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.

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.

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?

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.

Control

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...!

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?