Scary Stories

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I spend a LOT of time (probably too much) hanging around on message boards and forums relating to obesity surgery. I don't input very much - after all, I am not a "vet" yet, have not earned my surgical scars and all that. Every once in a while, I will put up a link to here on Misdirected if I feel it is especially relevant, but other than that - I lurk.

There are quite a few encouraging tales to be found out there. Formerly 600-pound men who are now avid wilderness hikers. A previously obese woman fitting into her wedding dress for the first time in 25 years. A grandmother getting into a swimsuit for the very first time in her life. The stories can be really heartwarming and encouraging to those of us just getting ready to take the plunge.

But I have recently been paying a lot more attention to those "other" stories": 

• "I lost 100 pounds but gained it all back..."
• "I am going through a bad time in my life and can't stop eating..."
• "My husband just left me and all I want to do is cry and eat..."
• "After 5 successful years, I am regaining again and I don't know why..."

Entry after entry of people whose surgery is not working out for them for one reason or another. Scary stuff.

I have not gone out of my way to look into relapse numbers. Normally this is the type of research I would be all over like stink on expensive cheese, but here I have held myself back. I couldn't tell you exactly why, only that it didn't feel right to be investigating failure before I have even started the process. I have been wanting to prepare myself for success, not for failure.

But the truth is out there: relapses happen. And it is scary to think that all this work, (and rearrangement of my innards) could go down the drain if I don't watch my step.  So, I have been carefully reading these relapse stories, and looking for common elements. I keep finding 3 common themes coming up time and again:

1. Lack of accountability. Most of the desperate pleas of those I see talking about their failures online are for someone to "straighten them out" or "tell them off." At home, these individuals are not getting the support they need. Maybe they live alone, maybe their family is disinterested, or maybe (most frightening) their support system is working actively to sabotage them. But they need someone to call them out, and tell them to get back on track.

2. Lack of exercise. This seems to be a major issue. I have yet to read anyone's story about how they are suffering from massive regains while they are still exercising regularly. Just about all the horror stories I have read talk about how the pressures of life, or exhaustion, or just laziness have kept them off the street, away from the gym, and placed them on the couch.

3. Emotional turmoil. The big push that starts the plummet of the cliff of a major regain seems to frequently be an emotional trigger of some kind. A lost job, the death of a loved one, the breakup of a long-term relationship (sadly common for those who have gone through bariatric surgery) all seem to be things that have forced these individuals to seek comfort where they have always gotten it in the past - from food.

Lor and I are lucky. She has me to hold us accountable to our diets, and I have her to push us when it comes to exercise. As far as emotional turmoil - we have each other to rely on if something goes wrong in either of our lives. It isn't like we're going to get divorced again. Been there, got the T-Shirt - it didn't fit.

For anyone else, I would encourage them to find a family member, community,  or friend to act as an accountability partner. My other advice would be to do it now - while things are still going well. Looking for help while you are desperate leads to bad, bad choices. Get someone in your corner right away, and keep them there - when the storm clouds roll in, you'll have someone to run to before things get out of control.

This lifestyle change that we have undertaken is hard enough without handicapping ourselves by trying to go solo. Do it with a friend, find a support group, get plugged into a relationship with a trainer - anything you can do to make sure that one bad day doesn't turn into one bad week, or one bad month, or a disastrous relapse to obesity. One thing we know about life - bad times will show up. Make sure that you have planned ahead, and have the tools you need to come out the other side with your "new self" intact.

Being Prepared Aint Just For Scouts,

- Hawkwind

Leaving the Tribe

I spent some time over the last couple days looking at the Obesity Action Coalition, and listening to podcasts by a couple of their members. Something, I am not sure what, set off the "advocacy" switch in my brain recently, and, just like I did with the Epilepsy Foundation, I am wanting to get myself plugged into the larger world of community and political activity around another issue I am personally invested in.

Here's the thing, though: I feel kind of weird getting involved with the OAC, or any other obesity advocacy group right now. Why? Because I am getting ready to have a surgical procedure to begin correcting the condition in a few short weeks. It is as if I was joining La Raza right before I had a DNA procedure that rendered me 100% Anglo - at best I would be a concerned outsider, no longer a real part of the group. I feel like I am about to lose my "tribal" status.

It is hard to describe the importance of self-identification that comes along with a disability like Epilepsy or Obesity.  In many ways, the condition is larger than the person you are. I am not a veteran, but have heard vets talk about how "if you weren't there, you don't understand." That is exactly how I feel about the conditions I have been fighting for most of my adult life - a small group of people really get it, and the rest may be concerned about it, but they won't ever understand what it is like to be a part of the "outsider nation". They won't understand the constant efforts (and failures) to gain control of your health, they can't have experienced what it is like trying to get help through our fractured medical system, they have never been laughed at or shunned for being different the way we have. It is almost a reverse form of class elitism, looking up from the very bottom rungs of society. 

But, if you haven't been through it, you don't understand.

The crux of my problem is this: I will always self-identify as a person with Epilepsy (or as "an Epileptic", on bad days.) There is no cure for it, no process exists to remove Epilepsy, or place it into remission. Even if I should ever enjoy 100% seizure control, it will be through surgical implants, daily applications of mind-numbing drugs, and constant vigilance - not because I wake up one day and have been cured. I will remain a part of this tribe forever - advising newcomers and their families, staying on top of news about developments and potential treatments, driving my elected representatives crazy by staying plugged into the politics around research and treatment.

What happens, then, when I take the "off-ramp" from obesity via bariatric surgery and the lifestyle changes that accompany it? Am I still suffering from the condition? Am I moved over into a "Veterans" or "Survivors" group - still having something relevant to add to the community? Or am I simply now someone who was a part of the community, but left - a person who joined the ranks of those who don't understand what it is to be Obese?

There is nothing wrong with being active as an advocate for a group you are not a part of. It is an important part of education and empowerment for those whose voices are not being heard. But it still feels to me, right now, that I am going to become external to the experience. American skinny culture, fat shaming, and bullying of obese kids are no longer going to be my issues, but the issues of a group I happen to care about. I will be standing with a group, but I will no longer be a part of it.

One of the first things a good doctor will tell you after your diagnosis of a disability is some version of "Don't let your illness define you." It may not be my definition, but it most certainly has shaped my community. And I feel very strange about potentially leaving the community I have been a part of for 25 years.

Wondering If I Have To Surrender My Tribal Membership,

- Hawkwind

The Choices of the Unwise

Yesterday I made some poor choices.

And no, not the ones you are thinking I made. I did not stop off at Ronnie McDoncald's house then swing by the grocery store on the way home to buy a chocolate cream pie. No, instead, I sort of forgot to eat. 

The evidence is right in front of me, in the MyFitnessPal app set up on my phone. (An aside - if you are trying to lose weight, embrace MyFitnessPal. Not a kickback in it for me or anything - it is just that good.) Yesterday's breakfast is listed (Decaf, English Muffin with carefully controlled amounts of Peanut Butter and Jam, topped off with trail mix), but then, for the rest of the day...nothing.  Factor in the exercise I did last night and I netted a whopping 469 Calories for the day. Not good.

I can also guarantee that I didn't have enough water - I remember filling my 20 oz. water bottle one time. Tack that on to my 14 ounces of decaf (I have a BIG coffee cup), and I am almost 30 ounces short of my minimum intake for the day.

Far from being a "diet victory" (Yay! Under 500 calories!), this was a loss of massive proportions. For one thing, today I feel like crap. My head is pounding, my stomach is upset, and I could not force myself out of bed this morning. Hangover, anyone? I didn't even get to catch a buzz at the front end in order to earn the day after. 

But, the real problem is that post-surgery, this kind of behavior will get me hospitalized. Both dehydration and malnutrition are major issues for those that have gone through any kind of bariatric surgery. Pulling this kind of stunt after my sleeve is installed will be every bit as bad as binge eating, and more dangerous in the short term.

So, what happened?

To be honest, I am not sure. I diligently prepped all 6 meals and snacks for Lor yesterday, so it isn't like I was never in the kitchen. Since her liquid phase started, I have not been eating my "real food" at the same time she does, or in her presence, out of respect for her pre-surgical process. But yesterday, somehow, I just never got hungry, and never remembered to eat after I had created (blended) a meal for Lor. Despite a busy day,  I had plenty of time. I just never got around to it somehow.

And getting kickstarted this morning will be even more difficult! Ever tried to eat with a hangover? If you haven't, good for you - but the rest of you know what I am talking about. It isn't like I can have a Bloody Mary with an egg in it. I can't even have fruit juice. Instead, I am going to have to re-hydrate until I can eat something, then wait for my day to normalize. Joy.

The lesson we should all carry away from this? If you are dieting, especially if you are pre- or post- surgery, DON'T SKIP MEALS. It creates bad habits, and you won't like the short-term effects either. You have been warned.

Wishing I Could Put My Head On a Shelf Until The Feeling Goes Away,

- Hawkwind

Lead Me Not Into Temptation

The Gathering of Cousins. I am the one with the beard.

This weekend was a special occasion in the family: two of my cousins are hitting their 50th birthdays this year, so a party was organized to get as much of the family as possible together to celebrate. It was wonderful - family members came in from as far away as Georgia to be there, and I got to see people that I hadn't seen in years. It was so nice to see uncles, aunts, and cousins without everyone wearing black for a change.

The problem came when it was time to eat. The aunt who organized the event was very concerned, wanting to be sure that there were items that fit into my diet. I assured her that I could eat most anything that came off of the grill. relieving her concern. No, the problem wasn't that there was not food available for me.

The problem was that everything else look so good.

There were huge bowls of potato salad. Tortilla chips with my mother's family-famous salsa. A beautiful marbled birthday cake with butter cream frosting. There were 3 coolers filled with different kinds of beer!

And here I was, without Lor, who couldn't come thanks to the effects of her pre-surgical diet. Alone and unsupervised, in a wilderness of food. 

I knew I was going to fail somewhere. I am no stranger to my own nature. So, I adapted. I made sure there was always a bottle of water in my hand, so any time someone offered me a beer (which was frequently - my family has watched me in action at get-togethers for 45 years now) I could just wave my water at them to show that I was supplied. I couldn't possibly live without some of Mom's salsa, so when items started coming off the grill I put a healthy dose of it on my burger instead of using chips to eat it. And I did have a single serving (about 2 Tablespoons) of potato salad, which I ate as slowly as I possibly could after I had finished both a lettuce-wrapped burger and bratwurst.

 I didn't go anywhere near the birthday cake.

All things considered, I didn't do too badly. It worked out to only about 10 grams of Carbs (almost all from the potato salad.) This time last year it would have been a couple of fully loaded burgers, a couple of bratwursts, a pile of potato salad, and a bowl filled with chips to go with Mom's salsa. This would have all been topped off with as big a slice of cake as I could've managed interspersed with half a dozen beers.

And I wonder how I got to 302 pounds?

The visits with family members were gratifying, though. Those that don't follow Misdirected all commented on how good I looked. Several that do look in here from time to time thought I had already gone through surgery, on the basis of my appearance. I actually laughed and joked and visited, instead of hiding in a corner, hovering over a plate, hoping no one would talk to me. I even participated in family photos without trying to hide in the "back line", behind everyone else.

Though it was nice to have everyone tell me how good I was looking, it wasn't the 33 pounds I've lost so far that made the difference for me. It was knowing that I was finally making changes in my life and sticking to them. At our next family get-together, I will have been through surgery, further committing to this new lifestyle of not being shackled to obesity. I will not have regained every ounce plus some extra pounds from failing on my latest fad diet. And looking forward to success, rather than anticipating failure, is making all the difference in the world for me.

Looking Forward To The Next Family Gathering,

- Hawkwind

The Psychology of Obesity

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An awfully pretentious title for early on a Friday, right? But today will be my first visit to a psychiatrist in many years, after a couple of very bad patient/doctor relationships - and telling myself to not worry about the visit today has got me thinking about why it is that a person becomes obese in the first place.

Visit any forum or message board dealing with obesity these days and you will find a few trolls - those individuals who have taken time out of their day to drop in and tell us that we are only "fatties" due to a lack of willpower. If we only had some self-control (as, presumably, these individuals believe they do) we would not suffer from this problem. To them, the condition of obesity is a product of nothing more than laziness. Running into an especially obnoxious troll post can infuriate me for hours afterward - which tells me that something inside that post has resonated with me. Apparently I, too, believe at least in part that if I had just tried a little harder over the past 20+ years, I would not be obese.

And here lies the problem with obesity, in a nutshell. The vast majority of us thinks that we alone are responsible for our condition. But, other than being fat, where is the evidence? The majority of us go to work, we raise families, we practice religious devotions, we do chores around the house - we do a hundred things a day that prove that we are not lazy - and yet we accept that the state of our bodies results from a failure in willpower.

Obesity sits in the same corner with drug addiction, alcoholism, and depression - conditions that a person who has never suffered from will never really understand. These afflictions of the mind are easy to marginalize and make fun of because they are invisible to the naked eye. A person on crutches wearing a cast is accepted as having a broken leg. But, in our culture, obesity is not accepted as a sign of a broken mind.

A few years back, Lor and I stopped by a local gym to check into monthly rates, thinking maybe we could get this thing moving on our own. The young and heavily muscled twerp behind the counter took one look at the two of us and suggested that maybe this wasn't the gym for us. We couldn't afford it anyway, so I just let it go. But I guarantee you that I went home and ate something afterward. "Healthy" society had just rejected me and made me feel bad. So, I went home and ate, which made me feel good.

Now, which activity do you think I return to most often? It is called a conditioned response - your mind drives you towards those things that feel good. The mind associates things which are good for itself (eating, sexual response) with pleasure, and things which are not good (being cast out of a social group, hitting oneself with a hammer) with pain. This is Mother Nature at work here, trying to secure the continued survival of a species. What Mother Nature did not count on is that we've now developed a cycle:

• There are so many things to eat which cause pleasure.
• Overeating develops obesity.
• Obesity causes rejection by social groups, which is painful.
• One retreats from the pain of rejection, by embracing the pleasure of eating.
• Back to step one.

This is, of course, a vast over-simplification - and I am no psychiatrist. But the logic is clear: why would I endure rejection and exercise (which is initially painful as well) when I could instead feel good by eating? Eating is a short-term pleasure, of course, but there is always another Quarter Pounder or Snickers bar just around the corner. I am not only eating things which are bad for me, then - I am also eating them more often.

See where this is heading?

I am not looking forward to bariatric surgery because the smaller stomach size will force me to eat less. I am looking forward to bariatric surgery because I will finally have the chance to look for "pleasure centers" that do not revolve around food. Weight loss will allow me to finally seek endorphin-releasing exercise. It will enable me to live a life where I am not constantly in pain. It will enable me to have a normal sex life. And, yes, it will enable me to interact with other people without the prejudice against obese people working against me. I am willing to have the majority of one of my internal organs removed and THEN go through all the normal work of weight loss, just to reset my association with food as the sole source of pleasure in my life.

It may seem unfair, but there it is. I have to live in the world as it is, not as I wish it to be.  I can only hope that my psychiatrist today agrees with me, and does not instead want to turn me into a multiple-year case study or something. Wish me luck!

Still Looking For Endorphins That Don't Make Me Fat,

- Hawkwind

The Hunger Games

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Things are strangely quiet here in the household, the kind of silence that descends in a horror movie right before something lurches out of the shadows. Think Rime of the Ancient Mariner kind of calm. We are 24 hours into Lor's "liquid phase", and...

...What's that? The great majority of you have no idea what I am talking about? Let me back up a bit, then.

Any bariatric surgery is surrounded by several periods of time (or "phases") in which diets are radically changed to either prepare for or recover from surgery. We have been in one of those phases for months now - the low carbohydrate phase, where patients are supposed to drastically reduce their carb intake for the 3 months preceding surgery. However, 2 weeks out from surgery, another major dietary shift occurs. The patient is now required to spend two weeks eating (drinking, really) nothing but protein shakes, clear liquids (like broth), and water. Why? In order to shrink the size of the liver, which has to be moved out of the way (laparoscopically, of course) in order to perform any bariatric surgery. The smaller the liver, the easier it is to move around in the abdominal cavity. But the patient still requires high amounts of protein to stay alive, so protein shakes and vitamins it is.

Immediately upon release from the hospital the patient will go back on the "all protein shakes, all the time" diet. This is to give the digestive system time to recover from the traumas that have been inflicted upon it, but also means that the patient will spend 4 weeks on nothing but protein shakes and an occasional yogurt. Many successful patients report that after they are done, they never want to look another protein shake in the face as long as they live.

We are now 24 hours into Lor's protein shake phase. And, while I had anticipated what would be happening to Lor, I hadn't realized what was going to happen to me as well. You see, I will not be eating any food that Lor loves during this 4 week period. Why torture her like that, right? What I had not anticipated is that, cooking boring food for one, I would be really reducing my caloric intake as well. For example, yesterday, Lor got a whole 750 calories in protein shakes. But, I was right behind her, managing only 950 calories in "real food". Plus, she hit her 60 grams of protein target for the day - I actually missed mine.

I am little perplexed as to what to do next, honestly. Do I increase my intake to make sure I stay sane and stable for the next month? Or do I stick it out, suffering in solidarity with my wife like I had originally planned? I feel pretty decent now, I must admit - I have not suffered through the constant hunger that nothing but protein shakes creates. I think I will just wait and see what happens next.

One thing is for sure, though - the next 4 weeks are going to be more interesting than I initially thought they would be.

Hoping Lor And I Do Not Cannibalize Each Other,

- Hawkwind

The Pre-Final Countdown

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Procrastination is a living, breathing animal that eats your best intentions and leaves you with the remains of wasted time.

I had every intention of producing a blog yesterday morning. When I sat down to write it, it occurred to me that the momentous events of the day were coming up later in the morning, so surely I should just write later, right? But later came and went, and left me in such a dither of emotions that I could never actually get anything coherent down to be published. So, here we are, 24 hours late, with the news that we've all been waiting for.

The day has come, the die has been cast, etc. - I go under the knife (the scopes?) on July 25th, just a hair under 6 weeks from Lor's surgery date. I do still have to pass muster with a psychiatrist, but that evaluation is scheduled for 2 days from now. Barring any catastrophic failures, this thing is a go.

I am not exactly ambivalent about the whole thing. The meeting with the nutritionist yesterday was extremely positive. I've lost a total of 30 pounds since we started the process in February. Lor and I are exercising every day, dietary changes have been made successfully - I've received a glowing report on my pre-surgical prep from the team over at ABQ Health Partners. It seems like I am prepared to succeed at this.

But...(there is always a but) I am still having trouble wrapping my head around where this is all going to wind up. My loved ones are cautioning me to not be overly optimistic about the final results of my surgery -  high blood pressure and sleep apnea, for example, have been a part of my family genetic makeup regardless of size or weight. Thanks to my currently over-sized body I will probably never be built like Hugh Jackman, but will instead be left with an apron of left-over skin reaching down to my knees. I mean, I am happy to accept all those results if it means I can finally walk without being in constant pain. But I was kind of hoping for more dramatic results than what I am being cautioned to expect. No one is trying to talk me down off the ledge, but I seem to be receiving plenty of warnings that the landing won't be as comfortable as I was hoping for.

I am left looking in the mirror now, trying to figure out what (if anything) will be different about me when this process is all said and done. My surgeon airily informed me back in March that the surgery would "Get me down below 200 pounds". I am 30 pounds down now, and I am just not seeing it in the mirror. Granted, I already feel better - I can walk two miles now and carry on a conversation afterwards. This from a guy who 3 months ago couldn't carry groceries out of the car without gasping for air during the process. I guess I was just hoping for something more tangible, and I am kind of afraid that even losing over 100 pounds post-surgery is still going to leave me looking like a deflated balloon. A deflated balloon with high blood pressure, sleep apnea, and excess skin hanging off me everywhere.

Later today is our bi-weekly "measurement" routine. I am hoping for some positive results there, because right this second I could use a win. I am not nearly as pumped up about having a date for my surgery as I had thought I would be.

Curiously Ambivalent,

- Hawkwind