When medical opinions collide

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Ten months and a five month waiting list ago I managed to finally meet the NHS dietician. She said:
Have you tried losing weight before?
Yes I replied, thinking of the drawer full of clothes that had become too small I’ve done Weightwatchers, Slimmingworld, Slimfast, calorie controlled, Atkins… She rolled her eyes and tutted at the word.
The fertility consultant says that women with PCOS, which I have, respond best to a low carb diet I said.
Atkins…Atkins is just awful. she said and launched into calorie controlled diets being the only non-fad diet option.

Like a good patient I listened, made notes and obeyed. Admittedly, my own eyebrows were raised on the need for protein for breakfast, but not poached eggs or baked beans as they were a ‘cooked breakfast’, and thus naughty and I will be spanked and sent to bed without my fruit snack (good, fruit is boring).

The NHS fertility consultant said Drop the sludge, Patient, drop two stone on two months. It can be done, ‘just run up and down a lot of stairs’.
Cue 1240-1300 calories a day, being continuously ravenous, convinced my stomach was digesting itself, that it would collapse in on itself causing a black hole into which my rebellious body, office space, city, country and ultimately anything within a several billion space radius would be sucked into and destroyed, never to be seen again.

Ultimately, according to my private fertility consultants, my metabolism and the optimum health of my reproductive organs, the bits that I was trying to make fruitful, was compromised. Crash dieting causes the body to redirect all energy to the live saving parts of your body, not the life giving bits.

Ten months and only 13 lbs later, my body is doing a wobbly, sludgy victory lap (or it would if it could get off the floor for laughing so hard) jeering
Laydeee! Hey, Dietician Laydeeee! In your FACE Laydeee . It deserves an ASBO.

The last time I lost weight to a noticeable level was on Atkins. I went from a size 22 to a loose size 18. Hunger didn’t exist any more, neither did skin problems (finally zit free, wahay!!) low energy or bitten fingernails (eating is an oral fixation, more on that another day). New trews were bought, found to be too big the next month, then assigned to the bottom drawer. They have since been worn to death and sent to The Great Big Rag pile in the sky.

So after plateauing for more months than most people spend on diets, I give up. Sod you, calorie control; yeah, and the horse you rode in on. I’m back on Atkins.

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Hair today…..

Yup, c'est moi.

Yup, c’est moi.

Any pet owner will understand the frustration of dealing with the sheer volume of hair a pet sheds. My husband feels the same. All around the house are little twists of long, dark hair. They are mine. While I am spared the excess body/facial hair impact of PCOS, I do lose an awful lot of hair – besides the grey ones that get pulled out with malice aforethought.

Every hand stroke through my brunette locks results in stray hairs clinging to fingers and stuck in ring claws. Those hairs are gathered together, twisted and usually shoved in a pocket.

Not that I plan to knit a sweater with them or worry about voodoo or witchcraft practices raining down curses upon my head, but more so that it’s not polite, considerate nor friendly to chuck stray hairs, former members of the Crowning Glory Band, on someone else’s floor.

At home, it’s slightly different. Because I clean them up, and because it’s the pit in which I dwell, I – actually, no, it’s the cat’s hair honest; nope, not me; I’d rather lie until my foot drops off than admit this, and, um, well, er…..oh bollocks. It’s me.

I drop the hair into the log basket, the fire, the arm of the sofa, the shower walls, twisting the bundles of hair into little balls while trying to remember to complete their journey to the bin. That’s fine. That’s cool and dandy, IMHO. That’s controlled, deliberate behaviour.

What is not cool is the bagless vacuum cleaner turning up great wads of hair, only partially the soft, short, fine hairs of a long haired ginger cat. The rest of it is dark and long….and definitely human. How in God’s merry name did it get there?! Since the black cat died blaming it on him is futile. His lovely fur is buried at the bottom of the garden beneath a thick layer of earth infused with our grief and regret.

There’s the OCD to consider. It’s not strong but is a compulsion. Without knowing it’s happening I repeatedly and swiftly pull at the hair at the sides of my head, easy to do as it’s so long. This happens because I concentrate, and as I’ve been concentrating quite a lot for work these last few weeks, you can imagine how hairy my desk could become without regular cleaning.

It’s worse at the moment as the hairdresser decided that very thick hair (in fabulous condition no less, she says with a narcissistic head toss) is a nasty state of affairs and started to ‘thin’ the front sides before I could stop her. It’s a nasty, foul haircut and needs exorcising; it makes me feel like I have a disease which, ironically, and according to the NHS, I do.

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The diet battle ground is in your head.

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Recently, my husband got me thinking about my motives for weight loss and led to my trying to figure out what I want. This last fortnight was beset with a workload requiring two, ten day weeks (thank god for freelancers), battling a tube strike, failing trains, flood, rain, stroppy commuters and eleven hour days. The upshot is that, as WordPress keeps telling me, my weekly posting goal was not met. Nor was the weekly diet and exercise goal. I felt under siege enough without adding famine to the above list of challenges.

In terms of my motivations to lose weight, it boils down to this: the only defined reason I want to lose weight is clothing. Not ‘fashion’ exactly, but clothing. Being able to go into every shop on the high street, should I want to, and find clothing my size. Currently, this is possible, but not easy. It’s made harder by my taste which can run to this, which is hardly mainstream, high street clothing.

I have had to accept that even high street clothing will not fit me well, even at my current size. I have boobs to be proud of with a clearly defined bust line; most plus size blouses are square tents that turn a curve into solid square block. I have a steep curve at the small of my back, it makes my arse stick out something rotten, but apparently that’s attractive albeit a bastard when it comes to finding trews that fit. Most clothing makes me feel like I have unnaturally narrow shoulders, short arms, short legs, hobbit-like feet….the list is endless and made all the more vexing when the national average size is 16.

An important change for any woman to accept is that the only person with the power to be critical about their bodies is themselves. We inherit everything we have, wether we like it or not. We learn, or allow ourselves to be taught, to view our bodies with disdain and criticism. We work to achieve goals that our individual biology and genetics render unattainable and berate ourselves for failing. We opt for surgery to achieve boobs/noses/cheekbones/fat levels/whatever the media tells us is currently desirable, or to hang onto a view that only youth means beauty.

Many moons ago there was an advert on UK tv, if you can find it in the intraweb ether, well done. In the meantime, this is the American version. I remember it so vividly because it’s true. How often do you hear men judging themselves by their dress size? How often do they ask if they look fat, or hate their thighs?

Hating your physical self will not help you achieve a media-perfect body. The key, I realise, is to accept everything about yourself, to stop being afraid of what others think of your body, but to carry it with pride. It’s you, after all. Your feelings about your body will be reflected in the way you move, this will speak volumes to others. Instead of giving them a message to look for the problem you perceive about yourself, then pick up on them looking, interpreting their feedback as a harsh criticism of whatever part of your body you are unhappy about, give them a message that you are confident and assured. And bollocks to their opinion. Who are they to tell you how your body should look?

So I wear clothes that skim over the lumpy bits, fit at the flattering bits and draw the eye to an overall good presentation. I wear black, head to toe, every damn day. I wear spiky, pointy shoes that women love and men find intimidating; sometimes they are red. Makeup is scant, hair is straightened (to avoid the super-sized comedy moustache fringe). And I’m happy with all this.

And the only opinion on this that matters is mine and my husband’s.

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Expectation Management Begins At Home

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This week London had the Tube strikes. My husband was a strike newbie. Being a veteran of many enforced route marches across London caused by strikes, I expected bloody carnage and fisticuffs galore.

Knowing my much adored husband as I do, there were three choices.
1. Let me handle it.
Doomed before it begins, this one; we’re both control freaks.
2. Let him handle it.
See above, with added risk of classic newbie errors.
3. Let’s talk about options and agree a plan.
So we did. By the time we hit Liverpool St we were already on Plan A1, and were prepared to switch to Plan B in a frantic, adrenaline-laden panic in the face of a hoard of rabid, thwarted commuters.

Day One
The bus queue was there, but a bit half hearted in the queuing department by latecomers trying to find the queue amongst the crowd. Words were exchanged. Hand gestures offered. Dumb-ass looks of bewilderment were received. Result: 15 mins queuing to get seats on the top desk with great views of London.

Day Two
Lessons were learned. Not by us (let’s not forget I’m a battle weary commuting grunt) but by the station staff. The moved the queue. People were on hand to point the direction, metal gates were up at strategic points to stop queue barging, staff were communicative. Each and every one of us knew exactly what was expected of us, and exactly how we were going to be ladled onto a bus. And we all behaved impeccably. All hail Liverpool Street station staff, you were amazing.

It was the sweetest strike commute I have ever experienced.

In order to bring someone on a journey (physically and metaphorically) they need to feel part of the process. They need to feel they are being listened to, that their ideas are valid.

When bewildered, generally they decide to take matters into their own hands. This can lead to a downward spiral of feeling embarrassed at a heckling, reacting angrily to their embarrassment followed by storming off, or getting a little…..tactile.

Keep people informed and they go away. Keep silent, and they meddle with your plans – or start complaining vociferously.

Greater Anglia trains, I am available to train you, and your staff, about effective expectation management for stakeholders (that would be we commuting stiffs who agree to trade money for the service you advertise and infrequently deliver, not your shareholders).

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Week 4

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No weight loss this week. At an average of 1600 calories per day, with brisk walks (not enough, TBH), you might think something would have shifted. Apparently not. Yet two weeks maintaining is better than a gain, right?

It’s demoralising. Counting calories, focussing on the main goal, on the Sunday morning weigh in, trying to avoid temptation of mid week weigh ins, making sure every last damn scrap of stuff with a calorie content is written down, refusing all offers of a small wine with dinner, a taste of birthday cake, the self imposed pressure on ‘being good’….and all for what?

Things have always come easy in my life. Well, they felt easy; the amount of sheer effort, work and sleeplessness is forgotten when the achievement came home to roost. Hurdles could always be overcome; when a path was closed, I’d find a way through, bringing my body along for the ride. My body, it seems, is getting its own back with passive resistance.

PCOS effectively means I have a hormonal imbalance. It means that my metabolism does not work properly, that my pancreas works overtime producing insulin, which is resisted with knobs on, that even if I ration my intake with almost famine-like zeal, I’m buggered something rotten. It’s damn frustrating to be thwarted.

But it’s only been a two week run, stop whinging some might say. Indeed, say I, though this is not the first time, nor doubtless the last, that my body and I go to war. The body wins the physical fight, leaving the mind to suck it up and change it’s perspective. For someone who has lived cerebrally for the last thirty-odd years, this is hard to accept.

I’ve been on a ‘reducing diet’ (fabulously old fashioned turn of phrase, that!) for the last few years. In May 2014, I weighed 276lbs (19st 10lbs), 25 lbs less than I do now. Sure, it’s still a positive direction for weight to go. And the painfully slow weight loss is based on diets for losing two pounds a week. That would be a projected sixty-odd pounds of flubber. My body invited those diets to a darkened underpass for a ‘quiet chat’. Guess who won? I’ll give you a clue…go ask the scales.

The body declined appeals to negotiate for a child. It refuses to let go of things it holds dear (fat), even if that thing will eventually kill it. The body is not a strategic thinker.

Moaning to my husband I said: Maybe I should stop trying to be something I’m not and just accept that I am this size, that it’s not going to change, that I’m ok being me in this package.
I wish you would. he said, not unkindly.

This was new.

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Weight loss does NOT cure PCOS

Retweeted as it sums up the approach I get from the NHS on many, many different issues, not least getting treatment for PCOS!

Stretchmarklandia

I really believe that if doctors stopped believing that weight loss cured PCOS, we’d have better treatment options.

I was inspired to write this post by a woman in a forum who was frustrated that she wasn’t losing enough weight to alleviate her PCOS symptoms. But even by the bullshit measure that is the BMI, she is not overweight.

Any time you look up “PCOS treatment,” “weight loss” is listed as a primary objective. This is problematic for two reasons: one, PCOS is a metabolic disorder, so weight loss is extremely difficult with PCOS, and two, weight loss does not cure PCOS.

If it did, I wouldn’t be complaining about exploding cysts, or horrible mood swings, or hot flashes. I lost 70 lbs. My weight is considered “normal” now. Where is my cure? Where do I cash in?

I ovulate now and my triglycerides are low. That…

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Falsus Corpus: Thoughts About Women’s Stupid Bodies

The title is a bit of a misnomer, though it’s worth a read as a male viewpoint of how we women can over focus on our body image, meanwhile criticising other women in an effort to feel better about ourselves (see: Fashion Buyers). Interestingly, the influence of media is not mentioned, though I suspect that women are trained to be more attuned to media than the men watching the women.

You Monsters Are People.

In prehistoric times the thing that made a woman the most desirable to the rest of her pack was having both arms. Things like sharp teeth and having no diseases were just perks back then. If you were some archaic human female spending her days trying to pull all the skin off a mammoth carcass, had most of your teeth, functional reproductive organs, and could start a fire without help, then you were probably the sexiest woman on the planet. Every man in your tribe would show up in front of your cave with a cup of dinosaur milk and a sharpened rock in the hopes that it might be enough to gain your favor.

Fast forward into modernity and the dinosaur milk has dried up. Everyone is arguing about body shape and what not to wear. There are campaigns endorsing fatness and abhorring skinniness where people make outrageous claims…

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Is it three weeks already?

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Week 3
Starting weight: 257lbs (it has been worse)
Current weight: 251lbs
Loss : maintain
Loss to date: 6lbs
Exercise: yes.

Learns: housework burns a lot of calories.

With an average daily intake of 1470 calories, walking early in the week to make sure it’s done, six hours of deep cleaning on the weekend, you’d think there might be a bit of a loss this week. Last week I mentioned the theory that the weight change you work on this week actually shows up in the next but one weigh in. Maybe there is something in that after all.

PCOS, as any Dr, fertility consultant or dietician will tell you, if you are unfortunate enough to need any of them, means weight is hard to lose. Am I bothered about this week’s results? No. Once, to meet the BMI requirements of IVF, I lived off 1240-1300 calories a day. All hail long term plateau, anxiety and a chronic sense of failure. I’m done with that.

The private fertility specialist said crash dieting, as recommended by our NHS consultants, was counter productive. The body redirects functions away from the reproductive system as it fights to keep the body going. The very part of your body you want to keep in tip-top condition is shutting down. And it takes time to get back to normal.

During this process, you’re still focussing on trying to get pregnant, gorging on prescription meds and Thinking of England so often sex becomes tiresome, boring and definitely not the fabulously good and dirty shag-fest you started off with all those years ago. Increasingly you both start to wonder if nookie will ever again be spontaneous, no-pressure and just shagging for the sheer fun of it.

Anyway, won’t of that maudlin business and back to cleaning; I can’t believe the calories burned. According to MyFitnessPal, it’s 280 calories an hour. A three hour stint is 853. Blimey!!! If I’d known this before I’d have been less of a domestic slattern and more OCD housewife. I have a sneaky feeling this place is going to be spotless from now on.

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Grieving for that which is lost.

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Sunday was a great day: some dear friends who had been struggling to have a baby for many years were delivered of a healthy baby boy. We are thrilled for them and so pleased they have succeeded.

Sunday was a day my husband and I wept for our infertility. We grieved, reminded that we had lost something that was never ours in the first place. While we were on our long NHS fertility journey, hoping and waiting and hoping some more that we were moving forward to a solution, albeit at snail’s pace, each breath became increasingly saturated with sorrow.

Hope was melancholy. It hung around us, clogging up the bookshelves with children’s books kept from our own childhoods, blocking pavements with protectively hooded prams, filing our ears as a small, flap-footed child ran, penguin-like, down the train platform squealing ‘daddydaddydaddydaddydaddy and it made us smile because it was ok, we had hope. One day, that would be us, our journey was not over yet.

When we finally agreed the medical approach had come to an end, the sorrow lifted. We agreed to sell the bassinet, the complete travel cot set and the other baby stuff we had put in the attic after the last miscarriage. We agreed that a life without children has its positives. We agreed to move on.

On Sunday, we sat holding each other’s hands, soft, apologetic tears pooling at the bases of chin and throat, realising this grief, this flattened, grey hope for something we once thought was so inevitable, so guaranteed, had not gone away.

So we weep and think kindly of our friends who have a lifetime of giving ahead, of memories and photographs yet to be made that will chart the tale of a life as it grows from that small, swaddled bundle they cradle on their breast to the adult he will become.

And we weep for losing something we never had.

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Confession Time – Week 2

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Week 2
Starting weight: 257lbs (it has been worse)
Current weight: 251lbs
Loss : 4lbs!!!!
Loss to date: 6lbs
Exercise: unbelievably old school levels of bad.

Learns: exercise less, eat more, it would seem! The truth is I was sitting at the dining table last night in long-faced, guilt-laden misery facing the need to exercise off 1000 calories this is weekend to keep my average at 1400 per day. It was not a good week. The weight loss is a miracle.

Exercise took second place to work, to avoiding torrential rain, to feeling cold and tired. I did some yoga on Knackered Thursday. The yoga felt wonderful – until I slipped repeatedly on the rug and gave up thirty minutes in to the practice, a sludgy, tangle-legged heap softly weeping tears of leaden-faced exhaustion. My back was stretched beautifully, so beautifully it ached enough to stop me sleeping and still aches now. Mea culpa.

Dinner on several days was not planned, proper food was skimmed over in favour of an evening of a chicken shish kebab (it’s ok, it’s grilled chicken and salad, ha bleedin’ ha) and an evening of my husband’s glorious (but generously caloried) cooking. Farewell 1400 average, hello 1600.

Ok, it’s not terrible, but MyFitnessPal shows it as a bar of RED above my target line. For a goal oriented person, this hurts. And I feel guilty about the lack of exercise as it lets me enjoy the nicer things in life. Diets are about denial. I don’t want denial. I want to have the lovely stuff – and know that I have to earn this.

So the lesson for this week is: earn your food. No matter how many calories you decide to have each day, consider them as calories that need to be earned. You burn them just to exist, burn some more to live. Want some dry toasted mixed seeds and some single origin honey on that gut scouring, parsimonious plain porridge? How about some truffle oil on that Jerusalem artichoke soup? Or, dare I say it, a rare rib eye steak with a warm grilled salad of avocado, tomatoes and red onion dressed with lime juice, handfuls of coriander and a liberal, suicidally high dose of flaky sea salt*? Excellent! Now get off your arse and earn it.

* Because you know, just know, that avocados love salt more than the cat likes murdering the hall carpet.

PS: I can’t help but remember a tale about the diet this week shows up on next week’s scales. I’m not looking forward to next Saturday…!

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