Found And Lost, Part 5

 (2 Heads - Coleman Hell)

The end of June 2019 had arrived, and I'd found myself back at BCKC for another round of frustration.  It helped that the receptionist was still somehow every bit as nice as she'd always been, and that nurse that came to take me into the exam area knew me by name now as well.  All of that was sort of muted by the fact that the scale was still extremely confident that I was morbidly fat.

Fatly obese.

...I give up.

"It's not so much that you're not telling me what I want to hear," I said to it conversationally.  "I get that.  It's the simple fact that I'm not above bribery to get what I want, and I have no idea how to go about that with you.  That's bad, because it basically takes the carrot off of the table, and ..." I patted the display on the scale that showed my thus far unchanged weight and then walked away from it, confident that I'd gotten my message across.

Once again, the nurse had the decency to laugh.  "I'm glad to see that you're keeping your sense of humor about this whole process.  It can take time."

I sat down in the exam room, casually held out my left hand for the blood ox meter, and then my right arm for the blood pressure cuff. "It's either that or I have a psychotic episode, and that comes with a larger co-pay."

We were both reasonably sure I was kidding.

We were also both reasonably sure I was right.

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"Forget the scale.  How do you feel?"

I resisted the urge to say the word 'fine' in Leonard Nimoy's voice, curbed my wise-assery for a moment, and gave my physician's question a moment's thought.  

While I hadn't lost any weight, at least not according to the soulless metal pain elemental out in the hallway, I had to admit that I was feeling different.  I was keeping my food intake in check, and had actually started playing games with my calorie count.  Each week between visits, I experimented with how much I could carve off of my initial 3,200 calories a day and still not feel like I was limiting myself.  Between May and the end of June, I'd pretty easily managed to get the number down to 2,500 calories a day easily, frequently bringing it as low as 2,300.  I still got to eat what I wanted.  I still front-loaded protein at every meal.  I still ate salad.

I'd taken other steps as well.  Instead of buying packages of sweets like cookies, I'd started buying snack cakes instead.  Those came individually wrapped, which meant portion control, which meant calorie control.  I could destroy a brownie, only take a mildly horrific blow to my calories for the day, and as long as I didn't do it more than once a day...it was enough.  Eventually, I'd gotten to the point where I wanted to see if there were better options for scratching my sweet tooth's itch.  I started experimenting with Luna Bars, Lara Bars, and plain ol' protein bars.  It didn't take long for my palette to get used to a less saccharin treat.  Then, one day, I realized that I'd pretty badly messed up.

Most sweet things no longer tasted good to me anymore.  Especially if it came in a wrapper.  My mainstays of gluttony had betrayed me.  If I wanted a brownie or cake, I was forced to actually make it now.  Higher quality sweet things were the only path forward, and that frequently took effort that I wasn't willing to put in.

So I ... stopped eating so many sweets.

Once again, Sloth is proved a valuable asset.

The food wasn't the only thing that had changed.  My activity level had changed too.  I'd started out with 10 minutes of walking, as the doctor ordered.  Two days a week, sometimes three.  Then I started noticing something worrying each time I would finish my walks.  I could tell that they weren't... enough anymore.  Don't ask me how, I just knew they weren't doing the trick for me anymore like they used to, whatever trick it was they were performing.  So I increased my time.  I increased my distance.  10 minutes became 15, because 20.  Half a mile suddenly became a mile, became a mile and a half.  My endurance was improving.  I could climb stairs without getting out of breath.

All of this registered to me over the course of a few moments before I laughed a little and said, "...I feel...good."  I detailed all of my findings to my physician, who rewarded me with one of her trademark smiles. "Putting the scale aside for the moment, you have to understand what you're doing here.  You identified a problem.  You did something about it.  You wanted to do something about it, and you did."  She leaned forward a little. "I need you to understand how much farther ahead that puts you than a lot of people.  You self-catalyzed.  Not just that, but I gave you goals.  You met them.  Then you exceeded them, and you did it intelligently.  That's huge, and I hope you understand that."

I nodded my head almost automatically, knowing immediately that I'd just lied.

Somewhat irritatingly, the physician knew it.  She had the good grace not to call me on my bullshit, and said nothing.  I sighed, which was the closest I was going to get to admitting what I'd done, and murmured, "It's not enough."

My physician offered me a smile tinged with real sadness.  "I know.  It never is, not for the ones who are really working for it."

I looked down at my hands for a moment before I asked, "How long until you start looking at a pharmaceutical remedy?"

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I don't do pills.  I always felt that they got in the way of listening to what my body was trying to tell me.

I grew up with the understanding that if it hurt, it hurt for a reason.  We are designed to get sick.  We are also designed to get well.  Allowing that process to happen strengthens us as biological organisms.  We are not designed to thrive in a clean and antiseptic environment full of hand sanitizer and foaming soap.

I ate I don't know how much dirt and worms and cat food growing up in the country.  I was frequently dirty.  Very.  Cuts and scrapes were treated with only mild concern, and frequently weren't treated at all.  

Some people need a little extra help to get by in the world, and I don't begrudge them that.  Medicine is a marvelous thing, but as a very wise man said, "All things in moderation."

So yeah.  I don't do pills.  My wife thinks I put myself through unnecessary levels of discomfort due to my sensitivity to weather changing.  I get headaches.  I very rarely take anything for them.  

My head hurts.  It's trying to tell me something. Perhaps I should be listening.  Perhaps I should also take the damn ibuprofen once in awhile too, but...yeah.

I'd been pretty blunt with all of my doctors about my feelings on taking a pill to solve a problem.  My physician knew what it had cost me to ask that question.

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"I don't think we're there yet," she answered quietly.

"How long?" I asked again.

She was silent for a moment before she repeated herself.  "We're not there yet.  When we are, I'll recommend two options. You can decide which one you'd like to use, if you use any of them."  She scribbled a few names down on a post-it note and handed it to me. "One is a pill.  The other is an injection.  They both have their pros and cons."

She didn't bother explaining to me what they were.  She knew as well as I did that I was going to go home and do my own research, and that I'd discuss my findings with her to compare notes when the time came.  When I tried to take the post-it note from her, she held onto it for a brief moment, making eye contact.  "We're not there yet."

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Supplements are a tricky thing.  They're not like normally regulated drugs.  Say what you want about the FDA, a lot of what they do is for a very good reason.  Part of what goes into a drug being declared safe and or effective versus a particular ailment is extensive testing.  Supplements don't bother with that.  In exchange for not being tested, proven, or regulated in almost any capacity, supplement vendors get to make some pretty insane claims.

For the most part, all you get for your trouble is expensive urine.

Like most things, there are exceptions.  For better or worse, the right thing used in the right place at the right time can often prove quite impactful.  My physician suggested that I consider taking a 1000mcg dose of something called Chromium.  Some studies had suggested that it could be a metabolic enhancer, something to help make my 'engine' run smoother and faster.  Faster engine = better weight management.  She was very blunt about the fact that it hadn't been definitively proven through trials, but it couldn't hurt to try it in case it was effective.

So, I started taking that.

She also recommended that I start taking vitamin D.  My levels were criminally low in my bloodwork.  Emerging medical science was beginning to paint a picture that showed vitamin D being responsible or related to a variety of factors related to the maintenance of homeostasis.  There was also the fact that I was light on it, and that was bad for a variety of reasons.

So, I started taking that too.

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"You're looking at a protracted siege here.  You know that, right?"

My visits to the bariatric center frequently ended with a visit to my psychologist, and this one was no exception.  His question prompted a raised eyebrow from me.  "You're talking about the calorie deficit, right?"

"I am."

"Yeah, it occurs to me that while I'm comfortably eating even less food than I was two months ago, I've made said deficit even larger than it used to be.  In my rush to be clever, it's possible I'm not doing myself any favors."

The psychologist rolled his hand a little and followed it with a non-committal noise.  "Sooner or later, your body will figure out that there's plenty of protein available now, and it will start burning fat instead.  I'm very confident in that.  When that happens, it's going to be a very slow process though.  Your body won't simply choose to ignore the fact that you're taking in nearly half the calories required to sustain you at your current weight, and now you've added physical activity to the mix."

"This feels like the biggest catch 22 in the world."

"Oh, quite the opposite," he offered.  His face bloomed into one of his usual smiles. "While it's possible to lose weight quickly by virtue of customized diets and high levels of physical activity, both of those measures exact a toll on the body.  They're both stressful for it.  You're young and reasonably healthy, but there's no reason to stress your body if you don't have to.  You're not concerned with losing weight, after all. You're concerned with your ability to lose weight.  That means that as long as the weight loss starts, slow and steady is the ideal path to follow."  He leaned forward on his desk.  "You're probably sick of hearing this, but you're very lucky.  Most people don't have the option for slow and steady by the time they get to where you are."

My answering smile was wry.  "You'll forgive me if I don't share your optimistic outlook on the situation."

I got another warm, gentle chuckle from him. "Thanksgiving," he said without preamble.  I blinked slowly and said, "Excuse me?"

"You want to know when this is finally going to start happening.  You want a time.  You want something you can put on your calendar, something you can plan around.  You want control.  You want to know how long we wait before we try the nuclear option, whatever that is."  He closed his laptop and stood.  "The answer is, 'Thanksgiving'.  You started this process in earnest in May.  My thought was that it could take as much as six months for your body to wake back up and do its thing."  He walked over to his office door and opened it, signaling the end of the visit.  I stood and followed him.

We stopped in the hallway and shook hands, and I found myself genuinely happy with how the visit had gone for the first time. "We do have a nuclear option, in case you were wondering," he murmured to me.  Then he gave my hand a squeeze before releasing it.  I got another smile and a happy little chuckle from him and then he walked back to his office.

I stopped by the receptionist on the way out of the office to schedule my next follow-up.  It had been agreed upon by all parties that I would give it two months and change before I came back.  Everyone agreed that this was going to take time, that I had to be willing to give my body time to start back up now that I was actively trying to achieve something.

I would have to wait until after Labor Day for my next check-in.