Where The Hell Have I Been?

Subtitle: I f’ed up.

Over the last 6 months, I have made 8 posts. 8 ÷ 6, carry the…

While I don’t need to explain this pitiful output and have ruminated about disclosure for the paucity of posts, I decided finally to out myself. Not that kind of outing. Anyone who reads more than one post knows I am out.

Also, everyone knows that I am a yo-yo’er. I have, however, maintained or lost weight consistently over the past 2+ years. Not this winter. My bingeing returned with a vengeance as my SAD ( Seasonal Affective Disorder) burst into major depression. So here comes the “outing” part. I have recurrent episodes of depression that are more significant than regular readers might have thought. The occasional mention of “my therapist” refers to the amazing woman who has been treating me for over 12 years with a myriad of meds and analysis. (Hey, she is the only one allowed to say that I have a form of bipolar illness. I don’t even get to say it.) No, I do not get manic – too bad because I could use a creative flair now and then. I have had episodes of hypomania that usually manifest as irritability (OK, more than usual), insomnia, and anxiety. One could call it Bipolar II – but we aren’t using the “B” word 🙂 I could provide history of my disorder and the amazing family history that snakes up both sides of the family tree. (It’s in the blood as the Amish say.) But that is boring and not the intent here.

Life had been smooth sailing until the end of December when I hit one of my lowest episodes in recent memory. No matter the cause – I like to blame it on my trials as a breast cancer surgery survivor – I tried to sooth myself with food. Even though it didn’t work, I kept trying and not writing and not weighing and gained almost 20 pounds.

Why should you care? Folks with depression and other forms of “more common and less severe” mental illness receive less support, acceptance, and tolerance from family and friends. My own wonderful partner called my lazy during this episode. I was suicidal.  People do not get treatment because of societal judgment of these common mental conditions that can lead to major bad outcomes.

Moral of the story: If you are depressed, get help. It is a major illness. Treatment is effective. Most of us are highly functioning members of society, even. If you know someone who is depressed, please be understanding, ask what you can do to support them. For god’s sake, don’t call them lazy.

With some tweaking of meds, support of my partner (who finally saw my distress), and other changes, I managed to stop bingeing and get back to monitoring. In one month, I lost 13 pounds eating on plan. Now it’s time to write again. Honestly, part of the reason for this post is to remind me that the next time I feel like bingeing, I need to check in with my brain AND my body.

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.

I Should Be…

Exercising. Writing. Walking the dogs. Cleaning the kitchen. Preparing for dinner.

Even my parents could never make me feel as guilty as I do about needing to do things. Interesting, now that I do not have a full-time, pressure-packed career that I feel more “shoulds” than ever. Perhaps it’s the seemingly sudden realization that I have missed an entire summer and the start of fall from surgeries. Maybe the disappointment of my return to being physically active is frustrating my body and mind. (Nothing like feeling sore after a 20-minute stroll to make one feel really old.) Hitting the wall the first day of NaNoWriMo was a stunner.

How hard can it be to write 1,700 words in a day when I can throw out 1,200 words per hour with writing prompts? Turns out pretty damn hard when your characters are too close to home; the situation you place them is leaking personal psychological overtones; you want to write more about buildings and the weather than the characters and plot. Writing stops being fun.

As if I had not revealed enough about myself in my 100th blog post, I have decided to do something I swore never to do and blog about a highly personal emotional issue. The reason? This is directly related to my weight/fat/body issues. It’s OK to stop reading, but I promise no history of severe mental illness is involved. No dark family secrets are lurking.

<Thirty minutes have passed.> I have difficulty identifying my emotional states, especially negative ones, and even more problems understanding why I feel the way that I do. Unlike some folks with this issue, I can empathize with others and describe what they are feeling. In fact, it’s part of what made me a good primary care doc. I could tell how they felt and reflect back to them my understanding. Ask me to do that for myself –  fuhgedaboutit. How does this relate to eating? For me it probably has been the largest contributor to my binge eating disorder and disconnection from my body. Unable to articulate and express feelings, I dealt with unpleasant (and probably pleasant) emotional states and the tension generated by compulsive overeating and eating to numb the sensations. Oh yeah, I developed all sorts of unusual body sensations (starting in my teens) that I knew were not explained by disease. Very frustrating later on as a doctor, having physical symptoms you know are not caused by physical illness. Throughout high school and college I threw myself into sports. The rougher, more intense and competitive, the higher chance of injury – the better. Looking back, these activities were a great distraction for my mind and body, which also helped store much calcium in my bones. 😉 Unfortunately, I did not continue athletic endeavors once medical school started and never caught a pathological love of running to quiet my body. Fortunately I did not develop other impulsive behaviors to numb myself – drugs, alcohol (close call there in medical school), cutting, perverse sexual activities, etc.

I do know that my difficulty with certain types of self-expression constrain my writing. Hey, I’m great at the technical stuff even though I rebel at structure. My sentence structure when attempting non-fiction limits my ability to connect with readers. Heaven forbid I try to write more imaginatively or delve into the feelings of a character that might touch on a sensitive (to me) topic. From a not-at-all famous line in a poem written to a high-school crush, “I can’t tell you how I feel because I don’t.”

Expressive writing, as described by James Pennebaker, is shown to improve many health outcomes, especially if negative emotions are included. Repression in one’s attempt to write expressively – not so good. I try to make expressive writing part of my writing practice. I should make it part of my daily writing practice or at least 3 times a week. Just like I should be walking every day now in addition to using the recumbent bike. Just like I should NOT have sampled Halloween candy just for grins. (It wasn’t very appealing, by the way, and only left me feeling, um, bad – I think. LOL)

I have refocused my NaNoWriMo novel so that it will be more fun. I am keeping the psychological bull in my personal journal. But, I thought there might be someone out there who would benefit by me “coming out” about my difficulty dealing with negative emotions and the impact on my body. Perhaps one person can benefit from knowing the toll it takes from holding back emotionally. That the impact can vary from preventing you from connecting with your body to being unable to connect authentically with others. If this sounds familiar, it isn’t hopeless, and you aren’t alone. Don’t try to go it alone.

Back to my starting line: How many “shoulds” are there in your mind right now?

The Grapes Of Anxiety

It doesn’t matter that I have a reason to be anxious – major surgery in 6 days to replace tissue expanders with silicone, repair symmastia (foobs have grown too close), remove chest wall excess skin, which is essentially some body sculpting required from the 138-pound weight loss. Sure, I am excited to get this part done, and of course there is the potential for complications (29% of breast cancer patients undergoing this type of reconstruction experience repeat surgery within 3 years). Also, I have a bit of pre-op dread, although much less than usual probably due to desensitization from 3 major surgeries in the past 2 years.

No matter, my anxiety levels are creeping up quickly. I feel a combination of paralysis – straining to do my usual activities – and hyper-awareness in body sensations, emotional sensitivity, inability to self-sooth, and just plain ol’ feeling out of control. I have taken as much control of the situation (surgery) as possible by close collaboration with my surgeon, having the same anesthesiologist who understands my tolerance for meds as well as my need to feel in control while feeling totally out of control. I kept my mouth shut (mostly) during a pre-op visit when the nurse insisted on repeating unnecessary blood tests and an ECG (just done 3 months ago!) but refused another chest x-ray. HEY! I don’t want to get cancer from unnecessary radiation! 😉

My loss of coping skills are most obvious by the total abandonment of my routines. Of course my toe boo-boo got in the way of walking, but I am not back on the stationary bike. My appetite is crummy, but I feel a need to eat. EEK! That hasn’t happened in quite a while. My solution has been to eat nearly frozen grapes. The sweet crunchiness of seedless red or black grapes seems to satisfy me without providing too many calories. It’s more the out of control feeling because I eat grapes when I’m not hungry. I just want some grapes. My concern is that next I will just want some ice cream. Then suddenly I will weigh 250 pounds – like last time. WOW. That is some catastrophic thinking. I haven’t stepped on the scale, but my smallest clothes are fitting just fine. I am monitoring my food intake, well, mostly…

Let’s face it – I’m just scared. Scared of surgery. Scared I might be slipping from healthy eating to the beginning of bingeing. Don’t cut me slack because I have this Stage 0 breast cancer that is essentially “cured” and only am facing continued reconstruction. Life goes on. There will always be obstacles that I need to face (death of parents, career snafus, family disruptions) and must learn to cope. Ups and downs are to be expected, but feeling this way, this threatened over what I have accomplished so far is not anything I expected.

There… all better. Not really. But at least it’s out in the open.

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

Mattie’s Melanoma

Sounds scary… and it is, but Mattie is “just” our 12-year old lab mix with whom we have shared our lives since she barely had her eyes open at the rescue shelter. One month ago during a routine visit, our astute primary care vet picked up a discoloration on her right iris. The differential diagnosis was very limited. By the time we managed to secure an appointment with the veterinary ophthalmologist post-vacation, anyone could see that her normally brown eye was distinctly black. The surgeon was certain that Mattie had melanoma, but she was reassuring most ocular melanomas in dogs behaved less aggressively than in humans in that metastases and local invasion were much less frequent, but her eye needed to be removed. Sad – we were all sad that Mattie would lose her eye even though she had lost most of her vision already. By the time she had surgery yesterday, her eye was already protruding, inflamed, and she had pronounced glaucoma. Thankfully, Mattie came through the surgery just fine, and we will pick her up later today to see her new perpetual wink.

Why write about this here? Well, it makes me amazingly sad to realize that Mattie won’t be around forever. (As if I haven’t had many other pets who have died.) That sadness, though, is about so much more. Both of my parents have health issues that limit them physically and are forcing me and my siblings to face up to the fact that they will not live forever or even much longer. (One might think a physician would be able to cope with the inevitability of death – nope, for me it’s a tad different when it comes to my family.) As I prepare to go spend 2 weeks with my family of origin, my anxiety is growing, and my eating is getting out of control for the first time in 8 months. Doesn’t matter that I’m not eating enough to gain weight. It matters tremendously that I cannot cope with my feelings other than returning to the cupboard to snack over and over and over and refuse to document what I am eating. Some things about my overeating are different. I am not eating fast foods. In fact, I took a drive the other night when I felt especially restless. I passed one McDonald’s, Taco Bell, Jack in the Box, Wendy’s, Carl Jr.’s, etc. after another, I was surprised at my disgust at the thought of eating such food. Soon as I got home it was another story – non-fat cottage cheese, an hour later non-fat yogurt, 30 minutes later a protein bar. Even my writing about this is disjointed…

So what am I doing to try to get back on track? I “came out” about my transgressions to my spouse (and here) and asked her to speak up if she saw me eating mindlessly. I made her promise for us to get back to eating our regular evening meal together  rather than just doing our own thing, which has been going on the past 4 days. I have recommitted to writing down every morsel that goes into my mouth. I boiled up a bunch of eggs and put the low-calorie protein shake (ick) on the counter to use in place of protein bars should I feel the absolute need to eat after dinner. I bought some new teas to make in the evening. This being southern Arizona, hot tea is not so grand this time of year, but the ritual of hot tea at night was a wonder for me this winter, so I’m going to try it again. My less painful knee will be taking more morning walks. I put my journals all over my usual haunts (even in the car) so that I can scribble what is going on in my brain when anxiety/restlessness hits.

For now, I’m waiting to hear what time we can pick up Miss Mattie. The house just isn’t the same.

black lab dog wearing sun glasses

Mattie in her glory days

Black lab lying on floor

Mattie at 5

old dog

Headed to vet yesterday