Back to the Future

When I started this blog last year, I did so in hopes of writing my way into better health, along with changes in diet and exercise. Ironically ,last year was probably the worst year of my life, healthwise.

I developed a sinus infection on my right side in April that just wouldn’t clear up but didn’t make me as sick as I had been with past infections. The worst thing about it was the awful odor I sensed each time I sneezed or blew my nose. “Blowing” my nose was not really a term that applied during this year at all; I could only blow through one nostril until Christmas. The odor was unlike anything I had experienced in a long history of sinus problems.

I am allergic to penicillin and sulfa but was on and off multiple other antibiotics until July, when I developed pneumonia. At first I ran a low fever for two days so I waited to see if I was coming down with a virus. On the third day, I woke up too sick to know what I was doing or needed to do. It took me five more days to arrange to see my doctor and, during that time, I experienced blood sugars as low as the 30s. My primary care physician diagnosed pneumonia and I spent the next three weeks getting well enough to resume a modified normal schedule.

Just before the pneumonia presented itself, I called for an appointment with my ENT, in the belief that I might need sinus surgery to clear this thing up once and for all. He did not have an appointment open until late in September so I had over two months to wait.

In March, I started attending a medically supervised weight loss program as part of my new commitment to improved health. By the end of September, despite my sinus problems, I had lost approximately 50 pounds. I learned more about diabetes there then I had in the three years since I had been diagnosed. My blood sugar dropped dramatically, I was able to reduce insulin to less than a half of what I had been taking, and I was exercising regularly. I looked and felt great and was looking forward to finally getting weight under control. The 100 pounds I had yet to lose did not seem at all overwhelming.

When I saw my ENT in late September, he took cultures from my right maxillary sinus. The results showed that I had two strains of pseudomonas aeruginosa (the same bacterial infection that killed 20 year- old Brazilian model and Miss World finalist Mariana Bridi in January 2009). My research on the Internet showed me that I had been luckier than I could have been. Pneumonia triggered by pseudomonas can be fatal to diabetics in just a few days. My delay in getting to the doctor in July had been very risky.

I was told that all the antibiotics I had taken since April were not appropriate to fight the pseudomonas infection and I began several rounds of Cipro and Avelox. A CT scan showed an unidentified mass in my right maxillary sinus and I scheduled surgery for the first possible opportunity – Christmas Eve day.

As many people told me – the physician and physical trainer at the weight loss clinic, my pharmacist, and a good friend who had years of prostate problems in the 90s – Cipro wreaks havoc on blood sugar, your gastrointestinal system, and prevents exercise, due to its links to ruptured tendons. My weight and blood sugar began to climb steadily. All my exercise efforts ground to a halt. I craved sugar and carbs. I had to add multiple OTC medications and probiotics to manage the stomach problems. I ate yogurt daily until I couldn’t stand it anymore.

Surgery was extremely easy. I had had endoscopy before and knew that I would have no problems with it. However, as a cancer survivor, I was apprehensive about what type of mass had developed. In the recovery room, my ENT reported that he had removed an “impressive” fungus and bacteria ball that had calcified and totally blocked by sinuses on the right side. He also told me that the pseudomonas infection had not abated at all. He had removed the diseased tissue and hoped that a month more of Avelox and an antibiotic nasal spray would finish off it off.

It didn’t. I took two more weeks of Cipro and started using an antibiotic nasal wash. My weight continued to climb. However, the odor from my sinuses was finally gone, leaving me to wonder if it had been caused by the blockage rather than the infection.

Now, in mid-February almost a year later, I finally know that the pseudomonas is gone. I have been able to breathe out of both sides for over a month and dropped all the OTC meds two weeks after finishing all the oral antibiotics. I do tire quickly and need a nap many days. I am slow to begin to exercise again; it took so long to develop a pattern of exercise last year and now I am faced with starting over. In fact, “doing it all over again” seems to be my agenda for 2009 in breaking my body’s craving for sugar, lowering blood sugar, gradually shaving off weight, and even remembering to ride the exercise bicycle or walk ten minutes back and forth on the driveway.

Despite the events of the last year, I have had some real breakthroughs in understanding and planning for my better health. A year ago, I thought that living as a healthy person would solve all my problems. Now I understand the difference in living as a healthy diabetic and a healthy person. Diabetes will not disappear because I live the life I should have in my earlier years. It will trigger negative episodes in managing my health in the future and I will have to start over again when it does.

Although it is still February, many of our trees and shrubs are beginning to bloom. By mid-March, spring will have arrived fully and I will feel that surge of energy and mental strength that comes with spending hours a day in the garden. A ten pound weight loss in the next few weeks will make it much easier for me to start seeds, move perennials, prepare planting boxes, and mow the grass. It will also get me down one size into the pants I was wearing in the pre-Cipro days late last summer. They are four sizes smaller than the ones I was wearing a year ago. How hard can ten pounds be?

Even Lance Started on a Tricycle

As part of building a healthier lifestyle, I’V started riding our stationary bike. It’s far easier on my knees than walking each day and, for some strange reason, I love to watch the number of calories and carbs I’m burning go up while I monitor my pace, miles per hour, and the total number of minutes I ride.

I’ve had to ride on resistance level 1. To tell the truth, I don’t even know how many levels of resistance there are on the bike – I don’t expect to see too many of them. I just pedal away at 10 to 11 mph on level 1, going nowhere and getting ahead at the same time.

Yesterday was a breakthrough, though. I decided to try the second level of resistance in three separate one minute intervals, five minutes apart. I watched every second of every one of those minutes and was so glad to see them finally end. But, I managed to do it. The third interval might as well have been a mountain stage in the Tour de France. I huffed and puffed, sweat pouring off me, and just sat on the bike resting for a full two minutes when my total time was up.

Last night I started planning on how and when I might actually tackle level 2 for TWO full minutes at a time – maybe next week. I’m getting ready to go out to the porch for my ride right now and am curious to see how those three intervals will feel today. It’s 10:00 AM and already 88 degrees with 45% humidity – more like the Tour de Death Valley. No matter, every rotation of the pedals brings me closer to that elusive thing called health.

One thing for sure, if I ever reach five minutes on resistance level 3, I’m buying myself a yellow jersey.

Making Choices

Originally, when I wrote my new principles about how I would like to live the rest of my life, I said, "I will make choices that leave me with the resources to contribute to the lives of others." I'm finding it necessary to edit that one substantially already.

It turns out that I can't make choices to contribute to the lives of others unless I first make responsible choices about my own life. I've seen that very clearly in the last few weeks, in my decisions to live healthier both physically and financially.

First of all, I've lost over 40 pounds since the early weeks of April by following a bariatric diet and exercising. But, a bout of pneumonia in mid-July caught me by surprise and triggered the loss of electrolytes in my system. And then, somehow, my blood sugar went crashing through the floor. Since I was diagnosed with Type 2 diabetes less than three years ago, I've never experienced the lows and they are terrifying and dangerous. It helps that our dog Harry comes to my side or wakes me up whenever my blood sugar drops too quickly or too low. I have no idea how he knows, but I'm grateful that he is teaching me to be aware.

I've spent every day since trying to learn the rhythms of my own body and its needs and am beginning to get the hang of it. However, I've decided to let everything I was committed to go in order to finally commit to my well being. I've said each year since I retired that I was taking a year to improve my health and every year other things distract me. No more - I never want to stagger and lurch down the hallway again with a blood sugar count of 40. I never want to babble about things and people that aren't there again because my body is stripped of necessary nutrients. I may not have another year, if I don't get it right now.

My mother will be moving here in a year and I want to enjoy her as much as I can. I want to walk the dogs with my husband in the evenings and kayak with him in the early mornings. I'm looking forward to healthy dinners with friends and sharing the vegetables from our garden with them. I want to visit with my sister and brother-in-law both here and at their home. And I want to continue to see my children thrive through whatever life brings them.

One day I'll return to my volunteer work as an activist for educational opportunities for our community's children. I love it and believe it is the work I was born to do. There will be new challenges ahead for me, both as a teacher and a learner. But, I see this moment in my life as an opportunity, not a challenge, and I intend to make the best use of it that I possibly can.

Refresher Course

I recently decided that our two-year-old Labradoodles needed a refresher course in who is in charge. It's going really well; my husband and I have remembered that we are supposed to be in charge and it's only been four weeks.

It's funny how one tune-up can lead me to recognize the need for another. I thought last week that I needed a refresher on how to get the most and the best out of my day and decided to write myself some guidelines. It was actually fairly easy to get a manageable number of things I was honestly committed to. Now, I look at them every morning with my first cup of coffee, just to get my eyes and mind open.

Here's the first one:
I will make better choices for my physical, emotional, spiritual, and financial health.

I think I need to begin simply by focusing on these things as health issues. They affect how I feel and manage. Depending on what I chose to do, I either end up empowered or depleted of energy.

One thing I've realized about myself is that I really don't have a lot of fear in my life. I've always looked at real fear as a source of energy, there to make me pay more attention to the situation around me. Consequently, I've been able to be a risk taker in a very healthy, productive way. The negative consequences I have experienced are ones I identified and was willing to accept at the outset.

But, anxiety seems to be a different issue for me lately, causing me just to ignore the issue that promts it. Sitting here as I wrtie, I can feel the physical reaction it causes: slight headache, distraction, acid in my throat and stomach. Gavin De Becker's book The Gift of Fear helped me realize the difference between worry and real fear when it first came out. It looks like I have some rereading to do.

My goal for today: Face one source of my anxiety and make at least three steps, no matter how small, to deal with the underlying issue.

A Year for Me

When I first retired, I stumbled across The Gift of a Year: How to Give Yourself the Most Meaningful Pleasurable Satisfying Year of Your Life by Mira Kirshenbaum. When I finished reading it, I set my goal for the next year to get the house organized after thirty years of working, raising children, and everything else that comes with a woman’s adult life. At first, it seemed impossible to consider clearing every closet, drawer, and shelf. But, after I slept for the better part of six months, I did begin to get thing under control. It took almost two years to complete, but, by the end of that time, the house was cleared of much of its clutter, repairs had been made, walls and floors were renewed, and our family could fully enjoy every space in the house. We were even confident enough to consider adding an addition to the house with the help of a contractor friend.

What we didn’t see coming was a new, old house. We stumbled across an empty foreclosure with two wooded acres in an area where we never even considered living. It needed to be stripped to the studs to begin the work to bring the house back to a state where it could be lived in. On our first visit, we laughed all the way through, saying, “Not us, not us!” But, somehow, we managed to find ourselves back inside with our good contractor friend whose specialty just happened to be bringing disastrous messes of houses back to life. After that visit, we saw it only as the retirement house of our dreams, designed and built to make the rest of our lives better.

Now, a year and a half after moving in, I realize how much our lives have improved and how this has become a new family home for our children, for my sister and her children, even for my mother who will move into a retirement center nearby next year. In this short time, we’ve had more family members visit than we have ever had in thirty-five years of marriage. We’ve used our dining room table more often than we have in the last twenty years. We’ve had more diverse and more interesting collections of people drink a glass of wine on the screened porch, enjoy a fire in the living room, and always laugh around the kitchen counter than we’ve ever had in our lives. And, despite my arthritis and bad knees, I’ve discovered ways to make it enjoyable for me to entertain large parties, small groups of friends, or family as often as we like.

However, along the way, I’ve picked up more clutter by way of morbid obesity and related health problems. And so, I find myself needing a new year to rid my life of those things that keep it from being the most meaningful, pleasurable, and satisfying life that I realize it could be. Just like setting the goal of updating our last house or planning a complete rebuild of our new home, I’m surprised to find that I have already prepared for the job ahead of me. I’ve paid strict attention to all the concerns of my doctors over the last three years. I’ve followed through on every test and screening that they have ordered and researched the underlying issues. Despite diagnosis as a type 2 diabetic three years ago, I’ve discovered through the process that most of my health problems can be significantly improved or eliminated through changes in diet and exercise and awareness and attitude. And for the first time in over twenty years, I don’t feel doomed to failure with regard to managing my weight for myself. I feel energized and ready.

As I write, I look out at the first vegetable garden I’ve ever had and realize that it's a tangible sign of my choice to live better and to contribute to a healthier life for our family and friends. It has taken months of preparation, from finding and ordering growing boxes that allow me to work smarter to learning to reuse kitchen and yard waste as compost, but the green tomatoes that I see on the vine promise that it will be worth it.

The next year holds other promises for me, as well.

Carrying Coal

Several years ago my sister surprised me with tapes by Michelle Shocked that rapidly became favorites thanks to their bluegrass melodies and the story-like quality of her songs. But, her lyrics about coal cars on the L & N railroad haunt me in a way I struggled to understand for a long time:

“I was born and raised at the mouth of the Hazard holler,
Where the coal cars rolled and rumbled past my door.
But now they stand in a rusty row, all empty,
Because the L & N don’t stop here anymore.”

My family comes from coal country. My father’s father spent his life as a brakeman for the Louisville & Nashville Railroad, carrying coal from the mines to the mills and factories of the South. Coal built the railroads and brought jobs, schools, churches, business, wealth, alcohol, crime, poverty, and illness to the small towns through which it passed.

As a child, I could point out the sites of strip mines from the car window. Seams of coal, glossy sides shining in the sun, lay exposed in hillsides and I was fascinated to find the odd lump of coal lying in the parking lot. I was forbidden to pick it up, dirty, nasty, priceless coal.

Mom was born in a coal mine camp in Tennessee where her father ran the mine commissary. He died of alcoholism when she was 8 and my grandmother moved her children into her family home in Kentucky and found work with the railroads arranging shipments of coal.

My great uncle was the assistant postmaster and was legendary in the area. Folks far back in the mountains and the mine camps knew he could be counted on to make deliveries from town when he brought their mail. Local doctors kept his garage stocked with sample medicines and my uncle distributed them to families who had no way into town and no means to buy the medications they needed. They would send whatever they could back with him as barter, determined to pay their own way for their illness if not for their health.

We visited the town where my mother was born only once with my great uncle. I have a picture of it in my imagination – two dusty dirt roads, company-owned homes set back in the trees, the company commissary that my grandfather ran, and, off to the left, a dark yawning hole – the entrance to the mine itself. But, I never seem to picture the freight cars or the railroad in a tiny mountain clearing that was too small to have paved streets.

I knew the railroads carried my father and his brothers away to war, delivered my great aunts to New York City for vacations, and brought my mother, sister, and me into the mountains from our home in Atlanta on summer breaks. And, although it began its journey in camps too small to command passenger trains to stop, coal was always the railroads’ most important paying customer.

The families of miners heated their homes with coal, as did my mother’s family and all the others who lived in the valley. My sister or I would come down with respiratory problems early in our visits to Kentucky and we would quickly resemble the runny-nosed children we saw on the streets of town. My great uncle would lead us to his garage, unlock the door and pull it open to display shelves and shelves of cold remedies, cough syrups, and allergy medications. Mom would locate the products we normally took, the door would be relocked, and we would go on with our visit, somewhat drowsier but less congested. We never really questioned why this lovely valley triggered our respiratory problems with such regularity.

Although we moved to Atlanta well before my mother was 30, her life has been plagued with allergies, asthma, and respiratory infections. Last year, she began to have chronic bouts of bronchitis at age 78. When I accompanied her to the pulmonologist for her initial visit, I was stunned to hear him read in medical records provided by her family doctor that she had COPD, Chronic Obstructive Pulmonary Disease. The specialist asked her only two questions about her personal history and the first was answered simply with a “No”:
1. Have you ever smoked?
2. Have you ever lived in a house that was heated by coal?

She did, of course. She was born by coal, fed by coal, warmed by coal, clothed by coal, and educated by coal. Somehow, its black dust has stayed with her, hidden in places where we could not see it or sense its effects. And, after all these years, it demands a price for its travels with her and the life it brought to the mountains and valleys of the southern Appalachians.

And now I know the words of the song are wrong – the coal cars have never been empty. They brought the very air that my mother would breathe from deep within the mines themselves. Now I sense the railroad is moving toward her, snaking its way toward a landscape we cannot anticipate, coal smoke blowing through its open cars, stopping to collect the riders who must pay its fare.

My mother will take passage. She was marked with coal for the journey long ago.

Routine Exam

In 1972, two days before my 21st birthday - the Thursday before Easter, I had a routine physical. I was home from college for spring break and had promised my mother that I would finally go to the doctor. I told him that I had a minor illness a month or so earlier and that the "townie" doctor who examined me in the college clinic was particularly attentive to my thyroid. After explaining that I had taken thyroid medication for a short while as a younger child, he proceeded to deal with the sinus infection that brought me to the college clinic in the first place.

However, our family doctor was more concerned. He checked my thyroid gland, immediately had me get up, dress, and go straight to the local hospital to take the medication that would allow me to have a thyroid scan the next day, on Good Friday. Our family doctor was a life long friend of my mother's and he called her while I was at the hospital to explain his concern and the urgency for the test.

Mom accompanied me to the hospital on Friday for the scan. My twenty-first birthday was on Saturday. My parents and our doctor insisted that I not return to school on Monday, as planned, but wait until Tuesday when the results would be available.

When the phone rang on Tuesday, I joined the conversation between my mother and doctor on another phone. My mother insisted that I get off, ordered me to get off, and wouldn’t hear anything else but that I get off the phone. Finally, I gulped and spoke straight to the doctor. "I'm twenty-one and I will not give you permission to discuss this with my mother unless I am on the phone." I've always admired the way he paused and then told my mother that he would explain the results to me while she listened, with my permission. He proceeded to tell me that the test showed that I had thyroid cancer, fortunately detected in the earliest stages. I had surgery about a month later and have had no further problems with cancer in thirty-four years.

I do still have to gulp and force myself to take responsibility to speak up occasionally but this moment reminds me of how important it might be.