Game Theory

Trying to figure out how to get all my vegetable servings in for the day has almost been like a game. I look at my tally calendar and see that it's already well past midday and I still have 5 more servings I need to get in! Then I have to do some major strategizing. It's actually kinda fun. It takes some planning indeed. Here's some of the strategies I have found to be helpful in meeting my vegetable daily intake goals:

1) I like to try to fit as many servings into breakfast as I can, so that I don't get myself into a bind later (for example, I am a nursing student and get home on Monday and Tuesday evenings at 11pm. I don't like to have to eat 4 servings of fruits/vegetables right before I'm about to try to go to sleep) What do I eat in the mornings to pack those servings in? Well, fruit smoothies work the best. I can get 4 servings in right there. I use a whole banana (which is 2 servings), and then a cup of frozen berries (another 2 servings). I put a scoop of Kashi chocolate powder in, a tbsp of ground flax seed, and then a cup of milk, soy milk, yogurt, or kefir and blend it all together. I also cook eggs often in the morning. I'll pour in a 1/2 cup of zucchini, spinach, and or bell peppers. Then I'll have a serving of fruit like cherries, grapes, or a grapefruit as a side dish.

2) Keep oranges, apples, frozen berries, frozen veggies, and dried fruits in the house. They keep for a long time and help out in those times when I didn't have time to get to the farmer's market or the grocery store.

3) Make a ritual of chopping vegetables for the week. I do my grocery shopping on Sunday mornings (when it's the least packed! and you don't have to fight for space in the aisles). Then I get home, do some things around the house, etc. Then at noon, the Splendid Table comes on NPR, so I put my portable radio on the kitchen counter and listen as I chop vegetables for the week. Caveat: Now that the local farmer's market is open, I go there on Saturday mornings, which means my Sunday grocery shopping ritual doesn't happen. I'm still in the development phase of a new ritual around the Saturday morning farmer's market encounter, but I'm thinking I could probably just listen to Splendid Table archives from the website on Saturdays while I chop veggies I just bought at the farmer's market. Other barrier to this weekend chopping ritual: I have found that in the summertime, I am out-of-town for most weekends, so I'm thinking about shifting my shopping and chopping days to weekdays.

4) Plan ahead for travel. For some reason, I always have in my head that I can only bring "snacky" things like granola bars and packaged items in my purse for plane travel. NOT TRUE. I flew back to Oklahoma last weekend, and I brought an orange and a banana in my purse, and they worked great. I thought ahead and remembered to bring an empty plastic ziplock to put my orange peel in. So yeah, fruits with sturdy peels like oranges, grapefruit, and bananas come already packaged, don't require rinsing, and smell better to your neighbor than a tuna sandwich. ;)
Helpful tip: so oranges can be particularly juicy. I always travel with a sarong/scarf around my neck, so that I can use it as a blanket on the plane, but it also came in hand for using as a towel to wipe all the orange juice from my fingers, face, and lap.
More notes on travel....It goes back to my treating-this-as-a-game approach. I've noticed this approach helps me make better choices at airports and restaurants. Instead of looking at a menu and being faced with the question of "What best satisfy what I perceive that I'm craving right now?", I now look at a menu and think, "What is going to give me the most fruit and vegetable servings?" It somehow becomes easier to choose the salad over the fries as a side or to choose a cup of fruit at the airport food kiosks or the banana near the cash register at the convenient store.

5)Eat your fruit/vegetable servings first at a meal. That way you don't fill up on the other stuff first and then aren't hungry for your fruit/vegetables and you may just find yourself so satisfied from the fruit/vegetables that you don't end up eating the chocolate chip cookie.

Success

While at times I feel like I'm not making much progress (my weight has gone up rather than down), then I look at my calendar on which I tally my fruit and vegetable intake and see that I have made tremendous progress there. Increasing my fruit and vegetable intake was a primary goal; weight loss was a secondary goal, so then I feel don't feel so down on myself and my project design.

When I started this project back in February, I was generally eating about 2-3 serving of fruits and vegetables per day. Now I consistently eat 7-9 servings per day, so I am really excited about having made plants a bigger priority and a habit in my daily diet.

While I am glad to see one of my primary goals being met, it might be time to do some redesigning of my project to speak to the weight loss component, since the literature shows a correlation between being overweight and developing breast cancer. So I'll be looking into making some adjustments in that realm of my plan.

the right kind of provider

One of the coolest things that has happened during this project involved my visit to a gynecologist who specializes in women's breast cancer issues. It was the best encounter with a health care provider that I have ever had, and I've been mostly happy with all my health care providers, but after going to this one, all the others now pale in comparison! Dr. S was so thorough in everything she went over with me. I felt like she was looking after me in all the areas of my health. When she saw in my family history that there had been multiple DVTs on my mom's side, she made recommendations and referrals for my sister see a coagulation specialist. She referred me to a dermatologist and assured me that this dermatologist was very aware of the correlation between skin and breast cancer and her beliefs in prophylactic removal of any sort of worrisome mole, and that she would be emotionally sensitive with her digital photography and not make me stand naked in front of a camera, then stick the pictures in my chart. :) She was also the first physician that actually addressed nutrition in a more emphatic and thorough way. She made suggestions of diet programs and the importance of lowering my body weight to prevent cancer. From personal experience and my own personal experience, I have noticed that providers tend to avoid suggesting weight loss or making nutritional changes. It's always really bothered me. I couldn't understand how nobody had told my mom the connection of red meat consumption with breast cancer or suggested to her any kind of nutrition and exercise changes. That seems like the cheapest way to do it. And it gives the patient some control.

While no one really likes to hear from someone else that they could lose some weight, it actually was refreshing for a provider to address it. It kind of was a wake-up. It wasn't the media telling me to lose weight, or my ex-husband, or my critical voice. It was an objective physician who is watching out for my health and well-being.

I was just so impressed when this physician sat down and went over all of these things with me. It really made me feel like I wouldn't slip through the cracks. I was being looked out for while I was also being expected to take responsibility for aspects of my own health. I might not be living in Durham a year from now, but I would seriously consider flying back for my yearly appointment with this physician.

In sight, in mind

I've been thinking I wasn't following through with my plan very well because it was too complex, but I just looked back over my outcomes, and they're not as many of them as I was remembering. I think the big lesson here is that I should have been reviewing my goals and outcomes on a more regular basis than every two months. I think my next action plan will be to make a few copies of my outcomes and strategies list and post them around (my kitchen, bathroom, breakfast table, car, and purse). That away the stress and energy that goes into trying to remember what they are (and as I've seen, my mind doesn't do that great of a job of remembering what they were anyway).

I am going to simplify one of my strategies, though. I no longer going to use the food chart from Beck's The Beck Diet Solution to write each food down that I eat. I think I viewed that as too tedious and time consuming. For my project, it's more important for me to make sure that I'm getting plenty of fruits and vegetables in my diet than to know how many calories I'm taking in. Weight loss is only a secondary goal for me, while the increased fruit and vegetable goal is a main outcome. I also think that my rebellious side kicks in when I say I can't have this and can't have that, so I'm going to focus on what I NEED to eat, and I figure if I'm eating 7-9 servings of vegetables a day and drinking at least 64 oz. of water a day, I probably won't have as much room as I usually do for the "bad" stuff anyway. So my food and exercise diary is now just a tallying each day of fruit/vegetable and water intake. It's back to the basics. Move more than 30 minutes, eat vegetable, drink water.

Simplification

I think my original plan was over-ambitious in that it was too complex. There were too many things going on with it, too many things were the focus in one day, making it easy to become lost and overwhelmed in it all. When I had a decent amount of time and energy to devote towards that complex plan, it was fine, but that's not sustainable. It's inevitable that life is going to bring about periods of high stress and time demands, so it's important to keep the plan simple enough to accommodate for that. It can be that the whole plan is simple or that there is a clearly laid out, simplified plan when time availability is significantly limited.

catch-up

Seeing that my blogging took such a hiatus, I feel a need to do a recap of the past two months.

Well, I definitely have seen that no matter how motivated and ready I think I am to take responsibility for doing what I can to control how my genes are expressed, there are some external factors that make that goal hard to maintain! Change is so hard no matter how much I want it. Humans are creatures of habit, and over the years, I've created some habits that aren't so conducive to my well-being. So this is a period of relearning.

I started out so motivated and excited and then lost momentum about after one week. Then when school demands were high and emotional life rough (winter weather, performance anxiety of being a beginner at something (nursing), not having an outlet for dealing with the illness, suffering, and death one often sees as a health care professional, etc.), my personal primary prevention project became lost its position as a priority and dropped down to a faint existence.

And it's so easy to be hard on myself. I get so frustrated when I realize how I put such an important thing on the back burner, but I would like to remember to be gentle with myself. Otherwise, I'll only end up with a backlash and rebellion against my new habits.

In summary, change is hard no matter how much you think you want it. So I plan on working on strategies to help me overcome this because will power alone won't do it. I need some tools and some support and a simplified plan.

recommitment

Wow. So I knew I had not been very diligent on my quest to reduce my cancer risk recently, but I think I was in complete denial about just how long I've let it go on. Two whole months have gone by since my last blog entry! While I have not been documenting my progress via blogging in the past two months, I haven't completely been neglecting my pursuit. Although, it hasn't felt like I've made working towards my fitness goals much of a priority either. But today's a new morning and an opportunity to recommit myself to the project.

post-poned blues

So today I was supposed to go have blood drawn to measure my cholesterol, triglyceride, and homocysteine levels. For an accurate reading, this requires that one fasts (no food, liquids, or medications) for 9-12 hours prior to the blood draw. And what do I do first thing when I wake up this morning? I ate breakfast!!! So it looks like I'll have to wait and post-pone part of my initial assessment to next Wednesday. Today, does however mark the end of my first four-day win, which involved drinking 64 oz. of water everyday, keeping a day map for each day, and having an eating curfew of 11pm. Sadly, I did not successfully complete this four-day win, since I forgot and ate something after 11 last night as I watched the Duke/UNC men's basketball game. But I did pretty well other than that, and am confident that I will achieve this next four-day win: my eating curfew moves up to 10:30pm, I will be exercising for 30 or more, and I will begin the four weeks of using Judith Beck's the Beck Diet Solution Weight loss Workbook.

Making My Day Map

Today I began taking an inventory of where I am at any given point in the day. I will do this for 4 days in a row in attempt to get a baseline idea of where my circadian rhythms are calibrated, so that I can begin to slowly and gradually change them to be more conducive to long-term, healthy, cancer-reducing living.

This was a suggested activity from Martha Beck's The Four-Day Win. As I suspected, I eat pretty healthy during the first 3/4 of my day when I'm busy with scheduled activities. I get home and have less structure and immediately begin to feed myself. A big key to making the changes I am wanting to make more permanent will be to replace the food splurges that usually occur at certain points of the day with other nourishing activities at that same part of the day. For me, such activities will include things like reading a magazine for 15 minutes or watching a TED talk online or going for a leisurely bike ride around a neighborhood or writing a letter on nice stationary.

In addition to the day maps I will be making for the next four days, I have also chosen to strive to get my water intake to be consistently at at least 64 oz. per day. Today while I was at clinical, I didn't drink near enough water, so I found myself playing catch-up the rest of the day, which was not ideal, since being dehydrated during the main part of the day left me with diminished energy levels.

You will be seeing this concept of 4-day increments for implementing changes since Martha Beck's book The Four-Day Win explains that four days is usually what it takes for your body/mind to get used to something. Then linking 5 four-day wins together for a total of 20 days makes something a habit. (and habits are hard to break!!)

so here's my disclaimer....this blog is in no way attempting to be giving others medical advice, nor is it endorsed by any of the authors or experts that may be mentioned in the text. it simply is an amateur's chronicling of a personal journey to make lifestyle changes to increase the amount of quality years of living using a variety of suggestions and techniques I have stumbled upon in one way or another.


Today I also went in and had a clinical breast exam performed. The results were negative for any worrisome masses/bumps. I took a baseline resting heart rate, bp, weight, and circumference measurements as well. I will be going in on Wednesday to have necessary labs drawn and a fitness assessment and body composition performed to complete my initial baseline assessment.

The beginning...

As a female in my mid-twenties, I have been hearing the message of the importance of administering self breast exams and early detection of tumors (aka "lumps") for the past 10-15 years via women's magazines, the gynecologist office, breast cancer campaigns, etc. This topic particularly grabs my attention since breast cancer has been a significant part of my own life. My mother has been diagnosed and successfully treated for two separate occurrences of breast cancer. When I was 21, my gynecologist detected a lump in my left breast during a clinical breast exam, which I then had an ultrasound performed to reveal that the lump was benign and due to hormonal fluctuations in my menstrual cycle. Nevertheless, that experience was a scary one, and one that has kept me awake some nights when I feel changes in my breast tissue or allow the thought of developing a malignant tumor take over.

The already high incidence rate of breast cancer in women all over the world and in the U.S. is enough to keep me on high alert. Add to that the genetic component often associated with breast cancer and the fact that my own mother has had it twice in the past 11 years, and I feel down-right frightened by the whole prospect of being directly affected by the disease. And while over the years I have done some reading on the topic and tried to implement lifestyle changes here and there to help reduce my risk of developing breast cancer, I am now choosing to go a few steps further and get a more organized, action-oriented, systematic approach to reducing my risk. The breast cancer worry will haunt me no longer, because I'll know and trust that I'm doing what I can.

This blog will chronicle my process as I work in 2008 to implement the life-long lifestyle changes that will help me live a quality life that is cancer free. :)