Frustration

[Note: Includes discussion of weight loss and history of intentional weight loss. Please avoid if you don’t want to read it.]

Visited the endocrinologist again to follow up on my med changes. On my way into the office, the doc asks how the meds have made me feel; I said that I haven’t noticed much change except my step counter says I’m walking more. She weighs me and happily congratulates me for losing 8 pounds in a month. I mumbled something like “Uh huh” and we moved onto the rest of the appointment.

The doctor’s congratulations brought up feelings that I didn’t try to unpack during the appointment. After the appointment I began to think about it, and why it upset me.

  • First: Why congratulate me? I haven’t changed my eating habits. I haven’t been counting calories, or carbs, or points, or anything that I would normally do when I’ve intentionally tried to lose weight. I have been a bit more active, but I’ve been MUCH more active in the past without losing weight. This is not something I have made or built or achieved.
  • Third: There have been times in the past when I was trying very hard to lose weight, and lost weight, and felt like I’d won something. I reveled in congratulations and people’s happiness. Right now? I feel like a bystander.
  • Fourth: There have been times in the past when I was trying very hard to lose weight and didn’t. I followed the diets. I’d do the exercises. And, despite doing it all “correctly,” I did not lose weight. Did I get congratulated on my effort then? Nope. I’d be blamed.  I’ve been told I was not measuring correctly, or I should use a scale, or a different diet, or more exercise.  I’ve been told I was lying about my intake and exercise, because I “couldn’t” not be losing weight if I was really eating and exercising like I said.
  • Fifth: Maybe I was a bystander before, too.
  • Sixth: I’ve been trying to build my arms up for the next higher weight dumbbells but noooo, body has other plans….

So, I guess I’m having some feelings here.

Finally, I reminded myself that the reason I pursued treating my borderline hypothyroid (which led to seeing an endocrinologist etc) is to feel better and have more energy. That my weight went up about 30lbs in the last few years without a change in eating habits is one of my symptoms; my weight may change as part of correcting it.  It’s OK to be a bystander here.

Tonight I tried out some shoes from Zappos on the treadmill and this Mary Lambert song came on.

We are, we are more than our scars.
We are, we are more than the sum of our parts.
— Mary Lambert, “Sum Of Our Parts (Alternate Version)”

Timings & Structure, Thyroid Edition

I started taking levothyroxine this fall, and got the standard spiel from the pharmacist:

  • Take first thing in the morning.
  • Do not eat anything else for 30 to 60 minutes after, including other oral medication.
  • Do not take with calcium or iron supplements for 4 hours after taking levothyroxine.

“You CAN have coffee!” the pharmacist chirped happily.  I was happier when she confirmed I could have my inhaled asthma meds.

This has been an adjustment. I was concerned it would bring up the anger-rebellion response I usually have had when dieting for weight loss. As it turns out, it hasn’t.  This has probably been helped by the fact that this is about a medication which has been showing direct benefits ever since I started taking it.

It also resulted in me forgetting the rest of my morning pills once or twice. Fortunately the vitamin B12 and D I can miss occasionally, but the SSRI can be dangerous if I stop it abruptly. Having a weekly pillbox helps me to know whether I’ve taken them.

I did take the “no calcium or iron supplements” a bit to the extreme by also skipping dairy and meat for 4 hours, which created the concept of “dairy o’clock” for me.  I have gradually relaxed that, but continue to adhere to the much more important “no food or meds for an hour”. I have a Detachable Pill Box which I can use to take my other morning pills with me to work if I need to leave before I can take them.

In the first month I took levothyroxine, I felt that I had more energy. According to my step counter, I walked more.  Also important is that my focus improved; I was able to complete tasks at work in less time than before.  And according to the scale at the endocrinologist’s office I lost 3lbs.

The endocrinologist seemed extremely pleased by the 3lbs. I tried not to pooh-pooh her parade by pointing out that it’s less than 1% of my weight, but damn, I was much more focused on the “able to get more work done” and “able to walk more” parts of the equation.

No, Really, Treat the PROBLEM

A comment for Treat Weight First? that I did not approve, but found striking for its ability to completely misunderstand, was:

There must be some powerful drugs in that koolaid you’re drinking. You admit you are morbidly obese, you have multiple health problems directly related to obesity, yet you shun the doctors that are trying to help you and others like you to lose weight. Amazing!

I posted here before that I’ve recently been diagnosed with multiple conditions that cause fatigue, muscle loss, and weight gain.

I repeat: cause fatigue, muscle loss, and weight gain.

What I haven’t posting about is that it’s been TWO MONTHS since the test that confirmed I’m deficient in human growth hormone — and I haven’t started treatment yet.

(Why? Combine a rare condition with an expensive, injectable drug treatment and you get fun “Who’s on First?” times with the doctor, insurer, pharmacy, and the drug manufacturer. I am not thrilled to have the drug manufacturer’s help line in my cellphone contact list. On the other hand, I do have the drug manufacturer’s help line in my cellphone contact list.)

Because I try to be a good patient, I read up on this new condition.  It has fun, familiar symptoms like:

  • A higher level of body fat, especially around the waist  (Like the 30lbs I gained since my dad died? Or the 50lbs between 97 and 2001? Or, er, my entire life?)
  • Anxiety and Depression (I didn’t have a problem with anxiety until about 4 years ago. Uh…)
  • Fatigue (So, not just hypothyroid?)
  • Feelings of being isolated from other people (So…not just getting older and less patient?)
  • Greater sensitivity to heat and cold  (So… not just getting older or hypothyroid?)
  • Less muscle (lean body mass) (Yeah, my weight lifting hasn’t had results it used to, it’s harder to build muscle…)
  • Less strength, stamina and ability to exercise without taking a rest (Like how I could walk a mile a few years ago and now I need to rest after a couple blocks? YES IT’S VERY NICE TO KNOW WHY.)

And a symptom that’s very, very scary for me: hypothyroid can cause impaired memory.

So let’s go back to that “koolaid” I’m drinking. And about how weight loss is going to “help” me.  Because weight loss will obviously fix the “obesity-related” health problems I have.  Except, wait — those hormonal deficiencies are “obesity-related” in terms of “people who have this tend to be fat”, not “caused by fat”.  And they’re screwing up my life. 

  • Weight loss isn’t going to fix hormone deficiencies.
  • Weight loss drugs won’t fix hormone deficiencies.
  • Weight loss surgery won’t fix hormone deficiencies.

If I were to lose weight without treating those hormone deficiencies? My quality of life would not be improved.  FUCK THAT.  Or, to be precise I am going to continue to focus on improving my HEALTH.  Because THAT will improve my life.

(How RUDE to put MY priorities first!)

And if, in the course of improving my quality of life — things like restoring my former energy levels (horrors!) and my former stamina (eek!) and regrow my muscle mass (Aack!) and reduce my anxiety and depression (gasp!) — I may end up losing some weight?  That’s up to my body.

Treating Weight First?

The Twitterverse has been busy talking about some new treatment guidelines for fatties. Ragen Chastain posted about a piece from Medscape called “New US Obesity Guidelines: Treat the Weight First,” which also has quotes from the lead author.  I also clicked over to the guidelines themselves. They start with an extremely helpful objective, to wit:

Objective: To formulate clinical practice guidelines for pharmacological management of obesity.

That’s the goal here. That tells you what this is primarily about: weight-loss drugs.  Two more were approved in 2014, at least in the US – Europe has been slower to approve the drugs.

There are a few things in the guidelines that I like.

First: Some medications have weight gain as a side effect.  I consider this is a useful fact for medical practitioners.  It makes no sense to prescribe a drug that has weight gain as a side affect and then chastise patients for the resulting weight gain.

Second: Yes, it makes sense for medical practitioners to be aware that medications can cause weight gain or loss, and to discuss that with patients. A fat patient may prefer a drug that doesn’t cause weight gain. A slender patient may want to avoid drugs that cause weight loss.

Third: They’re measuring that a weight loss drug is “effective” if the patient loses 5% or more of their body weight in 3 months.  If that seems low? Yes, yes it is. Worth anal leakage? I think not.

Fourth:

Historically, patients and providers thought that weight loss medications could be used to produce an initial weight loss that could subsequently be sustained by behavioral means. The available evidence does not support this view.

This is an important admission. The human body doesn’t like to have its weight set point messed with.

The things I disagree with?  It’s hard to limit myself to just a few, but:

  • I disagree that patients need to be moved from drugs that control chronic health conditions just because the drug may cause weight gain. What are the side effects of the new drug? Is it as effective?  Does the patient have support during the transition?  That matters too — especially with psychiatric meds.
  • I disagree that patients should postpone treating conditions like hypertension until they lose weight. If the patient wants to try lifestyle changes first, fine — but it should NOT be under duress. The medical profession is already known to mistreat fat people. This can become another justification.

On the flip side, I was prescribed a drug that can cause weight loss (Levothyroxine) this fall. The endocrinologist was thrilled that I lost 3lbs after a few weeks of taking the drug.  I don’t care about that.  I care about FEELING BETTER.  Obviously I’m un-American.

Guidelines: Pharmacological Management of Obesity: An Endocrine Society Clinical Practice Guideline,

Medscape: New US Obesity Guidelines: Treat the Weight First

Medpage Today: New Guidelines: Treat the Weight First

Tests Are In …

I posted before that I’ve been having some medical tests.

And that I’m seeing an endocrinologist to treat hypothyroid.

Some of you may have seen my tweet about getting a growth hormone test.

Turns out I’m deficient in human growth hormone.  This may explain why I have less strength, stamina, and endurance than I used to have. I have met with my doc to discuss treatment, and am starting it soon. I’m not sure how long it will take to show improvement.

I am finding that having hormone deficiencies that cause fatigue, muscle loss, anxiety, and depression can be similar to simply having depression in that it’s hard to get help when you’re fatigued and depressed. Especially when the deficiencies came on relatively slowly and gradually.

There will be more tests, such as an MRI of my pituitary gland. I’ve got potential posts in my brain about various things related to the tests and new doctors and so on. But right now, it’s still the busiest time of year at work. It gets dark about 4pm every afternoon. At least I know why I’m so tired.

Bad For My Blood Pressure

First visit at the endocrinologist to treat hypothyroid. Waiting in the lobby with chairs whose arms are a bit too tight. I am weighed. The doctor asks me to sit on the exam table, so I do – no back support, legs dangling. In taking my medical history she asks about my weight history.  After more history, the doctor decides to take my blood pressure. While she wraps the blood pressure cuff around my upper arm, she asks why I’m not dieting. We discuss it while she takes the reading.  146/92.

A visit to urgent care for a UTI that may have moved to the kidneys. I’m feverish. The automatic blood pressure reader inflates suddenly enough that the large cuff won’t stay closed on my arm. The nurse insists on using a standard cuff on my forearm. 160-something.

Arrive at my usual nurse practitioner’s office with coffee. Walking, walking. Sit, tech immediately wraps the large cuff around my arm, holds the cuff closed while triggering the automatic blood pressure reader. 138/88.

At the allergist for a checkup. Arrive early so I can get my allergy shot – I’ve been getting shots weekly for over a year. The usual routine of sitting until my name is called, confirming that I took antihistamines, confirming my name and birthdate, and so on is calming.  This time I’m going back for a checkup instead of reading twitter or a book in the lobby, but I’m still feeling relaxed as I sit on a chair with my feet flat on the floor, go over my med list, and then get my blood pressure taken. 126/80.

I finish a slice of toast with peanut butter and a can of diet Pepsi as I arrive at the endocrinologist’s office. I rest 5 or so minutes in the waiting room.  Once in the exam room I sit in an armless chair. When the doctor takes my blood pressure, I stay seated, feet on the floor, resting my arm at heart level on the counter, and we both stay silent. 132/82.

Healthy Habits Better Than Statins

You may recall a study from a few years ago about how certain healthy habits — consumption of ≥5 fruits or vegetable/day, regular exercise >12 times/month, moderate alcohol consumption, and not smoking — decreased mortality risk regardless of weight.

You may not have seen this part:

The results of this study reinforce the association between healthy lifestyle habits and decreased mortality risk regardless of baseline BMI. This finding is of great importance to both patients and health care providers, whose perceptions about BMI may lead them to believe only obese and/or overweight patients require regular counseling about lifestyle adjustments. Although the evidence suggests that patients across the BMI spectrum should adhere to a healthy lifestyle to optimize health, many patients with a normal-weight BMI may believe exercise and healthy eating, for example, are less important for them as long as they maintain a low BMI.

I’ve mentioned before that the emphasis on fat often leads thin people to assume they’re healthy.  Not necessarily — something the authors called out.

 In the pooled analysis that included all individuals in the cohort (normal weight, overweight, and obese), the adoption of each additional healthy habit decreased all-cause mortality between 29% and 85% (Table 2). To put this in perspective, statins decrease all-cause mortality by 12% in individuals at high risk for cardiovascular disease.  Given the tremendous benefits of a healthy lifestyle, policies and programs that encourage adherence to healthy lifestyles should be encouraged both locally and at a national level.

What can be done about this?  Encouraging moderate exercise & use of alcohol, abstaining from smoking, and eating more fruits and veggies.   The study authors also note that when primary care providers take the time to urge things things, it can be “effective in decreasing smoking, increasing fruit and vegetable consumption, moderating alcohol consumption, and increasing exercise frequency.”  (That’s more than they can say for weight loss.)

PS: I see references to statins a lot. They make money, despite side effects.  Not smoking? Doesn’t make money.  Exercise can make money, as can selling more fruits & vegetables — but not as much as a drug.  Hm.

Quote of The Day: On Sex

[Warning: rape]

I had a conversation with a therapy patient of mine recently that spoke volumes to the problems of living in a rape culture that no longer wants to use the dirty word rape. She told me that she and her best friend (both 19-years-old) frequently endured sex with their boyfriends that involved heavy drug use, painful and coerced anal sex, utter boredom for the women, regular transmission of STIs, no orgasms for the women, and “sex on demand” whenever their boyfriends wanted to have sex. When I asked her if she ever felt pleasure during sex, or ever wanted to feel pleasure, she said, point blank, “I thought sex was only supposed to be pleasurable for the guys, right?” Right. 

The Politics of Turning Rape into “Nonconsensual Sex” by Breanne Fahs

Y’know, romance novels are often seen as pure pulp, but they do ground readers in the idea of mutual pleasure.  It’s not the worse way to set some expectations for sex.  (OK, the “never needing lube” thing can be problem….)

I’m glad that patient is in therapy.

Oh, and anal shouldn’t hurt.

 

Milestones

So I threw this on twitter, but I’m repeating it here: I’m 48 years old & it’s been over a year since my last period.

I’m OK with the first.  I’m HAPPY about the second — and yes, it means I’m “officially” considered menopausal.  I had a few years of skipping periods in the fall & winter, then getting returning to regularity each summer.

Goodbye mood swings, goodbye cramps! Goodbye bloodstains in my pants!!

I wasn’t entirely sure I was in perimenopause, at first, despite the irregular periods.  I would sometimes feel suddenly warm and turn on a fan or ditch my cardigan, but not often.  I had problems sleeping and sometimes use ambien, but that was during some major life changes and I didn’t think much of it.  After I skipped 6 months I was pretty sure it was the start of menopause — and then I started having periods again. For a few months.  And… yeah.

Regularity?  What’s that?

I had my first period at age 10.  It’s been nearly 40 years.  I’m fine with being done.

Back from Norwescon!

As mentioned on Twitter, I was at Norwescon this weekend! One of the most delightful parts was the interview session with special guest Seanan McGuire, who is also Mira Grant.  I don’t have that to share with you, but I do have this from her book tour last fall for her book Parasite (which IS about genetically engineered parasites, and yes, it’s touched on in the video).

Minute 7 – how having a genetically engineered tapeworm could affect weight loss.

Minute 9:45 – could write a very socially-shaming book along the lines of “now that my PCOS doesn’t prevent me from losing weight, you actually think I deserve decent medical care?”

Minute 11:50 – poop transfers & your personal biome

Minute 25 – on bacteria & how antibiotics are overused

Minute 29 – on how drugs are mislegislated and miscontrolled

Minute 39:55 – on morning person encountering a night person

Minute 42 – “Do you honestly think it’s better to be dead than autistic?”

Watch and enjoy ;)

Wheezing Around the Block

One of the recent rants I moderated out of the comments included something* about how “wheezing around the block doesn’t count as exercise.”

Wheezing is a symptom of asthma, bronchitis, sinusitis, pneumonia, and other illness. Deciding that wheezing is only due to weight and only will be treated by weight loss is DANGEROUS.

I do wheeze. I have asthma. Now that  it is properly treated I can exercise without wheezing. My treatment plan is greatly helped by insurance to cover the not-available-in-generic Advair & other meds. One of my asthma triggers is exercise itself. This means I need to medicate pre-exercise. I’m also affected by things like air pollution and pollen.

If you’re fat and wheezing while walking around the block, you may need to see a doctor about your wheezing. It’s not necessarily “just being fat.” Waiting til you’re thin? A, may not help, and B, YOU COULD DIE in the meantime.

The fat haters of the world would have you believe you only wheeze if you’re fat and should lose weight to cure it. The fat accepters think that if you’re sick, you should be treated for that without having to lose weight first. I’m on the fat accepting side.

*Paraphrased to remove profanity & improve readability.

Saturday Ramblings

1am is still Saturday if you haven’t gone to bed yet, right?

Note to self: The expensive twice-daily asthma med works best if the evening dose is 12 hours after the morning dose, not 18 or 20. You carry it with you. Set an alarm on your phone & use it. Don’t just turn it off.

Kath posted about a current fat acceptance tag on twitter, if you haven’t seen it already. Also the HAES blog has a piece on activist burnout.

I started watching the first season of Mad Men on Netflix.  Is it weird that I’m describing it as “a grown-up Bewitched”?

N Things Make a Post

Thanks to This Is Thin Privilege for the shout-out.

Image from the Rudd Center Image Gallery

Image from the Rudd Center Image Gallery.
Not the blogger.

Jeanette took on the “Obese women get only an hour of exercise a year” thing.

…as did This is Thin Privilege.

…as did Marilyn Wann and many commenters on Facebook (signin needed).

On a personal note, my allergies are bothering me much less since Sunday.  Why? I spent over 3 hours Saturday doing “soak, rinse, repeat until the water is clear” on the electrostatic air filters for our furnace. Then waited about 4 hours for them to dry. Fortunately we replaced the windows in a few years back to the inside temp only went down about 10 degrees (and I set the heat UP about 5 degrees before I turned off the furnace to take out the filters).

Also on a personal note, I’m back into the swing of getting allergy shots once a week after an attack of life around November.

Tell Me Again How It’s “For My Own Good”

Lara Frater wrote about this and I wanted to boost the signal.  The Rudd Center recently came out with a study (PDF link) showing that weight stigma affects the stress hormone cortisol.

Exposure to weight-stigmatizing stimuli was associated with greater cortisol reactivity among lean and overweight women. These findings highlight the potentially harmful physiological consequences of exposure to weight stigma.

It doesn’t require being fat to have this kind of reaction, by the way. Both the lean and overweight women “were equally likely to report that they would rather not see obese individuals depicted in a stigmatizing manner in the media.”

What’s cortisol? Some highlights from Wikipedia:

Cortisol, known more formally as hydrocortisone is a steroid hormone […] released in response to stress and a low level of blood glucocorticoids. Its primary functions are to increase blood sugar through gluconeogenesis; suppress the immune system; and aid in fat, protein and carbohydrate  metabolism.  […] Cortisol counteracts insulin, contributes to hyperglycemia-causing hepaticgluconeogenesis and inhibits the peripheral utilization of glucose (insulin resistance). […] Cortisol can weaken the activity of the immune system.

Being fat (“excess weight”) is considered a cause of insulin resistance.  And it appears that weight stigma increases cortisol … which increases insulin resistance.  Which is the chicken? Which is the egg?

This isn’t necessarily new.  Weight stigma  has been tied to weight gain before.  What this study highlights is one mechanism.  There may be others.  We know that fat bias prevents fat people from getting jobs, from getting raises, and from getting proper healthcare treatment.   Fat people are also often paid less and harassed more than similar-qualified people who are thin.  None of this improves health.

So when I hear people saying that fat people just need more “tough talk” to lose weight “for their own good”? No, I don’t believe them.

Health At Every Size Principles

I sometimes post about Health At Every Size®, both the concept (which is trademarked by ASDAH) and the book Health at Every Size: The Surprising Truth about Your Weight, by Linda Bacon.  So I am pleased to see that ASDAH has updated its HAES® Principles to be more inclusive of different abilities and backgrounds. Weight bias and weight discrimination is explicitly called out.  Supporting individual choices is more explicitly encouraged. A brief framing of the Health At Every Size® Approach has been added, as well, noting that health is NOT “simply the absence of physical or mental illness, limitation, or disease.”  It also states that

[H]ealth exists on a continuum that varies with time and circumstance for each individual. Health should be conceived as a resource or capacity available to all regardless of health condition or ability level, and not as an outcome or objective of living. Pursuing health is neither a moral imperative nor an individual obligation, and health status should never be used to judge, oppress, or determine the value of an individual.

I suggest you check the full statement on the ASDAH site.

 

Things I’m reading

Kath as a post at Fat Heffalump on the feedback from her recent interview by Jasmin Lill on news.com.au, Brisbane blogger speaks out against online bullies. Go Kath!

Closet Puritan has a thoughtful response to some of the conflation between “Fat people are more common in communities with a Walmart” and “Eating more processed food from Walmart makes people fat”.

This Adipose Rex has some musings on Christianity and the body:

This Advent I am thinking about how if my body is a temple of the Holy Spirit, then this flesh itself is sacred — this same substance worn by the God of the universe, and shaped into God’s image. If I really believe in the words I recite every week, the resurrection of the body, then this is not some temporary meat-costume I will abandon so my soul can flit off to an immaterial heaven, but the too too solid flesh that will dance in the hereafter.

This reminds me of The Unapologetic Fat Girl’s Guide to Exercise and Other Incendiary Acts by Hanne Blank, which I’ve been reading. From the introduction:

Exercise—by which I mean regular physical movement that puts your body through its paces—is crucially important because it is something that makes it possible for you and your body to coexist in better and more integrated ways. It builds a bridge across the mind-body split. […E]xercise gives your body to you. […] Most of all, it teaches you that your body is not just a sort of jar made out of meat that you lug around because it’s what you keep your brain in, but an equal and in fact quite opinionated partner in the joint production that is you.

And over on the HAES blog, there’s an interesting discussion on healthism & privilege.

Things to Read

You may have seen this poor as folk post on why poor people might not eat healthy.   There’s also a great post on why “healthy food vs junk food” infographics are inaccurate, misleading lies.

From Linda Bacon and Lucy Aphramor at the the Health At Every Size® Blog:

“Obesity-related” disease actually tracks your social status more than what size clothing you wear. In developed nations, data show, members of stigmatized groups, including those who are economically disadvantaged and people of color, are the most common victims of illnesses typically grouped under the “metabolic” umbrella. […] With social status comes control over one’s circumstances – success at work, fostering loved ones’ well-being, being able to plan for the future, or even next week. The absence of those, no matter how punctilious our lifestyle habits, stresses our systems in disease-promoting ways. In contrast, being able to exert an influence over what matters to us is health-promoting.

And astronaut Karen Nyberg created a stuffed dinosaur in space.