I’ve put off seeing Dr. Z long enough. I had every intention of waiting until my monthly cycle was cooperating and I was back down around 185 pounds before scheduling my appointment. Well, my cycle was finally cooperating but my weight was hovering around 189 lbs. I’ve only weighed in one time at that weight that high since being in maintenance, and then was able to get back down around 185 last time. Well, I decided earlier this week that it was time to just go see him, the scale wasn’t moving, I am out of phentermine, and my cravings/motivation/etc. just aren’t getting any better.
So my appointment was on Thursday and I was weighing about 188.1 on my home scale – not the drop I was hoping for, but I knew it would put me 3-4 pounds up from my last appointment (which was already 2 months ago). While I was driving there, I flip-flopped about how I was going to be ‘in my head’ at my appointment. During my almost 3 years of maintenance, these visits with Dr. Z have been more about just checking in and keeping me somewhat accountable – updating him on what’s been going on. As my weight crept up a bit, we talked in general terms about stuff but I just haven’t really been able to commit to doing something like going back on Optifast full time to knock the weight off. Up until about 6 months ago, I was OK with where I was at and felt like my muscle mass increase and exercise level was correlating with my weight. Lately though, I know that I am not happy with the scale and the way my clothes are fitting. I can feel the extra 10 pounds. It isn’t terrible, and I’m still able to wear about 75% of my clothes (size 12) but I also had committed to myself that I would not let my weight climb like this and be “OK” with it. I had also hoped and planned to be at my goal weight on my annual goal-iversary – which is coming up on April 25th, just about a month away. The sad thing was that I had almost let myself believe that I couldn’t do it.
I weighed in with the medical assistant at 188 lbs. This was expected but kinda got me into my ‘white coat’ syndrome mode and a bit stressed out about having the +3.5 pounds written on my paperwork. She took my blood pressure and it climbed to my usual 140/72 stressed out blood pressure. I usually can keep it under 120/80 or lower, so this was a bit higher. She said it could be the extra weight, and I guess that is possible, but I feel like it was probably more likely due to the stress. She wasn’t concerned about it (and neither was I) but I could have requested her to re-take it later on and it would most likely have decreased. Anyway, that is how things started off.
Dr. Z came in and we talked about Ragnar and running stuff for a few minutes. But then he did something he hasn’t done in a really long time (maybe ever) – he said that my weight had climbed over 13 pounds above my goal and it was probably time to do something about it. You know, I’m such a rule follower and someone that needs a plan – I was kinda relieved that he was almost taking the choice out of my hands. Obviously that isn’t true, but he launched straight into his proposed action plan. We talked about where I thought the issues were and I told him probably snacking for no reason – justifying extra food as a reward for my exercising – and just plain old losing willpower at the end of the day. He suggested some different prescription drugs to try, something we haven’t seriously discussed before. He listed a couple of options and their intended benefit/target. The 2nd one he mentioned, Contrave, sounded like the best fit for me since it works on the brain to reduce the desire for food on reward pathways and it also helps with appetite control. This is a whole new path that I had not really seriously considered taking until now, but I trust him. I’m sure there is a financial benefit for these dr.’s prescribing these drugs (and obviously Optifast), but I also know that I am up against the horrible odds of regaining this weight back. The fact that I have kept it off this long is almost miraculous, so I keep hearing, but I know that I am starting to get pulled – extremely slowly – in the wrong direction. I also have a sense that the more recent changes and issues with cravings could be hormonally driven and I’m finding that as I enter this beginning perimenopause stage of my life, this isn’t going to be a picnic. He got my attention with the to-the-point plan to get me back where I want to be. He also showed me the graphs on the electronic chart on his computer, not that that was new information to me.
Another, and probably equally important thing he wanted me to do was to drop down to 1200 calories from the 1400 I have been attempting to stay at. I asked him if I should worry about when my calorie balance (after exercise) gets really low and he said ‘no’. I know there is tons of info out there that suggests that calorie deficits should be watched (starvation mode, blah blah blah) but I think sometimes I use that to over-justify my eating. Dr. Z said that I should always eat to fuel my exercise properly and after a run or workout – but eating cookies at night to add more calories back in hours and hours after I worked out is not a good idea (guilty!) So, I’ve lowered my daily calorie goal on MyFitnessPal down to 1200. Again, I do well with concrete guidelines. He also gave me a handout for a ‘food only plan’ – one that doesn’t use any Optifast or meal replacement products. I will still probably have at least one protein shake or bar a day for simplicity sake, but it was still helpful.
He wanted to see me back in 2 weeks to build that accountability back in (also another good idea as I tend to stay away until the scale is where I want it to be). I took the prescription for Contrave and the information packet (which comes in a fancy little zip bag) and told him I would look into it. And, as he has always promised, I left there happier than when I went in – no shame, just a plan.
So, back to the new drug…I read through the information provided by Contrave. This drug is comprised, in part, of the same medicine in WellButrin, an antidepressant. Of course, the packaging has pages of horrible and possible side-effects (what drug doesn’t these days) but most of them seem related to suicidal thoughts in younger patients or issues with patients that are already opioid dependent. This language was a bit concerning, but my takeaway from it was that patients that don’t currently suffer from mental health issues or depression are probably at a slightly lower risk. I did follow the advice on the packaging and explain to my husband that these were, indeed, potential side effects and that I was going to need him to be on the lookout for any changes in my behavior. I’ve never been even remotely suicidal in my life, so I’m not terribly concerned, but I’m trying to cover my bases. This is a big step for me to try this, particularly when I’m not exactly in a desperate situation.
Yesterday I decided to run over to Costco after dropping Erin off at gymnastics. Dr. Z had explained the costs of this prescription and a bit about the process to get it with a discount card at the pharmacy after my insurance would most likely decline to cover it. Basically, without any discount or insurance covered, the cost is a ridiculous $200/month. I wasn’t going to pay that. Ever. He said that it would be $70/month with the discount card – still kinda steep, but what hasn’t been in this weight loss process and I thought if I wasn’t using Optifast products but, rather, more ‘regular’ food from the grocery or other cheaper meal replacements, the cost would be about even. Anyway, after bracing myself for a long, drawn-out back and forth process between the pharmacy and the SWLC medical assistant, the pharmacy tech was actually able to take care of it while I shopped, AND at a cost to me (with no insurance – declined as expected) of $55 with the discount card from Contrave that I had given her. So, that was nice – for both the speed with which it happened and the cost savings.
So I’m now 2 days past my appointment and I’ve got the renewed mental focus that I’ve been lacking for quite some time. I’m very carefully and honestly tracking my calories. The scale is already down over 1.5 pounds in those 2 days. This is a really good time to be looking at everything a bit differently because, if my calculations are correct, this is the time of the month my body is going to cooperate with me the best and I can make some headway before the hormonal and physical surges start again. They are subtle, but paying attention to them and how either the drug or my lower calorie count helps me through those week(s) should be insightful. I fear it will only get worse as I get older, so I hear…