Who knew that toxins exist EVERYWHERE? I certainly wasn’t cognizant of my exposure to toxins. Teflon, PABAs, air, water, food, etc. But, I have learned so much and am constantly learning of the dangers of these toxins in our everyday lives. Most recently, all the soaps, lotions, and cleaning products have been updated in our house.
Arrow, StimuCath continuous, nerve block procedural kit ASK 05060-cch 19 Ga, 60 cm catheter, insulated needle, 18 g 3.81 inch
The catheter was advanced 3–5 cm beyond the needle tip. During supraclavicular catheter insertion, the catheters were placed dorsolateral to the nerve plexus.
During popliteal catheter insertion, the catheters were placed next to the nerve with the needle coming from the lateral side of the thigh. The catheter was advanced 3–5 cm beyond the tip of the needle to end within the space between the semitendinosus and semimembranosus muscles medially and biceps femoris muscle laterally.
AmbIT pump (Summit Medical Production, Inc., Salt Lake city, UT, USA)
After catheter placement, an initial bolus dose of 20 mL ropivacaine 0.75% was administered. All patients were evaluated for sensory and motor block prior to surgery. Before discharge, the catheters were connected to AmbIT pumps infusing ropivacaine 0.2% with an 8 mL/hour basal rate and a 12 mL demand dose once per hour.
On the fifth day, patients were instructed to stop the infusion for 6 hours and then remove the catheter if their pain scores were less than 5 and well tolerated by the patients. If pain was more than or equal to 5 we asked patients to restart their infusions and we did the same every day until the catheter was removed.
The results of study demonstrate that the prolonged use of ambulatory catheters for a period up to 5 days did not lead to an increased incidence of complications as compared to other studies. Main complications were minor infections and pharmacological symptoms, which resolved with catheter removal and without the need for additional medical intervention.
I’m currently on Week 8 of PWR at home by Kelsey Wells of BBG Sweat app. It’s a resistance/strength training program that’s 12 weeks long. I started it as soon as I got the thumbs up from the OB to workout again post-partum. I started with PWR at home beginner then moved my way to the PWR at Home 1.0. It’s a great workout to be able to do at home while the kids nap. The program is divided into chest/triceps, arms and abs, legs, back and shoulders. Basically, the goal is to do 5 resistance workouts/week with 3 LISS workouts and 1 HIIT. Well, in a busy world, it’s tough to fit in 5x/wk workouts.
So, it got me thinking and researching: What are the best evidence-based workouts out there?
Being a science-driven person (thank you med school!), I dug into the science looking for journal articles and browsing the thoughts of experts in the field. Here is what I found….
PWR at Home from BBG/Sweat is a Bro-Split program: Training each muscle at least 2x/week results in significantly greater muscle growth than training each muscle just once per week as you do in a bro-split. The main drawback of the bro split: it focuses on one muscle group on each day of the week. Training muscles more than once a week can cause significantly greater hypertrophy.
Fierce from BBG/Sweat appears to be a fullbody workout 3x/wk.
Just know that workout volume and consistency are the most important factors, so focus on those two variables and you will see positive results regardless of the split you use.
2 sets, 8-15 reps, want to go to failure. Little rest as possible bt sets and exercises.
Dumbbell Lateral Raise
Barbell Bench Press
The more I started reading about strength training, the more I came across articles and blogs about CALISTHENICS. I’m still a bit confused as to what it is, but it seems like the gist of it is to use your own bodyweight and for full body exercises that can be done anywhere.
High to Low Chest Cable Flies: 3-4 sets of 10-15 reps
Dumbbell frog pump- 2 sets, 30 reps, 8 RPE
Sledgehammer Swings x 30-60 seconds each side/Oak Tree Stepouts x 30-60 seconds each side
Banded Pulldowns x 30-60 seconds
Plank Punchouts x 30-60 seconds/Plank Pushaways x 30-60 seconds
Kris Home Workout Full Body C (with abs and glutes)
TransparentLabs.com: The Best Science-Based Workout Routine For BeginnersWorkout Instructions: Perform 12-15 reps Use weights that create fatigue, but not to create failure, (if you can’t complete 12-15 reps, reduce your weight). Complete one set of each exercise, moving from the first to the second, to the third, etc. Transition to the next exercise without a break
I had a patient come in for a 2 stage endovascular aortic repair. The patient had a 1st stage left carotid to subclavian bypass done about 3 days ago. We did a 2nd stage TEVAR for a descending aortic aneurysm. The patient did really well. Stayed in constant communication with the vascular surgeon as well as endovascular surgeon. A plan was in place. Patient was maximally beta blocked. I found dexmetetomidine to be a great drug for sedation pre-induction as well as blunting any responses to laryngoscopy during induction. Cordis for volume. Used the side port of the cordis for drips (nicardipine, phenylephrine). There were various times during the surgery where the surgeon wanted hypotension vs. hypertension. During deployment of the stent, SBP < 90. Once the stent was deployed, goal SBP 140 (MAP>90). Overall great case and great outcome for the patient.
What is a TEVAR (Thoracic EndoVascular Aortic Repair)?
A colleague of mine had suggested/introduced “The Obesity Code” to me and my reading list. It’s a fabulous read and I highly encourage a read/listen. Here are other books I have read and suggest. After The Obesity Code, I chose The Complete Guide to Fasting… and since then, I’ve added Eat Stop Eat to my audiobook library as well. I’m extremely intrigued about intermittent fasting. I’ve followed a paleo diet for years, however, I’m curious to see if I could actually try intermittent fasting and not succumb to hunger bc I love snacking!
To summarize: a rather normal dose of alcohol caused a decrease in fat burning, no change in carbohydrate burning, and a slight increase in overall calorie burning in men who were in the fasted state.
So the question remains. If metabolic rate increases, glucose oxidation stayed the same, and fat burning decreased… what the heck were they burning?
Turns out the answer is the alcohol… sort of.
In fact, blood acetate is such a priority that it’s mere presence can decrease lipolysis by ~50%, even when you are in the fasted state [Crouse JR, 1968]
And this is what happens when you drink during your fast. It’s not that you will gain more fat (unless you are drinking excessively), but you will stop releasing body fat, stop burning body fat, and burn acetate instead. This occurs without any change in insulin levels.
So sadly, it seems the answer is that you cannot drink during your fasts without diminishing your fat burning abilities.
I’ve decided to try the 16/8 IF schedule (16 hour fast, 8 hour eating window = 11a – 7p) when I go back to work.