My frustration rant

(David Deutsch) #1

Well, here’s my situation in a nutshell. I’m both a success story, and (hopefully not!) an impending failure that I am trying to prevent . . . but I keep feeling like the fates are lined up against me.

The success: In June of 2017 I weighed 208-210 (depending on the scale or the day) — I’m a short guy (5 ft. 4 inches). In January of this year (2019) I was down to 145.

Based on my BMI and my appearance, I still had about 10 - 15 lbs to lose, so my goal was to get down to 129. That was not meant to be.

In January I had surgery to both my feet, and about that time, the scale direction began to reverse, despite the fact I never strayed for even a second from the Keto WOE since the day I began in 2017. Today I am 158, and I am deeply depressed due to the 12 (!) lb weight regain that is coming in A YEAR AND A HALF after the weight loss began.

When I started to notice the upward trend, my primary care physician had a metabolic panel done, and initially I was concerned by the results, and I posted my concern in these forums. But now I know that the results were actually good. I was encouraged to watch the excellent videos by Dr. Mason, from Sydney, Australia, and my triglyceride to HDL ratio is 1.86, so my phenotype is likely the good one. I then had the arterial calcium study done, and I had a score of zero, so good news there.

But still I continued to gain weight . . .

My doctor explained it was my brain weight setpoint exerting dominance. He put me on Naltrexone over two weeks ago. It’s made NO difference, I gained five pounds since I started on Naltrexone. He told me to try lifting weights, which I have been doing for over two weeks. As mentioned, my weight gain continues, and I don’t think it’s muscle, because my pants are tighter.

In desperation, I contacted Dr. Mason’s office in Sydney, asking for an appointment — I live in Oregon, and I really didn’t know of any physicians within my area who could manage my issue and help me through it. Dr. Mason’s office initially offered me an appointment, but the costs of airfare turned out to be really high, and when I emailed them explaining the airfare cost issue to see if they could refer me to someone in the USA, they stopped communicating. I think they may have gotten insulted that I was balking at paying the airfare. I wrote back, explaining that despite the travel costs I was still interested in being seen by Dr. Mason, that it was only a hope to avoid the high costs of travel which motivated me to ask for a USA referral — but it seems they now are ignoring all my emails. Dr. Mason seems like a really nice person, but his customer-service front office staff seem like really hard, uncaring, uncompassionate people. For this reason, based on my experience described above, I would not recommend that Keto patients (at least those hoping for a supportive, caring environment from administrative staff) approach Dr. Mason’s office for appointments, which really is sad, because, like I said, Dr. Mason himself seems like an awesome guy with incredible knowledge — someone whom I really would have loved to have received a consult from. But I guess it was not meant to be.

In a separate thread in this forum, Tom Seest made several suggestions for locating local specialists (particularly cardiologists). I did try to make contact with each of his suggestions, but have not received any replies there either. [Correction — one recommendation was for chiropractic consult, which I did not follow, as although I support chiropractic practitioners for spinal adjustment, I prefer to get metabolic advice from physicians.]

(hottie turned hag) #2

@Nearly2Years I think you’re being a tad over the top when describing the office staff as you do; I’ve worked in med sci for 27 years in an esoteric field where appointments are hard to come by and I can assure you, they did their job correctly. What you describe does not betoken uncaring, not supportive etc. They are not therapists, they are just receptionists/office clerks.

As to the baffling situation itself of why sudden inexplicable weight gain…have you had a full endocrinological panel (not the same as the metabolic panel you cite) done? No changes in intake, activity, no new meds? Just brainstorming.

#3

I’m 6 years into maintenance and fluctuate several pounds, based on the season-12lbs isn’t that big of a deal really. Your surgery has most likely meant that you’re not as active as you were before so that will cause things to slow down a bit. Also, surgery is a major stresser on the body-you need to give it time to heal and get back to normal (it can take months). Also, have you started getting looser with your food-maybe snacking more when you were laid up during recovery? My dad is recovering from foot surgery right now and he’s on modified bed rest-he’s now spending all day reading/watching tv and then snacking, because he’s bored.

(Hyperbole- best thing in the universe!) #4

Also the inflammation from the surgery.

(Carl Keller) #5

I agree. It’s got to be awkward to be put in that position. Here’s someone who says they want to see my boss, then they say then can’t afford to travel to see my boss. I’m not sure what to say to that or to their request for a recommendation for someone closer to them. I would hate to tell them no I can’t because I’m incredibly busy and that I know very little about the LCHF doctors in their area. Instead of telling that person, “I can’t or I don’t know”, not responding isn’t unreasonable. No response is slightly better than a negative one.

It sucks that you can’t see who you want to see but there’s a whole slew of all-star LCHF doctors in the States:

Ted Naiman, Georgia Ede, Ken D. Berry, Eric Westman, Michael and Mary Eades to name a few. I would be chuffed if any of these men or women were my medical advisor.

https://www.dietdoctor.com/low-carb/doctors

(David Deutsch) #6

@BlueViolet . . . I hear you, and I honor what you say. My point is this: I sent three emails over ten days. All ignored . . . while I am trying to figure out what to do. A caring staff would hear a patient who is going through a rough time, and would try to be supportive by — at a minimum — acknowledging the receipt of emails, and at best (one would hope) respond in a way to make the patient feel wanted. An uncaring staff would ignore. It takes 60 seconds to acknowledge an email.

But you are coming from their side of things, as you say, and are stating I am “over the top” and are also stating the staff did “their job correctly” by ignoring three separate emails I sent over ten days. So I am now put in my place by you, as well. That is how the job of medical office staff is done correctly! Truly?

I wish I had been shown a little kindness, and a little warmth.

Silly me!

But turning to the substance of the issue: The endocrinological panels show no changes. I had surgery, but I gradually returned to activity, and weight gain continued. My food intake did not change.

(hottie turned hag) #7

This is truly a baffler, then.
Obvi things to r/o have been covered, hm.

I’d try a “feast” (3000-ish cals, high fat) then fast to maybe get things aligned. Can’t harm in any case.

(David Deutsch) #8

@CarlKeller when my email to their office (explaining the costs of travel were high and asking for a referral) was ignored along the lines you propose, I sent two other emails, telling them I definitely wanted to go ahead with the appointment. These two emails were ignored as well. Was this appropriate?

You are well versed in the resources for Low-Carb MD’s. I am/was not so much . . . and I appreciate receiving it. This is why newbies like me come onto this forum . . . in the hopes of learning without being called out for our lack of information (something which can make one feel intimidated from making inquiries, or even coming into this forum in the first place).

I was not trying to make the staff answer a question they didn’t know the answer to, but rather perhaps forward the question to Dr. Mason himself.

(David Deutsch) #9

@BlueViolet thank you. I will attempt.

#10

Maybe I’m reading it wrong but you aren’t actually a patient of the doctor you wanted to see though, correct? So take a step back and look at the situation objectively-you cold called a doctor’s office without a referral or previous history with them. They tried to set up an appointment to get you in, but you backed out, due to costs, (which is very reasonable, considering flight expenses).

So they don’t really have any obligation to interact with you anymore, since you’re not going to be following through and actually becoming a patient of their office. Why do you expect them to waste their time on a non-patient? I also don’t understand why you’d think they’d spend more of their time giving you a referral to another practice-especially when you live in a completely different country and most likely have no idea who practices in your area??

This one doctor isn’t going to work out, no biggie-there’s plenty of other options that will be much closer for you. Just start making phone calls and you’ll find someone, you can also check with your insurance’s practitioner directory for options close by. Our insurance also has an option to call and talk to someone who can help us find specialists. Maybe look into that and see if your insurance also has that option?

(Edith) #11

Don’t give up on the strength training. Two weeks is not enough time to see any change. But… strength training can cause fluid retention due to muscle swelling from working them out. I can be up a pound or two on days following strength training. That could be what caused the weight gain after starting your strength training.

I have not had any surgeries but I too started gaining weight after 1.5 years on keto. This month I started a zero carb trial and that seems to be helping. I’ve lost a few pounds, my joints feel better, and my recovery from exercise is much improved.

There are definitely doctors in the US who are keto as mentioned above by @CarlKeller. Traveling to see one of them would be way cheaper. I think Carl Franklin mentioned in a podcast that he now sees Dr. Ken Berry. Tennessee is definitely closer than New Zealand.

(Carl Keller) #12

@DaisyDawn answered it better than I could. I don’t blame you for wanting the best doctor possible but if you were to contact me and I knew you were in a financial bind to come see me, I would feel flattered and bad that you would have to put yourself in the red to come to my office.

One thing that I would like to point out about post-surgery weight gain:

So give yourself a chance to heal and maybe the gains will soon reverse. Getting depressed about it isn’t going to help. Just remember that you were in far worse shape at other times in your life.

(David Deutsch) #13

@CarlKeller Thank you so much for your thoughtful and supportive reply. Mu surgery was nearly six months ago . . . I’m trying to figure out what I can do to push back and reverse the trend.

(David Deutsch) #14

@DaisyDawn getting referrals isn’t a problem. Dime a dozen in my insurance: The problem is all my referrals from my insurance want me to eat carbs and get off keto. Which is why I have been trying so hard to find a keto MD. My insurance has been no help.

Ideally I need to find a cardiologist who wont be hostile to keto. But locally that does not exist.

(David Deutsch) #15

Thanks @VirginiaEdie .

I am looking at options based on @CarlKeller’s comments.

My frustration comes from the fact that when my weight loss started to reverse, I was still about 15 lbs away from my goal, and now I am 30 lbs from my goal. I just need to present my case to a keto friendly MD who can read my blood work and figure out what I am doing wrong.

(hottie turned hag) #16

@Nearly2Years if your labs are stable (no changes) that cannot be wherein the key to the puzzle lies. Interpretation thereof shall likely be similar no matter the doc.

This may be something more subtle like a metabolic slowdown, not quantifiable. If your intake is unchanged in both amount and type, the next thing I’d look at is metabolic slowdown.

I recommended the feast/fast above because when trying to accelerate my own loss, I read all round on here about this and the recurring theme was, to get metabolism going when one suspects it has retarded its speed is to gorge then fast. Before going to faraway docs this may be an easy thing to try.

I haven’t gained on keto but I have stalled; eliminating ALL CHEESE AND VEG broke the stall immediately. Tinker around with eliminating things and upping intake/fat then fasting, then see how you go.

#17

Have you looked into this yet?
https://www.dietdoctor.com/low-carb/doctors

eta: looks like there’s 3 practitioners in Oregon on the list.

(Jane) #18

Paging @Digital_Dave

He had emergency hernia surgery and he gained and it set him back several months eating the same way as before.

He’s back losing weight again and maybe he can offer some advice and encouragement

(Charlotte) #19

I’m just across the Columbia in Vancouver. So yay to a neighbor!!!

Here is my two cents. You want to be heard and I hear you… I don’t think you’re being over the top (no offense to @BlueViolet by any means). You are stressed out, concerned, worried, probably anxious to boot. So take a deep breath, and try something calming… something that takes your mind off of it all. I was huge on underestimating what stress does to the body, and I agree with the folks who say that you need to give your body time to heal. Your body is going to put healing at the top of its priority list and put everything else on the back burner.

Your body will do what it wants to do when its ready to do it. I learned that very quickly after starting keto. You can’t brute force your way through this challenge and expect any meaningful healthy lasting results. You can look for all the answers you want across the world, but in the end… (yup thats right) your body will do what it wants to do when it wants to do it.

What goes up, must come down… Try to hang in there and try to keep looking forward. Keep doing the things that have been making you successful in the past that you know work for you and when your body is ready to let go of the extra pounds, trust that it will happen. it knows what its doing. I think of my body as a whole different person from my brain and I treat it as an independent unit. That has made a lot of difference in how I look at my keto, my progress, and it has been a great way for me to maintain my stress. Micromanaging is counterproductive. I get you want answers. I used to over analyze everything I did until I would spiral into a rabbit hole of stress, doubt, and anxiety. Try to override your brain and trust your body and accept that your body is running the show, the only power you actually have over it, is what you put into it… I know that the whole accepting, trusting, and turning off the overthinking is extremely difficult, but if you can do that, you just may things starting to work differently. But thats just what has worked for me. I hope that things turn around for you. I truly do.

(Marianne) #20

I don’t know if health insurance in the states covers MDs in Canada, but Dr Jason Fung is another keto heavy hitter. He has a clinical practice in Canada - Intensive Dietary Management, I believe. I don’t know if you could see him personally, but I’m sure he has trained staff that 100% subscribe to the keto way of life.

As for the drug your doctor put you on, I’d be hesitant about taking that without more information. I think Western medicine is too hair trigger to fix something with medicine (which is treating the symptom) - same as what insulin and diabetes drugs do. Obviously, there is a reason you are gaining weight, but it sounds like you’ve been comprehensive about the tests you’ve had done and those have come back clear. If nothing about your plan has changed, your body may be temporarily self-regulating, only to re-regulate months from now (?). Also, I wouldn’t be hesitant to try “feasting” as suggested by @Blueviolet, and reexamining what you are eating as others mentioned.

You have lost so much - and probably gained many non-scale victories. Although you have gained more weight than you would like, please don’t throw in the towel. I think it is safe to say that you will not gain anywhere near all of your weight back if you continue with this way.

Good luck; please keep us posted.