Mission: Accomplished

Well, now, THAT was exciting. In a “drop at the beginning of a roller coaster” kind of way.

It has dominated my days and interrupted my sleep for nearly seven months now. I have missed deadlines, dropped projects, and skipped family gatherings because of it. The voice of Misdirected has grown fainter with every week as it approached, an inexorable monster that threatened to swallow me whole.

I am referring, of course, to the final exam for the ACE Fitness Personal Trainer certification.

Which happened yesterday.

We Don’t Need No Education

My relationship with education has been weird throughout my life. I didn’t go to college out of high school. I got married and started waiting tables instead. Who needs that education stuff, right?

My professional career as a database developer and project manager all came from books and week-long seminars. My success derived from an unusual talent: I was the person who was willing to Read The Flipping Manual. But I also had the ability to remember what I read. This didn’t seem unusual to me. I just thought everyone else was lazy.

Then my disability struck, and suddenly I was unable to remember my own name for long stretches of time. By the time my treatment stabilized, I could do a pretty good impression of a thinking person, but the memory was gone. I literally can forget what I am doing in the midst of doing it nowadays. I made a couple of abortive attempts at college in my thirties, but couldn’t ever keep up.

And that is where I thought my relationship with education would end.

Where Obesity and Literacy Meet

Fast forward a decade or so.  My upcoming bariatric surgery met my gaming blog, and the current version of Misdirected was born.

Suddenly, I was fielding questions I didn’t know the answers to. I went to various sources for information: my nutritionist, WebMD, my wife the massage therapist, my brother the personal trainer. The deeper into the process I got, the further down the rabbit hole I fell. In January of this year, I was suddenly 100 pounds lighter and writing a book about bariatric surgery, for goodness sake.

Then, in February, I happened to mention to my family that I was looking into getting some education about muscular retraining, weight loss, and lifestyle changes. Maybe, I said, at some point in the distant future, I would look into getting my personal training certification.

Later that week I was presented with a gift: my family had sprung for the ACE course materials for their personal trainer certification. Just one little detail: I only had 180 days from the time they ordered the course to take my certification exam.

Opening The Box of Pandoras

I suspected I was in trouble when the box of course materials arrived. Inside were anatomy charts, nutritional guides, exercise CD-ROMs, and over 1,000 pages of textbooks.

I confirmed I was in trouble after I completed the first “class”, took the final exam, and was presented with a grade of 40%.

Oh, man. What did I just get myself into?

I remember confessing to Lor that I would never be able to do this. There were twenty-two individual course segments I had to pass, for goodness sake! By the time I got to the end of a chapter, I had already forgotten everything I just read. And I had no previous experience with any of this: no frame of reference. What the heck was adenosine triphosphate? I never took chemistry! What was a muscular attachment point? I flunked biology in high school!

Twice, in fact.

I had apparently thrown myself off the deep end of reality, into the swampy morass of human physiology.

The Struggle Is Real

For months I studied, and quizzed, and attempted to memorize. My fiction writing slowed to a crawl. My posts to Misdirected became ever more sporadic, the closer I got to the date of my final exam. I stopped sleeping normally, waking up in the middle of the night to go study.

Everyone in my family was tremendously supportive, all patting me on the back with various versions of “You can do it!” I remained unconvinced. The time pressure was the real killer here. I was sure I could do this, given enough time. Say, 2 or 3 years. But not 6 months.

I finished the course materials, then threw myself back in again from the beginning. Then a third time. Each time revealed new weaknesses. Finally, after my 3rd time through, I took the practice exams with a week left before my final.

I managed a 76%.

I was crushed. Yes, it was a passing grade, but…a “C”? That was the best I could do?

Lor disagreed. “You worked harder for that C than I ever saw you work for anything in your life” was her take on it.

I would have to settle for it: I was out of time.

Test Day

Yesterday morning dawned early. Real early in my case. I was up at 2 AM, in a complete panic about the exam coming up at 8:30.

There was nothing else I could do. I resolved that I would not rush, that I would go through the exam multiple times, that I would read each question several times before answering. Breakfast was out of the question. My stomach dipped and rolled frantically as Lor drove me to the testing center.

150 questions. 3 hours. This is what the last 6 months of work had finally come down to.

After my meticulous progress through the exam, it was time to press the “Submit” button to have the test graded. I probably sat there for 5 minutes, willing myself to click the button. Only the fact that I was convinced I would throw up if I waited any longer forced me to move.

The spinning wheel rolled for a moment as the PC thought, then I was presented with a “You Passed!” message.

My final score? 77%

I have never been prouder of a C in my life.

Jeremy Schofield, ACE Certified Personal Trainer

 

The 1-Year Follow-up

The 1-Year Follow Up - The results of Bariatric Surgery

You may wonder where I’ve been the last couple days. I spent Monday meeting with my surgeon, finishing up the VNS procedure, and got cleared to start using both arms again. This seems like it would have been the perfect opportunity to publish my next Misdirected post, right?

But I had something else big coming down the road, so decided to wait for the update.

Because yesterday was my 1-year appointment with the folks at DaVita Bariatrics. One year ago yesterday I went under the knife and changed my life forever.

So, how did I do?

The Numbers Don’t Lie

So, let’s review. On July 25, 2016, I weighed 248 pounds. (Down from my all-time high of 302 pounds in February of 2016.) My blood pressure was 145/102. My resting pulse rate was 86. I was on a cocktail of 5 different medications. I slept with a C-PAP every night.

Yesterday I weighed in at 177 pounds. (Up 3 pounds from my previous low of 174.) My blood pressure came in at 118/70. My resting heart rate was 60 beats per minute. I am down to 2 medications (both anti-seizure meds) and stopped using the C-PAP months ago.

Other significant numbers?

In 2016 I had a 50-inch waistline. Today I am at 35 inches and still shrinking.

Last year I could barely manage walking half a mile. Today I can walk at least eight, or run two. (Though still can’t run a full 5K, darn it.)

Last year my BMI topped out at 47.3 (also known as “morbidly obese.”) As of yesterday, I was at 27.7. (“Overweight”, according to the BMI chart.) Given that I would have to get all the way down to 159 pounds to be considered normal by BMI, I think I am just going to settle for “overweight”, thank you very much.

Now, Gimme The Bad News

All of this has had a downside, of course.

As of yesterday, I was diagnosed with both anemia and a B12 deficiency. Neither is as dangerous as the health issues accompanying obesity, but both are going to have to be dealt with nonetheless. Both are potential side effects of the massive dietary changes that go along with bariatric surgery.

I keep shrinking. This may sound like it should be on the “good” side of the equation, but it is a real downer to keep having to buy clothes at thrift stores. Also, I am already down to Men’s Small in shirts. Where the heck do I go from here? Do I start shopping in the kids’ section?

Speaking of my body, I am still dealing with my new covering of loose skin with the texture and consistency of Play-Doh. It is a constant hassle to deal with and has even resulted in me having unexpected surgery for early VNS replacement.  Surgery to have the excess skin removed may or may not be an option. For one thing, it has to be deemed “medically necessary.” For another, I am getting a little tired of surgery at this point.

I am actually more of a slave to my stomach now than I was when I was obese. I have to eat constantly – every 3 hours or so. And everything still needs to be measured, and weighed, and parcelled out. Eating is no longer easy.

And man, do I miss beer.

The Final Verdict

So, considering everything, would I still have the surgery?

Absolutely. I wish I had done it years earlier.

While jogging(!) yesterday, Lor and I were discussing the concept of being in better shape now at 40-ish than at 20-something. In my case, I have never been athletic. I am, quite frankly, in the best physical condition I have ever been in, period. I don’t say “best shape” because, you know, parts of me aren’t great to look at. Aesthetics aside, though, this is certainly the healthiest I have been since developing Epilepsy. By a significant margin.

Bariatric surgery still isn’t a magic pill. It doesn’t change everything for you without effort.

But it certainly gave me the freedom to make (and sustain) changes.

If you are suffering from obesity, and nothing you have tried has worked, consider talking to your loved ones and your doctor about bariatric surgery. It is far from easy. But, in my case, it has allowed me to actually go experience life, rather than sitting on the couch and watching it go by.

And if I can do it, so can you.

Looking Forward To Next Year’s Appointment,

Jeremy

 

 

 

 

To Carb, or Not To Carb?

Into every post-surgery life, a little rain must fall. Apparently, it is my turn again, as my latest weigh-in has me up by 1.2 pounds. This would not be terribly significant if it were not for the fact that I am within spitting distance of my goal weight of 185. It seems a cruel joke by my metabolism, setting me back when I am under 5 pounds away.

What Do The Numbers Really Mean?

Now, first things first: gaining a pound when you weigh 188 (189, now) pounds is no reason to sound the alarms. So many different things can contribute to weight fluctuation. There is no way to determine if this is water weight, or “OMG I ate a cheesecake” weight gain.

For the record, I did not eat a cheesecake.

What I did do, though, is change a couple things in my workout habits. I have been hitting the workouts really hard. At the advice of our shared personal trainer, I have reversed my normal exercise routine. I am now doing weights first, then cardio-vascular exercise. This meant instant increases in all my weight levels for resistance exercise. It also means I am leaving the gym a heck of a lot more blown out than I was previously.

My trainer, Ian, also suggested that I look into HIIT exercise. High-Intensity Interval Training involves blasting out reps as hard as you can for a short time period (usually 30 or 60 seconds), then resting for a minute or two. It sounded interesting until I mentioned how low my current carb load is.

“Carbs are what your body uses for fuel,” Ian told me. “At your carb level, you are going to have nothing in the tank.”

Torn Between Two Experts

So, we have my Certified Personal Trainer, Ian, suggesting that my exercise level needs to be supported by increasing the carbs in my diet.

And we have my Certified Nutritionist, Patti, who insists that, for bariatric patients, carbs are the devil.

So, umm…yeah. Confused much?

Last week I made the judicious decision to increase my carb content by about 50% (to 90 grams a day.) I slept better, had more energy,  and got all the way through all my workouts.

And I gained 1.2 pounds.

Now, other factors have to be taken into consideration. Development of lean muscle mass means that, initially, weight will go up. This, in turn, will raise the Base Metabolic Rate, meaning that the body will burn more energy while resting. Which should, in theory, lead to overall weight loss.

Now, do I really think I added 1.2 pounds of muscle in a week?

Kinda doubt it.

Peering Into The Future

So, I am going to have to settle for looking down the road and deciding what my focus will be.

The fact of the matter is, I am not training for weight loss per se. I am training for functional muscle and endurance. Starting this weekend, I have some energy-burning activities on the radar.

On Sunday we will be participating in our first 5K.

Later this month we will be hauling ourselves up a 45-foot wall at Stone Age Climbing Gym.

We’ll be heading out every week on a different day hike into the Sandias.

And this will all culminate in the assault on the La Luz Trail, probably in August.

The theme here seems to be “energy-burning activities.” I am going to have to plan (and train) accordingly. This is going to mean enhanced carbohydrate intake. So I am going to have to be careful. Complex carbs, ancient grains, and regular food logging will be the order of the day. And, once the increased workout load stops, I will need to drop the carbs back to 60 grams or less a day.

Every time I start to panic, I can just reach into my closet and try on my beloved 501s. As long as the 36-inch waistline is comfortable, I won’t panic too much.

As of this morning, they are actually a little loose.

Now there’s some food for thought.

Are 34s On The Horizon?

Jeremy

 

Bariatric Surgery Misconceptions 3: This Is Never Going To Work

Wile E. Coyote property of Warner Bros. Inc.

The diet cycle experienced by those of us who are obese is a familiar one. We look in the mirror and sigh and/or cry. We read books, check out magazines, surf the internet. We find some new diet that looks like it might work. We try the diet. It works: for a while. Then, something happens. Maybe Real Life interferes. Perhaps we decide we can’t live on grapefruit and quinoa. It is even possible that we recognize the fact that obese bodies can not manage high-intensity interval training every day. But something interferes, the diet stops, and we gain all our weight back.

So, why would we expect bariatric surgery to be any different? And, let’s face some facts here: bariatric surgery is a heck of a lot more invasive and expensive than our usual diets.

Do we really want to invest so much if we are only going to gain the weight back anyway?

The Cold Equations

Here’s the truth: about 20% of bariatric patients eventually suffer some sort of regain.

Don’t get me wrong: that is a big number. For one in five people that go through bariatric surgery, the lowest weight they achieve after surgery will not be their stopping point. They will eventually creep back up to some other weight.

But notice what is not being said here: 20% of patients do not regain all their weight. They hit a low weight, then eventually add some weight back to that. The number of patients who end up regaining all their weight is so low that I can’t even find reliable numbers on the phenomenon.

Let’s say my desire for beer and Oreos finally takes me out back and roughs me up. As a consequence, I gain 50 pounds from my current 192. This leaves me, bruised and depressed, at 242 pounds.

In other words, I would still be 50 pounds lighter than where I started this process. And no doctor is ever going to tell you that a permanent weight loss of 50 pounds is bad for an obese person.

Heck, when I started this process, I was hoping to lose around 50 pounds.

The Hows And Whys

Regain is not an exact science. Some people decide they can’t live without certain elements of their old diet. There are those that determine they do not want to exercise. There are even a few people who lose too much (the mind boggles) and have to regain to be at a healthy weight.

The other thing to remember is that the process does not have to stop with regain. A person who regains still has the ability to identify the elements of their lifestyle that are not contributing to weight loss. You can always fight back.

Will it be at as easy as it was during the “honeymoon period” after surgery? Nope, not at all. But the fact is, the honeymoon ends for all of us. At some point, the “free” weight loss ends and the work of maintenance begins. That work is the same whether you have stayed at a stable weight or regained 20+ pounds.

Once again: bariatric surgery is a single tool to use in your fight against obesity. And any long-term weight loss is contributing to your overall health. If regain should happen, don’t give up. Just remind yourself that it could be (and has been) worse, and keep on fighting.

And put down the Oreos, for goodness sake.

Avoiding Oreo Alley and Beer Boulevard,

Jeremy

Bariatric Surgery Misconceptions 2: Goal Weight

Goal Weight

A great many of the issues I talk to people about make me genuinely empathetic. I can relate to something in their experience – if not the specific event, at least the way they feel about it. This is only enhanced with bariatric patients – after all, I’ve been through most of what they are going through.

However, there is one “bariatric subject” that I have no grasp of. Sadly, it is the one subject that just about everyone talks about:

Goal Weight

Your Doctor, Your Scale, And You

Go visit any bariatric forum, Facebook group, or message board. I guarantee, within the first 5 posts, you will see some version of the following message:

“Help! My goal weight is (X), and I am stuck at (Y)!!! What am I doing wrong???”

Goal weight, for the uninitiated, is the weight your doctor thinks you should settle in at after bariatric surgery. It tends to be the #1 fixation of bariatric patients. It is also, in my opinion, just about the most worthless of metrics.

Ever since the day I read an article that pointed out that the entire 2004 U.S. Women’s Volleyball Team were “obese” according to BMI, I have been suspicious of weight as a measurement of health. Need some more recent proof? Dwyane “The Rock” Johnson is, with a Body Mass Index of 34.1, obese.

Man, I would give a lot to be obese like The Rock. Just sayin’.

Weight is only one of several factors that determine health. But it tends to be the one thing that bariatric patients focus on. Why? Probably because we all have scales at home, and can check that number constantly. Seriously – I have more than one friend that feels compelled to weigh every day.

Functional Weight

We seriously need to stop with this obsession over numbers and start concerning ourselves with overall health.

Today, I can run 15 minutes straight. A year ago, I could walk about 10 minutes before collapsing on the couch and hyperventilating for half an hour. That, to me, is worth greater attention that the number on my scale.

My “goal weight” is officially 185 pounds. I may never get there, having slowed my weight loss way down by starting up again at the gym. I couldn’t care less. My clothes are still fitting differently every week. I am on my way to being able to run in a 5K in 2 months. By the end of the year, I hope to be able to bench-press my body weight.

In short, I am much more interested in what my body can do than what it weighs.

Body weight varies for all kinds of reasons. Water retention. Illness. Over- and under-eating. Any one of these things can cause that scale number to not move, or even move the wrong way!

But you have to ask yourself: what can I do now that I couldn’t do before weight loss surgery? How has my quality of life improved? More importantly, what can I do to continue improving it?

And the numbers of your BMI or on your scale will give you no help with that whatsoever. Find goals that actually mean something: participate in an event. Try on a new swimsuit. Take up a new hobby.

If you are healthy enough to do everything you want to do, weight is nothing but a number.

Just go ask The Rock. He’ll tell ya.

Though I Am Still Obsessed With The Number On The Treadmill,

Jeremy