The Further Adventures of Deluzy

More surgery?

I'm sick of this menstrual misery.  Just sick of it.

I'm now back to thinking that next summer it will be time for the surgical triple whammy of a hernia repair, hysterectomy, and abdominoplasty. 

My hernia is large; that repair will be deemed a medical necessity.

Given the gynecological history in my family (i.e., a mother who died of possible ovarian cancer, two older sisters who had hysterectomies due to benign growths) and my own severe anemia and menstrual pain, I know that a case of medical necessity can be made for a hysterectomy.

That leaves the abdominoplasty. Which I'd never consider on its own, but as long as they're slicing and dicing me, I might as well get it done.  It would be difficult to make a case for medical necessity there, as my panni is just big enough to be unattractive but not to cause skin rashes or impede mobility.  Still, there may be a way to get that covered, too.

If not, that's why a pre-tax medical savings account comes in handy -- though even reimbursement from that would be tricky because it covers things that are necessary, not optional. Still, who knows.

Obviously I need to do the research.

But I've had it, I think. I don't and won't have children, I'm 47, my periods are getting worse, female parts don't wear well over time in my family, my hernia is getting larger and becoming more inconvenient, and if I have a year to research, plan, and pscyh up, I could probably deal with another surgery. It will suck, it will hurt worse than the actual duodenal switch (mine was done laparoscopically), and it will be a long recovery -- but there you go.

That's today's current thinking, anyway. 

Now it's time to put that issue aside (I've been mulling it over for the past 24 hours) and do some work.

Scale number is dropping

and I must say that's a relief! 

I wonder if anyone who's had WLS ever gets entirely past the fear of regaining all one's excess weight.  If you've lived your life as a morbidly obese person with many failed weight loss attempts, the experience of regain and failure is all too common -- so even a small gain under unusual circumstances (like a vacation) can seem threatening and can call into question one's own faith in the ability to make weight loss permanent.

At any rate, I've dropped almost 3 pounds since my return, so I'm moving in the right direction. I have 0.4 more to go until I'm back in my happy zone -- that's entirely doable -- and I'm thinking I'd like to push past that back down into the 150s again this summer, despite the fact that all doctors are happy with my weight now: I think I'll just feel a little more comfortable in warmer weather with a few more pounds gone and slightly looser waist bands!

Now, however, it's time to shower, dress, and settle down to some research. It's a beautiful, warm day here, and I feel so lucky to have had a terrific vacation and to be working on an interesting research topic in the supportive, cozy environment of my home study.

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.

Preliminary lab results

I'm here in my office, about to climb into academic cap and gown, and my PCP called with preliminary lab results. 

Bottom line (for her):**

• My iron's low but not as low as it has been in the past.
• My protein is a little low (I need to look at all the numbers before I know what that means from a DS perspective -- possibly more protein shakes)
• My liver enzymes are still high (common after WLS) but coming down.
• My good cholesterol and bad cholesterol are great.
• My blood sugar is wonderful.

(Apparently I'm my PCP's only DS patient, though she has any number of other WLS patients, and she told me today that so far I've had the least number of health issues due to surgery of any of her WLS patients -- by a long shot. Frickin' amazing.)

But it's that fifth bullet point that blows me away the most.  Normal A1c levels are 4-6%, and I was at 11.7% on three different diabetes meds on the day of surgery.

Today I'm off all diabetes meds and at 5.1%. Smack-frickin' dab in the middle of normal.

Now, the A1c is up from a year ago's 4.5%, as my body adjusts and I'm eating more carbs.  My feeling is that I'll always need to stay aware and moderate those carbs -- maybe better than I do at present, in fact, and so I need to work on that now while I can and it's not a crisis stuation. And perhaps when I'm older the Type II diabetes will return anyway:  my mother was tall and skinny and had it, after all. 

But right now? I'm grateful for every second chance this surgery has given me, and I'm going to work hard to protect them!
_____________
** My PCP is going to mail me a copy of my labs so that I can go over them with a fine-tooth comb and send them on to Dr. K as well. I'm sure I'll see numbers that make me nervous because I always do -- but I'm glad that the initial evaluation, at least, is more or less positive.  We'll see what the vitamin results are a little later.

Note to Sharon: If I dare to  miss my 3-year benchmark labs in December, slap me with that wet noodle again! Tolerate no excuses about busyness. Who's not busy, after all?! 

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. ;) ). 

Too much information -- seriously

Okay, here's the monthly routine:

• A few days to a week before my period, my weight drops to its monthly low, whatever that happens to be.  Not only do I not feel like eating that much at such times, I feel as if I literally do not have as much room to hold food in me as I do during the rest of the month.

• Directly after my period, I'm constipated. For a few to several days. Minimal shitting, if it occurs at all.  (Most fellow DS patients will understand that this is, er, odd, to say the least. Particularly for me, as I shit like clockwork, each and every morning, usually several times within an hour of getting up.)  Hence, my weight soars, sometimes by as much as 5 or 6 pounds.

• (During my first year out from surgery, I worried that I had an intestinal block at such times. Now I know that it's part of my pattern -- though if I'm feeling stressed and neurotic, I can still whip myself into a frenzy over the possibility.  If I'm not stressing over that, I stress that I'll skyrocket my way back to 280 within, oh, 5-7 days.)

• To add insult to injury, my appetite returns.  I can eat a man with a hollow leg under the table.  Well, almost

• In desperation, I'll occasionally take a dose of a laxative -- Miralax or, rarely, ExLax. No, not because of what the scale says -- that's not my particular trip, though the rapid rise in weight does scare me --  but because the poop's in there, damn it, and surely I'll feel less bloated and stuffed if it comes out.

• Which it does, a day or two later following said dosing of said laxative.

• At which point, my body returns to its regular scheduled programming for the next three weeks or so until we lather, rinse, and repeat a month later.

I so do not remember this particular pattern from my pre-DS days.  However, I was pretty out of touch with my body at the time, and I could gain or lose 5 pounds without blinking an eye. Perhaps it happened then, too, and I just didn't notice the monthly pattern.

These days I notice.

For the record, I'm at that point this month where my appetite has -- presto, change-o -- returned. I have a date with that man with the hollow leg.  Oh, and my body gave up its monthly load of crap today.  Finally.

(See? I told you it was TMI.)

I enjoy being a girl

Not. 

I'm just waiting for menopause.  Menopause and I will be Best Friends.  We will walk into the sunset together.

Because this shit is for the birds.

It's also quite possibly an argument against the existence of God. Who would make something this ... leaky?  Design flaw!

It's not a miracle, for heaven's sake. It's more like a rough draft that still needs some serious work.

I give it a C.

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.

Mindful eating

That's what I've been practicing for the past couple of days in order to get myself out of the Carb Rut I'd been in for the past several weeks. 

I turn to carbs when I'm stressed, tired, whatever -- and sometimes that's simply about reverting to old patterns from the past because they're familiar and require less awareness and vigilance on my part -- in short, less energy. In view of my pre-spring break schedule, energy was in short supply.

Not that the carbs helped with that -- they really just made it worse in the long run.  A quick up, followed by a prolonged down. I'm not carb-averse, mind you; I simply need to keep them down to a dull roar. If I want them, I'll have them -- but I don't want to engage in the fatigued, mindless reaching for carbs. When I eat them, I want it to be a choice, and I want them to taste good, and I want to enjoy them.

Anyway, Protein First and Practicing Mindfulness have been working for me for the past couple of days.  DH and I went out for an early lunch today, I had a delicious chile verde, about a third of my salad, skipped all but a couple of bites of the rice and beans, and was stuffed. 

About 5 hours later I thought about what I wanted when I was out running errands -- and what I wanted was a small hot chocolate and a piece of shortbread.  I had them.  They were delicious, too.

I came home and had a piece of cheese.  More deliciousness.

And this evening I'll probably have a protein shake (not so delicious but necessary) and some popcorn.

My weight's dropping once again. If I stick to DS basics, take my supplements, and allow myself the occasional treat, it all works.

Which still amazes me.

Another amazing thing: I stopped at a clothing store that's a little pricey but it was having a 70% off sale.  I tried on three tops and jackets, none of them in styles I'd normally go for, all of them in medium.  I asked for the next up in one of them -- and the saleswoman brought me another medium, thinking I was already wearing a large.  "Well, the size you have on now is too big," she said then, surveying me.  "if what you have on now is a medium, then you need a small."

Hmm. 

I couldn't wrap my brain around that one.  I bought the medium.

One of the tops was a wrap top. Let me just say that wrap anythings have always looked crappy on me, fat or thin.  But this suddenly looked good.  Works with skirts or jeans and boots. $14.99. I bought it, too.

When I catch unexpected glimpses of myself in mirrors now, I'm usually struck by two things: 1) I'm much smaller than I think of myself as being; 2) I look just like my mother as I get older.

Both impressions are probably pretty accurate.

Looks (and looking)

I meant to write about this on Saturday but was too trashed to do so. 

I experienced a rare but sustained flash of anger in and around my appearance that day -- or rather men's reactions to it (note how I instantly phrased it as almost something to blame myself for!). I wore a form-fitting V-necked sweater-dress from H&M with a hem that hit a couple of inches above the knee, black tights, and black knee-high boots with a 3-inch heel --> a perfectly modest but admittedly sleeker and more streamlined look than I usually go for (my hemlines tend to be long, my clothes tailored but not fitted) -- and can I just say that there was a distinct and noticeable difference in men's reactions to me throughout  the day as I walked around San Francisco?

Specifically, they looked often and obviously. Male store clerks and passers-by held doors, served me immediately, blah, blah, blah. No one was leering, but I was suddenly aware of being so much more On the Radar Screen and Way More Visible than I'm accustomed to being.

All apparently because, as my husband put it when I came home In a Mood, I had "dressed sexier" that day, and of course the body I dressed -- my body -- is 120 pounds lighter than it used to be. And you know what? Saturday's reactions utterly pissed me off!

"Well, it doesn't take much, then, does it?!" I snapped at my poor husband, referring to men and their radars. "It's not like I've gotten myself up like a tart!" (And oooh, yes, I recognize that I still have lots of baggage around attracting male attention --> It's Still Not Okay, on some level, in my scheme of things.)

My husband, tolerant and patient man that he is in these particular situations, assured me that I looked pretty, sexy, and entirely respectable on Saturday (which, he claimed, was an appealing combo in itself and thus probably the source of the attention), and then just let me vent. (He cooked dinner for us that night no doubt hoping that I'd chill out with a little protein in me as well as a little rest - lol.)

So -- GRRR. I think I don't face this kind of issue often because I don't dress to show off my looks (nor was I aware of doing so on Saturday), I'm married, and I'm heading toward 50 -- all of which I realize I rather count on to keep male attention at bay because I never learned to deal with such things earlier in my life, really. Excess weight was an effective barrier against that most of the time.

But of course, none of those things (i.e., weight, marital status, age) necessarily impinges on one's attractiveness, or other's sense of it, or one's own sense, and so there's still lots to sort out, head-wise.

I sure am glad my husband married me when I weighed 268, though. Fat or thin, I'm sexy to him, and the least of it is my body.  I think I'd deck him if it were otherwise, and I think I'd have bitten his head off if he'd suddenly evinced more sexual interest in me when I became thin.