ATHENA

I was walking the dog the other evening when I stopped to compliment my neighbor on how beautifully he kept his front yard. He invited me to come see what he'd done with the back yard. My jaw dropped open at the designer-perfect kidney-shaped pool and jacuzzi with potted hibiscus and ferns, and shaded lounge chairs. Then came the fateful words, "You're welcome to come over and swim any time you like." This is God trying to tell me something, right? I wanted to say, "No, no, you don't understand, that would destroy my main excuse, that swimming is just too much trouble, and here you are just two houses down, inviting me to share your paradise..." But instead, I told him I just might do that some day. I went home and told my attendant. She thought it was a great idea and said she'd go with me once or twice a week. Another excuse (no one to help me) down the drain.

Remember how I told you I'm in that "don't bother me" stage on exercising? Well, now one part of my brain is searching frantically for new excuses (my bathing suit is too old, I'd have to paint my toenails, maybe the chlorine would ruin my hair) while another part of my brain is beginning to think this might be pretty neat. I remember how much fun and how relaxing yet invigorating swimming used to be. I imagine how great it would be to feel blood pulsating through my legs again. And what a great way to nurture a new friendship with my neighbor. No. It would be an imposition. That's the best excuse I can think of, and it's working just fine to keep me in my old habit of not doing any vigorous exercise. Pretty sad. Have you ever felt like this?

It's so much easier making changes in my diet. Even though I'm pretty conscientious about eating five fruits and vegetables a day and staying away from excessively fatty foods, I have this thing for chocolate. It's like a drug for me. If I need a boost, or as my Mexican attendant says, "subir el animo (raise the spirits)," chocolate does it instantaneously, the darker the better. The other day, however, I went to see my pulmonologist to see why I was feeling so crummy in the mornings (at least I didn't wait until I got sick this time), and he did a blood test. I was shocked to find out my sugar was high. I didn't tell him I popped a big piece of chocolate right before I left to see him. I went back to have it re-checked on an empty stomach, and it was perfectly normal. Really scary. Scary enough to make me cut back my chocolate intake to no more than once every other day (and that's a sacrifice!). I can make really big changes in my choices when I get scared out of my wits!

I want to hear your stories. Write or email me about what has prompted you to make changes that improved your health. What motivated you enough to get out of the "don't bother me" or "maybe" stages and into action? We'll share some of your stories in future issues of ATHENA and maybe that'll help others make wiser choices.

Eating Healthy
by Laurie Gerken Redd,

Laurie Gerken Redd, who has lived with a spinal cord injury since age 13, is Administrative Director of the Independent Living Research Utilization at the Institute for Rehabilitation and Research in Houston, Texas.

My healthy diet has evolved over the last ten years. I started learning about healthy diets and lowering my fat intake by just buying magazines and reading books about it. All the research was saying that a healthy diet was just so important for a healthy lifestyle. I decided to take a six week nutrition course that Rice University Continuing Education was offering, and it was wonderful. I learned a lot about the components of eating a well-balanced diet, including lots of fruits and vegetables.

About six years ago, I had surgery, and afterwards, I gained about 30 pounds. I think what I had done is increase my portions and decrease my activity, and I think that's why I gained weight. Later, I joined Weight Watchers, and the program really helped me with my portion control. It's a very healthy form of eating. Basically, what you do is write your food down so that you can keep track of what you're eating, so that you get your 5-9 fruits and vegetables a day and your carbohydrates and your fats. Also, what I liked about the program is that they stress that you have your indulgences, and you can have them once a day or whenever. I lost 30 pounds and have maintained that weight.

When I was 30 pounds overweight, I felt real sluggish. I didn't have enough energy, and it affected my transfers. I remember on Christmas morning about three years ago, it was right before I joined Weight Watchers, I was getting out of bed and I pulled my back muscle. I was in excruciating pain, and I think that it was caused by the weight I had gained. That's one of the things that led me to start losing weight. I thought, "I'm not going to live my life like this." That's when I really was determined to make changes.

I think it's important to have other people in your life who can help you have healthy habits such as eating right. My husband is wonderful. He has exercised for twenty years or more. He goes to the health club four or five times a week and he has a very, very healthy diet. It's great having him because we motivate one another. He's not complaining because we're having pasta for dinner. He wants it, and he helps prepare it.

I think a lot about what will happen if I do not follow a healthy habit. Like if I'm not exercising - what I think about really is how it controls my stress level, and that's a real motivator. The three keys to a healthy lifestyle are good nutrition, exercise, and stress management. If I'm eating right and I'm exercising, I know that I can control my stress. If I eat something that's real fatty and not really good for me, I know it. I don't feel well. Within an hour or so, my stomach is queasy and my sugar level has gone down.

I've noticed improvements in my health since I started about ten years ago slowly changing my eating habits. My energy level is good, and I feel really good most of the time. I'm a pretty healthy person, and I think it's because of the changes that I have made.

My advice to other women with disabilities who are trying to improve their diet is that I would recommend that you not try to do everything at once; try to do one thing at a time and concentrate on that. I put notes on my refrigerator to help motivate me. The other advice is I started taking a lot of magazines. It was easier for me to subscribe to magazines that I could read pretty quickly, like newsletters, and they really helped motivate me. One was the Nutrition Action newsletter, which is published by the Center for Science in the Public Interest. They call them the food police. They're the ones that said certain kinds of Chinese food are really bad for you, and popcorn at the movies is really bad. It's a real short newsletter, easy to read, and gives you lots of good hints. Another newsletter that I like is the Consumer Reports on Health. It gives you tidbits about little things you can do to improve your health. Exercise is always in there, and eating right is always in there, and they always have things like ways to get your fruits and vegetables in, little hints or tips on that. I use it all the time. I remember just this month's issue dealt with some easy, simple recipes or ways to get your fruits and vegetables and I said, "Oh yeah, I could try that, I could do that."

So, read books and magazines. Take a nutrition course. Surround yourself with other people who have healthful eating habits. There are several people in my office that eat a very healthful diet. The only thing that I think is important is that you can't live without indulgences, without letting yourself have something, and for me, it's chocolate. But I don't do it every day; maybe I'll do it once a week and on a weekend. It's important that you don't feel deprived.

Thinking About Improving Your Diet?
by Mary Pat Bolton, RD, MS

If you've been thinking about improving your diet, here's some good news. With just a pencil and paper, you can take the first step. Simply write down everything you eat and drink for at least four days, including water. Try not to change what you usually eat, and make no judgments. You're simply collecting data that will help you later.

When done, evaluate your diet according to the following guidelines.

1. Count the fruits you ate each day. A medium apple, banana, or orange counts as 1 serving. So does 1/2 cup of canned fruit or 6 ounces of fruit juice. You should be eating at least 2 servings daily - preferably 3 or 4. If not, you've just identified the first item on your Dietary Change list.

2. Follow the same procedure with vegetables. A serving equals 1 cup of green salad, 1/2 cup of other vegetables, or 6 ounces of vegetable juice. Aim for 3 to 5 servings per day, and include deep green and orange vegetables often. If you're below this goal, add another item to your Dietary Change list.

3. Now count your servings of milk, yogurt, and cheese. A serving is one cup of milk or yogurt or about 1-1/2 ounces of cheese. You need 3-4 servings per day from this group, and they should all be low in fat. Do you get that much? If not, plan on adding more.

4. Assess the bread group next. Here, a serving is defined as 1 slice of bread, 1/2 cup cooked cereal, rice, or pasta, 5-6 crackers, or 1 ounce of dry cereal. Eat at least six servings per day, with an emphasis on whole-grain products, like whole-wheat bread, brown rice, and oatmeal.

5. Now look at protein sources. Your daily intake of meat, poultry, and seafood should not exceed 5-7 ounces (cooked weight), and it should all be lean, skinless, and not fried. Most Americans need to make changes in this category, and one of the best is to substitute beans for several servings of meat each week. Eggs fall in this category too, and should be limited to 2 or 3 per week.

6. Now list all the "extras," you ate, including high fat foods, sweets, soft drinks, and alcoholic beverages. These don't have to be off-limits, as long as you eat them in small amounts. If weight loss is your goal, this is the group to target. Every gram of fat you trim from your diet saves you nine calories. That may not sound like much, until you consider that a single tablespoon of mayonnaise contains 11 grams of fat. Be aware of fat-free sweets and snacks, however - it's easy to eat them as if they were also calorie-free, but some are almost as high in calories as the treats they replace. Alcoholic drinks and regular soft drinks are also calorie culprits, providing as much as 150 calories per serving.

7. Finally, check your intake of water, coffee, and tea. Make a point of drinking 6-8 cups of water daily, and let moderation guide you if you enjoy coffee and tea. If you drink more than 2-3 cups per day, it's wise to cut back.

Now take a look at your final list of Dietary Changes, and congratulate yourself. You have just developed your own personalized prescription for health and well-being. Set a goal each week to work on one simple change, and give yourself time to adjust to new choices. A healthy diet can strengthen your resistance to infection, improve the way you feel, and make weight control much easier. It's a gift you can give yourself - don't you think you deserve it?

The Search for the Participating Physican
by Margaret A. Nosek, PhS

In the last issue of ATHENA, we encouraged you to become a "participating patient." In this issue, we're going to give you some tips on finding that golden nugget, the "participating physician."

This is a two part process. First, you need to find someone you like and whose skills you trust. Second, you need to see if their style of delivering health care matches your preference.

If your mind is open to the idea of maintaining your health, congratulations. It's so easy to ignore problems, hoping they'll go away, only to be faced with a crisis. The most important advice we can give is find a doctor you like when you are well, not when you are in the throes of a crisis. Dr. Catherine Bontke advised, "You want to have a close and mutually respectful relationship with your primary care physician because he or she will direct all of your care, even if you need to see specialists. Age can be an important consideration when looking for a physician. "You do not want to eliminate someone based upon his or her age alone," cautioned Dr. Bontke. "However, after 50 years of age, most doctors have a tendency to be less medically current. If you have a major health problem, the physicians you should see are usually between the ages of 30 and 45. They are more likely to be well read on current medical literature."

Accreditation is very important. 'Board-certified physician' means that a physician has passed a special set of rigorous tests from her peers that proves she has at least a fundamental knowledge of the subject. There are a number of certifying organizations nationwide that require physicians to take their boards every ten years. "Board eligible" means doctors who have to wait a certain amount of time in order to take their oral examinations. Often they are just as qualified as "board-certified," but the consumer should be aware of their status.

Another thing to check is affiliations. More often than not, physicians practice mainly at one primary hospital. You can judge that hospital by its affiliations. Affiliation with a medical school usually means the hospital is used as a teaching facility. Being at such a facility can be annoying because you have to deal with residents, interns, and medical students, but you will most likely get the best possible care. Call the chief resident of medicine at the closest teaching hospital and ask him or her, "Who is the best internist in town for my situation?" Or call the operating room nurses and ask, "Who is the best surgeon in town?" Never be afraid to ask. Ask whether there are physicians on duty 24 hours a day at each hospital you investigate. That's what you want; a qualified doctor there for you 24 hours a day.

For those of you who need insurance, try large organizations and national clubs. Teaching programs at medical schools accept patients who have little insurance or money. Be careful about health maintenance organizations (HMOs) and preferred provider organizations (PPOs). They usually limit physician and hospital choices. If your doctor is not part of your PPO or HMO plan, you can't see him or her without spending exorbitant amounts of your own money.

To find a physician whose style of delivering health care matches your preferences, start by asking other patients. Ask how well their questions get answered; ask how satisfied they are with the service. Try talking directly to the doctor and ask about his or her attitude toward working with you as a partner in your health care. The doctor's answer can be revealing, but remember you never really know a physician's style until the first appointment.

The first step toward improving your health is thinking about it. Now you have some tips about step number two: pick up the telephone, and start gathering information. In the next issue, we will walk you through your first visit with the doctor you chose, and help you decide if this is someone you can work with as a partner.

Making the Choice to be More Physically Active!
by Maura Cavanagh-Dick, MEd

Choosing to increase your physical activity is a major decision that could change your life. You've thought about it a lot and now you're ready to get more exercise. First, weigh the pros and cons of your decision. What are the benefits and drawbacks of exercising more? What would be required of you in order to accomplish this goal? Are you willing to make a commitment to try to improve your health? Make a list of the pros and cons for changing, then for not changing. If the benefits outweigh the costs, then you've made the right decision to become more active.

Once you have decided to become more physically active, take an inventory of your present level of physical activity. What are you doing now and how can you improve your activity level? Think about activities that you can do and enjoy doing - this may include walking or wheeling, gardening, cleaning your house, or participating in active games with your family, friends, or pets. You don't have to find transportation to go to a gym to exercise. Your home and neighborhood are full of opportunities to increase physical activities. You may also want to consider adding a structured plan of exercise into your routine.

Your exercise routine may include flexibility exercises such as stretching or yoga, aerobic exercises such as walking, arm aerobics, or water aerobics, and muscle strengthening exercises such as lifting soup cans or hand weights. Try new activities with the help of a friend or your personal assistant. The "catch" is that in order for these activities to promote your health, they must be done consistently and at a level greater than what is needed to support your daily needs.

Sometimes women with disabilities believe that a con of exercising is getting hurt or making their disability worse. Others believe that having a disability means they should not exercise at all. This is seldom true. Injury can be avoided by starting slowly and being sure to consult your physician for suggestions and precautions related to your disability. Also, you may consider consulting a personal trainer at a local gym to find out what activities you can do to enhance your exercise program. Many personal trainers have experience creating exercise programs for people with disabilities and they can help guide you.

Increasing the amount of physical activity in your life requires time and effort. However, there are great benefits you can reap by exercising more, such as feeling better, having more energy, losing weight, and increasing your self-esteem. Having an exercise program that you enjoy will help you maintain the healthy lifestyle that you are seeking.

Is Quitting Worth It?

Making any decision about behavior change involves identifying and then weighing both the benefits and costs of the behavior. Because it can be helpful to make this a formal, written process, we have included a "decisional balance" exercise (see page 7) in this issue. Doing a decisional balance exercise requires that you consider not only the costs of continuing to smoke (which may be even higher for women with disabilities), but also the benefits. You then complete the exercise again, weighing the benefits of quitting against the costs of quitting and assess the results. When you do this exercise, you should take into consideration both the benefits and costs for yourself and for others who also may be affected.

When you have completed this exercise, if the benefits of quitting and the costs of continuing to smoke are both high, it means that you are not ignoring or denying the risks associated with smoking; you are probably close to making a decision to quit. If, however, the benefits of quitting and the costs of continuing to smoke are both low, you may not be ready for a change yet. You may need to continue asking questions and accumulating more information about the harmful effects of smoking that are relevant to you and also to consider how important the benefits really are. For example, many women value smoking as a way to get a "lift" when they feel down, or as a relief from daily "hassles." This good feeling is momentary and "sets you up" for needing yet another cigarette. People who have quit smoking report actually feeling calmer and more energetic than when they were smoking.

The most difficult hurdle for many women who are thinking about quitting is their anticipation of strong cravings for nicotine. This cost of quitting can be lowered by over- the-counter nicotine replacement products. In addition, a new "drug" aid available by prescription seems to provide the most relief from nicotine cravings. The drug, bupropion, is one of a family of antidepressants, and is offered under two names, Wellbutrin and Zyban. When the drug is obtained as Zyban, a smoking cessation program available by both telephone and mail provides additional support. Note: If you feel better overall while taking Zyban, you may want to talk to your physician about switching to an anti-depressant intended for longer term use, such as Wellbutrin.

Decisional Balance: To Change or Not to Change

This decisional balance exercise is intended to help you:

Think about the Costs and Benefits of a behavior you might want to change and
Think about what is involved in your decision to change a problem behavior.

REMEMBER: It's your decision to change! You are the one who must decide what it will take for you to tip the scale in favor of change.

		Changing  	              Not Changing

Benefits:	Increased control 	      More relaxed.	
            	over my life.	              Don't have to worry	
	        Support from family 	      about changing.
	        and friends.				

Costs:     	Increased anxiety.	      Disapproval from
                May be depressed for	      friends/family.
   	        a while.	              Damage close
	        May be bored for a while.     relationships.
		Increased health risks.			

Now that you have filled in the costs and benefits of your current behavior, take a few minutes to compare the benefits to the costs.

In thinking about about what is involved in your decision to change your behavior, you can use the following space to list the most important reasons why you want to change.

The most important reasons why I want to change _______________ are:
1. ________________________________________________________
2. ________________________________________________________
3. ________________________________________________________
 
 

Need More information about improving your health? These organizations and websites can help:

Consumer Reports on Health
is available from:
Consumers Union of the United States, Inc.
P.O. Box 56356
Boulder, CO 80322-6356
To order, call toll-free
1-800-234-2188
$24/year

Resourceful Woman: Women with Disabilities Striving Toward Health and Self-Determination
Health Resource Center for Women with Disabilities, Rehabilitation
Institute of Chicago
345 East Superior St., Suite 1562 Chicago, IL 60611
Voice: (312) 908-4744

Disabled Women's Health Program
Washington Hospital Center, 110 Irving St., N.W., Suite 5W33
Washington, D.C., 20010, Voice: (301) 587-6396, Fax: (301) 585-5467;
E-mail: welnersmd@aol.com

Barbara Robertson's Women and Disability Resources
http://members.tripod.com/~Barbara_Robertson/Women.html