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May 13, 2008

From Flab to Fab

Filed under: By Ellen Bittner — Administrator @ 1:42 pm

   By Ellen Bittner

Chapter 2. The Battle of the Bulges


I knew I would need help in beating the odds of my genetics, and creating a longer lifespan for myself, so I decided to find a personal trainer.  I met with Vadim Vilensky, and told him what my goals were.  I liked his philosophy – “Fitness for the Real World” – and began working out with him.  I also adopted what I considered to be a healthy diet.  I ate sparingly (small meals with small portions), used artificial sweeteners, ate fat free and salt free products, and replaced the diet soda I was drinking with water.  (I made this last change after learning that carbonation in soda could be detrimental to bone health.) 
 
After working out with Vadim for several months I began to notice some very pleasant changes in my body.  My waistline was beginning to reappear and I could look down at my feet and see my toes again.  These changes also led to smaller clothing sizes, a welcome turning point because I now fit into a “Misses” size and no longer had to pay more for “Women’s” size clothing.  I also felt different – I had more energy and, as friends noticed, began to develop a “spring” in my step.
  With all of these positive changes, I was disappointed that the scale wasn’t reflecting the amount of work and effort that I was expending.  I rationalized that this was partly due to my increased level of fitness.     Regular fitness assessments showed that I was gaining muscle mass, and bone densitometry tests showed that my bone density had increased.  Nevertheless, I was feeling frustrated and wanted to know why I wasn’t seeing a more dramatic weight loss.  
  
Vadim suggested that I make an appointment to meet with his nutritionist.  She told me to keep a food journal for one week, and then we would meet to analyze it.  Imagine my surprise when she told me I was eating too little!  Although the formula for losing weight requires that you take in fewer calories than you expend; she explained to me that, by eating as few calories as I was eating, I was putting my body in a defensive “starvation” mode.  This meant that I was actually holding on to more calories than I needed, rather than metabolizing the calories I was taking in.  She also explained that I needed to incorporate some fat, healthy of course, in order for my body to properly absorb the nutrients it needed.  She made a few more adjustments to my daily food plan and recommended that I add two small snacks to my daily intake.  This discussion also left me with a better understanding of how to read food labels more effectively, in order to create a more balanced food plan (note that I’m not using the word diet).

 

I was eating more healthfully and the scale was beginning to show the results.  In the first few months I saw substantial weight loss, but then it stopped.  While I wasn’t gaining weight, it seemed to take forever for the next drop to occur.  Then, I’d hit another plateau.  As much as I was frustrated, and tempted to give up, I continued with my exercise routines and followed my food plan.  Why?  I still felt better and could move more easily; so I figured as long as I wasn’t gaining weight I was ahead.  Interestingly, I recently read an article in the Mind & Body section of The Journal News (May 9, 2009) that explained what was going on. The article, by Nanci Hellmich, actually recommends that you “Reach a ‘set point’ to set yourself up for dieting success.”  She wrote that it’s healthier and more effective to try to lose 10% of your body weight and then stop losing for a while.  The article suggested that you try to keep that weight off for at least six months so that your body could adjust to this new “set point” before attempting to lose the next 10%.  Imagine that, my body was doing this – much to my frustration – all by itself; or maybe that’s what my healthy eating plan is all about.


To be continued…
            
               
             
                   
                            

                                         

                 

     

 

 

 

May 2, 2008

A LAYMAN’S PERSPECTIVE OF CORONARY BYPASS SURGERY

Filed under: By Paul Jason — Administrator @ 2:04 pm

 Paul Jason

Chapter 11:  You Want Me to Volunteer to Do What?
     

The exultation which accompanied  the confirmation of my continued existence on Planet Earth was soon replaced by the reality that I hurt.  I mean every part of me hurt.  As soon as I was released from the restraints that had prevented my earlier movement, I discovered that my body ached.  My left leg felt very swollen and weak.  My back felt sore.  My chest felt like an eighteen-wheel truck had run over it.  An IV and a urine-collecting catheter were hanging out of me and I suspected that a few other tubes and/or wires were projecting also. I was sure the IV was feeding me pain-killers, as well as some saline solution.  In addition, a nasal prong was inserted into my nostrils to supply oxygen and assist my breathing.
 

To tell the truth, I wasn’t too anxious to survey the damage.  Dealing with blood and bloody wounds has never been one of my strong suits.
 

After the endotracheal tube had been removed, a nurse brought me ice chips to suck on to alleviate the soreness in my throat.  That soreness would continue for the next two or three days.
 

Some time thereafter, a young woman appeared at my bedside and announced that she was a physical therapist and that she was there to assist me from the bed onto the floor.  I retorted (with whatever energy I could muster) that I seriously doubted that she, at  about one hundred pounds, was going to be able to sit me (at about two hundred pounds and feeling like a dead weight) up in bed and then assist me into a standing position.  I guess she had second thoughts because she  left the room for a few moments, only to  return with a second one hundred pound young woman.  Well, I thought to myself, at least we have improved the odds.
 

Their first attempts to get me into a sitting position on the bed were filled with agony (for me), fear and a little disbelief.  I hurt in all directions.  Additionally, I learned for the first time that my dissected chest was very unstable.  At the least little movement, it felt as though my breastbone would pull apart.
 

I knew, prior to the surgery, that the patient’s chest is pried opened.  But, to tell the truth, I never understood the full reality of that statement.  My dismantled breastbone was literally held together with wires. It was unstable and would not begin to recover its stability for eight weeks or so.  To make matters worse, the surgery had very quickly depleted the major supporting muscles of their tone and strength, and I felt something like a marionette dangling loosely on its strings, incapable of creating assertive motion.
 

Nonetheless, these two young women were determined to get me out of bed, like it or not.  So slowly, and very painfully, they propped me into a sitting position, then maneuvered my feet and legs over the side of the bed, held me under the arms and lowered me to the floor.  There was not much that I could do to assist in the process and, as my feet hit the floor, I felt my rib cage quiver.
 


But the agony was not over.  After getting me to take a few assisted steps, they sat me down in a hospital armchair (the firm, vinyl upholstered, wooden arms type).  During these few moments, I discovered three other things: one, my left leg felt stiff and it was not working very well; two, it hurt just as much trying to sit down as it did trying to stand up; and three, I couldn’t breathe very well.  My breaths were short and shallow.  The anaesthesia was still working on my lungs. Every attempt to draw in air was resisted by a pair of protesting lungs and a protesting chest, both of which felt as though they were about to explode.
     

Coughing had become an excruciating experience.  I had learned, however, from cardiac patients I knew or had previously met, that CCU patients are generally given a “security blanket” to hold onto, and to hug against their chests, as assistance in those moments when unexpected coughing or body turning becomes inevitable.  In some hospitals, this companion comes in the form of a large-size Teddy bear, or some facsimile thereof.  Often it is decorated by the nurses with words of encouragement, the patient’s name and/or the date of the operation. When I asked for one at this hospital, what I got was a blank white pillow case stuffed with some bedsheets!! . . . my “security pillow”.  I knew right then and there that I was either dealing with a very dispassionate nursing staff, or a nursing staff that was undermanned and/or overworked and/or undersupplied.
 

I believe it is worth digressing at this point to mention that the American Nurses Association has been saying for years that most hospitals are understaffed.  Often these institutions supplement their regular nursing staffs with temporary nurses who may be unfamiliar with all of the particular facility’s routines, mission statement and medical staff.  We’ve all heard about this nursing shortage, but I believe that most of us don’t pay much attention to it . . . until it directly affects us.
 
I also believe that people become nurses for the best of reasons and intend to provide the best possible care for their patients.  I, therefore, gave my nurses the benefit of the doubt.  Nevertheless, when you are overwhelmed with post-surgical despondency, you really are not in an appropriate frame of mind to rationalize  why some RN is seemingly ignoring you in your time of need.  .
 

To overcome the breathing problem, I was soon introduced to a diabolical little plastic lung-exercising device, sometimes referred to as an “incentive deep breathing exerciser.” It consists of three enclosed vertical cylinders, five inches in length, each holding a small plastic ball.  The three cylinders are attached to a base which has a projecting flexible tube, at the end of which is a mouthpiece. The goal of the device is to get the debilitated, anxiety-ridden patient to suck on the mouthpiece hard enough to make the balls rise in succession to the tops of their respective cylinders.  Thus, on the first feeble attempt, the patient may be able to get the first ball half way up its cylinder while his lungs scream for relief. Sooner or later, the patient will hopefully improve to the point where all three balls will rise to the tops of their cylinders. With this surgery I immediately knew that it would not only be necessary for my lungs to improve, but my chest would have to heal as well.

 

This breathing exerciser was to become my nearly-constant companion for the next six or more weeks, until my breathing resumed its pre-surgical norm.  However, during that initial introduction to it,  I was convinced that this device had been created solely for the purpose of becoming my personal nemesis – - – my sworn enemy.
     

While these seemingly exhausting activities were going on, and in no particular order, an aide came into my room and announced that she was going to wash me while I was sitting up in the armchair.  I had detected earlier that my left leg and most of my chest was swathed in bandages, and my body had the telltale signs of various fluids (antiseptics, blood, etc.) all over the portions I could see.  Ever so gently, she began the first post-operative clean-up and I was most appreciative of her efforts.  While I thanked her profusely at the time, I never saw her again and was never able to fully express my gratitude for her kindness in momentarily returning to me some sense of dignity.
 

Later in the day a handful of relatives came to visit me.  Of course, visiting hours in the CCU are limited, but their presence was a psychological reaffirmation of my existence.
 

Also, the two physical therapists returned.  This time they got me out of the chair, assisted me while I shuffled twenty excruciating feet up and down the hallway, and got me back into bed, IVs, hanging tubes, wires, and all.
 

The inability to walk was psychologically devastating for me.  Walking had been my primary form of exercise during the prior twelve years; and I don’t mean strolling.  Sometime around my forty-eighth birthday I had set a goal of four-mile one-hour walks as a yardstick for measurement of my physical well-being.  Every time I went out onto the streets (and that averaged three times a week during the approximately seven months of agreeable weather in New York) I would aim to walk four miles in less than an hour.  I had devised a series of measured routes in my neighborhood so that I could walk with abandon, enjoy the scenery, and be assured of the distance I was traveling.  All I needed was a pair of sneakers and a wristwatch.
 

After awhile, the routine became sacrosanct and, to memorialize it, I decided, in celebration of my fiftieth birthday, to establish the “Paul S. Jason Annual Fifth Avenue Four-Mile Walk.”  I invited some friends and family members to join me at 8:00 a.m. on a Sunday morning in the Fall at 86th Street and Fifth Avenue in Manhattan.  We then proceeded to walk down Fifth Avenue (with the cross streets empty of most vehicular traffic at that hour on a Sunday morning) to the Washington Square Arch, a measured four miles.  This was not a race; but I encouraged all walkers to set a goal to walk the distance in one hour or less, if possible. Then, when everyone reached the Arch, I took them all out to breakfast.
 

I chose a walk in Manhattan because I was born and raised in New York City and I wanted to simultaneously celebrate my life and my lifelong attachment to this city. I chose Fifth Avenue because (i) it runs in essentially a straight line for the required four miles, (ii) it is lined with a great array of wonderful New York landmarks, and (iii) it concludes with a very visible goal line, the Washington Square Arch.


 

By April, 2000, I had already conducted ten of these annual events with a somewhat varying group of participants.  And, always, I had  managed to complete the walk in less than one inspiring hour.  Thus, it had become a source of joy, renewal and friendship for me.  Would that now be jeopardized forever? I had no way of knowing.
 
I forget whether or not I ate any solid food that first day. I was receiving nourishment intravenously.  I did, of course, slip in and out of sleep.
     

One of the other lessons I learned that day (I guess I should have known this before) is that hospital gowns are designed so that the patient’s rear end pokes out every time he gets out of bed or rises out of a chair.  No article of clothing has yet been devised by the mind of man to more quickly rob a middle-aged man (or woman for that matter) of his dignity than the hospital gown.   As my two young, female therapists assisted me with my first, feeble steps I didn’t know whether to cry (from the pain) or to feel embarrassed.  But I learned very quickly that when the body is broken and in pain, dignity dissipates straightaway and survival takes over.  For the balance of my hospital stay I was never again concerned with personal modesty; practicality ruled at all times, and that’s all I have to say about that subject.
 

Eventually, night settled in and I was thankful that I had survived the initial post-surgical trials and tribulations. My body ached, but somehow I knew I was going to get through this passage of my life.
 

Then as I lay in my bed, just minding my business, my surgeon suddenly appeared.  It was about 10:30 at night and I was surprised that he was still in the hospital since I was under the impression that he operates during the day time.
 

Mr. Jason, I have come to ask a favor of you.”
 

(“A favor of me.  What could I possibly do in this condition to assist anyone, let alone a cardiothoracic surgeon?”).
 

We have a critical emergency case who is being rushed into the operating room.  When the surgery is over in a few hours he will have to be moved into the CCU, and we have no available beds for him tonight.  Of all the patients in the CCU you are in the best condition to be moved . . .”
 

(“Best condition?  I’m half dead.  I’m just glad that my heart is still beating . . . and I can hardly breathe.”).
 

I’m hoping that you will volunteer to leave the CCU tonight to make room for this patient.  If you agree to do so, you will be moved to the sixth floor ‘Intermediate Cardiac Care Unit’ tonight.”
 


 

(“Tonight?  I thought I was supposed to be in the CCU for two days after my surgery. I just had a quadruple coronary bypass operation. Should I question the evaluation of the man who, ostensibly, had just saved my life?”).
 

Well, now I was not only physically debilitated as never before in my life (and clinically depressed I might add), but I was being presented with a moral dilemma.  Do I respond to the doctor’s request as a decent human being concerned about the welfare of others less fortunate than myself, or do I play the role of the very sick patient and plead my own cause?
 

I don’t think that anyone appreciates having to deal with a moral dilemma, under any circumstances.  But I do think that this was a special circumstance. . . a time when I was not operating with all of my reasoned faculties.  Yet, to my subsequent amazement, my spontaneous reaction was to agree to the proposition that was presented to me.
 

To this day, I still mull over in my mind whether that request was ethical or not, and whether my response was emotional or rational.  In hindsight I can see that I suffered no ill effects from that decision; but, at the time, I had no way of knowing what the outcome of that precipitous action might be.  
To be continued….

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