Hyperemesis Gravidarum

…Or HG, as it’s known.

What IS this little known (and hard to pronounce) disease that is said to affect 1-2% of pregnant women?  Hyperemesis Gravidarum literally translates to excessive vomiting during pregnancy.  Princess Kate was just forced to announce another pregnancy before she was ready because she is suffering from it for the second time.  It’s what those of us with one HG pregnancy hope we never have to deal with next go-around (if we’re lucky enough to have more children).

As a registered nurse in the mother-baby field, I had heard about this disease, but surely there is no REAL understanding until it’s happened to you.  Imagine the worse stomach virus you’ve ever had, and dealing with that for months; even being told it may last with the same intensity for the whole pregnancy!  I am not a dramatic person, however, I will say simply that there were lots of moments that I didn’t think I’d make it through, and until I could feel my baby kicking at 16 weeks, I did not believe she could possibly survive (and be healthy) with such conditions.

To spare you all the worst of the details, I will sum up by saying there was CONSTANT nausea, lots of vomiting, dry heaving, medications galore (to think, I was all excited to have an all-natural, holistic pregnancy – that went out the door very quickly).  There were a couple of ER visits, and a longer, one-week hospital stay for a new type of treatment (that unfortunately didn’t work). Home care nurses, 24/7 IV infusions, daily weights, and measured urine was part of the gig.  No one could cook ANYthing in my home (not even brew coffee) or that would send me into a tailspin.  My poor husband made his morning coffee in the garage every day.  Oh, and perfume or scented anything spelt like poison.

With the life sucked out of me and rapid weight loss and dehydration, I barely had the energy or desire to hold a conversation.  I remember telling my mother on the phone one day that I felt like a mere shell of myself.  My husband, family (especially my mom), best friend, and competent doctor were all on “my team” and I feel as though they were my cheerleaders pushing me to get through each day.  I often think about other pregnant women in the same situation without such a supportive team and it makes me so sad.  No one should have to be strong enough to deal with HG alone.

I am writing this blog to reveal my huge gap in postings last year as well as to bring some awareness to this disease we know so little about.  What causes it?  What can be done about it?  This is beyond ginger, hard candy, saltines, and Preggie Pops.  Lemonade, dry carbs, the juice from canned peaches, and ice pops didn’t help.  Everyone had such great suggestions and anecdotes about what worked for them; unfortunately, I didn’t find relief with any of it.  With all the medications and interventions, I was still incredibly sick for months and months.  I was lucky enough to be able to return to work around week 22 (of a 40 week gestation), but continued to get “sick” EVERY. SINGLE. DAY – including 3 hours before heading to the hospital for delivery.  I was weak.

Funny little story… I remember going out for a walk as soon as my IV was discontinued to build up my stamina and try to get myself back to be able to work a 12.5 hour shift at the hospital.  I let my ego get the best of me.  It sounds crazy, but I could feel the baby settling down and relaxing with the movement.  I said “That’s right baby, your mama loves to workout.  I’m sorry I’ve had to lay on the couch this entire pregnancy so far, but this will be our new normal”.  Ha!  So much for that!  After my lofty 4 house-long walk, I returned home and was sick the rest of the day.  Looking back, the humor is not lost on me.  I did ‘rehab’ myself back up to getting to the gym.  However, my workouts did not resemble what I had been able to do before or what I thought I’d be doing while pregnant.

Magnolia was born 6 lbs 6 oz (a healthy weight, especially considering we were told all along that ‘the baby’ was at risk for being small).  I was eating and holding down all food within minutes of her birth.  It was amazing!!!  I have felt great and have since put back on the weight I was down.

All thoughts of wanting to expand our family in the future are met with equal amounts excitement and waves of fear.  What if it happens again?  How will I care for Magnolia?  I’m told based on statistics that I have a 50% chance of getting HG with a future pregnancy. Yikes!  I hope luck is on my side.

We will figure it out as everyone does everyday with their lives – happy milestones and hardships alike.  Magnolia is lucky she’s so cute, as any past mention of ‘the baby’ being grounded for life because of how Mommy felt went out the window the moment we met this beautiful little person.  She brings us so much joy and makes my heart swell everyday.

I hope no one reading this ever has to deal with Hyperemesis Gravidarum.  But, if you do, please feel free to reach out to me or the wonderful organization called the HER Foundation (HelpHer.org).  Let’s spread the word about HG – it’s real, and it needs attention and research.

I am back to being able to savor the smell of a great cup of coffee.  I’m going to keep savoring it unless or until I can’t.  Magnolia needs a sibling one day.

In health,

Tara

Kids

A quick post for a quick story…

While at the park with my daughter today, we walked passed a man with two young boys (maybe 8 and 10 years old).  There were several sets of stairs they were walking by and both boys wore a huge smile as they ran towards the steps and up and down each set.  I should add that it was hot and humid today – probably almost 90 degrees at that time.  Their happiness spilled out in short bursts of laughter and drips of sweat.

When children are removed from the “screens” (computer, video games, etc.), and are given some time in the outdoors, they PLAY and stay active.  It’s just in their nature.  I’m not sure when that changes for us, but for an 8 and 10 year old today in a park on Long Island, running up and down the stairs was not a “workout”, it was simply a way to play.

Maybe we should restructure our attitude and language that revolves around exercise, workouts, etc. and just start calling it play time!

In health,

Tara

Green smoothie / quick lunch

After buying the huge box of organic spinach while food shopping this week, I figured I’d better start eating more greens before they go to waste.

My lunch today was a sandwich made with Ezekiel bread, hummus, avocado, tomatoes, and sprouts.  To add some more protein, I had a side of cottage cheese with chives, pepitas (pumpkin seeds), and a cherry tomato (which just didn’t fit on the sandwich).  It was delicious!  I washed it down with a green smoothie.  The smoothie came out better than I expected, considering I didn’t put much fruit in there to sweeten it up.  In fact, my 9 month old daughter wore a green mustache of approval after I let her try some.

Here’s how I made it: In a blender, mix 2 big handfuls of organic spinach, a small handful of frozen mango chunks, and 8 ounces of water.  That’s it!  This yields about 2 cups of the smoothie.  It can be pre-made and stored, covered, in the refrigerator for 2-3 days.  This helps if you leave for work early in the morning and don’t want to wake the whole house up with the noisy blender.

This smoothie consistency is much like a thick juice.  If you like yours a bit thicker, add more frozen fruit or ice cubes.  If you choose these additions, drink right away before it separates.

This was a great quick, healthy lunch.  Total prep time for whole lunch: 5 minutes or less.

In health,

Tara

Fitting in Exercise Post Baby

With a 3 and a half month old at home now, my husband and I have been experimenting with ways for us to get in our workouts.  Here’s what has been working for us…

1)      Grandmas – We are very lucky in that our mothers are more than happy to watch our daughter for us.  So happy, in fact, that we don’t usually ask – they volunteer!  Last Saturday when I was working all day, my husband took my mom up on her offer and headed to the gym.  Last night while my husband was stuck at work late, again, my mom was thrilled to spend some alone time with my baby while I snuck in a nice sweat session (Thanks again, Mom!).  With this bitterly cold and snowy winter upon us here in the Northeast, we’re keeping our workouts mostly indoors and that means trying to fit in more time at the gym.  We appreciate all the help we’ve been getting with the baby and by taking just a little time to stay healthy and fit, I feel as though I can be a better Mom to my precious girl.

2)      The switch-off – My husband and I have yet to get an app or shared calendars on our phones, but we do communicate well.  Once or twice a week I have been getting up very early to feed and change the baby before handing over the monitor and running to the gym and back in time before my husband has to leave for work.  I never thought I’d be one to be driving to the gym in the dark early morning hours, but it’s great!  The gym is not crowded at all and to be done and showered before most people have had their first cup of coffee in the morning is a bonus.  This leaves evenings for my husband to be able to hit the gym on his way home from work.

3)      Classes – More and more baby-friendly classes are popping up everywhere.  There are zumba, yoga, and boot camp type classes around that are specifically for moms and their babies/children.  Besides a great workout, you can meet other women with whom you already have lots in common and if your child needs to be fed in the middle of a workout, everyone understands!

4)      Opportunity – The rest of the hours (or minutes) I log for workouts comes in dribs and drabs wherever I can get it.  Earlier today I was doing sit-ups, pushups and squats in the living room while ‘attending’ a webinar as my daughter took a nap.  Other times I take walks with the stroller when I can – outside on a rare warm day or in malls.  I am a big fan of the Moby wrap to be able to carry the baby hands-free and lift some weights or do walking lunges down the hallway.  I also have been known to run up and down the stairs, checking in after each flight while my baby was playing on her tummy time matt.

As our little one gets a older and the weather gets nicer, our routine will open up with a few more options (jogging stroller, here we come!).  But in the meantime, this is what’s working for us!

In health,

Tara

Letter to Magnolia

As the end of the year approaches, we all see the multitude of media – advertisements, articles, magazines, television shows – focusing on weight loss that’s usually tied into New Year’s resolutions.  This morning while feeding my newborn baby girl before dawn, I was watching an infomercial promoting the desire to “be your tiniest self” this time of year in order to fit into that perfect dress for the holiday parties (early Saturday morning television – NOTHING else on!).  I have to confess that I’ve seen this particular infomercial before, but something struck me much differently this time.  As I looked down at my daughter who already, at 5 weeks old, LOVES to eat, move, and stretch her body, I couldn’t help but feel very disappointed about this message about exercise and vanity that go hand-in-hand in our society.  I decided to write a letter to my daughter about what I’d like her to know about exercise…

Dear Magnolia,

It’s a tough world out there with lots of disordered ideas about what makes up health and wellness.  I want you to know that exercise is SO much more than just an obligatory ritual performed as a means to gain popularity or fit into your skinny jeans.  Moving your body will make you feel strong and empowered!  One day you’ll be proud to be able to carry all your grocery bags into the house in one trip or outrun a dog that might chase after you.  You’ll be successful and happy because fitness helps fight stress, illness, aches and pains and improves memory.  Those who work out regularly are said to be more intelligent as well – due to the increased blood flow to your brain.  Your peers will look to you for advice and ask “How do you do it?” when they see the inner glow that is packaged along with a healthy body and mind.

A sense of adventure and appreciation for nature is provoked when getting to see the beauty and nature from the top of a ski mountain or hiking trail or while swimming in the ocean.  That experience is just not something even the best photograph could replace.  You will be more likely to engage in other healthy behaviors in order to preserve all the hard work you put into your health.  Who wants to smoke or skimp on nutrition when you have a 5K race coming up that you’re looking to set a PR in?  Exercise will be a way in which your Daddy and I bond with you.  It’s a good excuse to take a break from emails and cell phones and go somewhere we don’t have a signal (although by the time you can read this, it’ll probably be unfathomable that anyplace ever existed without a signal).

I want you to know that exercise isn’t a chore, but rather a privilege.  I look forward to lots of future quality time and conversations with you about this.  Maybe it’ll be over a nice, healthy meal at home, or maybe – just maybe – it’ll be on the way to gymnastics, or soccer, or on a bike ride to the beach.  I love you and all that your growing body and mind is capable of!

In health,

Tara (a.k.a. Mommy)

Pedicures for Diabetics

Whether you’ve been Type 1 forever or a newly diagnosed Type 2, you’re already sick of counting carbs and pricking your finger 4 times a day.  You already know from the doc that these are necessary to manage your health.  But, we all look forward to (and deserve!) a little pampering here and there – diabetic or not.

Read through these tips that will make getting a manicure and/or pedicure safer for diabetics.  Of course, you still need to check your feet everyday (and please consult with your healthcare provider first).

1. Bring your own tools and polish.  These can be purchased at a beauty supply store or online and will give you peace of mind to know you are were the first to be poked and prodded at with these.  You will still need to wash the tools well after use to prevent harboring dirt and bacteria.  Hot, soapy water will do for this.  And scrub!  Friction is what ultimately eliminates the critters.

2. Push back only for your cuticles.  No cutting!  The last thing you should be doing is messing with skin that’s currently intact.

3. File nails down; do not cut.  Cutting the nails could leave sharp edges.  These edges could potentially cut the skin surrounding the nail.  If you keep up with your nails in between appointments, there shouldn’t be much maintenance needed anyway.

4. Do not let them shave your feet down.  It may sound weird to those of you who have never seen or heard about this, but many places will actually shave off the calluses and dead skin layers on the bottom of your feet.  Clearly, anyone coming near your feet (or anyone’s, for that matter) with a razor should be stopped in their tracks.

5. Wear/bring your own flip flops when getting a pedicure.  This will prevent you from having to borrow theirs which are usually VERY flimsy and might lead to scrapes or cuts.  Wear only comfortable footwear that fits well and avoid the ‘thongs’ with the hard, plastic piece that goes between your toes.  Those can lead to blisters within a few minutes of walking.

6. Bring your own lotion for a massage.  None of us really know who has been touching, mixing, or using that huge bottle of lotion or what’s growing inside.

7. Have a first-aid kit with antiseptic spray on hand.  This may sounds like overkill, but if you do incur a break in the skin, you can deal with it right then and there.

8. Be sure to check your feet and all skin OFTEN and report any non-healing injuries to your doctor.  Diabetes interferes with your body’s ability to heal itself, and it’s important that you are diligent with maintaining your healthcare routine.

Make manicure/pedicure appointments ahead of time and let the manicurist know that you will be bringing your own supplies.  Remind them again when you first sit down in that chair as well.  After that, turn the chair massager on, sit back with a magazine, and enjoy the pampering!

In health,

Tara

The Caffeine Debate

Here are the facts:

90% of the North American population consumes caffeine, in some form, everyday.  This includes coffee, tea, energy drinks, supplements, soda, etc.

Coffee is among the top 3 most popular beverages in the world!  It sits up there on the list with tea and water.

Caffeine is the most consumed (and legal) psychoactive drug in the world.

With conflicting studies constantly surfacing on the risks vs. benefits of coffee, I understand that it is hard to keep yourself informed, stay healthy, and still enjoy that Cup O’ Joe everyday.   Have you ever noticed that you can run faster or lift more reps or weight at the gym when your workout happens to fall about an hour or 2 after you’ve indulged in your morning coffee?  That’s not in your head.  Caffeine, when consumed within reason, is the perfect way to get out of a workout rut and boost your performance temporarily when the day is dragging.

Part of the reason there is so much conflicting information out there is that everyone metabolizes caffeine slightly differently.  There are those that can drink a cup of regular coffee right before bedtime and confess that it doesn’t interfere with their sleep in any way.  These people would be considered fast metabolizers of caffeine. On the other hand, people like me have a cut-off time of 2PM for caffeine because it can linger in our systems much longer and disrupt sleep patterns.  These people, myself included, are considered slow metabolizers of caffeine.  This is important information to have when tweaking your caffeine intake and patterns.

Which category do you fall into?

Either way, drink responsibly!  If you stop and order a huge, triple-shot espresso first thing in the morning and chase your caffeine “high” the rest of the day, not only are you setting yourself up for withdrawal symptoms such as headaches and fatigue (and an expensive habit), but you won’t reap the psychoactive benefits of the caffeine.  My rule for caffeinated beverages is “keep it small to avoid hitting the wall”.  This speaks to portion sizes for your coffee.  Go ahead and have the cup of coffee in the morning, but keep it to 8-10 ounces.  This will give you a little boost to start your day.  If you’ve put in a busy day at home with the kids or at the office and need some energy to get you to the gym and through a workout, have another 8 ounces of coffee (just not too late if you’re a slow metabolizer of caffeine).  You will be revved up about the workout, have greater endurance and strength, and can feel good about doing so with less coffee in total throughout the day than many people have with their first, Venti-sized cup in the morning.  You will be avoiding the vicious cycle that is a caffeine addiction and not have to worry about hitting ‘the wall’ everyday once the last cup has worn off.

Everything in moderation!

In health,

Tara

Hospital List for Expectant Moms

Working as a women’s health nurse in a hospital setting, I find myself wishing I could get the word out to pregnant patients about a few things they could include in their ‘packed bag’ that will help make their stay much more comfortable and organized after having a baby.  Here is that list:

Notebook and pens. This will come in handier than you know.  It’ll become a place to record your newborn’s feeding times and amounts, diaper changes, questions for the nurse or doctor, phone numbers, gifts given while in the hospital – for future thank you notes, which leads us to…

Thank you cards. You’ll be busy in the hospital, but you’ll be busier once at home.  Get these out of the way when possible.

Slippers with tread and flip flops. Slippers are for the walking around your room and laps around the unit you’ll be asked to do.  Use the flip flops for the shower.  You never know how well the shower stall was scrubbed prior to your admission.

Pajamas, a robe, and old underwear. The robe is to throw on over that ever-so-glamorous hospital gown you’ll be wearing.  After a day or so, your daytime attire and nighttime attire will be one in the same during your short stay in the hospital (2 days for a vaginal delivery, 3-4 days for a c-section, usually).  The first couple of weeks post-delivery will remind you of how lucky you were to be without a period for 9 months.  So do yourself a favor…forget the sexy thongs or satin skivvies and go with old, cheap, and what will become disposable underwear.  Some hospitals will provide you with disposable underwear.  Remember that it’s a one-size-fits-most and if you’re bigger than an XL, you should definitely bring your own to avoid an uncomfortable situation.

Sports or nursing bra. If you plan on breastfeeding, come with a nursing bra and practice putting it on and opening the flaps ahead of time.  Ask to put this on BEFORE insertion of an IV if possible to avoid getting tangled and/or having to wait until the IV is removed before putting in on.  If you plan on bottle feeding only, bring a few tight bras (sports bras work well).  Plan on using ice, refraining from the urge to express your milk, and ask the doctor to prescribe an anti-inflammatory and the nurse to administer it to you.  These steps will make the process of your milk coming in to be as bearable as possible.

Pillows. Unless you’re one of the lucky ones that can sleep whenever, wherever, you’re going to want the comfort of your own pillow and pillowcase.  The hospital pillows can be used to assist in breastfeeding positioning if you forget your Boppy at home.

Boppy.

Cell phone and charger. Besides the massive group text and picture you’ll want to send out post-delivery, you’ll find the alarm feature comes in handy to set throughout the night for feeding times as well as pain medication times.  No, you cannot let the sleeping baby sleep through the night and skip any feedings in the beginning of their lives.  And, especially after a c-section, you’re not going to want to go many hours between pain medication doses, otherwise you’ll be “chasing the pain” and regretting it the rest of the day.

Camera and extra battery or charger. Duh!

Newborn outfits. For pictures and day of discharge.

Extra hat or blanket for baby. If you have a pet at home, take one home with the infant’s scent on it so the dog or cat can get accustomed to the new baby.

Pads.  Not panty liners, not the thong-fit ones. A couple of packs of the huge, highly-absorbant pads with wings to stay in place.  The ones you swore you’d never use once you saw them in your mother’s cabinet.  Hospitals will supply you with their version, but your own will be better.  Trust me.

Bottled water.  Surprisingly, many hospitals will only give out bottled water if requested for a meal.  You should be drinking lots and lots of water and unless you like it right out of the tap, bring a case of your favorite bottled water.

Snacks.  Are you used to eating many times throughout the day?  The hospital will give you three, portion-controlled meals per day.  Breastfeeding burns about 500 additional calories a day.  Even more reason for you to bring some healthy snacks.  If you’re lucky enough to have a fridge in your room, great!  But  most hospitals will at least have a main fridge that you can label your food and store in there.  Otherwise, try to stick to non-perishable snacks.  Remember, you cannot (and should not) eat right after surgery (for c-sections).  Most docs want to wait until you are passing gas or least 12-24 hours has passed.  Also, to avoid getting even more swollen, steer clear of salty foods.  And drink lots of water!

Toiletries.  Makeup, makeup remover, shaving cream and razors (just in case you feel up to it), shampoo/conditioner, lotion, soap, toothbrush, toothpaste, contact solution, anything else you use on a daily basis.

Baby socks. A couple of pairs.  Number one, hospitals don’t have these and those tiny hands and feet have poor circulation in the first few days.  Number two, they will fall off and be lost quicker than you can take a picture with them on.  Number three, use them for hands also - to prevent their long nails from scratching their delicate skin.

Medications. If you’re on a prescription medication and will need to resume after delivery, you may want to bring your own.  Just be sure to tell doctors and nurses what you’re on, why, the dosage, the times you take it, etc.  You will need a doctor’s order for it while you’re in the hospital and the nurses will have to sign off that they witnessed you taking it.  Also, pharmacy will have to to identify the medication first to ensure that the pills you’re given them are, indeed, what you say they are.  Why all this trouble?  Some people want to avoid having to possibly take a generic version of their medications.  If this isn’t you, leave yours at home and let the hospital pharmacy provide you with their medication while you’re a patient.

Magazine and books. You won’t have a ton of spare time, but you may crave some reading material during meals or burping sessions (for the baby, that is).  But remember, you need to sleep when the baby is sleeping!  He or she may keep you up much of the night, and you’re going to need little cat naps to be synchronized with theirs.

Car seat. The base will remain in the car.  Be sure to have that set up wayyy ahead of time and bring the instructions just in case you need to make adjustments.  The carrier part can be taken up to the hospital room.  You’ll most likely be taking the baby out after he or she is already buckled in.  This will minimize your time fidgeting around outside.

Hand sanitizer. True, it’s already on the wall in your hospital room, but you should bring one to keep at your bedside.  You will also need to remind most of your visitors to use it before they hold the baby.

Gum. Also good to have at the bedside for when doctors, nurses, and impatient visitors drop by early in the morning before you’re had a chance to brush your teeth.

Use this as a foundation and add whatever else you will need to make it your own list.  Anything that may make you feel prepared, relaxed, or comfortable (such as pictures of family, a religious symbol, etc.)…go ahead and pack it.  What’s the worst case scenario?  You don’t use it.  So what?  You’ll feel much better knowing you’re overly prepared.

Good luck and enjoy your little peanut!

In health,

Tara

Resolution

Here we are, just a few hours before 2012 gives way to 2013, and I am still being constantly reminded of the buzz word ‘resolution’ that so many people talk about around this time of year.  I have never been one to make New Year’s Resolutions because I am too impatient.  When the desire to change something comes over me, I want to begin right away…not wait for the next January 1st to arrive!  But there’s nothing wrong with using an important date to think about a fresh start in order to motivate you to implement some changes for the new year, if that will work.

Res-o-lu-tion [rez-uh-lu-shuh n] noun

  1. the act of resolving or determining upon an action or course of action, method, procedure, etc.

This is my favorite definition of resolution because it speaks to the process of change, rather than the lofty, end-goal so many of us stay focused on.

The number one New Year’s Resolution made (and broken) every year is….You guessed it – weight loss.

If you’re one of the millions of Americans that start out January 1st in the gym every year, only to find you’re using your gym membership card as an ice scraper by February, then something needs to change THIS year.  Maybe by truly resolving to set goals and follow the process, you will find more success this time around.

The best way to make a change is to understand and plan for the obstacles that will most likely rear their ugly heads.  Why is it so hard to resist dessert?  And chips?  How about fried food?  The truth is, we were hard-wired way back when to eat whatever we could, whenever we could.  Our ancestors did not know when their next meal would be.  The more calorie-dense the food item, the more appealing it is so it will help sustain us for the longest period of time.  Along the same lines are our cravings for sweet and fatty foods.  The sweet foods will give us quick bursts of energy – perfect for when we’re hunting and gathering our food or running from our four-legged enemies.  And what about the fat?  Well that packs a whopping 9 calories per gram, making it the most calorie-dense macronutrient of all.   Now we know why these junk foods call our name all the time!

These instinctive cravings were formed in a time much different from now.  There were no cars, video games, or computers back then.  There were no grocery stores or microwaves.  Our ancestors were not concerned about the longevity needed to live to 100; they were happy if they made it through one more day.

It is no longer true that the biggest hurdle getting in between people and their weight loss goals is lack of information.  Between health care providers, every magazine you can think of, and Dr. Oz, most people have access to all of the basic information needed in order to become successful at weight loss.  But how come we are still the most obese nation in the world?  We need motivation!  We need small successes along the way to help get us pumped about our long-term goal.  We can’t do it all at once!  And, it can’t all be done before your cousin’s wedding next month, or just in time to squeeze into your bathing suit for your upcoming cruise.  It has to be for health.  It has to be in bite-sized pieces (pun intended).

So go ahead and make a New Year’s Resolution.  Just be sure you take into consideration that it is a process and not an end result.  A goal of 50 pound weight-loss can easily be broken up by starting with a realistic, and healthy, 2 pound per week weight loss.  That’s the first goal which in and of itself will have a process, such as:

  1. I will work out for 45 minutes, 4 days this week.
  2. I will allow myself to have dessert only at Mom’s 75th birthday party this Saturday.
  3. I will make sure I eat at least 6 servings of fruits and vegetables and drink 6-8 glasses of water everyday this week.

That’s one example.  But you need to do what will work for you.  After making your first bite-sized goal and then listing a few of the methods in which you’ll achieve that goal, be sure you’re confident that you will be able to follow through with them.  If you cannot say that you are at least 90% certain that you will follow through with an individual goal or method, then bring it down a notch until you are.

The focus is direction.  Do what will work FOR YOU and what will push you in the right direction towards your ultimate goal.  Slow and steady wins this race.

Happy New Year!  May 2013 be the healthiest yet!

In health,

Tara