Skipped my meds and feel better than I have in ages. Didn't realize how much my eyes and stomach hurt from the new meds that I don't feel are any better than what I had been taking previously. I have an appointment with my PA this Friday, but I think I'm going to call, I just called and explained the situation so hopefully I will hear back from someone soon. Marginal improvement in my mental health is not worth the toll the meds have been taking on my physical body. Today I am trying to catch up on housework that I've been neglecting. Got some dishes done, took a bath, dropped Jane off at school, went to the chiropractor, and will be picking Jill up early from school so she can go to the dentist.

Yesterday at my cousin's baby shower quite a few people asked about Jill. We have a difficult relationship and that's my fault. I wasn't loving and nurturing as a caregiver of hers. My own needs weren't being met so I didn't have extras left over for a baby who was challenging and her own person from day one. In many ways Jane is easier to deal with than Jill, my book 'When Feelings Don't Come Easy' has illuminated a lot of the damage done, I regret the way I behaved, but know that the only thing to do is go forward instead of spending too much time living in my head or dwelling on the past. Dustyblue reminded me of The Day I traded my mom in for a robot, I had forgotten I had written that, going back was tough, but I'm glad I'm taking action instead of just worrying so much about all of this. Cutting this short so I can get some things done and lie down for a while. Didn't take any sleep meds last night so I tossed and turned, but I'm glad my body had the medication break. Looking forward to more of that in the future...

The Last Supper

Today is the last day of my life I will be able to eat whatever I want.

I've been in the intake process for bariatric surgery - specifically, a laparoscopic sleeve gastrectomy - for some months now, and I finally have jumped through all the hoops my insurance and the surgeons require. My surgery is scheduled for May 3rd. As part of the pre-surgical regimen, it is necessary to 'de-fat the liver' because it will be moved aside during surgery, and leaning it minimizes risk of bleeding. So, for two weeks, I will be on a 650-800 calorie per day diet. To achieve this, I will be consuming only sugar-free protein shakes for nutrition, although I can have water, tea and coffee (no milk, but since I drink my coffee black and tea with lemon and sugar substitute, I am OK there). No alcohol. I can have four 11-oz shakes per day.

I am going to be an angry, angry motherfucker during this process. I know, because a few weeks ago I tried the diet for a week just to see how bad it would be. It was pretty bad, and I was hangry as hell by day 3. Hopefully things will stabilize after a few days.

The surgery I am having is not something I want, but it's something I have finally come to acknowledge that I need. My goals are modest - I'd like to get off at least two, hopefully all three of the maintenance medications I have now been on for years. I'm on what I call the Holy Trinity of Middle Age - a statin for cholesterol, metformin for type 2 diabetes, and losartan for blood pressure. In addition to those I take a fairly strong NSAID for my right knee, which needs arthroscopic surgery but I'm hold off until after the stomach work. If I can get off of two or three of those drugs, I will be most pleased. In addition, there is a small chance I might be able to get off the CPAP which I've also been on for a decade-plus. I can't remember what sleeping soundly feels like at all anymore. That would be a huge win. And finally, I'm hoping to lose enough weight to provide some relief for my knees and ankles.

I resisted this surgery for years, because I felt that it was an incredibly damning failure of will to have to undergo it, and I was already depressed and considered myself a failure. So what changed my mind?

First, I'm in my mid-forties now. Several doctors told me frankly that doing this surgery after around age fifty just doesn't have anywhere the same benefits, statistically. So the window was closing. Second, although I'm still depressed, I have reached a point physiologically where I just don't enjoy eating a lot of food nearly as much. I used to exhibit classic binge behavior, eating for emotional relief. I still do that, but very very infrequently - perhaps once a quarter - and it's usually ice cream. Every time I do it, I feel terrible the next day, as my body can no longer handle that kind of crazy sugar dumping. Even a really large healthier meal leaves me feeling logy and not well. So, I no longer really enjoy food the way I did, and I can give it up as a crutch. Related to that, I now fly airplanes for emotional support - it's healthier and much much more effective, so I don't have to worry about losing a critical emotional management tool. Finally, I had a good talk with a couple of obesity specialists, and they walked me through what little is known about obesity mechanisms, and convinced me that this has nothing to do with my mental state or willpower - my body is broken, chemically, in a particular way. Since we don't know why that happens, or how to fix it chemically, the only proven option is surgery.

In fact, the evidence suggests that in the restrictive surgery I am having, the operant mechanism is not, in the main, the restriction of the stomach leading to the patient eating less. The mechanism seems to involve the fact that removing big sections of the stomach changes the secretion of various chemicals, including bile acids, which in turn leads to a significant change in gut flora. These changes, only dimly understood, seem to change both the hunger reactions of the patient as well as digestive efficiency in a manner which causes more than 50% of the observed weight loss.

Once it was put to me in that fashion, as a physiological disorder, it was easier for me to acquiesce.

As it was explained to me, the problem is that there are two physical measures by which the body knows the stomach is full and you should stop eating. The first is chemical - changes in chemical levels caused by food intake and digestion cause the brain to 'turn off' the hunger mechanism. The second is physical - when the stomach distends, the resultant pain and discomfort prevents further eating except in extreme cases. In my case, and the case of many obese patients, the first signal - the chemical 'switch' - does not work. That is, the chemical changes do not happen, so the brain never gets the signal to turn off the hunger pangs until I've eaten enough to distend my stomach - which of course is far too much, and results in my equilibrium body weight being far too high.

My surgeon also pointed out that I had nothing to prove as far as willpower. Prior to going to Australia in 2014, I set out to lose 60 pounds in a year. I did it, going from 360 lbs at start to 299.5 or so as I boarded the plane to Australia ten months later. I only gained perhaps 5 or 6 lbs in Australia, but while there, I messed up my right knee - and when I got home, I was unable to exercise (I had my left knee fixed in 2013). As a result, I shot back up to 355 lbs. By changing my diet as much as I was able, I managed to get back down to approximately 330 lbs, where I am today. My surgeon pointed out that I had managed to lose 60 lbs in 10 months and keep it off, but that my metabolism was such that I required heavy exercise to maintain that given my eating habits - and my eating habits were broken due to the issues described above.

That finally broke the logjam.


I'm starting the diet tomorrow morning. Tonight I'll go to one of my favorite restaurants, where I tend to eat heavily, for a Last Supper. And I'll daylog the progress of this whole thing.

Weight: 330.1 lbs

Today, I have had the last large meal of my life. :-/

Also today, I received two fountain pens, both Esterbrooks, a J and an LJ. The J has a 9556 nib and a 'BELL SYSTEM PROPERTY' imprint on it, and appears to have been manufactured in approximately 1940. Win!

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