Is this really the best we can do?

Day three of the #DDdailygratitude challenge and already, I’m inspired to share one of my posts in a longer blog form! Unfortunately, the motivation stems from all of the frustration and anger that ultimately turned into my gratitude for the day.

I’m scheduled for a resting metabolic rate test (also known as an oxygen uptake exam, or an indirect calorimetry test) next Friday, but I need to get pre-authorization because many health plans won’t cover the exam. I have been at a weight plateau since April despite working out regularly and monitoring my diet, and so my doctor wants to do this test so that we can better calibrate my nutrition. Basically, we’re checking to see the rate at which my body burns calories while I’m completely at rest, to make sure that my metabolism is behaving the way it should be. The results of this test will help me to make sure that I’m eating enough to support my energy output in my workouts, while still maintaining an appropriate calorie deficit to get my weight down.

The pre-authorization turned into a circus. Aetna couldn’t authorize the test without the appropriate CPT code. The doctor’s office didn’t know it, and billing had to transfer me four times before they could answer my question. Spoiler alert: the Google result for the code was correct and I could have saved myself a whole lot of hold time. When I called Aetna a second time, they gave me a benefit policy code to look up, but basically told me “We won’t cover this, unless your doctor says it’s medically necessary.” However, they couldn’t tell me what “medically necessary” means. Last I checked, the very act of referring me for the test could be considered my doctor deciding this was medically necessary… but I digress.

I looked up the benefit policy to better understand what was going on, and that turned out to be a very, very bad idea. You can find it here in full, if you’re interested. Basically, I would qualify for weight loss medication, no questions asked, but they won’t cover this test because it’s still considered “experimental” or “investigational” for weight loss. Mind you, the benefit goes on to acknowledge that medication works in conjunction with calorie restriction and exercise, and also that weight loss from medication is usually temporary…. but it has the studies to back it up, so it’s all good in their book. However, this test apparently isn’t considered sound science, so Aetna’s having none of it.

A quick PubMed search turned up an article titled “Indirect Calorimetry: A practical guide for clinicians,” which

“Measurement of energy expenditure is the most accurate method to assess energy needs. Indirect calorimetry remains a gold standard in measuring energy expenditure in the clinical settings… To achieve the highest quality of patient care, we should strive for patient-specific nutrition support regiments. Indirect calorimetry offers a scientifically-based approach to customize a patient’s energy needs and nutrient delivery to maximize the benefits of nutrition therapy.” [Nutr Clin Pract. 2007 Aug;22(4):377-88]

Meanwhile, a systematic review of energy expenditure studies, published in Obesity Reviews in 2012, turned up this endorsement of using indirect calorimetry to get more accurate information for patients:

“Today, many health professionals including dietitians typically use prediction equations because of ease of use, low cost and decreased participant burden, but emerging evidence is reflecting great disparities between predicted and measured energy values… The level of inaccuracies of prediction equations that are commonly used in clinical practice may potentially impact patient outcomes… As health professionals seek to improve their quality of service and provide appropriate nutrition care to prevent clinical morbidity and mortality, measuring energy requirements through IC [indirect calorimetry] may be the direction of the future.” [Obesity Reviews, 13: 753–765. doi:10.1111/j.1467-789X.2012.01000.x]

(In case you’re wondering, this is what happens when you’re someone who is naturally curious, who enjoys learning about interesting topics, who believes in doing the research on her own health, AND who also happens to work in academic publishing. Doctors either love me or hate me. There’s no in between.)

So, basically, I was in a really bad place when I called my doctor’s office for the third time today. I had a phone number from Aetna, and I needed my physician to call and make the case for medical necessity, so I’m not on the hook for $200. And that’s when today’s moment of gratitude stepped in.

daily gratitude day 3.jpg

The woman I spoke to this third and final time was so kind. She took down all of my information, and she reassured me when she let me know that she processes requests like this all the time. My doctor is at a conference through Monday, so she told me she’d share the message then, and she also promised to follow up with me herself Monday afternoon, even if she didn’t yet have an answer, just so I’d know where things stood at that point. She listened. She cared. It was so unlike every other conversation I had experienced so far today, and I was so grateful to her, I burst into tears. (What can I say? It’s been a long week.)

It’s a sad commentary on the state of our health care in this country that I had to jump through so many hoops today, and an even sadder commentary on human behavior in general that I felt so surprised and relieved to finally experience a little kindness.

We’ll see how this all plays out. I’m probably going to move forward with the test either way, just to know exactly where my metabolism stands, but I’d feel a hell of a lot better if it didn’t set me back $200. More to come!

In the meantime, it’s not too late to jump on this Daily Gratitude plan. Thanks to @thedaydesigner for pulling this together, and for making awesome planners – check out their website here. I love that they offer free printables so you can see how the layout works for you before ordering the full planner. I’ve been using their Daily Planner printable for almost a month and I love it, and I can’t wait to order my 2017 Planner!

Greek Veggie Quinoa Salad

Happy Monday! I spent a few hours yesterday prepping meals for the week and wanted to share a recipe with you. In preparations for the #bestfriendscleanse I’m starting in a few weeks, I’ve been collecting recipe ideas that fit in with the meal plan, and this Greek Veggie Quinoa Salad sounded so good, I just had to give it a try.

This is my spin on the Greek Chickpea Salad recipe in the Skinnytaste cookbook — I don’t love chickpeas in make-ahead salad because I think they get sort of gross by the end of the week, and I’m also not a huge fan of raw red onion in salads, because I find the flavor really overpowering.

greek veggie quinoa salad imageGreek Veggie Quinoa Salad (view & log on MyFitnessPal)greek veggie salad
Makes 5 servings, 16 ounces each

  • 1 cup quinoa, prepared*
  • 2 bell peppers (I used one red and one green – go with whatever looks good in the produce section!)
  • 4-5 persian cucumbers, or 2 cups chopped cucumber
  • 16 oz cherry tomatoes
  • 3 oz feta cheese
  • 4 oz pitted kalamata olives
  • 1 tbsp olive oil
  • 2 tbsp red wine vinegar

Chop all vegetables so they are roughly the same size. I like to cut my cherry tomatoes in half if they’re on the larger size; if they’re smaller, fine to leave them whole. Chop the olives as small as possible. Combine vegetables with feta and olives; mix so that all ingredients are well distributed. Add the olive oil and vinegar, as well as the salt and pepper, and mix well. Finally, add the quinoa 1/4 cup at a time, mixing well after each addition to ensure that the quinoa is well distributed through the salad. Portion out the servings; I used the 16-oz deli containers I mentioned in last Friday’s post and this recipe was the perfect amount to fill them.

*Ingredient tip: I love Trader Joe’s frozen grain options. Their frozen quinoa comes in 1-cup portions; heat them up for 3-4 minutes and you’re good to go! I always keep quinoa and brown rice on hands for recipes like this, when I don’t want to have to go through the hassle of making quinoa on the stove top. 

This recipe would be a great side dish with some grilled chicken or fish for lunch or dinner, or can stand alone as a snack. I packed it to have as my afternoon snack this week, along with a serving of Spark. I’m doing double workouts every afternoon this week to make up for the fact that I’ll be away all weekend indulging in one last summer vacation, so a heartier snack is in order to help get me through those workouts!

August Goals

Happy Monday! I have to be honest… I really can’t believe it’s already August. This summer is flying by and I feel like I haven’t really taken advantage of all of my favorite parts of this season just yet! The good news is, I have some great vacations coming up this month.

Excited for excellent music jams with bae

Excited for excellent music jams with bae

On Thursday, I fly out to San Francisco for a few days. I’m going to Outside Lands and I’m super pumped to see some of the musicians appearing at the festival. I’ve seen a couple of the acts before, but for the most part I’ll be seeing these acts live for the first time, and I’m really excited about it. The other perk to this trip? The friend I’m visiting is totally supportive of my efforts to live a more balanced lifestyle, so we’re scheduling workouts throughout the vacation. This includes a Madonna-themed SoulCycle ride the night I arrive, complete with neon accessories. I’ve never met a theme I didn’t like, so I’m pumped for this!

I embrace any opportunity to wear fabulous hats.

I embrace any opportunity to wear fabulous hats.

Later in August, I’m heading to upstate New York with my parents to spend a long weekend at Saratoga Racetrack. This is one of the oldest race tracks in America and it’s one of my favorite vacation destinations! Saratoga Springs during racing season is a ton of fun. I grew up watching horse racing with my dad and I’ve only grown to appreciate it more as I got older. There’s so much history around the sport and I love getting caught up in the spectacle of it all – there’s really nothing like the energy of a live horse race. Best of all, it’s easy to keep gambling expenses low – I usually only bet a few dollars per race, but it’s enough to make me feel invested in the outcome. In addition to spending the days at the track, we have reservations at some amazing restaurants, so this will definitely be a vacation with lots of splurges. The good news: Saratoga is a very walkable city! We can walk from our hotel to most of our dinner destinations, and also from the hotel to the track. Additionally, the downtown area also has some lovely parks for running, so I should be able to fit in race training while I’m away.

Finally, I’m working on nailing down some plans for Labor Day weekend, hopefully involving a lake and a boat and some awesome friends. It’s nice to have something fun to cap off the summer, so I’m hoping things work out.

Given all of these plans, it’s important to set out my August goals in writing – so here we go!

august goals

  • Build my mileage back up. I definitely had a setback in my running due to my injury, so this month is all about getting those miles back under my belt!
  • Stick to a cross- and strength-training regimen. Regular pilates, yoga, and Studio Poise classes will help to keep me healthy and will make my running training go better, so I’m refocusing on this. Additionally, I need to get back into the habit of lunchtime gym visits at work to do some strength training to help prevent further injuries.
  • Eat clean as much as possible. I’m a realist and I know that I will want to splurge when I’m on vacation, so this month I need to focus on saving my “cheat days” for my trips. That means being smart about grocery shopping and meal planning. If I’m focused and disciplined throughout the month, I won’t have to worry as much when I’m on vacation – it’s all about balance.

What are your goals for August? Any fun plans to maximize the last few weeks of summer?

 

Week in Review: 10-day Refresh & New SP Class

In the interest of staying on track with my goals, I’m going to start posting a week in review every Friday, reflecting back on my progress for the week.

Workouts

Monday – Nada. Driving home from a mini-vacation in the Hamptons wiped me out and I needed a breather!
Tuesday – T-BarRe-Xtreme at Studio Poise. A combination of cardio, barre, and TRX strength exercises – an awesome cross-training class. I belly flopped out of a TRX plank at one point… guess I need to practice those.
Wednesday – Pound & Flow, the newest addition to the SP schedule! 20 minutes of Pound to get your heart rate up, followed by 40 minutes of power flow vinyasa yoga. My shoulders have been really tight lately (I was in a car accident a few weeks ago and the seat belt really did a number on me) so I really needed to spend some quality time in down dog to start loosening them up!
Thursday – Nothing But Leg, again at SP. This is my FAVORITE strength class to help build up the muscles I use in running, and man, Alison put me through the paces yesterday. I’m going to miss this when it changes to a new, earlier time slot next month!
Friday – Pilates Reformer at Oceanside Pilates. I have fallen in love with the reformer to help me stretch and loosen up. It has helped my hip more than anything else. Unfortunately this class is ending after Labor Day, so I’ll need to find another reformer studio near me that doesn’t cost me an arm and a leg – any suggestions?!

You may have noticed a lack of running on here. Tomorrow morning’s 4 miler is going to be the first time I’ve laced up my sneakers since my injury six weeks ago. I’m going to take it slow, and will probably end up run/walking the entire route. The good news is that my BostonFIT coach picked an out-and-back route so if I really feel like 4 miles is too much, it’s easy enough for me to turn around sooner than scheduled.

Nutrition

Come to me, micheladas. I will drink ALL of you. It's made with tomatillos so that's practically a salad, right?!

Come to me, micheladas. I will drink ALL of you. It’s made with tomatillos so that’s practically a salad, right?!

I spent last weekend in the Hamptons with some awesome friends, and while it was a blast, it was definitely not the healthiest of weekends. Beer for breakfast, anyone? I’m also going to be jetting off to San Francisco next weekend for Outside Lands, and while that trip will also feature some SoulCycle classes for #balance, I also plan on drinking as many micheladas as I can get my hands on (WHY IS THAT NOT A THING ON THE EAST COAST?!). I had exactly ten days between the trips, so I preordered the Advocare Herbal Refresh before leaving for the Hamptons, and it was waiting for me when I got home.

I started it on Tuesday, and it’s a really simple program to follow. Eat as clean as possible (and while I’ve been great during the day, I have definitely slipped up at dinner a few times this week… oops) and follow the program. The program contains daily supplements – a probiotic that you take in the morning, and an herbal cleanse that you take in the evening. It also comes with a powdered fiber drink that you mix with water and consume immediately prior to breakfast.

The fiber drink has definitely helped me to feel more full throughout the day. I’ve upped my fruit and veggie intake and am also trying to drink a gallon of water every day during this process. I was feeling rough earlier in the week (see “TRX plank belly flop,” above) because of all wear and tear I had put on my body over the weekend. Too much beer, not enough sleep, and I was not feeling great. Today, though, I’m really noticing a difference. It’s been four days and I feel like my energy levels are better, my focus has improved, and best of all, I’m down two pounds (woo!). The refresh is only supposed to be used every 90 days, and I’m not sure I’d make it a regular thing, but for times like this when I really need to hit the reset button on my body during a jam-packed month, it seems like it’s a good tool to keep in my back pocket.

Weekend Plans

I’m gearing up for the weekend and aiming for balance. I’ve got my four mile run tomorrow morning, and then some friends are joining me for a beach day and a dinner party at my house. I love entertaining so I’m really excited to cook delicious food and catch up with these folks, some of whom I haven’t seen in far too long. Sunday, I’ve got a beach yoga class scheduled in the morning at Carson Beach in South Boston, and I’m planning to take a kayak out on the ocean afterwards if it’s not too hot. There’s a Boating in Boston location right at Carson Beach, and I have a season membership that I’ve yet to use, so I need to get in lots of paddling time before fall!

What are your plans for the weekend? 

Tackling tempation

I don’t know about the rest of you, but willpower and I don’t really get along all that well. More than anything, I really struggle with temptation. If there’s candy in my desk drawer, I’m going to eat it. If I open a bag of snacks, I’m not going to stop after the recommended serving size. At parties, I can’t just try a sampling of the appetizers; I park myself next to whatever is most delicious and munch away. With the holidays coming up, I know that temptation is going to be confronting me at every turn. I’ve committed to both #6W2C and #Fit4Fifteen to help myself stay on track through the end of the holiday season, but those challenges aren’t going to take me all the way on their own. I also need to employ some handy tricks to keep myself on track.

Tip #1: Pre-portion all snacks as soon as you get home from the grocery store. 

photo 3 (1)

I did my grocery shopping at the new Market Basket in my town last night, and I was super excited to find this Cedar’s Spinach Dip, made with Greek yogurt. Cedar’s is based in the Merrimack Valley, here in MA, and I’m a huge fan of their products. They’ve also been generous donors to the youth conference I volunteer with in the past, so I like to support them whenever I can. At only 50 calories per serving, this is a great thing to have on hand for an afternoon snack with pretzels or cut up vegetables. However, I know that if I were to just start dunking carrot sticks directly in that tub of dip, I’d exceed the recommended serving before I knew it. To ward off any temptation, I picked up small snack size dip containers and pre-portioned out the tub as soon as I got home. The tub contained twelve 50-calorie servings, so I portioned it into six small cups to have at work as an afternoon snack this week.

Tip #2: Stock your kitchen with healthy, nourishing snacks. 

You know the saying, “Monkey see, monkey do”? In my kitchen, it’s “Colleen see, Colleen eat.” If you keep your biggest temptations on hand, you’re more likely to eat them. Bypass those aisles at the grocery store and resist the urge to add tempting foods to your cart. You’ll tell yourself that you’ll only have those cookies once a week as a special treat, but we know that’s a lie. That ice cream will definitely not be for PMS emergencies only, and I don’t care how much you swear that you’re only buying those chocolate chips as an addition to protein pancakes, we both know those will end up getting eaten by the handful after a bad day at work. Try instead to make sure that you always have plenty of healthy foods on hand that still feel like you’re giving yourself a treat. Avocados are one of my favorite healthy treat foods – adding them to eggs or mashing them on toast feels so indulgent, but I’m getting the healthy fats that my body needs. I also always have apples, hard boiled eggs, and preportioned baggies of turkey or beef jerkey on hand. These are all snacks that are easy to grab and go if I’m in a rush, and they fill me up and satisfy me without destroying my healthy eating plan for the day.

Tip #3: The freezer is your friend. 

I could pretend that my kitchen is a place where you will find only healthy, nutritious food items. This would be a lie. Yes, I do try to avoid keeping tempting foods around, but I’m human, and sometimes a girl needs a Snickers. I keep a bag of fun sized Snickers bars in my freezer at all times. That way, if I decide I really do want a little chocolate treat, I can go for just one bar. The bar needs to thaw a bit before it’s edible (unless I want to break a tooth!) and that time helps me to limit myself to just the single serving, and to be mindful that I’m treating myself to this snack.

Tip #4: Don’t go to holiday parties on an empty stomach.

photo 2 (1)

I always have a snack before I go to a holiday party. It’s easier to resist all the tempting appetizers if you’ve already got something healthy in your stomach. I might make a half serving size of Shakeology, or I might grab a handful of almonds and an apple. It’s also a good idea to have a full glass of water before you leave for any holiday events, and to keep drinking water throughout the night. Hydrating will help you feel fuller, and it will also keep you from overindulging in the holiday punch! I know that my already weak willpower becomes completely nonexistent after a few glasses of festive sangria.

Tip #5: Plan ahead.

When I go out to eat, I like to read the menu online ahead of time and plan out what I’m going to eat. This gives me time to think about healthy substitutions so I won’t delay my dining companions when we’re all ready to order. It also lets me preview both appetizers and desserts so I can decide where I’d rather splurge. This type of planning can be harder if you’re attending a party hosted in someone’s home, but there are ways around this! Call the host and ask if there’s anything you can contribute to the event. Maybe you can bring a healthy appetizer option, or prepare a side dish that utilizes lots of delicious vegetables without drowning them in butter or cream.

Tip #6: Don’t forget to enjoy yourself! 

At the end of the day, the holidays should be about having a good time with the people you care most about. Don’t get so caught up in trying to make healthy decisions that you forget to have a good time. It’s okay if you slip up. No one is perfect! This is all about finding balance. Set yourself up to succeed by reducing temptation wherever possible, and you’ll find that your slip ups are few far between. And if you do overindulge on pumpkin pie come Thanksgiving, well, at least it’s only one day out of the year. Get up and go for a run the next day, and remember that every day is a new chance to start over and make healthier choices.

What are some of the ways you resist temptation?
Share your favorite tips in the comments!

Fitnasty for Life
This post is my contribution to this week’s #fit4fifteen link up, hosted by Carolyn over at Fitnasty for Life. Make sure to check out some of the other awesome bloggers in the link up – they’ve all got great stories to share!