Not G-Rated

Warning: If you're prudish, you should stop reading now. Ken and I went to AIDS Services of Austin's Art Erotica fund raiser. This is an annual event, very Austin, where erotic art is displaying and bid on. All the money goes to the Kirby Fund at ASA, which provides funds to people with AIDS that are in a financial crisis. It's such a worthy cause, and let me tell you....so fun.

I've displayed some pictures here. But here's the scene: a large empty warehouse, dark, techno throbbing beat, with fences all along at different angles, art hanging on them. There's dancers up on catwalks and the cutest young gay guys serving drinks on platters -- all they're wearing is tight little briefs. Big bar in the middle, your ticket gives you unlimited libations. The art is so wide ranging....some of it quite amateurish, some so sophisticated, some absolutely filthy, others abstract and refined. It's a treat to dive in visually. And -oh- there's some aural stimulation as well. There's a big booth on one side where you put on headphones and listen to someone's erotic experience as a performance piece. At the end, you get a little card that explains what was really happening as you listened. It's designed to allow you to experience erotica without visual input, which is not what we usually do. I enjoyed that. I think ASA's young people's group (called Q? or something like that) put that on. There was also live art taking place - three tableaus of models posing, with an artist painting or drawing their likeness on canvas. No pics allowed of that - too bad, cause it was pretty arresting - but one thing did rather irritate me. So the women are nude, right? But the men - nope, they've got their business covered up in a teeny-tiny g-string. This struck me as sexist, but then later I thought, you know it may a legal issue. You know how it is - the authorities are soooooo fearful of women's sexuality. We see a penis and we totally lose control.

I was thinking about how much of my life is not G-rated. As a nurse, and especially as a psych nurse, I am privy to the most personal parts of people, the parts that we hide from everyone else. Things as simple as showing me that rash on your groin that is really bugging you, to talking about the funny uncle that touched you inappropriately and now you keep having nightmares about him. It's so interesting. What I was born to do. I can speculate about why, but the core is that I've felt different than everyone else my whole life and finally, I truly appreciate it and embrace it.

I have more to talk about, I will do that when I get this week done at school. I am so busy my brain hurts and I feel guilty about writing this post but didn't want to wait. I read a super-interesting article about how 8 mentally-ill people in Austin accounted for 2700 ER visits over a span of 6 years. Can you imagine the cost of that? That's no typo -- only EIGHT people. It's incredible and points to a severely broken system. Also, weeks ago I heard on NPR that 1/3 of the people in Who's Who had lied about their military honors. So I thought I would write a bit about both of those topics.....so much there to ponder on. But next time.

Enjoy the pics. (Not you, Dani).

Downhill

Mid-semester has passed, I can feel the momentum of racing downhill. And yes, did a little of that Sunday at the Capitol 10K, the 35th annual event & the fourth largest 10k in the US. It was fun, kind of hot, but no complaints. Ken and I cheated a little and actually veered to Lady Bird Lake trails near the end. It was just so shady and nobody on them. We weren't timed anyway. After that, we had a big family lunch (excellent Thai food) at Holly's house, my aunt Pam was in town.

I've got two big projects left, well I guess it's actually three. Two are papers and the other is being videotaped while I do a psychiatric assessment of a "patient" (really a classmate). Tricia and I are doing this together, we take turns playing the role of the patient. We read a secret script of a patient with a particular disorder and we get to impersonate them. It's not strictly scripted, we choose how to respond, and we have to demonstrate an understanding of the disorder and its manifestations. But ick...who likes being videotaped? I have managed to settle my nerves by thinking through how much of this I've done in real life as a floor nurse on a psych unit. It's a standard routine for new admissions, and that actually was one of my favorite tasks.

The other projects are a health assessment of a family, which was quite complicated, it involved interviewing someone, drawing diagrams of her family health history and analyzing the psychosocial functioning of their family unit. Plus identifying a health problem that they are willing to address and developing a plan. Anyway, it's 20 pages long (really), with 3 attachments. The last thing is a paper and presentation (with a partner) on the new cervical cancer screening guidelines and how best to explain them to patients. The new guidelines actually decrease most women's screening to less than annually, and I've seen some patient reactions in clinical - most aren't very happy about the idea. So the assignment could have some validity - it's a difficult thing to explain the science behind it, and takes some finesse.

And there's the day-to-day fun. A pharmacology test every Thursday, other tests sprinkled in, yes like jimmies on an ice-cream cone. I actually ....gasp.... got a 100 on a pharm test. I really had decided that he just didn't give that as a grade. But I'm still taking it pass/fail. And there's the big group presentation in my research class. The topic my group chose is pain management in post-cesarean section women and an association with post-partum depression. Let me just scream now --- I hate group projects. I don't mind things with a single partner, but our freaking group has seven people. Yes, that's not a typo.

Clinicals are still the most fun on the block. I just wish they didn't take 14 hours a week to do. I have Peds now on Fridays, and I'm paired with a Pediatrician (a physician, not an NP). I have to say, she's great. She's young, just graduated last year, couldn't be more helpful. At the end of our first day, I hugged her and said I wanted to give her a best preceptor award. (yes, I hugged a doc -- ha) We see patients at a community clinic, most have no insurance and are covered under Medicaid. I got to see coxsackie virus on the first day. And it was an amusing day at the University Health Center after Spring Break - literally two days after the kids returned - they were all sick as dogs. I mean, no sleep, too much sun, too much beer... I think I saw Sherry hand out antibiotics to every single one and she never does that. It was highly instructional -- like, this is what happens when you're stressed, you compromise your immune system, you have a tickle in your throat but you go out all night anyway...yep, this is what you get. A monster sinus infection, strep throat, a terrible exacerbation of asthma, etc.

I've got my summer lined out. I'm taking a required nursing class first, Health Policy. Then I get to take my elective, and I am still researching that. So many choices, it's just way cool. Things like the psychology of health in AIDS patients, human sexuality, deviant behavior, the advertising of health promotion, etc. But before all that starts, I'm going to Boston for two days for a review course for my board exam. I know, it's a year early, but it gives me a heads-up on what's important this last year. And what's really valuable is the manual - I can then study that whenever I want to start, I'm not dependent on scheduling of a live class.

So I'm going to leave with a cool quote I got from a fellow nurse at a lecture.

Philosophy of Sharing Ideas (K. Kirksey)
A large group = culture
A small group = cult
2 people = love
1 person = psychosis

ha!

Catching Your Breath

It's almost Spring Break and I can't wait to have some unstructured time. It turns out that I'm going to write 5 papers. Really, yes, five of them. Two are fairly straight-forward patient write-ups like I will do with an acute-care visit as a real NP (it's basically all the documentation that's done in the chart), but in much greater detail. Like, 5 pages of detail just for a sore throat. But it's all good, one of my papers gets to be on Carl Jung's Red Book, and I actually ordered a beautiful replica of that off Amazon as a visual aid. I've been interested in Jung for years, when I first heard some lectures about him at the Unitarian Church in Baton Rouge. A truly great church that does incredible good work (the atheist says).

I'm starting to inhabit my role as an NP student. I realized today at clinical as I was introducing myself and examining patients that I really feel completely comfortable doing that now. Last semester, I felt a bit like an impostor in that white lab coat. I've had some excellent role models and teachers, and that is really what's made the differences. I do like most of my classes, but the clinical -- it's just plain fun. I so look forward to it. I'm going to end up doing extra hours because I have Pediatrics yet to start, but hey -- it's only going to help. I was reminded today that I have a privileged role in the full arena of human experience -- which is to say, sometimes awful things happen. I mentioned a child with leukemia in my blog months back, well I found out today that the child died. I was shocked because childhood leukemia has become an eminently treatable condition - I know the cure rate is over 90%. But not everyone survives.

Even though my clinical experiences are not in a psychiatric setting, I still see patients with mental health issues. I learned something valuable Tuesday when a young man came in because he's training for a marathon but having strange shortness of breath spells. His assumption was that it's related to overtraining. He described his HPI (history of present illness) to Sherry, and she immediately asked him about recent changes in his life and his stress level. And sure enough, he'd had a terrible loss recently and these breathless spells were anxiety. Now it took her a while, probably 15 minutes of quiet conversation to elicit that conclusion, but she pretty much recognized it right away. Afterwards, when we de-briefed, she explained to me that his breathless spells were happening when he was still and quiet, and able to think about his loss. He was having no symptoms at all while exercising. She said that in her experience, many people having severe anxiety of this nature for the first time in their lives will present in just this way -- feeling like they can't catch their breath when they're still and their mind starts turning over the problem. A big learning for me.

Some random things that I find interesting/amusing: there is an entire section in my psychiatry book on what they call the "drug-assisted interview process". Yes, they are talking about truth serum. Just like from the 1970's spy movies that I watched as a little kid. I have to say I was pretty dumbfounded reading this - I mean, I know that trying to ascertain exactly what's true in what a patient tells you is difficult - but really? We need to do that? Somehow, I'm pretty sure that won't be part of my practice. The UT campus went smoke-free on March 1st. I know -- it's 2012, I wonder how many places are left in America that aren't smoke-free. There must have been a powerful regent that smoked is all I can assume. Even psychiatric hospitals have been smoke-free for years, and believe me: those patients all smoke and one could argue, need to smoke when they're hospitalized. Can you imagine dealing with all your demons, maybe detoxifying from alcohol and drugs, and you have to quit smoking at the same time? I keep having these nifty little memory-lane experiences around campus. I met with a classmate to study Pharmacology (and by the way, I have an 89 in that stupid fricking class now. I will not let myself make an A in that thing) at a little coffee shop on Lamar. I drove by the little dog-leg intersection where Lamar meets San Gabriel -- and I immediately remembered when I burned my leg on the back of Bret's motorcycle on the way to class right there, back in 1983. He had to yield there quickly, and my leg pressed against the tailpipe. Ow. This happens a lot -- I mean, those were memorable years and it's just weird to be back now.

So one last thing: if you wear those cool canvas Toms shoes that all the young hipsters have now, wear socks. They really make feet stink. Summer's going to be fun.

NYU and Benches

I hate Pharmacology. My test grades are all over the place, and we have a test every single week. I know -- wah, wah, wah. Every single one of his multiple choice questions were answered with A, or B or C or (A and B) or (A and C) or (B and C) or none or all. Really. I mean, fricking really. OK. Rant over. I'm in hate with that professor. Thank you Jesus for pass/fail. Other than that, I'm learning and things are progressing. I do see the growing pains of the program showing. For instance, I am learning such incredible detail on drugs for hypertension, heart failure and asthma right now (things I will never prescribe) and I wish I could put that time into psychotropics, which I will prescribe. Now, do I need to know and understand the drugs for medical conditions? Absolutely, but not at this level of detail. That's the key. Clinicals are just plain fun. At the student health center, we saw 8 sore throats in the four hours I was there. It was cool because one of them was strep and one was someone with chronic sinusitis and boy - did their throats and tonsils look different than the others, which were just the common cold. It was a terrific education in throat pathophys -- ha. And man, as I exclaimed to my preceptor, them tonsils can get HUGE. One guy's were touching (the strep case). And when you're dealing with this population, it's always an eye-opener. One of our patients comes in for a sore throat but tells us he wants an HIV test. Um....ok...but you have to come back for a full STI review and counseling session.
I went to a conference on mental health by the Hogg Foundation http://www.hogg.utexas.edu/. Some good learnings that I did not know:

• Mood disorders are the sixth most expensive health problem in the U.S.
• The top 3 underlying causes (lifestyle choices) of death are smoking, diet & exercise patterns, and alcohol. If you manage those well, you're probably in excellent health.
• Education is the greatest predictor of longevity, particular at the high-school level. If you didn't finish high school, statistically you will live a much shorter life than someone who finishes. Someone with a college degree lives much longer than both of them, etc.
• There's a lot of interest in the positive correlation of depression with chronic disease right now. For instance, they know that depression and diabetes go together, they even know that a depressed person is much more likely to get diabetes (instead of the reverse, as one would assume).
• Usually someone with a mental disorder is first screened by a primary care provider (a family doc, a nurse prac) and often they are referred to see a mental health provider. Sometimes the PCP prescribes anti-depressants or anti-anxiety meds, sometimes they aren't comfortable doing that. But they do usually say, hey you need to see a counselor/therapist. And guess how many don't go? Seventy percent. I was shocked at that.

So my lovely daughter was accepted at NYU. She's been offically accepted at Northeastern, NYU, and Texas A&M. UT rejected her (she's not top 8%). No comments, but needless to say, I'm not happy about UT's holding 75% of their freshman places for top 8% in every Texas high school. I think it's a stupid policy, but it's the legislature, not UT. Anyway, here's a pic of her with her mascara all runny on Wednesday, when she found out from NYU. Yes, her head really is that big now, I mean she's going to NYU! (kidding - I'm a bad photog with the iPhone!) The deal that we've struck with Dani is that we'll pay for NYU for one year if she comes back to an in-state school after that. I'm pretty sure that's what she'll do. (I mean, who wouldn't want to live in New York for a year?)

Funny things still happening at the gym. There is a bench outside the spin room where most of us sit to put on our cleats before class. The other morning, I went up to the bench and there's a guy standing by it, he grasps the bench by one end and yanks it way up in the air -- takes a good look at the bottom, like where a kid might stick his chewing gum -- and sets it down. I stand and wait patiently while he does this. Then he looks at me and says "I do things like that." Yep, there are potential patients for me everywhere.

Worms

I'm in the thick of school although I haven't written any papers yet. I've had two tests in Pharmacology and get this, here's my grades: 74 and a 90. Quite a disparity, huh? And he was trying to convince us to take the class for a grade instead of pass/fail. Um, not me, fella. It's one of those classes where I listen to his lectures as I drive. And write things on index cards to memorize as I stand in line. Every available brain cell called to action, every available speck of attention.

Clinical is so much fun. If ever I waver about doing graduate school, clinical always reassures me that I'm in the right place and that I can do this. I look forward to it so much. I mean, what's more interesting than people with problems? And you know what, as a nurse practitioner, I'm in a privileged position to walk thru that door to someone's inner life. That will be especially true as I focus my clinicals in psychiatric work next year, but boy, it's already happening as I work with FNPs.

Here's some examples. I had weird worm week. First, I worked at my RN job at a private psych hospital for the day and had an interesting patient experience. A young man called me into his bathroom to check out his feces. Something I've done before, no big deal, usually it's blood. Ah, but this is a psych hospital, right? First he says, better bring your gloves. I say, well, I can go back and get them if needed. I'm thinking it'll have to be something damn special for that, like a little alien fetus. But anyway, I take a look and it's pretty ordinary. He says, a hysterical edge to his voice, "See it?! See it?!". Uh oh. I say as calmly as I can, tell me what you see. He says, "It's worms, see them, see them?" There are no worms there. "You can't see them? Look, look, see the wiggling!" and with that, he reaches into the bowl and starts moving things around with his hands. I think I jumped back a foot.

The next day, I'm at one of my clinical sites and a young woman is there, fearing she got worms from her new puppy. Since I'm the newbie, before we see her, it's my job to do a little research. Can humans catch worms from dogs? Yes, they can. We saw her & collected a sample. It sounded positive to me, based on her description. Be careful with new dogs, especially strays & puppies. The following day, I'm at my other clinical site, a family practice office, and a middle-aged woman comes in and says that she is certain she has worms. She's seen them, wriggling. Has no idea how she contracted them. Catch another sample. Now, what are the odds of that? I really doubt if lots of folks walking out there have worms. Just my luck to encounter three of them.

It's going to take some adjustment for me to get used to dealing with college students as patients. A young woman came in for a chronic cough that we diagnosed as sinusitis, but during the assessment we asked her about everything (as we always do), and one question was how much alcohol do you drink. Notice we don't say do you drink. She says, Oh not very much. So Sheryl, my preceptor, says, how many days a week? "Every Friday and Saturday. Sometimes Thursdays." And then, how much? "Oh, four drinks....well, five. (A beat passes) ...at least." Sheryl just writes it down, says nothing. I feel like my hair's on fire. At least 5 drinks 2 or 3 nights a week?! She's only 5'2" and weighs 110 lbs. That must make her drunk as a skunk. When Ken & I go out to Vino Vino (one of my favorite places), we always order only 3 glasses between us. I usually drink about 2 of them, and I feel good. I mean, I'm in no shape to drive. How does she do that? But I'm thinking Sheryl hears that often. I better adjust my attitude. And well, it's the psych nurse in me.....I want to talk about it with this girl. But certainly that's not on her agenda. She's made it clear she just wants a z-pak. Patients are seen every 20 minutes so we're out of time anyway. Another thing is that I'm only there 4 hours a week, but Sheryl has already told me that we'll see at least one STI (sexually transmitted infection) every time.

I've been thinking about clinicals a lot lately, because they are taking up so much of my time. 120 hours this semester, and I'll actually get even more. That's just a minimum. Right now, I spend 4 hours a week at the student health center, and 6 hours at a family practice office. After spring break, I'll add 4 hours at a pediatric community clinic to that. That's 14 hours a week on top of my full-time school.
And next year those hours double. I've been told that you pretty much have to work on them on weekends or you just can't keep up. But I learn so much. I was thinking about when I first got my business degree at UT, there was absolutely no "clinical" to that at all -- just here's your degree, you've never worked an hour in this field, go out and be a professional. It was ludicrous. Let me tell you, I was quite clueless at my first job as an internal auditor. And I was a good student. I think healthcare really has this right -- some other fields are doing similar things. My sister got an electrical engineering degree from UT about 10 years ago and she had to do some internships (externships?) for her degree. In nursing and medicine, clinicals are so important because people's lives are in our hands. That's true, guess I couldn't kill someone with a spreadsheet. But it also so well prepares you for the workforce, I don't think other disciplines get that.

Ready, Set, Go

First week of classes completed. I'm feeling better about this semester, no surprise I guess, since I know what to expect. My clinical hours have doubled (gulp!) but I expect to be able to handle that. One good thing is that my big clinically-oriented class (Primary Healthcare Concepts) has two papers instead of a weekly quiz. Papers are my strong suit, I did so many of them for my on-line BSN classes. And I finally have a psych class. It's Intro to Counseling Skills and the professor is the woman mainly in charge of the Psych NP program, she'll be teaching the majority of our classes next year. I was anxious before the class (what if I don't like her? don't respect her?) but I liked her a lot. She made funny little remarks about psych things - (oh, tell me what you mean when you say that), she was relaxed, and I thought her presentation was smart. It's a group of only eleven, so it will be cosy and like a little family. I can only imagine how well we'll know each other by the end of this thing -- ha. So far only one person kind of bugs me & I can handle it. 

My other classes - Research and Pharmacology - appear to both be taught by excellent instructors. The Pharm guy has been nominated for a teaching excellence award & I see why. First class was fascinating. He encouraged us to take the class for a grade -- not pass/fail. I'm debating what to do. I gambled wrong last semester & gave up my A points on Pathophysiology. Really don't want to do that again, but OTOH, I don't want to be any more stressed than I need to. My research class will be a social experiment. We were assigned to random groups of 6 students (big class - 50 people - all nursing grad students have to take it, not just NP's). I had never met any of the other 5 people in my group. We have 2 big projects to do together. Who doesn't loathe group projects? And I really think 6 is too large for a group. I hope I don't have to discover new things about myself but I bet that's how the social experiment plays out.

It's been interesting to think about transitions this week. Beginnings and endings. On Thursdays, I have another long killer 12-hour day at school, but I do get a break from 2-4. So I decided to revisit some significant places on campus that I had not seen in 26 years, since I graduated in 1984. I haven't done much of that yet because I didn't have a long enough break in my schedule & seems like I was always in a hurry to zip home. I walked from one corner of the campus (the nursing building is across from the Erwin Center) up to the women's co-ops, where I used to live (across from Kinsolving dorm). Let me tell you, it was one of the most intense emotional experiences I've ever had.

Memories just flooded over me, it honestly felt like I was back in time. Let me try to give you a flavor. I passed by the business building and remembered when they tore down the old hall across the street. We lay on the grass and watched the wrecking ball hit it. I passed by the lawn of Batts Hall and remembered when Bret taught me how to whistle with a grass blade between my thumbs on a break between classes. I saw the computation center and remembered my job as a freshman at the counseling center (see? even back then, I knew what I wanted to be when I grew up -- ha). I had to carry card decks of computer data to the center for processing. I walked by the big rusty communications building - still rusty - and remembered the day my boyfriend left for Germany and I was crying on my way to class. I ran into an old roommate in front of that building and had to explain why I was crying. Anna Hiss gym - laps and laps and laps in the pool, then hurrying home to the co-op for dinner. The Academic Center reminded me of many hours studying with Lori. We went there because we'd fill out a slip to request albums we'd listen to with headphones off reel-to-reel tape. Little different from an ipod. The Union reminded me of seeing concerts there - like Joe King Carasco in 1982. The Varsity Theatre is gone (most of the mural is still up); I watched a lot of art films there. And finally, I got to the co-op where I lived - Shangri-La. They have some silly name now, "Living/Learning Center". I couldn't go inside, all the doors require access codes (security is much tighter on campus these days). The big live oak in the courtyard where we did so many things - like our chili cook-off - is so huge. The back steps are still there where Kari and I would smoke clove cigarettes in the evenings (we were so cool). The tower chimed - same tune. Wow. It's all still there. It's such a privilege to be back.

P.S. to last post -- something important I forgot to mention is how important our guts are to our immune system and to healthy metabolism. There is a lot of research focus right now on the gut and the "good" bacteria that live there (natural flora). Some research shows that obese people have differences in their flora. So what can we do to take care of that? Eat yogurt or Kefir -- pro-biotics. It really will make you feel better and function properly.  

Seminar Learnings

I spent all day Thursday at a seminar on Food, Stress and the Brain. It was interesting and detailed, but did not cover much new ground for me. Which made me realize that I'm very plugged into all the current research on this stuff. I learned quite a bit in my Advanced Pathophysiology class on this topic - probably enough to fill up an entire lecture, scattered over the semester - and I read the Health section of the NY Times daily, pay attention to national news on this topic. You get the idea. Working out, wellness, and health is my hobby and I'm just lucky that it fits into my profession.
So not a lot of new details -- here's some of that stuff I already knew. There is a lot of current research into epigenetics, which means that our environment literally shapes the expression of our genes. If you repeatedly eat unhealthy food, it can "turn on" genes that make you fat. If you are sedentary, it can turn on genes that make you fat. Really. The hormone leptin plays a large role in appetite and weight set-point, and the drug companies are searching hard for a leptin analogue that they can give to people as a medication that will cause weight loss. There is an interplay of serotonin and dopamine neurotransmitters that create mood, which has a correlation to appetite. People with mood disorders frequently medicate with food, although I've rarely seen a severely depressed person("MDD" - major depressive disorder) that hasn't lost weight because they've lost interest in virtually everything. Mildly depressed -- oh, they eat all right. Frequently, and the wrong stuff, and then they feel better for 10 minutes. It's not a mystery to scientists that psychotropic drugs create problems with all our pleasure receptors -- they interfere with appetite and sexual desire or function. That's because we don't have the knowledge yet to target the drugs to only the proper receptors -- we're basically hitting them all with a big hammer. But it's getting better all the time. Newer SSRI's have less of those side effects than the original drugs that were introduced back in 1990.

High fat and high sugar combined in the same food should basically be regarded as a nuclear weapon to make you fat. Natural food can't compete with that stuff. They cause your brain to release chemicals similar to both marijuana and opiates. It's not a lie that you can feel addicted to that stuff. The message was, think hard before you eat something like that. Now, I believe in an inclusive diet with no bad foods, but I now think that these specific foods are just not going to be in my realm of choice after hearing that. It's interesting -- the speaker mentioned early on that of course, a primarily plant-based whole foods diet is the best choice. And that's about all she said about what exactly to eat -- the evidence is so overwhelming and so obvious on that point, all the health professionals in the room knew that and didn't need further instruction.

High calorie liquids give you about 1/3 the satiety effect of the same foods in their whole state. So if you eat a 900-calorie smoothie, you feel like you only ate 300 calories. They really shouldn't be part of a weight-loss plan if feeling hungry bothers you. There's no chewing, no bulk felt in the stomach, no fiber. And those things - the action of chewing, the bulk - set off hormone effects that cause you to feel full. If you eat too fast, you end up eating too much because you're outpacing the response. Another thing is that variety is not your friend when it comes to your regular diet. Lots of variety causes you to eat more. We find variety more palatable. This is why you feel stuffed, but can still fit in dessert.

So I realized that the overarching themes of the seminar taken as a whole was really what was new to me. The main thing was that what you do with the rest of your life (when you're not eating) is more important than adherence to any particular diet. Exercise is so obviously required for normal function that it shouldn't be regarded as an option. It's simply what the human organism has to do if you want to grow old without a heavy disease burden. Meditation, which can be in the form of yoga, properly balances neurotransmitters. People who are overly stressed are high in cortisol and low in serotonin. Meditation has been shown to balance these to normal levels. The speaker also talked about having goal-directed activities in our lives. Watching TV and going out to eat will not create a sense of accomplishment. We need things like knitting, art, volunteering. Live your life in a meaningful way and eating twinkies doesn't hold much appeal.

So at first I just dismissed the seminar, thinking to myself, Oh I learned nothing new. Not quite. The information was presented to me in its totality in a new way, a more holistic way. When I think back to the many NYT articles I've read over the years, then yes, certainly these themes emerge. Sometimes it's nice to have it all put in front of you. I'm thinking more about my anemic meditation practice and how to fit more yoga into my schedule. And about avoiding the cake balls at Whole Foods. Ha.

I walked Crabby today. She did the best ever, I think we were outside for 10 minutes. She did run up to the door 3 times but I just waited and then she went back to exploring. This stuff is working. Dani has her winter formal tonight and about 20 teenagers will converge on my house at 6:00. Pictures later. Austin's Star of Texas Tattoo Art Revival is tomorrow and we'll be there. It's a fun last weekend before school.