Sunday, June 30, 2013

Note to Self For Future Reference

On the genetic components of eating disorders: that what that actually constitutes is not a one-to-one inevitability but rather a systemic susceptibility to behavioral triggers.  That is, you are genetically susceptible to eating disorders if certain stimuli (i.e. dieting, which almost everyone does at some point in response to fat stigma) result in ED symptoms.

I am thinking of this because I think of how I would parent a girl around this stuff.  How I could raise a child who does not lose fifteen years.

Saturday, June 29, 2013

Being a Body

Today, at the gym, I had my first "girl, you are lifting too much weight" interaction, with a trainer working his client near where I was doing my thing.  (This never, ever, not even once happened to me in months of lifting at the Bed-Stuy Y, which is one reason among many that I pine for it.)  He walked by when I was squatting and said, "You shouldn't be lifting too heavy."  (Why?  'Cause I'm gonna get bulky?  Bite my fat ass.  'Cause my ovaries are gonna fall out?  Bite me harder.)  I said, "I've been doing this awhile; I'm fine," kind of testily.  Then he watched me rip 135 for 5x5 deadlifts, which apparently changed his mind.  He said some stuff about how hard I was hitting it, introduced himself and told me I should take his Monday-morning boot camp because "if anyone can do it, you can do it."  He was waiting for me on my way out to give me his card.  I was like, "I can not afford a trainer," and he protested, "no!  For the class!"  But seriously, I do not need his card to go to his class.  And his card doesn't have any information about his teaching schedule on it anyway.  I am just saying.

You know what I want to be able to do one day?  A pull-up.

Monday my squat weight goes up to 120 or 125.  I'm back in form, feeling good; it's time to start getting the load back up.

Yesterday I got a voicemail from my endocrinologist with my latest test results.  They're impeccable.  My cholesterol is "magnificent," which I am keeping in my back pocket for the next time my dad implies that I eat too many eggs.  Best of all, my IGF-1, which gives a sense of average growth hormone levels over time, has edged up into the low end of the normal range.  You know what raises growth hormone levels?  Resistance training.  It's still low, but it's high enough that my insurance would never approve the expensive treatments—it's normal enough.  "So just keep up what you're doing and come in in the fall," she concluded her voicemail.

That growth hormone thing feels like a big deal to me, somehow.  I remember seeing the pediatric endocrinologist.  I had stopped growing; my dad's markers of my height on the wall near the laundry machine were barely distinct from each other.  My height had slipped downward off the percentile chart as my weight ticked up.  I remember this being pointed out to me with percentile curves in her office at St. Luke's Roosevelt.  She tapped the charts with her pencil to draw my attention to the problem.  The pediatric endocrinologist was also a pediatric obesity researcher.  I was eleven, in the fifth grade.  I had several sets of x-rays done (growth hormone deficiency is diagnosed in a preliminary fashion by looking at the spaces between the bones of your non-dominant hand) and then an MRI in a closed machine.  The thing that piped in music was broken, and I listened to the banging of the machinery as I tried to stay completely still.  They pulled me out to inject me with dye, and then slid me back into the clanking, claustrophobic tube and scanned some more.  And the conclusion of all of this was an epi-pen and lessons on how to inject myself daily and a calendar with stickers to keep track of my injection sites and the promise to lose weight and a diagnosis I don't think I really understood.  I remember telling a friend about the height and weight lines.  "When they cross, I explode," I said.  I knew this was a joke, but I also could not explain the actual situation, what was wrong with me.  And the lines weren't going to cross; it didn't work like that.  I did not understand.

I took that epi-pen to camp.  Every night, when the rest of my cabin walked back together in the dark towards their bunks, I had to go by myself to the nurse's office, dial in the dose, find a site, swab that site with alcohol, set the pen carefully flush with my skin (hurts the least), click the plunger down slowly, re-swab and bandage, remove the needle to the sharps container, record the dose and injection site in a log, and walk back by myself to the cabin, where the other girls were already in bed, the companionable lights-out chatting winding down into sleep.

I'm glad that I was diagnosed and treated.  I do think that the freight attached during that treatment to my weight, which well might have evened out as I grew (and in fact, initially did) was misguided and ultimately counterproductive for my health and well-being, but I am glad that I have always had access to good medical care, that this rather urgent endocrine dysfunction was caught early and its symptoms corrected as well as they could be corrected.  I am glad that I am not going through life well under five feet tall.  Nevertheless, I have sustained from this experience and others a deep resistance to being a medicalized body and also a baseline sense of myself as physiologically dysfunctional, as broken.  I have been pretty upset at the prospect of going back to those daily injections.  I am really, really glad to hear that I do not have to, that it is off the table.

And yes, this reading is just barely normal, but it is normal, and it never has been before without medical intervention.  I have never been as healthy as I am today.  My endocrine system has never functioned so smoothly and so normally.  I still take medication for the PCOS, but there are people who even when medicated do not have a regular period, and I do.  I have a regular period without birth control and my growth hormone levels are normal, and my blood tests are the blood tests of a healthy person, and it kind of makes me want to cry with gratitude.

And what have I been doing?  The shit I am not supposed to do.  Feeding myself when I get hungry even though I am fat and am supposed to resist my hunger in penance for my fatness.  Eating until I am all the way full.  Eating things I like and want.  Eating saturated fat even though fatties and cheeseburgers and heart disease.  Eating without a plan, eating without knowing how many calories, eating, to the best of my ability, without restriction or control.  Lifting weights dudes will tell me are too heavy.  Never, ever, ever getting on an elliptical machine.  Fuck you.  Fuck you.  You don't know what's best for me.  You don't care what's best for me.  But I feel more sure than I ever have that I know, and I care, and I can act on both of those things.  I feel like I've gotten a toehold into something good, something powerful and real.  Dig in.  Hold on.

It is summer.  I am grateful to be young and strong and healthy.  I am grateful to be a sensate body, to feel the sun and my hips swaying when I walk and my legs trembling on the stairs down to the locker room.

Wednesday, June 26, 2013

Big Round Numbers & Getting Doctored

I saw my endocrinologist this morning.  She's busy, in the manner of research-hospital doctors, and so her nurse does the check-in stuff before she arrives for the consultation.  Weight, blood pressure, pulse.  I got on the scale, and the nurse, whom I like, put the big slider in the 150 notch.  Lady, are you kidding?  I got flustered, and managed to convey in some agitated precaffeinated sentence fragments that it was in dramatically the wrong place—it needed to be two notches up.  I've been hovering just over 250 for the last couple months.  She moved it up, then tapped the top slider down, and down, and down.  The balance didn't budge until it hit the far left side of the bar.  So she moved the big slider back down a notch.  Tapped the top slider up to the right of the bar.  "Looks like that's 250 even," she said.

That number is a big deal for me.  It is the bottom of my adult range, one of the foci of my elliptical weight cycles.  Seeing it gives me a flare of the old sense of thrilled achievement, and a more contemporary uncertainty about the unknown (what happens now?), and a sense of dread: the ghost of the historically-accurate sense that what comes next is that I gain fifty pounds.  After the appointment, I sat on a bench outside Central Park and it was this number that occupied my brain.  The big round number, the broad strokes of its categorical divisions.  And the absolute blank of being smaller than this.  I haven't been since I was maybe 14, 15.

"You lost a big chunk of weight," my endocrinologist said, when she sat down with me.  It had been a year since last I saw her.  I said, "I think it's more like a little chunk."  She said, "Looks like a lot."  She looked back at the chart.  "Thirty-something pounds?"

And again, when we were discussing the possibility of adult growth hormone therapy (my growth hormone levels are quite low, which they have been since I was a child—I had to give myself  daily injections of growth hormone for several years, without which I might never have had the adolescent growth spurt the delay of which triggered the diagnosis), she said that "It would make it easier to gain muscle and lose fat—which is always good—and you'd probably notice an increased sense of physical well-being."  "Which is always good," I added.  She turned towards me and leaned in when she spoke that aside, "which is always good," and her tone changed, became more colloquial.  It sounded like lady-to-lady talk, just the usual sort of stuff.  She said it the way someone would say, "I'll order dessert if you will," looking conspiratorial.  It was social bonding.

I have to fight my tendency to feel warm and complimented in these situations, when I am on the right side of the weight-loss talk, when someone's patting me on the back for being a little smaller than before.  I try to do that because obviously the fat-bad-thin-good thing is bad for me (and for you too!), and because I'm (still) a fat person.  Because as a fat person, even a somewhat-smaller-than-before fat person, I am necessarily negatively affected by a medical environment that substitutes treatment of weight for treatment of specific health conditions (some thin people are also negatively affected by that substitution).  That substitution enables what's actually wrong with me to be blamed on fatness, and ignored until it is more serious.  This has happened to me before—my cholecystectomy would have been way less painful, dangerous, and life-disrupting if it had not been an emergency surgery, and it wouldn't have been an emergency if my doctor at the time had diagnosed it correctly when I took my symptoms to her the first time.  (She thought it was binge-related acid reflux.  She felt really bad afterwards.  I was not, incidentally, binge-eating at the time.)

Because this weight-loss back-patting felt social rather than medical, I don't actually think that this will negatively affect my medical care, which is why I didn't feel inclined to press the issue (also because I'm not invested in my social relationship with my endocrinologist).  This doctor has been quite skeptical of the lose-weight recommendation for polycystic ovarian syndrome (which syndrome is the reason I see her).  Our very first session, I asked directly what the relationship between body fat and PCOS symptoms looked like.  She was frank: she said that we did not really know.  That fatness is one of the diagnostic criteria of PCOS because it frequently co-occurs, but that in fact the medical definition of "syndrome" specifically means that causality is ill-understood.  That I could try to lose weight, but that it might or might not help, and that the syndrome would make it more difficult.  (She also mentioned that it would be good for my hormonal regulation to add muscle mass, which is when I started precontemplating lifting.  Bless her for this.)  And in this appointment, there was no sense that, well, weight loss, good, everything must be in order.  In addition to the GH thing and the usual check-in exam and blood testing, she wanted to do a thyroid test and to start me on a vitamin D supplement.

The only place that I felt a potential overlap of fat stuff and actual treatment was when she was looking over the history of my blood tests: "Your glucose has always been fine.  Your cholesterol's been rather impressive."  I don't think any of my signals of good health—blood glucose, cholesterol, triglycerides, blood pressure, pulse—would be "impressive" if I were not a fat person.  They are "impressive" because they are surprising.  But for whatever reason, maybe because she was engaged in a close examination of my actual (good) health indicators, this did not ring my bell too badly.

So I am not going to soapbox if it doesn't feel necessary.  I'm at a place where these kinds of remarks don't shake me up (at least in this situation, where I have a doctor whose medical judgment I trust and who I know likes me)—they don't feel degrading or dismissive, they just feel like a little irritation, easily sloughed off, created by a routine stupidity to which doctors are as vulnerable as the rest of us, being, though doctors, still humans in the social world.  I don't need to change this woman's mind like I needed to change my high-school doctor's—both because the misdiagnosis thing demonstrated the consequences of her beliefs and earlier and perhaps even more significantly, because she was responsible to my parents, not to me, and when she fueled their fears of my fatness, my life got increasingly unpleasant.  But, happily, I'm a grown-up now, and I can pick my doctors, and I can pick my battles.

Thursday, June 20, 2013

Bullet Points

Been sick, been stressed, been silent over here.  A little collection of thoughts:
  • It persistently baffles me that I feel better about my body when it has few-to-no clothes on it.  I remember this being true when last I was this size, too, so maybe it has something to do with the specific clothes I wear or the specific size I am, but it's still kind of confusing.  
  • We have had the teeny, implicit recognition from my oldest dearest who'd been abroad most of the year that my body has changed in her absence.  It went like this: we were happy-houring and I mentioned a(n obnoxious) Facebook post in which a girl we'd gone to high school with was like, "Internet, I have lost weight!  I can wear shorts!  And horizontal stripes!"  Now, I do not personally wear shorts (or pants of any length), but horizontal stripes are my favorite, so I think this is bullshit for that reason alone (obviously other reasons too).  (In fairness to her, I will say that she looks awesome, although I think she still thinks she's too fat and I also think she might have looked just about as awesome before this shift if she'd stood up straight and dressed herself better.)  But the backstory was that this woman had taken up martial arts, and, I said, as these things sometimes do, it had changed her body somewhat.  "Right," said my friend, with a minute gesture in my direction.  "Like weightlifting."  
  • I am feeling super complacent about my size right now.  "Complacent" is sort of pejorative, but I mean it to signal something like "slightly checked out, in a good way."  My size has receded a little bit in my consciousness, which is always a relief.  One thing I think is relevant to this is that I've been this size for a minute now, and I always, always, without fail feel better about my body when it is not in a state of flux.  I get that initial "whee!" of being slightly smaller sometimes, but that breeds in me a constant-vigilance kind of watchful anxiety, in which I check myself in reflective surfaces all day long and scrutinize.  And that way madness lies.
  • At the gym the other day, the very-attractive-if-you-like-blond-banker-types dude next to me, who was doing step-ups in some weird pattern while I squatted, pulled out an earbud to talk to me as he was finishing up.  "You're strong," he said.  "That's a lot of weight."  It was 115, which is not actually a heavy squat.  (I was squatting 155 before my nomadism broke up my gym groove, and my dream-type goal is to one day squat 315.)  So he meant, pretty clearly, "for a girl."  But he wasn't a dick about it, and I actually didn't mind this encounter.  It was a reminder that what I can actually do is so, so much more than what I'm supposed to be able to do.
  • I'm a member of a heavy-lifting-for-mostly-women Facebook group.  The founder of that group is one of my Almosts: a person whose work and thought has notable points of superiority to the general consensus, but who does not diverge from it so far as to be exemplary/perfectly supportive of what I believe and need.  In that group, a long, long conversation about "fat shaming" (not really my favorite phrase, but the scare quotes are hers) was actually shockingly civil and productive.  Not perfect, but better than one would have expected.  I am trying to extrapolate from it some rules about my own conduct in these conversation, a set of guidelines for engagement.  The first one, I think, is Do Not Try To Prove Anything From Scratch.  Pointing people towards some resources is fine, but making a case that needs a book & not just a couple Facebook comments is wasted effort.
  • Weightlifting is still the best.  Gonna write it a love letter in just a minute.

Monday, June 10, 2013

On One Photo

My oldest friend's girlfriend put up a picture of me from the opening of said friend's first solo show, last weekend.  It's a grainy iPhone picture of me talking to another friend, shot from slightly below and at a three-quarters angle, which is a nice one on my face, but I suspect makes my ass look a little larger than it would look in real life.  My hair looks like hell.  The angle and/or the flattening effect of the low-res photo and/or the pattern on my sweater conspire to lop off my rack, but the lumpiness in my midsection (I was wearing a belt, because that sweater is slightly too big) comes through loud & clear.  One arm hangs at my side, held slightly away from it by the implied bulk of my arm.  The other hand is on my hip; my upper arm looks enormous (completely accurate).  But: you can see my jawline.  It's a faint shadow, but it's there: I have a neck and not a double chin.  My head doesn't look like a sphere mounted on my shoulders.  My features occupy a greater proportion of my face than my cheeks do.

Obviously the most important thing is that I am out supporting my girl and her art, and I'm having a good chat and a good time, but it's wicked tough to see a picture of myself, particularly a totally candid one I didn't know was being taken, and not up-and-down myself, scanning for what's okay and what's not.

Bottom line, I do not love it, but I can live with it.  Which like in general is pretty much where I'm at with my body these days, I think.  At this size, my body is less obtrusive in my mental life than it is when I'm 50 pounds heavier.  Not altogether unobtrusive, but definitely less obtrusive.  And at this size, too, I sort of feel within striking distance, which is to say, if I lost another 50 pounds, I would have a pretty different situation on my hands.  Somehow that altered proximity is kind of consoling—I'm not sure why, given that I have never been stably below my current weight as an adult, ever.  But the point is this: I don't love that picture of me, but I don't think it's going to haunt me all day.