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