Sara L.

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I had an interesting thing happen at church yesterday morning. A friend of mine, whom I love dearly, asked me who did my reconstructive surgery after my weight loss. I gave her his name, and then asked if it was for her or someone else. She replied that it was for herself; she's apparently considering an augmentation. But what blew me away was the sentence that followed:

"I just want to feel normal."

Whaaaaaa. . ?

Obviously, I'm not going to publish her name or photo for the sake of privacy, but trust me when I tell you this woman is as gorgeous on the outside as she is on the inside. She's naturally lean, never had a weight problem. Tall, slim, fantastic smile, cheekbones that could cut glass -- the kind of woman who makes everyone look twice when she walks in a room. But she's what we'll call "modestly endowed", and apparently she has reached a point in her life where it bothers her enough that she's ready to call a plastic surgeon and have that changed.

I was stunned, though I tried not to show it. I would never have thought that my friend had any insecurities about her body. From my perspective, she has no reason to have any insecurities about her body or her appearance in general. . . It was an eye-opener; a vivid reminder that you never really know what's going on inside someone else's head or heart. That's why it's so important to reach out the people around you -- make sure they're doing okay. Even more important:  reach out to your support network if you are struggling! Don't wait for someone to notice that you're floundering, because it may be too late.

Tonight’s game was a tough one. Our first baseman got bonked in the head on a bad throw, and our catcher (my daughter) has welts on her knee from being hit with the ball. I expect that it should be a glorious mix of purple and green by tomorrow, plus the bright red welts from the seam stitching.

So with all this trauma, you would think we won. We didn’t; although we gave a good effort. We struggled at the plate. That said, this was one of those times when our opponents approached the game with a single goal:  winning. One tactic we saw tonight was the other team rolling the ball to their first basemen instead of throwing it. It’s an easy way to get the ball to the fielder, so the short-term payoff is clear. Long-term, though, these coaches are robbing their players of the chance to learn. In the next two years, these girls will move to more competitive teams; they will be expected to know how to properly field and throw the ball. They won’t be capable of competing because their coach was more concerned about winning than he was teaching.

The challenges of short-term vs. long-term results carry over to other areas of life, including weight loss. There are lots of techniques we can use to accelerate our weight loss post-op – but not all of those techniques are good for us long-term. We learn bad habits, and then we have to break them down the road. It’s important to be mindful of the habits we’re building post-op from both a short- and long-term perspective. Otherwise, we set ourselves up for failure. We must be willing to invest the time and energy in ourselves to learn the proper habits that will give us lifelong success.

*whew!*

This is a little different from my usual blog entries -- I typically try to post something related to new medical findings, etc. But tonight I am just tired. This weekend has been crazy. . . We had thunderstorms Friday night, complete with hail (welcome to Oklahoma!). Saturday was lots of errands, including buying ant killer to try and eradicate a little fire ant problem on my daughter's softball team's practice field. We got the stuff bought, but then couldn't get the lock on the field gate to open. 

Today started quietly enough -- church, with a potluck afterwards. Then some friends asked if we had plans for the evening. . . Today was their anniversary, and they wanted to go out for dinner kid-free, but were lacking a sitter. So I ended up taking my twins and our friends's two kids to a movie and then to dinner afterwards. My only comment about today's experience is that the decibel level in a car with 4 children is deafening. Truly.

But looking back over the weekend, I didn't get nearly as much done as I wanted to -- but I was crazy busy the entire time. And before my surgery, I could never have maintained the pace I maintained this weekend. I would certainly never have contemplated taking four children on an afternoon outing -- I'd have been afraid I couldn't keep up.

So:  my weekend was entirely too short. I'm wiped out. But I enjoyed it (except for the doggone lock at the ballfield!). 

I read an interesting article a few days ago:

http://vitals.nbcnews.com/_news/2013/03/27/17488826-after-weight-loss-surgery-new-gut-bacteria-keep-obesity-away?lite

Please read the article on your own, but here's the nutshell version:  researchers took 2 groups of obese mice. They performed RNY surgery on one set and a fake RNY on the others (made the incisions, but reconnected everything as it was originally). Then they took 2 more sets of obese mice and introduced microbes (bacteria) from the guts of both surgical groups. They found that the non-surgical mice who received gut microbes from the RNY mice lost weight; non-surgical mice who received microbes from the "sham" RNY mice did not experience a change in weight. Furthermore, follow-up tests revealed that the non-surgical RNY mice kept relatively more of the slimming microbes in their gut than the other non-surgical mice.

Researchers are calling this a breakthrough, saying that obese patients may eventually be able to receive "transplants" of microbes that are found in naturally lean people -- the kind that seem to proliferate in post-RNY patients -- and experience the benefits of RNY without the surgical risks. What remains to be seen is how effective this would be long-term, and how diet and other factors play a role in the population of gut bacteria. Would someone who received microbe therapy but made no dietary changes maintain the required levels of "lean" microbes, or would those microbes die off and be replaced with "fattening" ones?

I find all of this ironic, though. For decades, it has been believed that obesity was simply a personal failure. If you were fat, it was your own darn fault; if you would just eat less and exercise more, you wouldn't have a weight problem. We still see alleged "experts" suggesting that fat-shaming might produce behavioral changes in obese individuals (because obviously fat people aren't already discriminated against). We see massive amounts of time and energy being poured into educational programs aimed at children, teaching them the USDA pyramid and the importance of exercise. Yet we continue, as a society, to pack on the weight. Patients who choose a WLS must frequently pay from their own pockets and are subsequently viewed as having somehow cheated their way to health -- yet those same patients and procedures that are producing metabolic changes that may be translated to non-surgical options!

I am also reading a book called "Why We Get Fat and What We Can Do About It"; it's basically an abridged version of "Good Calories, Bad Calories". The author, Gary Taubes, makes some very compelling arguments that the very same entities who pushed a "heart-healthy diet" on the American public is now trying to reverse the obesity trends by pushing the very same ideas about diet and exercise that mark the beginning of the obesity explosion (no pun intended) in the U.S. As the dogma of "diet and exercise" is pushed, medical research keeps finding "breakthrough" evidence that obesity is not a choice -- it is a side-effect with real and measurable causes. It has tangible markers besides excess body fat:  chemical changes in the body that affect every process are tied tightly to obesity. Yes society would happily continue to tell us it's a personal problem and we should be able to fix it on our own. That's like telling a patient who desperately needs a quadruple bypass they can't have the treatment because they chose to eat cheeseburgers. The concept is absurd, and it is widely accepted that cholesterol is influenced by genetics -- and yet, adiposity is not?

I sincerely hope that soon obesity will be treated as a chronic disease, not a moral failure. Until it is, though, we must continue to educate those around us. We cannot be afraid to speak up -- if we won't do it for ourselves, we must do it for the children and teenagers who are already at risk for obesity.

I wrote a while back that I had been suckered into coaching my daughter's softball team. . . Now that the initial rush to get things organized is over (uniforms, equipment, parent shirts, assistant coaches, practice schedules, roster, field assignments, etc.), I've had a chance to come up for air. . . And I've noticed something:

My daughter is a softball addict. She now marks her week by practice days and game times. If it's not an "official" practice night, she wants to be out in the yard playing catch. This has been particularly challenging because of the weather lately -- central Oklahoma has gotten rain for the last three days. We needed it, and I'm not complaining, but it has made my daughter very "itchy" to grab the mitts and go throw. It doesn't matter how cold it is outside -- she would happily play in a blizzard, I think. We shortened our practice on Monday of this week because it was 47 degrees with a very cold wind; my daughter complained.

And I'm thrilled by this turn of events, because I was the same way! Still am, to be honest; the hardest part of coaching for me is being on the field and not getting to play. And it makes me very grateful for my surgery and my weight loss -- every time I grab my mitt and go outside with her, every practice, every game, I am reminded of how precious this is.

4 years ago I got rid of the mitt I'd had since high school; I was convinced I wouldn't be able to use it again because of my obesity. Walking was exhausting and made my joints hurt, so there was no way I'd be able to run and play ball. A coworker, when he saw my post on FB about needing to get a new mitt because I was coaching, gave me a mitt he'd bought when he went into the Air Force many years ago and was playing in a base league, and I used it for a while. It was too big for me, though, so I passed it to my husband (who has hands that are more like paws) and he uses it when he plays catch with our son. I bought a new mitt a couple of weeks ago, and got teary-eyed in the middle of the sporting goods store simply because I was doing something I never thought I'd do again. And I have the opportunity to do this with my daughter, which means more to me than I can ever express.

I guess this makes me an enabler in her softball addiction. I am not repentant; I will play catch, help her with her batting, and further her love of the game -- in hopes of ensuring that she stays active and healthy for the rest of her life. And because it gives me time with my daughter that I would have missed out on otherwise, which is so much more valuable than any win/loss total!
 

I’m frequently asked what motivated me to undergo weight loss surgery. I give the fairly standard responses:  overall health, felt crummy, for my family, etc. . .

One of the main motivators, to be honest, was how my weight affected my kids. They were pretty young, so they didn’t care that I was much heavier than other mommies. They wanted me to run and play with them, which I couldn’t do – but I told myself that lots of other parents couldn’t, either. It bothered me, though; I felt like I was letting them down because I couldn’t play like they wanted me to. One of the biggest “motivating moments” came when my kids wanted to try soccer. When we went to our first practice, the coach told us that he never intended to coach a soccer team – but if he didn’t volunteer to coach, his son wouldn’t have a team to play on.

Sounds innocent enough, but it bothered me to know that I couldn’t have done what he did. I literally could not have coached my kids’ team. I couldn’t keep up, and I couldn’t move well enough to teach them the ball handling skills they needed to learn. That realization caused me to really start looking for more information about weight loss surgery.

Fast-forward about three years. My daughter has been begging for a year to play softball/t-ball. I signed her up last fall, but no teams had a space for her on their roster. This spring, I received a call from the league coordinator:  they had enough girls for a team, but nobody would sign on as the head coach. . .

So now I’m coaching a softball team of 7- and 8-year-old girls. Let it never be said that God does not have a sense of humor. It’s funny, though, that I’ve come full-circle in a way – from varsity player to obese mom to little league coach. And while I’m stressed about practices/game schedules/parents/uniforms/etc. at the moment, I’m so thankful for the opportunity to be part of my daughter’s athletic endeavors. I’ve gone from “I couldn't" to “I am!”

So I’ve had an interesting week. . . if the word “interesting” can be used to describe scary and rather life-changing.

I went back to Brazilian Jiu Jitsu on Monday after taking a few weeks off. It’s a very physical sport, but I intended to start slowly and work my way back in. The class went well, warmup felt great, drills went smoothly. The last 15 minutes of the class are reserved for “rolling” – the BJJ name for what other martial arts consider sparring. It’s full-contact grappling, in a nutshell; a chance to practice in real time what you’ve learned. While rolling, there was an accident – my neck popped from the base of my skull to the middle of my back. Lots of crunching noises. Everything went numb for a few seconds, then everything lit up with pain. I was eventually able to sit up on the mat, and later drove myself to an urgent care clinic. When the clinic heard my description of what happened, they declined to treat me and suggested I go to an emergency room.

By the time I was released late Monday night, after almost 10 hours in the emergency room, I had a diagnosis of a ruptured disk in my neck, with an accompanying blood clot pressing on the nerve root leading to my left side (unfortunate that I’m left-handed) and a follow-up scheduled with a neurosurgeon Tuesday morning. More tests on Tuesday, consult with neuro, wait for information. On Wednesday I found out no surgery is necessary. I’m spending the rest of the week at home, and expect to go back to work on Monday.

So here’s the dilemma – BJJ was my exercise of choice. I’m pretty sure my neurosurgeon is not going to release me to go back to BJJ; even if he did, my husband would be decidedly unhappy if I decided to continue. . . Right now, I’m not allowed to lift anything heavier than a gallon of milk. But once I’m cleared for “normal activity”, I have to find a new workout. I know that exercise is critical for long-term success, so I really don’t feel like I have the option to just “sit out”. Now it’s a matter of finding something that I enjoy as much as I enjoyed BJJ.

Given what I’ve dealt with thus far, this should seem like a minor hiccup, right? But there’s a sense of loss that I wasn’t expecting. It sounds weird, but I feel like I’m mourning a death somehow – a loss of freedom that I had regained with my new post-op body. I’ll get over it, and move on and find something else to do for exercise. But. . . I’ll miss it.

My husband and I are watching Avatar. We've reached the part of the movie (spoiler alert) where the arrogant jerk general dude decides to go bomb the heck out of the natives because of Jake's video log entry where he says, "there's nothing we can offer these people to make them give up their home". The core mission of the exploration team was to find a way to motivate the natives into moving from their home so the land underneath it could be mined for a vast deposit of a rare element.

We always have motivation -- but we don't always enjoy it. For example, most of us have bills to pay, so we are motivated to go to work whether we want to or not. Our kids can't go to school naked, so we are motivated to do laundry. The "Maintenance Required" light is flashing, so we get the oil changed in the car.

Unfortunately, people don't come equipped with a "maintenance required" light. We have to make an effort to ensure that we are taking care of ourselves physically, mentally, emotionally and spiritually. Being a healthy weight is great, but our goal should always be to be healthy in all aspects of our lives. We cannot sacrifice our psychological health for a magic number on a scale or an idealized image of how we should look. Allowing ourselves to become obsessed about our bodies is every bit as unhealthy as the excess weight we're working so hard to rid ourselves up.

How does this tie into motivation? It's simple -- our motivation must be to be healthy as whole people. Sound minds, sound bodies, sound hearts. We must be motivated not just to live day-to-day, but to thrive. We've all been given a second chance to be healthy; shouldn't we make the very most of it?

I remember sitting in my pre-op seminar next to my husband, listening to the man who would eventually be my surgeon talk about surgery options and the pros and cons of each. We had already heard from one post-op lap-band veteran and one RNY success story. The RNY patient had talked about how her taste buds changed after surgery when asked by an audience member if she struggled with foods she had craved before surgery. I remember thinking "yeah, okay" and moving on mentally. And now the surgeon is up there, talking about how both the band and bypass were effective for weight loss, but that only the bypass had an immediate effect on diabetes. And then he said something that not many surgeons probably utter in public -- "We don't know exactly why, we just know that there's an immediate impact on diabetes with the bypass."

And I had a moment of cognitive dissonance -- we don't know why it works, we just do? What else don't we know?

It didn't matter much, really, as far as I was concerned. Diabetes wasn't a big issue for me, although I was pre-diabetic. I was confident that my blood sugar condition was tethered to my excess weight, and correcting the weight would eliminate the pre-diabetes. By the end of the seminar, I had made the decision to pursue the RNY. The rest, as they say, is history.

I discovered post-op that my taste buds had, in fact, changed. The protein shake that I loved on my pre-op diet was now sickeningly sweet -- I literally couldn't gag it down anymore and ended up giving away the entire container. I still like sweets, in moderation, but I aim for sugar substitutes (stevia, Truvia, etc.). And I had read the articles about how even the artificial sweeteners seemed to impact blood sugar, but nobody understood why, exactly.

Apparently researchers are rapidly closing in on an explanation -- there are taste buds in the small intestine. Seriously. I couldn't make this up if I wanted to. There are receptors for "sweet" in the small intestine, and when they detect "sweet" they ramp up the production of insulin. This explains why eating sugar has so much more impact on insulin production than injecting glucose directly into the blood stream.

There is also research out there to indicate that this means artificial sweeteners may not be the harmless treat many bariatric patients have come to view them as. If "sweet" increases insulin production (and thus the absorption of glucose), than it's possible that even non-sugar sweeteners may alter what we're absorbing and in what quantities. . .

Which brings me full-circle. What else don't we know? Don't get me wrong, I have no regrets -- my surgery is still the best decision I've ever made. But how many "good" decisions aren't good at all -- just slightly less bad? What else don't we know about how the body senses food and other chemicals, and what impact that has on the endocrine system and metabolism?

Just something to think about, I suppose. But you can bet I'll be eyeballing the Truvia in my coffee a little more closely!

And since I'm not a fan of facts spewed forth without documentation, here are some links for your review. . .

Journal of Psychology -- http://jp.physoc.org/content/582/1/379.abstract

Nature -- http://www.nature.com/nature/journal/v486/n7403_supp/full/486S7a.html

Science Daily -- http://www.sciencedaily.com/releases/2012/12/121221123458.htm

It's that time of year again. . . the time when we all look at our calendars, look in the mirror and swear that this year will be different. "This year," we say, "I'll make the changes and make them stick."

How do I know, you ask? Well, because it's my annual ritual too. The last two years (2011 and 2012) have been great, from a health perspective. Since my RNY roughly two years ago (May 25, 2010), I lost 135 pounds with only the effort required to mind my protein, avoid foods that trigger dumping, and exercise. Since the weight came off, I felt so good that exercising was fun -- my family and I were doing taekwondo and brazilian jiu jitsu at least four nights per week. I hadn't been this healthy since my varsity softball days in high school!

Kicking off 2013, though, is a little different. Between the holidays, work, social commitments. . . Our TKD school closed, and instead of being in BJJ twice every week, I've been lucky to get there once every two weeks. Work has been very busy, with some overtime and some very stressful periods that left me mentally zapped; those were the days I just wanted to go home and chill with my family until bedtime. With social commitments right and left, we've been eating out a LOT. The primary consideration behind what we've eaten for the last two or three months has been convenience. . . which has led us to lots of bad choices.

The end result is that I'm starting 2013 with 13 pounds regained. Compared to the 135 I lost overall, it's not a big deal, right? It's definitely a wakeup call, though. It's a reminder of the cold, hard truth:  weight loss is not a destination. It's a continuing journey. A healthy life requires continuous maintenance -- vigilance, persistence, tweaking and fine-tuning. I'll never be "done". I will always be monitoring, measuring, assessing and adjusting.

I could be upset about this. I could be angry with myself, depressed about backsliding. But what useful purpose would that serve? I mean, really. . . Just as every fat person KNOWS they are fat, I know that I've screwed up lately. I know that I need to set a new course and make changes while I can still say my weight gain is "not a big deal". Being angry with myself doesn't help that, and neither does allowing myself to be depressed. Rather, I will devote the energy that I might have wasted being negative before (when I was trapped in a body I hated and didn't see any way out) to making the changes I know I need to make.

Thanks to my weight loss support team, I have the tools that I need. I mean, my surgery hasn't been reversed. My dietician has told me what I need to eat and where my focus needs to be. My body tells me that I need to resume regular exercise. So now I need to get on the ball and do it. Now is as good a time as any, so here I go. Workout gear assembled, account updated on MyFitnessPal.com, pantry cleaned out and groceries purchased. I can't turn back the clock, but I can make the most of my future.

In short:  it's on!