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.)

Back in my happy zone

Goal weight: 159. Happy zone: 159 +/- 5 pounds. 

This morning I was 163.6, down 2.6 from last week and considerably more than that from my frightmare high of 169.2  that sent me around the bend a couple of weeks ago. Officially I'm back in my happy zone.

(Note: There's nothing intrinsically wrong with that higher number for a woman of my age and height, or for anyone else, frankly. It's not the number itself but what it represents to me that I find hard to deal with:  i.e., I allowed my weight to climb to a point that I did not feel personally comfortable with. For most formerly morbidly obese people, especially those who have had successful WLS, gains like that are threatening. That's what this is all about, rather than about being some ideal, prescribed weight.  Hell, I think according to Weight Watchers I should weigh anywhere from 138-154.  Uh, no thanks.  I've seen skinny on others; it just doesn't wear well and it's not something to which I'd aspire, you know?)

My lower weight this week is a combination of factors: 1)  this tends to be the point in my cycle when my weight is lower; 2) I've been tracking my food carefully in Fitday, which has caused me to eat fewer calories, though not necessarily to eat as well as I ought; and 3)  I've been exercising more.

Yeah, I'm one of those middle-aged DS women (I'm 47) who, at 2 years and 7 months out from surgery, is able to eat a fair amount of food but who also must exercise -- as in, put in some genuine sweat equity -- if she's going to do that and maintain the weight she wants. I suspect this will be true for younger, 30-something DS women as they age, too, because it's a pretty common experience among women generally, WLS patients or otherwise.

Welcome to the human race.  Welcome to normal.

Scale frightmare

Can someone kill my scale for me?  Please?

I both don't and do know how my weight is at 169.2 (if that makes sense), a clear 10+ pounds over my goal weight: I look at my food journal and think, "Huh??? That number can't be right" -- and yet I've felt the added weight in the last week and I know I've been eating more carbs. "But ... but ... but I was 163.-something a couple of weeks ago!" Yeah, well, I'm not anymore, am I?! 

So I'm feeling a little ... I was going to type "freaked," but I realize that what I'm feeling is more specific than that. I'm feeling disempowered -- by a number? Not exactly. It's more that I feel fear that my weight is out of control (a very common fear for WLS patients and for many who have lost lots of weight by whatever means), and that fear itself disempowers me. I disempower myself.

If that's true, then I can take back that power. That's where the self-talk comes back in -- and yet I'm just kind of resisting that. I guess I want to be beyond having to expend that kind of psychological energy, to have internalized all of that more. Most of the time I feel as if I am and I have -- more or less -- but hey, not right now.

Fodder for the therapist tomorrow. He'll be thrilled -- mostly we just talk about stress management these days! ;)

A new day

Did a 2.25 mile walk first thing this morning get my day off to a good start?  It did.

Did staying focused on protein, minimizing carbs, and getting in enough liquids keep the day In the Groove?  It did.

Did working on staying in the present and not fretting about work on my day(s) off help me feel more focused and connected to life generally?  You guessed it -- it did. (I won't say I didn't do any worrying, but I simply tried to breathe through it, and for the most part I was successful.)

Suffice to say that today has been a much better day than yesterday. My husband and I even saw a movie together (Mongol -- beautiful cinematography and a script that was less than no where). This is a rare occurrence, indeed, as our tastes in films don't overlap much -- so whenever there's a movie that could be classified as "historical" we take advantage of it because that's about the only common cinematic ground we have. That, and perhaps documentaries.

As I contemplate the coming week, I'm resolved to stay focused on R&W.  Most of my work this week will be devoted to revising a chapter of my dissertation to send out as  an article on June 30; it's tangentially related to issues I'm working on in my current project, and I'd like to have at least one article under consideration at the beginning of the summer, with a couple more to follow by the end.  Whatever revisions I manage to make by the 30th will be it for the present, however; one pretty much always has to revise for editors, anyway, so there's no reason to knock myself out at this stage. Also, at this point, I simply need to put something decent out there.

In and around revisions this week, I'll continue to move ahead with the research component of my new project. That'll allow me to alternate between tasks, which in turn will hopefully keep me from becoming overwhelmed by either.

And on the food front, I'm considering not weighing this week so that I can focus on using the cues of physical hunger -- rather than the scale -- as a guide to more intuitive forms of eating. (The last time I tried this I actually gained weight, as I let "intuitive" equate with emotions; I'd like to bring that more in line with the intuitive nutritional needs of my body -- and then I think I'd be okay.)  I've reduced my carbs since being back from vacation, but I'd feel more comfortable cutting them back further, and I'd also like to up my protein.  I think I can safely say that I always meet my daily minimum, but I'd feel better if I hit closer to 100 grams a day.

Exercise? I'll never be a gym rat, but these days I truly enjoy a morning walk. Of course, I also enjoy sleeping in, so I'll need to figure out a way to juggle my love of bed with the slightly delayed form of gratification that walking represents.  In other words, I'll have to talk myself out of my sloth mode.

Not as easy as it sounds, but I'll give it a good shot this week.

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.

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.

Reentry

Yesterday's return to campus life and teaching following spring break was relatively painless, albeit busy (today will be even busier). I absolutely benefited from the rest I managed to get last week, and now I can take on the rush to the end of the semester.

There's some departmental fall-out from the search committee's recommendations to the dean regarding making an offer to a Chair candidate -- but I laid low yesterday, didn't get hassled as a member of that search committee, and feel comfortable and confident in the fact that, whatever shakes down, the committee did a responsible job.  Let others angst out and have all the Sturm und Drang -- I'm done!

With minor slips here and there, the mindful eating seems to be going well.  A little over a week ago I was at 165; yesterday I was at 160.4. Less than two pounds to go and I'll be back under goal. It's not even difficult to do: I make sure to focus on protein first, then try to choose complex carbs if I'm going to have them, and if I do opt for simple, refined carbs, I generally try to pair that choice with a little protein.  Okay, a few Lindt truffles followed by a piece of cheese may sound odd, but the cheese a buffer against the chocolate's hit to my blood sugar, it's protein, and the fat in the cheese means my system doesn't hang on to it -- so it's all good.

Time to get organized for the day.

158.6

Back under goal by just a smidge this week -- after being above goal by a few pounds for a couple of weeks.

Being above goal is frightening to me.  I feel as if I'll zoom back up the scale to 280 in no time flat, and so maintaining at (or preferably a few pounds below) 159 is critical to my peace of mind.

I'm trying to figure out if it's worth it to me to lose another 10 pounds and make 149 my new goal after living at 159 or lower for the past almost year -- or would that feel too restrictive,  make me crazy in the head?

I like seeing lower numbers on the scale in response to eating less.  I like feeling as if I can make those numbers move lower and as if I have power -- particularly when I'm stressed.

But I also know that there are healthier ways in which to feel empowered, that I tend toward OCD.  I worry becoming compulsive about such an effort to reduce my weight further. Frankly, I fear becoming eating-disordered in a new and different way from the compulsive over-eating which plagued me most of my life and with which I am most familiar.

I'm just mulling it over. No verdict yet. I need to make that choice  during a period of calm, not in the midst of intense stress such as I'm experiencing right now.

Monday Monday

Well, I'm up early PST to crank out a piece of work before I head to a 7:45 a.m. psychiatrist appointment for a meds check. I'm happy to say that this shrink is a good guy, non-manipulative, and both my anti-depressant and new anti-anxiety meds are working well; the mood difficulties of November-December appear to be behind me, despite the intense stress of my current work schedule - yay!.

Then I head to campus to teach a class, go to the usual weekly staff and faculty meetings, and hold office hours. I hope to get some grading done if students don't drop by.

Long day -- but then I'll have tomorrow and the next day at home to focus entirely on my work for a professional conference at the end of the week.

I haven't stepped on the scale yet for what I think of as my official weekly weigh-in (Mondays are the days for that). I'm still in my robe, but that'll happen when I doff all clothing before stepping into the shower.  The number is going to be too high for my taste, I know, and probably still above my goal of 159, tops.

That'll be a little crazy-making. On the other hand, I know what I need to do to bring that number -- whatever it is -- down.