Tuesday, September 3, 2013

Blogging and Fitness: Progress and Setbacks

So . . . how've you been since March?  Good?  Probably good.  You're not even reading this, are you?  You've stopped checking for updates, just because I stopped posting content, right?

Quitter. You are a quitter. Now let's talk about me.

The Good News:

The last time I wrote about my life, I was trying, not for the first time, to lose a lot of weight and get fit.  There's good news and bad news on that score today.  First, the good news: I've now lost over 100 pounds. I'm stronger than I've been in a long time, maybe ever, depending on how you measure it. I'm capable of balance and grace that I really thought were impossible for me. My blood pressure is around 120/80 most days, which is the upper end of normal, but normal. My resting heart rate is consistently between 50 and 60 BPM, which is lower than normal but consistent with hard cardiovascular training ( recently had my vitals taken regularly over a period of several days--more about that in a moment.

The Bad News:

The reason I had my vitals taken so regularly was that I had a small problem that had to be repaired with emergency surgery, followed by a short hospital stay. Years ago, when I was at my very most morbidly obese bodily volume, I had mysterious abdominal pain and a mysterious lump above my navel. One doctor diagnosed this as lipoma, a small fatty bump that forms under the skin on some people, but that's generally painless, and this was painful enough to cause nausea.  Other doctors diagnosed a hernia with fatty tissue (morbid obesity, remember?) becoming "incarcerated" and "strangulated" when it poked through.  I had surgery to repair it early in the summer, reasoning that I would have time to recover before school began.  I took the few weeks before surgery as a time to diet and exercise (with no coaching or guidance, of course.)  On the morning of the surgery, I weighed 396 pounds in a hospital gown.  I can't prove it, but I'll always be convinced that I once weighed over 400 pounds.  The surgery was an apparent success, but recovery was tough.  The standard advice is not to lift anything over 10 lbs. in weight for six weeks after hernia repair, and to avoid bearing down with the abdominal muscles.  There is no way to follow that advice without a powered lifting chair or bed when you weigh 400 lbs., so I did my best but screwed up repeatedly.  Still, I thought I'd recovered, and although I wasn't certain the hernia was gone, I told myself that I would exercise like a madman and lose the weight ASAP.  I'd get down to 300 lbs., maybe even a little lower!  I began exercising again about two months after the surgery, and for some reason that now eludes me, I decided that I would begin by running on the bleachers at my school. No, I can't think of any reason for a 400-lb. man to do that, either, but it turns out I didn't hurt myself doing it, because before I'd been doing it a week, an infection at the surgery site broke loose and I spent another week in the hospital, followed by a month at home giving myself anti-biotics through a PIC line (basically a fairly permanent IV line the patient can use to administer IV drugs at home.)

When I'd recovered from that, I went back to have the hernia repair repaired.  I was told that the last surgeon had tried a newfangled technique, but this guy was going to do something brutally simple, just sew a big mesh patch in place.  That would leave a big scar and the incision would hurt more as I recovered, but it would be strong like bull and I'd never see that hernia again. That sounded perfect to me. And I'd lost a little weight by that time, down to . . . about 350, I think?  Not enough, certainly. Again, I did my best, but getting out of a chair or off a bed was a major effort, and I couldn't afford to be bedridden.  I don't know whether I messed up, or they did, but it was clear almost immediately that the hernia was still there.  I went back to my doctor, who told me that if I could "reduce" the lump--squeeze it down until it went back inside, basically--I could put off attempting the repair again for a long time, maybe forever.  I never intended to wait forever, but I did think I'd wait until I got into better shape. Along the way, I lost and gained weight like a yo-yo; I went as low as 290 pounds, but I gained again until I was over 330 pounds.  Then, desperate, I joined Overeaters Anonymous, which turned out to be a bad move; I ballooned to 370 pounds before I gave up on that one.  Last year, after I left OA, I decided that I would go back to the only "diet" that had ever worked--low carb--and find a trainer to guide my exercise program. It worked.  I got lucky with my trainer, Wayne Carrels of HIPE Fitness, and I made rapid progress.  This summer, I plateaued around 280 pounds, but I could tell I was losing fat and adding muscle.  I considered going back to schedule a hernia repair, but by that time, I'd been living with it for years, and I was confident that I'd be much lighter and stronger next summer.  

That seemed smart until last Tuesday, when I found myself in nasty pain from warming up, then reached the point of dizziness a few minutes into a light workout.  I left the class and tried to reduce the hernia, tried to rest, tried to throw up.  Nothing helped much, and I allowed a friend to drive me to an Express Care (I still thought I'd end up reducing the hernia and breathe a sigh of relief.)  By the time we got there, I was fading in and out, pouring sweat, and apparently quite pale.  I was just trying to breathe slowly through the gut-twisting pain, but I heard people saying "BP 85 over 55" and "get two IV's, 18 gauge on both" and "America says the ambulance is a few minutes out."  It began to occur to me that I was in real trouble.  Long story short, nobody was able to reduce the stupid thing, and I had emergency surgery to remove 15cm of bowel and repair the hernia at 3:00 a.m.   It was the first day of school for my students.  I was not there.

The Silver Linings:

So here we are.  The hernia repair isn't the strongest; they couldn't use mesh because it raises the risk of infection (don't I know it?) and the bowel surgery is already an infection risk.  There's a possibility that I'll have to have the repair re-done yet again if it doesn't hold.  That means I've got to handle this recovery as well as I can.  But there are some bright spots here, mostly because my fitness level has changed so much:

  • I weighed 268 lbs. yesterday.  That means I'm about 125 lbs. lighter than I was the first time I tried to recover from hernia surgery, and although this procedure was a lot more disruptive than that one was, the recovery has been a lot easier so far.
  • I was up and walking much faster this time, out of bed the day after surgery and walking two days after.
  • I have some pain, but I haven't had to use any of the Tramadol they sent home with me.  I don't get much more than a dull ache with the occasional sharp jab, and I'm afraid to dull it too much, lest I cause some damage without realizing it.  I'll use it if I find that I need it, but I think the recovery is better without it.
  • I can't go back to the gym until at least October, and I won't be able to work at the level I was before for at least six months, maybe more like a year.  But I've kept my diet clean since leaving the hospital and begun to take long walks again.  Walking won't build muscle like the Turkish get-ups and pullups at HIPE, but it'll strengthen the injured area without causing damage, and it should let me continue to lose fat.
  • I didn't die, and I don't have to accept any permanent loss of function.  All I have to do is be smart and a little lucky while I recover, and I can still reach all the goals I had before.  It's just going to take longer than I'd hoped.  

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