Category: Life Style

It doesn’t take a psychoanalyst to figure out the dream I had in the wee hours of Monday morning, opening day of my new clinic. I’ll give you a few details and you can decide.

I was driving to the clinic right before dawn. It was dark and drizzling and damp and the kind of cold that cuts right to the bone.  Oncoming cars glared at me as I took every wrong turn possible. Not recognizing any road signs or landmarks, I ended up in Timbuktu. I stopped by an unnamed beauty salon to make an appointment with a stylist I had never met to get my hair cut.  I waited impatiently for at least twenty minutes chiding myself that now I was going to be late for sure. Finally, I decided not to make an appointment after all. I walked down a steep flight of stairs and tripped at the bottom, dropping my purse and spilling its contents everywhere. It took every ounce of energy to collect my scattered belongings. Prostrate on the ground, I army crawled to the car. Apparently my legs wouldn’t work.  The car door opened like an oven door and I struggled to get in. I finally made it to my office and someone asked for Julie. Three people looked up at once. Which Julie do you want? The receptionist, the MA, or the doctor.

Can you say anxious? More like petrified.

The truth is I made it to my office on the first day in plenty of time, with no wrong turns mind you, despite my crazy dream. And much to my surprise and delight, my five adult children (orchestrated by Carol, my daughter-in-law) had sneaked in the night before and left a thoughtful gift and hand-written note, each one having penned their personal words of encouragement for my first day.  Even my grandson, Uriah, contributed. “I like some of the food,” he wrote. Cherishing their sentiments, I paused to reflect on all the people who had been helping with this huge change.

For the last several months, Stephanie and I have been stealing away talking, planning, dreaming. My brother, Greg, has been so patient and kind helping with web design, logo, printing, the list goes on. During the previous weeks, family members and colleagues gave helpful advice or came by with well wishes and flowers. Lisa, my friend who owns a small business a stone’s throw away, lent words of affirmation and beautiful art for the walls.  My husband and son willingly assembled furniture and hung pictures.

Then there’s Gayle. The entire week prior she made phone calls, ran errands, helped me decide between this rug or that. Furthermore, Gayle has been the mature kind of friend who can identify with and validate your frustration and still direct you to take the high road.  Did I mention that in my dream Gayle was riding in the passenger seat? Not saying a word, she was like a guardian angel, steadfast and true.

Though my first day had its bumps, it was overall very satisfying. Patients were patient as I fumbled through the new electronic medical records system. My former boss and his wife dropped in mid-morning with reassurance and a lighted exit sign. The phone rang just enough to encourage me that I was not off my rockers to start this new venture. By the end of the day, Gayle and Stephanie and I were breaking into song. “People who need people are the luckiest people in the world.”(Don’t worry. I’ll keep my day job.)

But whoever said that was so right on. There is no way I could make this huge change all by myself.  And you know what I am figuring out? I don’t have to do it all by myself. I need help and that’s ok.

We all need help and support in change. It’s a creature feature and there is no shame in that.

At Oregon Weight and Wellness, our team wants to help support the changes you are making, no matter how big or small, to help move you in a direction, perhaps a new and different direction, of health and wellness.

I need to add a PS to all those dreamers out there. Just for fun, I looked up the meaning of Gayle. I found several: “festive party; to have the uncanny ability to stay calm in chaos; quiet confidence; a peaceful warrior; one who sees the light in others.” Interestingly, in Hebrew, Gayle means “a father’s joy.” At the risk of seeming overly sentimental or spiritual, I believe that even in my fear and trepidation, I have the joy and favor of God my heavenly father right with me.  I forget that oftentimes. The dream was a good reminder that change is hard but with God’s help, I can do all things. My hope is to hang onto and extend that same outlook to all He brings our way.

That overwhelming Déjà vu feeling enveloped me as I was cleaning the bathroom last Saturday at my new to me clinic getting it ready for opening day. Like a hug from an old friend it welcomed me back as if I had been there before and this was just part of my routine. It felt right, like I was supposed to be there.

You see, every Saturday as an 11-year-old kid I cleaned doctors ‘offices including Dr. Warren’s office where my mom worked as a nurse. It paid exceedingly well: $26 per week which was much better than the 50cents an hour I earned for babysitting.

When I first started, I worked for Rosetta Palone, an elderly Italian woman from coal country Pennsylvania. She taught me how to clean. She didn’t whistle while she worked but she told lively stories which made the time pass quickly.  Once we made the exam rooms shine, we’d take a break, “a fiver” as she called it. She always gave me 2 cookies and a Dixie cup of Coke.

Rosetta was a kind lady with a sparkle in her eye and an encouraging word at the ready on her lips. “You missed a spot,” she’d always smile as she admonished me, never shaming, but cheerfully pointing out dirt or dust in every last nook and cranny. She took pride in her work and taught me to do the same. “We need to do our best for the patients who come here to get well,” she’d say.

Eventually, I took over cleaning Dr. Warren’s office all by myself.  My mom served as Quality Assurance. She would let me know if the cleaning job was not up to snuff.My breaks involved sitting in Dr. Warren’s private office and peering through his thick medical books. I was captivated. I knew I wanted to go to medical school and become a physician.

Fast forward forty-three years. It struck me funny that I had come full circle, cleaning my own clinic, excited and nervous all at the same time. Am I ready for this?

Though this particular déjà vu experience was extremely positive, I realize they are not always. And it struck me that what we refer to as triggers might be considered negative déjà vu. Something we encounter in our present stirs up a negative subconscious memory from our past and triggers an old coping mechanism which has now become self-destructive. Stress eating might fall in this category. But it is oh so hard to change.

At Oregon Weight and Wellness, we provide a safe place to explore and address emotional eating triggers. “When did you start believing…xyz” is a question l find very instructive. It takes conscious effort to recognize This is not That. It takes courage to say That will not have control over me anymore. It takes confidence to try one more time to respond differently. Stephanie Husk, LCSW our therapist, has experience in helping people identify barriers for change Our health coach, Rachel, will also be available for support.

We may not have to dig under every rock, but we may need to get into a few nooks and crannies. No shame. No guilt. No judgement. And we will do our best so patients who come here can get well and discover that they really can live “weigh” different.  

This Thanksgiving falls very near the closure of WVP Medical Weight Management Clinic. As I reflect on this coincidence, I find myself overwhelmed with gratitude for the past four years.

First and foremost, I am thankful for my boss. I remember the day I sat in his office and started a conversation with him which very much resembled a friendly game of tennis. “Obesity is a problem, a big problem,” I served the dialog nonchalantly.  He looked up from his computer and the reams of paper which sprawled across his desk. “What do you want to do about it?” he volleyed right back to my court more interested and knowledgeable about the issue than I would have guessed. “Let’s start a clinic,” I chipped and charged. “You’ll need a grant,” he returned with an ace. I didn’t see that coming and I didn’t know the first thing about grants. He did and he got one. Game, set, match: Dean. He’s a superstar.

It was the support of WVP that enabled us to move forward with the project. I am so thankful for the WVP staff who put time, effort, and expertise into building us out. I might know something about building an obesity medicine program but I knew nothing about all the back end work of building a clinic. Kudos to the personnel in IT, HR, billing, and NextGen who had the patience and know-how to get things off the ground.

We started humbly in my original family practice office, but quickly grew and moved, not once but twice landing in a beautiful new building on 12^th street. We had our ups and downs to be sure, figuring out referrals, experimenting with clinic hours at the hospital, finding the right staffing, adding providers, trying out different groups, learning how to bill, being rejected again and again. I suppose the most fun for me was getting our program name out there, knocking on doors with Stephanie or Jeanine, meeting colleagues over their noon hour, promoting the medical treatment of obesity. The work was energizing. Again, I was surrounded by coworkers whose attention to detail made my job easier. Their excellence, encouragement, and enthusiasm carried me many days.

Finally, I am grateful for the patients from whom I have learned so much about the respectful and real treatment of people with obesity. I am particularly indebted to my very first patient. It was our brand spankin’ new body composition scale’s inauguration day and I waited eagerly if not smugly in my office while the MA roomed the lucky patient who was getting to use it first.

“What’s her BMI?” I inquired when the MA finally popped her head in to let me know the patient was ready. “I didn’t weigh her,” she replied and explained the patient was in a wheel chair. “’Well, I’ll help you,” I offered a little irritated, moving past her to solve the problem. “She is paralyzed,” the easygoing MA smiled softly, “she can’t be weighed.” Oh, that was a different story. And I sat back down surprised and embarrassed at my own arrogance. In addition to her inability to exercise and decreased metabolism, the patient was taking several weight promoting medications. I wanted to quit before I got started. How in the world was I going to help her?

Then I remembered the original vision I had for the clinic. I was not the helper; I was only a vessel through which the Helper would work if I would just let Him.

And so I am grateful. I am grateful for every person, every opportunity, every mistake, misstep, fumble, fear which has driven me forward to this point in time and without which I would not be here.  These last four years and WVP MWMC has been a great success. And I got to be part of it. Thank you.

As a general contractor, my husband enjoys good quality tools. “Good tools make you better at your craft,” he often declares to our kids who watch in awe as he lifts huge beams with ease or cuts through concrete like butter, skillfully employing whatever gizmo is in his hand at the time. We stand amazed at his completed projects as if he leaped tall buildings in a single bound. He’s an expert craftsman to be sure, but his tools rocket him to superhero status. Consequently, he never balks when I want to spend money on another useful kitchen gadget. And when he saw the ticket price for the doctor’s scale I purchased and placed in our bathroom, he just shrugged a low humph, unimpressed.

The scale is an extremely important tool when it comes to weight management. I have to know where I am in order to get to where I want to be.  The scale reveals trends. It helps with correlations. When I do X, my weight does Y.  When I choose A, my weight does B, and so on. And in order to measure these trends, I have to weigh on the scale regularly. For me it is every morning. Like clockwork, the alarm goes off; I stumble out of bed, use the facility, and stand on the scale. I greet it like a trusted old friend who is not afraid to tell me the truth, no matter what. I’ve worked very hard on my relationship with the scale.

I did not always harbor these positive vibes.  I hated my scale just like some of my patients tell me they hate theirs.  And like them, for a long time I refused to weigh myself. I even went bouts without owning a scale. When I did step on it, the scale only screamed obscenities at me. “You fat, lazy slob!” (I’m toning this down for reader discretion.) I was suffering from what many of my patients suffer: PTSD. And I don’t mean Post Traumatic Stress Disorder which I do not want to minimize as I know it is very real and I believe needs to be addressed in order to maintain a healthy weight. The PTSD to which I refer is POST TRAUMATIC SCALE DISTRESS.

Post Traumatic Scale Distress stems from the chronic relapsing nature of the disease of obesity we talked about last time. You step on the scale one day and see that you’ve lost weight only to gain weight the very next day despite all the hard work you are doing practically starving yourself. This gives way to feelings of hopelessness and so you stop weighing. Like I have done on more than one occasion, you may even start refusing to be weighed at your doctor’s office. “You and what army are going to get me on that scale,” I chided a poor MA once who was just trying to do her job. (But seriously, have you noticed that in most doctors’ offices the scale is conspicuously right in the middle of the hallway and you get weighed with your shoes on while everybody and their brother in law is walking by eyes darting in your direction? I mean it is criminal and worse, maybe a HIPPA violation.)  But how is that working for you? Not weighing. It did not work for me either.

Studies show that people who weigh regularly are better able to maintain a healthier weight. Thems the facts.  Let’s talk about the limitations of the scale though. 1) It measures one point in time. 2) It does not tell the difference between fat mass or muscle mass or water weight.  3) All scales are not created equal. 4) I can’t compare my scale at home to the scale at my doctor’s office where I weigh later in the day with my clothes on.  5) It is an inanimate object. 6) It has no voice. 7) It only has the power you give it. 8) It is a tool. A very useful tool when used correctly.

Do you need to work on a different relationship with the scale? At Oregon Weight and Wellness we help with this.  We will not weigh you unless you give us permission and then not until the end of your appointment.  In private.  Without judgment. The focus is on you, not the scale. That’s the Weigh Different Way.

According to the Obesity Medicine Association, obesity is defined as ” a chronic, relapsing, multi-factorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, bio-mechanical, and psycho-social health consequences.”

Wow, that’s a mouthful. Let’s unpack that definition one or two words at a time.

First let’s look at “chronic, relapsing.” Our bodies actually fight to defend a higher set point even at the expense of unhealthy weight. We are superb energy conservationists, designed to maintain homeostasis. Our brains can become blind to the satiety hormone leptin that is released from fat cells(mostly because of what we are eating) and then weight loss itself increases the hunger hormone ghrelin that is released from the stomach. Blind to satiety, driven to hunger. That’s a recipe for weight recycling.

Understanding the chronicity of obesity really sheds light on why so many of my patients are able to say without exaggeration, “I have been battling weight my entire life.” Furthermore, anyone who has gone on a diet only to regain the same 10, 20, or even 100 lb testifies to the relapsing nature of the disease. No wonder it’s so hard to lose weight; it’s the very nature of the disease!

With medical treatment for obesity, however, the dysfunctional cycle of weight loss and regain can be broken. After performing a complete history, physical, lab and body composition analysis, an obesity medicine specialist helps you to strategize unique, sustainable lifestyle change which correct the communication between the gut, the brain, and the fat cells. The focus is on small changes in nutrition, activity, sleep, and stress management. Sometimes medications are needed to target metabolic function, hunger and satiety hormones, or cravings. Bariatric surgery can also be a helpful tool.

Understanding the chronic, relapsing nature of obesity helps understand why weight loss and weight loss maintenance may need to be treated differently. At Oregon Weight and Wellness, we have what I call the R3 program to protect against weight regain. We establish a Realistic Goal Weight, a Refocus Weight, and a Reach Out Weight.

Many diets promise enormous amounts of weight loss in just three months. After working with people and truly understanding the chronicity of the disease, my conviction is that we need to work together over time and seasons, ups and downs, through celebrations and hardships, not rushing the process.

This Weigh Different approach builds resilience and helps you maintain your healthy goals. Its a marathon, not a sprint and we are in it with you for the long haul.

I love fall. The crisp morning air, the contrast of the colorful leaves against clear blue skies, the colder nights. This year my husband and l vacationed in New Hampshire’s Green Mountains just to see the fall foliage of the East Coast. The locals call people like us “peepers.” It was breathtaking for sure but you know what?  Autumnal Oregon is just as breathtaking.  There is a maple tree outside my bedroom window I could stare at for hours. I should say there was a tree. It’s gone now.

I protested vehemently three years ago when my husband announced he needed to chop down my majestic maple which had given me hours of daydreaming pleasure every October when its huge leaves turned a brilliant yellow. Something about its proximity to the house, the roof, the septic, he explained as he revved the chain saw. The kids were ecstatic of course when they didn’t have to rake its leaves anymore.

We still have leaves, mind you.  I made my husband plant fourteen more maples on the perimeter of our property to take the place of the one he sacrificed. With kids grown and gone, leaf duty falls to me. I actually look forward to it, re-framing the work as a productive form of exercise, fresh air, vitamin D, being outside with my dog, all that good dopamine producing positive thinking. And I capitalize on efficiency by blowing the leaves onto the grass first, then cutting the grass and vacuuming the leaves at the same time with my mulching lawn mower, grass catcher in tow. Think of all that compost. It’s energizing.

But today I ran out of gas. Literally. I was halfway finished with the job when the engine kicked off. I tracked down our gas cans. The two I found were empty. Simple enough, I reasoned. Just put the cans and the dog in the car and drive the three miles to the local gas station, have a chat with the owner Cindy while she fills them, and get right back to work. No big deal. But I felt drained. I could not move. Why?  Why did I have the energy to do the work of blowing and mowing but zero energy for the simple task of filling up gas cans? The all too familiar tape played automatically in my brain:  “You are lazy.”

I have heard that more than once from patients when I inquire about the barriers they face for positive behavior change.  “I guess I’m just lazy,” they often reply. I did what I encourage my patients to do in this paralyzing moment and investigated that negative thought. Is it true? What is the history? What is the proof? The truth is I’m not lazy just as I know my patients are not lazy. We do tend to take the path of least resistance, however.  It’s human nature. We come by it honestly and energy conservation serves us well most of the time. It is thermodynamics.

I still did not want to wrestle my dog into the car. So I told myself the next truth: I have enough energy to take the next small step.  I called my husband. “Don’t we have a gas can around here that actually has gas in it?” He told me where a third, full gas can was hiding.  I found it, filled the tank, and finished the job.  

Telling myself the truth and not condemning myself for my humanity changed the potential energy I knew I had into the kinetic energy I needed to take the next small step. Telling myself the truth sparked action.  Telling myself the truth makes all the difference.

This weigh different thing is personal for me.

Allow me to explain:  As I shared, I have four children, healthy children, who all had that pre-adolescent weight gain prior to their growth spurt (ok, except for you, Zach).  But my youngest son, Zeke, kept gaining weight. Worried and wondering, I elbowed my husband and whispered in his ear, “Kenny, we have to do something.”

“He’ll be fine,” Kenny replied, playfully dismissing my maternal worries in complete denial, I might add, of the firestorm of metabolic hormones raging in Zeke’s young body.

So I did what most mothers would do. I watched him. I watched him and I micromanaged his eating.

“Zeke, are you really that hungry?  Why don’t you wait a few minutes and see if you still need seconds.”