I met with Dr. W last week. He is my new Primary Care Physician (PCP). He is great in that he is thorough and and takes the time to answer my questions. His downfall is that he likes to talk but has the social aptness of a toad stool! He makes corny jokes and pauses in the conversation for reactions at the wrong moments. Think of your most annoying older relative and THAT is Dr. W! LOL! But hey he is smart and well informed and all in all a great guy.
We started off with getting my health history. I will take this one point at a time so I can cover everything...
My Thyroid: He said that probably the thyroid is the big reason for a slow metabolism and thus weight gain. He asked when it was diagnosed and I told him that when I got pregnant with Kaleb that I gained no weight while pregnant, initially lost like 40 pounds once he was born and then gained like 50 back in a very short amount of time. They checked my thryoid and found that I had Hypothyroidism. He said it is common for your thyroid to go Hyper then Hypo, thus my weight loss then sudden gain. Total yo yo.
My menstrual cycles and PCOS: We talked about how wacky my cycles were when I was trying to get pregnant with Harlie. He guess (before I told him) that I had PCOS. He asked what my Dr. had done for that previously. I told him I was on Metformin and we discussed my insulin resistance. He said that fat cells overproduce estrogen which prevents ovulation which is related to insulin resistance. (I can't remember how But I am guessing that Steph will know. Please post to remind me Steph). Anyway a few months ago I stopped taking my Metformin. Part of it was that I needed a prescription refill that would require a trip to the Dr. of which I didn't have the $ to pay for. The other part was that I wanted to know if I really still needed the Metformin. And how I would feel once I went off of it. Well that sorta backfired one me. I gained 38 pounds in the few months since I went off the Metformin. I have not changed my diet nor my activity level. The only thing that changed was I stopped taking the Metformin. He refilled my prescription. :)
My energy levels: I am TIRED ALL THE TIME! Even when I get a good nights rest the night before. I feel like I am always paying the sleep debt from my youth. He asked me to take a quiz about my sleep patterns. I scored a 14 (lower is better) and he took my neck measurement (16.5inches). Both of those numbers together mean that I am at risk for sleep apnea. Sleep Apnea is a problem that lots of people face. It can occur in varying degrees. But he wants to take a closer look at why I am not getting enough rest if I sleep for 8hrs at night and take a nap during the day. Harlie is now sleeping through the night and I don't get woken up at night anymore (except the occasional bad dream from Kaleb or Jasmyn). He ordered a "sleep study kit" to be mailed to me. I guess I wear it for 2 nights and then mail it back and they read the results and determine if more testing is needed. I will keep you posted on that. I have not recieved the "kit" yet. He also took a look at my throat. Apparently I have a level 4 airway. Basically when I open my mouth and say Awwww you can't really see down my throat because of the soft tissue (i.e fat) collapses in my throat. This was also a major factor in the decision to test me for Obstructive Sleep Apnea. He said I should mention that to the surgeon if I do the WLS since protecting my airway becomes important while I am under anesthesia. Scary!
My activity level: I try to walk and I was a member of a gym to which I went 2-3 times a week. (My gym went under because the building they were in refused to resign their lease) But getting exercise is super hard when I have 4 kids and a husband that works long hours. Dr W gave me some practical advice. He said that they way to burn calories is to work your muscles. So while the walking and elliptical are great, adding some weights to my work out would help me burn calories and thus lose weight. He gave me some exercises to do that engage each major muscle group and he recommends starting small (1 set of reps of each of 3 exercises daily) and working up (5 sets of reps of each exercise daily). The 3 magic exercises are truly *old school*. Exercise 1: Push Ups. Obviously he knows I can't do an ACTUAL push up. So he says to start doing them standing and pushing off the wall. Then work my way down to a table, a chair, then off my knees etc.... Exercise 2: Rowing. I don't have a rowing machine. So he suggests an exercise band held by my feet. Exercise 3: Lunges. Working to get my legs at 90* angles. Then add weights (milk jugs full of sand/water/etc) to my hands to increase resistance.
And lastly we talked about my mental status: We talked about the fact that I am on Prozac and why I started taking it. He asked me why I thought I overate. I told him that while I am an emotional eater that I really don't eat unhealthy-ily. But I could lower my portions. This is where he told me that the Jews in concentration camps lived on 500 calories a day and that that is all me *need* to live! LOL! Obviously he was not suggesting I do that, but it put into perspective on how much we as a whole overeat. But really this portion of the conversation was about how emotional stable I was and how I would battle the inner brain/emotional stuff of over eating. Basically the WLS can handle the physical but *I* still have to figure out the emotional stuff or it won't work. A high percentage of WLS patient gain the weight back by "overeating the bypass", basically stretching the pouch back out to accommodate more food. And over time that causes you to consume too many calories and thus gain weight. So the emotional side of this is really important. I personally think that I am much more healthy minded now then I was in my 20s but the problem is that I am still carrying the weight I gained in my 20s. I do have some work to do on my mind/emotional eating but I am in a better place in regards to this than I was when I was younger and gaining the weight.
So after all of that Dr. W gave me the referral to the Weight Loss Surgery Seminar. It is Scheduled for March 17th. I will keep you posted.....
Insulin resistance (IR) is a physiological condition where the natural hormone, insulin, becomes less effective at lowering blood sugars. The resulting increase in blood glucose may raise levels outside the normal range and cause adverse health effects, depending on dietary conditions. Certain cell types such as fat and muscle cells require insulin to absorb glucose. When these cells fail to respond adequately to circulating insulin, blood glucose levels rise. The liver helps regulate glucose levels by reducing its secretion of glucose in the presence of insulin. This normal reduction in the liver’s glucose production may not occur in people with insulin resistance.[citation needed]
ReplyDeleteInsulin resistance in muscle and fat cells reduces glucose uptake (and so local storage of glucose as glycogen and triglycerides, respectively), whereas insulin resistance in liver cells results in reduced glycogen synthesis and storage and a failure to suppress glucose production and release into the blood. Insulin resistance normally refers to reduced glucose-lowering effects of insulin. However, other functions of insulin can also be affected. For example, insulin resistance in fat cells reduces the normal effects of insulin on lipids and results in reduced uptake of circulating lipids and increased hydrolysis of stored triglycerides. Increased mobilization of stored lipids in these cells elevates free fatty acids in the blood plasma. Elevated blood fatty-acid concentrations (associated with insulin resistance and diabetes mellitus Type 2), reduced muscle glucose uptake, and increased liver glucose production all contribute to elevated blood glucose levels. {And a high risk for having a heart attack!]. High plasma levels of insulin and glucose due to insulin resistance are a major component of the metabolic syndrome. If insulin resistance exists, more insulin needs to be secreted by the pancreas. If this compensatory increase does not occur, blood glucose concentrations increase and type 2 diabetes occurs.
Having copied & pasted that I found how it relates to PCOS in two ways:
ReplyDeleteOver time, the above factors have damaged the complex ability of the body's cells to properly utilize insulin to convert glucose to energy. This process creates Insulin Resistance, which can cause PCOS in two distinct ways.
First, Insulin Resistance reduces the insulin sensitivity of your cell walls. Glucose has to pass through those cell walls to be converted into energy. Insulin assists this process. But when the cells' walls have become de-sensitized to insulin by Insulin resistance, the process can break down.
Glucose "bounces" off the cell wall, instead of passing through the insulin door to be burned as energy. With the cell door almost closed to it, glucose remains in the blood stream, causing elevated levels of blood sugar, which are sent to the liver. Once there, the sugar is converted into fat and stored via the blood stream throughout the body. This process can lead to weight gain and obesity, key factors in creating Polycystic Ovarian Syndrome.
The second way that Insulin Resistance causes PCOS is by raising insulin levels in the blood stream. Unhealthy lifestyles and genetic conditions cause the pancreas to overproduce insulin. The de-sensitized cell is, in turn, overwhelmed by this excess insulin and an excess of insulin "rejected" by the cell then free-floats in the blood stream, creating unbalanced hormone levels in PCOS sufferers.
Excess insulin stimulates the ovaries to produce large amounts of the male hormone testosterone, which may prevent the ovaries from releasing an egg each month, thus causing infertility. High levels of insulin also increase the conversion of androgens (male hormones) to estrogens (female hormones), upsetting a delicate balance between the two and having a direct effect on weight gain and the formation of cystic follicles or cysts in the ovary.
ReplyDeleteI honestly think you have PCOS & insulin resistance *because* you started off with one or the other. I don't think it matters which one came first. You & I we're stuck with these issues & the only way to ease the suffering of either is to lose weight. As far as I can tell (using my *incredible* critical thinking skills - haha - I think that every female in your family has it, just some have developed daibetes because they never treated the insulin resistance (they never lost the weight). Once you lose the weight the less you have the syndrome (metabolic syndrom, aka insulin resistance/PCOS). I've also read that you can have PCOS without having insulin resistance, but from all my research, I really think they go hand in hand - eventually. I think my grandma Dorothy was born with PCOS, but she never got insulin resistance because her digestive system has this awesome way of getting rid of fat & sugars! My dad's mom, however; I totally look like her & she died of a heart attack in her 50's. She had 5 kids, but she was overweight & had my dad 10 years after her 4th child. She had the body type of an insulin resistant person- most fat centered in one's stomach.
I'm impressed by your doctor actually knowing what it is! I had to tell mine what I had! Jen, all I think that matters is getting the weight off for your physical happiness. I think you are a very well balanced person considering what you've been through in your life & I think you'll just *love* being the "lesser" Jen! I feel more like myself now (I've lost 10 lbs. in a week!). I feel like the Stephanie I used to be! You do what *you* think is right for you. I'll be thinking of you every step of the way, too & I'll be there right along with you!
Love,
Steph