Sunday, November 27, 2011

Why Bother? Patient Lessons.

Tuesday With Marla

Gotta love her attitude!
Why bother? That’s what I thought. I worked hard on making changes, and in spite of my efforts, here’s the bland response I got from my doctor in this letter: “Your A1c is fine. Your lipids are high. LDL 105, HDL 46, Triglycerides 167. Stay on the statin. Continue to work on your diet and exercise.” If we hadn’t already discussed these results together, you and I, I would have just blown it, food wise.”

What’s this all about, you’re wondering? Let me fill you in. Marla has been working with me for about 8 months. She presented to me with high cholesterol, high blood pressure, and obesity. And her A1c, the blood test that gives a picture of blood sugar control over a three-month period, was just about out of range when she first came to see me. But most distressing to her, was her relationship with food, her struggle with binge eating disorder. Her emotional triggers were real, and life continues to have its share of stressors.

So what happened to Marla?

Here’s the quick summary, based on the concrete facts, the numbers, first. Her A1c dropped into the normal range, several points below where it started. And several points, on the A1c scale, is a pretty huge change. Her ratio of total cholesterol to HDL—the good cholesterol—improved significantly; it is now well within the healthy range, below 4.3. And it started at 6.1. Her good cholesterol is higher than ever, about 40% higher, likely the result of the significant improvement in her activity level. Of course I shared this great news with her at our recent session, expressing how pleased I was that she achieved this dramatic improvement while simultaneously reducing her dose of statins, the cholesterol medication she had been on from the start.

And while her BMI remains high, she is down 43 pounds. And get this—her food record today revealed proudly inclusion of Pay Days, the mini Halloween sized candy bars she gets on sale after Halloween. One or two at snack were consumed when she needed to eat, when she got hungry. And she ate them for many days, I’ll add.
Why so proud to be consuming these chocolate peanut candy bars? I’ll tell you.

Keeping dessert in balance, Marla now can enjoy her favorites.
These, though, are mine-homemade French macarons.
Because, as Marla stated, “Just last year, I thought that once I started I couldn’t stop—because that was what would happen—in the past. I’d find a trail of Pay Day wrappers strewn about my apartment, unaware of just how many I had eaten throughout the evening. Now, I’m not in deprivation mode. And I can record (and acknowledge) that I ate them. And I can eat them in moderation, and enjoy every bite.”

But when Marla saw the doctor’s letter, she had to work hard to remind herself that she really had done well, regardless of how his summary distorted things. “Lipids are high”? They are not only significantly improved, but almost all the values are now in the normal range. “A1c is fine”? How about “Job well done! You are now in the normal range as a result of your hard work! ? Marla had gone from a fatalistic approach about her health—she shared that she never expected she might outlive her relatives, many of whom passed on in their 50s of heart disease. And when she first saw the doctor’s letter she assumed, once again, why bother? I guess I can’t change the situation. She assumed that genetics tell all—her high levels were just meant to be, and there was little she could do about them. But now she knows that is not so.

Why bother?

Even if her levels hadn’t improved (which of course they had), was it really a “why bother” situation? Certainly not! She felt more in control of her food, was able to include whatever she liked now, in reasonable amounts, and was more fit than ever, with her increased activity. She felt physically better having lost weight, and mentally, was in a better place. And she was taking an active role in her health, rather than assume her fate was sealed because of genetics.

And then there was Sarah.

from the MOMA, NYC
Sarah, in her mid twenties, presented yet another “Why bother?” to me last week. (Was it a full moon, or just one of those weeks?) She has been working on recovery from anorexia and bulimia. Medically stable, she has been out of an eating disorder program for several months, since we began our work together.  And she’s doing quite well, I might add. There’s no crisis now, no flames to put out, no imminent need to push her self. Yet she still needs to continue her work to gain weight, to move into an appropriate weight range.

In our last session it struck me (us?)— getting healthier has its risks. It means she can’t blame any failures (such as not getting into grad school, or moving forward in a career, or in life) on her eating disorder. And recovery has another downside. When you peel away the eating disorder—the restrictive eating and thoughts or the binge eating—you are left having to feel. And quite frankly, feeling doesn’t always feel so great.

So why bother?

No, this is not me! But I did capture this amazing sight in Switzerland.
Because once you get to this better place with food and your health, and get support for managing those painful feelings, life is more fulfilling. You can rediscover your passions, and get more out of living. You can feel that what you do in the world makes a difference. And you can be more present to enjoy the people around you whom you care about.

Marla could have accepted her assumptions that there’s nothing she could do to change her course—but she didn’t. And the results, on all levels, speak to the benefit of her bothering.

In Sarah’s case, it’s possible that in spite of her eating disorder recovery, she may not get into the grad school of her choice. But without recovery, it is a guarantee for ultimate failure.

Life’s too short to not live it to the fullest. 


  1. I think one of the most important things I have learned recently is, using Sarah's case as an example, that life is not made up of either/or choices - it's not either succeeding to get into the grad school, or failing to get into the grad school. It's actually being able to see all the other possible outcomes that appear when life throws us a curve ball. Sarah might find that if she doesn't get into grad school there is something else out there she never considered before. And black and white thinking would certainly prevent any exploration of options.
    I like options. And imagination. And creating my own future. And being able to see past what I am 'supposed' to do with my life to find out all the exciting things I WANT to do with my life :)

  2. It is hard for me to even know what my passions are anymore. I hate the feeling of just surviving each day and not living it. I keep pressing on and am really trying to "bother" but it gets so frustrating. I see my RD, follow my food and exercise plan and really try to beat ED. I am not underweight anymore, but I still have yet to resume my cycle, have distorted thoughts and am terrified of eating and getting fat again. Sometimes it feels like there is no end to this and that recovery is not going to happen

  3. @PJ If only we could all do this--consider that even an unexpected or unintentional consequence could yield a desirable result! Unfortunately, for many, it feels too unsafe to be open to this possibility, at some points in their recovery.

    @ Anonymous There are many stages to recovery, and it appears, from what you wrote, that you have begun to tackle many of them. You may be eating more adequately, and maintaining in a healthy weight range. But the other aspects of eating--pleasure, enjoyment, flexibility--will take some time. So don't give up!

  4. This post came at a really good time for me (mid-grad school application process). I am realizing just how much I rely on my own food issues: if I have an eating disorder, if gives me an excuse to lash out at people, to not get in or even apply, to try. The post really spoke to me since it's specific to where I'm at: "It’s possible that in spite of her eating disorder recovery, she may not get into the grad school of her choice"...then i'll try again!

  5. Oh, yes, I relate (I AM Marla!)!!! It really is worth "bothering" and I also appreciated the feedback to remember to give myself credit for what I HAVE DONE (as it very well may not come from a busy primary care physician and in a form letter!). So I must remember to praise my own efforts. I haven't always been so good at seeing what I am doing right (too quick to beat myself up for what I'm not doing right or "perfectly"). So nice to be able to enjoy ALL foods in moderation, and even to forgive thyself for "slips" along the way! It makes the journey a whole lot less painful and seems like a more reasonable way to go in the direction of the desired destination. "The process" is a life-style change, towards a healthier way of life, be it losing weight (as in my case) or for others in gaining weight. Thanks, as always, for the great post!