Busting My Ass

Today we had a substitute instructor at aquafit who seemed intent on turning the class into boot camp. Eventually it transpired that she had confused us with the aquapower class afterwards and drilled us with tabata, a high intensity interval workout. Finally the most brazen lady yelled from the pool: „This is aquafit for chubbies!“ Not that it made the instructor change her programme.

It was still fun, but I’m afraid my arms and legs will be screaming tomorrow. I prefer our usual routine, which leaves me energized afterwards – today just made me feel powered out.

My weight went up and down a bit this week, but the general trend is down. I was 98.9 kg this morning, – 1.7 kg from last Friday. Low carb is quite effective for me. I think I burned more fat than the scale shows, though, because I lost 2.5 cm (one inch) of girth on my belly in just six weeks, but am a mere 3 pounds lighter than at the beginning of March. I must be building muscle from all those exercises where we work with the water resistance. It’s doing wonders for my back, in any case!


Floating On Top

The first aquafitness class was thoroughly enjoyable. As I wrote before, it’s a course dedicated to overweight people and / or those who haven’t exercised in a long time, so everyone but the instructor is quite large. That alone really helped me to be at ease, because I didn’t worry how I’d look compared to the others.

The group is lovely too; not all the new people on the list showed up, and more than half of the participants already knew each other from previous classes. The instructor made everyone introduce themselves to everyone, no matter whether you were a first-timer or not, which was a little awkward, but I managed. And as far as I can tell, everybody is genuinely friendly and nice. I liked the rapport the instructor had with the regulars. The general setting was non-threatening enough to keep my social anxiety in check.

From what I understand, there are two different kinds of aquafitness: the one where you can stand on the ground, and the one where the water is so deep that you can’t reach the floor. I’m doing the latter. The exercise is pretty similar to aerobics, just modified to fit the environment, and a little slower. Since you’re working against the water resistance, it’s just as exhausting as a normal aerobics class, but without the sweat and running out of breath.

I’m probably going to be sore tomorrow, but tonight I am feeling a good kind of heaviness in my arms and legs – the one that comes when you have exerted yourself. And my back ache already is a lot better after one hour only. Mentally / emotionally I am feeling rather well, too – just what I wanted to get out of this class.

Signed Up For Aquafitness

I’m not a “sporty” person, quite the opposite: about 50 pounds overweight – not morbidly obese (anymore), but in the area where my weight will most likely lead to health problems down the road. The last big check-up was five years ago when I applied for the clinical study. Back then I was physically healthy, but I am aware that it doesn’t take much to change that.

Since November 2014, I lost 8 kg/ 18 lbs. Not through dieting, because going on a diet flips some kind of switch in my brain which causes me to think about nothing but food all day long. Instead, I practice moderation, and thanks to the escitalopram, I am a little more active than I used to be. It’s a slow process, just a pound lost per month on average, but it’s trending towards the right direction.

My all-time maximum weight I had in 2003, when I was 17 kg / 37 lbs heavier than today. It was mostly due to the untreated hypothyroidism that I gained that much, but if I thought taking the appropriate medication would melt the fat away, I was mistaken. Even during my most active times, I would shed the pounds very slowly only.

A few weeks ago, I decided to sign up for an aquafit course – one especially for overweight and/or unfit people. Even though I loved the Tae Bo class, it was so physically demanding that I don’t think I’d be able to do it anymore, and even at the best of times it made me very self-conscious about my body, because the rest of the people were really toned… That definitely shouldn’t be a problem anymore.

Even though I talked a lot about weight, losing it is not my main motivation: I want to be healthy. At almost 36 years old, it is for the first time ever that I feel like my body might fail me if I do not take care of it. I don’t want to get rid of the physical symptoms of depression just to suffer from the side-effects of ill health. Thanks to Facebook I know that somebody I went to school with suffered two heart attacks last year, and even though his lifestyle was a lot unhealthier than mine, I don’t want to be next in line.

Apart from the physical benefits, I also hope for a positive effect on my mental health. I do not believe that an active lifestyle can prevent depression – it was from my most active period ever that I crashed into one of the bleakest phases of my life, and there are too many amateur and professional athletes suffering from it – but that it can help prevent a rebound. Especially since the biggest anxiety factor (being the only fat person among a group of slim people) is being eliminated.

Class starts the first week of April; just an hour once a week. Not a massive programme, but it’s one hour less of sitting on my butt.

Last Session Of The Year

Last therapy session of the year; the next one is on Friday the 13th (January 2012), to which my mum will accompany me. Apparently, my regular therapy is also coming to a close – I’ve had 31 sessions so far and if I recall correctly, that means only 4 more in the normal rhythm before drawing them out. Not sure about the time periods between them, but I do know that session 40 is definitely my last one. I’ll part with a laughing and a crying eye: laughing because my life improved so vastly, crying because I will be sorry to say goodbye to my therapist for good. The whole purpose of our relationship was that it would end again eventually, but I’ve grown fond of him… but, I guess that’s a bridge I’ll cross when I get to it.

We took a look at my uni schedule today, trying to find out what I can eliminate – all contact hours, homework and commuting time added up, I had a 50-hour-week and a BDI-II score of 20, with a tendency for the worse. Friday was crossed off the list completely and I’m supposed to figure out what I can do without until I reach a point where the work load does not push me into a depression anymore.
“We are pulling the emergency brake now,” my therapist said. “And if it gets too much,” he smiled, “just scratch another class off the list and go to the cinema instead.”
Eliminating classes wasn’t the problem, I didn’t need help for that. The huge difference is that if my therapist “allows” me to take it easier, I feel like I’m actually doing something pro-active and taking care of myself, whereas without discussing it in therapy, I’d have suffered from a bad conscience and felt like I was only procrastinating. That’s clearly something I still need to learn during our remaining time together: that I have a right to take care of myself and that I’m allowed to set limits.
A job is only possible in summer, because I’m going to have exams and an “en bloc” course and an excursion (probably followed by another protocol) during the upcoming semester break, and during the second semester my situation will hardly be any different…

Our roleplaying exercises were a little different today: not the usual dialogues acted out, but instead my therapist challenged me to defend my position. After I told him that I preferred learning at home over learning at the library, for example, he said: “Convince me! Why should I believe you are learning more effectively at home?” So I listed my reasons – that I felt more relaxed at home and could concentrate better because I wasn’t constantly aware of the people around me, that I didn’t have to watch my stuff if I walked out of sight of the desk, that I had more freedom on when I wanted to learn…
Later he made me stand up while he remained seated (a position I hate, because it causes me to feel vastly overweight – even though he doesn’t get that impression and it exists in my head only) and voice the effects the depression has on me as if talking to my mother: “I have troubles falling asleep and wake up in the night; the muscles in my arms and legs hurt, my joints too. I have headaches and backaches and stomachaches. My eyes are inflamed and hurt and I can’t always see properly because of that. I can’t concentrate very well either and doing my homework gets really difficult because of that. There are cognitive problems which make me forget words and sometimes I don’t even understand my homework anymore because of this.”
Only when looking back I realize I listed exclusively physical symptoms, but didn’t mention the sadness, crying and despair descending upon me. Had I spoken to my therapist directly instead of him acting as a proxy for my mother, I would probably have mentioned this, but since we hardly ever discuss intimate feelings in my family, I didn’t speak about this in therapy either.

One aspect I forgot about and which my therapist highlighted today was exercise. There is no room in my current schedule for any kind of physical activity. He described a scientific experiment to me, in which hamsters had been exposed to stress over a long time, leading to the hamsters becoming depressed. The source of stress was removed then and the hamsters got divided in three groups: group A had a nice cage, plenty of food and social contacts; group B a nice cage and plenty of food; group C a nice cage, plenty of food and an ergometer. Everyone suspected group A to show the fastest recovery rates, but in fact it was group C which was the most successful within the given time frame…
Exercise is supposed to be light and fun – no pressure to achieve any results, but regular periods of physical movement. I certainly remember how beneficial my Tae Bo classes were, even though I have nowhere near the energy for that now. But I’ll try to reserve a fixed time for swimming or cycling or something like that.

Health Insurance, Waiting Lists, And The Media

My sister finally has a therapy placement – starting December 2012. That’s quite a long waiting time for someone who needs helps – ideally as soon as possible – but hardly unusual here in Germany, because of our health care system.

Health insurance is mandatory here for every employee and a couple of other groups, for example university students. We have a system of two different health insurances: one is called “legal health insurance”, where you pay a monthly fee on a sliding scale according to your income and receive the “standard treatments”. Additionally, we also have a so-called “private health insurance”, where you pay a fee based on your personal risk (age, sex, occupation, pre-existing illnesses, etc.). I’ll call them LHI and PHI in this text respectively.
The majority of Germans have a LHI, as it usually is a little cheaper and also covers spouses and children who don’t have an income of their own. In LHI, all the covered treatments are specified by law, whereas in PHI, you make individual contracts with the insurances, so that their coverage and fees can differ vastly. Also, for LHI patients, the doctors will get their money directly from the insurance company, whereas PHI patients often pay out of their own pocket first and later get that money back from the insurance.
The LHI pay a doctor € 40.- for each of their patients they see – for each quarter year, no matter how often these patients use their services during this time. Individual treatments are reimbursed separately, of course, but for a PHI patient, the doctor gets money every single time they see him or her, just for saying hello. Also treatments for PHI patients usually bring the doctor more money (because they pay more for their insurance, they also get more fancy treatment options), which leads to some health care practitioners opting to see exclusively “private patients”. Doctors are giving the PHI patients preferential treatment since they want to keep their “money cows”, which results for example in them having much shorter waiting lists etc. for specialists, if any at all, while the LHI patients will have to stand in line.

This is, in a nutshell and somewhat simplified, the current situation in the German health care system. Psychotherapy is very time-consuming and expensive, so that in this sector you have a large percentage of therapists who’ll see PHI patients only, and the waiting lists for the remaining ones get even longer as they are hopelessly out of capacities. Waiting a year and longer for psychotherapy is pretty much the standard – unless you’re an affluent private patient willing and able to shell out money.
My relatively quick start with therapy (six weeks from the first phone call to the first session) and the programme I attend are only possible because my data goes into a study which looks into establishing CBASP as a standard method for treating chronic depression for the LHI and the costs for it are covered by third parties, so I was very lucky to qualify for one of their vacant spots. Had I not taken the route via this programme, my earliest possible session would have been in April, and I would only have been granted the standard therapy. I hit jackpot in this regard. Unfortunately, my sister has no such luck.

It goes without saying that in my opinion such long waiting times are scandalous, and recently it has come into the focus of the media too. Ralf Rangnick, a high-profile football coach, suddenly resigned from his job mid-season because of Burnout Syndrome (even though he never used the word in his official statement), so that now it’s a frequently discussed topic and concerns are being voiced that it takes entirely too long until mental health patients are receiving adequate treatment.
Whether the attention will bring lasting change remains to be seen. When Robert Enke, goal keeper of the German national football team, successfully committed suicide after years of severe depression in 2009, it very much highlighted the topic for a while, but eventually the media moved on, and so did the public interest. It’s become but a tragic footnote in the history of German sports.

Hugging Thin Air

Doing better again – the “beached whale” feeling is gone and my legs don’t hurt all the time either: I checked a book on meditation out of the library – something I wanted to try out for a long time, to learn disconnecting from the worrying thoughts. I haven’t actually managed to empty my mind yet, because every time I sit down, the urge to scratch fifteen different parts of my body at once arises, but I will hopefully get there eventually. The book also contains exercises on physical relaxation and they have been very helpful already, hence the improvement of the muscle pain.

I don’t believe sports or meditation or yoga and the likes can prevent or heal depression, else I wouldn’t have started one of the biggest crashs of my life when I was just going through the most extensive sports programme I’ve ever done. An episode of major depression is too forceful to come to a halt just because of that. However, I do believe that it can support you in dealing with side effects and soften the blow a little.

As I was walking outside today, I felt a sudden urge to wave my arms around in the wind. An urge to move. I didn’t really act on it out of fear the people looking at me flailing my arms would think I had lost my marbles, but it made me wonder whether my body is “waking up” from the petrification  of chronic depression, too.

Lethargy, Languor & Lassitude

During my last “good phase” in summer and autumn 2009, I had started doing Tae Bo, which is a special kind of aerobics that borrows its moves from martial arts and still is the most exhausting physical excercise I’ve ever done. When I first tried it out, I literally thought I was going to collapse, but it didn’t take long until one could actually notice how much more stamina I already had gained. It was a great feeling to go home afterwards: powered out, but with a sense of accomplishment. I even had the energy to do an additional medically supervised regimen at the gym – but as I slipped into the deeper depths of depression and also had a project to work on that took up most of my free time, I first stopped going to the gym and shortly afterwards attending the Tae Bo class. By the time the project was done, there was no motivation and energy left to get back on the sports programme.

I don’t miss going to the gym: that was something I did for my health, but it got old relatively quickly. Tae Bo, however, is still on my mind occasionally. Right now, I don’t have the required energy for something so demanding, but actually would like to go swimming, for example, to get into a better shape.
As far back as January my boyfriend and me had planned to do that together, but then I got sick with influenza and was knocked out for almost a month and afterwards I was hardly able to go for a walk, so that the doctor advised me to wait for a couple of weeks until I gained my strength back. Physically, I’m ok now, but too lethargic to actually get active – not only the oh-so-familiar leaden heaviness that comes with depression and that never left me completely, but also a lack of initiative. I really would like to go, but then I think of all the steps required to get into the water and end up exhausted without actually having done anything yet.
When my boyfriend was still staying with me, it was easier to motivate myself because it would also do him good, while now on a lot of days an “it’s only me, it’s not that important” mentality prevails. I can almost hear my therapist protesting as I type this and intellectually I know he’s right…