New Doctor and Med Changes

Visiting the doctor is very different from what it was a year ago. It used to be that the doctor would look at his chart, look at me, look back at the chart, shake his head and mumble before beginning the lecture of how I was shortening my life and how badly I needed to lose weight. It was always the same. Today, I had to see the doctor to get some meds refilled. Because of insurance changes I was changing doctors so this was a new one. As part of getting my medical history, it was necessary to walk her through everything that has happened over the last few years and the changes that have occurred during within the last ten months. I just love the shocked look on people’s faces when I show them the photo on my license which was taken when I was still over 400 lbs.

The interesting thing was when we went through the usual questions about current condition. My A1C and cholesterol are fine. I am off my C-PAP. I went off of one blood pressure medicine months ago. My testosterone shot volume has been reduced. I am lighter, healthier, and much more energetic. All these are things I’ve shared here before. I haven’t even had a gout flare in a couple months. During the conversation, the doctor asked if I have any medical complaints I needed to talk to her about. This was the first time that I had to think for quite a while to come up with something. I finally remembered the pain in my elbow from lifting, and she recommended an over-the-counter cream—I just used it and it worked wonders. There was really nothing else to discuss but the changes she was making to my final blood pressure medicine—my blood pressure had dropped lower than it should, showing I was now overmedicated.

I’ve been on Lisinopril for years. My dosage kept creeping up until they added HCTZ to it. Then they doubled my intake to twice a day. About a year before starting my health journey, the doctor added Amlodipine once a day, trying to keep me from stroking-out. Then came the change—no, not menopause. I started my health changes and after a few months the doctor dropped the Amlodipine. Today, my new doctor removed the HCTZ and cut my Lisinopril dosage by twenty-five percent.

I don’t remember doctor visits ever being so fun. We talked and I shared what I’ve experienced and learned over the last few months. I also shared the way my life has changed from losing the weight. The doctor paid me two great compliments—I could get used to this. She said I should hang around and talk to her other patients who just don’t seem willing to make changes. She also, when handing me the obligatory reading material, said, “Here’s some information for you to read, but based on our conversation, you could probably write it.”

It is amazing the difference in doctor visits when you take control of your own health and make positive choices. Most doctors go into medicine to help people. They can only help those who listen. They are also greatly limited when so much of our health is determined by our life choices between visits. There is no magic pill/drink/food/shot/operation going to make you healthy. The only thing that will either sustain your health or rebuild it is wise choices. These choices about what you take in (diet) and how much you burn (exercise) have to be made day by day, moment by moment. You have to develop a habit of choosing health.

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Latest trip to the doctor

Yesterday (January 15, 2015), I saw my endocrinologist for the first time in four months. It was an interesting consultation because rather than see the one I’ve been with for two years the clinic put me with a new doctor. Since I wanted the doctor to have a full view of where I’ve come from (and because I know doctors are often too busy to read a new patient’s entire chart) I laid out my weight and condition a year ago so she would have a proper perspective on my condition today. She found it hard to believe that I had ever been 425 lbs. I did this partly because I was a bit worried about the blood results since I have had to change my diet so much from where I was several months ago.

You see, when I was doing the Medifast program through Take Shape for Life the diet was very low carb, low fat, high protein, and nutrient rich. I was easy to maintain this because the prepared foods conveniently provided all but one meal a day. However, since dropping off the program in September and switching to carb-cycling it has not been so easy. But, my emphasis was different so I had to switch.

When I first started, I was in terrible shape. I’m talking about even after I lost the weight. No part of the previous program included conditioning. But that is to be expected. I needed to lose weight far more than I needed to get in shape. Besides, I was in bad enough shape that any attempt to exercise before losing the weight would have just caused injury (425 lbs. is a lot of weight for your body to move—or stop, once it starts moving). Because of this, while on Medifast, I did little or nothing to build muscle, but only concentrated on burning fat.

After getting my weight down to a place where I could exercise without injury, I was still very out of shape and decided to slowly start changing that. For a couple months I rotated weight machines with cardio, doing higher carb on weight days and lower carb on cardio days. My cardio day was usually either an hour on the treadmill or 45 minutes in the pool. My weight days included doing a full spectrum of weight resistance machines so every major muscle group was hit each time. As my weight kept lowering and everything began tightening and toning, I started adding in some free weights.

After a couple months of toning and tightening, I decided it was time to start building lean muscle to attack my body’s BMI from the lean side. This would increase testosterone, raise my metabolism, and in this way burn fat faster when I returned to cardio and fat burning later. I have spent the last couple months doing a hard regiment of weights to build muscle. I’m in the gym five days a week. Saturday and Sunday are rest days for my body, because it is when you are at rest that your body repairs and builds muscle. Overworking causes problems as your body releases cortisol which will undo what you work hard to build. Tuesday and Thursday are leg days. Since these days are very hard on my back because it includes squats and stiff-legged deadlifts, I only go for about 45 minutes or so. Besides, the weights being moved on those days are much higher than on upper body days. I also do kettlebell goblet squats and kettlebell Turkish get-ups on those days to strengthen form and to build core. Monday, Wednesday and Friday I hit upper body (arms, shoulders, back, etc.). I have really been hitting shoulders, back and biceps hardest. This day is all free weights, along with kettlebell swings, and kettlebell snatch. Upper body days are 1 ½ hours in the gym—except on Friday which I hit extra hard so it gets close to 2 hours. I really want to deplete my muscle glycogen reserves before going into the weekend, and also give my muscles lots to repair. Besides, this makes it possible for my wife and I to go out or do something special on Friday, if we choose. If I’ve really thrashed my muscles, I may move slowly but I don’t have to be as careful about what I eat on dates with my wife because high carbs and even simple sugars will largely be gobbled right up replenishing muscle glycogen stores—at least much of it will.

This liberty on carbs was a bit of a hard learned lesson. I had such good results on low-carb and have had such a history of carb addiction and its related problems that I had developed a carb phobia. Unfortunately, when building muscle one the primary fuel is carbs. Because of my fear of carbs I tried staying “lower carb” without any simple sugars or starches while trying to build muscle. I was getting very minimal results. Once I learned the lesson about this I started cranking up the carb intake as an experiment. I did some study and tried hard to get most of my carbs from foods with a lower glycemic index and a lower glycemic load to regulate insulin. This too can go too far, because I learned that along with testosterone and human growth hormone, there is one other essential ingredient needed by your body to build muscle—insulin. It is insulin that tells your body whether to convert carbs into fat for later use or to push them into your muscles as glycogen. This means I had to actually undo habits I had developed over months and allow myself foods higher in sugars and carbs. Of course, it’s best to go with foods that are metabolized slowly to cause a more gradual and manageable uptick in insulin secretion rather than super simple sugars that will cause a major dump of insulin along with the sugar crash afterwards and trigger the cycle of carb craving.

It was this new addition to my diet that I found the most frightening as I waited in the doctor’s office wondering about my lab results. So, what were the results? Well, I’ve been on testosterone for over two years because my weight and sleep apnea trashed my endocrine system. Now, after losing the weight I can sleep without the C-PAP, and last visit the doctor decided to try lowering my testosterone injections. Now, the doctor has decided to try weaning me off of it, so it was reduced even further. We have to go slow, because my pituitary gland has become totally non-responsive because I was bringing in the testosterone from outside and it had no need to order my body to make it. Now, we have to slowly reduce it, and hopefully the pituitary will return to functioning normally—we find out in my next visit three months from now. I was pretty sure my T levels were getting better—and so was my wife—so there was no fear here.

My fear was about what my A1C would look like. When I started this quest for health, I was pre-diabetic. My doctor had warned me I was just a hairs breath from going into full blown diabetes, and would someday be insulin dependent if I didn’t make a change. My family has quite a history with diabetes and heart disease so I knew what these would entail. I wanted nothing to do with them. I feared that my higher carb consumption had brought this number back into bad territory. My prior time with the doctor showed me to be out of danger for diabetes. My latest numbers show my A1C unchanged—even with the higher carb intake. In her words, “You are in no danger of diabetes; your diet is right where it should be.” This was good to hear. I don’t think I’ve ever heard more beautiful words spoken by a doctor.

I still have things to work on. My plan is to switch from weights to cardio with low carb to move from an anabolic (muscle building) to a catabolic (fat burning) state and burn off the rest of my excess fat. I know I need to do it, but a couple things make me wary. One, I don’t want to lose any of the muscle that I’ve built. Two, I’ve developed an iron addiction—I absolutely love lifting weights! People told me that if I ever started working out I’d get addicted. I always told them they were high, because I hated working out, and had tried over and over but never enjoyed it. The secret was first losing the weight. Now I look forward to getting to the gym each day. If my day is busy enough to keep me from the gym I get very irritable. Often I’ll run into the house from my last appointment or meeting, quickly changed just to run back out the door to get to the gym. I even carry my weight belt, gloves and straps in the car, and if wearing workout pants and sweatshirt is appropriate, I’ll just dress for the gym all day and run straight there after any appointments. One day, my daughter said, “Oh my Gosh, Dad! You’re turning into one of ‘those guys’ at the gym.” Funny thing is she’s right.

Lose the weight! Start now! Forget about just making another New Year resolution to be abandoned at the first offer of a brownie or the first sight of a candy bar in the checkout line. Get into a program that works! But don’t just approach it as “a program” for now. It has to be a life change. Think of it as making a change for life, because if you are heavy and unhealthy as I was that is the only way to actually have a life.