Going for a Walk

I last saw my weight loss doctor [who is also my PCP, but we do the appointments separately; in-person for general visits and telehealth (normally) for weight loss--she's an internist, but she was my weight loss MD first before I asked her to be my PCP when mine retired after I'd gone to him for 20 years] about three weeks ago. I'd gained about 15 lbs. since last December, mainly, I think, from going back to Ozempic, which doesn't work as well for me as Mounjaro (due to insurance--neither Medicaid nor the qualified assisted Anthem health plan I had in May and June covered the latter), and 2) I went through a period where I was overeating and eating a lot of calorie-laden food after I left Shriners and especially while my roommate was out of state for three weeks.

I've been much better with my eating for the last month/month and a half, but my weight hasn't budged a bit. Part of it is water weight--I just blow up ankle-wise in the summer, and while compression hose help, I can't go up on my diuretic because it was what was making me so dizzy a couple of years ago, so they cut it back. So about 5-7 lbs is water weight, because when we had a cool spell, I suddenly lost some. I had, at one point, been 328 lbs and had lost down to 208 lbs. I'm about 223 lbs now.

Sigh. So until (and if) I get insurance that pays for Mounjaro (or unless it goes to generic early--apparently that is being petitioned as the patent expires overseas first, even though it doesn't here for several years), we decided I would try to walk about three times a week, starting for about 10 minutes a day. I promised to do it the next day and did, but then the heat wave of doom came, so I didn't.

Today, it's supposed to get to 90°F, but it was only 76°F about noon, so I decided to put on some sunscreen and a floppy sun hat (since it is also very sunny and nice outside) and go up the street and back. There is an incline at either end. The close-up is me before I went for a walk. The other is me after. It took about 15 minutes to do the circuit. It's a small step, but it's a start. With the inclines, it's a fair little walk. Next time, I should actually bring my inhaler. It did hurt my back a little, but it should be better in the long run. The knees did pretty well, though. The key will be doing this and doing more activity.

Of course, since I got back, I've been helping my friend do some things around the house that apparently, despite normally being fairly minor, wiped both of us out, and I just woke up from a 2-hour nap, and he's still asleep. So I did more activity and kept on going, then my little windup key just wound down entirely. We have to put a fan together later (I'm talking one of those big shop fans) for his bedroom, so it's good I got some rest. It wasn't hard to put the other one together, but there was lots of bending, and if I remember, my back was not happy, even though he had to hold the fan part because it's so heavy while I dealt with all the screws because I'm the mechanically inclined one. 🙂

I know, it's a silly hat. I've got one in purple, too, though. They're good against the sun.

How do you like my 'Censorship is so 1984' shirt from the ALA? It's new. Also, look how tall my tomato plant is!

Go me!

So I was at my new PCP's office (my old one is retiring after 51 years in practice, and about 25 years as my doctor 🙁), and the resident [the doctor, who I've seen as my weight management doctor for three years but is also an internist was running late because another patient came in late (I saw her come in, and that's fine, she was in a wheelchair and looked like she needed a lot of help, and the resident was really thorough)] upon doing my history, went over my recent labs that were done at my pre-op appointment. I asked about my hA1c because, you know, that's always a concern for diabetics and it had been much lower than in the past before the last surgery, 6.4%, which was amazing, and this time it was 5.96%!!!!!!! And if you look below it is in the 'high, but in the 'increased risk for diabetes' range if I didn't already have diabetes. Go me! And go Mounjaro. It's been doing so well with my blood glucose that I've been taking insulin of either type about two or three times a week at most, if that--basically if my blood sugar goes over 200, and my endocrinologist is fine with that. She said I could probably go off the insulin if this keeps up.

Unfortunately, I did go off the Mounjaro a little early for the next surgery since I'd last taken it a week before I found out about the next one, so I didn't take it at the two-week mark, and if you go three weeks, they start you back at all over to prevent side effects. I didn't know that. I think I only missed two weeks last time. Anyway, she's put in a lower Rx, but that won't control as well, so I may need to go back to using more insulin for a while. And it's possible I can get the same control on a lower dose of the Mounjaro, too, so I'm not taking the highest dose like I was. I'm down to 217 lbs. I'm not sure how much weight I need to go down to. 200? 180? Certainly not to 145, my supposed 'target' weight. I don't know. That's something I need to start thinking about. With all the adjustments, I may not lose any more for a while anyway. I'm eating very healthfully and not very much right now, and not losing, mainly, I suspect, due to all the swelling I've been having due to my surgery. It's finally coming down to pre-surgery levels. Anyway, I'm thrilled about the hA1c. At my highest, in October 2018, I was at 9.1%, which was awful, out-of-control, and damaging.

Desert!

Just did my second session on the the range of motion machine this time the background was a desert scene rather than the Alpine village from this morning. I used to really bike through the desert when I lived in the Mojave. So it was nice. It's a 12-minute workout, 10 passive, 2 active. The first one put me out for most of the next three hours with some ice and a little pain increase. But I'm hoping to do better the second time. But I do have to lie down and elevate and ice my leg. I plan to hey back up and do things. Really. I did eat some cottage cheese and challah afterwards. That's in top of my banana breakfast. I don't reach much when I'm at home, don't get very hungry,

Also, Itook my next dose of Mounjaro to get back on track after surgery. I had to stop mine a week ahead. I stopped it 2 weeks out. IMPORTANT SAFETY TIP FOR USERS OF GLP-1 DRUGS such as Ozempic, Wegovy, Mounjaro, and Zepbound, please realise that these medications work by slowing the emptying of the stomach, and therefore if your are sedated for any reason, you can aspirate and choke to death or get a form of pneumonia, either of which can kill you. As a result hospitals and other centres that sedate will not do so if you've taken one within one week. I knew this, but forgot before my colonoscopy and was given the option to reschedule and redo the prep or do it unsedated. I chose the latter. A surgery would have had to be rescheduled completely, though, so yes, I went two weeks out.😊

My journey so far...

In November 2021 I was at my highest weight in my life with a BMI of 58.1 kg/m², had just gone into a 4x in women's clothing, and was miserable. My liver specialist had just added another diuretic because despite being on Lasix, my feet and ankles swelled horribly. I lost 20 lbs. of water weight that month. You heard me. 20 lbs just from fluid retention.

In December I got with a weight management doctor at the University of Kentucky. She put me on Ozempic at that time, which helped with my appetite, and while I was somewhat sketchy about when I ate well and didn't, and my weight fluctuated, overall I went down, sitting at the 60 lbs. total loss mark for awhile, going up and down 10 lbs. Last October I had to go off the Ozempic (which I'm actually on because of my diabetes--the weight-loss version is Wegovy), which was impossible to find. I tried _ten_ pharmacies. I was off for a month. My blood sugar soared. She then put me on Mounjaro, a different drug in the same class for diabetes (the weight-loss version is called Kepbound). What I found was that for me, the Mounjaro has been more effective with appetite with fewer side effects. I went down to 60 lbs lighter total.

Anyway, due to being off the meds and the holidays, I wound up soaring back up to the 40-lb loss mark in January. I managed to lose 10 lbs before my surgery in late February. Since then, I am officially 70 lbs lighter than my original high weight, according to the records at my doctor's office last week. That's mainly because I've been eating much better, I was home with my roommate's cooking, and have reduced my use of the vending machines at work, which is a real struggle because I stress eat at work.

So why is this all important? I desperately meed a knee replacement. Not only are imy knee joints bone on bone, my left patella is even shifted completely out of alignment. But understandably, my knee specialist [lthe same orthopaedist who did my rotator cuff surgery] is concerned about my weight. He won't do a surgery if the BMI is above 45, and prefers it to be under 40. My current BMI is 44.15 kg/m²--greatly reduced from what it was, but in the danger zone still.

However, when I did the calculations the other day, I am about 27 lbs from reaching a BMI of 39.9. We think that's doable. So we're starting to talk about doing the surgeries and I got a pamphlet on what to expect from them at my request. I am excited about the possibilty of reduced pain and greater mobility. Also, if I can do that, I will have officially lost over 100 lbs and have a total BMI reduction of 18.2 kg/m². It obviously won't happen tomorrow, but that gives me some time to prepare for the surgeries.

It was never about looking good, it is about health, and for that matter losing weight actually ages your face and makes you saggier, but I really want to do these surgeries and be more mobile. I'm only 57, too young to be as decrepit as I am. I've had trouble with my knees since high school. It's time to help them. Oh, and here are the obligatory photos. The first one is from September 2021. The other one is from yesterday. PS Shoutout to Dr. Stephanie Rose [women's health/weight management] of UK and Dr. Janak Talwalkar [orthopaedic surgeon] of Baptist. They've both helped me tremendously.

PS Both of those shirts are 3X, and the pants on the second picture are 3X. 70 lbs and I'm still in that size for the most part. Women's clothes are weird. But I was going into 4X and I think I'll be able to transition to 2X soon...I have one pair of pants already. And of course the shirt is mainly due to my bosom. :)  

[Update: I gave blood today and got a shirt for donating. They didn't have any in size 3X, so I took a 2X because I figured I might be able to wear it in the future. When I got home, I tried it on. I won't say that the line is perfect in terms of the cloth's drape, but I can wear it, and it's comfortable, even if it shows my belly roll a bit. I'm a little proud of myself. I could be doing better in my eating, but I'm apparently doing some things well.]