A Quick Guide to Hepatitis C

hepatitis c

What is hepatitis and HCV?

Hepatitis is a general term for inflammation of the liver. Any number of conditions can cause hepatitis, but one of the more common causes is a viral infection from the hepatitis virus, of which there are three types: A, B, and C. Type A is a short-term infection often caused by consumption of a contaminated food or water source. Type B is also short-term, though chronic hepatitis can evolve from an HBV infection in some cases. This type is spread by blood, semen, or saliva from an infected organism entering the body of an uninfected one – IV drug use, sexual contact, and animal bites can all lead to an infection of Hepatitis B. Vaccinations for both Type A and Type B hepatitis exist.

Hepatitis C is of particular concern because the virus can remain dormant for decades, often failing to manifest symptoms until an infected person’s immune system is compromised by age or a separate medical condition. Untreated, Hep C can lead to cirrhosis, liver cancer, and death. It’s also a factor in the fastest growing cause of cancer-related deaths in America presently, hepatocellular carcinoma (HCC). In fact, HCV is the leading cause of HCC in the western world. There is no vaccine for Hepatitis C.

How is HCV spread?

Hep C isn’t spread by casual contact with a carrier or through a vector (mosquitoes, animals, or contaminated food products). Needle-sharing is presently the most common cause of an HCV infection. Prior to 1992 HCV was spread through blood transfusions, but rigorous screening of blood products has eliminated that concern. In some cases, sexual contact, sharing of contaminated razors, and contact with unsterilized tattoo needles has led to an HCV infection, though these are much less common causes of the disease. Finally, a baby born to a mother with HCV will also carry the HCV virus.

What are the symptoms of hepatitis?

An acute infection of hepatitis C manifests with fever, fatigue, abdominal pain often accompanied by nausea and vomiting, jaundice (a yellow discoloration of the skin and eyes), joint pain, clay-colored stools, and dark urine. Bear in mind, however, that an acute infection from HCV is less likely than a chronic infection, which typically manifests no symptoms and takes years or even decades to cause damage to the liver (in the form of scarring or cancer). Many carriers of HCV will have no reason to suspect they’re infected (and as carriers they can still infect another person with it).

Who should be screened for Hep B and why?

Anyone who’s ever been an IV drug user or shared needles should strongly consider HCV screening. Currently, there’s also a huge push for baby boomers (anyone born between 1945 – 1965) to receive HCV screening because of the risk from contaminated blood products. Moreover, because of the time required for HCV to cause liver damage, baby boomers entering middle age are now at the greatest risk for complications. In fact, baby boomers are five times more likely to have an HCV infection than the general population and may not even know it. Health care workers who’ve been exposed to HCV by needle-stick injury or handling blood products should be screened. Some experts also suggest that incarcerated individuals living in close contact with others should also be screened.

Getting an HCV screen promptly will help anyone with an HCV infection receive care to prevent the potentially serious side-effects of hepatitis.

What’s the procedure for HCV screening? 

The first step in HCV screening is a routine blood test ordered by your primary care provider (PCP). This test is used to determine the presence or absence of an antibody for HCV. However, a reactive antibody test (meaning the antibody is present) only indicates that the person is a carrier. To determine if an active HCV infection is present, a second test for HCV ribonucleic acid (RNA) is done (See: “Screening and Management of Hepatitis C,” American Nurses Association). Both tests are required for a positive diagnosis of HCV, however, because (for reasons we don’t fully understand), 1 in 4 people eliminate the hepatitis C virus on their own – meaning they will have the HCV antibody, but not the active infection. Baby Boomers take note: Medicare covers the cost of the PCP-ordered blood test for anyone born between 1945-1965. 

How is an HCV infection treated?

HCV used to be treated with interferons with limited success. However, since the introduction of a new class of drugs called direct acting antivirals (DAAs) in 2012, the success rate for eliminating HCV is now an impressive 90-95%.  DAAs are given as an oral medication with very few side-effects. Unfortunately, they’re also very expensive and this is a major barrier to treatment.

Summing Up

Hepatitis C is a viral infection of the liver, sometimes leading to an acute set of symptoms but most often developing over decades with little or no obvious symptoms in the carrier. However, this chronic form of hepatitis can lead to serious outcomes later in life – scarring of the liver (cirrhosis), liver or blood cancers (HCC), and death.

Anyone with a history of needle sharing/IV drugs use, Baby Boomers (individuals born between 1945 – 1965), and anyone who received blood clotting products or an organ transplant prior to 1992 should consider being screening for HCV through a routine blood test ordered by their provider.

Remember, no one can diagnosis or treat an illness except a qualified, licensed medical professional like your primary care provider. If you’re concerned about HCV, contact your doctor or APRN and schedule an appointment to discuss your concerns. 


Legal disclaimer: Advice offered on this website is for educational purposes only. The information herein is not intended for use to diagnose, treat, or manage any health conditions or offered as an intent to treat any individuals. ALWAYS consult your primary care provider with questions regarding your health.  

Managing You: Why You Must Keep a Personal Health Record

Pop Quiz:

  1. Who is your primary care provider?
  2. When was your Tdap vaccination? Tetanus? Most recent influenza shot?
  3. Did you have a physical this year? What were the results?
  4. 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 have flow sheets to 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: 

  1. Your prescriptions, the dosages of each, and the frequency of administration
  2. Your immunizations
  3. Your physicals, including the list of current health concerns/chronic illnesses and doctor’s report on your overall health
  4. Lab results – (blood work, biopsies) and imaging results – ultrasounds, X-rays, and the like.
  5. Your insurance information.
  6. Reports from any specialists you’ve seen, histories of any procedures (surgeries) performed
  7. Emergency contact information
  8. Your allergies to any medications and/or latex
  9. A copy of your living will, advanced directive, or any legal documentation of this sort (including DNRs)
  10. 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.”
  11. 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. 
  12. 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).  

Note: This article also appears on medium.com.

Report from the Trails: Summer 2016

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The yellow-blazed Brown Marsh trail in Goodwin State Forest, September 2016. (c) Jace Paul.

Hello friends, 

Another New England summer has passed into history, and with it the prime hiking season for observing the full diversity of our region’s flora and fauna. This year, the state of the forests is all about water – or the lack of it. Droughts have become typical for Connecticut, as in many other states, and as of September 9, 2016 Connecticut remains in a state of Drought Alert, with most of the state in a moderate drought condition and some areas (the northeast region from Windsor Locks to Putnam) in extreme drought conditions. The combination of high temperatures and very low precipitation has both immediate and long-term effects on our ecosystem.

Tree health is compromised when dry conditions weaken or destroy the newer, non-woody roots, and water circulation to the higher parts of the tree is diminished. Poorly watered trees are more susceptible to infectious fungi, root rot, and insect invaders. The ash-borer, an invasive species that kills tens of millions of trees each year, thrives when trees are already compromised by drought. Of course, the big (bad) insect of 2016 was surely the ubiquitous gypsy moth caterpillar (Lymantria dispar), which devoured hundreds of acres of forest canopy across New England. Gypsy moth outbreaks are not uncommon in our region, but this year’s was the worst in some three decades because the species thrives when – you guessed it – precipitation is abnormally low. Trees already compromised by drought, then, experienced additional hardship when their canopy disappeared into the mandibles of thousands of hungry caterpillars. The outbreak was finally brought under control by the fungus Entomophagia maimagia, which normally controls gypsy moth populations but requires a wetter spring season to do so.

With this array of environmental concerns for trees, we should expect a “blink and you’ll miss it” autumn foliage event this year. The good news is that trees are hardy by and large, and it takes more than a year or two of drought conditions to cause lasting damage on forest health. However, given the reality of climate change and the expectation that drought conditions will occur more frequently in the coming years, tree health and forest mortality is a serious concern going forward. 

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Dusk on Pine Acres Pond, February 2016. (c) Jace Paul.

The drought also affected river, stream, and wetland health. If you’ve been out at all this summer, you’ve no doubt noticed the very low waterlines of many of our streams and rivers. Connecticut was forced to ban fishing in several areas due to the very low water levels of rivers and streams, where salmon and trout numbers are reduced. Diminished flow not only affects fish and other aquatic life, but also causes concentration of environmental pollutants like heavy metals and agricultural runoff, leading to decreased water quality. Algal blooms (particularly of cyanobacteria) can deposit toxins in the water, increase surface acidity, and choke out competing plants and fish in the surrounding environments.  Waterfowl and aquatic insects have fewer options for nesting and feeding, and plants that thrive in standing water or along river banks die off.

Mosquitoes, however, are more complicated: some species, like the Culex variety, thrive in drought conditions because they lay eggs in stagnant, warm water and in the muddy areas that remain when streams and rivers dry up. Across much of New England, however, the overall mosquito population was reduced this year.

Mammals and reptiles have been forced to venture farther afield for hunting and nesting, and bear sightings are on the rise across the state. Vernal pools, a critical component of our ecosystem where turtles home, dried up very early this year, and there was a rise in the number of turtles killed on roads as they attempted to find water.

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An old trail sign in Natchaug State Forest, April 2016. (c) Jace Paul.

Agriculture in Connecticut has also been impacted by the drought. The peach crop was already decimated by an unusual cold snap in February, but extreme heat and dryness became the nail in the coffin for peaches, pears, and plums across the state. This year’s apple crop will fare slightly better, with only a modest fifteen-percent reduction in volume due to the drought.

Given the many challenges to our natural landscape, the need for strong leadership in environmental justice is clear – but, unfortunately, the news from the political ecosystem is just as dire in Connecticut this year. Governor Dan Malloy, already under fire for gutting the state’s funding to hospitals, schools, and arts programs, announced a 14% reduction in the Department of Energy and Environmental Protection budget, forcing the agency to close three state campgrounds and drastically reduce services to other state parks and beaches. The DEEP outlined how this severe cut would impact the programs and staff that monitor environmental quality and oversee conservation efforts. Incidentally, governor Malloy also slashed the DEEP budget in 2015. In short, environmental concerns continue to grow, with the DEEP sounding an alarm on many issues, while the political establishment in Connecticut drains the resources available to combat them. 

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A marsh in Gay City State Park, June 2016. (c) Jace Paul

Thankfully, Connecticut has a number of private organizations picking up the slack. The Connecticut Forest and Park Association continues to play a vital role in protecting and supporting our woodlands. Without them, we simply would not have many of the trails that we do, nor would they be as well cared-for as they are. The Last Green Valley also helps protect the woods and wildlife of Eastern Connecticut, with programs like their RBV stream monitoring program doing what the DEEP no longer has the personnel to do. Finally, smaller organizations like the Friends of the Goodwin forest provide a tremendous service engaging the public with free educational programs and forest/park maintenance. If you can, support these organizations by donating or volunteering.  

If all this seems like a glut of bad news, the hiking season this year was nevertheless a wonderful one. Of course, nature is a web of relationship, and often a curse for one species is a boon for another. As a hiker, I observed fewer mosquitoes and deer ticks and more of certain species – the shore at Black Spruce Pond, for example, was rife with frogs, which drew magnificent herons and cormorants to observe, too. Snakes traveling afar afforded me the opportunity to see four of Connecticut’s fourteen species in the wild, including the eastern black racer whose numbers have been drastically reduced in recent years. As of today, I have done 67 hikes totaling 345.7 miles, including all of the Natchaug and Nipmuck trails.

Our forests and parks continue to be a jewel to our state, and if you haven’t been hiking this year, I urge you to do so while the weather is still accommodating. Above all, take action to protect the future of our wild lands and the species that inhabit them. 

See you on the trails.

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The Natchaug River, August 2016. (c) Jace Paul.

An Orange Chicken, a Quirky Quercus, and a Scenic View of Scotland (AND a Free Photo)

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The Chapin trail snakes through a magnificent understory of ferns and saplings.

Hello friends,

It often pays to take a detour on to unmarked or previously unexplored trails (but not into the forest itself, please). Yesterday, I discovered an entire new wilderness preserve purely by chance. I was heading north on the Nipmuck trail, planning to go just past Gurleyville road and turn around. Right around the site of the old Chaffeeville Silk Mill, I noticed a white-blazed trail exiting on the road, and through trees I spied a Town of Mansfield sign announcing the “Coney Rock Preserve.” The sign warned of a “steep” ascent leading to a grand view of the Fenton River. I calculated the total distance of the trails (I wanted at least six miles of hiking that day) and headed up the hill.

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The very old white oak (quercus alba) found in the Coney Rock preserve.

The choice to deviate from my planned hike was well rewarded, as I found myself at first in an extensive hemlock grove and then breezy, silent deciduous forest appointed with a gorgeous understory. Along the hike, I laid eyes on two barred owls in the canopy and discovered one of the oldest white oak trees I’ve ever seen (see photo at left). From about 1830-1850, deforestation for agriculture was at its peak in New England, with some 60-80% of all native forests obliterated by human activity. Connecticut forest, thus, are fairly young, and it’s a wonderful thing to find a tree as old as this grand old lady, who clearly predates the most frenetic period of deforestation. (A sad note: after a dramatic falling off in the early to mid twentieth century, deforestation in New England has been steadily rising in recent decades.)

 

I took the most circuitous route possible and made my way along the Olsen, Woodland Road, and Mullane trails to eventually return to the Chapin trail, where the park’s eponymous rock is located. The parks and rec information kiosk hadn’t exaggerated the view; it really is quite a magnificent west/southwest view of Scotland Connecticut. Unfortunately, the remnants of tropical storm Hermine have been cluttering our skies with low, grey clouds these last few days; I’m sure the view would be even better on a sunnier day.

As I left Coney Rock I took a photo of this gaudy mushroom – the Laetiporus sulphureus, also known as the “sulfur shelf” and “chicken of the woods.” August and September are great months for mycologists as many of our native species appear during this period; the Laetiporus is one such example. They grow in large fan-like clusters called rosettes at the base of oak and beech trees (but typically not conifers) and have a pleasant aroma. As you can see from the photo (below), they also have a shocking salmon hue, very bright and hard to miss if you see one. I don’t generally eat mushrooms, but those who do report that the edible Laetiporus has a lemony flavor and tastes a lot like, well, chicken. (N.b., while that links to a recipe for cooking the chicken of the woods, always consult an EXPERT mycologist on the proper identification of mushrooms you find in the wild. Many species are toxic and possibly fatal if ingested!)

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The shocking, orange/salmon colored “chicken of the woods” growing at the base of an oak tree.

 The free photo of the day is found as the featured photo for this article. That’s Chaffeeville road passing over the Fenton River, just at the ruins of the silk mill site.

Have a great day, friends!

 

Shoreside, Crystal Pond

IMG_3457Shoreside, Crystal Pond 

(c) 2015 Jace Paul

It’s dawn and the water is white and clean.

I pick up a pen and put my feet into the waves.

There are no boats to interrupt the trees in morning prayer;

Houses hunker down and hold the snoring bores within;

Still the lake takes my toes like

It has a fetish, its kindness knocks

Me over,

Supine, I, can wallow in the sky.
And it’s twilight and the water is right and clean.

I think too, you, see the cormorant, the snapping turtle,

And marvel at their potential.

We feel and see the grain of a good wood,

And with pinched fingers

Make a minor church.

I rest my pen and put my feet into the waves,

And minders mind their waterfront property,

Berth the boats, ignore the trees in prayer,

Hunker down in boring houses scored by sin,
And it’s dead of night, the stars give up their long dead light,

And the water is bright and clean.

This poem and many others is available in Where You Will Find Me by Jace Paul.

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Happy 100: The Post-Game Analysis on Bariatric Weight Loss

Salutations, friends!

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.

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January 19, 2016 – three hours after surgery. 

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.

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In 2010 (258 lbs) and again in 2016 (185 lbs). 

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.

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One week ago, at Mount Misery.

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.

Stay positive!

Ten Tips For Hiking Like a Pro

Hi friends!

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.

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A natural marsh along the Nipmuck Trail, May 2016. (c) Jace Paul

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.

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Pro photographers may balk, but a light, plastic 18-35mm lens (which I used to take this photo) is adequate for most of what you’ll want to shoot on a hike – unless you’re aiming for wildlife from a distance, where lenses with at least a 300mm focal length are required.

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!”

See you on the trails!