You Are Loved – A Post About Depression, Suicide and Mental Illness

There was a suicide that took place in the neighboring community, at a place where I walk daily. It occurred just before New Years, and was quietly responded to and cleaned up before most of us knew what had happened; all that is left now are some signs that someone made stating “You are loved!”.  A few more signs were placed out yesterday that I’m glad to see.  I’ve been thinking about this a lot because it’s clear that more hearts have broken since this particular one stopped beating.  There is an emptiness that is left behind.  I didn’t know this person but I can feel the rift just the same.

Depression and mental illness affect my family.  Holidays are difficult, and it can be overwhelming.  We often lose sight of the love around us when depression sets in. Even when things are down, it’s important to know that you are loved.

Reach out, and be willing to let others reach out to you. 

Know that you are seen. Know that you are noticed.  Know that there is someone who cares enough to listen so that you can be heard.  Know that you matter.

Crisis Hotlines

  • UNI maintains a CrisisLine and Mobile Outreach team at 801-587-3000, or by going to http://healthcare.utah.edu/uni/crisis
  • Utah County: Utah County Crisis Line: 801-691-5433
  • Wasatch Mental Health Crisis Line: 801-373-7393
  • National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
  • Trevor Project Hotline for LGBTQ teens: 1-866-488-7386

Online

Homeless Services

Volunteers of America | Youth Homeless Services – individuals may come to the Youth Resource Center for a shower, to do laundry or get some food. VOA works to build trust and break down barriers that led to homelessness in order to help teens transform their lives.

Anti-bullying

  • PS I Love You Day – wear purple to stand up against bullying, help end depression, and ultimately prevent suicide. The group uses positive messaging and events to remind you that you are special, loved, and that you are never alone.
  • Stand for the Silent – a place for you to talk with others who are willing to listen, accept you and offer their love and advice. A place you are safe to say how you feel without the fear of being judged.
  • The Bully Project: thebullyproject.org
  • Anti-Bullying Pro: back2school.antibullyingpro.com
  • Global Dignity: globaldignity.org

Contact me if you want a free sticker. T-Shirts are sold at amazon.com, with proceeds going to nami.org

Shopping on a Calorie Budget

I have a pretty steady diet of the things that I like to eat when losing weight, so I’m sharing what I buy here along with some simple and fast recipes for on the go. These foods currently supplement the Nutrisystem diet I’m on, but can be used anytime, regardless.

My local Smith’s Market has most of the items I’m listing below. Smith’s is a Kroger market, so depending on where you live, Kroger includes City Market, Dillons, Fred Meyer, Fry’s, King Soopers, QFC, Ralphs, Harris Teeter, Smith’s Food and Drug, and Kroger Supermarkets.

I also recommend Costco for a good portion of items. Costco has a great selection of top-quality produce, and carries the deli-sliced turkey and bacon crumbles I use.  I love coffee, so that also gets purchased here as well.

Shopping List:


Turkey Wrap – 175 cals

  • 1 – Ole Mexican Foods – Xtreme Wellness Tortilla Wrap (50 cals)
  • 104 g – Turkey Breast (100 cals)
  • Pico De Gallo
  • Shredded Lettuce
  • 1 Tbsp – Bolthouse Ranch Yogurt Dressing (25 cals)

Use 1 tortilla wrap – add 104 g (approx 6 slices of deli cut) turkey breast and as much pico de gallo and lettuce as you like.  Add Bolthouse dressing to complete. Roll and eat away.


Morning Egg Wrap – 182/190 cals

  • 1 Large Brown Egg (70 cals)
  • 2 Tbsp Tomatillo Salsa, or Green Enchilada Sauce (10 cals)
  • 52 g Turkey Breast (50 cals), or  14 g Bacon Crumbles (60 cals) (choose one but not both)
  • 1 – Ole Mexican Foods – Xtreme Wellness Tortilla Wrap (50 cals)

Mix the egg and tomatillo salsa in a microwave-safe bowl.  Microwave on high for approximately 50 seconds.  Use a fork to remove the egg and place on tortilla.  Add turkey or bacon crumbles, then wrap and run.


Maple-Caramel Latte,  16 0z – 101 cals

  • 1 cup Simple Truth Organic Fat Free Milk (80 cals)
  • 1 cup Water (as little or as much as desired)
  • 1 Tbsp Instant Coffee (or more if you like strong coffee/rocket fuel)
  • 1 Tbsp Lakanto Maple Flavored Syrup (21 cals)
  • 1 Tbsp Torani Sugar-Free Classic Caramel Syrup

Combine milk and water, then heat on high in a microwave for 1:30 minutes.  Add the instant coffee and syrups.  Mix (I either shake or blend to make it frothy) and pour into your favorite coffee mug.  Perfect for the season and upcoming cooler days.


Lunch Salad – 125/165 cals

  • Taylor Farms Mediterranean Crunch Chopped Salad (salad only – don’t add the feta, pita chips or dressing packets)
  • Cherry Tomatoes, sliced
  • 104 g Turkey Breast (100 cals), or  28 g Bacon Crumbles (120 cals) (choose one but not both)
  • 1-2 Tbsp BoltHouse Yogurt Dressing (25-45 cals)

The key here is to get your veggies in – these aren’t only good for you, but will help to make you feel full.  Add as much salad and tomatoes as you like, but stick to the plan for the rest of the stuff.  Mix in a large salad bowl and get ready to munch down.


Snacks

Any one of these snacks will keep you in the sub 250 calorie range:

  • Yogurt + 1 Med. Apple, 2 Mandarins, or 1 Med Banana
  • 1 Med. Apple + 1 Tbsp Peanut Butter
  • Cherry Tomatoes or Carrots + 2 Tbsp Bolthouse Dressing
  • Kirkland Signature Nut Bar

 

Nutrisystem Again, But Not Again

So a sort of perfect storm occurred, and I’m suddenly subscribed to a Nutrisystem meal plan.  It started when I received a small spot bonus at work, which I initially planned to use for a new cordless hedge trimmer at Lowes.  After that order was initially delayed, then delayed forever, I decided to look around to decide where to spend all that sweet moolah.

A couple of days later, I was shopping at the happiest place on earth where a perfect storm took place.  In front of me was the gift card display, and on a big sign it announced that the Nutrisystem $100 gift cards were on sale for $55 after instant rebate.  My brain started clicking.

Back in 2008 I had enrolled in Nutrisystem and had a lot of success using their meal plan to lose weight.  Say what you will about food-in-a-box diet plans, this one had worked for me.  After losing 30 pounds I  started running and was able to keep losing weight on a normal diet, and eventually got down to 195 (I had started at 265).  By then I had run a couple of marathons and several half-marathons, and was looking good, even if I couldn’t walk down the stairs in the mornings because of all the running.  Whatever. I digress.  Bottom line is that the meal plan worked for me.

Weight loss progression from November 2008 when I was 274 lbs, to April 2010 when I ran the Salt Lake City Marathon and weighed 195 lbs.

So here’s what I was thinking – with my cool spot bonus money combined with the Costco discounted gift cards, I could purchase a 28-day supply of Nutrisystem.  And that’s exactly what I did.

For anyone who has wondered, this is what 4 weeks (24 days) of Nutrisystem food looks like when it arrives

My 4 week update: I’ve lost about 20 pounds (starting weight 264.1 current weight 245.5)

There are several cautions that I want to raise:

  • Nutrisystem has a sneaky penalty for subscribers:  If you purchase a 28-day supply using their discounted subscription pricing, you effectively commit to receiving at least one more order from them, or face having a $125 penalty assessed for cancelling before the second order is processed.  There was no indication of this on the Costco site where I purchased from (you can check the Nutrisystem Terms and Conditions shown for the product here). I realized this as my order was being placed online… and that’s certainly not when you want to learn about a hidden cost.  I was able to mitigate the problem by going back to Costco and purchasing another month’s worth of gift cards.
  • Nutrisystem now advertises and sells what it calls a 28 day plan, but the reality is that you only receive meals for 24 days, not 28.  Why is this, you might ask? The answer is what they call a Flex Meal.  Here’s what they say: “While on Nutrisystem, you’ll get to enjoy flex meals and snacks – one breakfast, one lunch, one dinner and two snacks each week on your own.” That’s an inconvenient way to describe how they short your order for 4 days worth of food on that 28-day meal plan (and yes, they are truly shorting your order – see my next point).
  • Prices for Nutrisystem have gone way, way up and they deliver a lot less at the same time.  Because I was a recurring customer starting in 2008 I have access to the orders I placed then, and can compare them to what I’m purchasing now.  Here’s a comparison:
      Nov 2008: 4 weeks + 1 week free, male $277.99 (no discount)
      Nov 2011: 35 day program, male $259.99 (no discount)
      Aug 2013: 4 weeks + 1 week free, male $259.99 ($65 discount)
      Sep 2017: 4 weeks (technically 24 days), male $384.29 ($133.07 discount)
      Oct 2017: 4 weeks (technically 24 days), male $414.29 ($103.07 discount)
    That “discount” is a complete joke, because their prices have gone from roughly $7.94 per day for meals in 2008 (and only $7.43 per day in 2013), to $17.26 per day for meals in 2017… and that’s not considering what they consider their pre-discounted price.  That’s a 217% increase in cost.
  • Order processing is late; often later than you’d expect. My first recent order took 1 week to process.  My second recent order (keep in mind that it was a subscription/automatic order) was supposed to process 6 days ago. It bugs me just a little bit that a customer service agent told me it was waiting to be picked up by FedEx on Friday, but on the following Monday I receive confirmation that a tracking number was created (still no record of it in the system).  Did the agent lie? How would FedEx pick up an order that still had no shipping label created?  I now have a gap in the Nutrisystem diet because I’ve effectively run out of food from the first order.  Keep in mind that my prior orders in 2008, 2011 and 2013 always processed in one day.  According to their customer service, their official processing and shipping time is (now) 4-10 business days.
  • Customer Service is a soothe-sayer, and they aren’t great at placating.  That problem you’re contacting them about isn’t really a problem; it’s a feature of the program, or it’s their interpretation.  As an example, when I contacted them about the late second order I was told “With the way our auto-delivery system works, we weren’t scheduled to begin processing you(r) order until [order date].” Silly me.  I thought that with the order in their system for weeks, they could actually have planned to ship (or deliver) the order on the date indicated.
  • You have to call to cancel their Auto-Delivery program.  Even though you can order, edit and even delay your order online, the one thing you can’t do is cancel the order… which only makes sense if Nutrisystem plans to talk someone out of cancelling the service. According to the forum support topics How do I cancel my plan? and Can I customize, cancel or delay my auto-delivery order?, you MUST call to cancel the auto-delivery service. The best part? If you already paid and are due a refund, it can take up to 8 weeks to refund your money.

Once the second order finally ships, I’m placing the call to cancel any future auto-delivery with Nutrisystem (update: I’m now waiting to see whether an adjustment comes through from a comment/exchange about the two  orders with the Counseling Support team. This one has me stymied because it doesn’t make sense how the refund was calculated, but it’s to my benefit so I shouldn’t complain). Yes I’ve lost weight;  but the problems of cost/value, bad customer practices and poor customer service are enough to leave a bad taste in my mouth (and I’ll end with that pun).

Nov 5 update: Based on a Nutrisystem email invite to do so, I posted a review on consumeraffairs.com, which you can find here. Nutrisystem has responded, and we’re talking privately following the public exchange.  The product itself is great, however it’s the policies, pricing and t&c’s that I can’t wrap my head around. I truly don’t understand how the price can go up so significantly but see service levels drop so much at the same time, while the terms of placing an order have to be regarded carefully because commitments are required when none existed before. 

Numbers Are Trending Up!

I received a call for the bloodwork I submitted on December 2, and the numbers are (finally) good:

  • Testosterone: 864 (was 91) – target 1100-1500
  • Estradiol: 21 – target under 40

The plan is to go back in on February 14 for another round of pellets, at the same dose.  We will continue monitoring levels for progress.

From my standpoint it’s like a light switch was turned back on.  I can feel the difference (lower stress, less depression) and the dysfunction is gone.  I haven’t started exercising yet but there is a noticeable increase in my energy levels… meaning I need to get out and start running again!

The Burden of the Responsible Man

In my downstairs hallway there is a picture titled “The Burden of the Responsible Man” by James C. Christensen that was purchased several years ago at an artist reception in West Jordan’s Gardner Village.  It’s a great image – the poor man’s face is resigned as he looks at the carrot placed before him by the brimful of people he carries; and the jangling keys on his waist are each a separate responsibility.  The artist has a different take than I do for what the picture portrays.  I bought it as a reminder that sometimes responsibility can overwhelm, and must be let go in order to find balance.

James Christensen’s The Burden of the Responsible Man. I look at this and can see myself.

 

I have a history of being that guy who says yes when asked to do something, often to the detriment of my family or self.  One of my realizations was how I allow my health to suffer by giving too little attention on diet, regular exercise and family or personal time.  I often think about this when I’m up early to work on one thing (when I could be putting on running shoes), or working late (when I should be getting some sleep).  There are causes that I care much about, and I value opportunities to improve things where I find I am able to do so.  But it shouldn’t be at the sacrifice of health and happiness.

Christensen’s view was that burdens were really blessings and challenges necessary for growth. Although I think that true growth is found through acts of selflessness, I also think there is a foundation that must be maintained for personal health and happiness.  For people like me the hard decision is learning to say no to others, because I absolutely hate saying no. I hate feeling like I’m not helping someone, especially when I have been asked to help. But the reality is that I may be denying myself if I don’t.  One of the goals I have is to simplify my life by becoming responsible for less, and that means saying no more often.

It’s also important to make time for myself, and to defend that time.  Get rest, eat right, be active.  That’s my commitment, and it’s going to take one thing I need better control of: how I invest my personal time.

Metaphorically speaking, I’m taking the hat off, and turning in the keys.  And to hell with their carrot.  I’ll get my own.

Moving to Testosterone Pellets

I am anticipating change. Today is the day that I receive 2400 mg of timed release bio-identical Testosterone pellets with Anastrozole (an estrogen inhibitor).  I’m hoping for observable changes for my depression,  weight gain, lethargy, and nonexistent libido.

img_20161019_083910

The topical gels that I have been using over the past year have been ineffective.  I was originally prescribed Androgel pump, then Testim gel; and in both cases I haven’t seen any effect of using these.  In September 2015 (before starting the gel) I tested at 154 ng/dL, and in September 2016 was tested at 91 ng/dL.  My body clearly isn’t absorbing the gel.

Based on my low T numbers, I’m receiving 2400 mg of Testosterone pellets with a goal of raising my numbers between 900-1200 ng/dL.  Blood tests will be performed in approximately 6 weeks to determine actual levels for Testosterone and Estradiol so that any adjustments can be planned.  Every four months I’ll be going back in for more pellets.

The Procedure
Lidocaine is used as a local numbing agent prior to insertion of the pellets (plan to wait for 10-15 minutes while the numbing takes effect). A small incision is made, and a pellet trocar (essentially a tube with a push rod) is inserted into the fatty tissue above the hip, and the pellets are fed through the tube into the fatty tissues (testosterone absorption is aided by fat). The tube is removed and steri-strips skin closures are applied.  Those are covered with gauze and tape to complete the procedure. The whole procedure takes less than 30 minutes.

A video of the procedure (not me) can be seen on YouTube.

Following the procedure, some blood/drainage is expected.  Bandages typically stay on for 4-5 days. There will be bruising and tenderness for up to 10 days while it heals.

The following supplements are suggested:

  • Vitamin D3 gel caps (2000 iu) – take 4 daily for one month, then 3 daily. Vitamin D deficiencies are correlated to men with Testosterone deficiency.
    img_20161019_155318
  • Iodine capsules (12.5 mg) – take one daily for one month, then 3 times weekly.  Iodine helps increase testosterone levels.
  • Myomin (500mg) – a natural estrogen blocker that may be used if estrogen numbers are higher than anticipated

It’s also important to note that anti-inflammatories (Aleve, Motrin and Ibuprofen) should be avoided because they block the effectiveness of the Testosterone.  Alternative pain medications that can be taken include Aspirin, Tylenol and Excedrin.


Why am I doing this?

Last year I finally broke down and decided to seek medical help. After a few years of steady weight gain I was depressed, lethargic and uninterested in anything.  My energy was gone, I had lost inspiration, and constantly felt depressed.  I knew I needed to change the direction but could not be motivated.  It was this apathy, and a long conversation with my wife, life partner and co-conspirator Angela that made me place a call.

Admittedly, I hadn’t seen a doctor in years.  I no longer had a primary care physician, but started by scheduling an appointment with an endocrinologist to request a consultation.  It was from that appointment that I learned I was diabetic, and had low testosterone.  These two issues relate to each other because low T can lower metabolism and increase weight gain, which triggers diabetes.

I was placed on Metformin for the diabetes, and Androgel pump to improve T levels.  There was a noticeable affect taking the Metformin (I was no longer exhausted at mid-day, I slept better, and my blood sugars were lower).  I started the Androgel  two weeks later, and didn’t experience any significant change (as in there was no change). After my health insurance plan changed their tier pricing for Androgel, I was essentially pushed to the Testim product as a replacement.  Neither gel had a noticeable effect; apparently some men experience low absorption of gels, and this seemed to be my issue.

 

 

Reality Sets In

After 1 year I don’t have a routine down for my Type 2 Diabetes and Low Testosterone diagnosis.  I don’t sleep well. I’m constantly tired. I’m depressed. I think my doctor’s suck because with them it’s all about tests and prescribing medicine. There’s no discussion about lifestyle, and as much as I’d personally like to think it’s just eat less and run more to fix everything, it’s not.

Ultimately the best chance I have is to lose weight because it can reverse the diabetes and possibly remedy the other issue of low testosterone (which can be caused by type 2 diabetes).

So, the recipe seems to be take my medicine, eat right and exercise more. Only it’s not that simple.  This is about pushing past the depression and lethargy, and making a habit out of a lifestyle change.  It’s about a schedule that overrides other schedules, and in fact cutting things out in order to make room for the things that are becoming a priority.  It’s about finding motivation when there isn’t any.  It’s about learning new ways of doing things that I’ve done my entire life, and yes – I know it’s going to suck for a while.

It’s all about the plan, isn’t it?

When I checked my blood glucose this morning it was 191.  I hadn’t been testing recently and decided to do so.  It was a stark reminder to get my shit together.

 


Targets

Normal Blood Glucose
Fasting
Normal for person without diabetes: 70–99 mg/dl (3.9–5.5 mmol/L)
Official ADA recommendation for someone with diabetes: 80–130 mg/dl (4.5–7.2 mmol/L)

2 Hours after Meals
Normal for person without diabetes: Less than 140 mg/dl (7.8 mmol/L)
Official ADA recommendation for someone with diabetes: Less than 180 mg/dl (10.0 mmol/L)

HbA1c
Normal for person without diabetes: Less than 5.7%
Official ADA recommendation for someone with diabetes: 7.0% or less

Blood Pressure
120/70 blood pressure goal


Medications

  • Metformin 500mg (Rx) – 2 pills twice daily to improve blood sugar control
  • Loperamide Hydrochloride 2mg (OTC) – 2 pills twice daily as an Anti-Diarrheal because hey, Metformin
  • Victoza 1.2mg (Rx) – inject once daily to stimulate insulin production
  • Lisinopril 5mg (Rx) – 1 pill daily for blood pressure
  • Testosterone 50mg/5g gel – 1 tube topically once daily for depression (which I have) and libido (which I have none)
  • B12 Natures Bounty 2500mcg (OTC) – 1 pill daily
  • Taurine Solgar 500mg (OTC) – 1 pill daily for stress, blood pressure
  • Rhodiola Solaray 500mg (OTC) – 1 pill daily for stress

Equipment

  • OneTouch Verio Blood Glucose Meter
  • OneTouch Verio Test Strips
  • Unistik Travel Lancets AT1048/Comfort, or OneTouch Delica Lancets
  • NovoFine Plus 32G Disposable Needle 32Gx4mm (1/6″)

 

MIRL

Meal Prepping: A Prescription for the Kitchen

It’s true that half the battle takes place in the kitchen.  One of my favorite local running stores offers a simple weight loss plan written on a board in the back of the store: “eat less and run more“.  If the weight isn’t coming off, then eat less and run more.  It may be overly simplistic, but the basic tenant is true: manage your caloric intake and get regular exercise commensurate with your health and you will see results.

I’ve mentioned before that I’m a reddit fan, and I recently came across a post in the r/MealPrepSunday sub reddit that linked to a blog hosted by a medical student’s foray into meal prepping.  It has some really practical advice on setting up your kitchen, and includes some great, simple recipes that you can use to plan and create your own breakfast, lunch and dinner meals.

Remember that this is part of becoming a better version of you.  It’s time to start improving your health, your body, and your mind.

rollins-lifetime-quote

Check it Out: Prescription for the Kitchen: The Adventures of a Medical Student Taking a Bit of Her Own Medicine: Replacing Fast Food with Home Cooking