Fatness sucks: case in point

For two years, a friend of mine from school and I have been planning on arranging a hot air balloon ride to celebrate successfully completing our school program. Over the last couple of months we've been tossing dates back and forth and making a more specific plan. I finally called to make the reservation today, after including a couple more friends in the planned outing, volunteering to drive to the site, and encouraging everyone else to make their reservations soon too.

The hot air balloon company won't take me because of my weight. Their usual maximum limit is 240 pounds but they will allow up to 300 for an additional fee. I'm still over that.

Luckily, when I had to tell my friends I couldn't do it they were supportive, but the whole thing was awkward and embarrassing for me.

Maybe I can revisit the idea later. :-(

Update on phentermine trial

I've been on the 30mg QAM phentermine for about 2 weeks now and I thought I'd do an update. For one, it's not making me super anxious, which is something I was concerned about. In fact, the first few days I took it I felt extremely exhausted and sleepy. My weight was 357 on the morning that I started the phentermine and this morning I weighed in at 349.8, so it does seem to have kick-started my weight loss again and ended my last plateau. There's often one day per week that I don't take it due to my changing sleep schedule for work.

I do still feel hungry, especially when I first wake up in the morning. And sometimes I wake up at night and I'm so starving I go downstairs and have a protein shake or something quick. I don't know if that's because the phentermine has warn off by bedtime, or perhaps related to my ever-shifting day-night sleep schedule due to work. I don't remember being as aware of the intense hunger in the night during my days off before. I am eating, and thinking about, food less often. I did notice my usual upswing in my cravings for fatty foods in the week before my period, despite the drug.

One thing that I've noticed is that I sweat A LOT since starting the medication, even with mild exertion. For example, for work sometimes I have to wear a plastic gown to go into certain patients' rooms, and this has always been a sweaty, uncomfortable situation for me, but during the last two weeks if I find myself in that situation, I sweat through my scrub top to the point that there are dark circles under my arms, down my back and front. And just walking at my normal pace causes beads of sweat to roll down my forehead.

So, I've only lost 13 pounds in the 6 months my doctor has been intentionally working on weight loss with me, which is discouraging, but the rate over the last two weeks with the phentermine is brightening my outlook some. I have no certainty about keeping it off when I stop taking the pill, or how long it will work for. Another friends said it lost its effectiveness for her after about 6 months. Cautiously optimistic & glad to see the numbers decreasing again.

Phentermine trial

So I met with my primary care doctor again today. On the protein regimen (>100g protein per day, <100g carbs per day) I lost about 10 pounds over 2-1/2 months, then started glucophage 100mg BID in addition to the protein regimen and I've been plateauing between 354-358 for the last 2 months or so.

Today, I again brought up the possibility of getting a sleeve gastrectomy, or at least starting the referral process so that in 6 months if I'm still not making decent headway with medical management I can go ahead and get the surgery. I made it clear that I would keep being committed to any recommendations he could add to the medical side of things, and that as long as I continued to lose weight with his regime (and at a rate that will get me where I want to be before I'm 40) that I would postpone surgery, even beyond the necessary 6 month preparatory period.

He agreed to that arrangement, and wrote orders for some pre-operative lab work, mammography, bone density scans, etc that I am supposed to get done as part of the referral process to the surgical program. He also prescribed phentermine 30mg once a day before breakfast, to try to get me off my current plateau. I picked it up from the pharmacy and took my first dose around noon today. Normally I would be concerned about taking it so late in the day, but I'm working night shift tomorrow night, so I need to stay up late tonight in preparation for that anyway. My other concern with phentermine is that my personality tends toward the anxious (not outwardly, according to my friends, but very much so on the inside) and I worry about the phentermine heightening my anxiety. Fingers crossed that it's just an extra boost of energy to get some school work and exercise done.

I did 2-3 hours of yard work the other day and my body really felt it the next day. My arms were as weak as cooked spaghetti. Felt good to do something physically demanding though.

I will continue to track and share my progress. Here's my current front and side view. About 357 pounds this morning.

Met with my primary care doctor

I'm doing fairly well on the >100g protein (using shakes/supplements) and <100g carbs plan that my doctor outlined for me. I'm down somewhere between 4-9 pounds in 2 months of trying. I have a pretty wide day-to-day fluctuation so I can't give it an exact number.

I had a follow up appointment with my primary care doctor today. I had been to the surgical weight loss seminar a couple weeks ago, and hoped to get a referral from my doctor to at least start the 6 month process to get it approved. Not to necessarily go through with it, but to have it as an option.

My doctor wouldn't refer me. He wants me to give it at least a year of medical management with him before I consider surgery seriously. I showed him my graphs of weight over the last 15 years, and the yo-yo-ing. His plan for me is the protein diet, then metformin, then possibly phentermine. I've already been on metformin before, for about 8 years. I don't feel like it helped me with my weight loss. My weight yo-yo-ed during that time just as it did during others, and it gave me GI distress. Phentermine I haven't been on before, but stimulants kind of scare me. He also mentioned trying Topamax. I remember my mom being on Topamax "for migraines," but really for weight loss back in 2005 or so. It made her very verbally slow and very forgetful. I don't think I could stand that, in my professional or personal life.

Going to take this one step at a time but disappointed that he wouldn't help me get the other process started.

Attended surgical weight loss seminar

Last night I went to a surgical weight loss seminar put on by a local bariatric surgeon and his team. The doctor said he doesn't perform lap band surgery anymore because it's not proven effective in the long term. Just a few years ago my mom was trying to talk me into having that surgery with her. She got it, herself. Got down to a healthy weight but then gained it all back again. Whenever I pictured getting that done I thought I'd feel like Ping the Duck, in a childhood story I read, with a ring around his neck that prevented him from swallowing his fishing catch.

One thing the doctor pointed out in the seminar that I didn't know is that if you need to take medications regularly, and have them absorb well, a gastric bypass is not the best option -- you not only have limitations on absorbing nutrients, but on medications as well. The gastric sleeve, which is what my friend had, doesn't do this. But sometimes people get really bad acid reflux after the sleeve and end up having to convert to the bypass (which corrects the reflux).

I gave them my information at the seminar with the thought of starting their process in case my current gung-ho efforts at weight loss through increased protein and decreased carbs doesn't turn my health around enough. If I'm going to move forward in their process (which would take at least 6 months before insurance would approve it, including nutritionist and psychiatrist appointments leading up to the surgery) the next step is to get a referral from my primary care doctor and have him send over my labs etc. My next follow up with my primary care doctor is in 2 weeks, so I'll talk with him about it then.

Giving protein another try

Some time has gone by, obviously. I haven't made major headway in the weight department, but I have begun my new career in nursing and it is going well, despite my size. Whew.

At the end of last summer my primary care doctor retired and referred me to another physician in the same practice that specializes in obesity medicine. We met in January for a specially set aside appointment to discuss weight management: he wanted to have a larger block of time and really focus on that. It appeared to be a busy day at the office and we only really met for between 5 and 10 minutes, but I'm refocused on specific goals again. He wants me to aim for greater than 100g protein per day as well as less than 100g carbohydrate.

For a couple of years (and the last time I was updating this blog regularly) I was tracking everything I put in my mouth using the LoseIt app on my ipod. Although I think it was helping, it just began to feel to cumbersome and time consuming for diminishing returns. But I've used it recently to check in on those macronutrient amounts.

My doctor recommended a specific protein supplement (which comes in a whey powder to make smoothies out of, or a pre-packaged "shake" drink). He told me to drink 2-3 of those per day and then have a dinner of real foods, with about half protein (lean meats) and half non-starchy vegetables.

I am mostly vegetarian, but eat fish now and then. After the appointment I went to the grocery store and bought a couple weeks supply of the pre-packed drink and a tub of the powder, as well as some individually freeze-wrapped fish portions.

I'm about a month in now, and I'm doing really well with the protein drinks (and meeting the >100g protein requirement) but I can't bring myself to eat animal flesh, of any kind, daily. One or two tuna salad sandwiches a month, yes. If they have lots of celery and sprouts and lettuce and honey mustard to sort of distract me from the fact that I'm eating flesh.

I went veggie at age 9, and I think when you haven't eaten substantial meat for that long you just lose a taste for it. In my mid twenties I started eating fish again every now and then. Can't bring myself to eat more at this point though.

Anyways, so with the protein supplements, 2 of them per day definitely left me HUNGRY, but 3 per day plus a meal is doable. I make my own blended ones when I'm at home and use the pre-packs to bring to work for my 12 hour shifts (easiest lunch I've ever packed). I also eat almonds through the day. I do end up craving and splurging on carbs and sweets though. I'm working on that and making some headway.

With what I've done so far, I've lost about 5 1/2 pounds over the last 5 weeks. And that's with not complying with the carbohydrate limit yet (I'm working on it!). So I'm feeling optimistic. A pound a week adds up to 50 pounds a year if I can keep it up.

Another thing I've been thinking about though: a coworker of mine got a sleeve gastrectomy at about the same time I started this diet regime. She's lost about 30 pounds so far and has 30 more to go. Her whole process went smoothly and she feels great. I know weight loss surgery is a major, major intervention to contemplate, but I've been thinking about it more seriously after seeing her success.

I'm 35 now. Although I've been making major changes in my professional life over the last 5 years I feel like my personal life (love, family, babies eg) has been set permanently on the back burner due to my size. And I'm increasingly feeling like time is running out. I'm thinking about taking a more drastic approach that would get quicker more permanent results. I've lost 30 to 40 pounds before, repeatedly, the "traditional way" and gained most of it back when I went through a period of depression or had a medication change.

I think part of what really peaked my interest about the surgery my coworker had was that they remove part of the stomach that produces ghrelin, which is the hormone that makes us feel hungry. It is irreversible. I suppose if you were non-compliant with the post op diet you could potentially re-stretch your stomach beyond the banana size one they give you in surgery. I like that there are no foreign objects in there like there are with the lap band, and you don't have to get fills and adjustments.

So my plan for now is to keep going with the nutritional changes, and keep aiming for >10,000 steps per day (easy on work days, harder on my days off), but at the same time start researching weight loss surgery more in depth. My coworker had hers done in Mexico for $4,000 even, and while it sounds sketchy, she said it was the best medical experience she's ever had in terms of cleanliness, safety, comfort. There's also a surgeon in my county who does them and has information seminars about once a month, so I'll go to one of those soon and check it out.

That's where I'm at right now. I've updated my weight chart down at the bottom of the blog -- I'm at 358.4 lbs right now and I've been averaging about 6-7,000 steps per day for the last 3 months.  Next update sooner.

That argument with yourself...

After a long clinical day (I am a nursing student), my plan was to go to the gym to do an ab workout class. I've been to the class before, and really felt it the next day. My gym clothes were in the car, all I had to do was drive there, change quickly, and jump in. But I talked myself out of it :-/

I got a lot of exercise at the hospital today. Almost the self-required 10,000 steps, and I knew I could get above it doing chores this evening in between studying.

I've got two tests this week, and felt like I needed to get home to study ASAP, but that is not an uncommon occurrence. I need to learn to prioritize exercise as well as academics.

I told myself I didn't want to be ultra-sore for my 1st day attempting total care of 3 patients tomorrow. But really, sore abs would not get in the way of a nursing shift. That was a made up excuse.

Next time (Wednesday) I will do better.

Strange lack of body awareness

The other day I went for a hike, at a trail that I often use. It's hilly, public trail out on a ranch near town. Mountain bikers use it, too. I've done this trail about 10 or 12 times total probably. The first time, when I went with family, it probably took the whole group of us 2 hours or more to get around the whole thing. My fitbit rates it at about 10,000 steps and about 32 flights of stairs worth. So, it's a good, challenging workout for me at this point in my fitness.

One of the last times I went, though, I had the odd sensation that it was just OH SO MUCH HARDER than usual. It was warm out, sure, in the 80s, but not any warmer than the last time I had done the trail. Was it the week I had had previously, I wondered? Or because I was listening to an audiobook on my ipod that I had already heard before, rather than one of my nursing school lectures that I really had to concentrate on....yes, perhaps it was distraction that was key? Or maybe I hadn't slept as well or as long the night before? I even started wondering if maybe I had accidentally taken the 'long loop' instead of the 'short loop'.

It was only when I got to the end, back in my car, and peeked at my clock that I realized why. I had gone around about 20 minutes faster than the last time I did it, without even realizing it.

Inching downward

Over the last month I've gone from 351.6 to 347.4 (on average); that's a loss of 4.2 pounds. If I keep that rate of loss up over the next year (which seems very reasonable), I could be 50 pounds lighter by this time next year, which is VERY MOTIVATING.

Reporting in on last week's progress

From 12/26/11 to 1/1/12

Total steps: 34,820
Total miles: 18.34 miles
Total floors climbed: 39
Total calories burned: 21,727
Weight change: down 1.9 lb

Ups and Downs

I can't say I've made stellar progress over the last several weeks. I'm hovering right about where I was weight-wise. But I've gotten my sorry ass back to the gym and have been doing some treadmill walking. That's a start. And I'm getting my motivation back, which can't hurt the situation.

This weight loss stuff is hard. Maybe the hardest thing I've been up against in my life. And I have a hard time staying focused on it. Life gets busy, I injure myself, I get sick, I have a mood dip...and all of a sudden I'm off the wagon, spiraling downward (upward?) again.

A few weeks ago, I was walking back to my car from my last teaching session of the quarter, stepped off a curb funny, twisted both ankles, an fell, landing on my right knee. My ankles, thank goodness, seem to be healed, but my right knee is still complaining. I'm trying to be gentle with it. It doesn't feel good to get up from a sitting position, and sometimes when I am lying in bed at night, if I'm in one position too long, and try to move, my knee is very stiff and painful. Arthritis, I guess. Hopefully it will calm back down over time.

According to google, the site of my knee pain indicated meniscus or collateral ligament tears and arthritis. Ugh.

My plantar fascitis, while still present in small amounts, hasn't been causing me much grief lately. I am still wearing my orthotics every single stinkin' day. Which is probably a good idea for the foreseeable future.

That day I fell off the curb? I was lying there, on the pavement, in really bad pain...wondering if I would have to take an ambulance somewhere, if I broke something. A guy walking by stopped and asked if I was alright. "No!" I said, "I've sprained both of my ankles. It hurts really bad." He paused awkwardly, asked if I was going to get up. I said I didn't think I could yet. He walked away. Walked. Away. I can't imagine ever just walking away from someone lying on the ground in pain. Wtf?

Two motivation boosts for me right now:

(1) It's almost the new year as I write this, and even though that's just another day, it's a new goal-setting, reflecting time for me.

(2) If all goes according to plan, I will be starting nursing school in about 8 months. Eight short months. And I don't want my weight to be a big issue when it comes to being on my feet for clinicals.

I just have to keep that in the front of my mind and stay focused!!

1.5 pounds down in the last week!

I'm pretty happy with that loss (349.2 to 347.8). I haven't been perfect with my diet this week, but I've been pretty active, and am still feeling very motivated by my fitbit.

I don't have a lot of time to write just at the moment but I wanted to check in at least. I'm going to join a new "challenge" group that will run the day after thanksgiving until I think new years.

Today at work, while I was doing our daily mandatory walk of the grounds to do a safety check, I consciously walked faster to try to get more "very active" minutes logged to my fitbit.

It is thanksgiving this week. I honestly don't think it's going to be that big a blip on my health radar. I don't eat turkey, and I don't really see overdoing it too much on any one item. I'm planning to make a pumpkin pie and some cranberry salad, and my family is going to bring the rest (it's at my house). I do adore pumpkin pie, but I'm only making one, and there will be 4 adults and one child...so there shouldn't be *too* many leftovers.

Tomorrow I'm starting an internship relative to a class I'm taking right now, and I'm going to probably be on my feet for 5 hours straight. I hope I do alright.

The return of optimism!

This morning I am in a perfect mood. I got up early enough to have a real breakfast, and some coffee. My favorite health podcast is back (http://www.fat2fitradio.com) after a months long hiatus, the scale is moving in the right direction, I found some old favorite, extra warm socks in the back of my sock drawer this morning, *and* I will be done with work at 4 today and get to go see Puss n Boots with a friend. Life is good.

So far, so good!

What I've found so far, with the fitbit, is:

-It's motivating me to get more exercise in little ways throughout the day. Take the stairs, inject bouts of activity between sitting at the computer or whatever.

-When I get home after work, and up until bedtime, I'm constantly checking to see if I've reached my steps goal or not. If I haven't, I'm motivated to do more to try to get there before bedtime.

-Other than this morning, I've seen steady, gradual weight loss every day since I started wearing it. (this morning I was up 2 pounds, likely a water fluctuation)

-I'm doing more house cleaning, because it's one way to get active without making the effort to go somewhere new for the purpose of exercising. Double bonus!

-I feel like I'm getting a more accurate picture of how many calories I'm burning and how many I should be eating. I take my calorie limit more seriously when it's based on my actual activity rather than a weight based estimation.

-The combination of changing to a new online record system, and having a new gizmo to monitor my activity, has gotten me back to recording all my food intake again, where I was really struggling to keep it up with my old system, not because it was inferior, just because it was familiar.

-Ranked against other folks my age, my activity level is similar to someone who is normal weight. That means, eventually, I'll get to where I want to be if I can keep it up!

Trying something new...

I've been contemplating getting some sort of bio-logging device for a while now. I have one of those nike gizmos that you stick in your shoe and it tells your ipod your distance traveled, but I haven't really used it much. You have to have your ipod with you, and it has to be specific time that you are saying "I'm exercising now" rather than incorporating it throughout your day.

I looked at getting a fitbit or maybe a heart rate monitor many months ago, but I've been not getting by financially, and couldn't justify the purchase. This month, after making headway in my finances due to a 2nd job, and deciding to take a break from my YMCA membership, I finally settled on buying a fitbit. They have just recently come out with a new one, that tracks stair cases climbed, as well as steps and distance.

I've worn it every day since it came in the mail, and have found it really motivating so far. Each day I've taken more steps. I broke the 10,000 steps goal today, as well as the 10 staircases goal. You earn badges for intervals like that when you accomplish them. There's also a leaderboard where you can compare your stats to your friends or people in a group you belong to, that can be motivating through competition.

It's easy to conceal by clipping it to my bra (I hated those old pedometers that you had to clip to your pocket...they always fell off). I can check it discretely throughout the day, say when I use the restroom. And it updates wirelessly to my online account when I am using my laptop. So far, so good.

I was torn at first about what to do with food logging. I have been using the loseit system for the last yaer...and fitbit *will* update to my loseit, but only if I go over a certain calorie burn, and then it's as a "fitbit adjustment". For now, I've been logging all my foods into fitbit, but I log my weight updates in both places. I like that loseit allows you to export reports (like the last several weeks of my weight logs) where fitbit at this point doesn't. It makes it easier for me to update my records.

I have lost 2.8 pounds since Nov 2nd when I started wearing my fitbit. Yay!

I also went for a walk with my girlfriends today for the first time in months. We walked on a path that runs alongside the railroad track in town. It was chilly, but the sun was out.

I haven't been feeling great this weekend. I had to nebulize for the first time in months (for my asthma). But it was good to get outside.

Long time no post ... sorry.

I haven't been doing a very good job of keeping up on this blog for the last couple of months, or keeping up with taking care of my body. I haven't had a single day off in a long time (working 7 days per week and up to 12 hours per day for over 6 weeks now) and everything just sort of broke down.

I stopped logging my foods on loseit, and then I started again briefly, and then I stopped again. I have been getting exercise, but not purposefully exercising. My weight is, unfortunately, back up where it started at the beginning of the year.

I was inspired recently to restart my pedometer tracking since I am having trouble setting aside specific time to exercise. It took me a bit to find the thing, and it was out of battery juice, so I've gotten replacement batteries that I need to put in there. I'm going to start that tomorrow, and try to set a modest goal of increasing my weekly steps 5% each week. Several years ago I did a program where I was supposed to increase my steps 10% each week and I just couldn't keep up with the pace. I have a feeling that with everything going on right now, I had better just pick something manageable so I don't have another "failure" on my hands.

So...I've had a setback, but this isn't the end of things. I'm going to keep pushing forward.

My mom (although she lied to the whole family about it) had lap-band surgery about 10 months ago, and has lost about 65 pounds. She'll say something like, "All I had to eat today was a handful of almonds," and actually be genuinely proud of that. I think it's unhealthy... sick even. She keeps finding ways to bring up her weight loss in conversation with me.

I'll be posting more often now, to try and get myself back on track.

The assumptions of others (2011 Week 35 Update)

I lost 0.2 pounds last week.
I was 238 calories under budget.
I didn't log my food and exercise one day.
Exercise included walking (mostly at work) and gardening.
My diet was 9.5% protein.

Recently at work, there was a fundraiser for the alzheimers association. Two of my coworkers made homemade salsa and chips, sold for $5 per container, and all the staff and residents could buy them and the proceeds went to the nonprofit.

The residents where I work are older and forgetful, and one woman came to the desk, very angry, wanting to know where her salsa and chips were. She hadn't ordered any, but she was sure that she had. The woman who is in charge of the event made her a special batch just to keep her happy -- she brought the salsa that day, and the chips a few days later. We called her and told her the chips were ready for her to pick up, and she didn't pick them up...and still didn't pick them up.

I came into work yesterday, and the bag was open and much depleted. "Where did Pat's chips go?!" I asked, and my coworker explained to me that Pat said she didn't want them anymore, and she and our other office worker had been snacking on and off through the day.

Later, our manager came out to give me my lunch break before she went home, and when I got back from my meal, she looks at me kind of condescendingly, and says..."I notice these chips are open...have you been eating Pat's chips?!"

It kind of hurt my feelings that she would think I had just been tearing into someone else's food because it was there and handy. I explained the situation, and kind of made a joke out of it, and she laughed...but it hit me the wrong way.

Up a little again...(2011 Week 34 Update)

Up 1.4 pounds last week. :-(
Under 498 calories
Only 1600 exercise (walking, cleaning)
12 % protein

I haven't been extremely focused on fitness and weight loss recently but I am still tracking everything, every day. Sometimes the numbers going up and down seem so arbitrary. And I know that if that's the case I need to find OTHER measurements or successes to focus on. And loseit is helping with that---hey, I met my calorie goal last week, that's good. But whine, whine I wish my numbers were getting smaller faster.

My new job has started to feel a lot more manageable, and my class this fall is going well. I really need to start working more gym and exercise time back into my schedule. I think I'll work on that tonight.

Trying out a new mantra...

Somewhere I read the idea to ask myself:

"Is this what I want?" Is this *really* what I want?"

when I am about to have something unhealthy. I've been trying it out the last 2 days and although it's no fail safe, I think it may be helping a little bit.

It helps take me away form the immediate WANT SUGAR NOW and gets me to refocus on my goals and maybe have a glass of water or another healthier substitute instead, and hopefully slow down and acknowledge that I am feeling anxious or lonely, not really hungry.

Plodding along... (2011 Week 33 Update)

Here are my stats for last week:

Lost 4.9 pounds (most of the water weight I gained the previous week)
789 calories under budget
33% fat
55% carbs
12% protein
1,045 calories of exercise (walking and gardening)

I'm doing alright in my life generally right now but still having trouble with emotional eating and making a commitment to exercise. Things have been much busier than usual, but I'd still like to make time. Tomorrow I have the day off from work, and I have some errands I need to run, and study for a test that night, but I'm thinking I'll go to aqua aerobics at noon and get some exercise in. I haven't been in the pool in a while, and it sounds good.