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.

Sinking back into bed (2011 week 11 update)

This whole week, all I have wanted to do was sink back into bed. It has been chilly, and rainy. My mood is low. This afternoon when I got home from doing errands I was feeling a low energy and like I wanted to lie down for a minute, so I thought I'd listen to a podcast that I had fallen asleep during last night while lying on my floofy pillow chair in the living room. I fell asleep once again, about mid-podcast. And when I woke up, I was so cold, I decided I really needed to crawl back under the covers upstairs in my bedroom to warm up again. I thought I'd just read for a bit. Hah. I know better.

Now it's 8pm, my ridiculously long weekend is over, and I really do have to buckle down and get a few things done before tomorrow.

And I need to check in here, because it is going to help keep me on track, I hope. I'm down to 335.6, which is back about where I was two weeks ago. I don't know where that came from because I have been seriously overshooting my calorie budget all week, but it could just be water weight coming off I guess. I have been getting some exercise, mostly around the house, moving boxes, painting walls, cleaning, carrying things up and down the stairs. I'll put on a kitchen timer for 45 minutes or an hour and tell myself to keep moving until the timer goes off, to keep getting things done. I always work up a sweat that way, but I know I really should be going to the gym as well.

I got fitted for orthotics today (they took plaster casts of my feet), so I should have those in a couple weeks. Hopefully they will help with the exercise vs foot pain issue.

I have been watching a lot of movies, reading a lot of books. Sort of checking out of reality. I did make an appointment with a counselor for next week to talk about, among other things, stuffing my emotions down with food.

...followed by pain.

After my hike yesterday I did a bunch of cleaning around the house and then hosted my brother and his family for dinner. By the end of the day I could hardly walk. My right foot was in so much pain whenever I would even put the smallest amount of pressure on it to hobble the next step.

My parents had invited me over to watch a movie with them. Whenever I am off my feet for a while and then try to get up again the pain is back -- so sitting still for an hour and a half movie and then trying to walk out to my car, well let's just say I looked seriously impaired.

My insurance situation is kind of wonky right now, but I've decided it's time to take the next step in treatment, which wound be a cortisone shot in the bottom of my foot. I've tried the stretches and the special shoes, and they do help some, but not enough. I've got one podiatrist in town that I'm allowed to go to (by my insurance) so I'm going to call up next week and see about making an appointment. Hopefully the shot will do the trick. Plantar fascitis sucks.

Couch 2 5 K Update, Aches and Pains

The morning after my first try at Couch 2 5 K, I had the worst plantar fascitis pain I've had in a long time, and also was having some sharp pain in my right knee with just walking. So, for the time being, I'm won't be trying to run anymore. I am going to wait until I get down to a more reasonable weight... what would that be? Maybe below 300 lbs? Below 250 lbs? I'm not sure. It is probably something I should try again at intervals of weight loss and see how I do, how my body responds. But right now it is sending me a pretty clear message that I should walk instead of run!

Plantar fascitis has been a frustrating thing for me to deal with. I think I experienced my first symptoms about 5 years ago. It has gotten worse and worse since then, and the more active I am on a given day the more pain I can count on the next morning. I have talked to my doctor about it. He gave me some stretching exercises to do, and suggested I buy some orthotic shoe inserts.

I bought the shoe inserts (something like this), and also bought a special pair of "orthoheel" shoes (something like this). I try to remember to stretch out my feet with the exercises he gave me at the end of the day but I admit I have been slacking a bit there lately.

I understand that the next step is to go to a podiatrist and get an injection of cortisone in the bottom of my foot, which I have heard is pretty painful but would pretty much take care of the problem as long as they get it (guided by myself) in the right place.

If that doesn't work there is also a surgery to consider. Rather not go there!

I've also seen various products online...foot exercisers that are supposed to strengthen your foot muscles and in so doing lessen the pain, and splints that are designed to stretch your foot while you sleep. My doctor didn't mention these things, but I sometimes wonder if they would help. I also hope that once I get down to a more reasonable weight, maybe that will ease some of the strain on my foot, but I know that even very slim athletes get plantar fascitis, so that's not the entire root of the issue.