Fat and Muscle

[Image taken from the OH Main Board today where it was posted by Terri R.]

One of the things I talked about with Dr. Soo on Friday and then Dr. Kaufman on Monday was whether or not I needed to lose more weight before further skin removal / plastic surgery. 

Guess what?  They don't agree.

Dr. Soo, who admittedly has seen me much more naked (dear lord, those pictures!) then Dr. Kaufman, thinks I should aim to be about 140-145 before she does work on my thighs / hips / butt since, as she pointed out, there are still pockets of fat on my thighs that otherwise will need to be (painfully) liposuctioned.  My arms are ready to go surgery wise, but it would be possible to pair that surgery with the breast lift, but only if I'm at my final weight as a breast lift can have its results changed by even a 5-10 pound weight loss.  So she thinks that should come last.  As she pointed out, I'm still in the high overweight range for my BMI and she'd like to see me hit the normal range before surgery for the best possible outcome.

So yesterday I brought up to Dr. Kaufman (who, let me remind you, thought I was done losing when I hit the 180s) the idea of me trying to drop another 15 - 20 pounds in the next 6 months (June is the earliest I'd consider doing any further surgery anyway) at Dr. Soo suggestion.  His first response was to look me up and down, say 20?! and then he pulled out a calculator. 

No, was his verdict.  I shouldn't be trying to lose anymore weight. I've already hit 91% excess weight loss.  His concern is that losing more weight would put me at risk for muscle / organ wasting.  His feeling was that Dr. Soo wasn't taking into consideration how high my start weight was and that my loss now is 10% more than was expected. Ironically, this was exactly what Maria said to me over lunch the weekend before.  And my husband also thinks I'm done.  My mom?  Well, she agrees with Dr. Soo, that there's some more fat to take off.

So now what?  I mean, I'm Little Miss Compliance, right?  But with whose advice? 

Of course what I'm doing is asking them to talk to each other -- Dr. Kaufman offered to, but wants to wait until he has my current lab results to make sure I'm not already burning proteins as I've lost more than 15 pounds (other than the skin) since plastic surgery.  But I'm also planning to start working out hard again in March when I'm cleared to do so.  My thought is to stay at 160ish but try and drop my body fat / increase my muscle mass.

But then, who knows what can happen?  I mean, I wasn't trying to lose this last 15.  The swelling went down and it was just gone along with the extra skin. 

How shoulud I decide this? Is it my choice to make? I mean, I guess in the end I know it is mine alone. But I had an eating disorder as a teen (exercise bulemia) that took my body fat down below 15%. And I've spent most of my adulthood super-morbidly obese. I'm not sure I can really judge my body's fatness or thinness very well. I want to do the right thing. I just don't know what it is.

To my skewed ears, 165 sounds both low (compared to 367) and quite high (for a woman who's not-quite 5'5"). Ideas anyone?

Comments

[SignGurl]

Wow! I just can't imagine that Dr. Soo would want you to lose more weight if she knew what Dr. Kaufmann feels is right for you. Wouldn't it be better to have the surgery after your weight has stabilized for a certain period of time? I know that sometimes our bodies will get to a low weight but then stabilize slightly higher.

I can't imagine how conflicted you must feel since my head is now spinning thinking about it for you, lol.

[Bronwen]

Weeell, you're talking to a person that was a very svelte size 8 at 165. I think that I'd follow Dr. Kaufman's advice here, as he's known you longer and heavier, and I think there's something to be said for the difference in skeletal mass between someone who was once SMO and the Average Jane. I dont' know if it's urban legend or not, but I've heard it repeated so often that it's been ingrained in my mind - my skeleton is denser now as it had to compensate for carrying the extra weight.

From your pictures, I see lovely slender "normal" Ezpy. I certainly don't think you need to lose another 20 pounds! But then, I'm at 188 and I had someone tell me the same thing yesterday (I disagreed...). In the end, it's your perception that's going to matter. If you need opinions, then Paul's would be a good one to solicit. Eloise, too, as she's been in the same boat. For me, you look fab, chica.

[JEM]

I think it is completely up to you and how you feel, but what I would do personally is, for about 6 months, exercise, and eat healthy and see what your body naturally does. If you lose some weight, then maybe your body is not done. If you stay the same, then maybe this is a healthy weight for you. (Everyone's body is so different and you cann't just go by charts and scales.) I don't think a doctor can tell you what is right for your body and your lifestyle. You are a huge sucess whether you lose anymore weight or not, but why put yourself in a box. Being someone who feels being healthy is more important that being "thinner" I just kept eating as healthy as possible and excerised 5 days a week and it kept coming off. Even after people said I should be done. I finshed up at about 150-155 pounds and I am 5'7''. That is where my body has now stayed for over a year.

[Marianne]

I have to agree with JEM: exercise for 6 months and then make a decision sounds like a good advise. But I would like to see some other numbers: BMI is not the best indicator, what is your % of fat?

Also, what kind of exercise do you do? With all the weight you have lost it is a must to do weights. That will increase muscle before the surgery.Surgery is the best option for sagging skin, weights for flab muscles.

Lastly, I had good results (not miracles) with seaweed cream for fat (cellulite) loss. Any decent cream will do: no need to buy the most expensive one. Requisite for success: massage at least 3 or 4 minutes the area, leave the cream on the rest of the day...

Anyway: cheers on your accomplishments