Do no harm...

It's a simple statement, and those who take the oath understand that we must practice by truth and honesty. The whole purpose of the Hippocratic oath is to treat others within your professional scope with respect and trust to care for someone to the best of our ability. I see that we should all live with such conviction and do no harm unto others for the sake of all. 

It hurts my soul to see good people treated badly.  Kind acts not going unnoticed, but acknowledged publicly then refused privately, through email in a cowardly fashion for no given reasons.  In this journey together as a community, we must honor and respect each other's individual experience.  In doing that, you must realize that not everyone will be friends.  We are not all cut from the same cloth.  We all have different passions, goals, dreams and desires that do not have to mesh into one.  

We all have opportunities to do what is right, in our personal lives and our public image.  Some people will do anything to destroy the public image of others out of greed, envy, jealous and sometimes, just pure evil.  It is each individual's personal responsibility to choose to engage or not to engage is drama. Every single person has a choice in whom they choose to associate their allegiance or their claim to neutrality.  

It is in choosing to do something to give back to others and share your experiences that is important. Love one another, or walk away. It is not always about who does it better, but it is honorable to be righteous. It's easy to choose to do the right thing when your heart is in the right place. We are all righteous babes-- warriors in our journeys. Each story is different. Some of us tell our stories on blogs, others choose individuals they feel comfortable with to share in private. When others ask for help, we should always strive to be honest. #1 if you ask for help, you should be met with an abundance of compassion and opportunity to receive accurate information or an account of another's experience. 

Greatness comes from rising from the ashes like the Phoenix. 

In searching for your truths, please employ the basics of social etiquette. My experience in bariatric support groups has been that whenever someone who is not present to defend themselves is not available, it is likely advisable to not engage in criticizing or defending a person. I can't say I always live up to this, but I have been in the position of being a group member where someone who was not there was criticized for her food choices. I was offended this was allowed to go on in the group, and I left the group for quite due to my ethical dilemma with this situation. 

When I went back to the group, the dietitian actually let me work with the group. We focused on specific philosophical questions that were directed inward.

"What have you had to let go of within yourself to improve your life (after surgery?)" 

"How do you handle difficult, embarrassing, or tough situations with people who judge you for having surgery?" "What can you choose to do differently this week to be successful?"

"How have you implemented exercise into your daily life?"

The ideas shared were always inspirational. As a group, everyone had insight in their own behaviors and most of us could relate to other people in the group's experiences. It was uplifting to attend group at that point. We shared and laughed and grew together. That's what this journey is about, finding yourself and others to grow with and share your experiences. We don't all have to be friends, but we should ALL be nice to each other.

Bullying in the Bariatric Community

Some might say that after my snarky posts about the Weight Loss Surgery Foundation of America, that I wouldn't care to be there this weekend to Meet and Greet with so many of the wonderful, honest and supportive, lovely people I know there enjoying themselves.

Quiet frankly, I wholeheartedly support the social bonding that goes on in the organizations that exist for weight loss surgery patients and I continue to support the communities people have established to raise awareness of the obesity issues.  I especially want to send out a shout out to all of you there.

However, I want you all to remember to act nice, be pleasant to one another, and remember that we each have our own story.  Treat others with respect, kindness, and act like responsible adults.  Take care of yourself, first and foremost.  If you choose to imbibe, please limit your libations.  You are a grown person, and you need to act like it.  Please do not bully others, take part in the bullying, or let someone else be bullied.

 Size of your ego matters.  The words of truth matter.  Being a good person and act out of compassion of other's struggles:

THIS IS WHAT TRULY MATTERS.  

Being a "Bad Girl" does not mean doing bad things.  It means finding yourself, being open to other ideas, going outside of your personal beliefs and cultural norms to except other human beings' experiences.  Practice humility.  Have patience.  Let LOVE guide your actions. Take pride in behaving like a lady, cursing like a sailor, swinging your chickens like a Voodoo Queen, 

(Well, maybe Elvis, y'all are in Vegas-- Swing yo' batwings like a Diva!)

ALL IN ALL, my best advice to each of you is:

And if someone isn't playing nice, just tell them to go "Go have a Cupcake!"

 Peace be with each and all of you.  Save travels, good fun, and Be Sweet.

Being a Bad Girl means to change how you think, look inside to find peace within. 

Response to Criticism / Recovery Gardens?

Is it so hard to think about the Lapband procedure as being, "Outdated?"

The fact of the matter is that we have advanced in our scientific abilities to aid in the correction of obesity.  The vertical sleeve gastrectomy and gastric bypass procedures have less maintenance physically over the long term, though still pose significant risks.  Those risks include but are not limited to: comorbid disorders, surgical complications, metabolic conditions that continue, develop or ensue-- also, the treatment of risky behavior patterns not being addressed in the post operative education. The maintenance of restriction coupled with external risk factors, flu viruses and food poisoning causing vomiting alone are instances that could potentially do damage to the position of the band.  Erosion, malfunction, and water retention-tightness issues are serious with the band procedure. It makes sense to alter the size of the stomach and require less food, educate post-ops on the choices, vitamins, nutrition and exercise will go much further and create greater successes than what science presented 15 years ago.  

So, this is my clinical position on the gastric banding procedures.  I recognize that in instances where improper education and/or significant health complications occur, the band over bypass or band over sleeve may become necessary for the treatment of obesity.  I get that.  However, I encourage our public health care system to initiate programs to promote healthy aftercare-- or for that matter, health care for obesity.

Is it so far fetched for us to consider initiatives that integrate public farms where people are allowed to come and volunteer their time, work on the farm for food credits during a harvest?  Is that too much to require of people?  We can all do our part in the obesity recovery. Dr. Connie Stapleton of Post Op & A Doc offers a program she calls "Your Recovery Garden." I love this imagery, this idea that we are always growing. Our bodies, our minds... we are in control of the growth process through our choice to educate ourselves through knowledge and experience.

Why can't each community establish recovery gardens like the one to be built in Seattle?  

The Paradox

It's all coming together in a conundrum of fury.  The cosmic disposition that there is no greater good, there is no working to help one another in our society.  The fairness of it all is that nothing is fair and life doles out harsh realities all the time.  Our government, corporate entities and non-profits lie and say they support a healthier society.  The responsibility is at the bottom (individual) to make the best choices possible.  We each have a personal responsibility to do the right thing.

I can not tell a lie.  I have done a lot of wrong in my lifetime.  I have made mistakes.  I have broken promises to others and myself.  I have lied, I have cheated, I have stolen... It's hard to admit your faults.  I admit this because I want it off my chest.  I have done wrong to those I love the most. Good intentions must be followed up with action to correct the wrongs we've done.  I have done that.  Despite having expressed remorse before for my actions, I went through it again this week to the two people in my life who have shown me the most love, my parents.  They are the ones who have bared the brunt of my horrible faults.  Unconditional love is a powerful thing.  I think my father shows the most of it.  He is a man of God, and he often says the wisest words.  My mom judges, but she judges against a list of character traits that she defines as moral and ethical, even when it can sometimes come across as harsh, she holds people to the highest standards.  And rightly so.

We should all live up to what we hold in the highest moral regard.  Our society doesn't respect or reward doing the right thing.  My true intention is to help as many people as possible live up to their greatest potential.  But I must start with myself.  I must release the grudges in my heart so they don't develop into ailments of the body and mind.

As I write this, I am dealing with a conflict.  Having standards and expectations from potential employers to act with integrity.  I received a job offer a week ago today.  That job offer came with full time, salaried and benefited employment.  It quickly turned to "part time to start" and then an offer of "hourly, at a significantly reduced rate."  While I was ready to concede on full time to part time to start, when the hourly offer rolled in, I had enough.  I had to put a stop to it.  I have a master's degree and I am less than a year shy of my license (maybe not now, it may take longer to get licensed given the employment ordeal right now.)

Our society has lowered standards, holds less regard for experience and education, has put quality as a lower priority than worth.  Overall, I must value myself as a clinician, as a human.  So, I turned down a job offer because it became less of an offer and more of an internship.  At 6 years out from a graduate degree, I should not be lowering my standards for sub-par circumstances of intention.  The energy I would put into my clients is going to be invested in myself right now.  I know I have a lot to offer.  I know I am capable of creating great things.  I have and will

Binge Eating Disorder Awareness & Treatment

What is Binge Eating Disorder?  It's characterized as compulsive overeating while feeling powerless to stop.  This can happen alone or in social settings, and many don't recognize the behavior if it does not result in weight gain.  Binge eaters often eat when they are not hungry, not registering what they are eating or tasting their food. Those who suffer with binge eating disorder often struggle with feelings of guilt, disgust, or depression, worry about the consequences of their episodes, and beat themselves up for their lack of will power or allow it to negatively effect their self esteem. For more information about binge eating disorder, please reference the information available at http://www.helpguide.org/mental/binge_eating_disorder.htm

Behavioral traits of binge eating disorder: 

Inability to stop eating or control what you're eating

Rapidly eating large amounts of food

Eating even when you're full

Hiding or stockpiling food to eat later in secret

Eating normally around others, but gorging when you're alone

Eating continuously throughout the day with no planned mealtimes

Biological and psychological sciences are finally catching up on efforts to concentrate resources on research in binge eating disorder. Overshadowed by decades of focusing on anorexia and bulimia, we now see emerging data on the involvement of opioid, dopamine, and norepinephrine systems' influence on eating behaviors.  While treatment of dopamine and serotonin dysfunction may not completely resolve the influence of adipose tissue-derived hormones,  the improvements derived from healthy lifestyle changes supports the overall success of patients.  Exercise may lead to decrease anxiety and depression symptoms, improving mood and outlook on life. 

There are an increasing number of pharmaceuticals being approved to address binge eating disorder.  As a clinician, I have long resisted the approach to use prescription pharmaceutical to address behavioral issues, it can be a last resort that can make all the difference in the world. I allow snips of my personal struggle here on the blog sometimes, and here it is.  I started a new medication and realized that what I thought was "doing well" mentally, was not in fact doing well.  I realized I needed to address the issue, and I now feel better having discussed it with my doctor and the addition of a new medication. If you exhibit uncontrollable eating behaviors, there are several prescription options that may help you regain control.  These eating behaviors are compulsions, just as anxiety and depression are treated with anti-depressants, so can the dependency developed on food.  Talk to your doctor.  It is important to consider all factors related to the concerning behaviors and move forward with (self) care. 

In recent years, several medications used for other conditions have been approved to be prescribed to assist with weight loss.  Talk to your doctor about what you're currently on, and which of these medications might work for you.  The following are a few of the medications that have or will soon be approved to assist patients with weight loss: Paxil, Zoloft, Topamax, Adderall, and Vyvanse are leading the way.  Another in clinical trials is the drug, Nameda, a drug created to treat Alzheimer's. These are a few of many drugs being used to treat obesity, off-market from their creation. Some are approved by the FDA and some are not. 

Discuss with your doctor, GET A PRESCRIPTION, be responsible and journal the changes you notice in your mood, attitudes and behaviors.  Be responsible for your mental health by keeping a health journal.

I can stress how important it is to be mindful of your own body.  As you start any new regime, journalling can help you and your doctor identify what's working and what's not.  As you might begin to feel more control over your behavior, be empowered to make better choices - changing obsessions and compulsions comes from finding something else that is more health and productive to do with that time.  I find it helpful to stop, put whatever it is I'm eating down, and do something physical -- grab two water bottles and exercise -- build strength in regaining self control.  Record what you did, find new things to do!  I love personal training videos online, and I'm now collecting a catalog of quick videos to do when I need to distract myself from the binge. 

While all the research out there on binge eating disorder recognizes it as a disorder, insurance companies still struggle to accept the worth in covering behavioral issues with counseling. They are quick to prescribe, but psychiatric medication isn't always the best answer. Sometimes, it is simply accepting new realities and developing good self care routines. If you've had weight loss surgery, you now have the added stress of a tinier tummy.  The negative impacts on binging after weight loss surgery can result in dumping, discomfort, convulsions, stretching of your pouch: nevermind the damage it does to your teeth and esophagus.   Realize, it is actually possible to still attempt to eat large amounts of food for the tiny gastric fuel tank, but why?  You are going to cause more harm and be more uncomfortable than you should be.  This nervous, compulsive behavior must be addressed.  

When your surgeon's staff gave you the book and said, "Live by these rules," they weren't suggesting it.  They were requiring it.  If you find you are not living by those rules and you can not help but continue to do harmful things to your body, it might be time to seek further help in recovering from food addiction. We have to find out how to address the compulsive behavior - a WLS patient eating large amounts of food versus normal people eating large amounts are different amounts of food, but even with a smaller portion, we can exhibit the same behaviors - eating too fast, not chewing, making unhealthy food choices.  The key is mindfulness and behavior regulation. You are not in a competition with others to see how fast or much you can eat - it's not a race to the finish, it's a mindful allocation of nutrition. The rules change when you cut your gut, if behaviors stay the same your may push your chances to succeed further  from your reach. 

FitBit, how I love thee

If you keep up with my blog, you'll know that it is rare that I endorse anything.  The only thing I really try to endorse here is positive mental health and well-being.  On occasion, I will endorse another blogger who is doing it right.  I tend to leave product endorsements to those said bloggers too, but this time, it's personal.

For over two years, I heard about this great little device called a FitBit.  Everyone I knew who had one, loved theirs.  In January, I bought myself one because it sounded like a great thing. IT WAS THE BEST  investment I have made since weight loss surgery, though maybe I shouldn't say that since WLS caused me a lot of mental, emotional and health trauma, but I still don't regret the decision.

However, last week, I washed my FitBit.  I was completely devastated. One of my friends from high school posted on Facebook that they would replace it for free if you are an active user and you lose it, break it, wash it, etc.  So, two days after trying everything their help file would render, bag 'o rice, blow dryer (ok, that way my ingenuity,) my sweet FitBit did not turn on.  I had a super sad.  Like, Super Duber Grumpy Cat quality sad.

Imagine my delight when I received an email yesterday evening telling me all I had to do was this:

Write your Case # in a picture with your FitBit. 

And BINGO, they will send me a replacement. I am sad that I will not have it for the AllState Sugar Bowl Crescent City Classic this weekend. But I can live without it for just a little bit longer. Thank you, FitBit, for doing it right.

Obesity changes your brain

From a 2012 article in the journal, Nature Neuroscience, there are links to a high fat diet, neurogenesis and obesity in mice. The study put mice into two groups: those fed a normal diet and those who feasted regularly on high fat foods. After 1 month of chowing down, adult mice on high fat diets had quadruple the rate of new brain cell growth in the hypothalamus, a part of the brain responsible for regulating many metabolic processes. How does neurogenesis play a role in obesity?

To answer this question, researchers irradiated the newly created portions of rats’ brains. Not only did radiation inhibit 85% of neurogenesis, but irradiated mice gained significantly less weight and fat mass compared to the group that kept their new neural growth—even though all of them stayed on the same high fat diet. Furthermore, irradiated mice used more energy and were more active despite their unhealthy diet.

Our methods to treat obesity link, between diet and exercise, leave our the neural impacts on the brain. It's rather is thought-provoking, the connection has yet to be completely figured out in humans. There is still a mystery that lies within our genes, gene expression, hormones, stomach bacteria and how certain foods trigger desire for other foods.

Social scientists are pointing at the addiction to food in the brain and the link to chemical additives in what we eat. A 2012 study from the University of Amsterdam found that challenging cognitive training lowered addiction symptoms in individuals with a drinking problems. People who trained not only drank less—they actually improved memory capacity as well.

We must retrain our brains by diligently adhering to a plan. Set yourself up for success by planning for your week on Sunday; cut prep, plan your exercise and execute your plan. When you go off plan, make a mental note as to why, what prevented you from sticking to it, how you can do it better, and get right back on plan. Avoid idle time in front of the TV, if you are sitting in front of the TV, you could be exercising. In a recent study, LSUHealth Science Center found people ate 25% more when they had meals in front of the television, as oppose to those who sat down as a family to eat together at the table.

Change your lifestyle, change your life. You might still have genetics to fight, but you are one step closer to breaking bad habits and reprogramming the chemicals in your brain to like doing good things for yourself, like eating healthy foods and exercising. You may never love them, but doing them will help you do good for yourself.