Hello darkness, my old friend... and heading back to the light

It's been a few months since I blogged, and for all the new WLS friends out there, when I go radio silent that usually means I'm struggling.  At 2 1/2 years post-op and having surpassed my goal, I'm dealing with some weight regain.  6 pounds from my set-point, 9 pounds from my all-time low.

How did that happen?  I stopped jogging, maybe only doing it once a month.  Still getting in lots of steps, but doing less cardio has a consequence. I started grazing - mostly eating things I shouldn't (carbs) or don't need to (peanut butter), and mostly when I'm preparing food for others, but not always.

Why?  Stress and old habits.  There have been lots of stressors - but we all have them, and mine weren't particularly horrible (nobody died, nobody lost their job, my husband is very lovable).  I came off my 5 day pouch test feeling great, and that lasted a couple of weeks.  Then we had the stress of my father-in-law's health declining some more and the resulting anxiety that brought upon my husband.  And getting my son prepared for some very difficult testing - in that last month I baked like a fiend to reduce my stress, but instead of giving it all away I nibbled at some of it (just in small enough doses not to dump, like any addict learns to avoid the crash).   The testing went well, and all of the stress was worth it, BTW, but I HAVE to remember I have other coping mechanisms I should use.

Then I started looking into a new direction for myself - a new career, starting with a Master's program in School Counseling.  It's very exciting, and it set off a roller coaster of emotions.  The principal and guidance counselor I work with think it's a great idea and will write recommendations for me - Whee!  Up I go... Finding out my undergrad GPA was even lower than I remembered - crap.  Taking a practice GRE was painful but assured me that I could meet the requirements with room to spare - yay!  Realizing that the idea of my going back to school part-time was freaking out my husband and increasing his anxiety and depression - ouch.  Talking that through with him over our anniversary and having that reverse into his full (albeit still typically anxious) support - whew.  Realizing I could take the 1 hour MAT instead of the 4 1/2 hour GRE was good, and then when I took it and got stellar results was WONDERFUL.  Now my applications are turned in, and I'm just waiting - for the recommendations to get turned in, the transcripts to arrive, and the decisions to get made at the two different programs... and waiting is hard. I'm settling in for about 2 months of it.

Last week I started with the mental tweaking.  I changed my Facebook profile pic to the one of me about to do the triathalon I did in March.  I needed the daily reminder of what I can accomplish.  I reconnected with some old friends that I haven't visited in a while.

The last two days I have been making better choices.  I've eaten clean, surpassed my step goal, and yesterday I jogged 25 minutes and felt good.  I've reminded myself that I can manage my stress in healthy ways now.  Now I just have to re-establish the habit.  The scale hasn't started moving back down yet, but it will.  And when I'm thinking about baking, I'm back to asking myself - are you wanting to bake for a good reason, or because you want to eat the cookie dough?

I also found a new fun way to enjoy my jogging (especially good when our weather has been so stormy).  I've been taking my Kindle Fire to the gym and setting it up on the treadmill so I can watch movies/ shows while I work out and my kids play.  It's a great distraction, and yesterday I was actually looking forward to it so I could finish the movie I started the other day.  Anything that works, baby.

I'm feeling like I'm training for a race, but unlike my 5ks or triathalons, this one is the ultra-marathon of life.  I need to build up my endurance, because there is always stuff to endure.  Starting something new is exciting, but the challenges will come and I have to be strong enough to meet them.  To prepare myself physically and mentally.  To know when to ask for help and support.  To keep my priorities in order.

The journey goes on, one step and one day at a time.  It's easier on days I get a good sleep.  And more fun some days than others.  But I have the tools, and I can do this for the rest of my life.  We stumble, we fall down, but we pick ourselves up and get back up stronger and wiser.  All the other WLS vets out there - if you are struggling you are not alone.  If you are doing well - share!  We could all use reminders of success for inspiration.  

Truths! Birthdays, Graduation, and pics

I'm really trying to stay honest, and embrace the truth even when it hurts.  Here's my latest confession - I love butter/ margarine.  This is embarrassing - but I've loved it since I was a child.  My mom tells about me climbing out of my highchair and onto the thanksgiving table to sit down and chew on a stick of butter at my grandmother's while everybody was in the kitchen when I was 15 months old.  I used to stick my finger into the tub of margarine and scoop out a little once in a while as a kid.  As I grew up I grew out of it - or should I say changed things I liked to eat that weren't good for me. 

Since my surgery, really in the last couple months, I have rediscovered my taste for margarine.  That sounds gross doesn't it?  I think part of it is craving fat - which even with a tablespoon or two of margarine a day my consumption stays low (yes, I have been logging it).  That melt-in-your mouth feeling is part of it.  There lies a truth - if it melts in your mouth, it's liquid calories - a BIG NO-NO and major rule breaking.  So, just like I had to make a big change when I realized I was starting to compulsively eat popcorn, I'm going to have to make a big change here.  No more buying tubs of margarine.  I will buy sticks of butter, which I have no craving for, whatsoever.  Logical?  Of course not - it's a crazy psych thing.  Oh the webs our tricky brains weave.  I can use sticks of butter for everything cooking-wise that I use tubs for, and not be tempted.  Yesterday I threw out the tub that was in my fridge.  Wonder what the next thing is my brain will try to tempt me with...

On to a more positive truth - I got my new driver's license!  The truth part is that I actually put my REAL weight on the license for the first time in my life.  Not even my lowest weight, but the pound higher that I was on the day I renewed it.  I thought I needed to renew it by my birthday but it turns out I didn't have to renew it until next year.  Yeah, it was written right on the license, I know... But I decided to renew it early because I don't look like my license anymore.  And I'm 50 pounds lighter than the LIE I had on my old license.  But I took pictures of my old and new license (with all the potential identity theft info blocked out) for memories sake (and this blog). 

 

OK, so that's my old license.  I listed my weight at 190, which was 53 less than I weighed at my highest.  When the picture was taken I might have been 235.  I remember being relatively happy with the picture, because it only showed two chins.  I spent a lot of time on my hair and makeup that day, too. 

... and here's my new one!  I LOVE looking at those two pictures next to each other.  An added bonus is that people will actually believe it's my I.D. when I am asked to show it :) 

I still think that they should just have a digital scale built into the floor at the license bureau.  That way when you step up for your turn it would automatically weigh you and the they wouldn't have to ask your weight.  It's embarrassing for the average person to say their weight out loud to someone, and mortifying for the obese.  Plus, it's not like most people tell the truth!  Heaven forbid something had happened to me two years ago and they found my body.  I can see them saying "Oh, this probably isn't her, she's much heavier than the person we're looking for..." 

My birthday is in two days, and my mom offered to come spend the morning with me for a "girl's day" - something we used to do when I was little, and have tried to make time for occasionally now that I'm a grownup.  I asked my boys (10 and 13) for the birthday present of them watching themselves (without killing and bugging each other) for a few hours for my birthday present.  My mom is going to come and go on a nice long walk with me and my dogs.  Then she's going to come with me to a jewelry store.  All of my rings are WAY to big.  I'm guessing I'm wearing a 6 1/2 now - my old rings are 8 1/2.  I don't feel the need to spend the money to resize everything, but I've been wrapping medical tape around my wedding band and engagement ring for over a year now and want to get that done!  I'm thinking about instead of having several rings resized I would look at combining stones into a new setting.  I have no idea how much that will be, but want to explore options and get a sense of how much money I will have to save up.  Then we might go to a bookstore and browse...aaaah, the luxury of doing that without having the kids interrupt me twenty times.

I got an email this morning inviting me to my Center for Bariatric Surgery graduation!  In our program, if you have met your goal and kept it off for over a year, you are invited to that year's graduation party.  It's a formal event at a really nice hotel, and will be happening in October.  The only sad thing is that my surgeon has left the practice.  So I'm sad that when I walk across the stage with a slide show of my before and after pcitures I won't get to shake Dr. Ben-Meir's hand.  :( But, I'm really excited to be in the graduating class of 2013.  I need to start looking for an AWESOME dress.  Oh, and saving up for it, too. 

The Honeymoon's Over - Bariatric Betty's Uphill Climb

How many of you have heard someone actually call getting weight loss surgery "the easy way out"?  WLS patients wince every time we hear it, and many of us will actually address the ignorant person who says it.  Chris Christie just "came out" about having lap band surgery 2 months ago, and I can't blame him for keeping it quiet so long.  The judgment that so many people make about someone having weight loss surgery can be vicious.  And that's on top of the judgment people have already made about those of us who are morbidly obese.

In an interview Christ Christie gave with Brian Williams, he recounts his conversation with his doctor when he asked if he should really get the surgery.  He said his doctor said "If you came into my office with cancer and I knew that there was a 40 minute surgery that would give you a 90% chance of a cure, should you get it?"  Here's the thing - the surgery IS simple for most of us. 

The surgery itself (without complications) can have you in and out of the hospital in a couple of days, put Type 2 Diabetes into remission immediately, and start a rapid weight loss that can lead to a healthy weight and lifestyle.  But, what the typical person doesn't understand is that the real work starts before surgery, and continues for the rest of our lives. 

One of the WLS patients on a Facebook support group was preparing for her surgery with a multiple week liquid diet that the surgeon prescribed.  Weight loss just before surgery will shrink a fatty liver and reduce risks of complications.  A week before surgery she had a small bowl of oatmeal, just wanting something "solid" one more time before surgery and the post-op weeks of liquids and then pureed diet restrictions.  Worried that this might put her in danger during surgery, her husband put a call into the surgeon.  The surgeon cancelled the surgery - NOT because of the oatmeal causing any risks - it wouldn't.  Because the woman feeling such a strong need to eat something she had been told she couldn't have (even though it was a healthy food) indicated that she might not be ready for the lifetime commitment to dietary restrictions that a successful WLS patient must have.  She has to meet with a social worker now, and who knows how long her surgery will delayed until she is really mentally ready.

What happens if we don't make those right choices after surgery?  The obvious result - that we won't lose the weight we need to lose, or will quickly gain it back.  Yes, people go through the surgery and then sabotage themselves soon after - whether pureeing the unhealthy food they crave so they can eat it again (cheeseburgers, french fries, etc) or by consuming liquid calories - a big NO in the rules for post-ops.  Eating ice cream, drinking milkshakes, drinking alcohol - they are all forbidden (although some doctors will say you can have a small amount of alcohol occasionally after 1 year post-op). 

What are other outcomes of bad post-op choices?  If your Type 2 diabetes went into remission and you go off plan and gain the weight back, it will come back WITH AN ATTITUDE.  There is a high risk of alcohol abuse/ alcoholism, even if the patient was never a drinker before.  A patient who had RNY bypass will now absorb more of the alcohol quicker than a typical person.  They will get a bigger buzz/ drunker and it will happen more quickly with less alcohol.  Given that many of us were "using" food in an addictive manner, it isn't hard to imagine that we would look to fill that need in other ways.  Increases in alcohol use, drug abuse, compulsive gambling and other addictive behaviors have all been seen in post-ops.  Big hard rule - whatever your problems were before surgery, they will still be here after surgery.  So you have to work on the underlying issues every day, and continue to face up to them.

My honeymoon period (usually seen as the first 12-15 months post-op when you aren't hungry) is over.  I get hungry now.  I also still get "head hunger" - where I crave something but my body doesn't need the nutrition -  that never went away, I just became better at identifying it.  I have found myself eating things for the wrong reasons before and caught myself before it showed up on the scale.  My caramel calcium chews - that I started eating twice as much of as I should - a nice way to get kidney stones!  Threw them out after a week.  The cashews I had gotten to eat as a protein packed snack occasionally - but found myself snacking on multiple times a day (at 200 calories a pop!).  Got them out of the house and kept them out for over 2 months until I was sure I could see them and not be tempted.  The glaze on the peppermint candy cane cookies that I licked off my fingers and then started scooping off the drip tray - I confessed to my husband that I had a real weakness there and he said that the next time I want to make them for the holidays, he and the kids will do the glazing for me. 

This last one snuck up on me.  I was eating homemade popcorn in the evening once in a while if I was hungry, making a big bowl for the family and having a serving size myself.  Then my serving size grew.  Then I was making it every night.  I still didn't realize I was in trouble until I saw the scale change.  I gained 3 pounds.  From popcorn.  Do you realize how much (unbuttered) popcorn I must have been eating?  OK, that's not the only reason I gained weight - I had been doing more walking than jogging.  While I am still very active (12,000 - 14,000 average steps a day) I went from jogging 3-4 times a week to jogging 3 times a month.  Add to that the salt I put on the popcorn, and Voila!  3 more pounds. 

Don't get me wrong, it isn't unreasonable to expect a little regain.  18 - 24 months out the average patient gains 5 - 10% of their weight back, mostly because their stomach has expanded enough that they can eat more/ get hungry again.  Some people never have any regain - and I really want to be one of them.  I told my husband I needed to "go off" popcorn for the forseeable future and from then on whenever my son requests it he says "Mommy's not going to make it, you can make a small amount just for yourself and throw out whatever you don't eat".  Awesome hubby, isn't he?  Sure enough, just 3 days after no popcorn, and my weight was already back down 2 pounds just getting the excess salt out of my system.  I also started jogging twice a week again.

The scary thing is how I didn't realize my new night-time snack was a problem until it showed up on the scale.  First of all - I shouldn't need a snack every night!  First thing I should do if I think I'm hungry is drink, because I'm probably just thirsty.   And if I am hungry, most of the time it should be satisfied by protein.  And I had gotten lazy with my exercise.  I feel embarrassed to have fallen off the wagon - lured back into an addictive eating pattern (eating more, more often).  It will take conscious choices and deliberate actions for me to stay healthy.  I must stay more active than the average person, and I can't think I can snack like an average person.  "Within moderation" is a loaded phrase and WAY too subjective for me.  In the case of popcorn, I've decided it means 2 cups of popcorn once every 3-4 weeks, max.  It means get out of the freakin' house in the evening, when I start to have the head hunger, so I am distracted from it.  Luckily, I've got my kids baseball and soccer practices and games to help with that! 

Finally, to end on a good note - I had a BLAST doing the Akron Color Vibe Run 2013.  I ran 5k in 30 minutes flat - my new best time.  That might have been because it was cross-country - up slopes, down slopes, across the gravel, sliding on the wet grass, splashing through the puddles.  There was NO BOREDOM there, on the contrary - I was terrified I was going to fall and take some layers of skin off, so that adrenaline probably helped my time.  Also, four times along the run we were liberally doused with colored cornstarch, which made it really fun.  Here are some pics (the tutu is a common accessory in these races)

 

If you want to try a fun 5k, I highly suggest Color Vibe and The Color Run!  Lots of fun for the whole family - one of my sons ran it with me, and the other is seen above tossing a lot of magenta cornstarch!

So, to sum up my original thought, getting weight loss surgery may be simple for most of us, but being a WLS patient for life is not.  Running a 5k feels simple now - it's a short amount of time, and a reasonable amount of effort for that time and you're done.  Making the right choices all day every day, pushing yourself to stay active, reminding yourself to stay away from your triggers and deal with your issues instead of eating to deaden them - that's the hard part.  It's part of the reason I eat the same things almost every day - it removes the temptation.  It's like an alcoholic realizing that it might never be a good idea to eat in a bar if there is another option.  Unlike the alcoholic, we can't just stop eating.  We have to choose to eat healthy things that won't trigger overeating, which can rule out a lot of things for each of us.  We have to choose the proteins that will fill us and meet our new body's needs.  We have to avoid the carbs that are likely to make us ill/ get dumping syndrome.  And we need to take our supplements regularly to make up for the vitamins and minerals we can't get absorbed through our food.  And when we do that, we are healthy.  That's how I plan to stay. 

 

Bariatric Betty's body and mind - new pics

I'm coming up on my 6 month post-op point and so much has changed.  Many things, but not everything.

I am no longer diabetic!!!  That will always deserve first billing and multiple exclamation points.  I know that not everybody who has WLS has their diabetes go into remission, and that it can return, but so far I am among the lucky ones and hope to stay that way.  I was just talking to my 9 year old about it yesterday.  That I can assume I will live to see my kids grow up and maybe see grandkids or even great-grandkids some day is something I could not presume before. 

My body continues to morph into a previously unknown thing.  I wrote months ago about the bizarre feeling of realizing that my hips were holding up my pants (instead of my belly).  The first step in that particular revelation was understanding that those two bumps on my front that were feeling pressure from jeans, were in fact, bones.  Bones that I had never before noticed, but had always been there.  These bones weren't visible, but were noticeable for the first time because of the decrease in the fat pad that laid over them.

Recently I have experienced the surfacing of other underlying structures - bones, tendons, etc.  These are not always fun - they are sometimes startling.  I am reminded of an article I read several years ago where a formerly obese woman suddenly notice the prominence of her shoulder blades and thought she might be deformed. 

Lying on my side, the excess skin and fat redistributing down with gravity leaves my hip and pelvis remarkably exposed.  I find myself squeezing them, poking them, and outlining them as I get to know this new "normal" for me.  A few times I have asked my husband to feel them as well, and let me feel his bones to compare and reassure myself that these are indeed, normal.  You mean average people feel these things every time they lay down?  Weird. 

The Anterior Superior Iliac Spine.  Yeah, I looked it up.  Those bumps that help hold my pants up are now painful at times.  Not when active, nothing like arthritis.  They hurt when I lay down on my stomach - my preferred sleeping position.  I think it is more accurate to say that my skin hurts. Having less padding between the bones and skin has apparently made me very sensitive to the pressure.  I frequently find myself putting a pillow under my pelvis (in addition to the thick mattress pad we also have) to give a little extra cushioning. 

I also have lower back pain - a common complaint in WLS patients.  Our center of gravity has changed, and our core muscles are having trouble adjusting to the redistribution.  In my case, my large chest has always caused some back pain, and now that weight is leaving other parts of my body much more than my chest, that increased ratio has resulted in increased pain.  Just leaning forward when brushing my teeth can be fine 20 times, but the 21st and I look like the stereotypical old man, hunched over with a hand on their back.  Most frequently the pain comes when I'm getting up from a lying down position.

I enjoy seeing muscle definition in my legs and shoulders.  I think seeing definition in my clavicles and shoulder blades is attractive!  I never carried much of my weight in my legs, but the jogging has reshaped them anyway.  Feeling the steely tendons around my knees is fun.  Which brings me to a LACK of pain in my knees.  Many morbidly obese people have significant orthopedic issues, hip pain and knee pain being very common.  I was lucky not to have those.  However, I have always had "bad" knees, and even when just "overweight" would have problems where my knees occasionally "popped" out of alignment when I was running or climbing.  That would result in my being on crutches for a week or two at a time.  It didn't happen when I was a morbidly obese adult because I wasn't doing high impact exercise. 

When I started Couch-to-5k training I was very nervous about how my knees would react.  I found that if I opened up my stride and ran it hurt my knees almost immediately, but if I ran short strides low to the ground I stayed pain free.  Having my muscles and tendons tighter than they've probably ever been has given me more support, and I haven't had one incidence of "popping".  Yesterday I actually jogged 25 minutes and felt fine (although really tired) when I was done.  This is a picture of me from last Friday when I finished my first 22 minute jog.

A little hot, a little sweaty, tired and thirsty - but happy.  I can't say I ENJOY jogging, but I find it very rewarding when I'm done.  In two weeks I should be jogging 30 minutes at a time - that is supposed to be the equivalent of a 5k!  When I have completed that challenge, my goal is to 1) choose a 5k to actually run in and 2) Start training my dog in the Pooch-to-5k so that we can change our morning walk to a morning jog.  Next goal - Tackle the Tower  - a stair climbing challenge to climb the Terminal Tower in Cleveland. 

However, parts of my mind remain stubbornly unchanged.  I find myself choosing sedentary things - being online (like now), watching TV, reading - more often than active ones.  I can and do join my kids when they go swimming, play ball, etc for a while, but then often grab a book while they continue to play.  My fitbit calls me active, burning lots of calories and getting over 10,000 steps a day, but I have long periods between active times when I sit - and I don't have a desk job.  I hope those periods start to decrease.  I know once the school year starts I will be standing and walking 2 1/2 more hours a day M-F again.  The head-work continues to be the hardest part of this journey.

Looking forward to my 6 month post-op checkup on my 42nd birthday next week.  I'll be sure to post again then.

Bariatric Betty gets the call, just in time.

First, a warning, there is a rant coming...
A lot of things happened this week, starting this weekend.  I took the family to a local apple orchard where we got to pick our own apples.  It was a beautiful sunny day, my waistline is smaller than it's been in a year thanks to my increased exercising and decreased after dinner snacks, and I felt great.  Most of the best apples were high up on the tree, so after sending my older son to climb up a couple of times, I left him on one tree and climbed another next to it.  My younger son was with me and I climbed up about three or four feet and started picking.  When I came down I was pretty pleased with myself until I saw my older son stomping towards me. 

It turned out he had overheard a family laughing at me, saying "I bet that branch is going to break with that fat lady on it".  He was trying hard to restrain himself from going and starting a fight.  My younger son looked like he wanted to cry.  The family had moved on, and I steered us into another part of the orchard.  It's not the first time my weight has been made fun of, but that hurt my kids.  Try explaining that some insecure people are going to always find something to make fun of other people about - and that it's not worth getting mad over.  Not a fun discussion.  I tried to make light of it by saying "at least next year there will be less of me for people to make fun of..."

Here's the truth.  I feel horrible.  My kids had to hear people laughing at me.  And it is those cruel people who are responsible for their pain.  But I have to take responsibility for being a target.  I know that I'm working on losing weight.  I know I don't deserve to be made fun of.  But I also know that there are ways that you attract the wrong sort of attention and if I had already lost the weight, they probably wouldn't have sad anything this weekend.  Of course, they might have made comments about my chest, or my clothes or anything else, but something about being overweight paints a neon target sign on people.  Don't they think I would be thin if it was easy?  I know that most thin people don't understand the difficulty of losing a signifigant amount of weight (and keeping it off) when you're obese.  That over 85% of us either don't succeed in the first place, or gain it back.  And some people think that having a gastric bypass is "the easy way" to lose weight.  They don't understand that I'll still be on a restricted diet for the REST OF MY LIFE.  That I will never be able to eat as many calories as a naturally thin person.  My body will not stay a healthy weight if I eat like they do. 

I read a quote from an actress recently that talked about how she easily lost weight for a role recently.  She said "you just have to want it enough, eat less, and exercise more".  She went from being skinny to being underweight for the role.  Does she realize that she gained the weight she lost back, too?  For her, that was healthy, but I'm sure she was relieved to stop feeling hungry.  I'm happy for people who can eat the proper amount of food and feel satisfied and stay a healthy weight.  But my brain doesn't work like theirs, my metabolism doesn't work like theirs, and I'm always tired because I'm carrying around 100 extra pounds.  It's not easy.  Don't people like that understand that we wouldn't subject ourselves to lifelong dieting and surgery if there was any other way that we had found to make it work???

So when I spoke to Diane, my Patient Advocate at Hospital C for the rest of my life, on Tuesday it couldn't have come at a better time.  She recommended that I see a P.A. (physician's assistant) at a health services center nearby because he does a fabulous job documenting medically supervised weight loss for the insurance company, I called and made an appointment.  I meet him later today.

I also returned the elliptical I bought at Walmart for $200.  It was wobbly and having problems with the LCD screen and starting to make louder thumping noises when I used it, so I got a full refund.  Luckily, I found a used Nordic Track elliptical for $150 through craigslist, and bought it.  So now I have a better elliptical that was more affordable and I am back on it daily!  90 days from now, I should be able to get pre-certified approval for the surgery from my insurance company.  I'm on track, and not looking back.