This is a very long post—so much has happened and so much is happening!
I recently went in to have some bloodwork done, and I was extremely nervous. In February, my primary care provider suggested that I start a lose dose of Metformin, thinking that perhaps that would help my body better process food so I didn’t keep gaining weight. In March, we did some blood tests and found that even with the Metformin, my insulin levels were almost double the maximum of the normal range. Who knows what they were before I started the meds! Finally, this sudden massive weight gain was starting to make sense.
When I mentioned the results to my psychiatrist, she casually said, “Oh yes, it’s well-known that the medication you’re on can cause insulin resistance.” I felt so frustrated—why hadn’t she brought this up earlier? She knew what a struggle I was having, and it had been going on for a year by that point!
In fairness, the medication was one that I had been on for about a dozen years prior. For whatever reason, it’s only recently that it had started causing problems. I stopped taking it at the beginning of March.
We’ve had many times throughout this past year and a half where we’ve thought we’ve pinpointed the cause of the weight gain, and it’s just continued, so I was afraid that even this wasn’t enough. But I went off the medication, and we agreed to recheck my insulin levels in 3 months. The levels take a long time to balance out, so my primary didn’t expect significant results before then, and she didn’t want me to be disappointed.
I was very afraid of the results, and I asked my doctor not to comment on them until I was in her office so we could discuss them. I had convinced myself that I was still gaining weight even after stopping the medication and that this was one more thing that wasn’t truly the cause, because I was afraid to believe that we had finally found it and to be disappointed yet again. Unfortunately, she didn’t get that message, and she commented anyway. She said things were looking much better, at least, but I was still disappointed that her nurse hadn’t passed along the message!
My insulin levels are now barely outside the normal range, and we expect them to continue to go down, which is very exciting! I’m anxious to see how low they can go, but I’m also trying not to focus too much on those numbers… I don’t need another set of numbers to worry about! My doctor says she’s impressed by the difference and that it means we’re almost certainly right that it was the medication that was causing problems.
I’m so frustrated that it took us over a year to figure out, and that I’ve “let myself” get to this point. I know I fought it the whole way, but I feel like I should have fought harder (even though that’s not good for my body), or better yet, guessed myself that it was that medication and asked to go off it. But this is where I am now, and I just need to focus on the future and not the past!
I asked my dietitian a couple weeks ago if she felt like letting me know how my weight was trending, and she said she didn’t think that was a good idea. I knew she might say that no matter what, but I still took that to mean that my weight was still going up. I had thought it was staying pretty steady, but after that conversation, I found several pieces of “evidence” that said that I was still gaining, and I told her that. She noted that it might just be that I was afraid of being disappointed, and I agreed, but I still felt like that’s what was happening.
Over the past few days, however, I’ve noticed the opposite. Things that had become difficult physically are becoming easier, and I began to believe that I’m actually starting to lose weight. That my body is trying to “correct” itself. Even this belief came with mixed emotions, though. What if I’m wrong? What if I’m trying to trick myself into believing that I’m “acceptable” when I’m really not? What if I’m just getting used to this body and I won’t work hard enough to “fix” it?
I brought this up with my dietitian yesterday, both my belief and my related fears. She said I should trust my body and that observations like that were objective, but it was hard to believe. I have so much self-doubt! I pushed a bit, asking her to explain what she meant. She eventually told me that my weight gain appears to have stopped, and while she wouldn’t come out and say whether it was staying steady or finally going down, she strongly hinted that it was the latter. She also added that it definitely seems like it was the medication that was causing the problem.
I’m excited that we’ve finally figured out what’s been going on. It’s been such a drastic and sudden change, and my former dietitian kept insisting that it was “normal” for my body. I knew I was supposed to trust my treatment team, so I tried, and I think that’s what stopped me from pushing harder to get my primary to explore my medication list further. I’m incredibly upset that that dietitian led me astray, but I’m very happy that I’m with my current dietitian now. I truly can trust her!
I still have concerns. I don’t think I’ll get back to where I was, weight-wise, though I definitely want to. I’m still hoping that I will, or maybe even below. After all, the weight that was my “normal” was while I was on the offending medication, so maybe my true weight is even below that! I’m also on some thyroid medication to help those levels, so maybe that will help my weight drop further. I know these aren’t healthy thoughts, and I’m trying not to focus on them, but there’s still present.
I’m also concerned that my weight won’t continue to drop. If we have my insulin levels fixed and I still don’t lose enough weight, then it really is “my fault”. I honestly believe that my weight will go down further, but that belief sets me up for disappointment if it doesn’t. It’s safer to believe the worst and be happy if I’m wrong!
On top of this, I have my top surgery in two days! I’m very, very excited. I’m concerned about the recovery, and I know I need to eat and listen to my body to get back to where I want to be in terms of activity level and physical ability more quickly. The fact that I won’t be able to exercise much for a while is hard, and I’m tempted to eat less to compensate, but I’m going to work really hard to listen to my body. After all, healing is hard work, too!
I’ve told several nurses that I don’t want to know my weight, and they’ve written it on my charts. I plan to keep telling them that. Yesterday was close—the nurse went over some information over the phone, and I almost told her at the very beginning not to tell me my weight, but I didn’t. Part of it was that I didn’t think she’d bring it up, and part of it was that a little part of me wants to know. I’m not sure if I want to be relieved that it isn’t quite as bad as I think it might be or if I want to be triggered into eating less, or maybe a little of both. Regardless, when the nurse stated my height from my chart and asked if that was right, I responded that it was but that I didn’t want her to tell me my weight. I explained that I still struggled with an ED, and she said her son was going through that, too. She was very understanding.
The nurse also went over my history and my current issues and asked what she should put on my chart. She asked if she should put “anorexia that is well-controlled” or “history of anorexia”, and I told her to put the former. I know that I am still anorexic, even though I’m at a high weight. She said that’s what my primary had written, too, which I found comforting. Someday I think I’ll be ready to let go of that diagnosis, but I’m not there yet. She also asked if she should put “gender identity disorder”. While I don’t agree with that one, I need it for my insurance to cover my top surgery, so I had her put that, too.
I’m also worried about my body and the surgery itself. I feel bad for putting the surgeon and technicians through the “trauma” of seeing my body. I’m ashamed of how big I am and what a burden it will be for them to lift me from the operating table to the recovery bed. If I were the size I “should” be, it would be so much easier for them! I know these thoughts aren’t rational. They deal with people of all sizes and probably don’t give my size a second thought. I know that telling everyone that I don’t want to know my weight, and having anorexia on my chart, will make them think more about my current weight, and I feel like they might think negative things about it. But honestly… why does it matter? Even if they do think negative thoughts, that’s their problem and not mine!
I talked with my kids the other day about my surgery, explaining that all bodies are good bodies, but that I’ll feel more comfortable with a body that feels less gendered. I was careful to explain that there’s nothing wrong with having a big chest, and that my six-year-old, who’s very excited about her chest growing, is not wrong to want that. Different people have different needs, and I think she understands that. They’re very upset that I won’t be able to hug them for a while, but we’ve talked about different ways we can express affection while I recover.
As you can see, there’s a lot going on right now. I’m very much looking forward to having this surgery behind me. I’m so close!