Thursday, January 29, 2009

No more Ambien

It's been a week and I think this stuff is finally out of my body. I've actually had more and better sleep since I've been off it than I remember having in years. It's a spooky drug--probably fine for short-term use, not so much for long-term. It's been a hairy week, though; I basically lost the last several days to extended insomnia followed by many hours of crashing sleep. I had about a three-day, five-alarm migraine up until last night.

The good news is--now that I rode this withdrawal out--I feel more human and ultimately, more productive. I have a couple of jobs I'm going to go turn in paperwork for tomorrow, I scheduled a mammogram (I'm 40 now, have to do it, going to start bugging all my female friends who just turned 40 to do it too), and I'm trying to settle in for the six months of documenting what I eat. It's only been a couple of weeks. Sigh.

I am really trying to change my habits prior to the procedure, and I think even that is a big step in the right direction. I have to find more sweet things that don't have actual sugar in them, and I have to give up soft bread, which is really, really hard for me. I looooove fresh bread.

I'm thinking about this stuff all the time--how many calories is in this or that, how many calories have I had today, the smaller bites, etc. The sweets thing is what I'm the most worried about. For years I've said (only half-jokingly) I would go to rehab for my sugar addiction if I could. If the only way to satisfy the cravings were to shoot it into my veins, I am 99.9% sure I would do it--and I hate needles. I'm going to see if I can find some information on sugar addiction and read up on it a bit. Hopefully there's a good book available with some tips for how to shed this particular monkey from my back. It's not going to be easy.

Wednesday, January 28, 2009

Official denial letter arrives amidst Ambien CR withdrawal

My official hard copy of the denial letter arrived from insurance today. Basically, I meet all of their medical necessity criteria, except the six months of supervised diet and exercise, which I knew--and apparently, that is their sticking point.

Their criteria for deeming bariatric surgery medically necessary is as follows:

Age 18 years or older;

Body mass index (BMI) of 40 or greater or a BMI of 35-39.9 with at least one co-morbidity including but not limited to cardiovascular disease, type II diabetes, hypertension, coronary artery disease, or pulmonary hypertension;

Active participation within last two years in one physician-supervised weight-management program for a minimum of six months without significant gaps that includes monthly documentation of the following: weight; current dietary program; exercise program.

Recent evaluation by a multidisciplinary team including all of the following:

A recommendation for surgery for treatment of morbid obesity by a bariatric surgeon;

A separate medical evaluation recommending bariatric surgery;

Clearance for surgery by a mental health provider;

Nutritional evaluation by a physician or registered dietician.

I assume these criteria are typical requirements for any health insurance that actually covers bariatric surgery.

The letter wasn't alarming in and of itself, but did include a passage that stated no services denied as medically necessary would be covered per their contract. I am hoping that doesn't mean all the preliminary appointments listed above that have already been completed, because I will fight tooth and nail if they try to deny those things--I only did them because insurance required them, after all. Since the providers call before every appointment to see if it is covered--and since they have said "yes" every time--I doubt the charges could be denied for any of this stuff. Given my past experiences with this insurance, however, I notice they have to be called and reminded someone is reading their policies, statements, and correspondence in order for them to actually fork over the dough.


It's been a weird few days--this is the first time in about ten years (save a day or two here and there) that I haven't taken any kind of sleeping pill. I am glad to be getting this stuff out of my system, because if the way withdrawal feels is any indication, I doubt it was doing anything good in there. I couldn't sleep at all for the first three days, then I crashed for about 12 hours. The past couple of days I have been sleeping in long blocks of time--today I could barely rouse myself at all. I've had cottonmouth and tingling hands, and the dreams I've had have been really vivid and intense, like being in the middle of 2 or 3 movies mashed together.

Monday, January 26, 2009

Important Songs of My Youth (Ages 0-25)

Inspired by a high school friend on Facebook, this was fun to do. I think I admitted to everything!

Tiny Bubbles—Don Ho
Fever—Peggy Lee
Joy to the World—Three Dog Night
Stand By Your Man—Tammy Wynette
Yummy, Yummy, Yummy—Ohio Express
Cathy’s Clown—The Everly Brothers
Don’t Worry Baby/The Warmth of the Sun—Beach Boys
Copacabana/Mandy—Barry Manilow
Top of the World/Sing/Superstar—the Carpenters
She’s Always a Woman/Honesty—Billy Joel
Dust in the Wind—Kansas
Someone’s Rocking My Dreamboat—Ink Spots
You Ain’t Woman Enough—Loretta Lynn
Sky High--Jigsaw
If You Leave Me Now—Chicago
Maybe I’m Amazed--Wings
Baby Come Back—Player
Please Come to Boston—Dave Loggins
Saturday Night—Bay City Rollers
I Just Want to Be Your Everything—Andy Gibb
You Sexy Thing—Hot Chocolate
We are Family—Sister Sledge
Ring My Bell—Anita Ward
Play that Funky Music—Wild Cherry
Solitary Man—Neil Diamond
I’ve Got the Music in Me—Kiki Dee
Wildfire—Michael Martin Murphey
I Know a Heartache When I See One—Jennifer Warnes
ABC/Enjoy Yourself/Shake Your Body—Jackson 5
Superstition—Stevie Wonder
Send in the Clowns—Judy Collins
Hotel California/New Kid in Town/Life in the Fast Lane/Desperado/Best of My Love/Those Shoes/James Dean—Eagles
Cat’s in the Cradle—Harry Chapin
Knockin’ On Heaven’s Door/Rainy Day Women #12 and 35—Bob Dylan
If You Want to Sing Out, Sing Out/Moonshadow/Wild World/Where Do the Children Play?--Cat Stevens
Sara Smile/She’s Gone—Hall and Oates
I Will Survive/Never Can Say Goodbye—Gloria Gaynor
American Pie/Vincent—Don McLean
You Can’t Always Get What You Want/Ruby Tuesday/Paint it Black/As Tears Go By—Stones
Piece of My Heart/Mercedes Benz—Janis Joplin
I Was Made For Lovin’ You—KISS
Sad Eyes—Robert John
Free Bird/Sweet Home Alabama—Lynyrd Skynyrd
You and Me—Alice Cooper
If I Can’t Have You—Yvonne Elliman
Someone Saved My Life Tonight/Rocket Man/I Guess That’s Why They Call it the Blues—Elton John
Operator/Time in a Bottle—Jim Croce
Emotion—Samantha Sang
Sister Golden Hair/I Need You—America
Everything I Own--Bread
Killing Me Softly—Roberta Flack
Knowing Me, Knowing You/Dancing Queen/S.O.S./Fernando—ABBA
Love Will Keep Us Together/Shop Around—Captain and Tennille
Magic Man/Dog and Butterfly—Heart
Miracles—Jefferson Starship
Hopelessly Devoted to You/Magic—Olivia Newton-John
Tears on My Pillow—Little Anthony and the Imperials
You’re No Good/Blue Bayou—Linda Ronstadt
Back in Black/Highway to Hell/You Shook Me All Night Long—AC/DC
Fire and Rain—James Taylor
Danny’s Song—Anne Murray
You Are So Beautiful/Can’t Find My Way Home—Joe Cocker
Ain’t No Sunshine/Use Me—Bill Withers
Go Your Own Way/Sara—Fleetwood Mac
Bridge Over Troubled Water/Kathy’s Song/I Am a Rock/Scarborough Fair/The Boxer—Simon and Garfunkel
Helplessly Hoping/Find the Cost of Freedom/Teach Your Children/Our House—Crosby, Stills, Nash and Young
Lights/Open Arms/Any Way You Want It—Journey
Lady—Little River Band
I Know There’s Something Going On—Frida
California Dreamin’/Twelve Thirty/Straight Shooter/Got a Feelin’--Mamas and the Papas
The Logical Song--Supertramp
The Rose—Bette Midler
Heartbreaker—Pat Benatar
Mexican Radio—Wall of Voodoo
867-5309—Tommy Tutone
Jessie’s Girl—Rick Springfield
Rock Lobster/Mesopotamia/Love Shack/Strobelight—B-52s
Keep on Loving You—REO Speedwagon
The Breakup Song—Greg Kihn Band
Kids in America—Kim Wilde
Elvira—Oak Ridge Boys
Train In Vain/Should I Stay or Should I Go/I Fought the Law—the Clash
Street of Dreams--Rainbow
Love Her Madly/The Crystal Ship/You’re Lost, Little Girl—the Doors
Driver’s Seat—Sniff ‘n the Tears
Mickey—Toni Basil
No Guilt/I Know What Boys Like—The Waitresses
They Don’t Know—Tracey Ullman
Always Something There to Remind Me—Naked Eyes
Send Me an Angel—Real Life
No More Words/Take My Breath Away/The Metro--Berlin
Turning Japanese—the Vapors
Round and Round/Back for More--Ratt
Can’t Get it Out of My Head—Electric Light Orchestra
My Oh My—Slade
Don’t Answer Me—Alan Parsons Project
Let the Music Play—Shannon
Tempted/Black Coffee in Bed--Squeeze
Only You/Situation--Yaz
Cuts Like a Knife/Straight From the Heart—Bryan Adams
Oh My Love/Imagine/Jealous Guy—John Lennon
Total Eclipse of the Heart—Bonnie Tyler
Time After Time—Cyndi Lauper
Love Hurts/Hair of the Dog—Nazareth
Rock This Town/I Won’t Stand in Your Way—Stray Cats
In A Big Country—Big Country
When I’m 64/Across the Universe/Octopus’s Garden/Something—Beatles
What is Love/No One is to Blame—Howard Jones
Bitterest Pill—The Jam
Roxanne/Every Breath You Take—Police
This Town—The Go-Gos
Home Sweet Home/Looks That Kill—Motley Crue
Turn Me Loose—Loverboy
Bringin’ on the Heartbreak/Rock of Ages/Foolin’—Def Leppard
Red Red Wine/Please Don’t Make Me Cry—UB40
Panama/Ice Cream Man/Ain’t Talkin’ ‘Bout Love—Van Halen
Forever Young—Alphaville
Don’t Dream It’s Over/Better Be Home Soon—Crowded House
The Safety Dance—Men Without Hats
Hold Me Now—Thompson Twins
Bark at the Moon—Ozzy Osbourne
White Wedding—Billy Idol
The Killing Moon—Echo and the Bunnymen
Major Tom—Peter Schilling
The First Cut is the Deepest/Maggie May—Rod Stewart
Love Stinks—J. Geils Band
The Ghost in You/Love My Way—Psychedelic Furs
Ain’t Nobody/Tell Me Something Good/I Feel For You—Chaka Khan (sometimes with Rufus)
Girls on Film/Save a Prayer—Duran Duran
China Girl/the one about Major Tom—David Bowie
In Your Eyes—Peter Gabriel
Looks That Kill/Home Sweet Home—Motley Crue
Hand to Hold On To/Pink Houses—John Cougar Mellencamp
New Girl Now—Honeymoon Suite
Crazy For You/Lucky Star/Borderline/Oh Father—Madonna
If I’d Been the One--.38 Special
Cry Like This—Blue Room
I Want to Know What Love Is--Foreigner
Come Back and Stay—Paul Young
Lola—The Kinks
Party Girl/New Year’s Day/Bad/All I Want is You/Unchained Melody/Even Better Than the Real Thing/With or Without You—U2
Oh Yeah--Yello
Kiss/When Doves Cry/Alphabet St.—Prince
Heart and Soul—T’Pau
X—I Must Not Think Bad Thoughts/Breathless/Blue Spark/True Love, Part 2/Drunk in My Past/What’s Wrong With Me
Dead Kennedys—Holiday in Cambodia
Tubesnake Boogie/Sharp Dressed Man/TV Dinners—ZZ Top
Broken Wings—Mr. Mister
Opportunities/West End Girls/Where the Streets Have No Name—Pet Shop Boys
Never Say Never/A Girl in Trouble—Romeo Void
Jet City Woman/Silent Lucidity—Queensryche
I Touch Roses—Book of Love
Moving in Stereo/Candy-O/Drive/Let’s Go—The Cars
Living After Midnight/You’ve Got Another Thing Comin’—Judas Priest
Keep Your Hands to Yourself/Battleship Chains—Georgia Satellites
You Spin Me Round/Come Home With Me Baby/I Wanna Be a Toy/My Heart Goes Bang—Dead or Alive
You are the Light/Shelter—Lone Justice
Comfortably Numb/Brain Damage/Wish You Were Here—Pink Floyd
How Soon is Now?—The Smiths
Nights in White Satin/The Voice—Moody Blues
Mad World/Pale Shelter—Tears for Fears
Alison/Mystery Dance/Every Day I Write the Book—Elvis Costello
Fat Bottomed Girls/Killer Queen/Bohemian Rhapsody/Somebody to Love--Queen
Blood and Roses/Only a Memory/Cigarette/Beauty and Sadness—the Smithereens
Love Will Tear Us Apart/She’s Lost Control—Joy Division
She Sells Sanctuary/Wild Flower—The Cult
Homework—Girl Trouble
Small Blue Thing/Night Vision—Suzanne Vega
White Rabbit—Jefferson Airplane
I’ve Been Loving You Too Long/Try a Little Tenderness—Otis Redding
Hazy Shade of Winter/James/Following—the Bangles
Lonely Girl/Orange Airplane—Screaming Trees
Bad Seeds/I Let Him Get to Me—Beat Happening
Nowhere Girl—B Movie
All My Love/The Rain Song/D’yer Mak’er/Babe, I’m Gonna Leave You—Led Zeppelin
Walk on Fire—Little America
Penis Envy—Uncle Bonsai
What a Wonderful World—Louis Armstrong
Wild Thing—Troggs, Humans, X, etc.
Shake the Disease/Black Celebration/Route 66/Strangelove/Never Let Me Down Again—Depeche Mode
Heartache/Desire—Gene Loves Jezebel
Angie—Rolling Stones
Father Figure/I Want Your Sex—George Michael
Lyin’ Ass Bitch/Slick Nick, You Devil You—Fishbone
Oh L’Amour/Love to Hate You--Erasure
You’re Breaking My Heart/Joy/Coconut—Harry Nilsson
Breakin’ Hearts/Special/Add It Up/Children of the Revolution—Violent Femmes
That’s the Way I’ve Always Heard it Should Be—Carly Simon
Minimum Wage—They Might Be Giants
One Step Ahead—Split Enz
I’m an Adult Now—Pursuit of Happiness
Object/M/Let’s Go to Bed/Kiss Me Kiss Me Kiss Me—Cure
The Promise—When in Rome
Nasty/What Have You Done For Me Lately—Janet Jackson
What’s On Your Mind (Pure Energy)—Information Society
American Woman/Concubine—Butthole Surfers
Funkytown—Lipps Inc.
Straight Up/Cold Hearted/Blowing Kisses in the Wind—Paula Abdul
Reptile/Under the Milky Way—The Church
Strike It Up—Black Box
Elvis is Everywhere—Mojo Nixon and Skid Roper
Now That We Found Love—Heavy D and the Boyz
Punk Rock Girl/Bitchen Camaro—Dead Milkmen
Come Into My House/Ladies First—Queen Latifah
You’re So Vain—Faster Pussycat
Bust a Move—Young MC
Knock on Wood—Amii Stewart
Big Girls Don’t Cry/Walk Like a Man—Frankie Valli
I Would For You/Had a Dad—Jane’s Addiction
Brown Eyed Girl/Into the Mystic—Van Morrison
Inside Out—Mighty Lemon Drops
Push It/Independent/Shake Your Thang—Salt and Pepa
Sign Your Name—Terence Trent D’Arby
Mustang Sally—Wilson Pickett
Two Out of Three Ain’t Bad/Paradise By the Dashboard Light/You Took the Words Right Out of My Mouth—Meat Loaf
I Remember You—Skid Row
What It Takes/Dream On—Aerosmith
It’s Raining Men—Weather Girls
Johnny Angel—Shelley Fabares
Build Me Up Buttercup--Foundations
Sweet Child O’ Mine/Don’t Cry (Original)—Guns ‘n Roses
Sleeping Satellite—Tasmin Archer
Walkaway Joe—Trisha Yearwood
She Talks to Angels—Black Crowes
No Woman No Cry—Bob Marley
Black—Pearl Jam
She’s a Mystery to Me—Roy Orbison
Welcome Me/Kid Fears—Indigo Girls
The Needle and the Damage Done/Heart of Gold—Neil Young
Dreaming/Forever Live and Die—O. M. D.
Ring of Fire/Folsom Prison Blues—Johnny Cash
Love Song--Tesla
Blueberry Hill—Fats Domino
Drive/Nightswimming/Sweetness Follows/Everybody Hurts/Losing My Religion/South Central Rain (I’m Sorry)/Love is All Around/(All I Have to Do Is) Dream/Superman/Fall on Me/Seven Chinese Brothers—R.E.M.
Groove is in the Heart—Dee-Lite
Why Don’t We Get Drunk—Jimmy Buffett
Brick House--Commodores
About a Girl/Smells Like Teen Spirit/Drain You/Rape Me--Nirvana
Plump/Asking For It/Miss World/Doll Parts--Hole
Pride and Joy/The Sky is Crying—Stevie Ray Vaughan
Have a Little Faith in Me—John Hiatt
You Got Lucky/Breakdown—Tom Petty and the Heartbreakers
Don’t Fear the Reaper/Godzilla—Blue Oyster Cult
Similar Features/I Will Never Be the Same—Melissa Etheridge
Jacky—Marc Almond
Baba O'Riley/Behind Blue Eyes--The Who

Sunday, January 25, 2009

Weighing in on bathroom scales

For my entire adult life, I did not keep a bathroom scale in my house. A little over a year ago, my husband and I actually bought one--but only to weigh our luggage so it would comply with international air travel guidelines for a trip we were taking. The bathroom scale lives in the closet the rest of the time. I'm not even tempted to use it.

20+ years ago, when I was in the throes of an active eating disorder, I let the number on the scale control my life far too much. You weigh less in the morning, and your weight can fluctuate by several pounds on any given day for any number of reasons. I allowed that number to not only ruin my day or give me false hope, but to define my worth as a human being. For many years, I stated I would take my life if I reached 200 pounds, and at the time, I actually believed that I meant it (which is frightening).

For me personally, I find it more constructive to assess (a)how I feel physically and (b) how my clothes fit. I know when I'm making healthy diet and exercise choices and when I'm not. I don't even want to think about what the scale number is most of the time--it can be overwhelming and ultimately just lead to discouragement.

Going off Ambien CR

I decided this evening that I am just going to quit taking Ambien. I forgot to bring any with me when I went to visit my friends out of town last night, just toughed it out and tried to doze a bit with the Ipod on my special insomnia/quiet playlist. I didn't sleep all night.

When I got home today, I thought: why am I taking this stuff? I've been taking it for years, and it's not helping me much. I'm eating in the middle of the night, and I definitely don't need THAT. (I can imagine the complications that could cause over and above potential weight gain, particularly post-op when some foods are going to make me sick--I'm going to want to remember what they are so I don't eat them again.)

So, I'm awake for the second night in a row. I'd rather just stop taking Ambien and have a bad day or two, not have it in my body, and not pay for it--even with insurance, it is not cheap. I was also reading online tonight about some of the side effects others have had with it, both while taking it and while trying to discontinue its use. I have escaped unscathed compared to many of these folks.

I just hope I will be able to sleep at some point before too much longer.

Thursday, January 22, 2009

Your body does not define you

A friend of mine said this to me once and I wrote it on a post-it and hung it up for a long time.

When you hear people interviewed on TV for some weight-loss miracle that has worked for them, they will often say, "I felt like I was trapped in this body that wasn't mine."

As we age, we all struggle with our body's limitations. "I used to be able to (fill in the blank)", I've heard so many older people say; be stronger, be faster, be on their feet for eighteen hours straight, whatever the feat may have been.

For people who were not always heavy but became heavy later in their lives--particularly women--I have heard a lot of "I used to be a size (fill in the blank)".

I feel for people who used to be thin and are not any longer. (Unless they were mean to fat people; then I hope they blow up like balloons.) I imagine it is like being extremely beautiful and losing your looks in some way. If you were never thin and beautiful in the first place, you don't really know what you lost if you get older and remain overweight. I think this makes it both easier and harder; part of me thinks the ones who used to be are fortunate they had the experience of being what society declares attractive even temporarily. I'd certainly like to know what it was like for a few days so I could enjoy it.

There have been several TV shows and movies that used the ruse of putting women in fat suits to see if they were treated differently, and of course they were, but then could shed the fat suit and be gorgeous again. In the case of Tyra Banks, she got to cry top model tears while the overweight women on her panel comforted her for her suffering. I suddenly understood why Elvis shot some of his TVs.

The relationship a woman has with her body is far more complicated than just how much it weighs, how it looks or how old it is. I have gone through periods of hating my body, trying to destroy my body, accepting my body, feeling like I don't belong in my body...I don't remember loving it or even liking it. Acceptance is as far as I've been able to get, and that took years of work that is compromised every time someone openly judges me for my appearance. My own mode of body acceptance is seriously strained at the moment; it's become a really uncomfortable place for me to live, and it feels foreign, bordering on freakish. It certainly doesn't look like who I am inside, but then, it never really has.

It is a statement of strength to assert that your body does not define you and to work on really believing it. I am so much more than my body appears to be. We all are.

Insurance denied surgery today

Insurance turned it down flat. They want their six months of a diet. I'm in the middle of it, so no harm done. A little discouraging, but I wasn't expecting miracles.

Wednesday, January 21, 2009

A serious question

I swore I wasn't going to fib in the food journal, but do they really need to know I had four piroulines instead of two?

Sleep or lack thereof

My sleep has been really, really bad lately. It has never been good, not since I can remember. I'm a lifetime insomniac, since I was a young teenager anyway; I also have PTSD (post-traumatic stress disorder). The PTSD has improved drastically over the years, since I am no longer attacked while sleeping or awakened to the sound of violence and haven't been for decades. I've also been taking medication to help me sleep for the last ten years. My current fears involve possible intrusions from the outside world, and I do have them sometimes to an irrational degree. ("Did you lock the door? Are you sure? Well, I'm going to go look.") Unfortunately, I don't think this will never leave me completely, but I do the best I can. I would feel better with more locks on the doors (like about ten) and a really large, protective dog that loves me best. A razor-wire electric fence around my house and an armed guard might be nice, too. (I wish I was kidding.) A doctor looked at me once and said, "You have sleep apnea AND insomnia?" and I could tell he was thinking, Well, you're screwed.

Part of the problem with waking up often during the night--at least while I've been on Ambien/Ambien CR--is nocturnal eating. I've found wrappers and crumbs in different places in the house the next day and had no memory of eating anything or even being there. I have tried and rejected several sleep drugs over the years, and am about to try a new one. The only one that worked for me was Remeron, which provided the loveliest, most restful sleep of my life. I gained fifty pounds on it (one of the side effects is increased appetite), so I had to discontinue its use. (I managed to lose half of the fifty pounds I gained and keep it off, but at this point, who's counting?)

The other I wrote something weird in my food journal when I had a middle-of-the-night snack. Of course, I didn't remember eating or writing. That assignment was to write down why I was eating, what, what time, whether it was need-based or for some other reason. I wrote was "3:00 AM, 2 cookies. Want or love?" It creeped me out, and, taken literally, probably revealed more than I wanted it to--even to myself.

I have also been having nightmares, which isn't unusual for me, but some are easier to shake off than others. Like any nightmares, it feels as if my subconscious took a laxative and what comes out comes out. Last night's involved having to watch a dog be burned alive as part of some twisted ritual I wasn't part of but couldn't escape. The night before that, it was about being in the hospital with my mind alert, but unable to communicate with anyone, and being wheeled around on a gurney. I could feel the wheels wobbling under me.

These two examples are upsetting to me, but actually quite mild as my nightmares go. My dreams in general tend to be vivid and involved, like movies, with people I don't know taking part and plot twists aplenty. In the past, have had PTSD flashbacks manifest themselves as dreams, and we've all had those anxiety-based "naked in high school" dreams. I know a lot of dreams are symbolic, but I try not to spend a lot of time analyzing them, just chalking them up to the aforementioned laxative of the subconscious processing everyday life.

People are asking me lately if I am scared about having this surgery. The answer is, of course I am. But I've had several surgeries in the past few years, and this one is a lot less invasive than most of them. This one also has the capacity to really be a tool to help me improve my life. Yes, I could die, but anyone can die from any surgery. If my number is up, I have no control over that, so I don't see the point in fussing about that aspect of it. I'm more focused on the ways my life has to change and determined to make the most of what this could do for me.

Tuesday, January 20, 2009

Obama's Inauguration Day

I try not to pummel people with my views on current events. When asked or in a discussion, I make them known; I don't hide them. It's something I discuss only with people I know very well the majority of the time. I believe in respecting everyone's views and right to be heard, agreeing to disagree on all the big ones: religion, choice, politics, et. al. Hurray for freedom of speech! In that vein, one of the beautiful things about having a blog is being able to babble freely about what I'm thinking. There are many thousands of people who are much more articulate and knowledgeable about politics than myself, many of them with their own blogs. :o)

I watched the inauguration ceremony today until they went to lunch. Truthfully, I've never cared enough to watch an entire inauguration ceremony before. I was on the CNN/Facebook live feed, but watching it on TV. Being unemployed at the moment, I had the luxury.

Reading the live feed comments was a lot of fun, both from people I've actually met and know and people I will never meet. A lot of people were excited and moved, and some were not, but were watching nonetheless. Of course, there was chattered about what people were wearing, the trite along with the important. I loved seeing the footage of the crowds and the feeds from different parts of the country. As on Election Night, their reactions were every bit as gratifying to see as the event itself.

I loved seeing and hearing Aretha Franklin (and her awesome hat!), I loved the poet, and the benediction was great, especially at the end when we got to laugh a bit. I thought Obama's speech was extremely moving, articulate, and appropriate; I have always found him a wonderful speaker, maybe the best I have heard in my lifetime. (My husband and I were joking last night that he's almost too reasonable to be a politician.) I am glad that he reminded us of our own responsibility as citizens, that he acknowledged what many people have sacrificed for this day to arrive, and that there is a lot of work to be done.

I voted for Obama and was excited when he won. I would have been happy to see Hillary Clinton win as well, but Obama seems to be the shot in the arm American politics needed. I'm inspired to see people caring what happens politically and that there is at least an underlying climate of hope for so many of them. One of the CNN commentators said that, in a way, this was the world's inauguration; Bono said yesterday that it fulfilled not just an American dream but an Irish dream, a European dream, a Palestinian dream, etc.

The country is in a huge, frightening mess, and we all know it isn't going to be fixed in four years. A lot of voters my age (40) and younger don't feel they have had a President that was a true leader in their lifetime. I don't envy Obama his job, but I truly hope he can be the catalyst for positive change. If I didn't believe this was at least possible, I wouldn't have voted for him.

And that's just it. Many folks, including myself, are excited about possibility, at least for today, and why shouldn't we be? While possibility runs the risk of becoming a drug that prevents reason or focus, it can also become fuel to keep each individual person chugging along with our eyes on the prize--whatever that may mean for each of us.

Edit: on a lighter note, I had to Photoshop a picture of myself wearing Aretha Franklin's inauguration hat, which has its own fan page on Facebook....

Monday, January 19, 2009

the universe dangles the carrot...

The surgical place just called me to check in. They have everything insurance needs but that pesky 6 months' documentation and wanted to know my progress on it, so I brought them up to speed. They have 10 years of my chart notes and every other piece of the puzzle, so they had a confab, cleared it with me, and are sending it to the insurance company to see if they will approve it now rather than later.

I don't expect insurance to approve it now, but I'm already in the process of the documentation et. al., so what is there to lose by submitting it? Is insurance really going to read all 600 pages of chart notes before they approve this? (And why can't I find a job somewhere like that? I'm precisely the kind of freak that enjoys reading 600 pages of chart notes.)

I love that these people are paying attention! I knew I liked them. My psych eval was Friday, today is a holiday for a lot of people, and here they are calling me before end of business the next business day. The brownie points just keep a-comin'.

Too bad I can't have a real brownie.

Morning t'ai chi for beginners

This morning was my first time doing any t'ai chi, and it was interesting. Every movement has a meaning and names like Parting the Horse's Mane, Crane Spreads Wings, etc. It moves slo-o-o-wly, which is good; it forced my patience and made me relax. I can see how it centers as you breathe, push out all the bad chi, etc. Although I think my bad chi would vanish if the breathtaking, empty beach Mr. Nonthreatening is demonstrating the poses on was under my feet. He was barefoot, too; any exercise you can do barefoot is already better than average in my book. I'll get used to the woo-woo background music, or mute it when I learn the routine. I couldn't get into a couple of the squatting poses and always seemed to inhale and exhale at the wrong time, but I liked it and did feel more awake afterward. Anything that improves the circulation always makes me feel better, once I can motivate myself to do it.

I have a "yoga for large people" workout somewhere that I have to dig up. (I tried beginning yoga for regular people once--damn near killed myself. Five minutes and and it was the couch and ibuprofen for a couple of days.) The large people yoga was much more realistic. For example, the downward dog pose went to a chair, not the floor. Large-people yoga taught me how to roll forward at the knees to stand up, and it does teach good stuff about breathing. I hope the yoga for large people is still in print somewhere, because it's a really good idea.

I met a yoga instructor 15 years ago when I was working in retail, and she was in awesome physical shape. She invited me to come to one of her classes sometime, and I asked her, "Don't you have to be skinny to do that?" Sadly, I was at least 70% serious, but she laughed and laughed and told me no. I don't volunteer for public humiliation, so I wasn't about to contort in public. I just knew I'd get stuck in one of the poses or fart or something.

Sunday, January 18, 2009

Today is the last day of Food Journal, Week 1

I'm writing faithfully in my food journal, mumbling like Yosemite Sam as I go. Rackenfracken does this look like a cup? How many ounces? Merkenfergen don't forget the dressing. Does it say how many calories per serving on the package? Rackenfracken ah hate this.

(I never used to like Yosemite Sam as a kid, but grew to be rather fond of him and his cartoon foibles later in life. My former father-in-law and friend loves him and collects memorabilia with Sam's likeness. I'm a lifetime Looney Tunes fan, so references to the characters may pop up now and then. Mel Blanc was a genius. Horribly politically incorrect as they are now, many of those cartoons are true metaphors for life...particularly those starring Wile E. Coyote.)

I haven't exercised for a month or two. My recumbent stationery bike is sitting there in the living room, its seat scratched thoroughly and helpfully by the feline coinhabitants of my home. My Richard Simmons DVDs are dusty.

I did buy a tai chi workout DVD at Target yesterday. I've always wanted to try tai chi. My natural balance is famously bad. I thought it would be a good way to get back into the working out groove, and I'm pretty sure there is no yelling in tai chi. There's a nice nonthreatening middle-aged man in a tank top and yoga pants on the cover. No glitter. Nobody needs glitter first thing in the morning.


I have lived alone and spent enough time alone in my life that I talk out loud to myself and usually answer myself, too. (This is good, because my husband doesn't have the best hearing in the world and some ADD, so he has to be warned in advance if I want a response. He actually said to me once, and was completely serious, "It's only your voice I have a problem hearing." Yeah, you and every other husband, buddy. Bless his heart, my voice IS low, and a lot of my talking to myself and answering myself could be classified as muttering.)

Writing has always been another way I process everything. Growing up entailed learning to hide my writing well--better still, keep it locked up--and wait a day (or three) before I sent someone a letter. (I have written some doozies, and if they were received after junior high, I likely still mean just what I wrote.)

I am in the safest place I've ever been in my life. This is obvious, in part, because of what a mess my home office always is. (When I say my home office, I refer to the small second bedroom of our home, which I share with my husband's scuba gear, the majority of our books and DVDs, some stuffed animals, and various assorted other crap. It's probably about the size of a decent size walk-in closet, so you can say it's cozy.) I don't have to hide anything, because my privacy is respected. My writing isn't locked up; it's everywhere. I am perpetually trying to organize it and revise it, and there are post-its everywhere, not only stuff I want to write about or ideas but music, books, artists, movies, or whatever that I want to remember to check out.

If I wasn't in this place of relative safety, I would not be preparing for this surgery now. I was never ready to do it before. Even though I would like to go under the knife tomorrow and get on with it, part of me is glad for the time I have to prepare. I'm talking about the changes I have to make, and gradually making them.

One of my favorite happy things to do right now is making a list of all the things I want to do after I lose at least most of the weight--sort of a bucket list (though I hesitate to call it that because I've heard mixed reviews of that movie). So far it includes salsa dance lessons, parasailing, skydiving, some kind of martial arts, and going to Disneyland and/or Disney World because (a) I've never been anywhere like that and (b) I'll be able to fit on all the rides!

Saturday, January 17, 2009

Baby spoons

When I was at the nutritional assessment earlier this week, we talked about portion sizes a lot. The sample dishes were the size a baby or small child would use. "It would help if you got a baby spoon," she said. "That's how big your bites should be [after surgery]." She also said smaller dishes might help.

Today I bought myself a package of baby spoons, a bowl and a plate. I was grateful the store had one with this funky retro pattern on it; I am willing to follow the advice of professionals, but eating off Dora the Explorer plates might just send me over the edge.

Friday, January 16, 2009

The skinny on the pre-op psych eval

The first order of business was one of those true/false personality inventory type tests. I can't remember the initials, but it wasn't the MMPI, because I asked. It had five letters and was similar, though. One of the questions was "true or false, I have been on the cover of several magazines recently". Whoa!!!!

The next test seemed IQish; I felt like I was taking the SATs, because the first page was all vocabulary: "circle the word that is closest in meaning to the first word", with four words to choose from. The second page was a bunch of number and letter patterns where you filled in what would be next in the sequence. 12345 54321 etc. Not sure what that was about.

We went over my whole life history. (There's nothing like telling a total stranger your life history...smoke 'em if you got 'em.) He was nice enough, but I do prefer to see female health practitioners whenever possible; however, he is the only one my insurance covers at that particular practice. There was a big certificate on his wall that said he was certified to treat sex offenders, which gave me pause for a second. (I guess *someone* has to treat them; we can't just euthanize them all, much as I'd like to.) Explaining my early life to someone I don't know feels impossible; it isn't that simple to explain to people I do know. I just tick it off like a shopping list, which seems to be easiest for all concerned. I only used one Kleenex.

The difference between this and the two other psychiatric evaluations I've had in the past was asking what my weight was at different points in my life. He also asked who would take care of me after the surgery, how was I paying for it, things like that.

The guy is a psychologist, so he's not going to prescribe me drugs, and I'm not seeing him again. I only did this because insurance requires a psych eval. He said he treated it as a pass/fail test. Diagnosis is probably only a concern if you are entering some kind of ongoing treatment. He said I "was a resounding pass" at the end, anyway. He did recommend a sleep medication, and told me I might want to talk to my doctor about it, because my sleep or lack thereof was his biggest concern.

I can't speak for him, but I think we both left that room a bit more tired.

Monty Python foot

This whole week has been tough mentally. After the nutritionist appointment Monday, I feel like a Monty Python foot came out of the sky and stomped in my general direction, but there were no hilarious British guys tumbling around afterward. I have had no energy and keep going back to sleep after I do the stuff I have to--shopping, cleaning house, etc. I thought I was getting a migraine for a couple of days, and the meds for that do make me sleepy.

I sound like a lazy hypochondriac to myself, which is frustrating. (Of course, I am currently unemployed, so there's my internal built-in guilt from that.) There never used to be too much wrong with me medically--of course there couldn't be, there was no money or insurance. Until I was 30, I paid for my glasses, dentist, and any other medical stuff I needed with a VISA card. When I was at university, I used the on-campus medical clinic a couple of times, and thank goodness for Planned Parenthood. (I will always donate money to them.) I was younger then and could fake my way through most of the time. When I think back, there were many things I should have gone to the doctor for that I just had to ride out with over-the-counter drugs and time. I've been paying for it--in more ways than one--now that I am getting older.

My first experience with therapy fifteen-plus years ago was paid for on my own when I still earned minimum wage with no benefits. I met the therapist at my then-place of business and we clicked. I ended up giving her a nominal cash fee every session and worked at her house to pay off the balance, pulling weeds, housesitting, taking care of her pets. She relocated, I still had a balance, but she never tried to collect it. I tried to contact her years later to give her some money, and she never responded. Wherever she is, I will always be grateful to her for her help.

That therapist hooked me up with a free support group during the time I was seeing her. It went on for five or six months and was facilitated by a couple of counselors. I'm not sure which shingle any of them hung out, but they did do assessments on each of us prior the the group work. The rest of the group work was just that--a group. Sometimes we did activities or assignments, but a lot of time we just talked and listened. I did some of my most important therapeutic work there, so my participation ultimately made a positive difference in my life.

Support groups have a really interesting dynamic. I am not sure a support group is going to benefit me while I go through the specific weight-loss surgery experience, but I may try one, at least online. In a support group, you really go into the trenches with yourself and other members. They are not only seeing everything about you that you hide from the rest of the world, but watching you actively deal with it. It's very intimate and can be quite powerful, but you don't necessarily want to run into those people at the grocery store. I stay in touch with most of the people I've ever known in my life that have mattered at all, but I haven't remained in contact with any of the women from that support group. Fifteen-plus years later, I still remember most of their names and faces--and stories--and will wonder, from time to time, what happened to them.

I'm glad there are online support groups now. I was in one for several years and met one of my best friends there. This friend knows me as well as anyone else in my life, but I have still never met her in person. We have been writing and calling each other for nine years now, and to this day there are some things I have to discuss that only she understands, and vice versa.

There is a real freedom in online support groups. The use of a pseudonym, for one, is really freeing. You can be completely honest and truthful and people have to judge you for your words alone, not the way you look. If something you say helps them, or they like you, it is the greatest compliment because they are judging by your heart alone. You could be Jabba the Hut with a keyboard, but that doesn't matter--your words do. That's my kind of world.

Thursday, January 15, 2009


Insurance requires a psychological evaluation. Mine is tomorrow. It won't be my first. I hope it's my last.

Psychological testing is an interesting concept. My last counselor actually asked me every.single.session if I heard voices coming out of the TV, if I had a plan to harm myself, etc. It was completely insulting. I just wanted help sleeping. The only reason I've had ANY psych evals was to get sleep medication. The two therapists I had before trusted me enough to housesit for them and take care of their pets--that was one of the ways I paid for my counseling before I had insurance. I am nothing if not grounded in reality. (I saw a great T-shirt recently that said, "Reality continues to ruin my life." It still makes me laugh.)

Most everyone knows from watching movies and TV, if they hold up the inkblot, you're not supposed to say you see the devil. (I think the holder-upper might get really suspicious if you say you see fairies holding hands and frolicking in a dewy meadow, too.) Another hoot is the MMPI with the yes or no ("yes or no--I like everyone I know") questions, which I've taken at least once in the past as preliminary testing for employment.

I used to say my body was a test. This was, and is, somewhat true; it weeds out a lot of people whose character leaves much to be desired and whom I would rather not waste valuable time and emotional energy on. A former friend (former for a reason) remarked to me once, "Well, it isn't a fair test." Isn't it? If someone is going to reject you for the way you look, why not get it over with now?) What test is fair? It isn't about whether tests are fair, it's about whether they're effective. Life is full of tests, and I would wager most people would not consider most of them fair. Inevitable, justifiable, necessary or unnecessary--but not fair.

Why we eat?

According to psychologist Pavel Somov's book entitled "Eating the Moment" we eat for three reasons:

1. "to satisfy the need of the body,"
2. "to satisfy the need of the mind," and
3. "and out of habit when triggered by the environment."

Exercise 1--first 2 weeks

The following exercise from his book is meant to help you gain insight into why you eat.

1. After you ask yourself, "Why did I just eat?" keep a written log in a notebook.

Were you hungry? Did something in the environment trigger you to eat? Did you eat to cope, to address emotional needs?

If you ate out of hunger, write down "need based". If you ate because of stress, write down "ate to cope", and if you ate on a craving triggered by an environmental cue, write down "environment triggered". If several difference reasons coincide, try to determine the primary motive for eating.

Exercise 2--second 2 weeks

After completing the first exercise, move on to this one. Ask yourself before you eat "Why am I about to eat?" After you clarify to yourself the reason you are eating, then eat or don't eat. For right now, you make the conscious decision. Continue with this for as long as you feel as it is helpful.


So this is my assignment from the nutritionist for the first month.

I did something like this before in therapy many years ago. It was a little different, as I was to write down how I felt on a numbered scale (1-5 or 1-10, I think) when I ate; it wasn't important what I was eating, but why. It was actually helpful. I was still having some issues with bulimia at the time. I did learn a lot about my own triggers and patterns and ultimately at least become conscious of why I ate, which was the whole point. I was definitely an emotional eater. To this day, when I get angry and feel trapped and pushed to the brink of stress, I want some chocolate. Half a regular-size candy bar is plenty.

The writing down everything I ingest is driving me nuts. How many bottles of water did I have today? And I'm supposed to write down my exercise. I consider cleaning the entire house exercise--it takes all day, and it wipes me out. And I don't care what anyone else says, a big solo Costco trip is exercise, too. That store can be full of frighteningly fertile people with a well-developed sense of entitlement--many of them unpleasant--and that could make anyone need a nap afterward.

Monday, January 12, 2009

Nutritional Assessment

Today I had a "nutritional assessment". I talked about what I eat every day and my entire history with food while a thin woman took notes about it. (In all fairness, I liked her--she was nice, easy to talk to and very helpful.) It was actually kind of exhausting. (Did you have to clean your plate? Was food used as a reward? Do you have religious restrictions? When you say you have a bowl of cereal, how big is the bowl? What kind of milk? And so on.)

There were these pieces of crazy, wobbly rubber food everywhere--some of it looked frighteningly real, while some of it resembled cat vomit. I've been to a nutritionist once before, and this one did the same thing as the other one--picked up pieces of the rubber food for emphasis while she spoke.

I was reminded of this movie I rented years ago called "Eating". It came out in the late 1980s or early 1990s; I believe it was a Canadian film. One of the characters in the movie was filming a documentary about women and their relationships to food for her thesis. The "mockumentary" parts of the movie were what made the movie good, in my opinion--women talking about what their specific comfort foods were, among other things. Fiction or nonfiction, much of it was incredibly personal. Even though it was a scripted film, it felt very intimate. I checked a few years ago, but was unable to find it on DVD.

I have watched that movie with different female friends two or three separate times, and it always provoked conversations that were every bit as interesting as those included in the film (which was probably the whole point). I think everyone's relationship to food is incredibly personal (how could it not be?) but I don't know if it's as fraught with conflict for men as it is for women. I suppose it could be argued that the issue transcends gender and just depend on the individual, but a lot of women like to eat when they get together--happy, sad, or otherwise. One of my female friends and I used to have what we called chocolate parties--everything we brought had to have chocolate in it somewhere. Another of my friends--who is an amazing cook and loves food--asked me, "Who will I eat with [after you have surgery]?"

"Me," I answered. "I can still have a couple of bites." (I can also inhale...deeply.)

I didn't learn much about nutrition growing up. I know a lot of people didn't, particularly if they are my age or older. As a friend of mine in his 60s put it, "It just wasn't done [then]." Nutrition is truly a luxury item when you are worried about being able to afford food to eat at all.

I have a vague recollection of a food pyramid being addressed in school at some point. I also remember, as a child, ferociously coveting the picture of the breakfast pictured on the side of many cereal boxes of the day. The photos included the cereal in question, but also juice, toast, AND eggs, if I remember correctly. It was a veritable fiesta of cholesterol and sugar and more food than I could imagine having to choose from at one time, then or now.

I have a couple of assignments to do before I see the nutritionist again next month. I have to write about my relationship to food in quite some detail. I also have to keep a food and exercise journal for the next six months and probably the indefinitely foreseeable future. It includes what vitamins I take, how much water I drink, and what exercise I do every day. The nutritionist told me that the main concern of insurance is to track my weight over the six-month period, ensure I show up for appointments, that sort of thing, but they say they require this journal as well.

None of these specialists can tell anyone what surgery to have, but they can make recommendations. The one I saw today also recommended gastric bypass for me, due to my sweet tooth and several other factors. She thought stomach sleeve gastrectomy might be even better, but insurance isn't covering it yet because it is still considered experimental.

Truthfully, I'm already annoyed by the food journal, and this is DAY ONE. I'm writing down how many calories is in the food if I know it, and a lot of the amounts are still branded into my brain from my eating disorder days. I really, really, REALLY hate being told what to do when it comes to diet and exercise, for obvious reasons. "Chafe against" would probably be more accurate. (This is why, in part, I believe this surgery will work for me. If I eat the food and the food makes me sick, I have enough respect for my body to listen to what it's telling me to do and do it. After all, I live in there. Listening to someone tell me what they think I should do, when they have no concept of what it truly means to live in there, on the other hand...)

The drill sergeant approach to weight loss absolutely does not, will not, cannot fly with me, and I was open about that with the nutritionist. I don't think humiliation motivates most human beings to do anything but self-destruct and/or rebel, and I think the medical profession is just beginning to figure this out.

Wednesday, January 7, 2009

Working for a living

I need to be doing it. This is the longest stretch of time in my adult life I haven't had a full-time job--four months. I do some freelance writing and photography, but not much of late.

I'm trying to write a book. I've started writing books my whole life, and about 20-40 pages in, I discard them in disgust because they're never good enough for me. Perhaps I was destined for short stories and poetry; I have finished, even published, a couple of each. I wrote my first book about third grade; I would so pay to have a copy of it now, just for the laughs! It was about a dog named Fluffy (for real), and I wrote it on some horrible 1977ish stationery that probably had a mushroom print across the top. I gave it to my third-grade teacher in the box the stationery had come in and never saw it again. (I would have probably ripped it up later, anyway. I've always found ripping up my writing to be incredibly cathartic. Burning it is fun, too, but I have a little phobia about fire. Shredding is also the bomb, but in reality I usually end up ripping it up if I don't like it. It just feels good.)

I've also been doing other things since I've been out of work, like turning 40, cat wrangling, taking pictures, reading books, putting my vinyl LPs on CD, scanning old pictures and putting them on CD, putting up a Flickr site, and researching and pursuing this surgery.

I'm not feeling very motivated or optimistic about the job search. In particular, I am becoming gun-shy about Craigslist job postings. I've had a couple of in-person interviews from resumes submitted to employers that posted positions there, and one actual job that lasted two months because they lied about just about everything and didn't pay what they had promised. The last in-person interview consisted of me sitting in a waiting room all dressed up with copies of my resume for half an hour.
Probably fifteen people walked by while I was sitting there. Several of them made eye contact with me, and I smiled at them. One of the receptionists kept paging the person who was supposed to interview me--or pretending to. After about half an hour of this, she came out and said she was sorry, but they'd have to reschedule my interview.

They never called me, of course. I noticed that the company posted the position again on Craigslist this week.

Of course, my immediate default reaction was to think it was because of my weight. When I related this experience to a couple of friends--neither of whom has a weight problem, but they both happen to be twenty years older than I am--they said they had had the same thing happen to them. One of these friends was a man and one a woman, so apparently this kind of thing isn't always gender-specific, either.

I know there have been many jobs I haven't gotten because of my weight, and there are some I will never even attempt to apply for because of it. When I was younger, I took it much more personally when things like this happened. I was still trying to fit into society's ideal--or I still thought I should be trying to--as if my brain, skills, and personality had nothing to do with my value as an employee. (I also actually show up for work, am not a drama queen, don't steal, and can make people laugh, among other things.) I also knew in my bones, even at that time, that I was never going to fit into society's ideal. I could have had 15 plastic surgeries, thrown up every day, and never even come close.

The difference between then and now, for me, is that I have since learned that many people who fit societal beauty standards often never feel like they are good enough, either. Some of them feel like no one listens to them or values their brains because of the way they look. Even back then, as much as I wanted to be "gorgeous", I would have rather had someone really listen to me than look at me and stop listening. Every.single.time.

I also feel that getting older means the pressure is off. I don't want to be 19 or even 25 or 35 again, so why should I wish I looked as if I were? Outer beauty fades. Gravity happens. And when it does, I should hope that I have developed an above-average amount between the ears and in the heart, or life is going to be very, very empty.

Tuesday, January 6, 2009

Health Insurance and Finding a Surgeon

I've had a lot of health issues in the last ten years, not only the ones already mentioned but also depression, insomnia, migraines, unspecificied stomach issues, and a lot more. As the song says, I'm much too young to feel this damn old. I've gotten used to calling doctors and insurance companies, saving copies of things, filing appeals and the like. My advice is: document, document, document. Save everything until you have the statement showing $0.00 in your hand, then have a shredding party.

I haven't been working full-time for a couple of months, so I am dealing with my spouse's insurance on this procedure. They were taken aback to find out they were my primary insurance, so that had to be verified recently. Then they told me the only bariatric surgery provider they covered was over 50 miles away. I watched a web seminar on his site and went to the initial appointment, thinking his practice was my only option unless I was going to self-pay.

Well, I didn't like the doctor. He wasn't listening at all, he didn't bother looking at my medical records, and he was ready to run a bunch of tests I'd had in the last couple of years when the results were present in the medical records he wasn't looking at. He was extremely dismissive. In effect, he said, "We do the surgery, we make you sick if you eat ice cream, you get thin, end of story. Bye bye." That approach did not do it for me.

I had recently read about another facility in the newspaper who had gotten some positive attention for their standards in minimally invasive and cutting edge weight-loss surgeries. They happened to be more conveniently located. My husband and I went to their free seminar, and it was fantastic. It was interactive, informative...I took pages of notes and was ready to sign anything and go to work for them, too, if they'd let me. The bedside manner of the doctors was like night and day from the previous surgeon. This particular facility emphasizes nutritional classes, follow-up care, nutritional coaching, support groups if you choose to participate in them, etc. I was really excited by their approach, because it actually sounds like it can work. They gave us information on how to finance surgery if insurance would not pay and that was that. Imagine my surprise when they told me they were a contracted provider with my husband's insurance! Glad I asked!

I then went to retrieve my medical records from the first bariatric surgeon--there were about 600 pages of them, so I was grateful not to have to accrue them all again. It also made it much easier to fill out the new facility's application accurately--they want every bit of medical history and then some. My intake appointment, as they call it, involved meeting with a lady who does billing and is the liaison with the insurance, and then a consultation with the surgeon. A lot of it was review from the seminar and other research I've done.

The surgeon I met with recommended gastric bypass for me because I have "what they call" classic metabolic syndrome, where I gain all my weight in the torso, also known as the apple body type or, as I once heard it explained, "egg on stilts look." (Apparently, there is a connection between which bariatric surgery might achieve optimum results for each specific body type.) I asked him if PCOS was still present when there were no longer ovaries, and he said, "That's a really great question!" I don't know if anyone knows that answer.

My particular insurance wants 6 months of a physician-supervised diet, two years of chart notes at a certain weight and BMI, the psych eval, the nutritional assessment, and a monthly visit to check in with the nutritionist. There are nutrition classes prior to surgery and after it.

Another thing I like about this facility is that they call the providers to find out what your benefits are initially, instead of you doing that. It sets a precedent with insurance, and a good one--insurance is always going to be more attentive to the provider. Still, you have to be loud if you want anyone to listen to you at ALL. Loud, persistent, with your headache cure of choice at the ready.

"The Science of Obesity" TV documentary

In May 2008, National Geographic Channel aired a special called "The Science of Obesity". Clips from it are available on Youtube, Hulu, and other sites, but I don't see any DVD availability, unfortunately. I saved it on my DVR and re-watched it again this morning.

It explores a few different reasons that people may become obese, following cases specifically--one subject who had become morbidly obese from overeating over a long period of time and who ultimately underwent gastric bypass surgery, and one subject who has a rare hormonal disease called Cushing's Syndrome, caused by tiny tumors on the pituitary gland. The second subject was particularly compelling, as she had always been thin and athletic, weighing about 130 pounds, and suddenly her weight just skyrocketed to over 300 pounds without explanation. An endocrinologist has to diagnose Cushing's, and it is extremely rare. The second subject also underwent a surgical procedure, but hers was to remove the tumors.

I really recommend this show, simply because it is a scientific discussion that brings up topics regarding obesity that are not often discussed, such as how internal organs, digestion, and the body's movement are affected by obesity. In all my research and years of medical issues and testing, I had never heard of Cushing's syndrome. Rare as this syndrome is, it is something people at least be aware of. It can be present in children as well as adults.

The statistics given by this TV special for gastric-bypass surgery were that the mortality rate for gastric bypass-related complications were 1 in 100, much less dire than the ones I remembered hearing a while back and wrote about yesterday. Also according to this show, it takes about two years to lose 100% of excess weight post-op, and up to 20% of patients regain some of the weight they have lost. It was the only weight-loss surgery discussed; WLS was not really the focus of the show. I appreciated the way the information was presented. It didn't pretend obesity couldn't be serious or problematic, but it didn't promote body hatred and shame either--one of the featured subjects simply said he wanted to feel better, enjoy his life, and hopefully be around longer. However accurate the show may be, I feel that shows like this are beneficial, simply because they raise some awareness and promote discussion.

Monday, January 5, 2009


I would argue that we all have some, somewhere, about something. It's pretty hard to escape altogether, no matter how hard a person tries.

I consider myself low-maintenance in the vanity department; I could wear T-shirts and lounge pants for the rest of my life and be content. I wear makeup less and less the older I get. But.

If I know there will be pictures taken, or if I'm meeting someone for the first time, I usually wear it. I keep dyeing my hair. I Photoshop my acne out of pictures before I post them online or have them printed. I like a pedicure now and then.

In other words, I'm human. But.

I am not considering weight-loss surgery for vanity.

I've established and admitted to some vanity. Yes, I have body image issues, self-esteem issues, an eating disorder history. Yes, I would love to wear a size 8--but I went to my 20-year high school reunion in a size 28, and I had a good time. I felt that I looked as good as any other woman that was there--I'm just not as thin as they are. I may well have been the heaviest person in the room, but years of therapy, defiance, half a Xanax, good friends, and emotional maturity enabled me not to dwell on it. The entire time.

I'm going to admit something I'm not terribly proud of, though. I didn't eat when I was there. I took a couple of bites of my husband's food. I still don't like eating in front of people.

In other words, I'm human.

Oh, doctors

I am really picky about doctors. I love the joke about the only difference between God and a doctor (God doesn't think he's a doctor). I've "fired" a lot of doctors over the past ten years--most of my life, I didn't have health insurance, so I guess I am just drunk with power. Seriously, if a doctor doesn't listen, I'm gone. But if a doctor is great, I will recommend him or her to everyone I know. I drive three hours one way to stay with a primary care provider I've had for ten years, because she is the best doctor I've ever had, bar none. And who knows how many referrals I've given her--I've lost count!

I remember being a kid on medical coupons, sitting in the waiting room for hours until they got good and ready to see me, even if I had an appointment. That tends to give a person an attitude to begin with (not that I have any shortage of it). I'm sure they still do that every day to poor people, and it makes me furious, but if I start talking about what's wrong with the health care system as a whole, I could be here all day.

A watershed moment for me was when I was sitting on a doctor's table with a broken ankle at the age of sixteen. The bone had not yet been set, and I weighed a great deal less than I do as I write this. This doctor looked at me and told me I needed to lose weight. I snarled as if possessed, "Why don't you set my broken bone first and then we'll talk?" That was the end of my passivity with medical professionals of any stripe.

Let's see. There was the doctor who insisted on giving me a pregnancy test before I was even sexually active, which was highly embarrassing for a kid, but in the shadow of the aforementioned 3 cup sizes in a summer, reason left a lot of people I encountered--male and female. There was the urgent care clinic doctor who griped at me about my weight even though I was just trying to get antibiotics for strep throat and go home. Even my favorite doctor popped off once, saying only "you need to lose weight" before she looked at my chart--I had lost 40 pounds since the previous visit, and I wasn't quiet about it. She never did it again. She has never shined me on about my weight and the problems it can and has caused, but we discuss it like rational human beings. She knows I'm intelligent, I know she's intelligent, there's a two-way street there. (Too many doctors act like you've never looked in a mirror and they are giving you some brand-new insight into yourself, as if a light shone down from above and the angels sang: AAHHHHHHHHHHHHHHH!! You are fat!!! Light bulb!!!!!)

So my favorite doctor recommended gastric-bypass surgery for me when I first started seeing her. I couldn't afford it, and that was my reason for a long time. I had a good job with excellent insurance when I had to have my hysterectomy five years ago, and she suggested I have gastric-bypass surgery done at the same time. I refused; I was just dealing with too much at once, and in retrospect, I still stand by that decision. The recovery from a full abdominal hysterectomy was so long and so difficult for me, even at the young age of 32. I was home for six weeks, and didn't have any stamina at all for about a year. At first, I had to take a nap after walking to the mailbox, I was just so tired.

I knew weight-loss surgery was no walk in the park. I was never going to have gastric-bypass surgery; there were so, so many horror stories. I remember reading once back then that you had a 1 in 4 chance of dying during surgery and a 1 in 4 chance of dying within a year of surgery. I probably misunderstood those numbers (not good odds!), but they scared the stuffing out of me. I knew people that had done the stomach-stapling surgery when I was a kid who had had all kinds of complications. Even five years ago, my understanding was still that they would have to cut you completely open, which is why my doctor suggested that I have it at the same time as the other procedure.

Last year, I had an initial consultation with a sleep doctor who had that tactful technique of so many health professionals I cited above; before we talked about anything else, he blurted out, "You would be a candidate for bariatric surgery." (REALLY? What a shocker. Can I have that in writing?) Annoyed and half-crazed with lack of sleep (my specific sleep issues will play a part later in this blog, to be sure), I feigned patience and told him it was just not in the cards right now, as my current insurance wouldn't cover it, I didn't have five figures in cash lying around, and if I did, I'd pay my student loans off with it. I said something vague about the lap band--that I was looking into it. Needing no further encouragement, he pounced on it like a dime-eyed cat with a catnip mouse.

"Gastric bypass would be better for you," he persisted. "You'd lose more weight in less time."

I don't have a lot of patience to begin with, and what I was faking was completely gone. "Gastric bypass," I replied curtly, "sounds like something some Nazi thought up." I realize that is a rather offensive way to put it, but I was offended, too, and he dropped the subject, which was all I was trying to accomplish.

Gastric bypass, as I understood it at that time, did sound like something some Nazi thought up. Cut a person open, re-route stuff, permanently alter other stuff, it just didn't sound like anything any human being should do to another. It still doesn't sound like the most fun anyone's ever had. I know you can't eat more than a few bites, the food to be thoroughly chewed or it can get stuck, you can throw up a lot, etc. What other people did was their own business, but for me? Never.

Lap band sounded better to me--adjustable, reversible, not so extreme--and I kept reading about other weight-loss surgeries, like the stomach-sleeve gastrectomy. The Realize band started to be advertised on TV a lot recently, and it sounds good. One benefit of dragging my feet all this time is that technology and knowledge keeps improving, and I can continue to learn more and more. There has also been documented medical proof that my weight stays in a certain range despite a number of different eating plans and exercise programs.

Sunday, January 4, 2009

How Long Have You Been Fat?

I don't remember not being fat. More precisely, I don't remember not being called fat. Puberty and all its hormones seemed to do a number on me--as it does on everyone, to a greater or lesser extent--but I felt like a science experiment gone awry. 3 cup sizes in one summer, for instance. Men yelling at me out of cars if I wore a shirt that wasn't too big. Boys at school giving me smiles that begged for their mouths to be washed out with soap. It was terrifying to me. There was nowhere to hide. My dearest wish at the time was to be invisible, but between the ages of 12 and 16 felt like the most visible time of my life. I learned to wear baggy clothes, to make jokes, and to grit my teeth.

I lived with one family member who forced me to do situps until I felt sick and ate ice cream in front of me. I was eight years old at the time. I responded by stealing--money to buy food. I learned to hoard food and to stuff myself when I was able to eat, not knowing when I would be allowed to eat again or how much.

Doctors first became involved when I was about thirteen, first to find out if my accelerated cup growth wasn't abnormal. The diets began. Every stupid diet in the '80s, and there were many.
I tried smoking cigarettes to see if that would make me thin. It didn't.

I lived with another family member in my teens who did not allow me to eat with the rest of the family. I had special diet food, most of it frozen and all of it tasteless. He tried to put me on a doctor-supervised diet where I counted calories--1200 a day--and threw a scale at me one day after I got on it at his command and it read 150. It was an old metal scale, and he was a big man, but I ducked and it missed me.

When the bariatric surgeon asked me what my goal weight was two days ago, I said, "180. In my dreams, 150." He told me, matter-of-factly, I could probably weigh 120 after all was said and done, depending on how hard I was willing to work. I don't remember weighing anywhere near 120; it was probably about the fifth grade. I still can't get that number out of my mind; it is like being told, "Oh, yeah. You can go to the moon."

I became bulimic when I was about fifteen. I abused laxatives and diuretics, felt sick all the time, exercised constantly: aerobics, swimming laps, walking. I binged and purged. Calories, fat grams, and numbers on the scale lined my prison walls, and I never got thin. I never even got average. There's nothing quite like starving yourself for days, the loudest sound in the universe the ferocious growl of your echoing stomach. You're dizzy with hunger, and teenage boys are mooing at you anyway.

After about three years, I gave up on bulimia. I had gained 30 or 40 pounds. I was about eighteen years old by this time. I gave up, period, and concentrated on day-to-day survival.

I continued to gain weight through my 20s and 30s. In my 20s, I remember thinking things like, "Well, I'm okay, and if this is as fat as I'm going to get, that's fine." It started to hurt to walk. I couldn't find clothes to fit me without mail order. I didn't care; I was just trying to get through college and find myself in the world. It took me eight years to get a four-year degree. I dropped out four times, but I went back five times. I got the Bachelors degree when I was 28. I started a Masters program a few months later, ten days after marrying my first husband. I dropped out of the Masters after one quarter; it was just not where I wanted to be and I needed to get into the job market.

My first husband and I tried to have a baby, which required fertility drugs because I had PCOS (polycystic ovarian syndrome). With these drugs, I could get pregnant, but not stay pregnant. The body mimics pregnancy on them, so the taker is in for a roller-coaster ride of symptoms. I had an ectopic pregnancy and several miscarriages within a couple of years and was never able to achieve a live birth. I had a myriad of other female problems, including a cancer scare, and ultimately underwent a full abdominal hysterectomy at the age of 32. The first reaction of many people was to say, "Oh, you'll lose weight!" I don't know what planet they were receiving transmissions from or why they thought I even cared about my weight right then, as I was busy grieving, not only the fact that I could never have children, but my eventual divorce and the loss of my closest friend of 25 years. It was hard to find reasons to get out of bed in the morning for a span of time that seemed endless.

My weight never decreased after the hysterectomy. In fact, it shot up another 20 to 40 pounds and has hovered in that range ever since. Once I had my PCOS diagnosis, which came with type II diabetes, high cholesterol, and sleep apnea, I changed my diet drastically--for the better. I did more aerobics, used a treadmill, swam laps, bought a recumbent stationery bicycle. There were times I could lose as much as forty or fifty pounds, but it would not stay off for more than a few months.

I met and married my second husband at the highest weight I have ever been. He sees the person I am, having been blessed with that all-too-rare gift of knowing that people are who they are on the inside--a concept many pay lip service to, but do not really practice. He is an average-size person who is horrified by the actions and comments of other people regarding my weight, many of them strangers. He has seen me struggle, feel physically crappy all the time, and try to sleep normally or even find a comfortable seated position. He has heard me say "I shouldn't eat that" more times than he can count--several times a week. He sits across from me in restaurants; he will order fries and a milkshake, I will order a salad and water. He has seen me struggle with depression when I have so many reasons to be content. He is one of them.

It was not his idea for me to pursue bariatric surgery; I was dead-set against bariatric surgery for many years, but have researched it all along, because I believe in knowing what I'm arguing about. He would like me to live a long time and to be around so we can be together, and he supports whatever I choose. He is the cook in our house, and for the past two years, I have eaten better food than I have ever eaten. Fresh, organic, the works. It has affected my weight not at all.

I recently turned forty. The thing that distressed me about the number 40 was not vanity or the loss of youth--I never really felt young--but the notion that our time on this Earth is limited and I would like to enjoy whatever is left of mine a lot more than I am.

That's how long I have been fat. That's why I am doing this.

Only the Beginning

I recently started the process as a serious candidate for bariatric surgery and it seemed like a good framework to begin a blog. I am going through health insurance to do this, so it is an involved process requiring years of documentation, a physician-supervised and monitored diet and exercise program, a psychological evaluation, and more. People I know have many questions about how it works, what the timelines are, and just about every other imaginable aspect of it, and that I thought perhaps a blog would be the way to go. So I'm giving it a try.

My intention is not to write Only Specifically a Bariatric Surgery Blog, or The Definitive Bariatric Surgery Blog, and I hope that isn't all this one is going to be or sound like. I would like to believe that just about everything about me as a human being and what I have to say is more important than my Body Mass Index. A complicated series of events that took place over decades brought me here, and are only one part of the story, as they are for most people in my current position.

Considering bariatric surgery is a more complicated and involved process than one might imagine who hasn't had the need to investigate it completely. It's not an easy cure or way out, not a magic bullet, as many people with an opinion but not education regarding the topic seem to believe. (I have been researching this topic for about ten years and I learn something new about it every day, in part because it is always changing.) Bariatric surgery is one optional tool to help the obese people who choose to have it manage their weight and health in coordination with healthy lifestyle changes in diet and exercise. It is not an easy thing to decide to have, maintain properly once it has happened, and for many, it is not an easy thing to pay for. There is no guarantee that it will be effective, though it has worked for many people.

I am not going to talk about whether this surgery is right or wrong. Its inherent risks are well-documented and the choice to have or not have this surgery is up to the individual. If you believe bariatric surgery is a cop-out, I very much doubt I can change your mind. (My own mind tends to change when I decide it changes, and not a moment sooner.) Most people who reach the point of having bariatric surgery feel that they have tried every possible measure, both healthy and unhealthy, to lose weight--and I count myself among them. Diets, exercise programs, medications, eating disorders, drinks and pills and bars that taste like cardboard coated in flavor-free goo but that just might be full of that all-important protein are a regular part of our lives, along with the conflict that goes into every bite we take or even think about taking. The world at large feels entitled to have a opinion about our bodies--not just our own families and friends, but doctors, adult strangers, even children we've never laid eyes on before. We cannot go anywhere without thinking, am I going to fit in the seats there? We can't put on our walking shoes without thinking, Is some guy going to yell names at me out of the car today? Before we grocery shop, we wonder how many people are going to stare at what's in our cart this time. We try to be ready for any comment some nimrod throws our way, but the nimrods of Earth come up with some real lulus, usually when you're in a good mood, having managed to forget for a few minutes that you're fat and that your very presence offends the world. Contrary to popular belief, we didn't all get this way from sitting at home eating cheeseburger after cheeseburger. As my husband--whose weighs approximately half what I do--is fond of pointing out, "We have the same diet."

I begin this blog today with the hope of documenting my journey to a healthier life with more purpose. When they asked me why I wanted this surgery, I said, "To feel better." That pretty much says it all.

About Me

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Seattle, WA, United States
This blog focuses largely on a personal journey to and through weight-loss surgery. It's also about reading, writing, animals, photography, love, humor, music, thinking out loud, and memes. In other
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