Tuesday, November 26, 2013

Whole30 Update

I wrote this a few weeks ago:

"I'm on Day 10.  It's interesting.  I think I went into this whole thing with simultaneous beliefs of, "This will fix EVERYTHING," and "It is impossible for diet changes like these to fix ANYTHING."  I am so far wrong on both counts.  My favorite things so far, in no particular order:

1.  My food is delicious.  It's tasty, and I feel good eating it because I know how wholesome it is.
2.  I am not hungry in between meals.  This is huge for me.  I used to get so cranky and hungry in between meals during my epically long school days that I would often develop migraines and/or resort to eating crackers or trail mix or whatever I could find in the vending machine.  Now, I make it to my next meal, with maybe a small snack (packed and planned) if it's a really crazy day.
3.  I get hungry before meals, but not "hangry."  I am not the first person to discover this while eating Whole30/paleo, and I'm sure I won't be the last.  It's a very liberating feeling, to not ever feel like If I don't find a food item to put in my mouth this very instant I will either melt into tears or just DIE OF STARVATION."

So!  All of those things were true and awesome and I felt a lot better for the two-ish weeks that I made it without messing up on the Whole30.  Then the fact that my other half moved to a different city and we spent two frantic weeks finding an apartment in said city, packing up all his stuff, and moving him to said city - yeah, I got a little distracted and found it impossible to pack and eat paleo/Whole30 food all the time.  While I was doing it, though, I noticed improvements in my skin, my GI system, and I lost about 6 pounds.  But over the last few months I've been feeling more and more run down, and that didn't improve, even as everything else did.  I chalked it up to me not lasting the whole 30 days.  Until it got worse.  And worse.  And then I went to donate blood and got turned away for the second time in six months because my hemoglobin was too low.

A doctor's appointment and several vials of blood later, there appears to be something wrong - which is both a relief to not think I'm making up how crappy I feel, but also anxiety-provoking in that I'd really like to know what it is, please, so I can do something about it.  Some of my key vitamin levels were quite low, as was my hemoglobin, hematocrit, and most especially iron (after some serious meat-chowing, no less).  For the next couple of weeks, I'm under doctor's orders to eat as much gluten as I can stand, because she wants to see if I have celiac disease, and that's only accurate if you've been eating gluten for at least three weeks.  Even after I stopped attempting the Whole30, I was still eating substantially less gluten than I had before, and the difference now is marked.  My face is breaking out, my chronic skin stuff has flared up and is the worst it's ever been, I'm nauseas and bloated pretty much 24/7, and I seem to have misplaced my waist.

As much as I love baking and all things flour, I can't wait to be given the all-clear to go back to no gluten (even if I don't have celiac).  And then maybe I'll give this Whole30 thing another shot.

Thursday, November 14, 2013

What I Know Now

My patients, they do not leave me.  We exist now as a group, I feel them stringing along behind me when I walk to class or to my car, they hover over my head when I lay down and try to sleep.  Their voices echo in small phrases, glimpses swim in front of my tightly shut eyes while I rub the now permanent line that is etched between my eyebrows.  I struggle to recall faces, instead my mind is filled with a collage of body parts that I try to piece together - clenched hands on the exam table, the paper crinkling under their white knuckles, pale inner thighs that shrink away from my touch, chapped lips that answer my questions in whispers, eyes that won't meet mine.

Sometimes my patients are like the horses I grew up drawn to.  They size me up as I walk into the tiny exam room, the whites of their eyes following my every move.  I sit and lean back against the wall - I have no agenda, I want them to know.  I have tamed the single-minded eagerness to explain, to educate, to inform, to counsel that often fills us as we learn.  I know so little, it seems, I have been trusted with so much, I want to impart every speck of what I can offer, because even that is not enough.  Instead, I sit down and say hello.  I smile.  I ask how they are, and what brings them to me.  I set my pen down and listen.  I nod, and they seem unsure if they should continue to speak when I don't interrupt them immediately with questions.  I've stopped trying to have all the answers, but sometimes the questions still make my heart pound with anxiety.  I ask them anyway, my voice soft, the walls are thin, do you feel safe at home, where are these bruises from, how many partners in the last year, can you tell me how often you're shooting up, are you planning on becoming pregnant at this time, have you ever had symptoms like these before, how long have you had this pain?  I say, I'm so sorry that happened, that sounds really difficult, you don't need to apologize, ever, can you let your legs fall out just a bit more, you're in charge here, okay?, will you tell me if this hurts, let's use the other arm for this blood draw, let me know when you're ready.

I think back to a before time, when it felt important to do it all perfectly, to remember the order for collecting a Pap and how many centimeters into the cervix to insert the cytobrush in order to extract a sufficient sample, to perform a breast exam so flawlessly that no inch of tissue went unexamined by my probing fingers.  I think back to when I would recite my pelvic exam "lines" in my head on the drive to clinical, terrified of forgetting our textbook's directions for the best way to elicit cervical motion tenderness and what that would mean.  The words fall out of my mouth now, scoot all the way down, this is my hand on your leg, these are my fingers, this is the speculum, lots of pressure now, cervix looks good, little crampy now while I take a sample for the lab, you might have some spotting today, no need to worry, speculum coming out now, we're almost done, these are my fingers again, I'm going to press on your belly, any pain while I do this?, I'm making you have to pee, I know, okay, you are all set, you can scoot on back and up.

I know now that a sufficient sample and a smoothly performed exam do not erase the bruises on her inner thighs.  I know that my ability to rattle off the medication regimen for gonorrhea, chlamydia, pelvic inflammatory disease, and herpes does nothing for the woman whose trust has been shattered by a disease she did not give herself.  I hand her tissues and say, again, I'm so sorry.  I hope, maybe, that this tiny exam room with the fake wood paneling and the ancient posters on the walls can be something more than a bizarrely furnished box.  This tiny space we share where I ask them about their day, their dogs, their children, where I admire their socks and listen to what they say and even harder for what they do not say.  It is in this place I think, maybe, that in spite of all my weird and deeply probing questions, in spite of my hands inside them and my far from perfect technique, even in spite of all that I fumble and trip over and the answers I do not have, it is my hope that they feel safe.  That she sees that when the door shuts, I am with her and that is all that there is.  That I am long past the point of ever batting an eye no matter what she may ask or tell me, and that I will do my best to answer her questions but will tell her frankly if I cannot.  And maybe for five or ten insignificant minutes, maybe that is enough.

I've stopped trying to be right.  I only try to be kind.