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.

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!

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.

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.