So I've been through the first few chapters of the Beck book and three days of CBT exercises

And apparently, in March, since I started it, I have lost 7 lbs. Yay! I'm hoping it will help me get over the plateau I've been on for some time. My weight goes up and down by 10 lbs but doesn't go down past that. This is just under the 50 lbs I've lost since November 2021 (20 due to a diuretic, and 30 lbs with the help of diet and Ozempic). The book doesn't contain a diet plan--that's not what it's about--but rather you can choose any healthy, nutritious diet. She has you choose a primary and secondary so you have something to fall back on if the first doesn't work out for you. My primary diet is the DASH diet, and the secondary one is the Mediterranean one, as both are highly rated for efficacy, easy to understand, and close to how my roommate, the main cook in the house, prepares food.

Here's a better picture of the book, along with a link to Amazon. Again, if you have Kindle Unlimited, it is included in your subscription.

The Beck Diet Solution: How to Think Like a Thin Person

I've been processing some news rather than writing about it

For years I have been concerned that my bloodwork always shows my liver enzymes as very slightly elevated, because my mother had the same thing happen to her. It eventually progressed to fatty liver disease secondary to diabetes, then NASH Syndrome (non-alcoholic steatohepatitis), then cirrhosis, then to liver cancer, and then to liver failure, and it finally killed her.  It was terrible. 

I'd expressed this concern for some time with my PCP, but it was only a very little elevated, and so we took a wait-and-see tack, but I finally said something about my concerns to my endocrinologist. She ordered labs and sure enough, the values were higher than they should be. So Tuesday before last I had two liver tests: a regular liver ultrasound and an elastography, the latter of which measures the elasticity or rigidity of the liver. It wasn't a particularly painful test, it's just an ultrasound that I had to fast for, but it was difficult in that you had to (for the elastography) let out all your breath and then not breathe for awhile before letting in some air again. I was a little dizzy afterwards.

The next day, the results showed up on my patient portal and I read them. A couple of things were easy to understand. My liver was enlarged and I had asymptomatic gallstones. There was a mention of the wave result being correlated to a Metavir score of F4. That I knew nothing about, so being a former librarian, I looked it up, being congnizant that you shouldn't panic based on Google results. But the Metavir Scale goes from F0-F4. F0 is a normal liver. F1-F3 are various degrees of fibrosis in the liver. F4 is consistent with cirrhosis. That was a bit to make me think about panicking. I've had diabetes for aver 20 years with obesity and other risk factors. I thought there might be some damage. But cirrhosis is not good. Not at all. Fibrosis can be reversed in some cases, particularly in the early stages, as the liver has a great deal of resilency, but cirrhosis is another matter entirely, and can lead to liver cancer and liver failure.

I called my doctor's office to speak to her. Her nurse wasn't there that day, but they'd said they'd give her the message. The next day I hadn't heard anything, so I called back and spoke with the nurse. I explained what the score was supposed to mean and the nurse was like, oh, I didn't know that, let me get the doctor to call you right back, which she did. The F4 score is certainly concerning. She said she wanted to refer me to a specialist at the University of Kentucky, as they were the best ones in the area for this and if I went somewhere else, I'd probably wind up there anyway (I think she meant if it came to a transplant, as they're the ones who do that). So that was definitely hard news.

Fast forward to this Thursday and I hadn't heard anything about the appointment. I have the Informed Delivery from the US Postal Service that emails you scans of the mail you're getting that day and saw that I was getting something from my endocrinologist's office. I asked my roommate to open it in case it was the referral. It was just a copy of the results plus the intent to refer, so I went ahead and called her office and the referral clerk called me back. I do have an appointment with the University of Kentucky's Gastroenterology office (apparently that's where Hepatology goes under), but after reviewing my records the first available appointment was October 8th, when I'll be seeing a doctorate-level nurse practitioner. So maybe they didn't think I was as urgent as my endocrinologist's office thought. Or maybe, being a major univeristy teaching hospital, they just don't have the availability. I don't really want to make any assumptions. So it looks like I won't really know anything about my condition until then.  I have to admit, I'm pretty disappointed and more than a little scared.

I know that it often takes big things to scare us into making even small changes.  The best thing for fatty liver is to lose about 30% of your body weight.  For me, that's about 100 lbs.  Yeah, that's a lot.  I saw my rheumatologist the next day and told him about what was going on.  He asked me what I planned to do.  I told him I was cutting out the processed food in the vending machines.  I was trying to find ways to walk a bit each day beyond going to and from work (I get about 6200 steps in on average.  I'd like to slowly increase that to 8000.)  As far as losing weight, 100 lbs is too much to tackle.  My plan is to try for 15-20 lb. weight loss and then add another goal after that, taking it smaller bites.  He thought that was good, and he offered to get me to a nutritionist if my endocrinologist didn't.  I appreciate it.

I haven't eaten anything from the vending machines in over a week. I ordered and tried out some walking poles to help with my balance so I can walk around the neighbourhood, and some walking shoes are being delivered today (my New Balance work shoes, which look like black trainers, are actually steel-toed, and not flexible enough).  I went and spent $100 on things like large bags of nuts, raisins, craisins, jars of sunflower seeds, cheese I can cube, baked crackers, yoghurt, etc., so I have snacks and breakfast at work.  Here's hoping this helps.

UPDATE: My appointment has been pushed back to November 5th! Arrrgghhhh!

When did this happen?

One thing about being home so much is that I'm starting to get on YKWIA's nerves because while the first few days I was exhausted and asleep, as I began to feel better I tended to do lots of small talk and chatter, even though I tried to rein it in.  Apparently, I miss the interaction with other people, and he's been working on projects on the computer and studying, so there have been large blocks of time I've been on my own.  Yes, I've read, watched videos, listened to music, done chores, and I've taken occasional naps, but still, I'm kind of lonely and bored, and what I don't get is this is the hallmark of an extrovert, and I've always been very introverted.  I score INFP on the Meyers-Briggs, always very strong on the introverted side, although it's moved closer to extrovert over the years, as is normal (you tend to move closer to the other side of the spectrum as you age and experience life, if I understand things well).  Anyway, maybe this is part of my problem with reading.  Maybe somewhere along the way it didn't satisfy my need to interact with people rather than characters.  I also find watching the TV to be rather passive, although I do get immersed in the story, just as I do with reading.  Music I enjoy on a different level, both in terms of the actual sounds and the lyrics.  But still, somewhere along the way, I got to where it's harder to amuse myself--me, the kid who was always alone and felt unloved.  That's a little unnerving.

I cuddled with the cat for a while earlier, although I really didn't sleep.  He got right up on my pillow with his head up next to mine.  Then I fed him and the dogs, and he seems to be keeping this food down, so he's happier.

I'm not really sleepy.  I just ate something extra because my blood sugar went low despite taking my insulin back 20 units each time for the long-acting insulin [so 60 units twice a day, which I think is going to have to go down to 50 or 55] and keeping the short-acting one at 34 units for all meals, not 34-42-42.  I kept track of what I've eaten today.  Even with four little meals, basically, I've stayed under the recommended amount for losing weight.  I've been pretty full.  Today I've had two bowls of cereal with milk, a banana, some homemade cream of mushroom soup, a piece of bread, two little applesauce cups, two peanut butter and honey sandwiches, and I think that's all.  So I've had 1 serving of vegetables, 3 of dairy, 4 of fruit (there were raisins in the cereal), 2 protein, 6 servings of grain, and a bit of sweetener, for 1333 calories (an I've burned 2004 for the day) between my activity/steps and my metabolism.  It's not exactly balanced, but it's not bad. If I eat anything else today, I'll make sure it's a vegetable choice.  We've got a turnip-apple dish in the refrigerator, along with 'green rice', which is basically rice with spinach and onions.  So those are possibilities.  In the meantime, I'm making some more bread right now; we should have an extra-large loaf ready by 10:30 pm.

So the question is what to do now. I'm listening to the OneRepublic station on Pandora.  I could read.  I could watch another episode of 'Sherlock'.  I just don't feel like doing either of those things.  It's kind of annoying, actually, that I don't.  I don't want to go to sleep or I won't sleep well tonight.  Sigh.  Maybe I'll try reading. I'm not up to Julius Caesar himself, but maybe the book on his legacy on the landscape (called Caesar's Footprints: a Cultural Excursion to Ancient France by Bijan Omrani).  It might be good to read before tackling Caesar, as I'll have a better idea of the lay of the land for the Gallic War, anyway.  Actually, I should go to the library's website and check to see when each book is due, then come up with a reading plan.  I know the one YKWIA is reading is due on Valentine's Day, the next one that's due, but I think I should be able to renew that one.  I just renewed The Forgetting and The Oversight.  I just checked out Anatomy of a Genocide.  So that leaves Caesar's Footprints, The Landmark Julius Caeser, and La Belle Sauvage to figure out.  Okay, I guess I'll do that.

I pretty much petered out after I wrote here last night

and went on to bed, but couldn't sleep for some reason, and I probably didn't actually fall asleep till about 2:30 am, and I got up at 5:30, and what rest I did get was broken by my waking up often. Despite that, I got through my day without being terribly tired. I went into work at 7, getting a couple of egg and cheese biscuits since our cafeteria doesn't serve breakfast until 7:30. I caught up on all my various duties, both the charge entry and library positions. I filled some interlibrary loans. I was going to fill the clinic cart as well, but really, it's pretty well stocked from last time, and probably needs about a half a shelf of new books. I try to keep it full, checking it every week or two.

After work I went over to my friends' house, where we ate and watched various YouTube videos and a few short episodes of something on Netflix. I also got the Cthulhu game notes finished today (yay!), so I won't be pressed to do so tomorrow.

Tomorrow the plan is to get up about 7:30 am and finish the bedroom and vacuum the house. That should make the house livable and presentable. By 11 am I'll be over at my friends' to do grocery shopping and also to take one on an errand or two.

I have a mushroom growing up in the pot that has the little oak tree in it. I should probably remove it, but I am fascinated by fungi, so I'll leave it for now.

I think I'm going to call it a night, even though it's a bit after 10 pm. I may listen to a little music before actually sleeping, but I really have done well today as far as staying awake (I've also taken all my meds as directed, and my blood sugar is doing better as a result, so I am not getting terribly sleepy in the afternoons after lunch like I was. But starting Monday I'm going to try to eat healthier--I've been eating too many snacks when I'm not particularly hungry, and unhealthy ones at that, along with desserts, and I just shouldn't do that. I'm going to start tracking my food again and see if I can lose some weight. I've lost some (I'm 15 lbs under my maximum weight right now, but I could stand to lose, oh, technically about 110 more, although I'd be happy if I could just get down to say, 225 even (I'm at 291 no, at 5'4"), and would like to go down some for health reasons more than anything else. I get the fat acceptance people, and yes, I do believe that you can be healthy and overweight (although obese is perhaps another matter), but I'm not healthy, and so I need to take steps, including diet and exercise, that will help my health. If I can make small changes in my lifestyle, and stick to them, then hopefully I will feel better.

Reading

Three hours after I came home last night

Two women were robbed while walking about two blocks from here. I have generally felt safe in my neighbourhood, but crime can happen anywhere, of course. I don't know if the thing last night was in any way related to that or not. Probably not. But it's highly unusual to have the police out here.

I came home this afternoon and rested (yes, that means napped), and I've spoken to YKWIA a couple of times on the phone. The last hour or so I've been trying to find an important piece of paper to make a payment on something that cannot be paid online, I don't otherwise have the information to pay it like address, account number, and amount, and I'm highly annoyed because I'm sure I put it in a 'safe place', so safe I can't find it. The payments are made quarterly, so it's not with much frequency. Tomorrow I'll have to call the company and get them to send me the information. I can go online and initiate a loan, but I can't find any information about the very small loan I'm trying to pay on. Grrr....

This morning I went to my endocrinologist, which I dreaded because I don't feel like I've really kept my diabetes under the control they needed to be. But my weight and hA1c are both down, so it was a good report. They took some blood and an urine specimen, and I went on into work. It was nice to be able to give them a report of my glucose readings from the new meter without having to type in the readings manually. Today I had two goals:

1. Drink only one diet soda. I drink far too many in a day, up to two two-litres sometimes on the weekend, but even on an average day, about 4-6 20 oz. bottles. I managed to reach that goal, and while I was a bit sleepy in the afternoon from lack of caffeine, I did okay. I drank one sparkling flavored water and the balance has been regular water. Go me!
2. Enter everything I ate into my phone application. Everything. Which I did. And I made pretty decent choices today. For example, at lunch they were doing warm chocolate-chip pecan pie with ice cream, which I totally skipped in favour of spicy vegetarian black bean soup, broccoli, summer squash, a couple of slices of tomato, and a small seeded roll. Breakfast was the worst, as with my appointment I missed breakfast at work, so I went to McDonald's and got two egg and cheese biscuits, which are a combined total of 780 calories! Dinner was more soup, corn on the cob, a small roll, and about five tater tots, so still a bit heavy on the starches, but not horrible. Later I had a couple of pieces of string cheese, a banana, some sugar-free pudding, and a little bit of hazelnut spread on bread. So I've eaten about 2000 calories today and according to the application, which records my steps, I've burned over 300 calories. Even at that, according to my doctor, at my current weight I'd lose on that, but I'd like to take it down to 1800 calories slowly. If I hadn't snacked in the evening, I'd have kept it under that.

In general I'm going to try to eat less bread, more fish, eggs, beans, fruits, and vegetables, and generally make better choices, and see what happens. Although I am pescetarian (fish but no meat), I rely far too much on bread and cheese and not enough on protein and vegetables. Now that my knee is doing better, I also want to start walking, although today was far too hot and humid to start. Perhaps in the mornings or evenings.

Okay, I think I'll go in the other room for awhile. Tomorrow I have a bunch of things planned for the afternoon and evening, including appointments and 'The Awesomes', so I'm not sure if I'll get in early enough to really blog. Have a good night.

Okay, maybe this healthy eating is a good thing

I've lost 7 lbs since the beginning of the year, 6 of it since going on insulin (which is even better considering when you go on insulin, your cells use the glucose more efficiently and you tend to gain weight).

Go me! Now to keep it up. I'm not following any diet, just watching my portion sizes and trying to make healthy choices. Today I did have a bit of chocolate cake, but it was about two cubic inches in total size (tiny) and went into the food diary. I'm still eating too much fat and not enough protein, really. But I'm working on it.

Last night I ate a snack at bedtime since I was increasing the insulin, and my blood sugar was a little higher this morning (192), so I'm going to forgo it tonight. I guess I'll just have to see how my blood sugar rises or falls and go with what works.

It's amazing how much better I feel on the insulin. I'm not as sleepy all the time. I'm not foggy. So far, it's well worth the sticking myself with a needle thing, and they're tiny needles and portable pens.

Have a good night.

Yesterday I was very bad

I had a pop-tart. I had a very small piece of cake. I had some Snackwell's cookies. I ate nearly 3000 calories.

This morning? My blood sugar was 146, the lowest it's been since I started eating healthy and taking insulin.

Go figure.

I'm back on the healthy bandwagon though this morning. I had a brunch of light yoghurt, a banana, orange juice, and a peanut butter sandwich. I'm going to go over to the laundry room to check and see if they have any Diet Coke in the machine, and then start working on some things.

A successful first day

Well, I started the regimen of horse pills and this is what happened:

My fasting blood sugar was 232 this morning, which is lower than it had been. Now that was before I took the supplements, but I've been eating well the last three days (although I did have a Pop-Tart this morning, as the only yoghurt was lemon), so I'm assuming that had a lot to do with it, plus I was up about half the night working on the house for the walk-through tomorrow.

Two hours after lunch, though, I checked and it was 197. Now you must understand, it has been running in the high 300s, almost 400 after lunch in the same time frame. So, I thought that was pretty good.

I checked my blood sugar before eating dinner, and it was 124. 124! That's four points over norm. At best I am about 140.

Okay, so it may just have been a good day. I'll continue to monitor my levels to see how it goes. I did open the cinnamon/chromium picolinate capsules into my milk. Tomorrow I'll try it with yoghurt instead. I noticed tasting the fenugreek several times in the morning, but it isn't unpleasant. Anyway, we're going to consider it a tentative success.

Today I tried to eat healthier

I had light blueberry yoghurt instead of a package of blueberry Pop-Tarts. For lunch I had minestrone and a salad. I had an apple and a small package of trail mix for my snacks during the day rather than candy bars or chips. I came home and devoured a lot of hummus and pita, but I still wound up with 2353 calories (less than I burn as at a sedentary lifestyle, but much more than I really needed to eat). I had roughly 53% of my intake as carbs, with 17% protein and 30% as fat, so I need to tweak that. My nutrition was really great vitamin-wise except for C, E, and potassium, and I took a children's multivitamin, so the potassium was the only thing I was low in. I know all of this because I kept a food log on FitDay.com, and it calculates all this for you.

My fasting blood sugar this morning was 294. Two hours after lunch it was 244. I forgot to check it before dinner. It's usually in the 140 range by then. I also forgot to take my second Janumet, which I am going to take right now. I guess it's a start, though.

All in all, it could have been better, but it was probably better than it has been. It was slow and probably useless, but I walked 20 minutes to the bus stop this morning and got out and walked around the hospital a couple of times today. I need to start walking around the neighbourhood now that it's cooler. I got a ride home this evening, so I really should have. Instead I came in and gorged myself on spinach and artichoke hummus. But I guess it was better than pizza or some sort of thing. The least healthy thing in terms of salt, fat, and calories I ate today was the trail mix. Breakfast and lunch totaled only about 850 calories, so I was doing really well. I'll have to watch the later eating during the day.

I can't imagine why you would be interested, but my food log/information is public, if you want to see an example of how FitDay works or you're just curious.

One of the blogs I read, Ben Davis's Ben Does Life, chronicles a young man's struggle with weight and his exercise goals and achievements. Ben used to weigh 360 lbs. Since then he's lost 120 lbs., has run a marathon, and has done an Ironman competition. I find his story very inspiring. Anyway, somewhere Ben wrote that it's best to start making changes in a public manner. His point was we often don't hold up bargains with ourselves, but putting a log up and trying to lose weight (or change other things about ourselves, for that matter) in front of others make us more likely to achieve it.

I'm not going to lose weight overnight, by any means. I weigh 288 lbs., after all. I've set a goal to be 150 lbs. by my birthday (April 2nd) of 2012. That's a year and a half, or 78 weeks, making a goal of 1.77 lbs loss a week. I'm not going on a specific diet. The goal is to eat healthy in general, keep my calories down down but well-balanced and my activities up, drawing from various suggestions. I have a long way to go in terms of exercise; it's actually easier for me to eat better, but that's an important component in lowering insulin resistance and losing weight, so I need to do it. Walking is probably the best choice for me at this time. I do also have an exercise bike. If I can work with it, I may get a real bike come spring. We'll see. Anyway, that's what my main focus was on today. The food log really helps a person be more mindful about what he or she is eating; it's just difficult for me to remember to write down every thing. But the online aspect helps a little.

Trying to get a handle on my diabetes

Okay, so I'm a medical librarian, which means I know the complications of diabetes, have read the patient information and a few studies, know the medicines involved, and generally have a good knowledge of the disease's mechanism. The problem I have is what to eat, especially for a pescetarian (think vegetarian who eats fish and seafood) who has little time to cook and quite frankly is bad at it. I went to a diabetes education class but it was mostly on checking blood sugar and keeping meals to about 45 grams of carbs, but beyond that, I'm pretty clueless. I know how to eat healthy in general, but not how to eat healthy for good glucose control, and I've been terrible in putting any of the theory I do know in practice. But, my blood sugars have been consistently over 300 the last few days and I'm on four diabetes medications. I have to do something. I'm 130 lbs overweight and my body is breaking down, and I'm just 43 years old.

Now when I was a kid, one of the diets my mother tried was a diabetic exchange one, and it's the only one I ever tried and stayed on for more than a week or two, because it's fairly easy. So I've been looking at some information on the Internet and I've ordered some books from Amazon:

The Official Pocket Guide to Diabetic Exchanges by the American Diabetes Association
What Do I Eat Now? by Patricia Geil and Tami Ross
Diabetes Meals in 30 Minutes--or Less! by Robyn Webb

They had a special deal where they were just a little over $26 for the set, which means free shipping. Since they were shipped Friday from the warehouse in Lexington (the same city where I live), I'm thinking they'll arrive tomorrow or Wednesday.

I also checked out some books from the library today:

Diabetes Mellitus: A Practical Handbook by Sue Milchovich and Barbara Dunn-Long
The Joslin Guide to Diabetes: A Program for Managing Your Treatment by Richard Beaser and Amy Campbell
The All=Natural Diabetes Cookbook: the Whole Food Approach to Great Taste and Healthy Eating by Jackie Newgent (lots of vegetarian recipes)
Charting a Course to Wellness: Creative Ways of Living With Heart Disease and Diabetes by Teena and Graham Kerr (which has vegetarian options for many of their meat dishes)

Lest you think I just scoured the non-fiction section, I also picked up Death Masks by Jim Butcher, as I'm slowing going through all the Dresden Files series. :)

Anyway, I'm going to try to pay more attention to what I eat, use the exchange lists (it's small enough to fit in my purse), and start making meal plans instead of eating whatever comes to hand. It's a start, anyway. I need to exercise, too. The best thing to do would be probably walk around the hospital grounds every day for a break, because I don't have much time throughout the rest of the day.

Wish me luck!

It's not you, it's your germs

Could germs be making you fat?

Gut Bacteria Cause Overeating in Mice

That's not saying diet and exercise have no bearing on weight, but scientists have observed that transplanting gut bacteria from obese mice to those of normal weight results in the thinner mice gaining weight. So it may be one of the factors in obesity.

On the topic of diet and obesity, here's another scientific finding from today's news:

DNA test 'could predict most effective diet'

A simple DNA test may predict whether someone is more likely to lose weight on a low fat or a low carbohydrate diet, say US researchers.

The results from the small preliminary study of 101 women showed those on the best diet for their genes lost two to three times more weight than the rest.

Yesterday a friend asked me

if I were keeping a food journal in the new year. I hadn't thought to, but it's an excellent idea, so I went back to FitDay and started again. If you're in any way interested in what I eat/weigh (although I can't imagine why, really), the link is: http://www.fitday.com/fitness/PublicJournals.html?Owner=eilir. There's no weight on there; I won't be near a scale until Monday at the hospital. But even though I ate fairly healthy yesterday (except for a bag of microwave popcorn), I ate nearly 3,000 calories, and that's got to stop. Today I had a little over 700 calories for breakfast. We'll see how today goes.

Interesting

It's associative, not necessarily causal, but sodas--even diet drinks--have been linked with metabolic syndrome, the cluster of factors that leads to diabetes (this happened to me) and heart disease.

Study Links Diet Soft Drinks With Cardiac Risk

Some experts have said this for years

But a new study bears it out...

Diets just make you fatter

They're not talking about making changes to eat healthier, but rather the fad sorts of diets that people go through and put stress on their bodies only to regain the weight and then some when they go back to eating normally.