My household continues to abide without strife, hooray.
I appear to have hit on a balance for strength training and stretching that keeps my knees happy and doesn’t disappoint my back or hips or anything. else. Yay.
My state, Washington, has decided to start vaccinating more non-frontline workers who are under 65, and even to count comorbidities, so I may be vaccinated sometime in April. Hooray.
Washington state is also reopening indoor dining again. This was greeted with sighs and “Again?” and “That’s dumb” in my household.
I acquired and read Seanan McGuire’s new InCryptid novel, Calculated Risks. Recommended but makes the most sense if you have read the other books.
We’ve been watching the Australian “Miss Fisher’s Mysteries” of late. I appreciate that the attention to detail includes 1928 laws regarding women, along with how nearly everyone 30 or above was affected by The War (or as we would call it, World War I). I’ve also read a few more of the Phryne Fisher books by Kerry Greenwood.
Sadly, I am dealing with more acid reflux these days. I’m not sure if it’s stress or what, but I am making some changes as a result.
I’ve also written about knee issues, and that recently I wasn’t having them.
Apparently I tempted the fates or something, because last weekend I managed to do something to my left knee.
The good thing is that I have been able to treat it with using my cane more to reduce strain; elevation; an ice pack; and doing more of the exercises I learned in physical therapy.
I became aware of ibuprofen in high school, as a reliever for period pain. I used it with happy abandon for assorted cramps and pulled muscles. When my knees started hurting, I used ibuprofen. Headaches weren’t much helped by ibuprofen, but that’s what acetaminophen is for.
Eventually I had knee issues that ibuprofen didn’t handle, I added physical therapy exercises to ibuprofen. I didn’t stop taking it.
Enter blood thinners, to avoid another blood clot in my lungs.
You know what’s bad when you’re on blood thinners? Any other blood thinners. Like aspirin or naproxen or ibuprofen.
Seriously, that’s why older folks are often advised to take a low dose of aspirin a day – it’s a mild blood thinner, to avoid unneeded blood clots. But if you’re on specific medicine to make your clot less, then meds that adjust your clotting are bad.
Which means: I no longer take ibuprofen, naproxen, or aspirin. I can take acetominophen, but carefully, since my blood thinner med keeps my liver too busy to clear things like alcohol as fast as usual. Acetominophen goes through the liver, too, so I’m mindful about it. And, y’know, acetominophen didn’t really help with cramps anyway.
So here I am, in my mid-fifties, having to face arthritis, pulled muscles, and other ills without ibuprofen or naproxen. What to do?
I am more focused on strength training to support my knees and back.
I am more regular in stretching to prevent muscle cramps.
I am dealing with things like “sore neck and shoulder from sleeping wrong” with slow stretches and patience.
….and, if needed, I can drink. I just need to be aware it has stronger and more lasting effects than it used to have. :)
I never really stopped stretching, but now I’m starting to do a few yoga poses again. I stand in a “warrior” pose and marvel at how my mat holds my feet still, and I remember being able to have my feet further apart without any of the balance wobbling I’m doing.
I remind myself I used to spend 30 minutes on the treadmill and when I started again it was 3 minutes, so quit worrying about “used to do” and just do.
So. A few standing poses. I’m aware of my balance. A few floor poses. I’m aware of my back. A few twists. I feel looser. Getting off the floor is harder but doable.
MegaYoga by Megan Garcia
I often refer to the book MegaYoga by Megan Garcia when I’m unsure about how to position my feet and so forth.
This is written as I am rebuilding strength and stamina after a pulmonary embolism and other issues that made me persistently short of breath.
The newest Lady Astronaut book from Mary Robinette Kowal is fun. It features a 50ish woman, Nicole Wargin, who finds and defeats bad guys in an alternate world where the space race started in the 1950s; by the early 60s, there’s a moon base and a mission to Mars.
Nicole is an ex-WASP who admits she was probably only accepted to astronaut training because her husband, Kenneth Wargin, was a senator. To the surprise of everyone else, she excelled. By The Relentless Moon Kenneth is governor; Nicole wants more time with him, but is happy to live in the moon base 3 weeks a month since her arthritic toes like less gravity and no heels. That said, Nicole is frustrated that she doesn’t get to pilot the “big rockets”, just the on-moon “puddle jumpers”.
This world is like ours in the early 1960s, with sexism, racial segregation, and protests. Add in rapid global warming, food shortages, and an expensive space race, and Earth isn’t exactly a quiet place to be. Both the civilian government and the space organization – including Kenneth, Nicole and her coworkers – must deal with protests, riots, and sabotage.
I loved this book, but I also have some content warnings. If you are a completely “no spoilers” person, stop reading.
First: Eating disorders. In particular the narrator forgets to eat, doesn’t want to eat, and deals with resulting dizziness, muscle weakness, and fainting. She is supported in her recovery and her symptoms are treated. I came out of this book with a new awareness that forgetting to eat is not a virtue.
Second: A polio outbreak occurs at the moon base. (Polio vaccine development was delayed in this history due to the event that kicks off The Calculating Stars.) It’s noted that polio has an incubation period of up to 10 days, most people who have it are asymptomatic, and it can affect patients who’ve recovered years later – does that sound familiar? A recap of how polio spreads and how they wouldn’t know who had it for up to 2 weeks had me trying to back up through the couch, if that makes sense.
Third: Intentional weight loss to join the space org is discussed.
A person with a disability is defined as: A person with a physical or mental impairment that substantially limits one or more major life activities; or A person with a record of such a physical or mental impairment; or A person who is regarded as having such an impairment. – NW ADA Center
“Disabled” is still a term I wrestle with. I have a disabled parking permit because I use a cane to walk and often can’t walk more than 200 feet. I use a mobility scooter at big box stores or events. But I’m not considered disabled by the US Social Security Administration, because I can do work that I did before (software testing, which physically means “park self in front of computer”) (just not at the pace and hours expected by Amazon of a senior person) (which really the US tech industry assumption that everyone has 60 to 80 hours a week to dedicate to work is a serious problem that I’m pretty sick of, and has me considering other, part-time options).
So yeah, I’m disabled, but I’m not.
I looked up the Social Security info because my primary care ARNP suggested it. I still don’t think I would probably qualify – from what I’ve heard, it’s a pretty onerous process.
Cathy yelling “ACK!” Cartoon by Cathy Guisewite
In the mean time, I went from feeling a bit chuffed that I handled the walking at the primary care office fine while wearing a multilayer cloth mask, to … having an asthma attack walking down the hallway at another appointment in the hospital medical offices.
(I am a grownup, so I didn’t actually YELL “ACK!” out loud. Just, you know, THOUGHT IT really loud.)
I did take a minute away from other people to use my inhaler, which of course required removing my mask. But the inhaler helped my lungs relax. I continued walking. Slowly.
In May 2018 I was short of breath. I thought I might have pneumonia. Turned out they found a pulmonary embolism and I spent 4 days in ICU. I was finally discharged to go home and rest. This also came shortly after a kidney stone and high blood pressure diagnosis, and I was really, really, tired.
But my lung capacity, while better than with the PE, still sucks. “It takes time to recover from a PE”. Uh-huh. Also I was busy trying to hit deadlines at work, despite being tired all the time, and I only had so much time and energy to deal with crap. So I didn’t push to hard on why my lung capacity is still smaller than normal.
It’s over a year later. I still get short of breath trying to walk any distance. Slowing down helps but is frustratingly slow. So this week I’m going to the Pulmonary Clinic for lung capacity testing! Good! And to find out my unmedicated state, I’m not taking asthma meds and anthistamines for a day beforehand!
Oof.
“You can use a rescue inhaler like albuterol if needed up to 4 hours before the appointment.”
Uh, right.
What really worries me is that I’ll end up itching. I did confirm I can use topical meds, like hydrocortisone cream or antihistamine eyedrops. I may be focusing on itching to avoid thinking about shortness of breath. But still. No Zyrtec. Eek.
As many women know, hand washing of bras is recommended to keep them in good condition. This is not necessarily a huge burden!
Hand washing of pantyhose is also recommended. Thank heavens I don’t have to wear pantyhose.
And then came…compression stockings.
Compression stockings drying on towel bar
Compression stockings are often recommended for people who are on their feet all the time, who are flying, who have had lymph nodes removed, and to prevent blood clots.
In my case, I eventually realized that part of my left knee pain was actually located below my left knee. Where there was also swelling, and which felt better if I wore tight leggings. My ARNP diagnosed likely blood flow issues and varicose veins, and referred me to a vascular specialist.
The vascular team did an ultrasound of the veins in my leg. Leg veins have one-way valves which supposed to keep the blood going up my leg, back to the heart. It was confirmed that my valves are not all working well. In particular, the one-way valve just below the knee on my left leg – where I had swelling and pain – wasn’t really one-way anymore. Compression was recommended to reduce the swelling and help the vein to move the blood to the heart where it belongs.
I didn’t realize at the time that this would mean the hand wash only laundry would never end.
I was prescribed 20-30mmHg, knee-high stockings. The mmHg is “millimeters of mercury” pressure, and 20-30 is about middle of the range. I did go to a medical supply store to get fitted. I recommend it since you can get some knowledgeable advice on fitting and how to put them on without putting a fingernail through them. If you wear a common size you may be able to wear them home. My size 14-16 friend got fitted with thigh-highs after her cancer surgery and wore them home.
Initially I didn’t fit anything over-the-counter due to the swelling in my calves; after wearing leggings daily for a week, the swelling reduced enough that I could wear a standard size instead of custom made. I wear Juzo Max knee-high stockings, which have more of a flare at the top of the calf than the standard knee highs, and which wasn’t in stock but could be ordered. I also pop for the “silicone band” of little silicone beads to keep them up.
Pros:
No below-the-knee pain.
Much less swelling in calves.
Legs feel less tired.
Cons:
Stockings are expensive (mine are $78.39 per pair).
Stockings require hand washing.
Stockings need replacing every N months. Currently N is 2 or 3 months. I know folks who go 6 months, others who buy them monthly.
None of my leggings fit right anymore.
All that said, the compression stockings have been a really positive thing for me. The below-the-knee pain is gone. Walking is more comfortable. I still elevate my feet whenever possible, but my legs and ankles aren’t swelling every evening. These are all terrific.
I’ve written before about being deficient in Vitamin B12, so you may understand that this is a bit closer to home for me that others. And the endocrinologist has reminded me many times that I’m insulin resistant.
[Note: Includes discussion of weight loss and history of intentional weight loss. Please avoid if you don’t want to read it.]
Visited the endocrinologist again to follow up on my med changes. On my way into the office, the doc asks how the meds have made me feel; I said that I haven’t noticed much change except my step counter says I’m walking more. She weighs me and happily congratulates me for losing 8 pounds in a month. I mumbled something like “Uh huh” and we moved onto the rest of the appointment.
The doctor’s congratulations brought up feelings that I didn’t try to unpack during the appointment. After the appointment I began to think about it, and why it upset me.
First: Why congratulate me? I haven’t changed my eating habits. I haven’t been counting calories, or carbs, or points, or anything that I would normally do when I’ve intentionally tried to lose weight. I have been a bit more active, but I’ve been MUCH more active in the past without losing weight. This is not something I have made or built or achieved.
Second: I got a silver Translator badge in Ingress this week, in part because I had energy to walk around playing the game. This is good.
Third: There have been times in the past when I was trying very hard to lose weight, and lost weight, and felt like I’d won something. I reveled in congratulations and people’s happiness. Right now? I feel like a bystander.
Fourth: There have been times in the past when I was trying very hard to lose weight and didn’t. I followed the diets. I’d do the exercises. And, despite doing it all “correctly,” I did not lose weight. Did I get congratulated on my effort then? Nope. I’d be blamed. I’ve been told I was not measuring correctly, or I should use a scale, or a different diet, or more exercise. I’ve been told I was lying about my intake and exercise, because I “couldn’t” not be losing weight if I was really eating and exercising like I said.
Fifth: Maybe I was a bystander before, too.
Sixth: I’ve been trying to build my arms up for the next higher weight dumbbells but noooo, body has other plans….
So, I guess I’m having some feelings here.
Finally, I reminded myself that the reason I pursued treating my borderline hypothyroid (which led to seeing an endocrinologist etc) is to feel better and have more energy. That my weight went up about 30lbs in the last few years without a change in eating habits is one of my symptoms; my weight may change as part of correcting it. It’s OK to be a bystander here.
Tonight I tried out some shoes from Zappos on the treadmill and this Mary Lambert song came on.
We are, we are more than our scars.
We are, we are more than the sum of our parts.
— Mary Lambert, “Sum Of Our Parts (Alternate Version)”
I started taking levothyroxine this fall, and got the standard spiel from the pharmacist:
Take first thing in the morning.
Do not eat anything else for 30 to 60 minutes after, including other oral medication.
Do not take with calcium or iron supplements for 4 hours after taking levothyroxine.
“You CAN have coffee!” the pharmacist chirped happily. I was happier when she confirmed I could have my inhaled asthma meds.
This has been an adjustment. I was concerned it would bring up the anger-rebellion response I usually have had when dieting for weight loss. As it turns out, it hasn’t. This has probably been helped by the fact that this is about a medication which has been showing direct benefits ever since I started taking it.
It also resulted in me forgetting the rest of my morning pills once or twice. Fortunately the vitamin B12 and D I can miss occasionally, but the SSRI can be dangerous if I stop it abruptly. Having a weekly pillbox helps me to know whether I’ve taken them.
I did take the “no calcium or iron supplements” a bit to the extreme by also skipping dairy and meat for 4 hours, which created the concept of “dairy o’clock” for me. I have gradually relaxed that, but continue to adhere to the much more important “no food or meds for an hour”. I have a Detachable Pill Box which I can use to take my other morning pills with me to work if I need to leave before I can take them.
In the first month I took levothyroxine, I felt that I had more energy. According to my step counter, I walked more. Also important is that my focus improved; I was able to complete tasks at work in less time than before. And according to the scale at the endocrinologist’s office I lost 3lbs.
The endocrinologist seemed extremely pleased by the 3lbs. I tried not to pooh-pooh her parade by pointing out that it’s less than 1% of my weight, but damn, I was much more focused on the “able to get more work done” and “able to walk more” parts of the equation.
A comment for Treat Weight First? that I did not approve, but found striking for its ability to completely misunderstand, was:
There must be some powerful drugs in that koolaid you’re drinking. You admit you are morbidly obese, you have multiple health problems directly related to obesity, yet you shun the doctors that are trying to help you and others like you to lose weight. Amazing!
(Why? Combine a rare condition with an expensive, injectable drug treatment and you get fun “Who’s on First?” times with the doctor, insurer, pharmacy, and the drug manufacturer. I am not thrilled to have the drug manufacturer’s help line in my cellphone contact list. On the other hand, I do have the drug manufacturer’s help line in my cellphone contact list.)
A higher level of body fat, especially around the waist (Like the 30lbs I gained since my dad died? Or the 50lbs between 97 and 2001? Or, er, my entire life?)
Anxiety and Depression (I didn’t have a problem with anxiety until about 4 years ago. Uh…)
Fatigue (So, not just hypothyroid?)
Feelings of being isolated from other people (So…not just getting older and less patient?)
Greater sensitivity to heat and cold (So… not just getting older or hypothyroid?)
Less muscle (lean body mass) (Yeah, my weight lifting hasn’t had results it used to, it’s harder to build muscle…)
Less strength, stamina and ability to exercise without taking a rest (Like how I could walk a mile a few years ago and now I need to rest after a couple blocks? YES IT’S VERY NICE TO KNOW WHY.)
And a symptom that’s very, very scary for me: hypothyroid can cause impaired memory.
So let’s go back to that “koolaid” I’m drinking. And about how weight loss is going to “help” me. Because weight loss will obviously fix the “obesity-related” health problems I have. Except, wait — those hormonal deficiencies are “obesity-related” in terms of “people who have this tend to be fat”, not “caused by fat”. And they’re screwing up my life.
Weight loss isn’t going to fix hormone deficiencies.
Weight loss drugs won’t fix hormone deficiencies.
Weight loss surgery won’t fix hormone deficiencies.
If I were to lose weight without treating those hormone deficiencies? My quality of life would not be improved. FUCK THAT. Or, to be precise I am going to continue to focus on improving my HEALTH. Because THAT will improve my life.
(How RUDE to put MY priorities first!)
And if, in the course of improving my quality of life — things like restoring my former energy levels (horrors!) and my former stamina (eek!) and regrow my muscle mass (Aack!) and reduce my anxiety and depression (gasp!) — I may end up losing some weight? That’s up to my body.
Objective: To formulate clinical practice guidelines for pharmacological management of obesity.
That’s the goal here. That tells you what this is primarily about: weight-loss drugs. Two more were approved in 2014, at least in the US – Europe has been slower to approve the drugs.
There are a few things in the guidelines that I like.
First: Some medications have weight gain as a side effect. I consider this is a useful fact for medical practitioners. It makes no sense to prescribe a drug that has weight gain as a side affect and then chastise patients for the resulting weight gain.
Second: Yes, it makes sense for medical practitioners to be aware that medications can cause weight gain or loss, and to discuss that with patients. A fat patient may prefer a drug that doesn’t cause weight gain. A slender patient may want to avoid drugs that cause weight loss.
Third: They’re measuring that a weight loss drug is “effective” if the patient loses 5% or more of their body weight in 3 months. If that seems low? Yes, yes it is. Worth anal leakage? I think not.
Fourth:
Historically, patients and providers thought that weight loss medications could be used to produce an initial weight loss that could subsequently be sustained by behavioral means. The available evidence does not support this view.
This is an important admission. The human body doesn’t like to have its weight set point messed with.
The things I disagree with? It’s hard to limit myself to just a few, but:
I disagree that patients need to be moved from drugs that control chronic health conditions just because the drug may cause weight gain. What are the side effects of the new drug? Is it as effective? Does the patient have support during the transition? That matters too — especially with psychiatric meds.
I disagree that patients should postpone treating conditions like hypertension until they lose weight. If the patient wants to try lifestyle changes first, fine — but it should NOT be under duress. The medical profession is already known to mistreat fat people. This can become another justification.
On the flip side, I was prescribed a drug that can cause weight loss (Levothyroxine) this fall. The endocrinologist was thrilled that I lost 3lbs after a few weeks of taking the drug. I don’t care about that. I care about FEELING BETTER. Obviously I’m un-American.
Turns out I’m deficient in human growth hormone. This may explain why I have less strength, stamina, and endurance than I used to have. I have met with my doc to discuss treatment, and am starting it soon. I’m not sure how long it will take to show improvement.
I am finding that having hormone deficiencies that cause fatigue, muscle loss, anxiety, and depression can be similar to simply having depression in that it’s hard to get help when you’re fatigued and depressed. Especially when the deficiencies came on relatively slowly and gradually.
There will be more tests, such as an MRI of my pituitary gland. I’ve got potential posts in my brain about various things related to the tests and new doctors and so on. But right now, it’s still the busiest time of year at work. It gets dark about 4pm every afternoon. At least I know why I’m so tired.
First visit at the endocrinologist to treat hypothyroid. Waiting in the lobby with chairs whose arms are a bit too tight. I am weighed. The doctor asks me to sit on the exam table, so I do – no back support, legs dangling. In taking my medical history she asks about my weight history. After more history, the doctor decides to take my blood pressure. While she wraps the blood pressure cuff around my upper arm, she asks why I’m not dieting. We discuss it while she takes the reading. 146/92.
A visit to urgent care for a UTI that may have moved to the kidneys. I’m feverish. The automatic blood pressure reader inflates suddenly enough that the large cuff won’t stay closed on my arm. The nurse insists on using a standard cuff on my forearm. 160-something.
Arrive at my usual nurse practitioner’s office with coffee. Walking, walking. Sit, tech immediately wraps the large cuff around my arm, holds the cuff closed while triggering the automatic blood pressure reader. 138/88.
I finish a slice of toast with peanut butter and a can of diet Pepsi as I arrive at the endocrinologist’s office. I rest 5 or so minutes in the waiting room. Once in the exam room I sit in an armless chair. When the doctor takes my blood pressure, I stay seated, feet on the floor, resting my arm at heart level on the counter, and we both stay silent. 132/82.
You may recall a study from a few years ago about how certain healthy habits — consumption of ≥5 fruits or vegetable/day, regular exercise >12 times/month, moderate alcohol consumption, and not smoking — decreased mortality risk regardless of weight.
You may not have seen this part:
The results of this study reinforce the association between healthy lifestyle habits and decreased mortality risk regardless of baseline BMI. This finding is of great importance to both patients and health care providers, whose perceptions about BMI may lead them to believe only obese and/or overweight patients require regular counseling about lifestyle adjustments. Although the evidence suggests that patients across the BMI spectrum should adhere to a healthy lifestyle to optimize health, many patients with a normal-weight BMI may believe exercise and healthy eating, for example, are less important for them as long as they maintain a low BMI.
I’ve mentioned before that the emphasis on fat often leads thin people to assume they’re healthy. Not necessarily — something the authors called out.
In the pooled analysis that included all individuals in the cohort (normal weight, overweight, and obese), the adoption of each additional healthy habit decreased all-cause mortality between 29% and 85% (Table 2). To put this in perspective, statins decrease all-cause mortality by 12% in individuals at high risk for cardiovascular disease. Given the tremendous benefits of a healthy lifestyle, policies and programs that encourage adherence to healthy lifestyles should be encouraged both locally and at a national level.
PS: I see references to statins a lot. They make money, despite side effects. Not smoking? Doesn’t make money. Exercise can make money, as can selling more fruits & vegetables — but not as much as a drug. Hm.
I had a conversation with a therapy patient of mine recently that spoke volumes to the problems of living in a rape culture that no longer wants to use the dirty word rape. She told me that she and her best friend (both 19-years-old) frequently endured sex with their boyfriends that involved heavy drug use, painful and coerced anal sex, utter boredom for the women, regular transmission of STIs, no orgasms for the women, and “sex on demand” whenever their boyfriends wanted to have sex. When I asked her if she ever felt pleasure during sex, or ever wanted to feel pleasure, she said, point blank, “I thought sex was only supposed to be pleasurable for the guys, right?” Right.
Y’know, romance novels are often seen as pure pulp, but they do groundreadersin theidea ofmutual pleasure.It’s not the worse way to set some expectations for sex. (OK, the “never needing lube” thing can be problem….)
It’s not the worse way to set some expectations for sex. (OK, the “never needing lube” thing can be problem….)
