The Admonishment

So I had a call today from my substitute nutritionist. My regular nutritionist is in Australia for a month so her fill in called to check up on me. She doesn't have near the bedside manner as my regular nutritionist. She was very curt and short and pretty much went into full judgmental mode when she found out I hadn't filled my prescription for my blood pressure medication. For some reason, the pharmacy couldn't just mail it to me and I had to pick it up. On top of that, I was supposed to go to a drop in class for people with high blood pressure. I am delinquent on both counts. It was then she decided to go into full on scare tactic telling me that if I had continued high blood pressure I was at risk for kidney failure. My kidneys are particularly fragile being diabetic and high blood pressure was sure to fuck with them.

I'm trying to unravel my resistance to this new wrinkle in my health maintenance. It's not that hard, taking another pill and spending two hours in some useless class telling me to relax. But I haven't done it yet. I'm getting emotional writing this because I realize I am having a what the fuck reaction. Seriously, WHAT THE FUCK. I exercise all the freaking time. I've lost a ton of weight. I eat enough fruits and vegetables to bankrupt Whole Foods. My blood sugar levels are not just normal but AWESOME. And STILL my body says "hey I'm still fucked up in some way." The substitute nutritionist said that this was something that lifestyle changes weren't making a difference on and that I needed to take another pill and monitor my blood pressure the same way I monitor my blood sugar.

And I hate it. I fucking hate, hate, hate that my body still is fucking with me. I hate that THERE'S ONE MORE THING WRONG WITH ME. The ironic thing is that in this same conversation, the sub was telling me I graduated from seeing a nutritionist. I so had my diabetes under control I didn't need to see a nutritionist anymore. Since she was calling me at work, I couldn't say how much I needed the crutch of having a nutritionist. I couldn't say it scared me not to have someone to talk to once a month and to tell me I was kicking ass.

What all of this boils down to is how scared I am of change. I'm scared of having to do more more thing to keep myself healthy. I'm also scared to letting go of the things I do to keep myself healthy. I don't need to check my blood sugar every day. I probably don't need to keep a food log. I could probably back off the on the running. I do it because it scares me not to. And on the flip side, I am scared of doing more. I'm scared that doing more means there are insurmountable hurdles that affect my health and once I run past this one, there will be another. If it isn't my cholesterol, blood sugar or weight, it's my blood pressure.

The first step is that I got the sub to call the pharmacy and get them to mail the medication to me. I will then take my daily allotment of blood pressure medication. I will then take a fairly useless class on hypertension.

It's all about plugging on isn't it?

Doctor's Orders

Timing is everything, right? As I'd mentioned, I finally had my physical check-up with my doctor this morning and I had a whole list of things to discuss with her. What I didn't plan for was that I'd get the nasty DC cold for the 3rd time this year 2 days ago -- so I did go to the appt, but mostly was a zombie with a runny nose, sneezing, with gross watery eyes and that "I habe a code" monotone. My lymph nodes are all swollen up, so I hope that combined with the cold in general didn't do too much to screw with my blood work and the appt as a whole.

I did go over the list, though, and here are the results...

1. I got a refill on the BP meds. It was up a little bit today, still in the normal range but at the upper limits - but I think that could be cuz of just feeling like crap and rushing to take a cab rather than the Metro this morning.

2. I did get a referral to a nutritionist, hooray! My doctor loves that I'm learning how to cook and was very encouraging about trying to find ways to make that work with my IBS.

3. As for my pain in the neck? She said it's probably muscle spasms, and may be related to the start of arthritis in my neck. My Dr. Dad had said that too but I thought he was just being gloomy - I don't want to think about arthritis already! But she said as a start I should do the things that make sense, lighten my purse, switch sides with it, stretch more, go back to doing yoga, etc. She said even in looking at me she could see that I scrunch my right shoulder up and out of alignment, so i need to work on all of that.

4. Here's the new thing - which I'm not going to stress about until I need to. She thought my thyroid seemed a little enlarged, just on the right side. This may be nothing, it may be enlarged, it may be hard to tell cuz my lymph nodes and glands were swollen already from this cold. But I'm going in for a thyroid sonogram next Monday just to figure it out. Not stressing.

In general, she reminded me that I need to get more exercise - but she actually never said the words "lose weight," and I appreciate that cuz obviously I *know* that's what I need to do. I really do love this doctor, and this was only my 2nd visit with her but I know she's got the best bedside manner of anyone I've been to. I had a *terrible* primary care doctor for years here in DC, who was just not friendly or encouraging or supportive at all, and i'm so glad I've found this new - literally -caregiver. Even as I was sick as a dog this morning and stressed about the stuff we were talking about, she kept things light - she asked about what books I've been reading (turns out we're both Malcolm Gladwell fans), she asked what I'd thought about the Oscars, she asked what the best thing was that happened to me so far in 2009 (I said the Inauguration). I love it, I love that she makes it a 2-person conversation and that she makes it seem like she's really interested in me as a person rather than just numbers on a chart. It makes all the rest of this stuff so much easier to handle.

To Market, To Market

I've been flipping through my DASH diet book (Dietary Approaches to Stop Hypertension) to try and get some ideas about ways to incorporate more fruits and veggies into my daily life. And, it reminded me that low-fat dairy is just as important to work in, as well. It really all seems like it should be pretty easy to do, with a little planning at the store or while ordering out.

So, with all this in mind, I just went to the Giant on my happy Friday morning off and stocked up. My weekend cooking plans include:

- pork stir fry with brown rice, made easy with a bag of frozen stir fry veggies, lower sodium teriyaki sauce, and stir fry lean pork. **Note -- this gave me the brand new experience of actually asking the butcher at the meat counter for something specific. They didn't have pork for stir fry, and I got over my complete inexperience to ask if he could prepare some for me, so I watched as he trimmed and cut a pork center loin for me. Wow! I've never seen the whole process before. Kinda cool.

- roasted new red potatoes with parmesan. I really haven't ever roasted potatoes before, and I'll be using a DASH recipe, so this should make a nice side dish with the organic chicken breasts I got. I'll do some nice herbal seasoning on those, I think.

- fruit smoothies with bananas, frozen blueberries, organic non-fat yogurt and organic non-fat milk. Yum! But I better be prepared to run the dishwasher a few times to keep up with myself. (Note: I try to buy organic dairy whenever I can, especially after watching that documentary The Corporation a few years ago. Unspeakable horror at some of what they showed re: corporate dairy production.)

- and, this is so simple and such an easy addition -- I bought cute little grape tomatoes to plop on top of my usual lettuce side salads.

So -- these will be several ways I can start adding more fruits and veggies in an easy, natural way.

Any other suggestions???

Post nutritionist meeting

So my meeting with my nutritionist yielded a few insights.

A) No need to freak out over a freak number. Those things don’t really affect your A1C which essentially looks at how much glucose is in your blood over time. As long as that number is fine, I’m fine. In fact, my nutritionist and I talked about possibly lowering my dosage for the glucose medication.

B) My blood pressure is slightly elevated. Rather than prescribe medication, she recommended making my diet more DASH-like. It would entail some minor but profound tweaking. Eating less cheese, which is sad, and upping my vegetable intake even more. I get about six servings of fruits and vegetables a day. Two for breakfast when I have an apple, pear of other piece of fruit along with the berries in my yogurt. Three for lunch when I always have a large salad and whatever vegetables I have with dinner. It could be carrots and cabbage in a stew or kale in a spaghetti sauce. It will definitely be a challenge to get two more servings of fruit. It’s not that I don’t like fruit but having fruit for my carb content means I have to eat even less grains than I already do.

If I do insert more veggies in my diet, here’s a great way how:

Pasta Al Forno
This is a baked pasta with the rich tomato sauce of a regular rigatoni al forno but with less pasta and tons of veggies. This is really just a guideline. Throw in any veggies you want (within reason).

1 large onion finely chopped
2 cloves of garlic, minced
4 cups of vegetables
- For me this included a shredded carrot, two shredded zuchinni, about a cup of finely chopped kale, and a cup of chopped shitake mushrooms
½ pound of ground turkey
1/2 jar of marinara sauce
1 can of diced tomatoes
1 cup of red wine
4 cups of cooked short pasta like rigatoni, penne, or cavatappi
½ cup of mozzarella
¼ cup of parmesan

Saute the vegetables in 2 tablespoons of olive oil and a little salt and pepper until soft, about 15 minutes. Add the ground turkey and sauté for another 5 minutes. Add the marinara, canned tomatoes and red wine. Bring to a simmer and simmer for about 20 minutes uncovered. Add the pasta and throw into an 12 inch by 8 inch baking pan. Bake for 20 minutes at 350 degrees and then top with the cheese.

Gotta DASH!

I'll work on doing more of a background post about hypertension itself sometime soon, maybe over the upcoming long weekend. But for now, I will share the doctor-recommended approach towards addressing hypertension through diet. It's called the DASH Diet, as in Dietary Approaches to Stop Hypertension.

The DASH Diet is a variation of the usual food pyramid we've all gotten used to, and until now I haven't really made much of an effort to adjust to its recommendations. But, as T and I are sharing with you all, this is the first week of the rest of our lives or something like that. So, I'm going to start by making a very strategic trip to the grocery store this weekend. I've also just bought the book that's on the linked web site (call me a sucker, I'll buy the book...) which hopefully has tips on how to stick to the reshuffled DASH plan.

For a 2000-calories-a-day lifestyle (which sure will feel like a diet), DASH recommends you choose:

Grains - 7-8 servings, at least 3 of which are whole grains
Fruits - 4-5 servings
Veggies - 4-5 servings
Dairy, low-fat or non-fat - 2-3 servings
Lean meats, fish, poultry - 2 or less servings
Nuts, seeds, legumes - 4-5 servings per week
Fats and sweets - limited

I probably won't have a problem with the grains part. While I probably have more than 7-8 servings on most days (I LOVE pasta, rice, chips and bagels), I make a point to have whole grain stuff at home and I try to order the same whenever it's an option out. So I'll work on making smarter grain choices and fewer of them. I have to up my dairy intake, make sure I have lean protein once a day on average, keep eating beans but make sure they're in low sodium meals, buy some unsalted nuts to have on hand, and really cut back on fats and sweets.

I *know* the hardest thing will be to incorporate 4-5 servings EACH of fruits and veggies every day. I love fruits and veggies, don't get me wrong. But it requires more planning, more cooking, more trips to the store, and just more commitment overall to make sure that either fresh produce or well-seasoned frozen veggies are a big part of my day.

And, this is a post for another day, but another one of the - ahem - health issues that I inherited from my Dad sometimes has a dramatic reaction to, shall we call it, roughage. But that can be managed too, with planning, so there's really no excuse for not upping my fruit/veggie consumption.

I know, I've gotta just do it. Like Nike says. (But if I ever do win the lottery this is totally why I would hire a nutritionist and personal chef.)

Stef's Story

So.... here's my scenario.

I'm 33 and overweight, and I have been pretty much my whole life. I love food - I'm one of those people that can feel rapture from a good meal, and food is my comfort when I'm stressed, sad, happy, bored, or otherwise feeling *anything* - and I don't like exercising. I prefer napping. You can see wherein the problem lies.

Up until the last year or so, though, all my usual health stats were pretty good. But, in the summer of 2007, my Dad had a surprise health emergency as routine tests revealed that he'd had a silent heart attack and had almost complete blockage of his arteries. So he very quickly went in for a triple bypass - at age 59 - and came through with flying colors. He's now lost a lot of weight, is incredibly active, and just a few weeks ago climbed Mt. Kilimanjaro. Go Dad! So, he's become both an inspiration and a bit of a cautionary tale in my life.

Following his health scare last year, I went in for a complete physical and found out that I had officially reached the level of hypertension (aka high blood pressure) and my cholesterol was too high. My doctor put me on medication to control the hypertension, and it's been doing a good job. But -- I'm not all that comfortable mentally knowing that I'm relying on a drug to keep my health in check. I was able to lower my cholesterol significantly last year through diet, so I know that I *can* make positive changes when I really focus.

I know the things I need to do:

- Lose weight.

- Exercise more.

- Eat more nutritiously - with fruits, veggies, and lean proteins.

- Reduce sodium overall - which is hard, cuz my favorite snacks are salty, and I don't cook much so most of my meals are either purchased or come from a box.

- Cook more. (See the previous two.)

- Cut back on portion size. (I grew up in a house where dinner came on a platter, not a plate.)

- Reduce stress. (Any ideas????)

I have found that I'm much better at accomplishing a goal when I intellectualize it, so for me it's been helpful to learn more about the science behind health and nutrition. Understanding causes helps me produce the desired effect, or something like that. And that makes it easier to take a lot of the sometimes overwhelming emotion out of all of this.

I'm looking forward to having a buddy as I start this new adventure, so I'm really grateful to T for coming up with this idea!

My next goal: I have my annual physical and blood work ONE MONTH from today. I hope to lose a little weight and have my cholesterol at a healthy level by then.