I've been thinking a lot about this topic lately. Probably no surprise since I am in nursing school, right? I made a commitment to myself last year when I turned 40 to take better control of my health and make radical changes if necessary. Well, with all the stress of moving, being disconnected from my community, starting a new and intense school program, etc. my commitment to myself never quite stayed a priority.
I find it interesting that while our nursing program tries to encourage health, the program is not really designed in a way that promotes healthy living. It's hard to find the time to shop and cook healthy meals or workout...even if I had the energy to do any of those things! That being said, I am recommitting to becoming a healthier me. For my Acute Care class, we are charged with writing about either coronary artery disease or diabetes 2 and including our personal risk factors and a plan to mitigate our risks.
I don't think I blogged about this last semester, but for the first time in my life I was diagnosed with hypertension (HTN). It came a quite a shock as my blood pressure has generally run on the low side, but after 3 months of consistently high readings, I had to accept the fact that it was time to go on medication. I started taking atenolol (a beta blocker - see I'm learning something in nursing school!) in November. Normally, beta blockers are not a first line medication for HTN, but because my heart rate was also running high, it seemed like a good choice. Since starting the atenolol, my blood pressure and heart rate have cooperated nicely and moved back down into normal ranges.
In writing up my risk factors I also had to come to terms with how much weight I have put on. Once upon a time I was quite thin. I certainly put on some weight when I initially transitioned and began testosterone in 1998, but always maintained a "healthy" weight. In 2003, a short time after I returned from a month in Palestine, I began having episodes of extreme fatigue, joint pain, colds and illnesses that would come and hang on for weeks. It took almost a year of various tests, procedures, blood draws, and a bone marrow biopsy, before I was eventually diagnosed with chronic fatigue syndrome (CFS). While it was great to finally have a diagnosis, the bummer was that there was and is no known cause, no cure, and no real treatment options.
For me, in addition to a depressed immune system and severely challenging physical exhaustion, I am also subject to extremely agonizing joint and muscle pain. This pain does not respond to painkillers of any sort. About a year and a half ago, my doctor started me on a low dose of Elavil, a tricyclic antidepressant, that when given in low doses is thought to help with chronic pain and fatigue. Sadly, it has become apparent that while it did provide me with some relief early on, it is no longer working. But, more on that later.
With the CFS diagnosis, my lifestyle gradually changed...I found I could no longer work 40+ hours a week. I learned that I needed to be careful as I was highly susceptible to every little bug that came along and would feel awful for weeks instead of days. I had pneumonia 3 times in 5 years. My activity levels diminished and I began putting on weight. As I recall, I went from about 140-143 pounds to 155. I learned to be ok with that and accept it as part of my diagnosis. A weight of 155 still kept me in a healthy weight category in terms of my BMI. It wasn't until this past holiday break that I realized my weight was continuing to climb. I peaked at about 170 pounds and realized that despite the fatigue and the stress, neither of which I have a lot of control over right now, I could take better control of my diet.
In addition, even though I have spent the last year trying to use diet to control my dyslipidemia, it was not working. My most recent labs showed my total cholesterol as 288 mg/dL (125-200 is normal) and my triglycerides as 427 mg/dL (they should be <150). While these numbers might be partially connected to my lack of physical activity secondary to the CFS, there is also a genetic component at play. So another medication has been added to my arsenal, lovastatin.
So, in part because I need to create and implement a program to reduce my cardiovascular risks, but more because I want to be healthier and feel better in my body, I have recommitted to my health. To that end, I have begun using an free online program called My Fitness Pal that helps me track my calories, both via intake and via expenditure. I've never really been a calorie counter, but one week in and I am finding it helpful. It also allows me to track specific intakes of things like fat, sodium, and cholesterol, all important in my goal to improve my cardiovascular health. The good news is that in the week since I’ve started, I have lost 5 pounds mostly by just being more mindful of what I am eating. My goals include getting my weight down to 150 pounds and my lipid panel into normal ranges.
The other piece of the health puzzle for me is mental health. I have struggled with depression on and off since I was a teenager. Having chronic fatigue adds another layer. It’s hard not to feel depressed when you look healthy, but can’t do many of the things you used to. Memory challenges are another part of the CFS struggle as is physical fatigue from mental activity. Can you see how nursing school might be stressing my physical and mental limitations? I keep trying to cut myself some slack, but it’s a real challenge. In addition, in the last month I have been experiencing panic attacks more frequently, sometimes multiple times per day. Not a fun thing to deal with, especially when the people who helped me recover from my assault in 2007 are not a part of my day-to-day, face-to-face world. I feel isolated from the community that knows all the many layers that make up "Nick." So, I finally admitted to myself, and to my therapist (in Denver, via phone), that I am having great difficulty maintaining any sense of internal equilibrium. She was a huge help and thankfully, I now have a plan in place for coping. That plan includes starting yet another new medication, Cymbalta. I really do not like being on drugs, but am hopeful that this one will help not just with the depression and the anxiety, but with the muscle and joint pain I experience from my CFS. If it works, it will be blissful relief, but I know that the next 6 weeks or so will likely be rough. In my experience, these meds tend to make me feel worse before they make me feel better. But I'm taking the long view and trying to be positive.
So why am I writing this all down? I guess the reason is twofold. First, I want to have some sort of record of a starting point as I try several new strategies. I think its important for me to write about where I am now so I can see if I am making progress, since my memory often fails me. Secondly, I imagine I will need some support, encouragement, and gentle butt kicking if I look like I am veering off course. I really want to do more than just survive nursing school. I want to come out the other side a healthy, caring, compassionate nurse. I am looking to my community to help me achieve that.
Peace and compassion…
