Health for life

Hi,

Setting goals used to make me crazy but I think it is time to give this a try in the area of weight loss. I have been successful over the past year or more at taking off about thirty pounds but I am definitely stuck there. My weight hovers around the same numbers week after week. I go up a few and then down a few. I can hit a new low number but that does not mean I stay there. I am not clean with following my own programs.

There are two things that I have accomplished and I am very happy to remind myself that I have not gone back up to my original starting weight and Ive reversed my prediabetes. Those two things are pretty much miraculous in my book and I am very happy to have done them. It is that third goal, the one of losing weight that I believe I need to examine a little more closely.

I think that I have not accomplished the feat of "getting thin" because, inside my deepest heart, I dont really believe it is possible. I see other people losing weight and I wonder why I cannot. See that? I said "cannot." I did not say "have not" I said "cannot" which means "not able to." Yes, I have seen that inside me before and I think it is time to address it.

Ive shied away from setting weight loss goals because I have followed the diet du jour rules in the past, set the goal, and not reached it so many times that I began to believe that setting the goal was idiotic. It also became scary to face, so I simply left it behind. Right now I even feel like if I continue to examine the powerless "why Ive not done it" I will never get to the "accomplishment" so, for this moment, I am going to face the other direction and begin to be empowered.

For inspiration I am using John Barbans book the: "Anything Goes Diet," -- the separate additional PDF called: "Thinking Thin," which is about programming your mind for weight loss. I definitely need to reprogram my mind for weight loss. Since his is not a "hypnosis" session, it is simple for me to try out. (In case you would like to try it out here is a link to his blog: http://www.anythinggoesdiet.com/blog/ ) I am going to focus on the first two steps he shares. (As I am writing Ive tested the link and it leads to a blank page, so Ive contacted the author to let him know something is wrong. Hopefully it will be fixed, soon.)

The first tip is to ask yourself "What is this food going to do for me?" He suggests that asking yourself this question before you do an on-the-fly adjustment to your program, which usually means adding a snack, a meal, or doing something that is not on your agreed upon program, will allow you to admit to yourself exactly why you’re eating that extra meal or snack and decide if you really need it.

It gives you a moment in time to examine what you are doing to see where this action will eventually take you. If eating that food will satisfy a legitimate need that is one thing, but if it will only serve to screw up your weight loss, then maybe you need to set it aside and choose to do something else. It could go either way, so this is not a "moment to beat yourself up," it is simply a moment to step back and take a look to see if you want to end up where eating that item at this time will take you. Since weve previously established that "we are what we eat," will eating this food make you what you want to be?

While that is not actually "setting a goal" it seems like it would help you "keep headed towards your goal." This is about commitment. You will discover if you are really committed to your goal of getting to a particular size or if you are committed to satisfying your current food lust -- craving. Then you get to decide where you really want to end up.

His second tip incorporates your vision of your goal. He asks you to imagine that you have reached your exact goal. Imagine that you have been successful at your weight loss attempt and you fit into the size you always wanted to be. Assume that your weight loss is guaranteed and then imagine that your future successful self is standing next to your current self and having a discussion.

What would your future self say to your current self in any challenging situation? Would your future self allow your current self to over eat? Imagining that you have reached your goal will create feelings of success, accountability and responsibility right now to make that future a reality. Your future thin self will never exist if your current self does not do what it takes to get there.

So. Both of these supportive thinking exercises depend on having a specific goal in mind and not only having the goal, but believing that you can reach it. (Ha. I just got overwhelmed and headachy... Im going to go for a swim to give me a little "distance" and to have a little more time to think about me and my personal intention.)

Ok. I went and got myself ready to go for a swim (have not gone yet) and it has dawned on me that I do have goals. Ive had them in my mind all along. Ive talked about them before in this blog. I just did not blow a trumpet and make a list of what they are. Not keeping my current goals is what has been frustrating me. So Im going to use the two tips to support me in my current, already existing goals which are:

1. Daily: obey my eating program today
2. Ultimate: Wear a size 12 dress.
3. Intermediate: Reach the weight of 315 and use my success as a catalyst to set the next goal (current weight today is 329.25)

• Benefit: my blood pressure will normalize as I normalize my size
• Benefit: I will no longer have to be embarrassed from noticing others judging me (they may still judge me -- but it wont be about them looking down their noses at my body shape and size and making assumptions about me)
• Benefit: I will feel like I fit in when I want to and I dont have to "fit in."
• Benefit: I will be happy to go shopping at the "normal size" store
• Benefit: I will be happy to be able to purchase size 12 items on sale
• Benefit: I will be happy to boast about what the Lord has done for me!!

To reach my daily goal of obeying or following my current eating program I will use the question: "What will this food do for me?" -- as needed -- to remind me of what I can do for myself in this moment.

I will envision myself in a size 12 dress which would be an absolute dream come true for me. I can see what my body will look like in a size 12 dress. My tummy will be small. I will have a visible waist and my back will be smooth. I see myself wearing a cotton, flower print, knee-length, A-line, size 12 dress and looking in a mirror to admire how good I look. I can see my future self talking to my current self and being my "support group" of one who encourages me and reminds me to believe that I can do it. My future self knows that I can do it, because she is proof that it can happen. It is possible! She did it. So can I. I know because she is me.

My intermediate goal is reachable, too. As I go along I will set up new intermediate goals as needed to be markers of my successful journey.

• My eating program is currently the snack/meal/snack with a 24-hour fast on Monday/Tuesday. 
• I need to have fresh raw salad available for my meal and snacks every day. 
• I need high quality animal protein for all meals and snacks. 
• A snack is half the size of a meal. 
• On Monday, before the beginning of my evening fast, I can have two meals. 
• I can have shirataki noodles two times in one week. 
• I can have 1/2 of a potato or sweet potato if I go out to eat with friends once a week.

That about sums up my current program and goals. Praying that the Lord Jesus will give me the strength I need to remain committed to doing something good for me.

Remember: It is better to obey, than to make a sacrifice for sin

Be back soon,

Marcia

Did the stupid return on the Title again and it posted before I was finished writing, let alone finished editing. So sorry for the double post -- again.

Hi,

At this moment in time, the pain is gone and I am thankful. But my hands seem a tad swollen and a little stiff. I am not exactly sure whether it is the chlorine in the water or the beef that Ive eaten over the last few days. I make sure to get organic beef (no pesticides, no hormones) and Ive even found a little grass fed which is so much better for a human body. It seems the pain strikes most after the water exercise, though, so Im still not exactly sure what to think or how to correct.

This morning when I got up I was having a lot of pain in the low back (and I secretly decided that if my physical therapy causes this much pain so often, maybe I need to stop doing that...). The therapist is trying to build core muscle, so keeps increasing the reps or positions to get to the point of fatigue. She points out that irritation is not fatigue, though, and cautions me to notice irritation so the exercises can be modified. I pay attention, I do them caully, and still I get a lot of pain the next morning. Last Tuesday was the worst after PT on Monday. This morning was worse than usual, but not as bad as Tuesday.

Since the pain has subsided, Im thinking maybe my "not doing this" decision was premature. Ive decided to make sure I have a day of rest in between bouts of exercise so I shall play around in the pool tomorrow, but not today. I have just remembered that I know how to deal with this pain with another kind of exercise, which I think I might try on the days in between the pool. It consists of 10 minutes on the Airofit and some low back stretches that my doctor gave me, plus some crunches with my Golds Gym apparatus that helps me do them without straining my neck. Ive done them religiously in the past and they help to remove the pain for a while. I just dont know why I keep stopping doing them when the pain goes away. It is like I get lulled into a sense of, "OK, the pain is gone, I can stop now" -- but it is the continuing that keeps the pain away. Im pretty tired on the in between days, so Im not sure Im quite able to do that, but will think about it -- maybe test it and see how it goes.

As to the eating program: Ive got my salad made this morning but have not eaten yet. On this program, you only have to eat if you are actually hungry. My blood sugar was high this morning (127) so I think the reward meal I chose last night was not good. I knew it was not the best when I did it, but decided to test it out. It failed the test. I had gotten a grilled chicken salad and a turkey, ranch, and bacon, sandwich at Arbys. I needed the salad but could have done without the so-called grilled chicken (which I chose instead of the breaded chicken). When I opened it up at home it turned out to be deli-type sliced chicken and not grilled chicken at all -- but I was too tired and hungry to fuss, so I just ate it. That was the reason I had gone that route -- I was too tired to fix something at home. Im thinking that with the salad and sandwich I just did not have enough salad greens and vegetables. It was also overboard on the protein, and it seemed there was too much bread, too. The blood sugar number this morning is the final confirmation that I should not do that one again -- and I am back up to 338 this morning.

I had run out of salad last night before going to church but did not have time to make the new salad -- which went against my plan. The plan is: when the salad bowl is emptied, make a new one. I did not make the new one, because I just did not have time. Then later, on the way home, tired after a day of PT and then church and the two-hour drive I wanted something fast and easy. It sure seemed fast and easy to go to Arbys. Hardees was closed or I would have gotten a low carb burger there and a salad at Wendys. Arbys and Hardees are right next to each other, about a block from my house on the highway. (I live inside an RV/mobile home park.) So it seemed logical to go to Arbys. I like their market fresh sandwiches. I chose the one I did because it has more lettuce and tomato, though not much. Anyway. Now I know better. Trying to do the reward meal without strictly following the guide lines is what got me off track so many years ago. I dont want to continue the pattern, so must be caul to always have what I need at home -- especially the bowl full of fresh salad.

Im liking the combination of scrambled eggs and salad. It seems faster than peeling boiled eggs, and has more flavor, too. I just scramble the eggs, and pile them on top of my salad. The taste is amazingly good, to me. I always sprinkle the eggs and salad with what Julianna calls my "Everything" spice. It is my home made curry powder that Ive written about before. I was also running out of that, so I made a new batch this morning. No more being caught without what I need to stay on the program. That does not work. I also need to go and get some new salad greens today. The ones I have are either gone or just a touch old, so new ones will freshen up the larder and the program.

I am still waiting for my Shiritake noodles to arrive. The Fedex delivery says they will arrive on Saturday and I am looking forward to trying them. Im planning to use them for reward meals. I think they will be better for me than bread (especially) and I dont want to get used to eating too many high carb items. Although the night before last, I did a legal reward meal that included fried potatoes flavored with onion and mushrooms, which I could not even remember making for at least ten or fifteen years. I used to make them at home when I was growing up. It was a family staple. And I really enjoyed them on my legal reward meal. My blood sugars after the meal were normal at 130, but in the morning everything had dropped back to about 111. I was completely surprised and pleased to find out that if I do the reward meal the way it is supposed to be done, I get good blood sugars, while eating one high carb item.

Im thinking that the Arbys meal may have also had MSG or other hidden sugars for my blood sugar to stay elevated through the night, like that. It is back to the real salads for me.

Dont really have much else on my mind.

Hope all is well with you.

God bless.

Be back soon,

Marcia

Hugging a health insurer

Its an old conservative joke, but what is the one key difference between health insurers and terrorists? 

Answer: liberals only occasionally attack terrorists.

For the latest example of the continuing disdain for health insurers, check out this rather typical July 5 Washington Post article "Is this the end of health insurers?" After extolling one enlightened companys decision to self-insure its workers*, writer Sarah Kliff points out that hospitals can cut out the insurer middle man and offer the same service. The result, says the article, will be the wiser use of the premium dollars, lower costs and fewer coverage denials.

While the physician Disease Management Care Blog agrees that the health insurers have only themselves to blame for their bad reputation, it doesnt think that these companies are going to go away anytime soon.  Its not because, under Obamacare, U.S. citizens are now required to buy their product at any price.  Its not because they control hundreds of billions of dollars.  And its not because theyve had the ear of the political class for years.

The contrarian DMCB thinks theyll continue to stick around because they perform a two useful public services:

1. Keeping Providers From Going Belly Up: There have been too many examples of hospitals and physician organizations being unable to collect todays premium dollars and hold them as a promise to pay for tomorrows sickness.  Whether its not charging enough or being unable to say no, providers are vulnerable to running out of cash and being unable to cover their insureds health care bills.  The DMCB says its better to insulate hospitals and doctors from the perils of the underwriting cycle.  Insurers do that.

2. Keeping Providers From Going to the Dark Side: Assuming a hospital or physician organization can hold the dollars, pay for all that health care and end the year in the black, theres a good chance that theyll do it by ultimately employing the same tactics used by many mainstream insurers: denials of services based on determinations of "medical necessity."

*As an aside, self-insured companies dont always act in the their employees best interest.  Look at this infamous example and note that Cigna only "administered" the insurance plan on behalf of a self insured organization.

Were all aware of the past criticisms of "disease management." According to the critics, these for-profit vendors were in collusion with commercial insurers, relying robo-calls to blanket unsuspecting patients with dubious advice. Their claims of "outcomes" were based on flawed research that was never intended to be science; it was really intended to market their wares.  

But suppose the Disease Management Care Blog alerted you to:

1. A company that had developed a patient registry to identify at-risk patients who had not received an evidence-based care recommendation? Software created mailings to those patients that not only informed them of the recommendation but offered them a toll-free number to call if there were questions. Patients who remained non-compliant were then called by coordinators, who made three attempts to contact the patient and assist in any scheduling needs. If necessary, a nurse was available to telephonically engage patients and develop alternative care options.

If you think that sounds like typical vendor-driven telephonic disease management, youd be right.  Youd also be describing an approach to care that was studied by Group Health Cooperative using their electronic record, medical assistants and nurses.  When it was applied to colon cancer screening, a randomized study revealed each additional level of support progressively resulted in statistically significant screening rates.

Or how about.......

2. A major insurer that decided to use its claims data to identify its own "best practices" without waiting for any published evidence-based studies?  Since "strict experimental conditions cannot always be met," shortcuts like time-series analyses" and "propensity score approaches" will be used to "blur" the lines between feedback and evaluation, as well as the lines between provider and insurer?

If you think that sounds like an commercial insurer muscling into health care delivery while using quasi-experimental research shortcuts, youd be right.  Youd also be describing how Medicares Innovation Center is borrowing from the disease management industrys approach.  Its all here.

Lastly, theres......

3. A major insurer that decided to NOT to pay primary care sites enough fee-for-service or capitation, preventing them from hiring nurses who could provide coordinated care.  The insurer instead hired its own nurses and "embedded" them in the primary care sites while linking additional monthly payments of approximately $5 to pay-for-performance metrics.

If you think that sounds like a step away from the usual Patient Centered Medical Home, youd be wrong.  In this instance, having the embedded nurses did not get in the way of the sites achieving PPC-PCMH recognition. Whats more, compared to usual care in a prospective randomized study that was underwritten by the medical-home fans at the Commonwealth Fund, the embedded nurse approach resulted in better hypertension care, breast cancer screening and fewer emergency room visits.

Alas, disease management: to paraphrase The Bard, a rose still smells as sweet by any other name, especially if its used by Group Health, CMS and the Commonwealth Fund.