Day 86, Part Two: This Time, It's Personal

Phone appointment this morning with regular doctor went well. She is upping my Seroquel (sleep med) to 75 mg with optional 5 mg Ambien chaser if I wake up and can't go back to sleep during the night.

"Has it changed your mood?" she wanted to know.

"To what?" I answered. No, my mood pretty much stays at half-mast, Doc; I just want to sleep. I am having one of those puffy-eyed, flat-affect kind of days as it is. We debated about eventually changing the Lexapro, but when she consulted my chart notes she discovered I have already tried every freakin' antidepressant that was ever so much as a glimmer in Eli Lilly or GlaxoSmithKline's eye.

We talked about the sleep apnea, and she wants me to see the specialty dentist to get the mouth guard made ASAP. I have to see if I can get it covered first; they are not cheap. If I have to have another sleep study, I will straight-up plotz. She is willing to write me authorization letters for everything. I heart my doctor.

(A side note/update about Fun With Insurance Coverage--insurance still has not settled on my psych eval charges. They continue to debate back and forth with the provider's office as of 11:30 this morning. The date of service was January 16.)

*****

Next up: the nutritionist.

I weigh in. I have gained a couple of pounds. I am two pounds less than I was on the first appointment. This is not a shock. I am rather grateful I didn't gain more.

We procceed to Talk Seriously about What I Think Happened. What I think happened is as follows: I am not feeling motivated, I am sick of the BS, I have a hitch in my gitalong, I am discouraged. I have gone out to eat and I wanted a cocktail. I have gone out to eat and split dessert with Mr. Salted. I have gone out to eat and felt like crying because I'm not going to be able to enjoy food as I once did. I have eaten chocolate because it remains the most reliable source of pleasure on the planet. So sue me. I am still writing every blessed thing I eat down (give or take a Hershey's Kiss here and there), complete with calorie counts and protein content. I am exercising roughly half the time. I am not a complete and total screw-up; if it was Pass/Fail, I'd get a Pass. (I think. If I smiled a lot. Probably.)

I tell her I'm looking into getting counseling authorized by insurance and--DA DA DUM!!!!! turns out the wellness center is hosting a support group. It isn't free, but the cost isn't outrageous. It starts tomorrow night, goes until June 3. The flyers says, "help break the cycle of food addiction and emotional eating." It's facilitated by a nutritionist/counselor and there will be no more than eight members, which sounds like a good size. Support, therapy, reading, assignments, etc. I bit the bullet and took the money out of the tax-return/pipe-dream-of-further-education fund, which is flying out of the bank to pay this bill and that anyway. I really need to talk to some other people who are dealing with the same stuff; I think it could really benefit me. (Since I coughed up the actual cash, I know that I will not run screaming into the night; once I part with any money, to run screaming ceases to be my way. My way is, "I will get everything out of this that I possibly can, dammit.") I participated in a similar group fifteen years ago, and although it was not about food issues, it was extremely helpful. The book they are going to use in this group is called "Anatomy of a Food Addiction". It discusses brain chemistry and other contributing factors.

I have never talked about my food issues in a group of people I didn't know. I barely talk about them with people I do know. I wonder if I will be the fattest (SHALLOW!), and I wonder if there will be any men there. (It would be really interesting to talk to an acknowledged male food addict.)

I am feeling some (inevitable) dread, but also that this is a positive step in the right direction.

Nutritionist appointment

Just got back from nutritionist appointment #3. I lost (get ready for it) ONE (1) WHOLE FREAKIN' ENTIRE POUND. Two months = five WHOLE FREAKIN' ENTIRE pounds. To spare the expense of paying for a skywriter, whoomp! there it is. A concrete illustration of the reality of insulin resistance, sleep deprivation's effect on the cortisol hormones (I did not sleep one minute last night, fyi), and why I need medical intervention. 60 !@#$%^&* days, and I would say I deprived myself of anything that tasted really good for at least 55 of them.

I do like the nutritionist. She's easy to talk to, reasonable, and realistic. I forgot to turn my phone off and got a text during the appointment--the text ringtone is "Bust a Move", so she started dancing to it in her chair and we had a giggle. She didn't give me too much guff about that ridiculous craving assignment--she said a lot of people didn't even try to do it, at least I had tried. (I didn't try all that hard, it took all my energy to hold back the bile, but she didn't have to know that. I take my positive strokes where I can get 'em.)

She praised my food diary, which I have kept faithfully (grumblegrumblegrumble) and added caloric content when I had it. She recommended a couple of websites, calorieking.com and fitday.com, that have calorie counts on them. The new assignment is to incorporate more protein into the diet and begin to calculate that.

Protein becomes extremely important because immediately after surgery you are only taking in 400-600 calories per day. Post-bypass, the recommended protein intake is 60-80 grams of protein per day, which is a LOT. You're supposed to eat all the protein you need in a day before you eat anything else. I think the low-sugar Instant Breakfast and I are going to become even better friends than we already are. Apparently Atkins makes some protein drinks, and there is one called Muscle Milk that they sell at Costco and Super Supplements. SlimFast and Ensure have too much sugar (I thought I was the only person in the world who gained weight on SlimFast; now I know why I did). Milk, yogurt, cottage cheese, meat, tuna, tofu, peanut butter, nuts, beans, peas, lentils, cheese. She gave me a protein foods list with happy Clip Art illustrations of happy, happy food. Happy.

We talked about the water-drinking requirements for post-op. I'm drinking enough water, it's just how I drink it that is going to be different. You have to drink 16 ounces of water half an hour before eating, not drink anything while you eat, eat the protein first, drink 16 ounces of water after you eat.

We discussed the dreaded dumping syndrome, or specifically, sugar and dumping syndrome. I'll have to post more about dumping syndrome when I have the fortitude to research it further and make an articulate blog entry with some good information in it. Basically from what I gather, if you eat too much sugar, fat, and grease post-gastric bypass, you'll get violently sick. People don't know what foods are going to trigger dumping until they've had the surgery, though some have proven to be universal, and sugar is one of them. Simple sugars are apparently a huge culprit, so even the sugar-free chocolate isn't so hot because the sweeteners used in making it--the sugar alcohol derivatives, such as sorbitol--are catalysts for dumping syndrome. Splenda and aspartame sweeteners do not pose a problem.

She told me I won't be able to use chocolate to cope anymore. She wasn't mean about it, it was just a statement of fact. I told her I seriously thought I was going to need some kind of rehab. She gave me a food addiction website to look at and some sample questions to ask counselors if I got to the point where I could afford to see one. Since money is an issue, maybe a support group would at least provide some balm. It's not the amount of food or even the type of food I eat; it's the relationship I have with it. It sounds so trivial and silly, but it's a very real concern.

Tomorrow, the exercise physiologist. I'm so thrilled (NOT). It looks like I have to see him every time I see her, so, once a month. I'm not doing any more than I have to, and I told them that today.

Re: the disputed psych eval payment--I had to eat the $220 written report fee, but the billing person spent a good half hour on the phone with my insurance while I was there, who are now "reprocessing" the claim for the remaining $300.

Oh yeah, and it's snowing. WTF?

Taking care of business

That has been the order of the day/week/foreseeable future. I finally got our taxes done and e-filed today, and we decided that I was going to try and go for a Technical Writing Certificate at UW in the fall with the return money, if I could get in, etc.. The timing would all be perfect if I am even somewhat on schedule in terms of this surgery. So I have been looking into that as well. Mr. Salted has to have a gum graft, so we spent yesterday at the periodontist.

I haven't heard from the insurance yet on the psych eval and whether or not they will cover it. It's been lovely not having any appointments of my own this week so I could just take care of things. I've been finding tons of books I wanted to read--both regarding weight and body issues and not. We really cannot afford any additional counseling for me right now and so I'm intending to read as much as I can and also check out online support groups. I know there are many.

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.