By Lynn Haraldson-Bering
Maybe it’s just me, but have you noticed lately more people are actually writing about and talking about maintenance on the Internet? When I logged on to Yahoo this morning, I found a blog and an article about maintenance that I wanted to share with you.
In her blog (click here to read it), a woman named Micaela discusses how she gained 15 of the 50 pounds she “worked so hard to lose.” We DO work hard to lose, don’t we? But we all know losing, compared to maintaining, is the easier part of the journey. Micaela openly admits she’s stopped eating as well and exercising as vigorously as she did in the weight-loss process. I don’t know the answer to this, but what is it in our heart of hearts, in the center of our minds, that causes many of us to slip like that, to tell ourselves that “One more cookie won’t hurt” or “Skipping this week of exercise won’t hurt”?
I know that voice haunts me once in awhile. There are days when I wake up in the morning and the last thing I want to do is exercise, or pancakes with maple syrup sound much better than the yogurt and banana I’d planned to eat. So far I’ve pushed past that voice and stuck to my plan, but it’s not easy some days.
If you do read Micaela’s blog, be sure to click on the comments. A few people brought up some excellent points about maintenance. Of course there’s the usual, “All you have to do is…” comments which frustrate me because weight loss and maintenance is not as easy as just staying away from a certain food or exercising more. The mental work involved is more than just “all you have to do…” I hate it when people try to simplify such a complicated process with pithy statements.
The accompanying article to Micaela’s blog, “ Fit for Life: Keeping the Weight Off,” is in keeping with what Barbara and I talk about here, and it’s well worth the read. The “statistic” that still keeps me on my toes, even intimidates me sometimes, is that people who maintain their weight longer than two years (this article said three years) have an easier time maintaining in the long run. I just marked 18 months in maintenance on Sept. 12. While I admit it’s a little easier and I’m not quite as paranoid about gaining my weight back, the cold hard truth is that it is an every day thing. I can’t slack on the food or the exercise. My life truly is different than it was five years ago and must remain changed if I’m going to stay where I am. Even after 18 months, that task is daunting.
------------------------------------------
Just in case you don’t have enough reasons to lose and maintain your weight…
I received this email from my friend Rhonda, a radiologist in Florida, in response to my blog on my trip last week to see my maintenance group. Rhonda is also a successful maintainer (for many years) and reader of RTR. She reads test results every day of patients who are overweight and obese, and her observations give me even more reason to be grateful that I lost weight and motivation to stay at the weight I am.
“I am reading this blog on a short break at work, where I am reading CT (CAT) scans, MRI's and Ultrasound exams, and it struck me to let you all know one of the health benefits that your weight affords you.
“We all know and think about the decreased risk of diabetes, heart disease, stroke, etc., from weight loss, but one of the things that I see in my daily practice is how much harder it is to image someone who is significantly overweight. The bigger you are, the more x-rays it takes to penetrate your body and the fuzzier the pictures are (even a plain old chest x-ray can be suboptimal). The bigger you are, the more your own body fat throws artifact on a CT scan, making it difficult to see. Ultrasound is not good at penetrating fat, so there are a lot of things we can't see with it in large people.
“If you are big enough, you may not even physically fit into an MRI scanner and for many, important applications, the open configuration magnets (which are often a lower magnetic field strength) are not adequate. All of our CT tables and tables where we do angiograms have weight limits above which we can't move the table with the patient on it or risk the table collapsing. Never mind the risk to hurting the patient, the repair bills for those tables can run in the hundreds of thousands of dollars range, so we end up having to literally not perform studies on patients who are over the weight limit. Even mammograms, in very large patients, I have seen us have to take four overlapping images for just one view of one breast in order to be able to cover the tissue adequately (a standard mammo consists of a total of 4 films, 2 views each breast).
“Some would say that by not having tables large enough to accommodate the bigger patients (there are a few manufactures out there who offer them), we are being discriminatory to the obese. The problem is that these machines cost upwards of $1 million for MRI and CT scanners and the larger format scanners often times give markedly suboptimal exams for people with more normal body habitus.
“My point is that not only are you decreasing your risk of significant health problems by losing weight, if you do become ill (brain aneurysm, appendicitis, etc. -- things that don't care how much you weigh), the chances of us being able to use our high-tech gadgets to diagnose and treat you are markedly improved by your weight loss.”
I wrote back and asked her, “If you were to find a lump and doctors performed surgery, is the actual surgery more difficult through layers of fat and is recovery more difficult?”
She wrote back:
“Since I am not a surgeon, I don't have 100 percent knowledge of surgical complications, but I can tell you about my experience with angiograms.
“When we get someone who is significantly overweight (but not over the table limits), they are prone to an increase in several complications. First of all, they may be so big that we can't feel the femoral pulse in order to do the puncture. That means we may need to use ultrasound to identify the artery and guide puncture. The gel from the US MAY slightly increase the risk of getting an infection at the puncture site.
“Secondly, we may need to use a longer need to hit our target.
“Thirdly, once we get in the vessel, we then put a guide wire ( a wire that looks like a guitar string with a floppy end at the front and a stiff part in the middle and end) so that we can take the needle out and put our catheter (tube with holes in it) over the guide wire into the vessel. Much harder to get a catheter to follow a guide wire through several centimeters of layers of fat, rather than just a couple for normal sized people.
“When we are finished with the procedure, we remove the catheter and hold pressure on the artery to stop the bleeding: harder to hold in big people and this increases the risk of getting a hematoma (a big blood clot in the tissues). Even if you don't get a hematoma during the hold, one can develop in the hours following the procedure and is harder to diagnoses if it is buried amongst the fat. Also, our bigger patients tend to also have back pain, which makes it harder for them to lie flat in bed (which we require them to do post procedure in order to heal the site). So if they are squirming around because they are uncomfortable from their back, this increases the risk of them getting a hematoma.
“Regular surgery can be technically more difficult in big patients. I still remember a lecture from one of the teachers in med. school. The lecture was ostensibly about ovarian cancer (which affects the 4 "F's": female, forty, fertile, fat). Most of what I remember was slide after slide of the retractor devices this particular doc had designed to hold back the pannus of the patient to adequately access the surgical site. It can be harder to keep the surgical site clean, post-op, increasing the rates of infection.”
Thanks, Rhonda, for the great info.
By Lynn Haraldson-Bering
Maybe it’s just me, but have you noticed lately more people are actually writing about and talking about maintenance on the Internet? When I logged on to Yahoo this morning, I found a blog and an article about maintenance that I wanted to share with you.
In her blog (click here to read it), a woman named Micaela discusses how she gained 15 of the 50 pounds she “worked so hard to lose.” We DO work hard to lose, don’t we? But we all know losing, compared to maintaining, is the easier part of the journey. Micaela openly admits she’s stopped eating as well and exercising as vigorously as she did in the weight-loss process. I don’t know the answer to this, but what is it in our heart of hearts, in the center of our minds, that causes many of us to slip like that, to tell ourselves that “One more cookie won’t hurt” or “Skipping this week of exercise won’t hurt”?
I know that voice haunts me once in awhile. There are days when I wake up in the morning and the last thing I want to do is exercise, or pancakes with maple syrup sound much better than the yogurt and banana I’d planned to eat. So far I’ve pushed past that voice and stuck to my plan, but it’s not easy some days.
If you do read Micaela’s blog, be sure to click on the comments. A few people brought up some excellent points about maintenance. Of course there’s the usual, “All you have to do is…” comments which frustrate me because weight loss and maintenance is not as easy as just staying away from a certain food or exercising more. The mental work involved is more than just “all you have to do…” I hate it when people try to simplify such a complicated process with pithy statements.
The accompanying article to Micaela’s blog, “ Fit for Life: Keeping the Weight Off,” is in keeping with what Barbara and I talk about here, and it’s well worth the read. The “statistic” that still keeps me on my toes, even intimidates me sometimes, is that people who maintain their weight longer than two years (this article said three years) have an easier time maintaining in the long run. I just marked 18 months in maintenance on Sept. 12. While I admit it’s a little easier and I’m not quite as paranoid about gaining my weight back, the cold hard truth is that it is an every day thing. I can’t slack on the food or the exercise. My life truly is different than it was five years ago and must remain changed if I’m going to stay where I am. Even after 18 months, that task is daunting.
------------------------------------------
Just in case you don’t have enough reasons to lose and maintain your weight…
I received this email from my friend Rhonda, a radiologist in Florida, in response to my blog on my trip last week to see my maintenance group. Rhonda is also a successful maintainer (for many years) and reader of RTR. She reads test results every day of patients who are overweight and obese, and her observations give me even more reason to be grateful that I lost weight and motivation to stay at the weight I am.
“I am reading this blog on a short break at work, where I am reading CT (CAT) scans, MRI's and Ultrasound exams, and it struck me to let you all know one of the health benefits that your weight affords you.
“We all know and think about the decreased risk of diabetes, heart disease, stroke, etc., from weight loss, but one of the things that I see in my daily practice is how much harder it is to image someone who is significantly overweight. The bigger you are, the more x-rays it takes to penetrate your body and the fuzzier the pictures are (even a plain old chest x-ray can be suboptimal). The bigger you are, the more your own body fat throws artifact on a CT scan, making it difficult to see. Ultrasound is not good at penetrating fat, so there are a lot of things we can't see with it in large people.
“If you are big enough, you may not even physically fit into an MRI scanner and for many, important applications, the open configuration magnets (which are often a lower magnetic field strength) are not adequate. All of our CT tables and tables where we do angiograms have weight limits above which we can't move the table with the patient on it or risk the table collapsing. Never mind the risk to hurting the patient, the repair bills for those tables can run in the hundreds of thousands of dollars range, so we end up having to literally not perform studies on patients who are over the weight limit. Even mammograms, in very large patients, I have seen us have to take four overlapping images for just one view of one breast in order to be able to cover the tissue adequately (a standard mammo consists of a total of 4 films, 2 views each breast).
“Some would say that by not having tables large enough to accommodate the bigger patients (there are a few manufactures out there who offer them), we are being discriminatory to the obese. The problem is that these machines cost upwards of $1 million for MRI and CT scanners and the larger format scanners often times give markedly suboptimal exams for people with more normal body habitus.
“My point is that not only are you decreasing your risk of significant health problems by losing weight, if you do become ill (brain aneurysm, appendicitis, etc. -- things that don't care how much you weigh), the chances of us being able to use our high-tech gadgets to diagnose and treat you are markedly improved by your weight loss.”
I wrote back and asked her, “If you were to find a lump and doctors performed surgery, is the actual surgery more difficult through layers of fat and is recovery more difficult?”
She wrote back:
“Since I am not a surgeon, I don't have 100 percent knowledge of surgical complications, but I can tell you about my experience with angiograms.
“When we get someone who is significantly overweight (but not over the table limits), they are prone to an increase in several complications. First of all, they may be so big that we can't feel the femoral pulse in order to do the puncture. That means we may need to use ultrasound to identify the artery and guide puncture. The gel from the US MAY slightly increase the risk of getting an infection at the puncture site.
“Secondly, we may need to use a longer need to hit our target.
“Thirdly, once we get in the vessel, we then put a guide wire ( a wire that looks like a guitar string with a floppy end at the front and a stiff part in the middle and end) so that we can take the needle out and put our catheter (tube with holes in it) over the guide wire into the vessel. Much harder to get a catheter to follow a guide wire through several centimeters of layers of fat, rather than just a couple for normal sized people.
“When we are finished with the procedure, we remove the catheter and hold pressure on the artery to stop the bleeding: harder to hold in big people and this increases the risk of getting a hematoma (a big blood clot in the tissues). Even if you don't get a hematoma during the hold, one can develop in the hours following the procedure and is harder to diagnoses if it is buried amongst the fat. Also, our bigger patients tend to also have back pain, which makes it harder for them to lie flat in bed (which we require them to do post procedure in order to heal the site). So if they are squirming around because they are uncomfortable from their back, this increases the risk of them getting a hematoma.
“Regular surgery can be technically more difficult in big patients. I still remember a lecture from one of the teachers in med. school. The lecture was ostensibly about ovarian cancer (which affects the 4 "F's": female, forty, fertile, fat). Most of what I remember was slide after slide of the retractor devices this particular doc had designed to hold back the pannus of the patient to adequately access the surgical site. It can be harder to keep the surgical site clean, post-op, increasing the rates of infection.”
Thanks, Rhonda, for the great info.