Countdown to TTC: Week 37

 

Get HAPI ... Fork

For the holidays this year, I received many lovely gifts and some of them have even caused me to change around my weekly challenges for my countdown to TTC.  One such gift was the HAPI fork (pictured above).  I had been thinking about various habits I could try to adopt that encourage mindful eating (such as putting down my fork between bites, counting how many times I chew, serving my food on a smaller plate and waiting a certain amount of time before going back for seconds, etc.), but this new gadget really gave me a way to get started on those mindful eating goals without quite so much "mindfulness".  

The HAPI fork is a mindful eating tool that subtly warns you when you are eating faster than you should be.  The fork has an internal brain that measures each bite you take and then records how long you wait until the next bite.  If your next bite is sooner than a preset interval (default is 10 seconds), then the fork vibrates and a little light briefly turns red.  If you are eating at the preferred interval, you can see the light turn green with every bite but otherwise it just acts like a normal fork.  

Of course, I do think it is good to move toward actual mindful eating and a deep awareness of what is going on between myself and my meal, but for someone who has a hard time slowing down while eating and a tendency to shovel food this HAPI fork is a great help.  Even when I start a meal with focus, I tend to become kindof zombie-like about midway through and just hork down the second half of my portion without really thinking or sometimes even tasting it.  Part of that is related to other bad habits, but some of it is that I start to pick up speed as the meal goes on and I'm no longer quite as hungry.   

Although I find it inconvenient to use this fork at every meal (that's a fair bit of re-washing throughout the day), I find that I can use it once a day or so pretty easily.  Conveniently, the non-electronic part of the fork is dishwasher safe so I can give it a thorough clean once in a while.  Just have to make sure to remove the electronic "brain" before immersing it in water!

You are supposed to turn the fork on at the start of a meal and turn it back off at the end.  Any time there's at least a 15 minute interval after eating, the fork decides you have finished eating and records all the bites taken before that time as a meal.  Using the HAPI website, you can track your eating stats and monitor your progress toward goals by plugging the fork's "brain" in and letting it download your data.  I don't have a smart phone, but I also think the fork is wireless Bluetooth enabled and can transmit your data directly to a smart phone or tablet, which would probably be more convenient.

Below is a picture of the output the site gave me after my first HAPI fork meal (which happened to be Christmas dinner):

  
You find out how much of the time you were eating faster than target, how long on average you waited between bites, how long you spent on the meal, and how many total bites you took during the meal.  Although these data might not be particularly important for any one meal (except perhaps to discover how long you spent eating a specific meal), over time they do allow you to monitor your success and progress.  Plus, if you have a scientific way of thinking, like myself, it's just a pleasure to see so much quantitative evidence about yourself presented in such an appealing manner.   

As I approach my TTC start date, I will continue to use the HAPI fork but also try to move toward a more internalized mindful eating habit.  Still, when I know I'm really cognitively depleted and just can't pay any attention to how long I'm taking between bites, it's nice to know I can have a good angel reminding me to slow down and care about what I'm putting into my body.  

What about you?  Any great strategies or gadgets that help you eat mindfully or live a healthy lifestyle?  What do you think about the HAPI fork -- brilliant or evil?  What eating habits of yours would you most like to be more conscious about or improve on?

For more in this countdown series, see last week's challenge about Counting pregnancy costs. 

Countdown to TTC: Week 38

Calculate the Costs

As a result of the holidays and various other obligation, I am getting behind on writing up my "weekly" posts, but I have been working toward my goals and trying to remember everything I experience so I can eventually write up my backlog of activities.  A few weeks ago, I decided it was time to think seriously about medical expenses of a future pregnancy.  As we enter the new calendar year (the year in which I sincerely hope I will be able to conceive my first child), I intend to begin experimenting with prenatal vitamins and other supplements I want to take to have a healthy conception and pregnancy.  But diving into this more medical aspect of the process made me curious about the actual costs of pregnancy and childbirth.

Of course, there are perhaps more unknowns than knowns in this arena (Will I be able to have the vaginal birth I desire? Will I experience any pregnancy complications? Will my health insurance coverage change before I become pregnant?), but I decided the responsible thing to do would be to research what the costs might be for my current health insurance provider given some reasonable assumptions.  In addition, I was interested in figuring out what my maximum possible out-of-pocket expense would be given my current insurance situation.  Although I wouldn't be willing to place any bets on the accuracy of these calculations, they should give me an idea of what I should be aiming to save over the next several months.

Step 1:  I began my calculations by going onto my insurance provider's online member site and using their cost estimator tool (a nice service if you have access to it).  I asked for an estimate of the total medical costs associated with a pregnancy and vaginal hospital delivery in my geographic area (see below for the output).  The results I got were a bit confusing, but it seems to me that the numbers given for each expense category were total expected billings (not amount owed out of pocket, as I would have expected). 

Step 2:  Once I learned what the expected total billings would be for this type of pregnancy and birth, I had to consult my health plan's summary of benefits to determine what proportion I might be expected to pay of these total expenses.  My medical deductible and pharmacy deductibles are $250 and $100.  Once those are met, my plan expects me to pay the following for prenatal care and delivery costs:

Step 3:  Now that I had figured out the expected costs (assuming a vaginal delivery and a pregnancy that was not high risk) and what proportion I would probably have to pay, I could make some estimates.  I began by evaluating the maximum possible costs.  Knowing my deductibles and the additional out-of-pocket maximum for my plan, I determined that $2350 was the absolute most I would have to pay for a pregnancy that spanned only one policy year (I could of course be unlucky and accrue some high prenatal costs in one policy year and then some additional high costs for labor and delivery in the next policy year when new deductibles and out-of-pocket maximum would apply).  So, worst case scenario has me paying as much as $4700 for one pregnancy. 

Step 4:  Finally, I wanted to estimate the real expected out-of-pocket cost of the standard vaginal delivery pregnancy the cost estimator summarized for me.  Assuming a $200 copay for the delivery facility (even though the cost estimator predicted no charge for this actually), plus 20% coinsurance on all the medical tests and doctor's bills (although some portion of this would no doubt constitute no-charge prenatal care), and the full estimated amount for pharmacy, I came up with an expected total cost of $1836.  It would also be reasonable to predict an amount a few hundred less than this if much of my doctor's costs came from fully covered prenatal care and if my birth hospital did not charge a facility fee.  On the other hand, any sort of complications or need for additional tests or specialized care would quickly bring this up to the maximum possible cost. 

So, in summary, I learned that I should probably expect to spend a couple thousand dollars on my birth.  Even if I switch insurance plans (which I actually expect to do), I will most likely select one that has a similar deductible and out-of-pocket maximum.  I also realized that small changes in my assumptions can make a substantial difference in how much I would overall expect to pay for a single pregnancy and birth.  This could be a scary realization, but I think my response to the information is reasonable.  I will make tentative plans based on what is most likely to happen, but I will also be prepared for things not to go according to plan.  Probably a good approach to new parenthood as well, now that I think of it...

What about you?  Do you or did you know down to the dollar how much your pregnancy should cost?  Have you come by any useful information about paying for pregnancy and childbirth or tips for dealing with health insurance providers?  What are some top dos and don'ts when it comes to pregnancy-related medical expenses? 

For more in this countdown series, see last week's challenge about Eating right while eating out.

Countdown to TTC: Week 39

Eating Right, Eating Out

Aside from my general preference for loafing instead of moving, my biggest challenge to living healthy is what happens when I eat away from my own kitchen.  I am pretty good about having healthy things around and preparing my go-to nutritious meals when I am at home and following my normal routine.  Things start to get out of hand, however, when I go out to eat or go on vacation and start eating what's available at family and friends' houses.  Partly, I am easily caught up in the social aspect of eating and tend to eat very quickly when eating in a large group.  This is true when I'm comfortably eating with family but also when I am at a party with lots of people I don't know (in that case, I am eating to have something to do when I'm not sure who to talk to).  A bigger problem, though, is that when I'm not at home I find it harder to curb my impulse to eat when I'm not really hungry.  Especially on vacation there are so many tempting options that I don't want to wait until I'm hungry to eat or else I'll have to pass on some of the yummy foods.  So disappointing!

Normally I am just vaguely aware of the problem I have eating out and try to restrict the number of days I eat away from home.  It's generally a good strategy, but there are some times when it's just not possible and I would really benefit from having some additional techniques to avoid undoing all my hard work.  Now that the holiday season is upon me, it is particularly hard to avoid big social meals with lots of appealing food.  Plus, the usual holiday food fest will be multiplied by a season of job interviews for my spouse which will likely have us away from home several times during the new year.  So my recent goal has been to identify strategies to keep my eating to reasonable quantities while eating away from home.

Here's what I've come up with so far:

1. Pay attention to hunger cues and try not to eat to the point of being uncomfortably full.  I've actually succeeded pretty well on this one, even on Thanksgiving day, so that's a small victory!
2. Don't eat unless I am hungry.  This one has not been as much of a success--I think it is the root of my eating out/eating away problems so I want to work on it seriously over the next couple of months.  Particularly as the evening progresses, I just want to eat for pleasure.  Earlier in the day I find this less tempting, perhaps because there is usually stuff going on.
3. Don't wait until I am starving to eat.  Surprisingly, this also happens sometimes when I am eating with family or friends.  Since there is a group we are not always following my own hunger cues (or an event leads us all to ignore our hunger), so when we actually do eat it is harder to make healthy decisions.   
4. Enjoy all the desirable foods, but don't overdo it on any one thing.  Some people probably would want to change what they eat when they eat away from home, but I want to be able to enjoy all of the yummy options, especially since I know I will resume a fairly healthy and complete diet when I get back home.  So, I try to incorporate healthy elements but the main thing is not to eat a ton of something really fattening and high in calories just because it is suddenly on the menu.  This relates to strategies 1 and 2.  
5. When eating at a restaurant, hold back on bread and appetizers.  I am pretty good about eating approximately half of a restaurant entree and boxing up the rest for leftovers, but sometimes this still results in my eating a huge meal if I have a lot of bread or soup or appetizers before the meal.  I have recruited DH to help remind me that I don't want to overdo it on the starters just because they are there, and letting him know about this plan should also help me keep it in mind too. 
6. Don't give up on eating a balanced diet entirely just because I'm away from home.  This is especially relevant when I will be away from home for a few days.  Whenever I get into a vacation mindset, I start to just ignore nutrition and healthy food altogether.  I would probably stay on track a lot more if I continued to choose healthy breakfast and lunch options even though my dinners and desserts will probably a bit less than ideal.  Just because we will be going out for dinner most nights doesn't mean I also have to eat cheese danish or donuts for breakfast.  I plan to incorporate this mindset for my next long weekend away from home.

What about you?  How do you stay on track with healthy eating when there are so many opportunities to overeat and indulge in fattening treats, especially around the holidays?  Do you have any tricks for eating healthy while eating away from home, or do you find that just never works and you really need to limit the frequency of eating out to stay in control?  Can any of the same strategies be applied to cravings and the temptation to overindulge during pregnancy?  

For more in this countdown series, see last week's challenge about Walking.

Countdown to TTC: Week 40

Walk It Off

With the holidays here, I am finding myself getting hopelessly behind on my challenges!  I suppose it's just one of those life things I'll have to get over--I'm sure there will be more and more distractions and interruptions when kids are in the picture anyway.  But sometime a few weeks ago my weekly challenge was to add more walking to my daily routine and I've really made headway with that goal.

I live a 15-20 minute walk from my academic building which I go to approximately 2 days a week, but I normally get dropped off by my husband to save time.  Since adding this challenge to my routine, I have been able to walk to school at least once a week and sometime even more than once (it's usually later when I leave and I take the bus home).  I have noticed several time in recent months that walking any significant distance has caused me to have hip pain, but stretching my hips before I leave the house and walking for briefer periods seems to have helped.  Hopefully I am also building up my muscles for future longer walks. 

In addition, I've found lots of other opportunities to walk more, like walking to meetings in other buildings, shopping, walking the family dog while visiting for Thanksgiving, etc.  So far I have had no trouble adding an extra 30-60 minutes of walking to my weekly routine.  In the coming months, I will try to keep this up despite the increasingly wintry weather and plan to increase my walking intensity as I approach the TTC date.

Here's hoping I can keep up my motivation for this habit, because I think it's a good one.  I already added a pedometer to my Christmas list to give me a little mid-winter boost in enthusiasm.

How about you?  What's your favorite weight-bearing exercise to do outdoors?  Is walking your thing or do you find it boring?  How do you add more steps to your daily activity for good health?

For more in this countdown series, see last week's challenge about Strength Training.

Countdown to TTC: Week 41

Strength Training

Last week it dawned on me that maybe my plan of eating less and exercising the same amount as I have been for the past year or so wasn't going to result in the kind of change in fitness that I am hoping to achieve.  I do want to weigh less, ideally, but I really want to be physically ready for the challenges of pregnancy.  Even during the times when I lost a substantial amount of weight, I never really felt that I had increased in strength, flexibility, or endurance.  Usually, I felt weaker but also thinner and lighter.  As I've mentioned before, that won't do for this year's goals.  

But as obvious as it sounds that I need to add strength and flexibility training to my routine, I was really reluctant to do so.  I don't want to reduce the amount of cardio I've been doing substantially--partly because that might actually cause me to gain weight instead of maintaining the status quo and partly because it's the kind of exercise I find most tolerable (at least I can watch my shows).  And there are only so many hours in the day.  So, I have started to add strength and flexibility training in small, tolerable ways with minimal equipment.  My workout gear consists of (1) tennis shoes, (2) three and five pound weights (I like the kind with the non-slip coating that don't leave your hands smelling like metal), (3) a sturdy wall, (4) a sturdy chair, and (5) an inexpensive thigh workout device.  I think someone can make a perfectly good strength and flexibility routine out of these few items, but there are a couple of additional things on my wish list, such as a plush yoga mat, an exercise/stability ball, wrist weights for walking, and maybe some resistance bands.  As a person with very minimal upper body and core strength, here's what I have been trying so far:

1. Twenty wall pushups and a few squats any time I go into the restroom at work and there is no one else in the room.  The handicap stall has a fairly sturdy wall and enough room to do these moves while locked into the stall, so in case someone comes in they won't see my mini-workout.  If you have your own office instead of a cubicle or are at home most of the day, this would be even more doable.
2. A few minutes of stretching after my cardio workout.  This is the time when my muscles are most warmed up and I am at my most flexible.  I can even bend over and touch the floor sometimes if I stretch enough.  Eventually, I plan to build this up to a 15 or 20 minute yoga or Pilates video a couple times a week.
3. Brief but challenging core training.  My core strength is pretty weak, so I will feel the burn the next day if I do a few arms-up full situps and about 10 Pilates criss-cross exercises.  This is enough usually to wear me out, but if I have any strength left I will do some crunches or leg lifts.  Hopefully, my stamina will improve over time.  I am working up to the 12 minute seated core workout video that's available for free on SparkPeople.
4. Extra weight lifting and gravity-based leg workouts when I have time.  I will usually do 10 or 20 dumbbell curls, another 20 two-arm tricep extensions (where you hold the weight behind your head and lift up), and then just spend some time doing leg lifts and balancing my weight.  Unlike my cardio workout, I don't have a particular routine.  I just pull something from memory from the various strength training workouts I have done that targets an area I want to strengthen, and then I keep doing it until I feel the muscle getting tired.  Eventually, I would like to work up to a more specific, measurable plan.  

What about you?  Do you have a favorite strength or flexibility training routine that works for you?  Any suggestions on where to find a strength training plan that starts with the lowest level of ability and keeps you feeling motivated and continuing to see improvements?  How do you know when to increase the weight or try something different?  What has been the greatest fitness milestone you've passed?  I'd love to hear from you, so please share your thoughts below.

For more in this countdown series, see last week's challenge about Tracking My Eating.

Countdown to TTC: Week 42

 

Track My Eating

Last week, following my visit to the nutritionist, I took stock of my goals for the year leading up to TTC and decided it was time to get serious about tracking what I eat.  As I've mentioned before, I have been a member of SparkPeople for a couple of years now and will sporadically track my food when I consider my weight loss goals, but I typically lose enthusiasm for it when I am not seeing the kind of progress I want.  In the past, I have always stuck to dieting strategies that involve extreme changes in my eating behavior, show quick results, and fall apart the instant I return to "life as usual".  

Well, these days I am determined to live a healthier lifestyle, not just get back into a smaller clothing size.  I don't want to go back to the days of extreme, unsustainable dieting followed by immediate weight gain, but I worry that my body won't respond to more subtle changes in my diet and activity levels.  I am trying to keep my focus not only on how my behaviors impact how I look and feel, but on how my choices might one day soon affect my child's development in the womb and his or her attitudes and beliefs growing up.  That is a big responsibility and I take it seriously.  I don't just want to lose weight for my own gratification anymore.  In fact, as the nutritionist pointed out, maybe I shouldn't even be focusing on weight loss per se.  So this past week I decided it was time to focus less on the scale and more on what I am putting into my body.  

I'm sure everyone has their own method of accountability that works, but for me it's been the online tracking tools that really help.  I can enter down to the last detail everything that I ate or every ingredient I included in a recipe, and then I can reuse those entries over and over for things that I eat frequently.  Plus, I can get all kinds of reports, like the one pictured at the top of this post (Note: that is not a picture of my own progress report -- I actually eat about 1650 calories a day for my current weight, and that is the bottom of the suggested range).  For someone with a scientifically-oriented brain, these features are indispensable for maintaining motivation and enhancing my feeling of self-control.  

Admittedly, I am sometimes at a loss for what to enter when I eat too many things outside of my usual repertoire (I went to a reunion this weekend and tracking just went out the window for the day), but entering my food has helped me to be conscious of what I am eating and how much I am taking in.  It isn't so great when I reach the top of my calorie limit for the day and still feel hungry, of course, but it is very freeing when I realize I have eaten less than the limit and can indulge in a little something extra at the end of the day.  Plus, I think it motivates me to eat more fruits and vegetables just so I can see them being added to the list.  

So far, tracking consistently hasn't caused me to lose more weight (crossing my fingers that this will change in the future), but it has stopped me seeing those occasional weight gains of two or three pounds and makes me feel certain I am eating the right kinds of foods in the right amounts for good health.  I'm hoping to remain diligent in this practice throughout the rest of my countdown to TTC and continue into pregnancy.  

What about you?  How do you keep yourself accountable for what you eat and how much you eat?  Do you personally feel helped by calorie counting, or does it backfire for you?  Anyone else track what they eat carefully but still not seeing movement on the scale?  Any advice on how to stick with a healthy lifestyle even at the times when you aren't seeing much change or improvement?  

For more in this countdown series, see last week's challenge about Seeing a Nutritionist.

Countdown to TTC: Week 43

See a Nutritionist

Normally, I avoid seeing medical or health professionals unecessarily.  I believe preventative care is important, but the U.S. healthcare system really isn't set up for people to visit their doctors and other care providers just to check in.  Plus, as a graduate student I really don't like to do anything that increases my medical expenses.  However, a flyer in the office recently reminded me that my university provides several free services to employees and students to help them stay healthy or get healthier.  One of these services is an initial consultation and several follow-ups with a nutritionist.  Given my ongoing goal of getting ready for pregnancy over the course of this year, it seemed like a perfect opportunity.  So, this past week I added consult a nutritionist about preconception planning and weight loss to my list.  

In preparation for the visit, I had to track my food for several days.  Since I am a veteran user of SparkPeople, the only difficult parts about that were (1) being more self-conscious about my food choices knowing they would be scrutinized by a dietitian and (2) having to simplify my tracking to fit onto the form I was asked to use (since I usually make my food, I am often tracking a dozen ingredients per meal).  In the end, I brought both a filled-out form that was impossible to read and a super long printout of my food from the same days taken directly from SparkPeople.  The dietitian didn't seem to mind and actually looked more at my long, detailed printout.  

I really wasn't sure what to expect from my appointment, since I didn't have any choice over the dietitian and her philosophy--I was just visiting the person who works for my school health center.  The only time I've ever known someone to visit a nutritionist was if they had to lose a substantial amount of weight for medical reasons, which is pretty different than my situation.  Plus, a university is unlikely to employ someone to work with undergrads whose expertise is in chronic medical conditions.  So I shouldn't have been surprised when I came to the appointment explaining that I was frustrated with my current weight loss efforts because I am not losing pounds despite having recently reduced my caloric intake and tracking my food vigorously and her first question was "What would you say if I told you that you should stop trying to lose weight?"  

I don't think she particularly believes I am at an ideal weight, but she is a person who subscribes to a philosophy of being healthy at any size.  Throughout our conversation, she encouraged me to focus on healthy behaviors rather than fixating on the number on the scale.  She also pointed out that I may be making physical changes in preparation for weight loss right now (don't see any evidence of that, but who know maybe I'm stealthily gaining some muscle mass).  She also discussed some flaws with BMI as an indicator of health risk (click here for some alternative measures of ideal weight and here for an article about a new way of calculating BMI that may be more accurate for adults).  I have not yet found any research on the subject, but she suggested that even the "common knowledge" that BMI is directly linked to negative health outcomes may be flawed.  According to the nutritionist, studies which are able to include health-related behaviors directly in their analyses along with BMI typically find that body mass has not additional impact on health outcomes above and beyond healthy behaviors like exercise and eating right.  I don't claim to endorse this opinion, but it certainly gave me something to think about and I will want to research this more.

Although I have made a lot of improvements in my healthy lifestyle and the nutritionist was very positive about my health indicators like cholesterol levels, I still couldn't quite get on board with the idea that I should stop caring about my weight.   But I agreed with her that I am focusing too much on the scale and too little on the positive health changes I am making.  In the end, I didn't have a great answer to her question about my weight.  Honestly, if someone told me I don't need to lose another pound to be maximally healthy and ready for pregnancy, I just wouldn't believe them.  I'm sure I am at a weight that would make it possible for me to get pregnant and probably have an uncomplicated pregnancy, but I know I could have more energy and a fitter body to deal with the stress of growing a new life and then caring for a small child.  Perhaps getting on the scale every day and agonizing over the number isn't the right way to do that, though.  Based on my appointment, we agreed I would cut back to weighing in twice a week and pay attention to my hunger cues.  At my next meeting, we'll discuss making some changes to my eating habits that focus more on hunger levels than on how many calories I think I have "left" for the day.  It's a good start.  Hopefully the scale and my healthy improvements will match up soon, but if not I will try to focus on getting healthy with weight being a secondary component rather than my main indicator.  

For more in this countdown series, see last week's challenge about Planning with Pinterest.