Let’s just say the optimism I felt last night came crashing down soon after I met the endocrinologist. Sit tight and get comfy… this is a long one.
I’m still processing this, and my thoughts seem to get more jumbled by the minute, but essentially she believes my inability to lose weight is a direct result of PCOS and not any underlying thyroid issue. Just in case, she is running a pretty comprehensive metabolic panel, including testing for cortisol, androgens, testosterone, T3, T4, FSH, etc. She says my TSH, an indicator of thyroid function, is in the perfectly normal range. And when she says it’s in the perfectly normal range, she’s not kidding. The range is 0.4 to 4.6. I was smack dab at 2.6. So that suggests that my thyroid isn’t wonky.
The other possibility is Cushings sydrome, but people with Cushings seems to have distinct characteristics, such as a very round face and the development of fat pads on the collarbone and back of the neck. I have very nice cheekbones and somewhat visible collarbones-thankyouverymuch-that finally reappeared after I lost the first 20lbs. So… probably not Cushings, unless I’m some odd medical outlier that you hear about on Discovery Health Channel on Sunday nights.
What are my options? They’re not too good. In fact, they’re stunningly awful.
Struggle is not a strong enough word when describing the challenge women with PCOS have in terms of losing weight. It’s a vicious, interconnected web of obstacles. The increased weight gain increases the hormonal issues and insulin resistance, yet the hormonal issues and insulin resistance compromise the weight loss. It’s a catch-22. For some reason, my body seems to believe in calorie inflation. Every calorie it takes in, it assumes it more caloric than it’s true value. So it holds onto weight.
The endocrinologist says that I have the following options:
1. Maintain my current weight (60-80 lbs above a normal weight range) by continuing a healthy diet and exercise. I like to call this Work My Ass Off And Maintain My Fatness. You know how the side of a cereal box estimates the daily recommended calorie allowance being 2,000 for the typical woman? Even though I’m 5’9″ and in theory, I should be able to eat 2,000 calories and still lose weight at my current size, I will never be able to consume that amount of food and maintain my weight–no matter how healthy it is. I’m looking at a life of 1,500-1,700 calories daily, which normally, is totally okay with me, but will result in some hard choices or unwanted weight gains during vacation or holidays, like the 2 lbs I gained this past December, despite limiting my indulgences to Christmas Eve and Christmas Day.
2. Restrict calories further–as in a 1,000-1,200 calorie a day diet. While I mean no disrespect to those suffering from or surviving anorexia, I call this my Anorextic Eating Plan. The reason I call it this is because it requires even more planning and foresight than I already do (which some think is a little nutty). It requires obsessive thinking and acting as if I’m a daytrader of calories. It requires a level of calorie restriction I’m not used to but one that I have done. When I drop this low, I struggle with hunger, especially at the level that I work out. According to the doc, in many patients, a diet this restrictive is nearly impossible to maintain because the body starts craving things and getting significant hunger pangs. I would have to maintain this level of calorie restriction for life–even after getting to goal–because just like my body adjusted to my 1,500-1,700 calorie a day diet, it will adjust to 1,200 a day. How would I do this, you ask? Oh… no worries [*total sarcasm*]. She can recommend a doctor who specializes in weight loss with PCOS patients. His tools: diet drugs and liquid diets. I don’t see this as something that will be good for either my physical health or mental health.
3. Then there’s option three: Cut Up My Stomach And Put It Back Together Again. Or more appropriately called: gastric bypass. This would force the calorie restriction (as long as I was still good about eating healthy and I didn’t waste newly reduced stomach space drinking shots of tequila, eating wings and licking child-sized cones of Ben & Jerry’s. Supposedly, this works. And, again, she had a doc she could refer me to. I really just don’t know if I’m willing to consider that route. I don’t know if I trust that it will work for me or if it will simply allow me to lose another chunk of weight and then plateau again before I get to goal.
At the same time, option 1 ALSO doesn’t seem to be an option. Yeah, it’s a little bit of vanity. I don’t want to be skinny, I just want to be skinnier. But more importantly:
- As I age, my metabolism will slow further, making it even more difficult to maintain my current weight (hello–still obese!) and my weight will likely increase.
- At my level of activity, my weight can be problematic. Eventually, this will wear on my joints and potentially cause more injuries.
- Despite my healthy level of activity and my healthy eating habits, I don’t believe I’m at a healthy weight. Yes, I know you can be overweight and healthy, but there is a limit to how overweight you can be before it compromises your health.
And finally, my problem is entitlement. I believe that I work hard enough to be thin. I don’t deserve this. I shouldn’t have to deal with this. I know I have to get over that. If any of my students said that about a learning disability, health concern or mental health issue, I’d say “Suck it up, put on your big girl pants and deal with it. We don’t always get these choices, and it’s never fair, but it’s the cards we’ve been dealt with and we need to manage.”
Current status: looking for big girl pants.
I need to think about this more and do more research:
- I already have 3 PCOS books on reserve at Barnes & Noble that I’m picking up tonight.
- I scheduled a follow-up with my PCP to discuss my lack of satisfaction for these options and to see what other recommendations she has.
- I will be more strict about carbs and maybe even give up my daily 50-calorie dose of dark chocolate.
- I will be doing research on my own to find other endocrinologists in the area who specialize in PCOS.
- I may schedule a consult with the weight loss surgeon eventually. Or do a trial Adipex/1,200 calorie diet regimine.
- In the meantime, I’ll get the bloodwork done that the endocrinologist recommended and spend all day Saturday peeing in a bottle for the stupid cortisol test for Cushings. Yay.
I’m sure as hell not quitting. I called my mom immediately after the appointment to verbally purge the info overload and disappointment. Just as I was mopping hot tears from my cheeks and thinking about the Starbucks I passed on the way in, she said, “Well, you’ve worked too hard to just quit this. I hope you won’t be demotivated by this and quit all the hard work you’ve been doing. You enjoy working out and planning and cooking good, healthy meals to let this all go to waste. You still have options.” I made a mental note to ignore the glazed lemon pound cake or cupcakes and stick with an iced unsweetened passion tea and iced nonfat latte.
Then, when I got to work, one of the school nurses was sitting outside on her lunch break and said, “You’re looking fabulous–you look like you lost a bunch more weight.” I thanked her and told her she had no idea how much I needed that compliment today. And I did.