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To Save My Life - What Does It Finally Take? - July 21, 2012

Saturday, July 21, 2012

I am still steaming. And it's been four days since I went to the doctor's for a "routine" physical. She insisted, since I hadn't been there for a complete physical in two years. OK, that seemed fair, so Tuesday I went.

Back story to my visit:

I had needed a prescription for new CPAP equipment and had my doctor give me one. I was really annoyed that the company would not just give me what I needed, since the condition is stable, and has been since my diagnosis of obstructive sleep apnea six years ago. If you're fat enough (I am) chances are good that you may have this. I can't tell you how many people I know that do have it. Sleeping with a mask and continual pressure to keep the airway open through the night is a rough thing to get used to (success rate runs at only about fifty percent), but it sure beats stopping breathing 40 times an hour. That's not a typo. My sister one holiday event noticed I fell asleep in the lounge chair and stopped breathing. Some wakeup call (no pun intended). As bad as that sounds, I had a friend who stopped breathing 72 times an hour. Another friend of mine, a physician, told me it was a good ten years before he was diagnosed. That got me to thinking how long it took me to find out why I was always feeling so dopey (I always attributed it to an intense working environment and thought it was par for the course when one works 80 to close-to-100 hours a week): For me the diagnosis came after about 15 years. That's pretty shocking, that a major illness can go undetected for so long. Part of that is (I feel) the medical profession simply did not know about this disorder. I clearly have a memory of seeing a pulmonologist with a sick relative and as a "by the way" on our way out, mentioned to her that sometimes I wake up gasping. She told me she could give me medicine for that. This was in 1991, and she was a specialist. Looking back on it is simply shocking that she did know about sleep studies, or at least that's what it seemed. But little truly was known in the late 1980s and early 1990s about this condition. Sleep apnea is not a "silver bullet" diagnosis for all the ills that being overweight brings, as one friend sarcastically said (non-physician) until she reexamined her own situation. And she had already been diagnosed with obstructive sleep apnea. The condition is linked to heart disease, high blood pressure and an assortment of other "goodies".

So this was the road that led to the doctor's visit now. Before I went, I was waiting on a prescription refill for an elderly relative at Rite Aid. They have one of those blood pressure machines to occupy you while you wait. I went for it. I got a blood pressure reading of 171/96 and a heart rate of 85. The heart rate is fine, but the blood pressure results sent me positively reeling. I started to calculate it in my mind: The systolic pressure put me at Stage 2 hypertension and the diastolic pressure at Stage 1. If this were true, this was definitely not good. Now I really wanted to see my doctor four days hence.

As it turns out, even off the CPAP machine for several days, my blood pressure is fine: 128/80. It hadn't been when I first started seeing my doctor some five years ago. It was stuck in the 140 to 155 range. Other things, besides the morbid obesity, lead her to tell me back then that my body was "starting to complain". I seriously needed to lose weight, and I needed to do it then. A realistic initial goal is to lose 10% to start to see results with high blood pressure. I did. It's that dramatic. My doctor was proud of my efforts. More so, I was pretty proud of me.

But after awhile, complacency sets in. You know the drill: You lose some weight, then you get stuck. It's not a true plateau for many, because the old stressors and the bad habits really want to get it on again. They are fighting the new lifestyle with everything they have, they have been together for so long.

As relieved as I was that the blood pressure reading at Rite Aid was false, I was not going to be let off the hook that easily: Bad news was still on the horizon. It came the next day with the lab results. While at the doctor's, I signed up for the new patient portal. Whoever thought of this, is pure genius. It allows you to communicate with your doctor without having to leave incessant messages, missed call backs, new phone calls, ad infinitum. I was surprised that the very next day after the visit, I saw in my e-mail box a note from the doctor. I figured it was a "welcome to the patient portal" kind of message. I was dead wrong. Some of the lab results were already in and she wanted me to know that I was now "pre-diabetic". She was very blunt. My head started to spin, "How can this be?" Two years prior, my blood work results were so incredibly pristine, I wanted to frame them. I started to reexamine what lead to this moment. I've kept off a substantial weight loss of 35 pounds over the last four years. Yes, I had gotten down to 46.6 pounds gone, but that couple I just mentioned to you that want to get it on again, they are fierce competitors for my general good health and well being and they do not tolerate well anyone wanting to come between them in their love life. [They are not married yet, so help me, so there is hope.]

I started to look back at the motivators that kept me going on an even keel for so long: One was my old health insurance. My policy gave me back $200 every six months if I went to the gym 50 times during that period. It's a sweet deal (and other insurance companies I have seen, carry the identical policy), because if you join a "Y" or another gym that is cheap, this deal then virtually pays for itself. Another thing back then that I did to keep me going was to mix up the exercise, and with an SP buddy, we created together a challenge to virtually walk from one end of Cape Cod to the other -- close to 80 miles, by Thanksgiving. We finished that endeavor, and almost right on schedule. So what changed since then? My insurance policy changed and I am no longer offered a monetary incentive for my good work at the gym; my SP buddy and I finished that challenge, and I began another, but alone, that I have not been tracking as closely as the original one. These are not excuses, just an honest answer to myself as to why I am not working optimally on my weight loss progress as, of course, I should.

As a health professional I know the consequences of diabetes. I do not want to get there under any circumstances. What immediately popped into my mind was a young patient I had some years ago who was hospitalized for its consequences [WARNING: What follows is going to be graphic, but I feel necessary for the purposes of my writing all this. If you've come this far in the reading, congratulations, this blog is long. Feel free to stop reading now.]. He was about 25 years old at the time, and just flat out refused to acknowledge that he was diabetic. Even in the hospital environment, he would order fast food to be delivered. He was not heavy, and if I remember correctly, he was a Type 1 diabetic. The rules for the diet component, are the same for both types of diabetes. He refused to acknowledge that, and it was heartbreaking. He was in the hospital for an above-the-knee amputation of his leg. It just could not be salvaged, having suffered the ravages of the disease. He was refusing the above-the-knee surgery which was required, wanting to save the knee so he could have a better prosthesis for walking. It was too late. And here was the heartbreak in the story: He only gave permission for a below-the-knee amputation. When the surgeons went in, they saw, as they knew they would, that it was too gangrenous to be stopped at below the knee, but because of his limited consent, they were forced to respect his wishes. So they closed and concluded the surgery for the time being (hopefully). We, the medical staff, were then left with the task to convince him to go back to the OR and proceed with what was necessary to save his life. He only acquiesced, but literally allowed a slow progressive remodeling. He was still refusing what he needed, and only allowed piecemeal surgery in multiple steps, while still consuming the takeout food that was literally like putting a gun in his mouth. It just broke my heart. And his family was so incredibly unsupportive of this young man.

So now here I am, literally fighting for my life. With my hemoglobin A1C of 5.2% two years ago, to the current value of 6.3%, which is clearly in the pre-diabetic range (6 to 6.4% is pre-diabetic) I am in serious trouble here. The doctor's note was terse and there was no mincing with the words (and I do appreciate that, it was necessary to be said just that way): Any value over 6.4% is clearly diabetic.

So, I have three months before the recheck of the HbAIC. I've given myself until October 9th (the time around which I need to reschedule the doctor's visit -- and she does not want me to just schedule the lab work, she wants to see me as well) to lose 20 pounds, a realistic goal. I'm going to watch my diet very closely, and this time around I just cannot afford to give myself any treats (so long ice cream, goodbye gooey cakes, you will be missed). I really would like to keep all my attached parts, those that were given to me at birth, and those that I want to keep until the end.

That brings me to you folks: I'm reaching out for support to keep me on track for the next 80 days to ensure that I reach my October 9th deadline with a 20-pound loss. I want to lose the pre-diabetic "Scarlet Letter". I will post my progress, one way or the other.

What's your wakeup call?
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Member Comments About This Blog Post
  • PCOH051610
    Fantastic blog! Good luck with your challenge to lose the weight....I think everytime you get down you should re-read what you wrote here!
    2722 days ago
    So: how can we help? Do you need some new walking partners? I bet that you can find a few supportive friends right here, right now.

    2737 days ago
  • SOUTHPONDCAMP I know it isn't that easy....but you've totally got this. Really. You do. You have the tools and the just have to keep it together. The devil is always in the details. More exercise, less crappy carbs, good will come together. Take some measurements to add to the BP and A1c.....I've been working my azz off (literally) the last month and am not seeing much on the scale but all my clothes are looser...I wish I had some accurate before numbers!

    I'm watching you ((laughing, picture two fingers...pointing me and then at the computer screen (you!)....) so keep at it....and keep talking to all of us for encouragement! :)
    2737 days ago
    Will be looking forward to your blogs as you achieve the 20lbs loss!


    Scootergirl in Oz
    2737 days ago
    I am here "cheering" for you!! I know you can do this - 20 pounds is a do-able goal!
    Thank you for sharing your story - it is a scary thing to face diabetes. Diabetes runs in my family and it is a fear of mine that I might one day have it.
    Personally, I like a doctor who doesn't mince words. Just let me have it in plain language.
    I am here for you - with thoughts, prayers, cheers and all the support you need.

    2738 days ago
    Well, sweetie - here's what did the trick for me -

    It's not that I might die
    It's that I might LIVE - in a diaper - in a wheel chair - drooling into my bib.

    THAT's the alternative I don't want.

    You can do this. Make it a streak.
    2738 days ago
    i think you can do that! if you think you benefit from the gym, isn't it worth your money ? (even though i agree the insurance company should pay).
    2738 days ago
    Please know that you CAN do this! You know the results if you don't, you know what to do, and you have a track record of success. We are all here for you.

    2738 days ago
    okay let's get serious...go through your pantry, fridge, freezer...get rid of everything you KNOW is not good and nutritious. Give it all away to a womens shelter, friend, family member, homeless person, neighbor but get that poison out of your vacinity ASAP...seriously
    2739 days ago
    Oh honey, been in your shoes for sure. @ 4 ft. 10-1/2 in. and 192 lbs. (I still can't believe that) I was clearly morbidly obese, and I also clearly understood the ramifications of the protests my body was making. Initially it was hypertension. OMG, I was only 56 yrs. old! but that wasn't enough of a wake up call for me. Nope. Had to wait till my A1C was 13 and my blood sugar was 330 then a panicked call from my Dr. to get in there the next morning (which I did). Of course, that was NOT pre-diabetes . . . that was full on t ype 2 diabetes. Ok, THAT got my attention for sure, for just the very reasons this has YOUR attention -- the consequences of not taking care of it.

    It is so difficult to make lifestyle changes and you're so right. After doing the job of losing weight, there is that awful tendency to become complacent. BUT when those days happen, I look back in my journal @ where I was when I started. NOT pretty and NEVER, EVER, EVER, EVER want to go back there again.

    So . . . myd ear friend, what is your plan? Ar eyou going to start on Metformin or anything like that? Initially I was on ActosplusMet to get things under control. Of course, that was in connection with adequate exercise and proper nutrition. Within 3 mths. my A1C was down to 6.5 and went lower as time went on. Two yrs. later my A1C (as of Jan. 2012) was down to 4.9. Lots of blood, sweat and tears. But you have to get serious, and I know you know that.

    Wishing you all the best and whatever I can do, if there's anything, to help let me know. I'm here for you.

    bTW, if you haven't given it a read, try Dr. Mark Hyman's THE BLOOD SUGAR SOLUTION.

    One thing I didn't know was how connected Vit. D3 it to hormone regulation/production. Mine was in the basement. After therapy (10,000 units/week, then tapered x 4 mths.) my level was good, and I FELT BETTER.

    Hugs and hang in there.
    2739 days ago
  • KARL1266
    That is some scary stuff there. I, too, am what the doctors call "morbidly obese" and have been offered an overnight sleep study. I've refused before (family at home or any other kind of excuses) but your blog woke something up. I have been VERY tired at work lately. Maybe it's time for that study.

    20 pounds in 80 days seems like a very attainable goal. If you need anything just holler. I can support you any way I can or even kick you in the (virtual) butt if need be. It's the least I can do for all the help and support you given me over the last 10 months or so.

    I agree also with your comment that this time the doctor was right in not mincing words or softening the blow by praising past weight loss. Between the two of you, you have identified (most of) the problem areas. Now is not the time to rest on your laurels. Kudos for recognizing that and taking the corrective measures to ensure your success.

    Good luck and I'm here if you need anything (as we all are)

    2739 days ago
  • NUMD97
    You're mistaken, Bren. She has over the years commented on the weight loss and the improvements in my numbers. But apparently in the past two years, the numbers have taken a decidedly wrong turn in a "southerly direction", and she needed to not mince nor couch the words any. Pre-diabetic is serious stuff. My brother-in-law "graduated" from pre-diabetes to the full blown diabetic status. The difference, I believe, is that in my case, mine most likely has a stronger relationship with obesity and therefore something more in my control than his situation. And if that is true, there really aren't any more excuses, are there?
    2739 days ago
    Thank you for your in-depth blog. It really set the stage for your need to lose 20 pounds. I really like that you took the time to explain your situation.

    I am "morbidly obese" and that scares me.

    I'm with you on your realistic goal of losing 20 pounds by Oct. 9th. We can do this hand in hand if you wish!

    However, I do not call it losing weight. I consider it GETTING RID of weight. I am not losing it, as it is not something I wish to find later. If you lose something, you end up looking for it at some time or another. Nope, not me, I most definitely am getting rid of it. I have no intention of finding it again!

    I have to lose 60 pounds total or I face a very scary, intricate operation on my lower back which involves the placement of two rods on either side of my spine. I do not want that operation.

    I also have an appointment the last week of October. If I can show him progress, I hope the operation will not be necessary. Of course, I will still have the other 40 pounds to lose, but 20 by October would be great.

    So consider me your partner on this journey. We can keep in touch daily if you chose, and encourage and motivate each other, and sometimes give each other that kick-in-the-butt that we each may need sometime!

    Best of luck and keep in touch. You have my support.

    2739 days ago
    Count me in to be one of your resources to get you to your goal! Of cour I am not the best Sparker with my ridiculous health drama, but I do want to help, however I can.

    I'm kind of perturbed at this doctor. Not that I expect doctors to give you stickers and daisies, BUT I sincerely would think tha this doctor would give you props for your big life changes, the goals you have met thus far, and your drive to keep going going going. Ok, that was maybe a bit too much to ask, I agree I still stand by my stance that the doctor should have recognized your loss so far. Sheesh!

    I'm sure you already have some goals set, so let us know what the are so we can cheer you on!

    2739 days ago
    I need another wake-up call or something to provide motivation. Perhaps if I just sit down with pen and paper and make a list of pros and cons of losing weight I could finally get to my goal weight.

    I, too, have a CPAP machine and dragged myself around tired all the time for about 15 years before finally having the overnight sleep study. I could feel a big change with the machine (it's almost 2 years now) but the extra weight I have been carrying around will make my 2 knee replacements (2 years ago and 3 years ago) wear out sooner than the estimated 20 years for a normal weight. I really don't want to go through knee replacements again as that was a traumatic experience. I have been lucky to have normal blood sugars and excellent cholestrol levels but I seem to find plenty of excuses when it comes to exercising (I need to start a daily walking program). At this moment, there is a rainstorm going on outside (excuse for not walking this morning) but I do have a treadmill about 20 feet from where I am sitting in front of this what's the excuse?

    I hope you are able to lose those 20 lbs by October and I know it is possible as I once lost 50 lb in 5 months through a supervised diet I was on. I may have to get assistance from my doctor or some weight program as the past 3 years I have not done well losing weight on my own (of course, that was before SparkPeople).
    There is so much help available here on SparkPeople!!!

    2739 days ago
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