Fitness Fiscal Forecast

By Liz Sanner Davis, Certified Personal Trainer

Your workout program for 2017 may resemble the weather history of the Galaxy 7 cell phone – unhealthy here today and, Poof! dead tomorrow. January is already pushing against the heart-happy, founding father’s birth month and this question quickly comes to mind. How many of you healthcare leaders out there started a January fitness program with your staff or for them, and how many of you are already sleeping in or sleeping it off? Fair questions. It’s easy to set up a contest, challenge the plebes, appoint a progress reporter and offer a prize, feign support and then go on about your busy business of leading. After all, your top-dog position entitles you to a few things like covered parking, private office, dinner meetings, football tickets; doesn’t that level of privilege also mean you and your health are your business? Shouldn’t you get to skip out on your own workout if you worked 14 hours yesterday? Isn’t it okay- heck, wasn’t it expected – that you drink two gin-t’s at the First Friday Leader’s Conference Kick-off dinner and catch some z’s while your dedicated team walked four miles without you in 35 degrees the next morning?

Nope, not okay. In fact, a worthy leader has a deep and well-maintained level of integrity or s/he should not have been selected for leadership.

It’s your job to lead by example. You can fake it or put your heart into it, your choice, but it’s still your job. Especially in healthcare, you have an accepted responsibility to your co-workers to be fit and healthy, to appear energetic and ready to rock ‘n roll every single day. And if you don’t see it that way, move over Rover and let someone with equal leadership skills but superior wellness ethics take your place.

Most health care teams would rather have a leader with crooked teeth who plays straight than a boss with straight teeth who plays crooked. If you implemented a wellness program for your staff, review and revamp it. Be an honest, straight forward leader and join your team on the walking path to wellness. Follow up and follow through in the same manner that you approach all team goals. Your fiscal fitness forecast should read: Sunny and healthy today, sunny and here tomorrow.

Liz Sanner Davis is a certified personal trainer, writer and regular contributor to Frontline Synergy. She is married to Tom S Davis, author, healthcare leadership and team developer, speaker and Certified Registered Nurse Anesthetist.

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

Visualizing Fitness

The See and the Saw

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By Liz Davis, Certified Personal Trainer

Sit on a park bench, plant your feet firmly, close your eyes and visualize this:

You are energetic and tall, your core is solid,

your muscles taut, your breathing is even and relaxed,

you welcome the world with courage and confidence.

Now get up and walk toward what you see.

In his June 10 posting on ProCRNA.com, Tom Davis, CRNA, USAF Lt. Col (ret) and former Chief of the Division of Nurse Anesthesia at The Johns Hopkins Hospital, gives bullet-proof advice on developing and maintaining a Vision in Leadership. Your road map to physical fitness is encased in your personal view of how to achieve and maintain good health. Your physical well-being requires a personal vision.

When I work with wellness clients, we sit down for an interview in which we become acquainted with each other’s overall view of what wellness means. It doesn’t surprise me anymore to hear a potential client naively say, “I just want to lose ten pounds,” or “I’m getting ready for knee surgery and my doc says I have to get my quads in better shape first.” By the time our consultation is over, the potential client is a whole lot better informed about attempting to solve a health problem using a single stroke of the pen rather that creating a wellness vision, developing a plan for success and implementing it. When the consultee leaves the office he will either be sold or not buyin’.

Your surgeon truly does want you to develop better quads to enable a speedier return to normal after replacing your knee. But what she says and what you hear are not necessarily the same. She says, “Strengthen your quads,” and you may hear, “Go to a gym and do leg extensions.” Your internist says, “Lose 10 pounds to lower your cholesterol, and you may hear, “I will be healthy if I lose ten pounds.” Leg extensions will help strengthen your quads before knee surgery, and losing ten pounds will definitely lower your cholesterol, but neither insures a speedy recovery from surgery or a lifetime of quality HDL/LDL. A well-rounded plan will work wonders for achieving a wellness goal. A vision will work wonders for being able to live each day as part of the plan.

Consult a qualified fitness expert.

This is a must. Even if you have experience with exercise, getting another opinion, even an opinion to debate, is an important step in identifying your true needs. Pay for training with a qualified fitness expert OR go online and compare programs until you find one that wastes few dollars and makes common sense. Be absolutely certain to plan a well-rounded program that includes cardio, stretching, strength-training, Yoga and Pilates plus SAFE crunches.

Schedule your exercise time in cement.

Commit a definite time to exercise seven days a week and make it who you are, not just something you do. Those who say that exercising three to five days per week is sufficient are not wrong, they just aren’t addressing your state of mind. Three to five days is like belonging to a social club. But making a daily commitment to exercise who you are is like using the bathroom when you first get up each day. Your well-being will miss it when you miss it.

Establish a nutrition plan

You can do this by visiting a certified nutritionist or licensed dietician. You can take a class offered by your local health care provider. Or, you can go online again and find a common sense approach using a quality web site like Livestrong.com or Caloriecount.com. Stick to your food plan as if you were a politician in constant campaign mode.

Change your definition of the words “comfort, “hunger,” and satisfied.

There is no comfort in being overweight and overfat; there is little chance in the civilized world that you will ever experience actual hunger; and satisfaction is a noun. Daily structured exercise and a light, nutritious diet need to become your modus operandi for consistent wellness.

Weigh every Monday morning at the same time, au natural.

Weigh in the buff or wear precisely the same clothing items each and every time. Keep records of your wellness on a weight chart. Use a wellness journal to make daily and/or weekly entries of your progress, your state of physical being and your state of mind.

Assess and alter the plan.

Part of having a vision is “arriving” and enjoying the results. My older daughter’s high school cross country coach always spent the final practice before a meet having the runners sit in a dark room and visualize the entire running route, the hills, the rough paths, the potential pitfalls and especially, the final stretch. You will know in short order if your own exercise plan needs the adjustment, or if you do.

Your vision for wellness is very much like attending your grandparents’ 50^th wedding anniversary without using google. The address is Wellness World, Fit City is the destination, the vision. The route you take is the implementation of your plan to arrive safely and on time. Celebration is what you do when you get there. Develop your vision and a healthful, efficient plan for implementation. Then get off the bench and on the road. Drive safely and soon you will see what you saw.

Employee Wellness is No Joke

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Employee Wellness is No Joke

By Liz Sanner Davis. Liz is a Certified personal trainer and frequent author for procrna.com

It’s one of the biggest jokes in the lay community. Q. Where can you find the sickest people? A. In a hospital! You probably don’t think that’s funny because every day you look at people with broken arms or legs, or repeat patients who have brutally aggressive melanomas or who live with the consequences of diabetes. Their pain is not amusing. But the joke, the cynically funny part, is that the joke is really referring to the hospital employees, your physician or physician’s assistant, the chief surgeon or anesthetist, the head of HR or the department secretary, YOU. The overweight and out of shape hospital employee appears as a huge disappointment to patients who are sick and seek your help.

Two-hundred-plus years ago, extra body fat was considered to be a sign of wealth. Abbigail Adams, after all, was short and fat. In spite of her years of physical labor on the farm and having to endure significant revolutionary war shortages, Abby still “enjoyed” a majority of her years ingesting quantities of comfort food. She and others of wealth and repute often made huge contributions to society whilst making ample time, following the years of economic travails of the war, for sitting, eating and being served often, if not well.

Is that you? Are you, in spite of 40-50 hours per week on your feet, in spite of regular paychecks and good benefits, in spite of wellness issues smacking you with direct hits daily, are you fat and flabby with chronic pain that plagues you all the way to the peanut butter cups and chocolate bars in the break room? Well, then, the joke’s on you, ‘though the patient isn’t laughing.

Don’t get me wrong. Being laughed at is ok on occasion, but laughing with is a whole lot more fun, and being the laughingstock? Not fun at all. In a new society that likes to outsource responsibility for their health to the healthcare industry, what part of your health problem is theirs, and what part of the problem is yours to fix or to prevent?

One can follow the history of workplace wellness in a timeline that begins with centuries-old Asian cultures, where employers dictated the wellness rules to employees. Throughout central Europe taxpayers supported and still support mandatory month-long employee holidays, thermal baths included. In the 1800’s, westward across the pond the wealthy elite offered workplace exercise activities to other wealthy elite. George Pullman, of rail fame, was one of the first to provide for general employee onsite wellness. (http://www.marketwatch.com/story/companies-meddling-in-employee-health-since-1880-2013-04-11)

The1970’s until the present have brought gradual changes to wellness in America. We have tried to approach wellness the same way we approach politics – by keeping The Nutrition Party and the Exercise Party separate. But over the last 45+ years, we have learned that exercise coupled with nutrition equals wellness. Along the way during those 45 years, the cost of living, the cost of healthcare and, therefore, the cost of taxes has risen exponentially. Fewer people carry the large economic burden and as medical know-how improves and the need for healthcare increases, the health of over-worked, over-stressed and over-tired employees has created a greater need than ever for wellness in the workplace. Employers are stepping up.

Broward, in Ft. Lauderdale, Fla, advertises, “We are a hospital-based fitness center with professionals certified by the American College of Sports Medicine and the National Strength and Conditioning Association. Our staff includes nutritionists and personal trainers who are educated in exercise physiology and nutrition, helping you create a healthier body, inside and out.”
Employees at The Johns Hopkins, Baltimore, MD provide a wealth of options presented on a monthly calendar that guides employees to the right location whether to enjoy a walking program or a smoking cessation appointment. Incentives are offered to encourage participation and commitment, and who doesn’t love praise and free stuff?
Grant Health and Fitness Center in Columbus, Ohio promotes “…health enhancement and disease prevention.” It is associated with a vast network of area hospitals and all locations have employee-friendly hours, a no-excuses kind of offer to help you maintain your status as an employee rather than as a patient.
The Cooper Institute, Dallas, TX has associated itself with healthcare entities for decades and offers certification for employees to return to the workplace and develop wellness/fitness programs. The Cooper’s credible certification program attracts healthcare, corporate and government clients worldwide.

Providing employee wellness programs like these benefits the employer as well as the participant. Company insurance rates go down based on number of participants and proven results. Employee absenteeism is significantly reduced. People who work out together, work better together. They’re happier and, usually, just nicer to be around. And the quality of work provided by the healthy employee improves the entire company culture. Good health should reduce healthcare costs and reduced health care costs should lower our taxes!

But, be ready to pay if you want to play. Everyone wants something for free. If one thing has a fee and the other is free, we all know we will try very hard to make the freebie work, even if it really doesn’t. And if something costs nothing, the likelihood that we will follow through with the acquisition diminishes along with the return.

If wellness and fitness programs are not available at your place of work, get on it. the gym manager to your department chair. Head to Dallas to get certified at the Cooper Institute. After a rigorous week or two of classes and examinations, you could be qualified to blaze some trails to a clinic back home in Mississippi or Wyoming.

If wellness and fitness programs are available at your place of work, get to it. Join a program or help design a new one. Arrange to work with a qualified trainer. Get a work-out buddy and give and get the support that a partner provides, even and especially if you get to make a new friend doing it. For quality results, be certain to follow an integrated program that includes nutrition along with fitness. Be prepared and willing to pay the fee if it isn’t free.

So, what card will you be at work – the joke or the joker? Peanut butter and banana sandwiches may be how many of us got through college, but not through life. Take advantage of the whole-meal-deal offered by the employer at your place of work, and remember: The changes you make, the integrated health that you display to the patient, increases their trust and respect in the entire healthcare industry. Together, the patient’s trust and your good health will leave a permanent impression on history.

More:

http://www.corporatewellnessmagazine.com/worksite-wellness/the-evolution-of/http://www.bethesdaweb.com/employee-wellness-programs http://www.beckershospitalreview.com/hospital-management-administration/18-most-popular-wellness-programs-for-hospital-employees.html

http://www.fiercehealthcare.com/story/what-hospitals-are-doing-employee-wellness/2012-03-15

http://www.amnhealthcare.com/the-roi-of-hospital-employee-wellness-programs/

http://www.cooperinstitute.org/pub/class_list.cfm?course_id=303

Making the Case for Fitness

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Making the Case for Fitness

By Liz Sanner Davis, Certified Personal Trainer

Being fit for your job as a professional CRNA means you have fulfilled all of the requirements. You are educated, you are licensed and you are poised, CV on file and and needle in hand, to enter the operating theatre. But, wait just a minute! Are you really fit for the job?

In the exercise wellness industry it’s accepted that a “soft body” isn’t much of a marketing tool. In fact, in most aspects of wellness careers it is anticipated that job applicants will practice what they preach. But to become a quality CRNA or anesthesiologist, physical fitness isn’t required. Read your contract. Being able to do lunges isn’t there. Read the job posting, your BMI doesn’t merit even an honorable mention. There is no hands-on exam with weight-bearing exercises and cardiovascular endurance. You are allowed to be hypertensive, sleep-deprived, diabetic due to obesity, undernourished, even outright anorexic using scrubs and mask as the cover-up. If your education and your skills satisfy the needs of your Chief CRNA and his/her chief, if your personality blends with the system, if the clinic is in need of your skills and the state gives you a “go”, you’re hired. Being fit and getting fit can end up at opposite ends of the table.

In fairness, the greater acuity of the case and the more talent you bring to the table, the less important it is to have muscular curves in all the right places. Equally, a remote hospital serving a rural area is seriously more interested in your warm body than your sculpted one. But at the end of a 16-hour heart-transplant, or 10 years of them, your ability to focus, to react, to apply your years of education and experience, and to simply endure are all dependent upon your own physical condition. Umpteen years ago, some smart person over 50 said this: When you have your health, you have everything.

FYI: You will not be discriminated against for being too fat or too underfed in the modern American job market. You cannot be marginalized just because a needle is the heaviest thing you can lift. Note, however, that just because free speech about your human condition is ethically discouraged, that doesn’t mean the patient isn’t silently worried because of it. What is your long-term contribution to this or any industry if you don’t take your own health seriously? Where is your integrity in intentionally being less fit for the job than you can be?

BTW: The patient who looks at your puffy preo-op face and watery eyes may want to

post a facebook remark about patient satisfaction that reads, “I’d give it a 3. My anesthetist looked so unhealthy I was afraid he would expire before I did.”

Beki Preston, MD, JD, adamantly states that “above and beyond all other issues surrounding a surgical procedure the bottom line is always patient safety.” Well, that’s hardly a newsflash, is it? Everything you do is supposed to be directed toward the safest possible outcome for your patient. I brazenly make the claim that everything you do inside and outside of the OR affects the safe outcome of your patient. Your health affects his.

Get some shut-eye. Yours is an industry that has sleep written all over it. If your patient took the opportunity to ask you some pre-op questions on S-day, he might ask, “How much sleep did you get last night?” Getting through 45+ hours a week is not, as one popular anesthesia blogger and mystery novel author suggests,“just five minutes at the beginning and at the end of a gall bladder removal.” Case management, whether you work with or without supervision or whether the case is big or bread-and-butter, requires your full attention from pre-op to wake-up. You’d better be wearing your toe shoes and stay awake every minute that your patient isn’t.

Thirty brisk minutes of cardio starts your engines. Before your morning shower, just gitter done. Cardio will open your eyes and keep them open during the critically careful intubation of a beautiful baby, or the delivery of one. It will elevate your mood and your level of energy. Being bright-eyed and bushy-tailed enables you to look into the trusting eyes of your patient with authenticity, empowering you both. Yoga and stretching exercises will build your core, improve your balance and give you peace during difficult cases. Lifting weights and using bands will strengthen your muscles, bones and brain. Instead of complaining at the cooler about your cranky knees or the crink in your lower back, you can be aiming your complaints at the Ravens or the Rams.

Eat some measured quality calories. Your patient has a right to expect you to be fit and fed. Rolling your heavy backside out of bed and showing up for work with sleep in the corners of your eyes and frosting between your fingers, isn’t a poster for CRNA of the Year. A doughnut and cup of black coffee may get you through one hand of a two-fisted surgery, but a bowl of oatmeal with yogurt and an orange will last much longer without infusing fat chased by a post-sugar low. Turkey slices on a half multi-grain bagel topped with avocado alongside fresh fruit serve up lunchtime satisfaction and sustenance. When a team member offers you relief, go get some real relief. You don’t want to fill out on negative calories and return to Room #22 empty. Fill your vehicle with high-grade fuel to improve your mileage.

Your medical mantra should read: I am fit for duty. It’s unfair to the patient when you drag into work and try to manage your first few cases by rote. And it’s unfair to the care team if you call in sick on a Friday or Monday simply because you don’t take care of your total SELF. Additionally, it’s totally unfair to the industry to have killer expectations of you but fail to encourage and provide for your physical well-being.

We live in a country that regulates everything but your heartbeat. That, my fitness friend, is YOUR job. To be the best that you can be for the patient and for the team, do the best you can for your personal self. Get fit for the label you wear to avoid the tear. Earn the respect that you expect, the healthy income you are paid, and the important position you have established in the health and wellness industry. Get fit and be fit at the table.

Liz Sanner Davis,

bdyfrm@aol.com

Coming in April, “The Gym Rat”, a dissection of fitness programs provided to providers.

CRNA Wellness: Beverages are Making Us Fat

Driven to Drink?
The 6:30 a.m. drive-through line is long but the beverage baristas inside have got the gig down. Take the order, take the money, write on the cup, hand it off and move’em forward. Just across the overpass to our medical center, Starbucks customers line up bumper to bumper on their way to work. And another of the Seattle-based ‘bucks right inside the entrance to the med center picks up the slack. Mmmmm, creamy, sweet, warm…what’s not to like about lapping up your favorite frap on the way to tackling a heavy work schedule? Answer: The heavy part. Beverages are making us fat.

Getting Juiced
Let’s start with juice. Orange juice and the members of its expanding family, are loaded with sugar. They may be fortified with vitamin C, added calcium, or may contain those magical anti-oxidants that didn’t make it into your lunch bag, but most juices are also fortified with sugar, frequently over 15 grams of sugar per 8-ounce serving. An 8-ounce glass of Tropicana original orange juice has 114 calories. 70 calories are sugar and though it may satisfy 96% of your daily requirement for vitamin C, there is only a tad of added calcium and a smaller tad of vitamin A. Ounce for bounce, the payoff isn’t there. A fresh orange, however, has a much lower 62 calories of which 48 are natural sugar(fructose), and it provides 116% of your necessary vitamin C. An orange supplies twice the natural calcium as juice, three times the vitamin A plus 3.1 grams of natural fiber. Plus, you get to chew!

There are entire aisles devoted to fruit- flavored beverages in bottles, boxes and cans in your shiny, upscale grocery chain, but nothing satisfies your body’s needs like fresh, whole fruit, the more color and the more variety, the better. If ya just hafta have your bananas and berries in a beverage, get out the blender and give it a whirl. You won’t need to sweeten the pot.

Smooth Move
Blenders are used for making the smoothie. Originally, the smoothie was a fruit and ice beverage, sometimes with added sugar. Although it debuted as a beverage in the 1930’s, Wikipedia says that the term smoothie/smoothy was actually conjured up by the hippies, though I don’t remember seeing any at Woodstock, and that California, with its ready access to fresh seasonal fruit was the original venue for vending it. Now we blend smoothies choosing from yogurt, protein powder, kale, carrots, blueberries, strawberries, milk…the list is endless but the calories are increasing with the options. It isn’t difficult to find a smoothie shop right around the corner from your produce market, only you’ll drink close to 300 calories if you buy it already made. Go back around the corner, concoct your own smoothie and you take control. To get through a busy day in the OR and still get your nutrients, a smoothie is a great choice. Opt for low fat, no sugar-added, skimmed-milk, light yogurt or water-based, make either fruit or veggie drinks, and avoid expensive, high-calorie add-ins. If your smoothie is meant to enhance your work-out, a tablespoon of protein powder is a fine idea. If dessert is a smoothie, go back to the original 1930’s recipe by using simply fresh fruit and ice. Eliminate the sugar and pour it in a six-ounce wine glass. Now that’s a juice bar!

Are You a Soda Jerk?
Coke, 7-up, Pepsi, Dr. Pepper, Sprite, Mountain Dew, Orange/Strawberry/Grape/Teenage Crush(just checking to see if you’re reading closely), Cream soda and Root Beer are just a few of today’s and yesterday’s beverages-that-make-you-belch. For some reason, we get a kick out of slugging down that nutrient-free, sweet, fizzy bev and emitting a healthy g-blurp! within seconds after downing the drink. But colas do not satisfy thirst. They are wet and sometimes wild, but the ingredients are more de-hydrating than satisfying. If you choose a caffeine-loaded, high-sugar cola bathed in dark dyes, you are headed for more thirst after drinking than before. And you just slurped up at least 96 calories per 8 ounces. A 12-ounce Classic coke is 144 calories and the same fluid measurement of Pepsi or Dr. Pepper weighs in equally at 150. Don’t forget, there’s sodium in them thar streams of sugar and diet sodas have even more. When you just want a little something sweet, a clear soda is the better choice, and a tall, glass, glass of iced cold water is best of all.

The Buzz
Alcoholic beverages are a whole other fast track to fat. We try to jump-start the day with coffee; we imagine we’re getting a nutrient-dense kick with juice; we substitute meals and assume we’re enhancing exercise with smoothies; we pretend to quench our thirst with sodas; but there’s no denying the reason for consuming that 16-ounce margarita or two 6-ounce glasses of Menage e Trois…red or white. It’s recreation. Recreational drinking isn’t a sin, but be aware and compare. One 4-6 ounce glass of red wine is typically 120-150 calories, no worse than a large serving of crunchy, sweet, juicy, red seedless grapes full of fiber and dessert-like qualities, but hey, I only said, “Be aware!” White wine, though lower than red in calories by 25%, does not supply the same number of nutrients as red wine, obviously. Think spinach and mushrooms, dark and light. But neither red nor white is great for metabolizing fat… it’s alcohol, after all. You’ll still need to drink plenty of water and skip the sucrose to avoid those heart-pounding chest rhythms. And do you really want your morning mouth to feel like a cardboard balloon?

Hard liquors are worse for you than wine. If you insist on preserving your right to imbibe the hard stuff, keep these things in mind. On a regular diet of hard drink, Your tummy will get soft fast and your red nose may qualify for holiday hire. Above the others in calories ounce for ounce, more toxic to your internal organs, completely free of nutrients, and potentially more addictive than adult beverages with lower alcoholic content, hard stuff is a poor choice all the way around. Particularly if you are on a wellness program that includes weight loss, deep six the Ten.

There are those who think that a nice cold one quenches the thirst after a nice hot one. It doesn’t. You will not cool down by drinking two pints of Fat Tire after mowing the yard or after playing baseball for two hours. But you can get a fat tire. Beer does not re-hydrate; it doesn’t even hydrate; it is not a substitute for water. What’s not to understand? And if you have any interest at all in a flat tummy, fresh, sweet breath, skin that isn’t sticky and smelly and sweaty at bedtime, and if you’d like less opportunity to make a fool of yourself during Sunday afternoon’s TV Testosteronathan, then load up on water before watching the game, drink at least a quart before playing in one, and don’t touch a beer after mowing until you’ve fully re-hydrated with agua fria. That beer-belly syndrome? It’s nasty-looking, it’s high-risk and it’s for real. Try Sparks.

Be-hold!
Here’s a last word about the extent to which industry here in the States has embraced the beverage boom. Behold the cup holder! We are so dependent on doing something with our hands that nothing with wheels passes market inspection unless it sports a holder for a cup. Nothing with wheels is exempt. There’s a cup holder in your car, your truck, your child’s stroller, your grocery cart, your golf cart, your bicycle(okay, safety issue, fair enough), your yard wagon, your oversized cooler, your computer bag, your rolling backpack, your commercial bus, train or plane tray, and your beach roller bag, not to mention purses, fanny packs, exercise belts, cardboard drink holders…the list is endless, but not surprising, at least in the USA. In Germany, a Bavarian Motorwerks standard issue comes cup-free, but in Spartanburg, SC, BMW assembles the high-end European parts and adds cupholders, “nur fuer uns!”

You Can Lead a Person to Water, but Can You Make ‘em Think?
When you are offered “something to drink,” do you think coffee, water, or a shot of Jack?
Okay, so that may depend on what kind of day you’ve had in the OR and whether it’s
6:00 a.m. or p.m., but, truthfully, if you are a two-fisted cola consumer, a caffeine dependent addict, a juice bar fly, or a regular consumer at Friday Nights Live, it may be time to balance your beverage accounts. Click on some of the links below to read some nutrition facts and beverage tips’info. Start thinking about what, why, and how much you drink BEFORE you drink it. A flat tire is a lot easier to fix than a fat one. Prost!

Compare the Keurig Chai Latte to the Starbucks Frappuccino

Click here for Smoothies

How many calories in a glass of wine? Click here

How many calories in a non-alcoholic beer? Click here

What drinks cause dehydration? Click here

The truth about green tea…Click here

Please visit Liz at www.bdyfrm.com to read the daily Lizlines and Friday Lizlimerick. Discover

Liz’s Bands In The Park mobile browser, a perfect companion for your walking or running group.

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: The fitness group

The Fitness Group – Not Just a Numbers Game

There’s strength in numbers. If you need proof, count the number of defensive players on the football field; observe the light produced by one streetlamp compared to a dozen; taste the difference between a chicken breast with one tablespoon of pepper and one teaspoon; shake hands with each member of the medical team that successfully separated conjugal twins. A group with a goal cannot be stopped. If you want great results in your wellness program, call some numbers and form a group.

Men’s Health Magazine suggests signing up for an event as one of its “top twenty ways” in which “to keep yourself on a fitness program.” The motivation of preparing for a contest involving lots of people – and perhaps prizes – keeps you focused. And focus is something all anesthesia professionals can do. There are fun runs involving 100’s, maybe a few thousand people, somewhere every weekend through October as well as cycling tours, tennis ladders, bi and triathlons galore and all it takes is one other person to help keep you motivated. If you have more than 2 or 3 on your anesthesia team, you can have the same number on your walking team. Are you going to San Francisco for the 2012 AANA meeting? Take the team for the fun run and make healthy headlines. Did the recruiter entice you to move kit and caboodle to Kansas City? Your fitness groupies can gather at the head of the 17-mile trail at the south end and power a walk all the way to Town Center in Leawood, or keep going on a bicycle into Missouri! Promise the Biggest Loser a lean latte at Dewey’s Coffee Café or buy the “most improved” person a bagel at Einstein’s. Re-set the bar a teeny bit higher every week the team meets. Improvement and reward are inherent in teamwork.

Though expansion is a curse word of the weight-watcher, it’s the goal of the group. Your companions at the clinic need not be limited to anesthesia junkies (I use the term loosely), so once your “team” is up and running, let it grow. Evite another department, then another, and another to join you in the effort to be well. Perhaps you already have a wellness offer at your hospital and perhaps you regularly participate. Great! Now get out and evangelize and expand! Your improved level of energy and your own success at achieving and maintaining a fit, healthy body are perfect advertisements. Add your voice to the ads, and the group will go viral. Your team should “change up” because that’s what keeps it vibrant and challenging – sorta like 10,000 minutes on the schedule with five anesthetists on vacation!

Scott and White Medical Center, Temple, TX, has a hospital-wide cycling group that meets once or twice weekly, year ‘round. It is highly organized – matching shirts and shorts! – and has become so popular that spouses and community residents frequently join the 145+ membership for the Saturday morning ride policy of “no cyclist left behind.” Watertown Regional Medical Center in Wisconsin offers patients and employees one-on-one personal training sessions and several group fitness events each year. Cleveland Clinic in greater Cleveland offers free employee membership to its fitness centers where you’ll participate with a group of 1,000’s! Your upstate New York group can have a cross-country skiing team and your WEE employees in Colorado (We Enjoy Exercise!) can form a hiking club. New Mexican anesthetists can train together for the annual climb to Sandia Peak and Georgians can scramble as a team up the backside of Stone Mountain. The opportunities to form a cohesive, enthusiastic group committed to the freedom of wellness are only limited by your imaginations and the Dunkin’ Donuts sticking together in the anesthesia lounge.

It takes a leader and one friend to form a fitness group. Add a little organization with some consistent commitment, and “they will come.” Your health will improve as the result of being part of a team, and if it’s a good team, strength isn’t just added – it’s multiplied.

Click here for Cleveland Clinic’s wellness program

Click here for Scott & White cycling club

Click here for Kansas City bike trails

Please visit Liz at www.bdyfrm.com to read the daily Lizlines and Friday Lizlimerick. Discover

Liz’s Bands In The Park mobile browser, a perfect companion for your walking or running group.

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 Fitness: Decompress the stress

PROCRNA asked me to mount the March podium on the issue of stress-reduction which would be nearly laughable…except for the fact that I have so much personal experience. So here it is, the Body Firm method to decompress the stress.

Where do most of my clients turn for comfort during or after a tough day with the head, hands or heart? Why, food, of course. The number one method of coping with pretty much anything these days is comfort food or drink. Some of you will turn to the box of goodies in the lounge, some of you will opt to ingest a 16-ounce cola, and some (more of you than would like to admit it) will eat two or three doughnuts pretending it’s breakfast. But be careful of calorie-dense stress relievers. Sugar elevates your mood very briefly before acting as the downer it really is, dropping you as fast as a plumb line, and leaving unwanted calories and irritation behind. And in the long run, useless food raises your stress. Instead, munch on an orange, or snack on a handful of almonds, or both. An orange will administer quick sugar, it’s true, but it’s loaded with vitamin C and will provide nutrients along with energy. Nuts are a great source of protein that can hold you over until a real meal or simply sustain you through another case. Try walnuts or pecans, too, and limit your serving to a clean, even dozen. The crunch of the munch is very satisfying and brings fast relief.

You may be tempted to just flop on the decrepit sofa in the lounge when someone relieves you in the OR, not always a bad idea. But even better: Walk the hallway, stop to do squats every 12 strides, stretch your calves and quads and stretch your arms above your head, jog down the stairs to 2nd floor and jog up the stairs to 4th. Pause to do a couple of Yoga positions and bring your heart rate back to normal, then re-enter your case room with mental peace restored.

Dr. Coyote howled, Dr. Hound bit, Dr. Wolf snarled throughout the last heart case and, quite possibly, the patient’s heart is now doing better than yours. Instead of chatting it up with staff and cohorts when you exit the room, pull out a good read. Weird Sisters is a current hoot for chicks, and author, Olen Steinauer can capture either gender’s attention in short order. Try reading the daily “funnies” for comic and cardiac relief, or read anything cheerful that will take your mind off the present and help restore your equilibrium and your gift for humor. LOL.

You may not be in charge of selecting music for the gall bladder room. Pink Floyd or
George Strait may be the surgeon’s consistent choice of genre, but when you get to choose, or when you go on a break, listen to music that relieves tension. Relax with alternative sounds like waterfalls or crashing waves from a Narada collection. Classical melody from Smetana’s “The Moldau” or Debussy’s “Daphnis and Chloe,” and even big Wagnerian themes from “Tannheuser” or “Lohengrin” can fill your soul and remove the excess tension. Schubert piano solos or symphonies, unrestrained strains from LAGQ, Chis Botti love tunes on the trumpet or any of the music you simply know and love can take off the edge, and pull you back from it. Massage your hands and feet while you listen to music and get maximum de-fusing.

Finally, here’s one of the best stress-busters known to Venus or Mars – Meditation. You’ll need a quiet corner for this activity unless you’re an excellent self-hynotic. Close your eyes and preferably a door, get seated and settled with good core support, then start with slow, deep breaths in through the nose, out over the lips, switching to all nose breathing when you’re fully “centered.” Tune out any and all distractions and focus on the breath (Toothpaste trumps garlic!); in…and out….in ….and out…”…he loves me….he loves me not….one for you…one for me…” Relaxation is in the focus and in the rhythm.

K, I hate to wake you up, but there you have it – Body Firm’s favorite decompression session. An anesthetist has almost no time to relax during the workday. Morning break is not a given. Lunch can be 11:00 or 2:00 or not at all. The comfort and outcome of the patient will always be your ultimate concern. But put your own health next in line and treat your stress with safe, un-medicated relief. Your patient will benefit, and it may keep you from becoming one.

Visit Liz online at www.bdyfrm.com Read daily Lizlines and leave a stress-free comment!

CRNA Fitness: What goes Up, Must Come Down

What goes up when the rain comes down? Answer: Your weight. If you thought the correct answer was “an umbrella,” then you probably heard it from your kids or grandkids. March does bring rain, but even more than moisture, March brings a change of seasons. And as the season changes, so do your fitness opportunities.

If you have been walking on a row of treadmills all winter, hiking virtual trails while listening to gym-girl Greta’s visions of grandeur, aka gossip, on the machine next to yours, you’re more than ready to hit the pavement, wet or dry. Asphalt streets, dirt trails, and school tracks exist in nearly every community and only really nasty weather should send you back to Greta. Fitness experts often claim that outdoor cardio actually burns calories faster just because of the elements of wind, breathing outdoor air, and dealing with natural changes in elevation. Yes, on Lion days, you can go back inside and adjust your treadmill to outdoor standards, but it would be a shame to miss watching that Bartlett pear tree on the corner of Magnolia and Vine go through its spring metamorphosis. Don’t forget to take drinking water.

Bands work-outs are a fantastic source of strength-training and once you’ve taken them to your favorite park, you just might opt to stay outside in the wind and rain if only to enjoy the freedom and flexibility of the work-out. If you’ve been going to the gym three mornings a week to lift weights, or to do Body Pump, or to zip through the circuit of machines, taking your bands outside to a park will provide a nice break in the winter routine AND if you walk there, you can keep checking on that Bartlett pear. When the nitrates start falling from the sky, you can always take the bands inside at home or at the gym. Is there a fitness center at the hospital where you work? Is there a children’s outdoor area with some poles that support swings or climbing apparatus? Perfect for bands. How about doors with hinges. If there is a low-traffic area inside the hospital where some infrequently used doors with hinges are hanging around, that’s another perfect place for anchoring bands. Maybe you’ll need “permission” to use the space or maybe you’ll need the chief’s approval, but if you really want to do your work-out, you can work it out. Don’t forget your water.

March brings a variety of weather to your exercise routine – rain, wind and even some stubborn snowfall. You will probably need to do a blend of trail walks and treadmill, outdoor cycling and indoor elliptical, and you may need to tote the Totes. But it’s a great time, a hopeful time of year when as the season changes, you can take advantage of the change. Then when April arrives and the rain comes down, the only thing that will go up is your umbrella.

Learn more about the Bands In the Park work-out on mobile browser 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: 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.

CRNA Fitness: Selecting a Gym

Losing weight used to be numero uno on the News Year’s Resolution list but lately it’s given way to touchy, feely hopefulness charged with sentiment and inertia. In spite of the second-place status, ‘lose weight’ is a list-maker that will open gym doors and sell overpriced clearance tights…for about three months. Over 30% of the people who join a gym in January, will stop going by March, and may never return. If you are one of those who does follow through on your resolution commitment of losing weight, here are some tips for joining a gym and/or hiring a personal trainer.

The Goals

Establish your basic goals.

That means you may need to sit down at your computer and write down two or three well-defined things you intend to accomplish by joining, then select a gym that has what you need in order to achieve your written goals.

The Proximity

Locate a gym or trainer that is close to home or close to work or right on the precise route that you take to one or the other. If you have to go the least bit out of your way or have to stop at one light a little too long, you’ll be back under the covers in less than a month.

The Money

Gyms and fitness facilities are muy espensivo to operate so they want, they need your money. Still, wangle the best deal you can get. Three-month specials abound (‘cause they know you’re gonna quit in March!) and perks like a free trial visit, personal training packages, free classes, and guest passes are often an option. Accept an automatic withdrawal from your account ONLY if you fully understand the fine print in the contract. Yep! There will be a contract and you won’t get out of it easily in March…or June, either. Read, comprehend, then pay up and USE the place faithfully. Tip: Go as the guest of your buff and beautiful friend so you don’t have to listen to marketing hype first-time in the door.

The Machines and the Maintenance

Machines should be up to date and in good repair– you can tell by getting on one and using it or by counting the number of signs on equipment that say Out Of Order. It doesn’t hurt to take note of the rips and tears in vinyl machine pads, the cracked or missing water holders on cardio machines, or single dumbbells now divorced from their partners. Check out the bathroom, the showers, the toilets – um-hmmm – and ask straight out how often the cleaning service marches their bucket brigade from ellipticals to lockers and beyond. There is no better place to get colds, flus and infected scratches and wounds than at a work-out facility. If you have to step over the spit on the floor next to the squats cage, move on dot com.

The Environment

How’s the music? Can you hear yourself think? Is this a meat market or a family fitness center? Do you recognize some people from work or bridge club? Do people behave respectfully and share equipment and clean up after themselves on the gym floor? Does Jocko Madzilla remove the 800 pounds of weight plates from the leg press when he’s finished and does Little Lucy Latte get off the elliptical promptly when her time is up without re-setting the timer when no-one’s looking? These observations take time so take that time to avoid being sorry.

The Members

Then, ask the members who are there if they are happy with the variety and supply of equipment, with the quality of classes and with the level of maintenance and overall professionalism. Discuss their payment satisfaction and what they like best and least about the facility. Find out if theft is a problem and how issues have been resolved. Observe the members as they arrive and leave, as they work out and socialize, as they interact with personnel and how they treat the place, ‘cause that’s how they’re going to treat you.

The Trainers

This is my area, Kids. I’m an integrated fitness trainer and I take this seriously. If you want a trainer whether short-term or long-term, do your due diligence as real estate people like to say. Look at other client’s results, interview more than one client to get their comments and interview more than one trainer to feel the fit. Inquire about credentials and certifications and if you’re at a gym, ask the gym leadership to tell you what the requirements are for trainers – eg, insurance, certifications, age and experience. Then observe at least one session and don’t look at the trainer’s biceps and glutes; look at the attention he/she gives the client, the focus, the total professionalism. If the client is grunting, pouring sweat and hobbles for three days after the session, run the other way while you have two good feet. Efficiency, form, and safety are tantamount and pushing clients too hard is a deal breaker. Make sure the trainer keeps good records of client progress and has some level of education in nutrition. Supplements of any kind are not necessary for achieving normal, healthy results, but trainers often earn mega extra income by selling them. If you find a high-quality trainer whom you trust and who guides you to your mutual goals, that’s the deal maker. Just offer her/him a good tip and consider yourself pumped!

A well-run fitness facility is a social mecca for exercise where you can pay for the opportunity to get in touch with your wellness and, therefore, your well-being. With precious little time and money to spare during this extended employment drought, do your homework before you slide your card then stick with your plan beyond the Ides of March.

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.