Weekly Accountability Thread: Sept. 9 Edition

[Dr_Tigerchik]

How was your week?
What are your goals for the coming week?

[Dr_Tigerchik]

1. Another 7/7 days of healthy coping to get to 152 days… over the 150 mark
2. PT as directed
3. Journal daily
4. Be grateful for what I can do
5. Practice the 2 min pause skill!
6. See if I can figure out what I need and what I am willing to do health-wise right now

1. Yup! Hello from 152 days! I met the 150 day goal and am climbing to 155, which will be 5 months I promised myself I will make this
2. done
3. most days
4. I practiced gratitude that I am not in a wheelchair, on crutches, or in a cast
5. I used this skill a few times
6. yup, talked with my doctor about just trying to maintain weight right now / not get lots worse. I’m often in so much physical pain that’s all I can think about and the amount of mental energy it takes to deal with that leaves me nothing at all in terms of motivation to fight my anorexia enough to gain some weight. This is ‘harm reduction mode’ where my bmi isn’t critically low (it’s 17.9) so staying here until a little is more sorted out w the hip pain (specialist appt this Thursday) is the goal. I see her Fridays; I’ve met the 1700-1800 calorie goal since then

goals this week

1. 7/7 healthy coping to get to 159 days in a row next week when I make this thread… and in the meantime, 5 months
2. journal daily
3. pt as directed
4. practice and use 2 min pause skill
5. continue to be grateful for no crutches, wheelchair, sling etc
6. 1700-1800 calories daily

Thanks to everyone who chimes in on the thread, is lurking reading, etc. I appreciate you.

[Chowders]

@Chowders

Goals for this week:

1. Recover from race, back to normal training by the weekend, hopefully.
2. No reading phone at bedtime
3. Good nutrition
4. Invest decent amount of time on new project (do not spend time faffing on less important things). I need to find a better way to plan and manage how I do this project … part of the problem is that it’s a totally optional activity and I’m accountable only to myself … I’m extremely good at getting non-optional things done productively … but in this case time seems to drift. Maybe my goal should be to try a new way to manage my time for this project.

1. Didn’t feel great last week - lethargic - seemed to take me a long time to recover from my recent races (if that’s what it was). But came around a bit by the weekend and was good today

2. 6 days out of 7 (have noticed that if I don’t have a hard training day to follow the urge to slob in bed with phone is greater … which obviously is a bit self-sabotaging vs just recovering better with more sleep).

3. Not a great week for nutrition, albeit not terrible - just more like a normal person vs someone trying to do well at triathlon. Recently I’ve been calorie counting and doing a good job shedding a bit of excess weight. None of that happened last week. But back on track today so a good start to the week.

4. Did ok with time spent on new project. Getting some done in the morning helps, albeit that’s a clash with when I like to train more. And just spending 1-2hrs most days is enough - and did that maybe 4-5 days.

Goals for this week:

1. It’s 6 weeks until final race of the year, so a nice training block ahead. Plan is to do my ‘standard’ week of solid training, nail key sessions and get my S&C sessions done.

2. Good nutrition.

3. No reading phone at bedtime.

4. Decent time spent on new project.

Have a good week!

[Dr_Tigerchik]

153 days in a row of healthy coping! Today will be 154 which will make 22 weeks in a row. Have promised self
1740 calories yesterday so in range there.

[Michal_CH]

I’ve not been very attentive to ST recently, couldn’t deal with the new forum version…

I’m glad you’re coping very well! Please share, why you’re down on calories (last I remember was 2k kcal)?

As I’m writing it, I’m at the Catania airport, on my way back to Zurich. I spent the longer weekend on Sicily, which definitely contributed to not completing the last week’s training plan - I basically did everything apart from the long ride and long run. Maybe for the better, as my body might appreciate one more week of mediocre training post IM Frankfurt. I’m hitting the training hard this week though, >20h of well distributed training is expected.

[Dr_Tigerchik]

“Please share, why you’re down on calories (last I remember was 2k kcal)?”

Because my brain’s a mess for disordered and non disordered reasons.
We went from 2000 to 2300, my weight went up by a kg in a week, and as a response I freaked out and had some days at 1300-1700 calories. We learned if we’re going to up them we need to do it slowly so I don’t jump between ‘extremes’ like that. And, my brain, which had felt okay with 1900-2000, got scares of that amount again. So the number I thought I could manage mentally was 1700 which is probably maintenance or losing a little.

I’m not at a really low weight - I’m like 6 lbs underweight, going by BMI - so my doctor was okay with this. Is it awesome? No. But it’s better than going back and forth between something really low like 1300 and higher numbers.

The other reason is my hip pain right now is incredibly high. I am physically in so much pain it is stomach-turning some of the time, so the goal right now is just to maintain my weight as best as possible and fortunately if I lose a little more, it isn’t going to cause any dire medical complications. The pain is so high I can’t even think about much else and the mental energy to, say, fight my brain to get in the extra 300 calories that would get me to 2000 - fighting in terms of the fear about that number and the serious effort that it takes to even get down 1700 - is just. too. much. So the 1700 felt like “I can probably handle this each day and stable intake there is better than nothing.”

The physical pain is driving this more than anything else; I am just not all that hungry. The anorexic part of it is pretty secondary right now.

IDK if that explains it.

[madMike100]

I’m so sorry for all the pain you’re dealing with; hoping we can will you through this.

Just a quick (happy) check-in. While I am surfing the wave of life (and I don’t know how to surf, but I hope it smells better than the septic problem we had in the basement today), I can report that I did some (walk/jog) catch up in the last 2 days (21/day), and have now completed the first (672 mile) leg (of 5) of the virtual transcon in 2 months and 2 days, so I’m about 2 days behind where I hoped to be at this point. (I’m trying to complete this by April 30th with a reported “special prize” as motivation.) Sickness cost me 2 days off and a weak 7 mile day, but the movement is helping clear out some of the phlegm, although I’m still coughing a good amount.

Weight is down about 7 lbs since I started (22 left to go), and my half shuffle/half walk is netting me miles at about 12 minute pace (13 when exhausted), even at the end of a 20-mile day, so that feels pretty good. (I’ve also been dieting during this, never taking in calories during the exercise in the hope I’m burning more fats and staying, of course, in zone 1.)

I will need to start adding cals soon since I need to start a little biking to strengthen the quads to protect the knees, and I don’t want the glycogen to go to zero. (This will probably start after the wonderful septic aroma near the trainer dissipates.) I expect to start swimming in about a month.

I’m probably going to shoot for the half in Monterrey, Mexico (my wife’s home town) on March 2nd as an excuse to see her family. (Every time we’ve planned to go the state department has reported it as high danger for Americans, so we haven’t been back in 16-17 years, which is terrible. But they report that the state (Nuevo Leon) is much better now.)

Lots of organizing/running errands, not much studying or practicing right now. “Emergencies” each of the the last 4 days, each requiring about 4 hours attention. All the kids’ fall activities start this week, with 2 birthday parties on the weekend.

That’s all I can muster at midnight. Until I can post again.

[Michal_CH]

This explains your thinking and reasoning, thank you.

Where I think you’re right is the stability - an average number is better than jumping up & down, and infinitely better than nothing.

Where I think you’re not right is the direction - first, and I’m sure your technical mind knows it, but to gain 1kg fat on your body, you need to consume an excess of ca. 8000-9000 kcal (not 7x 300 kcal = 2100 kcal), please don’t be afraid of the water retention as it comes & goes, and can be beneficial for e.g. joints; second, and I’ll be bullish here, 2kg below BMI 19 is not great and there’s a reason why US insurance agencies claim BMI 22-23 being the healthiest (for women maybe 1-2 units lower, you’ll get there); third, and I’ll be bullish here again, I think 1700 kcal won’t work as it’s hard to get all the nutritional values with 1700 kcal, and your body will heal faster with an excess of calories (energy) and nutrients (build material). I’m aware it will be the hardest part, but I would recommending setting yourself a target (e.g. that BMI 22) and accepting the fact you’ll gain those kgs (e.g. accepting that, if you’re 170cm, you’ll be 9kg heavier in roughly 5-6 months), and your body will thank you for that.

[Dr_Tigerchik]

I don’t think you’re being bullish; I appreciate the slight pushback.
Can you say more, or point me to something, that explains the insurance agencies with BMI 22-23 (or 1-2 units lower for women)? I’ll push back here and say I’m not totally on board with insurance saying stuff like that - keep in mind that insurance denied an MRI last week despite my being in a ton of pain, having tried PT for 8 months, and having rested that hip for most of those 8 months, so as far as insurance making decisions I’m skeptical. But I am interested in what you said because I have heard BMI 20 being a goal in other settings. I will say most of my adult life my BMI has been in the mid 19s.

Thanks for the continued conversation. I mean that.

[Dr_Tigerchik]

I’m sorry you’ve been ill.

You said “exhausted” - it’s ok to put fewer, or 0, miles in on days you’re exhausted. Sending you hugs.

I hope you feel better. Sending e hugs as I can’t catch what you have from e hugs!

[Dr_Tigerchik]

got a little over 1700 calories yesterday
journaled a little bit
yesterday made 22 weeks of healthy coping in a row!

[Michal_CH]

As part of my work experience (I’m a management consultant / IT BA and I worked >5 years for a global re-insurance company), I’ve learned that life insurance companies model the life expectancy on the BMI (as one of the attributes). There’re some companies that will model it as a function on a discreet data, maximising life expectancy around 22-23 (some will model it based on a threshold, e.g. only looking at >30 for general population to add additional actuarial premium and some based on simple function on ordinal data type for BMI ranges). It’s a data thing and has nothing to do with individual underwriting or agent decisions.

Your health (=/= life) insurance has nothing to do with it and the US health care system is crap.

There’s been a few publications suggesting that the life expectancy is highest at the higher end of the recommended 19-25 (18.5-24.5) range. You can check this meta study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11051237/#:~:text=Results%3A%20The%20meta-analysis%20showed,–30%20kg%2Fm2 or this slightly older one: Years of Life Lost Due to Obesity

[Chowders]

Michal_CH said more or less what’s been going back and forward in my mind. I didn’t post it because although I’ve been straightforward with you in the past with my views, I’m also very aware of my lack of experience / expertise in what you are going through. And in the end I’m just here to support.

That said, I hope it’s ok to add a couple of things now that you’ve once again shown your incredible capacity to engage openly and in good faith with internet friends/strangers about your situation. I have no idea why insurance companies have an opinion on BMI but I think it’s well known that it’s a poor tool to judge things at an individual level (my understanding is that it has some efficacy at a population level and that’s what it was designed for). If I’m right about that then BMI is a bit of a red herring for you and getting your period back just seems like a much better indicator for you that you are on the right path.

I don’t know what that means for your in practice and I can’t imagine what it’s like having to battle with your brain on this stuff every day, but honestly it worries me that you & your Dr agreed to reduce your calorie target. I understand it was a tactical decision as you were struggling with what turned out to be a very temporary jump in weight.

You’ve said that it’s difficult to cope with the hip pain as well as the other stuff at the same time. And you sounded a bit overwhelmed at times in your posts last week - it’s clearly a tough moment. But actually I think you can deal with the hip pain and the other stuff. Not easy of course, but you can do it.

Let us know what the hip specialist says.

[Dr_Tigerchik]

I’m with you on periods back being a better marker for an individual.
re: reducing calorie target - I think it’s temporary and tactical to avoid the situation where I really undereat on some days. I was pretty honest that if the goal was 2000 right now I probably wouldn’t even try because if would feel too overwhelming and insurmountable.

please don’t underestimate the hip pain… it is literally stomach turning. That 1700 feels pretty challenging right now. I’m hopeful the hip specialist will have some ideas and answers and that will make the food stuff easier. For right now, five days of 1700-1800 calories in a row is better than flip flopping between 1300 and higher numbers.

again, all in good faith -really - I appreciate the concern and support. The whole thing just isn’t easy.

[Dr_Tigerchik]

thank you for the additional info and links!

[madMike100]

So sorry you’re dealing with this crap. It seems that the hip is the big thing right now and you don’t have enough remaining psychological energy to do max fight for the weight stuff. Understandable.

So dealing with that is issue number 1, and being able to reduce the pain will considerably improve your quality of life. That being said, I decided to look up “low-cost” providers for MRIs for people who don’t have insurance (since insurance turned you down) and a couple of firms showed up. The one I looked up (radiologyassist.com) doesn’t have any offices in Oklahoma (where I assume you currently are), but does in Dallas, which seems to be one of the closest places to your state. These seem to charge about $550-600 for a hip MRI (uninsured), which would seem worth it considering your pain and suffering. (But an academic’s pay would never be conflated with Fort Knox.) Of course, you’ve probably checked this out.

The other point is BMI is a stupid measure. Go back to body fat %, which they used before they got lazy and switched to BMI. In my 20s I did 4 Iron-distance races where you could get your body-fat % taken before the race, and each time I had the lowest percentage of the 100 or so athletes who chose to get it done, and yet my BMI was considered unhealthy (slightly too high) all but one of those years.

[Dr_Tigerchik]

155 days… 5 months in a row
1700 calories eaten yesterday. Didn’t have time to journal.
Hip specialist this AM, hoping for some progress forward

[Dr_Tigerchik]

update from Thurs appt: doc is confident it’s a labral tear. This is a presentation they’ve seen in other high level athletes. I’m reassured by the confidence. They think an MRI w contrast will pick it up, but they want the MRA done at their facility.
I had a ton of back pain from the drive there and back (all of 2 hrs). I had some back pain when I flew here - I would be in the car after and had a small spot that hurt - and I thought “this is a small unrelated thing from flying that will go away.” It did. But it came back, and a lot worse, on Thursday.

Time line is 2-3 weeks to get insurance to approve mri (I asked if I could pay for it could we schedule now and we said no and I get that, I understand the system should be fair so people who are in my position who can pay out of pocket can’t jump the line), 1-2 weeks to get that scan, hopefully see surgeon soon after that, 6 weeks or so after that for surgery. IF they have the diagnosis right.

That is a very long time.

If my back hurts again today I will go to urgent care, as that has escalated since Thurs and is worrisome. I am keeping track of the pain meds I’ve taken and how little I am moving so I have the documentation to say look, this isn’t sustainable.

Food wise I met the 1700 calorie goal for the days between doctors appts. I felt bloated and terrible yesterday and did not want to get on a scale, because I was very confident the number would be higher and that would mess with my head and make it a lot harder to eat. And, if it were a lot higher I wouldn’t be willing to do more than 1700 calories anyway. So when I told my doctor all this we decided to not do a weight check today; she said we can wait until next week or I can just stop in sometime this week and they can just get the number.

plan right now:
urgent care today or tomorrow if my back gets sore again
call the PA on Monday and tell her how much this has escalated
PCP on Monday or during week if back gets sore
do my absolute best to eat 1700 calories a day

I have now accumulated 157 days of healthy coping. I am proud of me.

[Chowders]

Well, that would explain the pain. I can’t quite remember the sequence of things but feels like that’s something your healthcare providers might have picked up before now? Or maybe it’s new? You sound a little unconvinced by the diagnosis? Would be good if you are able to accelerate the timescale given your level of pain.

[Dr_Tigerchik]

I had an MRI without contrast in April. The doc here thinks this wasn’t picked up bc that MRI didn’t have contrast. I’m actually fairly confident in the diagnosis because the doctor is so confident, but I’ll not be 100% confident until it shows on the test. Does that make sense?

I am documenting the pain meds I’m taking (time/amt) so I have some evidence to say “here is some objective-ish data about the level of pain, could you please please please accelerate the timeline in some way”. So there is some numerical data of meds along with the more qualitative data I can provide about “am spending days laying down as much as possible, and even that hurts.”

I did get my 1700 calories yesterday. and now 159 days in a row healthy coping.
Thanks for the support. Kind friends and family are helping me so much right now. I will pay it back when I am able to.