I have been to my clinic...

CATherine wrote:
On Thu, 24 Feb 2005 11:00:11 -0700, "Monique Y. Mudama"
wrote:

On 2005-02-24, CATherine penned:
The doctor wasn't there but a Nurse practitioner was there. She is
great. Very knowledgeable and helpful and answers my questions and
gave me the most thorough heart exam I ever had.

She told me i only had to cut my salt, fat and cholesterol in half
after she got my full life history!
(snippage)
Eek! I'd rather you eat more small meals, too =P Your blood sugar
won't spike as much and your stomach will also shrink, allowing you
to feel full with less food. Me, I couldn't survive on one meal a
day. I'm on the five or six meal plan =P

It is kind of hard to have several meals a day in my job, let alone
noon.

What do you do for a living? Surely they have to give you a lunch break?!
And, at least here in TN, the Dept. of Labor mandates two 15 minute breaks
per day as well. Do you have access to a microwave? A refrigerator? (I
realize not everyone has these in the workplace.) As others have suggested,
a small cooler for snack/lunch items that need to be kept cool. Or a
thermos filled with soup so you can sip on a cup when you get hunger pangs.

I find I cannot do my job with a full meal under my belt.

Ah, but the point of more small meals is not a "full meal" every time you
eat.

So the
most I do is peanut butter/cheese crackers or a candy bar. I tried
carrots and celery but they were not satisfying and left my stomach
rumbling.

Carrots and celery are mostly water anyway. Sure, they have some benefits
such as betacarotene from carrots. I'm honestly not sure what celery does
other than make soup taste better LOL PB crackers and cheese crackers are
convenient but not particularly healthy.

Jill

"jmcquown" wrote in message
.. .

What do you do for a living? Surely they have to give you a lunch break?!
And, at least here in TN, the Dept. of Labor mandates two 15 minute breaks
per day as well. Do you have access to a microwave? A refrigerator? (I
realize not everyone has these in the workplace.) As others have
suggested,
a small cooler for snack/lunch items that need to be kept cool. Or a
thermos filled with soup so you can sip on a cup when you get hunger
pangs.

Since my surgery I'm forced to eat 6 small "meals" a day since my stomach is
about the size of a golf ball. However, since then, I've felt *MUCH* better
and don't have those "highs" and "lows" throughout the day and I don't ever
get so hungry that I feel faint.

It doesn't even have to be "meals" per se. I keep pretzels or Cheeze-its
(or some baked snack food) and trail mix bars in my desk along with fruit
like apples and oranges. "Grazing" seems to be the way humans were designed
to eat.

Regarding breaks - like Jill pointed out, by law your employer is required
to give you a certain amount of break time for every certain number of hours
you work (numbers vary from state to state, but *all* states have these
laws). And, nutrition aside, ergonomically speaking you should get up and
move around or you'll end up crippling yourself from ergonomic injuries.

Hugs,

CatNipped

CatNipped wrote:
"jmcquown" wrote in message
.. .

NOTE: This RANT is in no way directed towards Lori!

Since my surgery I'm forced to eat 6 small "meals" a day since my
stomach is about the size of a golf ball. However, since then, I've
felt *MUCH* better and don't have those "highs" and "lows" throughout
the day and I don't ever get so hungry that I feel faint.

In 2003 it seemed to become a "trend" at my office for people to have
gastric bypass surgery. Let me make it clear: I do not have a problem with
this, per se. But some of the people who had the surgery done jumped
through hoops to get approval for it. When the local doctor who performs
the procedure wouldn't approve them, they drove 3-1/2 hours to Little Rock
to a guy they'd been told would approve them. I know of only one woman who
ate sensibly and in small portions but had always been overweight, even as a
child. She, of course, was the only one I'd call a success story. She
looked and felt fantastic the last time I saw her.

N. admitted to me and others she ate nothing but junk food and fast food.
J. ate enough food for 2-3 people just at lunchtime. B. didn't qualify as
obese so she *gained* 30 pounds in order to get herself into "shape" for
having it done! Why? Because she wanted to be a size 4, not a size 10. K.
was always talking about making fried pork chops or fried chicken for dinner
with mashed potatoes and all of it smothered in gravy. She'd shown us all
photos from just a few years before when she looked very good. Hello - so
stop frying everything and putting gravy on everything! "But my husband
likes it." I'm sure he does, but since he's not doing the cooking I'll bet
he'd eat what you put on the table. (BTW, her kids were overweight, too.)

The day before J. had his surgery, he ordered TWO fried fish dinners for
lunch from a seafood fast-food chain complete with fries and hushpuppies and
proceeded to eat both of them in an hour. His comment was, "I'm not gonna
be able to eat like this again for a while." After J. had his surgery (and
Lori, you know about this for sure!) he was supposed to have liquids for a
week, then soft foods - no fat! and work gradually into small, healthy solid
meals. 2 weeks after his surgery he chowed down on a hamburger and on pizza
and wound up in the hospital with a blockage because his body couldn't
handle what he'd eaten! And even well after that he'd be the first in line
when we had food at a company function and go back for seconds. (SIGH) I
never really noticed any appreciable weight loss - maybe 80 lbs but he was
already over 350 when he had the surgery.

B., the one who purposely gained weight, did get down to a size 4. But she
was also still the first one to seek out or bring in doughnuts and cookies;
she kept bowls of chocolate candy on her desk. She also looked rather silly
being a 55 year old woman who came to work wearing leather pants and skimpy
tops. Honey, you aren't 20 just because you're now a size 4 - get over it!

S. is the only one I considered successful. She was ready and willing to
modify her eating habits, which weren't bad to begin with. She already
loved baked fish and chicken breasts; lots of steamed vegetables and salads
with simple olive oil and vinegar dressing before she ever considered this
surgery. It was due to her blood pressure and having had no success with
"diets" for years and problems with her knees due to her weight. She was
about 30 and had been battling this since a child.

END of RANT

It doesn't even have to be "meals" per se. I keep pretzels or
Cheeze-its (or some baked snack food) and trail mix bars in my desk
along with fruit like apples and oranges. "Grazing" seems to be the
way humans were designed to eat.

Regarding breaks - like Jill pointed out, by law your employer is
required to give you a certain amount of break time for every certain
number of hours you work (numbers vary from state to state, but *all*
states have these laws). And, nutrition aside, ergonomically
speaking you should get up and move around or you'll end up crippling
yourself from ergonomic injuries.

Or, if you stand all day (as with some jobs) - take a break and rest your
feet.

Hugs,

CatNipped

"jmcquown" wrote in message
news
I know of only one woman who
ate sensibly and in small portions but had always been overweight, even as
a
child. She, of course, was the only one I'd call a success story. She
looked and felt fantastic the last time I saw her.

The surgery is helpful, but it isn't "magic" - you do have to work with it.

I'd been overweight all my life (the only one in my family, so it wasn't
eating habits). The way one doctor explained it seemed to make sense. At
the time I was born "fat" babies were "in". Fat babies were equated with
healthy babies and were "cute". My mom used to practically force feed me
when I was an infant. This doctor said that from age 0 to 2 was when the
*number* of fat cells are created and after that the fat cells only enlarge
or shrink. So if you force an infant to be overweight you are burdening
him/her with way too many fat cells for life. That person is then required
to eat on an almost starvation diet in order to keep the fat cells small
enough to be a normal weight. I think that's why I had to go on an 800
calorie a day or less diet in order to lose weight. Then as soon as I'd
start eating normally again I would gain it all back and then some!

snip

he'd eat what you put on the table. (BTW, her kids were overweight, too.)

Poor kids (see above!!).

The day before J. had his surgery, he ordered TWO fried fish dinners for
lunch from a seafood fast-food chain complete with fries and hushpuppies
and
proceeded to eat both of them in an hour. His comment was, "I'm not gonna
be able to eat like this again for a while." After J. had his surgery
(and
Lori, you know about this for sure!) he was supposed to have liquids for a
week, then soft foods - no fat! and work gradually into small, healthy
solid
meals.

Actually, liquids only for 3 weeks and then another 3 - 4 weeks of "soft"
food.

2 weeks after his surgery he chowed down on a hamburger and on pizza
and wound up in the hospital with a blockage because his body couldn't
handle what he'd eaten!

stands with mouth open in total shock I can't believe he did that - that
had to *HURT*. I remember in the hospital they gave me some liquid pain
medicine right after I had a half a cup of water and the medicine just came
right back up because my stomach was too full to hold it (kind of like a
baby's liquid burp or spit-up)!!!

And even well after that he'd be the first in line
when we had food at a company function and go back for seconds. (SIGH) I
never really noticed any appreciable weight loss - maybe 80 lbs but he was
already over 350 when he had the surgery.

If you haven't seen them yet, here are the pictures (and what's, for me,
more important) the medical statistics of me before and after surgery:
http://www.possibleplaces.com/changes/.

B., the one who purposely gained weight, did get down to a size 4. But
she
was also still the first one to seek out or bring in doughnuts and
cookies;
she kept bowls of chocolate candy on her desk. She also looked rather
silly
being a 55 year old woman who came to work wearing leather pants and
skimpy
tops. Honey, you aren't 20 just because you're now a size 4 - get over
it!

again stands with mouth open in total shock After my surgery I made the
mistake of eating about a teaspoon of jellied cranberry sauce (forgetting
that it contained sugar), and I was begging gawd to take me out of my misery
for the next 4 hours!!!!! I avoid sugar like the plague!!!!!!!!!!!

S. is the only one I considered successful. She was ready and willing to
modify her eating habits, which weren't bad to begin with. She already
loved baked fish and chicken breasts; lots of steamed vegetables and
salads
with simple olive oil and vinegar dressing before she ever considered this
surgery. It was due to her blood pressure and having had no success with
"diets" for years and problems with her knees due to her weight. She was
about 30 and had been battling this since a child.

My eating habits are very much changed as far as what I eat (I do eat less
more often because of the size of my stomach). I think what made it work
for me was the intestinal bypass. Less of what I eat is absorbed into my
body so I get fewer calories. In other words, I might eat 1,000 calories a
day, but probably only about 800 or less are absorbed into my body.

END of RANT

I agree with everything you said.

One thing to note is that this is *NOT* a surgery people should have done
just to get into a size 4. For one thing, you are only supposed to lose
about 70% to 80% of what you are overweight by (if you are 100 pounds over
your "ideal" weight you can expect to lose about 70 or 80 pounds). To lose
that last 20% to 30% you have to do what everyone else does - exercise and
what *what* you eat. And you have to *work* at losing.

Even though my stomach is the size of a golf ball, if I ate high calorie /
high fat foods often enough, I would not have lost weight (and my medical
statistics would not have changed so drastically). And to go along with the
change in diet I also do 20 minutes of yoga and 25 minutes of strength
exercises (crunches, etc.) *every* day and then 45 minutes (about 7 or 8
miles) about 4 times a week on top of that.

Hugs,

CatNipped

"CatNipped" wrote in message
...

My eating habits are very much changed as far as what I eat (I do eat less
----------------------
^ ------------------------------------------------------------

Oops, should have been "aren't" - I eat about the same things I did before,
just *NO* sugar!

Hugs,

CatNipped

CatNipped wrote:
"CatNipped" wrote in message
...

My eating habits are very much changed as far as what I eat (I do
eat less
----------------------
^ ------------------------------------------------------------

Oops, should have been "aren't" - I eat about the same things I did
before, just *NO* sugar!

Hugs,

CatNipped

You can well imagine how, given the talk about the cost of group insurance,
watching people refuse to cooperate with the dietary guidelines so as to
wind back up in the hospital - or doing some simple exercise such as
walking, would make a lot of people at the office upset. It was (they sure
let us know) a $40,000 surgical procedure covered by our group insurance
plan. (SIGH)

Jill

"jmcquown" wrote in message
. ..

You can well imagine how, given the talk about the cost of group
insurance,
watching people refuse to cooperate with the dietary guidelines so as to
wind back up in the hospital - or doing some simple exercise such as
walking, would make a lot of people at the office upset. It was (they
sure
let us know) a $40,000 surgical procedure covered by our group insurance
plan. (SIGH)

Jill

Definitely! Ideally the cost of this surgery is *WAY* less than what it
would cost for treating heart disease, stroke, cancer, joint replacement,
etc. - the things that are caused by obesity. But if it's just done for
vanity's sake or done to no avail then that would make me mad too.

Insurance premiums are way out of control. However, even more than needless
surgery, frivolous lawsuits make me angry. The cost of all that malpractice
insurance is passed on to the patients and thus to the insurance companies.
Everyone has to cover the cost of some idiot trying make a buck by suing the
doctor because their 90-year-old granny died under his care!

Hugs,

CatNipped

In article , "CatNipped"
wrote:

"jmcquown" wrote in message
news
I know of only one woman who
ate sensibly and in small portions but had always been overweight, even
as
a
child. She, of course, was the only one I'd call a success story. She
looked and felt fantastic the last time I saw her.

The surgery is helpful, but it isn't "magic" - you do have to work with
it.

My endocrinologist has been suggesting it for me, and, even if I did
have insurance that covered it, I am reluctant. Let me throw my
reasoning into the discussion.

By the actuarial tables, I should be 168 or so. When, however, I'm in
athletic conditioning, with low body fat and substantial muscle, I seem
to stabilize around 190. At present, I'm about 270.

I have a group of conditions associated with overweight, including one
called "metabolic syndrome X": diabetes, high lipids, and fat
concentration in the belly (my legs and buttocks are rock solid). I also
have hypertension and obstructive sleep apnea.

Many of these conditions would almost certainly be helped by weight
loss, although it's not a guarantee. My hypertension and lipids are
extremely well controlled by medication, although the diabetes needs
further drug adjustment. At least 30-40 pounds of the excess weight is
directly due to diabetes medication. Unfortunately, the one diabetes
drug that does not cause weight gain, and also perfectly regularized the
diabetes in combination with another drug, is toxic to my kidneys. We
may try it again in extremely low dose.

If emotional and schedule factors get me back into regular exercise, I
can say, from experience, I replace fat with loss and muscle mass. If I
had gastric bypass, my concern would be that I could not easily get the
protein I need for muscle growth, and also the carbohydrates I need to
keep my sugar reasonable during intense exercise. Yes, there are some
potentially reversible bariatric surgeries, but I think there's a better
long-term situation. I work at home and have a decent home gym; it's a
matter of emotional health and discipline to use it.

I'd been overweight all my life (the only one in my family, so it wasn't
eating habits). The way one doctor explained it seemed to make sense.
At
the time I was born "fat" babies were "in". Fat babies were equated with
healthy babies and were "cute". My mom used to practically force feed me
when I was an infant. This doctor said that from age 0 to 2 was when the
*number* of fat cells are created and after that the fat cells only
enlarge
or shrink. So if you force an infant to be overweight you are burdening
him/her with way too many fat cells for life. That person is then
required
to eat on an almost starvation diet in order to keep the fat cells small
enough to be a normal weight. I think that's why I had to go on an 800
calorie a day or less diet in order to lose weight. Then as soon as I'd
start eating normally again I would gain it all back and then some!

As a child and teenager, I ran to underweight. When I was a wrestler in
high school, my coach was always trying to push me into the 162 pound
class, but I tended to stay around 150 or so. My suspicion is the weight
gain is associated with not just type II diabetes, but with an
assortment of partially understood metabolic disorders associated with
it -- and, of course, the medication. Most medications for diabetes try
to keep extra sugar out of the blood -- this is good, because excess
blood sugar, and sugar metabolites such as sorbitol, cause the damage.
The bad news is that they lower blood sugar by improving the efficiency
of transport into the cells, whether or not the cells are ready to burn
it.

In article , "CatNipped"
wrote:

"jmcquown" wrote in message
. ..

You can well imagine how, given the talk about the cost of group
insurance,
watching people refuse to cooperate with the dietary guidelines so as
to
wind back up in the hospital - or doing some simple exercise such as
walking, would make a lot of people at the office upset. It was (they
sure
let us know) a $40,000 surgical procedure covered by our group
insurance
plan. (SIGH)

Jill

Definitely! Ideally the cost of this surgery is *WAY* less than what it
would cost for treating heart disease, stroke, cancer, joint replacement,
etc. - the things that are caused by obesity. But if it's just done for
vanity's sake or done to no avail then that would make me mad too.

Insurance premiums are way out of control. However, even more than
needless
surgery, frivolous lawsuits make me angry. The cost of all that
malpractice
insurance is passed on to the patients and thus to the insurance
companies.
Everyone has to cover the cost of some idiot trying make a buck by suing
the
doctor because their 90-year-old granny died under his care!

Malpractice insurance, and the associated extra costs of "defensive
medicine", are indeed part of the US healthcare economic situation.
They are, by no means, the only parts.

We know several ways to decrease the incidence of malpractice, but
there's resistance -- although this is changing with a newer generation
of physicians. Every study of malpractice suits shows that the #1
preventive is having physicians TALK to their patients, give the
impression of at least giving time if not actually caring, and, if
there's a problem, admit it quickly (which the lawyers say is the last
thing to do).

There are also great opportunities for risk reduction (aside from
efficiencies) by greater automation in clinical practice. A very large
part of medical errors are due to incorrect (or unreadable) prescribing,
of drugs or treatment. The Institute of Medicine of the National Academy
of Sciences recommended that the prescription pad be used only in
extremely unusual cases -- prescriptions should be written with a
computer-assisted prescribing system. The more access that system has to
the patient's medical record, the more problems it can avoid, the better
the mixtures of drugs it can recommend, and it can come up with cheaper
regimens that have better compliance.

One of the biggest problems, however, is what would be called a shell
game in any other industry: "cost-shifting". This is caused by a
combination of the US historical artifact, the employer-based system,
and unfunded mandates. When I speak of reforms, I am NOT speaking of
"socialized medicine", but actually letting the free market work. The
problem is that free markets depend on interaction between consumer and
provider. The US system alters that to an interaction between employer,
for which healthcare is overhead, and benefits managers (sometimes but
not always insurers) who manage reimbursement. While there were distinct
problems with the entire Clinton health plan, one part, which both Bush
and Kerry recommended to differing extents, is to get the employer out
of the loop and have consumer cooperatives contract with
providers/benefit managers. Both Presidential candidates suggested that
certain small businesses, etc., be allowed to buy into the single very
large system in the US that uses this model very successfully: the
Federal Employees' Health Plans.

Right now, the reimbursement received, for the same procedure, by a
provider differs with the market leverage of the third-party payor. Big
insurers, Medicare, etc., can get away with paying artificially low
rates, which sometimes don't cover costs. The providers, still having
costs to cover, increase the bills to less well insured and self-insured
patients.

Adding to the problem is the major unfunded mandate called EMTALA, which
requires patients to be seen and stabilized in emergency rooms without
regard to ability to pay. Socially, I believe this is a good thing,
but, as a Federal mandate, I believe the uncovered costs should be
reimbursed from Federal taxes -- not cost-shifted. I can look at one of
the top hospitals in Washington DC, which receives critical shooting
patients from the drug wars. Such people are rarely insured. It's very
easy to run up costs of hundreds of thousands to stabilize a multiple
gunshot patient. Sometimes, the hospitals can get these patients on
Medicaid, but, all too often, the costs get shifted onto the insured and
self-pay patients.

As an example of how radical the discounts can be, when I received my
pacemaker, the "list price" for the pacemaker itself and the
implantation was $24,000. Combining reimbursement and my copay, it cost
me $1800. My benefits were managed by the #2 manager in the industry,
with great market power.

In article , "Monique Y.
Mudama" wrote:

On 2005-02-24, Nan penned:
On 24 Feb 2005 06:00:05 -0800, "Katz" wrote:


I would encourage you to DEFINITELY get company insurance. Again, you
have
no idea. Ours just went up, as it does every year, & I think mine is
$80/month also, on a plan w/100% coverage. Why in the world do you have
to
wait til Nov. to sign up? How long a wait period does your company
have? I
never heard of more than a 3-month wait. I think no wait is more
common.
Mine is no wait.

Some companies require that you sign up for insurance when you are
first
hired. If you don't you have to wait for an open enrollment period.

Nan

I always thought this was a legal issue. At both my company and my
husband's,
benefits can only be changed during the enrollment period, or if there's
a
change in your family situation (marriage, new dependent, or someone
changes
jobs).


It really depends on the contracts. Usually, it's a matter of
administrative convenience to limit the times of changing coverage to an
"open period." In general, an exception is made for "major life events"
adding or deleting dependents. The latter may be rooted in
antidiscrimination law, but, if a company and its insurer(s) chose,
there's no reason they couldn't change at will.