Weight Loss

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Wednesday, December 30, 2009

It's Mental

This morning, I am:
  • knitting a blanket
  • sitting at my (old) new kitchen table
  • looking out at 1.5 inches of snowfall (the perfect amount)
  • drinking coffee
  • listening to an old This American Life podcast
This is what vacation looks like for me. It's not bad. It's a bit lonely--I don't see many people during my vacation, but I don't try very hard either. But it's restful, and I am doing some things that I won't be able to do much of for the next 6 months, once studying for boards begins in earnest. I've done a bit of reading, but not as much as I wanted--I ordered about 5 books in anticipation of all this vacation time, but didn't read very much of it.

The kitchen table I finally got yesterday off Craigslist. We have a breakfast nook in our new house, with windows on two sides and a built-in china cupboard. It's right in the entrance from our back door, which is our usual entrance to the house, so I wanted a table big enough to spread my anesthesia books out on to study, but not so big that it would block this entrance. My hubby was really against putting a table in this space, but I really wanted it. I just did. I wanted to be able to sit here with coffee and my books, I wanted to be able to make breakfast and not eat it in the dining room, I wanted to be able to sit and chat with hubby when he was cooking. So I finally found a table that met my requirements. It's not the greatest table but it's not the worst, the price was right and so was the size. And we're both happy with it. I'm really enjoying being able to sit in this spot with some natural light, drink my coffee and have my quiet morning.

We didn't have a white Christmas, which we usually seem to in this part of the state, but we got a little snow last night. Not enough to create any real problems, just enough to look nice. We are supposed to get more this week, but I don't think we are expecting huge amounts. I'm preferring this milder winter to the past two years of major dumpage. For the record, I really don't care for snow. I grew up in an area that rarely got snow, and when it did it was never more than 1". I don't like cold weather or snow. But now I live in Spokane, so snow it is. I'm dealing with it.

I've lost 3 pounds, yippee. Mainly I have been running every other day (even though I usually feel like I am dragging an ox behind me when I do), and not snacking. I am back to "only eat when you are hungry" aka the 3-year-old diet. I realized that I had gotten to the point that I was used to feeling full all the time. My restriction is fine, but I've always been able to eat even after I feel full (with no PB or barfing) and I'm sure this is stretching my stomach. I'm trying to reverse this trend now and actually use my band the way it's supposed to be used. The thing is, I've gained a net of about 5 pounds this year: I started the year at 177, lost to 165 (mainly through stress), then slowly gained to 183. That doesn't seem like too much in the grand scheme of things. But if things continue this way, I will regain back up to my previous weight--it will take time, probably years, but it will happen if I don't do something about my intake. The point of the band is to stop hunger so you can eat less, but I'm not hungry ever, and I'm still eating. That is madness.

So, I had cottage cheese for breakfast, and coffee. I'm not going to be draconian about this. I'm just planning to use the band. Eat a small meal when I am hungry, stop when I am full. Try to get my target amount of protein each day. If I'm not hungry but still feel like eating, I either chew gum or drink water. Pretty simple. Add in exercise, and hopefully get results. If I do this and feel like I'm getting hungry too soon, first I'll evaluate my meals to see if they are suitable to keep me satisfied, then if that doesn't work, go in for a fill.

This is all mental work. The band is a simple device, and it does one simple thing: it makes you feel satisfied after a small amount of food, and keeps you feeling that way for 3-4 hours. It doesn't have any effect on emotional triggers for eating, the desire to have one of those cookies sitting right in front of me, the choice of meal I make when eating out, how well I can resist my hubby offering me food when he is eating and I'm not hungry, my ability to get myself outside to run, or how I see myself in the mirror. All of those other things still matter, and they still have to be addressed. The longer this journey lasts, the harder this gets.

So, nearly 3 years out, there is less and less to write about this "journey." It's not as interesting as losing weight every week as in the first 18 months (your mileage may vary). But this is where that annoying phrase about WLS being only "a tool" comes into play. There are a lot of ways to fail at this, and just assuming that the band will do all the work seems to be the biggest factor in most of them.

Saturday, December 12, 2009

Baby, It's Cold Outside

I'm a rather solitary person by nature. I think it was why I was able to work night shift for 7 years. When I was single, it was easy to stay on my night schedule and do the solitary activities I love, like sewing, beadwork, reading, etc. When I met my husband I was still working nights and I worked them for 2 more years before making the switch back to days. It's much harder working nights when you live with a dayshift person.

All of this is to say that it is in my nature to spend time alone, although I love having a partner now and spending time together. When I get the opportunity to spend time alone, however, it is nice. As happens to most people who get married, that precious alone time becomes less and less frequent.

My husband's brother is in Portland this weekend from New York. I would have liked to see him, but I didn't have it in me to make the 700-plus mile round trip this weekend. It's been a long exhausting year, and so we aren't even planning to travel for Christmas this year, which is rare. I really needed a weekend to do nothing--no school or studying, no traveling long distances. So hubby is in Portland visiting his dear brother, and I am sure they are having a great time together. I would like to be there, but as it happens I have some alone time this weekend instead. It's been a very long time since I have had that.

I've done a lot today already: went to the sale at Joann's Fabric to get a new pair of sewing shears, got things to make a holiday wreath, and then made it and hung it, and now I've just gotten back from a run. This evening I plan on sewing and organizing the basement, and then maybe watching a movie and knitting. I'm not doing one bit of studying!

The running is going slow--I wasn't able to get out there during the week for various reasons. I'm still averaging less than 5 miles a week so far. But running in the cold is better than I anticipated, since I hate being cold. I found today that although my lungs want me to stop, I keep running longer because my legs start to get cold when I walk. Bonus!

I saw something really cool when I ran around the little park by our house. It has a pond, and people were ice skating there. I've never lived somewhere that you could actually ice skate on a pond! It looked like the cover of a Currier & Ives catalog. (Remember those?) Most of the people were preparing for an ice hockey game, but a few people were out there figure skating. It's not a very big pond, but the weather is perfect for it: it's been very cold, single digits at night with highs in the 20s during the day, and so it's been too cold to snow, and there isn't much on the ice to sweep away first. I'm not a cold-weather gal, but I loved seeing people out there skating on a pond. It made it feel very small-town, which happens a lot in Spokane actually.

I hope everyone's Christmas preparations are coming along well. Ours are pretty much done. Normally we go to my brother's house for the holidays, but his wife just gave birth to my first niece this week. As much as I would love to see them, and meet little Kiera, they are very busy with the new baby, and we are too tired to try braving the snowy mountain pass this year. So we are having some friends over for dinner and games and movies on Christmas evening. I'm really looking forward to it. We'll go see my family after the holidays when the mountain driving is a little less stressful.

Monday, December 7, 2009

Return to Form

I took a running break. I intended it to be just a few weeks but it ended up being about 6 weeks. I needed the break mentally more than anything else. Like anything else, if you run for a couple years (21 months) without a significant break, you'll get bored and lazy. At least, I will.

The break did me some good, although I have gained about 5 pounds more. In that interim, we have moved, and had a lot of other stress as well. Thanksgiving came and went. Last week I knew it was time to get out there again: actually, I was so stressed out I didn't feel I had much choice but to go move my legs and exhaust my lungs and think about anything but my life for a while. Today's run was better than last week, and I almost didn't notice that it was 15 degrees outside. The sun was shining and it was lovely. My legs want to do a lot more than my lungs are capable of right now, but hopefully we'll be back in sync soon.

Since we've "fallen back" to standard time since then, it gets dark by 4:30 now, so I decided to invest in a good headlight, as one less reason not to run in the winter. Our neighborhood doesn't have many streetlights, and it's an old neighborhood with sidewalks interrupted by old tree roots. It's treacherous without light. The headlight was a resounding success on my first night-time run--I was amazed at how much I was able to see with just a $25 headlamp.

Now I have some serious weight loss to concern myself with--in late January I was at my lowest weight of 165, and today am back to 181, after staying right around 175 for most of this year. This is significantly higher than I want to be, but despite the holidays being upon us, I think I can tackle this at least somewhat. I'm hoping we don't get tons of snow this year, so I can either run outside or get to the gym without too much trouble.

It was good to take a break, but I'm glad to be back. Weight loss will be a bonus--I need the stress relief and the endorphins. And I intend to take Bloomsday again next spring! It's the weekend before I graduate, but hopefully I won't have so much on my plate that I can't do it.

Thursday, November 19, 2009

A Deep Breath

Sorry for the long time without posting...we are coming up for air now. It's been a crazy week.

We moved last weekend. After 2 weeks of packing, the move was pulled off in one long day with two hired movers. I had a little last-minute mild freak-out because we didn't get moved before the first snow, but the snow we got (the day before the move) was minimal and we didn't get the frozen slick roads on moving day that I feared.

Moving day was more stressful and longer than anticipated, but we got it all done in one day. Yes, some things were broken by one of the movers (an inexperienced, strong guy without much sense of where things he holds extend into space). But it went fairly well, all things considered. It surprised me how much stuff we had managed to pack into our little apartment; easily enough to fill this 1800 square foot house we have moved into.

But! We love the house, so so much. We are renting, because we aren't in a position to buy and because I don't know if we will be able to stay in Spokane when I graduate in less than 6 months. If I get a job here, we'll extend our lease, and we may even have the opportunity to buy this house down the road.

We moved on Saturday, and on Sunday my hubby cleaned the old apartment while I unpacked at the house. He enjoys cleaning and I enjoy packing and unpacking, so it was a pretty good trade-off. The apartment looked GREAT when he was done with it. We should get our deposit back (we might have some knocked off because that mover crashed into a corner and knocked off a big chunk of plaster with a box, but we told the landlords and they may not charge us). I do like the organizing part of moving, but there is definitely a reason that we had not planned on moving again until after I finished school. It's so hard to do homework and study when most of my home is still in boxes. My mind has a hard time focusing when I feel like so much is in disarray.

The other big excitement is that my hubby started a new job on Monday. Yes, we moved AND he started a new job all within 3 days. He's been looking for work for several months now, so this is pretty exciting. Unemployment is hard, especially with both of us unemployed. But I think the time was important for rest and recovery, so while I think he wishes he had found a job a long time ago, I am proud of all the hard work he has done in the interim. It's been stressful, but overall it's been a good thing.

I have no idea how my weight is doing; my scale is still in a box. I usually weigh myself every morning so it's weird to go several days without doing so. There's been no exercise either, since every spare moment has been spent either packing or unpacking. I hope to get back into a healthier routine once we are more settled.

I must say, it is so wonderful to be in our own place and out of our apartment building. The tension with the sociopathic neighbor was so thick, it made being there miserable. He enjoyed doing things like parking just so I couldn't get into my parking space, or playing loud music at 7:30am, stuff like that. I'm way too old to be dealing with crap like that anymore. We spent many months trying to diplomatically handle the situation, first ourselves (mainly hubby) and then through the landlord. Finally, when it was time to resign the lease, and the landlords were starting to look at the option of evicting the neighbor (they preferred to keep us over him), we realized that would be a very long process, and it was the perfect time for us to just get out, before it started to snow so much that no one could move for a few months. So that's what we did. It was a disappointing end to a good relationship with a great landlord, but definitely the right thing for us to do.

So, my mind is full of things related to nesting and unpacking, but I'm pleased to say we are here and we are happy. Happy Thanksgiving to everyone!

Wednesday, November 4, 2009

Good luck moving up, cause I'm moving out...

It's been busy around here. My hubby and I live in an apartment that is the main floor of an old house. We've been having trouble with neighbors. Specifically, our upstairs neighbors have been acting unneighborly. We've been working with them and with our landlord for a few months now, but finally it became apparant that nothing was going to change. I can't study in our home because of the noise, and I am uncomfortable around the hostility and passive-aggressive behavior.

We were about to resign our lease (we've been here 2 years) when we realized that, hey, we can move.

I didn't want to move before I finished school, but suddenly it seemed the best solution. Our landlord toyed with the idea of evicting the upstairs neighbors so that we would stay, but eviction takes time. They wouldn't move voluntarily. And the winter is fast approaching; in about a month, it will probably be unsafe (or actually impossible) to move due to snow. We want to live somewhere where we don't share walls with neighbors anymore (maybe it's more me than hubby). So we decided to move into a house.

The decision came quickly, and the move as well: we are moving in about 12 days. It's not easy to get ready to move while in the thick of the semester, working and going to school. But it's the right thing to do. So it's been very busy here. But, the house we are moving to is just a few blocks away, and it's beautiful. Really, a steal for the amount of rent they are charging us. I can't wait to be out of here and into our new home. We have had great landlords here, and we're sad to be suddenly leaving, but it just doesn't make sense to deal with an untenable situation if we don't have to.

Between moving, working, wrapping up my research project, and studying, I haven't been running in a couple of weeks. And this week I've lost 2 pounds. Go figure. I'm thinking of going for a run today, but we'll see. I'm not stressing about it right now, which is nice, for once.

Thursday, October 22, 2009

Guest Blogger: Hubby

It was an unusually humid evening at Isla Mujeres, Mexico. Isla is a bean-shaped island just off the coast of the Yucatán peninsula, home of Cancun at its most north-eastern tip. My new bride and I were taking a walk, and she casually mentioned to me that she was seriously considering weight-loss surgery of one type or another. She was upset that she was obese, and felt that a surgical procedure could aid her toward the weight and health that she sought fit. I was taken aback.

My initial reaction was a form of confusion. Here was my new bride, my wife, a trained and intellectually-keen medical professional, who was going to “cop out” of hard work including exercise and a calorically-restricted menu? I married my wife knowing that she in fact was indeed overweight, and I never lost the sight of the fact that her weight was more of an issue for her than it was for me. I loved her more than anyone I had ever known, and it seemed odd to me that she was feeling as if I would not accept her given her weight.

That was my own issue, in fact. My wife had never gained a substantial amount of weight in our nascent relationship of a couple of years, and I knew that I was no muscular BMI-perfect “hottie” either. I honestly felt that through a joint regimen of active exercise and healthy diet, that we would both be able to achieve our individual weight loss goals. From my perspective, I knew that I would be able to gain or lose at least twenty pounds or more over a given calendar month, and so I assumed that Gwen would be able to do so also.

My wife later confided in me that in fact she had always battled weight gain in her lifetime, and in fact had even battled bulimia and forms of anorexia. Her mom had provided her morbid templates of unhealthy eating and living, and basically forced her to condition herself to purge her extra calories. Gwen had never been able to sustain a “reasonable” weight level, and her weight had fluctuated considerably since her junior high school days. A decade prior to our marriage, she had a substantial breast reduction, going from an obscene cup size down to a DD or D cup, reflecting about a 2/3 breast weight reduction. Weight and self-image had always been the bane of her existence, and even though she had found someone like myself who honestly loved her despite her obesity, it was still a salient and often daily concern of hers.

I honestly did not know what to think after our vacation. I only wanted the very best for my new wife, but I never really considered surgery for her as an option. Nevertheless, she looked into the surgical options, and came to a determination that a lap-band surgery would be her best choice. She discussed it with me, informing me of the pros and cons of the decision. To me it made sense, knowing that it was a fairly non-invasive approach, and the fact that it was reversible made me feel better. In the Spring of 2007, she underwent WLS surgery to have a lap-band in place. Over the next year, her weight loss was fairly dramatic, as is often the case with those who underwent said surgery. As of today, in late 2009, she has lost all of the predicted pounds she was supposed to have, which amounts to over sixty pounds. She is able to run several miles, and is in the best shape, weight, and health of her life. She is also still a knockout by any measure.

One of the considerations that I have dealt with in this journey is that I wanted to be sure that I did not look at her weight loss results as culminating in a “hot wife” or “thinner, sexier, mate”. However, I would be lying if I were. I was anxious to see what the net effect of the weight loss and healthier regimen would have on her overall physical appearance as well as inner demeanor. When I say “inner demeanor”, I meant her internal “thermostat” as to how she honestly perceives her weight, health, and overall appearance. To date, I know for a fact that she feels better about who she is and how she appears. I also know that my wife feels better about herself in general. A large part of this has to do with the fact that her WLS surgery is only the beginning. She needs to still take care of herself and monitor her nutrition and maintain her weight via exercise and proper association of folks that are similarly congruent in her path of wellness. At this juncture, it can honestly be said that my wife’s lap band is more of a secondary preventative measure, and her attitude toward proper nutrition and exercise, not to mention healthy habits in general, is her first level of defense against obesity and an overall unhealthful lifestyle.

Vanity is always a part of weight loss, whether we consciously acknowledge it or not. In my case, I honestly just wanted my wife to be able to attain a healthy weight and thus a healthy self-image concerning her body and appearance. However, I still have to smile when I think about how Gwen has transformed into a not just an even more gorgeous woman, but one that is dedicated toward a healthier lifestyle in general, regardless of her weight or appearance. This has rubbed off on me as well.

Approximately three months after the lap band surgery, we came across some of our wedding photos that we had hanging in our home on the wall. She remarked how “fat” she looked, with her flabby arms and chubby face. Looking at her at that moment when she said that, I suddenly realized that I could no longer reconcile who I saw when looking at my wife, and who I saw in the pictures of the bride during our wedding day. To be perfectly honest, I never really ever viewed her, in the wedding pictures especially, as “fat” or “obese”. But now, given my wife in front of me, they honestly looked like two very different persons. And yet, I knew that I absolutely loved my wife with all of my heart and intention before and after I married her, regardless of her appearance. The fact that she took her health and appearance so seriously after our marriage only extended the depths of my appreciation and love for her.

In short, weight loss surgery is not just a physical transformation, it is also a personal and inter-relationship transformation. Our western society tells us that we should look and act in a certain way, and when we don’t, an enormous amount of inadequacy and shortcomings tend to plague our personal judgment and self-perception. Many spouses of those who undergo WLS surgery of one type or another are usually eager to see the end result of the effort, which basically amounts to a physical change and appreciation thereof. In my experience, weight loss surgery is only the first step toward a true life transformation, and only seeing the physical results of this effort is seriously short-changing what the reality is. The reality is that it is a life transformation that has much to do with the inner person and their own impression of who they really are, and subsequently a physical transformation that becomes congruent with their inner self-image. I am often reminded of those who undergo sex-change (transgender) operations, and the fact that they must complete and pass a psychological process and examination prior to their physical surgery. In the realm of weight loss surgery, the emotional and psychological change prior and during and especially after the actual surgical procedure is every bit as important as the physical change.

My wife and I often look back at our wedding pictures, and it serves as an important benchmark as to how far she has come regarding her appearance. What is not so evident upon visual observation is how that woman in the wedding dress is in fact not just a thinner, slimmer, sexier, healthier woman…she is also a more integrated and balanced woman. Appearance is over-valued in our culture, but nonetheless it still stands a yardstick as far as how we subjectively determine who is “fat” and who is “not fat”. The fat bias is strong and prevalent, and much of it is unfortunately due to two factors: 1.) the general public’s ignorance as far as body types and healthy physiognomy, and 2.) the inability to perceive ethnic and genetic normalizations and tendencies toward one’s overall appearance and weight. My wife, Gwen, has always felt that she was a much thinner person trapped inside an obese body, and she has since rectified that. Fortunately, she has also come to terms with her overall baseline of health, weight, and appearance and thus can be properly attenuated toward such an ideal. Ironically, as her husband, I have much more work to fulfill toward both of those outcomes, and am thankful that my wife, heavy or not, obese or not, fat or not, chubby or not, has set a wonderfully balanced example for me.

I am so very proud of my wife, in her journey toward a healthier self-realization. It was not just a matter of WLS surgery, but also of hard work, character adjustment, and a fundamental appreciation for who she is as a human being apart from her weight or appearance. I love my wife, and even more so because of not just the work she was willing to do, but her pragmatic understanding that those who are in her life and perceive her as someone important in their lives must look past her physical presence and perceive her far more holistically. WLS surgery did not give her sudden physical acceptance. Her attitude adjustment and constant work in all aspects of her existence is what provides her that, and in turn helps her to know that her physicality and appearance is only a small subset of who she truly is.

(Gwen adds: This photo was taken when we returned from our honeymoon, at a friend's wedding. It was these photos, plus our wedding photos, that convinced me to proceed with WLS. I was appalled at how overweight I had become.)

This photo was taken April 2009 on Capitol Hill in Washington, D.C. Total weight loss 69 pounds.

Back again

It has been some time since I was last able to blog. School is back in full swing, and the stress is somewhat different at this stage of the process, but very palpable. I hit a wall of sorts about 2 weeks ago, when I felt I just couldn't do this for one more moment. Of course, I have to...there are 6 months left before graduation. So, like high school seniors around March, we continue to go through the motions and do what we have to do.

Our days are now mostly clinicals, which I mostly enjoy. 4 days a week we are in the operating room for 8 to 10 hours. In our training, we also happen to generate a lot of billing for the anesthesiologists, but we are not paid because it is part of our training. (This could be an entire blog post itself, but this blog isn't about anesthesia politics, so I'll spare you all.) On Thursdays, we have classes and no clinicals. In our off hours, we study for our classes, start studying for boards next spring, prepare for the next day's cases, and work on our research projects, most of which are wrapping up this semester. Then we have our real lives on top of that. Most of my classmates are parents, all but one are married, and we have the same complicating factors in our lives as everyone else does. It will be nice when we are graduated, have taken boards, and can start earning money for our work again. Mostly due to my school loans, we will be around $100K in debt by the time I graduate.

On the weight front, I haven't made my follow up appointment with Dr P yet, partly because I haven't remembered to do it when they are open, partly because I don't have my November schedule yet, and partly because I want to have more success to show before that happens. It's been a good fill most days. Some days, I'm still super hungry. Other days, I'm not hungry at all. I have had two days of mild heartburn in the past 3 weeks, which is something I am monitoring. If it becomes any more of a problem, I'll have to see the doc about it. Right now I'm about 4 pounds down since my fill. Meh.

I'll be posting a guest blogger post from my husband in just a little bit. He generously offered to write a guest post on WLS from the spouse's perspective. I think when I was spending time on the lap band boards, I heard a bit about marriages ending in divorce after WLS, but not much on the experience of spouses. I hope you enjoy his post.

Friday, October 9, 2009

The Lessons of the Band: 3 1/2 years later

The Click samples have gone out, and hopefully all the winners have received them by now. I was surprised by how hard it was to mail them. We used to have a post office outlet about 3 blocks from our house, but it has closed. We had to pick up a package at the postal hub last weekend, so we thought I could mail the packages from there...but no, the postal hub doesn't accept outgoing packages! WTH?? I finally found a post office that was open at reasonable hours, but it was surprisingly difficult in the age of Google. Anyway, I am glad that they have gone out, and hopefully others like the stuff as much as I do.

I am happy to report that my latest fill seems to be a good one, and seems to be staying put. If I follow my own rules and don't eat unless I am actually physically hungry, I can eat very reasonable portions (small end of normal) and stay satisfied for a long time. And I've lost about 4 pounds. But it still definitely requires me to be mindful of what and when I eat. I have impulses to eat for reasons other than hunger several times a day, and I have to consciously stop and determine if I am physically hungry and if there is something else that would satisfy me more, like doing something fun, talking to someone, or just getting out of the house. In other words, the band still isn't magic, even though I am at probably the best level of "restriction" I've had in 2 years.

I haven't had anything get stuck, or had any reflux, vomiting, or sliming. In other words, still none of the most common problems that people with the band complain of. I still haven't found a food that I physically can't eat because of the band. Some people like to use those things to help with their behavior modification. I can't really speak to that, because I've never experienced it. What I can speak to is my own experience, and that is that at the end of the day, most of this is the same mental work and energy that I experienced when trying to lose weight without the band. Only now I'm not physically hungry, which is exactly what the band is supposed to accomplish.

I knew in my brain that like a lot of other people, I ate for reasons other than hunger. But until my surgery, I didn't really get how significant that was, and you know what? I don't know that I ever would have, without surgery. I used to have a terrible hunger, and I was scared of feeling it. I was terrified that I would be suddenly hungry in a place where I couldn't eat, so I would eat "pre-emptively." Hunger truly was a significant factor in my difficulty losing weight and maintaining weight loss.

But it definitely wasn't all of the battle, or even close. I can see that now, as every evening I come home from a stressful day in the OR and start scavanging for something to eat. If I can get myself to stop and evaluate, usually I find that I'm not hungry, just looking for stress relief or comfort. Sometimes I am actually hungry, and in that case, I go ahead and eat something, but try to make it some sort of protein. If I don't stop and do a self-check first, I can often find myself in the midst of eating quite a bit of food (for a bandster) before I realize what I'm doing. And sometimes, not infrequently, I am conscious of the fact that I crave something specific--usually sweet--without being the least bit hungry. Sometimes I can talk myself out of it or distract myself. Other times, if I've tried for a long time but am still obsessed with it, I will just have it--a small portion--and be done with it. At least then it is a conscious decision, not soothing an impulse.

I hope to get to goal, but even if I get back to where I was at the beginning of the year (11 more pounds) and without the incredible stress that brought me to that point, I will be happy. It is certainly a lot easier to keep my eye on my goal when my hunger is tamped down with a good fill. And it's good to know that even after being "off the wagon" for several months, I can get back to a good fill level and lose again.

Inspiration: Featured Blogger

About 7 years ago (really?!?! it doesn't seem so long ago...) I was living in southern New Mexico as a travelling RN, on a contract. I'd had an interest in beads and beadwork for many, many years, and had always wanted to learn how to make beads. I was doing new things (I had just moved from my home of over a decade, Seattle, to start travelling) and decided to look up a bead artist I had become interested in when I lived in Seattle, Kim Miles. She had moved from Seattle to Taos, New Mexico some years before, and according to her website, she taught beadmaking out of her home studio on a 1-on-1 basis. I emailed her, and before I knew it, I was at her home studio, learning the basic craft of beadmaking from one of the best. And I was lucky, too: not too long after that, she decided to devote herself entirely to her art, and stopped teaching, so I think I was probably one of her last students. Making beads was an art I loved developing (until I started anesthesia school and no longer had time, unfortunately), and it was made possible because of the skills, and more importantly the passion and art, instilled and inspired by Kim.

I've followed her from afar since then, and bought some of her amazing beads (through her online store). She had a blog about her life in Taos, which if you haven't ever been there, is one of the most beautiful places I've ever been to in America. Then, gradually, she and her lovely husband Rick decided that they didn't so much want to be tied to their house in Taos anymore. They started to get wanderlust, the kids were grown and out of the house, and the open road called to them. So this year, Kim and Rick bought a trailer, fixed it up into a little home-away-from-home, rented out their Taos home, and hit the road. She's even got a mini bead studio in the trailer, so she can work whenever or wherever inspiration hits. Their plan: to visit any place their heart drew them to, and find a spot to lay some roots down. Isn't that fabulous?

In a way I have done this, when I started travelling in 2002. But I was single, no kids, and it wasn't too hard to sell my condo, pack the cats into my Jetta, and follow the jobs. Travelling that way is certainly a life-changing experience. But I love the idea of doing it with your mate, after raising kids, having a few businesses, and doing a lot of the other stuff you had wanted to do with your life. Their pictures mostly show them having a grand old time with each other or with friends and family they visit along the way, but I'm sure there's a lot of hard work too, in negotiating how to travel for so long in such close quarters with your spouse. Most marriages might not be able to tolerate it. But then again, maybe more could than we think, if they learn to take themselves less seriously and have fun with it, like Kim and Rick seem to.

Their adventures are an inspiration to me, that you really can find a way to follow your dream, no matter how unconventional others may find it. They look like they are having the time of their lives. Check out Kim's blog if you are interested in their adventures: Taking The Long Way Home.

Thursday, October 1, 2009

Strange week

So, I intended to mail the Click packages last week. We even went to the post office on Saturday. Only, the post office we went to actually doesn't mail packages. You can only pick them up there. Who knew? The post office by my house closed last month, so now I don't know where to mail packages. I will send them out as soon as possible, I promise.

I was hoping to find another place to do it this week, but it's been a weird week. As long-time readers of this blog know, I am in graduate school for nurse anesthesia, and it is a small program, only 8 students admitted each year. One student in the class behind me (class of 2011) has several younger siblings, and her high school-age brother suffered a devastating head injury last weekend. He was a patient in our hospital until he was declared brain dead earlier this week, and became an organ donor. Such a small program is pretty close; we become a sort of school family to each other, and get to know each other's spouses, kids, etc. I don't know her family, and I didn't know her brother, but I know her, and it has been a sad and emotional week for everyone. It's hard to know what to do or say when something so devastating happens.

It's been tough to get back in the swing of the school year. I think my classmates are all feeling that the end is near for us. We graduate in 7 months. We have just 2 semesters left, including this one. It's tough to get up the enthusiasm and energy for one more big push towards the final goal. I come home from clinicals most days just totally exhausted. Eating has been a challenge; I do fine all day but in the evening all hell breaks loose. I have to force myself to exercise. Everything is just an effort. It has been a long haul, both school and weight loss, and it's harder to be enthusiastic at this point.

One bit of good news is that the fill is good. I definitely notice a difference in my satiety. Hopefully it will start to pay off soon at the scale.

Off to find a post office, perhaps things will get mailed tomorrow? Sparkly Jules, expect an email from me soon.

Friday, September 25, 2009

Contest update, and fill update

Click contest:
I have heard from 2 of the contest winners. I am still waiting to hear from KernieC, and if SparklyJules wants to be a winner, I have stuff for you too. The other two should receive their Click stuff sometime next week.

My update:
I saw my surgeon yesterday, Dr P. I haven't seen him in over a year, since I've been seeing the PA. But the PA changed his office hours, so he's not there anymore on the only day of the week I can definitely make appointments, Thursdays. I saw Dr. P, and was shocked that he remembered me, that my band was done elsewhere, and that I was an anesthesia grad student. He still reminds me of the actor Philip C. Hoffman. We talked for a while about what's going on with my band, I updated him on the empty band-refill situation, and let him know that my weight has been stable for the most part since then. He asked if I wanted a fill, and I was honest about where I am. The fill level I have provides good restriction most of the time. It could possibly help me more if I had a little more fill, but I thought the majority of the problem was mental. This made him laugh; he said he's never heard a patient tell him that, usually it's him telling the patient. But it doesn't really help me not to look at my situation honestly. I've had 30-plus years to develop my eating habits and mental craziness around food. I know that I eat when I am no longer hungry, even now. That is by far the hardest thing to overcome.

But still, I have never been overfilled, have had extremely rare heartburn, no vomiting or "PB's", ever. We decided to go ahead with a small fill. He accessed the band, found I actually had 3.1 instead of 3.0 cc, and gave me another 0.5cc (which is actually a pretty big fill at this point) to a total of 3.6cc in a 4cc band. He told me to come back in a month to 6 weeks for follow-up.

This time, instead of following my old "liquids-only" instructions after a fill, I ate a small dinner. My husband made a curried mahi-mahi risotto and I had about 3/4 c. of that and was full. What are other surgeons saying about diet after fills these days? It seems like the old recommendation to have only liquids for 24 hours has gone away now, but I don't really know. Neither my surgeon nor the PA have ever given specific instructions for eating after a fill. In Portland, they started out saying liquids for 24 hours after a fill, then went to "take it easy", whatever that means. I'm wondering: is this no longer the general recommendation? Either way, it wasn't a problem. The fill seems pretty good. I just have to stop eating way earlier than I usually want to.

There's no getting around it. I like to eat. It's not easy to stop after a small amount when the food tastes good and I feel like eating it, even if I am "satisfied" or even "full." I used to be able to do it, when I was an early post-op and jazzed about the whole weight-loss thing (and still getting the positive reinforcement of constant weight loss). Now it's been close to 3 years, and that motivation has waned, and I don't see much weight loss anymore. I do hope to see some weight loss now, but it's going to be much more dependent on my mindset than on my restriction.

Tuesday, September 15, 2009

That's Why I Can't Eat Ice Cream....

Whoa. What we always suspected...

Ice cream really can control your brain
Certain fat molecules suppress appetite-control signals, study finds
(source:Reuters, via MSNBC.com)

Before you flip open that tub of Ben and Jerry's, be aware that ice cream really can control your brain and say "eat me."

A U.S. study by UT Southwestern Medical Center at Dallas has found that fat from certain foods such ice cream and burgers heads to the brain.

Once there, the fat molecules trigger the brain to send messages to the body's cells, warning them to ignore the appetite-suppressing signals from leptin and insulin, hormones involved in weight regulation — for up to three days.

"Normally, our body is primed to say when we've had enough, but that doesn't always happen when we're eating something good," said researcher Deborah Clegg in a statement.

"What we've shown in this study is that someone's entire brain chemistry can change in a very short period of time. Our findings suggest that when you eat something high in fat, your brain gets "hit" with the fatty acids, and you become resistant to insulin and leptin.

"Since you're not being told by the brain to stop eating, you overeat."

The researchers also found that one particular type of fat — palmitic acid which is found in beef, butter, cheese and milk, is particularly effective at instigating this mechanism.

The study was performed on rats and mice but the scientists say their results, published in The Journal of Clinical Investigation, reinforced common dietary recommendations to limit saturated fat intake as "it causes you to eat more."

The study was conducted by exposing rats and mice to fat in different ways — by injecting various types of fat directly into the brain, infusing fat through the carotid artery or feeding the animals through a stomach tube three times a day.

The animals received the same amount of calories and fat and only the type of fat differed. The types included palmitic acid, monounsaturated fatty acid and unsaturated oleic acid which is found in olive and grapeseed oils.

"The action was very specific to palmitic acid, which is very high in foods that are rich in saturated-fat," said Clegg.

Monday, September 14, 2009

The Real Cause of Obesity (Newsweek)

Newsweek is running a web-exclusive series called The Fat Wars: America's Weight Rage. There are lots of great articles in it. I thought this one was particularly relevent: The Real Cause of Obesity.

I'm so tired of the moralizing about obesity, the blaming, the shaming. We should take responsibility for the things that are within our control, and that means doing what we can to control our weight. But we should also acknowledge that there are things about our weight that are not so much in our control. There is a genetic predisposition to obesity in many people, and eating the modern American diet (in the modern American way: big portions, big calories) will unveil this tendency towards obesity in most of us. Also, when we lose weight (a lot of weight), our metabolisms adjust to help us hold onto whatever calories we ingest. Same goes for exercise: studies have repeatedly shown that our bodies respond to increased activity by increasing intake. Usually our exercise only burns a few hundred calories at a time, and it's very easy to ingest a few hundred more calories without noticing. This is why just exercise doesn't cause weight loss in most people.

The fat wars are becoming more public as talk of health care reform intensifies. The press and the public are identifying the biggest health care costs and arguing over how to address them in a system where potentially the taxpayers will be (overtly) bearing more of the direct costs, and obesity is one of those areas. There is a lot of finger-pointing going on. But WE know that obesity is not a moral failing. It isn't a sign of laziness or stupidity. The solution ISN'T "take the fork out of your mouth." Wouldn't it be great if, as a society, we could actually address the real causes and conditions of obesity as a society, in a holistic way, rather than pointing fingers and shaming? What if we could devote more research to things other than the magic weight-loss pill (that will make some company billions of dollars, even if it causes other health problems, a la Fen-Phen), and identify real ways to prevent and treat obesity long-term? What if we actually stopped publically supporting the corporations that profit from our food addictions and susceptibility to marketing and subtle ways of getting consumers to eat more high-calorie junk? What if we altered the way we work and live to make room for a healthier lifestyle as a society?

But no, instead we spend our energy complaining that the new surgeon general, Regina Benjamin, recipient of the MacArthur Genius award and champion of rural primary health care, is not qualified for the position because she is obese. Never mind that she is a real representation of the real problem that most Americans face: healthy lifestyle, extremely busy professional and personal life, trying to get a handle on weight. By all accounts she is active and healthy, but obese. Hey, that sounds familiar! Perhaps she could actually be an example for Americans? Is that possible?

Anyway, I found the article to be interesting and refreshing. Enjoy.

Contest Winners

The contest ended on Saturday, but I was out of town, rafting the Tieton River with friends. It was lots of fun, and renewed my jones for getting outdoors more and doing more stuff--hiking, camping. I want to learn how to river kayak, and living in eastern Washington, there are lots of rivers around here great for rafting and kayaking. So...stuff to look forward to next summer.

There are 4 contest winners: KernieC, Jo, and HillHilly, plus Sparkly_Jules, who asked not to be entered in the contest but officially has another chance here. You don't have to have had WLS (or be in the process) to be in the contest, so if you want to try this stuff out, I'm happy to send it to wherever you are.

So, contest winners, send me either your email address OR your mailing address in a comment on this post. I will not publish the comment or your personal information (I moderate the comments here), just use it to send you your goodies.

Thanks for your entries. It was really fun to read your stories on here, and fun to check out the blogs that were linked to some of the profiles. (SparklyJules, it's been a long time since I read yours...love it!)

I know some others have sent me links to your blogs in the past...some I have checked out, some I forgot to check but wanted to. Anyone have a blog you want people to know about? I think it's time to update my blogroll, so if you want yours linked here, send me the url in a comment and I'll publish it (AND read it, promise) here.

Saturday, September 5, 2009

Sharing The Love

CLICK came through and sent me a box of goodies yesterday. Lots of goodies! So it's only right to share them with my readers. I got a bunch of single-serving packets that are easy to send to you guys. I've been thinking about how to do this, and here's how I think it will go: I will send 5 people 3 packets of Click. (I could send more people fewer, but I'm still a poor graduate student, and shipping isn't cheap.)
So, let's call it a contest. It's a simple one. I want to know a little bit about my readers. What led you to WLS? It doesn't matter if you have already had surgery, lap band or another surgery, or if you are just researching it. Just a little something about what brought you here. Leave me a comment with your story (not too long, I don't even know what the word limit is for comments on Blogger). I will choose 5 of them and post here on the blog who they are. The winners will need to comment back with your email address or mailing address--I moderate the comments here, so I promise not to publish your personal information on the blog, I will only use it to mail you your prize, and will then delete it. Promise!

I'll leave this contest open for one week. Deadline is September 12, 2009. Have fun with this! And thank you to CLICK for making this contest possible. I think you are gonna love this stuff. It's yummy and has protein and vitamins and gives you energy, what's not to love?

Wednesday, September 2, 2009

Beginners: Are there foods I can't have?

@aminorharmony asked a few weeks back about foods you can't have after lap band surgery. She is having surgery soon (congrats!) and I was planning on addressing that a while back but didn't get around to it. So, here goes.

When I was pre-op, my doctor and nutritionist went over what foods I should eat, and what foods I shouldn't eat. There wasn't a "can't" in there. They told me that a lot of bandsters can't tolerate certain foods--breads are a common one, foods that are rubbery like eggs are a problem for some, foods that are fibrous like asparagus, celary, or pineapple are another. Basically they told me that it will be trial and error, and you'll know if it's something you shouldn't eat again. Bread is probably the most common problem food, and some people can eat one kind of bread product and not another, others can't have any bread-type food at all, not even tortillas or flatbread. Which is fine, because bread isn't the most nutritious thing you could be eating anyway. Grains are important, but you can get your whole grains in other ways and skip all the carbs in bread.

Personally, I have never found a food that my band wouldn't let me eat. I've never been super tightly filled, either--I think the most I have had is 3.5cc in my 4cc band, and I've never once had reflux or had any food come back up. The tighter the band is adjusted, the more problems you are likely to have with foods that form a gummy ball or aren't chewed well enough. Some people use this to their advantage. The band helps them modify their behavior by not letting them eat certain foods, like bread. But I would offer a caveat to this--the band will never prevent you from eating the real "junk" like ice cream, candy, or most other sweets. Unless you are overfilled, if you can get water down, you can get sweets down. This is one reason that people can be overfilled and still gain weight. They like having their band so tight that it prevents overeating, but they subconsciously alter their diet to include only "soft" foods that go down easily, and just trickle through the banded stomach. This is known as "eating around the band". So, if your band is so tight that you can't eat a good band meal--4-6 oz. solid protein, then a small amount of veggies--but you compensate by eating ice cream and processed junk foods all day, you can take in a lot of calories and get no nutrition. If the tight band causes you to vomit every time you try to eat solid food, or have a lot of acid reflux, you can risk a band slip, as well.

I hope that your nutritionist went over how you should be eating once you are banded, and I hope you've started eating that way before surgery so you know what to do, and can start changing your habits now. A good band meal consists of SOLID food. You should be eating about 1/2 to 1 cup total per meal, and it should consist of solid protein (chicken or meat, fish, etc.) followed by veggies, and if you aren't full/satisfied yet you can have a little starchy food like potatoes. You should not drink while eating, because this can wash food through the banded stomach and cause you to eat more. Your meal should keep you satisfied for 3-4 hours. All of this is once you are past the post-op diet and have had a few fills so that you are starting to experience what bandsters call "restriction".

Refill update

Well, here it is, September already. I miss you, August. Please come back soon.

Yesterday I returned to my band people to check out the status of my refill 2 weeks ago. It seems that my (new) band surgeon has turned over all things band-related to his PA, Brian. Which is fine with me. Brian is the band guy at NW Surgical Bariatrics. That's cool. I get that surgeons like doing surgery, not long-term management afterward. I know, I know, but really. There's a reason that bariatric surgeons often recommend gastric bypass when the band would work just fine--they didn't go to med school and do a surgical residency and a bariatric surgery fellowship just to manage fills and help patients figure out that drinking a McDonald's milkshake every meal will not help their weight loss. Surgeons like doing surgery. So my surgeon turned over band management to the PA, which is not unusual and works out fine for everyone.

Anyway, there was good news when he accessed my port: all 2.5cc were still there. It felt like there was nothing there again, but it was there. He said this isn't uncommon, and I know many people have talked about their fills "settling in" after a day or so. He added 0.5cc to put me at 3cc total, and told me to come back to check on it again in 2 weeks.

We also talked about how losing this last bit of weight is going to be all in the details. In the beginning, you can go along doing the "right" things 80% of the time and lose weight. But he used a good analogy for the last few (several?) pounds of major weight loss. He said if you want to get an A in a class, you have to get about 95% right, and that's what I'll have to do now to get an A in my weight loss. Eat the right things 95%, exercise right 95%. That makes good sense to me. He also reiterated what I have said on this blog for a long time: I am more efficient at storing calories than many people are, or in other words, I have to eat fewer calories to lose weight than most people do. There are people who are even more efficient than I am, and they have to work even harder, but a few calories makes a big difference for me. The same is true for most people who have WLS. If simple dieting would have worked for us, we wouldn't have had surgery.

I'm happy not to have surgery looming on me now. I still wonder what happened to 2.5cc over the course of 15 months (since my previous fill). The saline fairies must have taken it. I guess I will just be more vigilent about keeping a good fill level and going back to the office if things don't seem right.

In the future, if I do find the band is leaking, I'll do what I have to do then. For now, I hope I can get back to a place where I am losing weight again and keeping it off. I do acknowledge that gaining only 15 pounds with an empty band for 6 months is itself something of an accomplishment. I don't want to think too much about that, though, because complacency will not get me to goal.

Tuesday, August 25, 2009

Think doctors know everything?

I love watching my patients interact with various health care personnel. So many patients completely change their demeanor when any doctor walks into the room, whether it is THEIR doctor or not. Sometimes it is as if an angel had fallen from heaven. A lot of people think doctors know everything about everything.

Today I anesthetized two people who were being banded, and one who was having a gastric bypass. I was really glad my second band patient was already asleep when my anesthesiologist started talking about how ridiculous it is that we are doing these surgeries at all. (Good thing the surgeons weren't in the room; these surgeries are how they make their livings, and they happen to think they are doing a good thing.) Dr. R started talking about how there is a TV show that shows them how to do it--The Biggest Loser. (I'm not kidding.) Then he stated that those people probably keep their weight off (no, they don't) because they learned how to do it on the show (um, 6 hours of exercise a day, and a chef?) and their metabolisms go up when they lose weight. (I know.) Then he said something about how these surgery patients don't learn how to eat, they just get forced to stop eating because of their stomachs, and something about how lap bands are basically the same as the gastric bypass.

Yeah, I couldn't hold my tongue anymore.

Mind you, this Dr. R is about 6'5" and probably has a BMI of 19. He's like a stickman. I can tell you with every assurance that he has never struggled with obesity in his life.

I explained to him that I've had a band for 2 1/2 years, and I can eat whatever I want. Not everyone is like that, but it's always been that way for me. I explained that we have to learn how to eat, just like everyone else, and the surgery--whatever one it is--doesn't do all the work by a long shot. I didn't explain the differences between the band and bypass because I was busy, intubating the patient.

I think he was a little chagrined, and surprised. The last acceptable form of bias is against obese people, and it is terrible in the OR. I am so sick of hearing people bashing obese people and reciting every variation of the basic theme, "Why can't they just stop eating?" I doubt he would have spouted his ignorance if he knew I was banded. And this is an extremely competent and well-trained anesthesiologist, who knows a lot about clinical anesthesia and has a lot to teach us students. But they don't know everything about everything, even if they think they do.

And I didn't have near enough time to cite the research showing that patients who have recently undergone major weight loss experience a decline in metabolic rate of up to 50%, which is why it is so easy to regain weight after it is lost...

The upside was that I got to pick the surgeons' brains a little bit about my band leak. They seemed to think that replacing the port would probably solve the problem, because it was likely the tubing nearest the port that is leaking, and that gets replaced. The port is attached to about 6" of tubing that then attaches to the long piece that comes off the band itself. They thought it would have to be done in the OR under general anesthesia, though. I think I've spoken to bandsters who have had their ports replaced in the office--anyone out there verify this? I may have to price-shop if I have to self-pay for any of this work, so I may end up having one of them do it. (Although I think my surgeon would help me figure out how to afford it. He knows about my program, and he likes CRNAs, since the hospital he operates in only uses CRNAs.) These surgeons I was with today didn't know of many bands that developed a leak at 2 years post op. They also thought I should probably have some imaging done, i.e. a scope and/or fluoro to check everything out. More money...sigh. We'll see. I'm trying not to worry about any of that before I have to, but that isn't easy.

Monday, August 24, 2009

Click for you, too!

So, I've never done a product review before on the blog. My hubby sent the nice people at CLICK the link to my review, and they are so nice. They are sending some individual serving packs as samples. So when I see how many come, I will figure out some sort of give-away and you all can try this stuff.

There is a special rate right now on amazon.com (here's the link via MeltingMama's amazon store so she gets some little kickback-love) but they sold out immediately, apparently. You can still order it and they'll ship it when it comes in again. The special rate is $20.88; I paid about $27 at SuperSupplements.

I think the restriction I enjoyed for about a day is sadly gone. It seems I'm back to where I was with an empty band: able to eat too much. I stay full 2-4 hours but it takes more to keep me from scavanging for food. I'm not too happy about that...appointment next week sometime.

Friday, August 21, 2009

So far....

Breakfast 2+ hours ago: 1 c. of eggs scrambled with veggie sausage and onions. So far: not hungry. I assembled 2 pies just now and put them in the oven (one for my friend who watched my kitty while I was gone, one for friends we are visiting tonight) and had no urges to nibble the fruit or anything.

I'm hopeful that this will help.

Click: Love it!

So far I have lost 6 pounds this week, as of this morning. After my fill yesterday, the PA didn't say anything about how I should eat the rest of the day--and I forgot to ask. So I went with what I was always told by my original band surgeon--liquids for the rest of the day, then start up slowly the next day. I think this might be a little bit outdated, I'm not sure, but it's definitely safe. I didn't get that hungry at all yesterday, so that's good.

After the fill I stopped at Super Supplements to pick up some protein for the rest of the day. I don't keep much on hand, because I've never been a big believer in protein shakes as a daily part of band life (I know many people are). But I thought I should try some new ones, so I had some recommendations from Melting Mama's blog, and went to see if I could find some of the stuff there.

I found Click--the espresso protein shake that MM raves about. I like her product reviews because she is super picky--so if she likes it, I'm pretty sure I will like it, I'm way less picky than her. Anyway, WOW. It is great. It mixes easily in a shaker, no icky protein-y taste or texture. Tastes really good. And 2 scoops in 12 oz. has a double shot of espresso, and 15 g protein, for just 120 calories. It tastes great mixed in just water--I added a tiny bit of half and half afterward, but it probably didn't need it. I've had it over ice this morning and yesterday; it's supposed to be very good heated, but they recommend heating it after you mix it (I think MM actually adds hot water to the powder though). This stuff could definitely replace my morning coffee and give me some extra protein for the day. And I feel a bit better about replacing my morning coffee with something better for me rather than replacing a solid meal with a protein shake--since solid meals are how the band actually works, I don't like the idea of drinking liquid calories. Maybe that doesn't make much sense, but anyway, love Click. Highly recommended.

More later on restriction, is it here or not?

Thursday, August 20, 2009

Not just a fill....

I went to my (new) band surgeon today, because of course, as I have been posting for some time now, I am gaining and feeling out of control and needing help. It had been over a year since my last appointment, so I needed to be seen anyway.

I saw the PA (his name is Brian) and explained briefly what is going on. We went over how much I can eat, my exercise etc. I explained that my lowest weight was 13 pounds less than I am today, and the last time I was in my weight was about 15 pounds higher than it is now. (So, slightly better than I was then, but definitely lost some ground.) Yep, we both decided, let's do a fill.

Now, let's see...

The band was empty. Completely. Should have had 2.5 cc. Nothing.

Well, that explains a bit. And it isn't great news. Despite what a lot of band folks say about band leaks, bands really don't leak just part of their fluid. If there is truly a leak somewhere in the system, they go flat, just like a tire, because it is under pressure. Sometimes a little bit of fluid "goes missing" and no one is really able to adequately explain that. But a completely empty band that should have had fluid in it, that was known to have a certain amount of fluid in it at the last visit, is not a very good sign for the integrity of the band.

He refilled me to 2.5 cc, since I tolerated it fine last time. (I've never, ever been overfilled. Ever.) That's a big fill for one shot, but since I have had more and been fine in the past, and since I have never been too tight, barfed, PB'd, had any reflux, or anything, I agreed that it should be fine. He told me to come back in 2 weeks and he would recheck the level. If it needs to be filled again, he will fill me without extra charge. If I lose restriction prior to that, call the office.

If the fluid leaks out, we try replacing the port. (My understanding is that this is an in-office procedure.) If that doesn't work, I need a revision. I had already decided months ago that if I ever needed a revision, I was converting to a sleeve. BUT. My insurance doesn't cover bariatric surgery (or even medical weight loss). Even if I had the money now, I don't have the time, with 8 months left of school. And by the time I have a job, I am hoping to be pregnant, which delays this even further. (But also allows me to have more cash for this thing.) So, all around it is pretty sucky timing for me.

Here's hoping that I don't have to go down that road. I'd really rather not, at all. But if it comes to that, I know what I want to do, and it will be affordable (for me) by the time I have both the time and the ability to pay for it.

Meanwhile, it's not all about me. My hubby has some serious things going on with his child--nothing I want to talk about here on the blog, because it is not mine to share with the whole world. But any extra nice thoughts coming their way would be much appreciated. And yes, I am concerned, on multiple levels, and we will get through this together.

Wednesday, August 19, 2009


Okay, actually, I do remember one thing I was going to blog about.

In the past several months, one of the things that I have been learning about is control: specifically, the illusion of having control. Just like any other codependent, I have survived by trying to exert control in areas that I truly have no control. Mostly this is about other people's behavior; we (I) think that we can control other people's behavior, but we can't. We have no control over what other people do. In fact, there is very little in life that we really have control over. It's a rather revolutionary idea, because at least in the US, a lot of our culture revolves around creating your own destiny, which implies that you have much more control over what happens in life than you really do have. Learning to let go of this idea and accept that we can't control others, or the future, or very much at all other than our own actions, is a big part of becoming more satisfied with life.

Yesterday it dawned on me that there is another area of life that I do not have control over: my own body! Now, hear me out, because I know that most weight loss gurus, of the diet/exercise variety and WLS both, tout the idea that we do have control here. But the only thing we have control over is our own behavior: what we eat, how much we eat, how and when we exercise. What our bodies do with what we give them is NOT in our control.

Think about it: studies have proven over and over that after a major weight loss, formerly obese people's metabolic rates plummet. This is why diets don't work: our bodies try to conserve by dropping our metabolic requirements dramatically, so if you start eating more food you will easily regain, even if it isn't much. There are lots of calculators available online to determine your metabolic rate based on height and weight and gender, but none of them account for your body type or any factors that mitigate your own metabolism. How could they? There are so many. It is false to believe that all women who are 5'5" and 150 pounds have the same caloric requirements; a woman who has always naturally been that size can consume more calories without gaining than a woman who got to that size after a 2 year major weight loss. We all know this instinctively, but yet are told otherwise.

My point is that we tend to believe that if we eat what we have figured out is the right amount of food and exercise the right amount, we can force our bodies to lose a particular amount of weight. In reality, we do not have control over what our bodies do with the energy we put in and use. We have a good idea of the effect we can have by doing certain things, but we do not have that control. That's why it takes trial and error to actually lose weight. Yes, we have control over what we DO. NO, we do NOT have control over what happens after that. Usually it works out the way we think it should, but we don't have that control, we only think we do. Our bodies are ingenious in altering cellular energy requirements to maximize its ability to store fuel for future use, especially among those of us more prone to obesity, and especially among those of us who have recently lost a large amount of excess weight.

This realization helped me to gain a little perspective on my recent regain. It's not a moral failing--I knew this intellectually, but not emotionally. After all this time, my body has dropped my metabolism even more, and my habits have slipped so that the combination of the two made a regain pretty easy. It makes the road back seem a little easier. I can change my behavior, and my body should respond. But I can't actually cause my body to lose the weight. Maybe this distinction seems entirely semantic, but I think it's a big difference. If I worry less about the things I can't control, I can focus more on the things I can--my behavior.

Unwelcome Souvenirs

I just got back from a nice week at the coast for our anniversary trip. Going to the Oregon coast has become a tradition for us--our 3 wedding anniversaries have all been spent there. It's affordable and relaxing, what's not to love? It's one of my favorite places.

Upon returning from the coast, I discovered I had gained 5 pounds. I despaired. After two days of eating carefully, the 5 pounds are mysteriously gone. So, clearly, water weight, but still. There was a number on my scale that I haven't seen in over 18 months, and I'm still too close to that number for comfort. Fill tomorrow, and much more careful eating from here on out.

It's my birthday today, and we are planning on sushi for a birthday dinner. This can be done without loads of unnecessary calories, plus it is one of my favorite foods, so that's what we'll do.

I've had a lot of blog ideas lately, but at the moment they escape me, so perhaps there will be a flurry of new posts soon? Let's hope...!

Monday, August 3, 2009

Habit is the Enemy of Progress

I don't know if I read that somewhere or I made it up, but that is what came to mind when I started this morning's run. This, after stepping on the scale and discovering I have regained 14 pounds since my all-time low in late January.

(Here's the rationalization paragraph, brace yourself.) I will say that the way I got to my all-time low weight might have something to do with the regain. It was during that month when my personal life blew up and I was under even more stress than I have been since starting anesthesia school. The stress caused me to stop eating (I just wasn't hungry and couldn't make myself eat) and I was running to combat the stress, and I lost 12 pounds in 2 weeks. Slowly, in the 6 months since then, I have regained them, plus a couple more for good measure. Also, probably 2 pounds of this is hormonal water weight.

Still, it's not just that. I'm running more in the past few weeks, but this entire spring and early summer I have slacked off in the exercise department. And my eating goes from okay to abysmal. I went over what I ate yesterday, and I can't even record it here. It's awful. No bandster should eat as much sugar and junk as I have been eating. A fill won't fix that. That's my brain.

I think long-term weight loss success is a personal experiment. I have a scientific background, and I believe in the scientific method. For the past year I have been testing the hypothesis that I can rely entirely on my band to maintain my weight loss. I think I have established that this is not a valid theory. So it's time to come up with a new hypothesis (on purpose, this time!) and make this thing work.

I've wanted to believe that somehow, since my WLS, I could eat and act like a normal person, and maintaining my weight would become natural and easy. But I now accept the idea of food addiction, and the fact that I am a food addict. I need my band because, left to my own devices, I will eat myself to death. But even with it, I have to make some changes in my brain and keep working at them. They don't have to be hard, but the thing I have to fight is falling back into bad habits and thinking. I've developed some good eating habits, riding the wave of easily following them, and then not noticed when they slowly eroded into my old ways. Habit is the enemy of progress.

I want progress. I want to reach my goal. I want to change my brain. So how can I do that, in small, easy-to-implement steps?

1. Start noticing not-hungry again, and don't eat when not hungry
2. Start noticing 'satisfied' again, and be vigilant when eating; stop eating when satisfied.
3. Serve myself my own portions (I will eat everything on my plate, so must be more careful about this)
4. Focus on protein again

This is a start. There are a lot more things I want to change about my thinking, things like the idea that if food shows up in an unexpected place (i.e. in my classroom, at a meeting) then it's "free" and I can eat whatever it is, whether I'm hungry or not, whether it's in my plan or not. And I do need to get back to planning out my meals, the very thought of which just makes me tired and annoyed. This is much more about eating and thinking than it is about exercise.

Right now I am frustrated and tired of all of this. Why can't I be a normal person? But then, who is normal these days?

Wednesday, July 29, 2009

Born to Run

The scale is fickle and stubborn. Or else, it's stuck. Seeing how it's a digital scale, I doubt it's the latter, although it would make me feel better. It might have something to do with the pies I baked over the weekend...nah! Couldn't be. I made an appointment for a fill, and they rescheduled it for 3 weeks later...bleh!

For us in the eastern part of the state, the temps have cooled down a bit to the high 80s, while the West Side (i.e. Seattle) is sweltering this week, with over 100 degree temps. They are in a temperate weather zone, and are unaccustomed to temperature extremes over there. Few homes have AC, even a window unit. People are scampering to get the last fans at the hardware stores. It's a similar scene to 7 months ago, when they were trying to get by with 2 snowplows for the entire county when they had a rare snowstorm. But here, people are more used to the hot summers, and it is a little less humid (not that it's very humid in Seattle). It makes evening running a lot more pleasant, anyway.

I'm still trying to get my mileage back up after a long spring and early summer of slacking, mainly due to scheduling problems. My school schedule is now a bit unpredictable, and when I am working evenings it can be hard to get a run in before the temps are over 85 degrees. But I was looking back at my running logs over the last 18 months and while it feels like I am stuck in a rut, I have made some progress. My times are much better than last year (although still slow). For someone who isn't "built like a runner", I still get a lot of enjoyment out of it. I have legs that are much more buffalo than gazelle, and even after a breast reduction FOLLOWED BY a 70 pound weight loss, I'm still more generously endowed than Marion Jones (or even Venus Williams, probably). But still, I have to say, the number one reason I still run is simple: because I can. It isn't enabling me to eat like a beast, or lose weight like crazy. My heart rate is much lower since I started running (it's in the normal range now, instead of being high) and my BP is lower. But that's not what keeps me going out there. It is just because after feeling like the slow, fat one for my whole life, even as a little kid, I take pleasure in being able to simply do it and not keel over. That's all. That's enough to make it enjoyable for me.

I'm reading Born to Run by Christopher McDougall right now. It is about a tribe of Mexican Indians who are known as Running People. They are like ultrarunners--those guys who run 100 mile races--but even more extreme, running for 48 hours straight. It's in their culture and their blood, they run well into old age, and they have nothing but joy in it--and no injuries--all in handmade sandals. It's a truly fascinating book. I have nothing in common with ultramarathoners. I have no ambitions to even do a half marathon, much less any craziness like the Leadville 100 in Colorado (a distance of 2 marathons plus 2 1500 ft climbs, all at once, all above 10,000 feet elevation). None! But those people are damn interesting, and I love to read about them. It gets me a little more excited to go out and get in 3 little miles up the South Hill.

Saturday, July 18, 2009

Endless Summer

The summer heat has me eating a lot less and drinking more. Both are good things for me. I love summertime--love the heat, playing outside, wearing summer clothes. Even when I was obese, I loved it, though not as much since I felt less comfortable in shorts and totally uncomfortable in swim suits. But summertime just feels like freedom to me. One think I like about where I live now is that summer is hot, punctuated every couple weeks by a storm, and then is immediately hot again. There isn't a lot of humidity here. When I lived in Portland and Seattle, there was always the sense that you had to hurry up and go do something fun when it was nice out, because the rain would be back any moment. (Of course, that was tempered by the fact that on a beautiful summer day, there is no place more lovely to be than Portland or Seattle.)

Last summer, most of my free time was spent in Portland. I didn't really explore Spokane very much as a result. This year I am trying to get out more in this area and check out what there is to do here. I've spent a lot of time at the Spokane River this week, which has been lovely. I drove out to Lake Coeur D'Alene as well, but didn't find the park I was looking for.

One of my favorite things about summer is fruit...I love it when all the berries are in season, and fresh watermelon, and cherries. I eat my fill of them with zero guilt.

Hopefully the scale will reflect my reduced summertime eating, although it hasn't very much yet. Everybody get outside and enjoy summer while it's here!

Saturday, July 11, 2009

Band Thoughts

Today I was surprised and pleased to see MSNBC.com post an article about The End of Overeating, the book I just finished reading by Dr. David Kessler. Looks like he is getting some good press.

This weekend I am taking a class for my program called Law and Medicine. It is 3 days, 8 hours each day. This year because of scheduling conflicts, our last day of class is tomorrow, which is Sunday. We're pretty unhappy about that. The class is useful, but long and not terribly dynamic. Our instructor was the first CRNA in the country to earn her JD, and is very knowledgable about the subject. Amazingly, my program is the only one in the country that includes a class on law and medicine in the curriculum. Our final class will focus on how to read and negotiate an employment contract.

We get a make-up day off on Thursday, but that's not the same. Today I did a little reading, went to the gym, and spent the evening at Riverside State Park, hiking and cautiously playing in the river, which is notoriously dangerous. I stuck to parts that seemed still, avoided the current, and stayed by the bank. The park is huge and I drove out much further into it than I have before. It's such a beautiful park, I hope to have time this summer to play in it some more. My legs are tired, in a good way, from my run and from several miles of trekking.

I finally made an appointment with my new band surgeon for later this month. I will probably have to reschedule it but at least I'm on the books. Interestingly, this summer we start going on "field trips" to small CRNA-only practices in the area, and one of the places we go is the surgery center where my band surgeon operates. So once I find out when I am scheduled to go there, I'm going to see if I can schedule my appointment for the same day, for the sake of convenience. I didn't have surgery there; I had surgery in Portland, at a hospital that only has anesthesiologists (like most in Portland). But it's cool that this surgeon works exclusively with CRNAs. Anyway, I need to see the surgeon and probably need a fill. I just can't decide. I haven't been seen for my band in a long time, over a year, so I should go in anyway. I weigh about 2 pounds less than I did a year ago. I want to lose about 20 more.

At just under 2.5 years post-op, I'm a little frustrated, either with the band or with myself. I do believe that getting control of the psychological issues of weight loss are key to getting to goal for me, and would be no matter what surgery I had had. Perhaps if I had done something really major, like duodenal switch, I would have gotten to goal pretty definitively, but then I think maintenance might have been an issue, not to mention the issues associated with long-term malabsorption. But if I had it to do over again, I would probably have the sleeve gastrectomy. I have already decided that if I ever needed a revision or re-op due to a problem with the band, I would have the VSG. Why? It works like the band, but nothing needs adjusting, and there's nothing to slip. No wringing of hands trying to figure out if you need a fill or not, no convincing a provider that you really do need one. Yes, the initial attractiveness of the band was that it can be removed if necessary, and there was no permanent rearrangement of my anatomy. But, I dunno, there's just a lot to be said for having that angst taken out of the picture. I guess you have staple lines that could potentially leak, but I've seen this surgery done, and the staple lines created by the tools they use today are pretty solid, 3 rows of tiny staples. With a good surgeon, leaks are extremely rare. Any other post-op lap banders have this thought ever?

That's not to say that I haven't been happy with my band. It has served me well as the tool it was intended to be. At the time I had surgery, I wouldn't have considered amputating my stomach. Now I think it isn't as big a deal. But at the same time, since hunger isn't really the issue with me, it might not make a bit of difference, except that I wouldn't have to worry about fills or whether I have insurance to pay for them. I'd just have a smaller stomach with no moving parts. I could still eat ice cream and milkshakes and other things that would go right through. It wouldn't be any guarantee that I would be at goal now, or that I wouldn't regain.

I don't know. I wouldn't call it buyer's remorse. I'm not sorry I was banded, and I'm glad I've lost 60 lbs. (65 on a good day.) I have work to do on my eating, and thankfully, my band has helped me stay around the same weight for a year--but I am frustrated that I'm not getting any more headway in the direction I want to go. It's still a lot of work. Getting rid of hunger is only the first step, the thing that allows you to do the rest of the (much harder) work of controlling weight for life. It's still a work in progress.

Wednesday, July 1, 2009

Food Rehab

I've gotten to the "meat" of my book I have been reading, "The End of Overeating." The first two-thirds of the book are dedicated to exploring the science behind what makes certain foods irresistable, or "hyperpalatable" as the author calls them. He explains that the restaurant and prepared foods industries have sort of "stumbled" on how to exploit this science, without necessarily knowing the science behind it, through trial and error, finding what it is that people buy and eat, working hard to make a product that customers will consume compulsively. It's not surprising or necessarily that sinister that they do this; this is business, and they are in the business of selling as much of their product as they can. When your business is food, you make more money if you can get people to come back over and over for your food, and eat more than they should. If it is actually addictive--and the science indicates that compulsive overeating is at least very similar to substance addictions--it just makes the stuff sell better. It took something like 80 years or more to condemn the tobacco industry for doing the exact same thing.

The last third of the book talks about how to deal with our problem of compulsive overeating. (or "conditioned hypereating" as the author calls it). It's a chronic problem, and many, many of us have it. It (probably) can't be "cured," but we can learn how to deal with it, through cognitive behavioral therapy techniques and support and practice.

Wouldn't it be great to be able to relate to food like a "normal" person? There really is such thing as a normal person when it comes to food, although at least in the USA, it seems like normal is now overeating and obesity. A truly "normal" eater doesn't eat the cookies on the table if they already ate a meal and are full. A "normal" eater doesn't think about eating when they aren't eating--like thinking about what you'll have for dinner when you just finished lunch. A "normal" eater doesn't obsess about the donuts in the break room, trying to resist an irresistable urge to go eat one, or two, or four. A "normal" eater can eat just one or two cookies, and stop, even though there are more cookies sitting right there in the package. Those people really exist!

In terms of addiction, alcoholics call people who can drink one beer and stop "normies." Some people can just have one beer, others can't resist the pull to keep drinking after just one. That's how many of us are about food. We aren't "normies". A lot of things are happening in our environment that condition more and more people to have abnormal relationships (and obsessions) with food. I like the idea that there are things we can do to combat this conditioning.

The book has a section toward the end called "Food Rehab." (I think that's awesome.) I wanted to directly quote the book on the essential principles, but I don't want to commit copyright infringement, so I'm going to paraphrase the ideas in my own words. Really, do read the book, it's very interesting.

Essential principles of Food Rehab:

-We are biologically driven to overeat. It's not a character defect or a matter of willpower. We can only get better when we stop seeing ourselves as failing at willpower.

-Treating this overeating problem is a chronic problem that can only be managed, not cured.

-Every time we eat one of our "trigger" foods, filled with sugar/fat/salt, we reinforce the habit and the reward system in our brains and make it more likely that we will do it again the next time. The way to treat this is to stop the cycle of urges and rewards.

-Diets make this problem worse when they leave us feeling deprived.

-The treatment is learning a new way to respond to food. It can only be learned when it generates a feeling of satisfaction. If the change leaves us feeling hungry, unhappy, angry or resentful, the new ways will not stick.

-To regain control, the approach has to address all the different elements that go into our overeating. It is a multi-step process.

-We won't always be perfect in this new behavior, but we can learn from our mistakes so we are less likely to repeat them.

-We can learn a new way to think about food and put it back into its proper place in our lives.

Dr. Kessler put it much better than this...check it out.

I have identified some of my own specific triggers and some ways to start learning how to avoid them. In another post I will talk about them some more. I really feel like this mental and emotional work is the key to losing my last pounds and getting to a managable, healthy weight. All the fills in the world, and all the running I can do, will not help me if I don't learn how to control my subconscious drive to eat inappropriately. I think Dr. Kessler's methods are one way to help me work through this.

Sunday, June 28, 2009

We Are Different

I am still reading "The End of Overeating" and it is quite fascinating. The premise is pretty simple--that the food industry has contributed greatly to the obesity epidemic in the US by creating "hyperpalatable" foods that (some of) our brains basically can't resist--and most of the book is describing the science behind it, which those in research and development within the food industry most likely weren't even aware of, at least at first.

One thing this book states over and over is that people who have a tendency towards obesity have different brains than those who tend to be thin. This is both genetic and environmental, and it can be enhanced by childhood experience, i.e. eating a lot of these hyperpalatable foods as a kid, learning eating habits from our parents, etc. One interesting thing about the book is that he writes from a first-person perspective; the author is in the entire book, which makes the whole thing seem a lot less judgmental of "us fat people". He describes the development of several foods, like Oreos, Cinnabons, and certain milkshakes, going through the characteristics of each one that make them so hard to resist. I realized through reading this that all of these things are things I, too, find impossible to resist, and so I simply never eat them, or buy them. If they are around, I know I will eat them. But even so, avoiding these strongly triggering foods hasn't meant that I don't still overeat, or that I no longer have a weight problem.

But, I don't drink milkshakes, because I don't go to places that sell them. Just the idea of going through a drive-through or into a restaurant that sells them (the good ones) is enough to stop me. Okay, there is an exception: I will go to Burgerville USA (in Oregon) and have a shake while I am driving a long distance. There are lots of subconscious cues and triggers that make it very hard for me to resist it in this circumstance.

I think it has been several years since I bought a package of Oreos. I can't resist them. I haven't had a Cinnabon in at least 5 years, because HELLO! And I've changed more things too. I almost never watch TV, because the commercials are too triggering for me. We do watch some shows on DVD, without commercials. Even so, some of the shows themselves contain a lot of food triggers. I rarely go out to eat anymore, because even though I eat a lot less than I used to, I still eat too much, and it's better and cheaper to cook at home. Also, my hubby is a great cook and likes making dinner. We go out for breakfast once a week, because I love breakfast so much. That's about it, and it's a vast improvement from a few years ago.

Our brains are different. That is one thing that the past year of my 2 1/2 years post op has really taught me. There are people who can sit in front of a whole plate of Oreos, and if they aren't hungry they won't eat any. If they want a snack, they might eat a couple, but not the whole plate. Many others of us aren't like that. Even if we are full, we will eat them until they are gone. Period.

Having surgery did what I wanted it to do: it took away my physical hunger, which was real. It left me with all the other reasons that I was overweight, including compulsive overeating and emotionally conditioned eating. This past year has really opened my eyes to this reality.

This book doesn't make the food industry into the big excuse for obesity. It simply shows how the foods that were developed because consumers like them and buy them and can't resist them have contributed to our drive to eat highly caloric foods, too much of them, and too often. It's one more key to understanding how to get control of our eating, our weight, and our lives. It also points to one of the reasons that WLS is not a magic bullet, and without attention to all of our habits that contribute to the problem, we will not reach and stay at our goal long-term.

Friday, June 19, 2009

The End of Overeating?

My weight is coming down a bit. I've been able to be a bit more intentional about my eating lately, which surely has helped. Oddly, I've taken the last 2 weeks off from running because my right Achilles tendon was sore. Last night was the first time I had run in over 2 weeks, and my weight was already down 2 pounds by then. It's encouraging, but I want to see more movement than this.

I am reading a new book called "The End of Overeating" by David Kessler. It's a promising title...too promising, of course, but the premise is basically that America's overeating problem is (at least partly) caused by the manipulation by the food industry of the proportions of sugar, salt and fat in foods we commonly eat. The author argues that certain proportions of these basic ingredients trigger our brains to eat beyond our satiety. The book seeks to explain how we lose control over our eating, and promises to reveal how we can regain it. (I am thinking the answer will be in preparing more of our own foods, from scratch.) It is interesting. I'm not sure it's going to tell me a lot that I didn't already know, but even reading about overeating helps me be more conscious about what I do, so even that helps.

From the outset, this book reiterates what recent research has confirmed over and over: that we gain weight because we eat too much. It's such a simple idea, but we have fought the idea for a long time. I fought it, before I had WLS. Now I realize that I did eat more than I realized, even if the amount I ate might not cause another person to gain weight. It wasn't massive amounts, but it doesn't take much of a calorie excess to cause a lot of weight gain over time.

The book also talks in the beginning about the "setpoint" theory, that our bodies naturally maintain a certain weight range and somehow that setpoint gets messed up in people who are overweight. In fact, the author states, the setpoint, or homeostasis range, is only one factor in our weight. A lot of other things happen that override our body's weight homeostasis, and when we gain a lot of weight and then try to lose it, our setpoint often gets moved a little higher than it was before. We've all noticed that in our yo-yo cycles in the past. We blame it on dieting. It might be the actual weight gain that causes it, not the diet that revealed that changed setpoint.

I'm still fighting this seeming "setpoint" that I have reached of about 170 pounds. My body seems to want to stay here. Interestingly, it's exactly where my surgeon said I would land. But I could easily stand to lose another 20 lbs, and even 10 would make me happy. As tempting as it is to try to get there quickly through a "diet", I am resisting this urge, partly because I was always a terrible dieter, and partly because I want a more lasting weight loss. So I still work on this every day.

On the school front...I have 10 1/2 months left and I am very happy about that. The hardest part is behind me. It's nice to realize that by this time next year I will be graduated and will already have taken (and hopefully passed) my boards. We are finishing up our bioethics class next week. It's been a very interesting class. Then we will take Law and Medicine in July. Meanwhile, we are working about 30 hours/week in the OR. Tonight I am on from 3-11, which should be in OB rather than the OR--placing labor epidurals and providing anesthesia for C-sections. I enjoy OB anesthesia, and I also enjoy not getting up at 5am.

I am thinking of making an appointment to see the surgeon sometime this summer, just to check in and make sure everything is okay. I don't know if I need a fill or not. Sometimes I think I do, sometimes I don't. Since it's been over a year since my last appointment, I should go in either way.

Hope everyone is enjoying the summer!