Weight Loss

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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.