NEW BEGINNINGS

I am living with pain, both physical and psychological. If that sounds dramatic, you'll have to forgive me --- I am a bona fide diva, you know, even if under normal circumstances a rather low key one (or so I flatter myself). It's a torn meniscus, and plenty of people just live with such an injury, never bothering to have it fixed. It's not cancer, it's not neuralgia, it's not even rhumatoid arthritis. It's not any one of a million horrific injuries, diseases, or painful conditions that millions of people have to endure every day. But the knee hurts. Not so much that I can't do my job. Not so much that I need to regularly take medication for it, but daily and enough. It's weak enough to concern me that I could reinjure it if I'm not careful. Weak enough that, as a precaution, I've gone nearly two months without doing any significant exercise, the longest period of inertia since 2008, and the most costly.

The psychological pain is, as you might imagine, harder to deal with.

Here's the gist: my knee surgery did not happen as scheduled on Friday, and it's unlikely to be scheduled for some time.  To say that it is disappointing is an understatement, but there's more to it than that.

It's humiliating.

This is a hard post to write. Parts of it have been thoroughly mulled over for  months, as I struggled with how much to say and how and what and when. Things came to a head a few days ago when a mystery call came from the hospital. It was a mystery because my surgery was scheduled for the surgery center at my orthopedist's office --- the same place I had wrist surgery after breaking it in 2008. Suddenly, it was moved to the hospital, and after a chain of phone calls, I finally found out why. That was the first hit. The second came on Thursday morning, hours before my pre-op meeting was scheduled. The hospital called again, with an estimate this time.

They wanted $23,000 for a 15-minute, minimally invasive outpatient procedure, and that price tag does not include the cost of the surgeon or anethesiologist. That price, my dears, is well over six times what it would have cost me were it to happen in the surgery center.

I did some very quick, dirty research and figured out that I could actually fly to New Delhi, stay for two weeks in a moderately priced hotel, and have the surgery for a little over a quarter of what it would cost me to have it at the hospital ten miles from my house.

Now, I am insured, but my insurance would have covered less than half of those costs. I have also applied for worker's comp, since this injury happened on stage during the opening night of a performance. But that claim is still being processed, andI have no idea how much of this will be covered or when, and I was really, really hoping to get this matter taken care of before my next gig. It is terribly upsetting to have to wait, especially since I have to wait for a stupid reason.

You see, I could have had my surgery on Friday as scheduled in the surgery center, and paid less than one sixth of what the hospital would like to charge, and even if I'd had to pay for every cent of it out of my own pocket I could have managed that. But I am not eligible for surgery at the surgery center, as I was in 2008, because my BMI is now too damned high.  They have a limit, and I am over it.

There it is. After all my struggles, my work, my research and education, my hours of sweat, and yes, my pontificating, I have gained back enough weight that I am too fat to have surgery at the surgery center. And that, my friends, is humiliating beyond words.

I realize that it probably does not come as a surprise to anyone who's been following this blog, either; but I've been reluctant to come right out and say it in plain terms, for reasons you can certainly imagine and some you probably can't. But I've always tried to be open here. So it's time to come clean.

I do not, by the way, regret having made the big effort to lose weight and to become healthier. I don't regret a single minute of exercise or a single cookie skipped. I would do it all again and in fact, I plan to. (The" how" part of the plan still needs work; after all, I've been fighting this for some time now without the amount of success I want).

I do not count my past accomplishments as now somehow being invalidated, either. I did what I did, and I'm proud of it. I hope I can do it again.

I don't believe my methods were flawed. They worked. I lost 130 pounds, reversed my Type II diabetes, got off all meds, and got into the best shape of my life. I started running. I did two rounds of P90X. And I'm still at a lower weight than when I started.

So why have I, despite fighting hard, despite being well-educated about nutrition and weight management and general fitness, regained so much weight? There isn't a pat, easy answer. Some people are going to raise the usual refrain, "You have no willpower! No discipline!" and I shall pre-emptively call bullshit on that. I have plenty of both, and I've proved it. Weight loss and weight management and food relationships are complicated.

I thought, at one time, I had mine under control. Maybe I did, at one time. I know that I got so far off base a little, tiny, bit at a time and I think I can trace the start of it back to a specific time, place, and set of behaviors. That's a start.

What happens next? Well, now that I've got this off my chest, the plan is to go back to where I started. Tomorrow I'm rejoining the little neighborhood gym where I spent an hour a day on the elliptical, for about two years straight. They have a great Pilates class, and they have yoga, both of which will help a lot with strength and flexibility and will be good for my knee. They have my elliptical machine and they have stationary bikes, which I dislike intensely but are probably better for my knee than the elliptical.

Two days ago, when I still thought I'd be recovering over the weekend, I planned healthy meals. I made split pea soup and vegetarian noodle-less lasagna so nobody would have to cook and we wouldn't be tempted to go out or order in. I made sure we had plenty of salad fixins' in the house. I'll be planning ahead more, something I'd let slide in recent months.

While I wait for my claim to be processed, I plan on losing some weight. While I was writing this, I popped over to a BMI calculator and checked to see how much I'd have to lose to qualify for surgery at the center.

Ten pounds. Ten lousy pounds. When you're as heavy as I am, that's nothing.I'm not sure whether to be more embarrassed by that, or pissed off that the nurse didn't tell me that's all I'd have to lose. It would have saved me a lot of grief. Hell, armed with this information, I may just go on a smoothie and salad "fast" for a week and then try again. Crash dieting is not, of course, a solution to longterm weight loss, but in this one case, it just might be worthwhile.

But slow and steady is, of course, best, and ultimately that is what I'll return to. I'll give all my old tools another try, a really good try. And I'll look for new solutions, too.

It's a journey, not a destination, and as with all journeys, sometimes you get off track. Sometimes way off track. Sometimes you have to make a U-turn.

Consider this my turn signal.

Comments

[Brett]

Cindy...having known you for years - far too many years to post here - I am still inspired by you. We have many of the same issues: I struggle with my weight and all the psychological implications that brings; workout like a fiend 3-4X a week; have successes then life happens and I feel unprepared and I take my U-turn. Those damn uturns are gonna happen adn I try to be better equipped to meet them each time. Like you, I feel it happens gradually and then I feel defeated. I am trying to learn better preparation. All of this to you - KEEP UP THE FIGHT - we will do our 5K or 10K as soon as your knee is healed. One day at a time. I will always be here to support you! XOXO B

[Melanie Greenberg]

Dear Cindy -- Please count me as one of the people inspired by your journey and your honesty! And please don't feel any humiliation about "letting down" your readers. I read your blog because of your intelligence, your grit, your artistic life -- and only secondarily as a wonderful source of recipes and inspiration about weight loss and exercise. The things I love stay true whether you are at a low or a high BMI, and I have great confidence that you will come through this current trough with your spirit unbent! Please do not despair!! You are an amazing woman with a truly original voice (in all senses) -- you are greater than the sum of any BMI chart in a doctor's office.

[Cindy]

Thank you to everyone who has commented. :)

NewMe --- it's funny you should mention TPP's article in the Times, as she interviewed me for it but my content didn't make it into the article. Thanks for the tips about the blog and Dr. Blair (I knew I had seen that research somewhere, but could not remember the name of the researcher; and there's certainly more than one).

MSF --- love the way you put it, "weight loss is not a linear process".

Fran --- I agree with you, and there's a lot of research now to bear out what you say about fat cells and BMI. Some time ago one of my readers, who was then a med student and now a doctor, wrote in about how waist-to-height ratio is actually a much better indicator of health risk than BMI. In the post following this one, another medically trained reader has offered a very interesting explanation of why medical personnel use BMI as an indicator.

[Fran]

I have read, and really believe, that once we have the fat cells in our bodies--they're there forever. When we lose weight, they get thinner, but when we gain, they're happy. They are like the siren call for food. All of my adult life, I keep coming back to the weight I'm at now--I call it my body's happy weight. It's not where I want to be, but it's like the optimum amount for those cells. I think that it's a good explanation about why we gain back some of what we lost--over and over again. Why else?
Hang in there. As you say, it's a constant journey. By the way, BMI's are really a lousy measure of health and body weight. By using only the BMI, some 300 pound athlete with not an ounce of body fat might be considered obese.

[msf]

Cindy,

I've been a pretty close reader of your blog for a couple of years now, and I've noticed how reluctant you've been to write explicitly about the weight gain. Just as you've had to find strategies for dealing with all of the messages in our society that encourage a sedentary lifestyle and over-eating, you've had to contend with messages that weight loss is a linear process. Maintaining lifestyle changes for a lifetime takes so much focus. I think that few of us have the mental energy to be "on" every single day, regardless of how passionate we are about an issue/topic/goal/etc.

Kudos to you for writing this post and sharing your real, human experiences with this process. We need all kinds of examples and yours is as authentic, if not more so, than that of the person who finds it easy to stay in a "normal" weight range.

It's understandable to be angry and humiliated by this situation. At the same time as you're seeing yourself as someone who didn't qualify for the lower cost health care because of a single indicator of you (BMI), keep in mind that there are lots of other indicators that you are a healthy, vibrant, inspiring ATHLETE who needs this knee surgery to maintain and improve your #ss-kicking fitness level. YOU deserve it!

[NewMe]

95% of people--no matter how well meaning, no matter how hard they work, no matter how "well" they eat--gain all the weight back and often end up fatter than they were originally.

The tiny minority that maintains a significant weight loss typically exercises much more than those who have never been fat and eats significantly less than those who have never been fat--this from the National Weight Control Registry. Tara Parker Pope's lengthy article in the New York Times a few months ago shows the lengths to which weight loss maintainers must go to keep their weight down. It is not a question of willpower, as you yourself have said.

Just as an aside, I highly suggest a blog called Debra's Just Maintaining (justmaintaining.com), written by someone who freely admits that maintaining weight loss is truly one of the most difficult things one can do. Her posts on the science of weight (loss/gain/maintain) are a must-read.

Dr. Steven Blair, an internationally known exercise physiologist has done numerous studies showing that those who are fat and active (as you are) are actually just as healthy as those who are at a so-called "normal" BMI and actually healthier than those who are thin and inactive.

Stories such as yours make me furious. First, because the mainstream (and certainly the medical mainstream) continues to confuse thinness with being healthy (just like how most scientists--SCIENTISTS!--believed the world was flat until only a few hundred years ago) and this misconception has led to the misuse of the BMI, to the detriment of so many people such as yourself.

Of course, your situation also underscores the idiocy of a country as advanced and modern as yours not having a universal health care system. But that's another debate for perhaps another blog.

I wish you all the best and hope your knee is taken care of as soon as possible.

[Laurel Porter]

We've all been there ... Well, not EXACTLY there (with the complications regarding the meniscus surgery), but with the backsliding. My husband and I are there right now, in fact. However: We've done it before, we did it right, and we can do it again. For longer.

Power to the people, whatever their BMI!

Love you—Laurel

[Beverly]

Thanks for sharing.

[Kim]

You said this was a hard post to write, but for me at least this was an incredibly inspiring post to read. Thank you very, very much for writing this.