The nutritionist knocked 400 calories off the plan that I was already working with. That leaves me with 1500 calories a day to eat 3 meals and maybe 2 snacks. It means meal planning & prepping is a challenge. I think about how I know I kind of need to have a housemate to survive financially but then I know that I need a housemate that wouldn’t get in the way of all the health & food stuff I have to deal with. So that is another challenge on me at the moment.
I was reading an article about an individual who was transitioning (MTF) and how running calmed their mind. There were a few quotes that I found interesting and could also pertain to this entire experience.
“What they don’t tell you prior to transitioning is that once the thing you’ve been hiding behind is no longer there, you still need to deal with everything else; the losses accrued in the shadow of a truth you never thought you could live, and the collateral damage from those losses. It’s like addiction recovery, except that there are no 12-step groups for this.”
“When my mind becomes quiet on the trail, the soft voices of hard truths become easier to hear. One of the softest, hardest, and most persistent of these is that what I’m doing, transitioning, is not what I most want. What I most want is family. What I’m running after is love. Isn’t that what I’ve always wanted? Radically disrupting my biochemistry and sociological categorization is at best an unorthodox route to that, though. At worst, I’m scared that I’m slamming a door shut. Yes, I’m becoming who I am, and that’s wonderful, and I could still find someone, and dreams come true, but the facts on the ground are that my odds of ever partnering with someone again are uncertain. A lifetime of discomfort with my body and my identity, a lifetime spent chasing the illusion of security by secreting myself away and playing small, has meant that I didn’t start dating till I was 30. It’s hard for me to have faith that anyone could ever love this revised, unfettered version of me. I never trusted that anyone could love the old me either. Holding on to unsubstantiated hope for a love and a sense of home that may never come again is exhausting.”
“Maybe in the future toward which I’m finally running, I’ll acquire the skills to do that other work. But the home stretch is still beyond my line of sight, and right now, I need to focus my attention on where I am.”
I am trying my best to stay focused in the now. It is overwhelming and very difficult to do alone.
For my nutritionist appointment I’m supposed to do a 24 recall of what I ate.
I am walking into the appointment with a three week recall of exactly what I ate and the breakdown of Fat/Carb/Protein ratio.
I’m supposed to lower my carbohydrate intake to lower my triglycerides and I know you can do that with fiber but that’s my main nutrition question.
Then it’s the pureed meats question and cold pressed juice when I’m at liquid diet question.
I use the app LoseIt. I’ve used it for over 3 years now. You put in your plan height, weight, and how many pounds per week you’d like to lose. It then reduces your caloric intake weekly, very subtily so you don’t notice it. You just stick to adding in your food journal and you know when you’ve reached your limit. It is keeping me calm in this sea of doubt and worry now that I can’t exercise. (damn ankle reconstruction surgery)
The plan still says if I follow the food journal that I will lose 20lbs by April 18th. Before I thought I’d have everything completed by then. There is still a possibility (if I push myself) to get to the March 11th meeting but more than likely I will have to do the April & May meetings, pushing everything back another month. As of right now though I’m out of work from March 9th -April 1st.
I spent a better part of the weekend day dreaming.
There are considerations that one makes in their life when they are obese. Things that they can and can’t do because of a maximum weight limit. Fears that they have because of past incidents. Things that they had to give up once it appeared they would always be overweight.
I had bought a pass to zipline about a year ago, back when I was 245lbs. See the weight limit was 250lbs, so I had decided that I would be able to do it because I had lost enough weight. I was excited for it. I was going to go whether or not I had friends to go with. Then the doubt sets in. Will I get stuck in the middle of the zip line? Will I be able to climb anything I need to? Can my shoulder hold onto that weight while zipping through the air? I let the pass expire.
During Spelling Bee our choreographer wanted me to jump up onto a chair and a table. I responded back very strongly of how I did not want to do that. I knew it wouldn’t be easy for me to jump up on either of those items. Let alone be able to then get down and continue singing. She was very young spirited and very fit, so she’s never had to worry about sitting down and breaking a chair. I have. I’ve had it happen twice. Instead of trying, I just refused.
I love horizontal stripes. I think they are great. As a kid I got to wear them a bunch until I ballooned up and other kids teased me. We figured it’d be better to just take that material away from them.
I spent the weekend thinking about fencing classes, hang gliding, zip lining, running, about dancing and moving easier, about french boat shirts. I spent the weekend day dreaming of possibilities.
I had said to John at brunch on Sunday “What happens if I get everything I wanted in life?” He looked at me and smiled and then quoted Willy Wonka and Charlie and the Chocolate Factory
Willy Wonka: But Charlie, don’t forget what happened to the man who suddenly got everything he always wanted.
Charlie Bucket: What happened?
Willy Wonka: He lived happily ever after.
On most days I would find myself drinking 20 oz of coffee as my morning cup of coffee. I’d follow it up with 20 oz of diet soda at lunch, 20 oz of diet soda at 3pm, and sometimes 32 oz of diet soda at dinner.
I love coffee, soda, and beer. Things that I can’t have: soda and beer. Things I can have 8 oz of daily: coffee
Thursday marked a full week of trying to ween myself off of diet soda and to lower my coffee consumption. I still have some diet soda at home and I might treat myself tonight. After I finish that bottle, then I can no longer purchase it. It is difficult. It’s 12 oz of coffee right now and 20 oz of diet soda. Next week will be just coffee that I have to keep track of.
My food journaling is going well and i’m making better choices. I used my gym last night because I still can’t figure out how to fix the bike at home. Today I’ll check out the North Greenbush gym. I’ve got to figure out a routine, one where i can work out, shower and then go into work. Which isn’t as bad to figure out when its not as frigid and snowy.
Last night I actually thought about running again. Now I know it’s not going to happen until late March for me, probably. Because outside is crappy and treadmills are hard for the beginning of the C25K program. I thought about cross country skiing again too.
I am definitely exhausted this afternoon. This mornings appointment was rough in the sense that barium is not fun to drink and that it just sits inside of you afterward. You are full but you are hungry too. It’s a weird sensation. Tomorrow is a 6 month check up with my primary care physician. I get to tell him I’m moving forward with surgery, he gets to shame me about it and I pay him $30. So it’s gonna be awesome.
Next week I have three doctors appointments too. One is for my ankle and making sure that it really is better and that I don’t need surgery on that too. Then it’s the second psych and my nutritionists appointment. Once those two are done, then they can submit the surgery to my health insurance for approval. So by mid-April I should know if insurance will cover it. Once I get the approval, then surgery is scheduled and by mid-April I’ll have finished the last of my checklist of clearances.
I’m looking forward to the weekend because I’m looking forward to resting. Breaking habits is hard and takes over 21 days.
I wake up with random thoughts.
Like how excited I am about the possibility of wearing horizontal stripes.
As I type this I am in the fasting period for my upper GI and ultrasound. When I post this I’ll be in the procedure.
It’s a long appointment tomorrow and I can’t drive myself. My brother is taking me because I’ll be partially sedated for the endoscopy.
I had my first barium swallow back when I was fourteen. I was having chest pains at fourteen. There were several times I was rushed from class to the nurse. It wasn’t until the third time where the nurse urged my mother to take me to the hospital. By urged I mean either you take her or we’ll call an ambulance.
That’s when I got really comfortable with medical tests. At fourteen. I was diagnosed with Gastroesophageal reflux disease. I was so stressed about being closeted that I was making myself sick.
At twenty, I had a second barium swallow and a colonoscopy. I wasn’t able to keep food in my body long enough. I was getting sick immediately after eating. I was diagnosed with Irritable bowel syndrome. Stress and weight were factors of GERD and IBS.
I had to make major life changes. I had to figure out how to deal with stress, anger, and poor self-esteem. I had to slow it down a bit. I started to lose weight in 2004 on doctors orders. I didn’t really slow down until 2005 and by 2007 I was diagnosed with Idiopathic intracranial hypertension.
When all three issues act up in tandem I am in severe amounts of pain and physically cannot take care of myself.
I am tired of living this way. That is why I am making this decision. I’ve been dealing with the effects of my obesity for twenty-one years.
I am ready for something different.
Q: When do you remember getting fat? That is, has there ever been a time where you were not overweight?
A: I had a double chin in first grade.
Q: What was your weight in high school?
A: Honestly, I can’t remember a time when I was under 200lbs.
There was a time when I was working in Washington D.C. that we went out to karaoke. To impress, I decided upon taking the karaoke jockeys challenge of Kamikaze Karaoke. The Hardest Part by Coldplay was picked randomly by the computer. I didn’t know the song, I just knew that Coldplay was a bit whiney sounding and that’s how I should sing it. SInce then it’s become a song that has stuck in my memory and right now is what is stuck in my head.
“And the hardest part
Was letting go, not taking part
Was the hardest part”
Today I have the appointment that concerns me the most, part one of the psych evaluation. When I am asked if I have any questions about the surgery, this is where all my question lie. All the questions I have are about emotions, feelings, identity, etc.
Last night I looked up Identity Development of Bariatric Surgery Patients because it was on my mind. I found this journal article
The Impact of Bariatric Surgery on Psychological Health
A high prevalence of psychological comorbidities exists in obese patients, particularly mood disorders, anxiety, and low self-esteem. Extremely obese individuals are almost 5 times more likely than their average weight counterparts to have suffered from a major depressive episode in the past year . The correlation between these two conditions is multifactorial. Body image dissatisfaction, commonly seen in obese patients, is heavily correlated with symptoms of depression , and this is particularly true in women, likely secondary to societal emphasis on the female physique. Obese individuals are also subjected to prejudice and discrimination, which is likely to cause or aggravate depression [7, 8].
Furthermore, repeated failed attempts to lose weight are common in this population and are likely to aggravate depressive illness, hopelessness, and poor self-esteem , perhaps contributing to further weight gain. Interestingly, 25–30% of bariatric patients report depressive symptoms at the time of surgery and up to 50% report a lifetime history of depression 
3.3. Postoperative Psychological Health
Despite significant measurement heterogeneity evaluating the impact of weight loss surgery on psychological change, numerous studies and comprehensive reviews have reported overall postoperative improvement in depressive symptoms, self-esteem, health-related quality of life, and body image [21–24].
3.4. Self-Concept and Personality
Self-concept refers to a patient’s perception of “self” and includes several important characteristics with respect to the bariatric population: self-esteem, body image, self-confidence, and sense of attractiveness, and assertiveness. Although these factors have not been studied in a standardized or systematic fashion, a review of the literature seems to suggest that weight loss surgery improves self-esteem, self-confidence, and expressiveness . These changes appear to be correlated with major improvements in body image and weight-loss satisfaction after surgery .
Emotions have always been my hardest struggle. Sometimes, I feel like it is what kills anything good that comes into my life. That I’m too emotional. So the struggle of honesty vs. saying what they want to hear is stuck in my mind. Honestly, I am scared that this will change my identity. I dress in mens clothes for the aesthetic but also because of my size. I’m the funny fat kid, because I needed to fit in. I am a character actress because I do not fit the mold of an ingenue. I don’t believe someone could love me because of my extreme low self-esteem. I don’t believe I deserve love because in my head I say “Who would want to be in love with all of this? Physically and emotionally.” Now, I try to fight these messages as hard as I can. Sometimes I succeed, sometimes I fail.
The intake appointment wasn’t as bad as I imagined it to be. I got to talk to a few women who had the surgery and what their life was like now. It’s changed drastically for them, they have had doors open to them that weren’t possible before. They said clothes shopping is harder because now there is a larger selection to choose from.
I imagine the things that i’ve wanted to do but have been limited to because of my weight. Hang Gliding and using a Zip Line and I’d love to do indoor rock climbing again.
The process after the intake appointment is filled with seeing specialists and needing to lose 20lbs prior to surgery.
2 Psych Appointments
Cardiology Appointment w/ EKG
Endoscopic Ultrasound & Upper GI
Gastroenterology Appointment to review EU & UGI
2 Bariatric Care classes
Primary Care Doctor’s Clearance
I had my EKG this morning and was in and out of the Cardiology department very quickly. They said I do not need any further testing and that I am at a less than 1% chance of cardiac risk for surgery.
Tomorrow I have my first psych evaluation. Thursday the ultrasound & upper GI, Friday it’s the primary care physician and I round out the second psych eval on Tuesday of next week. My Gastroenterology appointment is scheduled for the end of March. The nutritionist has been the hardest appointment to schedule but i’ve been doing well with my old plan. I’ve lost 5lbs since being weighed at Tuesday’s appointment, most of that is water weight but I’ll take it. I started officially at 271 lbs and today I am 266 lbs.
I have had a few setbacks this week. My vacuum sealer died and my recumbent bike is shouting an error message at me. So I have a new vacuum sealer on the way and am looking into fixing my bike (or just biting the bullet and buying a real bike and a gravity trainer)
When I have a goal I can focus on it and reach it. My long range mind wants to figure out what happens when I don’t have a goal in mind later post surgery and a year afterwards. Hopefully the motivation comes from the changes that will open new doors in my life.
There is no other word to say how I feel. I am ashamed. I’ve been trying to research a lot of things about bariatric surgery lately and how one feels through the whole process. Back in 2009 I was pushing 300 pounds. I told myself I wanted to do it the natural way, the healthy way and I lost 50 pounds. I kept that off for a long time until I stopped believing in myself. In this past year, I have let myself go. Out of stress, out of shame, out of guilt. It’s like I purposely just stopped living. Still, things carried on around me. I changed jobs, bought a new car, bought a house and I got sick again. I had been getting sick for the past year, I just chose to ignore it or maybe I chose the pain. Maybe I’m afraid of a life I’ve dreamed of and never thought I was good enough to have.
So I’m scared. I go into the doctors office this week. We talk about plans, health issues, method of care.
I’ve been avoiding auditioning for shows or getting involved in anything because I have no idea what is coming. I don’t know how I’ll feel. I don’t know what I will look like. I don’t know what I will have to eat. I don’t know how friends will react. Especially those who have had the surgery and those who have said I was an inspiration for them to start running or exercising. I feel like a fraud.
Truth is, I don’t want very many friends to know right away. Many of them don’t even know this blog exists, just my running blog.
While there is a lot that you can find out about the surgery and the process and the aftercare, there isn’t a lot of what I’m thinking about.
What will I look like day by day? How will my energy level feel? How do I run and train for long distances? How do I take care of the loose skin? Especially, when I’m exercising. What will happen to my chest area? How do I explain to someone I am meeting for the first time on a date that I’ve got special needs? What will sex be like with hanging skin? How do I cook for family and friends if I can’t eat half of what I would make for them? What is the least disgusting method of eating pureed meats? How quickly can I schedule surgery? What if this doesn’t cure my IIH, IBS, GERD, Asthma, joint pain? What do I do then?
I want to take pictures along the process and record my measurements, workouts, and food stuff. I want this to work. I want to feel better.
This morning a role came in for me in a musical, a very campy musical. I thought about it and this self prescribed sentence I gave myself. No shows for 6 months. I thought I was doing it for good reasons but I wasn’t. I can’t work on my house until the spring anyway and my best friend is back to dating so I need something to occupy my free time. So I accepted the role. I don’t know what to expect but I know I’ll get out of the house and I’ll get to sing a great song and I’ll get to perform at The Egg!
I’m really scared that this will change how I’ve identified for most of my life. Let me rephrase that. I’m just really scared.