I Demonstrate Why “Patient” is a Misnomer

Wallowing in what may appear to some as self-pity, I’ve managed to transform my social network presence into  a multi-platform whine about my limitations while recovering from surgery.  I’ve used all my resources–Facebook, Twitter, and this blog.  Here, my whining has been about the effect of the surgery and my post-op recovery on my weight loss efforts.

The biggest whine has been about not being able to weigh myself. That inability was particularly difficult to bear because I was so close to hitting a major milestone: 50 pounds lost.

As I have reminded my Facebook friends ad nauseum, I had my cast removed today.  I’m not completely recovered–I’m wearing a boot for the next two weeks–but I’m able to stand on two feet for the first time in two weeks.  Upon returning home from the doctor’s appointment, one of the first things I did was proceed up the stairs at breakneck speed to stand on the scales.

My newest fashion accessory for the next two weeks.

I had no idea what to expect.  The conditions were not ideal; I had eaten some breakfast and was weighing myself with a boot that must weigh at least three pounds.  But the news was good: 2.2 pounds since my last, pre-surgical weigh-in, for a total weight loss of 50.8 pounds.

Let me repeat: 50.8 pounds.

I’m thrilled.  I’m excited.  But I’m still impatient.  Why?  Scroll down to the bottom of this page, and look in the lower left corner.  If you’re reading this on the day I’m posting this (Friday, May 31, 2013), it still reads “49 pounds.”  There apparently is a glitch in the My Fitness Pal software, and the “ticker” is not updating.  I was hoping to see–and to show off–a big “50” (actually 51, since the program rounds to the nearest whole number) on that badge.  I just have to settle for knowing that I’ve hit a major milestone, even if I can’t brag about it in the way that I wanted to.

Weight Loss Held Hostage: Day 9

I mentioned on Facebook earlier this week that perhaps I should not be reading Mark Bowden’s richly detailed account of the Iran-Hostage crisis, Guests of the Ayatollah, while on crutches.  I can’t stop from thinking of myself as being held hostage by my cast and crutches. They limit almost everything I do: I can’t drive, I can’t carry anything but the smallest and lightest objects, I move painfully slowly, etc.  But among my biggest frustrations is that it affects my weight loss. On the day of the surgery that led to my cast, I wrote about how it would affect my weight loss. Now I’m experiencing those fears first-hand, but I see them in the context of captivity.

Before I proceed, I want to make it clear that I’m not trying to trivialize the experience of those 66 Americans who experienced up to 444 days of captivity, or of the brave soldiers who flew in the aborted rescue mission (and especially the eight who lost their lives on that mission), or of a country that watched for over a year in shock, horror, and disbelief. Rather, I’m just expressing comparisons that come to mind as I read Mr. Bowden’s book.

Media attention – Those similarities inspired the title of this post.  Among my most vivid memories of the crisis are the daily updates that the three networks (kids, there used to be only three, and there was no such thing as cable news) provided on the evening news and on news specials.  ABC ran a show immediately after the local late night news that I believe they called “America Held Hostage” and included a count of the number days of the crisis.  This show eventually became “Nightline” and transformed Ted Koppel from “that reporter who looks like Alfred E. Neuman” to a full-blown media star.  You won’t get daily updates on the captivity from me, but this blog serves as my “Nightline” in a way.

Treatment of the captive(s) – On the rare occasions when one of the hostages was able to get a message to the outside world, he or she would usually say something like, “The captors are treating me well.”  While those statements were not always sincere, I can sincerely say that those around me (not my captors, since I consider my cast and crutches to be my captors) are treating me well.  I couldn’t ask for more from my family, who are always eager to help.  I’ve had to force myself to accept help from one of them at times, because I know that they feel like they need to help, and are disappointed when I refuse their assistance.  In fact, at times I remind myself of the Sesame Street song “Lonesome Joan”:

Oh Lonesome Joan, Lonesome Joan
You don’t have to do everything alone.
You can use a little help
Don’t have to do things by yourself,
Oh Lonesome, Lonesome Joan.

Loss of control – Even those hostages who truly felt that they were treated well would still have preferred their freedom.  With freedom comes control, and when I’m dependent on others, it’s tougher to lose weight. I have less control over what I eat, and because I’m not actively involved in the preparation of most of my meals, I’ve been less sure of my daily calorie counts.

No news is no news – One of the most difficult things for the hostages was knowing almost nothing about what was going on outside the walls of the buildings in which they were held.  Few knew about the failed rescue mission, and many wondered whether their government or their country had forgotten about them.  I’m also suffering from a lack of information.  While I think that my calorie consumption has been below my target level, I haven’t been completely certain, so I would like to have confirmation on the scales.  But, as I noted in my post on the day of the surgery, it’s almost impossible to weigh myself with this cast.  My doctor instructed me to avoid putting any weight on my right foot, so I can’t stand on the scales with two feet.  Standing on one foot doesn’t seem to work (believe me, I tried), in part because I’m too unsteady, meaning I need to support myself with crutches or the wall (and, I’m sure, transferring some weight off of my foot standing on the scales).  My unsteadiness also leads to widely fluctuating readouts on the scales, so that even if I wasn’t supporting myself, I still wouldn’t have anything close to a consistent reading.

I’ve heard friends say that the one of the worst things about having a cast is when your body part in the cast starts itching, and not being able to scratch it.  I haven’t experienced that physically, but not knowing my weight–and not knowing how successful I’ve been the last nine days–is like the itch I can’t scratch.

Newton’s First Law of Crutches – My body’s tendency to stay at rest is magnified when on crutches.  I knew that I would not be getting much exercise.  I don’t think I realized, however, much less I would be getting.  What I knew was that any walking that I did just for exercise would stop.  What I’ve found out is that much of the routine physical activity stops, as well.  Moving across the room–let alone across the house, up the stairs, out in the yard, or out in the neighborhood–is an ordeal, so I do it only if I have to.  I’m certain that I’m burning fewer calories than I usually do, which just magnifies my uncertainty about my progress over the last nine days.

A few days in Weisbaden – Upon release from captivity, the hostages didn’t immediately go home, but were flown to a U.S. military hospital in Weisbaden, West Germany (hey, kids, did you know that Germany used to be divided into East and West Germany?) to have their health assessed and to get acclimated back to their lives.  Their freedom came back in stages, rather than all at once.  That’s the way I understand that it will be with me.  In six days, I go back to the doctor, and I should get the cast removed then.  I will probably have my foot in a boot for a couple of weeks or so after that.  I should be more free to move around, and should be able to do more for myself, but the boot will still limit my activity and may continue to hamper my ability to weigh myself.

So I have to be patient.  Things will get better, soon.  I just hope that I can make it through the next few weeks with my sanity intact (insert your own joke here).

Mind Games 3: This Diet Goes to 11

As I’m reminded by some people I discuss weight loss with regularly, I’m not doing everything I can to lose weight.  I’m still hanging on to some habits that may be slowing down my progress.

I recognize at least four things that I could be doing.  They are:

• Getting more exercise.   I’ve gotten more active since starting my weight loss plan.  I’ve spent more time on our treadmill, and on the elliptical machine we bought recently.  I’ve also been moving more during the soccer practices I coach.  But I can do so much more.  I tell myself that I will do more now that the weather is warming up (and there’s some truth to that, since the new hasn’t worn off my Map My Walk app yet), but I have quite a ways to go before I get my activity level up to what my doctor recommends.
• Drinking more water.  The research is pretty clear that drinking more water promotes weight loss.  While my liquid intake is pretty high, not nearly enough of it is water.  I believe that my rate of weight loss would be higher if I would drink more water, perhaps even by…
• Cutting down on the diet soda.  Way too much of my liquid intake is diet soda.  Since I rarely drink coffee, but rarely go to bed at a decent time (guess what’s coming next), Diet Coke is often my beverage of choice.  I’ve discussed the effect of diet soda on weight loss before; some researchers have suggested diet soda actually inhibits weight loss.  I don’t know whether that’s true or not, but I do know that a chemical-laden diet soda cannot be as healthy for me as water.
• Getting more sleep.  In the last few years, a number of studies have come out suggesting that getting a good night’s sleep is associated with maintaining a healthy weight.  While I may not need as much sleep as many people I know, I need more than I get.  It’s not that I’m too busy, or can’t find time in my schedule, or anything like that; I’m simply not smart enough to go to bed at a decent time.

So have I not taken these simple steps to accelerate my weight loss?  That’s where the mind games come into play.  I’m consciously (not even subconsciously) holding these extra steps in reserve.  I know that somewhere along the line, I’m going to hit a “plateau”, where I’m eating what I’m supposed to, getting at least a moderate amount of activity, but can’t seem to make the scale budge.

Perhaps I should be doing them all now, and losing weight at an even faster rate than I am doing now.  But I can’t.  My mind tells me it’s important to keep something in reserve.  It’s like I’m Nigel Tufnel from This is Spinal Tap, showing off his special amp with volume controls that are numbered from 1 to 11:

Imagine me explaining my logic (with apologies to Rob Reiner and Christopher Guest):

Me:  Well, it’s one faster, isn’t it?  It’s not ten.  You see, most blokes gonna be dieting at ten.  You’re on ten, here.  All the way up, all the way up, all the way up.  You’re on ten on your weight loss.  Where can you go from there?  Where?

You:  I don’t know.

Me:  Nowhere.  Exactly.  What we do is if we need that extra push over the cliff, you know what we do?

You:  Put it up to eleven.

Me:  11.  Exactly.  One faster.

You:  Why don’t you must make ten faster, and make ten be the top number, and make that be a little faster?

(Pause)

Me:  These go to eleven.

Maybe it’s time for me to turn it up to 11.

Reason #5: I’m Going to Health

No list of reasons for weight loss would be complete without a discussion of health.  My health is not the only reason that I decided to make the commitment to losing weight.  It may not even have been the primary reason.  But it was most definitely an important factor in my decision.

Intellectually, I’ve known for decades about the health effects of excessive weight.  I’ve known that carrying this extra weight endangers my health.  But knowing that fact and doing something about it are two entirely different things.  The harmful consequences of excessive weight often seem to be in the future, so it’s easy to rationalize to myself that I’ve got time to deal with it later.  But lately, the health consequences of carrying all of these extra pounds have started to feel more real as my encounters with the health care system have become more frequent.

In a bold waiver of some of my HIPPA rights, here are some of those health issues I’ve experienced.

Sleep apnea – This won’t come as a surprise to some of you–college roommates, family members, the seismologists I notify before I fall asleep–but I snore.  I’ve been told that I take snoring to a new level.  While I should have taken that as a sign of sleep apnea, for a long time I thought I just snored.  In 2002 I spent a night in a sleep lab and was diagnosed with obstructive sleep apnea.  Since I’ve snored–and snored loudly–most of my life, and at various weights, I think that I would probably have sleep apnea even at my ideal weight.  However, I don’t doubt that the bigger I get, the more I exacerbate my sleep apnea.

I now sleep with a CPAP machine.  I know some people can never adjust to using them, but I am completely comfortable with it.  However, it’s an annoyance.  When I travel, it takes up extra room in my suitcase, and I’m also much less likely to carry on my luggage because it’s a hassle (and at least a slight embarrassment) to take the CPAP machine out of my luggage while going through security.  As I discovered recently, doctors recommend getting “retitrated” every five years or so, which entails a night in a sleep lab.  While that’s a benign enough experience, I discovered it’s a great way to use up my entire health insurance deductible.

Blood pressure – Blood pressure has been a nagging issue for several years.  Most of my adult life I’ve been in the “moderate” range, where doctors would tell me that it is not technically high, but is close enough to monitor.  When I was in Weight Watchers in 2007, I saw my blood pressure drop out of the moderate range, much to the delight of my doctor (one of the things I like about my doctor is that when I follow his instructions or make a healthy lifestyle change, I get lots of praise).  As my weight rose, so did my blood pressure.  In January of this year I started taking blood pressure medication.  In a way, I’m lucky, because the medicine is cheap and I don’t feel any side effects.  But the thought of having to take medicine because of my behavior infuriates me.  My doctor has suggested that my weight loss may allow me to go off the medication when I have my next appointment in July, so that’s become another of my goals.

Umbilical hernia – In April of last year, I had surgery to repair an umbilical hernia.  I won’t describe exactly what that is (feel free to read about it here), but it’s a condition that is most likely to occur in infants and overweight people.  Since I get daily reminders that I’m not an infant, this is another suggestion that my weight has led to a problem requiring medical attention.  It also managed to take care of my entire 2012 deductible.

The specter of diabetes – Thankfully, I have not developed Type 2 yet, but carrying excessive weight is a risk factor for Type 2 diabetes.  Although obesity is linked to several other serious health issues–heart disease, stroke, even some cancer–for some reason, diabetes scares me more than any other.  Even though those other conditions may be more final, maybe it’s the prospect of living with diabetes over a long period that worries me.  Whatever the reason, watching that blood sugar number inch up seemed to be a greater motivation than any other health concern. However…

One scary January night – About a week after I started this weight loss, I woke up in the middle of the night with some pretty pain.  It seemed to be coming from my abdomen or my side, and my first thought was appendicitis.  But it seemed to radiate throughout my torso.  When I tried to stand up, I couldn’t even stand up straight, I broke out into a cold sweat, and nearly passed out.  I seriously wondered whether I was having a heart attack, and was seconds away from having Kris take me to the emergency room.  Just as quickly as the pain started, it went away, and I decided to wait it out, and to visit my doctor first thing in the morning.  The doctor determined that it was a muscle spasm, but it was at that exam when my blood pressure was high enough that the doctor prescribed the blood pressure medicine I continue to take.

While it wasn’t a heart attack, the episode made the prospect of a heart attack much more real to me.

Is it age or weight? – Since about the time of my 49th birthday in August, I’ve been noticing a lot of little nagging aches and pains, and a general feeling of blah.  I know that aches and pains tend to be a natural by-product of aging. So as my 50th birthday gets closer and closer, I started asking, “Is it always going to be like this, or is this due to weight?”

Already, after 49 pounds, the answer is coming clearer.  I’m sure that some of what I’ve felt is age-related, but the nagging pains and the blah feeling have largely (no pun intended) subsided.

Personal health is important.  But increasingly, when I think of the interaction of weight and health, my mind goes to dollars and cents.  You may have noticed that I referred to costs of procedures and prescriptions that I wrote about above.  I’d obviously like to keep more of my money.  But it comes into play professionally, since I’m the executive director of a small nonprofit that faces ever-rising health care costs.  And finally, the policy wonk in me is keenly aware of health care costs, listening to the ongoing debate about the Affordable Care Act.  Experts tell us that obesity is one of the leading causes of health care problems, and, therefore, of health care spending.  I don’t want to contribute to that trend, so saving money on health care expenses is a definite motivator.

Who knows, maybe I’ll save enough to buy a new Michigan hockey jersey.

 

No Weigh, Jose!

I think I’m a pretty patient guy, most of the time.  Losing weight challenges that patience.  I can tell myself, “It didn’t come on all at once, so it’s not going off all at once,” but it doesn’t do much to make me more patient.

That’s why I weigh myself almost every day.  It’s important to me to see the progress as it happens.  It becomes even more important every time I approach a goal–whether it’s a 10-pound “landmark”, or one of the other goals I discussed in an earlier post.

That’s where I am now.  As I write this, I’m sitting at a 49-pound weight loss.  And that’s where I’ll be for at least a couple of weeks.  I’m sure my weight will change over that period, but I won’t be able to measure it, because of this:

My new fashion accessory for the next two weeks.

I had surgery today to remove a cyst in my ankle.  It’s one of my few recent encounters with the health care system that is not in some way related to my weight (more on that in a future post).  The surgeon instructed me to not put any weight on that leg for two weeks.

This gets in my way in so many ways.  Since I can’t put weight on it, I can’t stand on the scales.  Even if I could, the cast/splint thingy (note my expert use of medical terminology) adds a lot of weight, so the scales wouldn’t report my “true” weight.  It also limits my ability to exercise, which may slow down my actual progress.

If This Continues, We’ll Both Need New Jerseys

So I heard today that New Jersey Governor Chris Christie secretly had lap band surgery in February.  I’ve always felt kind of attached to him.  Maybe it’s primarily due to our similar sizes (it certainly has little to do with our political beliefs), or maybe it’s because he appears to have some personality traits that I like to think I have, or maybe it’s because I admired the way he handled the response to Hurricane Sandy and the storm of criticism he received from conservatives over his complimenting President Obama.

Whatever the reason, now that he has had the surgery and has begun losing weight, in my mind his weight loss and mine will always be linked.  Our situations match up in a lot of ways:

• Governor Christie is said to have weighed between 300 and 350 pounds before his surgery. I weighed between 300 and 350 pounds when I started my weight loss program.
• Governor Christie had his surgery in February 2013.  I began my weight loss in January 2013.
• Governor Christie had lap band surgery.  I’ve banned bags of potato chips from my lap.

• Governor Christie has lost approximately 40 pounds so far. I’ve lost 46 as of this morning (May 7, 2013).
• Governor Christie denies that his presidential aspirations motivated his weight loss. I can assure you that the possibility of running for president had absolutely no influence on my decision to lose weight.
• Governor  Christie revealed the details of his surgery in an interview that will air on NBC’s “Rock Center” this Friday.  I have a blog.
• Governor Christie is going to have to get a new fleece pullover with his name on it. I need a new belt.

OK, maybe our circumstances aren’t exactly alike.  However, I know that I’ll always view Chris Christie as my control group.  I’ll at least mentally compare our pace of weight loss.  I’ll be watching to see whether his weight comes back, and will also compare my ability to maintain my weight loss to his.  I’ll use him as additional motivation; I don’t want to fall too far behind what he’s able to do.  Who knows, I might even decide to run for Governor.

Mind Games 2: Do Re Mi and Other Scales

I weigh myself every day.  I weigh at least once, and on most days, multiple times.  I consider my weight first thing in the morning to be my “official” weight, since it’s the time of day when conditions are most consistent from one day to another.  I also log my daily results in My Fitness Pal.

Some weight loss experts advise against daily weigh-ins.  They say that while weight changes daily, there is often little correlation to the previous day’s behavior, so daily weigh-ins can lead to disappointments.  I understand that, and I often experience weigh-ins that don’t match my expectations.  When that happens, I usually realize that for whatever reason, my weight that day is an aberration, and usually my weight the next day seems to be more line with my expectations.

When my weight is higher than I expected, I dutifully log that weight, thinking that things will correct themselves the next day (of course, I do that only after re-weighing, then checking that weight, then going away for a few minutes to let the scales rest and think about what they’ve done to me, and weighing once more).  When my weight that morning is lower than expected, I sometimes decide not to record the actual reading, but my expected reading.  If, as I suspect, that morning’s weight is artificially low, I am afraid that the following day’s weigh-in will show a gain (though a net two-day loss).  A gain–any gain–is devastating, so I’ll fudge (the only fudge I can have) on my weight the first day to avoid a Day 2 disappointment.

Mind Games 1: Is This Going to Be on the Test? (Are You What You Eat or What You Say You Eat?)

I’m not a psychologist.  I don’t even play one on TV.  My only brush with psychology is the Psych 101 class that I took in college, and the graduate student who taught the class (the only class I ever had led by a grad student) pretty much made sure that I would have no further interest in psychology classes.

However, the deeper I get into this weight loss, the more I see that psychology comes into play.  Of course, I recognized that psychology was important in weight loss and built psychological elements into my plan (thus, the Social Network Weight Loss Experiment).  But I’m discovering all kinds of other mind games I’m playing.  Some are  positive: they’re tricks I play to keep myself on track.  Others are more sinister: I’ve noticed that they are ways that I almost unconsciously try to sabotage my progress.

What I’ve realized is that the challenge to weight loss is more psychological than physical or intellectual.  Most of us know what to do, and how to do it.  Cutting calories, reducing fat intake, and increasing activity are the key.  We all know that, and we’re all capable of doing that.  But we look for fads, new diets, and other shortcuts that are psychologically easier to handle.  Sure, there are diets and exercise programs that are based on scientific research that may accelerate weight loss, but even they require strict adherence to a program, ultimately depending on psychology to control the urge to stray from the plan.

I’m starting a new set of posts about the mind games that I find myself playing.  So, on to the first mind game.

Something I noticed on Weight Watchers, but have yet to experience on my current weight loss is what starts running through my mind when I’m logging what I’ve eaten. At some point in my Weight Watchers experience, logging my food intake became an obligation.  I viewed it as an assignment, similar to homework that I had to do when I was in school.  Even though I consciously knew that only I would ever see my food journal, I found myself keeping a journal that would look good if the teacher ever decided to inspect it.  There was always the temptation (which I’m sure I didn’t always resist) to log something different from what I actually ate.  The student in me wanted to focus more on getting the right answer than on actually being right.

The same thing is true for exercise, and it might be even more dangerous there.  On Weight Watchers, I didn’t regularly log exercise, even when I did exercise.  But I’m trying to do so now, using My Fitness Pal.  On Weight Watchers, I could earn extra points for physical activity.  I chose not to do so, because the descriptions of physical activity were vague enough that there were all kinds of opportunities for abuse.

Yes, it is going to be on the test–the test I take every morning.

The Topography of Girth®, Part 2: Why Pythagoras Didn’t Wear a Necktie*

*Which I explain in the nerdiest terms possible. 

I wear a tie to work nearly every day.  I go to a lot of meetings, some with little notice, and I would rather be overdressed in a tie than underdressed without one.

But there’s a problem.  Normal sized ties don’t really fit me appropriately, due to The Topography of Girth®**, as I’ll explain below.  To compensate, I’m faced with two less than optimal choices.  Either I can tie the tie really short, and end up looking like Oliver Hardy:

That’s another fine mess overeating has gotten me into!

or I can leave the tail short, and end up with this:

Note the cool Maize and Blue colors!

While this latter choice is preferable to the short tie (“You’re certainly right, Ollie!”), it’s not idea.  In order to have the tie look the right length, the tail ends up so short that it usually doesn’t tuck into the little sleeve on the back side of the big end of the tie.  With nothing to hold it in place, it doesn’t stay well hidden behind the wide part of the tie.

**OK, I know I’m using the ® symbol incorrectly, but I’m kind of proud of the phrase, and somehow adding the symbol seems to add an air of importance.  

Anyway, it’s all due to The Topography of Girth®: the unique geometry of the overweight man.  An engineer might say that there are three factors at work in the dynamic system of the necktie.***

***A good engineer wouldn’t say it.  But sounding like some kind of pseudo-engineer also seems to add an air of importance.

First, there’s the neck.  While the belly is the most noticeable place where fat accumulates, fat is an equal opportunity enlarger.  It ends up everywhere.  You’ve seen the evidence on my face.  The neck is not spared.  And it can have a very real difference on the length of my tie.

Assume, for example, that my extra weight results in a 1/4 inch layer of fat around my neck, which, viewed from above, would be roughly the shape of a circle.  Using the formula for calculating the circumference of a circle (C = 2πr, where r represents the radius of the circle), an additional 1/4 inch of radius results in a circumference that is 1.57 inches larger.  Since the tie goes completely around the neck, that much additional fat results in a tie that ends up more than an inch and a half shorter.

Second, there’s the phenomenon of the increasing hypotenuse.  For an overweight man, accommodating the belly means that more real estate must be covered from the neck to the top of the pants, which is the generally accepted ground that a tie should cover.  Allow Homer Simpson to explain:

The Geometry of Homer

For a man of normal weight, the tie goes roughly perpendicular to the ground, like line segment BC in the picture above.  Accommodating a large belly turns the tie into the hypotenuse of a right triangle to get to the same point above the ground (line segment AC).  Just as in a right triangle, the hypotenuse is the longest side of the triangle, so line segment AC is longer than line segment BC.  To cover that ground, I have to sacrifice length on the back end of the tie.

Finally, there’s the original phenomenon that I discussed when I first mentioned The Topography of Girth.  The target for the point of the tie got lower and lower as I got larger and larger.  To accommodate, I have to tie the tie longer and longer.  And, again, that means sacrificing length of the “tail” of the tie.

The inability to tuck the tail end of the tie into the sleeve/label on the back is the lesser of two evils, but is an evil nonetheless.  At best, I look sloppy when the “tail” is flopping all over the place independently of the “show” part of the tie.  So while it sounds minor, making my tie look better becomes another of the reasons for losing weight.

And it becomes a goal, as well.  And I’m already seeing signs of accomplishment.  It’s not consistent, or every day, or as completely, as I want, but sometimes, like this morning, I can actually tuck the tail of the tie into the little strap on the back.  Like this morning, for instance.

Two flaps! And it’s tucked into both! (Barely)