Dieting - The great adventure

I started off with a post on the death penalty and on cyborgs. Really. But, then I started writing about dieting and I shelved the other stuff for another day. The following is purely autobiographical. Those who can’t tolerate autobiographical blog posts, please turn away now.

It is remarkable, on reflection, how much time and effort dieting has taken up in my life. Then again, it is remarkable how much time eating and just thinking about food has taken up in my life too. Sometimes I think if I added up all the time I have spent thinking about food, women and the pain in my left leg, it is hard to see how I've had time to think about anything else.

I was a skinny kid. At some point early on there was actually concern about how little I ate. When a teenager, my appetite became voracious (not unusual for a teenager), but my metabolism burned through as much as I could eat and then some. I graduated high school full grown at 155 pounds. College at 165. I steadily gained weight after then until at age 32, weighing just 195, and feeling enormous, I starved myself for 11 weeks until I weighed 169 pounds again. I knew I couldn’t maintain that low weight as I thought about food every few seconds. My entire family was fat. There was no way around it. I steadily gained again, up and down over the years, and at my high point, weighed 255 – 100 pounds more than when I graduated high school. Knowing I could trim down to under 170 and look relatively small let me know that when people said I or others were just big boned, they had no clue at all what they were talking about.

I put on all that weight despite the fact that I spend the large part of most years dieting. For many years, up until the present one, I was on the Atkins Diet. You hear all kinds of criticism about it from people, but the studies seem to show it is the fastest way to lose weight, and, as it allowed me to eat a lot, it is the only thing that really worked for me. And, it worked fairly well for a long time. That is, if I was dedicated to it, and there is no point to being on it if you aren’t, I would lose weight, and quickly at first. After a few years though, I noticed that the weight loss was slowing down and when I went off it for a vacation, or a mental health break, I would quickly gain the weight back and that would become my new plateau. That isn’t unusual and despite what some people think, has nothing to do with Atkins. I’ve read that nearly everyone who goes on a diet ends up heavier after a year has passed.

In 2008 I moved to Virginia and didn’t diet for a year, which was why I went up to 255. But, something else happened soon after I moved which was much more important to my eventual weight loss. My brother, 4 years older than I was and very obese, died of a heart attack while sleeping, his hands tucked together comfortably under his head. It had all the appearances of death by apnea.

You probably know what apnea is, but if you don’t, google it. I’ll just say it is when you stop breathing while you sleep, or don’t breathe enough. I was a snorer and my evalovin’ gf had long told me I would often stop breathing when I slept. I knew that I barely slept my whole life. I knew I had been chronically exhausted my whole life. I thought it was just me - who I was. Naturally I put the exhaustion and lack of sleep together early in my life, but not really to the extent I did later. I also knew that I had never breathed normally through my nose in my life. My gf laughed at me for pulling on the end of my nose while I drove, but that was the only way I could breathe through both nostrils at once.

Sleep clinics had been sprouting up in the last few years, and I decided I might as well check it out. So, I did. To make a long story short, I took the sleep test. What I learned blew my mind. It wasn’t just that I would only sleep a few hours a night. It wasn’t just that I woke up frequently. It turned out I woke up somewhere between every one and two minutes. That seems impossible, but it was true. I would hold my breath until my self-preservation instinct would wake me up suddenly so I could take a breath and then go back to asleep for another minute or so. I knew that I would often wake up frequently, but I had no idea how frequently.

The doctor at the clinic recommended I try the CPAP machine. This is a small machine which basically shoots air in your mouth so you can breathe normally all night. I had heard about it from my sister, who was one among a few people who told me it had changed their life, and I expected the recommendation to work for me. I tried it one night at the clinic. I warned them that I literally had slept zero hours the night before and it probably wouldn’t be an accurate result, as I would pass out for a few hours no matter what, but they didn’t seem to hear me or care. I slept about 4 hours and they told me it worked great. But, I protested that when I had woken up during the night I felt like I was suffocating. Go get a CPAP machine they said. So I did.

I made an appointment with one of the companies on a list they showed me that leased the machines. I was embarrassed to even put the mask on in front of the respiratory therapist, but took it home and tried – for 3 months. Because the therapist had become a good friend, she gave me different masks to try, but nothing worked. I couldn’t sleep. I felt like air was rushing down my throat and though it was supposed to keep my throat moist as well, it didn’t. I now woke every few minutes to take a drink or to stop from choking. Plus the head strap really hurt my head. I doubt I ever wore it for more than an hour and eventually, I think it was for just a few minutes. I really tried. I wanted it to succeed, because I saw no other options.

Finally, when I couldn’t do it anymore, they sent me to a surgeon to see if he had a solution. He did. He told me that there was no way I was breathing through my nose more than a little, but, obviously, I knew that already. Then he drew me a life sized picture of the space I had in my throat to breathe right next to a picture of what it should look like. I was shocked. My entire life I had been breathing through a little half dime sized opening in my throat instead of a much larger figure 8.

You know the expression that your life passes before your eyes. In a sense, that is precisely what happened to me right in the doctor’s office. All of a sudden the mysteries of my life were explained to me. When I was a baby they thought I had childhood asthma. I think they were wrong. I think I just couldn’t breathe because my nose didn’t work and the opening in my throat was so small. It explained why I choked so often when I ate my entire life. And, mostly it explained why for my whole life I didn't sleep and was so tired. I had been so sleepy as a kid that my mother asked me once if I thought I had chronic mononucleosis. When I young and a runner I mused about the fact that while I could seem to run endlessly without much effort, I was sleepy the whole time, and I still remember thinking how strange it was while on a run that if there had been a couch conveniently on the side of the road, I would have gladly sit down on it. I did not seem to experience the runner’s high people told me about. More, I had very little ambition, little drive and just wanted to sleep all day long. When I went to grade school I would immediately try and go to sleep and it got worse the older I got. In high school I wrote a mystical sounding poem in a creative writing class about a “sleeper,” and I was the only one who knew what it meant.  I often fell asleep when sitting down or doing anything which required mental energy, like, say, studying. I barely got through high school (helped by the fact that they didn’t really want to fail anyone). I remember vividly one day another student ask the teacher why it seemed like I was snapped out of a stupor when called on. She thought I was faking. I remember thinking, some day you will all see that I had some weird disease. I didn't know what, but I knew something was wrong.

I did well enough in college to go to law school, and did okay there (until I just hated school too much the last year and completely stopped going to class or trying to learn anything) but, really, I could have slept the whole way through. When I raised my daughter as a young attorney I would sometimes regret how little energy I had to play with her although I mostly blamed this on the terrible pain I was suffering in my leg by then. Sure, I knew being so tired wasn’t normal, but, never did it occur to me that it was curable.  And, still, I did everything I wanted to do - work, play, read, travel, date and so on, because what else was I going to do? Sleep? I was even fairly workaholicish for a long time and, no real complaints - I've had a very lucky and happy life.  I just tried not to complain about it too much.

Now, a middle aged man, my doctor told me that if I didn’t have the surgery, which was uncertain, or use the CPAP which I couldn’t deal with, in his experience I would start having heart attacks within 7 years. He wanted to do surgery on my nose to repair my deviated septum and remove other blockages and then consider throat surgery, if necessary. Still sitting there, I started to look back at my life and wonder how different it would have been had I had surgery when I was young, even though this never seemed to occur to anyone, least of all me.  At the same time I thought about the physicist, Stephen Hawking, who has accomplished so much while suffering incomparably more than me with ALS, or other people who had far greater handicaps than I do and yet accomplished great things, and I felt like a whining baby. Everyone has an excuse. Still, I couldn’t help wondering. . . .

He performed the surgery on my nose in May, 2009. It wasn’t so bad. I took pain killers for only one day while still in recovery and my nose was packed with cotton and some plastic funnel like device for less than a week, if I remember right. It was uncomfortable, but manageable. When the packing came out, I was still uncomfortable, and my nose was a little swollen. But, very soon I did something I had never done in my entire life without pulling on my nose. I breathed through both my nostrils at the same time. And I could do it all the time. I am doing it now, and though this may seem normal to you, it is still wonderful to me.  I could even work out or sit down without seeing black spots. Why this had never alarmed me I can’t tell you. The surgery also improved my apnea, but not enough. It was throat surgery time.

I had a choice. He could use a technique where radiowaves burned my upper palate, shrinking it, or he could do traditional surgery, removing my tonsils and my apparently giant sized uvula. That’s right, a giant uvula. No man minds a giant organ, but it’s not the uvula you are thinking about. Oh, I also had a high placed tongue, whatever that meant. No, not so anyone would ever notice but an ENT, but there it was. The first technique he described was relatively new, it would not be covered by insurance, and was a little uncomfortable for a while. The second, the surgery, was permanent, covered by insurance, and incredibly painful, he said, producing the worst pain of any surgery ENTs perform. Apparently, having your tonsils removed becomes a lot more painful as you age. I chose the second method, despite his subtle hint I should go the other way. But, I laughed at pain. Hah hah. I lived with pain. Snort. It would be a trifle.

So, in December, 2009 I went under the knife again. Apparently, as much as I had suffered for nearly half my life from chronic leg pain, it could be a lot worse. True to my doctor’s word, I had not experienced pain like this before. Swallowing water or even ice cream, just plain swallowing, in fact – and you can't stop that – was like swallowing sharp glass. It was horrifying.

But, the pain was only part of the problem. I was on all kinds of painkillers including Oxycondone. I have never taken any casual drugs or any major painkillers in my life other than after my nasal surgery for a day. I did not react well to it. I started having obsessive compulsive conversations with two other people in my head, and they were not pleasant people. All I remember was that one was a man and one was a woman. I knew that there were not actually other people in my head, but I couldn’t stop talking to them either. It was dark and restless and very uncomfortable. Between the horrible pain and the incessant OCD conversations I could not sleep. The first night, and I’m not making this up, I tried to convince myself that I was a Nazi torturer and I was happy because I could torture myself. I think I slept a half hour until I gave up and just got up to begin my day suffering.

I called my doctor in the morning. An assistant took the call. I explained that there was something wrong with my pain medicine. They told me it was just a painful recovery and to hang in there. Somewhere in that period my daughter came down from NY to help me. At one point she patted my hair and it was like she was driving a knife into my head. I repeated the conversation with my doctor’s office the next morning, begging them to switch my meds. My daughter left that night to go home. She had put up a Christmas tree for me, completely decorated with ornaments and lights. After she left, I was sitting in misery on the couch, staring blankly and imagined that the entire tree tipped over and crashed to the floor. Unfortunately, I soon realized that what I had imagined was that I had imagined it. I had to go out to the shed, return with a hammer and a nail, and then fasten a hanger to the wall with which I tethered the tree after I righted it. It is funny in retrospect, but it was miserable then.

The next morning, after three days of virtually no sleep and intense pain the whole time, I told the poor resident who answered at my doctor’s office that either they put me back in the hospital and fixed the problem, or I would begin taking pills until I felt better. I meant it when I said it and I don’t know if I would have done it.  But, it worked. She told me go to the emergency room and a friend gave me a ride. They gave me a shot of something to kill the worst of the pain. I slept an hour. Given how used I was to not sleeping at all, an hour was actually refreshing and I felt marginally better. They didn’t change the type of my medications but spaced them out differently and, more important, gave me a throat lubricator of which I could take as much as I wanted! That helped a lot. I have no idea why they hadn’t given me it to me before, but based on the repeated apologies from the residents, I got the feeling they had screwed up and knew it. I would see my doctor in 4 days and thought I could handle the pain until then. I would say the pain had gone from 99 (100 on my scale actually kills you) to a 90, but that was okay. A few days later the doctor, after also apologizing repeatedly, gave me three new medications. I filled the prescription, but then put them away, deciding to take only the over the counter medication, Alleve. The pain was still horrible, but with the drug induced people gone in my head, and my throat lubrication, I didn’t think I needed it anymore. I actually am good with pain (okay, maybe not dental pain, but we all have our weaknesses). After another week, I was over a big hump, although it really took about two months to recover maybe 90%. And, for another six to eight months my throat would not feel quite right every time I swallowed.

But, in the meantime, something else wonderful happened. My apnea went from a 40 on the scale before my first surgery to a 2, meaning I no longer had apnea. Even my surgeon was really surprised. My oxygen levels at night were normal. And though you don’t change the habit of not sleeping for nearly 50 years, when I slept - I slept, if only 4 to 6 hours a night. I wasn’t waking up every minute or so or suffocating all night long. After a while, I felt much stronger, much healthier than I ever have as an adult and I could really breathe for the first time in my life. I'm sitting here right now doing it and I can't tell you how amazing it still is to me.

I realize that I probably can’t explain the difference to me to someone who hasn’t lived with something like this, but imagine that from the time you are a baby, you are kept on a narcotic, and one day when you are 49, they wean you off it. You think you might appreciate the difference? Those with their own issues, and I’m not claiming mine are special or especially horrible, will understand better.

I know that all of this seems like a big detour from talking about dieting, but it’s not at all. Over the course of the next year I started working out a little harder. And, I started thinking more about really dieting and losing weight. But, over a year passed since the last surgery while I recovered and slowly got in better shape. Finally, right after New Years, 2011, I went to my doctor and had a talk with the Physician’s Assistant. I told her that I gave up. I was surrendering. Atkins was just not helping me lose weight anymore and I knew I wasn’t capable of a regular calorie based diet no matter how they dressed it up. I wanted to cheat. I wanted a drug. You might be thinking, so what, you take a pill? What’s the big deal? But for me, it was a tremendous admission of defeat, that I wasn’t able to deal with the problem on my own.

Possibly, this admission was a long time coming. I had long realized that I had an eating disorder, one I shared with my entire family. Even though I was not all that overweight, it wasn't so good either, yet I had always been the “skinny” one in my family.

When I used the phrase eating disorder, some people, especially those who had no problem dieting or just not eating, looked at me like I was crazy. Just don’t eat so much, they sneered. But, I couldn’t stop. I loved food too much. I had no trouble being disciplined at other things, but I couldn’t stop eating. The only things that would stop me from constantly eating or thinking about it was being on trial, having a broken heart, or a high fever or headache, all of which were fairly rare events.

How bad was this? Here's an example. I once explained to a puzzled co-worker who just couldn’t understand the problem, that when I drove home for a half hour, if I didn’t have a little snack with me, some part of me, unseen and unsuspected by others, was wondering if I would starve to death during the drive home, even though I knew that was ridiculous. Even an upset stomach could not stop me or one of my siblings from eating. I could have a huge meal, feel full to the point of sickness, yet be thinking about when my next meal would be. One day I called my brother up and I told him I had a really difficult day, so guess what I did? He knew instantly. I went out and had a huge Chinese dinner, breaking my diet, comforting and punishing myself at the same time. He did the same thing all the time. We all did.

And, I hated hearing people who didn’t feel this addiction to food – an addiction from which I could not go cold turkey – tell me that all I had to do was stop eating or stop thinking about it. Just say no, is that it?  And, what could I say? Silently, to myself – F’ you.

So there I was asking my doctor for pharmaceutical help and feeling weak and a quitter, but also finally feeling awake enough to tackle the problem head on – if I just had a little help. I told her I didn’t want three things – something that would hurt me internally, something that would make me incontinent or speed. She said – pick one. So, I picked speed. The drug was called Phentermine and was part of the drugs that made up Phen Phen, which was incredibly effective, but had been ripped off the market when people started having heart attacks on it. Phentermine is not technically an amphetamine, but closely related so that it is a controlled substance. It affects your brain so that you don’t care about eating. She told me that all of her patients on it lost 40 to as much as 80 pounds over three months, the maximum time she’d let me on it. Yes, when it was over, I’d have to learn how not to eat so much myself, but this could be a big break for me. And, now that I could actually breathe, I thought maybe I could do it.

Oh, one thing to watch out for, she added. It was possible my blood pressure would spike, but it had never happened with any of her patients and it was very unlikely to happen to me. So, I started on Phentermine. Four days later, I had barely eaten and lost ten pounds, really forcing myself to eat a little each day. It was incredible. I wasn’t hungry at all. I told everyone I knew with weight problems about it. I did notice that my blood pressure had been too high when I checked it every few hours, but expected that it would even out in a few days. Right?

So, there I was on the 4^th night in the emergency room with my blood pressure spiking well into the stroke zone. I had called 911 late, probably a little before midnight, thinking better then than at 3 a.m., or dying during the night from a stroke. Of course, having high blood pressure doesn’t necessarily make you feel bad at all. It's the silent killer.  I felt great. A crew of senior citizens showed up at my house in an ambulance. They were a cheerful bunch and took my blood pressure. In fact, they each took my blood pressure for practice. My own reading was accurate. You’d better go to the hospital my elderly friends said. They strapped me to a gurney, although by all appearances, I was by far the healthiest person there. One of them started telling me her physical problems on the way to the hospital. I offered to let her lay on the gurney, but she didn’t think that would look right.

My blood pressure eventually went down in the hospital, but was still dangerously high, and I was told to give up the Phentermine immediately, as if there was any doubt about it. I didn’t mind so much what happened to me as I did that I would have to give up the drug and the amazing weight loss.

Or did I? Four months later I was talking to my physician. Want to try again, he asked, almost conspiratorially? This time, we will start you off at one quarter the normal dosage and see if that works. So, I got another prescription and started again. My blood pressure was not affected at the low dosage. But, unfortunately, it also didn’t have any affect on me. Sure, I told myself I wasn’t hungry for a week, but soon realized I was as hungry as ever. Still, I had been forcing myself to go down to 1500-2000 calories a day. My guess is I had been doing 4-6000 normally and sometimes much more.

After a month of this, I renewed my prescription and paid for a new month’s worth of pills. But, I never took another one - or maybe it was one more. Who cares? I realized exactly what I was doing. In fact, I realized that even while sitting in the doctor’s office a little part of me knew I was probably going to just take the pills as a placebo. I don’t mind placebos at all. I’m happy to take a placebo if it helps me. But, I was happier now that I was doing it on my own.

Now, a half year having passed after I started again, I have lost a fair amount of weight – possibly 35 pounds. It is not as much as I would have had lost if I tolerated the Phentermine, but I also know that I did it myself, which is a good feeling. And, I would have been long done with the Phentermine at this point and don’t know if I would have kept the dieting up or floundered again once I was off it. Who can say? My first goal was 205, which I passed recently and the next goal is 185. Unlike my usual dieting, I feel pretty confident that I can make it. After 185, I can’t say for sure. But, I definitely feel much better physically.

Don’t get me wrong. I still think about food constantly. I still open the refrigerator door constantly. I just don’t eat much. At the end of the day, all I’m doing is just saying no, just like all those annoying naysayers told me to do. But, I also realize that there are reason I can do now what I couldn’t manage to do before. It’s my nature to analyze things and I’ve sought of ranked what helped me get here, strange as it sounds. Whether it is right or not I’ll never know.

First are the surgeries. Being able to breathe normally has changed my life more than any other factor. Being much more awake, no matter what I’m doing, is still magical for me, and almost a surprise every day, even if I still rarely sleep more than 6 hours.

Second, is having a great workout partner – ironically, the respiratory therapist who helped me with the CPAP machine. It is true that I have had difficulty getting into workouts and having someone there to distract me, and for me to pathetically try to keep up with (it’s no comparison really), helps a great deal. This is true even if exercise is the least important part of losing weight (at least, that’s what a lot of studies show). I always say that I hate every second of every minute of every hour of it, but she makes it bearable for me.

Third, is the Phentermine. Sure, it could have killed me, and then when I went down in dosage it did nothing for me other than be a temporary crutch. But, I will give that crutch some credit. It helped me get started.

Okay, I will give myself a little credit. Because ultimately, it is me winning the mental struggle to not eat even though I want to all the time, and to exercise as much as I can, even though I’d rather not. And, I’ve just made up my mind to accept the minor but relentless suffering as best I can. But, that’s no different than almost everyone else struggling through it. So, shut up, I say to myself, and stop looking longingly at the refrigerator. It will be there tomorrow.