History of Asthma Definitions

As we travel back in time we will learn the definition of asthma has grown through the years.

• 30,000 B.C.:  Diseases are noted by their symptoms as opposed to their causes.  The symptoms of shortness of breath, wheezing, anxiety, nausea, headache, itchy and watery eyes, runny nose, etc are caused by the unseen spirits and gods.  
• 10,000 B.C.: Theories started to evolve in most societies that diseases (symptoms) were caused by some kind of imbalance inside the body.  These types of theories would hold strong through most of history.  
• 5,000 B.C.:  Asthma-like symptoms were described in ancient Egypt, although no respiratory diseases were described. 
• 2,697 B.C. Chinese physician Ch'i Po provides the first description of asthma (maybe):  "Those who do not rest and whose breathing is noisy have disorders in the region of Yang Ming (the 'sunlight').  The Yang of the foot in descending causes the present disturbance and is ascending it causes the breathing to be noisy."  You can read more by clicking here. 
• 800 BC?  The first reference to asthma was made by Homer in his epic poem The Illiad.    "asthma" was derived from the Greek word aazein, which means to exhale with an open mouth or to pant.  Actually, asthma is derived from the Greek word Panos which means panting.  Homer used the term to reference any dyspnea, including shortness of breath after exertion from fighting in a battle. So here asthma was basically an umbrella term that represented all causes of dyspnea (asthma, hay fever, bronchitis, emphysema, kidney failure, heart failure, pneumonia, tuberculosis, etc.)
• 400 B.C.:  Hippocrates introduced the term asthma into the medical community, using it to describe any medical condition that caused dyspnea.  Pneumonia and tuberculosis are the first two respiratory diseases taken out from under the asthma umbrella.  The cause of asthma was the same as any other disease, it was caused by an imbalance of one of the four humors: Blood, Phlegm, Black Bile, Yellow Bile.
• 1 A.D.: Celcus was the first to distinguish dyspnea from asthma.  He defined dyspnea as Moderate, unsuffocative breathing without a wheeze (it's chronic); he defined asthma as Vehement breathing that is sonorous and wheezing (it's acute)
• 100 A.D.: In India, asthma-like symptoms were referred to as Tamaka Swasa, with swasa meaning breathlessness.  It's a condition that closely resembles our modern description of asthma such as wheezing, shortness of breath, increased phlegm and coughing (kawa).  When severe it may result in sweating, trouble lying down and trouble speaking.
• 100 A.D. Aeretaeus of Cappadocia defines asthma this way: "If a difficulty of breathing is produced either from running, excessive exercise, or any other cause, it is denominated asthma, or any other cause, it is denominated asthma: that disease likwise known by the name orthopnea, is called asthma, because the patients during the paroxysms are affected with difficulty of breathing, it obtains the appelation orthopnea from the patients not being able to breathe easily, unless in an erect posture of body, in a reclining state, there is danger of suffocation taking place." The cause was "coldness of breath with moisture: the matter consists of thick gutinous humors lurking internally." Treatment was based on your age and sex. 
• 150 A.D.: Galen mostly agreed with Hippocrates that asthma was a humoral disease, and he was the first to define asthma as a disease of wheezing.  He noted that "if the breathing is rough and noisy it indicates that a large amount of thick and sticky humors in the bronchial tubes of the lungs has accumulated and become annoying because it is difficult to expectorate." 
• 650 A.D.: Paulus Aegineta defines the asthmatic as "those who break thick without fever, like those who have run fast...The affection arises from thick and viscid humours becoming infarcted in the bronchial cells of the lungs... Dyspnea is a common symptom which accompanies these and many other complaints... 
• 960 A.D.: Haly Abbas, like Galen, refers to asthma as a collection of gross phlegm about the cells in the lungs. His remedies are of an attentuant and incisive nature, and he particularises the vinegar of squills.  He cautious asthmatics to be aware of indigestion, and, therefore, forbids exercise after food, but recommends it before a meal.  After exercise he enjoins hard friction, no doubt with the intention of favouring the cutaneous perspiration
• 1000:  asthma was a chronic disease in which patients often suffered 'acute paroxysms with similarity of epilepsy and spasm.'  The flow of thick humours from the head to the lungs produced a situation in which 'the patient finds no escape from rapid panting, like the labored panting of one who is being choked or rushed'. 
• 1180:   Maimonides might have been the first to describe nervous asthma when he wrote how a patient who is "mentally agitated" causes his physical well-being to suffer and eventually he becomes physically ill. He was also to think asthma might be caused by pollutants in the air.  He believed asthma usually began with a cold and advanced to shortness of breath. 
• 1400:  Korean physicians believed asthma-like symptoms or coughing were caused by excessive eating, fear and shock.
• 1600: Jean Baptiste Van Helmont was the first to describe asthma as anything other than simply a symptom.  He was the first to propose the idea that asthma was a disease of bronchospasm when he wrote:  "The lungs are contracted or drawn together." He was the first to describe asthma as a nervous disorder. 
• 1650:  Thomas Willis is actually given credit for the nervous theory of asthma because he wrote more extensively about it. He described asthma as "obstruction of bronchi by thick humors, swelling of their walls and obstruction from without." He describes three types of asthma: 
• Pneumatic Asthma:  Dyspnea is a result of air passages in the lungs being obstructed or not open enough
• Convulsive Asthma:  The primary fault of dyspnea comes from the lungs themselves, "in the moving fibres or muscular coats of the air vessels or in the diaphragm and muscles of the chest or in the nerves of the lungs and chest or of the origin of those nerves in the brain."
• Mixed Asthma:  Both pneumatic and convulsive.
• 1675:  John Floyer described a hereditary component of asthma, and numerous exacerbating factors such as air pollution, infection, cold air, exercise, sleep, psychological stress, and tobacco smoke, and astutely observed the benefits of clean air and environmental change.  He was the first to separate asthma from other causes of shortness of breath.  You can read more here. 
• 1700 Bernardino Ramazzini was the first to describe occupational asthma.  
• 1750 William Cullen was the first to start removing lung diseases out from under the umbrella of asthma, defining asthma as dyspnea caused by spasp.  He defines asthma as: "Difficult respiration recurring at intervals, with sense of stricture in the breast, respiration performed with a wheezing noise; difficult cough at the beginning of the fit, sometimes none, free towards the end; and often with copious discharge of mucus."
• 1800:  Robert Bree believed asthma was a humoral disease and not a spasmotic disease.  He believed that some sort of paroxysm was present in the air tubes that caused asthma.  As the asthma fit progressed, the asthmatic would ultimately cough up some sputum, and with the sputum would be expectorated the causative agent. 
• 1850:  Henry Hyde Salter believed asthma was a condition of airway spasms or convulsions caused by a nervous disorder.  He strongly inculcated the idea that asthma was nervous.  He was the first to state that asthma was not a humoral disease, but an actual disease of the lungs and mind.  
• 1859: American physician J.A. Swett acknowledged that bronchospasm was important, but regarded 'bronchial inflammation' as the 'principal exciting cause of the paraxysm'. (1, page 109, 110)
• 1859: Berkart rejected the idea that 'mysterious derangements of the nervous system' caused asthma, yet he saw little evidence that anti-spasmotics of that time benefited the disease. Based on this wisdom he believed asthma was a product of transient obstruction of the bronchi. (1, pp. 110)
• 1873: Charles Harrison Blackley argued that symptoms of hay asthma (hay fever) were due to inflammation of the 'submucous cellular tissue' of the bronchi rather than 'spasm of the circular muscles of the bronchial tubes'. (1, pp. 110)
• 1870s: Mucus plugs were discovered in the lungs of asthmatics(1, pp. 110)
• 1890s: Eosinophils in both the sputum and the blood of asthmatics were found, which confirmed that inflammatory exudates layed a pivotal role in bronchial asthma (1, pp. 110).
• 1892: In The Principles and Practice of Medicine, William Osler believed the theory of bronchospasm was not proven, and he suggested attacks of asthma were due to 'swelling of the bronchial mucus membrane' (later referred to as inflammation), otherwise referred to as inflammation of the smaller bronchi. He also believed asthma was caused by a reflex spasm of the diaphragm and other respiratory muscles. He acknowledged asthma as neurotic. He believed the relationship between hay fever and asthma deserved attention, because he believed if the changes in the mucosal membranes that occured with hay fever were to occur in the lungs, this would further explain a paroxysm of asthma (1, pp. 111, 112).
• 1894?: Edouard Brissaud condisered the symptoms of asthma to be the product of both bronchospasm and hypersecretion, which constituted a form of 'bronchial urticaria' (1, 111).
• 1895: Arthur Foxwell suggested attacks of asthma were characterized by a combination of bronchial oedema, bronchial constriction, and contraction of blood vessels in teh lungs (1, pp. 111).
• 1959: The Condition of subjects with widespread narrowing of the bronchial airways changes its severity over short periods of time either spontaneously or under treatment. (American Thoracic Society: Am Rev Respir Dis 85: 762-785, 1962)
• -- Asthma experts at this time were working hard to differentiate asthma from COPD. Although it was basically defined, in 1959, as a form of intermittent airway obstruction that could be reversed with bronchodilators. Chronic bronchitis was defined as productive cough, and emphysema was defined as dilation of the air-spaces distal to the terminal bronchi.**
• 1962: Asthma is a disease characterized by an increased responsiveness of the trachea and bronchi to various stimuli and manifested by a widespread narrowing of the airways that changes in severity either spontaneously or as a result of therapy (Ciba Foundation Guest Symposium: Thorax 14: 286-299, 1959)
• 1975: A chronic condition is characterized by recurrent bronchospasm resulting from a tendency to develop reversible narrowing of the airway lumens in response to stimuli of a level or intensity not inducing such narrowing in most individuals (World Health Organization: Bull World Health Organ 52; 251-260, 1975)
• 1985: Reversible Obstructive Airway Disease: The acronym R-O-A-D was what I was taught in 1984 during my time at National Jewish Hospital/ National Asthma Center.
• 1987: A clinical syndrome is characterized by increased responsiveness of the tracheobronchial tree to a variety of stimuli. Major symptoms are paroxysms of dyspnea, wheezing, and cough, which may vary from mild and almost undetectable to severe and unremitting (status asthmaticus). The primary physiological manifestation of this hyperesponsiveness is variable airways obstruction. This can take the form of fluctuations in the severity of obstruction, after the use of bronchodilators or corticosteroids, or increased obstruction caused by drugs or other stimuli. There is evidence of mucosal edema of the bronchi, infiltration of the bronchial mucosa or submucosa with inflammatory cells, especially eosinophils; shedding of epithelium; obstruction of peripheral airways with mucus. (American Thoracic Society: Am Rev Respir Dis 136: 1285-1298, 1987)
• 1991: A lung disease has the following characteristics (1) airway obstruction that is reversible (but not completely so in some patients) either spontaneously or with treatment; (2) airway inflammation; and (3) increased airway responsiveness to a variety of stimuli. (National Heart Lung and Blood Institute, National Institutes of Health: Guidelines for the diagnosis and management of asthma, NIH pub no 91-3642, Bethesda, MD, 1991.)
• 1992-1997: A chronic inflammatory disorder of the airways in which many cells play a role, particular mast cells, eosinophils, and T lymphocytes. In susceptible individuals this inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness, and cough in early morning. These symptoms are usually associated with widespread but variable airflow limitation that is at least partly reversible either spontaneously or with treatment. The inflammation also causes an associated increase in airway responsiveness to a variety of stimuli. (National Heart Lung and Blood Institute, National Institutes of Health: International Consensus report on diagnosis and management of asthma, NIH pub no 92-3091, Bethesda, MD, 1992
• 2010: A lung disease that is associated with chronic inflammation of the air passages (bronchioles) of the lungs. The bronchioles are therefore sensitive to various stimuli (asthma triggers) that should be harmless. The degree of inflammation determines severity. When exposed to asthma triggers the inflammation worsens, thus causing acute spasming of the muscles of the air bronchioles (bronchospasm) which causes the bronchioles to become narrow, thus trapping air inside the lungs. This is called an asthma flare, and results in coughing, wheezing, chest tightness and shortness of breath. The episode is reversible sometimes on its own, and sometimes with therapy. Between episodes breathing is normal for most patients.

Life is full of choices

One of the things I hate to hear is, "I don't have time." I like to say to these people, "Well, make the time."

Some examples: I don't have time to exercise. I don't have time to read and learn. I don't have time to let my kids play sports. I don'thave time to keep up on politics. I don't have time to fill in blank.

Common excuses I hear: "I have too much stress," or "I have to much to do around the house, like laundry, paying the bills, taking care of the kids," or, "I have too much stress," or, "I have to work."

Life is a series of choices. Sure there are things that happen that we have no control over, although most of what we have are the consequence of the choices we make. For example, if you have a bad heart, it may be partially because you have bad heart genes, yet if you eat well and exercise, you can prevent.

For example, if you have too much stress in your life, it's because you choose to have a stressful life. Do you complain about your job because it's too stressful? Well, you chose that job, it didn't choose you. Get another one if you hate it so much.

So you have too much to do. I'm sure you can squeeze in one 20 minutes workout in the course of your day. If you do one less load of laundry, so be it. If you have dirty dishes in the sink overnight, so be it. Your body, your life, is more important than those dishes.

Sure you have kids, but your kids go to bed eventually. As soon as your kids go to bed, do your sit-ups and push ups or whatever you do instead of sitting on the couch watching your favorite TV show, or surfing the Internet.

Chances are, once you start working out regularly, you'll find that you have more energy, and you end up being more productive in less time. I find that to be true.

See, I choose to exercise and eat right because I want to live a long healthy life. I'm not like many Americans and "hope" to live a long life while still eating Big Macs and Butter Finger blizzards three times a week, while living a sedentary life. Or going to McDonald's for lunch every day.

Again, there are things that will happen in life we have no control over, yet most of what happens in our lives is the result of what we choose. If you choose to take control of your life and your body, chances are you'll have a much better life overall.

The same thing goes with educating ourselves. Sure our Lord and savior may have provided you with less of an IQ than the next guy or gal, but intelligence is not a byproduct of IQ: it's a bi product of effort.

If you don't have time, make the choice to find it. You'll only be better off if you do.

Body For Life Round 2

After reading Hussman's tips for success in the Body For Life (BFL) Program I understand now why you can do the entire 12 week program and still not look like the Arnold Schwarzenegger-like photos of fit and ready men (or women if you're a woman).

The BFL program has a contest, and I do not enter it. I don't want people to see pictures of what I look like with my shirt off (if you want to see that way you'll have to come to the beach here in Shoreline, or go to Great Wolf Lodge, or Michigan Adventure when I so happen to be there with my children).

I also don't expect to get a body like that either, although it would be nice. According to Hussman, to get a body like that you have to start out with a fat% of 20% or less, as the winners of the contest usually end up with a fat% of 10 or less (at least that's for men).

So, considering I'm still at about 30% (at least according to my scale which is probably inaccurate). So I'll probably have to go through the program another 2 times, and stick to it to a tee -- which I haven't been able to do (although I always intend to).

But that's not my intent on doing the program. When you have a disease like asthma, you need to exercise and stay in relatively good shape to better manage the asthma beast. The BFL allows me to accomplish this goal better than any other program.

My weight when I started back in February was 210 pounds (actually, I didn't weight myself until after I did the program a month, so I probably weighed more to start), and my present weight after 12 weeks is 195. So, I'm happy with the progress. No! I'm excited about the progress. That's 15 pounds.

Yet, considering my goal is 170, I have a long way to go, and a lot of time to crash (which is why it's important to eat a Dairy Queen Blizzard at least once a week. Seriously).

So I'm not a hypocrite. I don't preach that asthmatics should exercise regardless of how bad their asthma is, and sit around gaining fat. Nope! Well, sometimes I do. But right now I'm doing what I preach, and enjoying it.

So move your butt away from this computer and exercise. It doesn't matter what you do, it's just that you are doing SOMETHING!

The end of BFL round 1

On February 10 I started the body for life program. I committed myself to this workout schedule, where I have to FORCE myself to do 3 high intensity aerobic-cardio workouts to strengthen my heart and lungs and lower my resting heart rate. It also includes high intensity resistance training three times a week.

This also includes a diet which you can see here. The diet actually works perfect for me considering instead of eating 3 large meals a day you eat 5-6 small portion meals 2-3 hours apart. Plus you get one free day where you get to eat whatever you want, including banana splits, payday candy bars, Butterfingers blizzards from dairy queen, or whatever you've been craving all week.

As I wrote before, I don't really consider this a diet, just a lifestyle. The first few weeks were the toughest because I had to get used to the new routine. Because I was so out of shape, so winded with exertion, and so pathetic, it actually took me about a month to really get into the flow of doing the workouts.

Plus, considering my wife and I are pregnant, and we have lots of traveling with the kids in soccer, gymnastics, band, chorus, etc, there were many days we had to go to restaurants. And you know my rule for going to McDonald's: Big Mac, fries and a large Coke and enjoy every last drop of fat.

So, the 12 week program ended last Sunday for me. While in the past I've lost 20-40 pounds on this program, I only lost 13 this time. Ten of those pounds were in the first month, and the last three at the end.

I actually hit a rut the past two months of the program, but unlike the past, I didn't quit. Sure there were weekends where I spread my free day to 2 and even three days, yet I never lost site of the overall picture -- lifestyle. Plus, in the past when I gave up everything, and lost all that weight fast, all it resulted in was eventually gaining the weight back.

So last week, since it was week 12, I decided to take the week off, considering I was planning on starting a new 12 week program this week. I took Wednesday through Sunday off, ate bad and did not exercise.

This morning I weighed myself to see what the damage was, and I lost three more pounds. Funny how that works, eat like crap, sit around, and lost three pounds. Yet, since I stuck to the program so well, my metabolism was still working like crazy. My body was probably so used to my program that it had learned to store fat instead of burn it.

So, as the wisdom goes, sometimes you have to eat more to lose weight. Sometimes you need to stop exercising, or change your routine in some way to TRICK your body.

Now I think I'm in good shape to start the program anew. I've been studying Hussman's tips to success. I don't stick to all the tips, as common sense won't allow that to happen. As you know, in order for a program to work you have to stick to it. And to stick to a program you can't give up all the things you enjoy, which includes food and fun.

So BFL round one has ended. I didn't lose as much weight as I might have expected, although I feel great and and, after taking a week off, am ready to get back at it again. There's going to be bad days, such as when I go to Mackinac Island next month.

Yet I won't let myself lose sight of the big picture.

Asthma linked to anxiety and depression

So, do you have a little anxiety or depression to go along with your asthma? If so, new studies show you are not alone.

As a matter of fact, studies show that "Asthma may affect more than your ability to breathe, it may also make you more prone to developing psychological problems."

That's according to a report by Serena Gordon over at Healthday News.

She writes that "People with asthma are more than twice as likely to have depression or anxiety as people who don't have the chronic airway disease, according to a report in the March issue of the journal Chest."

The report notes that as serious psychological distress went up, the ability of the asthmatic to take care of himself went down. Dr. David Callahan, one of the reports authors, said the following:

"The prevalence of serious psychological distress was 2.5 times higher among adults with asthma, and as serious psychological distress increased, health-related quality went down. So, asthma makes quality of life worse and serious psychological distress makes quality of life worse, and together they synergistically make quality of life even worse."

This is of particular interest to me, because I remember when I was a kid pacing the living room anxious about my health, or of dying, or worried that the guy on the news who murdered his family in Flint will slip into our home at night and murder us all. Seriously, my parents actually had to ground me from watching the news.

When my asthma got really bad in 1985, and my parents had me admitted to National Jewish Health, I was diagnosed with anxiety. While my estimated stay was 6-8 weeks, I ended up spending 6 months there, the last three months in a 24 bed medical/psychological floor called 2-May.

The reason I had to stay there was because my doctors believed anxiety was inhibiting my ability to care for myself. In retrospect I have to say I agree with my doctors, yet back then I refused to accept I had such a problem. Typical teenager, right?

While I was very unhappy that I had to stay there, and the fact I was 3,000 miles from home exacerbated my anxiety, I do think the therapy I received there benefited me greatly. What worked best were the relaxation classes I participated in. To be honest, I still use the techniques I learned.

So, anyway, that's why this new report is of such interest to me. I still have some anxiety from time to time, yet you'd never know it if you met me, and it never impedes my ability to take care of myself. Perhaps this is due to my stay on 2-May (you can read about my stay at the asthma hospital by clicking here).

Also interesting was this this report from the University of Washington News from 2007 that notes: "Young people with asthma are about twice as likely to suffer from depressive and anxiety disorders than are children without asthma, according to a study by a research team in Seattle."

Obviously asthma doctors made that connection years ago between asthma and psychological, hence 2-May program.

Now, it should be noted here that, according to NationalJewishHealth.org, "Emotions do not cause asthma, but can make asthma worse, because strong feelings can lead to changes in breathing patterns. Times of 'good' stress and 'bad' stress can cause problems for people with asthma."

By "good" stress I think they are referring to excitement such as laughing, and by bad stress they mean anxiety and depression.

This is an important point to note because in the 1800s asthma experts, like Henry Hyde Salter in his book "On Asthma" actually believed asthma was literally a psychological or psychosomatic disorder, in that it was anxiety and distress that caused people to develop asthma.

At the asthma hospital I met many asthmatics who had both asthma and some sort of psychological disorder, be it anxiety or depression or whatever. In fact, my asthmatic co-worker just admitted she too has some anxiety.

No, none of us are crazy, and neither are you if you have episodes of anxiety or depression to go along with your asthma. Most of us learn to deal with it through the course of our lives, and some of us -- like me when I was a kid -- might need a little help.

How to diet at McDonalds

Here's a snippet of an actual discussion I had the other day at work:

Friend A: "So, when I'm dieting and go to McDonalds, I like to have a grilled chicken. They're grilled chicken actually tastes really good."

Friend B: "When I go to McDonalds I have the yogurt. It's like eating dessert. What do you do, Rick."

Me: "When I go to McDonalds, I eat a Big Mac, Large fries and a Coke."

Friend A and B in unison: "What!"

Friend B: "How do you lose weight if you do that?"

Me: "I'm certainly not gonna go to Micky D's expecting to eat good. If I go there, I'm gonna enjoy myself. If you give up all fun stuff all the time, you'll never succeed at any diet."

Actually, the bodyforlife diet that I usually do allows you for one free day per week. You can eat anything you want, regardless of how bad it is for you. That's why I love this diet so much. And, even with a free day, I've lost 40 plus pounds 4 times now.

Yes, I know what you're saying: I did gain my weight back all those times. But that's not because of the free day. It's because I CHOSE to stop being good. It's because life happens.

So my advice to dieting at McDonalds is: eat unhealthy and have fun while doing it. That's what I did yesterday when I took my kids out for a treat.

The key to staying in shape

My wife is quite a few years younger than me, and we have two of the cutest girls in the world. I often joke with my friends I did this so when I'm old I'll have someone to care for me. Although I was joking, I really wasn't far from the truth.

Having kids, and a younger wife, is even more of an incentive for me to stay in shape. To me, though, staying in shape doesn't necessarily mean being ideal body weight. I think the IBW system is flawed anyway, and is only good for medical workers doling out medicine and tidal volumes. This system doesn't take into account muscle mass, which to me is a major flaw, considering I'm 100% muscle anyway (so I lie).

Anyway, having kids is an incentive to keep in shape. For one thing, my 11-year-old is at an age I can go out every day and play catch with him in the summer, or play catch with a football, or in the winter go sledding. I find if I'm out of shape I waddle around and this sort of takes the fun out of these activities. They become a job more so than fun.

That's why back in February of this year I decided to make good on my promise to get into shape. I started the body for life program once again. Only this time, instead of my wife doing it with me, she's carrying an unborn baby around. I'm also doing it without the friends who normally get in shape with me.

I tried working out when during previous pregnancies, although I ended up gaining weight right with my wife. This time, however, I was bound and determined. I think one of the things that really helps me along is all the pessimism. I've had more than one person tell me I will never do it, that I will fail. So, that alone provides me the incentive.

Yet, despite that, I have lost 10 pounds since February. Again, my goal is not to lose weight, but to get in shape. To me, the two do not go hand in hand. Yet, losing weight is a good incentive to keep going, considering if you are losing weight you know you're doing something right.

That said, after losing almost 10 pounds after signing up for the biggest loser contest at my work, I dropped zero the next month. And, despite losing zero, I have continued to work out. And, even though I have hit a rut, a plateau, I have continued to muscle it. This is proof to myself that I can do it not just on my own, but without losing weight.

However, even though I've lost up to 40 pounds 4 times doing the bfl, I have basically completed the 12 week program once again, only losing 10 pounds this time. Yet, to give credit to myself, I took a few more days off because a) I have kids and they come first, 2) I have a wife and she comes first, 3) I work and that comes first, 4) I have a life, 5) I'm doing this alone.

So, considering all the obstacles, I'm actually doing quite well. This brings me to the greatest question of all regarding working out and eating well: How do you keep it off.

I actually think I've found the answer to that: don't lose weight to fast; don't give anything up; take some days off; enjoy life; do the best you can with what you have.

I think if you do a crash diet, you're going to gain all the weight back. Yet, if you eat well every day you can, and take a few days off here and there, and continue this year round, you can keep it off. That's the hard part: keeping it up.

So, instead of quitting my workouts and my diet now that the 12 week mark is up, I've decided to start another 12 week workout. Lord knows I'm not going to be perfect, and that might be the key to a lifetime of success -- at least for a normal person like me.

Yet who knows, I might fail again.