And the labs say...

It has been a few years since I had a complete physical. My doctor's office finally caught up with me, so I went last week. Why do doctors seem surprised when patients refuse to get a colonoscopy? It's truly not on my agenda. No one in my family has ever had a polyp problem, not even my 82-year-old mother.

The doctor asked about my eating habits and I explained that I'm on a ketogenic diet. "No issue with that!" was his quick reply. He said that he has a lot of patients who have had great success with controlling blood sugar and weight by taking a keto approach.

My lab results came in yesterday and my blood sugar and cholesterol are solidly normal, across the board, except for my triglycerides, which are blissfully lower than low. Hooray.

My weight loss seems to have stopped--I've been on a plateau for two months now, and that's disappointing. I read somewhere that keto is only good for weight loss for six months, and then it doesn't work anymore. Apparently, my body got this memo and took it to heart. Boo. It's discouraging since I still have another 50 pounds to lose. Sad face.

Anyway, I suppose that I can at least be grateful my blood pressure is great, my blood work is phenomenal, I'm not gaining any weight, and I'm never hungry. Yay.

Pain

I want to talk about pain. Not emotional pain, but actual physical, neuropathic, chronic, nociceptive and any other type of pain. I have it all. Except for somatic pain. I don't think any of my issues are related to emotions other than that the pain causes me to experience emotions.

I have been in constant, chronic pain since 1999. It started with a bad knee. Surgery helped, but even after I was declared well and healed, the pain never went away completely. I feel as though I've been collecting painful places in my body ever since.

One of the reasons I stopped going to the gym was that the initial muscle soreness and expected aches never eased. The more I exercised, the worse I felt. I hired a trainer who determined there was nothing wrong with my routine, form, or technique. I talked to my primary care doctor who sent me to a rheumatologist. The rheumatologist told me to meditate, do yoga, and stop trying so hard to do life.

My doctor had sent me to the rheumatologist because he suspected I had fibromyalgia. I blanched at that suggestion for several reasons. Maybe ten years ago, my then-primary-care doctor told me that fibromylagia was just doctor code for depression or similar mental illness. He said that most illnesses that required diagnosis of exclusion were really just emotional problems the patient wasn't willing to deal with head-on.

Years later, another doctor, the cardiologist I wrote about on this blog once or twice, told me almost the exact same thing. He said that fibromyalgia and chronic fatigue syndrome, both, were not physical illnesses at all, rather, they were physical manifestations of mental illness. He also said that they were largely named and then heavily marketed not by physicians or researchers but by pharmaceutical companies. I told him I doubted there was any validity to his belief and he countered with, and I quote, "Really? Then why do you think those 'illnesses' are treated almost exclusively with antidepressants? It's so doctors can get mentally ill patients who think the problem is physical or mechanical to accept the appropriate treatment for an emotional issue. That's also why meditation helps so much."

I feel like there are a lot of things medical professionals believe that may, in the end, stop ill people from getting appropriate, effective care. It's a lazy way to practice medicine.

Everything is relative, 2018 weightloss edition

At a meeting a few days ago, a colleague walked in the room, looked at me, and said, "Look at you! You're wasting away!"

I replied, "Really? You think so?"

The colleague asked me why I didn't seem enthusiastic about it, since she had never seen me wear such fitted clothes and I had obviously lost a lot of weight to be able to do so.

I explained: "These were my new fat clothes when I bought them...with deep shame."

So, although I'm grateful to have lost some weight, I still have nothing to be proud of. Talk to me when I weigh 120 pounds, and then you'll see me feeling some sense of accomplishment.

We agree to disagree

Frank believes my ketogenic diet is going to kill me. He said that the weight loss--I'm down 23 pounds--is surely coming at a terrible price. Frank won't accept that this is OK until he sees my blood work. He's sure that a high-fat diet that allows me to eat copious amounts of bacon, oil, avocados, butter, and eggs can't possibly be harmless. He's sure I'm clogging my arteries and ramping up my cholesterol to unhealthy levels.

I've tried to explain that dietary cholesterol doesn't really have an impact on blood cholesterol. That's all left to genetics and individuals' livers.

Here's the thing. I have a weight goal of 105-110 pounds and I think I can get there. I will gladly accept losing another 60 pounds from where I am right now, which will get me to pretty much the upper end of my goal weight, but it's a healthy weight--and admirable.

If this diet is harming me, so be it. I will go on record as saying that in the most fat-shaming society on the planet, I would rather die a skinny person than live as a fat one. If it kills me, it kills me, but by god, I will be thin when it does. Isn't being skinny really the very most important thing, medically? Why do you get weighed at the doctor's office? Why does the doctor tsk-tsk over a weight that's not ideal? Nobody cares about my blood pressure or my cholesterol. If you're thin, then you have achieved the American ideal of health--because you don't look like a big fat fucking failure.

Please pass the coconut oil.

The quest for 40 percent

It's no secret that I hate my body. I've been at war with my body for most of my life, hating just about everything about it. Early-onset arthritis, spinal stenosis, and SI joint dysfunction have been making me miserable for years and they're getting worse. Those conditions have been getting significantly worse for me for the past few years. I'm bitter about that because, historically, I have taken good care of myself. My body has not returned the favor.

My husband thinks I should stop complaining and go to the doctor, specifically, for my knees. Fourteen months ago, I fell knees-first onto a granite cobblestone crosswalk in Mexico. I twisted my ankle in the process, and ended up with some of the worst swelling and bruising I've ever seen on my body. I could only wear flip-flops for a week. When I got home, my doctor ordered an x-ray and was visibly surprised to learn I had not broken my patella. She did point out that, unrelated to the injury, my knee joint was rapidly deteriorating. I have done nothing about it since, and 13 months on, my knee is still painful and swollen. I didn't know swelling could last that long.

My bruised and swollen ankle in Mexico.

My leg, eight days after I fell.

 Back in November, the hamstring on my "good" leg started to tighten up and hurt. I stretched, I massaged, I stretched some more. Despite this, while pulling on a pair of yoga pants, I landed off-kilter, heard a frightening popping sound, felt white-hot pain shoot through my knee, lost my balance, crashed into the wall, broke out in a sweat, became instantly nauseated and almost fainted. I couldn't put weight on my knee for a week, having torn its medial collateral ligament. They don't do surgery on that one--it's just three or four months of rest and healing. In my case, there were ice packs, large doses of ibuprofen combined with Tylenol, and a small fortune spent on lidocaine patches. I wouldn't say it's healed (since it hurts a lot), but it's functionally better.

I'm still in significant pain, but I refuse to go to the doctor. Here's why. I know that my weight is an issue and I will be scolded for being fat. This will color any evaluation the doctor makes. Fat aggravates arthritis--I know that. I don't need to be told that. My goal is to be not so overweight the next time I ask for a doctor's help, so toward that end (and ending my pain), I'm dieting.

Yes, I'm dieting once again. My goal is to drop 40 percent of my body weight, or approximately 80 pounds. This will put me at such an indisputably healthy weight that not even the most egregiously fat-shaming doctor will be able to give me a hard time. Until then, I limp. And eat bacon.

Enter keto

I've lost 18 pounds since Thanksgiving. That's a blazing one-pound-a-week weight loss, I know. It's what I've typically done on diets in the past, but this time, I'm not so bitter about it and here's why: Keto.

If you're unfamiliar, keto is a high-fat, moderate-protein, minuscule carbohydrate diet.  I get 75-80 percent of my daily calories from healthy fats and, most days, I consume fewer than 20 grams of carbohydrates. No sugar, no flour, no grains, no fruit, no root vegetables, no pasta, no bread, no low-fat dairy. What I do eat: Lots of avocados. Eggs. Cheese (cheese!!!). Bacon. Fish. Cauliflower. Nuts. Cacao butter. Hemp seeds. Chicken. Turkey. Broccoli. Green beans. Spinach. Heavy cream. Sour cream. Butter. Gobs of coconut oil. Vodka.

I am never hungry. Sometimes, I go 24 hours without eating. It's not painful because I'm not hungry. I'm not resentful about dieting because, although it's painfully slow, I'm losing weight--and I'm never hungry.

Bonus: A high-fat diet is supposed to be good for the brain. It turns out that most of what we've been told about nutrition is flat-out wrong. If you take carbohydrates out of your diet, you need to replace it with something. If that something is just lots of protein, your body will store whatever it can't immediately process as fat. Your cholesterol level is largely determined by genetics and, to a smaller extent, exercise.

The ketogenic diet has been around for about 100 years. It was developed specifically to help epileptics, and it's still used that way therapeutically. It also stabilizes blood sugar and there are legions of diabetics who have been prescribed this diet. Once you get the hang of it, there's really no downside to keto. I do have to take a daily fiber supplement, high-potency magnesium, and I drink an electrolyte solution as part of my everyday two-liter water intake. I check my blood ketones every few days. My body refuses to go into a highly ketogenic state, preferring instead, apparently, to lollygag at the low end of the ketosis spectrum, down in the light-green zone. That's OK--I'm still burning fat and losing weight. Slowly.

I'm not celebrating my 18-pound weight loss. I've been here before. I have a long way to go. I went pants shopping yesterday and haven't even dropped a size yet (because my body despises me). It was a bracing reminder that I have a lot more work to do before I have any right to feel good about myself.

So, we'll see. If I lose a pound a week, that's 52 pounds in a year. Add another 15 weeks/pounds to get us to this time next year, and I'll be within a few pounds of my goal then. I hope my knees are still functioning enough so I can still walk by then, and if I can, I will walk into the doctor's office and maybe be lectured about waiting too long to seek help, but I will not be lectured or admonished for being fat.

Addiction is a choice

My husband and I have watched "Intervention" on A&E since it first came on 12 years ago. We have both known, and currently know, addicts. We still don't get it.

Frank and I consider ourselves to be empathetic and compassionate people, but between us, we can't seem to work up any feelings of sadness or sympathy for addicts. None. How is addiction not a personal choice? This is my question.

I understand that people take prescription medications and come to depend on them. Once they realize they're dependent, though, don't they have a choice? Can't they say to the prescribing physician, "This drug doesn't work for me. Is there another treatment that will address my chronic pain?" If surgery pain has subsided and the patient still wants the drugs, isn't it a choice to go find a heroin dealer and pay money to continue to get high instead of saying to the doctor, "I can't seem to stop wanting these pills"? If not, how is pursuing feeding the addiction instead of getting professional help not a personal decision, an independent choice? Who is holding a gun to that person's head and saying, "Use the money you have to buy heroin. Don't use it to see a medical professional who can help you through the withdrawal process." That gun-pointing person isn't there. Rather, the person has decided that however substance abuse makes him or her feel, they feel it's more important to make the choice to pursue that direction instead of going with a different option.

I understand how reward centers in the brain work, but I don't believe they force anyone to drink, shoot up, smoke, or keep gambling. That's just a choice of option A over option B.

People get sober when they want to, and if they don't want to, no treatment will be effective. It's a choice. If I'm wrong, please explain how addiction is an external force and not just an internally motivated personal unwillingness to be sober.