Moving on to OB

We have finished our pediatric anesthesia unit and have moved on to obstetrics. OB always scared me the most when I thought about anesthesia prior to starting school. Now it kind of excites me. Still scary, having 2 patients to think of instead of one. And of course, when things go wrong in OB, it gets bad fast.

Oddly, listening to our OB lectures makes me want to have a baby more. One would think it would be opposite, since we are talking about all the things that can go wrong. But it makes me think of what I would want.

I have baby anxiety. I'm getting older; I will be 36 years old this year. Yes, I know plenty of people get pregnant and have babies around this age. I hear it all the time. But until I get pregnant and deliver a healthy baby, all the reassurances in the world aren't going to take that anxiety away for me. With all the major revelations that have occured in my marriage this year, it would be best to wait at least another year before considering having a baby. But I am not getting any younger, so this fall is when I will consider whether I can start trying. Come about October, I may decide that it's better for our lives and our marriage to wait longer. But I have so much anxiety that I'm not going to get pregnant, I suspect that I will try anyway at that point. I graduate in May, so getting pregnant anytime after September would probably be okay for finishing school and taking boards and starting a job.

It would be perfect if I could revisit this whole thing a year from now and see what state my marriage is in at that point. And I could do that. But I will turn 37 next year...not when I want to START trying. The few people that I talk about this anxiety with (mostly my hubby, but a few other friends too, mostly ones my age) don't really like to hear about my anxiety. So I don't talk about it much anymore. But it is there, I really want to be a parent, so I will have to make some sacrifices in some areas to ensure that it happens.

Meanwhile, we start practicing epidurals next week (on lab dummies). We've already been doing spinals for several months; I have about 20 so far. Epidurals aren't drastically different; they are a little more difficult. But one nice thing that I never thought about before now is when we do spinals in the OR, say for a hip or knee replacement, the patient is not in pain to start with, so they are more sensitive to the pain of injecting local anesthetic and inserting the spinal needle. Versus a pregnant, laboring woman, who may be sensitized to needle pokes and all that, and may have a difficult time getting into the right position, but if you place a successful epidural, you've just become that woman's new BFF. They start out in pain and end up comfortable, as opposed to the surgical patient who wasn't in a particular amount of pain to start with when you started stabbing their back. (That's said tongue-in-cheek. If done properly, a spinal shouldn't hurt except for the initial local anesthetic injection. Only maybe 2 of my spinal patients have had any pain at all when getting their block. But sometimes it's very hard to do "properly", depending on the patient's anatomy.)

I never realized that there are quite a few options for anesthesia for labor before now. I guess I had the idea that you either get a full block, numb from the waist down, or no anesthesia at all. But in fact, depending on what the mom wants, there are a lot of variations and options, from just "taking the edge off" to complete anesthesia. I think that's pretty cool.

Happy Bandiversary

I knew there was something about yesterday's date that was striking a bell, besides being Friday the 13th. It was the 2 year anniversary of my band surgery.

At 2 years out, I am just about exactly the weight my surgeon said I would be, having lost 70% of my excess weight. I have been maintaining this weight, within 5 lbs either direction, since last June. I still want to get to 160. Today I am 168. But I'm pretty happy where I am.

The other day I was giving an anesthetic for another band surgery. I have done about 3 or 4 bands so far since I started my clinicals last July. The CRNA I was with asked the surgeon--who has only recently started doing bands, he's mostly a bypass surgeon--about how the band worked and the surgeon was explaining. He ended up saying that gastric bypass patients tend to lose about 70% and band patients lose about 50% of their excess weight. I asked him about the 5 year studies that show the weight loss is the same between the two groups, and he said that those studies were small and he didn't think they were reflective of actual results. I tend to disagree, but I'm not 5 years out yet.

I don't wish to lose 100% of my "excess weight". I think my actual excess weight is a bit less than what they calculate with BMI charts and other methods. If I had a tummy tuck, I don't know that I'd actually want to lose any more weight than where I am now. I'm wearing size 6 jeans (4 different brands, and not stretch either). My tops are either smalls or mediums. I have flab, but that isn't going to get much better without plastic surgery. Most importantly, I'm able to run and do things that were never possible for me before.

I haven't had any heartburn since those 2 times a few months ago. And those were the only 2 times in the past 2 years I have had any. I can eat more than I should be able to. But I think if I was more careful about stopping sooner, I would still stay full at least 3 hours. I can still stop myself when I find myself looking for food and ask, "Am I actually hungry?" Usually, the answer is no, and usually I can redirect myself. Sometimes I still eat something. Old habits die hard. But I'm at least aware that I am eating when I am not hungry, that I'm eating for other reasons.

It's not normal to lose 30 lbs in the first year of anesthesia school. Most people gain at least 10. I had lost 40 before starting, and I'm thankful for continuing to lose despite some good reasons not to. Losing these last 5 lbs is a struggle, and I hope to be successful in the quest. If I am not, if this is the weight that I am able to maintain comfortably, then I can live with that.

Being banded was one of the best things I've ever done for myself. Yay for 2 years!

Desire and Suffering

In most Buddhist teachings that I have been exposed to, suffering is said to be caused by desire. This is a universal human condition, and one that can be broken, according to the teachings. Thinking of human suffering being caused by desire is a concept that, to me, at once seemed intuitively true and incomprehensible. On the one hand, it is easy to see that the kind of desire that begets mindless consumerism and even addicitve behaviors like overeating, alcoholism, and sex addiction could be the source of suffering. On the other hand, what about the suffering caused by things like physical pain or illness? What about suffering caused by abuse at the hands of another person? These things don't seem as obvious to me, but Buddhism teaches that all suffering is caused at its root by desire.

There is one view that says suffering that we don't obviously cause our selves is caused by desire in others who inflict the harm on us. I think the point of the teaching is not this, though, but rather that we can choose not to desire that things did not happen this way, choose not to see ourselves as something separate from the world and therefore when illness, abuse, harm etc happen to our "selves" this is just a construct of our minds. This is a very esotaric concept, not one that I am at all versed in or experienced in, and one which I think is a rather advanced human condition.

What I CAN see is how my own desire causes suffering for me. First there is the endless desire for things, which always begets more desire for things. I get an idea in my head that I need a new pair of jeans, for example. I think about it for a while, decide exactly what to look for, and where to get it. I finally go and get the pair of jeans. You would think that my desire would thus be sated. But no, soon I am finding myself desiring some other thing. There isn't relief from this desire, only repeating of the cycle.

This happens to us with food, too. We decide: I want some ice cream. We obsess about it for a while, think about which flavor and brand we want, when and how to get it. We get the ice cream, and we eat it. And soon we are finding ourselves not fulfilled by having this desire met, but rather, right back in the throes of a new food craving. Sugar totally does this, for reasons that science has at least partially explained with insulin levels and other hormones. But anything that can be craved can cause this same reaction, with or without fluctuating levels of insulin.

Other kinds of desire can cause or perpetuate suffering. I am learning recently that one kind of desire is the desire for a different reality. Wishing that something was not true so much causes us to become stuck in the bitterness and anger and resentment that goes along with that desire. It can even cause denial of reality, which creates another kind of suffering.

I often find that I desire to be seen a certain way: as the winner of the argument, the "better" person, the morally or intellectually superior one. My desire to not have my flaws seen is, of course, useless: not only am I creating my own suffering by holding onto that supposed superiority, but my flaws are seen in sharper relief as someone who thinks she is better than the other person, and I create suffering for the person I am trying to seem better than.

Samsara is a state that is referred to in many different religions. Often it is described as the cycle of suffering and reincarnation. The idea of reincarnation itself isn't really what I used to think it was, literally being born again as yourself but in another form. If you're "good", you are reborn as a more evolved being; if you are "bad" you are reborn as something lesser and further away from nirvana, like an insect. I guess first you have to sign off on the idea that there is a hierarchy of beings that are certain distances away from nirvana. Then you have to accept that we have a bank of good and bad karma and the end of our lives is an accounting of what your balance adds up to. I don't think this is really the essence of samsara. It seems to me that it is more like the effect of desire and longing and suffering in the world. These things are self-perpetuating and affect the entire web of existance. I don't know how to reduce suffering in human existance, but I do find that being mindful of my own desires and how they are harmful to myself and those that I affect helps me.

If you are thinking that this is some radical new direction that my blog is taking, please take heart. These aren't radical new thoughts for me, only new blogging topics that seem more relevent to my life these days. It's not becoming a spiritual or religious or Buddhist blog. (Although if it did that would be fine; it's my blog after all.) I'm just feeling a little more contemplative today than usual. It is so much better than some of the mental spaces I've been in so far this year. I hope it is interesting or helpful to someone.

The White Path to Recovery

Today we went to our local Buddhist temple again. It was a simple service. Our temple does not have a dedicated minister; instead, a minister from Seattle flies to Spokane once a month for an afternoon service. The rest of the month the services are "MC'd" by members of the temple. An assistant minister gives a dharma talk (like a sermon, sort of) and there is chanting and a few simple rituals.

The dharma talk today detailed the parable of the White Path, as taught by Shao-tao. It is somewhat lengthy, so I've included the link. It is basically about reaching the place of enlightenment via a narrow path that separates two rivers, a river of fire and a river of water, and connects the east bank, which is our world of samsara, or suffering, and the west bank, the Pure Land, or afterlife. The river of fire represents our anger and resentment, and the river of water represents our unceasing human desire, which continues our suffering (as the Buddhists teach that desire is the source of human suffering). The character in the parable is urged along the path by two voices, that of Shakyamuni Buddha, the historical Buddha, calling from within the river and telling him not to fear, and that of Amida Buddha, from the West Bank, urging him forward. From the East Bank, there are bandits and wild beasts pursuing the character in the parable, from which he is trying to escape. These bandits and beasts represent essentially the elements of what we call "self".

This parable is described to represent our movement through this life towards enlightenment. I think it also serves as a good metaphor for recovery. You have to get through the anger and resentment and the desire for things to be different than they really are in order to reach the place of serenity. The path is narrow but can be traversed if you approach it with purpose.

I take a lot of comfort in Buddhism, a tradition that I am just beginning to learn about. I was raised a Christian, but eventually I realized that it doesn't feel true to me in my mind or in my heart. Still, I am a spiritual person, as I think most people are in some sense.

Buddhism isn't a theistic tradition and many would say it isn't even a religion. Buddha isn't a god. In fact, Buddha simply means "awake" or "enlightened". It is said that upon his enlightenment, Siddhartha, the prince who became the Buddha, was asked if he was a man, and he replied "no". He was then asked if he was a god, and he again replied "no". Then he was asked, "What are you?" And he replied, "I am awake." Hence he became known as Buddha, and he has a few other names: Shakyamuni Buddha, and Gautama Buddha are a few of them. He is not worshiped, but rather his example is followed and his teachings are studied in order to learn how to live this life and attain enlightenment. This sounds much more lofty than I think it is in practice. In reality, the Buddhists I have read and met seek simply to live without increasing or causing suffering in anyone, and to follow the teachings, which are fairly common-sense and practical.

The temple we go to is the only one in Spokane, and it is in the Jodo Shinshu tradition of Buddhism. There are so many different schools and traditions in Buddhism that I haven't even begun to understand the exact workings even of the one we attend, but the one difference I do know is that Jodo Shinshu discarded the monastic tradition. They do not have any monks; all lay people have direct access to all the teachings. The beliefs that tie all Buddhists together are the Four Noble Truths and the Eightfold Path. These are the things that all Buddhists agree upon.

This year has presented me with some tremendous challenges, and many of those I think are spiritual challenges. I have been trying to meet these with a spiritual tradition that feels honest and practical to me. In all Twelve Step programs, they speak of "the God of our understanding." This can be a real stumbling block to those of us who consider ourselves atheist, or agnostic, or are just turned off by religion. But one thing they teach is that it doesn't matter what that "God" is or even if it is a "God", just that you acknowledge that there is something outside of yourself that can restore you to sanity. To me, that is the Universe. Reading about these teachings and hearing the simple, profound Dharma at the temple really helps me to focus and strive to see the world outside of myself and my seemingly important problems that really are just a part of this world of samsara.

Fatigued

I'm getting used to living in post-crisis now. It's not the same as pre-crisis, when I thought things were pretty normal. Now I know they aren't, and my life is different in a number of inconvenient and irritating, and in some cases frightening, ways. Looking toward the future, I'm uncertain of what it holds. But I am working on living in the moment, being appreciative of 'now'.

I'm thankful that the crisis has passed. I know what is going on now, and it's better than waking up every day uncertain of what else is going to happen or what else I am going to discover that changes everything. I think I'm so thankful to be out of crisis mode that I might accept anything else that passes for normal in my life, which is a risk. I want to decide what is acceptable in my life.

What is left for me now is a deep fatigue. I am tired all the time. My days are filled with administering anesthetics and getting through school. My nights are filled with studying or going to meetings. People ask me normal things, like "how are you", and I am too tired to answer. I try to deflect the conversation back to them as quickly as possible, asking about their kids or anything I can remember that is going on in their lives.

In recovery-speak, this is a family disease, and I am in as much need for recovery as my husband is. But I am often resentful of how consuming "recovery" is, especially since I haven't yet reconciled myself with my own need for recovery. I feel like my circumstances are special or different: how can I be enabling behavior when I wasn't living with the addict, and couldn't see anything happening? Yet I don't think I am logically any different from the other spouses, so I am trying to analyze my situation and see what I can improve in myself--after all, this will only make my life better. But it's exhausting.

I run for stress relief. My eating is not great this week; I've been eating more sugar than I should, and bread and carby stuff. I've been noticing that I get hungry sooner than I used to, like 3 hours after eating. I haven't been super careful about stopping eating after a "small" amount of food, and it's possible that I've dilated my esophagus or pouch or even had a small slip. But I have no other symptoms. Or do I? Sometimes I get kind of a "cramp" in my stomach, not exactly a sharp pain. It doesn't seem to be related to anything I do or eat. Twice I've had a sour stomach when I wake up in the morning, but both times I had eaten right before going to bed, a big no-no for banded folks. I can't see my surgeon until my husband is working again. Hopefully this isn't anything serious.

Four Things

Four names that people call me (other than by my first name):
1. Gwendy: my nickname growing up
2. Gwendolyn: my father calls me that (my actual, given name)
3. Paltrow: my friend Kerry calls me that, and I call her Strug.
4. Gwennie or Gweneth: some of my friends use those interchangably

Four jobs I have had:
1. Farm labor, when I was 13
2. Delivering pizza, when I graduated from high school
3. Home health aide, at many places, the longest being an AIDS hospice while I was in nursing school
4. RN: I’ve been a ortho/trauma floor nurse, a burn ICU nurse, PICU, trauma ICU, medical ICU, and a traveler doing most of those things. And trauma resuscitation nurse in ED. And charge nurse. I’m tired now.

Four movies I would watch more than once: (I have seen all of these at least 5 times)
1. Bull Durham
2. Shawshank Redemption
3. Green Mile
4. The Color Purple

Four places I have lived
1. Fort Lewis, WA
2. Seattle, WA
3. Las Cruces, NM
4. Portland OR

Four places I have been:
1. Placencia, Belize
2. Florence, Italy
3. Vancouver Islands, British Columbia
4. Isla Mujeres, Mexico

Four Animals I have known or had in my lifetime
1. Buffy, my first cat (he was a boy)
2. Houdini, a mouse
3. Sissy Hankshaw, the first cat that was mine after I moved away from home
4. Sophie, my kitty now

Four of my favorite foods:
1. Salmon belly (saketoro) nigiri sushi
2. Gelato--my current fave flavor is honey lavendar
3. apple pie (made by me)
4. fresh baked bread

Four places I'd rather be right now:
1. Mexico
2. Sauvie Island, OR, in the summertime
3. Somewhere where there is no snow on the ground
4. Talking to my grandma

Four things I am looking forward to this year:
1. Getting close to graduation
2. The summer
3. Going to DC in April
4. Improving my marriage

Four TV shows that I watch:(All on DVD, not real time)
1. Mad Men
2. 30 Rock
3. The Sopranos, even though I have seen every season more than once
4. Sex and the City, still watch it from time to time although I’ve seen them all many times as well

Four Songs that I love
1. Beautiful World, Colin Hay
2. Sleep Don’t Weep, Damien Rice
3. Landing Gear, Ani Difranco
4. Constellation, Jack Johnson

Four modern conveniences I wouldn't want to live without
1. My laptop
2. My iPod
3. My Lapband—is that a “convenience”?
4. Microwave

"Sisters", You've Been On My Mind...

Let's talk about the "girls". I noticed in my last post about clothes that I mentioned my breast reduction but had never really talked before about what a good decision this was for me, or about the thing that a lot of MO ladies worry about.

For many of us, one "silver lining" of being morbidly obese (MO) is having large breasts. We worry about what will happen to our shape when we lose weight. Indeed, what will happen? It depends entirely on what is IN your breasts. If you are young and the tissue is firm and not very fatty, not much will change. The older we get, the more fat is deposited there, and the more the size changes with weight changes.

When I was in my 20s, I gained weight and lost weight, but my girls just got bigger. As I mentioned in the previous post, eventually I outgrew all the "standard" sizes and had to be fitted at Nordstrom, where I was deemed a 38H. There in the fitting room, I decided that my idea of having a breast reduction was going to become reality. To me, H meant "Have to have a breast reduction." Things were outta control. I was tired of people staring at my chest, not in any sort of admiration but in freakish amazement. And I was sick of not being able to really exercise without pain in my shoulders, neck, back and chest. It was too much. I really felt like I couldn't lose weight if I didn't do something about this situation.

So, I went to a surgeon that a coworker of mine had gone to. His name was Dr. Kropp, in Seattle. I would refer everyone in the area to him if I could, but he is retired now. He related to me and my friend Val because we were burn nurses and he had done much of his training in reconstructive burn surgery. He had a special place in his heart for burn nurses. He was also extremely kind and caring. When he did my consultation, he took measurements, had his female nurse take photos (this is routine; the photos do not have your face on them, and go to the insurance company for approval), and then met with me, telling me "If you were my daughter, this is what I would want for you." He explained the 2 different ways that he could do the procedure. He assured me that there was no chance my insurance would not cover the procedure, given how much there was to remove, and he was right.

I knew how good he was from Val. She had been a 42MM prior to her reduction. (They used to call her Valcano.) She was reduced to a C cup. She told Dr. Kropp, "All I want is to be able to jump rope again!" She told me all about her surgery, and her results were beautiful. So I felt very confident in his abilities. I scheduled my surgery for late September 2001--about 2 weeks after 9/11, it turned out.

When he did my surgery, he was able to explain why they had never gotten smaller when I had lost weight. I was 28 years old, and there was almost no fat tissue in them. He took about 1000g (1kg) off each side. (The most expensive 5 lbs I ever lost.) There were no drains, but about a zillion tiny sutures. When I went to have them removed in the office 2 weeks later, it took him and a nurse about 20 minutes, and they looked like tiny insect antennae. He told me to wear a sports bra (one the office provided) after my dressings were removed, and I wore it at all times except when showering for 3 months. This is very important for shaping. When I first saw them post op, they looked completely flat, and there was a lot of tissue around the sides. Wearing the sports bra causes the side tissue to mold into the reconstructed breasts and creates a nice shape.

As an ICU nurse I have seen numerous women post breast reduction (for unrelated reasons, mostly because they have been in car accidents and such). My results were much nicer than most others I saw, so I would recommend that anyone looking for a surgeon shop around, get someone with a lot of experience, and talk to other patients. It makes a big difference.

I am very glad I had the reduction before WLS, because I've been able to exercise vigorously the entire time, and was exercising for over a year before WLS. When I lost 35 lbs in 2003-2004, nothing changed at all. However, when I gained weight again, and got older, I did start getting more fat in there. They are now a bit deflated, enough so that I am considering some additional work whenever I get around to getting a tummy tuck (in a few years most likely). The shape is still pretty good, but there is definitely less volume. You can't really tell when I am dressed and wearing a good bra. My initial post-op size was 38C. Now I am 34D.

Everyone I've ever talked to about having had this surgery has said the same thing: she wishes she'd done it years earlier. Truly, if you have very large "girls" that are impairing your ability to exercise or are causing you neck and back pain, and you have health insurance, I'd encourage you to consider it. It was an emotional decision for me, but ultimately a very smart one. My health has been immensely better since doing it, since I have been able to be so much more active. The scars are not bad. It took about a year for them to start really fading. They are definitely still visible, but they look better than what I had pre-op.

A lot of women worry about what their mates will think if they have a reduction. To that, I'd say that most caring partners will want what is best for your health and happiness, when it comes down to it. They might like the large breasts, but they'll like the active, comfortable you more. My hubby didn't know me pre-op, but has been very happy with what I have post-op. It's not worth suffering over any longer than you have to, or not losing major weight over. That's my perspective, anyway.

How To Shop For Clothes While Losing Weight

It seems that sooner or later, you are going to have to face this question if you are undertaking a major weight loss project--whether by surgery or not. After all, you have to stay covered. First off there is a practical matter--jeans simply won't stay up if they are 3 sizes too big, and stuff starts to look ridiculous. Then you have to decide how important your clothes are. This is a big question for anyone who has been morbidly obese; after all we don't have a lot of selection or choice when we outgrow the "normal" sizes in the stores. If you have a job where you have to keep up a certain dress code or appearance, you are going to have to budget in some new clothes in sizes that you might not live in very long. Consider this when you decide if you can afford WLS; we don't get to jump from size 20 to size 6 overnight, no matter what your friends might think. Still, there are ways to make this a little less painful and expensive.

I think it helps to decide what is the most important thing in your wardrobe. For me, while I was in active weight-loss phase, it was very important to me to have jeans that fit. They didn't have to be expensive or any designer brand, but they had to fit, so I committed to buying 1-2 pair of Old Navy jeans in a cut that flattered me in each size. That was 5 different sizes once I started losing weight, at $30 per pair (unless I found them on sale). Not an insignificant expense, but one that I decided was worth making. I spent anywhere from 3-6 months in each size; for people losing more rapidly, this might not be practical.

Beyond this, I stuck to a few basic rules:
1. Skirts are forgiving, and often can be worn simply lower on the hips when they get loose, or can be altered.
2. Dresses in knit fabrics work for a lot of sizes.
3. Knit fabrics in general allow for a lot of use while losing weight.
4. A good belt goes a long way.

One thing that I don't think some people plan for is the fact that buying clothes becomes dangerously fun once you really lose some weight. Even when you aren't near goal, just looking and feeling so much better, and being able to fit into smaller sizes and new brands, can make shopping addictive. I think it helps to set your ground rules and your budget for transition size clothes. I accepted the fact that I would buy some clothes that I wouldn't wear very long, and tried my best to hunt for bargains and minimize wasting money.

Some things that people losing weight have done to keep things cheaper include:

-shopping cheap stores and sales (duh, I know)
-exchange clothes with other people losing weight--message boards like LBT or OH are helpful, and others I'm sure, as well as support groups
-thrift shops and consignment shops
-having a good tailor alter clothes that are too nice to just give up. Some items are too complex for this, but having a waist taken in on a skirt or pair of pants is pretty simple. This isn't necessarily cheap, though, so I save this for really nice things I can't part with. If you can do it yourself, great--but even though I'm a pretty good seamstress, there are many things I'd just rather pay a pro to alter.
-Ebay can be a big help, or not. I have found that I can do okay when I am looking for very specific things, but if you frequent Ebay, you know not everything there is a good deal. If you like to sell there, you can unload your stuff that no longer fits. I don't have time for Ebay selling these days, but I used to do it, and it's okay--it never made me so much money to make it really worth putting the effort into.

A lot of this is kind of obvious, I guess, but I think just thinking about the issue of clothes is important when preparing to lose significant weight (or once you've started and realize the problem). Shopping in your own closet is fun, digging out old things that ceased to fit when you gained weight--but for most of us this only takes us so far, until we either surpass our previous lowest weight and run out of old things, or get to the stuff that is just too old and out of date to wear. I eventually got to the old shirts that I bought several years ago that did fit again, but were purchased in that (painfully long) era when all shirts were shorter, even if they weren't midriff-baring exactly (and how happy I was when they finally started making shirts a little longer again, more suitable for us larger-breasted and larger-bellied ladies!). I was so happy to be able to buy shirts that were a longer length and toss those shorter ones to Goodwill.

I discovered some interesting things when I went through this process, too. For example, I found a lot of skirts that I liked but were just a little shorter than I was comfortable wearing nowadays--but if I bought a size or two larger, it would just sit lower on my hips and appear longer, and I could just wear a top over the lower waist. My waist has always been significantly smaller than my hips, so this works great for me. I also discovered which styles of inexpensive knit dresses were easily taken in at the sideseams to make them fit when I got smaller. Overall, my wardrobe became a lot more versatile as I had to change it around to accomodate my changing size.

Shoes and purses and accessories are the main shopping obsessions of obese ladies who like to shop but don't like to suffer the indignity of shopping for clothes. I found as I bought more clothes in transition sizes, I had to stop buying shoes and purses. I just couldn't afford it. Luckily, I had a lot of years to collect nice ones, so it wasn't that hard to do. I'm a lot more intentional now about buying things in general--I shop for a specific item that I need (especially now that I don't have my own income). I'm also lucky that my shoe size didn't change when I lost weight; this does happen with some folks, especially if losing more than 100 lbs total.

Underwear becomes an issue, too. I'm addicted to Costco's Itsee Bitsees panties, and bought them in mediums, then smalls. So I have about a million pairs of them in 3 sizes total; oh well. I have one style of Victoria's Secret bra that I love, and have had pretty good success getting them cheaper on Ebay. Don't forget to be refitted. The sisters shrink for most of us when we lose weight; we need to give them as much help as possible by making sure we wear bras that fit. Especially if your shirts aren't perfectly sized, it really helps to wear bras that fit underneath. I know this is a challenge when you are starting with very large bra sizes. Years before my WLS, I had breast reduction surgery, and I remember how expensive those H cup bras are. (Once I reached "H", I only bought one bra, and immediately pursued breast reduction surgery. The bra was $60 back in 2001.) So this might not be practical to keep up with perfectly if you start out a 44J or something. But again, Ebay can be your friend here, especially if you have a specific brand that consistently fits well for you. I've heard some people swear by some of the bras at Walmart; I don't shop at Walmart myself, so I can't help you there, but if you do, I'm sure you can save a ton of money doing that. Just be sure you know how to fit it properly.

What do you do with your bigger clothes? Well, for most things, I actually have kept them. The reason is that I hope to be pregnant in the next year or two, and I think I'll be able to wear a lot of it as maternity clothes. After I am done with childbearing, I will get rid of the big stuff. Things that I am pretty confident I won't be using again, I donate to Goodwill. If you are a part of a clothing exchange group, you're all set. And if you have really nice plus-size clothes, you can make pretty good money on Ebay, as that stuff is hard to find and a lot of us hated shopping in stores when we were morbidly obese. Consignment would work well for the good stuff, too. The undies are a loss, but that's why I don't spend a lot of money on them. The bras should be donatable, or possibly resale-able if in very good condition. Unless you think you have a good reason to need bigger clothes, like an upcoming pregnancy, it's usually considered best to let go of them when you reach goal and are maintaining it for some time. I had a few times before my surgery where I lost weight and thought I'd never regain, got rid of things, then had to buy them again, in shame, when I regained. So I would not be the one to tell you to chuck it all as soon as you shrink out of it. I'd make sure that you are really maintaining, at least within a few sizes of wherever you end up. But some people would say that is just allowing yourself to regain. Choose for yourself.

I hope this helps pre-ops and non-surgical folks (or recent post ops, or anyone really) at least in starting to think about how to tackle the problem. Nothing about major weight loss is cheap, although I'm sure there are ultra-frugal ways of doing it like there seems to be for everything else, if you want to put in the effort. Having a game plan and sticking to it is what worked best for me.

Karma, no drama

I am missing my boring, normal life I used to have. It seemed boring and normal to me--in fact a lot was going on without my knowledge, but I miss the ignorance-is-bliss part, anyway. Even though I am all about the Truth these days and knowing what is really happening, tonight I'm having a weak moment and wishing for what I don't have.

Legal troubles abound for hubby. He's in serious trouble, without going into details. It's hard to watch him go through this, and hard to have all this uncertainty for us both. I am afraid of the financial fallout for us both over the next several years. Whatever he has to do as the consequences of his actions, that is just what it is. Karma is a real thing, and I'm grateful that he is facing everything with a clear head and no illusions (or delusions) about it. He's trying to remind me that while a lot of bad things are happening right now, some good things will happen too. I do appreciate that.

I've missed more school time--Friday and Monday--and I hate that. I feel so behind, even though I'm not really, and I hate for the CRNAs to frequently see me marked off the schedule. I think I'm not that much fun to hang out with in the OR, either, because I'm so freaking stressed about things these days that I don't make any small talk or chit chat while we sit together (not all of anesthesia is exciting or busy stuff, surprisingly). I don't have energy for it, and so be it. Mostly I try to lay low and get as much out of my clinical time as I can.

There is something good coming up. I am going to D.C. in April for our national organization's annual political meeting. We meet with senators and talk about healthcare and nurse anesthesia. It's pretty cool. I discovered, upon looking through my closet last week, that none of my business clothes fit anymore. The suit I interviewed in for school is a size 18. Needless to say, that isn't going to work this year. So, despite both of us being unemployed, I had to find some business clothes.

I got some good deals at the outlet mall (Presidents' Day sale) and got some pants on sale elsewhere. All in all, I actually got quite a bit for the amount of money I spent, and now I have two suits (size 8) and all I need to meet Congresspeople and the leaders in my profession. The trip itself is paid for by our state organization, WANA, which generously allots money in their budget each year to send students from our program to this meeting. One great thing about our professional organizations is that they work hard to include socialization and political education about our profession when we are in school. It's very important to maintain our profession and assure that quality care is going to continue to be available to people who need it. There are other groups that would like to see us limited in scope of practice, which would put a lot of people whose areas are served only by nurse anesthetists at serious disadvantage. So the political stuff is important, and I'm excited to go to this meeting. Plus I've always wanted to go to DC. There will be lots of pictures!

A better month

As advertised, February is starting out much better than last month. I got my big assignment for the beginning of the semester done at last--my presentation on pediatric congenital heart defects. If anyone wants to ask me anything about Tetralogy of Fallot or hypoplastic left heart syndrome, now is the time. It will all be leaked out of my brain within the next 3 weeks. Anyway, I had to put it off for a while because for a few weeks things were way too crazy around here for me to be able to think about anything that complex and make sense of it. Then I went to do the presentation this Tuesday and the last 20 slides I had spent the previous evening making did not save--which was more than I could take. So I spent Tuesday night recreating them, and gave the presentation on Wednesday. It went fine, and now I have a little time to relax before getting into starting our thesis and research project.

I am down to my new low weight: 165. Woot! Only 5 lbs to goal. I hope I get there, but it's probably okay if I don't. I bought a new pair of jeans last week (Target has pretty nice jeans, actually) and thought they were 8's but when I got home learned they were 6's. It's my second pair of size 6 jeans and I can't believe they fit, still. When I interviewed for this program in February 2007, my suit was a size 18. It's easy to be excited about losing 6 sizes.

Running at the GU gym is going fine. I'm not running as far as I do outdoors, because treadmills are boring. I do listen to podcasts instead of music, which I like, except that there is a bank of TVs in front of the treadmills, which gets distracting when I'm listening to a podcast. But all in all, it's fine. I find now that I am running more for stress relief and enjoyment than for exercise or doing something "good for" myself. I am also lifting weights--upper body only, I think running is enough for my lower body. And working on my core. It feels good.

We've been getting to know the new freshman class at school. They are all pretty nice. One of them is an old friend of mine from my first ICU job, a guy I always got along with really well but never really got to know that well. So it's been fun getting caught up and all that. I've gone out with the freshman class for drinks a few times and it's been interesting. Most of them are younger than our class is, and most of them don't have kids. They are struggling with the same classes that we struggled with, the same personality issues and all. It's nice to be in a position to offer some (hopefully) helpful advice.

Things at home are going well. Hubby seems to be doing well on his recovery path. I went to see a therapist this week and he basically told me that I seem to be coping in a normal and healthy way and I probably don't need personal therapy right now. I thought that might be the case and wasn't sure if I should see this therapist individually or for couple counselling (which he also does). We are going to see him next week for a couple session to see if we can do some work that way. I think it sounds like it will be helpful and interesting.

Hope everyone is well out there. Thanks for all the kind comments and well-wishes. They mean a lot to me, truly.