Relapse Is My Middle Name

Those who remember my technical blatherings about the Stages of Change Model describing how people voluntarily change behaviors know that I have tried to relate my journey from merely thinking about eating healthy, to seriously planning, to acting on the set of behaviors, and then integrating the mechanisms (processes) of change to help me keep going. (Fifty-word sentence, good grief.)

Relapse is one of the stages, and I am in it. “Don’t despair,” I tell myself because this is normal. There is always something to be learned from a setback. And, recycling to a later stage of change means not starting all over. I do not need to build motivation. I do need to re-establish my ability to shun certain trigger foods. Regain my self-efficacy/confidence. This is especially hard given that I have a binge eating disorder. Yep, depression, anxiety, PTSD, BED. One wonders how I ever functioned so successfully in academia. Here’s a secret. I almost ate myself to death. I gained 150-pounds and no one talked to me about it. If I had reeked of alcohol think someone might have initiated an intervention? Yep? Do I harbor some anger at those charged with my training during medical residency, those who supposedly valued behavioral sciences yet ignored my tremendous weight gain during my residency? You bet. Time to let that go.

I have returned to the world of the present by being open with my family about what has been going on. Sought support from key friends and loved ones. Agreed to not eat in private. Talked with my long distance shrink who is an incredible sounding board. Finally, I stepped into my tightest jeans and found they were almost too tight to wear. Reality check.

Losing weight and maintenance are difficult enough without adding a binge problem. I don’t expect sympathy. It’s a real disorder that I magically thought had disappeared. Nope.

Ever vigilant without obsessing is a fine line. I’m back in the saddle and wearing my tight jeans.

I Have No Excuse

For not blogging over the past 2 weeks. For not reading my blogging buddies’ posts. For not staying on plan. For bingeing last week. I apologize to myself and to my friends. I am in learning mode – breaking down what led up to the binges because it was more than lack of stimulus control. Fodder for another time.

Vacation was great! We spent a week in Florida for fun and family then a week in Dallas for family and fun. A cottage on the beach was our home for 4 days on lush little Sanibel Island off the southwest coast of Florida. We walked, watched a few shorebirds (very familiar from living on the Texas coast), wandered around refuges, ate at cafes, enjoyed the 80° temps and humidity, took silly pictures, picked up shells, dreamed of living on Hawaii. Then it was off to Orlando to surprise Sue’s parents.

Sanibel DQ Santa

Last year on their annual visit to Sue’s sister’s home in central Florida, the folks spent 2 hours looking for the rental car – sigh. So, we spent a night at the Orlando Airport Hyatt (nice for an airport hotel), shocked the hell out of the almost 86-year olds, brunched, then caravanned to, well, let me just say that rebel flags and NRA bumper stickers dominated the mobile home neighborhood. (OK, I call it Crackerville, but so do they.) I love Sue’s sister not just because she is family but also because she is sweet and funny and thrives despite a tough life. We visited with nieces and husbands and boyfriends and babies. Ate BBQ. Drank a lot of coffee then flew off to visit my side of the family.

My Dad had decorated the house so beautifully. It was grand to see him looking well and actually playing the piano. It was difficult to be in their home at Christmas without Mom. I had to go shopping at the Galleria. (Tucson is not known as a shopping mecca.) Ooh, shiny! I bought more bras at Nordstrom’s after spending time with a “surgical fitter.” Sue and I enjoyed my sibs and their spouses; visited the cemetery where I left an angel on Mom’s grave; had a glorious Christmas Eve Eve (yes) dinner with everyone plus my mom’s sister (who looks just like her, which made me cry), my uncle, a cousin, and her kids. We are long past gift-giving except for the occasional doo-dad. Being together is more than enough.

A huge plus was seeing Ann of Dr. Fatty Finds Fitness for a delightful lunch between her morning and afternoon patients. Put two physicians together who “met” over their weight loss blogs and what do they spend the majority of their time talking about? Medicine. I have no doubt that her patients love her because she is so easy to speak with and is passionate about quality health care. Those of you who read her blog know what a crazy schedule she has between her practice, family, and amazing exercise routine. Let me just add that to be able to focus on her own health and then share that experience with the world is amazing. She is amazing. If you don’t read her blog, please do!

Jan & Ann

So you might wonder where I went astray on my eating plan. At the quaint cafe on Sanibel? Confronting the numerous biscuits and gravy across the South? During some romantic dinner? While eating with family over mashed potatoes and gravy? No. I was fine for 12 days. Then. I. just. lost it. I continued to be out of control the first 2 days after returning home even though I felt like crap. I knew this could spiral into 2 weeks, 2 months, 2 years. It’s happened before. It won’t happen again. I refuse to be undone by my self. All or nothing is no longer my way of life. I’m working hard not to hate myself because that only tugs on the periphery, urging me want to eat again. Yep, I did eat to punish myself in the past. I won’t do it now. I’m in the present. It’s good to be home.

Things I Learned This Week

Reading good fiction is much more fun than writing bad fiction, but criticizing others’ work doesn’t help me write more (or better).

I love having my sweetie home on weekdays, but I really enjoy my private time.

Making an appointment with the dentist is easier now than scheduling a check-up with my primary care doctor. The last visit with her started a cascade of events that led to my breasts getting chopped off.

 

The older I get, the later in the season that I start playing Christmas music.

 

I would have been a very neurotic mother. Our omega dog, Lucy, had some teeth removed. We cried together driving home. She was in physical pain. I was in mental anguish hearing her cries.

 

The closer I get to goal weight, the farther away it seems. I think my body is screaming “maintenance – soon.”

I cannot escape my SAD (Seasonal Affective Disorder) by living in one of the sunniest cities in America. The > 350 days of sunshine just delays the onset and the severity.

Light box on my desk for the season

 

 

 

 

 

 

 

After so many years of not wearing nail polish because of work, I don’t care if amethyst shellac makes my hands look old. It’s fun and less frustrating than trying on clothes.

 

 

 

 

 

I am very thankful for my amazing family and bountiful life, but the holidays are harder after a loved one dies. Missing you mucho, Mom.

Returning to Normalcy

Suddenly I realize my life has gone from “pre-weight loss –> post-weight loss” or “pre-Mom’s death –> post-Mom’s death –> post-grief” to now “pre-breast cancer” –> “post-breast cancer surgeries & everything is supposed to be OK”. In other words, my world has been focused on my boobs or lack thereof for the past 4+ months, and now it is time to get along with living. However, I have another 2 months until I can fully return to vigorous activity, which is driving me bonkers. Heck, I can’t even ride the recumbent bike for another week or so. (No noob/foob bouncing.) Also, the chance of needing additional surgery is pretty darn high over the next 3 years (up to 50% with my symmastia – uniboob – that was repaired), thus the need for extra caution. Can you tell I’m still in recovery mode mentally?

Like many women, at least those who post on the Breastcancer.org forums, I am experiencing the end of treatment let down. Nothing to look forward to, or rather dread. Just waiting to heal and back to the usual hum-drum of life – almost. Perhaps it is the “almost” that is bugging me. Exercise had become an outlet for anxiety or restlessness and was certainly adding to my sense of well-being. Walking or biking indoors took me away from worries and helped connect my body to my mind. I was beginning to see definition in my legs. Now I feel like a slug. Gaining 3 pounds has not helped this bit of angst, but hey it isn’t 30 pounds, and I don’t weigh 300 pounds again. Good grief this is rambling. I’ll just say that not being able to exercise or even do little bits of housework (!) is driving me nuts.

What does a daughter of my mother do when she feels out of sorts? Go shopping! As you undoubtedly remember, I started using “barefoot shoes” back in March. That pair of Vibram FiveFingers KSO is great for trails, but the black gets a bit hot in Southern Arizona and I was wearing a men’s size, so the toes are too long for my infantile 5th digits. I was lusting for a new pair with a different tread. Without further adieu, here is my little splurge that I cannot enjoy for another week or so: Vibram Komodosport LS

Aren’t they pretty? Well, at least the color is pretty spiffy. (Ignore the swollen ankles. I’m still retaining fluid like a sponge since surgery.)

Do you ever use “shopping therapy”? Ever felt guilty about it?

Insert Title Here (Cause I’m at a loss)

Perhaps the last 20 pounds are the hardest. No, the first 20 pounds were. Wait, maintenance is – experience tells me so. No matter, something has been going on in my body-brain connection that has me stalled. Suddenly cupcakes look tasty. Processed food no longer is a turn-off. The drive to eat healthy is not driving me. Even my thoughts about eating are disheveled, chaotic, fragmented, manifesting in dreams.

I could blame this on my breast cancer (99.99% chance of cure from surgery in May) and the discomfort – fuck it – agony of reconstruction. I could recall all of the literature on sleep disturbance and how that messes with one’s existence, not to mention weight loss. I could blame my coping skills, realizing that my teeny-weenie anxiety disorder is off the wall now as I await the next surgery in 1 month. Or, I could give myself a break, realize that the past 4 months have indeed been sucky on me and Sue (who is starting to crumble also), that it’s OK to be fragile even if your partner thinks you shouldn’t be, and that I do have adequate coping skills that do not include eating protein bars – 3 at a time…

Exercise has become a relief. The 30-minutes on the indoor bike are a time to experiment with the digital output, play with my heart rate, see what activities make me go faster (music) and with less boredom. I can walk in the heat but pay the price in, um, chestal swelling. Walking is much more relaxing, uses more muscles, and is still my exercise of choice – just not at 5 a.m. Writing helps. The kind of writing that simply is free form then putting it away. Tracking my eating had become sporadic – I’m back to putting everything into Livestrong. How easy it is to slip on such an important behavior!  I now am more avoidant of political issues, which was only fueling my anxiety and deflecting my true emotions. (I can’t do anything about which moron is chosen in the Republican primary anyway.) Sue and I have agreed ways we can help each other with my eating (rather, not eating protein bars), dealing with my increased anxiety, and her tolerance, or lack thereof, of anything Jan , and acceptable methods for her to be more verbal about her needs. I have a serious goal for a certain waist size and optimal health for surgery because it is going to be another long recovery process for my new foobs. I expect this one to be less painful and for both of us to cope better.

I’m OK, really. I’m not. But I’m working on it.

Absence Is A Relief

The past 2 days I have struggled with a certain food sitting in our pantry. My first mistake was allowing an afternoon to hit when there was absolutely nothing in the house I could or would eat, having reached the tipping point with tuna. And then, for some reason not having the initiative to get out of the house to go buy groceries. The third mistake was allowing myself to eat a protein bar. I read the label 4 times, duly noting the high protein content and also that it contained cane sugar, beet sugar, oats – all of which drive up my sugar cravings. Three times I put the bar back into its box. The fourth time I savored every bite. Then counting up my calories, I ate another one. Yesterday I did the same thing – 2 bars, staying within my calories but now totally off my no sugar/grains and processed foods. My cravings were back. This morning I am disgusted by my behavior (not with me) and the physical sensation that I felt afterward, but those damn bars sit there. For months I had ignored them. The absence of sugar desire, lust, cravings had been such a relief for so long.

Last night I sat quietly in our living area after reading and abruptly noted a total absence of pain in my chest (post-mastectomy pain). I was afraid to move, to change my breathing, fearful the magic would be gone, or that I was dreaming. The relief was so enormous that I fell asleep for 3 hours in the early evening – sleeping without discomfort for the first time in over 2 months, sleep that I had never obtained with pain medications.

This morning as I try to sort through what caused my brief sugar attack and the wondrous bout of pain relief, I realize how the absence of symptoms or negative emotions (cravings, pain, grief, loneliness, fear) can be as uplifting as the feelings of self-control, joy, love, peace. Not that I want to establish a sense of nothingness – not at all! I am just reflecting on how the easing of any type of prolonged distress can be so soothing.

I will not let myself get into a situation where those protein bars call to me and am confident that I can regain my no added sugar diet immediately. Getting that no-pain thingy though – quite the mystery.

Funky Me

Wow, 18 days since my last post. Seems like a million…

Not much has been going on in the Old Pueblo (the traditional name for Tucson) or in my brain, unfortunately. Along with our summer thunderstorm season, I’ve hit a bit of a low pressure in my spirits and haven’t had the inclination to post or even write outside of blogging, which is probably when I need to do so the most.

Thanks tremendously for the caring e-mails and phone calls checking  on me.

Here’s an update. Breast cancer Stage 0 is a breeze – breast cancer surgery for some folks completely sucks. At least the reconstruction process is sucking. I continue to have constant discomfort from the tissue expanders that are meant to stretch a space under under my pectoralis major muscles for soft, comfortable silicone implants – in another 3 months! One more fill of saline tomorrow then waiting for the final surgery while the stretching and internal repairing continues. My body still doesn’t want to heal the incisions completely, and I remain confined to no vigorous activity, especially in the heat. HEY! I live in Southern Arizona. Guess I could become a mall walker – as if….

I think the lack of activity is contributing to my brain funk – that and my difficulty with sleep because of chronic discomfort (hard to call it pain when I don’t take any pain meds). Driving is unpleasant because the foobs mash into my arms when turning the steering wheel. Got a little rap for ya – use your best urban poet voice and repeat after me: I got tits in mah pits and drivin’ is fo shitz

Added to the reconstruction blues was the first anniversary of my mom’s death (how dare she die right before my birthday?). Maybe this little down turn in my spirits isn’t so hard to understand after all.

I continue to lose weight, but that doesn’t bring much satisfaction because I just don’t feel healthy sitting around most of the time except for stretching and brief walks. (Now down 134 pounds – 9 pounds lighter than at the time of surgery 2 months ago.)

So, that’s where I am, in limbo-land trying to regain my sense of humor, some hint of positivity, and a chance to be active again. Oh yeah, not feeling these foreign bodies inside my chest would be a huge (and I mean HUGE as in they are way too big) step toward feeling better.

How do you climb out of brain funks, assuming you have ever had one?

Special thanks to our chihuahua-terrible mix for allowing his most honorable visage to represent my current state of whatever.

Why Write…

As in “Writing To Wellness”?

A zillion posts ago I promised to explain why writing is beneficial to one’s health, and specifically for weight loss. Since the mid 1980′s, James Pennebaker has demonstrated repeatedly how expressive writing helps different types of people get past traumatic events – everything from grief to rape to losing a job. (Check out his website for a quick introduction on how to do this along with plenty of references.) Pennebaker has found actual biological markers of health improvement, along with objective evidence such as decreased visits for medical care (and I include finding re-employment to be a health benefit!) It is important to note that this type of writing is NOT journaling or goal setting but rather writing expressively about a stressful event. Most blogs, including mine, rarely include truly expressive writing – and for good reason given the open format of the Internet.

Perhaps because writing is so universal, and academicians are forced to write incessantly, other researchers began looking at different types of writing. Narrating one’s goals has been studied by many investigators who have found that delineating goals for one’s self in terms of performance (sound familiar, fellow bloggers?) improved future results and improved feelings of well-being and demonstrated health benefits.

Those of you familiar with Julia Cameron’s work on creative writing might know that she has published a book on writing as an adjunct to weight loss. So now the commercial appeal of writing for behavior change is kicking in. (I am not endorsing her book as I haven’t read it.)

Bottom line is this:

1. I know from my reading of high quality, psychology research that certain types of writing improve health. There is no doubt that brief, directed writing about stressful events works. (Please read Pennebaker’s website on how to do this. I also recommend his 2004 book Writing to Heal: A Guided Journal for Recovering from Trauma and Emotional Upheaval.)

2. Goal directed writing can help lead to successful behavior change and can improve health. I don’t have practical resources for the best ways to do this except to be as specific in your behavioral goals as possible Notice I did not say a weight loss goal or an exercise event goal – rather write the behaviors that will lead to your weight loss and your desired level of fitness. Hey, you might not make the Ironman lottery next year!

Now, I need to go do some expressive writing of my own about Mattie’s death. /cry

Emerging From a Fog

Since last I wrote, or visited the blogging community, or stayed on plan… Well, no excuses. My father’s visit was wonderful but distracting and challenging food-wise. He is a feeder – for real. Despite knowing my food plan and decades of yo-yo’ing, he would put candy (home-made fudge) on my desk, buy ice cream (ICE CREAM!) and continually offer me crap. I found that when we would go out to eat, I could easily stay within my food plan, but at home my stimulus control was gone. His presence just made it worse. We negotiated about putting candy in his bedroom, having him buy ice cream in small cups and hiding it in the freezer where I wouldn’t see it. But our joint grief over Mom (just 4 months fresh), and his need to conjure her through his cooking rituals made it impossible to tell him not to cook. I found the fudge and his midnight snacks irresistible. I wanted to strangle him.

Then a wondrous event occurred over the week of Thanksgiving. Our entire immediate family, one of Sue’s sisters, and Mom’s best friend and her husband gathered at our home for almost an entire week. That time was a warm cloud of love filling the house.  We cooked, ate, played games, sat around fires outside and inside, laughed, told jokes, remembered Mom – and my eating sweets was totally out of control.

Amazing how one year of new habits can be easily overthrown. I am beginning to believe there is a carbohydrate addiction…

My skinny Father now is back in Dallas, exactly 1 pound heavier. Although I “only” gained 4 pounds over the 2+ months, I have felt completely out of control with food and sleep; my mood is low (OK, grief-holidays, I get it); and I have been searching for help. Sue is completely off her food plan also and could care less.

In desperation, I joined Weight Watchers last week after reading about the new points plan based on scientific evidence with more emphasis on protein and fiber. WW is a huge change for me, but I’m trying this for 2 reasons. 1.) I want to get away from the severely restricted foods we have used the past year, and WW seems to have a lot of tools that will help me to (OMG) cook. 2.) I need more social support. I hate groups, but I want to try in-person as well as on-line WW. The monetary commitment is a pain but adds another incentive.

For now, it’s back to daily monitoring of food, walking to resume the modicum of fitness that I had, reconnecting with my blogging buddies, and going back to all of those behaviors around food that I so neatly laid out almost one year ago.

Thanksgiving Family Portrait

This Is Your Diet On Grief

OK, let me rephrase that… These are my diet/food/hunger experiences during the grieving of my mother’s death after leaving the family and friends.

• Forget to eat.  Breakfast and lunchtime are over? Oops.
• One severe episode of wanting to binge, and I mean binge as in consume whatever edible substance could be found. Fortunately nothing in the pantry or fridge was “binge-able”. In the past, I would not have let that stop me and would have gone questing for food – fast food or obscenely fat and sugar-laden grocery store items.
• Monitoring food intake via Livestrong.com (my go-to site) or even by hand – totally forgotten about. How could that habit be so quickly extinguished?
• Food cravings – none. Thankfully, I still don’t have my ice cream fetish, even during my binge fantasy. In fact, food just doesn’t taste much at all. During the immediate post-death period when we were all gathered at my parents’ home and food was in abundance, some food tasted great such chocolate chip cookies, Tex-Mex, my birthday cake. Did I mention Mom died 28 hours before my birthday?
• Summer Diet Buddies – sorry about the last 2 weeks of not checking in except to say that I wasn’t checking in
• Physical activity – as if
• Sleep – erratic

This is what I know that I should be doing now, which is to rely on my eating and physical activity plan as a structure to keep me grounded. So easily stated and written. Grief is what it is, however, and I can’t fight it. Sadness, poor sleep, ridiculous feelings of abandonment, a sense that the world will never be the same – I have zero control over those normal adult responses to the loss of a parent. I can, however, fight my tendency to bad self-care.

Starting last night, I resumed my food diary at Livestrong and checked in with Summer Diet Buddies. Today – breakfast, no; lunch, yes; plan in place to resume regularly scheduled meals. Tomorrow I am headed to the new gym that I found just before Mom died – a gym specifically targeted to folks over age 50, which means a lot of younger people go there also for the accepting atmosphere, good rates, great pool, and classes for every body type and level of fitness. I made an appointment with a podiatrist to get my foot examined for the bony growth on top that is causing my 4th and 5th toes to splay out. (This might not sound like much to some readers, but it has only taken 2 months to finally schedule – another self-care issue…)

I’ll try not to rag on and on about my grief work here (and the irrational thoughts that burst forth) but will up date how I’m doing re-establishing my diet health behaviors and will probably refer to my emotional state at times.

Sorrow makes us all children again – destroys all differences of intellect.  The wisest know nothing.  ~Ralph Waldo Emerson