WORK/LIFE BALANCE FROM A MOM AND NURSE PRACTITIONER

Is an advance practice degree worthwhile?

4/27/16

While working as staff nurse in a hospital, I often heard from coworkers that earning an advance practice degree is not a wise investment of time or money. Bedside nurses make good money and only work three days out of the week, so what's the advantage of earning a degree where you will make the same amount or less money and work five days a week? First of all, these assumptions are not necessarily true, but I will address that momentarily. Yes, an advance practice degree program is a huge monetary and time commitment, in addition to a significant amount of stress, so you must have a good reason to earn the degree. To define an advance practice degree, this refers to Master's of Science degree in nursing  (MSN) or Post-Master's Doctorate or Phd in nursing within area of expertise. Certified Nurse Midwife, Clinical Nurse Specialist, Nurse Anesthetist, and Nurse Practitioners, are all examples Master's-prepared nurses with advance practice degrees. There has been conversation in the nursing community about streamlining all advance practice degrees to doctorate degrees, however currently the Masters and Doctorate degree programs are separate entities.  In the midst of completing a MSN nurse-practitioner program, I definitely wanted to quit a number of times, and questioned the value of earning the degree. I had stable job as staff RN, and earned a salary that allowed for a comfortable lifestyle. During the last year I was completing the nurse practitioner MSN program, I was simply-put, "burnt out". While pregnant working full-time, juggling my course work, I encountered a set-back in one course, which led me to feel the degree was not worth the sacrifices. I was completely ready to quit the program, but with some encouragement from family and friends, I continued on with the program. Retrospectively I think this is a completely normal reaction in any intensive Master's program, regardless of the field. After sacrificing your social life, family time, sleep, and money, it's normal to think "for what?"

One of my coworkers in the ER would brag as how he was making $150,000 as a staff nurse, and would be taking a pay cut if he were to become nurse practitioner (of note he was working two night-shift jobs). Yes, you can make great money as a registered nurse working bedside. The overtime and extra shifts are always available. Working three days a week you are able to work two jobs, as many of my coworkers did. This is not easy money, however. One reason to consider an advance practice degree, is the physical nature of bedside nursing. Being on your feet for twelve hours and moving patients takes a toll on your body. An recent article here by a ICU nurse in the Huffington Post explains why the 3 days work week of a nurse is so exhausting.  Not many people want to or are able to work all the way out into retirement as a bedside nurse. Without an advance practice degree there are not a lot of options outside of bedside nursing, other than case management, house supervisor, or nursing informatics (almost all these positions require a BSN). Many hospitals now require a Master's for nursing director positions or any upper management position. Nurse educator positions almost all require Master's education.

The argument that you will make less money with a MSN than a RN is not accurate. My first job as a nurse practitioner (NP) in the emergency room I was paid hourly, and was receiving $20.00 + more an hour than as a RN working in the ER after four years. In addition, I was still working 12 hours shifts at that time, so the argument that you will be working five days a week is also not accurate. Currently, working at a urgent care/internal medicine clinic, I still make $15.00 an hour more than I did as a bedside nurse. If 12 hours shifts are your preference, this is still possible with an advance practice degree. Many urgent care clinics hire NPs and have 12 hour and 10 hour day shifts. If you choose to work overtime as a RN, yes there is a potential for more money. Furthermore, if you have 10 years plus of nursing experience, you may not see a drastic or any pay increase with an advance practice degree. I should make the disclaimer that in California in light of high cost of living considerations, RNs are paid among the highest salaries in the country. In the Bay Area of California, the salaries are even higher for RNs. My friend who currently works as ER nurse in a region of the Bay Area, definitely earns more than I as a NP. However, cost of living in this region is also higher.

The cost of a MSN program should also not be a deterrent to earning an advance practice degree. There are so many well-paying jobs available in these fields, that the degree will be worth the money. After completing the nurse practitioner degree I had multiple job interviews and several offers, even before having passed the national board certification. In addition, so much funding is available for education, especially for specialty areas such as education and psychiatry. There is such a need in these fields that there is a lot of federal funding and grants available to pay for education in these areas. As mentioned in a previous post, I completed a Master's-entry level program, which consisted of a pre and post-licensure segments. I took out federal student loans during the pre-licensure portion of the MSN program, as the course load did not allow for work, and I  and needed money for living expenses. I was working full-time throughout the post-licensure MSN program, and paid for each semester out of pocket to avoid any additional student loan debt. This was financially taxing, however it was doable on the salary of a registered nurse. I wasn't able to do any lavish vacations or shopping, but I was able to pay both tuition and my bills. The hospital I was employed at also offered tuition reimbursement, which covered at least one semester of part-time tuition a year. Most hospitals do offer some sort of continuing education or tuition reimbursement funding to full-time employees. There are also federal and state programs offering loan forgiveness in exchange for a commitment to work in a medically under-served regions, such as national health service corps. More information on this loan forgiveness program is available here.

Lastly, an advance practice degree allows for you to challenge yourself and gain expertise in an area you are interested. For me it was primary care and preventative health. Although I loved the complex cases and excitement in the emergency room, working in the ER reaffirmed my decision to work in primary care, as there is such a need for preventative medicine and primary care. There are so many other areas of advance practice, for any specialty area of interest. Certified nurse midwife, clinical nurse specialist, nurse anesthetist, and acute care NP, are all advance practice degrees with practice in hospital settings without traditional business hour work schedules.

I think being a bedside nurse is an incredible and challenging job, and there are plenty of reasons to love being a bedside nurse. Once my life settles down, I have considered working as a ER nurse per diem so I may keep up my skills and still remember how to respond in a code. I am glad however, I stuck it out and completed the MSN degree. So many more doors have opened, and I love the new challenges and opportunities I have to make a difference in the lives of my patients. My advice is to contemplate your reason for pursuing an advance practice degree. If money is the only motivator, consider salaries and cost of a graduate program, but that may not be enough of reason to pursue an advance practice degree. Consider your long-term goals, area of passion in health care, and also consider what setting and hours are most compatible with your life. In the future of this blog I plan to feature advance practice nurses in different settings monthly to bring about more understanding and information about these professions. If are interested in being featured, please send me your information or comment below!
4/26/16
 
 




As I wrote about in update on home renovation, I had plans to revamp our patio. The patio is my favorite place in our home. Growing up I always lived in places with land, and my dad religiously planned out a garden every year. I always envisioned living in a place with a large yard and garden, however when I settled in Southern California, I had to tweak this vision. The patio is a little haven for me to relax and read, my son to play, and for me to have a small garden. Here is my progress so far. The décor is mostly secondhand, with the exception of the hanging lights and large planters, which are from Costco, and the seat cushions, from Home Goods.




 



A Glimpse of Healthcare Outside The United States

4/21/16


As with every election season, there is often talk about healthcare reform. Anyone who has any contact with our current healthcare system in the United States can tell you it needs work. The Affordable Health Care Act has made some positive changes and increased access to healthcare; however there are  many barriers in terms of insurance companies, unnecessary spending, and lack of providers, that limit and delay quality care to many people in need. As a new provider I am still navigating all the complexities of the multi-payer system currently in place in the U.S. I am always curious on how foreign systems operate, and if their citizens are satisfied with their healthcare system. I wanted to get more insight into a true single-payer system, but as I did some research only two countries Canada and Taiwan only employee a true "single-payer" system. More information on how these systems are structured and operate are available here. Most other countries have a mix of both private and government based insurances, as in the U.S.  As I have a good friend that is an Irish Citizen, I wanted to get her take on the Irish healthcare system to be able to compare and contrast the current U.S. system. I asked her a few questions about Irish healthcare which I find are issues in the U.S., which I would like to share.

Are services for massage therapy  and other complementary treatments covered by insurance?

Yes by certain providers on certain plans.

How does this compare to U.S.?

The same. Some plans, mostly PPO will cover complementary and alternative therapies.

How long do you generally have to wait to see a specialist?

If you are uninsured you go on the public list which depending on the consultant and the area you could be on for 18 months. If you have insurance you can generally get an appointment (provably with the exact same consultant in a different clinic) within a week- a few months depending on their schedule. Your policy may only cover you in certain hospitals/clinics but generally you can shop around and find one available within a few weeks. Dermatologists have much longer waiting lists for both public and private.  If you have a slow burning issue say pain that starts small but you can't work. If it isn't life threatening you can be on a waiting list to see a consultant for 1-2 years! Even if it escalates or causes your day to day life to be a complete misery nobody gives a shit... that stuff is hard.

How does this compare to U.S.?

Generally if you have a PPO plan, which are more expensive and require more out of pocket costs, you can schedule an appointment with a specialist without a referral, which usually depends on availability, but can be as short as a few weeks. For HMO insurances, sometimes the wait can be up to six months to see a specialist, and requires referral from your primary care provider. Dermatology referrals also take some time. In my pediatric clinic rotation there were zero dermatologists in a 40 mile radius who would accept a straight MediCal plan.

How much is a typical office visit to a general practitioner (PCP)?

A gp visit is usually between 55-65€.

How does this compare to U.S.?

A typical office visit copay is between $15 - $50. This does not cover any procedures or medications given in the office.

How much would you have to pay for a hospital stay?

For an emergency you pay €100 on the front desk and all care/procedures and stay is free. The €100 is largely a deterrent for people who are clogging up the system. The issues lie in overcrowding and understaffing. There are massive issues in emergency departments with patients being on trolleys in hospital corridors for days. It's horrific. The staff are amazing but under pressure and it's a thankless job especially in Dublin where there's a sizable amount of IV drug users clogging up the triage area.

How does this compare to U.S.?

  ER overcrowding is the same in the U.S. ER copays are typically around $100.00 for most insurances, however the hospital still has to treat you regardless of the patient's ability to pay. Often people are unable to pay and the bills never are paid for expensive testing and ER services. Hospital stays generally are based on your insurance deductible, which can be $1000. If you have not already spent $1000 in a year, and are hospitalized you will be stuck paying $1,000 or more of whatever your insurance will not cover.

Do you have choice in the primary care provider you see?

 You can see any gp you like.

How does this compare to U.S.? 

Depending if your provider is in your insurance network, you can choose your primary care provider. Some insurance will automatically assign you to a provider or group of providers.

What preventative services are covered?

The last government brought in a free children under 5 scheme which is still being rolled out.

Huge problems here as they never consult gps before they announce these things and run in to big objections from health care professionals.

Other things. Immunizations are all free for children. Maternity - you get 6 free gp visits pre-natal and 2 post-natal. Long term illness is also a thing so you don't pay for meds or visits. There's a shared services diabetes program to take pressure off hospitals. Free regular blood tests and nurse/doc visits a couple of times a year.

Oh just remembered free breast check for risk groups, cervical smear tests for risk groups, bowel cancer screen for risk groups (all different age brackets).

How does this compare to U.S.? 

This is essentially the same. Almost all insurance plans cover a yearly physical, which includes most preventative health screenings based on age and risk factors. Most immunizations are covered for adults and children.

Are there private insurance companies that manage the government insurance? 

Yep we have three private companies that provide independent insurance plans.  If you are uninsured (which is common post-recession) then you are simply looked after by the state - the care that I described in the previous mail is a basic cover that's open to all citizens and residents and European citizens as far as I know.   So basic care would be - in a hospital you pay your €100 and then nothing further. You'll go on a waiting list if you need to see a specialist but when you see the specialist you don't pay for that or any subsequent operation/procedure. 

If you have private health insurance that's where the bills start to come in. Your policy may not cover your entire procedure or stay etc. 

How does this compare to U.S.?

Private insurance companies do manage state plans, such as MediCal. The multiple plans and coverage varies, and is very complex.

People that are uninsured, is that because they are unemployed or refuse to buy a health plan?

Health insurance costs keep rising here. A lot of people had health insurance as a benefit from larger employers. During the recession as people lost jobs or moved companies there was huge fall off. At one point there was 1000 a week cancelling their plans out right (population of 4 million - that's a lot).  If you're unemployed and on a government support there's little chance of you affording insurance. My generation - it would be unusual for people to have health insurance if it's not provided by their employer. Last year all insurers collectively brought in a levy so it's more expensive for you to take out insurance after the age of 33 if you've never had it before. So I have to take out insurance now this month or next to not have to pay the levy.  I think that's their way of trying to get my generation in to the loop.


How does this compare to the U.S.?
With the passage of The Affordable Healthcare Act, insurance is mandated for all U.S. citizens. If you don't qualify for a government plan or have insurance through your employer, you can purchase your own private plan. This is loosely enforced through fines based on income level.



Are mental health services covered or easily accessible? 

Mental health services can be hard to access depending. If you are suicidal you're supposed to go to the emergency room and sit with all the drug addicts & winos who clog up the system. If depressed your first port of call is your GP.  From there treatment is at the discretion of the GP. There are services to access but they are all done through your GP. There are care centers both residential and non-residential around the country but concentrated in the cities.  There's also an odd gap where by children with mental health difficulties are cared from until the age of 16 and adults are only cared for from 18 years here.  There are not for profit counselling centers which see people on a donations basis.

How does this compare to the U.S.?

 

The situation is very similar in the U.S. Mental health services are very hard to access, and the first line is usually your primary care provider. If you are suicidal you will sit in the ER for sometimes days at time until you can be placed in a facility. For children it is also very hard to come by mental health services, especially if the child requires acute psychiatric hospitalization. If you have any other chronic health condition (i.e. seizures, diabetes) and need psychiatric hospitalization, it could take even longer. Referrals to psychiatrists can take several months, and many psychological and counseling services are not covered by insurance.

Are contraceptives and abortions covered?

 Eh... this is a long question. So contraceptives under the state health care (GP card and Medical card) - Condoms no, copper coil yes, implant yes, pill - yes morning after pill - I'm not sure. 

All available privately at fairly cheap rates. Coil is €80 and €120 for GP to insert, Pill is about €15 per month, Morning after pill around €35 etc. 

Abortion is illegal in Ireland... Rant alert. Despite huge pressure no government will hold a referendum required to change a statute known here as the 8th amendment to the constitution. It’s a hangover from having the state and the Catholic Church hand in hand for so many years yet no government will commit to holding a referendum. It’s frankly horrendous as in recently (last year) the law was amended a tiny bit to allow for aborting fetuses if the life of the mother is at serious risk. An Indian woman died of septicemia due to an incomplete miscarriage a couple of years ago causing a massive back last.  It’s a source of massive outrage and shame here. For me it’s horrendous to think that in 2016 I am still subject to other people's moral stand point. 

I could go on about this at length. If you decide to have an abortion you need to travel to the UK at your own expense (you can go to Belfast or traditionally London) but this is horrendous. This is also true if your unborn baby is sick, dying or you definitely will not be able to carry to term. You still have to travel for abortion even if there is a zero per cent chance of your baby surviving.

How does this compare to the U.S.?

 

I felt this was an important question, as with any election the issues of abortion and access to contraception is being addressed. This one I had to look up, as state laws vary so much on abortion and contraception. Most insurance plans cover contraceptives, with the exception of some employers refusing for moral reasons, such as Hobby Lobby. Planned Parenthood, and other such state or federally subsidized agencies usually offer contraceptives at reduced cost or free of charge, although many politicians are trying to defund these organizations. More information about the move to defund Planned Parenthood, and their funding is available here. Currently 32 states prohibit federal funding for abortions, with the exception of cases of rape and incest, and some states rape and incest are not exceptions to federally-funded abortions.  Private insurance coverage of abortions are limited to conditions which threaten the mother's life in 11 states. 28 states require a mandatory waiting period after counseling before receiving an abortion. California not included in one of these states. More information regarding state laws on abortion is available here.

This was so interesting to compare and contrast these two systems. I would love to hear other people's experiences with health care systems outside of the U.S.  If you have comments please leave them below or send me an email.


TGIF: Our week with hand, foot and mouth

4/15/16
This week was a doozy. Last Thursday I was out with a friend at lunch with my son, who is normally well-behaved at lunch if he has something to distract him. He was so fussy he was throwing his toys and refusing to eat. My friend who is a PA, pointed out a rash on his arm. My son frequently has eczema flare-ups, so I hadn't thought much of the rash, but it did look different. That night when I got my son ready for his bath the rash had spread all over his diaper region, hands, and feet.



He was still fussy, but didn't have a fever or any other symptoms. I kept him home from daycare the next morning, and took him to the pediatrician who confirmed my suspicion of hand, foot and mouth disease. Hand, foot and mouth disease is the general term for a viral infection, most commonly caused by the Coxsackievirus or Enterovirus. This infection can present with symptoms of fever, rash on hands, feet, and sores in the mouth. Adults are less likely to develop rash, however can have the other mentioned symptoms. This infection can be spread through close personal contact, air, blister fluid, saliva and stool. Generally, the illness is contagious within the first week of symptoms. This infection is usually self-limiting, meaning requires no medication other than treating a fever, and will resolve within 7-10 days in most cases. The most serious complication in children is dehydration related to being unable to take in adequate fluids if mouth sores are severe. That afternoon after my son's rash developed, I started to feel chilled, but chalked it up to the unusually rainy weather we had been experiencing. However the next day, I was shivering, had a sore throat, and a fever of 102. I was so fatigued, I couldn't get off the couch. I took a good look in my throat the next day, and I had ulcerations in my posterior pharynx, confirming that I had also come down with hand, foot and mouth disease as well. Anything I ate burned, and I could only tolerate eating yogurt for a few days. The fever only lasted a day, but the ulcerations in the throat were 4 days, and were unbearable. Thank God, we are both feeling better for the weekend.  If you suspect your child has hand, foot and mouth disease make sure to see your pediatrician. More serious illnesses, such as Kawasaki disease, can present with similar symptoms. More information on hand foot and mouth disease is available on CDC website here. Have a great weekend!

Are you on board with your child's obsession?

4/14/16
It seems like all small children go through a phase where all they fixate on something . Our son's started at about 18 months with trains, in particular Thomas the Train. I think it started with us going to a Christmas exhibit with the old train sets, although I can't be sure of the trigger. After that, it was "choo-choo" this and "choo-choo" that. All he wanted to watch ever was Thomas the Train. My husband bought him a plastic train set and took all Christmas Eve assembling the tracks over the entirety of our small living room. Our son was beside himself with excitement, so much to the point that he wouldn't eat or sleep or do anything else but watch the damn trains go round and round. We kept the train set up for a few days, but when he started refusing to do anything else we had to hide it away only for special occasions. Of course he figured out where we kept it, and will occasionally persuade us into taking it out. His only real interest in TV is Thomas the Train. We've watched every episode of Thomas and Friends on Netflix, and have 4 different DVDs. I knew it was bad when my husband starting getting involved in the plotlines and characters. "Diesel is a real dick", my husband commented once. In the memoir, Someone Could Get Hurt, by Drew Magary, he writes a hilarious essay about his daughter's obsession with princesses, called Princesses and Paleskins. Magary writes about his daughter's short-lived fixation with princesses and other such phases. In this essay he talks about how each group of toys is bittersweet because it represents a phase in his daughter's life that will not be repeated. I see this sentiment with my mom, as she holds on to old toys of my brothers and I that we have long forgotten. I'm sure in a few years I will look over all my son's trains misty-eyed, and miss these days when he was little and life was simple.
Here is the link to the memoir by Drew Magary. I think it's a hilarious read for any new or expecting parent.



The PDX experience: My favorite Portland spots from the 4 quadrants and beyond

4/13/16

Just arriving at PDX is already better than LAX, because you don't have to get a cab, uber and fight traffic, you just hop on the max line that will take you downtown. I lived in Portland, Oregon for four years, and try to make it back once a year since I moved away. I am trying to plan a trip this year, although with a new schedule and toddler it's more difficult. In thinking about a trip to Portland I became inspired to write a post about my favorite spots to visit. Portland, for those of you not familiar, is divided into quadrants NW,SW, NE, and SE. The Willamette river divides the East and West sides, and Burnside divides the North and South sides. Here are my favorite places to eat, shop and sight see in all of the Portland neighborhoods and outlying regions.

1. SouthWest

I lived in John's Landing and Downtown Portland, both areas of SW, and have lots of favorite's in this area.




I'll start with mentioning the food carts. Portland was at the forefront of the food cart/truck craze. The downtown food carts are stationed between the downtown blocks and are open during lunch hours M-F and some are open late after bar closings. There is cuisine from Thai, Mediterranean, Mexican, vegan, you name it. You can get a huge meal for $5.00 (which on some days was my last $5.00). If you are downtown shopping or sight-seeing this is a great place to stop and get a bite. I read on the food cart website, that the downtown carts not be in this region for much longer. I used to live downtown blocks, and I would stop and get lunch at the carts on my way to work most days of the week.



Happy hours are big in Portland. One that is worth going to in SW is Portland City Grill. Located on the 30th floor of the Big Pink downtown building, the view is worth it in itself. The regular dinner and lunch hour menus are quite expensive, however their happy hour menu is reasonable. My best friend and I would go Sundays afternoons right at opening since during happy hour their is open seating. We would try to be as cavalier as possible as we ran to the nearest open booth with a view and would stay for hours chatting over drinks and au derives.

Huber's, also in Downtown, is the oldest restaurant in Portland. They are famous for their Spanish Coffees, which the preparation is a production in itself.



Voodoo donuts, is of course a famed Portland donut shop located near Burnside, although locations now exist at the airport and in Eugene. The downtown location is open 24 hours, although you may risk getting mugged during the late night/early hours.


The favorites are the named "voodoo donut" a jelly filled donut with a pretzel steak in its heart, and the infamous bacon maple bar.

Of course I have to mention Stumptown coffee. Stumptown is now available in many locations nationwide, and their beans can be bought at whole foods, but this is still hands down my favorite cup of coffee ever. The largest stumptown coffee shop was right next to my old apartment complex on SW Stark and 3rd, and I used to go get an Americano every morning. The vibe is super pretentious, and the baristas aloof, but they will make an amazing shape in your coffee and it will taste amazing. I recommend getting a cup of coffee, a voodoo donut, and then stroll the esplanade.





Scooter's is on the border of Burnside. It's a small dive bar, but is fun and has the most stiff drinks ever and jello shots. It's a good place to go before a concert at the Crystal Ballroom.

If you want something a little more classy, The Departure the restaurant or lounge in the Nines a beautiful boutique hotel right next to Pioneer Square, is a great spot for cocktails. Check out the deck on the warmer non-rainy months.
Depature photo via




The Rose Garden and Japanese Gardens, both in Washington Park, are beautiful in both rain and shine.

Japanese gardens photo via
NorthWest
The Pearl district in NW, has plenty of fine dining. One of the most raved about is Andina, fine Peruvian Cuisine.  The microbreweries in the Pearl district are a must if you are a fan of craft beer. The Bridgeport Brew Pub is one of my favorites.

On NW 21st street, a favorite spot for happy hour is Serrato. The Painted Hills Burger made with filet minion is amazing!
Painted Hills Burger photo via



Crystal Ballroom and Lola's Room
The Crystal Ballroom is a venue located right next door to Scooters, a McMenimen's bar and music venue with a bouncing dance floor, which is a lot of fun unless you have bad knees.


The Tube is another eclectic bar to check out. I haven't been there for over seven years, but it was at the time a hipster bar literally in the shape of a tube. From what I understand, the building and atmosphere has changed since then.


Powell's
Powell's on Burnside, is one of the few remaining thriving physical bookstores. You can get lost among the many color-themed rooms. My husband and I ended up spending $100.00 on our last visit to Powell's because I found so many children's books that brought me back to when I was a kid!


Forest Park
Forrest Park accessible from the NW neighborhood has a numerous hiking trails. One trail will take you to the pittock mansion, which is a historic mansion overlooking the city. Tours of the mansion are offered several days of the week.
Pittock Mansion



 


SouthEast
Mount Tabor Park


If you know me, you know I love Mount Tabor.  I have probably made every one of my friends and family go to this Park at some point. From what I understand it's located on an extinct volcanic ground. The park with the grand trees and view of the city has a magical aura. There are short hiking/jogging trails, scenic overlooks, tennis courts, and playgrounds


Doug Fir Lounge
There are many small pubs and dive bars in SE, however one music venue and pub I iconic to Portland is The Doug Fir. My former roommate used to work here, and so I've seen a number of shows at this venue. The music venue is an intimate basement setting. The theme throughout is of a mountain lodge, and the décor is uniquely Pacific Northwest.
Doug Fir Lounge Photo via



OMSI (Oregon Museum of Science and Industry) is located on the south waterfront, and has a multitude of hands-on exhibits and a planetarium.


Sanborn's
Brunch is a "thing" in Portland. Some of the hot brunch spots, such as Mother's and Screen Door have several hour wait times on the weekend. Portlandia had an episode mocking this phenomenon, called Brunch Village. The best kept secret in the East side is Sanborn's, a cute breakfast spot in the Brooklyn neighborhood. My former roommate and I stumbled upon this place which was down the street from our house one Sunday morning, and were hooked on the veggie breakfast burrito with a side of mango salsa ever since.


NorthEast
Admittedly, I don't have too much to say on this region, the reason being I never lived, or had any friends that lived in this area. I spent most of my time here at the Lloyd Shopping Center, or the now-named Moda Center to see a Blazer's game. Therefore I only have a few suggestions here.
The Last Thursday in the Alberta Arts district is the antithesis of the traditional "First Thursday" wine walks, with fire dancers and other street art and performers.  The Alberta Arts district also has many boutiques and galleries for shopping.



Outside of Portland

Timberline Lodge at Mt. Hood
I've been here a few time without going skiing or snowboarding, and I can tell you it's still worth the drive. The lodge itself is literally out of a movie; The Shining with Jack Nicholson, was filmed here.



Carson Hot Springs Resort
This rustic resort north of Portland, offers hot mineral bath soaks and wraps for $20.00. The drive up is very scenic, past the Colombia River and near the Colombia Gorge. The mineral water baths are especially soothing on a rainy day.
 
Wine Tasting
The Willamette Valley is on the same latitude as the Burgandy region of France, hence the amazing Pinto Noirs in this region. There are many wineries, mostly South of Portland, with tasting rooms. I would recommend  Trisaetum, Penner-Ash, and Argyle.




 

Post your favorite Portland spots in the comments below.


The Struggle is Real: My pregnancy weight gain and postpartum loss

4/5/16

Before I was pregnant and I heard stories of women gaining 50-100 lbs during pregnancy, I would think "Dear Lord, how could you let that happen?" Well, I will share with you how I let this happened during my pregnancy. Excessive weight gain in pregnancy, is defined as over 35 lbs for a woman who has a normal BMI (19-24.9). Excessive weight gain during pregnancy is not just a matter of vanity. Excessive weight gain in pregnancy is linked to increased rate of C-section, pregnancy-induced hypertension, and gestational diabetes, just to name a few.  I started my pregnancy at  a normal BMI of 22, and maintained modest and steady weight gain throughout the first two trimesters of my pregnancy. I was working full-time in the ER and was walking somewhere between 3-4 miles a day just at work, so I really had no problem keeping my weight gain slow and steady. During the start of my third trimester I had a lot of stress, which I will write about in another blog. After experiencing regular contractions at 30 weeks  my OB/GYN sent me to the hospital for monitoring. A test used as a predictor for preterm labor, fetal fibronectin, was positive, and I was seen by a perinatologist. The perinatologist advised there was a high likelihood I may go into labor in the next two weeks. I had to be hospitalized for two days receiving medications to stop the contractions and develop the baby's lungs in the case of a preterm delivery. After being discharged I was put on activity restriction and taken off of work. Bored at home, and thinking labor was impending, I found myself baking batches of cookies, not caring if I put on a few extra pounds. I would do a short walk around the block, but of course I wasn't getting much exercise at all. After a month of this, and still no arrival of the baby, I had put on a good amount of weight. At one doctor's visit my husband came along and the OB/GYN commented on how I had put on seven pounds in one week. "What was your initial weight?" she said scrutinizing my chart. I was so mortified she was asking this all in front of my husband. I was huge and swollen, and sitting at home in the hot July heat made it no better. On our way home from the doctor's office my husband and I stopped for lunch at Chic-fil-A. I ordered a grilled chicken salad and as my husband ate his chicken strips and fries I couldn't fight back the tears. I felt so huge, awful, and embarrassed. My husband of course thought I was overreacting, which just led to more tears in the middle of Chic-fil-A. I gained a total of 50-55 lbs by the time I delivered, which was at 41 weeks.
37 weeks pregnant at 191 lbs
 I had a 10 lb 2 oz baby, and fortunately was able to have a delivery without any major complications. I was checked again for gestational diabetes, since my baby was technically macrosomic (larger than 8 lbs 13 oz), which often correlates with gestational diabetes. My blood sugar and my baby's were normal, however.  My blood pressure was elevated after delivery for a day, so I had to stay in the hospital for additional day, but myself and the baby were both incredibly healthy. I lost twenty pounds within the first two weeks of delivery. That still meant, however I had 30 lbs to lose. Breast feeding alone utilizes 500 calories in addition to your daily need, so with that alone there is the potential for weight loss of a pound a week. I was exclusively breast feeding for the first three months, and did see gradual steady weight loss. I counted calories to keep myself at 1600 daily calories, which was enough to keep my milk supply steady and to see weight loss. I had lost another 10 lbs after the first two months after delivery.
2 months postpartum on a paddle board 162 lbs
I began doing short walks, a mile or two several weeks after my delivery. At about two months postpartum I started incorporating more high-intensity work-outs in the form of Jillian Michaels videos. The 30 day shred and the Beginner shred are my favorites because they are full body workouts in 20 minutes you can do in your living room. I would recommend if you are just getting back into working out postpartum, to start with the beginner shred.I felt so tired and sleep deprived, so getting motivated to work out was tough. 20 minute workouts were doable, and will have your heart rate elevated to the level where fatburning starts. I lost a total of 10 more pounds, and when I returned back to work at 4 months post-partum I had 15 more pounds to go to reach my pre-pregnancy weight. While I was on maternity leave all my coworkers had started the Medifast diet and all had drastic weight losses. I of course wanted to get on this bandwagon ASAP and lose the remainder of my weight. The Medifast diet is extremely calorie-restrictive, averaging about 1000-1100 calories a day, thus not recommended for lactating women. It's also not recommended to do cardio exercise while on this program. There is a modified version of the diet for lactating women, which may be an option for some. After I stopped breastfeeding, at about five and half months, I started the Medifast diet. I had my husband do it with me for motivation. I ended up losing 12 pounds over six weeks (my husband lost 20 lbs), and was at my lowest weight in many years. The Medifast diet has fast results, but is difficult to stick to and continue with long term weight maintenance.

7 months post-partum 136 lbs




I did not keep all of the weight after dieting off. After going off the diet I did end up gaining about 8 pounds back due to going back to old bad eating habits. Currently now that I am over a year and a half post-partum, I have maintained my pre-pregnancy weight, and am still active, keep a balanced diet and have maintained a healthy BMI. I was not one of those women who immediately lost all the weight and looked amazing one week after giving birth. If you are one of those women, I envy you, but I think it's work for the majority of us. It's overwhelming becoming a new mom, while losing sleep and losing your pre-pregnancy shape. It was a lot of effort for me to lose the weight and maintain it, but I know that keeping myself  at a healthy weight is not only beneficial for my mental and physical health long-term, but allows me to have the energy to keep up with a growing toddler day to day.



Here is the link to the 30 day shred DVD that I highly recommend and still do. .

Spring Cucumber Mojito Recipe

4/4/16
If you are parents like us, you don't get out to enjoy drinks that often. My husband and I have come to terms with this, and make the best of having nights in at home. This weekend with warmer weather after putting our son down, we grilled, made cocktails and had dinner on the patio. I thought I would share the cocktail recipe courtesy of my mixologist husband. It's similar to a mojito, however there is no added sugar so it's not as sweet, which I prefer. Enjoy and comment below!

Ingredients
½ Lime, Cut into quarters
6 Mint leaves
2 Slices of cucumber cut into quarters
2 Oz Cachaca Brazilian Light Rum
.
4 Oz Sparkling Water
 
Directions:
 
Pour 2oz Cachaca into a mixing glass and then put the lime pieces, mint leaves and cucumber into a cocktail glass and muddle until the lime and mint are broken down.
 
Use a cocktail strainer to pour the contents of shaker into a rocks glass over ice. Then add the 4Oz of Sparkling water to top off the glass; stir with a cocktail spoon until very cold, and serve immediately.  Garnish with a Cucumber slice.