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!

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Giving Low Carb A Go

Despite aquafit, cutting out the coke and counting calories, I gained 1.1 kg in a week – almost two pounds. After the initial disappointment, I knew I had to make up my mind: either continue as I did, with the very slow weight loss and occasional gains in between, or get serious about it. So I am officially dieting now. Calorie counting, and no carbohydrates after 6 PM; and in just two days the weight went back down to 99.5 kg.

I’m not going to lie, the low carb approach is hard for me. Contrary to popular opinion, proteins don’t fill me up longer than carbohydrates. Going hungry during the day is not too bad, because I know the next meal is coming eventually, but I also get hungry before it is time for bed. Last night, I got so desperate that I drank a huge cup of broth – at 23 kcal and a negligible amount of carbs, it was the only way to shut up my stomach without messing up.

During the day, I still eat carbohydrates. Partly because high protein breakfasts don’t sit well with my stomach, partly because I would fall off the wagon within 72 hours. I like them too much. Funny how it is not the cola or chocolate that are giving me a hard time, but stuff like rice or fruit.

I am not sure how long I am going to do this. As long as it doesn’t make me miserable, I guess. Even though I can boast a long history of unsuccessful diets, the last one was a few years back, and I never tried low carb. I hope that this new approach in combination with the depression treatment will give me the willpower to stick to it for a while.

Cola Addiction Revisited

Long-time readers of this blog may remember the post about Cola-addiction I wrote over three years ago. Even though I was fully aware of how unhealthy it is, I couldn’t go a day without it. When I noticed recently that my cola consumption had been comparatively low for several days in a row, I decided to attempt kicking the habit. It’s been over 48 hours since my last glass now and, to my surprise, easier than expected. The cravings are manageable, and the headaches I’ve had over the past two days may or may not be related to withdrawals. They are nuisance rather than a huge problem anyway.

Why now? The biggest factor in this is the valdoxan: since I’m sleeping better, I don’t feel as groggy anymore and thus don’t need the coke to “wake up” my brain. Plus I was ready for it – right now, I feel like I can handle making lifestyle changes and sticking with them. I am motivated by my weight loss; my depression index and anxiety are low, and I have a moderate amount of energy. Why not seize the chance?

Coming Clean About My Weight

I have always been reluctant to share the actual numbers when it comes to my weight. It wasn’t so much being afraid of what the anonymous blog readers would think, but rather my real life friends. Which doesn’t make much sense, since everyone I meet can see how heavy I am at first glance. So I decided to own up about the numbers, for better or worse, because it’s a pain in the ass to write about the whole topic without being able to give precise figures.

I am 171 cm (5’6”) tall. The normal weight for my size and age would be 61 – 72 kg (134 – 159 lbs).

My all-time maximum weight was 117 kg (258 lbs) in 2003.
I started therapy with 104 kg (229 lbs) in 2010 and was relatively stable at that weight until the venlafaxine seriously cut into my physical activity.
November 2014 saw me at 108 kg (238 lbs).
As of last week, I am back in the two-digits, weighing in at 99.5 kg (219 lbs) on Friday.

So there you go. I have not been under 100 kilograms since the first semester of university. My next goal is to make 95 kg, then 90 kg… The line between the overweight BMI-category and obesity lies at 88 kg (194 lbs) for my height, and I guess that is my current target weight. If I ever make it that far, I will decide whether it’s worth the effort to try losing more weight. It took me 15 years to get back under 100 kg, so I’m not really spending any serious thoughts on that as of now. Instead, my eyes are firmly on the 95 kg mark.

One Pound At A Time

As I am typing these lines, I am 100 g or 3.5 oz away from reaching the weight that has been my target for the past 15 years. When I do – and since the aquafitness class starts this week, I have no doubt that I will – it means that I have successfully lost all of my excess university weight. It’s been my goal for such a long time that I don’t even know what the next one should be. Most likely, I’ll just try to lose another 5 kg / 11 lbs and take it from there – but I am also aware that muscles are heavier than fat, so my short-term goal is losing visible belly fat rather than a certain number on the scale.

There’s a certain genetic predisposition for weight gain coming from my maternal family’s side. Even on the oldest family pictures we own, that pre-date the First World War, my ancestors appear stocky and rotund. The only difference between them and me is that I am quite a bit taller than they were.

I was born a chubby baby, and never lost that appearance. Robust build, strong muscles; not fast, but good stamina; extracting every last calorie from a meal. Genetically designed for foraging or farm work. But unlike during prehistory (and most of history), I don’t have to actually find or grow my own food. There are no famines anymore in my part of the world where those “genetic gifts” would have made the difference between life and death.

Without the thyroid problems, I still would have been overweight. No illusions about that. They pushed me firmly into obesity territory, though, and ever since I have been struggling to leave it. Every ounce lost is the result of great effort, as if my body was desperately trying to hold on to the weight.

My husband, who easily eats twice as much as I do, has a different kind of metabolism. He used to be skinny, and even though he isn’t anymore, all it takes for him to lose some pounds is to exercise more. Within two weeks of starting his new job (where he’s on his feet all the time) he began looking visibly slimmer. If he put his mind to it, in a few short weeks he’d probably lose the 8 kg it took me over a year to get rid of.

I’m really hoping that the exercise will make the difference. My eating habits are pretty good – not perfect, but I very rarely exceed my calorie limit. Anything excessive makes me sick quite quickly anyway – fast food or junk food usually results in digestive problems. The only time when I can’t seem to go without it is when PMSing…

My ambition is not to become thin; that would be unrealistic. I never was, never will be. Sometimes, I wonder what that would be like. Would I carry myself differently? Would it influence my behaviour? Because being large has certainly left its mark on my psyche – I had my fair share of ridicule from strangers, and criticism from relatives. I never forget that I am fat, not even when alone. I wonder whether there is a certain point where I would?

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.

Depression Symptoms & Antidepressant Side-Effects Assessed

It’s becoming very clear that despite taking twice as high a dosage of venlafaxine / effexor now, the timed-release capsules work much better for me. The nausea and vertigo vanished completely, and in the mornings I don’t go through withdrawals anymore either. I do feel quite drained from the experiences of the last three weeks, though, very tired and listless. I lost 6 kg (13.2 lbs) – 4 kg over the first weekend and another 2 kg since – and even though I would welcome further weight loss very much, it goes without saying that vomiting, diarrhea and skipping meals due to nausea is not exactly a healthy way to drop the kilos and at least partially responsible for the feelings of weakness. On top of that, venlafaxine also suppresses my appetite for a good part of the day, until it returns in the evening and I suddenly start scouring the kitchen for all the stuff I did not buy when shopping…
There has been no improvements of the symptoms I primarily started taking venlafaxine for yet, the cognitive impairments and lack of energy, but I do feel more emotionally stable recently. Next Friday I have a follow-up with the psychiatrist, when I’ll find out whether I’ll increase the dosage further or stay on it for the time being.

As for the welfare process and related paperwork, the main appointment at the job centre had been cancelled on Tuesday already because the lady had become sick, and the one who works on our case at the employment agency was replaced with a colleague due to illness as well. While being very friendly as well, this colleague could do little more than collect the forms we had filled out at home and the documentation we had brought. Other than that, we will have to wait for them to get back to us. I handed in the questionnaire on my medical complaints today; the question was: “Do you have medical conditions which influence your current job or have done so in the past? Please give a short description of your illness respectively your symptoms and tell us which kinds of occupation would be influenced by these.” The space left blank was less than a quarter or a page, so I could not go into much detail:

“Diagnosis: chronic recurrent depression with comorbid panic disorder.
– permanent / daily symptoms: muscle pain in legs and arms; social anxiety; slowed-down thinking; word finding problems; problems falling asleep (at least 2 hours / night); severe lack of energy; hypersomnia; decreased libido
– frequent symptoms (at least 3 days per week): stomach pains; digestive problems (diarrhea); back pain; memory problems; concentration problems; depressive emotions (sadness, emotional emptiness, hopelessness); headaches
– periodically appearing symptoms: insomnia
– under stress also anxiety attacks
– currently (since mid-March 2013) additionally vertigo, nausea and vomiting due to starting an antidepressant regime (venlafaxine)

Because of the diverse symptoms, I am physically, intellectually and emotionally affected with any kind of occupation.”

That is as accurate an assessment as I could give of my daily problems in such a small space, and each of my healthcare providers should be able to confirm them. I learned today that the medical service will first contact my general physician for information, which is a bit of a problem since at least 80% of my depression treatment has been done by my therapist; the general physician does get reports from my psychiatrist, but except for the fact that I have participated in the medical study he does not know anything about the psychotherapeutic treatment. I do hope they’ll get in contact with him as well – if our regular case worker had been present today, I would have asked her, but her colleague was not familiar with the protocol in such cases.

The Third Day On Venlafaxine

I lost 4 kg (8.8 pounds) since Friday. Even though it is getting easier on my digestive system and the nausea usually starts dissolving 90 minutes after taking the venlafaxine, I still can eat only selective groups of food, and only in small portions –  apples, bananas, pineapples, potatoes, rice, bread. Oh, and my soy drink works too. But meat, fish, eggs or vegetables make me instantly sick. While I actually welcome the weight loss, I hope that does not lead to a rebound further down the road…
The brain zaps are increasing, and sometimes it feels like thousands of ants are crawling over the surface of my brain.

Physical Side-Effects of Depression

In the therapy sessions, we usually concentrate on the emotional and behavioural aspects of depression, since this is the area where we can work on change. The physical side-effects of depression, which used to even eclipse the emotional pain quite often, will go away too when the depression vanishes.
For a long time, however, I wasn’t aware that these two aspects – mental/emotional well-being and physical pain – were so closely related. I blamed my thyroid and the Hashimoto’s disease for feeling fatigued and for the memory problems I was experiencing, even if the lab results showed that my medication was perfectly adjusted. For all the other complaints, I saw three doctors in total who all diagnosed me with a variety of conditions which usually matched the most recent physical manifestations, but always ignored the full picture. Nobody suspected depression before I started having panic attacks, and even though I personally suspected a mental health problem earlier, all the symptom lists for depression I checked mentioned weight loss and sleeplessness, while I was (am) clearly overweight and slept much more than the average person: I always dismissed the self-diagnosis again on these grounds. Only at the hospital I learned that in chronic depression, weight gain and hypersomnia can occur too, as well as many other symptoms.

Today, I wanted to take inventory of the physical side-effects which one would not necessarily relate to depression and which I experienced over the course of the years.

Permanent or frequent complaints:

• Muscle pain in the limbs: I’m not entirely sure when this started, but by spring 2009, I very often had severe pains in the muscles and nerves of my arms and legs. Sometimes it would feel like a “tennis arm”, sometimes like the kind of muscle cramps you get when over-exercising. I combatted the pain with ibuprofen, paracetamol or aspirin, which brought relief for a few hours.
  My second general physician diagnosed me with multiple sclerosis because of it.
  When I was put on an antidepressant in summer 2011, the pain went away after only four days. It returned after I discontinued citalopram; my therapist was the first person who told me that it was stress-related and caused by an inability to relax. Ever since, I lie down and try to consciously relax all of my body whenever I feel the pain. With the progress in therapy, the days when my limbs hurt become fewer and fewer.

• Inflammation of the eyeballs: This symptom first occurred in spring 2009 too, when my eyes became red, dry and sensitive to light. In the beginning, the intensity would be sometimes less, sometimes worse, but last year, it was permanent.
  My first general practitioner diagnosed it as hay fever – never mind that weather or seasonal changes had no influence on it at all. My sister and niece both have hay fever, so I am rather familiar with its symptoms, and I was very certain that the inflammation of my eyes was not allergy-related. The next doctor saw it as a symptom of MS, together with the muscle pain.
  As with the muscle pain, the inflammation vanished when I started to take citalopram and returned afterwards. Recently, the inflammation had come back, but as I try to counteract the stress, it gets a little better every day.

• Headaches: I used to have headaches very frequently; up to four or five times a week during the most intense periods. The most common form was a consistent, one-sided pain directly behind the eye, as if someone was relentlessly poking me into the eyeball from behind. In 70% of all cases, the left side was concerned. Rarely (once every couple of years), I will also have a case of migraines, when I can’t tolerate light and sound and have to lie down in a dark, quiet room with a wet cloth on my face.
  The headaches started very early, during my teenage years already, and currently occur on about two or three days per month.

• Digestive problems: Another group of symptoms that I had since adolescence – stomach aches / cramps, diarrhoea, a couple of episodes when I couldn’t eat anything but apples and plain rice, one episode of histamine intolerance that vanished after two weeks. Now I experience those problems about 2 – 3 times per month, but during the worst of it, that would be 4 – 5 times per week, for months on end.

• Backaches: For about twenty years, I used to have “typical” complaints like tense muscles around the shoulder and back of my neck, but in recent years, there have also been intense phases of lower back pain. The latter first occured early in 2008, about two weeks after I had started a new job that pushed me to the limit in regards to social anxiety. I didn’t make the connection back then, but in retrospect, it seems very clear that the job and the new type of backaches were related.

Infrequent or singular complaints:

• Vertigo: One morning in 2007, I woke up with such a heavy case of vertigo that I literally couldn’t get out of bed. Lifting my head alone brought such waves of nausea that I had to vomit. It took three days until I could leave the house and see a doctor for it, who was clueless and referred me to a specialist. I had my ears and head checked, especially the sense of equilibrium, but everything was fine. They sent me home, “If it happens again, come back.” So far, there has been no second episode of unexplainable vertigo.

• Chest cramps: This is a strange one. The first experience was the night after I celebrated my 18^th birthday with a party; I woke up in the wee hours of the morning with a feeling as if my stomach was starting to petrify. Since then, I have spells when it happens a couple of days in a row, just to stop again just as suddenly for about half a year.
  Very often, the cramps come at night and I wake up from the pain, but sometimes they can also occur during the day: the muscles around my stomach become hard and cramp; a very intense ache that I feel under the sternum and in the middle of my back. Sometimes, I can sense the muscles there going tense a few hours before the actual cramping, but usually it happens within minutes only.
  Heat helps as it relaxes the muscles. At my most desperate, I had hot water bottles on both chest and back and was drinking hot water to relax the muscles from inside as well, because the pain can get so intense that I can hardly stand upright anymore and feel like opening my chest with a knife just so I can reach under the sternum and massage the muscle.
  Some people have suggested that it might be heartburn, but it feels completely different and is not inside the oesophagus or stomach, but very clearly outside of it.
  It appears that the chest cramps have become less intense and more infrequent, but is too early for making a definite call still: I had episodes of up to nine months without them and experienced some chest cramps this spring, so it will need at the very least a year without them before I consider them gone.