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Wednesday, 18 November 2009
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Enough...what?
It's 3 a.m. and I've been up for over an hour, again.
My stomach is upset. Could be a bug, or food poisoning. Or not. Hard to say.
I've been mulling over a conversation I had yesterday with a coworker, someone I like and care about.
I'll say that if you don't want to read about someone losing weight, you could stop reading this now.
Coworker: "You've lost more weight."
Me: "No, I haven't."
Coworker: "You look great."
Me: "Thanks. This is enough. I'm not planning on losing any more."
Coworker: Nod of support.
I don't know what it is, exactly, because there have been so many changes in my life in the past few months that changes in weight seem minor in some ways, major in others.
I found it interesting that "coming out" about losing some weight, but not "all" the weight that someone else might regard as "excess" is radical in its own way.
I started this path when I first was having some symptoms of sleep apnea. When talking with Dr. Scary Smart (my endocrinologist) about 9 months ago, he suggested a particular prescription medication. "Your insurance won't cover it, but it's generic, so you'll be spending around $40 a month, and you might expect to lose about 20 pounds. Once you stop taking it, the weight would come back. We're talking about $200 for a 20 pound weight loss that isn't permanent. Do you think it's worth it?"
At the time, I scoffed at the idea.
That was before I started feeling like I was exhausted even after 8 hours of sleep.
A long time ago, I did use a CPAP machine for a short time. I hated it. These days, I'm mostly the only person at night with my SuperHeroPrincess, and I often crawl into her queen-sized bed to comfort her back to sleep in the middle of the night (she's only slept through the night a handful of times in her nearly 5 years). A machine I was attached to wouldn't work for me at the moment. I would use a machine to help me breathe while I sleep if I needed to -- but I wanted to explore other options.
I came down to this other option -- figuring out a way to be just enough smaller to avoid the symptoms I was experiencing. I don't have any expectation that anyone else in the entire world would have an alieviation of symptoms of sleep apnea if they lost weight, I just knew for me that there was this threshold that I had crossed, that when I was on the other side of, I didn't have those symptoms. So for me, treating the sleep apnea meant doing something to be just smaller enough to be able to sleep comfortably on my stomach.
I saw an ear, nose and throat specialist who thought that I wouldn't benefit from surgery. I asked her if she thought losing weight would help. "Maybe," she said.
So I went back to the endocrinologist. "Yes, I want to try the stupid medication." Okay, maybe I didn't say "stupid." But he was okay with it, provided I kept an eye on my (usually exceptionally normal) blood pressure. And so far, my blood pressure has remained okay. I also started on an antidepressant at the same time, one that in the past has led me to lose a small amount of weight when I was on it for a short period of time to treat an increase in my normally low-level but consistent depression.
I'm not having the sleep apnea symptoms now. But I have insomnia from the medication. And a few other side effects. If I stop taking the medication, the weight and the sleep apnea are likely to come back. If I continue on the medication (provided my doctors feel okay letting me continue), I'll likely still have the insomnia and other side effects (so far, higher-than-normal blood pressure isn't among them).
What I don't feel a need to do is to lose more weight. This is enough. I got what I came for. I'm still fat. I'm still me. I will still be me if I stop the medication and regain weight. I don't know if the point I'm at now is "natural" for me -- it's 45 pounds less than my highest weight, 20 pounds less than where I started a few months back, and about 20 pounds more than the least I've weighed as an adult. Is it sustainable? I don't know. Is it uncomfortable to be at this weight? No.
I don't know how long my regular doctor, Doc Thoughtful, will be comfortable with me staying on this medication. Funny how he was sort of propritary about me, and I have pretty much stopped seeing Dr. Scary Smart and returned to seeing Doc Thoughtful for my diabetes checks, and I'll be seeing him again in a couple of weeks. So, we'll see what happens then. In the meantime, I'll be awake.
Thursday, 03 September 2009
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Book review: The Princess Knight
This is my first ever book review of a children's book. It's also a long mommy blogging-ish post, so feel free to skip it unless you are interested in how this fat feminist is parenting her SuperHeroPrincess.
Last week, I arrived at the library with SuperHeroPrincess in tow just before closing, trying to find a book about Mexico for 4-year-olds. Harder than it sounds. As I was looking for the books (with the help of the awesome librarian), SHP was playing on the computer (or most of the time, waiting for her turn to play on the computer). Just as we were leaving, she announces that she wants a book about princesses, and I don't have time to do a search, so I scour the shelves looking for something suitable. She settles on a book with a sparkly T-Rex on the cover about a quartet of dinosaurs who go trick-or-treating, and I find The Princess Knight, by Cornelia Funke and illustrated by Kerstin Meyer.
I settle in to read it to SHP while she is in bed, after the T-Rex who trick-or-treats, and find that I love it. SHP is interested, to be sure, but I'm reading it to see what happens next.
By about page 3, the queen dies. Usually, I'm not keen on stories in which this happens, but SHP has already been exposed to her share of stories when the queen dies (Snow White, Cinderella), and in the books we've read where this happens, it's glossed over, and on we go with the story.
In The Princess Knight, the king is draped over the pale queen's body, a nursemaid holding the tiny baby girl. It's a sad picture, to be sure, and it has prompted questions. But I think these are important questions. She's asked before about the queen in Snow White, but the illustration here prompted more in-depth questions.
SHP hasn't yet been exposed to death personally, the closest she's come in real life is hearing about the death of a neighbor's grandfather. But she does read about death, and pretend to kill and die when she is engaged in play, and I think it's time she began to understand a bit more about this.
When she asked why the queen died, what I said was, it used to be that when babies were born, sometimes their mother died, but this hardly ever happens any more.
"Why?"
"Because we have midwives and doctors and better care for moms when they are pregnant."
I didn't go into how in some contries, there are still many moms who die when their babies are born. I did remind her that it's not what happened when she was born.
She asked about the king being sad, and I told her that the king missed his wife, the queen.
"Why?"
"Well, when a person dies, they aren't in their body anymore."
Lucky for me (because I was very tired in that moment), she didn't ask the next logical question, which is, "where do they go when they aren't in their body anymore?"
I do have an answer for when that question comes up about my belief about it*. I have no idea if the answer I give will suffice. I'm sure it will need to change as she grows older, and I will definitely want to hear what she thinks about it.
But the first answer was sinking in a bit. Hard to understand, definitely.
We have an aging dog, who I think I have mentioned before, is the best dog in the whole wide world. Sure, you might know a really good dog, and I have known some really good dogs, but our Madamoiselle Marble Rye (not her real name) is the best dog I've ever known. She's 12, past the usual lifespan for her breed, and although deaf, with hypothyroidism she's had since she was about 5 years old, and some hip pain, she recovered from some non-life-threatening surgery not long ago and is frisky and loving and so great. When we lose her, and she isn't in her body anymore, we will all be extremely sad, and miss her so much. (Yes, I'm crying now.) That's when death will be real for SHP. I hope that it's a long time before anyone else close to her dies. But I do want her to know that when she pretends to be dead (a la Sleeping Beauty) she can also pretend to be kissed back to life by a mom, a dad, or a stand-in prince, but that's not what death really is.
There's a part of me that doesn't like violent play, that includes killing (usually "killing bad guys") but I also know that bad guys (and bad girls) exist, and that I want her to know that if she is attacked, attacking back is an appropriate response (in a proportionate way). We don't own guns. But in The Princess Knight, the king raises his daughter the same way he has raised his sons, to be a knight, and although she struggles to mount a large horse in heavy, outsized armor, she learns to dodge and fight and parry and joust (I'm probably using all of the wrong words here) and she is able to defeat her brothers. I won't tell you what happens in later part of the book, but suffice it to say, there is an ending that SHP and I were both happy with.
After we read it for the third time, SHP asked if we could get her a sword. Several boys in the neighborhood just a bit older than her have play swords and shields, wooden ones. She sees them playing, and has played at being the princess while they are the knights. I'm not really into weaponry, but I'm thinking of maybe locating a nice wooden sword and shield kit. Good for upper body strength. Maybe we need two, so her dad and I can play with her (or at least an extra shield). We could also go to a RenFair -- (I'll have to see where the nearest one is to us) -- both she and her dad would enjoy it.
I've been thinking a lot about her playing at being a princess, and what it means. She wore her Sleeping Beauty costume (just the dress, not the tiara and heels, thankfully) to the park last night to play, and she did attract a fair amount of attention from other kids she didn't know, and immediately got cast in the role of princess in their play. It's an identity she can slip into. She's never had a blankie, or a pacifier, or another loved object, but she has shown attachment to items of clothing from time to time, such as a favored fuzzy jacket (luckily, living in the Pacific Northwest, it was rarely too warm for her to wear it). These days, she's starting to understand that she has "dress-up dresses" and "school dresses" -- and that she can't wear the "dress-up dresses" to her new preschool.
I think that what it means to be a princess is to be a daughter growing up with privilege, and inheriting some amount of power from that privilege, and learning how to manage that power. SHP is, as strangers tell her, beautiful. She is also small for her age, strong for her size, has more than everything she needs, is surrounded by loving adults and a caring community. Even thus far, it hasn't been a pristine path for her, but in many, many ways, she is privileged. And I want her to understand that with power comes responsibility (and not just Spiderman gummy candies). She is at least equal parts SuperHero and Princess. She likes to lead. She could stand to learn more grace, to share her gifts more (I know there is time), and to use her power for good, and not evil. She is mortal, divine, human, magical, special and ordinary. I often feel like I can't get enough of her. When people told me a few months ago that "this was a fun age" I nodded but thought, "Fun?!? Exhausting!" but now I see what they mean. It is fun to be around her, her silliness, wildness, limitlessness, expansiveness.
She could use a sword AND a shield. And a princess dress to wear under her armor. Maybe we can glue a tiara to a safety helmet for her?
* Here's what I think I'll say: When people die, they aren't in their bodies anymore. They can't move, or talk, or do the things we usually do. But they aren't gone altogether. We carry them with us. In our memories, in our thoughts, and in our bodies. We are all made up of the same stuff -- stuff that a long time ago came from stars. And the stuff from those stars made up the earth, and sun, and moon, and planets. And the earth was just right for the stuff to come together to make the first plants, and animals, and dinosaurs, and mammals, and eventually, over a really, really long time, people. And when each of those plants and animals and dinosaurs and mammals and people died, their bodies went back into the earth, which then became soil for more plants to grow, and animals to eat those plants, and people to eat plants and animals, and everybody gets recycled that way. But our thoughts, and how we treat each other, and how we love each other, that lives on in how other people think, and feel, and live. Okay, now I'm crying again.
Tuesday, 01 September 2009
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Between a rock and a hungry place
I'm up at 4 a.m. and I just had a bowl of raisin bran with 1% lactose-free milk (organic).
Why?
I was hungry.
I am hungry. I have been hungry. By all estimations, I'm likely to continue to be hungry.
I ate pretty normally for me yesterday, in the sense of what I do when I'm not completely overwhelmed and I plan well. Plenty of fresh fruits (including freshly picked blackberries from my friend's farm-like property) and vegetables (including yummy small carrots from the farmer's market, tender, crisp, sweet and a little peppery, very unlike the ones that come in little finger-sized chunks in the plastic bag at the supermarket). Mr. Rounded made dinner -- chicken in a mild fresh tomato, yellow and green bean and potato curry with brown rice. Breakfast*, lunch, dinner, with snacks in between. So why was I hungry at 4 a.m.?
Maybe hunger isn't something I can prevent.
I ran across this at work yesterday while reading a Medscape (requires registration) article on "Polycystic Ovary Syndrome, Obesity and Reproductive Implications: Hyperandrogenism and Insulin Resistance" by Swedish physician and researcher Angelica Linden Hirschberg, MD, PhD, and nearly dropped my spoon:Many women with PCOS suffer from a craving for sweets, a reduced feeling of satiety and a tendency toward binge-eating.[33] We have demonstrated that women with PCOS have reduced meal-related secretion of the gastrointestinal 'satiety peptide', cholecystokinin, compared with BMI-matched controls.[34] Furthermore, patients with PCOS display dys-regulation of ghrelin, a hormone secreted from the gastric mucosa, which stimulates hunger and food intake.[35] Thus, there is evidence of disturbed appetite regulation in patients with PCOS, which, together with the characteristic endocrine/metabolic abnormalities, may explain why these women have to struggle to maintain normal bodyweight. Increased appetite in patients with PCOS may be part of an anabolic constitution that predisposes an individual to obesity and insulin resistance. It seems likely that this constitution, probably of genetic nature, provides evolutionary advantages in times of nutrition shortages. Furthermore, we have demonstrated that the constitution of women with PCOS may be an advantage for physical performance.[36] However, in times of unlimited food supplies it may, together with a sedentary lifestyle, lead to the development of obesity and reproductive failure.
I really like the part where they've "demonstrated that the constitution of women with PCOS** may be an advantage for physical performance." Now, if only I could become a full-time endurance athlete in training... (this article also stated that exercise alone had a similar treatment effect as losing weight through dieting.)
But, it does really back up the feeling I've had most of my life that I'm really hungry. Hungrier than my life circumstances would lead me to expect to feel. Hungrier than other women of the same height and physical activity levels. Compounded with other things, I think this is about as close to an explanation for "why I am fat" as I'll ever get. Not an excuse, and not that I need to explain myself, but it does explain to me why I experience the world as it relates to food and hunger the way I do.
So, armed with the compassionate (if still weight-loss focused) perspective of Angelica Linden Hirschberg, MD, PhD, what do I do with this knowledge?
I don't rightly know.
I know that if I eat as much as I'm hungry for in a casual way, without some planning, I gain weight. Gaining weight isn't bad, per se, but for me, it gets me into a place where my blood sugar is harder to manage, I don't sleep well, and since life is cruel this way, I feel hungrier and more tired. If I eat in a way that is geared toward allowing me to feel satisfied and stay about a half step ahead of my hunger, I can basically manage to stay where I am. Where I am is okay... but I do have a "grass is greener" maybe a little less weight would bring my blood sugars down a tad more to where I was having a beautiful little reading on my blood sugar meter each morning without having to add in any other medications to manage diabetes.
And, how is this not dieting?
Right now, I'm focused on experimenting. What can I do to be treating myself in a loving, caring way, with all of the demands of life swirling around me, to provide my body with what it needs in a proactive way?
In the meantime, I'm going to try to not be annoyed when I feel hungry. I'm instead going to remind myself that it's my "constitution." It's how I'm made. It's not all bad. It mostly just is.
* Dairy yogurt gives me a very bad tummy ache (even though it's supposed to be lactose free). But lately, I've been eating soy yogurt at breakfast. As a result, I feel so much more feminine.
** I was told I had PCOS when I was 20 years old.
Tuesday, 25 August 2009
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A different take on workplace wellness
Jon Robison, PhD, MS, will be offering a workshop and closing presentation at the Healthy Worksite Summit in Bellevue, Washington, on October 8, 2009. The workshop is titled "Weight Loss at The Workplace: A Smart Investment in Tough Economic times…or Money Down The Toilet?" He's also presenting the next day at the Summit in Spokane, Washington.
Visit his website for other upcoming events where Dr. Robison will be presenting. -
Hip news
First, I don't know what happened that made a bunch of my posts show up on the Fatosphere feed -- I swear, I did nothing to make it happen. It's happened before. I'm sorry.
My hips (or the muscles around them) have been hurting for a while now, and I'm not sure why. Too much sashaying, perhaps? But, aside from my own hips, there's news about hip fractures in The New York Times, and the news is good. The Fatosphere's favorite science and health reporter, Gina Kolata, reports in Hip Fracture Rates Drop; Reasons Are Unclear that "Drugs that slow the rate of bone loss may be part of the reason, but they cannot be the entire explanation, osteoporosis researchers say. And although experts can point to other possible factors — like fall prevention efforts and a heavier population — the falling rates remain a medical mystery."
My first thought, when I saw the headline was, heavier population! But it may not be heaviness, per se, but fewer thin and frail elderly."In the United States, said Katherine Flegal [why do I get excited when I see Katherine Flegal's name?] of the National Center for Health Statistics, there are fewer thin old people than there used to be. She provided data on people 70 and older with body mass indexes of less than 22, meaning that their weight in relation to height was near or below the midpoint of the range considered “normal weight.” The percentage of men in that category was 14.6 percent in the years 1988 to 1994. In 2005-2006, it dropped to 10 percent. Among women, the percentage fell to 15.7 from 20.6."An unintended consequence of a better nourished and less thin population may be that there is less bone loss, and stronger bones from the get-go. And this is good. Kolata writes "Hip fractures often are the start of a downward spiral for elderly people, leading to a loss of mobility, a nursing home and other fractures."
So, Katherine Flegal has the data on people 70 and older with body mass indexes of less than 22. Maybe she could report all the BMI category breakdowns for that age group, so we could have something to link to when the trolls claim there are no old fat people.
Not everyone can maintain a BMI of 22 or higher as they age, so for those at risk of hip fractures, fall prevention measures, medications to slow bone loss, and strength training can reduce the risk.
wellroundedtype2
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- Name: WellRoundedType2
- Gender: Female
- Member Since: 9/22/2007
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