Stringing XMas Lights

SD 7/23/13; first fill 9/23/13; second fill 11/4/13

It’s April. We here on the east coast in the mid-Atlantic have had a more challenging winter than most. While I love snow and think it’s beautiful, we’ve had so much of it this winter. The average snowfall in this region is between 16-22″ (as measured at the two large airports, one next to DC and the other about 30 miles to the west.)  The 30-yr average for this region is 15.4″.  This winter, we had 32″.

That is not why I titled a blog on my band weight loss journey Stringing XMas Lights.

This is:

What looked like lumpy boobs in the last post now looks like I’m stringing lights.

In frustration, I talked to my therapist, a nurse practitioner who prescribed me Adderall for my constant urges to snack and adjusted my medication. {We added Welbutrin back into my medicine regimen, which I also had to stop before surgery and did not go back on afterwards).

As we were wrapping up and talking about menopausal hormones, I told her that before my surgery I had been on Cytomel and Synthroid, two hormone adjustment medications, that I had not gone back on after my band surgery. She told me that if my hormones were low, there would be no way I would lose weight regardless of what I was doing. So she told me to go get a blood test (and include Vitamin D levels).

I made an appointment with my primary care physician, who scolded me for stopping these two medications and not going back on.  “Why didn’t you go back on?” he asked.  I shrugged.  Because I already take 4-6 medicines and supplements and I’ve always hated taking pills?  I didn’t say that, but that’s probably a big part of the reason.

So I have a renewed prescription for these two medications (generic: lyothyronine and levothyroxine) and we’re going to see if that makes a difference. I expect it will, since my primary Dr. told me that hormones were the gas to my engine, and if I didn’t have the gas the engine wouldn’t run.  (I should have told him I have plenty of gas, but I just thought about that now.)  🙂

Before I go, though, I want to say something about my primary care physician. I have seen this doctor for about 25 years. He used to run a weight loss clinic and helped me lose weight when phen-fen was popular (I always had appropriate testing done each visit while I was on that medication).  He’s my husband’s and son’s PC. His wife was my acupuncturist for several years.  He has a very sarcastic sense of humor, and I know several people who haven’t liked him for that.  However, I’ve always liked people with a sense of humor, regardless of whether it’s clever, witty, goofy, dry, or direct. When I was at my heaviest, he once told me that I looked terrible. Well, he was right. He was also the one who suggested, more than once, the band surgery, and recommended me to the surgeon who performed it when I was finally ready for that solution.

But this time he crossed my line of tolerance. First of all, he poo-pooed my going on Adderall. “Well, of course it’s good for weight loss, it’s a stimulant.” That’s not why I went on it, although I did go on it to counteract a  function of my brain that was making it difficult to control my eating. He also poo-pooed my therapist, for telling me to get the blood test. “What is she going to do with that information? She can’t do anything with that information…those psychiatrists don’t know what they’re doing sometimes…”  To which I should have replied, Well, I like her better than I like you, but I also just thought about that now.

He told me it was a waste of money to get the blood test now, he knew what it should show.  The blood test should be taken after I’d been back on the hormone medications again. While he was scolding me for not going back on those after surgery, he said something that shocked me. After having the whole day to go over it, I realized that I was really pissed off.

He said, “You know, you’re the first patient I know of Dr. A’s that’s a failure.”

“A failure? ” I replied, in a shocked tone. “Well, yes, you’re not supposed to hit plateaus on the band, you’re supposed to have a steady weight loss.”  

I thought about that all day yesterday and by the time I got home after working late, I was fuming. I was even wondering if it was time to find a new primary care physician.

I know exactly what I want to say to him when I go back for a followup in about a month. By the time I go back to see him, I will have had time to prepare this statement so that I can speak it without emotion, because I am not eloquent, nor can I think rationally when I’m emotional about something. This is what I plan to say to him:

“Dr, K, you said something the last time I saw you that really pissed me off. You said I was a failure with the band. Well, that was insulting and mis-informed. I have been a member of band Facebook pages, band forums, band blogs, and band support groups, I can tell you that I am by far not the only person struggling with the band.”

I might even add: “You cannot shame into compliance – I would have lost the weight a long time ago if it were that simple. I hope you’ll think twice if you ever have the urge to say something so denigrating and negative to me in the future. ”  

Medication

SD 7/23/13; First fill 9/23/13; Second fill 11/4/13

I have one addiction.

All throughout my life I have engaged in activities and avoided succumbing to emotionally and physically addicting behaviors. At the age of nine I spent my entire savings gambling – playing a game at a school carnival trying to win a teddy bear. I did not win the teddy bear and vowed never again to spend all my money in pursuit of trying to gain something. When I walk into a casino, I go in with a set amount of money, play until that money is gone, and leave with whatever winnings I accrued while playing. The first time I tried a cigarette at 13 I coughed and found it tasted disgusting, yet I became a brief social smoker in my early and mid-twenties, not inhaling to avoid becoming addicted to nicotine. I did inhale other substances, but none to the point of making it anything other than a fun weekend or a social activity that I easily put away when it came time to engage in a productive life.

I suppose I could become addicted to shopping because I like to buy things and I have way too many things, but I never got hooked to the point of corrupting my paycheck-to-paycheck existence, spending so much that I could not pay my mortgage. I drank fairly consistently in my late teens (when beer was legal at 18) and into my 20s, but one too many hangovers left me unwilling to continue drinking alcohol enough for it to become an addiction. Now I’ll have a beer or glass or two of wine a few times per month, and a hard drink maybe once every several months.

I believe, however, that we all have an addiction. We are all tied to at least one that feeds our mind or our emotional state with a release of endorphins or seratonin. It sure as heck isn’t sex for me.  I am addicted to food.

I suppose that many obese individuals have this problem and we become willing to have surgery to control our eating when we cannot do it ourselves. I chose the surgery that does not make me sick when I eat a cupcake (or two), or a candy bar for Halloween, or a second helping of my favorite pecan pie at Thanksgiving. Therefore, much of the success a band patient experiences, or doesn’t experience, comes from between our ears. We must tackle the addiction to food with a restricted stomach but an unfettered mind.

I saw a new psychotherapist last week, because my health care insurer sent me a notice that my former psychiatrist was leaving their network. One thing I addressed with this new psychotherapist was my desire to address my overeating – my urges to snack despite my reduced stomach capacity. We discussed my caffeine habits (I drink coffee and tea during the week) and she told me that many people drink caffeine to calm them down – despite caffeine being a stimulant. We discussed my issues, in addition to snacking, with concentration, daytime fatigue, difficulty focusing and my disorganization and cluttered environment, all symptoms in common with Adult Attention Deficit Disorder (ADD).

This is not news to me. I forayed into a diagnosis of ADD with another psychiatrist over a decade ago and took a popular (non-stimulant) ADD medication at the time, which did help my concentration and focus.  I stayed on the medication for several months but I gradually stopped because I was not convinced the changes were significant enough to warrant my being on yet another medication.  However, my new psychotherapist indicated she wanted to prescribe for me Adderall. Adderall is an amphetamine (a stimulant), of which one of the side effects is weight loss.

The goal is not to use the drug for weight loss, but to address the issues (such as distraction and the repetitive behaviors associated with eating) that might encourage me to snack. It still does not address any emotional connections I have with food.

I do not feel guilty using medication to help me on this journey. I am committed to making this band and weight loss program work, any way I can, until I can get a better understanding and control over all the reasons I put too much food into my mouth.  I see this as adding additional tools to my toolbox to get me healthy – physically and psychologically.

I’ll let you know how this goes.

In addition 

Lap Band and Food Addiction

SD 7/23/13; First Fill 9/23/13

Overeaters Annonymous is an organization that models a 12-step program to end addiction similar to that in other addiction programs such as Alcoholics Annonymous.

Yet, I perceive that the reaction of just about everyone would be different if one uttered, “I am a recovering addict from alcohol” and “I am a recovering addict from food.”

I knew many years ago that I had a psychological food addiction. I tried to explain to people that when it came to food, my “stop” button in my brain was broken. I knew I was overeating but was fairly powerless to stop – – or to stay stopped. Even after I managed to wean myself away from most junk food (chips and cookies), the urge was still there, and I filled it with healthier, if not less fattening snacks (nuts, popcorn and dark chocolate).

Deciding to get the band was my way of getting my stomach to say stop to my brain, and for the most part it has been working. With a smaller capacity I am eating less food and therefore losing weight. But the urge to eat – to snack – especially heading into the darkening autumn days of hibernation season, has not abated. I am even more aware of this psychological addiction and control issue now that I am forced to look at everything I am eating because my capacity is altered, although so far, I haven’t had any food get stuck, nothing has come back up, and I haven’t experienced any painful eating scenarios.

So, as I type this, I eat a small bowl of popcorn that I told myself I wasn’t going to have earlier. (Only 70 calories per 2 cups – not the Movie Theater Butter kind I would eat before I had my surgery.) I am combating these snack attacks using my band and my quest for better health. I can deny some desires to eat when I can identify that my urge to eat is from boredom, but the urges that stay with me and continue to grow I don’t ignore – but I do put rules in place.

You want to snack? I ask myself? Fine, you can snack on as much roasted seaweed or watermelon as you want.  (Because really, has anyone ever gotten fat by eating too much seaweed or watermelon?)

You must have popcorn? I ask myself. If so, you may eat no more than 2 cups at a time (time being morning, afternoon and evening) and it has to be the 35 calorie/cup variety. (Angie’s Boom Chickapop, found at Target.)

In  the meantime, I go the the monthly bariatric support groups held by the hospital where I had my surgery, and I’ve just paid $50 for a 12-week weekly weigh in program for accountability on a (secret) Facebook page (as we head into the high-munch days of the holidays).  I may even do some more research into Overeaters Anonymous if I am unable to address my psychological issues and the chemical responses food produces in my brain.

This is a very enlightening article by the way, on this very subject. It’s worth the it will take you to read it. http://www.nytimes.com/2013/02/24/magazine/the-extraordinary-science-of-junk-food.html?pagewanted=all&_r=0