gonna stick to 30 days of paleo and then I'm introducing food groups one by one. I'll probably settle on a primal diet because I want my fatty yogurt back and an excuses to get samples from the lady that sells the really good milk at the farmer's market.

7. I was listening to some pod casts and they say that paleo dieters typically see a performance drop that can last up to 3 weeks. 3 weeks to change your epigenetics to run on a higher percentage of fats. It feels like a long time, but it's nice to have a set point I can look forward to.

8. It's really nice not being bloated. I've lost 2 pounds of water weight and my stomach has really flattened out. It makes me wish I took some pictures in the beginning.


*In case you were wondering, here are the 7 levels of vegetarianism  Presumably you get more super powers of self righteousness as you get higher. And if you don't know what I'm talking about, you really should watch Scott Pilgrim Vs the World. Excellent comedy if you were ever a fan of video games or the arcade era.

Level 1: The "I don't eat red meat" vegetarian. But they do eat bacon. And chicken. And maybe lamb. And sometimes McDonalds when they're craving it. Hey, I had a cousin who was allergic to beef but still manages to eat McDonalds once in a while because they thin it out so much. In fact, you never knew that they didn't eat red meat util that night you made a roast for a dinner party. P.S. This person isn't a vegetarian, they're just irritating.

Level 2: Pescatarian. Not technically vegetarian, but it gets throw in with them a lot. Cut out all animal products but sea food, eggs, and milk.

Level 3: Lacto ovo vegetarian. Only eggs and milk. This is typically the highest level nutritionists are comfortable with putting children at. Kid's have higher protein requirements, but eggs are good enough stuff to do the trick.

Level 4: Lacto only vegetarian. Dairy only. This is what the Hare Krishna's eat. But they also cut out garlic and onions too along with anything too spicy because they believe flatulence interferes with meditation. They make good food. I used to eat a lot of lunches with them.

Level 5: Vegan. No animal products. Including honey. That's stealing from bees. Any vegan who is vegan for spiritual or humanitarian reasons gets my respect. But if they say it's for health alone, I'm going to roll my eyes at them.

Level 6: Raw vegan. Everything vegan, but never raise the temperature above 118 degrees F! That means cutting out your legumes, tofu, and grains, unless you sprout them. That chops out a lot of your protein, unless you supplement with powders. Yeah...don't put children on that diet. Unless of course you like your wee ones placid and developmentally delayed.

Level 7. Fruititarian. You only eat fruit that naturally falls. Anything else might hurt the plant. Only vegans that wish to ascend to vegan heaven go fruititarian. Because with the vast amount of nutrient deficiencies you're going to get with this, that really is the only place you can go.

Wednesday, October 24, 2012

Ugggg....Craving sugar.

Totally craving crap right now. I'm also feeling very grumpy, like a bratty child. Because I want sugar. Not just sugar, strait up crap. McDonalds burger and chicken nuggets. These aren't things I normally go for, but today my body has decided to take out all the heavy hitters. You will not just crave sugary junk will crave the lowest of lows. McDonalds. 

Sour Twizzlers. Dark chocolate. And as long as we're fantasizing, I'd like some fat gummy bears the size of an egg. I think about egg sized gummy bears quite frequently. 

Sugar cravings are supposed to pass if you just tough them out. It's funny, my boyfriend told me that when he went through this process he felt "suffocated" for bread, rice, and pasta. I could care less about those. I just want straight up crap. You know, I was telling myself that this was the perfect time of year to start this up because there's such a nice overlap of so many veggies in season right now. But the Halloween candy is harrowing.

The good news is, I think I've over done it on the food. I don't anticipate spending as much as I did on this new menu*. The more I think about it, the more I realize that my 130 spent is probably going to be closer to two weeks of food for me, not one. Which is great for my pocket book!

Also tomorrow, my CSA is coming in for the first week. Yep, bought into a crop share. Which is great! But there's so much food in the fridge already. This shall be interesting. My boyfriend is coming down tomorrow. I'm going to try to stuff him with as much of my extra food as possible.

I'm either full and craving sweets, or ravenous and craving anything. As my body is adjusting to utilizing more fats, I'm more full and therefore I'm craving sweets. Eventually my brain will catch up to this madness. I just gotta wait it out.


*I always seem to come up with new words to describe diet, or anything that sounds too weight loss obsessed like cutting sugar. Sometimes I take a second look at what I just said and geeze, it sounds pretentious. But there's a reason behind why I've developed this habit. 

If I use the word diet, it is typically in the blandest way possible. To me, diet is just a catch all term for whatever one particular person happens to eat on a regular basis. But more often than not, people are hypersensitive to the word diet, and they immediately think I'm trying to lose weight in the most unhealthy way possible if I use the word in a sentence. While I'm no fitness model, I certainly don't need to lose weight. I'm well aware. So I dance all around certain words because I'm bound to get a lecture on how I don't need to lose weight if I use the damn word completely scientifically. "My diet is ____", "I'm changing my diet", whatever. Then you have to go through a bunch of patronizing "Oh no! Don't do that! You're much too skinny already!" Or worse, you feel like you've alienated someone because you triggered their own issues and now they're playing the comparison game in their head. I really don't want that.

More often than not, I just want to smack someone upside the head because those sorts of comments make me feel like assumptions have been made that I don't identify with. That I need to be put on watch because I'm on the verge of self destructive behavior. It's patronizing to treat me like a teen girl who can't tell the difference between magazines and realistic expectations. The same thing happens when I talk about "improving my body". So I've learned to be specific with that too. I'll be thinking VO2 max, strength, power, and functional stuff. They'll be thinking...OMG EDNOS. Quick! Reverse it with friendship and finger shaking!

Words. They're loaded. Now I say crap like "resetting my taste buds" instead of "cutting sugar" without even thinking about it. And the same people that freaked out on me before, nod their head like everything makes sense. Yeesh. They mean well, but sometimes I'm not sure who is coddling who.

Tuesday, October 23, 2012

What's for Dinner: Marinara sauce with hot sausage and chunky vegetables over spaghetti squash

Cooking anything elaborate (AKA anything beyond sandwiches or leftovers) has to be a very social process for me. Since I'm in a long distance relationship and paleo requires a lot of cooking, I'm posting some meals here. Then I get to feel like I'm talking with someone the whole time, when in reality I'm just lonely. Ouch. That came out a little harsh.

I'm doing dinner posts because lunch is always left overs, and breakfast is a hurried forage for a piece of fruit before I scramble out the door, if it happens. Lunch used to be forage too, like a piece of fruit, a granola bar, boiled eggs, single serving bag of edamame, a fat carrot or some variation on that. Always grab and go. Better than buying Chick-fil-a and compromising both my wallet and moral values eh? I still consider it a good plan for anyone who can't bring themselves to arrange lunch, but is happy to toss things in a bag. 

Anyway, onto the food. I find myself arranging the stuff on the table to make it easier for me to think. Since yesterday's food tasted bland to me, I decided I needed some spice today in the form of hot sausage. I also have been feeling nostalgic for grains, so I decided that I'd give the spaghetti squash on my list a try. Cause, you know, it's got spaghetti in the title. That and needing to get rid of the last of the mushrooms, and the meal was already coming together. I'm gonna make my chunky sauce and have an Italian night. You can see that in my mind, I was going to make a tomato and avocado salad too, but to hell with that. Also yes, cheese is there. Not on the diet, but I'm not cutting dairy until the yogurt is gone, so whatever, Mr. Cheese. Not splitting hairs here. 

Ingredients for dinner minus a can of sauce, a can of stewed tomatoes, and spices.
Except for the good intentions in the back.
 This is the Spaghetti squash. You cut it in half, gut out the seeds, put them face down on a cookie sheet, and bake at 350 F for 45 minutes. Which is almost exactly the right amount of time to be leisurely with your sauce.
It's squash. Squash is not a fabulously photogenic fruit. We are kindred spirits.  

Sauce it coming along. You add spinach last. 

And they're done at the same time! Noodles never do that for me.

The flesh pulls off easily in angel hair sized strands.

It even swirls well on the fork.

Two bowels of this = Dinner. 
I loaded up on more sauce after I was done with this, I just wanted to show what the squash looked like next to the sauce.

Thoughts on taste: Of course my spaghetti sauce was the shit. It always is. I already like it the way I cook it, so no surprises there. However, people are lying to you if they say that spaghetti squash tastes just like pasta. It doesn't. It tastes like a very mild squash. Also the squash isn't particularly filling on it's own. But the squash is not without it's merits. It absorbs the flavor of the sauce very well, it clings to the sauce, and it spins on a fork better than pasta does. It fills the role of pasta quite nicely. I can and will eat this again.

Day 1. Initial Impressions on paleo. Differences have been noticed!

Today has gone fairly well considering I didn't sleep much last night. I'm not complaining! I did that to myself. Just stating facts. But now I'm home and comfy. I'll probably make good progress with my work after I decompress a little.

So, once again, I'm not full paleo right now. I'm just grain and legume free. As we speak, I just finished off the Chobani plain yogurt in the fridge with some strawberries. Because yogurt is pricey, tasty, and perishable. I'm not going to let that go to waste. Surprisingly, there is yet another half tub of no name local yogurt in there because of bad fridge organization and planning. That tub is the really good stuff. Super fatty and creamy and delicious. No way in hell am I going to toss it. There's milk and cheedar too, but I remain uninterested. Knowing myself, the milk will go bad, I'll throw it out, and then I'll agonize over whether or not to freeze the cheese or eat it. Such is life.

My opinions on the diet so far.

1. I was completely bloat free today and Monday. On Sunday a friend convinced me to head to a fair for a few hours where I ate fried butter and fried snickers. And a hamburger on a pasty white bun. I've always wanted to eat fried butter. So I did. To feel so good the following day, wow. Quick turn around.

2. Beyond straight up skipping a meal, I become full way before I become stuffed. You would think this is self explanatory, but it's not. A lot of times, my body hasn't told me to stop eating whatever I'm eating until I'm stuffering from it. I'm gonna keep that typo right there. It's now a new word. Stuffering: overeating to the point of uncomfort. This happens most when it comes to candies. I don't feel satisfied until I'm stuffed, so I keep eating until the bag is gone. Or if it's a big bag, the majority of the bag is gone.

Now this makes sense for two reasons. The first is that fruits and veggies have a lot of fiber in them. They fill you. The second is that fats and proteins produce stronger satiety signals to the brain than carbohydrates. So you become full way before you stuff yourself to oblivion. It's one of the reasons I like Wolf's book. The science matches up to the physiology and metabolism we've learned in class.

I like the way that this matches up here too: eating fat and protein release less insulin than carbohydrate. Overly simplified, insulin is a storage hormone. So a body overwhelmed by insulin would be in storage mode right? Or on the flip side, promoting less insulin release would promote less insulin resistance, which is a big issue in type II diabetes, obesity, etc. Yet the body is still provided ample carbohydrates in the form of veggies and fruit. The only thing that limits the veggies you eat is filling up. This isn't Atkins, which sigh...yes I did that for about a week when I was a teenager because my parents were doing it, I was convinced I could 'beat them at it', I had body issues, and it was summer so meals were very laissez faire around the house (AKA: I could get away with it). Atkins is not an easy diet to follow, I didn't feel awake or well when I was on it, and then everything halted when I passed out the first day of band camp. Yep, I took band camp very seriously.

Nutrition seems like something that should be inherently simple to me. Or at least the ideal should. Yet everything is needlessly complicated because the scientific literature started fighting a war in the 80s and it's still going.

To me, I think there are different tiers of dietary health. I also think those tiers need to account that each person needs something slightly different depending on their ancestry. I would organize them like this, with the most important on the top:

1. Get enough calories. Keep from dying.
2. Get enough macronutrients and micronutrients. You know, to prevent deficiencies like kwashiorkor, pernicious anemia, whatever.
3. Get enough nutrients while removing all food allergies and intolerances. Even the minor ones.
4. Follow an allergen free diet while eating organisms that were harvested in optimal health. Low pollutants, better living conditions, etc.

That's it. It should be that simple. I should never have to count calories or tally points. I should just eat until I feel compelled to stop. Food shouldn't be some crazy, uncontrollable monster. Weight management shouldn't be some mysterious thing confined to the world of celebrity diet. It should just intrinsically make sense.

I'm really holding out for this paleo diet because it does seem to make sense to the principles I laid out. It removes all the common food allergens which probably gives your body enough of a rest that it can finally feel what a healthy base line is like. And once I get to that point where all the extra noise is drowned out and my body can be heard, I'm going to add foods back in, one by one to figure out what my own bad guys are.

I'm very excited about all of this. I've always wanted a personalized diet and now I've got a plan. It feels like I could really make this happen.

Starting Paleo.

I have a couple of different blog posts I want to write right now, but I'm on a time crunch because it's late and I want to go to bed. My body is pulling me to sleep, which is a good sign. Those signals have been screwed up for the past couple of months. 

But I must write this. Recently my boyfriend has become more and more interested in paleo eating. What is paleo? Essentially cutting grain, dairy, legumes, and processed food from your diet. That leaves meats, fruits, vegetables, and nuts (This is sans peanuts, that's a pea and classified as a legume). The benefit is that you eliminate the some of the most common culprits of food allergies while eating a crap load of nutrition dense food. 

He's been eating about 5/6 meals paleo now. The 6th meal is usually shared with the guys at the station and whatever is, is. But since then, his incredibly finicky digestive system has quieted down and he's starting to get his undergrad abs back. You can't possibly know how bad his digestion was before, so let me explain. When we first started dating he would get regular explosive diarrhea. And next to the bathroom, I would be curled up on the bed, hidden in covers shouting "I'm SORRY! I'm killing you! My food is killing you!" To which he would reply between horrible noises, 

"No! It's ok! I'm way better than I was when I was in undergrad! You've made things much better!"


This would back and forth for quite some time, at least once a day. Every morning, actually. Bad digestive problems. Bad. Sometimes recognize the food you ate 1 hour ago bad. To get from start to finish in an hour...your food has to be charging through. Like cavalry. We got through this because I started force feeding him activia yogurt. Then when he decided he liked it, he'd eat 3 containers a day. This helped. A lot. But still, on and off, all was not well in the gut.  

That's not to say anything of my own digestive issues. I bloat easily. Coffee gives me issues. Stress can make me blot for the door 3 times before 10 AM. When I went overseas this summer I swung between constipation and liquid fire over the course of a week, with one or two pleasant days in between. At least I was going. The other group members....were not as proactive about getting their hands on fruit and veggies as I was. Ow.

Hence, I've come to believe that the GI is a picky creature, but ultimately the canary in the coal mine for our health. Well, that and moods. 

Back to paleo. Boyfriend has gotten miraculous results of...not needing copious amounts of yogurt to keep himself in balance. His gut problems are not problems. Whoo! That's the big thing. The beautiful body is icing on the cake. He doesn't have gut problems! Considering that I love him very much and my plan is to be in it for the long haul with him, I want him to be as healthy as possible. I'm more than happy to pick up this diet with him. 

It also makes sense to me because my greatest feeling health wise was my last year of undergrad. I was biking up a big hill every day to get to class, but I was also too lazy to cook rice or noodles for the most part. Rice and noodles are boring as hell to me and they require you to take out extra dishes. So I'd often make huge skillets of stir fry and just eat the whole thing. Don't get me wrong, I ate a lot of lentils and double fiber bread too, but those gave me horrible gas. I've always needed copious amounts of vegetables to remain happy. 

About two days ago I bought the book "Paleo Solution" by Robb Wolf and I've been reading it over the past couple of days. The science matches up well with what we're being taught, and connects a few extra dots. I have more to say on that later as well as some disappointment in how little preventative medicine we get, just not now at 1:36 in the morning. 

One thing Wolf is a big proponent of is trying the diet for 30 days straight, no cheating, and then making your opinion. And in order to do that, you have to get rid of everything in the pantry that contains grain or legume, or milk. Which is a lot of food, and who wants to waste that money? As a ex grad student that is just becoming accustomed to paying extra for my health, I still have sticker shock for a lot of things. Even if something is not good, even if I hate it, I'll still hold onto it. Case in point, my boyfriend used to leave a lot of instant macaroni and cheese and canned peaches in my pantry. I hate instant mac. But I can't throw the food away, because just in case. 

So today I removed all the food, and satisfied my inner prepper by squirreling it away in the corner of my closet. It's now real emergency ration food. You know, for hurricanes, tornadoes, zombies, and stuff. And since it's shelf life stable, I can set it and forget it. Would I be happy eating that in the Apocalypse? I think it's safe to say that I'd get over it. 

Luckily, in this endeavor to clean everything out, the fridge is almost already cleaned out. I apparently have a grand stock of plain yogurt, milk, and cheese, but little else in term of offenders. I'm not willing to get rid of the yogurt though. It's a really expensive organic creamy variety that is too tasty to let go in the trash. It alone doesn't seem to send my bloat alarm off. I won't buy anymore, but I'm not going to trash it. So the thirty days will just technically start after the yogurt is gone. It's so good.

Which means I get to spend this time not sweating the small stuff, i.e. extra fruit and yogurt, while I prepare my kitchen to meet this new diet. But you know, I can certainly start the rest of it now.

I started with the pantry

after. ow.
 I say ouch, because it's disappointing when there isn't much to eat there. The glass jars of pasta sauce had soy oil in them so they had to go too which made me very disapointed. I had just bought those because I was trying to stay away form metal cans. BPA and stuff. But if I'm going to do this, gotta do it right. So I put up the pasta sauce for now. My zombie apocalypse spaghetti needs something to go with it anyway. There was also some salad dressing mix that I had been meaning to try but it had wheat in it.

Crap! I just realized that my multi vitamins probably are bound together by wheat. It's a common pill additive. Whatever, I'm going to be eating so many fruits and veggies that they'll be useless. It is a shame that I recently bought them though. Maybe I can donate them to my overseas clinic.

On the flip side, there's a lot of disgusting food I've been wanting to ditch for a while that I never bought and will never eat unless I'm forced. Canned peaches. Instant mac. Creepy canned meat with gravy. Sorry, that's too similar to dog food for me to get into.

Here's all the stuff haphazardly thrown on the table and squashed up. Its not the kind of hoarding I used to do when I was cheaper about my meals, but it's a reasonable amount of food.

Fare well.
 The next step was to go out and buy new food to stock the fridge and the pantry. I used a shopping list from Wolf's website to guide me because I wanted to make it easy. I have a tendency to buy a lot of veggies but forget the meat aisle because the prices piss me off. Then I forget to thaw what I already have. I also rarely buy condiments or things to help me cook the food. Knowing this in myself, I figured it's best to just go by the shopping list so I knew I'd have all the ingredients for meals in the book. I figure Wolf is trying to make it easy on me, so I might as well make it easy on myself.

Did I buy everything on the list? No. I ran out of money after 130 dollars went down. Restocking a pantry with new higher quality oils, buying more meat than usual, getting the omega 3 eggs, buying more at once than usual period, that adds up. And grant you me I was having sticker shock the whole time. It's always uncomfortable when you grocery bill doubles.

Some things I switched for other things. Spinach instead of mixed greens. Brussel sprouts instead of asparagus. Forget the macadamia nuts and pecans for the price. But let's not split hairs here. It's not in the spirit of paleo.

Here's what I bought. I think the chicken is hidden behind the broccoli. 
Hey, you gotta forgive the arrangement. I just tried to fit it all on the table.
Bam! It's food! The dining table is a standard card size if you're wondering. 

Then I set to making myself some dinner with left over food that I had in the fridge. Which was mushrooms, cucumber, orange pepper, bok choy, cabbage, beef, and lettuce. I had a roommate last year who used to make spring rolls with a crap load of herbs, so I figured I'd try the same with lettuce. I also had some left over vegetable soup to go with it.

I made a stir fry with the beef, mushrooms, cabbage, and bok choy. That mix was nested in romaine lettuce. The sweet peppers, cucumber, and cilantro were added fresh.

They were alright, but hard to eat. Stuff falls everywhere. Also I wouldn't add cilantro next time. I spiced with ginger, garlic, and tamari, but not nearly heavily enough. The meat could have used more something. It is pretty though.

Tonight's dinner
And I was very full when done. There's extra for lunch.

The whole meal. 

Wednesday, October 17, 2012

Sugar update.

An update on how I'm dealing with the cutting out sugar junk food stuff.

I believe I've been able to keep this up for a week, although I haven't been the best at recording my goals. Usually, I do that in an online site called In many way's I've distilled it down to a glorified to-do list, but hey. I'm the type of person who needs a little glory in hum drum tasks in order to get them done.

But At least I know I've kept up with this starting Oct 10th, which makes today the start of a new week. One week down.

In this week, I have swerved two birthday cakes, free sodas, desk candy bowels, brownies for just because, a variety of treats my roommates have created, the discovery of peppermint bark in the freezer, and pumpkin pie I created on request for my boyfriend's station. Then I volunteered for a walk over the weekend and helped set up a food table for participants: cake, doughnuts, and strawberry cream bagels! The amount of sweet choices in our society are overwhelming. I don't even count the stuff you've got to buy here. The pit of walmart and grocery stores could count for at least another 3 or 4 exposures.

Sigh. That was all free sugar. Free sugar, every single day of the week.

However, I do know that my tastebuds are changing a bit. Since I'm only avoiding sugary junkfood, I'm still fine with eating chips or salty snacks if they're available. I've never had crazy cravings over those and I'm rarely tempted to buy them. So I went to a lunch presentation yesterday and there were BBQ chips. They tasted really sugary. Sweeter than salty. I'm not going to beat myself up about them, but I will add them to the list of sugary junk foods for now. I also find my plain yogurt really palatable, and slightly sweet. Plain yogurt isn't really something that stuck out to me as palatable the first time I tried it. Or the second.

So the sugar cravings are getting better. But there's going to be MORE birthday cakes and brownies this weekend. Because everyone is born in October. Yep, that's why the holiday season starts early in my mind. October brings on fall treats, but also every other friend of yours with a birthday. Then Halloween happens and you've got candy coming out of your ears until Thanksgiving. Which sets you up for a week until the Christmas candies and cookies are baked and mailed. Then Christmas rolls around and with one last hurrah we get inundated with enough sweets to last up to at least Jan 1st...the day of reckoning and resolutions.

And by that time, we all try to go cold turkey against 4 months of steady sugar and we've just set ourselves up for Fail.

It's getting better. I've got this one.

Tuesday, October 16, 2012

Beating around the bush; afraid to get snagged in sticks.

I have a discussion group that I attend about once a week during lunch. It's offered every semester and if you attend enough meetings and write up a reflective project at the end, you are promised an extra week or so for your interviews in forth year. Almost everyone does it at some time or another. It's kinda like a book/movie/random thoughtful thing club. Except I don't really read the books or watch the movies. I don't have time. Truthfully, I don't think any of the second years do, just the first  years. They haven't gotten to the point where they know what to prioritize. Everything is super serious when you're a first year in first semester.

The meetings typically start like this. None of the second years have read the material because they've been studying path all week. Though truthfully, I know our group and they're not the most forward of the class, err...excluding myself. Either way, we always start out quietly reading the handout that outlines the discussion topic for the day along with the summary of the movie/book/etc that seeded this topic.

Meanwhile the star alpha first years are detail dropping like no body's business; they're very eager to talk about reviews they looked up online, the plot of the story, and of course what the idealistic doctor should have done. And goodness, do the first years spring forth with idealism. Idealism that is simultaneously fluffy and well, stiff. Very black and white terms, with little explanation. The non alpha first years then nod in agreement and they say very little. A premature conclusion is reached, and there's a predictable awkward pause while the moderator tries to pry some actual opinions out of people that do more than scratch the surface.

Of course by this time the second years have finally figured out what the hell is going on, (thank you first years!) and we piss all over everything.

Or maybe that's just me. I piss all over everything.

I seem to be the one that leads the charge more often than not. As self conscious as I am about being the loudmouth, I can't handle awkward silence. In T-minus 10, I will be off like a rocket and there is nothing that anyone can do to stop me.*

However, then something magical happens. Once that seal of unanimous thought is broken...the quieter first years start having opinions. Thoughtful, deep, interesting stuff. Now they've got something to say! They're speaking a little more each time. This makes me squee inside.

I will keep this up if it kills me. I will do everything I can to encourage them to have a voice in the face of their class. To take pride in it and know it's worth. And if that means I have to make a bit of an ass of myself by announcing a taboo opinion of oh, something like...that the 'sane' population actually glamorizes and glorifies the manic portion of bipolar episodes to the point of creating a flourishing street market for adderall. That it is actually cruel and insensitive to act like a patient's hesitation towards mood stabilizers is no big deal when they're identity is at stake...then let's make an ass of myself in a discussion group. Now half the students probably think I'm an adderall addict and sympathizer, but whatever.

Of course, I know I could be politically correct. I can remember the right talking points to say and regurgitate sprinkles with the best of them. But if there's something I can't do, it's play politically correct in a discussion about personal reactions to a topic. Being politically correct in a free, open discussion is the first step to castrating your identity.

There could be any number of reasons they do this. I don't think it's because they see the world in black and white terms. It might be that first years are afraid to show their inner snark or they are uncomfortable with picking opinions they're not sure if they're allowed to have. I'm waiting for them to blossom into some lovely sarcastic, sassy ladies. Because if there's one thing I can't stand, it's beating around the bush because you're afraid to get snagged in the sticks.

Later this week, we'll dance this little dance again. I'll keep playing my part. For as long as it takes.


*Unless they're my mother. She is the master that trained me. I am no match.

Love my mom!

Friday, October 12, 2012

Pumpkin Eater.

Is using old exams to study cheating? I'd say when the professor provides them and the entire class has access, no. Another option would be if the professor specifically told you to use them as an outside source, even if he did not provide them. That was the case for the test we took today. Professor explicitly said in our review, "Use the old exams if you want to see what questions I ask. The two most recent ones are posted online and I know the others are floating around."

And the others most definitely are floating around. We have a class drop box which notes and resources are regularly uploaded to. The exams were posted for everyone by the previous classes, because they were given them as resources by the same professor.

So we've got the approval to use them. And go figure, the vast majority of concepts from the exam are repeated year to year with minor variations on a theme. Some questions are just the same old ones. There's only so many ways to ask about the concepts the professor wants you to know.

Despite the go ahead from the professor himself, I still got in a conversation today with a friend that felt that using the old exams was sketchy. It wasn't pure enough. He said it felt like cheating and felt un-honor code, which of course is all but saying...that it's cheating. The only way to go about studying for the class was the lecture slides and text book...and the two exams that were explicitly posted. Not the even older ones that had even less to do with the test we took today.

And besides, that's going to ruin people when they take the step 1 right? Because everyone totally doesn't forget everything in between now and then anyway before reviewing in a month long frenzy.


I'm clearly on the other side of the fence. I found these exams to be immensely useful. Hitting back and forth between lectures to pick apart each question. Especially the wrong choices. I have to figure out WHY each one of these answers doesn't work. By the time I've worked through the question, I may have dived into notes from 3 different lectures. I really like practice questions because they allow me to think about the material in a different way than just slides. I get to play with it. So when ever practice questions are offered, I'm going to go for it. They keep me focused. On lectures. Lecture slides alone put me to sleep.

So I explained myself. I'm not sure why I felt obligated to. If I wanted to psychoanalyze myself, I'd it's because I have my own honor code ingrained in my identity. That his comment claiming using the exam resource=cheating was an indirect blow to my pride and identity. Thus, I had to soften it somehow. Or maybe I'm another self righteous twit of the world who just has a lot of opinions.

He did one of those things were you retract your statement half way. You know the kind of "you're ok because you actually studied the concepts behind the questions, but I'm sure the rest of the people didn't because they're lazy" sort of crap. Paraphrased of course.

Then he told me that he used an extensive stack of old exams in undergrad to pass biochem, held his fingers apart to show me how many inches thick, received form his fraternity. They had a file. Riiiiiiiight.

My response. "Oh yeah, I remember that class. I got a C."*
His: "I got an A."



*We went to the same undergrad. Not mentioned: I also had to bust my ass in a graduate level course to make up for that C. Barely scraped by with a B. Proof for the kiddies that a C or two does not kill your application. You can make it, and you will survive.

Wednesday, October 10, 2012

First day without sweets. Also, it appears the genital and rectal exam schedules are up.

I missed a meeting today. One of those general student gov meetings where nothing important is actually said. But I guilted myself so much over it. Once I decide that something is my responsibility, I take it very seriously. I don't leave myself very much room to screw up. Then I couldn't pay attention in our exam review because I was too busy shaming myself over a lunch meeting where people just talk at you. Your contribution amounts to another body in a crowd of 50. And I know it's not a big deal. But I will guilt the living hell out of myself if I don't show. Especially if it's because I forgot. I don't know why that makes it worse, but it does.

When the review was over, I had to meet up at my preceptors office because we were seeing patients today. She keeps a plate of candy on a separate table and I could see she had restocked it with Hershey's kisses. Chocolates.

Naturally, I wanted one. A lot of it had to do with the fact that smothering my anxiety with chocolate was sounding pretty attractive at the moment. There's a certain jitters you get before you go to see patients and it's always compounded if you're already jittery about something else.

But when I realized where my line of thinking was following from all I could think of was, "what the hell?" Seriously, I'm going to assuage my anxiety with little treats? And then I had to shake my head at myself because...any anxiety that can be assuaged with little treats and goodies can't possibly be that big of a deal at all. Probably not worth worrying about.

In case you were wondering, I did not eat the chocolates. The temptation got a little greater when the other members of my small group arrived and of course started eating candies off the giant plate. However, I'm on a mission right now. I'm resetting my taste buds. There will be time for sweet garbage in my future, it's not like I'm giving it up for the rest of my life.

On a completely unrelated note, it looks like November is going to be interesting. I have an autopsy to attend, and we get to learn male and female exams all in one month! I think I'm scheduled to learn the rectal exam two days before Thanksgiving. You just gotta shrug your shoulders at that one. Whatever is, is.

The students who have already had theirs (we've been learning this one small group at a time), well those students said that some of the volunteers for these exams are actually our professors. Uh...ok. hmm. I mean a patient is a patient, but this is going to be interesting. On one hand, I have to appreciate the instant feed back of whether you're doing it right or not. On the other's weird. They're my professors. I'm just not ready to get to know them on that sort of level. Or to put it less lightly, I'm not ready to see them with their pants down while they tell me the proper technique for examining their prostrate/cervix/whatever. I mean, there's a reason we're not doing this exam on each other when that's usually how we practice.

It's not the body parts either. I have had very few squick out moments with the cadavers in gross anatomy. Only two. One day, I'll share them with you. I think what weirds me out is mixing nudity with the whole concept of teacher. There is a part of my brain that takes great comfort in norms and rules. Teacher is supposed to be clothed. Not only that, but those clothes are typically the ones that represent a position of great power and authority. Hospital gowns are the exact opposite of that. In fact I can't associate anything with hospital gowns beyond frigid vulnerability. So my brain is taking these two images and can't mash them up in a satisfying way. I'm not quite sure who is supposed to be the vulnerable one here. Is it both of us? But I know the volunteers do this every year. They're probably freer than a fart in the wind. So I guess it's just me.

I'll get over it. I always do. You wouldn't believe it, but I have a pretty good game face.

Tuesday, October 9, 2012

Sleep and sugar.


You know, I still can't bring myself to take sleep seriously. For myself, not others. And I've seen the data while I was in grad school. I know that poor sleep patterns and messed up light/dark cycles are connected to having your metabolism totally screwed up. How your body fuels itself is orchestrated by the gene called CLOCK. Nice acronym eh? Well clock genes are responsible for your circadian rhythm. They're turned on and off by light. They control when is the best time to utilize the food you eat. If they're all screwed up, then your body doesn't do a real good job of burning it's fuel. Mice with disrupted clock genes are more than chubby. They're obese, and insulin resistant. Sleeping enough and sleeping regularly is important. You want your body to be charging up for breakfast before you're awake because it knows the schedule.

And yea. Sleep is good for mental alertness or so I've heard. What's that study with the military recruits? That 20 hours of sleep deprivation gives you the same shooting ability as a person with a 0.08 blood alcohol? Did they ever do one with driving? My factoids are gumming up in the gears. I read it at one point, but I couldn't tell you.

Nope, I'm just not mature enough to tackle my sleeping issues just yet. Or to stop taking 3 hour naps in the after noon to make up for 5 hours of sleep at night.

On a second note, the holidays are coming. I say this ominously. My roommate has already been cooking up a storm, and I have participated enough that my sugar cravings have resurfaced. I'm anticipating having to re-curb them, which is always a pain in the ass. The only way I've successfully found to fight full on sugar cravings are to go cold turkey for a week or two, and then to only introduce sweet sugary goodness back into my life once a week. And it suuuuuuuucks. It sucks.

But once I get through that kind of detox, at least my body doesn't have to fight itself anymore. My taste buds revert back into finding sweetness in a much broader range of foods. And best of all, I'm not constantly jonesing for something sweet. I hate sugar cravings. They're constantly crawling and itching at you. Squirming around in your insides. Irritating as hell. Completely distracting. Can't stand it.

So I better do something about them now before the triple threat of Halloween, Thanksgiving, and Christmas roll by. If you count the left overs and the pre overs, then you can get a good four months of unrestricted access to anything and everything your cravings desire.

And since I know my limitations, I can only focus on one health related thing at a time it seems. I'm going to put snoozapalooza to the side. As long as I'm getting enough of it, screw the schedule.

Sigh. I hate to do this, but it's time for another weekly round of no processed sugary crap. I keep telling myself I don't have to like it, I just have to do it. Bah.

Wednesday, October 3, 2012

Carrying stuff to class.

Egads! I have lost the adult sippy cup. Apparently this is a big deal for me. I had grown attached. Suddenly I'm not drinking so much anymore. I put getting a new one up as a quest in Superbetter.

The sleeping thing. I've forced myself not to nap when I came home, thinking that I'd get my sleeping schedule together. Maybe this is working. I'm certainly tired right now and I would go to sleep if I didn't have clothes in the laundry room. I'm not too keen on leaving things behind in public spaces since I left the sippy behind in class.

In other news, the last few days I've been thinking about death and the end of existence. Yeah, I know you probably weren't expecting that to come out of my mouth. It started up that night I spent some time talking to my friend. Truthfully that's the first time I've really talked to any of my class mates late into the night about anything philosophical  Something I used to a lot in undergrad. I know. It's been well over a year that I've been here. But I'm still not particularly close with them.

Well the problem is philosophical conversations discussing death, and life, and meaning, is that they follow you straight into class. We're learning about cancer in pathology in class right now. And I'm seeing cancer patients in the wards who are younger than me. And I saw part of this film,, in part of a discussion lunch meeting.

A very small turtle was attacked by ants two days ago. I swooped him up and started picking all the ants off his tiny body. He really could be no larger than a 50 cent piece. On further inspection one eye was eaten out and sunken in. I couldn't tell if he was dead or not. So I took him inside and washed his body. But it was really too late. I don't know why I got worked up over a turtle. Drying him, testing to see if I could get a withdraw reflex on his foot. But no. He was dead. I put him under a bush. Today, less than 24 hours later, I couldn't find him. But then I realized that a volcano of an ant hill had been built around his shell over night.

I don't really know how to describe I've been feeling the past few days. Quiet. It's certainly not the first time I've thought about all of this. It's just hitting a little harder than usual.

Then you compare to the grinding and churning rat race and...everything just feels like it's going by too quickly. Let's say I live a long time. To 100. Only get what I have right now three more times. Which feels like a blink. Is that selfish?

It's got me thinking about memory, and how I process time. I notice the moments I process time the fullest, usually I'm experiencing something very new, that my brain has had to bite off in little chunks. For example, my first semester of medical school compared to my second. Anatomy and histology labs were very engrossing for me, there was constantly something new to explore. But second semester, much like this one, there were simply lots of lectures and studying for multiple choice exams. Sure the material is new. But the pattern is the same crap I've been going at for years. It blurrs.

I spent five weeks in Peru last summer working in a clinic. Those five weeks felt twice as long as these last six weeks of this semester. Seven, if you count the first week I was back in town helping with our orientation events! But living in a different country meant that well, everything was new and different. Each day was a struggle just to understand Spanish. And it was fun.

I've never had that great of a long term memory. Things get filtered back into some vague space for the most part and there's no telling what I'll find. Often this is a good thing. I forgive people easily, because I truly forget. But some memories I truly wish I could keep. It seems that the years that have stuck with me better are often when I write more. So I'm going to write more in this journal.

Oh I'll still keep on writing about me striving to be a better person. That's just who I am. I've been reaching back for years with different thoughts about reinvention, getting in shape, having more experiences, "becoming better". That's really not going to go away any time soon. It is a part of who I am. I will always write about my quest to conquer health and schedule. But I'm going to write more about medical school too. Even if it kinda scares me.

Tuesday, October 2, 2012

Snoozapalooza: Part 1.

I am going to sleep!

Sept 30th: 6 hrs.
Oct 1st: 7 hrs, 50 mins.
TONIGHT: Probably 7 hrs 20 mins.

Really, I am doing better just trying to make a conscious effort!

Also, I've been putting on contacts when I get home. It forces me not to nap. Because I never nap just a bit. I always crash for 3-4 hours and then can't sleep more than 4 hours later at night. Sadly, the effects of my sleep are not additive. I just wake up feeling like I've gotten 4 hours of sleep.

So no more writing! Bed!

Monday, October 1, 2012

Ethics Professors, I think I'm finally getting you.

Had an interesting presentation in my ethics class. Typically the class is taught by two lawyers who rotate out, and I have found their aggression irritating. One likes to rant about how "professional athletes", "professional hit men", and "professional sex workers" have ruined the title of "profession" which should only be used for doctors, lawyers, engineers, and what ever other acceptable upper crust job that parents push their children towards. The other told us if that if they were the one grading the essay questions, that they would fail half the class in our small group. And with one test accounting for 40% of your grade, that's part of the reason I went sort of nutso last week. This is despite the fact that ethics does not tax the brain anywhere close to the way pathology does for the most of us, and the die hard aggression didn't feel necessary. One on one, these are fine people to talk to, but inside of class time...sand paper on skin.

So the guest lecturer today was a physician who had been on both sides of medical errors. Making and taking. And truthfully, it's hard to listen to someone tell you that you are going to fail some day, and that you will hurt someone. Probably scar them for life. This man was matched and surpassed the intensity of our previous professors, pushing back into the isles, picking random people, and demanding on the spot answers. One student was caught off guard and he completely ripped into them.

But once the meat of the lecture started, he made great points. When an error happens on your fault, you've got to make yourself completely available to that patient. Become completely accessible 24/7 to them. Make house calls after your hours. Let them be a priority in your life and do what ever it takes to face the issue head on. Not because of malpractice, but for your personal healing. Because when the error comes, you're going to feel isolated, wanting to crawl into a hole out of shame. But you've got to follow that patient through to the end to get closure together. That I can really get behind.

I took back my reservations about the anger and aggression that has been steaming off my ethics professors when I looked at this man. There was sense. They were angry, bitter even. But they're doing it this way because they've seen things. Yet they came from a generation where ethics was not even taught. Everything was learned in the field. I believe they are moved deeply to scrape off a bit of that green before we step into whatever it is they've seen. And irritated with their class or not, that fury is fueled by an attachment to us. Because they once were young and fresh too.

I have to appreciate that. So thank you. I will now save my angst for neurosurgeons who make "It's not brain surgery" jokes whilst lightly bestowing themselves a single pat on the chest or wrist at the same time. Seriously dudes. Cut that shit out.

I'm calling this one snoozapalooza.

It's good to have a friend. Someone to listen to you vent and vents with. I'm really thankful for that. It's my food for the soul. Something I've always seemed to need more than sleep. 

So meh, as usual, I'm starting my quest for better sleep at the beginning....where I seem to sterotypically forget that I'm trying to better myself, and it becomes obvious exactly what square I'm at. Getting screen time in the middle of the night and winding myself up socializing. 

But it's worth it! I'm in a very happy mood right now. I'm set to get about 7 hours of sleep and that's really not so bad considering. It's been a great weekend to recharge. 

I'm calling this quest snoozapalooza. Even though I realize that a lot of my last troubles happened from my eating, the sleep issue is more pressing for me now. Besides sleep is linked to clock genes, which are linked to synchronizing your entire metabolism. It is really cool stuff. Your body pre prepares you for your breakfast in the morning before you even get up, and for the rest of the day as well. And it's all controlled by the light that comes in through your eyes. Disrupt a mouse's clock genes through genetics or just screwing up their light dark schedule and they start building up metabolic disorders, which is fancy talk for weight issues, diabetes, and the rest of the associated list. 

Sleep is more than just for comfort. It's friggin important. It's also one of the first things I throw out of the window when I get into my "coping cactus"* funk. It also seems to precipitate my most disordered eating. It only makes sense to tackle that first.

So ok snoozapalooza. Let's go. 


*Coping cactus: That's your bad guy where you treat your body like a neglected houseplant, the cactus, in favor of getting other things done. Sleep wrong, eat wrong, drink wrong, live as a shell.