Monthly Archives: January 2018

The Migraine Curse

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Guess what guys, migraines suck. Part of the reason I began my epic weight loss journey was my unrelenting and chronic migraines. I’ve been afflicted with migraines since soon after I hit puberty. Fun fact: being a woman and having hormonal surges also sucks! Migraines affect about 3 million people per year, and 75% of those people are female. Migraines can be difficult to treat and debilitating. 2% of people will have chronic migraines, defined loosely as migraine headaches more days of the month than not.
Historically, migraines have been treated with suspicion and degradation in the medical field. They fall into that nebulous category of diseases that we don’t understand the pathophysiology well and that don’t have a lot of objective findings. Prior migraine theory has postulated that the underlying cause was vasospasm and vascular dysregulation; this theory has not been outright disproven but more current information is leading towards a more neuronal driven model based on abnormal trigeminocervial afferent nerve activation. This obviously is still an area of much research, and hopefully with time we will gain a better understanding of the underlying process.
Treatment for migraines falls into four main categories:
1. Identifying and avoiding triggers
2. Lifestyle changes
3. Abortant medications to stop active migraine
4. Preventative medication to help stop recurrent migraines
In my lifetime I have had hundreds of migraines. Some last a day, some have lasted for more than 2-3 excruciating weeks. On and off I’ve qualified for the diagnosis of chronic migraine over the years. I’ve tried many many different treatments including multiple different abortant medications and preventative ones. At one time I was taking 3 different prescription meds and two herbal supplements to try and prevent migraines.
The thing is, none of it was working well. These medications work well and help many people, but it wasn’t a solution for me. Over time I gradually weaned myself off all my meds and have been using a much more holistic approach. I started to focus more on lifestyle changes and triggers to help manage my headaches. This is not an approach for everyone, and in fact I still get debilitating headaches, but overall the quantify and duration has been improved in the last 18 months.

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So what are the most common migraine triggers?
1. Stress
2. Sleep
3. Caffeine intake
4. Diet: anything from processed food to alcohol to cheese to food additives can be a trigger. Note that chocolate had not been proven to be a trigger food, but cravings for chocolate are a warning sign a migraine is coming your way.
5. Environmental/weather changes
6. Dehydration
7. Over-exertion
8. Drugs
9. Oral contraceptives
10. Teeth grinding
11. Medication overuse
It’s not hard to see how many of us can check nearly every trigger box on here. I set out to work on what I could most easily control and change. Starting with my diet, I eliminated caffeine and cut way back on processed foods. I think this has been the biggest help to me. I now only drink caffeine at the start of a headache, and it helps to reduce my symptoms.
I also cut back on taking medications when I have an acute headache. I rely on more multimodal therapy, using an ice pack, caffeine, sunglasses and dark quiet rooms to help my symptoms. In the past would be chugging ibuprofen all day and night and ducking into the bathroom between patients to give myself toradol injections. I found that didn’t really help things improve any more rapidly. What I really need to get better is sleep and time.
As you can imagine, when you are a busy working physician, those things are hard to come by. I struggle with sleep so often and my stress levels are chronically high due to my line of work. It’s been a battle to try and get more sleep and learn to relax and meditate and stop perseverating on every single little thing.
So if you see me rocking my headache hat ice pack and sunglasses around the hospital, no it’s not an awesome new fashion trend.., just one woman trying to feel better, get through the day, and overcome the migraine curse.

 

You don’t need a gym to get a great workout: Stairs

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So let’s be real, gym memberships are expensive. Exercise equipment and weights are expensive. I’m going to be doing a series of posts about how you can get a great workout without breaking the bank. These are all typical exercises that I do regularly.

This first one is my favorite exercise to do when I’m pressed for time and I just want to bang out some quick cardio with the bonus of a leg workout. If you own a ranch house, this may not work for you (unless you have a basement?). It is so simple: use your stairs as a homemade stairmaster.

Going up and down the stairs is some of the best exercise you can do. It burns a lot of calories and is great for cardio. It also is great at strengthening your leg muscles, especially your hip flexors, quads, and glutes.  As a rough estimate, depending on your weight, you will burn roughly 100 calories walking and 150-200 calories running up and down the stairs per 10 minutes. Therefore you are burning calories really quickly and it’s a great time-saving workout.

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The great thing about doing the stairs is that you can do them at work. If you can’t find time to workout at home, go do some sets of stairs whenever you have a few minutes. Even done in short 5-10 minute increments, you will still get in a good workout. If, like me, you don’t want to risk sweating too much at work, then just walk up them at a slow or regular pace instead of taking the elevator up.

My dogs like to keep me company at home and sit at the bottom of the stairs when I do this. They are like my little cheerleaders keeping me motivated! Rob and I like to do the stairs together sometimes, too- we will alternate and high five each other as we pass one another. Whatever you can do to keep your workout motivating and fun!

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Eating your feelings

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Who here copes with life by eating?
Meeeeeee!!!!!!!
Eating is just very comforting! I love food! As I have gotten older I actually have more appreciation for good food and so I love to enjoy it. There is little more that I enjoy more than going out for a good dinner and drinks with my husband. I do not want to be a person who cannot indulge in the good things in life, including food.
Here’s the problem, though- there has to be balance! I historically will come home from a long day of work and just pick up the first thing I see because I’m tired and starving. And the first thing is usually animal crackers or popcorn or Taco Bell burritos I grabbed on the way home. It’s easy and it’s fast, but then you become trapped in a cycle of just eating junk!
Boredom is my biggest enemy. Because I work a lot when I’m off I just want to veg out with my dogs. And the more I sit around, the more I snack, snack, snack. I will eat till I feel sick, just because it’s there in front of me.
Using an food tracking app has really helped me avoid this pitfall and stop the bad snacking. When I saw how many horrible empty calories I was eating a day, it really triggered the guilt for me and it has helped me get control. And to go along with it I have changed my snacking foods. Berries are my favorite snack to have on hand. They are naturally sugary and a much better alternative to eating processed snack foods. So now the blueberries are the first thing I reach for when I come home.
I still have my emergency stash of nutty bars… but I haven’t had to reach for them lately. But when I do I am not going to beat myself up! I am not perfect! As long as I keep working on it everyday, that’s what matters.

Realizations

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When did you first realize you were overweight? Has it been your whole life, or a more recent change?
When I was 13 I got my period, and I also got hips and thighs and a butt. There wasn’t one isolated moment, I just started to notice over time that I didn’t look the same as my friends and I wasn’t treated the same. I was buying size 10 and 12 jeans- the same size my mom wore. I was also tall (I’m 5 foot 9), and so this just exacerbated the difference between myself and the small diminutive girls who were most popular.
I remember going to middle school dances, and having a good time, but standing on the sideline during the slow songs. Now of course, this may also be because I was smart, opinionated, and a little odd even then- but I knew I was ridiculed for how I looked and this played in to my “social status”.
When I started high school I earned a nickname “bubble butt” for how my butt looked in my spandex volleyball shorts. Now being the people pleaser I am, I just rolled this in to my personality and laughed it off. But it still hurts to be made fun of for how you look. I’m sad to say that at times, I could be just as cruel to others- caught up in the machinations of the high school girl hierarchy. How much better we could have been if we were just accepting of each other! I wish I could have told my younger self that nothing I thought mattered did, and to let it go and just live life.
Even though I was obese, I did not let it define me. I have realized that I am so many things, and my weight is only one part of what makes me, me. I am a doctor, wife, mother of furry children, friend, daughter, sister… I am a person I am proud of, regardless of my weight. Becoming healthier and losing weight has not changed who I am, but it has let me be the best version of myself.

Goal Setting

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When you are losing weight, it is very important to set specific and tangible goals for yourself. This helps to ensure a few things:
1. That your goal is attainable and safe. The recommended rate of weight loss is 1-2 pounds per week. Losing weight gradually has been shown to produce better, more sustainable results. A good example of this is the show a the Biggest Loser. Anyone can lose weight in that environment- exercising all day and eating very little, but when those people go back to their daily lives they nearly always gain the weight back. Longevity and sustainability are keys to lasting weight loss. If you set a weight loss target that is not achievable, then you are setting yourself up for failure.
2. Goal setting helps you focus on not just the weight and the number on the scale, but what benefits you will see on a day to day basis in your life. For example, daily arthritis aches and pains are extremely common in obese people- the extra stress the weight puts on our joints is severe. Improving pain from osteoarthritis is a great goal to have. Another option is set goals based on the activities you want to be able to do. I want to be able to walk up two flights of steps without feeling like I am going to keel over- that’s a good easily trackable goal that I can improve on over time.
I started off weighing 275 pounds in the summer 2016, which was an all time high for me. More seriously, my BMI was 40.6- placing me in the category of morbid obesity (BMI > 40), yikes! That was truly a wake up call and had me considering gastric sleeve surgery. I have been close to that weight multiple times in the last 10 years and it is not uncommon for me to lose and gain back 50 pounds in a single year. This roller coaster has been very disheartening and difficult to endure, but it is imperative to keep a positive attitude and keep looking forward!
My weight goals are both short and long term.
My initial goal was to get my weight down to 220 pounds, down from a start of 275.
Past this my goal was to get down to 200 pounds by the end of August 2017 (BMI 29.5 and not obese but overweight!) and I achieve that goal! I set this goal for myself because my husband and I went on a 3 week long hiking trip out West. We traveled to Wyoming, Montana, Utah, and Colorado to hike and see state and national parks. We took a similar trip in 2015 and it was the best thing we’ve ever done, but at the time I was not in good enough shape to do strenuous multi-mile hikes in the dead of summer. I fell several times on the trails and we had to cut short several of our hikes because of that. So this time I was well prepared and in shape to safely complete strenuous hikes in the mountains and desert. Injury is a real and scary possibility when you are out of shape, and I was fall and injury free! This trip was a wonderful adventure, and it was great motivation to keep on track!
My next goal is to lose 100 pounds total. It has been really hard. Since my big trip a few months ago, my weight has been plateaued. I continue to get more in shape, but the numbers on the scale just aren’t budging. I am relying instead on improving my strength and endurance to measure my progress. I know I’ll lose 100 pounds eventually, but it sucks to see the scale taunt me!

When You Have a Bad Day

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Here’s something that won’t surprise you- I’m not perfect. None of us are, and from time to time we are going to slip up.
For example, I made it my goal this year to try and do some exercise every day. That’s a pretty high bar, and I am approaching a full year of everyday exercise!!! In the beginning, there were days I just couldn’t do it and as time went on I’ve been more and more consistent. I don’t freak out if I am sick or feeling badly… slipping in a quick 15 minutes of yoga or walking is still exercise! Go up the steps at work, whatever you can do to fit it in. You don’t have to run a marathon everyday, just do the best you can.

Also, I am still trying to not eat any fast food or fried fatty foods. Well I continue to blow this one. When I was sick I was totally exhausted and just wanted something fast and filling- so I had Fazoli’s one day and Applebees another and maybe some nachos and Taco Bell. And you know what, they hit the spot at the time!
The most important thing is to not let these bad days derail your whole plan. I have done this in the past… one bad day leads to a week leads to a month. I’m learning resiliency by being able to start each day fresh, and not dwell on my past mistakes.
“I tried and failed. I tried again and again and succeeded.”
(Gail Borden)

When is selfishness a good thing?

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When you make a huge change in your life as I did in the last year, you really have to put your priorities in order. Because to work on yourself, you actually have to prioritize yourself first. I was doing a crappy job of this before. At the top of my list has always been medicine… whether it be my schooling, training, or my current job.
Now don’t get me wrong, I absolutely love my job as a physician. But my problem is my job is also my identity… who am I if I am not a physician? I got so wrapped up in my work that I was sacrificing other parts of myself, and this had to change. I still love my job and I will always go above and beyond for it… but it is taken a backseat in my priorities.
In order to get healthy, I had to put myself at the very top of the list. This means you need to be a little selfish. You have to be willing to say no to other pressures and obligations in order to devote the time needed to better yourself. That might mean 30 minutes totally to yourself to work out… or 30 minutes to cook a quick dinner instead of getting takeout… or even 30 minutes to soak and relax in the bath.
I have found that when you put yourself too far down on the list, you start to burn out and lose sight of the joys in everyday life. So, whatever it is that works for you, taking the time to devote to it is worth it.

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