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Archive for the ‘doctors’ Category

When success isn’t a habit

They say the habit of success creates more success.

What if you don’t have a habit of success?

My weight loss has currently stalled, and it’s messing with my head.

When I was in my early 20s, I did Optifast. Very unhealthy, but I didn’t know that then. I don’t have any records, but I’m pretty sure I lost around 100 lbs. I do know I ended up as a size 18, 2 sizes smaller than I wore at my HS graduation. Unfortunately, while Optifast was great for fast weight loss, they don’t teach you anything about dealing with any emotions that might affect your eating, nor do they actually teach you much about how you actually need to eat going forward. At least, that’s how it was in 1990.

In 2005 I went on the Atkins diet and I lost 100 lbs in 9 months. Unfortunately, I didn’t do it in a really healthy way. I didn’t know I was allergic to soy, which is in absolutely everything (salad dressing in particular) and it made me throw up a lot. I was intentionally eating low carb and unintentionally also really low calorie. I got down that 100 lbs and then I was stuck. I have journals from that period. I was not cheating. I was not over eating for my weight at the time. I was diligent, obsessive, and really, really frustrated.

In 2007 I developed another hernia and the surgeon told me that if I didn’t lose more weight they couldn’t fix it and I would die. So I stuck to low carb and got a little crazy with the calories and I lost another 20 lbs. I also lost my hair, my libido, my energy, my tolerance to cold, and my menstrual cycle went insane, but my TSH was still fine, so it couldn’t possible be a thyroid problem.

In 2011 I finally paid out of pocket for a Reverse T3 test and was not even slightly shocked to see that is was really, really out of range. So then I paid out of pocket to see an Integrative medicine specialist (the doctors who have an MD, but have also studied holistics, herbals, and non standard treatments.) He finally diagnosed my very low thyroid. He diagnosed my trashed adrenals (too many years of extreme dieting, another not-surprise). He diagnosed my trashed gut biome. That was kind of a new thing in 2011.

Then we moved unexpectedly and I lost access to my great new doctor. My weight ballooned with stress and bad eating. My hormones went insane. It was a nightmare. I tried several diets and got absolutely nowhere. Not even the 20 or so lbs I should have been able to count on just from water weight.

Utterly demoralizing.

So I studied more. I fixed my food sensitivities. I lived on homemade soup for about a year trying to solve nutritional deficiencies. I got my thyroid properly propped up. I sorted out my adrenal issues and support as necessary. I spent an entire summer focusing on fixing my gut biome.

I have high hopes that I have fixed the basic non-food issues that caused my problems in the first place.

But what if I didn’t?

My early Weight Watchers results have been good, but I’m now at a set point I’ve been to at least twice in the past. This is the weight I was when low carb stopped working. This is the weight I was when I first did Optifast.

I am absolutely panicked that this is the best I’ll get.

Intellectually I know that isn’t likely. I know that plateaus and stalls are normal. I know that my body is reshaping itself because my clothes are fitting differently. I know that I’m weighing and measuring and following the program. I know there is absolutely no reason that it should stop working right now.

But what if I’m wrong?

I tried telling myself that this new place is better, much better, than where I started. That isn’t helping in the slightest.

So I’m working out my panic in a blog. Because that’s what bloggers do.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Summer upgrades

This summer, I’m getting upgrades!

NEW KNEES!!!!

I found a surgeon who is willing to take me as a patient, and this summer I’ll be having both knees replaced. The worse knee in July, and the second in September.

Obviously, I’m very excited about it.

Back in 2015 or so when I saw my first orthopedist about why the heck my leg hurt so much, he sadly looked at my xrays and carefully explained that, although there was a lot of damage, I was too young, and too fat, and my knees couldn’t be replaced, so I should go talk to these people about pain management.

I wasn’t in a great place at that point, either physically or emotionally. I didn’t go talk to other surgeons. I didn’t do any research. I just accepted that as a fact, too fat for knee replacement. Somehow I believed it was a limitation of the replacement parts or something. Eventually in 2016 I went to see a pain specialist, and I’ve been working with her ever since to manage some basic functionality. And I’ve just lived with ever decreasing mobility and constant pain.

Fast forward to last winter. My hospital adventures started in an emergency room, and although most of that is hazy because they were very prompt at providing the good drugs, one moment stands out very clearly. I was listing the various medications I’m on for my records, and I think I said “and I’m on x dose of y pain med because of my knees. I have severe osteoarthritis in both knees, but they won’t replace them because I’m too fat.” And the nurse’s reply rang in my head like a bell and I still remember it perfectly, in part because I didn’t expect profanity. She said “That’s the biggest load of bullshit I’ve ever heard. You need to get another opinion.”

Since she’s a nurse in a hospital, I assumed she definitely knew something I didn’t, and I filed that away.

Fast forward to my eventual release from the hospital. The second time. My insurance provided homecare specialists, including 2 therapists, one for arms, and one for legs. I made sure to ask each of them who they thought was the best person locally for knee replacements. They each independently recommended Dr F.

Once I was feeling better, one of the first things I did was call for an appointment.

“I’d like to make a new patient appointment to see Dr F at the Alexandria office.”

“Alexandria, that’s tough, let me see…oh, here’s one next Tuesday.”

“Perfect.”

So I only had to wait a week to get in to see him. By the time the day of the appointment arrived, I was so nervous. I wanted this so much!

Dr. F was a jerk about my weight. But it wasn’t completely superfluous. The statistics are clear, fat patients have more problems and more infections post surgical than normal weight patients. I was not happy that he gave me a long lecture about bariatric surgery and told me to go talk to these people, here’s a pamphlet, as if there was some chance I hadn’t already looked into that option. In truth, by the end of my appointment, I wasn’t perfectly sure he’d accepted me as a candidate until he said “I’ll send the nurse in to schedule.”

It’s on!

Now I am very, very focused on doing everything I can to improve expected outcomes. I’m back in the pool 2 days a week, working as hard as possible. I also found out that they now make seated elliptical machines and I’m using that to improve flexibility in my knees as they are now. When I saw my pain specialist I discussed the need for extra meds so I can manage the pain of more exercise when my latest cortisone shot wears off in about 6 weeks. I’ve always been as sparing as possible with the good drugs, but now that there is an end in sight, I’m willing to take what I need to build strength.

Turns out my pain specialist also respects this surgeon, he’s the one she refers knee patients to. Although she agrees he has the social demeanor of, well, the average surgeon.

I can’t even properly explain how excited I am that I’m going to get my life back.

After the hospital

Warning, pictures of an iv line below and discussion of syringes and stuff, in case you are squicked by that sort of thing. My favorite cat picture has been added to keep the iv picture off the teaser.

2017-04-02 10.00.27

I was finally out of the hospital, but I was not suddenly all better. I still had a drain in my belly, a PICC line in my arm, a blood clot in my leg, and no strength at all.

The most surprising thing about my hospital stay was how long it was. Really, the minute they don’t think you need constant attention, they send you home. The home care industry is huge and they have a lot of interesting things that make it work.

One of the most fascinating innovations is home iv antibiotics (and I assume other meds). This is a good explanation of how it works.
elastromeric-pumps-001

The PICC line is a semi-permanent iv line. Instead of a needle at the site where it enters your skin, they have inserted a very long tiny tube up the vein. They then set the end in a stabilizer that is adhered to the skin. Mine looked very much like this:

PICC

That whole assembly and dressing has to be changed weekly. You have to be very aggressive about infection prevention. The exterior ends have a twist connector that seems to be standardized in hospitals. All the syringes and extenders and tubes all appeared to have the same connectors.

They make extender tubes that connect to the short connections on your arm so that you can reach the ends one handed and do your own iv. The home care nurse attached the extender tube for me and then on days when no one came, I was able to easily do it myself. It takes the balloon about 30 minutes to empty. That link doesn’t explain the whole process. First, every time you touch anything, you clean the connections with alcohol wipes, even if you just removed the sterile cap. You flush the line with a syringe of saline to make sure the line is clear. Then you connect the antibiotics and wait. When it’s done, there is another saline flush, to get the last of the meds out of the tube. And then you flush the tube with heparin, which is an iv anticoagulant to keep the line clear of any clots. It was a slick system and the home care people assigned by my insurance sent me all the pieces and part. In fact, I have a ton of left over stuff to donate. You can’t give it back, but a lot of veterinary clinics will accept donations.

The biggest annoyance with the PICC line was showering. It can not get wet. It should not get sticky. It hurts when tugged on. I was provided with a little net sock-thing to go over the dangling parts to hold them still that I’m sure works great on people with arms smaller than mine. Mostly on me it just squinched itself into my elbow. But for a brief time it would stay put, just long enough to protect the plastic bits from the wrapping. Then Mike would break out the PressNSeal wrap, and wrap my arm twice around. The standard width of the wrap worked well enough for the length of my arm. Pat that down so it’s all stuck to my arm, and then tape the top and bottom edges. Then do that every time you want a shower. And be sure he’s on hand to help you take it back off because it can be hard to see the edges. It was annoying, but doable. We went through slightly more than an entire large box of wrap.

One tiny up side of the PICC is that because of the risk of infection, I wasn’t allowed to clean cat boxes. Between the initial surgery and the infection recovery, I got about 2 months off from cleaning cat boxes, which normally is done Every Single Day. I haven’t gone that long without cleaning cat boxes since 1993 when I had my own place and got my first post-college cat. Fortunately a dear friend was doing cat sitting as a job at the time and she added us to her schedule. She did a great job, the cats already knew her, and I got a side benefit visit every day, which was really lovely. 

Then there was still the drain in my belly. That was more annoying to me than the line in my arm. The drainage bag had to be lower than the insertion point most of the time, which left me with a lot of tubing always trying to tangle between my legs, or get caught on my skirt. I couldn’t sleep on my side. It had to be very carefully dressed to keep the insertion point dry.  It had to be drained and flushed every evening. That was really a good idea, as I believe the the whole infection started when one of my original surgical drains clogged long before it should have, and that drain type didn’t have a way to clear it. This one had a connector mid way that could be opened, twist-locked to a syringe of saline, and flushed every day. Because of the tubes, I wouldn’t drive with it, even though technically I was allowed. I had that for 2 weeks.

At the 2 week mark I had an appointment with “Interventional Radiology” which I’d never heard of before my hospital stay. They are the people who drain abscesses and put in drains. I’m not entirely sure what else they do. Mike and I hoped that appointment would be short so he could get home to a work meeting.

Ha. Yeah, right.

Instead, I had a surprise cat scan, just to check things out. This was highly annoying because Surprise. It would have been nice if we could have planned things better. Although, no longer the trusting sorts, Mike did bring his tablet ‘just in case’. Also, I hate that nasty, nasty contrast you have to drink. They tell you it just tastes like water, but they are wrong. If I had known it was coming, I’d have brought something to mix it with so it would go down easier. A trick I learned in the emergency room, so I know it doesn’t interfere with anything.

Some hours later I no longer had the drain. The removal of which was easy. I still had the PICC because the doctor in charge saw something that might be something, and best to be safe. Sigh. But ok, another week of iv antibiotics. I did that, and then I had 2 more weeks of oral antibiotics before I was done. I can’t really do yogurt, so I drank komboucha and took my probiotics every day.

As soon as the drain came out and I felt like I could drive again, I went to a local hair place and got my hair washed. I’d looked into that after my initial surgery. I had no idea you could just show up and pay someone to wash your hair, no cut or trim necessary. And it’s CHEAP. Even at DC prices, I only pay $10, and that’s because I tip 100% on the $5 charge. Completely worth it.

I had visiting occupational (arms) and physical (legs) therapists come right after my release from the hospital. I wish they had started coming a little later. Really, I was too exhausted all the time to do the exercises they gave me to do. I’d gone from 3 weeks of careful surgical recuperation, to 2 weeks of strict bed rest, to suddenly being home. Even walking from my chair to the bathroom was twice as far as it had been in the hospital. Just doing my best to care for myself, getting meals and drinks, going to the bathroom, taking a shower. All those things were exhausting. I didn’t really have anything left for ‘exercises’.

I almost forgot to mention the blood clot. It didn’t hurt, so it was more of an annoyance than anything because that’s what kept me in the hospital for so long. As soon as I was out, they turned the management of my blood thinners to my primary care doctor. Fortunately, blood clot issues don’t really run in my family, so I only need to be on them for 3 months. I go for a blood draw every week or two, and will in fact be going again on Monday. It doesn’t affect me too much except the restriction on getting a massage, which I would dearly love to do.

The week after the drain came out, the PICC was removed. That was a huge relief. At two weeks after the drain removal I was allowed to go back to the pool, my preferred exercise, and I finally felt like I was on my way back to health. Not a short road though. Before surgery I’d been hitting the pool  4 days a week from 6-6:30 am to walk very briskly. It had to be brisk, at that hour the water is really, really cold. When I got back in nearly 3 months later, 15 minutes of gentle walking was wearing me out. I started back at 2 days a week, 15 minutes. Last week was 45 minutes. This week I’m adding another day.

Whew. Way too long a story, I think, but that’s the highlights.

 

 

 

 

 

 

 

 

 

 

 

 

More from the cardiologist

My husband had his two year follow up from the cardiologist the other day. The good news is, he looks great. She’s very pleased. The better news is, he also had a stress test (which he utterly failed 2 years ago before his quadrupal bypass) and he passed with flying colors.

The best news is, he’s finally off the beta blocker, which slows down his heart rate and is known to cause weight gain. The doctor is sure that isn’t his weight loss problem. Really, she’s sure. I think she just doesn’t like that as an answer. Because the last time she cut his dose his slow weight creep stopped, and it has been slowly, painfully inching down, even though his meals (which I procure, so I am certain) haven’t changed a bit.

The bad news is, he got another lecture on being fat and what a risk factor it is for future problems. I am very, very glad he takes his health seriously, but I don’t really love to hear doctors pushing weight loss surgery. There was a conversation about whether or not our insurance really will cover it, despite categorically stating that it doesn’t, but we’ve put that aside for the moment.

Because as a fat woman, you can be certain that 1) I have looked into the surgery and 2) I have friends who have had it. More research will be done, but one thing that seems to be standard is, in order to have the surgery, you must have been in a standardized weight loss program of some sort for 6 months before you  can be approved. And if that is the case, we might as well start there and see if he ever even needs to consider surgery. Which, off beta blockers, I think he won’t need.

And that is how we joined Weight Watchers.

 

Which way is care?

I wrote this some months ago and held it back because it felt too raw, but now it is January and the season of dieting, so it’s time to post it.

On a private forum with women I care dearly for, there have recently been a number of posts about how they are once again getting back on the strict diet wagon in the endless pursuit of a size they like better.

My next thought was that I, too, should get back on the diet bandwagon because there is no question that my life would be easier if I were lighter.

And right after that thought, my stomach clenched. And I was overcome with a very visceral feeling of fear. And it was all I could do not to cry.

This is crazy.

I have spent over half my life depriving myself of food. Punishing myself for being fat. Eating what I ‘should’ even when I really, sincerely, would rather never eat again than have another bite of kale.

Just the passing thought of another strict diet was panic inducing. I can’t. I feel frantic, and sick about the idea. My body is enacting a flight response. It is clear to me that my body and mind find the idea traumatizing.

Even worse than that are the voices ringing through my mind as I type this. The kind ones say I shouldn’t give up on myself. The firm ones tell me no pain no gain and if I just try <insert preferred method> that it will be easy and I’m sure to see results.

The last results I got were burnt out adrenals and a thyroid crisis.

There are even uglier voices in my head too. Quitter. Loser. Fat lazy slob.

At what point does something you do for yourself become something you do to yourself?

Why is cutting bad, but starving yourself good? Why are recreational drugs bad, but damaging your brain chemistry via food is encouraged?

I think about the best eating plan to follow and I feel despair. Another long procession of food that I don’t want. Forcing myself to eat, and yet still so hungry.

Does saying no make me weak? or Strong? Is it self love, or self hate?

If it were a job I hated that much, people who love me would tell me to do everything possible to find another job.

If it were a relationship with a person that caused me such fear and anguish, people who love me would tell me that it’s a bad relationship and that I should remove myself.

Somehow because it is food and fat, the rules are different.

But after a lifetime of self torture, I’m ready to try living a new way, where I might treat myself with love and respect and ignore the voices that tell me I must fit into a mold that is too small for me.

So no more kale for me.

Is it really hate?

I recently read this viral post on Facebook about one woman’s journey to Thin, and how it wasn’t as great as she’d always been told it would be. (It was such a big hit that Cosmo did an article on the post.)

A life long fat person, she finally decided that society was right, and everything that was wrong with her life was because she was fat.

I felt deep inside that as long as I was fat, I wasn’t going to be able to stop hating myself enough to ask for more. So much cultural messaging says that if you are fat, you should be grateful for whatever love you can get – even if that love isn’t love at all.

So she went on a program of extreme weight loss. She doesn’t detail her method, because that’s not what this is about. I’m sure it was calorie restrictive and exercise abusive, because that’s what she says, and she got down to a place called Thin.

And you know what? Every horrible voice in my head, every bit of horrible anti-fat messaging from society was validated when I lost weight.

Attention from the opposite sex and better jobs and everyone was nicer and more thoughtful. The heartfelt dream of every fat person in America.

For five years, I got to be treated like a human being.

And it pissed me the fuck off.

I think that quote, right there, is one of the most important things she says in the whole piece. We the fat are told that all our problems will go away if we can just get to Thin. So she did. And sure enough everything was fixed and everyone was nice, even though she was exactly the same as she’d always been.

I understand completely. Glennon Doyle Melton talks in some of her interviews about how women are taught to be smaller and smaller and take up less space until we’re barely even there. Being fat flies in the face of this cultural imperative. Not only that, we do it on purpose. It’s a different kind of prejudice than racism, because your skin color is luck of the draw. If you’re fat, It’s Your Fault. So we deserve every molecule of heaped scorn and derision. No accomplishment can ever balance out the size of your behind. It boils us down to one, single aspect of ourselves and balances the entire universe of our experience on that soft, jiggly fact.

Statistics prove that We the Fat make less money, get less comprehensive medical care, have fewer opportunities, and miss out on more social niceties than those of normal weight. Put a normal weight person in a fat suit and they are horrified and astonished every time. It’s not codified. There is no law that allows it. But it is unending and universal.

Then life happened, and she didn’t have time to obsess about every bite of food she put in her mouth, and she didn’t have time to exercise every day. And she had a baby. And over time, she put all the weight back on. And now she doesn’t care, and she’s going to fight a society that says she has to.

My allegiance lies with fat me who missed out on half of her life because society said that she didn’t have the right to live it. …My allegiance lies with every kind and wonderful person out there who is told that they have nothing to offer the world because their body takes up too much space.

The second line that really, really stuck in my head is this.

I will not give the abusive assholes who say that they matter more because they weigh less the satisfaction of watching me hate myself into a small enough body to be loved by them.

Is the obsessive dieting and the endless determination to be thin at all cost a form of self hate, rather than the self love that society and medical professionals tell us it should be?

Frankly, I haven’t decided what I think yet. They tell us to diet to be healthier, but it hasn’t actually done me any good in the long run. Extreme dieting isn’t sustainable, every bit of data and research proves that. Yo-yo dieting is worse than no dieting at all. The research shows us that too. Did I diet all those years because I loved myself and wanted to be healthier? Or because I hated myself and wanted to be the ‘good girl’ that society wanted to see?

I think I know the answer, and I think I don’t like it.

More sleep

As I mentioned, I’m getting more sleep now that my husband has an autopap for his severe sleep apnea.

I also had a sleep study done. Because we were pretty sure I have restless leg, they sent me to an actual sleep lab. I’d had a sleep study done once before, probably fifteen years ago. Back then I was diagnosed with ‘hypopnea’ which just means I didn’t breath hard enough when I was asleep. They tested my lungs six ways from Sunday and determined they weren’t the problem. I had night time oxygen for a while. Then the problem went away.

Sleep studies start about two hours after my normal bed time. I got the very first appointment, but I think that just led to me sitting around longer. I had plenty of time to change, set up my travel fan, my white noise maker, fill out the required paperwork, and read a chapter of my book before the attendant came to wire me up.

If you have an in-center study done, I’d like you to know that when you get home, if you rub lotion into your hair where that nasty adhesive paste is, it will come right out. I know, it seems counter-intuitive to rub more goop into your hair to get other goop out, but it works brilliantly. My mother in law had to wash her very short hair three times to get it all out, where as mine was clean first try.

I suppose some people actually sleep in sleep centers. But I’m not sure how. The temperature was wrong. The bed was wrong. And I was wired like a lab rat. I could barely turn over. Fortunately, I was tired and it was well past my usual bed time so they got some data. Not much. I had a very unfortunate experience in that the attendant didn’t respond to my bell, even though I rang it as instructed every 10 minutes over an hour. By the time he showed up, I was furious. When I woke at 2am I just wanted to run to the bathroom and take some advil for my knees, which I couldn’t reach because of the wires. By 3 am when he finally came in, I was up, mad, and never going to get back to sleep.

The next morning you  can bet that I was on the phone to the people in the main sleep center offices. I filed a complaint. Partly because I wanted the incident on record in case I had to do it again. I didn’t want to be charged for it. But mostly because I was mad. And I’m the sort that is willing to raise a fuss. But a lot of older people do these studies, and they don’t raise a fuss. They aren’t comfortable doing so. Which may or may not be why the attendant was sub par during my experience.

They did get enough data. Fortunately. And I do have restless leg. Well, actually I have restless leg and Periodic Limb Movement Disorder. If you’re awake, it’s restless leg, when you’re asleep, it’s PLMD. I have both. Sometimes.

Me, being me, I got on Google and looked into all the non-drug options. Blood sugar is fine, had my iron tested, dramatically upped my magnesium, took the proper amount of the Bs. None of that made any difference. Then I tried some things like valerian and GABA as natural sleep aids. They didn’t help either. I never have trouble getting to sleep, I just can’t stay asleep because I’m twitching.

I now have an appointment scheduled with a sleep specialist to see what he has to say about things.

Although I must say, getting my husband on his machine has made a very unexpected positive difference in my own sleep. I wonder if bad sleep is just a habit I can train myself out of?

Wouldn’t that be something?