I suppose you could read that headline in more ways than one. You could think I mean to take it all off "the end," as in your posterior. Or maybe you think I'm throwing in the calorie counter and saying, "Enough already!"

What I really mean is this is the final installment of this weight loss miniseries (although we may revisit the subject at a future date). The first of six installments was published on July 29. Since then, using theories and tips culled from a diet coach and internet advice I've passed along, I've managed to cajole 10 pounds to jump from my frame.

Ten pounds in 6 weeks is not a particularly grand loss, but I'll take it.

Understanding the Value of 10

To appreciate the value of minus-10-pounds, I had to find another way to frame it. So here's what worked for me. You know those rectangular soda cases, the kind that fit into your refrigerator and hold 12 cans? Those things weigh exactly 10 pounds.

Now spend just 1 day with one of those cartons. Get to know it intimately. Carry it wherever you go: upstairs, downstairs, to the restroom, around the mall or through the supermarket. When you get up from a chair or sit down, hug it. When you hustle up to the bus stop with your youngster, carry it along. Grabbing lunch? Shove it under your arm. I don't even want to think about how you'll struggle with that thing at work.

I guarantee you will be thrilled to lose that 10 pounds once the day is done. You will never look at 10 pounds quite the same way. The value of losing 10 heavy, burdensome, bulky, always-dogging-you pounds will come home to roost. And you'll also start to notice that you look nicer without that carton clamped to your hip. Ah, and when you lose 20...? I'm still working on a mental picture for that.

Hey, it's been fun shrinking together, even a little bit.

Final tip: You are worth any and every effort it takes to claim optimum health. When you are carrying too much weight, it threatens both your physical and mental well-being. So stay informed and involved, be pro-active, move around as much as possible. In the end you'll see yourself lighten up - in more ways than one.

Here's kudos to our federal government for its efforts to spread the word about the prevention, treatment and containment of the novel 2009 H1N1 influenza virus as we head into the fall flu season.

From three federal agencies teaming on a series of televised PSAs with Sesame Street, to continual updates, new guidelines for employers and schools, and other recommendations from CDC, FDA, HHS and the Department of Homeland Security, NIH and the White House, much is being done to ensure Americans are aware of the seriousness of the situation and the steps we can take to keep us from becoming another H1N1 statistic.    

Many of you do not, however, feel like congratulating your facility's efforts to protect nurses, patients and others against H1N1, according to a recent spot poll on the ADVANCE for Nurses homepage.

Meanwhile, one recent offering from CDC will prove useful to healthcare providers to pregnant women concerned about taking the H1N1 vaccine when it becomes available. On Sept. 1, CDC posted a feature on the topic on its Web site with answers to some of the most pressing questions, such as:

• Why does CDC recommend pregnant women receive the 2009 H1N1 influenza vaccine?
• Is there a particular kind of flu vaccine pregnant women should get?
• Are there flu vaccines that pregnant women should not get?
• Will the seasonal flu vaccine also protect against the 2009 H1N1 flu?

Check out all the questions and answers at http://www.cdc.gov/H1N1flu/vaccination/pregnant_qa.htm.

Ah, the seduction of food. That's right, you heard me. Seduction. There is absolutely an unspoken attraction to a firm mound of mashed potatoes and a pool of satiny butter. And there is no doubt that a warm apple pie, with a dollop of vanilla ice cream slowly melting atop a flakey crust, teases the senses and leads to irrational desire!

The Temptress

Like a leading character in a romance novel, food can be a temptress: sensory and sensual, urging us toward emotional cravings and overindulgences which end in dieter's despair. Madame Indulgent Foodstuff (I think of it as a she, with some salty experience in her (shelf)life...) can be adventurous, foreign, expansive, uncontrollable, irrational, demanding, dangerous! She wears fluffy icings, sugary come-ons, multi-colored sauces and colorful garnishes to cover her health-wrecking ways. She's a sly one, infiltrating our minds, our bodies, our organs, our cells.... and ultimately our waistlines! Off  with her head!

   Wait a minute, not so fast. You need food to survive. You can't simply go cold turkey (which, by the way, would be quite nutritious). Instead, you've got to control this wild entity and turn her into the ladylike Harbinger of Health (HOH, which for "Big Brother" fans, is not representative of "head of household") that she can be.

Find the Alternative

It's all about choices. Madame Foodstuff may show up, for example, as a cinnamon bun. According to The Diet Detective, Charles Stuart Platkin's "Think Before You Eat" online platform for weight loss, one cinnamon bun with icing commands from 620 to 846 calories. To burn that off, you're looking at 3.63 HOURS of walking! That's an additional half shift. Ouch!

   Turn to an HOH option instead, and opt for a piece of cinnamon raisin toast. (One slice of Pepperidge Farm brand will demand a mere 80 calories from your daily diet budget.)

    Think of food however you will. But remember that self-esteem makes itself known in the company you keep, as well as the food choices you make. Put the madame in her place! And before you fall for her seduction, just stop.... and, as Platkin advises, think.

Here's a physician assistant student getting his career off on the right foot. Read the nice things he has to say about nurses.

     "The Association of Weight and Health Promotion Practices of Middle Aged Women" is the erudite title of the doctoral dissertation of Ann Townsend, DrNP, MSN, APRN-BC, RN and director of Our Lady of Lourdes Medical Center Outpatient Heart Failure Center in Camden, NJ. She also happens to be the very first graduate of Drexel University's Doctor of Nursing Practice degree program. (She'll be featured with other recent grads in an upcoming issue of ADVANCE for Nurses, PA/NJ/DE edition.)

     In chatting about the degree program, we touched on her dissertation and I asked her what her research revealed. What gems were uncovered? "I learned a lot about obesity and how it affects women. I found exercise is one of the most underutilized tools we have," said Townsend. "Women yo-yo and focus on their weight so much, but the activity piece is so essential. As caregivers, I don't think we stress that enough."

Optimum Exercise?

 So I asked, "What is optimum when it comes to exercise?" I was thinking she might tell me how many minutes a day to walk, or how many crunches to do, or how often to lift weights. But that's where she surprised me by offering a completely different perspective: "‘Optimum' is the moment a woman starts."

    Come again?

     "Anything a person starts to do; that's optimum. Just start. I found 75 percent of the women in my study didn't do anything at all. So just beginning to take those first few steps is most important of all," said Townsend.

Rest for the Weary

She also stressed the importance of teaming exercise with relaxation. "Activity must be balanced with rest," she noted. "I found that stress is a big issue for women, who so often handle multiple roles. They develop a sleep problem. And lack of sleep is tied to obesity... it interferes with the hormonal balance of your circadian rhythm."    

    So, while calorie control for weight reduction is important, "that isn't always the path," said Townsend. "People are always looking for one answer, but there isn't just one. Exercise is an important component and it is absolutely underutilized."

    Boiled down to a quick tip: Get moving.

What's worse: a nurse Jackie who is stoned on painkillers, or withdrawing from them?

This seems to be the dichotomy of the Jackie we see in most episodes of Nurse Jackie - the drug-addict who's somehow still managing to keep it all together - and the opiate-craving, agitated and unraveling Jackie we see in the finale.

By the finale of season one, which aired last night on Showtime, Jackie's world of addiction, lies, secrets and adultery has imploded.

Her boyfriend/hospital pharmacist/opiate-supplier, Eddie, has been replaced by an automated pharmacy machine that's accessed only with a password and tracks every pill it dispenses, and who it dispenses the medication to. Jackie's control over her secret drug addiction: Gone.

Soon after, Eddie (who recently surprised Jackie with a "1-year anniversary" gift), finds out Jackie's married, and stops by her husband Kevin's bar for a few drinks. Hours later, a drunk and uncontrollable Eddie shows up at the hospital and confronts Jackie - and we still don't know what, if anything, he told Kevin. Jackie's control over her secret love affair (and possibly, her family life): Gone.

Cut to an uncharacteristically frantic Jackie pacing the hospital bathroom, digging deep into her pockets for pills that aren't there. For the first time all season, her go-to pick-me-ups at the hospital - Eddie and her painkillers - have vanished, and a desperate Jackie downs three vials of morphine while lying on the floor of an empty hospital room.

That's how the finale ends: With a stoned Jackie lying on the floor - exactly how season one opened. Clearly, not much on a positive note has changed with Nurse Jackie. Jackie's world has officially collapsed. But what we don't know is how Jackie will pick up the pieces. Could season two be a turnaround? Could next season feature a nurse Jackie trying to get sober and succeeding?

Considering its Showtime, I'm going to have to say no. Showtime is characteristic for its dark humor - it's sex, drugs and dysfunctional characters. On the other hand, her affair is clearly over, and I have to wonder how she'll mange to keep her addiction going much longer without getting caught. (Even an obviously high temp nurse whom Jackie confronted for being high, fired back, "It takes one to know one.")

I see the potential for good things to come, and for us to eventually be able to erase the words "drug-addicted" and "adulterous" before "Nurse Jackie" - but things look like they might get worse before they get better.

The Star-Ledger had a great interview with Nurse Jackie's producers, Liz Brixius and Linda Wallem, where they reflect on the first season and offer teasers for season two. You can read the full article here, but I found this part interesting: Writer Alan Sepinwall asks the producers, "Something that's come up with a lot of my readers is about the logistics and the reasons behind Jackie keeping her family a secret from the folks at the hospital. How does she do this? [...]

"Wallem: [...] from our own experience of not being sober, what you do is you compartmentalize with your lies. It fuels the drama. You like to keep things separate. Season two, it's going to be a little harder for her to do that.

"Brixius: It's not particularly original for us to say it, but if you build a better mousetrap, you get a smarter mouse. It's fun to watch Jackie navigate her own contraption."

Jackie's mousetrap has definitely snapped. The question is whether Jackie will leave the trap behind and start anew, or simply try to wiggle herself out of it. Let us know what you think.

After the recent flurry of town hall meetings, many blasting healthcare reform, you may have noticed an eerie silence on the debate.

President Obama has retreated to Martha's Vineyard for some reprieve. Congress is taking a break. And Republicans, whom healthcare reform supporters hold responsible for inciting the elderly with tales of billions of dollars in Medicare cuts, are also silent.

But starting today, Democrats will hold 1,000 meetings across the country to muster more support for their embattled healthcare initiative.

Despite calls from the Obama camp for bipartisanship, the Republican lions are already out of their den, preparing to take their piece of flesh - the public option.

Mainstream Democrats won't have it - healthcare for everyone is the reform in healthcare reform.

On the other hand, elder Republicans say drop the whole thing - in the midst of a recession, an overhaul of the healthcare system is just not feasible at this time.

 As the clouds of dissent start to gather when will it rain? Will Obama play politician or Democrat? Will he, as Sen. Joe Lieberman of Connecticut suggests, choose to scale down his plan for total reform and settle for health delivery and insurance reforms?

 Stay tuned: weather next.

So, while I usually greet the coach's somewhat simplistic advice with, "Duh, like I didn't already know that...," I'm rethinking my attitude. Maybe the truth is we all really do already know what to do, but we just hestitate to do it.

During this week's consultation, the coach revealed the brilliant overall game plan he devised just for me: Don't eat too much. DUH!!!!! (old habits die hard ... and I actually pay for this wisdom?) Of course I already knew that was the grand scheme, but the coach offered a "trick" to make it easier to bite off less that I can chew.

"Put your normal portion on your plate. Be happy with what you see. Yummy, yummy. Now slide 1/3 of it to the side and leave it there. Don't eat it," he growled, as playful eyes looked up to see my reaction to his simpleton edict.

I asked, "Wouldn't it just be easier to take less, right from the start?"
"No!" bellowed the coach. "This teaches you that you don't have to clean your plate. This teaches you that you can walk away from temptation. This teaches you that you are in control. Just do it! No excuses! Now get outta here..."

So the funny thing is, since putting this plan into action, whenever I resist leaving the last few bites on the plate, I hear that gravel-coated voice saying, "Just do it!" And, like magic, I do.

Whadda guy...

Television producers seem to be cashing in on the dynamics of the nursing profession. "Mercy" will feature three female nurses - all somewhat glammed-up, I might add - when it debuts Sept. 23 on NBC. "HawthRNorne" has already weighed in, with Jada Pinkett Smith in the lead role of a "tough-yet-caring chief nursing officer," according to TNT hype.

Most provocative is "Nurse Jackie," deftly played in a street smarts-meet-compassion tone by Edie Falco, late of "The Sopranos." It's a tough role, and a portrayal sure to raise questions, debate and eyebrows. Think Florence Nightingale in a biker jacket.

Kudos to the "Nurse Jackie" folks for catapulting her out of the realm of the ever-benevolent, all-giving, angel-like aura that cheats nurses out of their true human complexities. Hurray for giving her spirit, backbone and even misguided decisions. Falco's Nurse Jackie seems "real" in the standards of that fiction-and-fact collision known as a television series.

But here's what I want to know: How long will it be before we see "Nurse Jack" on the tube? Why not a series about a feisty male nurse who can battle sexism in this healthcare profession that still seems embued with an over abundance of estrogen? How about some testosterone to add a little heft to pop culture's portrayal of nurses?

I mentioned this to my mother, a strong-willed woman of 92, and she scoffed. "Male nurses? It still just doesn't seem right to me," she said, without any logic behind her words. What was behind her words was history, stereotyping, and yes, sexism. When will society wake up to the fact that men, too, are human beings full of compassion and the ability to render care on all levels? Why are males limited to only 5.4 percent of the U.S. nursing population?

TV producers are missing an opportunity to "up" our collective thinking, impact our understanding and explore a new dimension. They thought "Star Trek" was the final frontier? Nah, "Nurse Jack" is still light years away.

Having just chewed (exactly 25 chews per bite) one half of a green bell pepper and one half of a red bell pepper, I have made a discovery. They don't taste the same. Blindfolded I can tell one from the other. I'm not so sure I could have made that claim last week.

What's the significance, you ask with a shrug.

In my ongoing quest to pare down to my 20-something shape (yes, you can snicker if you want to...) I consulted a "nutrition coach" who happens to be a retired MD and a former university football coach. I asked him, in all seriousness, why I can't whittle myself to my preferred proportions.

Giving him a moment to laugh, I then told him about all the healthy grains and nuts and fruits and veggies and lean meats and fish I eat. In told him how I try to avoid sugar and white carbs. I told him how I sweat 5 days a week in a gym (owned by a trainer who does not believe in air conditioning!) for 45 grueling elliptical/treadmill minutes followed by weight training on intermittent days.

He pretty much told me to put away my violin. He said I could slim down to whatever weight I want by doing two things: Drink more water, and eat less.

Duh. No kidding.

But then this curmudgeon of a coach gave me a couple of practical tips to help me accomplish both. He said every time I feel hungry, drink water first. Period. No trick to it, just do it. He mentioned how his own 99-year-old mother has been doing that every day for the last 70 years and he believes it is her secret to slim longevity. So I've begun.... sloshing as I move about the office.

 His next useful tip was to "chew, chew, chew" my food. He didn't mean just chew enough to swallow, but chew until there is nothing even remotely resembling solid food in my mouth. I tried it, and I have to say it accomplished a couple of things. It made me eat much, much slower, and in turn I ate much less. And while I was on chew No. 19 of that green bell pepper, I realized I never really paid much attention to the flavor before, because in my "past" life I would have already swallowed it. Hey Mikey, I like it! (You have to be a certain age for that one.)

Who ever said you can't teach an "old" (ahem) dog new tricks?

AIDS seemed to be a hot topic Wednesday at the National Black Nurses Association Convention in Toronto. The last full day of the conference commenced with a spirited skit that raised awareness about how nurses can best encourage testing and navigate sensitive issues in caring for patients with recently diagnosed with AIDS.

The topic came up again later in the afternoon in one of the sessions on healthcare in the Caribbean.

Gloria Callwood, PhD, RN, at Johns Hopkins School of Nursing, is piloting studies of HIV-infected pregnant and parenting women in Baltimore and the U.S. British Virgin Islands (USBVI). Her findings are disturbing. Here in the U.S., she said 64 percent of HIV-positive women are African-American and many more are affected by syphilis and gonorrhea, or "diseases we thought we'd cured."

Though much of her data is from the USBVI, Callwood reminds us that, "as we become more global, these health conditions are everywhere. Just because I'm a nurse in the U.S. doesn't mean I won't be caring for someone who lived in the Caribbean."

But for those of you who've been dealing with HIV in the U.S. for 20+ years, some of Callwood's data is encouraging. Pregnant and parenting women who are HIV-positive in Baltimore had the same level of self-esteem as their non-diseases affected counterparts.

"In our country, women have been exposed to nurses and to doctors and studies that give them reason for optimism," she said.

To me, it seem like there's an interesting juxtaposition at play. Do you all find that, in your hospital, clinics and community outreach projects, getting people to test for HIV is the hardest part? Are your patients as hopeful during the treatment phase? Anyone have strategies on how we can harness that optimism to encourage others to be tested?

Greetings from the 37th annual National Black Nurses Association conference! There was certain energy among the attendees on Tuesday, which was enhanced by the sea of red everyone was wearing as part of the "Go Red, Girlfriend" campaign by the American Heart Association.

Lots of talk today about global health concerns. One of the most interesting speakers was Dorothy Powell, EDd, RN, FAAN, who's in the midst of establishing a center for long-term medical mission trips in Central America and the Caribbean between her employer, Duke University School of Nursing, The University of the West Indies and the Pan American Health Organization.

The timing is right for the project. Powell said that, although 250,000 U.S. students participated in study abroad programs, with 50 percent focused on service learning, most of the trips lasted fewer than 8 weeks. The downside of short-term missions is it's hard to achieve transformative change without postop or follow-up care, she said.

"We feel the burden of the world's weight to do good," Powell said. "It may not be good enough when these missions aren't attached to continuous enterprises that provide long-term service."

During the question and answer session, one nurse who's leading a service project in Haiti over Labor Day stood up and recounted the story of a student who approached her and said he thought his work would change the lives of those he served, but ended up enhancing his life instead.

I'm curious - over the years, we've covered many nurses volunteering in amazing medical mission trips throughout the world. If you've participated, do you feel you gained more than the citizens of the underserved countries you're there to serve?

I saw an item from the Mason County News, Mason County, Texas. It offered snakebite tips to readers who probably have seen more than their fair share of rattlers, water moccasins and copperheads.

But what caught my eye was the fact that the tip sheet was penned by a trauma nurse, Cindy Loeffler, RN, working at Hill Country Memorial Hospital, Fredericksburg, Texas.

Loeffler took her expertise to the masses in an accessible public forum where countless people could benefit. As such, she launched her own community outreach and brought further visibility and stature to her profession by offering insights from her counterparts at Texas Trauma Coordinators Forum. Through her educating words, readers learned how to identify venomous snakes, how to avoid their toothy wrath, as well as what to do if they do find one chomping into their vulnerable flesh.

Having spent some two decades on a features desk at a daily community newspaper, I can attest to the fact that such useful and informative "fillers" are welcomed by editors scrambling to fill space on deadline. A bylined article from an RN at a local hospital, rather than a PR department missive with manufactured quotes, carries weight.

E-mail is the preferred method of submission (no retyping by time-challenged editors required), and about 600 words (terse, tight, to-the-point) is the target length. Today, many news outlets are beefing up Web sites, and devoting space to "citizen journalists," offering to link written wisdom to a legion of readers (something not easily accomplished by on a personal blog).

The point is: If you have something to say, say it. Reach your fellow nurses right here, by setting your fingers to a little keyboard exercise. Or, if you have something to share with the world-at-large, do what Loeffler did. Find a voice in print. The pen remains mightier than the sword.

Relax, the headline was meant only to get your attention. What I want all of us to take off is extra poundage. And yes, I know, I know... you don't want to hear one more holier-than-thou voice saying "you really ought to lose some weight..." or "you have a pretty face but...". I understand, I've been there. I've been up and down and all over the scales in my lifetime for one reason or another. And yes, I go to a gym every day, but no, I don't look like I do...  I'm just trying to be healthy.

I can, however, vouch for the fact that extra poundage is a self-imposed bondage. Unless you have developed extreme self esteem, the feeling of too much flesh can keep you at arm's length from people, experiences, clothing, activities, skills, careers and even emotions you may wish to explore. That's certainly a poor trade-off for a fast-food lunch. And perhaps even more important is the fact that our eating and exercise habits will become the norm for our children as we teach by example.   

That said, I got it into my head that if I blog a healthy tip or two a week, ones we can adapt easily, we might be able to support each other in a shared quest for health. I would certainly welcome ideas from you!

So... here are two discoveries I've made this week:

1) A Web site called Diet Detective sent me a little wake-up call this morning via an e-letter. It asked me if I knew what it takes to burn off 1 tablespoon of mayo. Answer: 28 minutes of walking, 16 minutes of biking or 12 minutes of running. Ouch!

2) Milk has lots of sugar in it! Who knew? I thought a cup of skim milk was completely innocent until I saw it contains 90 calories, 12 grams of sugar and 13 grams of carbs. So, a little investigation turned up a product call Hood's Calorie Countdown "dairy beverage". I bought some yesterday (it is stocked at Wal-Mart) and somehow these geniuses have pared skim milk down to just 45 calories a cup, with only 3 grams of sugar and carbs. I tried it; I liked it.

As a member of the ADVANCE for Nurses task force on healthcare reform (I'll discuss resources we will offer nurses on this topic in my Career Beat column next month), I volunteered to cover President Obama's press conference on healthcare reform July 22, from my living room. The only advantage the journalists present had that I didn't was I couldn't ask questions.

Here are some observations and thoughts about the event:

Obama was speaking to the press but also to Congress, policymakers and the public. Over the past 2 weeks, he has been vocal and visible while advancing the need to pass healthcare reform legislation before Congress leaves for its August recess.

Many in Congress as well as the president's supporters are questioning why the deadline must be met. After all, healthcare reform legislation has been back and forth on the front and back burners of Congress's agenda since at least President Truman was in office.

Those who question the need for urgency say it's taken this long to make this much progress, so what is one more month going to matter. When questioned by a reporter at the press conference about the deadline, Obama responded if deadlines aren't set, nothing will get done again and healthcare costs will continue to skyrocket.

Prior to the news conference, George Stephanopoulos of ABC News stated the reason for urgency is with any new administration attempting to enact historic legislation, the precedent has been if it's going to get passed, it must be before Congress' summer break, or momentum can swing and the opposition usually benefits. In this case, healthcare reform could once again be shifted to the back burner.

The president acknowledged there are many uncertainties left to work through and made it clear he like everyone else "wants to get it right." He said what every American wants to know about healthcare reform is "What's in it for me?"

Backing up his "pedal to the metal" style of leadership for healthcare reform, he talked about the endless stories he heard on the campaign trail and the letters that come to the White House every day. Clearly, nurses could provide him even more heartbreaking accounts of the patients and families they care for every day.

It's hard for me to believe nurses and anyone who has dealt with the current healthcare system wouldn't support the need for change. As Obama pointed out last night, every advanced country in the world spends $6,000 less per person annually than we do in this country - and our people aren't healthier than those in countries.

Those who are fortunate to have health insurance in America know firsthand how insurance premiums and costs of care have risen in the past decade. For many of us, like me, soon to be Medicare recipient, we don't have any idea what the cost is going to be for us under a new plan. We have to trust our representatives in Congress and our president — and that's not always easy.

As someone who has advocated for universal healthcare for about 40 years and has been frustrated with this longstanding quagmire of not getting anything done, I was hopeful after the recession hit all of us so hard —many much harder than I — Congress would be committed to bipartisanship, similar to the consensus that occurred post-9/11.

The process is not without pitfalls, however. About a month ago, I was pleased to learn the energy bill sailed through the House and was hopeful it would do the same in the Senate. However, as I learned just recently, 22 amendments were attached to the bill to secure the needed votes. Right now, word out of the Senate is that bill will not pass because of the amendments.

This is just one more example of politics pure and simple, goodies for the most vocal and influential of House members so they can ensure votes from their constituents next election. This practice has to stop. You need to let your elected officials know you don't want to pay for an unneeded bridge in Walla Walla, WA.

I admit my expertise in finance and economics is nil. But like you, I hear the stories of patients who not only are physically ill but emotionally spent after losing money and energy negotiating the current system, and not getting even basic healthcare.

As nurses, I hope you are getting involved by writing letters to your elected representatives, and speaking and supporting the American Nurses Association or your specialty organizations. Meeting with ANA President Rebecca Patton and other nurses last week, Obama asked for nurses' support and pointed out how patients and families rate us as the most trusted healthcare professionals in America.

Let's live up to this recognition and work to get healthcare reform passed in 2009.