The Further Adventures of Deluzy

Trajectories and transitions

I'm really struck by a set of common experiences that people have with their WLS surgeries and the results -- and I'm talking across the board here: i.e., about those who have had the same kind of surgery, those who have had different kinds of surgery, and those who are at different points in the weight-loss, regain/bounce, or maintenance process.

On the one hand, the different experiences are as varied as the people themselves.  Duh.  But on the other hand, there seem to me to be certain periods and phases that we go through -- not necessarily in the same order or, even, necessarily, for the same reasons, or to the same degree.  I'm not talking about the changes in self-concept and identity that occur for some -- and the resulting and often dramatic reordering of lives. I'm simply talking about reactions that do come up pretty frequently across the WLS population -- myself included.

In no particular order, I think about the periods and head trips that I've gone through so far -- and continue to experience. 

• There's the fear at the start that one's WLS will not work -- because nothing else has in the past.  Not really. Not for any sustained period of time.  Will I be the one person for whom this surgery will not work?

• There's the amazement when the weight does start to come off.  Relatively quickly. It's the rediscovery of hope, the possibility of a second chance at health and normality.

(Relatively quickly but not effortlessly, I might add, because virtually every WLS patient must learn how to eat all over again for the particular requirements and demands of his or her form of surgery. Let me tell you, that's a process that takes place on every level -- mental, emotional, physical, psychological -- and that's before the going even gets tough and you run smack-dab into the issues you may or may not have known you had all along.)

• There's the gratitude that something is finally working.  It's really working.  Ohmygod, it's working.

• There's the panic that occurs when you encounter your first plateau. For some it occurs within the first 6 weeks to 2 months; for others it occurs a little later. For a lucky few, perhaps it never happens at all, but I haven't met those folks. My surgery has stopped working. I've broken it. Here I've put myself through financial, physical, and emotional hell ... I've risked my life in surgery and compromised my nutrition for the rest of my life ... and this has stopped working??? I am so fucked and I am so unhappy and scared.

• There's the first sprouting of the seeds of trust in one's surgery -- once the first plateau passes and the weight begins to drop again.  Maybe I can do this after all.  Maybe I'll get there.

• For me, however, that trust does not have strong roots because it's planted in the sandy, shifting soil of 40+ years of morbid obesity. At 2 years and 7 months out from my surgery, and after losing the basic amount of weight I'm going to lose (i.e., 110-120 pounds, from 280 to 155-170 or so), trust may be more difficult than it was in the beginning -- because now there's no dramatic weight loss to reassure me.  Instead, there are gains, losses, and fluctuations. I put myself through more head games and head trips now than I ever did during my weight loss phase.

And I guess that's where I find myself right now -- in the land of head trips when it comes to the scale, weight, and food intake. 

When I read  the blogs of folks who are closer to their surgery date than I -- say, within their first couple of years -- a lot of them remind me of myself when I was at that point, and I've got to say a lot of them sound a lot more grounded and less neurotic than I do now!  They're in that preliminary period where they're trusting their surgeries and themselves and forging a new relationship with food -- and they're not obsessing on the scale or a few pounds. They're not counting calories or points.  (If they're sensible, they're counting their protein grams, but that's a different issue.) They're letting the process work.

I remember that. I'd like to be there again. 

They're so relieved to be losing significant amounts of weight that they can't imagine worrying about 10 or 15 pounds when they've been 100, 200, or 300 pounds overweight. I have to say I totally get that. In fact, WLS folks who worried about anything less than, say, a 30-pound gain (why that number as opposed to any other?) bugged the crap out of me in the first couple of years, quite frankly. Jesus, stop being so fucking neurotic. Be glad you've lost the weight and don't fret about the details.  Make peace with a healthier weight, and don't drive yourself nuts.

And now I find that while I still feel that way intellectually, I myself am in a much more ambivalent state with respect to my own weight, post-weight-loss phase. No, I don't subscribe to a rigid window of opportunity when it comes to weight-loss windows; still, I'm pretty much at where I'm going to be, give or take, say, 10 pounds.

But there's the rub, you see. It's that plus-or-minus factor that never would have been anything I cared about at 280 that can make me a little nuts now.  And I'm not entirely sure why. ( I have some ideas about it, of course, some of which have to do with cultural expectations and experience and some of which have to do simply with my own psychological history, but I'm still mulling them over.)

It's a weird journey, that's for sure.  And it sure as shit doesn't end at "goal" weight.

RDA nutritional guidelines: carbs and calories

Click to enlarge.

I haven't decided what I think about these standard nutritional guidelines in relation to being a DS patient, other than to note the obvious, which is that DS absorption issues skew  these recommendations. Obviously.

However,  I note that its recommendations for daily calories consumed  for a woman of my age and height are right about what I'm averaging in Fitday -- on one of my major intake days.  Which doesn't even take into the account the fact that I malabsorb a significant percentage  (though who really knows how much, at this point) of the calories I do consume.

So maybe the amounts I'm eating just aren't that unreasonable, particularly considering that I am a DS patient.

Here's an interesting link to the median intake of carbs for men and women:

The Recommended Dietary Allowance (RDA) for carbohydrate is set at 130 g/d for adults and children based on the average minimum amount of glucose utilized by the brain. This level of intake, however, is typically exceeded to meet energy needs while consuming acceptable intake levels of fat and protein ...The median intake of carbohydrates is approximately 220 to 330 g/d for men and 180 to 230 g/d for women. Due to a lack of sufficient evidence on the prevention of chronic diseases in generally healthy individuals, no recommendations based on glycemic index are made.

So, in other words, Americans tend to consume more carbs than is recommended (we know that, and I certainly fall into that camp). 

On a bad day, I'll get on up there into the median zone cited here.

But not even necessarily on a regular basis, and not when I'm staying aware.

So maybe I've been totally freaking myself in the past several weeks about my intake (somehow I think *S* might be nodding her head vehemently right about now).  Maybe, with the exception of eating too many carbs for my own good, I'm not that weird or unusual.  Maybe the 8-10-pound gain I've experienced in the past year really is about a DS bump that's minor and not unreasonable or a symptom of a dysfunctional relationship to food (which I nevertheless do have, however).

Interestingly, according to the chart at the top of this chart, my current weight is perfectly reasonable for a woman of my age and height.

(Man, and I don't even think of myself as a person who head-trips herself that much about food intake, weight, and all the rest ... but I clearly do.  Not to state the obvious or anything.)

Lighten up

The feedback (here and elsewhere) is that I need to chill out and cut myself some slack in the aftermath of the B&J's incident from last night.

I don't entirely agree.  It was a slip of addiction (so I should punish myself?) -- not the act of eating ice cream itself but the amount, and fact that I ate it rather mechanically but with determination, waaay past the point of enjoying it -- but I probably do need to let it go, if only to move past it. It's certainly what I can and have told others to do, so am I going to exempt myself from my own advice? These aren't moral issues; they don't even have to be huge head trips -- although my overeating has always been emotional, and I tend to need to look at that when I diverge from the food path I intend to follow.

Am I hard on myself?  I feel as if I am in other realms (work, perhaps) but not over food-related/DS-related matters.  On the other hand, I was stressing about work, mostly, when I ran afoul of B&J's, so the two are no doubt linked.

Either way, I'm realizing I need to come up with some comforting strategies for the evenings, when I have always been the most vulnerable to eating for emotional sustenance anyway. And now that old history/pattern is coming up for me at the end of each summer work day, as I assess what I've gotten done that day and figure out goals for the next day. Lots of anxiety hits then but I haven't really been acknowledging it, just shoving it aside and hoping it will go away.

I need to let myself have 15-30 minutes at the end of each day to process and make the transition from work to relaxation, acknowledge fears, talk myself through them, reframe them, and let go until the next day. Otherwise I simply want to stuff fears and tension by turning my attention immediately to, say, reading for pleasure (or food) to "bury" the fear and distract myself from it.

I've met my writing goals for each day this week, however, and so that feels good -- this, despite the BSOD and ongoing computer woes.

I'm tracking in Fitday this week, too, more so that I can review the results after 7 days and analyze my food choices a little more carefully rather than with the intent of restricting this week. And that feels positive.

So maybe I need to focus on these things rather than on my slips.  It's one thing to accept responsibility for the latter; it's another to flagellate myself over them.

Pitching a fit

My desktop PC is still in the shop, but I went to campus today for several appointments and picked up my beautiful MacBook Pro that supports both  Mac and Windows platforms. I opted for the 17" screen so it's actually heavier than shit for a portable model, but it is a lovely computer.  The keyboard isn't as comfortable as my ergonomic PC keyboard, but oh well. I can deal for a few days.

I had a good session with my therapist  whom I see every couple of weeks,  talking mostly about weight and work stress today.  It was a productive meeting in which I realized what I've intuitively sensed in the background:  i.e.. I'm just so pissed that, at this point in my life, I 1) still battle fear and insecurity (pretty much mostly in work-related realms -- and not for any good reason, either, I might add, except for a childhood history, a gift that keeps on giving), and 2) I still have to do the heavy lifting therapeutic work of intervening in that fear, talking myself through it, finding ways of caring for myself without reaching for carbs, and coming out the other side of it.  Which I can do, and am doing.

But you know, sometimes I just get sick of working on my shit.  For the past week I've wanted to lie down on the ground, kick my heels, eat some cookies, and have a good old-fashioned tantrum.  "I'm just so pissed!" I exclaimed. "I'm not filled with rage, I don't think I have deep anger issues anymore -- but I'm absolutely irate and feel like rebelling!  Didn't I already do this?  Haven't I earned time off for (and from) endless self-examination and working through issues? Time off for good therapeutic behavior and application ... something?!"

Well, sure, if life worked that way -- but of course it doesn't. Instead, you keep meeting up with your issues througout your life and become better and better able to deal with them in constructive ways.  Yeah, yeah, I know.

But I'm still extremely annoyed, and I might just try to get back at the universe by eating a piece of cake and showing it that it's Not the Boss of Me! Nyah, nyah! Neener neener nanny goat!

(Who is the boss of me, then?  I am?  Oh hell, that's an even scarier thought!)

Size weirdness - yet again

So someone tell me how I can try on a size 8 dress and have it be too big?????

That was this evening's head trip -- and it honestly had to do more with the odd sizing of this one particular style of dress by one maker than it did with the myth that I'm a size 8. Because, however flattering that myth might be, I'm not. (But the whole experiences weirded me out so much that, even though the dress was pretty, inexpensive, and perfect for hot weather, I didn't get it.)

After the size 8 dress, my brain was so scrambled that I wasn't able to assess whether the exercise clothes I was trying on were too large or too small  -- and that's what I'd gone shopping for in the first place.  I made a surgical strike at an inexpensive store for some moisture-wicking walking togs (think REI, only I wanted something cheaper), and I came home with several items, only some of which actually fit. The bottoms work, the top is too small. I've already removed the tags. Sigh.

The moral of the story (which I thought I'd already learned): don't try to make sensible clothing decisions when you're having size freakout. Or else take a friend -- though actually, I hate shopping for clothing in the company of others.

The weirdest purchases of the evening were three pairs of shorts. All on sale, all inexpensive, and god knows I didn't own a pair of shorts. Um, I haven't worn shorts since I was about 7.

One pair hits at the knee and looks good.

Another is that weird-ass item known as a skort (it is to a skirt and shorts what the spork is to the spoon and fork -- or a mule is to a horse and a donkey). I've always disdained them on general principle --  until I tried one on this evening, and -- it's nice.  Comfortable. Flattering. Looks entirely like a short skirt but with a little modesty coverage if you happen to strike a particularly un-ladylike pose and flop into an armchair with your legs spread. (I'm having trouble with the singular/plural thing in and around shorts, let alone skorts. I don't have my subject/verb agreement down in this paragraph, I'm afraid.)

And the third -- well, both my husband and I admit the third pair are strictly schlubby wear. In other words,  I wouldn't be caught outside my back yard in them -- but yeah, basically, you do have to wear something in the backyard on a hot day, and these got my vote: $9.99. The price was right.

Of course, now the weather is about to turn cooler, so  while the exercise wear  makes sense, the other purchases weren't immediately necessary.  But hey, summer has only just begun -- I'll need them eventually.

Such a day

I’m up in the middle of the night – woke up and was too wound up from the day to go back to sleep immediately. I know --  let's blog!

 I spent the entire afternoon at a local  branch of Kaiser (an HMO under which I grew up and also under which I watched my mother die). The department had a professor visiting from another university to do a review of the undergraduate major (this happens every 5 years and is a big deal for the department), and at lunch he said he’d lost the sight in his left eye two hours earlier.  HUH??? He looked a little worried (uh, YEAH!), and it turns out there was a complicated story, but he’d had eye surgery 7 weeks ago and, well, today he couldn’t see out of the eye.  He could distinguish light and dark but that was it.

 I was the only woman at the lunch, and when he inquired in a low voice if there were a Kaiser up here, I said, “Yes, of course” and told him that I’d be happy to take him there.  So while he was on the phone to his eye doctor back home (who said “Go immediately to the hospital!”), I was on the phone trying to get through to eye doctors at Kaiser up here (I ran into nothing but phone trees and voice mail – what a joke). While he and the male faculty members were deliberating about the guy’s schedule for exit interviews with assorted university personnel on Thursday afternoon, I was grabbing my keys and saying “Let’s go – the rest of that can wait.  We’ll call in from the hospital.”  (Which we did, multiple times. Short version: he missed the interviews. Gee, under the circumstances, does that even matter? I think not!)

Bottom line: I went from zero to bitch in about 10 second flat once at Kaiser Emergency. God, the actual intake people aren’t even medical staff these days. However, I did get the man in ahead of other folks there, sat with him in the various examining rooms more or less at his request, listened to the doctor tell him he needed to return home that night (rather than the next day, when he was scheduled to leave) to see his medical team in there who would might have to perform emergency surgery, and pitched a slight fit when the guy continued to worry about work and and our program review.

Back out in the waiting room, he got on the phone with Southwest Airlines which was going to charge him way more for changing his ticket -- at which point I’d had it: I grabbed his cell phone out of his hand, went stalking back to the nurse, thrust the phone at her, asked her to please tell them that it was a MEDICAL EMERGENCY, and returned the phone to him only after that had been fixed. Then, while he was arranging his flight change, I arranged for the doctor to write a letter explaining the situation, just in case, and for copies of his records to take back with him.

Afterward I took him back to campus to check out of his hotel, drove him to watch student films at a campus film festival for about 60 minutes (because he could see so well – NOT! but he wanted to do it), and then to the airport at 8:30 p.m.

It was exhausting, mostly because the whole scene just pushed all my old, old caretaking/Kaiser buttons. I didn’t really realize it at the time, but I learned a lot about how to deal with bureaucracies when I was taking care of my mother in my 20s, and I learned more when I was fighting for my own surgery, and I’m good at it – but I also hate it. I hate seeing incompetence and inertia and folks not taking action when action can make a real difference, and I hate passivity, and I can’t stand seeing people be scared and taken advantage of because they’re not able to stand up for themselves in the moment because they’re sick or disabled or vulnerable in some way. RANT, RANT, RANT. It makes me absolutely nuts.

The whole day was even more baroque than I’ve reported, but this gives a flavor of it.  After I came home at 9 p.m. and spilled the whole story to my husband he said, “Wow, dear, you can be my bitch anytime!” That cracked me up – but I’m still amped up now, hours later.

 I hate Kaiser. I actually hate HMOs, period (HeathNet, under which I had my surgery, was almost as bad).

 I hope the guy ends up being okay.  I liked him a lot, and in his position I would have been a mess.

About half an hour later:  You know what? I am a mess right now! For reasons too numerous to list here but of which I'm all too aware as I think about them, today was just a triggering series of events on several fronts -- hence my insomnia and, now, the small flickerings of an anxiety attack in the offing.

I think I'll be fine: I'm going to stay up another few hours, see my husband off on his overnight hang-gliding trip, and then take myself back to bed for a serious lie-in. In the meantime, I'm going to do my best to breathe, chill out, get grounded, and regroup. The solitude and the sleep should relax me.

And hey, to make sure they do, there's always Ativan if needed. That's what that long-standing prescription of 11 years is for, after all.

And to add a little cheese to my whine ...

My weight's been up by a few pounds in the past several days -- during exactly the same time that I've been riding herd on my carb consumption and being vigilant about maximizing protein.

Sigh.

I can feel that I'm constipated, despite my use of a couple of laxatives to unplug me.  Frustrating. It's a little too far past the end of my period for monthly timing to be the culprit, so you got me.  Sometimes I think eating a lot of meat stops me up, and indeed, it might be that since I've ratcheted up the meat in the past few days to amp up the protein. 

I probably need to eat a few Krispy Kremes to clean out my system (kidding -- though since DSers don't process fat very well and most of it passes right through them, eating something high in fat and protein and low in carbs might not be a bad idea.  A big plate of bacon and fried eggs, perhaps). In general, activity seems to help over time, as does caffeine.

Part of the problem could be my large hernia, of course, interfering a bit with my guts. It poses no danger, apparently, but it could be one of the factors in occasional temporary back-ups.   

Anyway, it's at times like these that I not only don't like what I see in the mirror but I suspect that the image I see there is a bit body-dysmorphic  I spent about 30 minutes trying on and discarding clothing today after my shower because -- here we go -- I felt as if everything I put on made me look fat.  The more items I discarded, the more stressed I got -- and yet this is not something I usually do. 90% of the time I pick out what I'm going to wear and it's no big deal. Today, however, I stressed big-time..

Head trips suck.

Disordered eating

Link: Elastic Waist - Rants and musings on weight, body image, celebrities, fitness, food and other fixations.

Okay, I admit it. Although I'm genuinely very satisfied with my weight-loss results (and even think my face looked better with 40 more pounds on my frame), sometimes I feel like a B+ student instead of a straight-A honor's candidate.

Why?

Because I did not get down to Skinny.  I just got down to -- Normal.

How sick is that?  Rationally, I don't like the way Thin looks.  On pretty much anyone.  I like the way Normal looks, and I like how I look, being Normal. More importantly, I like the second chance at life that Normal gives me.

But part of me wonders what I would look like Skinny -- even though, intellectually, I know that the answer is, "Unhealthy. Old. Unattractive."

That'd be okay, though, right, because I'd be Skinny?

I have a pretty positive body/self-image at this point in my life, I think, realistically speaking -- and yet I still have these thoughts in passing -- so I can imagine how genuinely emotionally tortuous the vicissitudes of a full-blown eating disorder are.  It makes me sad for those in the grip of one, and it makes me rejoice for those who are emerging.

And it also makes me frustrated with myself and a tiny bit insecure, no matter how far I've come.  (Is it really okay that I'm not a Stick?  A size 2?)

Hmm.  You know what?  You bet your sweet ass it is. (And I like my ass now.  True, it's a tad flat, and unclothed it has a certain sag factor to it -- but in well-fitting jeans?  It's okay for a middle-aged chick. ;) ). 

Two data points

Getting to altogether new lows in weight can be scary, I think -- I mean, it's great for someone who's been morbidly obese for the vast majority of her life, but it felt like such unfamiliar territory that I found it unsettling. I think my lowest weight on this WLS journey (for a nano-second only, mind you) was 152-point-something. I stared at that number on the scale as if it were an alien from Mars and felt simultaneously elated and frightened.

Now, of course, I'm in the low 160s (i.e., a few pounds above my stated goal of 159), and I'm just trying to feel my way with that. There's often a well-known "bounce" of up to 20 pounds that happens with my form of weight-loss surgery after initial weight loss and the equally initial period of stabilization (I suppose the actual amount depends on one's basic size and other variables).

Is my current gain part of that? Or not? Is it avoidable? Is the gain okay with me? Is this amount okay, but more would not be? I've lost the hysteria I'd feel when the scale showed 159+.  Is that a Good Thing (in that I'm OCD) or a Bad Thing (in that my OCD kept me in check) -- or, simply Is It, without any kind of value judgment attached?

(How very Zen of me.  How extremely unlikely and unconvincing of me.  I haven't a clue, really, how I'm feeling about this as I write this morning.) Right now I'm simply asking myself where I'm at with the gain (but also obsessing about how I can be more or less newly in a size small in some tops, despite a gain of several pounds?!)

Best not to get too obsessed with numbers, I guess, is one message I need to focus on. The scale is one data point, clothing sizes are variable (notoriously so for women, according to era, fashion, maker) and another set of data points, and then there's fitness (poor), labs (um, gulp -- still need to do those!), and probably others as well.

As with everything else since my DS surgery in December 2005, I'm going to have to feel my way through this phase to see where I'm at and how I feel in my head, my body, and my clothes. I hate that.  I'm a control freak, and I like to  How I Feel and What I Should Do About It.

Whatever "it" is.

Two steps forward, one step back

That's the little dance I do with my carb consumption. 

It's a dance I do at night, in particular: I'll have eaten well and healthfully all day and then the night comes.  Night no longer scares me, as it used to do when I was a child, and the house was rocked with fights between my parents, or marked by my father's nocturnal visits to my bedroom.  My mother, long dead, no longer feeds me saltine crackers to comfort and quiet me in the middle of the night; my father no longer buys my implicit promise not to tell what goes on between us behind my bedroom door with food.

But 40 years later, I sure do like to eat at night, and what I like to eat are carbs! I've worked through a lot of the early food/trauma-related issues of my past, but let's face it, really archaic patterns and associations die hard, and it takes extra energy to build new ones to replace them. My carbs-as-comfort food association will be something I contend with all my life, and basically, that's okay with me.  Everyone has something, right?

I'm glad I can report that yesterday I took advantage of my membership at GNC and bought a month's supply of protein bars and shakes (yes, I still use them as one of the tools in my arsenal to make sure I get enough protein and don't veer too far off track) -- but I'm not thrilled with the fact that, later that evening I also dived face-first into a bag of Doritos and a few tiny bags of M&Ms. (Some Doritos, rather than two cereal bowls' worth, and a single 100-calorie packet of M&Ms would have been fine in my book -- but not the amounts that I went for.)

Mostly I find that the higher I boost my protein during the day, the less inclined I am to carb out at night, so that's my plan for today. Let's see how I do.