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.

Operation (de-)Dust Mite a Success

The quest to cut down dust mites in our bedroom was a success.  I woke up Monday morning without a headache and without needing to blow my nose.  I hadn’t noticed these symptoms much until they were gone, but they were.  Even better, I seemed better able to handle other asthma triggers the rest of the day.  It was even better than the additional meds (Flonase and Spiriva) had been alone.

Today I again washed the bedclothes in hot water.  I didn’t wash the comforter, but it did get a spin in the max-heat dryer, which kills dust mites as well.  Yesterday I did more thorough cleaning in the living room than I had in months.

Amazing how breathing better makes all the difference.

Thankful Thursday

[Another weekly exercise in gratitude.]

1) The man of the house made dinner — patty melt for me, with minced onion & mushrooms mixed into the patty, and a chili burger for him.   Yum.

2) Successfully moving my sleep schedule earlier, so I get to work in good time and get enough sleep.

3) The cable company is currently our of lives and we have faster internet access now.  (Meaning we have TV, net and phone through the phone company and cheaper than phone+cable company.)

4) Asthma medications so that I can be more active.  Lung capacity for the win!

5)  My body is generally well and capable.

Thankful Thursday

[A weekly exercise in gratitude.]

1) Had a good doc appt today, have new treatment plan for allergies & asthma. 

2) The other day I had the mini-gym at work to myself, so I didn’t have to keep myself from singing along to my iPod while I was on the treadmill :)

3) The wonderful relaxation I get from stretching. 

4) Hearing Carrie Fisher state that one of the benefits of having a life-size Princess Leia sex doll is that when someone tells her to go fuck herself, she actually can….

5) The new Star Trek movie tonight pretty much made up for Star Trek V. ;)

Medical Records Out My Ears…

[One of the occasional series of posts about my typical day.]

Flipping the charts by photobunny on Flickr

Flipping the charts by photobunny

Or, Annual Physical update the 2nd (and hopefully final :)

What I didn’t mention before was that the day of my annual I was near the tail end of my period.  It wasn’t bad enough that we couldn’t do my pap smear (yes, this 400lb 42-year-old woman has a sex life) but it did mean my urine sample had a bit of blood in it.  Which necessitated going in to give another urine sample a week later.  So my urine tests were all a week behind my bloodwork and pap.  Which is probably why the THIRTEEN PAGES of full test results didn’t arrive for another week after the initial, “Here’s the summary of your results” letter I wrote about here (and that letter arrived a couple days after a phone call to discuss my vitamin B12 & D levels.)

Then WellRoundedMama made a few excellent suggestions about vitamin D & TSH.  I started to write a reply, and dug in the file box for last year’s even longer test results for comparisons, and … well … my reply was getting onto all sorts of other stuff and, really, getting to post length.  So, here ’tis. Continue reading

Annual Checkup Update: Lab Results

[One of the occasional series of posts about my typical day.]

During my annual checkup last week, my ARNP said that she would call if the labwork found a problem and that she usually sends an “all clear” note if things are unchanged.  I asked if she could send me the full resuts, and she agreed.   A few days later she’d to let me know that my vitamin D levels are still a bit low, my vitamin B12 is good, and everything else was fine. Today I got the followup letter with lab results.

I’ve debated whether to share them here.  On the one hand, this blog is about my body and how it works, and the lab results are certainly relevant – it’s why I asked for more detailed results.  On the other hand, my lab results are not a referendum on whether I am “allowed” to be fat. I am fat. That’s just how it is.

So if you wanna know the rest, read on.  Continue reading

Fat folks more likely to be Vitamin D-deficient?

I got a phone call from my RNP; my screening tests show no problems, but my vitamin D is still a little low.  She suggested I continue to take a 1000iu Vitamin D tablet a day.   During my checkup RNP also urged me to start taking a multivitamin again.  I have, and it has 400iu of vitamin D too.  So now I’m actually getting 1400 iu of Vitamin D a day from pills, plus whatever’s in milk and fish.

I began to wonder if this was too much, so I started playing with Google…and found that being fat is correlated with increased risk of vitamin D deficiency.

  • Producing from sunlight. One study compared how much vitamin D fat women produced from UVB rays vs “normal” weight women. Both groups increased their vitamin D levels, but the increase in vitamin D from the simulated sunlight was 57% lower in the fat women.  (Chart – note “BMI” should be “Body weight (kg)”.)   This implies that fat people need more sun exposure to produce the same amount of vitamin D.
  • Absorbing from pills. The study also compared how much vitamin D was absorbed from oral supplements.  Again, both the fat and thin women increased their vitamin D levels, but the thin women absorbed more.  (Chart – note “BMI” should be “Body weight (kg)”).   This implies that fat folks need higher oral doses of vitamin D.

*headdesk*

Well, being fat may be one reason why my vitamin D levels are low.  But there are others. Continue reading

Day in the Life: Annual Checkup

[One of the occasional series of posts about my typical day.]

Ah, the joy of the annual physical.  One new thing I learned is that some STD screening tests that used to require a vaginal swab to test now don’t – chlamydia, for example, can be checked with a urine sample.

For my first visit with this ARNP (summer 2007) I deliberately ate breakfast before going in.  She came recommended as being very responsive and not blaming everything on weight by a friend, but the friend in question has a BMI of ~30.  My BMI is more like ~60.  I wanted to have all my wits about me as I determined whether I could work with her or not.  I had prepped a few quick explanations of Health At Every Size and was ready to discuss a HAES approach.  As it happened, the only time my weight came up was when the assistant who was prepping me waved me at a a standard 350lb scale.  I shook my head, but before I could ask if there was a scale that measured higher, she said, “Oh that’s fine, can you give me a urine sample?”  and we went on with the ritual of filling the cup, blood pressure, and changing into a gown.  The RNP greeted me by name, stating, “So you are 41 and healthy, and we’re going to keep you that way,” as she was shaking my right hand. In her left hand was the multipage history I’d filled out prior to the visit, which she referred to as we discussed my health history.  The RNP didn’t bring up my weight.  Neither did I.  I think I was in shock.  The next day I went in before breakfast (basic 12-hour fast) and had blood drawn for tests.  This led to discovering my vitamin B12 and D deficiencies.

This year I just went in fasting.  I felt a bit slower mentally from not eating, but not by much.  The assistant didn’t even glance at the scale as we walked by it. The assistant announced that my blood pressure was 132/88, “Not bad for someone who’s about to have a pap.”  All righty then! :) Continue reading

…and the other reason why I exercise

It’s called, “Use it or lose it.”

Last fall* I pulled a muscle in my right leg.  Kept up my daily walks, pulled it again – or maybe pulled another muscle.  This aggravated the occasional pain I would have in my right knee, and added some hip and thigh pain too.

By November I was noticeably limping much of the time.  I couldn’t walk without pain. I couldn’t drive without pain. I would climb stairs using my left leg only.  I stopped sitting on the floor because I wasn’t sure I could get back up.  I stopped taking baths because I wasn’t sure I could get out of the tub.

I was afraid to go to the doctor, because I didn’t want to hear that I should just get weight loss surgery. Or a knee replacement.  I considered just buying a mobility scooter and moving to a 1-story dwelling.

This was very scary.

In December I pulled myself together to go to the doctor, or, rather, my ARNP.  She ordered knee x-rays to confirm some arthritis in both knees.  She also prescribed physical therapy, which I found to be a fantastic and empowering experience.  The physical therapist determined that my right quadriceps & hamstring muscles were significantly weaker than the left ones.  There was also some loss of range of motion, but mostly I was lacking strength.

So I started doing targeted strength exercises.  Single-leg raises, seated leg extensions, side leg lifts, bridges, steps, “chair squats”, and more.  All with 10-15 reps per set, 1-2 sets a day, on each leg. Over an hour’s worth of homework, all told.

I also was urged to begin going for walks regularly again.  Over time we increased the difficulty – using deeper steps (I’d started with a 2″ deep phone book) and exercise bands to increase resistance.

I am still doing those exercises, though not every day. Most of them I do now with a 10lb ankle weight a couple times a week.  I also take baths, get on the floor, and go upstairs more often… because if I do it today, I can probably do it tomorrow.  :)


*For the curious, this was the fall after I got my asthma and vitamin b12 deficiency under control and had loads of energy that I had to do something with.  So I began going for walks and started riding the bus, which also involved walking.  I began slowly, working up gradually, did all the things I’d been told would prevent injury…and got injured anyway.   Sigh.

A bit more on asthma….

It’s been great hearing that others have run into the “You mean it’s asthma, not just that I’m fat?” experience.  Thought you would be interested in this, from the American College of Physicians Home Medical Guide: Asthma ….

Main symptoms of asthma:

  • Wheezing: May occur with or without shortness of breath in response to a trigger or for no obvious reason.
  • Shortness of breath: Often associated with wheezing or coughing, but may occur alone.
  • Coughing: A sputum-producing or dry cough may be one of the signs of asthma.
  • Chest Tightness: Although often a symptom of asthma, chest tightness may be mistaken for a heart problem in older people.

It’s noted that most of these are also symptoms of other problems, and all 4 can be symptoms of chronic bronchitis (although chest tightness is less common in bronchitis).  So diagnosis can require trial and error.

Exercise is listed as one of the most common triggers for asthma.

Exercise is a common trigger in asthma and may often be the only thing that brings on asthmatic symptoms. The problem is that shortness of breath on exertion is often attributed to weakness or not being in shape rather than asthma. […]

In some children, after the first episode of wheezing with exercise, there often follows a period when they can run and play for a long time without problems. Sometimes, this so-called refractory period has the unfortunate effect of reinforcing to a skeptical teacher or class-mate that the child was just trying to get out of gym.

Really.  So much makes more sense now.

Day in the Life: Vitamins

I posted yesterday that I finally admitted that I have asthma and began using an inhaler before exercising. Walking uphill became easier.

The second change came a few days later, when the new ARNP got the results of my blood tests. “You have a severe vitamin B12 deficiency. Do you eat eggs and meat? Or are you a vegetarian?” Yes, I eat eggs and meat – had been craving them muchly the last few years – but I was still deficient. It seems that I don’t absorb vitamin B12 very efficiently, which led to anemia.

I started taking vitamin B12 supplements. I still do, every morning.  (I absorb less than most people, but “some” of “a lot” works out to “enough”.)   At a follow-up appointment she also urged me to take Vitamin D supplements, because I’m on the low side and we live north of Toronto.

Within 1 week of starting vitamin B12 supplements, I had more energy, more endurance, and stopped craving meat and eggs all the time.  Instead of insisting on eggs and meat for breakfast, I began eating things like fruit and yogurt.

What I’ve realized since then was that my activity had been limited by the lack of B12 and the asthma. Now I’m not. Now I’m limited only by my current fitness level – and I can improve it.

The scary thing?  The B12 deficiency was only found because I changed my medical practitioner.

You see, a few years ago I noticed I was feeling run down all the time.  It’d been a gradual thing.  More sleep, dealing with sleep apnea, exercise – all would give me a small boost, but not get me back to where I used to be.

Most commonly, people with anemia report a feeling of weakness or fatigue, general malaise and sometimes poor concentration. – Wikipedia entry “Anemia”

I complained to my then-ARNP.  She checked to see if I was hypothyroid; when the TSH came back normal, and she pointed out I had a history of depression and I was, of course, morbidly obese.

Common early symptoms [of B12 deficiency] are tiredness or a decreased mental work capacity, decreased concentration and decreased memory, irritability and depression.
Wikipedia entry “B12″

She suggested upping my antidepressant dosage, that I exercise more, and perhaps look into weight loss surgery.  (Because of course having a surgery that itself can cause vitamin deficiencies is exactly what I needed!) (*pounds head on desk*) Continue reading

Day in the Life: Breathing

Most days I use my inhaler pretty soon after waking.  What does asthma have to do with being fat?

For a long time I didn’t think it was asthma; I thought I was just fat and out of shape.  I took Claritin to keep my allergies under control, yes, but I didn’t have asthma.  I might be panting walking up hill sometimes, or climbing stairs, sometimes even weezing, but that just means I’m fat and out of shape. Right?

After an encounter with way too much woodsmoke, I admitted to myself that it wasn’t just allergies. (I could almost feel my lungs close.) Once I accepted it might be asthma, it occurred to me that it usually was easier for me to walk uphill after it had rained.  Cleaner air?   Hm.

I described my symptoms to my (new) ARNP, who exclaimed, “Exercise-induced asthma!”  She began typing on her computer. “I will prescribe an inhaler.  Use the inhaler, 2 puffs, at least 20 minutes before exercising!  Two puffs, twenty minutes, okay?”

How do I explain the difference my asthma treatment makes?  Oh, yes.  Occasionally I do a Woman At Large aerobics tape.  15 and 20 minutes in, there’s the usual “let’s all check our pulse” bit.

  • If I’ve used my inhaler, my pulse is between 140 and 150 (“target zone”) and I’m keeping up with the exercises.
  • If I haven’t used my inhaler, my pulse is between 110 and 120…and I’m usually having trouble keeping up.

In both cases, I will be flushed, breathing a bit hard but still able to talk, and generally feel like I’m exerting myself at a good level. But I’m doing more work and getting a better cardiovascular workout with my inhaler. Continue reading

Mom weighed over 300lbs too

If she ever got up to 400lbs she never told me, but then, she probably wouldn’t. I remember she had a chart during one of her diets.  At the top was ”  03″, and before the 0 was a shiny bit of Wite-Out.  It was clear that mom didn’t want anyone to know the first number.  At the time I assumed it was a 3, but now I wonder.  I wear about the same size clothing, now, as she did when she was in her mid-40s.  I am 2 inches taller, but still…I don’t know.

I do know (because she told me many, many times) that the smallest size she wore as an adult was a 1960s size 16.  This was brought about by a combination of:

  • A job where she was on her feet all day throwing things;
  • Weight Watchers;
  • Amphetamines.

Continue reading

Life at ~400lbs

me, stretching

me, stretching

I weigh about 400lbs. Sometimes 409, sometimes 397, usually in between.  Over the years I have encountered folks who talk about how “If you weigh over 300, you aren’t living, you’re just existing.”  Or  “being a bit overweight is okay, but if you weigh some huge amount, like 350 or 400 or 500lbs, well then there’s all these things you can’t do, like hold down a job or get out of bed.” And don’t forget “Anyone who weighs [above arbitrary threshhold] has diabetes and high blood pressure and knee problems and will die in five years, tops.”

I’ve been in that “really huge” category for over 15 years.  During that time I’ve worked at various jobs, traveled around the US and Canada, attended college and taught at a college.  I’ve been leered at in my swimsuit at Disney World, posed for a life drawing class, exercised with friends and a personal trainer, and gotten married.

I started this blog to talk about what it’s like to weigh about 400lbs.  How bad is my health?  How much can I physically do or not do? How it does being fat affect my life?

For example, I happen to be “apple-shaped” – I have a big belly, which means I can’t do a very good traditional seated forward bend, which stretches the hamstrings and back.  So (as seen above) I do an adapted version of the pose, stretching my back and other muscles in my legs.  I do the hamstring stretches in other ways.

Why doesn’t the photo show my face?  (Don’t I know that “Headless Fatties” are dehumanizing?)  This blog is all about my body, so I am putting the emphasis on my body.   Second, I feel that maintaining a bit of anonymity will make it easier for me to be honest.

Happy September, everyone :)