So Monday I met with the new doctor based on the recommendation of my PCP. He's a specialist in diabetes and thyroid. My thyroid labs shows everything is normal but just kissing the top of the normal range - everyone seems to feel this is fine so it's not a concern. I don't have diabetes but my past history with PCOS (polycystic ovarian syndrome) is usually a pre-cursor to diabetic issues because of the insulin resistance. So seeing this doctor (Dr. T.) was a logical choice.
Just a reminder.... I'm seeing this doc as part of my attempt to figure out why I'm not losing weight. I haven't lose anything in 15+ months and nobody can figure out why because I'm consistently in a calorie deficit and should, in theory, be losing 2 pounds per week.
Dr. T. had obviously reviewed my file before he saw me and was very familiar with WLS in general - so that was encouraging. One thing he told me that I was a bit surprised about. Even though all my outward symptoms of PCOS have disappeared with the weight loss, all the hormonal havoc that goes along with PCOS is still going on inside my body. And the reactive hypoglycemia is probably a direct result of the insulin resistance portion of PCOS in combination with RNY. So remember back when I discovered that PCOS was the root of my obesity and inability to lose weight? Yeah... so now I'm feeling that resentment all over again. I had mistakenly thought the PCOS was gone and no longer an issue for me. Dr. T. confirmed that because of the PCOS (and even with WLS) that I need to work three times as hard as anyone else just to lose the same amount as someone without PCOS.
We talked about my food journaling and my average of 1300-1400 calorie intake. He was fine with those numbers and said to keep journaling and to keep my intake within that range. (Good, because that seems to be where my body is comfortable with food.)
We talked about my GoWearFit and that I knew I was burning about 2100 calories on a sedentary day and 2300-2400 on an active day that included exercise (which wasn't often these days). He wants me to burn an extra 300 calories every single day. Which for me is about 1 hour brisk walking (or similar to what I'd burn during a 5k race with a time of around 50 minutes). Ummm.... I could have said "sure, I'll do that" - but I know it's not a real possibility at least 3 of the days of my week. I'm barely keeping my head above water on school days and I can't see an extra hour hanging around anywhere in my schedule. So I told him the truth and he accused me of being resistant to his suggestions (I can't remember his exact words, but they weren't nice). Would he rather I lied to him? We had discussed my schedule so he knew I was gone from 7am to 11pm most days of the week. I dunno - kinda pissed about that whole discussion. To me it smacked of those typical doctor recommendations of "eat less, move more".
We discussed that my GYN has taken me off the Depo Provera as an attempt to help me lose weight. (He didn't think that'd make much difference.) So no Depo means I'm not taking anything for birth control (not that you need birth control when you're not having sex, of course) -- but he was concerned that I was not taking anything to help control the PCOS and endometriosis. So he's asked me to contact my GYN and ask to be put on a low estrogen birth control pill. He thinks this will help with the hormonal imbalance from PCOS and also assist with my bone recovery related to the osteopenia. I'll call Dr. O and see what he thinks.
(I know this is getting long, I'm sorry but it was a big appointment with lots of info.)
Ok, so here's the BIG one. Dr. T. asked me to try a diet pill. OMG right?! That was a huge shock to me and I seriously balked at his suggestion. Why would I need to take a diet pill when I have the best tool for controlling obesity right inside my body? Why can't we just make my RNY work again? I hate the idea of a prescription diet pill. Hate it. Hate it. Hate it. It makes me feel like a failure. I couldn't lose weight on my own pre-op - I was a failure. So I had RNY. I lost for 10 months with RNY but then I couldn't lose any more weight no matter how hard I tried - another failure. And now I'm told I need a diet pill to make me lose the last 30 pounds. Sure does feel like another failure. It makes me cry when I think about it too much. So yeah, I hate this part a lot.
Even when Dr. T. gave me the Rx slip I still wasn't sure if I was going to do it or not. You know me, I had to do the research on it. The drug is called Adipex. It's designed for short term use to help jump start weight loss. It's a slow-release drug, so not sure how that would work with my shortened digestive system since we are discouraged from using slow-release drugs. The drug is designed to do two things. It boosts metabolism slightly. But mostly its an appetite suppressant -- which seems silly for me since I don't really get hungry post-op and controlling my eating is not a problem. So I'm not sure what the appetite suppressant part of the drug will really do for me. One of the big side effects is jitters and possible high blood pressure. A lot of people who report on their experience say they had huge amounts of energy because of the stimulant of the drug - but also that they had difficulty sleeping because they were so wired.
After the research and some soul searching, I finally decided to give this a try. No, I'm not happy about it at all - but after re-reading my post about all the work my medical team was doing -- and my commitment to do whatever it'll take to figure this thing out. I guess that answered my question, huh? I gotta try, at least. I don't have to be happy about it, but I gotta try. I took my first dose this morning.
So in addition to the Adipex I'm also going to redouble my efforts in food journaling -- being more faithful with recording stuff every day instead of just a few times a week -- and also with figuring out how to exercise more. Even if I can only find time to workout 3 or 4 days a week when my schedule isn't "quite" as packed, I'll do what I can (shoveling snow counts since we got 8" last night!). School is done in 5 weeks so my time crunch should let up a bit soon (until next semester of course). I'll work on fixing the treadmill today - replacing the motor that's been dead (I've got the replacement part, just need to see if I can install it properly). I'll get my Gazelle back from my parents and have that as variety to the treadmill. Just read about the health benefits of skipping rope, I might even dig my old rope out and give it a try. I'm going to try. I see Dr. T. again in a month.
So there you go. It's all been weighing on my mind ...but oddly, it feels a tiny bit better to have it all written out here and out of my head. Thank you all for your support and encouragement.
~Pam
Showing posts with label PCOS. Show all posts
Showing posts with label PCOS. Show all posts
Wednesday, February 10, 2010
Thursday, October 12, 2006
What I've Learned About PCOS ...
In the past few weeks I’ve learned a lot of new things about how my body is working – or not working, actually. I’ve read so much information that my poor brain is in information overload these days. So I thought I’d share a bit of it here in case it might help others who have PCOS and also share some resources that I’ve found helpful.
What is PCOS?
Polycystic ovary syndrome (also known clinically as Stein-Leventhal syndrome), is an endocrine disorder that affects 5–10% of women. It occurs amongst all races and nationalities, is the most common hormonal disorder among women of reproductive age, and is a leading cause of infertility.
The symptoms and severity of the syndrome vary greatly between women. While the causes are unknown, insulin resistance (often secondary to obesity) is heavily correlated with PCOS.
What are the Symptoms?
However, as PCOS symptoms worsen, insulin resistance also gets worse, which then causes additional weight gain, and with additional weight gain the symptoms of PCOS get worse again … and the circle continues. So getting just one part of that circle under control will help to stop the cycle.
How Does Insulin Work?
Insulin is a hormone secreted by the pancreas. It helps the body convert food into energy by converting carbohydrates into blood glucose which is used by cells to run the mechanics of our body. Once converted, glucose can pass from the blood stream into the cells that need energy to function. Inside the cell, glucose is either used for energy right away or stored for future use in the form of glycogen in liver or muscle cells.
The body’s capacity to store glycogen is limited and can be depleted quickly (10-12 hours). The average person can store approximately 300-400 grams of carbs (once converted to energy) in your muscles and about another 75-100 grams in the liver. (For comparison, 100 grams of carbs is equivalent to about 2 cups of cooked pasta.) When both the liver and muscles are glycogen full, excess carbohydrates are stored in adipose tissue or body fat.
What is Insulin Resistance?
Insulin resistance occurs when the normal amount of insulin secreted by the pancreas is not able to properly make the conversion of food into energy because of some defect in the process (researchers are still trying to figure out the “why’s”). Because the first release of insulin didn’t do the job it was suppose to, the pancreas secretes additional insulin to maintain the proper level of blood glucose. Eventually our body stops responding to the excessive amount of insulin and will not be able to use the food you eat as energy – thus those calories are quickly stored in adipose tissue (body fat). Eventually tests will show that insulin levels will stay high over time, when it should instead go up with each meal and then return to normal. And if blood glucose levels remain high for extended periods of time, it essentially blocks our body’s ability to use fat cells for energy.
What’s the Solution?
Diet, lifestyle and medication are the most common recommendation in the research that I’ve read. For decades doctors have recommended the same types of diets for their patients to lose weight - low-fat / high-carb / caloric restricted diets with moderate exercise. However, for PCOS and Insulin Resistant patients these types of diets will actually worsen the symptoms – and this new research seems to be slow in getting into the doctor offices of our primary care physicians.
Doctors are still recommending the same, across-the-board diets no matter what types of illnesses their patients have. But the plan an insulin-resistant patient should be following is actually low-carb / high-protein / moderate-fat type of diet with a daily vigorous exercise program. Your diet should have 30-40% of total calories coming from carbs, 40% coming from protein and the remainder from “good” fats. Avoiding refined / processed carbs is the key and trying to eat as close to whole foods as possible – such as whole wheat bread rather than white bread or old fashioned oatmeal rather than the little packets of instant. Or better yet, concentrating on getting your carbs from veggies, fruits, nuts and seeds instead of wheat or grain products. There is also some medications that can aid in putting insulin levels back in balance and I plan to explore these further and talk to my doctor about this option.
What did I do wrong?
I’ve been dieting for months now – actually about 14 months – and have had very little success.
I lost 24 pounds in the first 4 months, then not another single pound for 6 months after that. No matter what I tried (diet change, workout change) I couldn’t lose any more weight. I continued eating right and exercising during that 6 month plateau. But eventually I got weak, frustrated and discouraged. Over the last 4 months, I gradually cut back on my workouts – from 6 days of intense workouts to 3 days a week. I saw the weight creep back on slowly but I just didn’t have the heart to go back to the intense workouts that were doing nothing for my weight loss.
I also talked to my doctor about what I could do to make things work better. Instead of any real help, my doctor (fully aware of my PCOS) simply “patted me on the head” (metaphorically, of course) and told me to use more willpower and I’d lose the weight.
At that time I didn’t know about the connection between PCOS and weight - is it right to assume he didn’t either? He’s my doctor; I should feel like I can trust him when it comes to my health. Unfortunately, I no longer have that trust.
But now that I know about the connection between carbs, blood sugar levels and my insulin resistance (I haven’t been tested yet, but all the signs are there) --- I can look back at my food journal and know that I wasn’t eating right for my condition. Instead of the 40-40-20 formula I was eating 60c-20p-20f. WOW! No wonder my body was rejecting my weight loss efforts. I was sabotaging myself and didn’t even know it.
The online food journal was estimating that I should have been losing 30 pounds every 10 weeks. If that were true, then would have lost 150 pounds within a year. But the calories-in vs. calories-out theory that may hold true for healthy people, does not apply to those who have a metabolic issue that prevents weight lose.
Resources
I’ve done a ton of research and have found several great resources. All of the information above has been collected from various websites and books I’ve found in the past few weeks. I’ll share several resources here:
The International Council on Infertility Information Dissemination, Inc.
This website focuses on infertility, however they have an outstanding section on PCOS that I found the most helpful. The FAQs are thorough and covers many things that other sites do not.
Soul Cysters
This is a “support group” type website with forums and discussions with women who have PCOS. The “Research” section is comprehensive and in depth. I haven’t fully explored all there is to find at this site, but it is at the top of my to-do list.
Polycystic Ovarian Syndrome Association
This website is an actual association where doctors, professionals and patients can join for a fee. However, there is a ton of great information here. I especially enjoy the forum section where people are discussing their treatments and symptoms.
Natural Health Solutions for PCOS
Dr. Nancy Dunne dedicated her medical practice to the treatment of PCOS after her daughter was diagnosed. She takes a natural approach to the treatment of PCOS and its symptoms through a specialized diet of whole foods and the elimination of wheat/grains and dairy products. The resources here are abundant and often have a different spin from other researchers because of her natural approach. She has also written a book (either hard copy or downloadable e-book) that has more information than you ever thought you needed to know! I bought it and am about ¼ of the way through so far.
This post has gotten really long, so I’ll close for now. As I learn more about PCOS and how it affects my weight loss journey, I’ll share it with you here.
Talk to you later
~Pam
What is PCOS?
Polycystic ovary syndrome (also known clinically as Stein-Leventhal syndrome), is an endocrine disorder that affects 5–10% of women. It occurs amongst all races and nationalities, is the most common hormonal disorder among women of reproductive age, and is a leading cause of infertility.
The symptoms and severity of the syndrome vary greatly between women. While the causes are unknown, insulin resistance (often secondary to obesity) is heavily correlated with PCOS.
What are the Symptoms?
- Irregular menstrual periods - no menstrual period, infrequent menses, and/or irregular bleeding. Any type of irregularity could be a symptom of PCOS.
- Oligo or anovulation (infrequent or absent ovulation) — While women with PCOS produce follicles — which are fluid-filled sacs on the ovary that contain an egg — the follicles often do not mature and release as needed for ovulation. It is these immature follicles that create the cysts.
- Hyperandrogenism — Increased serum levels of male hormones. Specifically, testosterone, androstenedione, and dehydroepiandrosterone sulfate (DHEAS).
- Infertility – often the result of anovulation.
- Cystic ovaries — Classic PCOS ovaries have a "string of pearls" or "pearl necklace" appearance with many cysts (fluid-filled sacs).
- Enlarged ovaries — Polycystic ovaries are usually 1.5 to 3 times larger than normal.
- Chronic pelvic pain — The exact cause of this pain isn't known, but it may be due to enlarged ovaries leading to pelvic crowding.
- Obesity or weight gain or the inability to lose weight — Commonly a woman with PCOS will have what is called an apple figure where excess weight is concentrated heavily in the abdomen.
- Insulin resistance, hyperinsulinemia, and diabetes — Insulin resistance is a condition where the body's use of insulin is inefficient.
- Elevated LDL and reduced HDL cholesterol levels, as well as high triglycerides.
- High blood pressure
- Hirsutism (excess hair) — Excess hair growth such as on the face, chest, abdomen, thumbs, or toes.
- Alopecia - male-pattern baldness or thinning hair
- Acne/Oily Skin/Seborrhea — Oil production is stimulated by overproduction of androgens.
- Seborrhea is dandruff — flaking skin on the scalp caused by excess oil.
- Acanthosis nigricans (dark patches of skin, tan to dark brown/black) — Most commonly on the back of the neck, but also but also in skin creases under arms, breasts, and between thighs, occasionally on the hands, elbows and knees. The darkened skin is usually velvety or rough to the touch.
- Acrochordons (skin tags) — Tiny flaps (tags) of skin that usually cause no symptoms unless irritated by rubbing.Prolonged periods of PMS-like symptoms - bloating, mood swings, pelvic pain, backaches Source: INIID
However, as PCOS symptoms worsen, insulin resistance also gets worse, which then causes additional weight gain, and with additional weight gain the symptoms of PCOS get worse again … and the circle continues. So getting just one part of that circle under control will help to stop the cycle.
How Does Insulin Work?
Insulin is a hormone secreted by the pancreas. It helps the body convert food into energy by converting carbohydrates into blood glucose which is used by cells to run the mechanics of our body. Once converted, glucose can pass from the blood stream into the cells that need energy to function. Inside the cell, glucose is either used for energy right away or stored for future use in the form of glycogen in liver or muscle cells.
The body’s capacity to store glycogen is limited and can be depleted quickly (10-12 hours). The average person can store approximately 300-400 grams of carbs (once converted to energy) in your muscles and about another 75-100 grams in the liver. (For comparison, 100 grams of carbs is equivalent to about 2 cups of cooked pasta.) When both the liver and muscles are glycogen full, excess carbohydrates are stored in adipose tissue or body fat.
What is Insulin Resistance?
Insulin resistance occurs when the normal amount of insulin secreted by the pancreas is not able to properly make the conversion of food into energy because of some defect in the process (researchers are still trying to figure out the “why’s”). Because the first release of insulin didn’t do the job it was suppose to, the pancreas secretes additional insulin to maintain the proper level of blood glucose. Eventually our body stops responding to the excessive amount of insulin and will not be able to use the food you eat as energy – thus those calories are quickly stored in adipose tissue (body fat). Eventually tests will show that insulin levels will stay high over time, when it should instead go up with each meal and then return to normal. And if blood glucose levels remain high for extended periods of time, it essentially blocks our body’s ability to use fat cells for energy.
What’s the Solution?
Diet, lifestyle and medication are the most common recommendation in the research that I’ve read. For decades doctors have recommended the same types of diets for their patients to lose weight - low-fat / high-carb / caloric restricted diets with moderate exercise. However, for PCOS and Insulin Resistant patients these types of diets will actually worsen the symptoms – and this new research seems to be slow in getting into the doctor offices of our primary care physicians.
Doctors are still recommending the same, across-the-board diets no matter what types of illnesses their patients have. But the plan an insulin-resistant patient should be following is actually low-carb / high-protein / moderate-fat type of diet with a daily vigorous exercise program. Your diet should have 30-40% of total calories coming from carbs, 40% coming from protein and the remainder from “good” fats. Avoiding refined / processed carbs is the key and trying to eat as close to whole foods as possible – such as whole wheat bread rather than white bread or old fashioned oatmeal rather than the little packets of instant. Or better yet, concentrating on getting your carbs from veggies, fruits, nuts and seeds instead of wheat or grain products. There is also some medications that can aid in putting insulin levels back in balance and I plan to explore these further and talk to my doctor about this option.
What did I do wrong?
I’ve been dieting for months now – actually about 14 months – and have had very little success.
I lost 24 pounds in the first 4 months, then not another single pound for 6 months after that. No matter what I tried (diet change, workout change) I couldn’t lose any more weight. I continued eating right and exercising during that 6 month plateau. But eventually I got weak, frustrated and discouraged. Over the last 4 months, I gradually cut back on my workouts – from 6 days of intense workouts to 3 days a week. I saw the weight creep back on slowly but I just didn’t have the heart to go back to the intense workouts that were doing nothing for my weight loss.
I also talked to my doctor about what I could do to make things work better. Instead of any real help, my doctor (fully aware of my PCOS) simply “patted me on the head” (metaphorically, of course) and told me to use more willpower and I’d lose the weight.
At that time I didn’t know about the connection between PCOS and weight - is it right to assume he didn’t either? He’s my doctor; I should feel like I can trust him when it comes to my health. Unfortunately, I no longer have that trust.
But now that I know about the connection between carbs, blood sugar levels and my insulin resistance (I haven’t been tested yet, but all the signs are there) --- I can look back at my food journal and know that I wasn’t eating right for my condition. Instead of the 40-40-20 formula I was eating 60c-20p-20f. WOW! No wonder my body was rejecting my weight loss efforts. I was sabotaging myself and didn’t even know it.
The online food journal was estimating that I should have been losing 30 pounds every 10 weeks. If that were true, then would have lost 150 pounds within a year. But the calories-in vs. calories-out theory that may hold true for healthy people, does not apply to those who have a metabolic issue that prevents weight lose.
Resources
I’ve done a ton of research and have found several great resources. All of the information above has been collected from various websites and books I’ve found in the past few weeks. I’ll share several resources here:
The International Council on Infertility Information Dissemination, Inc.
This website focuses on infertility, however they have an outstanding section on PCOS that I found the most helpful. The FAQs are thorough and covers many things that other sites do not.
Soul Cysters
This is a “support group” type website with forums and discussions with women who have PCOS. The “Research” section is comprehensive and in depth. I haven’t fully explored all there is to find at this site, but it is at the top of my to-do list.
Polycystic Ovarian Syndrome Association
This website is an actual association where doctors, professionals and patients can join for a fee. However, there is a ton of great information here. I especially enjoy the forum section where people are discussing their treatments and symptoms.
Natural Health Solutions for PCOS
Dr. Nancy Dunne dedicated her medical practice to the treatment of PCOS after her daughter was diagnosed. She takes a natural approach to the treatment of PCOS and its symptoms through a specialized diet of whole foods and the elimination of wheat/grains and dairy products. The resources here are abundant and often have a different spin from other researchers because of her natural approach. She has also written a book (either hard copy or downloadable e-book) that has more information than you ever thought you needed to know! I bought it and am about ¼ of the way through so far.
This post has gotten really long, so I’ll close for now. As I learn more about PCOS and how it affects my weight loss journey, I’ll share it with you here.
Talk to you later
~Pam
Thursday, October 05, 2006
PCOS Insulin Resistence & Weight Loss
 |
| PCOS Support Groupswww.ProjectPCOS.org |
So I'm just coming off of 14 months of self-imposed dieting, exercising and self sacrifice because I knew I needed to give my hardest and most dedicated effort before I even thought about WLS. I consulted my doctor several times (2 different doctors, actually) throughout the process and mostly just got a pat on the head and was told to keep up the good work, stick with the plan and just have more willpower.
So this past August I finally gave up in frustration after losing a mere 24 pounds then putting them all back on during the dieting process -- and decided to go forward with having weight loss surgery to help me get healthy. Up until about 2 weeks ago I've been at peace with my decision to have WLS. Then I read something on some message board or forum somwhere that caught my attention. Someone mentioned that they had PCOS (polycystic ovarian syndrome) and that it contributed to her weight gain and her inability to lose weight before her surgery.
This shocked me. I was diagnosed with PCOS over 5 years ago and never knew there was a connection with my weight. Oh sure, the doctor gave me a pamphlet that explained what PCOS was and a general overview of the disease, but he never mentioned anything to me about what "other" things go on with my body besides the primary problem (the cysts). And silly me trusted that his pamphlet of information and his little chit chat was the whole truth.
So I started doing some research a couple weeks ago based on that random comment from some un-remembered person.
Honestly, right now I'm so angry with what I've learned. Not angry that I know so much now, but angry that my doctors sat idly by while I've struggled with my weight, never once mentioning to me that the PCOS could very well be the reason for the rapid weight gain, the reason for the terribly difficult time I was having losing the weight and that all these other mysterious symptoms and annoyances could all be related to this one disease.
The thing that gets to me the most is that after reading all this, I believe I am insulin-resistant and that if I'd only followed a very different diet plan that the past 14 months of dieting could actually have worked for me.
What's more ... there's actually drugs that have shown proven results for PCOS patients in their quest to control the insulin inbalance and actually HELP them lose weight.
So my dilemma?
Now I know there's another option out there for me. Even though I've gone through this entire process to prepare for surgery and am about to have my paperwork submited for insurance approval --- I feel like I can't ignore all this.
I need to speak to somebody who can answer all these questions for me. And I know right now that I don't trust my PCP or even my GYN to help me because I have this huge amount of anger toward both of them. I can't move forward with surgery and still feel at peace.
Does anyone have a suggestion for a doctor who might be able to help? Someone who specialized in weight loss, general medicine, GYN and can do a complete analysis of my overall health and maybe suggest which way I should go.
Because right now I'm feeling pretty lost.
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