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!

Staying busy, although I slept in today

Two days till surgery and two days from five weeks since the last. I've officially shed all the water weight I had from swelling after the surgery... I'm down to 213 lbs from an original 328 3-4 years ago, so I've lost a total of 115 lbs. The incision is healing really well. Halfway through my leave, and I am not bored but am rested. Yesterday, I made time to study Latin both from my Wheelock text and from Mango via my library card. I am very rusty, and I used to be pretty proficient. I've done things I never make the time for, like that. A lot has been appointments and that range of motion bike, and we watch 'Desperate Housewives' at dinner every night but Friday (there's always some show; this is just the current one, because we'd been watching another Marc Cherry show prior, and I really enjoyed it, so I said I'd give it a try). Last night I was up to 3 AM updating the 'what to do if anything happens to me' document, not to be morbid, but to be practical, and I didn't manage to before the first surgery. With the exception of one piece of information I need to call on tomorrow, I'm finished. I'm also going to call the ROMTech rep back who left me a message during PT on Friday, as she thought she was delivering a device and I just need a new patient number and know how to put it in, since I already have one, from what I've been told. I did call Saturday and left a message, but I want to make sure she got it since the surgery is the next day. Not being able to do business today is making it harder... I had no clue about the holiday until it was mentioned at PT. My days all run together. But for those of you who have been working hard, enjoy your time off!!!

Feeling good

Week four, and my incision is finally to the point where I can wear pants that aren't super wide. These are a little big on me now, but they used to be so form-fitting that the only way I could get them off was to peel them off wrong side out. 😅 I think they're 22s and I wear an 18/20 now. Mostly. You know how women's sizes go. They may even be a 24. I didn't look. I can still wear them as long as I don't overload the pockets. But I was a 30/32, so that is a big change. But I'm trying to wear pants instead of shorts now just in case a dog forgets him/herself and gets up on me. They don't want any open wounds for surgery in case of infection, especially near the surgical site. The dogs have been really good, the closest was yesterday one got onto the bed with me when my roommate left my barrier down (my door has reached that time of the year when it won't stay closed on its own, so we use a dog gate, and he pushed his way in, because he loves me and my bed). Actually, the cat has been the closest to getting me, as when he's hungry he does these little bites, and he almost got my ankle the other day. Still, I'm just being careful, keeping an eye out, and wearing pants till surgery, even the skinny ones, except on PT days, which I only have one more before surgery.

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.

I sat in a regular chair last night

There was a time that I would come over to play the weekly Call of Cthulhu tabletop tabletop role-playing game (you know, like Dungeons & Dragons, but this is Lovecraft, so with tentacles and sanity loss) that we've been playing almost weekly since 1991, and I'd get out my 'special chair', a gold-coloured metal folding one. The reason is the gamemaster had this table that folded up and it has some chairs that folded up and were stored inside - but they were pretty flimsy, so much so that another player who was smaller than I in a fit of pique plopped down on one and busted it, and so he was pretty concerned with my weight (about 250 at the time) I would break them. Then he got a table with some sturdy farm chairs and I moved to those and have ever since, the special chair being retired. At some point he got a table and six chairs from his mother-in-law (while they were married) and they are normal but not particularly sturdy. I have never been in one, as I had been, at over 300 lbs. in danger of breaking one of them, and I would be embarrassed and it's not like you can replace something like that, something that's a set. So it was an unwritten agreement between us that I not sit in those.

Last night I was helping him with something but of course with my leg it was best if I did it sitting down. I thought he'd pull over the farmhouse chair I was currently sitting in at the kitchen table, but no, he got one of the kitchen chairs and motioned me to it. I asked him if he was sure and he said that there was no reason I couldn't. I set gingerly in the chair and finally eventually got comfortable.

I actually weigh less than he does at the moment and I know he's very proud of what I've done with the weight loss. But that moment really brought that home. You have to understand that he is never cruel about these things, just merely practical. He never meant to hurt my feelings by not letting me sit on certain chairs... He just didn't want anything broken or for me to be hurt. But he did mean to make me feel better this time. And I really appreciate it.

People who are normal really don't understand how much fat people walk on eggshells when it comes to chairs. You go out to a restaurant with friend and you're on the rickety chair, and you sit there balancing and wondering if it's just going to go out from under you. Or you sit there going oh please please please don't give me the booth because I won't be able to to enjoy my meal because I'm going to sit here squeezed in unable to even breathe. It's a real problem and don't even get me started on planes am I going to be able to fit even with the extended seat belt are they going to make me pay for another seat? I agonized on that when I went to Chicago those 5 years (well 4 years; when I got hit by the car I had to cancel one). It just is maddening and all because you're fat.

Of course 'fat' is a very subjective term. I thought I was terribly fat when was 12, and looking back, I wasn't. People 140 lbs. who were 120 lbs. in high school think they're fat. Certainly the weight tables and diet industry don't help. I'm supposed to weigh 145 tops for my height. The last time I weighed that I was 4'11" and in junior high. I would be fine at maybe 160-180 at smallest. I always said I'd be happy with the 180-200 range. This morning, even with the swelling, I'm at 217, which 1) is 5 lbs. less than Friday morning, so hopefully the swelling is going down and 2) means that overall I've lost more weight because the last non-swelling number was also 217, so if it weren't for the fact my left leg looks like an elephant's, particularly in the evening, it would be less. So I probably weigh something like 212 within the inflammation. That amazes me. And since I'll be away from the vending machines, junk food in general, and I don't have much appetite anyway, I may lose more. We'll see.

To catch up, post #2

 September 2021 May 2025

_______________ ____________

Weight: 328 lbs. Weight: 228 lbs.

BMI: 57.6 kg/m2 BMI: 40.1 kg/m2

Size: 4x - 30/32 Size: 2x - 18/20

I've been given the go-ahead to have my knee replacement surgery this summer, contingent on my HbA1c, which a home-test says is 7.3, but yesterday I had an official lab draw and it was 6.4!!!!!!!!

I have dental work scheduled for June 24th. I have to wait 3-4 weeks after that to do the first surgery, so sometime in late July or August. But I should be able to call Monday and, barring any trouble with my bloodwork, etc., go ahead and at least schedule. I'm nervous yet excited. This is all getting quite real.

I feel much better physically than I did back then. I'm not so winded when I bend over. I do have more pain in my knees in some ways because my cartilage is completely gone, but still...it has to be helping. And it's nice to be in sizes I haven't been in since at least 15 or 20 years ago. I do have a little impostor syndrome going on. The medication has been a big part of it. I still eat badly at times. I'm hungry in the morning but not at night as a rule, and that helps. I'm not very active because of my knees. I'm trying to do chair yoga, though. My insurance has a benefit where you can get into a lot of fitness online for $10 a month (or in-person and online for more in tiers).

It's now officially 100 lbs. That last pound has been elusive, and I've been retaining some water of late, so I've been fluctuating up to 232 or so. But I got a little dehydrated from a cold and went down to 225, and today I'm exactly at 228, so I'm right at the 'hey-I-lost-exactly-a-hundred-pounds-mark-and-I'm-happy!

I feel pretty good. I've lost almost a whole person. I'd like to get down to 200. I think that I'd feel best there. The 'normal' weight for my height is insanely 145, which I think would be too thin for me. Even in high school, I was 180. The last time I was 145, I was in 6th or 7th grade and four inches shorter!

But 200 would be nice, a BMI of 30.5 (right on the edge of class 1 and class 2 obesity, but well under severe obesity). It's ridiculous how low you have to go to get to overweight. I know BMI is not the best measure, anyway. But I know I felt well at 200 lbs, and I hope with the knee replacements I can finally be more active and achieve that by being able to walk.

v

Hope I can do this

Just 26 more pounds and I can have my knee surgery. If I can lose that in three months (by my next appointment) I might be able to do it at the end of the year. I'm at what I think is called Stage 4 (the worst) end-stage osteoarthritis of the knee, meaning it's bone-on-bone without much of any cartilage. The gel shots helped for a while but haven't held the last year or so and we've needed to do cortisone at the three-month mark to supplement it (insurance only pays for the gel every 6 months and 2 days). I have been in so much pain that even with ibuprofen, I've been at my desk with pain throbbing enough that I can't hardly think. If I could have the first surgery late in the year, I wouldn't pay anything out-of-pocket. So I have a lot of incentive to lose the weight soon and make it a 100-lb. loss. It's doable. Until the last couple of weeks I was losing about 2 lbs. a week, and it hasn't gone up or anything. But for the surgery, my BMI has to be under 40. If I lose 26 lbs. it'll be at 39.9. Wish me luck!

Images for dramatic effect. Hey, it's not a HIPAA violation if I share my own knee images. 🙂 Besides, many of you are either medical folks or have gone through similar stuff yourselves.

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.]

Sorry, I didn't mean to fall off the face of the planet...

Last week was a little busy, and hard.  So on Tuesday night, I had my talk with the behavioural therapist through the AbleTo programme my insurance is partnered with.  I spoke to her about things about my childhood and my family I haven't told more than a handful of people, and it was very intense.  It's actually a programme with modules for helping depression, but she asked a couple of questions and I guess I opened up. A lot. She called my case complex, but apparently, it was in line with the module to explore some past issues that were causing problems today.

The next day I could not get out of bed. I felt bad. My stomach hurt really bad, and I think that was a result of going up on my Ozempic because the side effects always hit about two days after I take the injection I got it on Monday and took it that night. But I just couldn't drag myself out, and I felt real blah and off.  My friend, who used to work in psychiatric care, said that often you can get a 'therapy hangover', and it's the best description I can find for it. I wound up calling in to work. I've never taken a 'mental health day', but I just couldn't function. I spoke with my boss later and she understood.

On Thursday, I had the five appointments plus errands to do.  The telehealth with my psychiatrist went well because, despite Wednesday's issues, my depression is much better. We have another appointment in three months. I also had my gel injections in my knees, and those went well.  At midday, I had the PT evaluation.  The therapist thinks that part of the issue is benign paroxysmal positional vertigo (BPPV) is a problem in the inner ear. It is the most common cause of vertigo, which is a false sensation of spinning or movement. It comes from calcium crystals that build up in the inner ear and get into the wrong area of that. It can be treated with a certain manoeuvre that resets where they are so it can be absorbed. This works in most cases. I had a slightly postive test, so he did the exercise for me and set up and appointment to follow up tomorrow at 7:30 am. A greater part may be vestibular-ocular reflex (VOR). It is a reflex that helps stabilise the visual field during head movements. It occurs in response to head movement and leads to the eyes moving in the opposite direction to maintain a steady gaze. That was more positive. He doesn't think they explain the whole problem, though, and I told him I have a neurology appointment on Tuesday for a workup as well. He'll also see me Friday after the neurologist gets a chance to do his thing.

I dragged a friend to that appointment and he read in the car, because then he had a dental appointment I was taking him to and we weren't sure there'd be time for me to come and get him otherwise.  I got out earlier than they expected, so we went on and I read while he had that appointment.  Then we got some Cajun food for an early dinner. At 7 pm I had a call with the behavioural coach from the AbleTo people and that went well.

Friday I went back to work and it was Sabbath.  Saturday was restful. I did a couple of errands and the game notes, and that was about it. I got the notes done by 12:30 pm, which is a record.  Also yesterday evening we went out with friends to Joe Bologna's, an Italian restaurant here. They're celebrating 50 years in business.  They're in a beautiful building with stained glass...it used to be a synagogue years ago.

We were celebrating one friend's birthday and my upcoming one as well. The birthday kids got free desserts. It was really fun, and it was the most social interaction I've done outside of work in a long time.

In the middle of the night, my roommate and I spent two hours talking about various things, a really great conversation.

As a result, I got up a little late, started my chores late.  Our friend we game with called right before she'd normally left. Her son, who lives with her, was exposed to Covid, so they were staying home just to be sure everything was okay. She didn't want to take the chance, and we appreciate it. So I have some more time to finish my chores (I'm taking a longish break right now).

So as you can see, it was pretty busy last week.  Today was also a day I started a weight loss programme that's aimed at improving healthy habits, presented in partnership with my pharmacy benefit with another application-based system.  They sent me a scale and I'm weighing daily. My goal is to lose 20 lbs in 16 weeks.

Okay, I need to get back to my chores. I'll try to write more regularly.  Sorry about that.

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

On a suggestion from Beck's book

I made an 'Advantages Response Card' to read at least twice a day, especially before mealtimes.  Here's what's on it regarding why I want to lose weight, including the rating, signified by a number of asterisks.  This is based on Cognitive Behavioural Therapy (CBT) principles:

1. I'll be happier when I look in the mirror. * 
2.  I won't feel so self-conscious. **
3. I'll be in better health. ***
4. I'll be more likely to live longer. ***
5. I'll feel better physically. **
6. I'll like myself more, ***
7. I'll feel more in control. **
8. I'll feel like I've accomplished something important. **
9. I'll be able to move around better. ***
10. I'll feel more confident. **
11. I'll feel better in my body. **
12. I won't hurt as much. ***

 As you can see, most of mine are physical, but with better consequences emotionally as well, especially regarding my self-image and self-confidence.  So far it looks like it will be helpful.  I've put it on an index card, my phone, and my Kindle, and here, to review before mealtimes.

My behavioural coach, plus a milestone

recommended this book, which is not actually a diet book, but rather a cognitive behavioural therapy (CBT) approach to helping people with their relationships with food. I'm five chapters in and I'm finding it very helpful. It makes sense. It's all about changing your thoughts and justifications into healthier ones. The Beck Diet Solution: Train Your Brain to Think Like a Thin Person by Judith S Beck, PhD, whose father was the one who first developed CBT. If you want the Kindle edition and you subscribe to Kindle Unlimited, it is included for free.  By the way...this is my 12,000th post.  Yipee!  It took a little over 21 years, but it's a great milestone. I'm enjoying writing again.

Not used to this yet...

One of my Gen X groups had a post about how someone had bought a mood ring, and I brought out the one I have, which I usually have to put on my pinkie. It doesn't fit any of my fingers--it's too big for my pinkie but too small for the ring finger as of yet, as I've lost weight. But that got me thinking, so I tried on my other rings, as I usually don't wear them at all because they're too small. I've been a size 10 for ages (when I got married 31 years ago, both my husband and I had size 10 white gold rings, which we switched because my women's ring fit him (he was 115 lbs dripping wet) and the men's ring fit me better). I was about 50-70 lbs less than I am now at the time.

Oddly enough, one ring fits really well or was even loose, and it was a size 8. It's my high school ring, something I haven't been able to wear in ages. I'm not sure why it's fitting, but hey, yay!

>

Sigh

It's been a long while. I've posted almost 12,000 times on this blog for over 20 years, but I haven't felt like writing for some time. That makes me sad. I've gotten caught up with life and I'd been relying mostly on my phone for Internet interaction, and it was just harder to do that, for one.  I have a laptop though now AND I just got a folding table big enough to write, read, do crafts, etc., on, rather than having a computer on a stool and being uncomfortable in my chair because I had to put a leg on either side.

I do post a lot on Facebook, and that's for people I'm friends with, and almost all of them are people I know personally, with the exception of a few librarians.  I guess I feel safer there in some ways than over-sharing to the great world beyond.  I know, that hasn't stopped me in the past. But I'm 55 now and a little wiser than when I started.

So let's see...I think I last wrote in February.  We got a puppy then and she was so tiny at 8 weeks that she could go between the slats of the picket fence.  Now she's nine months old, and she's nearly 50 lbs.  She finally has a big girl bark, is very tall and long and lanky, and generally is getting very big.  My roommate thinks she's part Lab (that part is obvious, as she has webbed toes and Labrador waterproofing) and part Doberman, much like the dog he had when I first met him over 30 years ago.  I'm leaning towards part Great Dane with her build, but he is probably right.  She's a joy, very enthusiastic, loving, and a good companion to the other dog, who is a Lab/Pit cross and now much smaller than her.

Healthwise I'm dealing with ageing.  I've lost 50 lbs. since early November and 28 of that was from late December on.  (I was put on a different diuretic in November and I swear 20 lbs. came off because I am a sponge.)  I'm on medicine now called Ozempic for my diabetes, but it helps with weight loss and I'm doing pretty well on it, despite early side effects.  I just went up to the maintenance dose.

I do need to lose weight because I have chondromalacia, which is a loss of cartilage in the joint.  My knees are to the point of being bone-on-bone and I need a bilateral knee replacement, but I need to lose another 40 or so pounds.  They'd like my BMI to be under 40, but 45 is a hard stop and I'm 48 now.  So I need to work harder because I'm in a lot of pain and it's very difficult to walk very far.  I do have an ADA placard for out in the community.  I had one at the university but they only gave me a temporary one as they couldn't read my GP's handwriting. I had him redo it and resubmitted it, but they denied my request.  I have a couple of weeks to submit records, which I've requested, and perhaps I can get one on appeal.  You can't just park in a spot on campus without their specific hangtag, you see...my state-issued placard doesn't do a thing.  And they're pretty tough.  One of my former co-workers used a prosthetic leg and they made him send over records, and he finally got it. I've had it all summer, though, and it's been a godsend.  Without it I'm going to have to walk probably a quarter of a mile from my car to the bus stop and back, and that is very difficult and painful.

I'm also most likely going to have my gall bladder out soon. I go to a surgery consult the first week of September.  They'd found gallstones on an MRI of my liver but I was asymptomatic until I had fried fish and was in extreme distress for a week.  I'm a little leery of this. Even with the weight loss, I weigh about 280 lbs., so lots of visceral fat and higher mortality chances with any abdominal surgery.  Hopefully, it will be laparoscopic, as I don't want to miss much work.

Next week will mark the five-year anniversary since I moved in with my roommate.  All in all it's gone very well, surprisingly well, actually. Neither of us were particularly sure about the move and living together.

At work, headquarters took over my surgery and outpatient visit authorisations, leaving me without a position, but my boss (who's only been here a few months) really went to bat for me, and they did a lateral move into a position I've had before that is technically a few rungs down, but because of the way they did it, I didn't lose my pay, although I'm on the high end of the scale for this one.  I'm back in checkout.  One day before I moved I had a panic attack, because when I did it before, I was alone for the better part of a year, did the phone and e-mails, and generally had trouble keeping up.  Now there are two people at checkout (although my work buddy, who is very bubbly, is moving to registration, so they're trying to hire someone for the checkout position that's open), and one person who's job is to schedule phone and e-mail requests, letting me focus on the patients and families for the most part.  So it's actually been nice.  Not as much pressure and I get to interact with families and see the improvements in patients' lives. I do, being an introvert, get drained by too much interaction, but I also find it satisfying in this case.  So everything's going much better than it could have.

I've been working every day on a series of exercises to help keep my mind sharp.  There's Wordle and Latin Wordle, plus I'm studying languages on Duolingo.  I'm trying to brush up on my rusty Spanish, German, and Latin, plus I'm taking Irish and Welsh.  I was going to try to learn Modern Hebrew (I've studied Biblical Hebrew), but that wasn't going well, as the characters were very small, and it just wasn't clicking. I'm going to take my Biblical Hebrew and do some work on that instead and then go back to the modern after I get a grip on the ancient language.  But I'm getting through the ones I've studied before pretty quickly and understand more than I thought.  My grammar is actually still pretty good, it's just the vocabulary that I'm having to pick up again.  German is extremely easy, even though I haven't had it since 1985.  Latin is my most-studied language (5 semesters, including Mediaeval as well as the normal Classical, plus a little Humanist), so it's going well, although there are a lot of angry parrots in this one. (To be fair, Hebrew had a dove that liked warm wine--you can see why I was having trouble).  I've already used a little Spanish to check a person out at work without having to use the video interpreter, and I asked one of the in-person interpreters what the word for 'stickers' is and put it on my bulletin board because the kids love those.

Okay, I guess I'll sign off for now. I'm on vacation. No plans, not going anywhere, but I took the week off between now and Labor Day.  I'm hoping to get some rest and work on some new hobbies and actually do some reading.

And for some reason my neighbours are setting off fireworks for no discernable reason.

:)

So this morning I weighed myself not once but three times just to make sure it was right. I've lost  20 lbs since the move (at the end of August).

I found this to be an interesting read

After 'The Biggest Loser,' Bodies Fight to Regain Weight

I never watched this show, partly because I thought it was terribly unhealthy in its approach to weight loss, and it reinforces the simplistic view that weight loss is just a matter of willpower, and there's the issue of fat shaming. Obesity and weight loss are actually quite complex issues. The study referenced by the Times was published online today in the journal Obesity: Persistent metabolic adaptation 6 years after “The Biggest Loser” competition. It's a little scary that six years after losing the weight, their metabolisms have slowed so much that to maintain their weight (and several have gained either part or all of the weight back, or even more), they have to significantly eat less than a person their size would need to. Strict dieting is not the answer, obviously. And I read something a year or two by one of the contestants (not sure who, or which season) about how the exercise had harmed her joints, going from inactive to major almost boot camp-style exercise hours per day in a short time. Why do people call this entertainment, anyway?

I'm not saying weight loss is inherently evil, or obesity is somehow good. What I am saying is that the factors involved are not entirely understood, the goal shouldn't be so much about weight loss as health and moderation in diet and exercise, and people shouldn't have horrible relationships with food--and should learn to embrace food as the staff of life, a basic necessity, enjoy flavours without gorging ourselves, and food should not be something that fulfills us emotionally, or causes us dread, or somehow makes us sick because of things we ascribe to it that aren't necessarily based in science. Food is not the adversary; our bodies are not the enemy. Making small changes, being mindful--those can help when they build up. Making good, healthy choices, can pay off. This doesn't say, 'just give up', it just says that the mindset we often have towards diet and exercise simply is not good for our bodies.

I finally came out of hibernation

because I was hungry, which was good, as I my blood sugar was going a little low (68). I found a package of peanut butter crackers I'd forgotten were in my lunch bag and ate them, with a few multigrain crackers as a chaser. I feel a bit bleary, and my back hurts from so long in bed, but generally, I think it helped. I've found that a good lie-in bed is good for me about every three months or so, especially as I don't sleep like I used to.

The snow has stopped. I'm not certain how much we got. The parking lot drive is clear, and the steps are shoveled. I don't think I'll have any trouble getting out, as I just have to get the snow off of my car, which I can see from my window. I'm the only one who put their windshield wipers up last night; hopefully that will help. Today it's gloomy and there's perhaps going to be rain or a little mixed drizzle. But given how much rain we have in the forecast, the snow won't be around much longer.

One good thing about not eating much this week; I've lost four pounds exactly. It's not the best diet plan, and there's only so much peanut butter one can eat, but hey. I did eat a fish sandwich meal at the cafeteria Friday with the promise of paying later. Yes, I'm like Wimpy from Popeye. But I always do pay, so they let me; I just try not to abuse that. But otherwise it's either been bread and peanut butter or crackers and peanut butter for awhile.

Okay, I'll take the rest of my medicine and think about getting a shower. I'm moving slowly but really, isn't that the point on a day off? :)

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.

Disheartening, perhaps, but I believe it's true

Diet and exercise alone are no cure for obesity, doctors say: For most of the nation’s 79 million adults and 13 million children who are obese, the “eat less, move more” treatment, as currently practiced, is a prescription for failure, a group of weight-loss specialists says

A group of respected physicians is challenging the common assertion that obesity can be easily fixed by diet and exercise.

For most of the nation’s 79 million adults and 13 million children who are obese, the “eat less, move more” treatment, as currently practiced, is a prescription for failure, these doctors say.

In a commentary published Thursday in the journal Lancet Diabetes and Endocrinology, four weight-loss specialists set out to correct what they view as the widespread misimpression that people who have become and stayed obese for more than a couple of years can, by diet and exercise alone, return to a normal, healthy weight and stay that way.

“Once obesity is established, however, body weight seems to become biologically ‘stamped in’ and defended,” wrote Mount Sinai Hospital weight-management physician Christopher Ochner and colleagues from the medical faculties of the University of Colorado, Northwestern University and the University of Pennsylvania.

Everyone agrees that diet and exercise are important, but relying on only that ignores the constant battle those who are or who have been obese have with their biology. More doctors and insurance companies should learn about this and change their practice as a result.

Go, me!

So it's official.  I'm 25 lbs lighter than I was at my highest weight a few months ago.  Five more pounds and I'll meet the goal my endocrinologist set to increase my insulin sensitivity.  My tops are fitting much better,  although I am the same dress size,  but my pants are pretty loose. I might be able to get into a smaller pair of jeans now. I haven't been dieting, really,  although I have been pretty poor of late so I've been eating less overall. But whatever the reason,  it's good to be shrinking rather than growing in size.