Guest Post: Exercise for Weight Loss

[Here’s another guest post from Dave Banko about healthy diet and lifestyle.]

The first thing nearly everyone asks me when they hear about my weight loss is: what exercises did you start doing?  They are astonished when I tell them I didn’t start exercising until I had been following the diet program for 3 months and had already lost 50 lbs!

Exercise is a good thing and beneficial in so many ways, but the professionals from Cambridge and Oxford Universities who put together the ‘What’s the Right Diet for You?’ program were clear that the only way to lasting weight loss is to control your diet.

Many of my failed weight loss attempts in the past were due to starting to exercise first. If you listen to the gym and exercise video promos about the amazing results you will get, always in the small print is a legal disclaimer that this must be in conjunction with some sort of diet.

I remember this from the military too.  When preparing for a weigh-in, I had better results by reducing my physical activity.  Likewise, when preparing for the run or physical fitness test, I had better results when I wasn’t trying to lose weight too.

I have a choice, either consume fewer calories or burn more calories, so if I exercise I’ll burn more calories and lose weight, right?  Not exactly.  Exercise does burn more calories, but not as many as you think.

Whether you walk or run a mile, you still use about 100 calories performing this activity.  But your body already burns 2000-2500 calories per day just sustaining itself, and 100 calories is the equivalent of a single chocolate chip cookie. Your body is more complicated than that.

When you exercise, your body burns the energy most readily available, starting with the glucose already in your muscles and blood stream, then the glycogen in your liver, and finally burning fat.  When you finish a good workout, these energy sources are depleted and your body craves carbs to quickly restore these energy reserves.

To lose weight, I want my body to continue burning the fat, so instead of eating carbs, I should go for protein to help rebuild the muscles without interfering with the fat-burning process.

But protein isn’t what my body craves. As my body instinctively wants to restore the status quo, I will crave sugary and fatty foods. Has anyone else seen the ‘Snickers’ commercial suggesting that’s what you should have when you are hungry? Since I’ve just done a lot of exercise, I am physically and mentally tired, so my willpower to resist these cravings is reduced. Plus, I’ve done a good job exercising and naturally want to reward myself with a treat, like cake – something sugary and fatty.

To illustrate the dangers of over-estimating the impact of exercising on weight-loss, in ‘What’s the Right Diet for You?’ the researchers had participants exercise and showed them how much cake they burned off over one week by exercising (in this case, 4 pieces of cake). Then they removed the cake consumed as extra calories when the participants cheated on their diet by giving in to cravings, and there went 3 pieces of cake leaving only 1.  Then they showed how on the days in-between workouts the participants did less exercise than they normally did when they weren’t exercising at all (this was tracked before they started the exercise program) which equated to half a slice of cake.  So after all the effort, at the end of the week, they only burned about half a slice of cake in actual extra fat lost.

How did I start exercising?  When I started dieting, as I mentioned before, the key was to start with small changes. I did the same thing with exercising. After starting the diet itself for a few weeks, I tried walking a little more. I started walking the 1/2 mile to the train station to go to work instead of getting a ride. I started walking around the office more. At the start, I couldn’t do more than 1 flight of stairs so I started pushing myself to take the stairs more often than the elevator.

At the 3 month point and 50 lbs lighter, I already felt so much better and had so much more energy I felt I couldn’t contain it, so I bought an activity tracker and started walking.

(I have a bad ankle from a parachuting accident in the military so I can’t run or cycle, and an impingement in my shoulder so I can’t swim either.)  I just started walking around the block, and gradually went further and further. Now, a year on, I regularly walk 8-10 miles a day and average between 50 and 70 miles a week. I’m also walking exclusively in the office and not using the elevator at all, even to go up 4 or 5 floors.

Once I started tracking calories consumed in My Fitness Pal, linked with calories burned in the Activity Tracker, I noticed the numbers don’t match. I could burn an extra 1000 calories walking, but if I ate more than an extra 200-300 calories that day, I would gain weight. Again, our bodies are complicated.

One final note: When you exercise, you are strengthening your muscles, but you have no control over where your body reduces the fat. Your body stores fat all over, though it may concentrate more in one area than another, like the stomach or the hips. When losing weight, the body draws from fat all over. Exercising a particular muscle group will not have any effect on where the body draws the fat from. Only once all the fat is reduced will the results of your sit ups start to appear.

Please keep in mind there are healthy levels of fat and often the advertised stereotype in magazines is not healthy.  We want a healthy lifestyle and body image and not to go too far the other way to be too thin either.

Exercise is a good thing! Not only does it strengthen your muscles and your heart, but it boosts your metabolism, reduces cholesterol, and stabilizes your systems.

But you cannot expect to have lasting weight loss on exercise alone. You must start with and control your diet first and foremost, then add exercise as a supplement, wary of potential negative diet effects.

Feel free to contact me with at with any comments or questions.  [Crew Dog: Or comment below.]

Guest Post: To Count Calories or Not to Count Calories?

[This is the next in a series of guest posts about healthy diet and lifestyle from Dave Banko.]

Counting calories was the subject of a major debate in my Facebook weight-loss support group, and the short answer is: there is no correct answer.  A lot depends on you and how much you need to lose.

When I started losing weight and weighed over 360 lbs, I didn’t need to count calories.  The idea of a food diary and researching calorie content for everything I ate was too extreme for me, and the changes I was already making to my eating lifestyle resulted in dropping the weight relatively easily.

When I got down to around 250 lbs, it was becoming more difficult. With a much smaller percentage of body fat left to lose, and so many cuts already made, the margins were smaller, and I found I had to start counting calories to work off the last pounds.

If you want to start counting calories, smart phone apps make the process much easier. I researched 3 different ones and settled on My Fitness Pal.  I only use the free version, and haven’t seen a need yet for the premium services.

This app has a huge database of foods to search and automatically load, including many restaurant menu items which makes going out to eat easier.  You can also pre-load and copy items.  And it interfaces with a number of activity/step trackers like Fitbit so you can automatically include the calories burned from exercise.

Two of the most interesting functions I found are 1) the ability to track what I ate against my weight the next day, and 2) the ability to pre-plan meals.

  • The 1st thing I did was track my normal usage for 1 week, then started experimenting with diet and exercise over a 2 week period.  While the average male stat is 2500 calories per day, I found for me the break-even point was 2200.  If I ate more than 2200 calories, I generally gained weight, and if I ate less than 2200 calories, I generally lost weight.  I say ‘generally’ because it isn’t an exact formula.  Calorie counting is only a tool, but not the only tool you should use to lose weight as there are many other factors too.
  • The 2nd is the ability to pre-plan.  If I know what I am planning to eat for the day, or what restaurant I’m going to, I can look up the items I plan to eat and the calorie content and see how it fits so I know how much I can consume and stay within my daily allowance.  Also, if I’d like a glass of wine, some chocolate or ice cream, I can add this in and know where I need to cut back in other areas to have my treat and stay within the limits.

Someone asked me about cheating, by not entering everything.  This tool is for me, to help me with eating healthy.  The only person I’m cheating by not using the tool properly is myself.

One final point, as referenced above, your body is very complex, and simply counting calories will not do it.  If you are staying within your calorie limits, but the majority of the food you consume is unhealthy or out of proportion, it will have negative effects on your health and you may still gain weight. One calorie is not like every other calorie!

So, if you decide to count calories or use something like the Weight Watchers point system, your first step should be to adjust to healthier foods in the correct ratios.  Then you can use a calorie counting tool to help control the portion sizes.

As always, feel free to contact me at with any comments or questions not covered.  [Crew Dog: Or comment below.]

Medical Procedures: What It’s Like to Have Medical Botox Injections

In my experience, this was one procedure it was best not to think too much about ahead of time: having a 30 gauge needle stuck repeatedly into your head in order to inject multiple doses of neurotoxin.

Most people think of Botox as a cosmetic procedure that reduces wrinkles.  But Botox is used medically to treat several conditions, such as repetitive neck spasms (cervical dystonia) and chronic migraines.  Botox injections work by weakening or paralyzing targeted muscles or by blocking specific nerves.  Although scientists still don’t know exactly how Botox works for chronic migraines, according to The Migraine Trust:

A recent US study by Rami Burstein et al using animal models suggested that botulinum toxin inhibits pain in chronic migraine by reducing the expression of certain pain pathways involving nerve cells in the trigeminovascular system…

Unlike many of the other conditions in which it is used, it is not thought to work by relaxing overactive muscles.

In my case, the Botox injections were prescribed to treat chronic migraines (more than 15 headache days per month) which had not responded to any prescribed medications.

Since I was a bit apprehensive, I did research prior to the procedure, and watched several YouTube videos about the procedure, which made me think a little too much about needles going into my scalp and face.

I couldn’t find a good video that demonstrated the procedure for patients – most of the videos are either commercials for the product, technical demonstrations for healthcare professionals, or patients talking about their experiences.  This video is a technical video produced for healthcare professionals, but it gives you a good idea of the procedure:

My treatment began with me lying on my back on the examination table, and receiving injections in my forehead, temples, and scalp.  After that portion of the treatment was done, I was asked to sit in a chair and put my head on a pillow on the exam table.  (My arms were crossed, and my head was resting on them, like in the elementary school game of  Thumbs up, 7-up.)

While I was sitting in the chair, injections were administered to my scalp and trapezius muscles.

Unlike in the video, my provider did not use ice packs to numb the injection sites.  Some of the injections stung a bit as the Botox went in, but they didn’t hurt as much as some of the patients on YouTube had said they would.  Also, some of the injections were more painful than others.  For me, the injections in my left temple and behind my left ear were the most painful.  That’s the side on which I get most of my migraines, so the nurse practitioner figured those nerves were hyper-sensitive.

One of the injection sites on my face bled onto the pillow a little bit when I was getting the injections to the back of my scalp, and the injection sites were a little bit red and swollen for about an hour after the injections, so I kind-of looked like I had hives (or bee stings?).

But the staff was very careful to follow sanitary procedures, including cleaning the sites with antiseptic and treating the site that bled with clean gauze.

Also, I had no negative reactions to the Botox, so it turned out to not really be a big deal at all, and my apprehension was for nothing.

The entire procedure took about 20 minutes, and the effects should last for about 3 months.  Botox injections are not a cure for migraines – they are a treatment, meaning that they don’t fix what’s wrong; they only treat the symptoms.  If the injections work to lessen my migraines, I will have to continue getting injections once every three months for the rest of my life.

After injections, results are typically felt within 3-4 days.  However, studies show that most people do not experience the full effect until 6 months of treatment, which would be after the second or third series of injections.

If individuals have not responded by two to three treatment sessions it is generally considered that the individual is a non-responder.

(In other words, like other treatments, Botox for chronic migraines doesn’t work for everyone.)

Potential Side Effects of Botox treatment: Pain, swelling, or bruising at the injection sites.  If the person administering the shots isn’t careful to avoid certain muscles, you could have a drooping eyelid – or be unable to hold your head up – until the Botox wears off.

NOTE: Even though the injection sites might feel a little weird (slightly swollen, numb), it is very important not to rub the injection sites, as this can cause the toxin to spread outside of the designated areas.

[For more information on Botox, see this 2009 New York Times article.  Note that Botox has been approved for chronic migraine treatment subsequent to this article.]

Have you had medical Botox injections?  What was your experience with them?  Please comment below.

Update: One week after Botox

Still having debilitating migraines, but I’ve started to feel a little bit better.  Still very light-sensitive.  Less motion in my forehead muscles – can still make a Spock eyebrow, but the eyebrow doesn’t go as high.  Slight furrow when I frown.  Shoulder tension noticeably reduced; able to activate shoulder muscles that had been constantly tense.  Puffy eyes.

Update: Two weeks after Botox

Still having debilitating migraines, but also a few productive days.  Still very light-sensitive.  Very little motion in forehead muscles – can’t make a Spock eyebrow anymore.  Almost no motion when I frown or try to look surprised.  Shoulder tension noticeably reduced, with better range of motion of shoulder muscles.  Eyes still very puffy – but not drooping.

Update: ~ Nine weeks after Botox

My provider had informed me that, for some people, the effects do not last the full 12 weeks.  For these people, he said, Botox wears off a week or two before the next treatment.  For me, the Botox wore off 2 1/2 to 3 weeks before my next treatment.  My migraines returned with a vengeance, like they were making up for lost time.  While I appreciated the reduction in migraine symptoms and migraine frequency for nine weeks, having them return and knowing there’s nothing I can do about it for nearly three weeks until the next scheduled treatment sucks.

[The FDA approved Botox for migraine treatment at a 12 week interval, so even if it doesn’t last the full duration, the provider cannot shorten the interval.]

Guest Post: Slow Down! You Eat Too Fast!

[This is the next post in the guest series from Dave Banko on healthy diet and lifestyle.]

I remember being scolded as a boy for ‘inhaling‘ my food and not chewing it.

In basic training, the instructors would count our chews and slow down our caloric intake in other ways, but, when you only had 15 minutes to eat and it was taking too long, that changed to “Down as much as you can in the last 5 minutes!”  Needless to say, I ate too fast and this didn’t help my weight.

Having lived and traveled extensively in Europe, I’ve noticed this is a major difference between the European and the American culture.  The American culture is very “results-oriented” and this seems to apply to nearly every aspect of life, not just business.

I remember going to a restaurant in London for the first time.  What stood out for me was the space between tables (the owners weren’t trying to maximize how many people fit in the room) and no one pressured us to leave after we’d been there a few hours (not worried about increasing turnover).  I came back to the US and went to dinner at a restaurant where we took our time and noticed the table next to us turned over 3 times while we were there and the waitress was pressuring us to pay the bill and leave.

Slowing down your eating is a major recommendation of the ‘What’s the Right Diet for You?’ program.  


Day 1: The researchers gave each participant a hamburger for lunch then secretly timed them.  All of them ate their hamburgers in less than 5 minutes, some in less than 2 minutes.  The researchers then asked for feedback and nearly all participants were still hungry.  Some said it was like a snack and they could easily eat another.  Then the researchers took blood samples, which showed that the hormone telling the participants’ brains they were full was low.

Day 2: The researchers gave each participant another hamburger of the same size and calorie content, but required them to take 30 minutes to eat it.  To help, the researchers had the participants sit down and use a knife and fork.  At the end of the 30 minutes, they again asked for feedback.  All of the participants felt full!  While some said they could eat more, they no longer felt hungry and were able to stop after one hamburger.  The blood samples supported this as the hormone levels were doubled!

After changing *what* I ate, the next big challenge was *how much* I eat and this information alone was very helpful.  I put this to the test myself and couldn’t believe the difference.

In my 2nd blog post, I spoke about the French Paradox.  How can the French (and I’ve seen this in other European countries like Spain, Italy and Germany) eat rich fatty foods and still stay thin with low cholesterol and heart disease?  They eat small portions over extended periods of time, so their bodies can process it properly.

To them, food isn’t something to conquer, ‘Man vs Food,‘ but part of an event to be enjoyed with friends.

Here are a few of the techniques I use to slow down when I eat:

  • Sit down to eat. If you are standing, or are in an uncomfortable position, you will be more inclined to rush eating.
  • Take a sip of water or other drink in-between bites. If alcohol, alternate alcohol and water, as alcohol adds calories too.
  • Have your meal with someone and engage in conversation during the course of your meal.
  • Cut your food into small pieces.
  • Chew your food thoroughly before swallowing. As your mouth includes digestive enzymes, this also helps digestion and fully processing the nutrients in your food.
  • Try to spread out your meal. When I’m at home, instead of having my meal all at once, I’ll spread it out over an hour or two.  For example, for breakfast, I’ll start with a large glass of water with lemon, then have a 150g container of full fat natural yogurt.  About 15 to 30 minutes later I’ll have some fruit, usually some berries like blueberries or strawberries.  Another 30 to 45 minutes later, I’ll have my 2 eggs.  I’ll have also had another full glass of water with lemon, and tea without sugar during my meal.  I’ve now had about a 450 calorie breakfast over 90 minutes and don’t feel hungry at all.

Unfortunately, we can’t always take the time to slow down.  In those times, you will need to use your will power to remind yourself you have consumed enough food and your body doesn’t need more, even if you still feel hungry.

As always, feel free to contact me at if you have any comments or questions not already covered.  [Crew Dog: Or comment right here! 🙂 ]

Health Hack: Evening Checklist

It’s easier for me to run my nightly health and hygiene routine without needing a checklist, since I’m a night owl, not an early bird, and since there’s less to the night routine.  However, on a bad day all bets are off.

So, in the interest of symmetry, and since early birds (or off-their-game night owls) might find it helpful to use checklists at night when they’re tired and thinking less clearly, I have also created an Evening Health Checklist:

Evening Health Checklist – One Sick Vet

Again, feel free to print it out and use it, or create your own.

What will you do to hack your health today?

[In case you missed it, the Morning Health Checklist is here.]

Guest Post: Setting Weight Loss Goals

[The next post in Dave Banko’s guest series on healthy diet and lifestyle.]

Setting challenging but achievable goals is important in all aspects of our life, and weight loss is no different.  

When I started, I set the goal for myself to lose 100 lbs in a year. Even though I had never lost more than 15 lbs on any previous diet, I set this goal based on several factors:

  1. I wanted to give the new program a full year and, based on a weekly goal of losing 2 lbs a week, 100 lbs in a year seemed reasonable.
  2. I saw several middle-aged celebrity men who lost 100 or more lbs with diet and exercise (not with surgery).
  3. I also had 2 colleagues at work who recently lost a significant amount of weight, one of whom lost 100 lbs.

The example of friends and public figures achieving this gave me hope!  Although I haven’t been successful before, it has been done, and so I should be able to do it.

I hope sharing my story will inspire you that you can do it too!

100 lbs is daunting, especially having never lost more than 15 lbs before.  After initially setting this end target, I went back to set short and intermediate goals.

Rather than focusing on the end target, I knew if I focused on the short-term goals, the intermediate and end goals would come.

My friend’s Facebook group agreed we would do a weekly virtual weigh-in on Friday or Saturday.  To avoid embarrassment, we wouldn’t report actual weight, but just how many lbs up or down from the previous week.

Even though this was voluntary, it did apply a level of peer pressure to want to be able to report a positive result.  (You could lie of course because no one actually observed your weigh in, but the only one you’d be hurting is yourself.)

I found this combination of reasonable short-term goals, support, & accountability to both my family and a group of others on a similar journey very helpful.

There were some who opted not to do this, and none of them reached their goals.  Not everyone who set goals and reported regularly achieved their goals as quickly as they wanted, but it did help them keep going in the right direction.  The group also offered nothing but encouragement, celebrating our achievements with us and lifting us up when we were struggling.

Although group support is the primary strategy of ‘Emotional Eaters,’ I highly recommend it for anyone wanting to make a significant long-lasting lifestyle change.

I tracked my weight weekly and celebrated my intermediate successes.  Every time I reach a 0 (350 lbs, then 340, then 330 and so on) it felt like crossing a minor milestone.

Then crossing the BMI index: I started at 45, and going below 40, from very obese to obese was huge for me.  Then again, when I went below 30 from obese to overweight.

Finally, I also celebrated loss by body weight %, starting at 10% of my starting body weight lost, 20%, 25% and so on.

This may sound like a lot of celebrating, but for those of you who, like me, struggled for so long, seeing real progress is something to celebrate!

The ‘What’s the Right Diet for You?’ program succeeded so well, I decided to extend my end goal from 100 lbs in a year to 150 lbs total taking me back to what I weighed on active duty.

I reached the 100 lbs lost mark after 7 months.  I’m currently about 10 lbs from the end goal.

These last few lbs have been much harder.  I set weekly targets at just 1/2 lb per week and don’t meet this target every week, but I keep working towards it.  I am thrilled with what I achieved and how I feel, so I won’t let missing the short-term targets get me down.  Having the target, though, helps me stay focused until the day comes when this new eating lifestyle is so ingrained I no longer have to think about it.

Finally, I realized each day is a new day. It hasn’t all been success. I have had days when I over-ate and even binged. I’ve missed targets. But I know the plan works. When I stick to it, I see the results. So when I have a bad day, I don’t beat myself up about it. I start fresh the next morning; it’s a new day! 🙂

As always, please contact me at with any questions or comments.  [From Crew Dog: Or comment right here at One Sick Vet 🙂 ]

Managing Your Own Healthcare: How Many People’s Jobs Do I Have to Know How to Do?

My personal Tricare experience: I have received several years of harmful care, after decades of inadequate care, from Tricare.

Recently, my soon-to-be-former PCM defended his negligent/health-threatening care by telling me that I had not been aggressive enough in managing my own care.  I countered that aggressively managing one’s own healthcare is very difficult when one has a chronic debilitating condition (especially a condition that affects one’s cognitive abilities).

But today I’m having a good day, abilities-wise, so let’s talk about fighting fire with fire.  You want me to aggressively manage my own healthcare?  Look out, buddy, you just summoned a pissed-off veteran, and you’re about to regret it very, very much.

A friend of mine has a saying about dealing with others, especially those who work in any area interacting with clients/customers.  When encountering roadblocks in daily life having to do with the ignorance, apathy, or incompetence of others, my friend asks exasperatedly, “How many people’s jobs do *I* have to know how to do???”  (Meaning, since you can’t do your job correctly and give me the information and assistance I need, I will have to learn all of the information, procedures, laws, regulations, etc. myself in order to get the result I need.)

We have decided that the answer to this question is “ALL of them.”

ALL of the People.  ALL of the Jobs.

To be fair, there are some *awesome* people in this word who like their jobs, know how to do their jobs well, and like helping others.  When these magical unicorns cross your path, you do whatever you can to make them stay in your life, and you let them know how appreciated they are.

For the Non-magical-unicorn days, which is most of them, you learn how to do ALL the jobs.

Alright, soon-to-be-former PCM, you want me to aggressively manage my healthcare?  You got it.

Today I visited a Tricare Patient Advocate.  I walked in to the largest MTF near me, went to the information desk, and asked for the Tricare Patient Advocate and they hunted around until they found one, who came out and spoke to me face-to-face.

[I had previously located a Tricare Patient Advocate email address for a local advocate.  I emailed in November, and am still waiting for a response over five months later.  (Not the same advocate as the one I spoke to today.)]

The Patient Advocate gave me the contact information for the DoD’s Interactive Customer Evaluation (ICE).  I am going to contact ICE and provide “customer evaluation” on the negligent care I have been receiving, such as waiting 27 months for an MRI/Arthrogram of my wrist, even after I specifically told my soon-to-be-former PCM that my shoulder orthopedic surgeon suspected that I could have a torn ligament in my wrist, and then requested that my PCM submit a referral for an MRI and Arthrogram, which he did not do.

I will tell them that I gave up on ever receiving the care I needed from Tricare, and instead requested an MRI/Arthrogram from the VA, which I received within 6 weeks and which confirmed that I have *two* torn ligaments in my hand/wrist.

There are a few other things I will discuss with ICE about the inadequate care I received from this PCM…

But, next, after speaking to the Patient Advocate and confirming that my PCM did submit a request for referral to a wrist orthopedic surgeon after I confronted him with the results of my (VA) MRI/Arthrogram, I went home to aggressively manage my referral.

I called my Tricare region’s customer service number.  I never reached a human being. (ALL of the People. ALL of the Jobs. ALL of the Computers?)  I chased menu options long enough (15-20 minutes) to figure out that I would not get the level of information I needed from a machine.

So I bit the bullet and created an account on my region’s Tricare website.  I had been avoiding creating an online Tricare account, given the government’s track record on protecting personal information.  I don’t want my health information compromised.

But I needed access to the information, which I got after I created my account.  I was able to see the referral letter and, most importantly, the authorization number.

There are several useful pieces of information on Tricare referral letters.  If you keep reading past the name and contact information of the healthcare specialist to whom you have been referred, you will see this sentence: “This authorization is valid for the dates and service codes that follow on the back page.”  Keep reading until you reach the dates and service codes.  Make sure that your treatment takes place with the date range, and that you do not receive any treatments that were not authorized, or you will have billing problems with Tricare (as in, they may refuse to pay).

If you keep reading past that section, you will see a section titled “If You Would Like to Choose a Different Provider.”

Did you know that if you are not referred to an MTF, but are instead deferred to network, you can choose to see *any* in-network provider of the same specialty?

Also, as per the referral letter, “if your authorization number begins with a 7, you do not need to notify us of a change in provider.”

[Authorization numbers can also begin with a 4, in which case, you *do* have to get prior authorization to switch providers.]

***CAUTION: “You may not switch providers if you have already begun seeing a provider for the service authorized in this letter.”

Armed with that information, and all of the research I had done on orthopedic wrist and hand surgeons since my (very-belated) diagnosis, I called the office of the in-network surgeon I had selected, and scheduled an appointment for later this week.

This probably shaved several weeks off my wait-time, instead of waiting for the referral letter to come in the mail and then trying to figure out how to change providers.

The Patient Advocate also gave me advice on how to switch to a different PCM, given the current constraints of the system (patients being forced to use PCMs at MTFs only; no network PCMs; MTFs not accepting new patients due to being over-capacity).  We decided it would be best to remain with my soon-to-be-former PCM until the wrist/hand surgery is complete, so as not to cause hiccups in the system.  But I will be switching to a different PCM and a different MTF as soon as that is complete.

Meanwhile, I continue to receive excellent care for my other health issues from the local VA facility.

As far as resolving my issues with Tricare, I followed the chain-of-command, as well as rules of common decency.  I tried resolving my inadequate healthcare issues first with my PCM, who got defensive and hostile.  Then I went to the Patient Advocate.  Next I will file an evaluation with ICE.  I will also be completing an Army Provider Level Satisfaction Survey (APLSS).  If I still don’t receive a satisfactory resolution, I will continue to pursue the matter (on the days my health permits me to battle).

I have no illusions that my PCM will change his methods as a result of these actions.  He is impervious to feedback, and I’ve seen much worse healthcare providers remain in the military healthcare system, sadly.

The best I can hope for is:

  1.  To insist I get the care I need for my health conditions and injuries
  2. To insist the providers of this care are highly competent
  3. To hold this PCM accountable for his negligent care by reporting it
  4. To provide helpful information to others who are dealing with similar situations

I suspect by the time I am done, my soon-to-be-former PCM will regret having ever told a pissed-off veteran to be more aggressive about their healthcare.  Mischief, I mean Healthcare, Managed!

Guest Post: Starting the Right Diet for Me

[Dave Banko continues his guest post series on healthy diet and lifestyle.]

The host of this blog, Crew Dog, wrote an excellent article posted on 9 February 2016 about the ‘What’s the Right Diet for You?’ program put together by doctors, nutritionists and dietitians from Oxford and Cambridge Universities in England. As mentioned in my first post, I watched this program just as I was starting my latest ‘diet’ and the comprehensiveness of the program along with the science behind their recommendations impressed me.

Of the 3 over-eating categories, Constant Craver, Emotional Eater, and Feaster, I was clearly a Feaster. I love food, and once I start, I don’t stop until I am literally stuffed. I no longer know what it feels like to be full.

A number of things could have led to this. Everyone in my family is overweight, so there may be a biological predisposition. I also learned to eat very fast growing up, and in the military, which bypasses the response time for your stomach.  I wanted to get my money’s worth at ‘all you can eat’ buffets. And it’s just common courtesy when you are a guest and you enjoy the host’s food to have seconds (or thirds). I suspect all of these thing got me to this place, but now how do I get out of it?

The plan for the ‘Feaster’ is have a ‘high protein low glycemic index (GI)’ diet.

High protein’ doesn’t mean I should have an all meat or protein-based diet, but rather a higher ratio of protein than a general diet.

Low GI‘, doesn’t mean low carb. It means the carbohydrates I eat should have a low glycemic index.

The glycemic index is how quickly the carbohydrates are metabolized. A lower GI (below 55) metabolizes more slowly, prolonging the release of glucose and insulin into the blood stream.

High GI foods shock your system with a rush of glucose into the blood stream requiring a spike in insulin levels to accommodate. Too many spikes over a prolonged period of time reduces your body’s ability to respond and results in diabetes.

Low GI Foods High GI Foods
Hummus Cornflakes
Beans/Legumes Sugar
Whole Grains White (Processed or Refined) Grains
Whole Grain Breads White Bread
Pasta White Potatoes

So I cut sugar and eliminated processed/refined grains except on my cheat days on the weekend, but then still keeping them to small portions. I also made sure I added some form of protein to every meal.

The protein combined with the low GI foods helps me feel satisfied for longer.

I no longer could depend on my body to tell me when I was full, but by adjusting the foods I ate and the ratio, I would feel satisfied with less and it would sustain me for longer periods before I’d feel hungry again.

I didn’t stop there though. Just because I was a ‘Feaster’ didn’t mean I couldn’t learn something from the ‘Constant Cravers’ and the ‘Emotional Eaters’ too.

Constant Cravers were recommended to implement the 5 and 2 diet, so I skipped dinner 2 nights a week. Emotional Eaters were recommended to join a support group, so I joined the online Facebook Group my friend started to encourage each other in our weight loss and fitness goals.

I put the whole program together and the results were over 130 lbs lost in 13 months.

My routine looked like this:

  • Sunday to Thursday, strict adherence to the eating program using food I like to eat.
  • Tuesdays and Thursdays as my ‘fast’ days skipping dinner.
  • Friday and Saturdays are my cheat days. (after our virtual weigh-in for our Facebook Group on Friday mornings)

On my cheat days I would enjoy some of the higher GI foods I avoided during the week, as well as wine and ice cream, but I still would not go crazy on portion sizes.

During the week, my plate would look like this:

½ fruit and veg, ¼ complex carbs, and ¼ meat or other protein source

At this stage you may ask, “What about exercise?”

One of the points stressed in the program is that exercise is beneficial to overall health and fitness but, to lose weight, the #1 factor is diet.

I can bear witness to this, as numerous times I started weight loss programs with exercise. In 6 to 9 months I might lose 10-15 lbs, but I didn’t control my diet. Then something would happen and I’d have to stop exercising. Because I didn’t control my diet, as soon as the activity ceased, I put on the weight plus some as I was eating more because I was hungrier from the physical exercise.

I did add exercise into my routine, but I followed the program’s advice and kept my primary focus on my diet.

I will expand on the details of my routine and how it evolved over time, as well as tips and food tidbits I picked up along the way, in subsequent posts.

For now, I have one final piece of advice to include in this post – Start Small!

You can’t sustain a crash diet, nor is it healthy for you. Also, if you would have told me before I started that I’d be satisfied eating as little as I do today (now I aim to consume 1800-2000 calories per day in a healthy balance) when at the time I must have been consuming 4000-5000 calories per day, I would have thought you were crazy. And I would not have been able to sustain that big of a drop.

Small changes will have an affect! If you reduce the foods that aren’t helpful and increase the ratio of the good foods while starting to decrease the overall portions, you will lose weight!

After a while, your body will adjust to the reduction and your weight will stabilize – the dreaded plateau! That’s the time to make another round of adjustments.

Let me give you an example. I was working in a city and because I was being reimbursed for lunch, I would go out to buy something every day. I found a great little shop that used whole grain breads and natural ingredients in their sandwiches and fantastic soups.

When I started, I would order a large soup, a large sandwich, a dessert and a diet coke. The first thing was to cut dessert and the diet coke (more on that coming later as well). After a while, I then reduced my sandwich from a whole to a half, later eliminating the sandwich altogether. My lunch calories started around 1500 and ended up being 300-400 (with the piece of whole fruit the office provided). The transition from 1500 to 400 calories for lunch took 6-9 months.

Remember Rule #1 – This is a healthy eating lifestyle, not a diet!

Habits take time to break and to form new ones.

Good luck and feel free to contact me at if this has helped you or if you have specific questions not yet addressed.