WEEK 6 - "If it doesn't challenge you then it doesn't change you." - Fred Devito

I know it sounds trite to define a term as an opener (7th grade writing class, anyone?).  However, it is fitting to start with the definition of stress as I have learned a lot about it in my life and while out here in Portland.  Stress is, "strain or tension resulting from adverse or very demanding circumstances." 

I am by no means saying that my sabbatical is a stress in my life.  Rather, the contrary!  But, I am putting the big picture together as I reflect on the three major components to my sabbatical thus far: Heartland Fitness Resort and Spa, Crohn's case study, Portland.  Let me elaborate....

I spent the first couple weeks of my sabbatical at Heartland Fitness Resort and Spa.  I was learning the business, helping out wherever possible, and spending time to reflect on the health/wellness industry.  I met a wonderful woman during that time.  She came to Heartland to work through some difficult life decisions and process some hard things that were revealed to her prior to her arrival.  While at Heartland, she focused on self care.  She ate healthy food when she was hungry.  She motivated herself to exercise at least three times a day.  She took time to sleep when she was tired.  When she felt she needed to be alone, she gave herself that grace; and when she needed to share she found a healthy person to explain her thoughts.  In three weeks, she was a changed woman.  Was it Heartland that changed her?  I would argue she changed herself.  She stepped back and listened to her body meeting her own needs as they surfaced with timing and grace.  In doing so, she was able to decrease the stress/strain in her life so she could focus on growth and renewal.  

After leaving Heartland, I worked with my Crohn's case study.  Through research, interviews and listening to the doctors I realized that stress is often the main trigger for flare ups!  Things that cause stress are easy to pinpoint at times.  However, many people don't realize that lack of sleep, not eating when hungry, and just letting life "get to you" cause stress on the body.  That stress translates to an increase in inflammatory chemicals.  The inflammation is the root of many diseases such as heart disease and diabetes.  As many of my friends state about me, I live in a happy bubble where things just go right.  In my world, medicines work.  In my world, a change in diet will cause the health outcome desired.  In my world, sleeping can be a cure all for many things like a headache and flu.  But, Crohn's is different.  Medicines work or don't work...regardless, they can have terrible side effects.  Changing the diet doesn't always produce positive outcomes.  In fact, a diet rich in fiber, fruits, and veggies can cause more harm than good to a Crohn's patient.  And it is difficult to pinpoint where stress is stemming from in people.  So, the visit to Barnes Hospital did not give us the results we wanted to hear.  The Crohn's was not under control and it could have been due to stress as a trigger.   

Big E

 So, what do the above two scenarios have to do with my trip to Portland?  As stated in an earlier blog, my decision to visit Portland was based on the fact that Portland has been documented as one of the healthiest cities in the U.S. as it is known for its low incidence of inflammatory diseases such as heart disease and diabetes.  The more I spent time there talking to people and observing the culture, the more it made sense to me.  It is the overall lifestyle and control of stress that matters most.  Let me pause for a moment to give respect to my two educational loves, nutrition and exercise physiology.  A proper diet and exercise are part of this equation of low stress.  Don't hear what I am not saying...I am not saying that sitting back drinking a beer while watching TV and eating McDonald's is the answer.  I challenge you to think about things that cause you to feel happy, truly happy.  Those are the things to focus upon.  A well balanced diet rich in colorful fruits and veggies eaten in a relaxed atmosphere with friends provides quite a bit of satisfaction.  Even for individuals who do not enjoy scheduled exercise, a hike through the woods while sharing with a family member releases dopamine in the brain and deep enjoyment.  Focusing on living in the "here and now" relieves a lot of pressure from the question, "what if?"  I met Big E during my trip to Portland.  He is currently a bus driver and former military personnel who previously lived in the Mediterranean.  I explained to him that both Portland and the Mediterranean are known for their health and wellness.  I asked his insight and he shared that the longer lunches, locally grown produce, and an active lifestyle decrease stress.   Our bus ride was full of deep conversation and a lot of laughs.  He made a recommendation as to where I should go for my next stop, and I took his advice.  I stopped at First City Cycles as the Portland Bureau of Transportation shares that "Portland has been successful in making bicycle ridership a part of daily life in Portland."  Statistics boast that 6% of commuters bike to work in Portland.  This is about 10x the national average.  The individuals at First City showed me the comprehensive biking routes, the free apps for the phone and more support materials that support the biking lifestyle.  They also shared that everyone in the shop takes the day off on Mondays so all of their staff can bike the city and host a ride for others who are interested.  It shocked me.  I had not heard of a business effectively shutting down one day a week so that the workers could pursue their passion (biking) and share it with others.

 I returned to the place I was staying and continued the conversation with Kristin and Kip.  Kip was more than happy to share his thoughts.  He explained that he watched two documentaries that may lend a little more insight: Happy and Stress.  He explained that Portland is really a happy place full of resilient individuals who want to be there.  The cost of living is high and it rains over 3/4 of the days in the year.  But, Porlandians embrace the culture, weather, and whatever life throws at them.  Below you can find a video of Kristin sharing her thoughts:

  
After interviewing individuals, watching documentaries and reflecting on the past 5 weeks, I realized that a relaxed attitude combined with a healthy diet while experiencing new challenges in physical activity allows for the healthiest individual possible.  So, I guess getting up at 4:30 in the morning to do boot camp, working through lunch to eat a Mediterranean salad in front of my computer, rushing home to care for the kids, and running everyone around all night before crashing at midnight is not the best for me.  I believe I knew that...but, it didn't sink in until now.  Somehow I thought that my diet and exercise regime would "win" and keep me alive and CVD free into a ripe old age.  My research is proving me wrong.  When I get back into the office after my sabbatical, stopping at noon and eating that salad with a friend/colleague may be a healthier choice that brings me more health benefits and happiness.  :-)  

_________________________
I also wanted to share some of my new and exciting physical activity based adventures while in Portland.  Check a few out....

HOT YOGA - 105 degrees for 90 minutes while exercising indoors!  No joke.   It was more challenging than the three marathons I have completed and the two child births that I endured. 

 

The trails in Portland were plentiful and inviting!  Although this photo shows an empty trail, there were people on the trails most of the time.  It is a hiker's paradise! 

Being the competitive person that I am, I hadn't participated in a "fun run" before.  It was a new experience.  They had bib numbers...but, that was just so you can look up your pictures online after the race.  The runners started in 5 minute waves and no finish times were taken.  It would be a great experience for someone who was just out to enjoy the day...but, I wouldn't recommend it for the athletic enthusiast. 

WEEK 5 - "Portland, Oregon won't build a mile of road wihtout a mile of bike path." Lance Armstrong

Portland has been named one of the "healthiest cities in the US" as well as the best place to live in the US....and there are many articles outlining why that may be (Top Three Healthiest Cities, Forbes: Healthiest Cities, #1 City to Live)

My sabbatical has a health and wellness based focus so I can bring the information back to the community and classroom.  I have been in Portland a little over a week now and I will remain here for almost two more weeks.  I thought I was going to arrive and see non-smokers biking everywhere picking up fresh produce at the farmers' market with lots of disposable income.  I have noticed that my assumptions were not true.  There is a large smoking community.  The restaurants have fries next to their sandwich and bars offer 20 different beer on tap to choose from.  So, why is everyone touting it as a healthy city?  As I walk/bike around Portland I am baffled by the contrast between what I see and what I thought I would find.  Scratching my head and wondering where to go with the observations I have, I decided to interview locals asking why they think it is the healthiest city and what makes it so unique.  

 This is Kristin.  This picture was taken as she was celebrating her 50th birthday (notice the nachos and Snickers).  She and her boyfriend Kipp own the B&B that I stayed at the first week in Portland.  I spoke with them at length about the differences between Portland and the rest of the country.  I shared that I was trying to wrap my head around the reasons Portland is doing so well health wise.  They had some great insight:

• Locals are VERY active (biking, walking, hiking)
• There is a sense of community.  Even people from the suburbs of Portland claim they are from Portland.
• The attitude is very different!  When you ask someone "what do you do" rarely will they share their occupation.  They discuss their hobbies, passions and family life.
• The jobs are much more entrepreneurial in nature...not as many 9-5 punch the clock jobs.  They think outside the box!

After speaking with them about the difference in attitude and the pace of life, I sat back and observed.  People stop and "chat" more on the street with strangers.  Conversations run longer.  I hear the passion for the city and life when I speak with individuals.  They are proud of who they are (in general) and proud of the city they live.  

I walked down to the local coffee shop and asked the individual working there what his thoughts were.  About 10 minutes into our conversation, one of the patrons stopped by to join in the topic.  His name was Christopher (Toby) Kinkaid.  We hit it off instantly and sat to talk for over an hour.  He shared his entrepreneurial spirit and what he was working on.  He explained that e-book writing was much easier than it seemed to me.  In fact, he wrote a book entitled "publishing e-books, concept to cash flow."  Christopher (Toby) Kinkaid's books  During our conversation, he discussed the benefits of having a steady and passive cash flow.  This "passive cash flow" seemed to be a theme amongst individuals in Portland....I noticed people were not afraid to fail or chase their dreams!  Toby was an example of that.  He inspired me to start working on a book during my sabbatical.  What do I have to lose, right?  

With this new revelation, I wanted to look into people who embraced physical activity/exercise and marketed it in a unique way.  I contacted Adam Boesel, the founder of "The Green Microgym".  He agreed to meet with me and have me interview him.  I explained that I had many students who want to open their own gym...but, many gyms open without a large following and quickly close.  It is a tough market.  He shared that you need to have something different that sets you apart.  You can't just open another gym and expect to have a clientele.  He went on to explain that it is the "purple cow" hypothesis.  If you have a ranch and people pass by your ranch, it takes a lot to get people to talk about your cows.  Cows aren't that exciting.  But, if you have a purple cow then people will talk.  It is unique.  The purple cow will essentially market itself!  Adam wanted to find a niche market that no one had tapped.  And he did it successfully!  As one of the patrons wrote on a review of The Green Microgym, "I want to tell you a little bit about my gym, The Green Microgym in Sellwood. First of all, it's one of three gyms like this in Portland, and it originated in Seattle. Each gym is a franchise. The concept is simple: working out helps to generate electricity. As a result, it's cheaper than places like 24 Hour Fitness, though The Green Microgym IS open 24 hours a day. It's a small gym, (which I love), with ellipticals with iPads that have Hulu and Netflix and iPod chargers. It also has a few treadmills, a room of bikes (they're getting ready to offer Spinning classes), and some weights. If you fill up a card with 10 workouts, you receive 50% off (or more) from local places like Nike or The Grilled Cheese Grill. In other words, you get rewarded for working out. They also have programs to inspire fitness, and offer 1 free personal training session when you sign up."  Adam took me to his garage where he demonstrated how harnessing the energy using his bike worked.  With one unique idea, the world began talking about his gym...how many gym owners can say that about their business?  

This week has been eye opening.  As I reflect on the similarities between healthy cities in the world, one thing comes to mind...the human spirit!  A spirit filled with excitement and challenge is healthier.  A spirit that is willing to stop and spend time with friends and family has balance.  A spirit where a two hour lunch in the middle of the day is permissible allows an individual to focus on relaxation and embrace a better pace in life.  A spirit that explores the outdoors provides a connection with the world around.  With those realizations, I gave myself permission to have a beer and fondu with new friends after my hike yesterday.  And, it was delicious!

WEEK 4 - "Some people think that to be strong is never to feel pain. In reality, the strongest people are the ones who feel it, understand it, and accept it."

Week 4 started with a visit to Barnes Hospital and Medical Center in St. Louis, MO.  I am the "plus one" for my Crohn's case study.  He is a single male with little/no medical background.  It can be very confusing to go to the doctors' office and not have someone there with you...especially if you are getting a lot of anatomy and physiology based information thrown at you very quickly and it is emotional to hear the results.  I always recommend that patients go to the doctor's office with a close friend or family member who can take notes, help ask important questions and discuss the results with the person following the appointment.  It makes for a much more effective and enjoyable visit.  To give you a little background, below are the notes from our visit three months prior to this visit.  He originally visited the doctor because he has an ostomy bag and there was a periostimal hernia that was presenting and causing him to be on a 20lb weight restriction with respect to lifting.  It was impacting his lifestyle and his job.  Below are the notes from our first visit to Barnes together in June.  They will shed a little insight into what we had discussed as well as what we hoped may happen.  




NOTES FROM THE VISIT IN EARLY JUNE:  

Let me know if there is anything else I can help with. Things to keep in mind... The small intestine is also called the small bowel and contains three sections: the duodenum, jejunum and ileum.  Most of the digestion and absorption of nutrients occurs in this location in the body.  The large intestine is also called the large bowel and contains the cecum, ascending colon, transverse colon, descending colon, sigmoid colon and rectum.  The natural ending to the large intestine is out the anus.

PAST SURGERIES:

• The first surgery was a Sticturplasty (http://emedicine.medscape.com/article/1893397-overview) and was done on many sections.  The doctor seemed to indicate 5+ sections on the small intestine were affected and surgery was done on them.  It was also indicated that they now know that it was likely not the best solution...but, it was the best solution the medical community had at the time.
• The second surgery was a resection of the small intestine.  They took out the section of the small intestine that previously had the strictureplasty.  It sounded like several feet of small intestine were removed at that time.  I do not recall which portion of the small intestine was removed.
• The third major surgery was primarily to create the ostomy (the bag).  http://www.ostomy.org/ostomy_info/whatis.shtml

(the image to the left is a model who has Crohn's and lives with an ostomy bag)

Currently, the individuals at Barnes would like to "start from scratch" and determine what is going on with both the hernia and the Crohn's disease.  To do so, blood work must be done to look at metabolites to see if the Imuran (http://www.rxlist.com/imuran-drug.htm) is at the correct dosage.  It looks like the Imuran dosage that was initially prescribed could be as low as 1/3 of what is needed to keep the Crohn's disease in check.  They would also like to do an MRE (a special MRI looking at the intestine specifically - http://www.hopkinsmedicine.org/healthlibrary/test_procedures/gastroenterology/mr_enterography_135,61/) September 3rd to see if where the end of the small intestine (traditionally the ileum) meets the large intestine has inflammation or if it is just a funky angle.  There is a little concern as the last time a scope was used to see what was going on, it couldn't easily pass that intersection.  Both the blood work and MRE will allow the team at Barnes to determine when the hernia surgery can take place.  It looks like with a combination of the Imuran and Remicaid (http://www.monmouthgastro.com/procedures/remicaid-infusions.php) that the Crohn's will be under control by September at the earliest and they hope November at the latest.  After the MRE in September, Dr Shaker, a colorectal surgeon, will meet with you to go over the results and prescribe the next course of action. Surgery will not take place that day.  But, it could be scheduled soon thereafter.  

We are waiting on 6 vials of blood to be successfully drawn to get baseline blood values.  Once that blood is drawn it will take 7-10 days to get results for the metabolites.  

RESTRICTIONS:  Unfortunately, the 20lb weight restriction remains in place at work and home until the hernia surgery and healing has take place.  

Additionally, with the increased Imuran dosage, blood work will need to be done on a monthly basis to check for liver function. 

After following all of the doctors' orders from June, my Crohn's case study and I returned to Barnes on September 2nd.  We needed to find out if the Crohn's was under control and if it was under control we anticipated that we may be able to schedule surgery. Unfortunately, our results were less than desirable.  We found out that the Crohn's is not under control and that the inflammation from the Crohn's may be causing more strictures in the colon.  It was suggested   to proceed with an increase in medicine to attempt to better control the disease.  It was also discussed that once the Crohn's is under control that he may need a surgery to remove any problematic fibrotic strictures in the colon that could cause blockages in the future.  The doctors stated that they are concerned about doing the hernia surgery due to the massive amount of scar tissue from the above surgeries...they would like to focus on getting the Crohn's under control prior to even discussing if the hernia surgery will be an option.  It looks like we will continue to adhere to doctor's orders and wait to see where to go from here.  
________________

THINGS I HAVE LEARNED ABOUT CROHN'S THROUGH THIS PROCESS:

• The disease is not as responsive to diet as I had hoped it would be (that doesn't mean that we are giving up on the juicing and healthier dietary choices)
•  Stress is a major trigger for this disease (and many others!).  It is horrible what stress can do to the body.  
• Medicine for treatment of Crohn's is relatively new and is VERY expensive if insurance covers it.  If insurance does not cover it, a family can be thrown into financial duress!