Wednesday, August 18, 2010

Days 45 - 49

Today we journey to the Netherlands.

'Why?' you may ask (as if you would) - to sit in a tent, smoke weed and eat German meat that we have frozen and brought with us. If it was allowable, I'm pretty sure S would have packed his suitcase to Australia with German meat and then repurchased all his other personal items once he got to the island in 2009.

It is worth noting that I am wearing shorts today. Shorts. I rehearse witty reparte in my mind to arm myself when a stranger rags me on how fat I look in my shorts. Then I remind myself that my shape is the same regardless of what I wear. Also, it seems unlikely that European people would actually be rude. Also, I have fucking Ausstrahlung. 


I put on a cardigan just in case.

Then I let go of the negative feeling sitting in my chest.

I'm allergic to the adhesive on dressings it seems. I've been keeping the scar covered since it opened up more and when I pulled the dressing off the other night and started to bleed.

I'm writing this while S showers. I'm supposed to be packing.

So I decided to go to the doctor. Any lingering doubts about whether I needed to or not were cast aside when I realised how exciting it would be to go to the doctor in Germany (S has written a comprehensive guide re going to the doctor in Australia vs Germania).

The surgery is in an apartment building. It's dark inside and the walls are covered in mahogany cabinets. One wall is covered in pictures of Christ and the Madonna. There is a model of a doctor in a white coat riding a motorcycle. Newspaper articles on the wall, time spent overseas with Red Cross, competitive kick boxing.

I sit in front of the doctor and S sits off to the side. The doctor speaks to me and I smile and wait for S to explain that I sprechen keine Deutsch. I can tell that they are talking about how I speak only English. I can tell that they are speaking about how the consultation will be paid for privately. I don't think my travel insurance will cover me given that the surgery is a preexisting condition. Maybe I should have thought about this harder. It's possible I was too optimistic.

The doctor speaks to me in English and asks me how I am. I explain my issue. The doctor cannot understand my accent when I say 'weight loss'. 

I lie on the examination table and pull up my dress. The same pretty dress as last time I realise. When I try to pull off my dressing or point to the wound the doctor jokes about having practiced medicine for 32 years - he thinks he's getting pretty good.

The doctor is speaking to S in German again but he has his hand on my foot. It's meant to be reassuring and it is.

I'm self conscious and my ankles are crossed. He's calling S up out of his chair to look at my wound. I had actually been hiding the wound from S, turning away when I changed the dressing. Here he is standing over me, discussing it with the doctor in German. The doctor speaks in English again, he explains that larger wounds through fat tissue often have trouble healing, fat tissue has trouble regenerating in this way and it's generally not preferable to operate in this way. When he says the word 'fat' he taps my bare stomach lightly and I flinch. He starts to explain that he is using the word fat in a clinical sense. I wave him away, it's ok, it's just fat, it's just a word, it's just my body, it's ok.

He puts betadine cream directly into the two openings along the scar. A hydrocortisone cream goes onto the eczema next to the scar - it mustn't go into the openings though. He covers it with a large dressing, a proper one, not just a big square bandaid.

S takes me to the chemist and we buy the creams and the proper dressings. I will take antibiotics for 3 days, they will continue to work in my system for another 7 to 10 days. I should not expect the wound to get better straight away. I should shower only once every two days and change the dressing after the shower. I should not swim.

We take the train to Kamen, where S's father lives. I think he knows a few more words in English than last time I saw him. He comments in German about how Stefan is not wearing a jacket, then he notices that I am wearing sandals. S doesn't translate; his father is pointing at my feet and I can recognise the word for 'barefoot'. 
'I heard it was Summer'
'No summer in Germany', his father says in English.

I can communicate that I would like some strawberry cake, that I would not like some fruit, that I would like to drink water. I can make a joke. S's grandmother is 95 and her eyes are so bright. She looks 10 or 20 years younger to me. I can understand S's father telling me she is doing so well because of the quality of the care he provides her.

I can say 'Goodbye Grandma'.

Still no scales. I'll be happy even with a 2kg gain by the end of the trip to be honest. I am eating a lot less than last time. Less spontaneous eating of sweets, trouble finishing my meals.

It's time to go.

Start weight: 112.5
Current weight: 105
Weight lost: 7.5
LT goal weight: 75
ST goal weight: 99

Friday, August 13, 2010

Days 34 - 44

Any time I felt nervous about the prospect of things going terribly, terribly, terribly wrong I would reassure myself that I am most likely the youngest and lightest person in the trial.

N and I had been talking (about weight loss, what else? No, no, I kid, sometimes we talk about law. Sometimes.) and I had told her I was considering lap band. Imagine multiple metaphors where I push enormous stones up hills or swim against the tide toward a beach and we can pretty well skip the rest of the conversation. I had gone so far as to sign up for top cover with a health insurer with a view to going ahead with the operation in 12 months time. I'd applied for a loan from my bank to see if it would be possible to go ahead sooner. My GP was willing to give me the referral but was encouraging me to wait the 12 months and to see an endocrinologist who specialised in weight loss in the meantime.

N msg'd me and told me to call a surgery about a clinical trial - she had already called them and made an appointment for the following week. At the time I was 109, 107 on a good day (read: dehydrated after drinks the night before). I was able to determine with some gentle prodding that I needed to have a BMI of 40 on the day of the first appointment or I would be excluded. I assumed at the time that it was going to be an efficacy study of lap band which was perhaps naive given how long the procedure has been about. I calculated my BMI to be 39.4 on that day.

There was no way I was letting an opportunity like this pass me by.
So I ate.

For the first time in my life I could eat anything, at any time, in any quantity with absolutely no regard for my weight. In fact, I was slightly nervous that I would not be heavy enough.
Irresponsible? Maybe. Fuck off, lol.

Ultimately I scraped through. At my first consult with the surgeon he asked me to confirm my BMI and weight. I didn't look 112kgs, he said. I keep it packed around my liver and in my tits, you see.
Getting bloods done to confirm our suitability for the trial we were able to identify other candidates in the waiting room from their telltale boxes of vials. There was something like 15 vials to fill. It would have been less than a normal blood donation but it looked enormous. Many of these other women (no men that day) were mothers with small children crawling over them, sticky and enthusiastic, others seemed to be late 40's, vibrant lipstick, booming voices and strong opinions. Scarf wearers. Fuck, if there is one sort of fat woman I don't want to be, it's one of those. This fat archetype sits second on my list of fat stereotypes I do not want to be, directly after Sweaty-Dim-No bra-No shoes: The Caboolture fatty.

This is when I realised my prospects of success were probably quite good, being young, healthy and relatively light. My willingness to abuse diet drugs helps too I guess.

Saturday I went shopping - I wanted sundresses for Germany. I noted that my larger scar was tender and puffy. It was a darker red, almost purple and I thought I could see pus under skin. I was basically shitting myself. I had been cocky and the universe was punishing me.

I went to the GP and waited for 2 hours. I reassured him that the opening at the end of the scar was standard, and had been viewed by my surgeon. He poked the scar, made thoughtful noises, and then prescribed me antibiotics "just in case". I went back to my strategy of feeding the scar with positive thoughts.
That night I spread out my dresses to show K and A. Going to my room to try one on to show the girls, I took off my hoodie and t shirt. As I pulled it over my head I felt cold dampness - there was pus all over the inside of my shirt. I was frozen in place with my shirt halfway over my head when A found me. She calmed me down and encouraged me to take a shower. Under warm water, gently pressing my stomach, more and more was coming out of the opening at the end. I was certain it was all over.

The literature they gave us to read over before consenting to go ahead with the study outlines risk. In an earlier trial they had concerns about the effectiveness of the method of attachment. A number of participants were operated on a second time to confirm the implant was still correctly attached. In all cases the implant was successfully reattached or it was confirmed the implant had been correctly attached all along. One participant developed an infection after the second surgery and ultimately her bowel was perforated and she had to use a colostomy. The implant was removed.

I was sure this all meant that I was destined to shit in a bag for the rest of my life.

On Sunday I realised that a second part of the scar had opened. Visions of the whole fucker undoing like a zip and my entrails unraveling into my bedsheets while I slept.

One of the receptionists from the surgery reassured me this was a good thing and all the shit inside had to get out and then it would close again. I was certain I was rotting from the inside out like a ripe avocado filled with black putrid flesh when you slice it in half. My organs were liquefying and would drip out of my scar. On this day I realised my dettol cream expired in 2007.

I've completed the course of antibiotics and I'm in Germany. S took me to the chemist to translate for me so I could get more dressings. The pharmacist encouraged me to see a doctor if the scar had opened.

In the shower, nothing more comes out of either openings. The skin around the scar is pink instead of red. The second opening as well as the first are shorter and don't gape. It's possible that there was an abscess in there the whole time waiting to let go. I prefer this scenario because I can reassure myself that it has done what it needs to do and it is resolving now. The circle of life. You know, for abscesses. Or whatever.

It's been a week since I weighed myself.

Start weight: 112.5
Current weight: 105
Weight lost: 7.5
LT goal weight: 75
ST goal weight: 99

Tuesday, August 3, 2010

Days 29 - 33

Everything you knew intuitively about weight loss is a lie.

People who stop exercise gain weight. But exercise is not the most important factor in achieving weight loss. I’ve been to the gym 4 times now since the pain has stopped. 15 minutes, 20, 25 and today 30. Back to normal! It's nice to let go of the lingering negative feelings I had about exercise. I can go, it will help, but if I don't it isn't the end of the world - other things are more important.

I worry about the scars a little. This is my way. I caught chicken pox when I was 20 and there is a scar over my third eye. I cried and cried. I might have been fat but at least I was pretty. Silliness of course. Now it's invisible, a soft cleft above my nose.

V showed me the scars from her lap band. They're silver like stretch marks and they fade into the landscape. It takes her a moment to find each one to show me and I take this to be a good sign. I will be happy if mine are like hers eventually.

The large scar is still red. At the corner there is a small opening - inside there is a stitch that will slowly dissolve. It still weeps.

I showed it to the clinical nurse. I wanted to be reassured that it was normal and not infected. She said it was fine. I wanted to be able to continue thinking positive thoughts about the wound.

A whole range of literature points to positive post-surgery outcomes linked to positive thought.

N and I started meditating weekly at West End 3 or 4 weeks before the surgery coincidentally and it made me feel much more prepared for the surgery. Some days I actually feel like I crave meditation.

A few days later and I was still worried about the opening. N said that hers was less gunky than mine. She told me to shower twice daily, leave the sapoderm on for longer before rinsing, put dettol cream on the gunky spot but keep the bandaid the hell off it. It needs a little air.

In the shower I notice that where I was concerned previously that this larger scar was less neat than the others, it seems to have straightened out. Maybe it was still swollen. Positive thoughts.

Today it seems less gunky.

I have digital scales and I play a game where I step on and off before he can clock a final weight. Best out of three I tell him. Delicious moments 2kg lighter than the final weight before I step off again and he runs back down to zero.

Naked in front of the window, the wind is audible through the trees. I wonder how much my hair weighs. Piercings and uncut nails.

The house is painted in shades of grey, a model of itself. A movie set. Dream worlds from Beatlejuice and Drop Dead Fred. No sun. Quiet. Three fish tanks along the back wall of my bedroom. There is a tiny eyeless shark in my hand. Dark, thin, slimy, angry. I hold it close to its mouth - childhood lessons on how to hold snakes. Its tiny jaws are snapping. The house is empty. Its long tail turns around and digs deep into my hand. Dreams where my mother pushes a pin through my palm as I press one into her eye. There’s no pain here. I’m on the back stairs and the air is still. I throw the shark out of my hands as quickly as I can to escape short, pointed teeth. It squirms on the grass below me and I am slamming the door and running to my room but it’s back with me.

I told the psychologist about how terrifying it was when I went back up again a kilo. He is reassuring. His accent is soft. I have three years of support. Be wary of people around you who have more to gain from the maintenance of the status quo.

A whole range of literature points to positive post-surgery outcomes linked to positive thought.

I can do this. I can do this. I can do this.

Start weight: 112.5
Current weight: 106.5
Weight lost: 6
LT goal weight: 75
ST goal weight: 99