Get Fit for Duty

By Thomas Davis, CRNA, MAE, Lt. Col (ret)

Follow @procrnatom on Twitter

Obesity is today’s smoking. In an article published in USAToday, authors O’Donnell, Barry and Covington make the case that obesity and inactivity could outpace smoking as a cause of cancer in the upcoming decades. Further, a video accompanying the article presents evidence that childhood obesity greatly increases the probability of depression as an adult. Connecting the dots, if you are inactive and obese with an elevated risk of cancer, and if your children are also obese, their risk for adult depression greatly increases as well as their risk for cancer. Nobody would consciously wish cancer or depression upon themselves or their families and yet the bad news is that obesity with its co-morbidity is rampant in our profession and our society. The good news is that you are the one who can change the course of your personal history with three simple steps; get motivated, change your behaviors and use technology to stay on track.

Get motivated

If you’re obese, you have more than a few extra pounds to lose, a task which you may view as a daunting. Make it manageable by tuning into your thoughts becoming aware of your inner dialogue. Are you thinking I Can or I Can’t? I Hate exercise or I Can Learn Some Exercises I like? Thinking I should is not a call to action; however, thinking I will sets you up for success. Here are some tips for motivating yourself to re-claim a healthy body,

Have a reason Write down a purpose for changing your lifestyle and read it every morning and evening. Use affirming words like can and will and focus on what you know you get out of it, not what feel you’re giving up. Make it your goal to gain health and avoid focusing your attention on losing weight.
Get a buddy. Share the accountability with a friend who has a similar desire to improve his/her health. Team up, check in frequently and support one another.
Keep a Journal. Writing a daily entry in a journal helps you track your success while providing a frequent reminder of your goal and the many reasons it’s important to you.

Change your behavior

Behavior that is repeated becomes a habit. Here are some behavior changes that you can make today and when repeated daily for 8 weeks will become healthy habits.

Morning workout/stretch. Wake up your body by getting in motion in the morning. An early morning gym workout is optimal however many people don’t have the time or resources to make it happen. That’s OK but it’s not an excuse for inactivity. Develop a plan to do a short home workout, stretch and crunch every day before you start your morning routine. Check out the 7-Minute Workout..
Park at far end of lot. Every step you take counts so park where you can take the most steps. While walking in from the lot, think about why you’re doing is and what other things you can do that day to support your goal.
Take stairs. Take the stairs whenever possible. Only take the elevator if the distance is more than your legs will tolerate, in which case, take one set of stairs and then the elevator.
Drink water. Your body needs water to function properly. In addition, when you are well hydrated salt is cleared from your system which reduces water retention. Your digestion and metabolism both improve when you are well hydrated.
Eliminate sugary drinks. Sugary drinks will sabotage your wellness efforts. It only takes a few high-sugar drinks to double your calorie intake for the day and consuming them diverts you from what your body really need – water.
Bring your lunch. Control the number and quality of calories that you eat by bringing your own food. Pack a high-nutrient low-fat low-sugar lunch and do not eat anything that you do not bring with you. Avoid the temptation of making your lunch an appetizer before eating lounge food.
Ban lounge junk food. It’s not always possible to control the behavior of others however banning junk food from the lounge raises the level of awareness of your colleagues and may motivate some of them to join the new healthier you. At the very least, don’t be the one bringing the junk.

Use technology

Harness and use to digital technology to your advantage when developing a healthy lifestyle. Texting and social media connect you with friends who can offer support as you share your progress. As well, there are countless apps you can use to develop your exercise and nutrition program and track your progress. Following are ten apps as described by their advertisements.

Keas Keas is a web-based, holistic wellness program, focusing on health goals and activities. Just imagine a site where you combine social media, fun interactive games, informative quizzes, and a little bit of healthy competition between you and your peers. You can choose to focus on whatever is important to you. https://itunes.apple.com/us/app/keas/id432425118?mt=8

Fitbit Live a healthier, more active life with Fitbit, the world’s leading app for tracking all-day activity, workouts, sleep and more…track basic activity and runs on your phone or connect with one of Fitbit’s many activity trackers to get a complete picture of your health—including steps, distance, calories burned, sleep, weight, and more. https://itunes.apple.com/us/app/fitbit/id462638897?mt=8

Endomondo track all your workouts using GPS, check your stats, and reach your fitness goals. https://itunes.apple.com/us/app/endomondo/id333210180?mt=8

My fitness pal MyFitnessPal makes it easier to log your food and activity. The more you log, the more you’ll learn about your habits and how to make healthier choices. And, best of all, logging gets easier the more you do it. https://itunes.apple.com/us/app/myfitnesspal/id341232718?mt=8

Daily burn A new workout streamed to your mobile device every day. https://www.amazon.com/DailyBurn-Daily-Burn-Streaming-Workouts/dp/B00HAPXDWK

7 minuteWorkout Become your own personal trainer to lose weight and get fit with fast, simple daily workouts. 12 high intensity bodyweight exercises. 30 seconds per exercise, 10 seconds rest between exercises. https://itunes.apple.com/us/app/7-minute-workout/id650762525?mt=8

Fooducate Fooducate is a diet coach for people who want lose weight and keep it off by eating healthy, real food. Track your food, activity, sleep, hunger, and mood. https://itunes.apple.com/us/app/fooducate-nutrition-tracker/id398436747?mt=8

Map my run Track and map every run with MapMyRun and get feedback and stats to improve your performance. Discover the best running routes, save and share your favorites, and get inspired to reach new running goals. https://itunes.apple.com/us/app/map-my-run-by-under-armour/id291890420?mt=8

Shop well ShopWell lets your food do the talking. The free SHOPWELL app tells you what’s in the food you’re buying at the grocery store and offers suggestions of new foods to try that fit with your lifestyle. https://itunes.apple.com/us/app/shopwell-healthy-diet-grocery-food-scanner/id393422300?mt=8
Meditation studio Meditation Studio is the award-winning, 5-star app with over 300 guided meditations from more than 30 leading experts. Whether you want to relieve stress, ease anxiety, improve sleep, ease confidence or simply feel a bit more calm and peaceful, this app is for you. https://itunes.apple.com/us/app/meditation-studio/id1066018502?mt=8

We are an obese society, rapidly expanding. A large number of us in healthcare need to be wide awake and ready to roll as early as 6:30 a.m. and obesity is not society’s best friend. Throw out the stress and the excuses and focus on improving your health. Do something every day to support that goal, get a buddy to have some fun and share the load; adopt new behaviors two at a time until good health is a habit. Be a healthcare role-model for the respect we have for society, for our careers, for ourselves and our children.

Special thanks to Liz Sanner Davis for editing and collaboration.

Thomas Davis is a noted leader, educator, speaker and clinical anesthetist.

Join Tom and a group of leaders for the values-based leadership webinar. Click here for information.

Snack for the Long Run

By Liz Sanner Davis, Certified Personal Trainer

“Sugar and Salt, preferably together,” is the tantalizing message sent and received by a huge percentage of American snacks. Fifty or sixty years ago, coming home from school at 3:30 to a “snack” meant a glass of milk, an apple or a piece of bread slathered with Skippy. Today’s children come home at 5:30 to a bag of sugar and a package of salt.

Watching parents and children and their chubby chums walk or waddle down the snack aisle of Ralph’s or Teeters is mind-numbing experience. Watch what goes into their grocery carts. Caramel nut chocolate Turtles, popcorn fortified with candy and nuts, and Sweet and Salty Chex mix, then mixed some more. The snack aisle is the path to nutrient poverty. Multiple shelves are stacked floor to top with gummy-this, and that, while tiny hands and taller teens reach out to grab colorful boxes and cellophane bags of sugar and salt. Talk about high-fiving your kindergartener!

Sweet-and-Salty snacks has become the new normal for junkies. “Hold on, now,” you exclaim. “My grandpa always sugared his sweet potatoes and salted his watermelon slices two generations ago. “True enough,” I offer as a rejoinder, “And my grandfather had sugar diabetes.”

Quick, convenient, easy to store and landfill-ready are the current snack prereqs. Child-friendly and digital means finger food. Goodness forbid that we ask our children or spouse to sit at the kitchen counter to stick a spoon in Greek yogurt or fork into juicy chunks of melon while chit-chatting about a day at school or at work. Snacks today must be quick and convenient so that everyone’s life can be lived quickly and conveniently.

Yes, participating in the twenty-first century Snack-Pack will insure that your life is indeed quick, but you and yours may not find your maladies to be convenient.

A short risk list associated with snacking on fructose and sodium includes these hazards:

Hypertension
Weight gain or obesity
Dehydration
Lack of physical satisfaction
Tooth decay and gum disease
Nutrient deficiency
Digestive disorders
Depression
Gastrointestinal dysfunction

To avoid sounding like a POTUS candidate – big on criticisms and short on solutions – here are some great snack options, low-calorie, nutrient-dense or both. You might actually have a good time preparing them and even more fun distributing them among your children, their friends or the adult who walks in the house later than you do, wearing that hungry look.

10 Wheat Thin Hint of Salt crackers(or the equivalent), stacked with 1 small slice of low-salt deli turkey cut into small squares, 1 slice of avocado, divided
½ apple, sliced into eight pieces with a dab of natural peanut butter on each
1 whole orange, peeled, each section cut in half
A bowl of mixed melon cubes
16 unsalted almonds and ½ piece of whole fruit
½ cup of plain yogurt with six strawberries, stemmed and cut in large chunks
¼ cup of blueberries, ¼ large banana, 2 tablespoons granola, ¼ cup of plain yogurt, mixed
Green zucchini and carrots, crinkle-sliced and dipped in plain yogurt mixed with salsa
Smiley face multi-grain, peanut buttered bread rounds with blueberry eyes, banana slice nose and strawberry lips!

It doesn’t need to break the bank to snack well without sugar and salt. And you can fill your health needs without filling the land. Mix your own healthful dip, cut a pile of veggies and a whole melon on Sunday before the busy week begins. Mid-week, ask your teen to do it again. And is there some family law against the big kids peeling their own oranges and getting some rind under their nails or helping toddlers count their crackers and carrot sticks? Snack time could be the ultimate family fiesta amore!

Helping children get to college, paying off the mortgage, achieving personal job satisfaction are essentials in the long run. Make your own fixings to get yourself and the entire family back in the business of preparing and consuming healthful low-salt low-sugar snacks. Nix the mix and the long run will be healthier, seem shorter…and taste sweeter.

Liz Sanner Davis, Personal TrainerCertified by The Cooper Institute, Dallas, TX

bdyfrm@aol.com

Chief CRNA: How to Motivate your Staff

Being an effective Chief CRNA involves multitasking to meet the needs of the patient, the institution, the regulatory agencies and the needs of your staff. Staff engagement is a buzz word in corporate America. According to Wikipedia, An “engaged employee” is one who is fully involved in, and enthusiastic about their work, and thus will act in a way that furthers their organization’s interests. As Chief CRNAs, it is easy to become so focused on the daily grind that we often ignore things that will promote engagement within our staff.

An interesting article by Martin Dewhurst et al and published in the McKinsey Quarterly addresses the issue of staff engagement. All too often, administration relies on financial recognition for motivation of employees. Dewhurst et al point out that there are more effective non-financial motivators of your staff. According to the report, the top 3 non-financial motivators are:

Praise, commendation and interaction with the supervisor
Attention from leaders
Opportunities to lead projects or task forces

“The survey’s top three nonfinancial motivators play critical roles in making employees feel that their companies value them, take their well-being seriously, and strive to create opportunities for career growth. These themes recur constantly in most studies on ways to motivate and engage employees.”

“One-on-one meetings between staff and leaders are hugely motivational,” explained an HR director from a mining and basic-materials company—“they make people feel valued during these difficult times.” By contrast, our survey’s respondents rated large-scale communications events, such as the town hall meetings common during the economic crisis, as one of the least effective nonfinancial motivators”

“A chance to lead projects is a motivator that only half of the companies in our survey use frequently, although this is a particularly powerful way of inspiring employees to make a strong contribution at a challenging time. Such opportunities also develop their leadership capabilities, with long-term benefits for the organization.”

Click here to read the original article posted in the McKinsey Quarterly

As Chief CRNAs we need to not only ensure that patients receive the highest quality of care but also that they receive the care from a motivated and engaged staff. Finding ways to involve and value individual staff members will pay high dividends in the long run.

Chief CRNA: Patient Safety and the Aging CRNA

We have all heard the stories of the super star who played one season too many leaving the sport at the bottom of his game rather than at the top. The physical effects of aging are well documented in the literature and we are reminded of those changes every time we pre-op a geriatric patient. As the baby boomers reach retirement age, many super star CRNAs who carried our professional torch for the past several decades are experiencing many of the physical changes that they see in their aging patient. The question arises, does the aging healthcare provider pose a safety risk to the patient? How can the skills of the aging CRNA be fairly assessed to ensure patient safety? Is aging really a problem anyway?

Canadian researcher Michael J. Tessler M.D. writing in Anesthesiology and published in the on line blog Community Health Network (Older Anesthesiologists have Higher Litigation Rates) notes:

“We found a higher frequency of litigation and a greater severity of injury in patients treated by anesthesiologists in the 65+ group. The reasons for these findings should become an active field of research.”

Click here to read the blog

An editorial published by the ASA addressed the issue of the aging Anesthesiologist. The editorial reminds the reader that the older provider brings years of experience to the job and has valuable insight to be shared with the younger providers. From the editorial:

“Older physicians, including anesthesiologists, have developed a wealth of experiences during their years in practice that regularly benefit patients,” said Dr. Warner. “The study’s findings remind all physicians that they need to understand their practices, the changes that they personally will experience as they age and the value of working with colleagues to gain continuous feedback about their personal performance in patient care.”

Dr. Warner added, “All physicians should know their personal limits and adjust their practices as they get older to best serve patients. For example, older physicians may choose to reduce the number of hours they work during the nighttime to ensure that they are well rested and alert when caring for patients.”

Click here to read the editorial

CRNAs tend to be at the front line of patient care and are found at the head of the table providing hands on care. We need to respect the knowledge and skills of our “experienced” CRNAs while, at the same time, protecting the safety of the patient.

Here is the question for procrna.com readers: How do we assess the continued competency of the aging CRNA? Use the comments box below.

CRNA Wellness: Heat and Hydration

Some very important things come as pairings: Your hair might be colored salt and pepper; it frequently rains cats and dogs; the OR has its ups and downs; Chez Paul offers wine and cheese. And summer? Summer pairs heat and hydration. As the temperature soars along with the humidity, here are some things to help you stay hydrated and withstand the heat.

The standard daily drinking water prescription for adults is eight glasses – that’s eight eight-ounce servings and varies by little from one body type to another. Add extra activity or summer heat to the mix and the recommendation increases to nine or more glasses. Move to an arid climate or humid tropical haven, and set RX-it a glass higher. You don’t need to drink until your food floats (see dilutional hyponatremia) but if you wait until you FEEL dry and thirsty before refilling your tank, you’ve waited too long to refill.

Click here to learn more about avoiding dehydration

Drinking water in most countries outside the USA is served without ice and often at room temp. Although it remains part of the drinking debate, there is a certain amount of logic in drinking your beverages at room temperature, even tepid. But the American Council on Sports Medicine recommends cold water to challenge metabolism and burn the most calories. Others say that water is water; just get wet.

When I counsel clients on their nutritional needs, I encourage them to up their intake of watery vegetables and fruits. Raw, grilled or steamed tender crisp, between all those tiny turgid veggie cells are gazillions of antioxidants wrapped in high-fiber packages and dressed in vibrant, low-calorie color. Stylin’ as well or better than their veggie friends, fresh nutritious fruit comes water-tight. Red watermelon and strawberries (lycopene), orange cantaloupe and papaya(beta carotene), dark blueberries and purple plums (vitamin C ), green kiwi and honeydew melon (potassium, vitamin C) are refreshing, hydrating and abundant in summer. Make use of a juicer, blender, or food processor and create a colorful beverage to accompany your dinner salad. You can eat cold and be hot!

There always seems to be some Dallas Bubba who does his five-mile run mid-day in an adjusted summer temperature of 91 degrees Farenheit. Frequently, Kansas City’s Woodside tennis round robin doesn’t even begin until 9:00 a.m. with the sun bearing down. Golfers in hot, humid Florida are notorious for teeing off after 8:00 a.m. and for some strange reason, there’s always a crowd of daytime skaters in July on both boardwalks, east and west. Are they all nuts? Did they just consume a gallon of water each? Or, fancy this possible explanation: Perhaps members of Active Anonymous tolerate the heat because they are active and in shape. Withstanding both hot and cold temperatures is easier for those who maintain a healthy weight and strong, muscular body. Between the lines you know they have developed good eating habits and skills of endurance to even be labeled “strong and muscular,” but there is also a true chemical composition to the fit body that isn’t in the make-up of a soft, flabby, heart-stopping structure that acts more as a respiratory challenge during hot weather than a shelter in the shade. Only the strong survive the heat; the flabby flail.

While you’re sipping on your unflavored, cool, spring water, contemplate the following quips while remembering: Water hydrates, it softens your skin, it aids in digestion and the absorption of nutrients, it cools the body, it fills you up…and especially during the heat and humidity, it puts out fires.

Water spots

Booze on the Beach and Coffee with Caffeine are hot-weather de-hydrants. Nix the mix.

Being in shape increases your tolerance for heat. Round is a shape, not in shape.

If your body heat comes in flashes, drink water, stay still and switch to flash drive.

Water follows Salt. Take your dips without the chips.

Water is the fountain of youth.

Read Liz’s daily Lizlines Monday through Thursday and enjoy the Frisky Friday Lizlimerick each and every week at www.bdyfrm.com.

Ms Liz is the owner of Body Firm Integrated Fitness Solutions. She has developed the Bands In The Park work-out for indoors or outdoors and provides fitness consultations and complete, integrated online instruction. Contact Liz for a consultation to receive practical, affordable nutrition and fitness assistance and access to over 60 exercises, useful recipes and lesson plans.

CRNA Wellness: Wake-up call

My humorous Native American name for my younger daughter was Face In The Soup. When she was tired, SHE WAS TIRED, and by the 6:00 p.m. dinner hour, her face went down on the table and it didn’t come up. As a young mother, I learned quickly to make sure she had received all of life’s necessities before OUR dinner time because no matter what happened in my own life, at 6:00 p.m. her curtain was going down. If she were now an anesthetist on the job, her adopted name could be Dies on the Table or Puts Patients at Risk.

Chuck Biddle, CRNA, PhD, chief editor of the AANA Journal and multi-published author of sleep deprivation articles, quotes another anesthesia industry sleep expert, June J. Pilcher, when he reports that: Fatigue caused by lack of adequate sleep results in diminished cognitive function, impaired vigilance, decay in problem-solving ability, degradation in memory, and eroded motivation.
Click here to read the article.

Okay, so I can’t tell you anything that will make the surgeon close that thoracic cavity in time for you to be eating dinner by 6:00, or to watch Dancing With The Stars, or to shower off the sounds, smells and stress from the OR and still drop into bed by 10:00. But I can give you some simple fitness suggestions for making sleep more useful when your head makes contact with the pillow-top. People who are fit and healthy sleep better than those who aren’t. Simple. True.

Physical exercise is way at the top of ways in which to elevate energy but tire the body in such a manner as to make sleep deeper and easier. Although it is a personal choice as to what time of day you should do your cardio or tote that bail, you can figure it out in just a few morning or evening trips to the gym, or on the elliptical in front of your Netflix pick. Morning cardio elevates your metabolism and your heart rate which energizes you for the better part of the day but fatigues you in a pleasant way by or before gall bladder number six. Doing your cardio before bed does the same thing to metabolism and heart rate so you probably want to take a bit of down time between cardio and vespers. Some of you may prefer to do a lunchtime cardio on the days it’s possible, a great substitute for pop ‘n pizza. Try to create some routine so that your body says, “It’s time to cardio; it’s time to eat; it’s time to don the scrubs; it’s time to let down; it’s time to sleep.”

Stretching and crunching before bed is another great way to relax and create routine before the sandman comes. Tom S. Davis, CRNA, MAE, likes to say, “Every day that I don’t make time to stretch is one day closer to the day I won’t be able to.” If you don’t have a designated work-out area at home, keep a Pilates mat, a towel and a 55cm fitball (inflatable stability ball) in your bedroom so that it’s easily available every evening. Do various crunches that access all areas of the abs followed by a thorough five-minute stretch routine that leaves you feeling loose, relaxed and calm. Wind down by finishing your toilette routine. Then crawl in and let go.

Eat dinner right before bed…and you’ll sleep poorly. Drink coffee right before bed…and you’ll have to interrupt your sleep to offload. Consume alcohol in excess…and reflux, insomnia and restless sleep will be your companions. Wear a belly to bed that looks like an eminent delivery, and you’ll wake yourself up with your own snores, not to mention that you’ll be sleeping alone. In short, what you put in your body all day is the very same thing you’ll put into bed that night and your sleep will thrive or dive because of it. Lower the bad fat in your diet, especially lower the sugar, decrease the volume of intake and put down the fork, fingers or chopsticks between every few bites. Intentional eating of reasonable kinds and amounts of food are your fitness friend, and quality sleep will become a close relative.

Finally, stay away from negative news, time-consuming e-mails, family complaints and anything else that puts your head in a quandry and reduces your tranquility. Say, “Good-night,” to your honey, calmly go through your affirmations, prayers or meditation minutes and put out your lights. Six hours, seven hours, preferably eight hours later, your fit, healthy Self will be refreshed and ready to take your life back. Then go pop into the OR bright-eyed and bushy-tailed and clip on your nametag: Saves The Lives of Others.

Other Tips
Take a power nap during your break.
Don’t stop for restaurant food on the way home.
Don’t drink alcohol.
Avoid drugs and sleep aides.
Get extra sleep BEFORE call.
Avoid arguments.
Split your cardio into morning and evening.
Eat very lightly if it’s late.
Read relaxing lit.
Do Yoga.
Meditate.
Say, “Good-night, Gracie!”

You can visit Liz during your waking hours at www.bdyfrm.com. Read the motivational, entertaining Lizlines Monday through Friday and watch for her original Lizlimerick once a week. Ms Liz

Fitnotes
Chuck Biddle, CRNA, PhD, is a professor and staff anesthetist at Virginia
Commonwealth University, Richmond, Virginia. He is editor in chief of the AANA Journal. Email: cbiddle@hsc.vcu.edu.

Tom Davis, CRNA, MAE is chief nurse anesthetist at Scott and White Medical Center, Temple, Tx and former assistant professor of nurse anesthesia at University of Kansas. He is the owner of and consultant for Procrna.com. Email: tom@swcrna.com

CRNA Wellness: Nutrition

Gary, Gary, quite contrary
How does your garden grow?
With onions, tomatoes,
Vine-ripe sweet potatoes,
And lima beans all in a row.

April is the time to plan ‘n’ plant the garden. The delightful thing about your garden is that it will provide a solitary escape after a 50-hour work week. Or it will serve as a dual retreat for you and your partner. And, it’s sure to be a family affair in which everyone can select some favorite veggies to coax and encourage to fruition. When you grow things, you grow, and when you grow, your body heals.

Sweet potatoes are an amazing garden food, big on nutrients and huge on color. There are lots of varieties but pick one that grows well in your soil. Beta carotene has enjoyed solid mag’ rap in the last ten years having been praised and criticized nearly equally. The truth about sweet potatoes is that in addition to the starch and sugar, the abundance of A, C and beta carotene make every sweet sensation worthwhile. I recommend that my clients consume at least one serving of a variety of sweet potato each week. Prepare it clean – bake without butter, boil and peel, microwave in a potato bag and slice, cut into strips and bake as fries. You don’t need salt, fats, or seasonings of any kind to enhance the flavor of this already sweet, generous source of nutrients. Click here to learn about Sweet Potato nutrients.

Green beans provide a rich supply of vitamins A and C that do not stick to your ribs or add unwanted calories to your spring plate. You can plant pole beans or traditional snap beans in a raised garden. But if you have room for rows and rows of snaps, haricot verts or favas, go ahead and plant the seeds, fertilize, water, watch for worms, harvest and enjoy. Eat them fresh-steamed next to your grilled tuna, or stir fry them with onions and mushrooms. Cut and drop raw into veggie soup or snip, steam and eat them with your fingers in front of HGTV. If you get at this early in the season, you may have time to plant a second crop. Click here to learn about Green Bean nutrients.

Yellow zucchini is becoming more and more expensive to purchase, so you may as well grow your own and eat the best. Like sweet potatoes, the vines take up some space but vertical gardening is always a space-saving option. Packed with vitamin A and plenty of C, this vegan delight is so low in calories that you can eat a bowlful of sunshine several times a week. Stir fry it, steam it, slice it and grill it with olive oil or flavored Pam, and use the leftover slices on a fresh veggie sandwich. Watery and lightweight, zucchini begs to be undercooked. Your lean machine will love both yellow and green. Click here to learn about Zucchini nutrients.

Tomatoes are a thing of beauty in your diet and on your table. By now most guys know the health benefits of lypocene to the prostate, and both genders are continually reminded through research studies of the cancer preventative capacity in a snappy tomato. There is some proof that cooked tomatoes are a better option than raw but all kinds, sizes and methods of prep are tasty and healthful. Think A (B) C then go ahead, prepare a big old ground white turkey burger, slap on a thick slice of Beefsteak tomato, put on a layer of avocado and support it all with an unbuttered whole wheat bun and some leafy lettuce…serve steamed broccoli florets as a healthy side, and indulge. You’re a Garden Gourmet! Click here to learn about tomato nutrients.

Mary, Mary, quite contrary,
How does your garden grow?
With orange, green, yellow, red,
A rainbow in the bed,
With rich vitamins all in a row.

Gardening is an art form that delivers pleasure to every sense. Feel the cool rich earth slipping between your fingers, see the tiny sprouts and watch them flourish, hear the sweet songbirds nearby, then smell and taste the results of your labor. There is no place on earth like a garden for feeding both mind and body. This, you understand, because you’re a healer.

Read Liz’s daily column lizlines at www.bdyfrm.com

CRNA Fitness: Circuit Training

The Circuit Train

Working out can be whole lot simpler when you know the drill! If you need one day a week to “relax your mind” while actually getting your work-out, try circuit-training. There are several good things about using an established circuit and here’s just one. You can go get a member of the training staff for a free orientation around the circuit. Reservations encouraged.

A circuit provides a moderate level work-out and consists of gym-level machines set up in a circle, a neat little rectangle or at the very least, all on the same side of the gym. If they are not grouped, it’s not a simple circuit, it’s a hairy maze. There will be one or two machines for each specific muscle group and in a well-thought-out arrangement, muscles will be grouped to keep you in order. Remember? It’s 4:30 a.m. before a 12-hour day of one heart, two gall bladders and whatever last-minute trauma is scheduled and you’re looking for a straight-forward work-out, not discombobulation. Start with shoulders and begin working your way around the circuit.

Overhead Shoulder Press and perhaps Incline Shoulder Press will be your starting place. If you’ve not had the orientation, you’ll need to read the instructions printed on one of the supporting braces of the press. Adjust the weight plates, adjust the seat front-to-back and up or down, sit with “Body Firm” posture, use an overhand grip and press the contraption overhead(or angled up and outward) until fully extended. Voila! Rest 30 seconds between one or two more “sets” or press onward.

Note: Adjusting the set-up options correctly and appropriately is tantamount to getting the most out of each exercise, but even more importantly, to remaining uninjured. Too much weight can crash back down, hunching shoulders can pinch your neck, exhaling at the wrong time can challenge your heart(and not in a good way), and failing to use your abs will arch and injure your back. Use caution and common sense. You too, Men!

Chest Press and Seated Chest Flies will be next and, once again, read the instructions, adjust all of the set-up options – front to back, seat up or down, weight plates – and be seated. When seated, your feet should be flat on the floor unless there are little angled platforms for your feet. Both of these machines are harder than you think so err on the side of caution and keep it light until you’ve found the level of exertion that challenges without causing pain.

Seated Lat Flies are the reverse of Seated Chest Flies – not to be confused with seated front flies which require elbows bent and arms to open and close like French doors – and may be part of the same machine. To work the chest, you’ll face outward; to work the back, you’ll face inward. And the Seated Lat Row, which has three set-up adjustments, should be next.

These require feet flat on the floor, not tucked behind you so you fall forward, nor extended in front so you can row your boat. You’re not in an outrigger canoe in Hawaii. You’re in the gym, darn it, at 4:30, darn it, before doing a heart, darn it…feet flat on the floor, please.

Triceps and biceps are next on the circuit. Note the work-out moving from strong shoulder exercises, to large chest and back muscles, to the smaller, but potentially so down-right gorgeous tri-bi muscles, the ones that never show in the OR but show big time on a beach…in Hawaii. You can see what’s on my mind in February! Biceps will be a standard Seated Biceps Curl and/or a Preacher Curl. I don’t get why this is called “preacher” but google says it’s because the arm position resembles someone praying. You’ll actually look like someone holding a Bible or a hymnal a whole lot more than praying, but whatever floats your boat is what you should visualize. Just do it! Remember, the key to good biceps curls and triceps curls is the anchoring of the elbow and maintaining neutral wrists. Curl is the basic motion, not the rolling and bending of the wrist to avoid effort.

Legs are next and last. Expect to do Seated – or angled supine – Adduction and Abduction as well as Seated Leg Extensions and maybe Leg Curls. You’re a lucky little guy if there is also a Seated Calf Raise and a Leg Press. A circuit is not generally meant to challenge to the extent or even in the same way as a full-blown 45-set work-out, so three leg machines are really enough. Lunges and squats are “on on your honor.” Crunches can wait.

Okay, you’re done. But if you did only one set of the circuit, take a 60-second break, not a 5-minute text conversation with your broker, and do the circuit again. People tend to monopolize equipment at the gym, especially cardio equipment, but the circuit may be popular, too. So you may just want to claim each machine in its turn and hang onto it until you’ve completed your two or three sets of each. Then when your legs are finished – and they WILL be – you can wobble in and out of the shower, hide your coif under a scrub cap, and take a non-circuitous route to the hospital without looking back.

To learn more about exercising with safe, efficient form, visit Liz at www.bdyfrm.com.

Read Lizlines and the weekly Lizlimerick posted Monday through Friday every week of the year.

CRNA Fitness: Make the Most of Your Meeting

Boston, Seattle, San Francisco, Honolulu, Jackson Hole, San Antonio…there are some amazing destinations for anesthesia meetings right here in the USA. Most of the venues are places where there is a long list of thing s to see and do. And all of the destinations provide plenty of opportunities for you to stay active.

Run For Fun

AANA’s annual meeting has been offering a 5-K fun run for just under a decade. It’s an easy 3.1 mile course along the city’s most scenic route with shuttle service provided start and finish. Runners, walkers, strollers (those are the people who stayed up late the night before) are all welcome and you’re the celebrity. Beautiful surroundings, beautiful celebs, and a free t-shirt as beautiful as t-shirts get, make all that exercise a beautiful bonus. Sometimes the local ANA offers early morning fitness classes at the host hotel with leadership provided by CRNA’s who apparently enjoy waking people up as much as putting them to sleep. Click here for the AANA wellness run in San Francisco

Take Your Bands

Exercise bands are almost as easy to use as they are to pack. You can do a complete work-out in your hotel room, in the hotel gym, in a park, at the beach or looking out over the harbor in Seattle or Boston. All you need is two or three bands, a doorjamb, railing or a pole to anchor them, a little backpack to carry them, or a waist small enough to tie them around your middle. With access to cool water and a hotel-sized washcloth, aka sweat rag, you’re good to go. Bands weigh less than an I-pad and they pack flatter than a ten-dollar bill.

Rent A Bike

One of the best ways to see your city and get some great exercise at the same time is to rent a bike. Google “bicycle tours in Vancouver” or “rent a bicycle in Austin” and refine the search from there. Be sure to use the word bicycle because otherwise you’ll end up with Harley Suzuki as your travel companion, which might be a blast, but you won’t get much exercise unless you fall off and have to walk back. You may be able to get a private, guided bicycle tour – more money, of course, but if you like to be at the head of the class asking questions, money talks and the expense will pay off. Click here to learn about bike rental in San Francisco.

Many cities have initiated bike-share programs. This service goes by a variety of names – like Q-bikes in Portland, B-cycle in San Antonio, or simply Bike-share in Boston – and features a fleet of bicycles that anyone can use. Just swipe your credit card at the vertical terminal, release one of many bikes from its locked stall, then ride it on marked cycling routes throughout the city, or directly to a destination. Parking stalls and routes are indicated on maps at each bike installation so you won’t get lost. Each time you stop to sight-see near a bike-share stall, just slide the bike into a rack, it locks automatically, and very shortly it will become someone else’s exercise partner. The beauty of the service is that it generally doesn’t require a helmet. One of the drawbacks of the service is that it generally doesn’t require a helmet… AND if you have to wait for a bike to become available when you’re in Brooklyn, you could be late for cocktails in the Bronx. Click here to learn about community bike share in San Francisco.

Walk

If you didn’t download a city map and a printable walking tour before leaving town for your meeting, you can ask your hotel concierge to highlight the best walking destinations on a brochure and outline some routes for you. Check things off on your brochure as you go so you don’t miss the major attractions, and don’t be afraid to get off the beaten path. Make note of noteworthy and eccentric establishments as your cabbie whisks you through the city from the airport, then go back and find them on your feet. You’ll run into the best coffee art cafes, the most interesting old houses, and charming little corner stores that you won’t find on Tourist Avenue. You may burn enough calories to almost justify the mouth-watering apple fritter you found at Dave’s Sugar Shack not to mention the energy you’ll have the rest of the day just from staying on your toes. If Rick Steves or Lonely Planet has published a travel guide for the city you’re visiting, it’ll be a quality purchase, and when it rains, you can walk the halls, climb stairs between 2^nd and 12^th, or go to the hotel fitness club. Remember to pack your Nike’s and your fitness duds so you can avoid blisters and excuses. Click here to learn about walking tours in San Francisco.

Go to The Fitness Club

One of the criteria for selecting a hotel is the quality of the fitness club. Every large hotel in a large city has a fitness center and some of them have glitz galore. The Omni in San Diego, the Sheraton in Seattle, the Sheraton in Boston, even the Holiday Inn in Columbia, MO all have exceptional facilities for working out. Check online or talk to the actual hotel desk staff before you reserve your room and ask about these items: Cardio equipment(treadmills, elliptical trainers, lifecycles, walking tracks); strength-training equipment(training circuit, free weights, vertical bands stations); abs room or abs corner (mats, fitballs, body bars, medicine balls); and towel service as well as a decent-sized pool. Gym-rats are going to get to the facility early, so go really early or go a bit late, but get going.

Your anesthesia meeting is a place to learn more about your ever-changing industry but it’s also a place to have fun with old friends and to make news ones, a place to experience a new city in a new way. Hike Aspen Mountain, jog the stairs next to the San Diego Convention Center, power walk the promenade while cruising between glaciers in Alaska, cycle from Fenway Park to The Old South Church. You won’t be putting anyone to sleep or trying to stay awake for one whole week. Go make the most of it!

You can visit Liz at www.bdyfrm.com and learn more about her Traveling Bands comprehensive work-out indoors or out, and how to gain access to the Bands In the Park mobile browser. Read motivational, entertaining Lizlines every weekday including the weekly original Lizlimerick.

CRNA Fitness: Cardiovascular Exercise

Cardio is probably the most common form of structured exercise in America.

In the 1960’s Dr Kenneth Cooper, the founder of The Cooper Institute in Dallas, TX, introduced aerobic exercise to the fitness world and made cardio a common household word. Cooper soon after became crowned the “king of hearts.”

Cardiovascular or aerobic exercise is any structured exercise that elevates the heart rate for a sustained period of time such as jogging, power walking, elliptical training, treadmill walking, and lifecycle pedaling and is essential to any quality fitness program. Not only does aerobic exercise strengthen the heart, it raises the metabolism, which burns calories, which helps you lose or maintain weight, not to mention releasing feel-good endorphins which makes you feel good to be around. And you’ll notice that someone who has just completed a cardio work-out doesn’t usually slouch out the gym door..they hustle out. Cardio is better than Boost for raising your level of energy and it’s lower in calories, too.

To get the most out of your cardio, allot a specific amount of time, start out a tad slowly, then pick up the pace, sustaining a challenging speed for the majority of the work-out. Turn on your i-pod or watch a video flick, but take mental time to focus on form and breathe smoothly, with rhythm. Did I mention water? Drink before, drink during, drink after. You do not need any beverage other than cool water for normal work-outs. Remember, you’re trying to burn calories, not drink them. Allow a two to five-minute gradual cool down, wipe up the sweat and stretch. It’s okay to stretch before the session begins, but you won’t be warm enough to do a great job of it. Better to simply be fully awake, get a few calories from an orange or tiny bowl of oatmeal, get partially hydrated and “hit the road.” If you’re really slow at getting warmed up, you can stop after five minutes to stretch before continuing, especially if you’re on pavement, otherwise, five to ten minutes of long leisurely stretching following your cardio is ideal.

Stay off the pavement if you have bad knees, wear padded pants if you cycle, don’t carry anything heavy when you power walk, make like a camel for all cardio, and burn, Baby, burn. You, too, can be crowned the King and Queen of Hearts.

You can visit Liz at www.bdyfrm.com where the unique, informative and entertaining Lizlines are posted Monday through Friday. Don’t miss the weekly Lizlimerick, always a Liz original!

CRNA Fitness: Procrna Fit-tips

Integrating healthy concepts into your life is like riding a tandem bike. It takes two participants and a bicycle that works. To meet the challenge of getting in shape this month, be sure to integrate both sound nutrition (see January posting) and efficient exercise into a quality plan. Once you have tweaked or completely revamped your daily diet and selected a venue for structured exercise, start supplementing your coffee break with some gentle stretches like slow, easy toe-touches to loosen hamstrings and relieve stress on the lower back. When the lunch-break-boy finally makes it into your room, take a few minutes in the lounge to do seated leg raises and neck rotations. And if some kind soul mercifully shows up to give you a potty break, take an extra minute to carefully lunge back down the hall on your way to relieve the reliever. As your 8-hour day stretches into 12, remember, careful stretching provides relief, while too much coffee requires it.

To read Lizlines and to view seated leg raises, click on www.bdyfrm.com.

Liz Sanner Davis is the owner of Body Firm Integrated Fitness Solutions. She is the author of Lizlines, posted each weekday on her web site.

CRNA Fitness: Nutrition

The Gas Range
By Liz Sanner Davis

Think of the food on your plate as Fuel. Think of the container it comes in as the Gas-can. And label the inside of your body as The Tank. At every meal you must carry the fuel in a gas can and deliver it unpolluted to the tank if you want to have enough gas to live life and to give life in the OR. When the patient is short on gas, he crumps. When you are short on gas, you crump. And when low-grade gas is delivered to the tank ( think paper bags with famous logos, cardboard boxes with grease-covered bottoms, and paper cups with sippy devices), you and your patient may both wind up driving on empty. During the month of January, try making this change in your nutrition habits at work. Bring fresh lunch foods to work prepared in your own kitchen – last night’s leftover salmon is a worthy protein, light yogurt and low-sugar granola, a crisp apple, a ripe avocado big enough to share are all perfect pick-me-ups. Or stack your own turkey sandwich made with whole grain bread, lettuce and tomato. Avoid saltyfoods from the cafeteria and resist the urge to send out Smiling Samantha for pepperoni pizza with stuffed cheese crust, “double-the-olives.” Fill your tank with superior grade fuel delivered in a pollutant-free gas-can. You’ll sustain two lives – yours and the patient’s.

Liz Sanner Davis is owner and trainer at Body Firm Integrated Fitness Solutions, Temple, TX. Visit Liz online at www.bdyfrm.com and read her humorous and motivational Lizlines or Lizlimericks published daily.