Progress Beyond the Scale & Medical Updates

After I got back from Ireland I had a very small gain that was around 3 pounds. Not bad all in all. I think most of it was water retention from the long plane ride home. I did a lot of walking on my trip. My "low" day for steps according to my fitbit was around 10,000 steps. I was also able to control what I ate and when. Yes, I indulged a fair amount. Rich food, decadent desserts, and lots of Guinness. I drank more in that 10 days than I have in probably the last 6 months. At least. Aside from the indulgences, I had the weight off within a couple days.

The week after I got home I went to DC for a work conference. That trip was harder. Most of the meals were catered or were networking functions at a restaurant others chose. It left me having to make the best choice out of a lot of bad ones. I came home with about a 7 pound gain! I was only gone 3 days! Luckily I had most of it off by the time I had my Thursday weigh in for TOPS and turtled (turtle = stayed the same).

The Monday after I returned from DC I had a follow-up with Dr. Hendrick. I was dreading going in because I had a gain. I didn't know what he'd say and I thought for certain I was in for a lecture. It turns out my gain wasn't as bad as I thought, about 0.5 pounds. He only mentioned it briefly during the appointment though.

We had a fantastic discussion! Successes I had on my trips and struggles. We went over strategies for getting back on track. He talked about the gains I had on my trips, but told me to look at the broader picture. It had been 6 weeks since I had seen him. I had a total of a half pound gain. He said when I'm at home and doing things right, I'm losing. The trips were just trips. I have ideas on how to handle business trips in the future. And I was within my rights to enjoy Ireland to the fullest. He told me I am on track and doing really well and to be proud.

The last thing we talked about was tracking my food. The way he put it blew my mind. I have my reasons why I eat the foods I eat. It  could be a meal that fuels my weight loss or it could be a comfort meal, but I need to track it. Why? Because I need the data. All MyFitnessPal, or any food journal does, is measure the nutrition value of a meal. Yes there are multiple meals a day, but it measures that one meal to the standards and needs I have. If a  meal is "off" I can look at the data and see where I can improve. It's a tool to measure my fuel intake. Nothing more or less. It isn't judging me or my behaviors, just the content of my food.

When I said I had never looked at it that way and to just treat it as data he grinned and then got the scientist in me going. He told me to treat each meal as an experiment. My hypothesis is to see if the meal I built fuels my weight loss or not. The data will tell me and tell me where I can tweak. Silly doctors and knowing their patients! Looking at it that way has helped though.

****

Yesterday I had my 6 month follow up with my pulmonologist since starting my CPAP. It went well. I was commended for taking it with me on my business trips and to Ireland. Dr. J wanted to know if I filled the reservoir with Guinness. I told him no and that I used Jameson instead. He laughed.

I got some grief because I have missed some nights here and there for usage. Some nights I fall dead asleep the moment my head hits the pillow and before I get a chance to put the mask on. Other nights, I haven't wanted to wear the damned thing. So I need to get better about that. I also was lectured a bit on my usage each night. I am supposed to use it for at least 6, but 7 is preferred for optimal sleep. My average use was about 6 hours 45 minutes. Part of that is due to a bit of a crazy schedule right now with Marshall filling in on some night shifts and I don't get to bed until 11:30-midnight. Ugh.

As the appointment was winding down he asked if I had anything else to discuss. I told him I had taken his advice and started seeing Dr. Hendrick. Dr. J recommended him after my 1 month appointment and I was frustrated that there was no change in the scale.

Dr. J lit up and said he had been getting updates. He wanted to know how I was doing and was very congratulatory when I said I was down 35 pounds from my highest, but I didn't know what my chart said there. According to their office I'm down 25 pounds. He apologized for not even looking at that part of my chart. He was excited that I am getting so close to being 10% down. He wanted to know about my Dexa scans and if I had a second one done yet. I told him no, but the first one was cool. I told him that according to the scans I have 140 pounds of bone and lean muscle. Dr. J and his nurse stared at me in surprise.

Dr. J came over to me looking very serious then, but with a bit of pride too. He wanted to know if we had set a goal weight yet. I told him I hadn't, but given my muscle and bone mass, that I think I am looking at 180-190 pounds at the lowest. Provided I don't lose too much muscle mass. He freaking beamed at me. He said that should be my absolute lowest and right at 200 pounds might be good for me. 200 POUNDS. I never thought I would hear a doctor say that would be a healthy weight for me. I'm so used to hearing that I need to be under 150! Anyways, Dr. J said that I am not due for another year and if I keep up like I am he has no problem scheduling another sleep test to get me off of it! Then he said if I get another 50-60 pounds off before my visit next year to give him a call. He will do the sleep test then! I almost hugged him.

His nurse was walking me out and talking to me about everything. We had talked a bit in the exam room about my energy and sleep quality. She said she was wanting to get more active but that it was hard. I bit down on my initial reply of she didn't need to lose weight. Body image issues are so rough, and if she wants to get healthier, good for her. I told her that if she really wants it, she'll find a way. She asked what I was doing for workouts and how I fit them in. I told her I go on my lunch breaks a couple days a week. She looked kind of surprised and asked why that time. I was blunt and said I won't get up early, and once I get home I'm done. It's what works for me. She agreed with that thought and said she would try it. I told her, quite honestly, if I can get my butt in gear and do this she can too.

She looked me dead in the eye and whispered, "You're my new hero." I had no idea what to say other than thank you.

I wanted to deny it. I'm still so close to the beginning of the journey and haven't done much. At least it feels that way. But I have done a lot. I have been hearing from quite a few friends that I inspire them, and it warms my heart. I see Marshall making small changes because of my examples. I wasn't expecting someone, who is pretty much a stranger, to say that to me.

I think that doctor's visit was a success. :)

***
Oh, one last note for this post. The fall rally for the TOPS chapters of the Front Range was while I was in Ireland. When I got back I was given an award I had been awarded. Between the 1st of January and end of July I had lost 20.25#!

What's up Doc?

About a month ago I had a follow up appointment with my pulmonologist to see how my sleep apnea is doing. Thankfully it's doing really well and he is really pleased with my progress. Because it is so mild the benefits and changes are subtle. I am sleeping deeper, I'm not tossing and turning, and I am having more vivid dreams. The dreams are really screwy sometimes, and I wake up scratching my head as a result. Holy cow they are vivid.

In the conversation with him I mentioned that my weight hasn't really been going down and I am getting frustrated. I have cut my calories down, kept exercising and changed some of what I am eating. I am stuck in the same 5 pound range. He asked if I had heard of the bariatric specialist in town. They have worked with him quite a bit and he has a good success rate. He focuses on lifestyle changes, and he does not do surgery. The one thing he said that really grabbed my attention: "Dr. Hendrick is an actual MD. They bill to your insurance. It's not fad diets and woo woo bullshit."

So I made an appointment.

My first appointment was about 2 1/2 weeks ago. The first appointment is getting all of the baseline stuff done. Height, weight, percent body fat, percent muscle, and measurements. They use a body fat scale that has handles on it to get a more accurate picture of percent body fat. The ones for your bathroom that you stand on only send an electrical impulse up to the hips. The one with the handles actually goes up to the neck. They also do a DEXA (Dual Energy X-Ray) scan. This is normally used for detecting bone loss and osteoporosis. However, with the right software it can be used to determine bone mass and lean muscle mass. I also had to get a full blood panel to see where I am at right now.

I found out I have 140 pounds lean muscle mass. On the print out from the fancy scale they have what my Basal Metabolic Rate (BMR) is and how much I should aim to loose. It didn't put me automatically in the healthy BMI range. The weight it said I should lose would put me at about 180 pounds. They take into account lean muscle mass and don't want me to lose muscle to get to a healthy weight.

**MIND BLOWN** Never had a doctor think like that.

After I read that, the nurse crossed out the BMR and weight loss goal. Cue a very confused face from me and I was thinking they wanted me to go lower. Nope. They aren't setting a weight loss goal for me yet, if at all. There are more important things to work on at the moment than just the weight. It also depends on where I am happy, where my body is happy, and what is maintainable.

**MIND BLOWN AGAIN**

Wait...it might be ok if I only lose to 210 pounds? Yes. Yes it is. Because it is still healthier than where I am at right now. But I was told to not worry about that for now. I was also asked to track my food, but not to worry too much about calories right now. I'm not counting calories right now. Wait, what?!?

This is different from anything I have done before. Very different.

He looks at treating obesity as the complex disease that it is. He sees 4 facets to treating obesity. Nutritional, Physical, Metabolic, and Emotional. Per our conversation today:

"Weight loss won't make you happy. You have to be happy with your life and what you are doing, weight loss is a by product of that."

I also got my blood results back today. Everything is fine except my Vitamin D and my A1C (the marker for diabetes). The Vitamin D is easy enough to fix. However, I am officially pre-diabetic. My A1C is at 5.7% and the top end of "normal" is 5.6%. So I am just barely pre-diabetic, but we can reverse this. Given family history and my best friend's death, diabetes scares the shit out of me. Things just got real. Really real.

Dr. Hendrick is not above using fear as a motivator he said. It can be a great tool when used appropriately. I believe him. He wasn't mean about it, but he was honest.

We talked a lot about eating and emotions today, and I learned a lot. I guess I shouldn't say that. I saw a new way of looking at things.

- We eat to meet different needs. Sadness, stress, anger, joy, health, fuel, and more. No one need is better than the other emotionally. They are what they are. I just need to sit back and look at my meal and ask why am I eating. Is what I am eating now fulfill my health needs or is it fulfilling an emotional need?

- The reason we emotionally eat certain foods is to fulfill and emotional need we aren't meeting otherwise. So when we take out a food that is "bad" we have to replace that food with something that fulfills the emotional need in it's absence. Meditation, yoga, walking, doing hobbies. Anything at all that makes you happy and fulfills your emotional needs.

- If I am fighting a certain change or emotion I need to ask myself why and dive deeper into the why it is bothering me and how to handle it.

He is focusing much more on the mental aspects than anything else right now with me. I feel drained and overwhelmed.

I am to start working on changing the following things:

- 3 meals. Breakfast, lunch, and dinner. No snacks and no skipping meals.
- Track food, but don't worry about calories for now. I'm to eat and feel satisfied.
- No sweets or grains (breads, pasta, oatmeal, quinoa, potatoes of any kind, and corn to name a few). Since we are trying to reverse pre-diabetes this is key.
- try for a fruit and veggie at every meal.

He is pleased with how much I am working out and to up my workouts if I can without injuring myself.

I am not expected to be perfect. They want me to make baby steps. As long as I am making progress they will be happy. If I have any problems or frustrations I am to call them. They are there to help me.

Overall, I like the doctor as his staff. They are friendly and supportive. He lays no blame and doesn't shame. He genuinely wants to help.

Right now I am just nervous, scared, hopeful, and trying to be optimistic.

Ok, that's enough for tonight. I am going to post about the costume for Steampunk Sailor Jupiter tomorrow night.

Sleep Apnea

I have probably started and deleted this post a dozen times over the last 6 weeks or so. I just couldn't bring myself to write and admit some of the things I am about to share. I'm slowly making peace with all of it, but it hasn't been easy for me.

Back in January I went to the doctor because I hadn't been sleeping well for a long time. I was restless, my legs were twitchy, my back was killing me, and I was waking up just as tired as when I went to bed. Poor Marshall has been wearing earplugs for years now in part because of my snoring (the other part is traffic noise). Then I was listening to a friend's follow up interview on Half Size Me. She and Heather discussed her diagnosis of sleep apnea from when she was overweight. Heather asked the question of what Brenda would say to those who have thought of getting tested, but haven't. Brenda's answer wasn't anything I hadn't heard before, but it was the way she said. Sleep is so important for all of our bodily functions and mental acuity. The part that got to me was when she said it is medicine that is just as important as any pill or injection you could take.

So I got a referral to a sleep doctor. I met with him and it wasn't IF I had sleep apnea, but how bad. So I did a home sleep study. Turns out I have fairly mild sleep apnea all things considered. I had anywhere between 11-40 events per hour depending on the stage of sleep I was in. And off I went to get my fancy pants CPAP.

I was not happy with the diagnosis, but I was glad to know what was wrong. I didn't want the CPAP but I was determined to give it a fair shot and use it. I had to see if it would help.

The first night was the worst, but not for the normal reasons. It wasn't because I had this mask and hose coming off my face. It wasn't because I look bloody ridiculous wearing the blasted thing. It wasn't because of the Darth Vader noises I now get to make.

It is the fact I have to wear it at all.

I went to bed early so I could lay down and get used to this thing under my nose and a new way of breathing. I laid down and started to read. I laid there for about 10 minutes and I burst into tears. I tore that mask off and sobbed. Marshall came in and was bewildered as to what had happened. I only cry that hard when something truly awful has happened. It took me a while to calm down enough to tell him what was going through my head. It all hit me like a ton of bricks.

How did I let myself get to this?

How have I not loved myself enough to take care of my body?

Why did I feel I have to hide?

What bully did I listen to and take their words to heart to believe I'm not worth loving?

All I can say is I have been beyond blessed to have my husband. He talked me down, hugged me, wiped away tears and just held me.

I felt like I truly had hit rock bottom. I have hit some really low points, but this last month has been rough. What little weight I have lost according to my scale I have gained back, but my smaller pants still fit so that's alright. But I have been self-sabotaging my efforts and eating like crap again. Some days I realize it and stop. Some days I realize it and give in. Some days I don't realize it until it's too late. But it's getting better.

Today I had my one month follow up appointment. My doctor is very proud and impressed.

I had 2 days out of 30 that I wore it less than 4 hours. I remember those nights too. I had gotten too hot and started coughing. If you cough while wearing a CPAP you feel like your are choking and drowning. It's awful. I was so asleep I didn't realize that I was coughing because I was hot, so I just tore the mask off and turned off the machine.

My average number of events is 0.2 hour, and every 4th or 5th night I'm not having ANY events at all. My doctor said this was phenomenal.

I am not tossing and turning as much and if I do it's because of my hips and back hurting. I'm sleeping deeper through the night. To the point I wake up disoriented because I was sleeping so hard.

I had been disappointed there weren't leaps and bounds in my energy or other improvements, but my doctor was fine with it. He reminded me that I didn't have severe sleep apnea and that I wouldn't see these huge changes almost overnight. Mine are going to be smaller and more subtler changes.

He asked me how I liked my CPAP and was very surprised when I told him I hate it. I hate that I have to have it and I hate using it. It serves it's purpose and is necessary for now. It is another medicine to get me healthy. I told him I working towards getting back to where I don't need it. He grinned, told me he loved my attitude and he would be more than happy to order a new sleep study when I get to where I want to be.

I'm not sabotaging myself like I was now that I have kind of processed all of this. I'm letting myself be angry and heal. I'm doing better, but it's a long hard road. If weight loss was just about calories in vs. calories out, I could get the weight off pretty quick. It's so much more though.

Lesson from all of this: If you think you have an issue, go get it checked out. It may not be the answer you want, but if you can get help and feel better it is worth it.

***

To end on a happy note I just got home from MD for a work conference with the US Pharmacopeia and the FDA. Flowers are already starting to bloom back there and I am jealous! It was a great conference. I learned a lot and met some awesome people. 

Sunrise Sunday morning in Denver

 In a weird fluke I got to fly first class going both ways. Now that I have seen how the other half live, I'm not sure I can fly in coach again!

Stuffed French Toast and fresh fruit. Notice the real plates and silverware!

Warm cinnamon roll

Supposedly looking towards Pittsburgh

Flying over the Appalachians

 Went to a nearby mall Sunday night to walk and have dinner. I drooled over Teslas and fancy pens.

 I brought a coat I hadn't been able to wear, but I can now wear again. I was thrilled when I found out it fit again!

A little tea treat for myself

 I also got to tour the little museum at the USP and I would have loved to browse through there longer.

Pharmacopeia from the 1800's. They would send out individual pages as they were requested with the latest updates.

The USP

 The flight home was a little turbulent. We were flying over some impressive thunderstorms. The sun was setting as I watched the storms roll by. I wish that picture had turned out.

Bowl of warmed mixed nuts

 Dinner was a seafood stew with rolls and a salad. We got a warmed cookie for dessert.

I don't know how I got so lucky to fly first class, but I won't argue!