Three days into the AT, around Lime Rock springs in a crushing 92F heat, I sat down on a rock while my companion went to filter water and wrote these words: “There are places that scrape against the sky, where cold, clear water trickles from the earth, and the spirits of forbearing history reveal their timeless secrets in rustling needles, slow grumbles of thunder, and speechless boulders. It’s hard, hard work to reach these places. But they are necessary, and worth every aching step, bruised tendon, and startling challenge to our egos and self-assumptions that come with getting to them.”
All told, I spent an incredible four days on the Appalachian Trail. The goal was to complete the 51 miles of the Connecticut portion, but ultimately we managed 32 – slowed, alas, by the soaring temperatures. Heat dents the reserves of even a seasoned hiker, and with the thermometer cruising well toward triple digits we lost much time to stopping to rest and filter water.
We spent our first night at Sages Ravine, then made our way up the formidable north side of Bear Mountain. From there, we made our way to Lion’s Head and another spectacular summit. Our second night was spent at Limestone Spring, an isolated AT campsite that involved descending a sheer rock wall to reach! From there, we returned to the AT and made our way up Prospect Mountain, then along the Housatonic River and through the fields and farms of Falls Village as the solar eclipse peaked, and at last reached the summit of Mount Sharon, where we made camp. Just as darkness fell, a massive thunder storm rolled in – we covered the tent quickly and mostly stayed dry, thanks to my partner’s ingenuity with her backpack’s rain fly. (The group of Yale students nearby weren’t as clever.) From Mount Sharon, we descended into the environs of West Cornwall and then ascended Mount Easter, then traveled along the ridge line, then up again to the lofty and breathtaking Pine Knob. At the edge of the Housatonic State Forest, we hooked up with a very kind Ranger who drove us back to Kent. (Thanks, Judy.)
I was sorely tired and yet even now I miss it dearly. I find myself longing for my feet on the trails again, a feeling that’s with me daily. Since then I’ve only had time to summit Mount Greylock in Massachusetts – the final peak of New England’s tallest in each state, save Katahdin which I will ascend next year.
Highlights – drinking from cold mountain springs, the strange and varied sounds of wildlife at night, the breeze along the back of the mountains, making do where cell phones don’t work, mystical and glorious stone stairways that summon Tolkien, and even – just a very little – outdoor privies. Also, there’s a real spirit among AT hikers, an easy friendliness and willingness to share food and stories, and – with through hikers – an almost solemn focus to their work. As for the remaining 20 miles, I intend to finish those up in October.
Six peaks and some 32 miles in three days. Hard, hard work – and the best work ever.
When was your Tdap vaccination? Tetanus? Most recent influenza shot?
Did you have a physical this year? What were the results?
What are the medications you’re currently taking, and what are the dosages?
If you did poorly, don’t beat yourself up – many Americans are unaware of how to keep track of their health. But think about it: do you keep your motor vehicle documents like registration and proof of insurance in a handy folder in your car, along with records of all the service work you’ve had done on it? Do you store your tax returns and important personal documents in a safe, convenient place at home? If you do, then why aren’t you doing the same about what is arguably the most important thing you possess – your body? Shouldn’t you be showing the same diligence, if not more, for your health and wellness?
Allow me to introduce the concept of the Personal Health Record. Simply put, the PHR is a detailed library that contains all of the most up-to-date information from your electronic medical record (EMR) – the database held by your doctors and insurance providers for the purpose of medical coding and billing – and your own notes on your health. In contrast to the EMR, your PHR is yours to control, modify, and manipulate as you see fit. It can be used through a platform of your choice: an online database, an app for your phone, or – as in my case – a hard copy in a three ring binder with color-coded tabs.
If you’re familiar with pedometers, FitBit, or apps for your phone like CouchTo5k and Fooducate, you already understand a little of how a PHR works. Most Americans, in fact, have used a fitness or weight loss program or app at some point in their lives. You’ve probably written down how much exercise you did, or tracked your caloric intake for a diet, at some point in your life. Your PHR, however, is more complete, integrating the information your health care team already has into a more comprehensive picture of your biological profile. A good PHR can include your fitness routine and calories consumed, but also keeps track of much more.
The benefit of maintaining a PHR is, of course, knowledge – and, thank you Sir Francis Bacon – ipsa scientia potestas est: knowledge is power. Here’s how one paper, in the Journal of American Medical Informatics, put it:
Personal health record systems are more than just static repositories for patient data; they combine data, knowledge, and software tools, which help patients to become active participants in their own care.
In other words, PHRs give you a variety of additional tools to manipulate data. For example, if you track you blood pressure daily, you can use you PHR to determine your average BP over the course of a week. You can form a data set for how many calories you’ve burned while exercising. Raw data is just the beginning; with the magic of mathematics, your basic data allows software programs to draw conclusions about your health, and advise changes when needed. (You can also manipulate the data yourself, if you’re so inclined.) The article continues:
One of the most important PHR benefits is greater patient access to a wide array of credible health information, data, and knowledge. Patients can leverage that access to improve their health and manage their diseases. Such information can be highly customized to make PHRs more useful. Patients with chronic illnesses will be able to track their diseases in conjunction with their providers, promoting earlier interventions when they encounter a deviation or problem. (The complete article is available here. The National Center for Biotechnology Information is a tremendous, free scientific resource by the way.)
This a critical conclusion: tracking your health improves your general well-being. If you’ve got up to date information, you can – as is described above – note quickly any deviations from the norm and get medical assistance faster. Keeping on top of your weight, having blood tests results on your white blood cell count, A1C, iron levels and much more, recording changes in your weight or sleep patterns, and so on allows you to make smarter decisions. Being conscious of your health on a daily basis gives you an advantage, too, when time is crucial. Often, it’s small symptoms that are overlooked or – worse – ignored that signal a serious health issue.
And they’re not joking about speed and ease of communication, either. I get my office visit summaries, diagnostic images, test results, and more through MyChartPlus, and last time I had blood work done I had all of the lab results before my doctor did. I can also make, cancel, and reschedule appointments online or with my phone. My doctor can send me letters or messages through it, too.
So what should you include in your PHR, and how should you manage it? Well, the format is a matter of personal taste; you may prefer a desktop software program – as simple as a Word or Excel sheet or a more complete program created specifically as a PHR like Microsoft’s HealthVault (n.b., Microsoft ended support for the Healthvault for the Windows phone literally today, as this article was published. The online and desktop service seems to still be available). Web-based applications like MyMinerva or Dossia Health Management System give you the piece of mind of knowing your data is backed up offline – though, conversely, it comes with the risk of security breaches that could put your private medical information into someone else’s hands. For smartphone users, the MyMedical and OnPatient PHR apps are both great, but shop around to find the one you prefer. And, as I mentioned before, you can also keep your records in a well-organized binder – a bit old fashioned, I suppose, but easy to access and reference when you need it. I print my information from my EMR or get copies at the doctor’s office, and file them away for use when needed.
As to what information to include, I am of the mind that more is better. I include a daily record of all my exercise, I take my vitals and record them each morning, and I even haveflow sheetsto monitor my diet. Full disclosure, however: I am of the “Type A” personality, to the degree that I color coordinate my pens to my scrubs, and my scrubs to my lunchbox.
Here’s a saner list of what you want to include, at a minimum, in your PHR:
Your prescriptions, the dosages of each, and the frequency of administration
Your physicals, including the list of current health concerns/chronic illnesses and doctor’s report on your overall health
Lab results – (blood work, biopsies) and imaging results – ultrasounds, X-rays, and the like.
Your insurance information.
Reports from any specialists you’ve seen, histories of any procedures (surgeries) performed
Emergency contact information
Your allergies to any medications and/or latex
A copy of your living will, advanced directive, or any legal documentation of this sort (including DNRs)
A journal with anything you’ve noticed or consider worth reporting (what are called Observations of Daily Living or ODLs). This can include simple reports such as, “I’ve had a dull pain in my side for the past three days,” or “I’ve been feeling nauseous a lot lately.”
A brief record of your emotional/cognitive health and what you do to maintain it. This isn’t often recommended, but I think it’s important. Doing things you enjoy – and that reduce anxiety – are vital to good health. Making a record encourages you to remember to take care of your emotional being, too – through meditation, creative arts, gardening, a hobby, or whatever it is that gives you joy.
Your fitness routine and at least a sketch of your diet.
It may seem daunting, but I ask you again to consider: aren’t you worth it? Don’t you deserve at least as much attention as your car? At least some experts think most of us just don’t care, and that’s why PHRs have yet to come into widespread use. Maybe they’re right. I prefer to think, however, that most people would embrace PHRs once they see how easy they are to use and the benefits they offer. Being “in charge” of your health is empowering. There’s a sense of pride in ownership when we are diligent monitors and protectors of this fleshy vehicle that carries us through life. Maintaining a PHR gives you a complete picture of your wellness, and with that knowledge you’re better prepared to make smarter choices for continued good health.
One final note – if you need some information to get your PHR started, remember that the Health Insurance Portability and Accountability Act gives you the right to inspect and receive copies of all of your medical records, electronic or otherwise, upon request. Ask them what software program they use to manage your EMR, and how you can get a login ID and password to access all of your health information. If your PCP doesn’t offer an online EMR, ask that they do so (it’s 2016, come on).
I love it when the universe aligns for a fortuitous coincidence, and how’s this for kismet: yesterday was the six-month anniversary of my sleeve gastrectomy, and when I stepped on the scale in the morning it read: “168.0” One hundred pounds lighter than I was about a year ago.
I’ve been carefully monitoring my progress throughout the procedure, all the way back to the first pre-op appointment in 2014. The total process from an initial seminar at Hartford Hospital to the surgery proper on January 19 took roughly one and a half years. That time was spent in close consultation with a dietitian, pulmonologist, and cardiologist in addition to my surgeon, the rock-star and pioneer in his field, Dr. Pavlos Papasavas. A psychiatric examination, sleep study, and support group attendance were also part of the preparation.
Considering the significance of a centenary drop in body weight (and, incidentally, a drop in BMI from 39.0 to 24.5), I think a recapitulation on the journey is needed. If you’re thinking about surgical weight loss, or you’ve had it, or you’re just curious, you’ll enjoy my look back at what I’ve lost and gained from having my stomach removed.
The replay on…the value of surgical weight loss.
The question I’m most often asked is, “Why have surgery?” Some folks want to know if I tried it “the old fashioned way” first (I did, many times) and others wonder why I took the risk of going under the knife for a serious elective procedure. In medicine, everything is about odds. Treatment for an illness, whether with drugs or surgery, is always a risk. The health care team calculates the dangers of treatment against the risk of not treating an illness at all. I approached my surgery with the same mathematical rationale: was the risk of complications and even death from surgery greater or smaller than the long-term damage of morbid obesity? I already had a very high BMI, hypertension, hyperlipidemia, sleep apnea, and a pre-diabetic fasting blood sugar (my A1C was 6.5). The research showed that each of these symptoms related to weight would be dramatically reduced or eliminated by surgery. Overall, life expectancy for someone who has a gastric bypass or sleeve is increased by 85% compared to obese persons who do not have surgery.
So it was, logically speaking, a no-brainer. Of course I was nervous ahead of surgery – who wouldn’t be? But after the procedure, the payoff became immediately evident. Within a few months, my hypertension, hyperlipidemia, and blood sugar levels were resolved. Sleep apnea was gone by May, and I felt incredible – more energetic, focused, and grateful than I had been in decades. At six months out, my doctors concur: I’m in outstanding health.
The next step: At my last consultation with the surgery team, in May, we set a weight goal of 170-175lbs. I’ve exceeded that, so technically my weight loss target has been met. I still continue to lose weight, however, at a considerable more modest rate of one to two pounds biweekly. I would be happy to settle in at around 155-160, providing a comfortable buffer for any weight gain after the so-called “honeymoon” phase is over. But with all of my health issues resolved, any surplus weight loss is really just icing on the low-carb, sugar-free cake.
The replay on…diet and exercise.
Of course, surgery is the catalyst for a weight-loss journey, not the panacea for obesity. I used the initial “boost” of losing 40 pounds in the first month to exercise constantly. Sticking rigidly to the nutrition guidelines prescribed by dietitian have also made this process a success. I have a “rule of five” to which I adhere fanatically; these five foods are strictly verboten, never to be eaten: rice, pasta, bread, refined sugars, and ANY kind of corn or potato-based fried or baked snacks (chips and their like).
For proteins, I stick to non-fat dairy (Greek yogurt), 1-2 ounces of nuts per day, fish, beans, and lean meats. About 70% of my daily diet is vegetables, greens like kale and spinach, and low-glycemic load fruits like cherries, raspberries, and strawberries. Never before in my life have I eaten so many salads, nor did I ever think I could relish a good salad as the old me did a fat pork chop or bowl of Chee-tos. River and I counted the number of salad dressings (no more than 5 grams of fat per two tablespoons) in our fridge the other day, and there were nine!
I am obligated to take in a minimum of 64 ounces of water per day, and since I can’t “chug” 32 ounces of that in a go, I need to sip constantly throughout the day. I still take my morning coffee – with skim milk and Stevia. Soda is a never, ever – I have not had a single drop since the start of this year, and never will again.
Eating out has been a bit of a challenge. Not only is it hard to ascertain what you’re eating when someone else prepares it, but I’m budget-minded and dislike paying too much for a meal I can’t possibly finish. I get creative and order side dishes, salads of course, or just plan to take my meal home to finish over a few days. On the bright side, I have a much greater appreciation for the quality of food. Like many of us, I used to go for quantity – line me up at the buffet so I can pack in as much crap as possible. Now, I can afford to eat small portions of excellent-quality foods.
The next step: Despite the protests of my dietitian, I’m considering going pescetarian (a vegetarian who still consumes fish). The goal for someone post-surgery is 70 grams a day, and I’ve calculated out how to take in that amount through beans, dairy, nuts, and fish. It isn’t very difficult at all. Relying more on these foods for protein would cut out some of the very unhealthy and hard to avoid saturated fats in meat. In terms of fluids, I grew tired of plain water about a month ago and have been adding those dreadful aspartame/sucralose based sweeteners to it. Not only are the sweeteners problematic for health, but the dyes are nasty as well. I’m challenging myself to return to plain water, or sweeten my drinks with fruit.
In terms of fitness, I have a lot of sagging skin around my lower abdominal region, and I need to strengthen and tone my core. Time to use my gym membership and left those weights.
The replay on…emotional and spiritual benefits.
You’ve already read about my renewed sense of gratitude and joy. To some extent, I’m sure, these are products of improved biology, but it’s also how different I perceive myself…and how others treat me. I must say, I have not been complemented on my physical appearance this much since, well, ever. It comes so constantly that I’ve become quite unsure of how to respond, anymore. It’s flattering and I am always humbled. My dating options have improved; apparently I’m now in a different “league.” Even strangers seem warmer and more appreciative of me. It’s bizarre, too, being one of the lightest people in certain places, or realizing in a room of people who’ve never met me before that I’m not “fat” to them. A guy at work even asked if I’d been on a wrestling team before…it blew my mind.
Next step: Interestingly, the surgery has completely eliminated my libido (and I didn’t have much of one to begin with). I don’t know if this is a result of the surgery itself or just a facet of my new perspective on life or understanding of myself. I now struggle with dating, even though I have more options in that arena. Do I really want a partner? Have I become a sapiosexual or even an asexual person, now? Has my sexual identity changed? I’m still trying mostly because I feel obligated to not “give up” on romantic life, and the superficial perks (a readily available babysitter, second income, someone to go out with for fun) are compelling. But most of the time, I’m rather frustrated and even feel some antipathy for becoming romantically attached to someone. Maybe I just haven’t given it enough time.
I also want to keep up with mindfulness practices like yoga and meditation. As work in nursing is very stressing and frantic, I need to cultivate more pose and calm in my life.
So there you have it! I’d really love to hear from YOU, readers, so do feel free to post in the comments below.
Let me tell you, it’s spring at long last here in the Last Green Valley, and hikers are out in droves. (Which, in hiking, means meeting two people on a typical hike instead of one.) As usual, I’m seeing the usual mix of seasoned trail explorers and neophytes, and remembering my first forays into the forests some years ago. When you’re just getting starting with hiking, it’s common to make choices that seem smart from a ‘common sense’ view, but are actually harmful to your hiking efforts. Today, I’m going to cover some of the mistakes that newbie hikers make, and highlight some quick and easy tips that will help you hike better – and enjoy your time on the trails much more.
For this post, I’ll be joined by my amazing friend Haley, who is a dietary aid and nutrition major at the University of Connecticut. Haley knows her stuff when it comes to health and diet, and she’s a great cook too – check out her blog for diet tips, recipes, and more. It’s right here.
Tip One: Take Care of Your Feet
Wearing running or training sneakers on the trails is a rookie mistake I observe all too often. These types of shoes are best suited for level to moderately-sloped surfaces, and they don’t offer the type of arch and ankle support you need on rocky trails or steep ascents. If you’re waking up the day after a good hike complaining of sore feet, chances are you’ve got the wrong footwear for the job. Be smart and get some hiking boots, paying special attention to ankle support. Distressing the muscles around your ankle can lead to sore feet and even knees and serious injuries down the line.
Tip Two: Stagger Your Fluid Intake
Keeping hydrated during exercise is obvious. But don’t guzzle twelve ounces of water at the start of your hike, and then down another twelve or more at the end. You want to ration your H20, sipping 2-4 ounces about every 10-15 minutes. Chugging a bottle of water is going to place extra strain on your already hard-working heart, because the sudden influx of fluids will raise your blood pressure (which is partially a function of fluid/blood volume). Your kidneys will also work extra hard balancing the alternating states of hydration and dehydration. Keep your metabolism running efficiently with a consistent fluid intake. Oh, and don’t forget the electrolytes – these are critical to proper fluid balance in your body. Just don’t grab Gatorade or any of the sugary beverages…
Tip Three: Throw Away the Refined Sugars
Your pack should always have a few snacks in it for extended hikes. Exercise of less than sixty minutes’ duration won’t place enough of a demand on your body for extra calories, so if you’re just out for a quick hike, you can consume some lean protein about 20 minutes before and after for muscle recovery. But while it’s tempting to grab a trail mix with M&Ms or sugar-coated raisins, these processed sugars are used least efficiently by your body, and can actually slow you down when your glucose levels drop. “Most people know this as the ‘sugar crash’or ‘crashing,'” Haley explains, “and it happens when your insulin levels are too high.”
Your best snacks contain natural sugars. Bring some strawberries, cherries, blueberries or another low-glycemic load fruit with you. Nuts like pecans, cashews, pistachios, and almonds are another great source of energy that also contain healthy fats and a good dose of protein, too. Granola bars and oat-based products are fine, but check labels – refined sugars are often found in excessive amounts in many of these foods.
For sustained activity, Haley recommends complex carbs. “Complex carbs, like oats or whole grains, are important for hiking and sustaining the body for a long period of time,” she says. A bag of potato chips, on the other hand, will kill your energy levels, and the high sodium content will make you thirsty even when your body is adequately hydrated.
Tip Four: Be a Smart Packer
Bringing a lightly packed day pack on any hike is a great idea. However, don’t overdo it. Many new hikers are giddy with the prospect of taking photos, reading a book, or trying out new hobbies like rock-collecting when they hit the trails. Just remember how much harder your body (and back) have to work with a heavy load. If you must bring a book, pick a slim, softcover one – but to be honest, most people find the forest itself stimulating enough, and never crack a book to begin with. Photography equipment is great, but plan ahead and select just the lenses and tools you know you’ll likely need. With equipment, don’t fall into the trap of buying tons of gadgets and gizmos in the outdoor section of the store. You won’t need a portable shovel on a hike. Really. A compass, a whistle, a map (all of which, to be honest, you have on your smart phone), a poncho, a little food, and water and extra clothes (see below) are really your only necessities. If you’re going out in the evening, add a headlamp and bug spray to that list. Cooking equipment or utensils are only necessary for extended hikes, and if you need to cook, get a “pocket rocket” collapsible stove – they typically weight just a few ounces.
Extended hikes require even more frugal packing, especially if you’re trying to make good time. Liz Thomas, an exceptional distance hiker who recently completed the Pacific Crest Trail, carried a pack with her that weighed just seven pounds for the 80-day journey. (She hiked into nearby towns for food and water.) That’s on the low end, but certainly a day hiker can carry everything he or she needs in 15 pounds or less.
Tip Five: Be Prepared for Weather Changes
Checking the weather before you go out to hike is smart, but weather conditions can change unexpectedly and accidents do happen. Many a new hiker has gone out in shorts and a tee shirt in the morning, only to find themselves shivering in cold, wet weather later on. Get a cheap plastic poncho for rain, and keep some extra layers of clothing in your pack. An extra pair of socks, a light jacket or sweatshirt, and a hat and gloves in the spring are strongly advised. (By the way, those extra socks will come in handy if you should be crossing a river or stream and slip, too.) A savvy hiker dresses in easy to remove layers. As weather conditions change, or as your body’s internal temperature rises, you’ll want to be able to remove outer clothing as needed. And even in sub-zero temperatures, avoid absorbent fabrics like wool. They may feel toasty and dry at first, but after you’ve started sweating, you’ll be drenched and uncomfortable. Choose fabrics that wick moisture away from the skin instead.
Tip Six: Let Someone Know Where You Are
The standard wisdom for hiking is “Never hike alone.” I routinely flaunt that convention, and to be honest it’s just not realistic for many of us, anyway. So instead, just give someone advance notice about your plans in the event something should happen. Let them know where you’re going, and about what time you expect to be back. It’s extremely unlikely that any catastrophe will befall you on the trails, especially if you plan ahead. But just in case you should experience an injury, it’s wise to have someone in the know about your location.
Tip Seven: Adopt an Attitude of Gratitude
We all want to reap the physical and spiritual rewards of a good hike, but remember: this hike isn’t just about you. Be mindful of the forest and its inhabitants by adhering to the rules of the park. Stay on the trails, pack out your trash. Most professional hikers cultivate a sense of respect and gratitude for the earth, reminding themselves that they are guests in the woods. As your time spent hiking increases, your sense of connection and respect for nature is sure to increase. Notice that feeling and cultivate it.
Tip Eight: Take a Break (But Not For Too Long)
If you’re trying to lose weight or build muscle mass, you probably want to push yourself to the limit. While you definitely want to keep your heart rate high and keep burning calories, your body will manage both more efficiently with brief breaks to rebound. Break every thirty to sixty minutes, but only for three to five minutes at a time. Resist the urge to punish yourself; your body knows what it can do and when it needs a break. Haley explains that resting is “about listening to your body and taking a break when you need to. If you get fatigued, you may not be able to work a, hard or continue going as strong as you would if you took a short rest.”
Tip Nine: Hiking is the Best Training for Hiking
If you’re planning to hike for a weekend, or thru hike a major trail, consider working hiking into your daily routine beforehand. Many pro hikers carry their gear with them any time they leave their house in order to adjust their bodies to constantly carrying a load. Wear your hiking boots to the grocery store, and use stairs to mimic steep ascents and declines. Getting your body used to the strains of hiking will decrease the adjustment time once you’re on the trails. And, it’s helpful to take a hiking “mentality” too – focus on your steps and where you plant your feet, be mindful of balance and posture, and practice moving at a pace that works for you. One way of looking at hiking is “mindful walking.”
Tip Ten: Show Courtesy to Your Fellow Hikers
Hiking is a pretty lonely sport, to be sure. Most days I don’t encounter any other people when I hike. But when you do run into someone else, be friendly and say hello. If someone hiking behind you catches up and wants to pass, step to the right so they can pass on your left. Offer some trail mix or a little water if you can spare it. You’ll find hikers are a special type of people, with great stories to tell and knowledge to give to anyone who’ll listen. Most of them are there for the same reasons that you are: to test themselves and their limits, to find a deeper connection with the world, to uncover new truths or wrestle with hard questions. Hikers are wanderers and seekers, and they will welcome kindred spirits.
Oh, and many hikers have “trail names” that serve as shorthand in the same way that CB radio call signs do. Mine, you may have guessed, is “Factotum!”