LESS AND MORE

I'm going to ask you to do something (it won't take but a second), and, depending on the result, I'm going to tell you to take action.

Go here, enter your information, submit, and come back.

I'll be waiting right here.

•••

Done?

Congratulations, you now have your BMI. Your Body Mass Index.

BMI isn't a flawless tool by any means; however, it's the best we have for free, it's easy, and it is applicable to the general population, for you have to be heavily muscled, and I mean heavily, for this number to be inapplicable.

If your number is below 25 you're dismissed now. Head to recess.

If your number is between 25-30, you have some work to do, and I'd ask that you stick around for information on possible coming attractions.

And if your number is above 30--I'm not going to candy coat it--you have to! you must! you need to! lose weight. Now. On behalf of your kids, your friends, your pets--whoever it is that you care about most--lose weight.

"Obese" is not about how you look. It's about what's going on in your body.

Damn dress sizes and bathing suits; the kind of damage your weight is doing has nothing to do with hating your jeans or being uncomfortable with your body. No, the damage is life-threatening.

Again, no sugar coating, your obesity (for above 30 is classified as "obese") is opening you up to the kind of risks that will eventually kill you, punching your ticket to The Happy Hunting Ground much earlier than you intended to get there. And before you die, the medications you're going to have to take to keep you alive longer will complicate your daily living, making the life you have left less livable. Medically, your weight is doing severe damage. It's killing you.

Before I go any further, its imperative that I state that I'm not speaking in any professional capacity whatsoever. I work in the medical industry and am paid to talk to doctors about the products I have responsibility to sell. I am not selling to you. I am not even telling you what products I sell. I am providing you with some information and corresponding warnings. I'm not going to site my sources; you're just going to have to trust me or seek to validate the information yourself. Additionally, I'm only going to give you widely-known statistics, not the targeted specifics I use on a day-to-day basis. This is not a sales call; it's you and me having a conversation punctuated with a call to action.

For many disease states, your BMI is a good indicator of your risk. Today we're talking specifically about your risk for diabetes, which drastically increases your risk of cardiovascular-related death. Drastically to the tune of 70-80% of people with diabetes die of CV-related causes (that's heart attack and stroke, folks).

An over-30 BMI is a grand risk for Type 2 diabetes. (I'm not going to get into type differentiation here.)

Diabetes? Who cares, right? So many people have it and they're alive and kicking, yes? Yes. But the raised sugar levels in their blood (for, simply put, that's what diabetes is: sugary blood) require daily medication--very often necessitating insulin shots to sustain life. And diabetes isn't just inconvenient in the way of treatment, it's also a generous benefactor of severe sight degeneration, loss of nerve response, lower-limb amputations, dementia and Alzheimer's.

Treated and tightly controlled, diabetes doesn't have to make you lose your vision, your feet, or your memory; doctors know how to stall the disease's progression. But once a doctor diagnoses you with Type 2 diabetes, you're generally already well into the disease and damage is underway and enthusiastic.

The lifestyle that took you to a BMI of 30 is doing damage right now.

But you can stop it.

One out of every four people over 60 has Type 2 diabetes. And researchers at the University of Chicago predict that the overall incidence (across all age groups) in America will double over the next 25 or so years, taking the current incidence of diabetes from 23.7 million to 44.1 million. (Present U.S. population is approximately 300 million.)

Why the doubling? Obesity. Plain and simple. Obesity. A BMI over 30.

I spent all of last week at a world-renowned medical teaching institution being schooled on physicians' perspectives regarding diabetes treatment, risk, and complications. One of the leading practitioners there said that he tells his patients that the first five answers on how to lose weight are 1. eat less, 2. eat less, 3. eat less, 4. eat less, and 5. eat less; the sixth answer is exercise.

Why am I harping on this? Well, because last week I had the fear of God lammed into me.

I am healthy. My weight, though more than I want it to be aesthetically, is perfectly healthy. And because I know what happens to my risks if I reach the "overweight" classification and how they further increase if I get to "obese," I must stay that way.

I love my husband. I love doing yoga. I like looking at my computer screen to write and to design. I love my family. I have so much in my life that I ought to be grateful for, and each bit is a reason to care for myself. I cannot let my eating get out of control. I have to make sure I'm taking care of the gift of a body that God gave me.

So do you.

The call to action: if your BMI is over 30, eat less. Please. Your eating less will help you lose weight. As you lose weight your risks will go down. As your risks go down you can have confidence in your health and you can continue to enjoy your family without the hindrance of necessary medical care or concern about premature death.

And as a bonus, you'll be that much more comfortable in your own skin.

This is me begging you.

GI UPSET

I am a drug rep. Since becoming one I've come to see and speak the world a little differently. For instance, because I've pedaled gastrointestinal drugs I'm now very comfortable discussing fecal matter, evacuation, bulking agents, and stool habits, though I am sickened when blogs feature posts on potty training processes. For if we're talking digestive results, my clinical hat is on; and my personal prism dictates that potty training isn't deserving of that particular beanie--so let's not have to hear or talk about it at all.

However, I have no issue discussing or reading about mucus or blood in the stool, diarrhea, constipation, and improving bowel motility. And it's not just with physicians and their cohorts that I'm at ease addressing these subjects; I'm completely comfortable speaking of GI issues with family and friends. And when discussing the matter, it is stool or fecal matter; it's not poop, crap, sh*t, or any other informal euphemism.

(Though the colloquial terminology Gastroenterologists enjoy can be pretty coarse. In one office I used to call on, reps waited for the doctor in a designated patient room. While waiting and rolling around on the doctor's chair--just kidding, I can't let myself do that; I always stand patiently while my feet threaten to throb right off my cankles--I was examining all the imagery scattered about the room. A colon model inflicted with every unpleasantly imaginable. A nearly-dead kidney model. A poster of the entire GI tract riddled with ulcers, polyps, and lesions. When the doctor finally dropped in to see me, I said, Doc, I think if you leave patients in here waiting long enough your 'artwork' is going to scare them to death. His response: What can I say? I have a pretty sh*tty job!)

When I called on Gastros I often kidded that if everyone had regular bowel motility there would be fewer car accidents, more summer picnics, winking at strangers would become a habit, and, as a whole, we'd verge on world peace.

So we meet, you and I, and I learn that you've recently experienced some bothersome gastrointestinal upset. Don't be surprised if I start artfully digging and making you slightly uncomfortable with some of the language I use and what I'm not bashful about discussing. I only want to help. You and everyone who knows you. And my helpful goal is to get you to go visit a Gastro or, if you've already been, to induce you to agree to get scoped. It's really not that scary.

And there's a chance that if you do go through with an endoscopy procedure you'll be put out with propyphol, "the Michael Jackson drug" as we're terming it these days, and the 30 minutes you're out will be the best 14 hours of sleep you've ever banked in your life.

INTERNAL WELFARE

I have a medical crush on my internist. She's the best kind of doctor. She practices the best kind of medicine.

May brought me the obligation of scheduling my annual physical. And though I'm devoted to routine medical care, I kept circumventing a call to her office. For I knew there would be blood.

The anti-depressant I take is metabolized by the liver. So my doctor, being the superstar that she is, mandates that I have my blood drawn annually to verify that my super dose of Sane isn't having a negative effect on my liver. That kind of vigilant medicine confirms to me that I've picked a stellar doc. Yet all my faith in her and dedication to health doesn't mean that I'm revved up for my annual interview with a vampire.

Nevertheless, I eventually made my appointment.

In the patient room, once my weight had been taken, blood pressure noted, and pulse entered into my chart, I perched on the exam table and answered my doctor's routine questions.

What supplements are you taking these days? she asked.

I rattled off the names of the handful of pills I habitually cram in my mouth every day. Stuff like Calcium, Vitamin D, Folic Acid (oh calm down, it serves more than just the pregnancy purpose), B12, Iron, Glucosamine, a Flinstone vitamin some days, a grown-up multi-pack other days, and on. Once I'd finished my list, accompanied by the doses I take, I stopped, Hey, wait a minute--do I even need to take all this crap? 'Cause if I don't have to, I'd rather not.

Well, let's find out, she said. Go off of everything aside from your antidepressant for a month and at the end of the month we'll send you for blood work to see what's necessary and what isn't. Throughout the month, if you have any symptoms, note them.

Not only was I game because it was a very attentive and essentially brilliant notion, bein' as it's darn good medical practice, but I've been wanting to make sure that I'm being a responsible vegetarian and getting everything I need. Some vegetarians can get lazy and ignore things like beans, whole soy and dark greens; for the most part, that's not me, but one can never be sure how good they are at anything until it's verified.

(Frankly, responsible vegetarians often maintain more protein-rich diets than do omnivores; the rumor that vegetarians have a tough time getting protein is a dirty one. I'm not the kind of person that's going to take going meatless truly seriously unless I've done enough research to know that for me it's smart, safe, viable, reasonable, and interesting. (Do know that this isn't me trying to convince you to drop the drumstick--I wouldn't do that; it's me merely clarifying my line.))

One month passes sans supplementation. Then a tearless trip to the phlebotomist (wherein the vampire siphoned eight vials out me, an indication to you of just how mant tests my attentive doc ordered). And a week later, back to my internist's office without a list of lurking symptoms.

The result of this experiment: I am absolutely healthy. No danger areas. No nearing Insufficient. In fact, all things necessary for good health now and great health in the future are in the higher part of the ideal range. The only supplementation I need to restart is Calcium. And not because my blood shows a deficiency, but rather as prevention because I'm the poster child for future osteoporosis. (I used to pedal an osteoporosis medication so this is something I know a little bit about; of the risk factors I have 3 of the most significant. Careful prevention's essential or I'll become a part of the clan of incredible shrinking women.)

No doctor, I'm not lacking iron. No other doctor, I don't even come close to having a Vitamin D deficiency. Instead, I'm a portrait of health.

MY PARAGUARDIAN

Sometimes gals who frequent this blog send me emails seeking more information on a topic or tidbit a post referenced. I'm quite sure that when these inquiring readers get my response they regret their email because what they receive in return looks like an eight part treatise that they know they'll have to sacrifice making dinner for the fam in order to read in entirety.

After composing my most recent IUD inquiry, it occurred to me that I should just post the response and if I get further questions I can just send over the URL to this longer response. Save myself a little time. (Not that I'm not happy to write the replies; I have just found that I've rewritten the same reply a few times.)

The question: Why did I go with the copper (ParaGuard) IUD as opposed to the plastic, hormone-secreting Mirena IUD?

A few reasons I'm pro-copper (for my own little cervix):

• With the copper IUD patients don't lose their periods. With Mirena, due to the progesterone it secretes, a patient could lose their period altogether or have it greatly reduced. That sounds lovely, I know, but although that time of the month is just plain rotten I'd rather have my monthly red reminder; it's a sign that I'm not pregnant and that the prevention I'm using is working.

• ParaGuard offers 10 years of protection rather than Mirena's 5 (or 7, depending on who you ask, but the FDA has only approved 5 years). I've had my ParaGuard for 7 years and I love that I didn't have to have it replaced two years ago.

• No hormones. The copper in the ParaGuard IUD is what prevents fertilization and/or implantation, while Mirena secretes 20 mcg (micrograms) of progesterone every day. Even though progesterone is widely considered a "better" hormone to have a little extra of in your body than estrogen, my body makes plenty of hormones and I don't need to add to it.

• Often women break out when they first get their Mirena, and I think I do a great job a making blemishes on my own as well. I know two gals who had a Mirena placed and then had it taken out when their skin exploded. A good friend has one now and just made an appointment to get hers out because of the same skin problem. Each of these women (a small sampling, I realize) are in very different stages in their lives and each has experienced the same problem.

That's why I'm a three-cheers-for-ParaGuard! chick.

There are a few caveats I'd be remiss if I didn't tell you about though:

With the ParaGuard IUD patients' periods don't only stick around, they can be heavier for the first six months or after placement. And, in my case, my cycle remains erratic. (But that randomness is common with all types of IUDs. When I go in for my annual and the nurse asks when the first day of my last period was, I always respond, I haven't a clue. She gives me a strange look. Then she asks my birth control method. I tell her IUD and she then nods her head in understanding.)

My period does come monthly, but I'm never sure just when in the month it'll drop in for a few days. But do know that in my case, it's not like the flow starts and I find myself up a creek without a tampon; there are are the same signs that I'm about to have my pleasant time of the month.

Additionally, with ParaGuard the cramping is worse. I'd never experienced cramps before I had my ParaGuard placed, but since that day my periods have been peppered with cramping. They are worse some months than others.

So although I get more cramps and have had a heavier, more erratic period, I love the ParaGuard because my skin stays the same (with the minor monthly upsets and punishment when I neglect to wash my face properly), my mood is unaltered by any additional hormones, and my period is a great reminder that I'm not pregnant. Whenever I am feeling cramps and realize that I essentially made the choice to get them, I just remind myself that the pain of cramps is much less than the pain of unplanned, unintentional child-rearing.

NEWS OF A VERY GOOD NATURE

I had my blood drawn today (routine, Ma, don't worry) and, for the first time ever, I didn't cry. Didn't even tear up. Was scared to be sure, but didn't find myself with a quivering lip.

Let's chalk one up for the good guys (whoever they may be).

A word of advice: Always tell the phlebotomist (I love that word) that you're skittish about needles; do that and you'll always get the butterfly needle. Unless the vampire is masochistic, but my experiences have indicated that generally they're quite empathetic, seeing as if you freak out their job gets more difficult. Butterfly: a good situation for all.

VITAMIN D: OUR LATEST PANACEA

About a year ago, I attended a physician speaker program on Vitamin D. (Actually, I've attended three or four talks where Vitamin D was the hot topic, but this one a year ago scared the devil out of me.)

Vitamin D? You may wonder? Why in the world would doctors take an hour and a half out of their busy days to listen to some peer blabber on about Vitamin D? It's a thing, okay? Vitamin D deficiency can cause many a problem. New data and research keeps on comin' out regarding the necessity of Vitamin D and what its deficiency can spawn. I leave every one of these talks reminding my self to up my Vitamin D intake . . .

At this particular talk a year ago, I went up to the speaker post-talk to tell him how compelling and downright scary his presentation was. Before I had finished saying, "I feel like I need to go home and start shoveling handfuls of Vitamin D down my throat," he looked me up and down and said, "You're deficient."

He didn't say in what exactly I was deficient. But for the sake of the conversation I assumed he meant Vitamin D.

And finally, I am pounding my daily Vitamin D. All 2000 IUs.

MOLE DIGGING

Constantly, I'm harping on my husband, my parents, my siblings, my friend (I'm not sure I have more than one) to stay out of the sun, wear exorbitant amounts of sunblock, and to have mysterious moles checked out. Harp. Harp. Harp. Megan the Harpy.

To be an example of practicing what I preach, I went to my dermatologist today for a full-body scan. I showed up to the doctor's office shaking in my boots. I knew said scan would turn into a biopsy. Why? 'Cause I'm me. And that's how things go if you're me. (And I am.)

Sho 'nuf, the very-likable-aside-from-that-whole-I-have-a-scalpel-and-needles-thing derm told me I should make an appointment to have a mole on my abdomen excised for biopsy. Of couse it's one of those no-need-to-worry-we're-just-being-safe moles, but nevertheless, Miss Megan was instructed to speak to the scheduler for an excision.

Yes'm. I muttered, envisioning shiny needles, scapels, and an intubation tube.

Does your schedule permit doing it now? a voice from the corner inquired.

Blast! I forgot about the husband I brought along. For moral support.

It's better if we can get it done today, the traitor confessed.

I knew the evil beast was right. I would fret from the moment the doc mentioned the necessary excision until the actual cutting appointment, whether it was hours or years. He just wanted to save me mental trauma (and save himself from hearing my babyish worries).

So two stitches. I have two stiches in the spot where they excised the mean mole.

Get your sorry selves to the dermatologists to have your skin scanned. I did it. Be responsible and take care of your skin so that your family isn't saddled with the responsibility later.

ORAL EGOTISM

They took 18 x-rays. They poked, prodded a lot, checked for bleeding, and took pictures.

It could have been traumatic. And for some it is.

But I love going to the dentist.

I love it because lying in that Naugahyde recliner is a total ego trip. I leave the office feeling like a million bucks. Every single time.

And I brag about it. I make the visit a competition with The Husband. Whoever comes out with fewer oral issues wins. I'm a winner. I always win.

Today we went to the patient establishment appointments with our new dentist here in Reno. I'm horribly embarrassed that it took me this long to get it together and schedule a check-up and cleaning.

I was a bit nervous, thinking, What if it's been too long since my last appointment [it's been a year] and everything has fallen apart? What if my last dentist had no idea what he was doing or saying and I actually have a mouth full of rotten teeth? What if I have to get a shot? (I've never had one in my mouth before, and am, of course, terrified.)

After my 18 x-rays, I perched nervously waiting for my new tooth fairy to arrive and check out my chompers.

She appeared and I saw that our Dr. Mary (as she has us call her) is way too pretty to spend all her time peering into other folks' oral cavities. So it was a little strange lying in what looks like a torture chair with some hot chick directing her brown, bright eyes in to my mouth. Fabulous bedside manner you could say. (But you shouldn't.)

Poking around my gums, "Have you bleached?"

Thinking, Oh dear, she's asking because they're dingy and yellow and need a full color overhaul, "Yes."

"They're very white."

Bless you, my dentist.

Wedging the round mirror in my mouth, "Oh, your mouth is so little! So dainty. All of you is dainty."

Dainty? Moi?

Bless you, my dentist-friend.

Reviewing my digital x-rays with me, "Everything looks great. No problems here."

Bless you, my dentist-love.

Bidding me farewell, "You have no worries. You have immaculate home care."

After that, I heard nothing else. I put Immaculate Home Care on a loop and let it play in my head for the rest of the day. Periodically, I sang along out loud.

Immaculate home care. She said so.

I so won the competition with Spouse.

(Thanks, Mom and Dad.)

TRIGLYCERIDE PRIDE

Want to know what that is? I'm here tell you: that there is the picture of health.

I take my health seriously. I’ve been blessed with great physicial health, and I safeguard that as best I can. This body’s the only one I’m gonna get (despite the fact that in the preexistence I signed up for Caitlyn’s silhouette, not the one I ended up with). I’ve consistently taken an interest in overall physical wellbeing, but the nature of my occupation has infused an increased vim for caring for my body in a preventative fashion. Thus the routine physicals that include the horror of a blood draw.

I went to my internist today for a follow up on that blood work, and when the darling woman walked into the patient room, the first words out of her mouth were You're really healthy!

She went over the lab paperwork with me. Yadda yadda CBC. Yadda yadda potassium. Yadda yadda calcium. All that’s fine and good—but I was after the cholesterol results. This is my first cholesterol check, and of course, I've been terribly curious up to this point. With all the yoga I do and the lack of meat in my diet, life would be awfully unjust if I had crummy cholesterol.

But today the world was a just and sunny place—blue birds flying all around and rainbows popping up here and there.

My doctor said that I should frame my lab paperwork. No kidding. (Picture me now shining a First Prize badge pinned on my chest; it's sure how I feel.) She commented that my cholesterol was so good that the thought had occurred to her that perhaps I hadn’t eaten the two days prior to my test. Ah, such was not the case; the day before my blood draw The Husband and I enjoyed an inordinate amount of pizza, cheese bread sticks and Jelly Bellies.

The news of my terrific cholesterol results got me so riled with pride that I started making phone calls once back in the car. Dad! I have great cholesterol! Mom! I have great cholesterol! Husband! I have great cholesterol! Coworker! I have great cholesterol!

Dear Reader! I have great cholesterol!

MY TWILIGHT EXPERIENCE

Healthcare providers that practice good medicine order blood tests. I happen to see one of those practitioners and was thus sent to the vampires. And I’m not talking about Edward and Alice.


Lab results take about a week to get to your physician. I waited until exactly one week before my follow-up appointment to do the blood draw. See, I don’t do well with needles. (Me too, you say—who actually does well with needles?) But when I say that I don’t do well, I mean that I cry. Like a toddler.

I behave like the adult I sort of am on the drive to the lab.

I behave like the adult I sort of am when I decide that I’m not going to ask for the kiddie butterfly needle—I’ll go with the adult-sized one.

I behave like the adult I sort of am while signing in at LabCorps and perusing Family Circle in the waiting room.

I behave like the adult I sort of am when walking to the back with the vampire.

I behave like the adult I sort of am until I see the chair I’m asked to sit in.

Then I cry. I try to hide it. The blood sucker sees right through my act. I’m not very good at this, I tell her. And in a flash of self-effacing honesty I add, I cry. (Like she cannot already hear it in my voice.) Do you have kids, the vampire asks as she wraps the latex tourniquet around my right arm. No, I whimper. Oh, I just thought that if you did, you’d have to be tough about things like needles. (Who says things like this to a 25-year-old with tears trickling down her cheeks?) What do you do when you have to go to the hospital? I-I-I’m healthy; I don’t have to go to the hospital often . . .

I do not remember the rest of the conversation that I believe I held while staring at the wall to my left.

It hurts. Not just a small pinch. A big pinch. I think of how stupid Bella Swan is to want to go through the change to be a vampire herself. It. Will. Hurt. Stupid. Four vials later, the vampire in the white lab coat is done. I mutter something cordial yet catatonic, grab my jacket, and stumble from the clinic to my sedan.

However, if ever you are Sparks and have to have your blood drawn, I recommend the vampire, Desiree. She barely leaves a mark.