What Should I Eat, Since I Don't Like Hospital Food?

Here's part two of my not having a heart attack at age 40 regimen. Trust me, hospital trays for people on cardiac diets are not anything to look forward to!



DIET

Eat a nearly vegetarian, low fat diet. The physician I spoke with recommended Dr Dean Ornish, a cardiologist who advocated a mostly vegetarian, very low fat, "good" carb diet for reversing heart disease. Apparently it works, and unlike other diets is supported by randomized controlled trials. The only drawback? It is considered too strict for most people to succeed. After all, not everybody is trying to recover from a big infarction. It's also very anti-fat, even the "good" fats such as olive oil or the fats in nuts and seeds. He makes the argument that all fats contribute to weight gain (because they're the most calorie-dense food substance there is). And that even good oils, such as olive oil, still have saturated fat, which recommends avoiding at almost all costs.

So I guess as a compromise, Ornish wrote a new Spectrum book in which he reworks his diet to include people who don't need such drastic measures. His diet is still pretty much the same: mostly consisting of good carbs and fiber, high in protein but low in meat. So accordingly I've tried to increase my intake of heart-healthy foods: in order of amounts, vegetables, fibery foods (oats, ground flaxseed), and fruits. And believe it or not (I never thought I'd be saying this) I don't miss meats and cheeses and fatty foods. You do kinda feel better if you're snacking on baby carrots or hummus rather than deli meats and chips. I rarely eat red meat, although it really is too good to give up entirely. But I try to treat it as a treat. And I've even tried to decrease (not eliminate) my intake of chicken (even the white meat is pretty fatty), lean pork, and all oils.

However, I'm still all about nuts and seeds. I think they do help, in moderation. And I also eat lots of fish, fat be darned. They're high in omega-3 fatty acids, which are heart-healthy. I'm particularly going for sardines, tuna, salmon, catfish, and shellfish. I feel better, for instance, if I snack on a bag of that pre-seasoned tuna (some varieties have enough oil to almost be considered a light tuna salad), rather than whatever I used to chow on.

What do you think? I think the Ornish diet, all told, makes more sense than Atkins, which is high fat. Or South Beach, which proscribes foods based on glycemic index, which may not be accurate. A white potato may be high in carbs and have a high glycemic index, but if you eat it with other fibery foods its glycemic load is actually lower and slower than if eaten alone. (That's just an example; we've actually abandoned white potatoes in our house for sweet potatoes.)

So I'm calling on you, my readers, for a dietary consult. Any recommendations? What do you eat at home to stay healthy? What do you bring to work, and how do you bring it?

Don't want to diet? There's always Part 1: Fitness.

The Post-Lunchbreak Desk

One thing I'll sorta miss as an ICU clerk is that my desk or station (and I get my own) is the hub of all the unit activity—the pharmacy and laboratory tube stations are there, the phone, computers, the pharmacy fax machine, the regular fax machine, and usually half or all the patient charts are there. Usually I try to manage all this randomness in somewhat of an orderly fashion, but those agents of chaos, nurses and physicians, are constantly at my desk—throwing charts around, trying to find patient labels, looking for medicines, rifling through all the papers on the printer, thumping the side of the fax machine, etc.

So you can imagine what it looks like when I go to break and the staff are free to play at my desk for half of an hour. I'll come back to a bottle of pee in a biohazard bag, three or four open pneumatic tubes (which are the size of footballs), charts thrown open, the phone off the hook, some tubes of blood, bags of IV medication all over the place, three phone lines blinking on hold, and a note saying the printer is broken. Usually a nurse runs up and exclaims how they've been dying since I was gone.

I feel sort of like the mother hen of the unit; I feel like a housewife coming back from vacation to a house occupied by a hapless husband and sons.

Achieving Mere Competence.

Finally catching up on the most recent Change of Shift, and I really dug this post by the Muse. The theory is that you become a professional nurse, make the uphill climb to becoming competent at what you do, and then you "squat":

You have mastered the ability and the workload of your position and compressed the actual hours needed to do the work into 10-12 hours/week. You now have 20-28 hours to wander and act like you’re doing something important

When what you should be doing is achieving more education and qualifications and reinventing your role. Every 5-7 years, in fact.

I think I was squatting in my old role as a critical care tech. My best days were when I was running all day long, for twelve hours, trying to keep up and manage all the tasks that needed to be done. But otherwise, on average days, all the work I needed to do could have been done in three or four hours. The rest of the time I chit-chatted, observed or assisted (which is nice, like getting paid for clinical), or...I don't know what I did. Probably stared off into space a lot. Thought about my next meal.

I don't want to do that as a nurse. I know nurses who are really good, but spend most of their time "charting", by which I refer to a really slow process of carefully and deliberately entering information into the computer charting software, in order to look somewhat occupied. Mind you, I would not mind getting paid an RN's wages to do that...but I'm still young and idealistic and I don't think I want to spend hours of my life doing that.

But I can already feel it: I never want to go to school again. Two years of working full time and schooling full time were horrible. Manageable, but I never want to do it again. Honestly I have no desire to get my BSN or my MSN, because they seem aloof and academic, studying nursing theories, and researching which nursing assessment scale with a goofy acronym (e.g. BUTTS versus ARSE) is better, and community health studies.

You know what I am attracted by? The idea of certifications outside of a school: the trauma nurse certification, the CCRN, etc. These still excite me, because they don't sound like school. They're technical, specific, and "real". And I could do this in the every 5-7 year timeline; transfer units, achieve a new certification, get new skills, and become a new nurse all over again.

And I still sometimes have fantasies of advanced practice nursing, in cardiology or trauma or some interesting field. But that would require...more school.

Well, I'm a Licensed Professional Nurse

Got my RN license in the mail!!

Kinda disappointing to go back to my old job for another week until my RN gig starts...I'm half-hoping they'll tell me I can't work in a tech role as an RN and send me home early.

My Epic, Inspiring Battle Against Familial Hypercholesterolemia!!

Okay, so it's not that epic or inspiring. At least it probably won't get me on Oprah.

Also you'll have to bear with me since Firefighter George is on, and I might start writing like how he talks: "and then the LIVER makes CHOLESTEROL, and the CHOLESTEROL goes ALLLL THE WAY TO YOUR CORONARY ARTERIES, and then what, kids? YOU DIE!" (Okay, he never says "you die"...)

So after speaking with nurses, doctors, and a natural-minded physician (who, besides the nurses, was the first to mention diet and exercise), here's the regimen I've come up with to fight cholesterol and reduce cardiovascular risk. Mine, that is. I can't say it'll work for you. I'm going to break it up over several posts, as it's quite a lot of content!

The first, most important, but most unpleasant subject:



FITNESS

I have to exercise almost every day. I joined the local gym and have gone at least four days a week so far. I want to increase that to at least six, around work. I do mostly cardio but I'm starting to lift weights. Why? I want to reduce my abdominal fat, build lean muscle, lower my blood pressure, and lower my resting heart rate. None of these risk factors can be easily modified except through exercise. And honestly, not counting the willpower involved, these are the risk factors that are the most easy to modify or eliminate.

The natural-minded doc recommended Dr Dean Ornish's program for reversing heart disease. I'll talk more about his diet later, but he strongly recommends cardio exercise almost every day, if not every day. It makes sense to me. I don't have studies to prove it, but I feel that your heart disease risk rises proportionately as level of physical activity falls, and that this factor, more than saturated fats or trans fats or white sugar or high fructose corn syrup, is the reason why rates heart disease and diabetes have done nothing but rise over the last century. It's probably only rivaled by tobacco smoke's direct contribution to lung diseases.

All I can think is that our cave man ancestors, and probably our ancestors up till a century or two ago, spent most of their days working and moving. You know, living by the sweat of your brow. Who got gout, dropsy (the old name for heart failure), and diabetes? Bankers and nobility. What do we all live like these days? Bankers and nobility! Most of us work in jobs with low physical requirements, and our personal lives are not physically taxing. And if we can't reproduce physically intense labor in our work environments, then at least we can artificially reproduce in it a gym. My only qualm is that 30 minutes in a gym every day still isn't like 12 hours of laboring on a farm...but the evidence seems to suggest that it's still beneficial enough to keep you alive and healthy.

So I've been going to the gym more than a month, and my motivation to become physically fit hasn't lagged, like it has in the past. Why? I think it's because I want it for the right reasons now. I'm not going because I want to lose weight; I'm going because I want to spend the final decades of my life healthy and able to move. Not slowly dying like many of my unfortunate cardiovascular patients.

It will also, of course, help improve my LDL and HDL levels...but maybe not enough for my liking. Hence, I need to drastically change my diet and probably use medication. Stay tuned for those exciting subjects...

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I PASSED THE NCLEX!!!

75 questions. One hour. That's it!

I had to be downtown at the testing center by 8 am Tuesday morning. Of course, we decided to have a snowstorm that morning, so I left extremely early. I took the transit train and ended up downtown by 6:30. I found the right building but couldn't get into the testing center until 7, so I spent my life savings on a tea and yogurt parfait in the lobby's Starbucks. Once I got in, the staff at Pearson-Vue (the testing center folks) were surprisingly welcoming and nice. No paperwork, really, just having my photo taken, my fingerprint checked, and my palm veins scanned.

I can't talk about the test content, of course, but suffice to say the exams at my nursing school were probably a little harder! Of course, that's probably the point of school.

I was out in a little over an hour, back on the street and walking to the train. I couldn't believe it. That was it? The snow was so beautiful, since it was still bright and early, that I had to walk around downtown a bit before hopping on the train. We had arranged a babysitter for the morning (my wife was going to the dentist later that morning), but I was back before we even needed it.

On Thursday I was at work, hearing endlessly about how could I only have been there an hour, and back in the bad old days we had to take 1600 questions over two days, and we had to wait six months for the results, etc etc, from the more experienced RNs. :) I paid the $7.95 to find out my unofficial results, and by 8:40am they were available, and said, in a tiny corner of the screen, "pass." I was elated. I printed a copy of it, magnified it on the copier, and taped it up on the ICU break room fridge. Pretty sweet!

When I got home that night, my official letter (which they said could take up to four weeks to arrive) was waiting for me! So much for paying for "early" results, but whatever. The point is...

I can legally work as a license-pending RN. Me, RNLP.

It was quite a feeling to mail in my $50 to the state Division of Professional Regulation. I'm becoming a legally registered professional? Me?! It's so weird.

Hope the Fortune Cookie's Right!

Ack agh agh ack agh!

I take the NCLEX this week. That's mostly why I've been a nonexistent writer. And blog reader. I'm so out of the loop.

Here's some interesting things you might not know about the NCLEX-RN examination. You will be identified by photo, fingerprint, and palm vein technology. Apparently a fingerprint scanner can be fooled by a good photocopy? Or maybe people were testing on dismembered fingers...Anyway! You cannot take any belongings with you, including calculators, watches, phones, or LIP BALM. Breaks require being fingerprinted on your way to the bathroom and your way back. The test is (most of you probably know this) adaptive, which means if you answer questions 95% right, you automatically pass at the minimum 75 questions. If you're really bad, you fail at 75 questions. If you're borderline, you keep going until the computer decides you're smart enough to be a nurse—up to 265 questions. If you hit 265 or the end of the six hour limit, your last 60 questions count the most. But some people are randomly selected to take all 265 questions. I know when I keep going past question #75, by about question #120, I'm going to feel like a moron, and that I'm on the edge. Hopefully I'm just one of the random folks.

We went for sushi tonight, and my fortune cookie said "You will pass a difficult test that will make you happier."

Hopefully my next post will be signed by a Registered Nurse!

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Say Hello to My Cholesterol

It turns out my cholesterol is through the roof. I don't have a real doctor, so I went to the resident physicians who work the family clinic attached to my hospital to have my levels checked. It goes a little something like this:

Total cholesterol: 370+
HDL: 32
LDL: 320
Triglycerides: (can't remember, but they were okay - 70s-ish)
Glucose: 88 (so I'm not prediabetic)
BP: 135/89 (kinda high!)

My LDL is high enough that my coworkers were ready to call a code blue on me when I got the results. Less than 100 is optimal. I'm still thinking about scheduling myself for the cath lab! My HDL level is not bad but I'd like to have it above 40.

They want to start me on simvastatin. The more I read about it, the more I'm inclined to do it despite my 'young' age (hey, I'm pushing thirty here!). Statins have some risks that are pretty recognizable (as in, they won't sneak up on me in my sleep), but besides lowering LDL and raising HDL they also seem to confer antiinflammatory and antioxidant protection to vessel walls and they stabilize existing plaques, if you have any. Besides, after talking to my parents and siblings, it turns out most of them have severely high cholesterol levels that are refractory to just diet and exercise. My mom, for instance, isn't medicated because her HDL is very high too. And whether this leads to cardiac events is up for grabs, since there have been healthy folks in my family who had high cholesterol and had no heart problems, and other people in my family with presumably lower levels but worse living habits had heart problems. But all in all, I think the risk:benefit ratio is in favor of taking a low dose of statins and titrating it (hopefully down!) as concurrent diet and exercise hopefully also improve my levels.

My plan? Well, I'm cutting out as much saturated fat as I can. I've gone to only skim milk and almost no red meat and no cheese (no cheese! how could I live!). I've begun purchasing much more fish and improving my fish-cooking abilities. I've begun eating sardines, herring, and other canned small fish which, despite their unpopularity, taste quite good, don't make your breath bad, and are very high in the omega 3 fatty acids that bring down cholesterol levels (while also being very low in mercury). And I really, really like shellfish—you can get a "seafood mix" of frozen shellfish for $2.99/lb here!), so I have an excuse to buy more of that.

I also joined the local gym with my wife. I plan to bring my waist size back from the brink of 40" (it turns out my waist is that big, even though I wear 34-36" pants - I guess I let 'em hang too low!), another identified risk factor, and improve my muscle mass and metabolism. Also want to bring down my blood pressure and my resting heart rate (which hovers around 88, but drops to 60-70 when I'm in better shape!)

Any advice? Any thoughts whether I should take the statin? I've all but resolved to take it, but I'm going to another doctor on Wednesday (a more natural-minded and dietary-knowledgeable one) to see what I can supplement with it and how I can eat better. Fish oil capsules, anybody?