Three or so margaritas into the afternoon, we got the bright idea to form a half marathon team in honor of little Zoe and give the proceeds to Arkansas Children’s Hospital (where she had gotten all of her care).  Needless to say, the next morning – in addition to a whopper of a hangover – I now had a commitment to propel my body 13.1 miles forward in space.  How many steps had I run in the previous decade prior to this commitment? Um……none.

But I put on my big girl panties and “trained”.  Sometimes I trained with more vigor, sometimes – like say, the whole month of November – with a lot less.  But I concluded my preparation two weeks before the race with a long “run” of 13.8 miles.  I say “run” because I would slog (slow jog) for two minutes, walk for one, take lots of potty breaks, change the channel…..anything to relieve the “ouch” of the effort.  My time? 3 hours 17 minutes.  Not really good, but the best I thought I could do.  I really wanted to do 2 hours 48 minutes which would be about a 13 minute mile, but I really didn’t see how I would shave a half hour off my time in two weeks so I didn’t worry about reaching that goal too much.

Yesterday, March 7, was the big day.  Half marathon in Little Rock.  Wanna know how I did?  Too bad, ’cause I’m gonna tell ya’ anyway.

2 hours 43 minutes which equals a 12minute 28 second mile. For 13.1 miles!! Five minutes LESS than my “I’ll never be able to do this” goal of 2:48 and about 34 minutes short of my previous “best” effort.

So what did I learn?

(1) Goals: you’ve gotta have goals.  You will never be able to fix what you don’t measure, think about and change.  If my husband (y’all know him as Dr. Hekier) hadn’t pushed me to define what time I wanted to achieve – and what pace per mile I needed to achieve that – then I never would have pushed a little harder on the hills, never would have glanced at anything but the scenery and certainly not at my watch.  If you want to lose weight, define for yourself how much you want to lose and how fast.  Each pound equals 3500 calories.  So how many calories do you need to not eat each day to reach that goal?  A goal you can measure every day or even every meal is realistic to follow and act upon.  A nebulous goal of “I want to be a size 6 by Christmas” doesn’t tell you what to do every time you sit down for a meal.  “I need to eat 400 calories this meal so I can meet my calorie deficit for today to lose one pound this week” is a measurable index.  And if you don’t meet it? Fine, you can meet it the next meal. If your goal is vague you’re much more likely to just give up and not try again next time.

(2)Amazing results don’t only come from amazing effort – sometimes they come from just some effort.  I am not a natural runner.  My legs are short, my endurance is terrible and I tend to stop any activity that starts to hurt.  I can’t tell you how many times I’d stop running and just walk when I got a little winded or tired.  But it didn’t stop me from getting on the treadmill two days later and trying again.  Over 7 months, even these half-hearted efforts made me stronger, faster and more resilient.  You may not want to eat the perfect “in the box” meal each and every day, three times per day.  But just by cutting out the junk – the chips, the sweet tea, the soda, the ice-cream – you will lose weight over time.  The harder you push – the more you stay in the box and the more you exercise- the faster the weight will come off.  But even some effort is better than none at all. 

(3) Be accountable.  I did most of my training by myself which allowed for all of the walk breaks I described earlier.  One reason I kicked tail in the race is because there were a lot of people around me who were exciting and inspiring.  There’s a lot of fun to be had in shared pain (no, really!), a lot of inspiration that comes from seeing someone older/sicker/heavier do something better than you ever could.  But it’s also human nature not to slack off as much when other people are watching you as well as the natural competitive nature that comes from doing something with another person with similar goals.  So many diets fail because we do them alone.  One of the great things about the band is that it gives you a community.  If you go to support group, you can be inspired by others’ achievements, you can get excited by their solutions to problems (e.g. night-time snacking) or if you want, you can find a friend and set up a little competition.  Who can lose the most weight in 4 weeks or who can increase their exercise time the most… or whatever.  And remember, your office visits act as automatic accountability because every 4-6 weeks or so, somebody’s gonna be watching and sending you to the principal’s office if you’re off course.  If that’s not inspiration to straighten up and fly right, I don’t know what is!

(4) Turn to experts-then actually do what they tell you to do.  With my training I did the same thing many bandsters do: I said, “I know, I know”.  I knew I was supposed to gradually increase the distance on my long run every week, I knew I should do some interval speed work on the track to get faster.  But knowing and having a willingness to do something are very, very different.  Speed work hurt, long distances can get boring.  What I wanted to do was sit on the couch and read cheesy novels on my iPhone Kindle app.  But now that I’ve caught the bug, I’m willing to look back at what a really rigorous training program looks like and I’m willing to surrender.  Yes, once per week I’ll go to the track instead of another slow run on the treadmill and I’ll do my long runs when and how they tell me to.  D’you want to lose weight? Stay in the box, eat three meals plus one protein heavy snack per day, take your multivitamin every day and exercise.  Don’t drink with your meals and don’t eat or drink crap.  Do you want to do all that? No.  We repeat it over and over and patients say, “I know, I know” over and over, but until you actually DO it….nothing happens.  I wanna crash and read books, my patients want to drink sweet tea.  We both have to make a choice, which leads me to my last point…..

(5) Success is sweeter than you can even imagine!!  When you really, really, really just don’t want to give up that third slice of pepperoni pizza, stop for just one second and think about your ultimate goal.  I can now tell you from experience that reaching that goal is an absolute slice of pure joy and wonderfulness.  And I’ve got a tangible feeling to carry with me while I train for my next race, even during those dark early morning hours when it’s cold and my nose is running and my ankles hurt.  If you get into a size 6 or 8, then even if you gain a little back, you can hold onto that feeling of goodness that comes with achievement and use it to power your drive to get back there. 

Once you achieve a goal, nobody can ever take that away from you.  If you got to a level of health or fitness or thin-ness that made your toes curl with excitement, then that is who you are.  You are NOT the overweight person you were when you first walked in this office, even if you gain a little back.  You will always and ever after be that person that achieved their goals, you are strong, you are capable but you might have just gotten off course – temporarily.  Let that person be in charge to get you back to where you need to be, not the defeatest person who failed every other diet they ever tried.  I will always be a runner now – because I ran a distance that makes most people shudder.  I wasn’t the fastest, the most graceful, the most challenged – but I was a finisher.  You may never grace the cover of a fashion magazine, but once you lose your weight, you will always be a finisher, too.  If I could, I’d even share my medal with you. Maybe.

Together with the multiple emails and phone calls I have made, and the pressure from emails and phone calls from concerned patients, Blue Cross Blue Shield has extended the deadline for Wadley’s designation as a Bariatric Center of Distinction for 2 more weeks until March 12. They have indicated via email that they will review the situation, but have not allowed us to participate in the debate or review process.

We remain concerned that despite this 2-week reprieve, they might remove the Center of Distinction designation on March 12, and thereby deny access to care for many of our patients.

I urge you to email and call the representatives below. They are the ones that I have found are most involved in the decision process.

Dr. Carole Flamm
Executive Medical Director Office of Clinical Affairs Blue Cross and Blue Shield Association
312-297-5905
Carole.FLAMM@bcbsa.com

Dr. Allan Chernov
Blue Cross Blue Shield of Texas Medical Director
allan.chernov@bcbstx.com
972-766-1149

Are you nervous about talking to an insurance company employee? You shouldn’t be, but if you are, send them an email. Or call them after hours to leave a message on their voice mail. If those insurance company employees come to the office in the morning and get dozens of emails or voice mails from people upset with their arbitrary decision to deny access to care, it will get their attention. The fact that they gave us a 2-week extension means that we have their attention.

There is a LapBand patient and advocate on Facebook named Cher Lewis who lives in Dallas who is sympathetic to our cause. She invited me to be a guest on her Internet Radio talk show to discuss this issue because she sees this as a dangerous trend towards the denial of access to care by an insurance company. I’m glad to see that someone outside of Texarkana has taken a stand on this issue, and I urge you to do the same.

This is not only a health issue, it is a consumer protection issue. Each year insurance companies raise their premiums at a painful rate. I know this personally, because in our office we doctors pay for Blue Cross of Texas policies for our families and our employees. Each year we pay higher and higher premiums. Yet as doctors we generally get the same or less each year for the same procedures or office visits. So where does this money go? It goes right into the pockets of insurance companies.

Don’t let them get away with this. Be creative. Use Facebook, MySpace, and Twitter and enlist others in your cause. Get people in your church and workplace to call.

Even if this doesn’t affect you directly now, it might in the future. If today an insurance company doesn’t allow you to get bariatric surgery, what will stop them from denying other care for any other medical problem in the future? Let’s make a stand together, because together we can show the insurance companies they work for us, not the other way around.

Regards,
Dr. Ron Hekier

PS Later today I will send out a lengthy email explaining the history of the Center of Excellence centers and what it means for the future of healthcare in this country.

We have established and been designated a Blue Cross Blue Shield Bariatric Center of Distinction for several years and were stunned to hear this news.

What was their reason?  They said they only mean to certify centers that provide gastric bypass in addition to Lap Bands.  They said that it was a mistake to certify us in the first place, and somehow they “overlooked” the fact that we did not perform gastric bypass for all these years.

This is difficult to believe.  When we applied for the the Center of Distinction we provided Blue Cross Blue Shield with all of our operative data which clearly shows that we perform Lap Bands only.  This is a decision we have chosen voluntarily since the safety profile is so much higher with a Lap Band than with the gastric bypass which requires cutting and stapling the stomach and instestines.  So they knew that up front.  Additionally, every 3 months for the past few years, we have provided our data to Blue Cross Blue Shield, which clearly shows that we are not performing gastric bypass.

What this means is that those patients who have a policy with Blue Cross that requires a Center of Distinction, which for our patients includes Blue Cross Texas TRS (for teachers), Blue Cross Illinois, and Anthem Blue Cross, they will lose the ability to have Lap Band surgery in Texarkana and have care in Texarkana for bariatric related procedures as of next Friday if the situation holds.

The nearest Bariatric Centers for Distinction are in the Dallas area and Tyler area.  There are none in the whole State of Arkansas and the closest in Louisiana is way down in southern Louisiana.

I personally spent 3 days trying to reach someone who would listen to me.  I was out of town when the message first arrived a week ago Friday, and when I got back to the office on Tuesday I immediately took action.  I first called the Blue Cross Texas rep in Dallas, Celeste Stewart, but she said she had no say in the matter and gave me contact info for a rep in Chicago with Blue Cross Blue Shield, named Wendy Marinkovich.  Ms. Marinkovich said I would need to talk to the Executive Medical Director, Dr. Carol Flamm, but refused to give me her phone number or email! On Tuesday, Ms. Marinkovich took my number and said Dr. Flamm would call me back.

In the meantime someone not connected with Blue Cross gave me the number for Dr. Allan Chernov, the Medical Director for Texas.  I called him and got his administrative assistant.  They took down my name and number but I never heard from him.

Wednesday, Thursday, and Friday, I made many phone calls and sent emails trying to reach someone.  I still couldn’t even get the contact info for the Executive Medical Director in Chicago, Dr. Carole Flamm, because they refused to get me her contact info.  Luckily, on Friday I was able to find her phone number and email on the Internet.  After leaving her a voice mail, and sending more emails to Ms. Stewart, Ms. Marinokivch, and Dr. Flamm asking that they please call me, I finally heard from Carole Flamm, MD at about 5:30 PM Friday.

We had a lengthy conversation, but she essentially said there was nothing she would do, and the decision to remove our designation as a Center of Distinction would not be reversed.

My personal opinion is that this is all a matter of Blue Cross Blue Shield trying to make more money, and keep their policy holders from getting the medical benefits they are entitled to.

Here is a story I told Dr. Flamm which shows Blue Cross Blue Shield behavior of placing money over a patient’s health:

Back in 2007, my surgical partner, Dr. Keilin and I attended a conference entitled “Building & Managing Bariatric Surgery Centers of Excellence.”  One of the speakers was Dr. Michael-Anne Browne, at the time the Regional Medical Director for
Network Medical Management for Blue Shield of California.  On January 23, 2007, she spoke at the conference and she was asked about the difficulty in obtaining third party payor coverage for bariatric surgery.  Her verbal response follows: “The problem with Bariatric Surgery is not that it doesn’t work.  We know it works.  The problem is that it has expensive up-front costs.  The average return on investment is 4 years.  The average Blue Shield of California client switches providers in 2 to 3 years [to another third party payor.] Therefore for every patient we approve for bariatric surgery we create a better financial risk for our competitors.”

The point of the Regional Medical Director for Network Medical Management for Blue Shield of California was clear.  Blue Shield of California will deny access to bariatric surgery to our clients for financial reasons, despite being aware of scientific medical evidence
indicating that those patients’ health will improve with access to those services.

For those of you with Anthem Blue Cross, you might have heard in the news how the White House, the Dept. of Health and Human Services, and the House of Representatives Committee of Energy and Commerce are all investigating how it is that Anthem Blue Cross in California can justify their proposed rate hikes of 39% for policyholders, when their parent company had$2.7 billion in revenue in the last quarter of 2009 alone.
For some background see:Anthem Blue Cross Internal Documents

Here in our office, we provide our employees with Texas Blue Cross Blue Shield insurance.  Each year we have seen our premiums skyrocket, and an annual rise in 20% is not uncommon.  Yet the pay from Blue Cross Blue Shield, to us doctors as health care providers, has stayed the same or dropped most years.  For those of you that have been with us for a few years, look at your EOBs.  You will see we are generally making less each year for the same office visit.  Or if you just had a Lap Band compare it with an EOB from someone who had one from a few years ago.  We are making less each year.  So where is this money from extra-premiums going?  Not to pay health care providers, but rather to the profits of the insurance industry that is supposed to be giving you the medical care you pay for.

Think about it.  For those policy holders that are paying for a service, i.e. access to medically necessary procedures including weight-loss surgery when medically necessary, they are not being given access to those services.  Sounds like thievery to me.

Who does this affect?  Directly it affects those policy holders mentioned above.  But in reality it affects all of us.  Because pretty soon, all flavors of Blue Cross Blue Shield may require surgery performed at a Center of Distinction.  Also, what is to stop any other insurance company from sending an email at a late afternoon on Friday to a doctor or facility saying they can no longer provide a service to a patient?  It is Lap Bands now, but it might breast cancer surgery, elective C-sections, spinal injections for back pain, or anything else in the future.

We applaud consumer watch dog groups watching this issue: ConsumerWatchDog.org

We must make a forceful stand now, which is why I am sending you this extraordinary message.

The typical insurance rep probably rarely hears from a doctor or patient.  Please take just a moment to leave a brief message or an email to the following people:

Celeste Stewart
Blue Cross Blue Shield of Texas Specialty Programs Manager
972-766-6829
celeste_stewart@bcbstx.com

Dr. Carole Flamm  
Executive Medical Director Office of Clinical Affairs Blue Cross and Blue Shield Association
312-297-5905
Carole.FLAMM@bcbsa.com

Dr. Allan Chernov
Blue Cross Blue Shield of Texas Medical Director
allan.chernov@bcbstx.com
972-766-1149

Wendy Marinnkovich
Manager, Network Credentialing. BlueCross BlueShield Association
wendy.marinkovich@bcbsa.com
312-297-6357

Additionally, I have another option I recommend.  My brother is currently serving on the staff for the House of Representatives Subcommittee on Commerce, Trade, and Consumer Protection.  It is the full committee, chaired by Rep. Waxman that is holding hearings on Anthem Blue Cross of California’s exorbitant proposed rate increases.  My brother pointed to me that Rep. Ralph Hall serves on one the subcommittees of that office.  He serves on the Subcommittee on Health.  Rep. Hall is the representative for many of us here in East Texas.  A map of the district he serves is shown on this website:
District 4 – Rep. Hall
Please contact Rep. Hall on this urgent issue as well.   The number for his Washington D.C. office is 202-225-6673.

For those of you who think you have no dog in this fight, let me remind you that if abuses by insurance companies are left unchallenged they eventually will effect us all.  Here in Texarkana many gynecologists no longer perform obstetrics and won’t deliver babies because of insurance and malpractice issues.  One of our neurosurgeons does not perform intracranial surgery anymore so if you have a head injury from an accident, or a ruptured intracranial aneurysm or similar brain injury on a day or night he is on call, you will quite possible die in the local ER while the Texarkana hospitals try to get you transported to another city to the care of an neurosurgeon.  There are rumors of another prominent doctor in Texarkana that may drop Blue Cross altogether because of fights they are going through to get paid on surgical procedures they have performed over the past year.

If you do nothing now, you might find yourself in the Emergency Room in the future needing care for a heart attack, stroke, appendicitis, or a whole host of problems, with no one to care for you.

I urge you:  contact the Blue Cross Blue Shield reps I have noted above.  Contact Rep. Ralph Hall.  Get the word out on Facebook, MySpace, Twitter, and any way you can.

I will not give up.  I hope you don’t as well.
Dr. Ron Hekier

But before you take these comments to heart, I want you to consider a few things first.

Remember that people who know you are used to seeing your face a certain way.  They’ve spent years gazing on full cheeks and a round profile.  As you lose weight, you’re not going to look like that anymore.  If they met you for the first time after you had lost weight, they would think you looked perfectly normal and fine.  But since their mental picture of you is with a different amount of fullness to your face, they’re just as inclined to think that it makes you look sick as that it makes you look good.  Not because you do look sick, but because you no longer fit their preconceived portrait of what you should look like (to them).

That’s the most benign explanation.  But of course, there are more insidious reasons that people may want you to feel badly about the weight you’ve lost.  Some may be jealous of the weight you’ve lost (wishing it were them), some may be jealous of the person you’ve become and of the people who now admire your figure.  Friends, spouses, siblings all may get jealous that you’re the cute new thing on the block while they’re still just themselves.  Some people will react to those feelings by putting you down to pump themselves up and make themselves feel better.

It’s this last group I most want you to look out for and avoid reacting to them whenever possible.  Their goals are not in your best interest, and if you let them sabotage your confidence, you’ll never know what you might have achieved.  You look in the mirror – if you like what you see, then don’t worry about the people who try to bring you down.    Trust me, we’ll tell you here in the doctors’ office if we think you’ve lost too much weight (and of course threaten to sit on you and unfill the band a bit, if needed).  Let your own inner voice be your guide, not the misguided or malicious (even if unintended) voices of others.

Weight Loss Surgery Channel and he was gracious enough to have Dr. Keilin and I share our knowledge with his audience.  (Craig is a successful gastric bypass patient from many years ago.)  After our filming session we got to talking and Craig shared his thoughts as a weight loss surgery veteran.  He says in his support groups he asks people who have fallen off the wagon “What was your f— it moment?  At what point did you say, awww f— it, I’m going to have a pint of ice cream.  F— it, I’m going to have that Chocolate Blizzard.”

Ask yourself.  What pushed you over the edge?  Now if you are about to have a F— it moment, stop yourself.

I came very close to having one myself just now.  Some background….  I am training on my indoor rowing machine.  (For some background thoughts on this check out my post from November 2008 : http://blog.noscales.com/best-exercise-for-weight-loss-and-fitness-indoor-rowing-with-xeno-muller.html )

Well, I am planning on competing in an indoor rowing competition in Boston next month, (it’s my mid-life crisis, I just turned 40 ), so I am taking this very seriously and really watching my diet.  I don’t think I’ve had any processed food or white flour in about 3 weeks.  No snacks, nothing.

I am following a strict training plan developed for me by an Olympic champion rower (Xeno Muller from the above post) and I just think I can’t handle the program from an aerobic standpoint.  There are 3 weeks left before my competition and I am freaking out.  In a rare display of frustration, I quit my planned 40 minute row after 25 minutes.   Upset, I came into the house, looked at the fridge and considered getting some junky food.  (Luckily we don’t have too much junk food, just some stuff we allow our daughters to have.)  I came close to saying “F— it.  My exercise sucks.  I am in crappy shape.  I will never reach my goals.  I should just eat an ice cream sandwich.  F— it.”

Well I stopped myself.  Internally I told myself “You are trying to progress.  You are trying to take a step forward.  You are frustrated that you are moving forawrd as quickly as you would like, but having that ice-cream sandwhich won’t help.  It will set you backwards, and make going forwards even harder.”

So I had 3 spoonfuls of low fat cottage cheese.  After I finish this post, I will have an egg-white omelet.  Then I will go to sleep and try for a better day tomorrow.  If you find yourself saying “F— it”, stop yourself.

Oats get a lot of great press for lowering cholesterol and having lots of fiber.  But these benefits really only come from oats that are not super-processed, i.e., not instant oats in a packet.  “Real” oats are called steel cut or Irish oats and can be found in any health food store, and maybe even some groceries.  But they take 20-30 minutes to cook, otherwise it feels like you’re grinding down your teeth with little pebbles.

So here’s the trick: the night before, combine your oats and water and bring to a boil (you can do this while you’re cooking dinner).  As soon as the water boils, cover the pot and take it off the heat.  Now leave it on the stovetop overnight.  In the morning, put the pot back over heat and bring it to a boil.  As soon as it boils (about two minutes), take it off the heat, add some protein powder, Splenda or stevia or whatever other flavorings float your boat and voila! Nearly instant oatmeal with all the benefits of whole oats.

Which reminds me: another trick I’ve learned is that protein powder tends to gum up into little balls if you add it immediately to something super hot (like coffee).  Wait until the oats are a little cooled off, then add the protein about a 1/3 of a scoop at a time instead of all at once, stirring after each addition.  That way, the protein melts into the food instead of glomming up into unattractive, unappetizing blobs.

But then a few weeks pass and dust starts to collect on the parts of the machine that are exposed.  The rest of the machine is of course, covered with clothes.  Suddenly instead of a glorious emblem of fitness, the machine is a convoluted hat-rack.  A very expensive, sometimes guilt inducing hat-rack, at that.

I may just be projecting because this has certainly happened to me with several different pieces of equipment, but I don’t think I’m alone in this.  I’ve talked to lots of people who have bought fitness “stuff” that just ends up sitting around ’til it gets sold in a garage sale at $0.10 on the dollar.

So what to do?  Here are my New Year’s thoughts on actually exercising and using what you’ve got.

1) You’ve got to like exercise before you actually do it.  If you dread it – whatever “it” is – you ain’t gonna do it.  Don’t buy a treadmill because you think using it will make you look like the skinny-Minnie marathoners in the magazines.  Buy a treadmill because you’ve got a stack of movies you’re dying to see and getting on the treadmill will allow you 30+ minutes every day to watch them.  Or better yet, because walking/jogging/running gives you a hit of endorphins that makes your whole day great!  We just got this slippy-slide thing that lets you mimic speed skating in your living room.  It’s a blast, so we use it.  But a stationary bike? Not my speed, so never had one.  Makes my behind sore.  But I’ve got patients that swear by them.

2) You’ve made your choice, now work it! You found something you like – so do it.  You can’t just go through the motions, tho’, you’ve got to actually sweat.  Are you an outdoors person and enjoy walking? Groovy – but 30-40 minute miles while chatting with a friend is called “strolling” not exercising.  If you’re a walker, pump those arms, move those legs, get some huffing and puffing going.  Here is a link to a program that will take you from barely able to walk out the front door to running (ok, slogging, but still!) a 5K. You can do it! http://www.c25k.com/

3) Speaking of intensity, here is one of the great fat burning programs of all times and it will accomodate anyone from the least to most fit, from the idle rich to hardworking folks with no extra time.  It’s called HIIT and it goes like this: warm up for 5 minutes, then for 15-30 sec exercise all out doing whatever you’ve chosen to do (run, swim, walk, jumping jacks, skipping, squats-whatever!), then go back to a restful, relaxed pace for 2-4 times that length of time, then repeat a few times.  For example, you run all out for 15 seconds, walk slowly for 45 seconds to catch your breath and let your  heart rate come down, then you repeat this cycle 10 more times, then cool down for 5 minutes.  Total time: 21 minutes.  For some people, the “all out” phase may be walking briskly, and the rest interval may need to be 5-6 times the length of the high intensity interval in order to do it again.  But you’ll find by doing this several times per week, that you’ll soon expand your exercise tolerance dramatically. Knees hurt too much to do this? Try doing it by tossing a basketball in the air or throwing it hard onto pavement instead.  There are all kinds of upper body-only exercises that will allow you to raise your heart rate in the high intensity phase.

Now get moving!

But let me tell you, starting all at once (with every change that you might need to make) can be a Herculean task (can you tell I signed up for a word-a-day email? herculean means something that would take the strength of Hercules to overcome).  Not even Lance Armstrong could step out his front door one day and run a marathon.  He would have to start with short runs and gradually build up to longer more extensive training as he got stronger.

What does this have to do with you? It’s extremely hard to change all of your habits in one fell swoop.  What would I like to see in an ideal world? I’d like to see all my patients exercise 5 hours per week, I’d like to see 80+% of your meals be within the box and I’d like to see everyone lose 1-2 pounds a week until they reached their goal. 

But Hekier and I just started a new nutrition program ourselves and making all of the changes above would be well nigh impossible given how hard it is for us just to make some minor adjustments in an already healthy lifestyle.  We’re trying to really focus on cutting out “carbs” (e.g. bread, rice, pasta) and focus on fruits and vegetables instead.  Just one little difference, and boy-howdy….. it’s tough!!  And when you don’t succeed it’s really tempting to just give up.  “Well, I already cheated with some toast, might as well just have rice with dinner.”

So my tips for getting started and staying on track-based on recent personal experience-are:

prepare, prepare, prepare: plan out your menu for the week, shop for everything you need, make as much as you can in one day so you don’t spend every day in the kitchen for hours.  Always bring your lunch/snack/dinner with you to work, never leave it to chance to figure out what you’re going to eat

Do a mental clean-up: get rid of any thoughts of who you “used” to be, of what you used to be able to wear or how long you used to be able to exercise.  Figure out where you are NOW, and then celebrate every success, no matter how small.  Doesn’t matter what was, only what is and what will be.

Get your posse behind you: want to start walking on the track? Great! Bring your children and let them run around on the grass in the middle of the track while you walk.  Or even better, let them roller-skate/bike/skateboard on the streets while you run/walk along with them.  Make your spouse vow to eat healthier with you.  Get some friends to join you in signing up for a 5K walk and train together.  The more people you have supporting you, the better you are likely to do.

“Just Do It”: there are lots of times I just don’t want to exercise but I promise myself I can quit after 5 minutes if I’m still not in the mood.  Know what? In the last 10 years, I’ve only quit once.  Once you’ve started, you’ll keep going 99.9% of the time.  If you can just start, you’ll finish.  But if you never start…… you’ll never finish.

So my mistake of the week is this: IF YOU ARE TOO TIGHT, THE BAND WILL NOT RELAX ON ITS OWN

There are some people who actually don’t feel the full effects of a fill for up to two weeks afterwards, but the opposite -m a feeling of being too full (e.g. the feeling that the food is not going down, everything but liquids comes back up as a productive burp, lots of night-time reflux or vomiting)- is NOT going to get better.  As soon as you feel that way, call the office and get an unfill.  If you wait until the weekend, it may be Monday morning before we’re able to see you.  Don’t assume that we’ll be available to meet you in the ER for an unfill or that somebody there will be able to treat you.  If you feel too full, your best bet of being unfilled the quickest is to call or come in during business hours Monday-Friday.

We hope your New Year starts and ends with all the very best things you can imagine!!

with love,

Dr.s Hekier and Keilin, Betty, the two Debs and all the rest of the NoScales crew