Consult Scheduled

The nurse from Dr. T's office called yesterday.

He's reviewed my medical history, and my consult is scheduled for June 25th at the hospital. 

I'm so excited, and terrified, and nervous, and thrilled, and EMOTIONS.

---

Saw my therapist yesterday for the second time. I'm pretty sure she fell asleep a couple times. I think I need to find another psychologist. I've never seen one before, but I'm pretty sure they're supposed to ask questions and give feedback - not awkward silences and fall asleep.  I don't think this one is right for me- Nervous about breaking up with a doctor. But I'm a grown ass woman.

Tell 'em Bey!

comics

comics about weight loss surgery suck.

in general.

My husband and I own a small comic book store. Naturally I wanted to see if there was someone out there in comics addressing this subject. Other than gags or political cartoons, there's not much out there at all. I guess people are pretty touchy about WLS. Maybe this is an opportunity for me to finally write something interesting.

Anyway, the best thing I found was an old Natalie Dee piece that I'd completely forgotten about. (I love Natalie Dee!!! Read more of her stuff here.)

In other comics news, I've been mentoring a girl at my old high school who just finished her first graphic novel. It was 23 pages (which is a lot for a debut piece) and she did it as her senior project. My high school is a private college preparatory / boarding school - very intense academics and mountains of pressure. Her final presentation was this morning, and she asked me to come sit in on it.  For anything else, I wouldn't have gone back to that school looking like I do. But she worked so hard, and genuinely seemed want me there.

So I went. I got up early this morning, I put on makeup, picked the one semi-almost-professional outfit I have, and drove to the school that I went to for 12 years.

I forgot how polite and well mannered everyone at my school was expected to be. Like Stepford Teenagers. After UVA and going to class in sweatpants, it was a little surreal to be back in a school with really high expectations of student conduct and appearance. No chubby students. Everyone must participate in athletics and extracurriculars.

And then I remembered looking at some old photos of me in high school. At the time I thought I was fat and ugly and nerdy. But what I see today in those old photos is a very lovely girl, normal sized but tall, and trying her best.

To go back there today, weighing 300lbs and looking like a hot pink mess, was awful and oddly liberating. A total "fuck it" moment - I'm here as a successful person with expertise in something.

And then an former teacher of mine came into the room, and I went from proud adult mentor to shameful fat failure in 0.0003 seconds. She looked exactly the same as when I was in school over ten years ago. Young, pretty, thin - the math teacher - the focus of at least 40% of the boys locker room talk. I wanted to curl into a shame-ball.

But I didn't. Instead I met my mentee's mother, gave them both a hug after the presentation, took photos with them, chatted politely with some of her students, and tried not to be as awkward as I felt.

Today's Recommended Research Resource

Bariatric Pal - great resource for first hand accounts, and lots of post op patients who are happy to answer questions. Very active community convieniently . I have learned a lot from them. There are no stupid questions. You can ask them anything WLS related- including stuff about sex and farting.... Gotta love any community where a post titled "5 days post op, diarrhea." has 125 views and 4 replies.
-  My only caveat is - there are some people who've had terrifying complications. The thing to remember is they are few and far between. I just have to keep reminding myself of that when I read some of the stories.

Feel free to friend me on Bariatric Pal.

Weird Fear

I have these runaway nightmare thoughts about what will happen if I get the surgery and my eating doesn't stop. Will I shove food into my body, cram it into a tight space, until it has no where to go except burst the staples? Will I die like that woman who filled her esophagus with food until she suffocated?

Thankfully it appears those fears are largely irrational.

Here's a great post by Gourmind:

I just attended another fabulous conference, The 24th Annual International Conference on Practical Approaches to the Treatment of Obesity. I learned a lot about new surgical techniques and heard an intriguing new way to understand the honeymoon period after gastric bypass. I'll write about that when I have an article to discuss.Today we turn to the experience of hunger. During the first 12-24 months after gastric bypass, most patients report a drastic change in their experiences of hunger and taste. And they are usually totally surprised and delighted. Someone suddenly prefers yogurt to chocolate. Another can be satisfied with one bite of a piece of cheesecake and literally throw the rest away. Someone else enjoys vegetables for the first time in her life.Researchers at the Interdisciplinary Obesity Center in Rorschach, Switzerland (I swear, that is not a joke, here's the link:http://www.kssg.ch) wanted to investigate hedonic hunger before and after gastric bypass and in non-obese controls. By hedonic hunger we mean the drive to eat palatable foods in the absence of energy need. (Think hedonism, the desire for pleasure.)So, hedonic hunger might include emotional eating, cravings for certain foods even after eating a meal, and that gnawing need forsomething even when we're not hungry. Before you start cursing human biology for this drive to eat in the absence of the need for calories, let's see if this drive might be adaptive. By adaptive I mean, did it serve an evolutionary purpose? Did a behavior or a physiological response increase an individual's or a species' chance of survival?I think so. Let's consider a college dorm. I used to use this example with my intro psych students all the time in a discussion of motivation. Let's say you just ate dinner and are comfortably full, about to hit the books for the night. A friend sticks his head in your room and asks if you want in on a pizza. "No, thanks," you say, "I just ate." And you dutifully open your books.Half an hour later the pizza arrives and the aromas of bubbly cheese, meat and fresh dough permeate the corridor. You are still not hungry but that smell is absolutely unavoidable! Before you know it, you are eating a piece of pizza. And you do feel some hunger and it does taste great. Your appetite changed in response to the environment.Now replay this vignette about 100,000 years ago when one's appetite needed to adjust itself in response to food in the environment. Let's say you are not especially hungry, but the smell of fresh-killed meat wafts its way to you. It was adaptive for you to generate some hunger and eat because you never knew where your next meal was coming from.Of course, in 2010, an excess of hedonic hunger can contribute to obesity. Food is so readily available that we do not need to adjust our hunger in response to the environment. But try retraining the primitive parts of your brain to eat only when they are hungry and let me know how that works out!So, the study. The researchers used an instrument called the Power of Food Scale (PFS) that measures one's mental experience of and preoccupation with food overall and in 3 contexts: when food is available, when food is present, and when food is tasted.Here's a taste (couldn't resist) of some of the items:      I find myself thinking about food even when I'm not physically hungry.
      When I know a delicious food is available, I can't help myself
      from thinking about having some.
      When I'm in a situation where delicious foods are present
      but I have to wait to eat them, it is very difficult for me to wait.
      When I taste a favorite food, I feel intense pleasure.
They had 3 groups of participants: patients preparing for bariatric surgery, patients who had had gastric bypass at least 1 year ago, and non-obese controls. The results are in line with the researchers' hypotheses that hedonic hunger decreases after gastric bypass:For the total PFS score, the Food Available subscore, and the Food Present subscore, post-bypass patients did not differ from the non-obese controls, and the pre-bypass patients reported significantly higher ratings. Further, the post-bypass patients reported significantly lower on the Food Tasted subscore than both other groups.So, how does this contribute to our understanding of the gastric bypass honeymoon period? These results show a difference in the post-bypass patients' mental experience of and preoccupation with food, bringing them in line with non-obese controls. The quantitative results of the PFS support the qualitative reports of patients in that first year after surgery.Two points come to mind, one regarding future research and one regarding an overarching theory. One drawback of this study is that it is cross-sectional. This simply means that the pre-surgery group and the post-surgery group were different people. A more powerful design is a longitudinal approach, in which the same individuals are evaluated before and after surgery. An even more interesting study would be a longer longitudinal approach, to track the mental power of food through the first few years after surgery and gain greater insight into the gastric bypass honeymoon period.Regarding theory, I can't help but think of one of the diagnostic criteria for substance dependence:      a great deal of time is spent in activities necessary to obtain
      the substance, use the substance, or recover from its effects.
The mental effort dedicated to planning, obtaining, consuming, and enjoying the effects of an addictive drug can become ritualized, with favorite settings, companions, utensils, and other environmental factors necessary for the full experience of the substance. Might the preoccupation with obtaining food, preparing food, sometimes sneaking food, consuming food and recovering from its effects be considered in the same light? I'm not saying I think all food is addictive (see previous posts) but there does seem to be a similarity in the mental experience of those who struggle with both food and addictive drugs.

*phew!*
It looks like other people have been concerned about this same issue - without the graphic imagination.

Photos

So here we go.

As of today I weigh 303.2 pounds. I'm 5'8" tall, which puts my BMI at roughly 46. (Yes. BMI is not super reliable, but it is one of the metrics they use to determine your eligibility for bariatric surgery.)

2 weeks ago at Toronto Comic Arts Festival

A month ago I decided to pursue bariatric surgery - specifically RNY Gastric Bypass. It's statistically the most effective treatment, with better and more long term weight loss results than lapband or the sleeve. I also have more than 150lbs to lose, so the choice is pretty clear between the surgeries.

The decision to have the surgery was not easy.

The idea of voluntarily cutting my body seemed utterly deranged to me for a long time. I'm terrified of general anesthesia. There is a pretty good risk of complications, and a statistically significant risk of death both during and after the procedure.

But is my fear of death stronger than my desire to live a fulfilling life?

Complaints:
My chest aches and I'm sure my heart is creaking under all this weight. I don't think 29 year olds are supposed to feel this way. I'm tired of my all consuming obsession with food. Having a child seems inconcievable (hah.) with all this weight. A dangerous pregnancy followed by a miserable obese motherhood?

I want to take control back. I want to have a casual relationship with food. I want to be able to have a kid in the next few years.

Gastric bypass is not a miracle cure. It's a tool.  I like to think of it as an opportunity to turn my body into an ally, rather than an obstacle. But the source of my eating is found in my head, not just my stomach - so like a 5 star general, I'm attacking my obesity for the first time from 4 different directions.

One on One Therapy
I've started seeing a psychologist for the first time ever. My first appointment was yesterday and it was... tumultuous. I came home and sloppily cried for a half-hour while trying to clean the house. Then I ate a piece of chocolate cake and felt a little better. Emotions=Eating. That relationship has never been more clear to me than now.

Nutritionist
Haven't made my appointment yet, but this nutritionist works with my therapist on a regular basis - consulting with patients who have eating disorders. I'll call her this afternoon.

Group Therapy & Support Groups
So far I've had two experiences with group work.
About a year ago I went to an OA meeting. It was not for me. I bought the AA book, and I still read it from time to time - but I just can't give myself over to a "higher power." There's too much groupthink and psuedoreligious stuff going on, that my brain just goes "NOPE - this is stupid." and then I eat cake.

A couple weeks ago, I had the opportunity to sit in on a support group for people who'd had bariatric surgery. Some were recent patients still struggling with week 4 diets. A few had done the procedure years ago and were successfully keeping the weight off or openly discussing their troubles with it. Every person had a different experience, but it seemed that everyone shared this opinion: Despite all the pain, the discomfort, the complications, and the new complexity in their lives - bariatric surgery had changed them for the better. Sadly that Bariatric Surgery support group only meets once a month, but I'm going to go to every meeting I can before and after my surgery.

Group therapy is also offered through my psychologist's practice, but it's a general anxiety, depression, & mixed bag of psychotherapy stuff. Not particularly intended for eating disorders. I'm going to give it a shot next week.

Surgery
I've gone to the seminar required by all perspective patients at the bariatric surgery center. They have my information and I'm waiting for them to call back to schedule my consultation. At the seminar the doctor told us that he refuses to perform the surgery on anyone who uses any nicotine products whatsoever. I quit smoking cold turkey the next day. I am eager for my consultation!

And the good stuff: PHOTOS!

My wedding Spring 2013 - I got myself down to 260 in time for my vows. 

Wearing a size 22/24 wedding dress. I'm 40lbs heavier, just a year later.

2012 - Roughly started the year at 280 and worked my way down to 260 with diet and exercise. Back up to 270 before we moved.

Culinary School 2009 - Oh to be 230-240 again!

College 2003 - Probably 170lbs. This photo is from Halloween my sophmore year, when I was going clubbing 3 nights a week  and felt the sexiest and most confident I've ever felt in my life. My struggles with weight gain started the next year when I ballooned over 200lbs in just 8 months. 

When I started college, I weighed 160lbs. My BMI was 24 and I was convinced I was obese. It's amazing the kind of warped things your mind can do.

Sticks and Stones

I'm fat.

It's okay. I can say "fat." I can even say it out loud. In front of other people.

I started saying it two years ago. Before that, when other people used to say, "You're not that big," it made me feel all flushed and angry. My IQ is 147, and I own a mirror. You don't have to do me the favor of pretending I'm not fat. 

Nobody says that anymore - not since I passed the 300lb mark. They just made those sounds ("tch" "wep" or "naaah") that people make when they don't want to lie unconvincingly. Now I feel like I have to pro-actively declare my fatness - just to spare friends and strangers the agony of figuring out what to say when I can't fit in a restaurant booth, when I broke that chair, when I get winded from a short walk, when I have the audacity to have a normal sized husband.

Most people are decent human beings. Not terrific, not saints - but decent enough that they're not pointing and staring at the fat woman.

Many people are amazing and accepting without reservations.
My husband is one of them.

A small minority of people are total fucking assholes.
That group of teenagers who started laughing and singing "all that junk inside that trunk" when I passed them on the sidewalk. Assholes. Their parents walking behind them who joined in? Double-Assholes.

---

The purpose of this post is not to make any statement about fat shaming, body positivity, adipositivity, or any tumblr buzzwords. I just want to make it clear that I am conscious of my size. I know what other people think about it (good and bad). It would be disingenuous for me to say that I don't care about what other people think. I do care. Whether or not people are assholes - I don't want to be laughed at.