OPTIFAST Program Ends at Queen Anne, but Group Continues!

Queen Anne Medical Associates, PLLC, is phasing out its OPTIFAST Program. (We are happy to sell you the remaining OPTIFAST stock - and we can tell you where and how to buy OPTIFAST products if you would like to continue using them.)
 
We WILL be continuing our Thursday afternoon Weight Management Support Group. I'll continue to offer this in a "drop in" format,  and we won't be charging anything to participate. Why do this? Frankly, I appreciate having the support - and we have developed a strong core group that really cares about each other. Plus, the more we work together, the more we understand why weight management is such a struggle. And, the more we learn to how to succeed.
 
So, have a wonderful Thanksgiving. Remember, it's ONE meal. Get some activity that day, and you'll be okay. Let's plan to meet together again on Thursday, December 4 from 5:15 p.m. to 6:15 p.m. Usual place: second floor conference room.
 
Remember, we're all in this together.
 
Linda Gromko MD

The Case for Morning Exercise

OK, so not everyone is going to turn out for rowing at 5:15 a.m. But there are clear reasons why people actually do this. For one, the water is absolutely calm - provided it's not windy. There is very little water traffic at that time, and almost no competition from inebriated  power boaters. The sunrises over Lake Union are spectacular. And now and then, you see a blue heron perched on a pilon, or even a bald eagle.

The best part of early morning rowing is that you get up and get your day's exercise out of the way. Nothing will likely distract you at that hour. And you can progress with your day - energized and guilt-free!

Naturally, it doesn't have to be rowing.

A brisk morning walk - maybe around Greenlake, maybe to your local Starbucks for a Skinny Latte - will accomplish he same important work. You get up, fill your lungs with fresh air, organize your day, and get going! And, you're done with your day's exercise with no risk of later distraction.

You can Zumba to a DVD. You can swim laps and take a shower before heading for work.

As always, the best exercise is the one you'll do!

Try it. We're all in this together.

Linda Gromko, MD

Week 24: Anne's Story

When it comes to weight challenges, we've said many times that "it's not about the food." That how it was for Anne (not her real name). She told me her story during a clinic visit last week, and gave me permission to share her story with you.

*****

68 yo Anne presented to the clinic for her Women's Health Exam. She has lost over 65 pounds through Weight Watchers. She is ready to begin swimming again. She feels very envigorated, and feels this is largely due to a recent event which enabled her to reconcile her past family history of abuse.

Anne was raised by an alcoholic father and an enabling mother, in a home with three abusive older brothers and one younger brother. It was common in her household to hear arguing between the parents, and it was common for her mother to be struck by her father to the point of injury.

The boys were the priority in the family. Anne recalls hours of insults from her father, directed at her. She was repeatedly called a "whore," and "no good." If she studied late, her father would rage, "Go to bed; what do you think you are doing?" If her grades were less than perfect, he'd begin an opposite tirade - belittling her once again. She could never find a balance that pleased him.

The parents divorced when Anne's mother finally had enough - when her mother was 72. Later, the father died. Her mother became more demanding on Anne's time, and the brothers came by only once a year - never producing any substantive support. Anne became the caregiver - at least the one who did the shopping, the laundry, and the errands.
 
At the same time, Anne was struggling with increasing weight and other health problems. She tried numerous diets, but without long-term success.

A couple of weeks ago, Anne went to visit her brothers. She stayed in one of their homes. Memories of abuse in a childhood controlled by the men in the family, came flooding back. At one point during her visit, Anne was cold and went to turn up the thermostat. Her brother barked, "Don't do that," raising his hand as if he was about to strike her.

At that moment, Anne flashed back to five-year-old Anne, sitting at the top of the stairs in terror, listening to her parents argue. Adult Anne went to bed in tears that evening, dreaming that her threatening brother was trying to kill her.

Anne left the vist early, contemplating her childhood on the return trip to Seattle. She had spent a lifetime protecting that five-year-old Anne - by tending to her career, by buying a home, and by not marrying into another abusive partnership that replicated her parents' marriage.

She appreciates now that food was always her comfort - insulating her against the harshness of her father and the inability of her mother to protect her.

Anne is now ready to nurture the adult Anne, and she is beginning to explore the forms that nurturing might take.

She is confident that she will continue to lose weight and continue to swim.

As she says, "It was never about the food."

********

 

Sound familiar? If you, too, have used food as a comfort, try to identify what caused the need to seek this comfort. What served you as a child may not be needed as an adult.

 

Take care; we're all in this together.

Linda Gromko

www.LindaGromkoMD.com

Week 23: Odds and Ends that Keep Us Afloat

On Thursday, June 19, we had a small, but productive group. Here are some of the odds and ends we shared. Perhaps they'll help you!

1. Water aerobics:

We reviewed that there are excellent deep and shallow water aerobics classes offered at our local recreation centers. A group of us attended one on a Thursday evening, had great fun and exercise - for a mere $6 each. Check your local Parks and Recreation Department.

2. So what to do about a swim suit?

Nobody seems to like how they look in a swimsuit, at least in the over-50 crowd. But here's a resource that came up:

From Junonia.com

 



Junonia.com sells active wear, including swimsuits like the one at right, for women from size XL through 6X. They carry swimsuits, athletic wear, swim cover-ups, even swim shirts. They even market swim separates!

Land's End sells swim separates also, and in a broad range of sizes. Both vendors have great return policies.






3. Snacks, anyone?

If you are looking for the crunchy variety, try to find "Good Bean" snacks. Made of chickpeas (garbanzo beans), these come in a  variety of flavors, i.e., cinnamon, spicey, sea salt, etc. Drugstore.com or Amazon.com carry these. They're not inexpensive - but they may get you through the day with far less caloric impact than so many of our favorites.
 

The Good Bean

None of these ideas will win a Nobel Prize in anything, but sometimes a simple solution can keep us going through another day.

 

Remember, we're all in this together.

 

Linda Gromko, MD 

Week 21: Time for a Movie!

Looking for an interesting film that resonates with your nutrition/weight management efforts? Try this one!

"Fed Up" takes the viewer on a fascinating analysis of the American diet. According to this film, the problem is sugar. It's in so many processed foods - and clearly contributes to our nationwide rise in diabetes, obesity, hyperlipidemia, etc. Efforts to increase activity, i.e., Michelle Obama's "Let's Move" campaign, just aren't enough!

"Fed Up" draws a frightening parallel to the tobacco industry. The brain's response of the sugar addict looks much like that of the cocaine addict on a PET scan. It's projected that today's generation of young people will have shorter lifespans than their parents! And government subsidization of corn farming, nationally-branded fast foods in public schools, and the super-sizing of soft drinks leaves the viewer to question what can possibly be done to arrive at a sane balance.

Go see it. Eat your whole fruits and vegetables.
We're all in this together.

Linda Gromko, MD

Week 20: Treatment Plan Exercise

Here is our exercise from last week's group:

"You are a health care provider. A new patient comes to establish care with you. He/she is bright, funny, and well educated. You like him/her instantly. Your patient explains to you that their main frustration is their weight. Your patient explains that this has been an issue for many years, and that they have tried numerous approaches with varying degrees of success.

Knowing what you know, what are your recommendations for your patient?"

Here are some of our group members' ideas:

• Examine their reasons for wanting to lose weight
• Talk with them about their goals/objectives: staying the same/weight loss?
• Ask if this is a reasonable time to tackle weight loss goals
• Ask what the patient can or will do to lose weight
• Ask the patient to meet with you frequently
• Suggest, "if you stumble, just get right back up."
• Ask your patient if they are willing to track their food intake and exercise routines, so you can review them together
• Explore your patient's sources of support
• Create with your patient a practical plan for a short term approach - as well as longer-term strategies
• Suggest tools, i.e., My Fitness Pal, Sparkpeople, for tracking.

The next question: "Your patient returns with some success, though not as much weight loss as the patient desired. What do you recommend now?"

Our group's ideas:

• Review the original plan
• Remind them that if they are trying to lose weight, any loss is good
• Check if their expectations are realistic, or just "wishful thinking"
• If your patient isn't following their specific program, find out where they are deviating and explore if this is making a signigicant difference
• Explore why the patient is/is not staying with their plan
• Explore: is this realistic at this time? If not, adjust goals, add exercise, just keep going
• Are there factors which sabattoge the patient's efforts?
• If your patient isn't succeeding, leave a door open - a way back without shame or the sense of failure.

A wise group, don't you think? One of our themes was that we really do know what we need. But sometimes, when we depersonalize a question, i.e, "what would you do for your best friend in this situation?" - we find our own best advice.

Our third question involved when to recommend weight loss surgery, and we'll continue on this topic next week.

Remember, we're all in this together.
Linda Gromko, MD

What's Your Treatment Plan?

Over the past few months, we have discussed a variety of weight management programs. Most of us have done or are doing OPTIFAST currently. Most of us have done a variety of other plans, i.e., TQI (which isn't really a weight management program, but offers very sound nutritional advice), Weight Watchers, etc. We've talked about creating hybrids of various programs.

We've discussed weight loss surgery.

And we've hammered home the need for exercise as part of a weight management program.

We've discussed obstacles which may stand in our way - including:

• busy lives
• grief
• boredom
• our own perfectionism
• our own lack of self care (taking care of other people's needs when we can't get ourselves on our own to-do list!)
• resentment
• depression
• protection/insulation
• need for comfort or soothing, etc.

So how are we doing? Most of us recognize that left to our own devices, we tend to lose track and gain weight. If we're holding steady, that's certainly not bad!

But many of us express frustration about not keeping weight off as effectively as we'd hoped.

I've always maintained that most of us are - or should be - our own best doctors. Yes, I've heard the line, "A doctor who treats himsef has a fool for a patient!"

But we usually do know ourselves reasonably well.
So, knowing yourself as you do, what is your current recommendation for your own treatment plan? Think about it; write it up. Shore up your resolve.

We're all in this together.
Linda Gromko, MD

Week 18: When Your Life is in the Blender!

How many of us have had the experience where big, life-changing events were happening all at once? Where nothing seemed to "flow" with order or reason? Where, in spite of our best intentions, things were simply out of our control? Life...in the blender - and on HIGH!

In our last group meeting, many of us were in the midst of blenderized living. We had deaths in the family, critical medical experiences in family members, dealing with elderly parents, and planning for surgeries. Not "light" content.

And, what do we do when life is in the blender? Many of us turn to our long-term comforts of carbohydrates, chocolate, salty-crunchy snacks - understandably putting aside what we know we need, and finding some respite in the midst of the storm.



So, we struggle again. Wondering why it is that we succeed in so many areas of our lives, yet falter with food.

We've talked in our group about "running the bases." ("When I'm running the bases, I'm in the game.")

Let's review:

• The pitcher = what life throws at you
• The bat = how you react
• lst base = intention and attitude
• 2nd base = habits and behaviors
• 3rd base = self-care ("self-basting")
• Home base = reassessment, improvements in health & life.

This week as we reel from the fast pitch, check your intentions and attitudes. What behaviors are serving you, and what behaviors are hampering your progress? And what are you doing to take care of yourself?

Go back and review the Serenity Prayer. What things can we control and change, and what is simply life in the blender?

Sort it out, and we'll get through it.

We're all in this together.
Linda Gromko, MD
 

Practical Question: How does one plan for surgery?

It looks like a couple of our members are having surgeries in the near future. So last week's discussion centered on preparing for a surgery.

Everyone's circumstances vary, of course. But the following are pointers from my own personal and clinical observations that might help you someday.

• If you have the "luxury" of a scheduled surgery, rather than an emergency surgery, pick a date that serves you and your loved ones best.
• Ask your surgeon, "What can I do to ensure the best recovery possible?"
• Think and plan ahead. Pay your bills, do your laundry, clean your house - or hire someone to help you. Come home to a clean, ordered living space.
• Ask about post-operative foods. You may be advised to eat more protein, for example. 
• Constipation is a common problem for people who require post-operative narcotics. Increase your fluid intake and eat fresh fruits and vegetables to prevent constipation. 
• Simple, easy-to-prepare meals will be helpful. There's nothing wrong with prepared foods, but do check your labels for sodum, calories, and protein.

• If you use a sleep apnea device, i.e., CPAP, ask when you shoud start using it post-op. Remember that narcotics can worsen sleep apnea - temporarily, of course.
• Blood clots in your lower extremities can be life-threatening. Prevent them by getting up and moving around; at least, wiggle your toes!
• Ask your surgeon about mobility - and mobility assistance. Depending on your surgery, you might benefit from a rolling walker or cane during your early recovery. These can be selected by a physical therapist and often delivered to your home.
• Make sure you have your regular medications - and any special post-op medications available. Prepare a "medi-set" ahead of time.
• Expect to feel overly stimulated when you make a trip to the pharmacy or grocery store - even overwelmed! It will pass. Plan on making no more than one out-of-house excursion per day in the early post-op period.
• It's normal to feel more tired, so take naps and allow yourself to rest.

• Taking deep breaths and coughing can actually prevent a pneumonia. Ask your nurse how to "splint,"i.e., how to support your incision by pressing a pillow against yourself.
• Concerned about bathing and shampooing? Rinseless shampoo can be purchased on-line or in a beauty supply store.
• When it's time to go back to work, consider returning on a Thursday or Friday. That way, you can go for a shorter time and have the weekend to recover.
• If you're going back to work for partial days, be sure to rest in the morning and go to work in the afternoon. If you start your workday in the morning, you'll never get away!
• Post-op blues or depression aren't uncommon, but ask your doctor if depression lingers.
• If you will be limited in mobility for more than a couple of weeks, ask your doctor for a temporary disability parking permit.

Be sure to ask your questions. There are no stupid questions - except, perhaps, for the ones you don't ask!

Remember, we're all in this together.
Linda Gromko,MD

Most People in Japan are Slender!

I just came back from the trip of a lifetime: a week in Japan, sponsored by the Japanese Society for Home Hemodialysis. I gave three talks. The first was for the Conference of the Japanese Society for Home Hemodialysis in Shizuoka. The second, for a group of young nephrologists at Kyoto University, and the third was for the staff of the Sakai Rumi Clinic in Kobe, Japan.

Linda with a Group of Young Nephrologists at
the Golden Temple in Kyoto, Japan

My first observation - arriving at the Tokyo Airport (Narita), and heading for Shizuoka by way of the Shinkansen ("bullet train") was, "These people really move!" They walk with purpose; the trains are never late.

The food was fabulous. I ate sashimi (raw fish) for the first time, though I doubt it will become a regular part of my diet. The tempura was extraordinary. Normally, I don't have eye contact with my food as I did with the little tempura'd fish. And I did eat a tiny squid! I thought it was a baby, but was reassured that it was a full-grown adult.

The food was fresh, beautiful, and quite filling. Dessert? One night, it was a scoop of sesame ice cream the size of a golf ball. Another night, fresh melon with three perfect fresh strawberries.

So, all along, we've been stressing exercise and portion control. The Japanese people I met had it all figured out.

Remember, we're all in this together.
Linda Gromko, MD

Week 15: A Grain of Grace

Last week was one of those weeks where we had a little tiny group of two! Traffic, other commitments, who knows?

But it led to an interesting discussion and one which is very appropriate for the group as a whole.

We were discussing various problems we'd encountered; she had a history of abuse from a very young age. It seemed like she had triumphed against horrific odds, becoming the happy and well-adjusted woman she is today.

 

Sometimes when people are asked, "how did you possibly get through all that?" we hear the answer, "you just do. You do what you have to."

 

 

But in reality, not everyone does get through a challenging life unscathed. Some people tune out. Some people suicide. Some drink or use drugs. Some people "check out" of life, never accomplishing  much - even though they are still living.

 

 

So I asked my compadre, "Why do you think you made it through?" Clearly, others in her dysfunctional family hadn't fared as well.

 

"There were little bits of grace: grains of grace," she said. "There would be the right person to help when I needed help. And I made it through."

 

I would submit that we have all experienced grains of grace: talking with the right person at the right minute, maybe finding the book we needed to read. Perhaps an art exhibit or a symphony performance allowed us to see the expansive universe beyond our own distressing sphere - just enough to give us enough hope to get us to the next level.

 

We'll be talking about this a bit more.

 

Take care; we're all in this together.

 

Linda Gromko, MD

Week 14: A Tame Little Exorcism is a Start!

Here is the exercise we did last week, having named a variety of our collective and personal demons:

"We hypothesize that there are "demons" that prevent us from maintaining a healthy weight. Pick a demon from the blog (last week's entry) that applies to you - even in a minor way.

Now, write a brief note to that demon, and explain to it what - if any - function it might have served for you at one time. You may even wish to express your gratitude for that service. Most importantly, explain to your demon why you would like it to go away now, and forever."

 

 

Here are a few of our Demon Letters:

 

"Dear Demon of Positive Strokes Through Food,

Go away. I have enjoyed the positive strokes. They felt good. But go away. I've got enough other - and better - sources of positive strokes."

 

and another:

 

"In the past, resentment gave me the illusion of power in a situation where I was unsafe and, in actuality, powerless. It was safe to feel resentment - no one could see the feeling. And I could feel at least somewhat powerful and in control by acknowleging the strong feeling, but not acting on it. I wanted to do many things to punish my abuser but was strong enough not to destroy my future by acting on those impulses. It was an appropriate coping mechanism - given my realities then.

 

"Resentment no longer serves me well - I am safe and powerful and can take care of myself. I can say out loud what needs to be said. I have the freedom to make the choices I want - positive or negative. I no longer have to define myself in terms of opposition to someone else."

 

Here's another:

 

Food as a demon:

"Dear Food:

On one hand I want to exorcise you - at the same time, I need you. The beauty of OPTIFAST was that I could, in many ways, exorcise myself from food - knowing that only program "food" was allowed. In many ways, that was a tremendous relief.

 

"But food...real food (not the highly processed and refined and chemically altered junk food I am so often attracted to)...I want to think of you not as a demon, but as a friend. Someone who can be my partner in good health.

 

"If I could partner with whole foods and exorcise refined junk foods, that would be a gift."

 

And finally,

 

"Dear Demon,

You - the arbitor of correct function and academic excellence - assisted me in the pursuit of scholastic achievement and even getting into professional school. But the perfectionism you required and the continual criticism and comparisons between me and other people have decreased the enjoyment of my life, and limited my sense of self worth. While I recognize that perfectionism occasionally has its place, you are no longer relevant in my life.

 

"Therefore, I thank you for any service you may have provided, and require that you leave my life now and forever."

 

Interesting thoughts!

 

One group member commented that she could have written a letter to nearly every demon on last week's list. By all means, do that!

 

As a personal note, I'm always interested in the way we sigh briefly when assigned an exercise, and then write like mad! Kind of telling, I think. We've got stuff to say.

 

Remember, we're all in this together.

Take care,

 

Linda Gromko, MD

Week 13: Naming the Demons Before We Exorcise Them

As usual, we had an animated session last week. Our challenge was to give examples of "demons" that prevent people from maintaining a healthy weight. Here's a short list - see if any apply to you:

• A personal history of sexual assault
• A personal history of parental neglect
• Stress
• Fear of failure
• Dealing - or rather, not dealing - with gender dysphoria ("If I'm heavy, I can't transition")
• Need for comfort
• Shame - never feeling good enough
• never a good enough mother
• never a good enough parther
• never fit enough
• never consistent enough
• never committed enough
• never thin enough
• Criticism and judgment
• Fear of being personally rejected ("It's easier to be rejected because I'm heavy than to be rejected because of who I am.")
• Low self esteem
• Depression
• Having been truly hungry as a child
• Having been bullied/taunted when younger
• Loss of friends, family, partner from any means
• Addiction - personal or in family of origin
• Frustration with the pace of desired change
• Resentment of other people who appear to have it better.

One commonality among demons is that we feel the need to be protected from them - to be insulated from the pain they cause. Sometimes, that protection - in the form of food - served us well for a while.

A young woman in literal danger of sexual assault might think she'd be less at risk if overweight. And perhaps her overweight really did serve her at one time - just not now.

A transgender teen might see transitioning to the correct gender as being impossible. Extra weight might protect him/her from "going there," - a process which seems so difficult as to be just a dream. Later, the extra weight doesn't serve, and the gender issues remain.

We also discussed the way food itself can become a demon. Always everywhere, food beacons. It's there at every celebration, every lonely moment. It's our addiction, our requirement, our ever-present reward. But this "demon" is necessary for us to live - provided the demon is managed. 

We also discussed that food is manufactured in such a way as to be purpsefully addictive, i.e., laden with carbohydrates and refined sugar that keeps us coming back for more - even when we don't even want it!

In tomorrow's group, we'll be inviting some of our demons to leave!
Should be interesting.

Remember, we're all in this together.
Linda Gromko, MD

Demons - Do We Harbor Them?

At our last group session, we started talking about demons! We just barely got started with an animated discussion, and it was time to go. So we are carrying this session forward, and it will become our topic for the meeting of Thursday, March 20. Here's a preview:

It is said that some people carry "demons" that prevent them from maintaining a healthy weight. These demons may include issues or traumas, past or present, that occupy a person's mind. It is also said that until people face and conquer these demons, they won't achieve their weight goals...or achieve their full potential in ANY area.

Here are our questions:

• What do you think are examples of such "demons?"
• What does one do to get rid of a demon?
• What are the demons you personally have experienced?

Does a person have to have a demon to have a weight problem? Probably not! It's completely possible to have settled into a pattern of beheviors that shoot you in the foot without having some underlying problem - I guess. But none of us would chose obesity! So why do we keep doing the very things that sabottage ourselves?

Please give these questions your consideration, and we'll take it up again on March 20. Remember, nobody is required to share their deepest secrets. But perhaps someone's story will help the rest of us.

Keep up the good work.
We're all in this together.
Linda Gromko, MD

Week 11: Stepping Up to Bat - for Ourselves!

In our baseball metaphor, we recognize that life pitches us fair balls, strikes, walks, fast balls - and we don't know what we'll be facing as we step up to the plate. We don't have any control over what's pitched to us. But we do have control over our general preparedness, and we do have control over our responses!

So, how do we prepare ourselves as we step up to the plate when we have at least some idea of what we're facing? At our last group, we discussed the following questions. A sample of our responses follow.

1. What things do you do to prepare yourself as you face a significant challenge? How do you get ready?

• "I remember before my medical school interview, I practiced every interview question I could imagine - out loud and in my car. By the time the interview actually came, there wasn't much that could derail me."
• "Mentally prepare: think 'I deserve to be here.'"
• "Think through it: imagine the right way and visualize success."
• "Have all necessary supplies ready."
• "Prepare the environment; how can I make the task easier?"
• "Learn as much as possible about what to expect; talk to people and read on-line."
• "Study the problem. Understand what's needed for success. Make a plan and test it, and modify it until success is achieved!"

You get the picture, this group is prepared. We set ourselves up to be successful!

                        

2. What things have you done to prepare yourself for your Weight Management challenge? (Also, what things do you do every day to prepare yourself?)

Here were some of our ideas:

• "Have water and snacks on hand."
• "Be our own best friend."
• "Focus on food preparation. Have your food ready and avoid impulse purchases."
• "Make lifestyle changes."
• "Cut back on soda."
• "Cut back on TV time - and especially eating in front of the TV."
• "Change my shopping habits."
• "Don't let 'bad' food in the house."
• "Find the best recording tool for yourself, e.g 'My Fitness Pal,' etc."
• "Tell my husband what to expect - and how to help me."
• "Eat protein for breakfast."
• "Work on other rewarding activities, besides food."
• "Clean out old clothes; buying new things can be a reward."
• "Plan for exercise. Take exercise clothes in the car."
• "Bring my own food to work for lunch and snacks."
• "Throw away foods that threaten my resolve; dump the cashews!"

Certainly, there are many things we can do to stack the odds in our favor. We've done it in our work; we've done this professionally. And we've done it effectively.

Now, the challenge is to transfer this preparedness - even preparedness for the unexpected - into our Weight Management.

A couple of members noted privately to me that there are specific demons that have held them back - sort of like a sprinter with a weight belt! It's time to examine our own demons - if this applies.

Take care. Remember, we're all in this together!
Linda Gromko, MD

Week 10: Being Our Own "Best Friends Forever"

Last week, we posed the question: "if your best friend were exactly in your situation, what would you do to support him/her?"

Our creative group had no difficulty exploring this.

In fact, we were quite good! We were non-judgmental. We listened. We asked how we could best help them. We had coffee with them. We walked around Greenlake with them. We made a special effort not to undermine their efforts - even when we didn't quite agree. We supported them, as long as their actions weren't harmful to them.

We need this kind of friend!

Linda with BFF Andrew Faulk, MD
(with whom she shared a cadaver table in med school)



 

So how can we be this kind of friend...to ourselves? What stands in our way?

Here are some things the group came up with:

• We are already busy supporting ourselves by self-medicating with food - which, in turn, undermines our health
• We allow our stresses - like work, family - to get in our way
• We don't have the time for ourselves that we might readily give to a BFF
• We harbor negative thoughts and feelings, and we talk to ourselves in negative ways
• We don't stick up for ourselves
• We don't make the effort to be as "nice" to ourselves as we would be to our BFF
• We don't trust, admire, or respect ourselves enough
• We are perfectionists - of ourselves, but not so much of others
• We fear that after putting in the work to succeed, we may find that our lives won't be that much "better"
• We fear disappointing ourselves...again
• We see that if we lost weight, etc., that we would have to address our other issues
• We don't reframe our own self-beliefs (e.g. "I am a person who exercises" rather than "I only exercise when I have to")
• We may not think we deserve a BFF!

So, perhaps we need a "friend make-over!" Check out the list above and see what might apply to you. Then, make it a point to find yourself a non-food treat - as BFF Kim and I are doing in the photo above.

This week, we'll get back to the basics of running our bases. So start by preparing yourself to go to bat...this time, for yourself.

Remember, we're all in this together!
Linda Gromko, MD

Week 9: Back to Reality, and That's Just Fine!

I am back from a magnificent journey to Bangkok, and happily readjusting to my world. In addition to an appropriate amount of information on transgender health, here's what I learned:

• I can fly! (I've been flight phobic for years, though never let it limit me.) But the trip involved 20 hours of travel each way. I knew that I'd grown up a lot when I heard myself think, "Turbulence, how soothing!"
• Knowing a little of the language helps.
• Most of the people traveling were younger. It made me think that international travel is for the young, or at least for the physically fit! Another incentive to exercise and stay strong.
• Travel-related recreational eating is fine, as long as it doesn't contnue at home - and it hasn't!

Linda relaxing on a dinner cruise in Bangkok



 

So, back at home. At the last Weight Management Support Group I attended, we discussed the question, "If your best friend were exactly in the situation you're in, what would you do/say to support them?"

We had plenty of ideas. We are, after all, a group of smart, creative high-achievers.

This week's session will deal with how we can be better best friends to ourselves.

We're all in this together.
Linda Gromko, MD

Week 8: No Spanx in Bangkok!

Greetings from Bangkok, where I have been attending the conference of the World Professional Association for Transgender Care.

It's absolutely beautiful here, and I have had three Thai massages: a 120 minute treatment cost me $30.00. Heaven.

The food has been quite heavenly, also. And I have left the Spanx at home, and gone off the grid completely!

Yes, there have been little pancakes with chocolate elephant designs perfectly embossed within. There have been pastries, and I have eaten more cookies than I have eaten in the last 5 years.

So where does this put me in my "Running the Bases" model?

First base: "Attitude and Intention." Well, I intended to enjoy Bangkok and not be so constrained as to disrespect this wonderful journey.

Second base: "Habits and Behaviors." Walking has stayed in the mix, and I have consumed enormous amounts of fresh watermelon and pineapple.

 Third Base: "Self Nurturing." Here, I've achieved HONORS! Three massages - so far, a lovely wool shawl from the Jim Thompson House, and - get this, a handmade quilt with elephants on it - purchased at a tiny market across the river from the hotel.

Home Base: "Reassessment/Self Talk." This is where the drill becomes really critical. If I can happily say, "Yes, I went off the grid for a conference/vacation, but I'm rowing the day after I get back," I'll be perfectly fine. A little damage control needed? You bet. But the point is, if I know I can go off the grid, and keep running those bases, I'm still in the game!

Besides, I know where the Spanx are kept.

Take care,
We're all in this together.

Linda Gromko, MD

Week 7: Happy Valentine's Day!

Last week's group focused on the important question:

"If your best friend were exactly in your situation, what would you do to support him/her?"

It's not an easy question. How do we support anyone? What do we say or do when a friend is struggling?

As always, our talented group of truly gifted individuals had plenty of ideas. Here's a sample:

"Take it slowly, and be happy with the progress you make. Any progress is better than none. Think about how weight loss will enrich your life. It'll be hard, but you can do it. Keep yourself honest: write down your food and exercise daily. Make sure your relationships are with people, not with food."

 

"I love you just as you are, but I understand this is painful. You are not alone. I believe in you and will help you in any way I can. I care about you and want you to succeed. You can do this! It's a process, and it makes sense to make small changes slowly. Remember, you can't change forty years of habits in a blink!"

 

 

"Many people equate more and better food with more and better success! Let go of this idea. Bring the same intent and quality to your food and lifestyle that do bring to you professional work."



 

 

"I would ask her what she needs to feel supported, rather than giving her what I think she needs. I would try not to pass judgement, and give her honest feedback - if she asked for it."

 

"I would tell her to: 1) trust her gut, 2) play to her strengths, 3) maintain the behaviors that support her weight management, like exercise, and 4) have the courage to follow the message, "Do the best you can and love will back you up!"

 

 

***

 

Well, no surprise. This exercise is a therapy tool. Of course, your "best friend" could and should be you! So on this Valentine's Day, think of this exercise. Not just as it applies to weight management -but as it applies to the many ways in which we support ourselves, or perhaps, miss the opportunity to do so.

 

I'll be in Thailand this coming week for the WPATH conference, so no group on February 13. On February 20, our group member and colleague, Donna Henderson, has graciously agreed to facilitate the group. Thank you, Donna.

 

Have a wonderful week, and make sure you get yourself a supportive Valentine's Day treat! Just like you'd do for your best friend!

 

We're all in this together.

Linda Gromko, MD

Week 6: We Resent Having to Worry About Weight, but...

Sometimes, it feels like we do everything right. We don't smoke, we don't drink to excess. There's no heroine in our collective bloodstream. We vote, we pay our bills, we get to work on time and we do our work effectively. Some of us even floss.

Yet, we don't have the luxury of eating casually. We eat with consequences: guilt, feeling deprived, suffering health problems that come with being too heavy. We have anything BUT a casual relationship with food!

This highlighted a sense of resentment for one of our members. She was very clear: it wasn't a resentment of the people who seem to eat anything they want. More, it was a resentment of the "fate" of having to be so vigilant.

And even though she has lost a significant amount of weight, the work doesn't seem to balance out the benefits - at least not yet.

We asked if there might be a parallel somewhere else in her life where she had had to really work, to sacrifice, to make things right.


And sadly, an abusive childhood had led her straight into therapy for many years! Now that she's dealt with this ("it is what it is"), she does great with life in general, though she will have an occasional mental health tune-up (therapy session) when she feels the need. Resentment about this issue doesn't occupy much mindshare.

The point is, she's come to terms with facts that weren't the way she wanted them to be - but has found ways to maintain stellar mental well-being. She's done her work and knows what she needs to do for self-care.

This seems like an excellent example of running the bases: she approached her childhood issues with 1) attitude and intention, 2) habits and behaviors, and 3) self-nurturing. And she keeps on running - modifying her self-care behaviors as needed - and not allowing her background to interfere with a full and happy life.

My hope is that someday we'll see our weight issues as manageable - just like this mental health issue has been managed. Not with resentment (which would be understandable), but with practical self-knowledge of just what it is that we need to do to stay on track.

Next week's exercise - which we haven't discussed yet - is:
"If your best friend were exactly in your situation, what would you do to demonstrate your support?"

We're all in this together.
Linda Gromko, MD
www.LindaGromkoMD.com

Week Five, and Many Resoutions have Evaporated! But, Not Ours!

The holidays are over, it's week FIVE of 2014, and many people have simply cashed in their New Year's weight loss resolutions - or the exercise promises - or any other wish that seemed so possible as the New Year began.

But not us! At Queen Anne Medical Associates, we have a sturdy group of folks who want to crack this case. We want to answer the question,

"Why do people as smart, funny, and successful as we are still struggle with weight?"

So, we meet, and we talk, and we write.
We explore new approaches to weight loss, and we answer our objections to behaviors that could help us - like exercise. In fact, we're putting on those swimsuits with the knees and we're going to Water Aerobics on February 4 at the Ballard Pool!

Last week's Journal Exercise went something like this: "If your best friend were exactly in your situation, what would you do to show your support?"

We'll talk about this on Thursday, January 30.

The next question: "Resentment has come up as an opponent in our weight loss struggle. Examine your own resentments, i.e., whom or what do you resent? as it pertains to your life."

We're all in this together.
Linda Gromko, MD
www.LindaGromkoMD.com

Week 4: Linda's Diamond, Journal Exercise

Welcome back, everyone.

Here's my baseball diamond (your's may be completely different):

My pitcher is life, sending us fair balls, walks, strike-outs - and not always within our control!

• First base: Attitude & Intention
• Second base: Habits & Behaviors
• Third base: Self-nurturing (someone said "self-basting!")*
• Home base: Victory: Improving my Life

Now the trick here is that you keep running the bases - forever! Not for a prom dress, not for a wedding, not for a job interview. For the victory of improving our lives.


In group last week, we itemized factors which are "team mates" and "opponents."

Team mates (things that help):

• Queen Anne Medical Associates, PLLC
• Partner, kids
• Like-minded people
• Comfort
• Spiritual practice
• Volunteering

Opponents (things that don't help):

• Unrelenting food messages and images
• TV
• Stress
• Loneliness/boredom/grief
• Health issues
• Resentment
• Trauma
• PTSD

There are dozens more, but this gets us started.

Week 4 Exercise:

"If my best friend were in exactly my situation, I would encourage him/her by...."

 

Good luck, get writing.
We're all in this together.
Linda Gromko, MD


*Source may be Dave Barry? Tell me if you know! LG

Week 3 Exercise: Just a Little More Baseball

Welcome back, committed person who wishes to live a better, healthier life!

Last week, we examined the expression,
"If I'm running the bases, I'm in the game."

This came from a client of mine who faces a number of challenges, but found if she consistently did the same behaviors that seemed to keep her on track, she stayed on track.

For one of us, the expression, "Suit up and show up" summed it up. And how often it's true that if we just attend, the battle's nearly won.

We looked at the baseball metaphor, and asked, "Who's the pitcher?" For some, that was "life" or "circumstances," or perhaps, "things beyond our control." Some felt the ball was food.

And the bases? Plenty of ideas: Attitude, Intention, Physical Activity, Self Care, Setting and Reaching an Appropriate Goal, and then, Maintenance!

Seems that to maintain a healthy weight,

• We show up
• We find an attitude that supports our doing the things we need
• We intend to enjoy better health and self-respect
• We learn to take care of ourselves - whatever that might mean
• We set and re-evaluate our goals, and
• Do it over again and again!

This week's exercise:
Who (what) are our teammates, and who (what) are our opponents?

Take care.
We're all in this together.
Linda Gromko MD