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My NP student just left after her final day here with me.

Ana is now in her later 20's. She was born in Mexico and came to the US in early childhood. She's the first in her family to finish college. She's the first in her family to get a professional license. In three weeks, she'll be the first in her family to have a graduate degree.

She's a sharp cookie, fluently bilingual, with a very caring heart. I see a bright future ahead of her and for her family and it has been my privilege to serve as her preceptor for the past 18 months. I only hope I've been able to teach her enough.

It's sobering to realize that she'll likely be practicing 30-40 years from now, maybe mentoring a new provider as I've done for her, learning the art and science of medicine. She'll be doing this long after I have hung my stethoscope up. Today for the first time, as she departed, it's hit me that my time to lay this burden down will come all too soon. Not tomorrow, not next year, maybe not for another decade, but it will come. My schooling, my residency is so long ago, it's no longer in my rear view mirror, not that the details of the learning process ever ends in this profession. Continuing education is a way of life to be able to do this job.

Mid-day we hit grand rounds over at the hospital. Really a fascinating presentation on bariatric medicine - the medicine of weight loss/weight management. (Not that this one doesn't hit way close to home!) Hearing a bariatric surgeon from the practice I went to in consultation 6 months and 85 lbs ago, was quite fascinating, particularly when it came to the endocrinology and microbiology of obesity.

I spoke with my colleague after he finished his lecture. He seemed truly happy to see me, asking for my details. The phrase "You look fabulous" is always music to my ears. I wanted to know what exercise does to leptin, and peptide YY. He didn't know. We did spend a bunch of time taking about the probiotics they're pushing at people and the research papers about it. The statistics of how many kids hit with large doses of antibiotics in early childhood wind up with weight problems. That one hit close to home as well. I was on tetracycline from the just past 2 to almost 3. The mouse studies they quoted with adjusting the gut flora and finding the mice's weight shifting from normal to obese and back to normal just with manipulating the gut flora is both fascinating and confusing. More questions than answers as of yet.

Enough gazing at my navel for now; I have too much to do. Time to head for home and hearth. Tomorrow it's back to the gym in the morning, and then here again to do battle with paperwork, trying not to feel like Sysiphus rolling the boulder up the hill.
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Somehow, I'm not surprised most of the time who notices that there's less of me. More often than not it's a diabetic, or someone else who's struggling with their own weight. Folks who don't have a weight problem often look at me and think, "now what's different?" I can't tell you how many times I've been asked when I cut my hair or if I just trimmed my beard. (For the record I haven't cut my hair since 1992, and I always trim my beard down to 1 inch in length at least once a month, if not twice.)

No fewer than 10 patients today commented to me about my weight, or rather my weight loss. Most were surprised having not seen me in the last three months. Today marks three months since I started. The statistics? I've dropped 52 pounds, 8 inches off of my waist, 3 suit sizes, 4 pants sizes, & 2 shirt sizes. By my calculations, I've run 170 miles in that time, and probably walked in equal amount.

I am not hungry all the time. I have said this to people, and more often than not, they stare at me in disbelief. "How can you not be hungry?" I would think I would know if I were particularly hungry. So many have made comments to me about my willpower. I honestly don't think it's particularly strong.

I'm simply faced with choices. I can live without my arthritis & my psoriasis, or I can eat wheat. That one's a no-brainer. Now that I understand the connection between the two, it's no struggle to make that choice. Staying off of the wheat reinforces my choice to stay low-carb as well, and with exercising, I'm losing significant amounts of weight. I feel better. That one's also a no-brainer for me. It's not a matter of willpower, it's a matter of how I want to live and what I want out of life.

My Doc was right. I didn't give up wheat; I've been liberated from it. There's no cold turkey for me. There are no white knuckles here. I have been asked by a fair number of people if I miss certain foods & my honest answer is, "not really". For a man who never met a slice of bread he didn't like, this is a C-note change. Like I said, I can live without my arthritis & my psoriasis, or I can eat wheat.
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I fell into bed last night at 10, so when my bladder awakened be at 5:30, there was no going back to sleep. It left me time to get to the gym for a run prior to work.

I find when I get on the elliptical, each time I try a slightly different goal to see how it feels. Some runs it's to get to a certain mileage goal, other times to reach a certain calorie count, and still others to focus on the time spent. Today it was to try and keep the heart rate within the recommended levels for the most amount of time. More often than not, I allow it to get into the 150's, which was appropriate for when I was in my 40's, but now the machine says to stay at 136 or less. I cannot push as hard as I have been if I meet this goal, but I got a sense today of how I feel when I observe it. I did 54 minutes today, 3 2/3 miles and hit a caloric burn of 805, keeping the heart rate at under 137 for 46 of the 54 minutes. I quit today 6 minutes short of the hour because I was tired. Enough was enough.

Stopped at the hospital for a light b'fast and to use the electronic scale. I'm definitely off of the plateau I was on. I checked with my Doc's office; between the visit I had last Monday and 2 weeks prior to it, I dropped 5 lbs. In the last week it's been 8. I'm not eating or exercising any differently in that time.

I was rewarded today with one of my colleagues in the MD lounge, looking at me and wrinkling her brow. Then she asked if I was losing weight. She was the first one to notice and say something.
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I'm so loving this.

Today marks two full weeks completely wheat free. I walk without pain most of the time. My hands are working with no trouble. No longer am I having to deal with red, swollen, tender, hot joints in either my hands, feet, wrists and most importantly, my ankles. I have my moments where there's some discomfort from challenging my ligaments, but they're fleeting and controlled by my morning Celebrex.

And I'm no longer constantly scratching my head because of the psoriasis. It's a fraction of what it was.

This morning I ran on the elliptical at the gym for just over 45 minutes, covering 3.1 miles and burning a glorious 700 calories, if the machine is to be believed. A 15 minute mile ain't bad for someone my age, and for somebody my size, its downright impressive according to my doc. I had an appointment at 10:30 this morning and left the car at my office, choosing instead to make the 2 mile round trip on foot, just because I could. (And I am blessing my podiatrist office neighbor, who got me into these running shoes which are giving me the correct foot/arch/ankle support so I'm able to do this without injuring myself. He caught me me going out for a hike on Sunday afternoon and called out to me from behind, "not in those shoes you're not!")

So far I've said goodbye to 19 lbs since I started with the change 3 1/2 weeks ago.

Figuring out what's safe to eat is still a bit of a challenge. Deciphering wheat products in all of their incarnations is interesting. Maltodextrin? No, not on the list of things that are safe. Did that soup get thickened with flour or cornstarch? Not chancing it. Dealing with picking the croutons out of my salad, even though I told the waiter not to add them, and then skipping the dressing in favor of just plain oil and vinegar on the table. Again, hold the maltodextrin please. At least the waiter heard me, when I said, "dressing on the side please." It is however so totally worth it, not to have the arthritis and to be able once again, not feel disabled. It's kind of hard to identify as disabled, after doing a 3 mile run on the elliptical.

Incidentally, that's not something I would yet dare to do on open ground, and may never think of doing so. Running, your feet hit the ground with 3 g forces - multiply your weight by 3 and that's what your feet and weight bearing joints 'see' with each foot strike. The damage left by the 22 years of the psoriatic arthritis ain't going to tolerate that at my current size. One technically pedals an elliptical, so its a superb cardio workout, without the joint trauma. I've always wondered what it would be like to run a marathon, though. I doubt that with ever happen, but who knows? It I lose enough, I suppose anything is possible. Without the wheat on board, and without the pain, I itch to move every morning when I get out of bed. I can't wait to get out and see things, listen to the sound of the wind in the trees, in my hair, on my skin. It's delicious.

And this morning I finally felt it again. The first recurrent inkling of the runner's high. That was one of the things I used to love about the elliptical. Once upon a time it would hit at about 25 minutes in to a run. This morning I had my first taste of it again, some 35 minutes in. What a delicious sensation!

Off to patient care. My day awaits!
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I've just gotten back from an hour-long walk. I covered 3 miles; actually a little bit more.

Sitting down right this moment this feeling really, really good.

Walking is feeling, well good. It isn't the high that I remember having 10 years ago when I was working out on the elliptical stepper. I started out on the elliptical because it was possible for me to do, plus it was accompanied by a really great calorie burn, but honestly I never thought I'd fall in love with doing it. However, when I got to a point that I could do 20 to 25 minutes of fairly exertional jogging on the machine, I began to experience the runner's high. Up until that point I'd always thought the people who talked about the runner's high were indulging in a group hallucination. I remember being in the state where the sweat was simply pouring off of me, and all of a sudden there'd be this sense of almost euphoria, a sense that "God is in his heaven and all is right with the world."

I guess it's too early to expect that again, but it simply hasn't happened to me, at least not yet.

The rains will be arriving in this part of California likely within the month. We had drizzle light rain early this past week. Once the rains begin in earnest I am not going to be hiking out-of-doors the way I've been doing for the last couple of weeks. Now my husband and I purchased a gym membership a dozen years ago at 24 hour fitness. By paying for two years upfront, we got renewals for life for $49 per year. Even though I have not been using it the last several years, I've been continuing to pay that small amounts in hopes that I would get back to the gym. That day was yesterday.

Last evening at six I walk then, changed clothes and got onto an elliptical stepper for the first time in longer than I care to remember. The machines have changed a bit; either that, or I've gotten shorter. I managed 32 minutes and according to the machine 2 miles, Burning (according to the machine) some 400 cal. I had to adjust the machine couple of times while I was in the midst of my 'run'. Resistance first was moved up and then down. Incline got changed, & 25 minutes in, I needed to reduce the incline by almost half. It's interesting to be on a machine that monitors your heart rate. I managed to keep mine smack in the middle of the 150s.

I will admit to you I am feeling it today. My glutes are aching, in ways that walking does not produce. Similarly my quads. This may not make sense to anyone who's not involved with exercise, but it's definitely a sense of it hurts so good. Frankly when I got home last night, I expected I'd be a lot more sore today than I actually am. It certainly didn't stop me from doing a 3 mile hike just now.

I stopped by the gym to step on the scale; apparently, I've dropped 9 1/2 pounds since I started, not quite two weeks ago. A chunk of that is water weight I'm sure. Still, nine a half pounds is nine and half pounds and I am grateful not to still be hauling it around.

I hope you all will bear with me. I'm sure that posting about this has got to seem somewhat self absorbed. So be it. I'm still amazed at the difference in how I feel. Two weeks ago tomorrow, I eliminated 90% of my simple carbohydrate, the bulk of which were wheat products. As of today, I am four days, completely wheat free. My psoriasis is all but gone. Granted, my skin disease was mild, but I was constantly scratching my scalp due to the itch that the plaques caused. Well there's no more scratching, because the plaques are basically gone. Yes, I still have joint pain, but the character of the pain has changed. The inflammation is gone. There's no more redness, swelling, or increased warmth. The permanent joint changes I have suffered are still there and those will not be going away. However, while sitting down right this moment feels really, really good, I can get up and walk, even after the hike I just took, without abject misery and that is clearly progress. If this is what a eliminating wheat will do for me, then I'm willing to do it.

The other thing that I'm remembering is the other thing that exercise to me, which is it's surprisingly an appetite suppressant. Hiking and the elliptical don't leave me ravenous, they leave me not really particularly hungry.

Well, time to head for home. I need to get the recycling done and there's a shower with my name on it.

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