Thursday, May 25, 2017

Finding the best answers to your questions

One of the most important skills you will ever learn in your life is figuring out which questions to ask and when to ask them to get the answers you need. You will never learn how to do much of anything in your life if you do not learn how to ask questions and, not only that, but learn to question the answers you get in return.

For instance, "I want to learn about apples." is not a question. It is a statement. "Teach me about apples!" is also not a question. It is a command, even if you add the word please. Think about what you really want to ask. "Can you teach me about apples?" Okay, now you are getting closer to the question you really want answered. "Will you teach me about apples?" Even closer, but the topic at hand is a large one. Look for where you actually want to start learning. A good question to start working with is "What makes an apple good to use in an apple pie?" This question is a good question because it is specific and gives the person you are talking with an idea of what you are actually interested in learning.

Here's another example. Say you want to learn how to bake bread. First of all you would find someone that knows how (the right person). Then you would wait until they have the time to help you and a place ready to show you how to bake bread. You would try to read up a little ahead of time if you can and show up well rested and ready to learn, hopefully without any preconceptions (the right place and time). Now you could ask them what the chemical structure of bread is, why it browns when it bakes, or what type of butter to use on it, but none of these are very good questions to help you towards your goal of learning how to bake bread. True it might be useful information, but you can always learn the answers to those questions later once you have learned the basics. So your first questions should be, "What are the ingredients we use?" and "How do we start?" two specific and useful questions.

A good question asked at the right time to the right person helps the person answering it almost as much as it helps the person asking it. If the person you are asking questions to has no idea of your level of knowledge of the subject or your specific area of interest they cannot help you nearly as well as they could if they knew these things. Good questions are one way of helping a person understand what you want to know and what level of difficulty you want it explained at.

Sunday, May 14, 2017

The Curse of Invisible Illnesses

The hardest thing about having an invisible illness (other than coping with the illness itself) is that people do not understand the symptoms and can judge others for them. This happens even within communities of people who have the same, or similar, invisible illnesses or who are caretakers for people with them. The problem is in so many cases symptoms manifest differently for different individuals even if they suffer from the same illness. In addition to that, people expect certain behaviors and actions to mean certain things. On top of the challenge living with the invisible illness, people need to navigate the often rocky roads of social interaction that are only made more treacherous by their condition.

Invisible illnesses affect people's interactions with others on a daily basis. People who do not live with these challenges often have trouble understanding how much it can limit the person with the illness or how different that person's experience of the world is from theirs. When someone is affected more or less by their illness than another person it can change the entire experience making one person's life completely different from the life of another with the same diagnosis.

Take, for example, two individuals with Autism Spectrum Disorder. One might be non-verbal and have some mental delay, but be able to adjust to change and deal with chaos, while another could be brilliant, but meltdown over the slightest change in schedule and be unable to eat food with any texture to it. These are extremes, but you can see how the two individuals would have very little understanding of the other's struggles even though they have the same disorder. You could make the same comparisons for anxiety, depression, and even physical conditions like Chron's or hiatal hernias. While the majority of individuals will have similar symptoms those on the extremes or those with multiple conditions or complications will have very different experiences than the norm.

Society depends on social constructs. For example, white lies are considered just part of life to most people, the grease for society's wheels. “How are you?” is answered by, “I'm fine and you?” whether or not the person is actually feeling fine. How about when a person, say with autism, does not understand the concept of lying? When every answer is the straight truth? That person is thought to be rude, abrupt, and lacking in manners, maybe even self-centered, but that is just how they are. There is no intent to upset the people they are talking with. So something that sounds positive, difficulty lying, becomes something that sets the person apart from others and not in a positive way.

Most people read others' actions based on their experience of the world and within the framework of societal constructs. This works most of the time for most people until complications like invisible illnesses are thrown in. The easiest way to avoid the problems that can spring from this is to not judge, specifically to not immediately judge negatively. Consider what could cause the person to do what they are doing beyond what your knee-jerk reaction to it is. Ask them if the motivation for an action is unclear and then believe them when they tell you. Most important of all, never tell the person they do not have the challenges they say they do or place moral judgment on them for actions necessitated by their invisible illness (like canceling plans due physical or mental complications, not understanding subtle cues, meltdowns, panic attacks, etc). Dealing with the physical and emotional impact of invisible illnesses is hard, throwing in having to dodge the misunderstanding of others based on it is something most people never expect when they get their diagnosis.

There is a wonderful article, The Spoon Theory, that explains part of what living with an invisible illness is like: http://www.butyoudontlooksick.com/…/writt…/the-spoon-theory/

Saturday, May 13, 2017

What is Autism Spectrum Disorder (ASD)?

Many people have heard of autism, but there is a lot of misunderstanding about what it actually is. Autism Spectrum Disorder (ASD) is a developmental disability that currently affects approximately 1% of the world population and about 1 in 68 children in the United States. ASD is an umbrella term that includes the previous diagnoses of autistic disorder, Asperger syndrome, PDD-NOS (pervasive developmental delay - not otherwise specified) and childhood disintegrative disorder. Boys are diagnosed with ASD at a much higher frequency than girls, although this may be due to misunderstanding of symptoms in girls therefore underdiagnosing them. ASD is a lifelong disorder. It is not something a child will “grow out of” and early intervention can greatly improve a child’s long term life experiences.

What classifies a person as having ASD is trouble with social communication and a need for repetitive behaviors. People with ASD range from being significantly impacted by their disorder to highly functioning and can range from severely mentally challenged to brilliantly gifted. No two people with ASD will show exactly the same symptoms. Only a very small percentage of people with ASD are savants.

Some things that are common in people with ASD are:
- Lack of eye contact
- Trouble relating to other people in a "normal" way
- Trouble expressing themselves, particularly emotionally or in social settings
- Fixed and repetitive behaviors
- Intense interest in a single or limited number of (often quite unique) topics
- Trouble adapting to changes in routine
- Odd speech patterns or speech delay
- Taking everything literally, trouble understanding figurative language or pretend play
- Abnormal reactions to sensory input
- Stimming (repetitive behaviors that are either self-soothing or in response to intense emotions)

Children are often diagnosed when their parents and pediatricians see that they are not reaching the same milestones other children their age should be meeting, although some children are diagnosed when they start losing skills they had already acquired. Although moderate to severe cases are often diagnosed by the age of two, many children, especially those who are less impacted by the disorder, are not diagnosed until much later. Some people are not diagnosed until they are adults.

There are many other conditions that are comorbid with ASD. Many people also have seizure disorders, sleep problems, stomach conditions, mental health issues, and sensory processing disorder to list a few. Due to autistic symptoms (like being non-verbal or processing sensory input differently) it is often hard to diagnose comorbid conditions in individuals with autism and in many cases they are written off as “part of the autism” when they are actual separate issues.

Although there is no completely established cause for ASD yet, there has been research and we are currently learning more about what might cause it. Although originally it was believed to be caused by lack of emotional connection by the mother, that is no longer believed to be a cause. It is believed that there is a genetic component to ASD. It has been shown that if a child has a sibling with ASD they are more likely to have it themselves and it does tend to run in families. It has also been shown that ASD is most likely triggered during gestation or shortly after birth. Children who are premature or low birth weight, born to older parents or to mothers who took certain drugs or had certain complications during pregnancy are more likely to develop ASD. Although there is a huge debate about a link between vaccines and autism, many large studies have been done and, as of now, the science stands firmly behind no link. The CDC is currently doing a large, ongoing study called SEED (Study to Explore Early Development) in hopes of finding out more information about the cause.

Many people are dismayed at an ASD diagnosis, but unless functioning is highly impaired and there is significant mental delay many, if not most, people diagnosed with ASD can live full lives, going to school, working, marrying and having children of their own. A diagnosis just explains why things are different with a person and allows the people around them to give them the support they need to thrive. There are many interventions and supports available to people on the spectrum today. People with ASD are just experiencing this world in a different way than the rest of the population.

Sources for details that were not already stored in my brain:
https://www.cdc.gov/ncbddd/autism/index.html
http://www.autism-society.org/what-is/facts-and-statistics/
https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/index.shtml


Saturday, May 6, 2017

Weight Loss: I finally met my goal weight

Most of my life, I wasn't the type of person who really cared about what I ate or what I weighed, although I knew that staying at a healthy weight was important. I wore what felt good and looked acceptable to me. I wasn't concerned about the number on the clothes or the brand. I knew I was healthy enough to be as active as I wanted to be. That was really all that mattered.

I had been raised with my parents thinking I was fat and trying to fix the problem, in both subtle and not-so-subtle ways. My mom just flat out told me I was fat and needed to lose weight, but also insisted I eat whatever was put in front of me and fed me way more food that I needed. My dad did things like talk about how clothing styles and hair cuts affected how people looked, or what camera angles were flattering. He also cooked in the healthiest way he could in the 80's and 90's (if you tried to eat “healthy” then you will understand how unpleasant that can be), both to help his health issues and to improve my weight. I, however, never really cared that much, beyond just accepting I must be fat. However it did train some seriously unhealthy things into my world view.

When I came home from college for a visit, I saw a picture of myself from senior year up in my allergist's office, but I had no idea it was me at first. It was a familiar person, a pretty girl, I must have known her, but she couldn't be me since I was fat and she was definitely not. When I realized it was me, I was in shock. I had never seen myself like that, as “pretty,” not as “fat,” and the two terms were definitely not meant to go together. The me I saw in the mirror had never looked slender and attractive like that. I realized then I hadn't actually been fat when I was in high school. I had been 5'7 and wore a size 10. I walked and/or biked miles daily. I was strong. I had been perfectly healthy and completely convinced I was fat. The problem was, by that point, I was decidedly on the route to officially being fat (thank you, college cafeteria food) and my innate view of myself in the mirror was permanently warped to view what I saw as fat and unacceptable.

I got engaged in 1999 and, like many women, decided to lose weight to look as good as possible for the big day. I already did martial arts, but I focused on it more and tried to eat healthier. I also joined a group called TOPS (Taking Off Pounds Sensibly) with a friend of mine and weighed myself for the first time in years. I was 205.5lbs the day of that first meeting and I knew I had already lost some weight before making it to that meeting. The last weight I remembered weighing was 165lbs and that was during my senior year of high school, five years prior.

Around that time a picture was taken of me that reinforced my decision. I had no idea I looked like that! I knew I was overweight, but I really looked fat. I took it as good incentive and that that first year in TOPS I lost 15lbs. I stayed in TOPS, actively trying to lose weight and was working construction, but I when I got pregnant around three and a half years later I weighed exactly the same weight I did at my wedding, after many ups and downs on the scale.

I was diagnosed with gestational diabetes during both of my pregnancies and learned a lot about nutrition and healthy eating. I also learned that after two bouts of gestational diabetes my chances of getting Type 2 within ten years of the birth of my second child were well over 80%. I also managed to keep my pregnancy weight gain down to an reasonable amount, around 25lbs with the first and 20lbs with the second, and lost most of it between pregnancies and a lot of it after the second.

At that point, I started having health issues, many of which I learned could be eased by weight loss, and I kept trying and trying to lose the weight while struggling with one health issue after another. I kept a food journal about 90% of the time since 1999. I stayed with TOPS for close to a decade. I tried pills, many kinds. I tried exercise. I tried teas. I tried fad diets. I tried cleanses. I tried life style changes. I read books. I monitored my calories. By 2016, I had been keeping under 1400 mostly healthy calories a day with sensible exercise for three years and I had gained ten pounds in that time. The entire time I had been constantly obsessed with food and disgusted with my physical appearance. Body dysmorphia is a painful struggle, no matter what other people see, all you can see is a warped and awful image of yourself.

A previous specialist had suggested a weight loss medication, but I didn't like the idea of just taking more pills. Between my health issues and the continued weight gain though, I decided to look into it. At this point I was sent to a nurse practitioner who specialized in weight loss. She checked me for underlying health conditions and found some. She put me on a slightly lower calorie count while we dealt with that and then started me on phentermine, a prescription amphetimine used for weight loss, because it was the cheapest option (my insurance wouldnt cover any of the weight loss medications and I didn't have much money to spare). Normally it can only be prescribed for three months, but in her program she can prescribe it for six. I had to see her monthly, have my blood pressure carefully monitored and had to have an EKG before I started on them. I was also told I could eat as few as 1000 calories a day during this time.

I was prescribed phentermine for six months, but it took almost nine months to make it through all of them due to taking a month off for the sake of my blood pressure and having to stop for awhile before and after surgeries (I had three in that time span). When I started in this nurse practitioner's program I weighed 206lbs. My highest weight ever had been around 230lbs. The lowest I ever made it to before was 180lbs. My goal weight had fluctuated through the years as well, depending on which doctor I talked to. It had been as low as 150lbs and as high as 165lbs This one told me staying between 170lbs and 175lbs should be a good healthy weight for me.

Now, after a short stint being pre-diabetic, my youngest son is nearly ten and I am very definitely not diabetic. In fact, on January 21, 2017 I hit the top of my weight range goal. I weighed 10 lbs more than when I was a senior in high school. When I get to the bottom of my range that will only be 5 lbs more. I feel as though I look “right” in clothes now, like the image I see matches the one in my mind. I don't look like I did in high school, of course, and there are some changes that came with weight loss that bother me, but I am lighter and healthier and I finally made it!

1. Keep a food diary, preferably online so it can track the calories for you. Measure your portions and write the food in your diary before you eat it. Write down everything you put into your body that has calories. You will be amazed at how aware you become of what you put into your body and when. Find problem times and/or foods and come up with acceptable alternate options. Always serve yourself a single portion instead of eating out of a bag or box.

2. There are no bad foods, just bad quantities. A slice of cake is fine, an entire cake, not so much. If you buy high quality treats and eat a single portion slowly, truly giving yourself the time to savor the flavors and textures, you might find you need less to feel satisfied than if you mindlessly shovel down cheap options. Spending the money on high quality treats can also make you value them more and try to make them last longer before you have to buy more. Restricting a specific food, unless you have an allergy, almost guarantees you will cheat and then blame your “poor will power” and yourself for it. If you want chocolate, have it! (I did pretty much every day the year I reached my goal.) Just have a single serving (or less) of high quality chocolate and give yourself the time to enjoy it.

3. Work with a doctor. There are many underlying health issues and medications that can make losing weight difficult or even cause you to gain weight. Make sure you are not struggling needlessly against your own body. Get a healthy weight goal range for your age and build from your doctor. Dress size and BMI are not the end all be all and your doctor will be able to give you a truly healthy weight goal as well as a sensible and safe daily calorie limit.

4. Taking in fewer calories than you use is how you lose weight. Have a calorie limit and try to keep under it the majority of the time. Exercise, but don't panic if you aren't spending an hour a day sweating. Exercise is necessary and good for your health, but recent studies have shown that it is not as important to weight loss as people thought. Generally the calorie burn from exercise, unless you are obsessively exercising, is too low to affect weight loss significantly. I reached my goal weight when I was the least physically active I have ever been due to two foot surgeries and an abdominal surgery, so you can't blame physical inactivity for lack of weight loss.

5. Last but most important, you are human and therefore imperfect and that is just fine! You don't need to be perfect to lose weight and be healthy. You just need to meet your goals more often than you don't. You wouldn't chew out your best friend for eating too much at a party, so don't do it to yourself. You would tell your friend that they will do better, no one is perfect, it's a process, they are doing good most of the time, and so on. Don't treat yourself any worse than you would treat your best friend.

Before

At goal weight

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