My plan to get the weight off is off to a slow start, thanks to the grumpy knees. It’s hard to get an exercise program going when you can’t walk, and for a couple of weeks around Christmas, I wasn’t doing much more than hobbling and hiding under a heating pad. It’s been about two years since I was diagnosed with arthritis in the knees, and so I was due for a few bad days. I just wish I knew what triggered it —  I have no idea why the knee got inflamed, and the only thing that seemed to knock the inflammation down was time, rest and heat.

It took a couple of weeks after the holiday for things to settle down, but last week, I felt it was time to get moving and see what happened. Half a mile walk, and that evening, things felt pretty good, so the next day, I did it again. It still felt pretty good, so the day after that, I spent some time doing some cleanup and hauling stuff around in the garage. That left things pretty sore, so I spent a day just sitting and resting — and now it feels pretty good again. Not 100%, but probably 95%.

One of the interesting challenges of arthritis is that one of the best methods to keep it in check is to exercise the affected joint, but if you cause inflammation, you make it worse. So there’s this set of lines you travel through and try to navigate between too little and too much, and when you’re just starting out, “too much” might not be a lot. One of the best ways to impact arthritis is to get off excess weight, but if you can’t exercise, getting the weight off is an interesting challenge. so it all twists into itself and it’s this slow, careful process to get the knotted tangle cleaned up and everything moving forward smoothly.

One of the lessons I’m learning — the hard way, repeatedly — is that this is something you can’t out-stubborn. I have to learn when to back off, when to shut it down and use rest as a therapy. I’m getting better at that, but honestly, my personality is to just bulldog through everything that gets in the way, but some things win, and it’s not always easy to realize you need to go around and try a different strategy…

The answer: just keep trying. Learn to listen to the body, pull back when it tells you to, push forward when you can. It’s a balancing act. And not get frustrated when it’s not right the first time, and not focus too hard on results too quickly in ways that cause serious regressions or major downtime by injury. It took many years to get to this point — it won’t fix itself overnight any more than a baseball player can score five runs with a single swing. Baseball players know this — and yet sometimes they still try. they’re wired that way.

And so part of the trick here is to rewire yourself.

When I started talking to my doctor about these issues, that was one of the things he emphasized. It’s not so much about weight loss, it’s about restructuring your lifestyle, and with it, the health changes will come. If you don’t fix the lifestyle issues — even if you lose weight, changes are, it’ll come back.

That’s something the diet industry doesn’t want to talk about — diets don’t work. Even if you lose weight, most people gain it back. Many people gain back more than they lost — and there’s growing evidence that yo-yo weight loss is more harmful to your health than doing nothing.

The plan my doctor and I talked over years ago was to understand what the root causes of the weight were and deal with the lifestyle and diet issues, to get everything under control and moving forward. Remember that in 2004-05, when this process started,  I was living on the burger and fry diet five or six times a week (at least), so to say my diet was a disaster is understating it.

All of these things are habits — and habits are tough to change. It takes about six weeks to rewire a habit, and even after that, can take longer before it feels natural. If you break the cycle of rewiring along the way, you tend to fall back on the old habit again and then have to start over. That falling back can be caused by many things, but a prime cause is stress, so stress is one of those things you need to learn to manage and reducing stress in your life is an important aspect of all of this.

I also found what worked best for me was to keep it simple; one of the worst things you can do is change everything at once — because you’re dealing with so many habits that you’re going to lose out on some of them, and once you do, they cascade and you tend to lose everything. What worked for me was picking some pieces I felt I could change and doing them.

Over time, I went from bad fat-laden, calorie heavy breakfasts, fast-food lunches and generally eating way beyond my metabolism, and eating really crap stuff.

Today? Well, before christmas I spent two weeks logging my food.

(digression: the first and best weapon in getting your diet under control is the food diary. I’ve used a number of tools, including pure manual paper logging, but today, I like Livestrong.com as a place to manage that information. Food diaries, if you’ve never done them, mean you take a period of time and you log everything you eat. EVERYTHING. When, how much. what. and then you work out what the nutriional aspects of that food is. I’ll probably talk about food diaries in more detail later, but suffice it to say, it is a great tool for showing you the food you’re eating that you don’t realize you’re eating by forcing you to be aware of it, but it also gives you a baseline for understanding where your diet now, so you, or a nutritionist, can figure out what you can change to improve it, one dietary problem at a time. this presumes you don’t lie to yourself, of course, and that’s sometimes the hardest part of using a food diary, because deep down inside, you know you’re screwing up and hate to force yourself to admit it. And sometimes, doing that alone makes a big difference…)

What I found was pretty much what I expected to find. My diet breakdown was about 35% calories from fat, anywhere from 30-50% calories from from carbohydrate, and the rest from protein. My goal has been a balanced, 30-30-40 diet, so these numbers are things I could take to a nutritionist and feel happy with. It’s a huge change from when I started (when I was probably 50% or more fat in the diet, much of it saturated), and it affirmed to me I was eating pretty much at maintenance (finally) although not losing.

The problem? That’s a gerat diet for a normal person, but for a diabetic, the carbs are too high, and that’s contributed to the weight I’ve gained since I started treatment, since one of the drugs managing the blood sugar does so by reducing insulin dependence and encouraging moving carbs into the fat cells. Which I need to better manage by reducing carbs so they aren’t there to sequester, which… (like I keep saying, it’s complicated….)

So I need to get those rations to around 35% fat, 30% carbohydrate, 35% protein. I don’t want to raise the fat percentage to reduce carbs, that’s for sure. And I’ve already pulled a few hundred calories a day out of the diet, but I need to pull out another 500 or so to make sure the weight loss gets going on on the downward slope, but I’ve found I have to be careful how I do that, or there are side effects. So I know what I need to do, but finding the right combination of changes that work for me has been — a bit of a challenge.

The big problem spot in the diet is mid-day, when I’m running around and at work. At home, I have my stock of stuff and on weekends things tend to work pretty well. But the weekdays are fighting back. See, carbs are portable. I can stuff Clif bars in my backpack and haul them around (and I do, for those times when my body starts doing the “you need carbs” dance or I end up in a meeting that spans a normal mealtime). Protein? You can’t just stuff a turkey breast in a backpack and not expect bad things to happen if you haul it around for a while — this all requires more planning and care. Most proteins need refrigeration, where carbs tend not to; so I’m having to figure out how best to change all of that around, and yes, that means “carry your lunch”, and using blue ice bricks and stuff. and that means changing out some habits, and…

And in my case, this is more complicated than usual, because of some food allergies. One common protein you can use that doesn’t require refrigeration is nuts, and so peanut butter is a common item in all of this. And guess what? I have a nut allergy, so that’s off the list.

Fortunately, I do in fact like turkey and it’s now a staple. The current goal is to move to a much lighter carb load during the day, and swap in some turkey, add in a regular salad and include a couple of pieces of fruit for morning and afternoon snacks to help regulate the blood sugar across the day, and see what happens.

So we’ll see. It’s been working on weekends, so it seems time to shift it to the weekdays. I’ve picked up the lunch sack. I know how I have to change my shopping (and laurie’s a huge help here, also). The grumpy knees have made me, honestly, not really feel like screwing around with other stuff so much, but now they seem to be cooperating again (mostly). So know we see how it goes, I guess.

And if it doesn’t work, we’ll learn from it and try something else…

The weather was wonderful here in the Bay Area today, so I went out for a walk. Not a huge one — a total of half a mile, but just before christmas, one of my knees decided to secede from the Union and I’ve been working to bring it back into the fold since.

I think I need a bit of a digression for that to make sense. Back in late 2007, I was out birding and walking, and while out, took a step back and landed in a gopher hole, twisting my knee and doing the “hop around on one leg cussing like a sailor” thing. So I got myself home and got ice on it and gave it a couple of weeks to recover.

It didn’t get better. So I resigned myself to having it checked and went to my doctor, and told him I’d torn the meniscus. So he sent me off to the orthopede and we took xrays of the knees, and he sat me down and said “see this? you’ve torn your meniscus”.

And so I asked him if we needed to go in and clean it up. His response wasn’t what I was expecting, it was “no, we’re trying to delay your knee replacements as long as possible”. And then he showed me the arthritis. Which today I realize shouldn’t have surprised me, since there’s a family history — and since i tore the meniscus of one knee back in high school (long before arthroscopic surgery was invented), grumpy knees the predict the weather isn’t exactly a new thing.

But I do have to admit hearing that I should expect knee replacements at some point didn’t exactly make my day. But we talked over various options and ways to manage it when it flared up, and thanks in large part to 500mg of Relafin twice a day, the last three years have been almost painless (literally), beyond the usual weather predicting grumpiness and the occasional twinge.

This wasn’t a twinge, however. For reasons I don’t know (I have no idea what caused the flareup), the other knee, not the one I messed up in 2007, but the one that’s been grumping at me for 30 years, decided to have a major argument; swelled up, stiffened up, lots of pain and general “don’t you know it’s the freaking holiday, why now?” kind of thing. So for the last month, I’ve been living mostly on the couch under a heating pad. There were a couple of weeks where I should have used crutches, but I’m too damn stubborn some days…

This is the kind of thing where it just takes time to get the inflammation down, although I was starting to think I might need to get my dosage raised or consider a switch to a different drug (but the Relafin works well, I tolerate it nicely, and honestly, I really don’t want to load up on larger doses of NSAIDs unless I absolutely have to…). Fortunately, while it flared up a second time during the trip to SoCal (the main reason we cut the christmas trip short and cancelled our plans for Salton Sea….), it’s been slowly getting better and the last week or so has finally been getting almost back to normal.

So when I say I went out for a walk, given how things were two weeks ago, that’s awesome. Not pain free, but now it’s time to start the dance down the thin line of getting exercise onto the joint without so much exercise that it flares up again. The nice thing is, 30 minutes under a heating pad after lunch at work and the stiffness and pain was all gone, which is what I was hoping for. Shows that we’re almost back to normal.

But this has complicated some of my plans for the last few weeks; I couldn’t implement the exercise program because I couldn’t exercise, and I’ve been doing a lot of sitting on the couch with the iPad consuming stuff rather than at the laptop creating stuff, but that’s also a nice break; I don’t do that enough, honestly, and it gave me a chance to catch up on some reading, which I’ll try to do reviews on soon — that’s been on the todo list for a while.

Being limited to what birding I can do from the car has been annoying, so it was nice to get out to EEC in Alviso and wander a bit. And the downtime has given me a chance to put some research time in on some issues, and you’ll hopefully see the results soon.

And I get to keep my own knees for a while longer, even if they occasionally behave like spoiled teenagers and pout when the weather’s bad…