Tuesday, February 21, 2012

Why Getting Old is Really Complicated

Today I would like to take a short break from talking about myself to talk a little about how hard it is to be an old person.

I recently visited my grandparents in Georgia (oops, still talking about myself). My grandfather had just returned home from knee replacement surgery, followed by two weeks of rehabillitation. This was his second replaced knee, and, as with the first one, he took it like a champ. He was clomping around with his walker, not taking much pain medicine, and generally doing well. We celebrated his 81st birthday while I was there.

But watching him manage his medications and instructions really got me thinking about how complicated his medical regimen has become.

For example, he was prescribed a diuretic for leg swelling. He was supposed to take one tablet in the morning and a half tablet in the afternoon. This requires him to remember that the dosing is different for morning and night, and to have the dexterity to pick up the pill and split it in half.  The medication works by having the kidneys eliminate the extra fluid, so he has to hobble to the restroom on his post-op knee even more often. Once in there he (like most older men) has some prostate issues, so there's that to deal with.

My grandfather is still pretty sharp, but I noticed that on this visit his memory is not as great as it once was. It seemed like he was having trouble remembering complex instructions from one day to the next. His eyesight is pretty good but his hearing is abysmal. The terrible hearing means that sometimes he doesn't hear instructions in the first place.

So you can imagine how challenging it was for him, and his physical therapist, to make sure he is doing his knee exercises three times per day. He has to remember the instructions (luckily she took the time to type them out), do the exercises, and then ice the knee afterwards. The physical therapist only comes three times a week. The rest of the time my grandmother has to help position the pillow under his leg for the exercises, and put ice packs around his knee after. Her dementia makes all of this really complicated- if he sends her to the kitchen for the ice packs, she might forget what she's looking for by the time she gets there.

I also wonder about the number of specialists my grandparents (and most older folks) are seeing. There are several physicians writing orders and prescriptions without really communicating with each other. We are really lucky to have my Uncle Sam, who goes with my grandparents to most of their appointments and keeps track of what's going on. He's extremely intelligent and willing to research and ask questions to make sure he understands. But many 80-year olds have children who are aging and who don't have the time or ability (or inclination) to be this involved. I would guess that my uncle spends at least 20 hours each week working with my grandparents to make sure they get to their appointments and keep their medications refilled.

In the hospital, we are really quick to label people as "non-compliant." Sometimes our patients make the concious choice not to make necessary lifestyle changes or follow instructions. But I wonder how many of our patients just didn't hear, understand, or remember what they were supposed to do. Also, if it gets too complicated to send your wife to the kitchen for an ice pack, do you eventually give up on icing your knee? Are we taking the time to ask why the patient hasn't complied?

So long for now, KISS (keep it simple stupid), and don't worry, I will be back to my usual self-centered self in time for the next post!

Wednesday, February 15, 2012

Food Matters and My Go To Recipes

Image credit: Craig Allen, Flickr

I finally read Food Matters, by Mark Bittman. I have told you before that I will basically do anything Bittman says in the kitchen.  I was a little worried that it would try to convince me to go vegan or something (I haven't watched Forks Over Knives for that very reason).  I don't think I can give up bacon or Parmesan cheese, so I would probably keep eating meat and dairy and just feel guilty about it. I had a Catholic upbringing and I definitely don't need any more guilt in my life.

But I digress. Food Matters is about an approach to eating that's healthier for the diner and the planet- less meat and dairy, fewer refined grains, very few processed foods; lots more fruits and vegetables. Bittman has not given up eating animal products, but he has cut way back and filled the gap with tons of fruits, vegetables, nuts, and whole grains. For the diner, animal products, refined grains, and processed foods can create a myriad of health problems. For the planet, livestock produces greenhouse gasses and mandates huge amounts of grain production for feed; the refining and processing of foods involves energy consumption to strip away the nutritious parts of food and add stuff that's not so great.

So I'm following Bittman's advice- increasing the amounts of plant-based foods in my diet and limiting the meat and dairy. I wasn't eating much processed food, except for some Lean Cuisines at lunch, so that wasn't a big change. I found that having a CSA bag full of fresh veggies every week encourages me to cook more often, which means lots of leftovers for lunches.

Food Matters is a really simple, common-sense guide, but the one area where I disagree with Bittman is regarding protein- he argues that we don't need to eat nearly as much protein as we think we do. He suggests eating larger quantities of fruits and vegetables to create satiety.

Maybe I have trained my body to think it needs more protein than it really does, or maybe my activity level is to blame, but I need some sort of protein at every meal and snack. I can eat a gigantic salad and feel full in the moment, but an hour later I'm hungry again. So for me, the challenge is finding a way to get enough protein from non-animal sources. Here are some of my go-to foods:

Creamy Hummus: I got this recipe from Stephanie, a classmate of mine from Nursing School and the healthiest eater I have met.

1 15oz can organic chickpeas
1/4 cup tahini
Juice of 1 lemon
2 cloves garlic, crushed
1/2 tsp sea salt
1-2 Tbsp olive oil
2 Tbsp water
(optional- add a dash of: parsley, paprika, cumin, onion power, and/or hot sauce)

Put everything but the chickpeas in the blender and process until combined. Add the chickpeas, 1/3 at a a time, and blend thoroughly. When everything is added, let the blender run for about 5 minutes to really combine everything (prevents biting into a chunk of garlic).

I like this hummus best after it sits in the fridge for at least a few hours. I cut half of a whole wheat pita into wedges and toast them in the toaster oven, and serve the hummus with the pita chips and some delicious carrots from the CSA bag. It's my favorite post-workout snack, containing healthy fats, protein and fiber from the beans, and complex carbohydrates.

I discovered these No-Bake Energy Bites this week on Pinterest. I made them for breakfast (substituted raisins for the chocolate chips). The were a little too sweet for me, so next time I'm going to try 1/4 cup honey and a little extra peanut butter. But I love the combination of oats for complex carbohydrates; flax seed, and coconut for healthy fats; and peanut butter for healthy fat and protein. I bought whole flax seeds and ground them in my food processor. I think a coffee maker works too.

I also really like tofu, and to me the secret is getting it crisp. You buy firm tofu, drain it, set it on a paper-towel lined plate, and place another paper towel and an upside-down plate on top. Leave it for at least 30 minutes. Slice it thin (you can marinate or season it at this point if you want), heat some oil in a skillet over high heat, and place the tofu in. Leave it alone for about 3 minutes and then flip it over.  Remove from the pan and stir fry some veggies with garlic, ginger, and/or soy sauce (or whatever you like). This week I made a stir fry with tofu, red pepper, carrots, garlic, and spinach (the pepper was from the grocery store but the rest was from my CSA bag).  I served it over a little brown rice- a delicious dinner and a really great lunch the next day.

I am still eating meat and dairy, but I'm trying to use them more like a condiment than as the main part of the meal. I really like adding a little bacon to things because you get tons of flavor with just a few slices. I also like sausage in soup- it seems like the smoky sausage flavor really permeates everything else. Bittmans's Cassoulet recipe uses one pound of sausage for eight servings- lots of flavor, just a little meat. Likewise Parmesan and Asiago cheeses are great because it only takes a tablespoon or so to flavor an entire dish. I have been making mini pizzas on whole wheat pita, my new favorite bread- top with tomato sauce and veggies (whatever you have in the fridge), sprinkle on a little Parmesan, and put in the toaster over. It's a five minute lunch or dinner with almost no cleanup.

So long for now, KISS (keep it simple stupid), and try adding a few more plants to your plate at each meal!

By the way, if you want some motivation to eat more veggies, check out this video describing the cancer-fighting properties of various vegetables. Spoiler alert- garlic frightens vampires and cancer cells!

Tuesday, February 7, 2012


Image credit: DarkMatter (Flickr)
Six months later, I'm still running.

I've come a long way since July. I can run an entire 5K without walking. I'm getting a little faster. And sometimes I find myself trucking along with a loose, easy stride, not counting the minutes, just enjoying the act without really thinking about it. You know, like a real runner.

But I have to admit that I don't always love the actual run. I still feel pretty slow and awkward most of the time. The weather tends to be either too hot or too cold, plus too windy, too rainy, or too humid.

What I do love is the way I feel after I finish. It seems like the harder the actual run feels, the better the endorphin rush is at the end. Plus I get this great sense of accomplishment when I go out and get it done. Also, people saying, "Hey, have you lost weight?" isn't too shabby either.

Still, despite all of the medium and long term benefits, I sometimes have trouble making the right this moment decision to get off the couch, put on my sneakers, and get out there. I don't always win the battle. What gives me the extra push most days is that there is always some sort of running event looming in the near future.

It turns out that you can run a 5K pretty much every weekend if you want. I have done three so far, with another one planned for later this month.  For me, they are just the right distance -about as far as I normally run, but with the added motivation of an official clock. Plus when yet another lady with a jogging stroller zooms past you, you feel encouraged to step up your game. They get a little bit easier every time. So now I'm ready for a new challenge!

Last year my friend Jennifer asked me if I wanted join her and some others for something called a mud run. I laughed at her and the idea of running that far. This year I came back bashfully to ask if she's participating again.

That's how I got signed up for the 2012 Jacksonville MS Muckruckus on March 25. It's a 10K run on a muddy course with a bunch of obstacles. I'm honestly not sure exactly what I'm getting myself into, but I'm feeling motivated to step up my distance and my strength training to help me through. Being part of a team is an extra challenge- I don't want to be the one dragging along a mile behind everyone else!

I admit I have a bit of an ulterior motive in telling you about all of this- part of the requirement of participating is that I have to raise $100 for the National MS (Multiple Sclerosis) Society.

MS is a pretty terrible disease, and it's not that uncommon. It basically damages neurons, which interfere with the brain's ability to communicate with the rest of the body, which affects movement (click here if you want a better explanation from the Mayo Clinic).  The disease is progressive, and there is no cure right now, only treatments to slow the progression and control the symptoms. You have probably met someone in your lifetime with a diagnosis of MS.

So anyway, if you have a few extra dollars laying around and would like to support this great cause (and help a girl out), here is a link to my fundraising page.

So long for now, KISS (keep it simple stupid), and try signing up for something that challenges you a little.

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