Here I Am

Most of my family was in town last week.  Some went back home yesterday and everyone else will leave on Monday.  My long term readers know just how much I love my family and how my world revolves around them for the week or so they are here.  So, I have been very busy having fun since I last posted.

I've been practicing moderation lately with regard to my eating.  I think I did well most of the time.  I ate what was served in normal sized to even small portions.  I ate peach cobbler and mashed potatoes, but only small servings and no seconds.  In fact the peach cobbler was a little tart and I never ate any more after my initial serving.  I could have done better though, I could have stopped eating after I decided it wasn't the best, but that seemed wasteful.  Stopping is the next hurdle I must overcome.

There were times during the week, that my niece would mention that she was hungry and I'd realize I was too.  We would be so involved in whatever activity, that I wouldn't be thinking about food at all.  In these situations, I would think that perhaps this is how 'normal' people relate to food.  They just go about their business, realize they are hungry, eat and then go back to whatever they want.  

It was freeing.  I really enjoyed this time with my family since I wasn't obsessing about food all of the time.  There was no pushing food on me either.  It was a nice easy going time.

Lest, I leave the wrong impression however, I did GAIN weight this week.  I know that I had too many indulgences.  At my goal weight, it might be OK, but not now.  Not while I am actively trying to lose.  The treats are gone so they are not here to tempt me.  I am fully back on the healthy choice wagon now with my food choices.

 I did not drink enough water all week.  It wasn't on my radar. Today, I have made that a priority.  And I have already seen the results.  I'm flushing out that excess water.  I have read from more than one source that if a person isn't taking in enough water that person will retain water.  It must be a survival mechanism that kicks in.  I'm getting plenty in now, and my body is regulating itself.  LOL!!

Finally, I did not do any formal exercise.  I did move a lot more than typical though.  Most days, I spend several hours a day at a desk.  Not last week.  We played games and moved a lot, so I feel like that part evened out.

Speaking of exercise, I'm investigating Tony Horton's 10 Minute Trainer.  Has anyone got any input to share with me on that?  He's the guy that did P90X.   Even though that sent me to the doctor, I'm thinking this might be OK.  There is not as much kicking.  I'm going to see my doctor tomorrow.  I plan to ask his opinion too.

Guest Post

Recently, I was approached by Jen asking to do a guest post.  She works in an office specializing reconstructive surgery after weight loss.  It seemed like a good fit; something my readers might like to know about, since I've discussed it on this blog before.  Enjoy her post, while I enjoy a little more free time.

Loose Skin Blues

Massive weight loss is a huge decision, most of you reading have either gone through a massive weight loss or are contemplating going through a massive weight loss. One of the most common hesitations in losing weight is the resulting loose skin that occurs once your body has gone through a significant weight loss. It is common knowledge that losing weight = loose skin. Loose skin not only occurs with a massive weight loss but also with natural body occurrences such as pregnancy. This is because once your body stretches through weight gain or through pregnancy; your skin loses its elasticity. I work for a medical reconstruction and cosmetic surgery practice in Kansas City, here our surgeons see many individuals on a day-to-day basis that have these exact concerns. First they come in to talk about weight-loss and bariatric surgery, how it works and your results. Many patients, however, decide they want to go the less expensive and natural way by strict diet and exercise but are concerned about the loose skin. Our doctors always tell patients to be realistic, being healthy is far more important than having loose skin. Even when you have loose skin after weight- loss there are ways to remove it such as tummy tucks. The loose skin, although it may not seem like it, is a proud reminder of how far you’ve come and if you take that extra step to remove the loose skin, your body will be an entire trophy dedicated to yourself. In this post, we will see why and where that extra skin came from and how to reduce or remove it.

How We Burn Fat

As we all know, matter cannot be created nor destroyed, so when you exercise and diet fat is not simply “disappearing” off your body. What occurs is a form change, just like water and steam. The glucose and sugar that is harnessed from carbohydrates are the first fuel sources. Once the glucose runs out, fat takes over. Your body is a constant interconnected conveyor belt that removes essential nutrients from the fat and delivers them to specific body parts. Hormones that regulate our blood sugar levels activate an enzyme in fat tissue called lipase. Lipase ignites fat cells to release triglycerides, which is what makes fat cells fat. When they receive a signal from lipase to exit the fat cells, the triglycerides break-up into glycerol and fatty acids and then enter the bloodstream for use in your body. The process of breaking down triglycerides into reusable energy is called lipolysis which is shuffled and reshuffled to produce heat, water, carbon dioxide, and ATP. Since the fat tissue has lost some of its components, the cells shrink.

Why the Extra Skin?

When fat tissue is worked and the cells shrink, wouldn’t it make sense that your skin would shrink as well? Yes and no. In the cases of moderate weight loss, skin can certainly shrink back to fit the body’s new size because of its elasticity due to collagen in the skin. However, collagen does have its limits. Collagen fibers weaken with age and results in wrinkles. Rapid growth or weight gain also outpaces collagen production in the skin causing areas to over-stretch, leading to stretch marks commonly seen in pregnancy and adolescents going through puberty. In cases of massive weight-loss, the skin that has been stretched has lost its collagen strength making it very difficult if not impossible for the extra skin to shrink back to its former shape. Those undergoing gastric bypass surgery or bariatric surgery feel this pain. As the number of patients going through weight loss surgery increases, so do corrective surgeries for the unwanted and uncomfortable skin. This extra skin can actually be a serious problem and can actually cause infections, rashes and even back problems.

Treatment Options

The most important determinant of how much loose skin an individual will have following weight loss is their age. Younger patients tend to have less loose skin than those who are older because of the strength of collagen in your skin. The next most important factor is the amount of weight loss. An individual who loses 200 lbs. is more likely to have excess skin than someone who has lost 80 lbs. There are other factors of who is more likely to have loose skin such as smoking, sun damage and skin color.

-          Exercise: Exercise that includes increasing muscle town can tighten connective tissue. For patients who have undergone bariatric surgery are recommended to add a regular exercise regimen that is helpful to maintain ones weight and can also serve to tighten  loose skin to some extent.

-          Losing weight slowly: Your skin has already lost its collagen from either age or being stretched to its max. By losing weight slowly the loose skin from each pound of fat burned has more time to shrink itself back. This will only be noticeable by small measures and the amount of loose skin shrunk depends on the individual.

-          Body Contouring Procedures: For those that are losing 80 lbs. to over 100 lbs. surgical procedures are available to tighten skin and remove the extra pockets of skin that inhibit your body from being as toned and tight as the individual would like. Below are the most common procedures for massive weight loss patients.

Abdomen, Thighs and Buttocks- The abdomen is usually one of the greatest concerns for individuals following massive weight loss. In both men and women, excess fat is stored both in the abdomen and beneath the skin of the abdominal wall. Consequently following weight loss in those areas, extra skin appears. Large amounts of hanging skin can lead to the collection of moisture between the skin folds resulting in a condition called intertriginous dermatitis, which leads to irritation, redness and pain. Occasionally, the skin may even breakdown, bleed and become infected. With proper documentation, many insurance companies recognize this problem and provide full coverage from surgical removal through a tummy tuck or abdominoplasty. The abdominoplasty will solely remove the excess skin from your stomach which is ideal for women following pregnancy. However, for those who have undergone weight loss surgery or a massive weight loss, excess skin is not limited to the stomach but also results in the buttocks and thighs. Because of this, surgeons will perform a procedure specifically for weight-loss patients called a body lift. This involves an abdominoplasty, thigh and buttock lift all at one time. This addresses and removes loose skin and cellulite along the thighs and buttocks as well as the abdomen. Although the resulting scar is lengthy, it is confined to the waistline and is hidden by underwear, panties, or a bikini.

Breasts- Following a great weight loss, breast size and shape often change significantly in both men and women. Everyone worries about sagging breasts as we age but few know that massive weight loss greatly accelerates the process. As women advance from girls to teens to twenties and into their later years, the glandular portion of breasts is replaced by fat. The original glandular tissue is significantly more firm than fat and consequently the skin becomes unable to retract completely and produces severely ptotic or sagging breasts. This is called breast involution. There are many treatment options for women following weight loss. If a woman desires less sagging and wants to be larger, a breast lift or mastopexy is needed. Again, surgeons will tell you your options and also remind you to be realistic with or breast augmentation may be satisfactory.  The problems in men are similar however treatment is slightly different. Men tend to have larger breasts when over-weight. Depending on a man’s age, degree of weight loss, and a few other factors he may result in large breasts, large and/or sagging breasts, or satisfactory breasts following weight loss. Large and/or sagging breasts in men is called gynecomastia. Here liposuction alone may be satisfactory, however this is not typical. Most men with both sagging and large breasts go through a two-staged procedure. The first stage is liposuction and is performed to remove excess fat and some glandular tissue. Over the next few months, the breast skin will retract slightly. Three to six months later, the patient will return to evaluate the situation and determine if the outcome is satisfactory. Delaying the second stage allows for significant skin retraction and if a skin tightening procedure is desired it is likely to require smaller incisions.

The Bottom Line?

Being healthy has far greater importance than excess skin. Although, having excess skin can lead to some serious issues there are non-surgical ways of preventing infections such as keeping your excess skin dry. For those who are able and want to remove the excess skin, it is important to remember that these procedures should only be considered after ones weight has stabilized; especially after weight loss surgery. This can range from 7-18 months after weight loss. The most important factor in finding a plastic surgeon who can perform these procedures is that they must be board certified. If your plastic surgeon’s website or office does not advertise that they are board certified you must RUN! For everyone who has heard horror plastic surgery stories, this is probably where it started, having a surgical procedure done without a board certified surgeon. Use ASPS (The American Society of Plastic Surgery) to find a board certified surgeon near you.

Post written by: Jen is a writer for a medical reconstructive and cosmetic surgery center in Kansas City. She has two kittens and loves to write about all things beauty, women, health and fitness! She spends her days outside and at the center where she learns as much as she can from the board certified surgeons. This plastic surgery center specializes in breast augmentations and breast reconstruction.  Jen also has a personal blog Littlefurrymusings.tumblr.com where she writes about all kinds of things that she thinks others would enjoy.  

Typhoid!!

I am planning to go on a mission trip in the fall.  Last week, I met with my doctor to discuss the needed immunizations since some take time to become potent.  We started the injections that day.  I got two hepatitis shots and a prescription for an oral typhoid vaccine, which I started the next day.  (The pharmacy didn't have that in stock, go figure!) I'll go back in a couple more weeks for more shots.

Both my doctor and the pharmacist discussed proper dosing and potential side effects of the medication.  But, I still had no idea!!  I was told 'fatigue' along with some other things like headache, upset stomach and the like.  All of which I thought were typical side effects of just about anything.

The typhoid vaccine is four doses administered every 48 hours.  A few hours after the first dose, I noticed a headache and felt very tired.  I realized what was going on and took some Excedrin for both symptoms.  I functioned pretty well and 48 hours later took dose number 2.  Again the same symptoms appeared but this time with a little more ferocity and did not go away as quickly with my old favorite Excedrin.

By the fourth dose, I could hold my head up but I didn't want to.  I sat most of the time with my head leaning back against something.  I won't discuss the other issues except to say that my digestive system was upset.  Needless to say, no weight loss happened during this time.  Even with the digestive issues, I'm sure being so sedentary burned very few calories.  My weight is up slightly.  It should fall right back off now that I've finished the regimen.

I am now, or soon will be, immune to typhoid for 5 years.  Now that all of that is over, I can get back to the business of weight loss and blog about it again.  

Musings on Moderation

I believe moderation is a good thing.  I am not very good at practicing it.  When I'm in to something, I am all in.  When I am excited about something, it is my primary topic of conversation.  When I don't care for something, I avoid it completely.  Extending this mindset to weight loss, I'm either on a 'diet' or not.  In trying to practice a little more moderation in all areas of my life, I have come to some realizations in the weight loss piece as well.

Mainly, that my goal now is to lose weight.  Silly isn't it?  Not exactly.  I am not setting a goal to lose two pounds a week, or even just one pound per week as I understand many physicians are touting now.  Nope.  My goal is to lose weight from one week to the next no matter how large or small.

This change in mindset did not come about overnight.  Although, I have wanted to moderate in my weight loss efforts for some time, I was afraid to.  I had an event coming up and couldn't risk it for one.  But mostly my all or nothing thinking had me concerned that if I loosened up at all, I'd just pig out.  

So, I began to think about my likes and dislikes in food and eating plans.  I also began to think about my lifestyle and what would be reasonable.  Some of my conclusions:

• I grow weary of counting stuff.  No matter what it is.  I don't want to weigh and measure every bite and decide how many points, calories, carbs, fat grams, etc are involved.
• Counting stuff feeds my perfectionistic tendencies, if 1200 calories is good, then 1000 is better, and 800 would be even better.
• My household at this time, seems to have a revolving door of guests.  This is a good thing and a goal for which 65MD and I have longed for some time.  It is not, however, conducive to strict eating plans.
• Right now, I have no major events on the horizon.  No weddings, graduations, etc for which there will be pictures made.  The closest thing is my birthday in August.
• I know what good food choices are and are not.
• I believe I will be happy with a slow loss.  (I think a slow, steady loss will be faster in the long run, since I bounce up and down the scales so much.)

I have decided that my eating will center around lean protein and green vegetables.  That won't be hard.  I eat that way most of the time now.  I will allow myself one fruit per day, but harking back to my issue with counting stuff, I'm not going to be militant about it.  If there is watermelon in the house and I want more than a cup, I'll eat it.  White bread, white potatoes and other starchy vegetables will be severely limited.  There aren't many of this type of food in my house anyway.  Sweets will be limited to special occasions only, like my birthday in August.  I'll continue to drink water.  I like it so that is almost a non-issue.

I will monitor my weight closely, at least in the beginning to ensure that my plan is working.  I've been doing this since July 1.  So far, I've lost 0.4 lbs.  I think this is the right thing for me.  I feel like I am ready to relax the rules a little bit and get on with life.  I probably needed the strict parameters for this time to develop better habits.  I'll know soon enough if that is true.

More about the Grocery Fast

Timothy asked in the comments yesterday if there were some items I was not going to restock.  The answer is a resounding YES.    I'm not buying any more non sugar sweetener that isn't agave nectar for one.  But more important than the list of what I'm not buying is how my shopping changed yesterday.

I went armed with a list which is typical.  What was on the list and how it came to be on the list were different.  65MD and I keep a running shopping list.  We add items as we run out.  Except for the month of June.  We did not automatically write down what we'd just finished.  We would think about it and decide if that was what we really wanted.  Sunday night, together we went over the list.  We agreed we had a good list and I went to the store on Monday.

As I was making my way through the store and down the list, I noticed that I was making a circle around the store.  That is an old Weight Watcher trick I learned.  Shop the perimeter.  I loaded up on fresh produce; our biggest item we missed during the month.  I filled in with a little dairy, deli and a few miscellaneous staples.  I needed nothing on the aisles.

I don't think I'll go back to making grocery shopping a focal point of my week.  In fact, I don't think I'll even go every week.  We've learned that life doesn't fall apart when we don't have a particular food item.  That was a good lesson for us.

Two Topics

I have two items to share today.  I'll just hit the high points of my topics so as not to get too long and wordy.  

First the fast:   The grocery shopping fast ended today.  I had thought that it would last at least another few days. But, last night as 65MD and I were discussing our weeks, I realized if I did not go to the store today I wouldn't get to this week.  I didn't spend any more money than a typical shopping week when I went weekly.  There were a few things that we were completely out of that I had to restock, but most was what was wanted for a dinner party later this week.

I noticed towards the end of the month that I felt a sense of relief when I used the last of something.  Almost a gladness that it was gone and I didn't need to deal with it any more.  I like being able to see everything that is in the cabinet or refrigerator.  I still have some non-sugar sweeteners that I'm using.  I won't allow myself any agave nectar until it is gone.  I have promised myself I won't allow food to pile up like that again.

This purge has spilled over in to other areas of our life as well.  We decluttered our basement and have started on the closets.  I'm not talking about clothes.  I'm talking about those high shelves where stuff gets pushed back and forgotten.  We are not crazy hoarder people, but we are creating a huge pile of stuff to donate or yard sale.  It feels good!

Second, monthly stats.  My weight stayed the same this month.  I had finally dipped down below the prewedding weight but sadly regained that.  It does not make me happy to report a no loss month.  But, the scale is only on measure.  I lost 2.25 inches during the month which leads me to believe that I have replaced some fat with muscle.  The biggest change was in my thighs.  My pants and shorts don't seem quite as clingy as they once were.  I feel a change in the way all of my clothes fit and I've had a couple of people ask if I've lost weight.  So, I'll not fret over a small uptick.  If this really is muscle mass, I'll know soon because muscle burns more calories than fat and my metabolism will be stoked.

Also, my scales report a loss in my fat percentage.  I don't put a lot of stock in that because I've read that there are too many factors that can skew those numbers in a home situation.  This time, though, I'll say they are at least confirming my suspicion even if I haven't lost quite as much fat as they indicate.

It was a very good June for me.  I'm looking forward to an even better July.