Martin Family Adventure

My scale had a nice surprise

I got on the scale the night I got home from Florida. I was surprised by what I saw, so I decided to check again the next morning to double check what I was seeing. When I woke up, I got back on the scale and sure enough, I'd lost 6 pounds the week that I was away. I ate a LOT of salads and did a lot of walking while I was gone and it paid off even though it wasn't really what I was aiming for. I usually crave salads when I'm traveling because it tastes real compared to all the fast food and carbs that I could be eating for a quick hunger fix. I think I ate about 6 or 7 salads while I was gone and I don't even have an estimate of how much I walked while I was away. Considering all the hiccups that this trip had, it was nice to come home to a sweet surprise on the scale. 

I'm really trying not to put that weight back on now that I'm home. I'm also trying not to let myself get too obsessed with thinking about it. I could easily let myself get overly restrictive and hard on myself but I'm fighting that as much as I can. 

I guess I didn't fail my psych evaluation like I thought I did because I got a call from the Bariatrics center to make an appointment for me with one of the surgeons. I'll meet with him on Monday afternoon and in the meantime, I have video links they want me to watch that explains the surgeries and risks. I've done one out of three so far and it's really imformative. It's a pretty cool system. If I have questions in the midst of the video, I can click on a link to email a question directly to the surgeon so that we can talk about it when I get to the appointment. 

I'm still keeping my options open and will go to the appointment as a means of educating myself. I think this is one of the hardest things for people to understand even though I've said it many times in this blog as well as on Facebook. I'm not settled on what I want to do. I'm NOT pursuing the gastric bypass (which is what quite a few friends are concerned about and is the one that comes with the most risks surgery-wise). I'm interested in either the gastic sleeve or Lap-band, but neither one are set in stone for me. I'll be talking to the surgeon next week about my options and the risks involved, but that doesn't guarantee that he will even move me through to the next step. My insurance may decide they won't cover any of the procedures and then that decision will be made for me no matter what I want to do. I realize that people care about me and love me and have concerns and I appreciate those so much. This isn't something I'm going into lightly. My doctor wouldn't even give me the referral for a Lap-band for the last two years. I've been going to the same doctor since Zach was a baby and I know that he wouldn't give that referral if he didn't think that it would be a helpful tool for me. This is all something that I really want people to understand. 

I did really well yesterday, but I'm finding that as much as I like to be home, it's a really difficult place for me to be when it comes to food. When I'm traveling, I don't crave all the stuff that I usually do when I'm home. I don't have easy access to a cupboard or fridge full of food and I have to eat out. I'm really careful with money and so I don't overeat at restaurants because I know it will cost money. Yes, I know I should think about the considerations as to what it costs to buy food for home, but there's a huge difference in buying food in the store and the minimal cost of it compared to buying a prepared meal at a restaurant. Add to the fact that I love salads while traveling and their minimal cost while dining out and it's a perfect choice for me. 

I've had to reset myself today already, but unlike I used to do, I'm not beating myself up about it and I'm dusting myself off, giving myself a pep talk, and having my do-over right then and there. I'm plugging along and I have some new motivation with the 6 pounds I lost. 

My psych eval at the bariatrics center

On Tuesday, I went to my first official appointment at the Bariatrics Center. This was to meet with the program psychologist for an inital psych evaluation. The appointment did not go as I had hoped and I left feeling a bit defeated. 

The center pyschologist was very sterile and stand-offish. I guess I've been spoiled by my two therapists that I see. Both of them are very approachable and have a nice "bed side manner" (for lack of a better term). The center pysch gave me a quick run down of what the meeting's purpose was and then ran down her list of questions while typing the answers into her computer. There was no warmth to her at all. In between questions, there was awkward silence as she looked at her computer and then back to the paperwork that I had done before the appointment. It was extremely uncomfortable. I felt like I was sitting in front of the judge and jury all wrapped up in one person. 

The questions were pretty straight forward: what was your lightest/heaviest adult weight, do you smoke, do you drink, do you do street drugs (no, no, and no), why are you pursuing surgery, how do you think this will alter your life, etc. 

When I talked about my past struggles and my current BED, the feedback that I got was pretty discouraging. She talked about the fact that I would have to overcome that in order to get things on track before the surgery and if I haven't been successful in doing that now, how did I think I was going to be able to do it before the surgery. That got me really irritated. I understand all of these things. I've been reading up on the different types of bariatric surgery for two years so I'm not ignorant about any of it. The part that really set me off inside was when she asked how I thought I could get on track with the possibility of surgery in the future but I couldn't without the surgery in the future. How do I even answer those questions? So much of this process is psychological- the surgery and the BED. 

The upside to this appointment was that the center psych wants to consult with both of my therapists so that she can get a better picture of who I am and how they feel about the surgery. I realize she can't get to know me well in an hour's time and I know that my therapists are very supportive so being able to talk with them will hopefully give her a more comprehensive view of me. 

I walked out of the appointment feeling discouraged, defeated, and like it was a waste of my time. I've never been in a room with a therapist and felt so....not sure of the word.....invalidated, maybe? I guess I wanted to be seen as someone that was looking for a tool and not a quick fix and I didn't get that feeling from the psychologist. Maybe that's just her default mode because she sees a lot of people in her office that expect they don't have to make any changes and think that the surgery will fix everything. I'm not one of those people so when I tried to make that clear, I didn't get any indication from her that she understood or that she believed me. That was disheartening. I felt like I completely blew the whole evaluation. 

Since that appointment, I've tried to distance myself from her demeanor and lack of warmth and have told myself that maybe that's just how she is and I'm over-interpreting it all. I have a wonderful group of friends and family that support me and so I'm sitting tight until the center psych gets back to me after she's talked to my therapists. 

Answers...

I really appreciate all the feedback I get when I post here. It means a lot to me. I also appreciate when people ask the hard questions because it gives me the opportunity to think about my journey and my intents for the things that I do and the choices I make. This blog is here to share my story but to also learn from each other. I'm very open and honest and I don't mind when people ask questions. Sometimes I write things here that I realize aren't quite as clear as I would like them to be so when you ask questions, it gives me the chance to clarify and explain things further. 

I've had a few people off the blog ask some of the same things that have been asked in comments so I'll try to answer them as best as I can in this post. I hope that those of you that have commented don't mind if I quote some parts of the comments so as to put my answers in the proper context.

"I fear that the surgery is a band-aid, and though I think it could be a valuable tool for you, until you can cope with your BED I wonder how this will help."

"I think it might be better to take some time to work on the issues in therapy, and maybe have the surgery at a later date when you know you're in a good position to be able to follow the food restrictions afterwards without going overboard."

"I'm a bit concerned about how the lap band and the eating disorder will interact."

These are really great points to bring up. The Bariatric Surgery Clinic in my area has a lot of pre-op requirements that have to be met before surgery can take place. There is typically a 6-7 month wait from the time you start with the program until the surgery takes place. During this time, there are meetings with support groups, the dietician, testing outside of the clinic, meetings with the surgeon and nurses, a full psych evaluation, therapy, and counseling. There is also a minimum of 5% of body weight that has to be lost (sometimes more, depending on the procedure and your starting weight) pre-op. 

I have actually been in therapy for a year and a half with one therapist and for 6 months now with a psychologist that specializes in eating disorders. Both of them are working with me on different aspects of learning to cope with BED and to make behavior modifications. One of the things that my psychologist (the one that specializes in eating disorders) said, as well as my primary physician, is that therapy is going to be key in any behavioral modification program, even more so than the part a surgery plays into modification. All three feel that with where I'm at now, the Lap-band will be used in conjuction with a LOT of therapy, dietary changes, and a behavioral modification plan as a tool to achieve success not only in weight loss, but primarily in learning to manage and overcome my BED. 

One of the requirements for being able to have the Lap-band surgery is that I would need to follow nutritional guidlines and undergo therapy. One of the reasons the clinic requires a full psych evaluation and behavioral modifcation to be put into place before the surgery is to make sure that their patients are mentally able to handle the surgery and the life-style changes reguired for it to be successful. The paperwork from the clinic makes it very clear that acceptance into the bariatric surgery program is not a guarantee of surgery. There is a lot that has to come together in order to get the green light for surgery. If I'm clearly not ready to handle the commitments of the procedure and the psychologist at the clinic doesn't feel that I'm ready, I won't get the go-ahead. 

There are many different types of therapy, aversion therapy being one of them. Traditionally, aversion therapy was quite brutal with its electrical shock therapy and such. Today, though, there are different ways to use this therapy while still being ethical. In fact, aversion therapy is a commonly used therapy in treating OCD and other compulsive disorders. Think of the Lap-band as a modern version of aversion therapy. When the Lap-band is first put into place, bingeing is pretty near impossible and trying to binge becomes painful and unpleasant with vomiting, etc. 

"I believe that in a previous post you said that you would not treat cancer with radiation or surgery, so I am wondering what the difference is for you here."

Another great point to bring up. I don't put the Lap-band and chemo/radiation on the same level. For me, using chemo/radiation would be too high of a risk with introducing something into my system that has the potential to kill off not only cancerous cells but also the good cells. My personal opinion, from watching friends and loved ones go through these processes, is that they have great potential to do harm. I know there are many sides to the chemo/radiation do-or-don't-do argument, but this is where I stand on it. I watched my grandfather die a slow and painful death while going through two years of chemo and radiation and I have watched it unfold in other people, as well. That's just not something I'm willing to do to my body. Surgery, however, I see a little differently. If there is a highly positive prognosis of surgery being able to remove cancer without harming the rest of the body further, I would be in favor of it. In other words, if I had breast cancer and the doctor told me that it would be easy to remove and with very few complications, I would most likely consider it. If the doctor told me that the surgery had a lot of complications and health risks, as well as the possibility that removing the cancer could potentially spread it if something went wrong, that I would rather find alternative routes to combat the cancer. These thought processes will probably not make sense to some, but they are something I've felt passionate about for many years. When it comes to the Lap-band, the complications and risks are very low. There are no chemicals being spread through my body to kill cancer cells. It is something that can be removed (unlike the chemo and radiation once it enters your body). These are where the differences lie for me. 

"From an outside perspective, which you can take or leave with no offense to me, it seems that the overwhelming problem you face is the compulsive disorder... not your weight."

I think it's very difficult to separate these two issues. Binge Eating Disoder (BED), which is a compulsive disorder, often causes obesity (there are some cases in which it doesn't because of other factors). Those with BED not only struggle with complusion, but they also struggle with the weight caused by it. Compulsive disorders have their own set of issues, but BED also usually carries with it depression, guilt, frustration, and anger due to the weight issues. The obesity that often happens as a result of BED causes a lack of energy, self-esteem, and mobility. From helpguide.org:

The binge eating cycle

Binge eating may be comforting for a brief moment, but then reality sets back in, along with regret and self-loathing. Binge eating often leads to weight gain and obesity, which only reinforces compulsive eating. The worse a binge eater feels about themself and their appearance, the more they use food to cope. It becomes a vicious cycle: eating to feel better, feeling even worse, and then turning back to food for relief.

It's also important to know that people with BED don't always binge eat due to stress or for comfort. They may eat simply because that is what they find the compulsion to do. Many bingers don't want to eat when they binge. 

"Because from an outside perspective, you seem like an incredibly healthy woman- in mind, body and spirit."

I like to think of myself in this way, but the reality of it is that there is a part of me that doesn't feel any of that at times. There are parts of me that I'm just beginning to be comfortable in sharing and those are the parts that totally contradict being that "incredibly healthy woman- in mind, body and spirit." Just like everyone, I have those days that are hit-or-miss when it comes to feeling this way. For a long time, I've been quiet about my struggles and come across as that woman described above so I think it takes people by surprise when they see a part of me they're not used to. 

"Also (I would be saying this on an earlier post, but I don't know if you see new comments on older posts), I really, really hope that you're bringing David along for some therapy sessions, or that you do so in the future."

As a heads up, I see every comment that's posted no matter when the blog post was made as they come to my email when you post them. 

I really do want to take David to some of the therapy sessions provided by the bariatric surgery clinic. The psychologist that I see that specializes in eating disorders also wants to do some family therapy because we all, as a family, contribute to each others successes and shortfalls. There are many ways that I think David would benefit from going to my therapy sessions and I also feel that my kids would benefit, as well. 

Wow.....I didn't realize that I was going to end up writing so much. Thanks, again, for the feedback and questions. I always welcome them. 

The Lap-band isn't a cure-all, but sometimes people need a helping 'band'

I sent off the paperwork for the Lap-band procedure yesterday. It took me 3 months to finally put it all together and get it in the mail. I was surprised to get a call today to set me up for my first group consult. July 11th is the day. I dreamed last night that I forgot important information on my application and it was sent back and I was put at the back of the waiting list. That phone call was a reassurance that I was only dreaming. DAMN, that phone call was quick! It was only yesterday that it went into the mail!

With all the hesitation that I had with filling out my food diary, now that it's in the bariatric surgery office and I have an appointment for the group consult, my mind is a lot more at peace. I'm looking forward to hearing more about the program and deciding where the next part of my journey takes me. 

When I was at my therapist appointment last month, we were talking about why I was holding back with sending in my paperwork. Why was I stuck on the food diary? I told her that I wasn't sure what to write in it. The instructions were very clear as to what to put in it, but I had this feeling that if I was honest with it, the people at the surgery center would tell me that I just need to cut back and that I didn't need the surgery. I also had the feeling that if I put down that I was eating healthy, they would tell me I didn't need the surgery. I felt like I was doomed to be rejected right from the start. My therapist told me that I needed to be honest with the food diary and that the surgery center was used to seeing the diaries of people with Binge Eating Disorder. The center wouldn't exist if it weren't for people being honest with their food diaries. Still, though, I held off. I would start my days out good and feel like I couldn't write in the diary because it wasn't a true representation of what my eating patterns are like. Then, the end of the day would be shot to hell and by then, I was so discouraged that I didn't even think about writing in the diary. 

I'm sure that it's normal for people to be contemplating bariatric surgery to go back and forth in their decision making process. There were times over the past three months that I told myself that a Lap-band was just a cop-out. Then I would tell myself that my doctor has been seeing me for 13 years and he never would have made the referral if he didn't think it would help me in any way.  As soon as I felt like that, I would get discouraged about the food diary and the vicious cycle would continue once again. My therapist asked me some hard questions. What if this IS just a cop-out? Is that so bad? After all, it's not an easy process to get the Lap-band and I'm going to have to make hard choices and tough habit changes so in the long run, it really isn't a cop-out. It's hard work. Even if I decide that I don't want to do the procedure, what's it going to hurt to go to the consult and listen to what my options are. I'm under no obligation either way. She told me this last month and it's taken me this long to let it sink it and finally do the paperwork and get started, but that's not a bad thing when I look back at it. I try not to jump into things head first and I usually have to go through a processing of sorts when I make the big decisions. Sure, it may have taken three months to get to this point, but here I am and I'm cool with it. 

I understand that the Lap-band isn't a cure all. There's a lot of counseling, behavioral modification, diet changes and exercise habits, and so much more that go along with the Lap-band. I know that and I'm ready to look into it further.