Let them eat cake

I wasn't going to write about this.  I certainly wasn't going to say, in public, that I'd gained eleven pounds between my initial appointment with the surgeon and my appointment with the dietician six weeks later.  Yes, you read that right:  11 pounds gained in 6 weeks.  That's some championship-level eating right there.  So, how did it happen?

When the surgeon asked me that question, he wasn't pleased.  He most certainly wasn't happy with the response, either.

Half of that time, I was traveling for business.  I was attending conferences and meetings all day (from 7AM-10PM usually) and the other half, I was too tired to cook, so most of our meals were from fast food joints, take out and delivery.  It sort of became the running joke in our house about where to go for dinner.  I mean, c'mon, there's only so much KFCTacoBellKelly'sRoastBeefBostonMarket a person can eat, right?

So, there you have it.  My confession.

As I said, the surgeon wasn't pleased with the answers I gave him.  "Let me guess," he asked rhetorically, "when you went dowstairs for the buffet breakfast every morning, you walked right past the fruit, oatmeal and cottage cheese and went straight for the eggs, bacon, sausage and bagels."

"That's not entirely true," I said, truthfully, "I did put a few pieces of fruit on my plate before I hit the eggs, bacon, sausage and bagels."

He was not amused.  "You have a wiring issue in your brain.  I'd bet that if you see someone else eating it or you smell the food, you can't resist it, even if you're full and you don't actually want it."

Light bulb!  "Yes!  That's exactly what it's like!"  It's like someone finally telling you that hey, yeah, you're fat, but it's not entirely your fault.  It's a relief to know that it's not just my lack of willpower or disdain for the treadmill that has made me fat and kept me this way - there's a biological reason as well.  It's not just the arthritis in my knee and ankle, my slow metabolism, my IBS, PCOS, glucose intolerance or any other number of things wrong with me.  There's a larger underlying issue that isn't going to be resolved by beating myself up about it.

And after some tears - of joy and shame - we agreed on a date.  July 6th.  My Independence Day.   I am working as hard as I can to do what I need to do to make that date a reality.  In the week between seeing the dietician and my follow up with the surgeon, I lost three of the 11 pounds I'd gained.  He'd like to see me lose 5-7 more in the next month before I see him again. 

To do that, I've stuck strictly to the dietician's recommendations.  I set up alarms on my calendar to remind me to eat and when to drink. I eat by the clock, even if I'm not hungry, because that's what I'll need to do post-surgery as well.  I've been walking more.  I'm not setting aside gym time, but I am walking around my work campus much more and taking an extra walk during lunch time when I can get in another mile or so (and when the weather cooperates).

I've also scheduled the next psych appointment, dietician appointment and called my primary to send over additional documentation to the surgeon.  Sometimes it feels like getting prepared for this is a full-time job.  I should have the psych clearance after my next appointment (awaiting a call back to schedule), the dietician's clearance after my next visit on June 13th, pulmonologist clearance is being written up now (even though the sleep study results are still another week or two away from being complete) and then the final hurdle will be getting the surgeon's final sign-off and the insurance clearance.

Exciting times!

Let the Countdown Begin!

I can't write as much as I'd actually like to right now because I have some other things I need to work on tonight, but...

I met with the surgeon tonight and my tentative date for my surgery is July 6th!

I have quite a lot I still need to get done in the next month before my next follow up with the surgeon:

• Lose 5-7 more pounds on my own
• May support group
• Dietician clearance
• Psych clearance
• Pulmonary clearance
• Physician's notes from my Primary Doc
• Final approval from the insurance company

Rock-a-Bye Baby

What a difference ten days makes!  In that time, I've come and gone on another business trip (which means I ate and drank way more than I should have), met with the dietician, met with the pulmonologist, stood up my surgeon and had a sleep test done.

I'm not busy!  Who's busy?!

I met with the dietician earlier this week and I have to say that while I did not really connect to her on a personal level, I took notes anyway and asked clarifying questions about some of the rules I will need to follow (and actually implement now).  Some of the fun stuff I've mentioned before, but am now living:

• No mixing of food and beverages.  This has been a challenge!  I can't drink anything (even water!) 20 minutes before OR after a meal or snack.  It will stretch the pouch and push food through faster, making me hungrier, so this is a habit I need to get down.
• No carbonated beverages.  Ever. The dietician explained that carbonation will stretch the pouch and that the carbonation will not really have anywhere to go once it's inside you.  She told a fun (well, fun if you have MY sense of humor) story about a woman who drank some soda and then foamed at the mouth.  Doesn't really sound worth it if you ask me.  This is going to be a challenge for me since I'm a big soda drinker. Having weaned myself off regular soda, I'd learned to enjoy the diet stuff.  But now, think about it, that means no more sparkling water or CHAMPAGNE!  One of my favorite adult beverages of all time will now be relegated to the Do Not Touch list (along with dirty socks and a host of other things).
• Eat every 3.5-4 hours.  Start the clock as soon as you wake up by eating something within the first 1-2 hours.  This isn't that difficult for me since no matter what time I eat at night, I tend to wake up famished.  I've been incorporating a low-fat cheese stick (I'm currently obsessed with monterey jack) either before I leave the house or on my commute into work.  I make sure to either pack or buy enough snacks to keep me going between meals as well. 
• Eat S-L-O-W!  This is a toughie for me since I practically inhale my food.  Each bite is supposed to be dime-sized and chewed 6-8 times.  Meals should take at least 20 minutes to finish (and for me, they never do).
• Count Calories.  Pre-surgery I should aim for 1600-1800 per day.  Post-surgery, I should expect to have between 800-1000 a day.

To be honest, following the "rules" above, I've managed to keep my calorie count where it's supposed to be for the last few days since we met - on the lower end of the range, even.  Stretching my meals out really does help me get that full feeling that used to be so evasive.

After all of that fun, I met with the pulmonologist who could totally have a career in stand up if this whole doctor thing doesn't work out for him.  He, along with my surgeon, suspect sleep apnea.  Since the connection between a lack of sleep and overeating is well documented in scientific circles (no really, it's not JUST my excuse), it was important for them to test me to determine whether or not I have sleep apnea or some other sleep disorder.

I was able to get an appointment for the next evening, so I headed there after work (since my appointment with appointment with the surgeon was moved earlier as he had a conflict and then I was running late).  The pulmonologist took me over to the sleep study suite so I could check out the rooms.  It was like one minute you're in a hospital and the next, you've been whisked away to a hotel room.  Except that before you can go to sleep, they connect you to a gazillion wires, strap belts around you to monitor your breathing and stick some tubes in your nose.  Fun, right?!?!?

Not so much.  I'm not sure how they expect people to pass this test in the first place.  It's almost like it's designed for people to fail.  For starters, they want you to try sleeping on your back most of the night.  Blech.  You're strapped to all of these wires (which are thin, don't get me wrong, it's not like sleeping on bundling cables), but the kicker is really the tubes in the nose.  I have enough trouble breathing, thank you very much!

Since it takes two to three weeks for the results to be analyzed, I don't have much information yet.  I did not meet the criteria for the insurance company to cover the cost of the CPAP machine, but that doesn't mean I don't have sleep apnea either.  Apparently I did wake up quite frequently throughout the night so all of these years I've been complaining about being sleep deprived, I wasn't kidding.  Oh yeah, and don't share a hotel room with me because despite my protests over the last decade, I snore.

In other news, I am now scheduled to follow up with the surgeon on Monday, so stay tuned!  I hear that my next three clearances should be coming quickly which means then it's just up to the surgeon to clear me and get my date confirmed!



Slow Down, Chowhound!

In my quest to lose weight, get healthier and prepare for Life After Surgery, I actually timed myself at breakfast yesterday.  My grandmother, God love her, said something along the lines of making pancakes on Sundays and since we were visiting, she wanted to make them.  Now, not only do I not ever really pass up an opportunity for food, I certainly don't pass up a chance for Grandma's Cooking.

I had the good luck of getting the first batch of three pancakes.  I carefully doled out one tablespoon of Olivo spread (half the calories of butter!) and lightly drizzled the Aunt Jemimah Lite syrup over my triple stack of flapjacks.  'You never did use a lot of syrup," my grandmother commented from the stove.

Then, I checked the clock.  8:55 AM.

With Grandma still manning the griddle and my Grandfather poring over the NY Daily News, I sat there with my plate of pancakes and made a conscious effort to not inhale them.  First, I cut the stack in half.  I looked at them, curiously, then I started cutting all around the crispy edges and taking miniscule bites and then just chewing, chewing, chewing, chewing, chewing until my jaw ached.

At 9:00 AM I'd finished the first half.  Five minutes?  It felt like forever.  I dragged out the second half of the pancakes until 9:13 AM.  It felt like torture.  There was a Corningware full of extra pancakes right in front of me and it had just taken me eighteen minutes to eat three pancakes.  For the sake of comparison, let me just say that in eighteen minutes I probably could have eaten at least six or seven, not just three.  I allowed myself one more and made it take me another seven minutes to finish.  By that point, I was actually full.  Not stuffed, but definitely satisfied.  This is interesting because I don't think I've ever only eaten 4 of my Grandmother's pancakes. 

Maybe there is some truth to slow eating.  But regardless, slow eating is something I am going to have to train myself to do because once I have the surgery, I will not physically be able to inhale my food like I'm used to doing without there being negative consequences.

Which got me thinking about the Slow Food Movement.  If you take the politics out of it, this boils down to eating whole, local foods that are organically grown and taking the time to prepare and enjoy them.  It also brought me right back to Michael Pollan and his "In Defense of Food", the premise of which is: "Eat food.  Not too much.  Mostly plants."  The idea that we should go back to eating the types of things our grandparents (and since I'm so lucky to still have mine, I'd even go back a generation further and say, my great-grandparents!) would recognize, and nothing else.

I've always had excuses as to why I can't shop at farmer's markets or buy only organic produce.  Yes, it's more expensive than buying the stuff that's been sprayed with pesticides and God only knows what else.  But at the end of the day, if we were eating the quantities of food we were meant to eat; eating slower so we actually allowed ourselves to feel full and not pushing our plates away with the signal that it's empty; and eating whole, real foods...we wouldn't be in the predicament we're in.

Now, I am not pointing fingers or telling people how to live their lives.  I most certainly couldn't do this if I wasn't planning to have surgery to physically restrict how much I can eat.  I also don't think I could do this if I had a large family or a spouse who ate really large meals.  The truth is that I can do my part here and that every small effort can lead to bigger changes down the line.

Clearance #2: Primary

I've been remiss in telling you that I received my second clearance, but that is mostly because of my hectic work and travel schedule as of late.  It's also because the story of how I had to go about it isn't really a Reader's Digest version and I simply haven't had the time.  It was a challenge, for sure.

I had been with my primary doctor for almost a year.  I really liked her.  She was a no-nonsense woman, rather unassuming, but extremely caring.  When I hit a particularly bad time last year, she talked me through all of my options and helped me decide which medication might be the best for me.  She also, at that time, offered me the kind of advice you might expect to get from your friend or even perhaps your minister, but certainly not what you'd expect to hear from your doctor considering how rushed they typically are.

Despite not having appointments later than about 6PM or keeping weekend hours, I really liked the practice.  It wasn't too far from home or work and I could get my labwork done downstairs when I needed to, thus saving me from having to drive all over town and make multiple appointments for things.

After I'd met with my surgeon, I called my primary's office and let them know that I needed to come in for a physical specifically for clearance for bariatric surgery.  I also let them know at that time that I was planning on having it at a different hospital - one they are not affiliated with.  They scheduled my appointment and I thought I was - as we say in New England - all set.

Three weeks later, I get a call from someone in their office informing me that my doctor will not write a clearance for surgery unless I am having the surgery at the hospital with which she's affiliated.  Three weeks may not seem like a lot of time in most circumstances, but in that time I'd already:

• Met with the surgeon
• Scheduled my follow up appointment with the surgeon
• Met with the psychologist
• Scheduled a meeting with the dietician
• Met with the cardiologist
• Been cleared by the cardiologist
• Scheduled an appointment with the pulmonologist
• Scheduled a follow up appointment with the psychologist

I was moving quickly.  They informed me that not only would I have to change hospitals (which meant changing surgeons), but that I'd have to change all of these other doctors as well.  Three weeks after I'd informed them.

I flipped out.

Yeah, I got irate and belligerent.  Because what I hate more than inefficiency and ineptitude is when people use false empathy to try to calm me down.  Don't tell me that these policies are in place to help your patients.  They're not at all helpful.  These policies are in place to ensure that the hospital you're affiliated with gets the business and so therefore all of the doctors that are part of that plan get the business as well.  Let's be clear, this was not a requirement by my insurance company who is actually footing the bill - it was an office policy established by the doctors in that office.

What she proposed would mean that I'd have a choice - out of all of the bariatric surgeons in Massachusetts - of two doctors.  Two!  The first choice would be with the doctor who did my gallbladder surgery last summer.  Now, he was nice enough and he did a good job.  He was actually the first bariatric surgeon I contacted when I made this decision.  But I didn't feel like his program was right for me - for starters, his procedure is more internally invasive even though it's "laprascopic", that procedure would mean a higher chance of side effects, he requires a much longer time on shakes before you move to soft solids and he mandates that spouses must attend the support group meetings.  Now, while that may be great for some people, and while my husband supports my decision, he shouldn't have to go to these things - especially not for several months before my surgery date is approved and scheduled.  The other doctor, my only other choice, works with this guy in the same practice.

This is too serious a decision to only have two choices.  How would you like only having two choices of cars?  Or only two choices for airlines?  I'm not letting someone cut me open unless I feel completely at ease with them.  This is a major surgery and I refused to be strong armed into agreeing to croneyism.

And so, I did the only thing I felt was appropriate:  I dumped the primary doctor that I'd had for a year and found a new one that works with the doctor and hospital I've chosen.

I made my appointment and they were able to take me the following week.  I'd only scheduled a consultation, but she did a full physical and upon receipt of my records from my surgeon, wrote the clearance letter.

I am still fighting with the old practice to have my records released.  Even though they're being sent to another doctor and even though they are electronic, I have to send them a $15 check.  They actually expected me to pick them up and bring them to the new doctor.  What is this, 1985? 

But now all of that frustration has passed.  I'm close to being done with dealing with them and I am one step closer to achieving my initial goal of having my surgery this summer.  I have three doctors appointment the middle of this month - so I'm hoping that I can get a few more steps along this path before month end.

On Congruence and Judgements

Lately, I've been traveling quite a lot for business.  On my last business trip - and by last, I mean the one that happened a few weeks ago, not the one I'm about to start today - I attended a Communications/Relationship Management workshop.  I've probably taken a half dozen similar courses in my career and speaking from experience, you're generally lucky if one or two things per course really stick with you. 

The one that stuck with me this time was the idea of congruence.  In psychology, congruence is essentially the consististency between your inner and outer selves - who you say you are and what you actually do that shows the world who you are.  Sure, this is primarily based on perception, but there is a strong case to be made about congruence.  If you lack it, people generally won't trust you because there will always be something off about you.  A lack of genuineness.  It's an important thing to have for a number of reasons, but it's especially important for me - not just because I believe in living as authentic a life as possible - but because if you're going to be an open book (and unless you want to be labeled as James Frey and Greg Mortenson, i.e. frauds), you've absolutely got to have congruence.  For my words to carry any weight, I must live by them - for they are not mere words on paper or screen - but the very proof of my existence.

This is really heavy for a weight loss blog - no pun intended, you're probably thinking.  I know.  But I'm getting there.  I promise.

It's imperative for my own ethical and moral sanity (I've given up on attempting to achieve psychological sanity, at least) that I have congruence in my life.  To me that means not backing down unless it's a battle that's not worth fighting; trying again and again and again and never giving up on something if it's what I really want; being open to life - that no matter how many times I am burned or hurt, I will still approach people with an open heart and open mind; believing that the vast majority of people are genuinely 'good'; allowing intention to carry weight.

Being an open book isn't the easier choice here.  Just so you know, keeping all of this in my head and struggling with my weight or other challenges in my life and just not telling another soul about it would be incredibly easier.  I wouldn't have to answer to anyone for my decisions.  I wouldn't have to justify anything.  I would just go about my life in a bubble and not share anything about it.  But that's just not who I am at my core, because at my core, I believe we learn and grow by our own experiences and that we instinctively choose to surround ourselves with people who have also gone through them so that we have a baseline of understanding.  Let's be honest - it's why the majority of my friends aren't thin or at least weren't always that way.  My weight has been a huge challenge for me and to try to separate it from who I am is next to impossible.

But what all of this means is that I also have to bear some of the responsibility when people take offense or feel strongly about something in my life.  Because I am not hiding it.  Because I am being open about it and some people just don't like that.  And so, I've found, it's the same with the choice I've made here, the one regarding bariatric surgery. 

I met my first real detractor this weekend and it was tough.  I know this is the right thing for me.  I know that given my medical history and how long I've been overweight that the chances of my successfully losing the weight AND keeping it off are less than 5%.  I also know, in theory at least, that there will be people who disagree with this decision.  I don't think it's that I didn't expect that; it was really that they refused to listen to reason and not having had any of the issues I've had, can't at all relate.

No one would ever tell an amputee to try harder to walk.  Just push yourself harder in physical therapy and you can overcome the greatest of odds.  No one would tell a diabetic to go off their insulin and just change their eating habits to control their blood sugar.  No one would tell someone with a life-threatening disease to just work harder and get over it.

But apparently it's acceptable to tell a fat person that they're just not trying hard enough.  That because Weight Watchers worked for them, it will work for me.  That because they never learned to maintain their weight loss, that I won't either and that bariatric surgery won't fix that.  That because I have lost weight before, I can do it again.  And I can keep doing it - living in this yo-yo pattern - gaining back every pound and then some after each diet.

Let me tell you, it is not acceptable to tell a fat person they're not trying hard enough.  Weight in this country is out of control.  It has a lot less to do with the choices people make than the choices that have already been made for them.  Food dyes, additives, preservatives, the high cost of whole/real/unprocessed foods, the inability to trust that even the fruits and vegetables are safe let alone that our meat isn't contanimated.  If the 20-30 minutes of daily exercise that the Federal Government "recommends" were enough to make us thin, well, I wouldn't have this blog. 

Fallacies abound and the weight loss industry with their almost $60 billion in revenues spread the worst of them:  That if you eat 'this' and not 'that' that you can be thin; that if you take this supplement, the weight will melt off; that if you buy this product or work out 7 days a week for an hour a day or push yourself past the point of exhaustion and just continue to spend money in search of that elusive number on the scale, you will finally be happy. 

What's worse is that we buy into them.  I've bought into them.  And now it's time for reality to get it's fair share:  I will not ever lose the weight I need to lose to be in the 'normal' BMI range by dieting and exercise.  No amount of shitty Nutrisystem food or P90X will change that.  You don't have to like it or my choices, but until they're yours to make, you really shouldn't be judging mine.