Tag Archives: bariatric surgery

A few weeks ago I got to take a week long business trip to Irvine, California.  I took advantage of the opportunity to go out to the beach a couple of evenings I was there, and walk in the sand.

I lived about a year and a half in Hawaii when I was a child, and it's been that long since I've been in real surf.  (I maintain that beaches in the Gulf of Mexico do NOT have real surf.)

It was awesome to walk on the beach in the edges of the surf.  It was awesome in a different way to get reminded of the sheer power of the ocean when I didn't pay attention and got my feet yanked out from under me by one of the larger waves.  (No serious damage was done, just Mother Nature reminding me that she'll knock you on your ass if you don't respect her.)

As it was, I walked a LOT further down the beach and back than I originally intended to.  I had forgotten that walking on sand at an incline is a LOT more strain on the legs and feet than on level ground.  So I was incredibly sore when I got back to my car (not to mention having sand EVERYWHERE) but it didn't appear to flare my rheumatoid disease any worse than it already was.

Yes, it appears that my RD/PsA is not in remission as we had hoped.  We're currently waiting on blood test results that will inform our treatment decision, but just from my pain levels and where the pain is, I can definitively say I am *not* in remission.  It was a nice thought, but now it's time to reassess, remake the plans, and move forward.  My pain levels are reaching the point of interfering with good sleep and trying to keep me from moving.  But my week in California taught me that moving actually lessens the pain - at least after the first few minutes.  I was

My pain levels are reaching the point of interfering with good sleep and trying to keep me from moving.  But my week in California taught me that moving actually lessens the pain - at least after the first few minutes.  I was in a situation where because of parking costs, I had to walk about 2 city blocks each way to get lunch every day.  This is in addition to my evening forays to the beaches.  Once I got up and started moving, I felt better.  (The weather helped because it was drop-dead gorgeous the entire time I was there.)  So I'm committed to stay on my exercise program.  Right now I'm focusing on water walking/swimming twice a week, and plan to start adding on light weight training soon.

I also went to a meeting of an in-person weight loss surgery support group, and found that I like them and the format very much.  They even convinced me to join them in a 5K walk later this month.  So the Mister and I are going to start walking as much as we can in the Texas heat to prepare for it (he's doing the 5K with me).  I may not finish, but I'm going to give it my best shot.  I have told my friends who are runners that this is NOT a gateway for me to start running.  They just laughed.

So that's where things stand in TheAntiChick's world.  Not perfect, but doing OK.

So today marks the one year anniversary of my life-changing surgery.  I had my checkup with my surgeon yesterday and got the best surprise.

You see, I have a scale that is consistent but not accurate.  It has consistently throughout this process weighed me 5 lbs lighter than the doctor's scales.  I thought I could trust it.  Yesterday morning, I got on and it said 198# which I converted in my head to 203#.  I had been down to right at 200# and had been waiting to break into what WLS peeps call "ONE-der-land".  I'd perversely hoped that it would happen for my check up day.  But alas, weight fluctuations happen and while I wasn't upset about the seeming gain, I was a little disappointed to have my official 1-year weight over 200#.

But, when I got on my doctor's scales, this is what was displayed:  199.74# with a BMI of 29.5 - which made me VERY happy.

A BMI of under 30 means I am no longer clinically obese, now I'm just overweight.  I actually reached that point a few pounds ago, but this is the first time it's been recorded in my chart.

I don't like the BMI for a lot of reasons, but it is the measurement that's used most often clinically.  So getting that "Obesity" classification off my record is a big win.

I don't usually post a lot of pictures on this blog, but today's a special day.  Here's where I started.  The picture on the left was a few years ago at my nephew's wedding, the one on the right is my wedding in 2015.  I topped out at 306# a little after this.  I don't actually have any pictures of me at my highest weight.

 

 

Here's my pics today:

 

And a face-to-face comparison from just before surgery to now.  This is where I think the weight loss REALLY shows:

I've already written about the health improvements I've seen from the WLS.  While I'm afraid that my rheumatic disease is not, in fact, in remission, the other improvements are amazing.

I was setting up my pills today for the next couple of weeks and kept looking for more pills.  That can't be all the medicine I take!  Yep.  I now have only 4 prescriptions I take regularly - my allergy medication (one pill and a nose spray), my proton-pump inhibitor to protect my sleeve from meds, and my cholesterol pill.  I hope to lose the cholesterol pill soon as well.  I do still have migraine medicine for when I need it, but no longer take a preventative.  Even with the vitamins and supplements I need to take, I'm taking MUCH less each day than I used to.

So 1 year out.  Not quite to goal, but under 200# and that's amazing.

More to come...


Picture from the No Body Shame website

I have previously talked about my struggle with the cognitive dissonance between wanting to support/promote/embody body positivity even though I have had WLS.  Cognitive Dissonance

My news feed this morning sent me to Dances With Fat, specifically to a post talking about not allowing weight loss talk in body positive spaces.
Do Body Positive Spaces Have to Allow Weight Loss Talk?

And this led me to another post by the same person about Weight Loss and Size Acceptance

These two posts got me to thinking hard about body positivity and weight loss, specifically weight loss surgery. I don't want to think that I am not an advocate of body positivity. But the Size Acceptance (SA) community, the Fat Acceptance (FA) community, and the Body Positivity (BP) community seem to have a blanket exclusion for anyone who wants to change their body size/shape, regardless of the reason.

There are two separate issues I identified with the articles linked above - speech and behavior in SA/FA/BP spaces, and where people who want to change their bodies for whatever reason fit in the movement.

I agree that SA/FA/BP communities need safe spaces in both internet space and meat space, away from talk about weight loss. I totally get that and wholly support it. I don't expect to go into SA/FA/BP spaces and say or do anything that sends the message that people of size need to change themselves. It's their space, and they establish guidelines for speech and behavior in order to protect the other people in that space. It would be pretty rude of me to go in there and say that people are okay at whatever size but that it's still better, for me at least, to be smaller.

Then there's how people who have or want to lose weight fit in the SA/FA/BP movement. I know a lot of people through my WLS support boards who got fed up with their body and size and looking "better" is their primary motivation for weight loss. That's totally cool, and I consider that as valid of a reason for weight loss as any other. But I'd have a hard time saying that they promote body positivity or size acceptance.  They can advocate against discrimination and bullying of people of size (and most do), but when aesthetic reasons are their primary motivation, it doesn't mesh with the ideals of body positivity.

Then there are people who share my mindset about weight loss. My primary motivation is my health, period. If I could have affected the health improvements I have had through WLS through any other means, I would have done it. I wasn't all that unhappy with my size, and would never have done anything this radical just to fit in smaller clothing. I am finding myself thrilled with some of the superficial changes, but they are absolutely secondary (or even tertiary) to my health goals. I had WLS *because* I love myself.  But the SA/FA/BP community doesn't just want me to respect their need for safe spaces without diet talk, they want me to believe that I'm not SA/FA/BP because I want to be healthier.

Therein lies the problem for me. One woman commented  that she needs to lose some weight because the fat itself is impeding her from being able to take care of herself. Her lymphedema (extreme swelling of the extremities) requires her to compression wrap her legs and she's unable to physically do it because of the amount of belly fat she carries. Her health is impaired by the fat itself. It's not a theoretical exercise of whether fat people can be healthy, or if losing weight really leads to better health. Her fat keeps her from taking care of herself. She doesn't care about fitting into smaller clothes or an airline seat, she needs to be able to move well enough to maintain her own hygiene, dress herself, and take care of her medical needs. Yet the author's response was that losing weight is never permanent, and the commenter needs to focus on accepting herself where she is.

As a nurse, this kind of one-way thinking horrifies me.  Hell, as a rational thinking human, this horrifies me.

Yes, the evidence shows that diet and lifestyle changes are rarely successful long-term. The evidence also does not support the idea that being overweight automatically means that someone is not healthy, or that someone who is thin is automatically healthy. Weight is not the only factor in health, and it needs to stop being treated as if it is. The overweight patient with an ear infection needs treatment for the infection, not to be told to lose weight. The overweight patient who tears a major ligament in their knee needs surgery and physical therapy, not to be told there's nothing to be done until they lose a set amount of weight. Shaming someone about their weight is counter-productive. No one should feel bad about themselves because of their weight/size. And frankly, if you're not part of that person's medical team, their weight and size is none of your concern.

But when the excess tissue ITSELF is causing health problems, it is irresponsible to maintain that the person should do nothing about it in the name of SA/FA/BP. And some health conditions, even if they are not directly caused by excess weight, can be vastly improved by losing weight. It is irresponsible to tell a person that there is no benefit to losing weight because it cannot be kept off. Shaming a person for wanting to better care for their body should be completely against the tenets of Body Positivity. That person is not saying other people need to make the same choice or preaching that her size is unacceptable. She is saying that she - and she alone - needs to try to do something in order to maintain or improve her health.

Interestingly, when doing a little research for this post, I found that the Health at Every Size (HAES) curricula does not, in fact, teach that everyone is at the size/weight they should be, and instead states that many people have weight-related health concerns. HAES advocates learning to eat intuitively and physical movement to improve health. The difference is that HAES wants people (especially medical professionals) to start looking at more health indicators than weight and de-emphasize weight as a primary health indicator.

Here's what I believe. People of all sizes need to learn to love their bodies and quit buying into society's media-driven image of what beauty is because diversity is beautiful.  People who don't fit society's warped view of an appropriate size/weight suffer a great deal of discrimination right now. Size shouldn't impact your ability to get a job or raise or promotion. It shouldn't impact your ability to exist in public spaces (doors, chairs, etc.). It shouldn't be the only thing medical professionals look at, and it absolutely shouldn't be a determining factor in treatment decisions. Fat is not a moral failing, and it shouldn't be treated as one. Fat people aren't lazy, and they are not fat because they have no self-control. No one should be harassed or bullied in any fashion because of their size. In fact, someone's size/weight is none of your business unless you're on their medical team. Even then, the person deserves nothing less than professional and compassionate care.  Diets don't work and are very damaging to health.  Weight-cycling is more damaging to someone's health than being overweight alone.  Basically, I believe almost everything that the SA/FA/BP groups purport to believe.  The only point I differ on is the exclusion of people who have reasons to need to change their body.

So I'd like someone to educate me as to why I have no place in the SA/FA/BP movement. Because I just don't get it.

 

<--- this pic is where I started

this pic is where I am now -->

I actually started this post back in March, when I was 7 months post-op.  Work, grad school (#gradSchoolSucks btw), family issues, etc. derailed my good intentions to start writing regularly again.

May 17 was my 9 month anniversary of surgery.  I met with my surgeon and my rheumatologist that week.  They were both very happy with my progress.

There are days when I wonder what the heck I did to myself. But they are few and far between, and usually right after I've eaten 1 or 2 bites too many, or eaten something that my sleeve disagreed with. Most days, I really can't complain, and would do this surgery again in a heartbeat.

My rheumatologist believes my rheumatoid disease (RA/PsA) is in remission.  She'll re-do all my bloodwork in August and see where it stands.  Right now, I still have some joint aches, but it's mostly minor.  I seem to have been right about the meds causing a thyroid issue, because all of the associated symptoms are gone.  I am now off my RA/PsA meds, we are tapering off the meds for fatigue, and I accidentally stopped the migraine prevention meds without tapering but didn't have any issues.  Since surgery, I have gotten off (or am currently tapering off) 5 medications, including all blood pressure medicine, the med for fatige, my RD meds, and my migraine preventative.

Back in March, I had to run out at lunch and get some new slacks for work. I had been able to get by through "shopping my closet" for pants I'd stored away years ago thinking "I'll get back into these someday". Well, someday came, and it's now long gone. Those pants from almost 2 decades ago had become too baggy to be respectable, so I took a chance on some lunch shopping.  I went from a 22/24 pant to an off the rack 16.  I couldn't find off the rack pants that fit the last time I was in a 16 as a teenager.  But now "curvy fit" pants are available, and they work for me, as I have a small waist compared to my hips.  I also didn't plan ahead, and did the shopping in 3" heels, without any issues.  That would have crippled me a year ago.

Now at the end of June, those pants are getting loose.  Not so loose that I have to replace them, but starting to look a little sloppy.  I'm now in an adult Large shirt from a 3X.  I bought skorts at Sam's the other day, which never could have happened when I was in plus sizes.  I have lost 102# as of right now.  My BMI is teetering on the overweight/obese line.  One more pound lost, and I will no longer be clinically obese.  I could stop losing weight right now and all of my docs would be thrilled.  But I'm not stopping.  I have another 30# or so to lose to get to my target weight, which I set by looking back to the weight I was the last time I looked and felt awesome.

I still haven't started exercising regularly again since the health issues of the winter/spring.  But I'm feeling good and it's only my insane time pressures with work and school that are keeping me from it.  I have a plan to ease back into the workouts so I can start rebuilding some lost muscle.

Life is pretty darned good from this side, I must say.

 

If you don't read the XKCD comic, you should. XKCD Duty Calls

I've been a "netizen" since the early days of dial-up AOL. I probably shouldn't admit that, since it reveals just how long I've been on the internet and thus how old I must be. For an introvert like me, the internet provides a lot of social interaction from arm's length. This has upsides and drawbacks. One of the upsides that I see is that it provides people with access to support groups they might not have access to in real life for many reasons. Over the years I've been involved with many online bulletin boards, discussion groups, message boards, etc. I like being able to talk to people all over the country and/or world who have similar situations, hear their stories, and discuss our accomplishments and challenges. I've had support in this way for various health conditions I've struggled with, marriage, spirituality, parenting, and many more.

So it was entirely predictable that when I started thinking about weight loss surgery, I'd seek out some online communities for WLS. I found one right off the bat, had some very positive interactions with some of the board and WLS veterans, people who had surgery and had kept their weight off for a couple of years or more. I got exactly the support I needed, shared experiences from people who had been through the surgery I was contemplating, and lots of discussion about the insurance process, all of the appointments needed, the surgery process, and much more. I didn't feel the need to go find another board because that one met my needs.

With my long history on the internet, I know that anywhere there are people, there are politics. When writing on the internet, you can't convey body language or tone so it's easy to misinterpret what someone is saying. People take offense easily, and cliques form. It's the nature of a community. There are always people who annoy me online, and I pretty much just ignore them. Some people engage in online battles for a number of reasons, and it can get messy. But for the most part, people work it out and you just try not to step in the mess. The board I'd found seemed to have appropriate, mostly hands-off, moderation and the veterans were a great source of information and inspiration.

I was warned that the WLS boards are full of misinformation and not always the best support for newbies, but I have a medical background and am pretty good at weeding out bad information. I don't have the time, energy, and access for in-person support groups, even though my surgeon offers them. I also offered my take on things as a registered nurse having done a lot of research into the procedure, because once you're a nurse you just can't help but educate people about medical issues.

As frequently happens, the board I was part of blew up with accusations of long-standing members bullying and terrorizing (yes, that's the actual language that was used) new members after months of tension originating from new posters who were not interested in actually changing their relationships with food and their lifestyles. They seemed to want the surgery to be a magical fix for their weight, without requiring any change to the way they eat. The veterans of the board were marginalized and attacked for trying to provide sound advice and experience, and accused of bullying when they would not coddle people who seemed to be looking for absolution and/or permission for poor and even dangerous decisions.

I'm not posting this today to rally up rebellion or retaliation. I'm not going to name the board in question. I'm posting this because a few people interested in or who have had WLS read my blog and I want you all to keep a few things in mind about online support groups.

Support groups can be fantastic. They can also be detrimental, even dangerous. It's up to you to carefully evaluate what you need and what you are getting from a group. No one is qualified to dispense medical advice in a support group. I as a registered nurse, can share some of my knowledge and research with you. But I cannot give you any medical advice. It's not legal, and it's not ethical. I don't know you, I don't know your medical conditions and history, and I don't have your medical record and treatment plan to reference, nor do I have orders for you from your physician to implement with you. Even doctors and nurses can have incorrect or outdated information, too. But the lay people are only repeating what they have read or have been told. Even more specifically, they are repeating WHAT THEY UNDERSTAND about what they have read or have been told. As a nurse, I can tell you that a LOT of people don't understand completely what they are told/taught by their medical professionals. Bottom line, take what they say, do your own research, come to your own conclusions, but for the love of all that's holy, LISTEN to your doctor and your medical team. Unless they are incompetent, they are the final say in your treatment and recommendations. If they are incompetent, find another doctor/team.

Piggybacking onto that, recognize that every doctor and team out there has a slightly different plan and set of rules. There are still doctors out there who will tell you that you'll damage your sleeve if you drink with a straw. That's malarkey. The reality is that SOME patients swallow a lot of air when drinking with a straw, and it can cause a LOT of discomfort in a new sleeve and for some people it never stops. Those people will be miserable anytime they drink with a straw, forever. Most people will have no discomfort, or it will only last a few weeks. But air in the sleeve cannot damage it. Just like you can't stretch or burst your sleeve by drinking too much liquid. You can make yourself miserable, but there isn't enough pressure to damage the sleeve, liquid will either come back up or go right through. But you'll have people online swearing that you're going to kill yourself if you drink with a straw. Or drink carbonation or whatever. Because they were told that by their doctors. Or they misinterpreted a short-term restriction as a forever restriction. The variations include post-operative diet progression plans as well as weight-loss diet plans. Some programs preach very low carb, others are more moderate. The one thing they all have in common is that you have to change your relationship with food, and the sleeve is just a tool to help with that.

Some online boards are run as a profit venture. For WLS, they could be operating a store selling WLS vitamins or protein supplements and foods, or they could have a business that coordinates surgeries out of the country. This is not a bad thing, because those are needed services to the WLS community. What it can mean, however, is that the motivations for the way the board is run and moderated is not about providing support, it's about profit.

Also, while it shouldn't need to be said in this day and age, nothing you put on the internet is truly private. Don't ever think that private messages are not accessible to other people, especially moderators/admins from the site you're on. You're trusting those people to preserve your privacy, and that's a mistake.

I'm not telling you to stay away from support groups. In person, they're usually moderated by a person from the surgical team who makes sure that the information is consistent with what that team teaches. Online, they can be a great outlet for people who don't have access to an in-person group for whatever reason. But they should never replace your medical team in terms of advice about what is or is not allowed for you at a given stage pre- or post-op. And it's easy for an online community to become an echo chamber, where dissenting opinions or criticism is not tolerated. If your online group coddles bad choices and reinforces them, it's not going to help you in the long run. A good support group helps you recognize when you're resisting the needed change and helps you keep to your plan to reach your goals. That often requires blunt critical feedback, and it's not always easy to take. But it's necessary. If you just want people to pat you on the back and tell you your poor choices are OK, stick to friends on Facebook or whatever.

Bottom line, don't let any group, especially an online one, replace your own common sense or the advice of your medical team. Having people support you with a huge life change like WLS is a good thing. Just remember what it is, and what it is not.

I know it's been weeks since I posted anything on this blog. The end of the year is always a bit of a blur for me, and this year is no different. Mea cupla.

Halloween rushes into Thanksgiving, and then there's a rush of birthdays and anniversaries for me before Yule gets here. Add in the end-of-term school projects and shopping/knitting for presents before Yule and people pestering me to start my holiday baking, and it's a recipe for craziness. I have one more school project due in two days, and then I'll be done until January 9th. So Saturday will be the start of my holiday rush and I can start catching up on sleep.

During nursing school, I thought I would never be so happy as when semesters ended and I could catch up on sleep. All I can say now is #gradSchoolSucks. In fact... https://twitter.com/#gradschoolsucks In many ways nursing school was worse, but grad school is right up there.

I have another year to finish my Master's program. Three semesters. Six classes. Forty-eight weeks of coursework. I don't regret deciding to go to grad school, but boy has it been a slog. I have so many things piling up that I want to do, and I'm tired of saying "I'll do that in 2018." But if I try to add things into my schedule now, I'll end up sick from the stress. Dare I say it again? #gradSchoolSucks.

In other news, things continue to go well after my weight loss surgery. I'm now about 3-1/2 months out, have lost 62 lbs, and am having wardrobe crises regularly. So far I've been able to avoid going clothes shopping, but that won't last much longer. I'm able to eat pretty much anything I want, though things with a lot of sugar and/or fat I have to be very careful of. I'm also still working on slowing down when I eat, because it makes me physically very uncomfortable, and the habit of wolfing one's food down is hard to break. I'm getting to the gym about once a week, and am trying to ramp that up, but #gradSchoolSucks.

My RA/PsA is doing much better now that I'm back on my meds. And while my inflammatory factors are still a bit elevated after the surgery, they're low enough that we are no longer considering biologic therapy, which is a good thing. We may still have to raise the dosage on my current medication and/or add in a second medication, but that's preferable to biologics if it will work. I finally ordered a splint for my thumb that has let me get back to knitting. My blood pressure is back into normal ranges after we stopped the medication, so all of the health indicators are heading back in the right direction.

All in all, life is good, if way too busy. And #gradSchoolSucks.

1 Comment

intuitive_eating

So for the past few weeks I've been struggling with how intuitive eating does or does not fit with weight loss surgery.  I don't have a healthy relationship with food to start with, so I'm admittedly at a disadvantage.  We grow up with certain foods being labeled as "bad" and "good", and some foods being held out as "treats".  Someone I know posted this week, "Treats?  What are we, dogs?"  It certainly made me think about how our society programs us for unhealthy attitudes about food.  I want to get away from that.

I agree that intuitive eating is a healthy approach to food.  Do I want chocolate cake?  If so, I should eat chocolate cake.  Thinking that I can't have the cake, or that it's forbidden or "bad" increases the likelihood that I'll binge on it.  Checking in with my body about what it wants and needs is certainly a good approach.  Food is not a moral issue.  Food is not good or bad, it's just food.

Most of the WLS community is sold on low-carb eating, many advocate a ketogenic diet.  The discussions on the boards frequently label anything with carbs as "bad" even including fruit and starchy vegetables.  Anyone discussing eating bread or rice is quickly informed that those foods have no place in our diets during the weight loss phase.  I find that kind of labeling problematic.  Especially given that I cannot eat low-carb.  Going into ketosis makes me incredibly ill for weeks, where most people get over the "carb flu" after 2-3 days.  So carbs are part of my diet, though I do try to eat mostly whole grains, fruits, legumes, etc. for my carbs and limit refined flour and sugar products.  But occasionally I want half of a bagel with cream cheese, dammit.  I refuse to start labeling food as "good" or "bad" just because everyone else does.

My sleeve actually is helping with part of the intuitive process.  My newly rearranged tummy has definite ideas about what it likes.  If I eat too much sugar, too much fat, too fast, or don't pay attention to when I'm full, I physically feel very bad.  Certainly reinforces the whole "listen to your body" thing.  My tastes have changed, and I'm having to re-learn what foods I do and don't like.  I am trying foods I would never have tried before this whole process started, as well.  Definitely steps in the right direction, I think.

Then there's the "have to" pressures.  I "have" to eat a certain amount of protein every day.  I "have" to drink a certain amount of water every day.  I feel pressure to eat vegetables and fruits, even the ones I don't like because they're healthy for me.  There are days I don't want another protein shake, or another chicken breast, or whatever.  There are days I just don't feel thirsty and the water just tastes awful.  Because I don't have much of an appetite anymore, if I practice completely intuitive eating, I can subsist on shockingly few calories and little hydration for several days before I'd feel the need to eat or drink more.  That doesn't seem healthy, but is it good to force myself to eat or to eat something I just don't want?  Is that any healthier?

Sometimes we have to hold our nose and take medicine that tastes awful.  There is a school of thought that food is medicine, and we should essentially hold our nose and eat what is healthy for us even if we hate it.  That school of thought is what has made me miserable for most of my life around the so-called "need" to eat vegetables.  While I see the logic, it's just not going to work for me.

So what am I supposed to do about the protein requirements and the fluid requirements?  My therapist asked me last time what the consequences were for not meeting the minimums.  If I don't drink enough fluids, I get migraines to start with, and other issues also arise.  So in order to stay healthy, I have to drink whether I want to or not.  All I can do is add flavorings to my water to make it more palatable.  With the protein, I suspect that missing a day here or there isn't a problem, but on an ongoing basis I'll start losing muscle mass.  So it's best if I strive for the protein goal every day in order to stay healthy and active.

As with so many things in life, I think that there's just no black and white answer.  I need to find ways to get all of my needed macro nutrients into my diet, most days anyway, to keep moving toward a healthier place.  Forcing myself to eat things I just don't want however, is going to push me back into an unhealthy relationship with food.  The best answer I have come up with so far is to start thinking of every food option for these macro nutrients so I can give myself options.  Like having different flavorings available to make the water more enticing, I need to have different options available all the time for my protein to give my tummy and taste buds plenty of variety to choose from.  Maybe the message my body is trying to send me is "enough with the freakin' protein shakes!!" and it's not about the protein per se because hummus or a nice bowl of lentils could meet the protein needs without forcing myself to drink another shake.  Maybe I'm just not listening ENOUGH to my body, even though I'm doing much better with it.

Food for thought.  (Pun completely intended.)

1 Comment

mri_anterior_cingulateI used to hate the term "cognitive dissonance."  That's because I had a guy one time use it as the reason to quit seeing me  when it was very clear to me at the time that the only dissonance was that I was smart and fun to be with, but I was also fat and the woman he had the hots for looked like a magazine model.

I'm starting to come to terms with the phrase, though, since I'm now going through it.  I find

myself trying to hold conflicting thoughts (or at least ones that seem conflicting) about body image and relationships with food.  I'm coming to understand just how frustrating a true cognitive dissonance can be as I try to tease out the layers involved.

It started when I read an article about a video blogger who had made the statement that you're not body positive if you're on Weight Watchers.  I dived into the rabbit hole of the internet, and ended up watching videos and reading articles from people in the body positivity movement for hours.  The vlogger that started it all for me had clarified that she was aiming that statement at people who are positioning themselves as leaders or examples in the body positive movement yet promoting ideas and products that are body shaming.  The statement made more sense in that context.  I agree that there is nothing body positive about the way WW does business or the messages they send.  That the WW program is healthier than most other commercial diet programs is not saying much, given that the evidence is pretty clear that diets make us fatter.

But I started wondering how she would see me and my choice to have weight loss surgery.  Can that choice mesh with a body positive mindset?  I brought the subject up with my therapist, and it started a very interesting and thoughtful conversation.  I'm still processing all of it, but want to share where I'm at in the hopes it helps someone else.

Some body positive activists clearly state that if you are trying to change your body shape, size, etc. that you are obviously not accepting it and that you are not espousing body positivity.  That was troubling to me because I do believe very firmly in many of the things the body positive movement is trying to promote.  I believe there needs to be a place in the movement for people who for whatever reasons want to change their size and shape, but know that it doesn't mean anyone else's shape or size is wrong or bad.

I can honestly say that my size and shape had little to do with my decision to have WLS.  Even though I've suffered bullying and a certain amount of discrimination over the years because of my weight, I had mostly come to terms with it.  I haven't looked in the mirror and hated what I saw for many years.  I don't feel pain when someone refers to me as "fat", because I am.  I'm also a strong, intelligent, sexy woman and my size doesn't alter that at all.

My decision was based on my health, which was in a decline for reasons not directly because of my weight, but certainly exacerbated by it.  The decision was made when Dr. B told me that the stomach tissue to be removed is directly responsible for a large part of the inflammatory factors that are driving my disease, and any weight loss after surgery would only serve to decrease the inflammation further.  The weight loss would remove significant stress from my screaming joints and could even render my medications more effective.  It wouldn't cure my auto-immune, but it held a great deal of hope for improving the condition.

Even clarifying this makes it sound like I'm bashing people who choose WLS because of aesthetic reasons.  I do not want to put forth that message.  Everyone has different priorities, and makes decisions based on them.  Those reasons are just as valid as others.  It's just not where I was coming from.

To make it even more complicated though, as I've lost weight I've found myself thrilled to be giving away clothes that are now too big for me and seeing some of the changes in my physical appearance.  Does that mean I didn't really love myself to start with?  Or that I cannot have a place in the movement because I'm liking the changes I'm seeing?  Or is that just playing into the societal expectation that only thin is pretty?  And since I’m trying to improve my health that I'm redeemed as a "good fat person"?

Health is a touchy subject in relation to body positivity.  One of the concepts that is hard for people to grasp, but is central to body positivity is that thin does not equal healthy.  That is very true.  Thin people get illnesses and fat people can be healthy.  You cannot tell by looking at someone whether they are healthy or not regardless of their size.  Did I have any guarantee that the surgery and weight loss would improve my health?  No.  However, other than reducing the stress on the joints, the weight loss itself isn't what's impacting my health.  It's the inflammation caused by the tissue that was cut away and the fat cells I’m losing.  It's a fine distinction, and perhaps it doesn't matter.  What about people for whom the weight itself has been shown to cause health problems, and losing it has improved their health dramatically?

I struggle with the health aspects of the body positivity movement.  I do believe there is a point - which is different for each person - at which the weight simply cannot be healthy.  When the weight itself prevents a patient from being able to move adequately to perform what medical professionals refer to as "activities of daily living" or ADLs (bathing, dressing, grooming, feeding are examples), then as a medical professional I simply cannot agree that the person is healthy at that weight.  I fear that the "health at every size" movement can go too far and give some people an incorrect belief that they are healthy when they clearly are not.

But even that definition - which I've been working on for months, by the way - fails when I properly expand body positivity to include more than just weight/size/shape issues.  Body positivity is also about people who are differently abled.  If a person is not able to do some ADLs because of a medical condition or injury, are they  then "unhealthy" because their condition keeps them from meeting my definition?

If a person who is unable to perform ADLs due to weight (or any other cause) is unhealthy, what does that even mean?  Here's where I converge again with the movement.  Because honestly, if I'm not their caretaker or on their medical team, absolutely nothing.  It is none of my business what anyone does in relation to their health if I'm not invited into that situation as a medical professional.  Doesn't matter if they're my best friend, my spouse, my child, or a stranger on the street.  It's not my business, nor is it my place to offer comments or advice.  Society treats fatness as a moral failing, and people seem to think it's their business to shame or confront people "because it's not healthy."  I think that's completely unacceptable.

Weight is a measurement of mass and gravity.  It is not a moral failing.  Our society needs to quit treating it like it is.  Our media needs to show many different kinds of bodies as "normal".  Our healthcare providers need to quit treating weight as the cause of every medical problem and shaming people who don't fit the "ideal" size and shape.  I read an account of a woman who went to her doctor with an ear infection and was told to lose weight and was not prescribed an antibiotic.  Another whose abdominal pain was dismissed for years because she needed to "be compliant" with weight loss and no testing done to reveal the invasive cancer actually causing the pain.  Absolutely unacceptable.  I'm on board with the movement about changing these things.

But then, I also participate in online support groups for WLS.  The people in these groups tend to be very focused on weight and BMI.  We gleefully post how many pounds or inches or clothing sizes we've lost.  We commiserate with people who are losing more slowly than others, congratulate the ones who are having "success", and share tips about our lifestyle changes.  We talk about caloric intake and carbs and "good" foods and "bad" foods.  How does that fit with the idea of body positivity?  It doesn't feel like it fits at all.  I can't (and shouldn't try to) change what other people are using as goals and benchmarks.  But perhaps I should take the advice I read today, and find different numbers than those on the scale and tape measure to gauge my success by.  I knew my health was declining when my heart rate was near 100 at rest and would jump to 150 walking from the parking lot to my physician's office.  Or when I couldn't even complete a cardiac stress test because I was too out of breath after 3 minutes on the treadmill.  I can judge the improvements in my health with numbers like these instead of my weight and my jean size.  I wonder how changing the language I'm using for myself would affect those around me?

So where's my place in the body positivity movement?  I don't know, but I found an article today that gives me hope that I have one.  The author talked about body positivity being about loving your body as it is right now, and taking responsibility for its care.  That can mean (but doesn't have to) making different choices about food and exercise and changing the size or shape, if it's coming from a place of caring for your body instead of hating it.

Perhaps, like most things in life, it's about the process and not the results.  I'm not trying to be a role model for anyone, or a leader in the body positivity movement.  Ultimately, it doesn't matter whether anyone in the movement accepts me and my thoughts and choices or not.  My actions are all I control.  I offer my thoughts and feelings with a small hope that it helps someone who's struggling, even if it's just knowing they're not alone.  My therapist (need a cute online name for her I guess) says that lots of people never even think about these things, and by examining my thoughts (even the dissonant ones) about it, I'm ahead of the game.

I'll have to think about that.

foodnotmoralThree weeks have blown by since my surgery day.  I'm now eating soft foods and working on getting my protein and other nutrients from food instead of relying on protein shakes.  I still have a protein shake every day for breakfast to get a good start on the day with about 1/2 of my protein goal right off the bat.  But through the day I'm working toward small regular meals with protein to meet my nutrition needs.  It's a slow progression, but it's been steady, and I still have no complications.  (knock on wood)

One of the things I found when I researched the gastric sleeve procedure is that most people lose their hunger drives and cravings.  I was convinced, however, that I would be the one person this didn't work for.  I'm happy to report that this was not the case.  I have to set reminders on my phone to eat and drink because I just don't get the same hunger signals I used to.  This has caused a sea change in the way I see food.

I wish I had grown up with a healthy relationship to food.  For a number of reasons, I didn't.  I know I’m not alone internalizing moral judgments about food - vegetables are "good," ice cream is "bad" for example.  And of course, the biggie - if you're overweight you're lazy, have no self-control, and are "bad".  There are lots of theories as to why our society imposes and reinforces these moral judgments about food.  I don't really care why, I just need to get those voices in my head to shut up.

Here's where the beauty of this procedure comes into play.  The messed up food voices are still in my head, but I no longer confuse them for physical hunger or cravings.  After I was cleared for soft foods, the Mister and I went to the grocery store.  Immediately, I was attracted to this amazing smell from the produce section and tracked it down to the nectarine display.  I have HUGE food issues going back to childhood and have severe anxiety when trying to eat anything out of my comfort zone.  I can't tell you if I had EVER actually tried a nectarine.  We bought a couple, and they were pretty good.  (They'd be better with granola or in a cobbler than by themselves in my book, but really pretty good.)  This is something that would NEVER have happened before.  Then we walked past the Little Debbie display.  Now, Little Debbies, specifically the honey buns, have been my downfall for a long time.  I'd clear out a whole box of them in 2 days before.  The messed up voice in my head said "oooh, Little Debbies.  That would count as soft foods.  We should get some."  Then the part of my brain that imagined actually eating one went, "eh.  Doesn't sound that good."  Walked by with no issues.  Same thing happened with the Pop Tart section on the next aisle.  (Chocolate Fudge Pop Tarts were another gotcha for me in the past.)  It was incredible.

I don't know if this effect will last forever.  But if it lasts long enough to help me establish a different relationship with food, it will be so very much worth it.  I think I could have gotten there with enough time and therapy, and admit that surgery is a drastic solution.  However, it's working so much better than I could have wished for.  It's still too early to say "best decision I ever made" but the evidence is racking up pretty fast for it.

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kitty_napThe radio silence has been due to my having surgery last week and being in recovery mode since. The short version of this article is as follows: surgery is never fun, it's weird not feeling hungry, and life is good. If you want the details, keep reading. Otherwise, have an excellent day, see you next time.

The surgery went very well. I have a history of having severe nausea after anesthesia, and considering it's the #1 post-op complaint about bariatric surgery, I was a bit worried. But my anesthesiologist gave me a drug beforehand, plus a scopolamine (motion sickness) patch, and gave me IV Zofran during the procedure. Whatever she knocked me out with caused me to lose a chunk of time, I don't even recall being moved from the pre-op area to the surgical suite, nor being in post-op recovery at all. I had absolutely zero nausea. I had filled a couple of prescriptions for dealing with it at home but haven't opened them up at all.

My post-operative pain was there, but it wasn't even comparable with the pain after my knee reconstruction. It was enough I couldn't ignore it and limited some movement, but it wasn't unbearable. Which is good, because I found out that Dilaudid doesn't do jack for me. If the pain had been much worse, I'd have asked to try morphine instead, but it was already lessening by Day 2. Tramadol took the edge off, so I didn't ask for Norco. Went home Day 2 and by Day 3 my unmedicated arthritis hurt worse than my stomach. At this point, it's slighty sore when I move certain ways, and that's it.

Recovering from surgery means a lot of sleeping and laying around doing nothing. Since my arthritis is flared up, I can't really do any knitting or crafting that I would like to when forced to rest for hours on end, so I've been watching a lot of Netflix. And drinking. Water, I mean. Well, and the protein shakes. My instructions are to drink at least 48 oz of fluids and get about 60 grams of protein in, with more being better and fluids being a higher priority than the protein at least to start. I didn't meet the fluid goal until Day 5, and still haven't met the protein goal, but I've been improving every day.

When researching the surgery, almost everyone I talked to said that their appetite completely went away after the surgery, and they had to remind themselves to eat. While I really hoped that it would happen for me as well (and worried that it wouldn't) it's been a huge adjustment. I'm really not hungry. My stomach can be empty, and I know I'm physically hungry, but I just don't feel hungry or interested in food. It's not quite a food aversion (though I am getting hellishly sick of protein shakes) but just a general disinterest. I'm using timers on my phone to remind me to drink and eat because I'll get involved in something and just not think about it.

I had arranged to work from home this week because of the surgery, and it was a good call. Today is probably the first day I think I could manage the office if I had to. My department has started offering part time work from home, and my days are Tuesday and Thursday, which breaks the week up well. I was on the fence about it, but after this week I will definitely take advantage of it.

I'm already down about 13 lbs from my weight on the surgery day, so that's awesome. Of course, the journey is just beginning, but I think I'm off to a great start.