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Archive for the ‘Health’ Category

The Horror Novel You’ll Never Have to Live: Surviving Without Health Insurance

In 2005, I was a robust 25-year-old living in Chicago and working as a project assistant for an artchitectural and engineering firm. In the fall of 2005, I started to lose weight.

This was a good thing, I figured. I worked out a lot. I ate right. It’s just that losing weight got… easier. It was nice. After so many years of working out relentlessly just to stay at a reasonable size, I didn’t have to think about my weight anymore. As the months passed, I started to experience other problems, though. I started to get recurring yeast infections, infections that could only be cured with prescription medications, not the usual over-the-counter stuff. My gums bled when I brushed my teeth. Not just a little blood, but bloody spitfuls of the stuff. I was thirsty all the time, to the point where I could barely survive a 45-minute plane right to Indianapolis without having at least one tea or juice on hand. I honest to god thought I was going to die if I couldn’t have a large drink every hour. And when I got ingrown hairs, they would form huge pustules on my body that had to be lanced and drained. As the months passed, the symptoms got worse. My sinus infections dragged on and on. When I went to various urgent care doctors and explained that I was exhausted all the time and getting weird infections, they said I must just be stressed out. I was so tired, in fact, that I couldn’t get out of bed on time for work. I started to get confused, and had trouble concentrating. My boss had to call me in twice for making data entry errors that I hadn’t had problems with before. I dragged my ass into work an hour late sometimes. An hour late! But I was so exhausted and frazzled I didn’t care; nothing seemed to really matter except sleeping and drinking juice. I also become increasingly hungry in addition to thirsty. I had to eat an extra meal between breakfast and lunch. I was chowing down on burgers and ice cream for lunch… and continuing to lose weight.

I remember lying in the bathtub and rolling up into a sitting position and feeling the bones of my spine against the tub. It hurt. I didn’t have the usual padding there to protect me from the hard tub. It was like being inside someone else’s body. I had a “catastrophic” health insurance plan through my employer, so when I went to the doctor with these complaints, it was always to somewhere cheap like the 24 hour urgent care or Planned Parenthood. I had a $2500 deductible, so everything was out of pocket. I was 25 years old, making $40,000 a year living in Chicago; after rent and paying my student loans, it didn’t occur to me to spend a bunch of money on tests. I was 25! Surely there wasn’t anything wrong with me but stress. I never went to the same doctor, so there was nobody to connect the dots related to my various symptoms. b9b2_horror_movie_shower_curtain_bath_mat_curtain

My body finally gave out one Friday after coming home from Indianapolis for another work-related trip. I stepped off the train and got myself a hot dog because I was so hungry. But it gave me such bad heartburn I had to stop eating it. I trundled home via the bus. I could barely walk up the three flights of stairs to my apartment. I was so goddamn tired. I came home and drank and drank and drank – water and juice and Gatorade. And I peed and peed and peed. It was all I could do to stumble from my bed to the bathroom. I had to grab hold of the couch for balance.

At some point, my roommate and girlfriend at the time found me standing in the bathroom. Just… standing there staring at the door. She brought me to the couch where I apparently went into convulsions and started vomiting. I blacked out and wasn’t fully conscious for 36-48 hours, when I woke up in the ICU and had a doctor patiently explain to me that I had type 1 diabetes, an immune disorder that usually shows up in children, which is why nobody thought to test me for it at 25. Sometime the year before, an immune response from my body backfired, and my immune system started killing the islet cells in my pancreas that produce insulin. I would no longer be able to survive without taking 4-5 shots of synthetic insulin a day and carefully measuring and monitoring everything I ate and all of my physical activity.

What they did not tell me was that having this immune disorder also meant that outside of an employer-sponsored health insurance plan, I was now forever uninsurable. And the medication it took to keep me alive was going to cost me $500-800 a month without insurance. The ICU trip alone was over $20,000, with thousands more in bills coming in for weeks and weeks after I got out of the hospital. Even after my $2500 deductible, I still owed an 20% of that cost. That was *with* insurance. I just laughed at these bills. Laughed and laughed.

Four months later, still recovering from my experience in the ICU and adapting to a life totally reliant on taking medication, I was laid off from my job. To retain the same health insurance plan I paid $60 for through my company was $800, paid for on my own. I had to cash out my 401(k) in order to pay for it, because unemployment was just $340 a week (rent alone was $550 a month).  If I went just 60 days without some kind of insurance, my condition would be considered “pre-existing” and I would become uninsurable for 12-24 months *even through an employer sponsored plan.* So I had to find some way to pay for health insurance – health insurance which still didn’t even pay 100% for my drugs. So it was $800 a month for my premium PLUS another $300 a month for the only partially-covered drugs. This was just to stay alive. To keep my head above water.

I picked up temp jobs, and after getting through my 30 days with them, was able to sign up for some shitty insurance that technically covered me (so I wouldn’t fall between plans and get hit with the pre-existing thing), but didn’t pay for my medication, so I was still paying out of pocket for that while trying to pay rent. Credit cards became my friend. I had four of them. Eventually, this situation became unsustainable, and in March of 2007 I packed up all my shit and moved to Dayton, Ohio where I lived in a friend’s spare bedroom, rent-free, while trying to live on expired insulin and checking my blood sugar the minimum amount possible to save on the cost of the testing strips, which were $1 a piece and which I was supposed to be using 7-8 times a day.

Without the temp agency I’d been at before in Chicago, I found myself uninsured once again while trying to rack up the requisite number of temp hours I needed from my new temp agency to qualify for *their* shitty insurance which, once again, wouldn’t cover my medication anyway. So it didn’t make a difference to how much I was spending on drugs (most of my medication costs were going on a credit card at this point). But it did start the “pre-existing condition” clock running again. I only had 60 days to get insured again, but I wasn’t getting enough hours yet to qualify for the new temp agency plan.

I was sick, my medication was working sporadically, since it was expired, and my credit cards were rapidly getting maxed out. I was mostly unemployed and only not technically homeless because I had a friend with a spare bedroom. I just stopped looking at my credit card statements. Being in debt, I figured, was better than being dead. But I knew that if I didn’t get lucky at some point soon, I was going to end up dead.

I signed up with another temp company, but was still 60 days out from being able to use their insurance. I ended up twisting my ankle and had to go to the ER. The bill was $800. When I got it, I just looked at it and laughed. I never paid that bill. I had to go back to the ER again with an issue related to my IUD. That bill was $600. I laughed at that one too, and didn’t pay it.

I could pay those ER bills, or pay for the medication that kept me alive.

Easy choice.

My temp company had me working a temp assignment for three months at a local company. I finally went to the temp company and said, “Listen. I can’t pay for the medication that keeps me alive. Either these people need to hire me or I need to get a full-time position somewhere else.” I went to my employer and said the same.

The temp company and my employer got together and – bless their hearts – my employer bought out my contract from the temp agency. My salary was just $32,000, and I didn’t negotiate at all, because I got first-day health benefits. And the premiums were free. Yes, free – the company paid 100% of the premiums and there was no deductible. I immediately ordered new drugs – the drugs that kept me alive – and paid nothing for them.

That company saved my fucking life. My spouse sometimes wonders why I still do freelance work for them, and why I don’t charge them the rates I do everyone else.

It’s because they saved my fucking life.

But because they saved my fucking life, they also got me for a really good deal. At that point, things were so bad I would have worked for nothing. I would have just worked for the health insurance. Their insurance plan was so good, in fact, it was a common joke over there: “Hey, if you lay me off, I’ll work for free. Just let me keep my health insurance!”

But today, that shit is over.

Today, you don’t have to joke about working for a company for free, just to get the health insurance.

Today, you don’t have to juggle eight credit cards to get the medication you need to live.

Today, for the first time in the U.S., you can sign up for health insurance no matter how much money you make, no matter what your health condition. Even if you have cancer, or you had cancer, or you’ve got some shitty immune disorder like mine. You don’t have to go to bed on some shitty mattress in some friend’s basement hoping and praying that you’ll get some lucky break before your expired medication stops working. You don’t have to beg a company to hire you just for the health benefits.

Today you don’t have to pay $800 a month for bare minimum coverage, and cash out your 401(k) and live on expired medication. You don’t have to run up multiple credit cards with medical bills. You don’t have to cry when the bills from the ER come in.

You can go to healthcare.gov and find a health plan that works for you, with coverage starting in 2014. Can’t afford it? That’s OK. The government will subsidize plans for people who can’t pay for them. You don’t have to worry about being unemployed and homeless and dying of some treatable thing in an alley somewhere.

You don’t have to hope you’ll get lucky – hope that some friends will take you in, and an employer will show you mercy.

All you have to do is be a human being. And you’ll be treated like a human being.

I don’t wish my experience on anyone. It’s my fervent hope that nobody in the U.S., ever, has to live with the fear and terror I did during that year from 2006-2007 when my whole world imploded. I want people to forget what it’s like to live that way. I want them to think that this is the kind of story you’d only hear about in some shitty SF dystopia novel.

I don’t want it to be a story that anybody in the country ever has to live again.

So go get yourself some health insurance.

Eating the Pie

Most folks know that I’m a type 1 diabetic. The type I have is an immune disorder – my white blood cells decided to attack and eat the cells in my body that produce insulin. This means I’ll die without taking multiple daily shots of insulin. Blood sugar naturally goes up due to all sorts of things, including stress and circadian rhythms, but primarily, blood sugar rises when you eat. When I eat, I have to take insulin or my cells will effectively suffocate and starve, sending me into a coma, then death.

I’ve lived with this for the last seven years. Most people get it when they’re kids, but it’s been known to occur when folks are in their early 20s and in a few outlying cases, when folks are in their 40s. It’s a pain in the ass, quite literally sometimes, but you learn to live with it. The alternative is dying, so you kinda have to deal. If you’d have told me I’d be testing my blood sugar 8 times a day and jabbing myself with a needle 4-5 times a day full of synthetic drugs in order to live by the time I was 26, I’d have laughed at you. But them’s the breaks.

But having an immune disorder has its challenges. Depression over the disease being one of them. It’s not like I’ll ever get better. Unlike being a type 2, it’s not like losing 50 lbs and living on vegetables is going to effectively cure me, either. It doesn’t go away. There’s no “fighting” it. There’s no cure.

That can get to you.

I was in the grocery store the other day, listening to this guy oversharing with the woman giving out free samples, and it became clear in just a few minutes of eavesdropping that he was a diabetic. Most likely a type 2, but the end result is effectively the same.

“I sat down and ate a whole key lime pie yesterday,” he said. “You know, sometimes the urge to eat is just so overwhelming. I just couldn’t help myself. I went to bed, and the next thing I knew, I woke up in the hospital. I guess I’d gone into a coma because my blood sugar was so high. And they had to work hard to bring it back down. And the doctor had a come-to-Jesus conversation with me, and my wife was crying, and everyone was very upset. But I just had to eat this key lime pie.”

key_lime_pie_LR

This is one of those “diabetics you always hear about.” The ones who drink to pass-out drunk without checking their blood sugar. The ones who don’t test their blood sugar because it’s inordinately expensive, or because they don’t understand the disease. Or, because… well, because being sick is depressing.

One of the results of being on medication like insulin is that sometimes you can take too much, and your blood sugar dips low, low, low, to levels you can’t even imagine. This triggers your body’s “I NEED TO EAT” response. You have not felt hunger until you have felt the hunger of a person with a blood sugar number of 35 (normal is 80-120). I am also a mostly-reformed binge eater, so I am sympathetic to this NEED TO EAT A WHOLE PIE.

But when you’re eating a whole pie without taking your medication, there’s a lot more going on there, and I’m sympathetic to that, too. You get tired sometimes. Sometimes you just want to eat a whole pie. Or drink more than three or four beers. Or eat a plate of cheese fries without consequences. You want to pretend you’re young and healthy and fearless and your choices have no immediate repercussions. I am like this about life a lot more these days. Some of this is just being in my 30’s, with responsibilities, as opposed to in my 20’s, when all I had were some student loans and a rent payment. It sucks to have to think things through. To muddle through possible consequences. To be an adult.

Because sometimes you really just want to eat the whole pie.

 

Surviving the Long Dark Tea Time of the Soul

As we come out of the long dark slog that is December and into the rapidly lengthening days of January, I can’t help but look back and be amazed at what I got done in December. December is, traditionally, a horror show of a time of year for me. For most of my life, I’ve been useless from mid-November to early January. When I lived in Alaska, this time lengthened from about October to mid-January. I was able to push through this in Alaska primarily by sleeping this entire time. And the summers with their four hours of dusk and twenty hours of daylight more than made up for it.

But being a college student in Alaska whose sum total of responsibilities is showing up for class vs. a working writer with a mortgage are very different, and this December the sheer amount of work I took on meant that I simply didn’t have time to check out for a season.

Last month was a month of deadlines. I’m writing eight blog posts a month from November to February for a freelancing client, and I wrote and distributed ten press releases for another client last month on top of that. I also started teaching a copywriting class – also from November to February – and I was astonished to learn that it takes me something like 20-30 hours a week just to prepare for classes.

The day I spent 12 hours sitting in front of my computer, preparing a PowerPoint presentation for a class, and then another five hours the next day working on class notes, I realized the brain fog was winning. I started to worry about hitting my deadlines. I started to dread them. I had a short story due for an anthology on the 31st of December, and was seriously considering backing out because it was just going to be impossible for me to make that deadline on top of all the others. Because in addition to all of this work, I also had a 40 hour a week day job, and was trying desperately to rewrite a fantasy novel and work on a proposal. I even thought about returning the substantial retainer from one of my clients and saying I just couldn’t meet my obligations.

Winter was winning.

By mid-November, I was already exhausted. Sleeping too much, living too grumpily, and totally unable to read or concentrate on anything without extreme effort. I’ve tried eating Vitamin D pills, but that never worked for me. So instead, with an understanding that a lot of people suffer this time of year from lack of light, I started sitting outside to work. The weather was still OK here in November. I found that the days I worked outside, in the sun, I could think more clearly. But just in case I thought it might be a fluke, well, there was the day when I was so busy at work with meetings that I didn’t get to go outside, and when I got home that night just the idea of heating up soup sounded exhausting.

I’d been putting off getting one of those “happy lamp” sunlamps for yonks. People in Alaska had them, but I always scoffed at them.  It was like admitting you couldn’t cut it. I mean, it’s just sunshine! Your brain should be smarter than to get all wonked up because of lack of light.

But the evidence had been mounting for many, many years. And I was just too stubborn to see it. It wasn’t until I was in danger of drowning in work, fearful and freaked out, that I finally did something.

The happy lamp at home in my office.
The happy lamp at home in my office.

I was going to wait for my next freelancing check to get a proper lamp – to get the ones I wanted was a little pricey. But it turned out my parents asked what I wanted for Christmas about the same time I was having my seasonal-related meltdown. They happily bought me a nice big sunlamp for my office at home and a small sunlamp for my desk at the day job.

To say these lamps changed my life isn’t actually an overstatement at all. On the way to a Christmas shindig with my partner, he turned to me and said, “I’m really happy you got those lamps. You have so much more energy now. You’re so happy. You’re not asleep all the time. And you’re not so grumpy anymore.”

I went from staring over the looming cliff of deadlines, then – completely fearful and frozen, unable to act – to taking action and meeting them. In the process, I also ended up being a much more pleasant person to be around for my partner, which is always nice. Nobody wants to hang around with a listless asshole.

Traditionally, I’ve been able to tame my depression with regular exercise. It helps burn off all that stuff that makes me anxious and gives me a just enough happy hormones to carry on. But when the sun went down, it always got harder to exercise. I got sluggish. Making food and getting out of bed were nearly insurmountable tasks. And even when I did exercise this time of year, if just didn’t move me the way it does during the summer. It barely made a dent in my lethargy.

I admit I’m astonished that it took me 32 years to buy a fucking sunlamp, but then, I’ve always been suspicious of what I think of as “hippie” cures. It just seemed too easy. Maybe I just needed to take more Vitamin D? Maybe I should exercise more? Maybe I’m just depressed for emotional reasons and my life ACTUALLY sucks!

But in fact, I was depressed because my brain wasn’t getting something it needed. In my case, I’m lucky, and it was something simple like buying a couple of sunlamps (I had to get off the Pill many years ago because it was actually causing a similar sort of depression, which was even more greatly magnified during the winter. The time I thought most seriously about killing myself was during a particularly bleak Nov-December while I was on the Pill).

This is all to say that life is a lot better than it’s been any winter previously. I’m meeting my deadlines. I’m working very hard. I’m getting out of bed on time. And I’m writing fiction again in earnest (though I will be writing it even more earnestly once I clear off some of these outstanding obligations – my teaching job and one of my freelancing gigs are up at the end of February, which should help clear my plate).

I’m hoping that in the future, I’ll spend a lot fewer seasons mucking about lethargically in the long dark teatime of the soul.  It’s not exactly the world’s most fun place to be.  I like this sunny one better.

Becoming Meat

I had to go to the doctor yesterday, which is something I have to do often and have come to hate and resent more than is probably appropriate. I had not been to my endocrinologist for nearly a year and a half, which isn’t to say I haven’t been to the doctor in all that time. I’ve been in for two surgeries and some followups, and been to urgent care twice. Which is probably why I was avoiding my endocrinologist, whom I’m supposed to see every 90 days.

When you go to doctors this often and get interrogated about your habits and your health and then jabbed with needles, prodded by fingers and knocked about the feet and knees to test your reflexes to ensure you’re feet aren’t going to fall off, well, it gets to you. I get so angry walking into the reception room that I have to start cutting things away, disassociating myself from… well, myself, and pretend all of these invasive indignities are happening to somebody else.

I learned this trick with strong emotion early on. I feel things as intensely as anybody else, but in times of great stress, trauma, or emergency, freaking out and breaking down aren’t useful. Nor is screaming at people when you’re angry, because they tend to just tune out. Emotion is seen as a weakness in this culture, and when women do it it just reinforces stereotypes about hysteria. So I learned to cut away those parts of me that were angry or overwhelmed and just endure things like they were happening to someone else. It comes in handy during doctor visits now. I honestly don’t think I could endure them without this trick, because the alternative would be to burst into an angry tirade at my doctor and ask her what the fuck all these appointments are for.

We go over the same litany – do you exercise? Do you test your blood sugar? What vitamins do you take? What do you eat? And then there’s the same boring tests every damn time, the same height/weight (am I expected to SHRINK every three months?) tests, the blood pressure, the pulse, the thyroid test, the reflexes tests, the breathing tests, and then, of course, the blood test and finger pricking and blood drawing.

And when it’s all over, every three months, I hear something to the effect of, “Well, nothing’s wrong yet. I’ll see you in three months. “

Chronic conditions are huge downers, because it’s not like after five years post-cancer they declare you cancer free and you run off into the sunset saying, “Fuck you cancer!” and you can at least tell yourself at night that the chances of recurrence after a certain point are very slim. Instead, there’s this expectation that every day, I get closer to dying. That we’re just waiting until something goes wrong. It’s a disheartening way to live. It’s not like I go in every three months and we talk about new treatments and therapies, or advances in insulin pumps or cheaper testing strips or some other thing that will make my life better, faster, longer. No, it’s just “Well, nothing’s wrong yet.” And then I pay out a couple hundred bucks and leave with some prescriptions for daily medications that will cost several hundred more dollars each month (all of this *after* insurance). Even if I have a slightly higher than my usual A1c, it’s not like we have a chat about ways to fix that, because, yanno, if my blood sugar numbers have been higher than usual, I pretty much know exactly why. It’s generally not some mysterious thing, it just means life won during those particular three months. Some days my struggle is easier than others. The last year of craziness meant something had to slip, and my numbers certainly did.

So if I know what I’m supposed to do, and nothing’s ever going to get better, what’s the fucking point of this? Why am I spending hundreds of dollars for someone to tell me I’m still sick? The “best” outcome of any visit is just to hear that “nothing’s wrong yet.” Catching things that are wrong early is great, but do I really need to come in every 90 days for that?

The indignities you put up with as a constant patient are exhausting. You start to feel like a thing, a slab of meat. And then people have to treat you like you’re stupid. During this particular appointment, there wasn’t even any small talk. It was all business. It was kind of exhausting, and it felt so pointless that I was angry for hours afterward. “Do you test your blood sugar?” she asks me, and I nearly lost my shit at that. “WHY NO I JUST SPEND HUNDREDS OF DOLLARS ON TESTING STRIPS BECAUSE I’M BUILDING HOUSES FROM THEM.” I mean, what kind of stupid thing is that to ask somebody with an immune disorder like mine where not taking synthetic insulin for more than 48 hours results in death? I mean, come on. Seriously?

And yes, before folks ask, I have the best endocrinologist in the area, one who isn’t taking any more new patients, and who I know I’m lucky to have because she’s so thorough. This is the best of the bunch. It’s just the way it fucking is. And you know, it gets to me sometimes, how you start to just have to tune out from the whole process, because it’s so exhausting and humiliating. It reminds me of my defective body, the one I learned to love after so many years of being told by the media that I was a useless person because I wasn’t femmy eye candy. I learned how to revel in my body’s strength and power, and to be put in a position where I’m seen as defective again is just aggravating. How do you combat perceptions that you’re defective meat when you know it’s true? When you know that a hundred years ago, you’d be dead, and you’re only hanging onto life through constant monitoring and multiple daily shots of a synthetic hormone that your body no longer makes?

My illness is largely invisible, and most people don’t realize how bad it is, and how seriously I rely on synthetic insulin to live. I appreciate a lot of that invisibility, and maybe that’s the issue. Because when I go into the doctor, I get treated like a sick person. In real life, I get treated like a healthy person who can hit things hard. That’s nice.

But on the slab, I’m just another defective body. Another piece of meat.

The Unreasonable Weight of Being

Some folks might know that I’m a Jillian Michaels fan. I mean, how can you not love somebody who kicks people’s asses all day, screams at them to suck it up, and then provides a thoughtful psych evaluation on them after she’s beaten them raw?

I was working out six or seven weeks ago and listening to one of her free podcasts, and she said something, only half-joking, like “If everybody would just do everything I tell them to do, they’d have no problems.”

And I thought… well, fuck it. I’m just going to do whatever the fuck Jillian tells me to do, because nothing else is working.

Physically, I’ve had a rough couple of years, mostly due to my extended-honeymoon-eating-fest, new day job that no longer requires me to bike to work, and some surgeries that left me down for the count.

Low-carb alone wasn’t doing it for me anymore. I was too addicted to high calorie items like nuts, cheese, and whipping cream, and when you’re eating a dessert every night that’s 1200 calories (what? It’s whipped cream mouse! Low carb! DELICIOUS! Yeah, didn’t figure out that calorie amount until I actually started… counting calories), no amount of working out (unless you’re clocking in three hours or more) is going to be able to help you.

The working out, I already had down. So I just made a commitment to getting in 60-90 minutes a day and logging it to make me accountable for it. So instead of 20 minutes here, 20 minutes there, I was committed to daily strength and cardio work.

The biggest challenge – and one I have fought against doing my entire life – was calorie counting. One of the reasons I’m a fan of Jillian is that she’s less of a bullshit fad dieter than most gurus. It’s all pretty simple. Burn more than you consume. Work out this much, but not more than this much. Eat this much, but not less than this much. Balance. I like balance.

I’d always known the calories in/calories out thing before, but I just didn’t buy it. See, just like calculating how much insulin I take based on the number of carbs I eat and my current blood sugar number, weight loss is supposed to have… well, not an exact formula, but a general formula that’s calories in, calories out. Balancing my blood sugar, though, taught me that trying to use that math to precisely predict what my body was doing was hopeless. However, if I came to it with the expectation that I was going to be getting an approximation of what was really happening instead of an exact number-by-number results, I’d feel better.

3500 calories might equal a pound, but just because you burn 3500 calories doesn’t mean you will burn a pound. It makes it more likely, sure, but saying “FUCK YOU I BURNED FOUR POUNDS AND ONLY LOST TWO THIS IS BULLSHIT” becomes more likely when you think of it that literally. That was the problem I always had with doing it. I watched people starve themselves on 800 calories a day and plateau, then go on huge binges, then gain back more than they lost. The body doesn’t like trickery. It will fuck you right back – the t1 diabetes has taught me that. Most mornings, my little formula of 1 unit insulin for every 15 carbs ingested might work. Others… I might be shaky and sucking down juice at 8am. No discernable reason (oh, I’m sure there’s a reason, but we don’t understand the individual vagaries of bodies enough to calculate all of the relevant variables. We can only go by the most obvious ones).

Instead of expecting precise miracles, then, I expected approximations. I calculated my BMR – basic metabolic rate. It said that on an average day, a person of my height and weight burns about 1900 calories. So, ok, that’s a starting point. My goal, then, was to cumulatively eat and/or burn enough calories that I was getting less than that each day.

But there were two important tricks here that I never did before on my other eating regimes. Only one of them is totally Jillian-approved.

First, I’m not allowed to go below 1400 calories. My goal is 1500. Crazy people may go as low as 1200 (::shudder:: ) but anything less than that and you’re well into starvation mode. That’s the point where not only are you hungry all the time, but your body kicks all the shit into gear that halts weight loss. We’re not meant to starve. We’re meant to hang onto fat. And I have a body that is very efficient at doing just that. I suspect it does it with even greater efficiency than most people. That’s one of the big reasons I avoided low-calories diets. I was also prone to bingeing. If I went hungry, bad things happened.

So there was one more thing I did here to fool my efficient body into easing back to my maintenance weight. I added in a meal one day a week where I was allowed to eat 1,000-2,500 calories more than my 1500 goal. So one day a week I’m eating anywhere from 2,500 to 4,000 calories that day. Jillian would not approve of this level of consumption (she’d recommend a day where you’re eating maybe 300-500 calories more), but it works very well for me.

Some of the changes were easy, like switching to non-fat lattes and reduced fat cheese and making a greek yogurt mousse instead of one made entirely of whipping cream. Others, like switching from Crystal Light and Coke Zero to water, and throwing out all my “snack” cheeses, were a lot harder. Worst of all, though, was getting used to cooking with cooking spray or 1tbs of olive oil instead of huge amounts of butter and olive oil… and bacon. We ate that stuff like liquid candy (WHAT?? IT’S LOW CARB!!). Also off-limits were the three-kinds-of-cheese-plus-bacon-plus-roast-beef wraps I liked to get from the cafeteria at the day job for lunch. Now it’s Chipotle, generally, with my usual carnitas fajita bowl (no rice, no beans, no cheese, plus guac) for 505 calories a pop.

At the end of the day, doing the one thing I didn’t want to do finally worked, and I dropped 20 lbs and can now fit comfortably back into 80% of my wardrobe.

But short-term drops aren’t really what I’m looking for. I’m looking for a way to not let this happen again. I’ve spent my whole life vacillating between 185-250lbs, and you know… I’m tired. I’m tired of having four sizes of clothes in my closet. I’m tired of thinking about it. I’m tired of dealing with it. I just want to find a weight and stick with it. Before I met J., I’d managed to maintain a very nice weight for myself for nearly two years. It was workable and relatively easy. I still got to eat pizza occasionally and I worked out regularly. But when Life Things happen, I inevitably get out of my routine, and things go sour.

So I’m turning to Jillian’s advice for that part of it, too, because, let’s face it – I just have no idea how to maintain a single weight for more than two years. As soon as the wacky Life Thing happens, it throws me out of whack, and there I am, with a closet full of clothes that are either too big or too small for me again. The other problem with calorie counting is that, you know, it’s not some fad diet thing. It’s something you have to do forever. If I want to stop fighting my body, I need to track my calories in vs. calories out every day, and ensure that, on average, I’m not eating more than I burn in a single day, without going below my 1500 base (or, when I get to maintenance again, my 1700). That’s the only way to manage it.

Ideally, of course, I’d just get to the point where I don’ t need to track this stuff anymore. I’d get so good at calorie counting and automatically knowing about how much of X type of exercise burned so many calories that I could just keep it all in my head. But I don’t trust myself to do that. It’s basically how we all do it now, and for me, as for most folks in the U.S., my guesstimate is so laughably wrong it’s… yes, laughable. Also, wrong.

So, I went against all my principles and started calorie counting and exercise logging, which is a lot less painful these day because of apps like MyFitnessPal, which keep me accountable. And this is where I’m at after nine weeks or so. Back down to a reasonable weight where I look slightly less like a mushroom, and another ten weeks or so from maintenance weight. I also feel like I’m in a better place for additional physical activity, because honestly, one of the other reasons I made the switch is because it was getting harder to move around all that extra weight when I was exercising. I felt physically weaker because my body was being asked to lug around more.

There is no particular point to any of this, of course. On my deathbed I won’t be all like, “Thank god I started counting calories!” or “If only I had lived my life at a size 6!” In fact, I rather like myself as I am. But there are some cold, hard realities I have to face when living in a world that tells me that a 2,500 calorie burger-and-fry combo is a normal meal, and sitting at a desk all day is a normal way for a human being to spend 9 hours. None of these things is a reasonable expectation, and to counteract them, sometimes you have to do things that may, on the face of it, seem unreasonable.

 

Eating Real Food

Half our cauliflowers appear to have been eaten by some kind of fungus, but these two turned out lovely, and we’ll be turning them into a fine cauliflower mash tomorrow.

And here’s what our garden currently look like, after harvesting some peas, a tomato, two cauliflowers, and two broccoli (including harvest of broccoli florets after initial head harvest):

I’ve been growing more keenly aware of where my food comes from (and what it’s actually made out of) the last couple of years. I grew up eating fast food. My parents both worked at a fast food company for 25 years. It was just… what you ate. It never occurred to me that you should eat any differently. I didn’t spend much time in the produce aisle until I was 18 and interested in dropping some weight I’d put on while on the pill. Switching to fruits, vegetables, and protein meant dropping 60 lbs in about 6-8 months. It felt almost effortless.

I’ve read all the books – like Fast Food Nation, The Omnivore’s Dilemma, In Defense of Food – and watched all the shows, like King Corn, Supersize Me, and Food, Inc.I know how we got here. And I know why.

These days, I work hard to eat well.

And, of course, that’s just it – I have to work hard to eat well. Folks who haven’t tried it really don’t know just how tough it is. Fast food, prepared food, soda, crackers, canned soup, frozen meals… these are revolutionary, time saving victuals that make it possible to feed a tremendous number of people on a very small amount of land with 80% of the base made of up just one versatile commodity crop – corn.

And it’s a blessing.

Yes, it’s killing us prematurely, because we have no defense against a double bacon cheeseburger. It sets off all of our primitive pleasure centers. Why not eat them all day?

Because, of course, you’ll die of malnutrition. But you’ll keep doing it, and doing it, like a rat with a way to self-administer cocaine. Giving up carbs is really hard to do. Even before I was sick, I’d get the shakes, and intense cravings. Then there are the visual cues, which are constant. As somebody in marketing and advertising, I know just how helpless we can be in the face of $5.99 single-topping pizza specials, particularly when you’re exhausted after work, haven’t eaten in six hours, and are faced with the prospect of an hour’s cooking time before food ingestion.

It’s amazing that we can feed ourselves so cheaply and easily in this country. Try growing a garden. Try losing half your cauliflower crop to fungus, like we did. “It’s a good thing we’re not relying on any of this to feed ourselves,” I told J. as I pulled out the cauliflower. Our little garden is just for fun. When we get a house with more land, we’ll likely be able to feed more of ourselves with it, but even a “for fun” garden is disappointing when you discover half your land was wasted on crops that don’t feed you.

As sympathetic as I am to the bullshit and poison that’s ended up in our food, I’m also very much aware of how things were before cheap food. Farming is not a fun life. Food doesn’t just roll out of the truck at the end of the day, full-formed. And after you grow it, you know… then you need to cook it. And that takes time. And planning.

On the one hand, the West is addicted to a diet that’s killing us. On the other hand, we spend less than 20% of our income on food and spend less than, what, 10 hours a week? preparing food (on average). As somebody who’s had to rebuild her entire conception of food from the ground up, I’m still sympathetic to the thinking behind where we are today.

There is another way to eat, I know, somewhere between industrialized, corn-fed fake food and fungus-ridden-today-we’re-eating-dirt-grown-your-own-grass food. There are farmer’s markets. Local agriculture. All that jazz. But that doesn’t take into account how people are going to eat during the winter, or those precious spring months when you’re growing what you’ll gorge on come end of summer. You end up eating a lot of turnips and jam and drinking a lot of vodka.

What”s on offer now is so damn good that’s it’s been a struggle to break the pizza-burgers-prepared-food-cycle. Taking that next step – the parsley-at-all-meals-turnips-all-winter step – is something I just don’t know that I can do if I want to continue to maintain a modern lifestyle.

There’s a better way to eat. And I’m still struggling to find it.

Things That Need Doing

Stepped on the scale today for the first time in, what, six months? When I was living at my old apt, I was very good at weighing myself once a month and making adjustments accordingly. It kept my weight steady and my clothes fitting and all was well. Now that my house is so damn cold, I’m less inclined to strip and step on a scale. So I’ve avoided it since at least October when the house started getting chilly.

I knew I’d put on 10lbs or so since J. and I moved in together. I actually managed to get that back down to +5 before the holidays. Then came the holidays, and winter, and tax season, and this really great website with low carb coffee cake recipes…

Despite getting up at 5:30 in the morning to do 30 minutes of exercise and another 20-25 minutes 3 times a week when I get home, it just hasn’t been enough to make up for the coffee cake and cold house. They’ve also cut the workout program at work, which means no more twice-weekly strength training sessions and no more gym membership.

What happened is just what I suspected would happen when I ceased being vigilant – I’ve gained a retarded amount of weight since J. and I first met a year and a half ago – most of which I’ve put on in the last 4 months of coffee cakes and cold houses. Nobody believes me when I say this is what happens when I stop paying attention.

What actually moved me to get back on the scale was my crazy sugar numbers. My blood sugar has been a lot harder to control, and far more frustrating. I wanted to know if the weight gain was indeed substantial enough that it may be causing insulin resistance. And oh yes, dear reader – it is.

There are some quick and easy changes I’m making right away: no more low carb cookies and coffee cakes, for one (do you have any idea how many calories are in almond flour?), and sticking to the lunch I bring into work instead of adding snacks from the free salad bar at work. I did manage to eliminate my peanut butter/low carb English muffin fix way back, which is how I curbed the initial weight gain and got things back under control. But now there’s that coffee cake thing…

My 20 minutes pilates/15 min free weights workout each morning is pretty solid. What I need to work on now is getting at least 30 minutes 5x a week of cardio instead of the current 20-25 3x a week. A lot of the problem with getting this in is wonky sugar numbers. Some days I turn my insulin off at 3:45 and I can workout for 50 minutes. Other days, I turn it off at the same time and I can only workout for 20 and then my sugar crashes and I start to tremble and all the energy goes out of me and I have that intense hunger spike and desire to burn the world to the ground. I need to get this timing right if I’m going to workout properly every day after work.

I’m also working toward doing at least 40 more minutes on Sat or Sun to get me to 6 days. 6 days a week of 30-50 min a day is pretty much the only thing that moves me. It’s just a really tough routine to put into place during the best of times, and right now the house is cold and I’ve got a crazy day job and personal deadlines.

But. The alternative is very bad. This is a good reminder of what happens to me when I don’t stay on top of maintaining my weight with monthly weigh-ins. I know some folks thought this was odd – if you’re happy with your weight, why be so vigilant?

Here’s why: because aside from that whole immune disorder thing, I have great genes. I’m very good at packing weight away, and when you have aforementioned immune disorder, this is a very bad habit to get into. I have been displeased with my numbers, and not feeling well to boot. Now I have a better idea of why. I’m still quite pleased with how I look (I spent a long time learning how to like myself, and reorienting how my self worth was measured in a society with weird ways of measuring worth, particularly in women), but my numbers are bad, so I don’t feel as well, and I’m not throwing out my wardrobe because I’d rather eat coffee cake.

So, here’s what we’re going to do to get back to maintenance:

Monday/Weds/Friday

Workout: 20 min pilates. 15 min free weights
Breakfast: 2 eggs w/spinach
Workout: Bike to work (if not snowing, more than 20 degrees out)
Lunch: Leftovers. No more salad bar additionals.
Workout: Bike home (if not snowing, more than 20 degrees out)
Workout: 25-30 minutes elliptical
Dinner: Entree and side. No more tortillas/low carb bread
Dessert: Yogurt and berries

Tuesday/Thursday

Workout: 20 min pilates. 15 min free weights
Breakfast: 2 eggs w/spinach
Workout: Bike to work (if not snowing, more than 20 degrees out)
Lunch: Leftovers. No more salad bar additionals.
Workout: Bike home (if not snowing, more than 20 degrees out)
Workout: 25-30 minutes elliptical. 25 minutes circuit training.
Dinner: Entree and side. No more tortillas/low carb bread
Dessert: Yogurt and berries

Saturday

Breakfast: Low carb pancakes (no almond flour makes a big difference)
Workout: 40 min circuit training
Lunch: Soup/sandwich/leftovers. No more “it’s a special occasion” carbs
Dinner: Entree and side. No more tortillas/low carb bread
Dessert: Yogurt and berries

Sunday

Breakfast: Low carb pancakes
Workout: 15-20 minutes elliptical
Lunch: Soup/sandwich/leftovers. Ditto above carb curb.
Dinner: Entree and side. No more tortillas/low carb bread
Dessert: Yogurt and berries

This eliminates the low carb bread/tortillas I’ve been snacking on and low carb/high calorie coffee cakes and cookies I’ve been making. I think this alone will make a big difference. I’m telling you, I could live on low carb coffee cake forever.

I’m not terribly happy with this, but I’m less happy with my sugar numbers right now. If I’m going to do some of the things I’d like to do this year, it’s also very important that I get into some semblance of fighting shape. And all this happy-happy-joy-joy stuff has aided me in becoming a bit doughier than I’d like.

Thing is, you want to be a certain kind of person, you have to start living like that kind of person, no matter how frustrating it may be. And there’s a certain type of person I’d like to be. And she works out a lot more than I’ve been able to the last few months. It’s too bad she doesn’t eat as much coffee cake as I’d like, either, but them’s the breaks.

Back At It

Up at 5:30 this morning to add 20 min of pilates onto my 15 min morning free weights routine. *Damn* I am out of shape.

This thing with having a chronic illness is that you just notice more when you’re lazy about taking care of yourself. During the last couple of weeks of sporadic workouts and weird food, I’ve been experiencing some mysterious aches and pains – especially in my core – and inflammation. There is likely also weight gain tied to this, as my clothes aren’t feeling so hot on me, either. I just can’t get away with letting things slide for a few weeks. I just feel it too much now.

Not that there’s been complete fail, mind. I still bike to work 5 days a week, do my morning weight routine 5 days a week, and even during last week’s laziness, I still worked out for 20 min on the elliptical twice that week. It’s just that… well, it’s not enough for somebody with a sendentary job and wonky immune system.

A couple of weeks of pilates and getting back on track with my after-work workouts on the elliptical should help. 5 days a week pilates, 4 days on the elliptical – in addition to weights and bike riding commute – should do the trick.

I’ve also been combating some hunger issues. I’d been getting wacky-hungry at work between 9-10am and vainly searching for food. Some of this is just stress eating, but it’s stress eating triggered by mild hunger. I went ahead and added a little more protein to breakfast – two scrambled eggs w/spinach in the morning instead of just one egg – and that seems to have done the trick (an extra 70 calorie egg in the morning beats a 350 calorie english muffin with peanut butter at 10am).

As we head toward the holidays, I’m being more mindful of what I eat. One of the drawbacks to getting the pump is that it made me a lot less careful with what I ate – and my #s and my body are paying for that. It’s time to stop. I’m a carb addict, which means it’s incredibly hard to change my habits when I get used to indulging again. Too much “well, it’s the holidays!” means shitty sugar numbers, shitty health, and shitty mood.

And you know, I’d like to stick around those extra 15 years.

What I’m Up To

Drowning in Day Jobbe work. This will be the state of things until the end of January or thereabouts. Hard push for the next 6 weeks.

I’m also working on cobbling back together a good workout routine. Regular workouts are great, buy my sugar numbers have suffered. Lots of lows this week as I work hard to recover my sugar from Thanksgiving excess. It’s certainly “allowed” to relax my restraint for a day or two, but man, I pay for it later. I’m starting to think the occasional slice of apple pie and sedentary days just isn’t worth the resulting 3-4 days of achiness, inflammation, depression, and rocky sugar numbers.

Yeah. I’ll be skipping the excess at Christmas, I think.

Also, I’m reading a damn bloody book, which I’ll be blogging about soon.