The Endless Plateau

(This post has now taken 4 days to write. WTH?  I'm so addicted to Pinterest and Tumblr again that I keep getting distracted). 

Source

This post has been about 4-5 weeks in the making. I've spoken about it a little on Facebook, but of course not all of my blog readers know me over there.

For the first 5 or 6 weeks of my new healthy lifestyle, things were wonderful. I was coping well. My cravings were not as severe as I had experienced before.  And the scales kept moving, in the same direction each time I stool on them.

At the twelve week mark, I had lost about 11-12 kgs. More than 10% of my body weight. A great start, with the kind of results that keep you motivated to continue making good chilces every single day.

And then nothing. Zip. Nada. Not a gram was lost. In fact, over the following 6 weeks I managed to gain 2kgs, despite being so good. It was frustrating, to say the least.

There are a few probable reasons for this though. First 16 years ago I was diagnosed with  PCOS and later, Metabolic Syndrome. And while for years it has not been terribly problematic, I have not had a period since early May (sorry if that is TMI for some?). So I don't think that is helping.  The PCOS makes weight loss quite difficult, and these two things mean that I am very insulin resistant. Which means I need to take more insulin to get my BGLs down to optimum levels. The more insulin I take, the more weight I put on. (So 2 years ago, combining massive doses of insulin with a 9 month, large dose course of Prednisone and I went from an overweight but still pear shaped (and even pretty at times) woman to a bloated, puffy, apple shaped one).

Speaking of which. I'm on insulin. Which unfortunately, has the side effect (at least for a type 2 person) of increased weight. Also, I wasn't eating enough so I was having constant (a couple a day) hypos, which then meant I was having to drink or eat high GI foods to settle them. Not helping.

Then, it turns out that 3 more of the drugs I'm on have the side effect of weight gain. One of them has been particularly problematic, with me having several troublesome side effects (inability to urinate, severe muscle twitching - more like flailing, which I had no control over, drowsiness, dry mouth etc).

The biggest concern with this is that it is the drug that finally after two terrible years, got on top of my nerve pain. So I'm torn.  Well, truthfully, I'm not torn. Joel is.  He doesn't want me to stop taking it. He is loving having me in less pain, more engaged with the family and happier. I want off. Now. I don't want to be stopped by anything. I want to get healthy. I mean really, really healthy.

My GP is away on holiday at the moment so I don't want to do anything rash.  A few months ago when we started the Endep, I was on a small dose (30mg a day). It was doing almost nothing, pain wise or for sleep & restless legs, which was why I was on it in the first place.  But we wanted to persist (this was before the decision was made to start the Oxy), so he tripled my dose.

It was around then that the problems I mentioned earlier started, and they have continued to deteriorate. So, for now I've cut down from 75 to 50. Some of the symptoms are settling a little. Some of that nerve pain is back though. I suspect we're going to have a rough time balancing what to do here. As I said, I'm torn.

I want to come off my anti-depressants and the Oxy that the Dr prescribed.  I had wanted the Oxy for the worst, worst pain. Instead he gave me a slow-release version that I am to take morning and night. It isn't terribly good for the pain (certainly not the dramatic result that tripling the Endep had) and very, very quickly I came to the realisation that after just a month, my body was becoming addicted.  I wasn't 'psychologically', (does that make sense?) but there were a couple of nights where I fell asleep before I'd taken them.  I woke up and decided that since I'd slept ok, I wouldn't take the dose (in my defence - because of my eyes, I can't read the pamphlet. I honestly didn't 'click' right away that it was a sustained release, though I look back and wonder why that wasn't obvious to me, so I didn't know that you could not miss doses).  Anyway after doing this (missing 2 doses in a row) I had a days long anxiety attack.

I didn't realise for days that it was because of the Oxy. I felt little difference pain wise, so I kept missing doses and for days, it was a bit of a nightmare. Headaches, morbid feelings (and dreams!), agitation, scratching again, trembling, sweating, crying but not knowing what the hell was wrong with me. Just the feeling that something was terribly wrong. I felt like tearing my skin off, like it was crawling with something. Nothing was, of course but it was a terrible, horrible feeling.  I wouldn't wish that week on anyone.

Co-incidentally, about a week or so later a friend of mine online (who is also taking Endone for crippling pain that she has suffered from for years now) linked me to an article (after which I found another and then another - the last one with figures that stunned both Joel and I) in the newspaper that described what I was feeling - even better than I had been able to. Now I have no idea if they were on the slow-release (I am on Targin) or the quick (Endone), but at that point I was on just the slow. It was a low dose (I'd tried a lower dose for nothing. We increased it, for some relief) that I was on. 30mg twice a day. And after 3 weeks, it seemed my body was hooked.

In my Doctor's (and my) defence - starting with the stronger opioids was not one we took lightly. He even less so than I.  We waited 7 months from the first discussion before we made the decision. We tried several other drugs. We tried different combinations. I tried other therapies. We talked about the risk of addiction. I was up front with him.  I believe that I have a very addictive personality. I fixate on things (much like my children do) and get hooked. There is a history of alcoholism in my extended family. It's something I've always been conscious of (one of the reasons I no longer drink. I felt I was drinking too much about 15 years ago so I just stopped) and I had concerns about becoming addicted. But I felt safe on the small dose I was on.

But I didn't realise when he first gave me the prescription that I was on a drug that had to be taken morning and night. I had been wanting a take-as-needed drug, for those really unbearable days.  I have proven that I am able to be very sparing with drugs. I take valium for debilitating muscle spasms. But because it's addictive, I take it as rarely as possible.  I actually asked him to write on my script and on my file, that I have to make a bottle of 50 last me at least 3 months. If I take it more often than that, then I think it's a problem for me.  It's working well. I've only refilled the script twice this year and we're nearly 10 months in.

Anyway (I'm getting distracted here), this was where I found myself. Over the past few weeks, while almost every single aspect of my life is going wonderfully (I am going to write the next post all about that. I don't want to ruin it by talking about all of this stuff. I want to post this one and then be done with the yucky for a while), I struggle with such high anxiety every single time I take the tablets (the Targin and the Endep) or my Insulin (I was on quick release Novorapid and an Extended release Lantus. I am now only on the Lantus. Yay for me! Such an acheivement in just a couple of months).

It's like I feel trapped. Which might be an odd choice of words when noone is holding a gun to my head, but it's how I feel. I don't know how to break the cycle. I want to come off the Oxy and the Endep, but I need to have enough relief from my pain that I can function (believe me - for the past 2 years, I have not been even nearly functioning) and work on getting even better (therefore not needing the drug. See. It's a nasty little circle, no?).

What would you do? Go off the drugs that are handling your pain, to stop side effects and weight gain?

Spring Break

We are going here in about 20 minutes....

Where I am going to do this....

And my children are going to play and be silly and have our undivided attention....

See you in a few days. Have a great weekend.

Why I'm ok with only a 500g loss this week

                                                                      Source: overdresstoimpress.tumblr.com via Melissa on Pinterest

               
I've just realised that I never did get back to you on the "How".  I wrote about the "Why", but I didn't get back to it. I have both boys home today, so we'll see how this goes. :-D (I'm sorry; it's going to be long).

I didn't lose any weight in Week 7, and Week 8 was just a 500g loss. And those of you on my Facebook know, I wasn't happy.  I was actually feeling incredibly discouraged toward the end of last week. It actually looked (around Wednesday/Thursday) that I was possibly actually putting on weight.

I'm trying so hard, being so good; to not see results on the scales was messing with my head, in a big way. I can literally say to you that at the moment (for the past 2 months), my diet is about as healthful as can be. I've never been able to say that before. I've never even been able to pretend that before. But I'm living it. So the feeling that it was all for nothing - not a good one.

But I realised something fairly important. At no point did it occur to me to stop. At no point did I think to myself "Well, what's the point? This is too hard. They were all right about me. I can't lose weight. It's not my fault. I'm sick. I'm insulin resistant. I'm on 2 medications that carry the side effect of weight gain. What can I do?".

Not once. It's my normal M.O.  It's what I've done every single time I've attempted to lose weight. It gets hard, my body resists (oh, how it resists) and I start making excuses.  I start forgetting to think about portion sizes.  Then I allow myself a treat 'here-and-there'.  Which is less 'here-and-there' than every day. I pretend (to myself even) not to notice.  I never acknowledge that I've fallen off the wagon.  I eat when I'm alone, when no-one can see.  I start binging again. I excuse myself. There are so many excuses, you know? There is so much going on with my body and my psyche and my life that there are so many perfectly 'reasonable' excuses.

But this time, it didn't occur to me to use them. It never occurred to me that this was anything but the best thing I've ever done for my body.  For the first time ever, I'm not doing this just to lose weight.  In fact, I can honestly tell you that the weight loss is the secondary reason.

I'm doing this for my heart. I'm doing it for my heart and my kidneys and my blood vessels. I'm doing this because I'm suddenly so, so afraid of dying. Of not watching my children reach adulthood.  I'm looking at food now as fuel. I'm trying to nourish the only body I'll ever get with the best food I can. Vegetables, lean and fresh and delicious. Lean protein, grilled or stir fried. Fruit twice a day - and fruit that is perfect for this diabetic body. Only the good fats. Avocado. Olive Oil. Nuts. Small (85% less than before) amounts of pasta or rice or wholegrain bread.

Not only am I coping with it; I'm enjoying it. Last night I made a huge bolognaise for the family. Alexander's favourite food. One of Joel's favourite. They had two huge helpings. I took my medication and drank a glass of water and waited. Then I filled my plate with a fresh salad and used a soup spoon to get a small amount of the pasta and sauce.  My plate was about 80% salad (very basic one. Cos, continental cucumber, the most amazing grape tomatoes, a tablespoon of corn kernels) and 20% Spaghetti Bolognaise.

And I looked at it and genuinely couldn't imagine why on earth I had always eaten it sans salad. How I had simply heaped that dinner (lean as it was) high onto a plate and left off the salad for years.

I think part of it is that growing up, salad was a rarity. We ate a lot of vegetables - steamed or boiled (basically like everyone else growing up in QLD in the 70s and 80s). Salad just wasn't really something we did very much.  I don't know if perhaps my parents didn't like it, or we were just meat and potatoes kind of people. Salad, if at all was served on sandwiches or rolls.

Not any more.

So here's what I did. And I feel like a bit of a fraud with this bit, but I'm going for honesty. One of the biggest problems I have had my entire life is that whatever chemical in our body that tells us 'I'm full" never really worked for me. There was never really that moment when I could tell myself "That's enough".   On top of that, I grew up in a family where you were absolutely never allowed to leave food on your plate. ("Don't you know there are children in Africa who would do anything for that food?").

I'd tried Duromine about 8 years ago.  It was good. I was never hungry. But it was expensive and I wasn't able to afford a second prescription. Money is available now, but I felt like it was a fairly drastic step (though not as drastic of course, as surgery). But I'd seen some natural appetite suppressants in a pharmacy.

I've actually never been a fan of the diet industry. The meal replacements, having someone cook for you etc. While I'm sure some work, my issue is that I'm not sure that you're really learning any new habits. But I thought it was worth trying these appetite suppressants to give me a little bit of help while I tried to overhaul my eating habits.

And overhaul I did. As I mentioned, I was set to have weight loss surgery (gastric sleeve). I had spent months and months lurking in several sleeve forums, both here and overseas. I was reading about their lives after surgery. What they ate. What they couldn't eat. What they struggled with. What they liked. What was hard etc.

When the surgery got ruled out (so that I can get neck surgery), I gave up. I assumed that I was never going to lose weight. But then I decided that I could simply overhaul my habits.  I remembered what the surgery people had been able to eat once they went back onto solids. It was a very, very small amount, but I realised I was going to need to do that if I had any hope of losing weight.

source

So for the first few weeks, I tried the suppressant. I cut my meals down by roughly 85% of what they had been (it's mortifying to say that). I stopped eating after 8.30pm. Nothing but tea or water until 9.30. Water only after that.

I tried also to cut out just about any food that was processed. So essentially my diet became 2 slices of fruit per day (usually an apple and a not-quite-ripe banana. Not quite ripe is best for diabetics. It allows me to still eat my favourite fruit without the spike in my BGLs); 5 or 6 serves of steamed or raw vegetables. A tiny amount of carb with each meal (because I'm on insulin) and protein with each meal. I cut my protein portions down though (so a piece of steak or chicken would be smaller than a deck of cards).  Lots of water.

For the first two weeks, the appetite suppressant worked. In fact, we ran into all kinds of trouble. I was having constant hypos and was dizzy all of the time.  I lost weight quickly, but after a couple of weeks, I plateaued. I realised that I wasn't actually eating enough, or more to the point, often enough.

So I reduced the appetite suppressants, (only taking one half an hour before dinner, and none in the morning) and put in some snacks.

I'm off the suppressants now. I think they gave me a boost initially (though again - I feel like a fraud having depended on them), but not for long. But it gave me a little bit of a psychological buffer so that I could replace the fatty and bad-carb foods I had been eating for decades.

More tomorrow.

A Question of Ethics

A friend (she has an awesome Gluten-Free blog for those of you interested) of mine linked tonight to an interesting article written by Julie Robotham for Essential Baby. It talks about research seeking a Prenatal test for Autism.  Like me, she has children on the higher end of the Autism Spectrum.

Basically, the gist of it is that researches want to be able to screen for autism as early as possible, in this case - before birth.

They are following families who already have children on the spectrum - particularly boys. Blood tests, ultrasounds, particularly of the baby's brains are being studied (as well as cord blood at birth) to see if they can pick up hormonal or chemical changes that may link to developing autism.

Andrew Whitehouse, who heads the autism and related disorders program at the Telethon Institute of Child Health Research in Perth, said there would probably never be a cast-iron diagnostic test during pregnancy for autism like those available for Down syndrome. Instead, a test would only point to an elevated risk of autism

I would love to have been involved with a study like this, simply for the science of it. Having had a boy already on the spectrum, and knowing we were having another boy, we knew that there was a better than average chance that Samuel may follow Alexander and have autism. We weighed this up before we decided to try to have a second child and it was something we discussed in detail.

The benefit of screening is that it could potentially make the road to diagnosis smoother for parents (rather than the convoluted, stressful path most travel), and thus access to early intervention easier. And earlier. There is no question that the earlier children with autism (as with so many disorders) can gain early intervention, the better the projected outcomes.

So for that alone, I'd have loved to be involved in a study like that.

But of course, it begs the question. How many parents would want to screen their unborn children for things like autism? Like the tests for Down Syndrome and other Trisomy conditions, would parents then face the ethical question of whether to continue a pregnancy? With tests that can only predict elevated risks, is this a road we want to go down?

Food for thought.  What do you think? Would you want to know?

What she said....

Mostly I’m sad about just plain reading. When I pass a bookshelf, I like to pick out a book from it and thumb through it. When I see a newspaper on the couch, I like to sit down with it. When the mail arrives, I like to rip it open. Reading is one of the main things I do. Reading is everything. Reading makes me feel I’ve accomplished something, learned something, become a better person. Reading makes me smarter. Reading gives me something to talk about later on. Reading is the unbelievably healthy way my attention deficit disorder medicates itself. Reading is escape, and the opposite of escape; it’s a way to make contact with reality after a day of making things up, and it’s a way of making contact with someone else’s imagination after a day that’s all too real. Reading is grist. Reading is bliss. But my ability to pick something up and read it—which has gone unchecked all my life up until now—is now entirely dependent on the whereabouts of my reading glasses. 

Nora Ephron - 'I feel bad about my neck' (read her. She's all kinds of awesome).

Week 7

I'm in Week #7 of this new healthier lifestyle. I've not dropped any weight this week, but good things are happening nevertheless.  I asked last week if people wanted any of the "hows" and I got a few people saying they did.

I have been feeling a bit 'off' of late. My 37th birthday is only a few weeks away, and for the first time ever, I'm feeling a little negative about it. I'd not previously been one to hate the ticking over of the clock. I looked forward to my 30s for years, waiting for that time they say you're more comfortable in your own skin.  And in a way, they were right.

But this year, I approach 37 with trepidation. A keen awareness of how quickly time travels. I'm watching my children as they approach 10 and 5 and I'm blown away by how swiftly their childhoods are passing. I have this constant state of urgency, almost panic.

My mother died at 43, only 6 years older than I am now. She had 4 adult children and 5 (at the time) grandchildren. Other than her ALS she was relatively healthy (it seems so bizarre to write that). Her blood pressure was fine, her heart was strong. She had no asthma, no diabetes, no heart disease. She rarely got the flu.  She worked hard, running around after beloved 2-3 year olds until she could no longer do so safely.

I'm 36 and I can't say the same. I have diabetes. Not just pre-diabetes. Not just insulin resistance. I'm 11 years into Type 2 diabetes. I'm insulin dependant. I have nerve damage. Eye damage (though we still don't know what caused that), enough to make me give up my drivers' license. I'm morbidly obese and suffer all of the pain that goes with that.

I am mentally unwell. I suffer with depression and anxiety and have been diagnosed with Bipolar 2 (though I have my doubts now about that diagnosis).  Despite the fact that I don't drink and I've never smoked a cigarette in my life, I'm hardly an advertisment for good living.

I'm hiding. I can't make eye contact with people anymore. My head is down, my handbag carried across my front, arms around my chest and stomach. Frumpy clothing. Everything about me screams "Stay Away. Don't Look at me". 

I have two sons. This is NOT the message I want to pass on to them. I want them to love being out and about. Love exercise. Love a healthy lifestyle.  

Months ago, my GP spoke to me about a Weight Loss Surgery. One of the more drastic measures - a gastric sleeve. I had had lap band surgery recommended to me a few years ago, and I dismissed it immediately. Back then, I wasn't nearly ready to think about it. I also wanted very much to have a second child, so I ruled it out on the spot. I'd heard of so many cases when lap bands had failed, so it seemed too big a risk to pursue.

Now though, our family is complete (whether we want it to be or not). I'm many kilograms heavier than I was 7 years ago and my diabetes has been virtually uncontrolled for 4 years now. I've done a long stint on Prednisone which was very damaging to me, both physically and psychologically. I've been housebound. Partly because of my pain and the fact that I can no longer drive. But if I'm honest with myself, a large part is my desperate fear of being looked at. By anyone.

The sleeve not only reduces your stomach to about 15%-25% of its normal size, but it apparently takes away the part that creates Ghrelin, the hormone responsible for appetite and that (I've read) increases our desire for high-calorie foods. I was told by the Doctors that this surgery would effectively cure me of my diabetes overnight. It's hard to look past that. But, it is drastic, expensive and irreversible.

I talked to Joel, and I talked to people who had had the surgery. I spoke to my new GP, I spoke to my Rheumatologist and I spoke to my new psychologist. Everyone felt that given my health, this surgery was the best thing I could do for myself. It was going to cost us several thousands of dollars, and honestly, we just did not have them.  So we decided we would apply (we're told we would almost certainly be approved) to access Joel's superannuation. I had an appointment with the surgeon and a plan. 


And then the pain stepped up, in a big way. There was clear nerve damage. My left arm and hand became useless. The pain in my shoulder and neck became overwhelming. No drugs worked. We tried increasing Ibuprofen and Mersyndol. We tried Norspan patches - different strengths. We tried Panadeine Forte. I took Glucosamine, a barrage of vitamins in fact. Nothing. I had CT scans, X-rays and ultrasounds to investigate.

Severe bursitis. Bone spurs in my neck that were impinging my nerves. My situation was getting worse -the pain was strengthening and my ability to cope with it was plummeting. The GP said he felt that it was going to have to be neck surgery for me.

Suddenly we were at a crossroads. I can only access that Superannuation once. One surgery. We don't have health insurance. We keep talking about it, but it never actually happened. Soon, it became clear that weight loss surgery was not going to happen.


This realisation terrified me. I hadn't realised how much I was sub-consciously pinning my hopes on that surgery. Telling myself my life would really start after the surgery. I'm not one of those women who are comfortable with their fat. My Doctors had told me it was the only way I was going to lose weight. They weren't cruel about it. But they acknowledged that given my history, my chronic, severe pain, my diabetes and insulin resistance (Metabolic Syndrome, I'm told), the chances of me losing the weight myself were almost non-existent.

It was tough to hear that. But I believed it. I wished I had more confidence in myself. More willpower. Or at least more acceptance of my body. There are so many I'm seeing online now, so out and proud of their bodies, no matter the shape. I admire them. But I can't pretend for a moment that I am one of them. My fat makes me hate myself. My fat makes me scared to leave the house. But worst of all, my fat is killing me.

So after recurring dreams about dying, I woke up one morning, a few weeks ago and decided that it was the day for a new start. Right then and there. Starting simply, with portion size.

I decided I had to be extremely honest with myself if this was going to 'take'. This is getting too long now. This is the "Why". Tomorrow, the "how" (so far).