(first) decision made

If I'm lucky it will be the last decision.  Since the melanoma on my arm was staged as 1B, I am going to have the surgical oncologist remove the larger area around the melanoma and also the sentinel lymph node(s).  Surgery is scheduled for April 8.  I will go early in the morning for the radiation study that will find the right lymph nodes, then surgery will be early in the afternoon and I will be home by supper time.  I'm blessed with insurance with an out-of-pocket limit that I will quickly exceed, so I don't have to worry about the cost of chosing the more significant surgery, just the recovery time.

Two reasons to decide to go ahead with the lymph node biopsy even though one surgeon said I didn't need it.  First is that removing sentinel nodes really is the current recommended approach for melanomas with depth greater than .75 mm and a second risk factor (mine was .83 and had a miotic rate of 1 /sq mm).  The second reason is a principle for making sense of low probabilities that I learned when I had CVS genetic testing with my first pregnancy: only do the test if the incidence of the problem you are testing for is greater than the incidence of complications from the test.  In the case of sentinel node removal, the chance of finding something is 2-8% and the chance of complications is 1-2% (both according to my doctor).  I am tempted to say that the chance of a benefit to me from this surgery alone is about 4% (calculated on the basis that I have a 5% chance of a positive node and an 85% chance that will be the only positive node).  The risk of significant harm is very low--most of the possible complications are short term.

I realized also why I am so resistant to going with the standard treatment.  When I was diagnosed with diabetes, I quickly found what would work for me.  At the time, the standard for well-controlled diabetes was an A1c between 7 and 8 and a low fat diet--I decided to join the community of tight control diabetics and keep mine below 6 by eating low carb.  It has worked wonderfully for me. I think the standard of care has since changed to A1c between 6 and 7, so the medical community has realized at least some of what a few mavericks and a community of patients reading the research literature understood 10 years ago.

When I started to research the melanoma decision I quickly learned that there is no good treatment for melanoma that has spread and the standard of care does not have much to offer.  Neither of those hit me as a big surprise.  My husband's illness (Multiple System Atrophy, a form of Atypical Parkinson's) has no treatments that actually slow down the disease, they only relieve symptoms.  And my own experience with diabetes was with realizing that the standard of care was lousy.  So I jumped right to looking for an alternative to the standard of care, but it is harder to take those kinds of approaches with cancer because the risks are so much higher.  Thankfully, there is a good chance that after this surgery I will have done all that I need to do.

A year later

I think a year ago I probably was at my maximum weight.  I don't weigh myself, in fact I usually don't even look at my weight when I am weighed at the doctor's office.  But we waited nearly half an hour at the gym before we could swim last Thursday, and I took the opportunity to weigh myself.  A doctor might not be happy with my weight--184--but I am.  My guess is that I have lost 30 pounds in the last year.  Photos are from June 2011 and November 2012.

 























A year and a half ago I decided to try taking Metformin, hoping to improve my diabetes control a little more and hoping it might help me with my pattern of post-menopausal weight gain.  I kept increasing the dose, because I felt it wasn't doing anything.  I went up to 1000 mg twice a day, and thought maybe that was helping.  Then I got something like the flu, though my flu test was negative, and lost a clothing size in a week of being mostly too sick to eat.  After that we spent all of Christmas vacation cooking, but my clothing size didn't go back up.  It was in mid January that I started following the Primal way of eating.  I think I went down another clothing size in a month, and after that I have been very very slowly losing inches (as judged by how my clothes fit).  A few weeks ago I switched my pants down another size (luckily I kept a lot--I have one more size in the attic).

I went off the Metformin last summer when I learned that my A1c was 5.8--exactly what it was before I started the Metformin.  So I don't think I am eating particularly lower carb than I was; the difference is that I very rarely eat anything made with grains or refined sugar.  I eat large meals--I am not careful how much I eat--but I have given up snacking except for a bedtime snack.  I also started supplementing with iodine and over the course of the spring and summer I worked my way up to 25 mg., which I think has given me more energy.  Having more energy makes me happy! I'm doing pretty much the same exercise--swimming twice a week, some walking and gardening.

I'm very glad to have found what works for me.

dawn effect and fasted exercise

I have always eaten something before exercising, even 5:30 am masters swimming.  I have a cast iron stomach--the only time it ever bothers me is if I catch the stomach flu.  When I first started training for triathlons, I ate a little carbohydrate and protein before morning training, something like an orange and a couple of pieces of cheese.  Even after I went low carb, I was prone to feel out of energy and irritable if I went too long without eating (though my blood glucose was not problematically low).

I also had read that for some people with type 2 diabetes, morning high blood glucose (the dawn effect) would just go higher and higher until the person ate something to stimulate the body to produce insulin.  The liver would release glucose, but the body wouldn't be able to use it until it got that insulin.  I never tested that myself; it matched all my assumptions about eating before exercise.  And when I was training for racing, the approach I took worked well for me, as it fit into my fueling strategy for racing.

Now that I am following the primal way of eating, I have been paying attention to the arguments for not snacking and realizing that I'm not hungry.  I am less and less prone to that running out of fuel feeling.  So I decided I would do a test and see if my blood glucose went high if I exercised without eating first.  My test was swim practice-- 1 1/2 hours of swimming starting at 5:30 am.  I tested after my warmup and an hour or so in after some hard swimming.  I first tested the way I had been doing it, and then five days later I tested without eating first:

July 5
5:00  120 waking
5:25  115 before exercise, just after eating melon
6:05    93 after 1/2 hour of warmup
6:45  105 after swimming hard
7:30  125 1/2 hour after finishing workout
8:30  137 just finished slowly drinking my breakfast smoothie
9:40  119 to see if it came down

July 10
5:15  116 waking
5:50  100 after 1/2 hour warmup, no food
6:30  106 after swimming hard
7:40  120 after showering and driving home
8:20  130 after slowly drinking my breakfast smoothie

So there certainly doesn't seem to be any harm in fasting exercise for me.  I felt a little less energy, and a little strange when the food hit me afterwards.  But my body will adapt.