Your subtle changes make a world of difference in your life. But more importantly is the one factor that can truly override all your fears and failures. It's the guarantee that someone else will support you as you begin to make small changes in your daily habits so your future gives you back the uplifting happiness you so richly deserve.
Let's look at a true story
Mary (not a real name) had come into my office. She complained of gaining 40 pounds in the last five years. She didn't really understand how the weight had slowly crept up on her. But it was getting to a point that she couldn't even get out of bed now, but had to roll out of bed every morning because of her weight. She was 194 pounds.
Her right shoulder hurt if she slept on it, and she had a little pinch in her left buttock if she moved her spine a certain way when she was lying down. Because she'd added 40 pounds, her breasts were now larger than they'd ever been. No bra fit. She had yeast infections under her sweaty breasts. And she told me that her belly was now hanging over her underwear and the weight was pushing on her bladder and she couldn't hold her urine like she used to. Her fat made it hard for her to wipe. Everything was just a mess.
Mary had always been proud of her appearance
Even at 5' 5", Mary didn't play sports, but she used to go to the gym a couple of times a week and she enjoyed her workouts and classes there. She kept her strength up. But when our mom and dad moved in with her she stopped going to the gym. She eventually canceled her membership. Her dad was now deceased. I asked Mary what she does in place of the gym and she said, “Nothing.”
(Many caregivers give up things they loved for the sake of their loved one.)
I then asked her what her mother does during the day
Mary said her mom really didn't do anything. She would read some and listen to books on tape and then watch a lot of TV. I asked Mary what she was doing during this time while her mother was keeping herself occupied. Mary said she often watched TV with her mom. Since they both liked the same shows, she felt this was a time to keep her mom company. “Were you always a TV watcher?”, I asked her, and she said no.
(Many caregivers feel they need to keep their loved ones company.)
I then asked her about the foods she was eating
Mary said that she really didn't snack much. They had three meals a day and they were small meals. I then asked Mary if they ate all their food, kept any leftovers, or if they threw it out.
Mary said they pretty much ate their portions, but she cooked enough to have leftovers. If they did have the leftovers they would eat them over the next couple of days for another meal.
And I asked her if the portions were any larger than what she used to eat. She said, “Oh yes!”. She makes enough for herself, her husband, and her mom plus some, and then ends up eating more than she probably should. As a younger active woman, she never used to eat this much.
(Many caregivers make more food so they can have leftovers but end up eating larger portions.)
4 Things to Watch
We looked at 4 things Mary had to recognize in order for her to get her weight back down.
#1 - Was Mary sleeping all through the night or was she getting up with her mother? She said she woke up intermittently throughout the night. Her mom just woke her when she got up to go to the bathroom. Mary still heard her getting up. So basically Mary was not getting a good night's sleep which she had to have. If she didn’t get her sleep, she would not be able to lose weight, she would snack more due to fatigue, and she would lack the energy which could help burn off calories.
#2 - I asked Mary when she had her quiet time. Did she arise before her mother got up or did she stay up after her mother went to bed? Did she take time out during the day to walk and think about her life, her wants, and her own needs? Mary said she did get up prior to her mother so she did have her quiet time every morning with her Bible. But she said something interesting…she told me that whenever she dreamed of a different life, or things she wanted to do, have, or be, she became depressed because she didn’t have those things. She felt that if she ignored “hope”, she would feel much better.
#3 - I asked Mary if she snacked throughout the day and what she snacked on. She said she did snack only once a day. As a “pick me up”, she ate a cookie or a piece of cake. She admitted, sheepishly that sometimes if they had dessert she just kept the fork in the pan and took a bite. I asked her if she ever snacked on fruits and vegetables like a carrot or an orange. She said no.
Did she drink a lot of water throughout the day? She said, “Not as much as I should.” "What do you drink, Mary?" She admitted that she drinks diet coke, but "only 3 cans a day".
#4 – I then asked Mary about her clothes. Clothes are very important to most people and my patients are no different. We wear 20% of our clothes 80% of the time. So I asked Mary if her clothes fit well, and did she liked what she wore.
Mary said, "No, my clothes don't fit anymore and my favorite clothes, especially don't fit, but I don't want to give them away because I want to get back into them." So, she is now trapped to wearing things that she doesn't like, but they are the only clothes that fit. Someday she is going to lose her weight, she tells me, and get back into her nice pretty things.
I asked Mary if she thought that was a realistic view. And she said, “It’s another hope, isn’t it?”
And then she said something that struck me.
She said that part of the reason these were her favorite clothes is that she used to go out in them. She had a few close friends so she would go out wearing these clothes and she always looked nice. I asked her if she missed her friends and she said, “Yes, and Suzanne, I don’t feel good in these fat clothes, so I don’t like to go out anymore.”
Mary’s weight was definitely affecting her health - emotionally, physically, mentally, and socially.
Let’s change Mary…
I am going to show you how I, as a physician assistant, give Mary the hope she has long lost. I am going to talk about the small changes she made to put her life back on track.
After all, this weight gain was so subtle. Nevertheless, 40 pounds in 5 years?
But I'll show you how caring for a senior has a such little, minute, subtle change but made a HUGE impact on Mary's life.
We turned this around for Mary.
What I haven’t told you so far is Mary’s age. Surprisingly, she was quite young, only 42.
Mary had to get these extra pounds off for two very good reasons:
1 – she was on her way to chronic diseases such as heart disease or diabetes (she was prediabetes now)
2 – she was going in the wrong direction and would only continue to add more weight as the years went by
I continued to do a deeper dive into Mary’s life
I told Mary we were going to review her body parts. We were going to go from the head to the feet and talk about every inch of her body. She kind of looked at me in surprise but I told her it wouldn't take that long.
Starting with the head I asked her if her hairstyle and color was something she really liked? She said she kind of let it go. She didn't get it highlighted anymore and she'd cut it shorter just for the lack of time. It was more convenient. How did she feel about it? She just sighed.
Eyes: Mary felt her eyes were in good shape but she was using her cheaters more and more every day. We continued with her teeth, hearing, and down to her shoulders, her breasts, her stomach as mentioned previously. I asked about her back, her knees, her ankles, and her hands and feet. Did they swell?
Next, we worked on self-perception.
I asked Mary if I could go on an imaginary journey with her. She agreed.
So we closed our eyes and I asked her to imagine herself lying in bed in her bedroom and getting up for the morning. What does she do and where does she go? Is anything different from 5 years ago?
Then we talked about preparing breakfast and what we would do between breakfast and lunch. Is anything different from 5 years ago?
What did she do after lunch? Is anything different from 5 years ago?
How did she prepare supper? Is anything different from 5 years ago?
What did she do after supper? Is anything different from 5 years ago?
We began to see her subtle changes.
Lastly, we worked on self-recognition.
Because Mary had told me she was not going out with her friends anymore but staying home with her mother, I knew her home was important to her.
Was her home a place she really wanted to be? Did she like how it looked? Was she keeping up with it as she would like? Was she proud of her home’s appearance?
This is when Mary broke down. As tears stung her cheeks she explained that she was not happy. Her home was not happy. Her husband was not happy.
She was suffocating in a home she couldn’t keep up with, a body that was failing her, a life she didn’t understand, and relationships that meant so much were leaving her.
We closed our eyes and pictured every room in her home.
She explained to me that her garage was overcrowded.
Her hobby room was full of way too much stuff. She just threw stuff in there now and it was a “catch-all” for junk. Now, there was no organization. And, of course, her clothes closet reminded her that she couldn't fit into her favorite things anymore.
Humans are the only organisms on earth that can do this.
Imagine yourself in the upper right corner of every room in your house. Look down at the room and see yourself in that room. What are you doing?
Watch yourself as you go through your day in your home.
What are you doing in that kitchen you never used to do? What are you doing in the living room you never used to do?
What are you doing in the bedroom you never used to do? How about the bathroom?
How about the car? Getting in and out? As you view yourself throughout the day, what has changed in the last 5 years?
Because Mary’s lifestyle had changed so quietly, so surreptitiously, we agreed to change everything back just ever so slightly.
I listed out for Mary a list of things we could work on.
None of this were new. In fact, all these suggestions were from 5 years ago.
We started with her hair. That’s something that would make her feel better immediately.
We took her non-fitting clothes out of her closet and put them in another closet.
She bought 2 new outfits she really liked and wore those.
She decided to go out once a week. One week she would go out with a friend and the next week with her husband.
I knew Mary had to get back to sleeping better. We got her a sleep apnea test. She did not have sleep apnea but suspected her husband did. We got him tested as his snoring kept Mary up. Sure, enough, he got a CPAP machine.
Because Mom got up at night to pee and this woke Mary, we asked that Mom not flush the toilet and be as quiet as possible.
This worked for a while and then her mother was still waking Mary. So Mary got earplugs and slept with those which drowned out any noise from her husband or her mother. If Mary woke up in the middle of the night, I had her cover her clock with a towel so she could not look at the time. She fell back to sleep. This took weeks of trial-and-error to bring Mary’s sleep back up to healthy.
Mary's soda intake
I looked at Mary’s soda intake. Soda habits are very hard to break. Mary loved her Diet Coke but she agreed to start with one less can a day for 2 weeks. She then spread her other two cans out over the course of her day. She added water in where that third can used to be.
Once she got adjusted to that, we went after that second can, adding water back into its place. This took Mary about a month to get rid of that second can. Some days she would go back up to two cans, but they were getting more and more infrequent.
(I will tell you that Mountain Dew was one of the hardest sodas to take away from my patients. Some drank 8-12 bottles a day. It took months to get them off the drink.)
Mary's eating habits
We agree that Mary would eat the same foods she was currently eating but would cut her portions down by twenty-five percent. She was OK with this. She would put her normal portion on her plate and then scoop off 25%. We didn't worry about carbs. After all, taking away 25% of her food was probably taking away 25% of her carbs, too.
Mary’s gym experience
Mary really, really wanted to get back to the gym. She said she could do a 30-minute workout on one circuit and strengthen herself and she could walk for another 30 minutes.
We asked her mom if it was OK if Mary went back to the gym, instead of watching TV with her. Her mom said she didn’t know why Mary was watching TV with her anyway. Mary took off to the gym.
I was concerned about Mary’s right shoulder and her bra, which didn’t fit her anymore.
I asked her to buy a bigger bra for now.
I also referred her to physical therapy for her shoulder and her lower nerve pain that radiated down her buttock. This fixed her up 100%. I only recommend the best physical therapists in the area.
You see, pain is a horrible experience. It must be stopped. If not, two things will happen:
1 – Mary will not work out or worse, stop going to the gym.
2 – Chronic pain leads to depression and then the cycle of eating and lying around starts up all over again.
All of these changes were subtle.
They did not happen overnight.
I also agreed not to weigh Mary when she came in.
She just told me her weight. We were just focusing on feeling better with better habits, not weight.
But the good news is…Mary did begin to lose her weight.
- Drinking more water and cutting out Diet Coke gave her so much more energy.
- Sleeping all night without being interrupted also helped her lose weight but gave her energy, too.
- Going back to the gym lifted her depression.
- Going out with her friends and her husband took her mind off her mother and she saw her life beginning to emerge again, out from under the suffocating blanket called caregiving.
I share all of this with you to say: I hope you have a doctor or medical provider who can spend this kind of time with you and help you realize your goals.
You deserve this and more importantly, you deserve the ongoing support this person can and should provide to you for your own happiness.
After all, isn't this what healthcare is all about?
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