A journal of healing

Posts tagged ‘domestic violence’

Trauma informed

little girl

I have spent a great deal in the past months seeing a variety of doctors for various reasons. At every visit, every time, the patient care-tech brings me back to the visiting room to wait for the doctor. It is their responsibility to weigh, check blood pressure and ask a few questions. One of those questions is the medical community’s answer to being trauma informed. It misses by a huge mark.

Being trauma informed simply means being sensitive to a patient’s history or the possibility of the patient being in a dangerous living situation. We are talking domestic violence, and all forms of abuse: mental, physical and sexual at any age. Being a trauma informed  means everyone on your team from the receptionist to the doctor is sensitive to how they treat a patient. Some may say this is over the top but the concept is very important to the true wellness of all patients.

For example, the patient who keeps coming back with bruises or injuries from falls. Very suspicious if the patient is only forty. Maybe not so for someone who is eighty. But in the case of the eighty year old, she or he may have a care giver who has been frustrated in having to provide care and pushes them to make them move faster, or hits them when they spill things. And the patient is not going to do anything about it because the next step is being forced into a nursing home. They are living in an abusive home and are trapped. They certainly are not going to be forth coming about it.

Patients who have experienced domestic violence of any form will react differently to the way someone approaches their safety bubble. What I mean by this is that everyone has a comfort zone for how close people can get and how comfortable they are being touched. Some people are huggers and touchers and love to get close to anyone, including a stranger. People who have been abused have much larger safety zones and very often do not want to be touched. This not wanting to be touched can range from the patient being able to tolerate it by disassociation or the patient who has a panic attack at the mere thought of having to be touched, which often leads them to not go to the doctor when they really need to.

It an attempt to becoming trauma informed, our local medical center has all providers asking about the safety of their patients? It is a useless attempt to meet a standard. First of all, it is not the doctor who asks this question. It is the care-tech, the gum chewing little twenty-something who is trying to beat a record of some kind by seeing how fast she can get patients in the rooms ready for the doctor. They change regularly and even so, I doubt highly any patient who is in a domestic violence situation is going to open up to that individual as if they are going to be able to do anything. AND… it is none of their business. The lack of sensitivity to the situation of an actual abuse situation is very typical. Unless there has been some form of specific training done with people who are asking that question, simply asking the question almost makes it worse. What are they going to do if a patient says, “no I am not safe. My husband routinely comes home drunk and beats the shit out of me and then rapes me.” The response to that can make or break the patient. The care-tech’s only course of action would be to type ABUSED into the chart. That works!

I would love to know how asking this question, “do you feel safe in your living environment” is the proper opening for a patient to disclose something so humiliating and degrading as being abused. And how many providers are even trained to handle the situation past the physical? Do they know who in the community is providing help for domestic violence? But the bottom line, most patients will not jeopardize themselves by spilling the beans about their crappy home life in a brief visit to a doctor, especially if there is not a relationship built over time with that doctor.

But being trauma informed goes beyond asking that inane question. It is things like how the patient is treated by everyone; from the rushed handling of the care-tech to the actual doctor. Patients who are victims of abuse will react from the way they are placed in a room and then left abruptly to wait for an extended period for the doctor. Letting the patients know if the doctor is running late, or checking in on the patient to see if they are ok would go much further to calm a nervous person. Having the doctor explain what and why they are going to do something BEFORE doing it will help also. Even the simple act of having them listen to the heart can be traumatic. Some doctors will do it over clothes, some doctors reach right in without warning for skin contact. Sometimes there may be a need to hold the patients head while examining their throat for example. This simple act can terrify someone who has had their head restrained in an abusive act such as forced oral sex. Lying down on an examining table makes anyone vulnerable, but for an abused patient, it is excruciating.

For some patients, the act of disrobing will send them back to a place of past abuse. These patients need a sense of safety which throwing them into a sterile, brightly lit room and demanding they disrobe behind a flimsy curtain does not provide. Then they have to sit in anticipation of being probed on a ridiculous scary examining table sitting in the middle of the room as if they were a piece of meat shivering in a paper gown. Would it be so absolutely terrible to provide a soft blanket to comfort and to also help with limiting the exposure while being examined? Something that simple is being trauma informed.

The patient is brought back to the exam room and sat down after being weighed. For some, being weighed is very traumatic. I know that doctors need the vitals but unless you are suspicious of your patients and do not trust them, can you not simply ask them what they weigh? Or make it part of the exam in private and not in a hallway where everyone is walking by. The scale calculates and the care-tech yells out the reading like everyone needs to know….and you still have your boots on. I skip it and refuse. Unless I am there for weight related issues, I know what I weigh and I will tell the doctor if they ask.

Health care workers are highly trained. But in the area of trauma informed, there is much to learn. This study goes hand in hand with a comprehension of the ACE study, which identified the link of abuse to chronic illnesses. I have asked all the doctors who I see if they are aware of the ACE study, and none of them are. I am going to leave a couple of articles for them to read. (see below) We need to work on this information being disseminated and so if you found this helpful, read and print these out and give them to your doctors.

Ace study: http://www.ajpmonline.org/article/S0749-3797%2898%2900017-8/fulltext

PDF of journal article: http://www.ajpmonline.org/article/S0749-3797(98)00017-8/pdf

https://acestoohigh.com/2017/01/05/dear-doctor-a-letter-from-a-survivor-of-sexual-trauma-to-all-medical-professionals/

https://acestoohigh.com/2016/08/10/childhood-trauma-leads-to-lifelong-chronic-illness-so-why-isnt-the-medical-community-helping-patients/

 

 

 

Midsummer Dreams

Nightview 2015

The light has shifted ever so slightly in the garden at night. I have been doing an epic battle to keep everything hydrated. But even so, things are crisp or wilted. My glorious ferns are gone and the grass is brown and crunchy. The trees in their deprived state are dropping leaves early. I fear for how brown our fall will be this year.

I am not good with the heat. The other night, the little air conditioner in our bedroom could not overcome the heat and it was still 80 in the room. I find myself longing for a storm or two. I realize I could never live somewhere that was sunny perpetually.

I spend my last hours of the day in the garden readying from my Kindle. It’s so dry that the bugs and mosquitos are less and so the light does not attract them. I finished a non-fiction book intended to reflect on what it is like to live with PTSD. It was a story of woman who was raped by her boyfriend over a period of times when she was 16. She lived with his threats and never told anyone. The book revolves around her growing up and dealing with the ramifications. She is splinter from her family, her own choice, and ends up as a disenfranchised woman living in a hovel.

Although the book explained about triggers it was not a good representation of what it is like to live PTSD. The woman in the story goes to a psychiatrist and is “healed” by simple breathing methods and other mindful exercises. She meets a man and life goes on off into the sunset. Although the authors attempt to help bring awareness, I think she misrepresents the truth.

People do not ever heal from PTDS. They learn to cope. And while some are better than others, it still can rear its ugly head at any moment. Triggers come from everywhere. I was reading where a female soldier (nurse) who had PTSD after being in Nam was fine for years. Then she moved to a new area to work at a hospital. She started having horrible flashbacks and attacks. She could not figure it out when on a very still night she heard the sound of a chopper flying to the landing pad at the hospital. It was not the first flight since she moved there. Normally it was noisy with other ambient sounds and this was so subtle she never paid attention. But her ears did. They heard and she would start to have panic attacks.

The shift in light for me is a trigger. I am so sensitive to it that I am aware before it really gets to the point where it bothers me. Something about the afternoon light before sunset in the fall and winter makes my chest tighten and other sensations. It has to do with sunset around 5 pm. This was the cocktail hour when my parents would barricade themselves away from us and start drinking. Yes, this still affects me forty years later. I am aware of it and can normally deal with it. But I still get a stomach ache and my mood shifts.

This morning, as many Sunday mornings, I sleep an hour or two longer than normal. It is very common for me to have nasty dreams but there is a prevalence of one reoccurring situation and it often plays out in these stolen moments of extra sleep. I have no idea why and I cannot control my dreams. Even after being divorced for over 13 years, I still have horrible dreams about the way I was treated. I am not going to dwell by explaining this as I need to let the dream I had this morning go. But my point is PTSD does not just end.

I know what I have to do and will tend to it. The summer ending is always hard for me. We are off to the River for our long extended stay in a couple of weeks. That will help me to focus and ground. There needs to be more awareness of PTSD, and not just for Vets. It affects many people in many ways.

 

Say Good- Knight….

hawk 15

My fellow blogger, the Doc Victo, talked about how she longs for a Scottish night. I admit, I too have often thought I wanted a strong and commanding male in my life. I wanted to be the Princess, the damsel in distress, to be saved by a powerful male knight. I want someone to protect me and keep me safe. But in thinking about this, I realize how totally opposite this is to my real personality.

Yes, I do want someone who makes me feel safe. But that really does not mean I want them to slay dragons for me. What I honestly want is for them not to cause me distress. I want to be able to rely on them to do what they should, when they should and be able to give back to me when and what I need for support in my life. It should be a two way street. When they are in need, I should be there for them.

This is not how it is in my reality. I live with a very needed person, who at times sucks the life out of me. I have been doing some thinking on this and came to the conclusion, I chose this path. I am the type of person who puts themselves in a place of being needed.

For example, I was not happy with my career until I began teaching. I taught in some capacity since 1981. Having my own classroom as a high school teacher was a dream. But it was exhausting. Being a teacher, you are totally in a position of giving to people what they need in some fashion. It is a constant flood of answering questions, directed and guiding and then the comforting and soothing to make students feel good. I can remember coming home and telling my husband to leave me alone for a bit so I could get out of feeling depleted and stabilize.

It sounded so terrible when I though how selfish this was, but it is not. People who are in positions such as teachers, doctors, nurses, all care-giving clinicians are all susceptible to this feeling. But being who they are, they feel guilty for it. To be in these positions, you must have a nurturing persona to begin with. It is who you are.

But there is a time when you have to step back and say I need some self-compassion. I need someone to take the load for a while. People with successful marriages have worked this out. There is a lot of research and new programs being implemented to help clinicians to learn to step back and take care of themselves. I have a program we offer in our orientation series based on the work of Dr. Kristen Neff to give our staff tools to work with when they are having burn out or are overwhelmed. http://self-compassion.org/

I thought about the idea of having someone who was my knight, my protectorate and shield, and I know I would not really like that. I am too independent and too strong to let someone over shadow me. I also do not like forceful men because of my past history with that type of being. I chose to put myself where I am. When I am disappointed with my current relationship, it is because I am measuring this person to my expectations. He too has learned to be passive and submissive and let me do for him, because I will. And the game goes on.

I also have put myself in a position at work which is completely exhausting. My day is filled with putting out fires. There is always someone in need or an issue I must deal with. Sometimes there is a line out my door of people with a questions of some sort. I come home drained and have again instituted the leave me alone for five minutes rule. I spent yesterday not doing any work related activities and stayed away from the computer. It did recharge me. I will need a longer respite soon.

I think if I lived in the days of yore, when knights in kilts were everywhere, I would still be who I am. I would be the woman in the village who had the docile husband, own either my own shop or farm, and would still be independent, be in a position of fixing either people or issues and yet, overwhelmed. It is who I am.

I need a hero

This morning as I pulled the pillow over my eyes, I sat warmed by the breath of my little boy dog leaning his nose in to check to see if I was awake. He knows that I was, but it was a ploy for either a belly rub, to go out a pee, and or breakfast. It was for all three. But in the moments of silent greyness I began to think about what I wanted to write today. I have been building this post for a long time and it comes from very deep within. So deep, I was not able to articulate it. But the words were pulled out after reading Cissy White’s post last week. http://healwritenow.com/weathering-extremes-mindful-ptsd-3/

I met my first husband when I was 19. I loved the man with all my heart. The night we met, he made me safe. I had been drinking and was pretty tanked. Instead of taking advantage of the situation, he suggested we go walk and we did. We walked for a while until I was less out of it and then we came back to the bar where our friends were. I did not drink any more. Instead, I sat on his lap with his arms around me. SAFE. I remember to this day the feeling. Later, as I left with my two girlfriends, I sat in the back of the convertible and said I was going to marry him. I did less than two years later.

Somewhere in that time frame, he did not make me feel safe anymore. But I kept hoping. He was clever enough to know that was the trigger for forgiveness and so he would often pull out the hero and dance it around for me. I fell for it every time. But it was not about his needs; it was mine needing to feel safe. He provided that once in a while; enough to keep me there and enough to keep the marriage going. But the truth really was that any alternative was more frightening to me and he knew it. On leaving the disaster of our wedding, my mother told me very clearly that I was not ever going to be welcomed back to her home. Those words have rung in my head ever since.  Early in the marriage, that reality hit and he knew I was trapped. The hero for me disappeared completely, even though he was a cop.  Later in the marriage when all sense of safety or love was gone, he would parade being the hero for other women and then rub my face in it. It was the ultimate destroyer of my self-esteem. I was not worthy and he made sure I knew it.

I have a few heroes in my life. One is my oldest brother. He was there for me in my early years but then when I was 9 he moved on to go to college. It did not last and he came back home until the family split and I moved up here with my parents. He and my brother lived in an apartment in the old town so my younger brother could finish his high school senior year. My oldest brother never came back home and he never knew all that went on, or at least he never said. But in his couple of visits, his compassion for my plight was evident, so I think he had an idea. To this day, when I am in a situation, it is he that I call. Being a hero comes naturally for him. He is the president of the ambulance corps, and volunteer firefighter for over fifty years and a retired Captain of the Syracuse City Fire department.

I have a few other heroes. One is my therapist John, who I saw for over two years. He was there through some of the roughest times of my healing. He was always honest and compassionate and loving. Another hero is a man I have never met, but his writing and book helped guide me to the next level at a difficult time. All I have to do is look to the sky when Hawk flies over to be reminded that he is always close.

This is where I begin to struggle to open up and share what I feel about my current situation and marriage. I have been beating myself up for a long time about what I feel. I do not love my current husband. There are times when I loathe him actually. We were hastily married eight years ago when I thought I was in deep trouble with ovarian cancer. In truth, I also just wanted to be married again. I was married 27 years previously; most of my life by then. It was very uncomfortable for me not to be Mrs. ….even though I never use MRS. I am MS. I also want to be really rid of my ex-husband’s name. So we married in a small wedding in front of a judge. I remember sitting on our coach the night before crying my eyes out in anger because I knew it was a bad choice. But I did it anyways because….if I died, the man would have nothing. He was penniless, actually in a great deal of debt, had no friends and had alienated his family. He was married three times before, had a live-in girlfriend for many years that ended abruptly and a so forth. What was I thinking?

I know now I was his hero. I saved his ass many times over. He went back to school, racked up a ton of loan debt that was going to get paid off when he began teaching, which never happened.  He went to work for a company for a while and then that fell apart. In hindsight, there is something terribly flawed with him. But he has the life he wants and he knows he is safe. I am the one trapped. I will not throw him out but I got damn close last year. But the reality was he would have ended up in a terrible situation because there was no way he could pay for himself.  And, he is as manipulative as they come and would have gone after everything I own and take down every ounce of credit that I am attached to him with because we are married.

Now as bleak as that sounds, there are times when it is good. He is a calm being which is good because if he wasn’t we probably would have killed each other. He puts up with me. He has no idea of my past and I will never share it with him either. We do things together and he is a good companion. I often say he “plays well.”  He does little around the house, and would do less if I let him. I could fill up pages of my complaints, but then I am reminded I made this bed, so to speak.

But he is definitely not my hero. And I resent that more than anything. This is what I want in my life. I wanted someone to keep me safe. Instead, I have someone attached to me who is more afraid than I am and unable to function. Again, this is another reason why I cannot just dump him. His course of depression would be a threat to his life. How can I call myself a compassionate person and do that to him?

But my anger often simmers ready for an eruption. My continued disappointment with the situation often overwhelms me and I lash out. He cannot comprehend the level of anger because he does not understand the past. Why do I not tell him? Because, in truth, he does not care. The man does not CARE for anyone, including his own daughter.   I have never met an entire family who is as self-centered as his. I am not going into a long history of this, but let it suffice to say that his major lack of effort is a family trait. I think his survival has been basing his entire life on someone else taking care of him.  At 65, he is not going to change.

But last night while the wind howled I thought, “No one will rescue you. If it gets bad you will be on your own.” I’m in survival mode. It’s automatic. My hyper vigilance is on high. Always.”  (Cissy White)

http://healwritenow.com/weathering-extremes-mindful-ptsd-3/

 

So no one is going to rescue me either. That is such a deep wound that continues to bubble from within. I wonder if I am going to die not knowing what it would be like to be able to trust people. I don’t and history has taught me not to. I am always on a varying degree of being on guard. The few times I have let down my protection and made myself vulnerable has ended up disastrous. There is not much left.

When I die, they will look at the body and say, “Oh she was so fat all her life, no wonder she had a heart attack.” What they will not know is I died from the deep wound of a broken heart that was multiply stabbed and never healed.

 

 

 

Storms and trauma

Heron Hill 2012  Heron Hill

Wow, this has been a week. The frozen air and deep snow has put a pall on everyone around here. Many people are having issues with their roofs leaking. We had a bit of an issue here at Heron Hill with a dripping window, but I had my contractor come and they shoveled the roof. It stopped. But one neighbor had it so bad her kid was telling us they were doing a bucket brigade the other night. One neighbor who is a young single woman had it pretty deep on her roof. She had someone shovel it off only to bury her house up to the first floor windows. She hired some schmuck who just took his truck and plowed her yard into the street and up into our yard. We have a hill which he was trying to shove it up. I was getting pissed, but I decided not to call the cops on them. It is illegal to plow snow across the street and into another’s yard. But… it’s not worth the fight and the hard feelings forever.

The girls at work are fighting like cats. We had one person swear at our front receptionist because they were following policy and would not admit this person without her badge. We slide the badge through a reader to release the doors. This caused quite a dramatic scene with some real hard feelings and stems from someone who should represent the best of the best. Our VP is extremely vigilant that her staff follows rules and regs to the letter… as it should be. The small bickering and internal fighting is everywhere.

A lot of what is happening here in the frozen tundra is threatening everyone’s safety. This is a topic is near and dear to me. I have been writing variations of posts in my head about this topic. I will be sharing them in a series of blogs for a while. They take a lot out of me to write.  It all stems from this blog post: http://healwritenow.com/weathering-extremes-mindful-ptsd-3/

I am going to take pieces of what she said and share what I felt while reading it. The first part is in relationship to our weather and her reaction to her weather.  Cissy White, the author, nailed it. She talks in this post the feeling or lack of feeling safe. She says,

I’m rattled by all the severe weather. The flood and snow drifts taller than me surrounding my home. Today, we got a blizzard warning for the coast where I am and who knows what’s coming next.

“My once sanctuary no longer feels safe or warm. 

When my home feels cold and unsafe I feel cold and unsafe. The warmth is escaping.

It’s not that I can’t see how beautiful the snow is or how powerful Mother Nature is. Those things I know. What I feel is threat and fear.”

 

I love a good storm especially thunderstorms. I like a ripsnorter of a blizzard if I am home and do not need to go anywhere. But storms are usually short in duration and cause little harm (so far for me.) However, the change in the air, the light and wind are huge triggers for me and puts me into hyper vigilance. I used to think it was like a high, but the copious years of being in that state have now taken their toll on me.

This trigger stems from one of my earliest memories. When I was around three or four, I was the last child of five at home. My mother at that point had lost her live-in domestic and was on her own for the first time in her marriage of thirteen years. She used to stick me in a playpen out on a small enclosed porch for hours. The pen was in a place where I could see out the low window of the door to the back yard. There were windows all around and they were open but what they call jalousie windows and rain did not come in.  A storm had blown in and it was a beaut. I remember being terrified at first and crouching in the corner of the pen. But as the storm raged, I got braver and actually looked out the door. There was a huge old oak tree out there and I am not sure if it got hit or what. But I only remember an electrical sound like a transformer about to blow up (and that in actuality may have been what happened.) But to this day, that sound turns me inside out. I watched in fascination and panic. It is like the high one gets from a roller coaster. Cortisol and adrenaline flows throughout me when I get like this which is poison. Now I do not have to be in an actual event for this reaction. I only have to perceive a threat and whamo.

But as long as my little house here, Heron Hill as I call it, remains warm and dry and no trees are falling on top of her I am fine. I will sit out on the back porch, either the covered one or the enclosed one I have and watch. I will often wake up with the distant flash of lightening and get up and watch the storm blow in. I spend hours storm watching.

But her comment about the warmth escaping and her sanctuary is no longer safe is something I totally understand. Any child who has lived through trauma understands.  We build our homes as a refuge, a place we can let our guard down and release the portable walls we walk around with to protect ourselves. It is exhausting to put up a brave front all the time. Some nights I climb into my soft bed and just cry from that release and overwhelming fatigue. I am safe here, surrounded in the environment I built. I own my home. Only me. It is filled with my stuff except my husband’s den downstairs. He came after I had bought Heron Hill.  It is my garden. Mine! I pay for her, protect her and keep her running. ME! It is a symbiotic relationship completely.

But the snow is piling up and it feels like we are drowning. My house is very high up on a hill. The main floor is actually the second floor if you enter through the front of the house. But this floor then exists right to the back yard on one level. My front windows are on the second floor. But the back windows overlook the deck and the snow piles are right to the window sills. We had our roof cleared and ever since we have been having this periodical very loud bangs emanating  from the cathedral ceiling, which is the roof. It is scary as hell. The ceiling in not sagging and there are huge beams that span the house. The house is 60 years old, just like me and is in great shape (not like me). I am sure it has to do with the subzero temps we have steadily suffering with. But it makes me feel unsafe in the one place, the only place on this earth, where I do not feel threatened.

Today I took the long way home to drive past a specific tree. I have no idea what it is. But in February, it sets these buds way up. This is a huge tree, at least thirty feet tall. The buds will actually unfurl to be leaves, but for now they look like unopened tulips. When the low light of morning hits this tree, the buds are pale pink. When I first saw it eight years ago I burst into tears. I used to drive that way every morning but more recently found a faster way to work. Now it is a rite of spring for me to drive by and look for this tree. Today, the buds were very tight but they were there. So….. it can’t be too long.

I hope you will take a look at Cissy’s post. I am going to make several comments about it. She was posted on ACES too HIGH, which is another blog and more about childhood trauma. All very interesting reading and I think will help people understand and have more compassion for each other.

http://healwritenow.com/weathering-extremes-mindful-ptsd-3/

 

 

 

Judgment

Goddess of the garden

Yesterday, The Good Doc, Victo Delore posted a great post on the vulnerability we all have to react to stimulus without the complete picture. Here’s her post: The Bigger Picture With shame attached, I would have reacted the same to the original situation and thought, “who dares to park in a handicap spot without the credentialing”?  I have a placard to hang from the mirror which is totally out of date. I lack the desire to be labeled handicapped but there are times when it sure makes my life easier to have less of a walk into the store. I honestly have also parked when I am in my car without the mirror handicap sign but only on really bad days and in a rush. One day I was feeling particularly cheeky and parked in the “for expectant mothers” spot. One of the few perks for being fat is you can look pregnant and people won’t ask, “hey, you preggers or just fat?”

Being judgmental is normal. We are taught it at an early age because we are judged. We are criticize and directed for correction as soon as we can voice a decision. When a baby first says, “NO”, the parent thinks, who the heck do they think they are? This is not a bad thing  because we need to learn parameters and boundaries. We also need to test the waters.  Learning what is acceptable is part of being assimilated into a culture.

I was raised by two incredibly judgmental parents who were raised by even more harshly judgmental parents. There was a code instilled in my family of needing to be perfect and that has completely messed with me and all of my siblings. This voice has been a deterrent for me at times because I do not want to face criticism and judgment. But the question begs, who is doing the judging?  When I take the time to really feel what I am thinking, I realize it is often not me; it is the old voice of my parents. It is the illogically comments from a time gone by. It was a mindset that I needed to be aware of so I could protect myself. But I also needed to play along in order to survive in the clan. I rebelled early on when I disagreed with their bigotry and hatred. I still hear their reaction to things and people that are not my real feelings.

I have a huge quantity of personal triggers that set me off. People who have PTSD react to stimulus that others cannot fathom. I have worked very hard to become aware of my triggers and try to deal with them. I am so sensitive to things that no one else can comprehend what they do to me because it is “nonsense” to them. For example, a certain color of light or a shadow on a wall used to completely upset me and bring on a sense of fear and despair. I now can explain that it is the color of light that happens at sunset and the low shadow is a marker of that same time frame. Why does this set me off? Because they are indicators of the time when my parents would begin their drinking.

People with PTSD have a bag of “stuff” to deal with that is so individualized that no one can comprehend what they are dealing with. It is that personal. Yet we hear people all the time say, get over it. We hear and feel the judgment. No one can really comprehend the pain and total suffering of others, ever. We do not have the ability to understand their triggers either. We need to have compassion. And it starts with not judging.

One challenge I am working on for myself is the “pause.” I try to take a moment and step away from the visceral reaction to something and breathe. In the second of calming I often can see a different story than the original view. Much like the good Doc says in her post about seeing the old couple and realizing the real story takes a moment of reflection. This process is hard and I often fail. But for the times when I do, it makes for a sweeter time of it. Unless it is a real jerk….and they do exist.  Ok, that was just to make you smile.

 

My mother and Weight Watchers

stone goddesses

I began Weight Watchers in January, 2015. I am strongly letting everyone know that it has nothing to do with being accepted or trying to meet anyone else’s expectations. It is about me getting my Psoriatic Arthritis under control, which it is not. I found out that inflammation changes the hormones and body chemistry making it very difficult to lose weight. In fact, most people gain. And I am like most.

In the last two years, I sat back and watched my weight steadily increase, some of it since last May when I had a horrible incident with a kidney stone that was 6mm big. It threw my chemistry completely off and within a month I had put on 8 pounds. I thought it was fluid, but it kept climbing higher, even after I passed the stone.

I did a lot of research, as I often do when I come up against something. I thought about bariatric surgery and discovered it should be called barbaric surgery. I asked around a lot and found from the mouths of people who had the surgery that it worked at first, but then MANY gained back some, if not all. And then on top of that heartbreak, they all had some form of  new issue such as diarrhea, hair loss, pain, mal-nutrition, anemia and the list went on. This to me was not an option for me because of the other complications with my blood clotting. I scratched it right off the list.

Then I looked into serious weight loss plans. Again, major rebound issues coupled with health problems. One program was good for small weight loss like 20 or so pounds, but very impossible for long term. The diet was 500 calories with multiple supplements. Really? How does that change a life for better?

So I turned back to old Faithful Weight Watchers (WW). This was my third go at it. First time I lost about 30 pounds but rebounded. Last time I gained right off the bat. This time…. well…. First my story. This is triggered by a friend’s blog I read tonight.

My weight issues began when I was very, very young. I do not remember ever not having a weight problem. I was pudgy as baby. I had severe food allergies and then that seem to not be a problem. There is one picture of me around three and I am not fat but I am not thin. I was tall though. A picture of me at five is that of a beach ball. It remains that way the rest of my life. But in truth, there is a picture I found of me standing up and I was around 13 or 14. I was fully developed, taller than any woman in my family and thick. Not fat, not thin. Shapely. I think at that time I was a size 14-16. The same size clothes now would be a 10-12. I had fabulous legs because I rode a bike everywhere and for miles. I walked, skated, swam all the time and danced. I had a bit of a gut compare to others, but I also had a shapely figure. But by then, I learned to hide, so to see a full shot of me was startling. I also realized I was not the beast my family had portrayed.

My mother, sister, aunt and both grandmothers were petite women. No one was over 5’1 and no one was over 120 pounds. In 6th grade, I was 5’5” and 117 pounds and in a DD bra. I was considered an aberration and chastised soundly by everyone. I can remember my aunt telling me to wear a girdle when I was 13.

My mother decided right about then she was going to “fix” me. She put me on this diet of green beans and Jello. I like both, but it was all I was allowed. I bought lunch at school and that was when you did not have choices, just one hot lunch for 25 cents. Our house was filled with candy and cookies. My father made his own root beer. We had store-bought bakery goodies and donuts every Sunday. Dinner was a roast or casserole with white bread, whole milk, fresh butter, and some dessert.  Crème sauces were big and on everything like fish, potatoes, veggies and meat. Veggies were lima beans, corn, peas and potatoes. I did not have a tossed salad until I was 16. Fruit was rare and often a “salad” was a canned pear on a leaf of lettuce with a glob of mayo and a maraschino cherry. Very chic! Very 50’s.

So her solution to my EATING problem was making me eat beans and Jello for a while. Now mind you, when I was younger, if you did not eat your dinner, you were severely punished. As children, we did not eat with the adults until we were older. On holidays we were allowed at the dinner table, but no talking and no messing around. Just eat and shut up.  I learned very early to eat everything. I was the kind of child who hated being scolded in any manner. Still don’t like it.

My mother could out eat us all. Her metabolism was not given to me. My siblings could eat and remained thin until much later in life. Not me. I ate what was on my plate. Rewards were foods like a special Dunkin donut covered in frosting. Birthday meals were fried chicken or lasagna. Candy lurked everywhere, dishes and bowls of the stuff. Fortunately for me, I am not a big fan of most hard candy, but in a pinch. My mother and father had buckets of Fanny Farmers’ assorted chocolates. There was always a full cookie jar on the counter in the kitchen.  Cheap soda was in the refrigerator and the famous root beer was shared on special occasions. Even alcohol was allowed early in life and on special occasions. I learned to love Cherry brandy by the time I was eight

The part as an adult that I have had to work on so very hard is to get my mother’s critical voice and disapproving looks out of my head. She would skew her face up and would look at me with such distain sometimes that it would hurt me to the core. Food was the enemy she deemed and would go on rampages to humiliate me or shame me into “doing something about my weight.”

Dinner often turned into a battlefield, especially if they had been drinking, which….. they did every night. Some nights, it was a race to be done eating to get away before something happened. Common tortures were a heavy knife handle to the elbow for having it on the table. We had these ball shaped salt shakers which my father would swipe up and pelt at you for some perceived misdoing. As time went on, and my siblings left to go to college or their own lives, I was the featured target. My father would take his dinner plate and fling it at the back of your head like a Frisbee. If he was really out of it, he would fling whatever he could reach.

But I always ate my dinner with my head down and quiet until I was around 15. Then I began to cook for myself and eat privately when I could. My parents often never got to dinner or it would be ten o’clock or so. They were so smashed it didn’t matter. My father munched on cheese and crackers and Mom smoked. But by this point in my life, my food issues were tightly engrained and my body was never going to be petite. NEVER. I ended up at 5’ 6’ inches with size 8 feet. (Mom’s were a size 5) My hip bones (pelvic area) were a good five inches wider than hers, and at her  4’9 inches, I towered over her.

But her voice never left me. is I will always see her dark hair framing her disapproving looks.

Fast forward to now, the present moment… well we will back up first. When I started working at my job there was this woman who I saw for the first time from the back and my heart skipped a beat. I swore it was my Mom.  Something about the way she held herself.  This woman and I do not get along. She is critical of everything and everyone. She has a frown on her face most of the time. She especially does not like me. I am in the position she held for ten years as head of Education. She is a nurse, I am not. This is my failing and she and a few others let me know at every opportunity they do not approve of me. It was very hard for me to get passed her and ignore her and her cryptic comments and her LOOK.

Now, present moment. What does any of this have to do with Weight Watchers? I was doing WW on line since January. But they offered a deal at work and were going to have meetings there. So I signed up and arrived early to the first meeting last week.  Who do you think walks in to join? Mind you, if she has ten pounds to lose, it is a lot. So there I am and all the old guilt, resentment, and uglies surfaced. I could barely speak in the meeting. We had to share why we were there and I wanted to stand up and scream because my mother was a mean bitch and so are you….(looking at this woman). But in a shaky voice I mumbled about being a big beautiful woman and that I was here to get healthier. I went home so upset I thought I should quit.

But I did not. Instead, I challenged her. She has four other participants and we have our own team from HR/ED. We will win. This week our team all had significant weight loss. I am doing really well, after a couple of stalls. This will happen and then I lose a few more. Right now I have lost 5% of my total body weight from where I started. It’s all numbers. I am still big. I am also still in pain. But I have not had a shot in two months. It will be interesting to see what happens once I get a shot and calm the inflammation. Right now I can barely walk so I am not exercising. But that will become necessary soon.

The team that loses the most total poundage gets a lunch provided by the other team. I will enjoy watching her serve me……hahahah. I keep holding on to that.

 

 

 

Why I only see the bad in me…..

On my last post, someone asked this question and I thought it is an excellent question. I knew the answer but I went and did some research anyways. Here’s the question:” Why is it I know all I did wrong and think of nothing right? or see mistakes, not successes?”

When humans first roamed the earth they were given a very basic nervous system called the limbic system to protect them. It is a genetic piece of work that still is within us. The system is our warning system that something is wrong and to do something about it. It is fear radar. I have written before how this all works. Through time, the brain became more evolved and we developed the capacity to override the limbic system by learning in reality what is harmful. For example, we know a hot stove can hurt us, but only if we do certain actions like touch the burner. We do not walk around and every time we face a stove, we go into a panic mood or better known as fight, flight or freeze. Unless you hate to cook.

But children who are raised in trauma based environments face a different learning sequence that changes how they react to things as adult. It is not a failure in the child, it is actually another mechanism put into place to protect the child. It appears that genetics predisposes us to develop in certain ways. But our experiences, including our interactions with other people, have a significant impact on how our predispositions are expressed. In fact, research now shows that many capacities thought to be fixed at birth are actually dependent on a sequence of experiences combined with heredity. Both factors are essential for optimum development of the human brain (Shonkoff and Phillips, 2000).

I often wondered why my reactions to things seemed so much over the top. I am very sensitive. I have learned to accept this part of me as a gift, along with the desire to learn to live in peace with it. I am definitely prone to hyper arousal. I would go off and very little would sooth me even if I knew cognitively that things were not as bad as I was making it out to be. When children are exposed to chronic, traumatic stress, their brains sensitize the pathways for the fear response and create memories that automatically trigger that response without conscious thought. These children have an altered baseline for arousal, and they tend to overreact to triggers that other children find nonthreatening (Child Trauma Academy, n.d.).

We all have voices in our heads. And those voices are the echoes of conversations we have heard before since infancy. Many can override negative voices through affirmations and other verbal training. They can change the imprints of negativity. However children who grow up in violent or chaotic homes are too busy trying to survive. Consumed with a need to monitor nonverbal cues for threats, their brains are less able to interpret and respond to verbal cues, even when they are in a supposedly nonthreatening environment.- if a child’s caretakers are indifferent or hostile—the child’s brain development may be impaired. Because the brain adapts to its environment, it will adapt to a negative environment just as readily as it will adapt to a positive one. But if a child’s caregivers are unresponsive or threatening, and the attachment process is disrupted, the child’s ability to form any healthy relationships during his or her life may be impaired (Perry, 2001a).

The question is why do some people only hear the “bad” in their lives? I do not take compliments well. I always am waiting for the other shoe to drop. It is my parents voices I hear which is totally unfair since they are both long gone. Why can I not move on? But if the early environment is abusive or neglectful, our brains will create memories of these experiences that may adversely color our view of the world throughout our life. Explicit memory, which develops around age 2, refers to conscious memories and is tied to language development. Explicit memory allows children to talk about themselves in the past and future or in different places or circumstances through the process of conscious recollection (Applegate & Shapiro, 2005).

This study goes into the effect of long term negative environment. It explains that the brain continues to grow and develop with whatever stimulus the child is exposed to. One way that early maltreatment experiences may alter a child’s ability to interact positively with others is by altering brain neurochemical balance. Research on children who suffered early emotional abuse or severe deprivation indicates that such maltreatment may permanently alter the brain’s ability to use serotonin, which helps produce feelings of well-being and emotional stability (Healy, 2004).

This was an excellent study to help understand the long term impact of childhood trauma and sexual abuse. More and more information is coming out on the long term effects which will help with acceptance. But the most important acceptance is self-acceptance. Based on this study and others, the situation is daunting. If you are chemically and physically wired for hyper-arousal, self-deprecation and negativity, how do you overcome it? Can you overcome it?

Yes, I believe so. All humans have neuroplasticity, which means our brains will create new neuropathways for life. The process slows down as we age. And it takes more than just verbal input. You have to train the body as well to not react to stimulus incorrectly. You have to learn your triggers. You have to learn what is safe. And by that I mean feel within your body, mind and soul what is your place of safe. And you have to forgive….forgive your predators because if you do not, you are still giving them power. And you have to forgive yourself when things set you off course or upset you. This process takes a lot of work and I honor any who keep on trying because I know it is hard. Just as the child who repeated falls when learning to walk, they get up and keep trying. So goes our lives. You can teach an old dog new tricks.

From:

Child Welfare Information Gateway ISSUE BRIEF. November 2009, Understanding the Effects of Maltreatment on Brain Development

 

2015 New years and dream

Goddess of the garden

Again I am amazed at the amount of stories and bloggers of people who have some form of PTSD and Trauma based issues. And the level of trauma ranges from violence and sexual abuse to anxiety and to incurring self-mutilation. When I first starting this new post, I thought I would focus more on the clinical aspects of trauma inflicted issues but then I thought “who was I to write about things like that?” After spending some time reading other posts I think I will continue to share my journey in the hopes that maybe others can relate. I find in the plethora of blogs out there on the topic there is also a difference in each one. And in my own pursuit I have come across information I did not have. I have felt compassion and understanding and I find this soothing. It is sort of a community. And since I do not see childhood abuse or sexual abuse or domestic abuse going away, I think it is important to talk about it and share.

So in that vein, I am going to share a dream I have had off and on for the last (I sat for about fifteen minutes while writing this and realized the amount of years and was shocked) over twenty-five years. But I must give a brief history for it to make sense. I met my first husband when I was 19. We got married a year and half later. There were signs then that he was violent and a liar and cheat but I did not pay attention. I want to get out of the even more abusive situation at home. I did love him, very much so. He was in a band, had long hair, was over 6 feet and large. He wrote poetry and sometime songs. He wanted to go to Canada with me and start a farm and not be in the military. He was pretty close to being drafted when Vietnam ended. I was a total hippie and the thought of raising plants and animals for a living has never gone away. I would never have raised animals to slaughter, but I love cows and sheep. I grew up on farms of my friends and was no stranger to the hard work that is farm living. But I was young and very healthy and strong back then.

From the day I met him, being unfaithful was going to be a part of my life with him and his friends. His best friend was cheating on his girlfriend and wanted to “date” my best friend, and was hitting on her. That was how he and I met. Once we became a couple, in short order, I realized we had a different meaning of being committed. I never caught him red-handed, so to speak, before we got married. But there were signs. I wanted to be married and on my own so I went onward. But there were a couple of situations where his temper flared, including taking a hammer to the windshield of his van and smashing it right where my face was. This was to be his method of attack in the future. He never hit me directly in the face, but would smash things very close to my face such as the wall or throw something. But, after the home I came out of, violence was nothing new.

What became more pervasive was the onslaught of girlfriends. I will not go into all the details of it right now. In the later years it got so bad that he would pick up women at bars in front of me and go off. Early on I knew something was up and would go through his wallet and find names and phone numbers. I had no shame about going through his wallet either. I knew what he got paid, I knew what he gave me, and I knew how much cash he blew on going out. Early in our marriage, he would explode when confronted on things, and I learned to let it go. But I did not let it go. I brought it all inward. It ate away at me all the time. What self-confidence and self-esteem I had was GONE by the time I was 25. GONE! I remember we both went on medication induced diets and I lost a ton of weight. I was gorgeous and had a body like Marilyn. I attracted a lot of attention. But my head image never changed and I had no realization of being anything but a fat, ugly, unwanted woman. The weight came back incredibly quickly and doubled. He had joined the police department, and the level of ostracization became intense. He quickly gravitated to a couple of women in his class and became too friendly with one in particular. This relation lasted for years. She made it very clear to me that he was involved with her. I was embarrassed and humiliated because everyone in our personal circle knew about it and accepted her and the relationship. She was not the only one, believe me, in the 27 years we were married. He had one affair that lasted nine months before he had to confess because she contracted a STD and he had to tell me. BUT…. I have to explain something that will make sense why I was subjected to this for so long and never got out.

After he became a cop, he changed. I believed in marriage being sacred. My mother instilled abject fear about divorce in me. She said it was the ultimate disgrace and failure on the woman. At the time, I did not know her mother was divorced. I did not find that out until several years after she died. I thought it was my duty to stay and put up with it. In hindsight, I know I was also terrified. And this is what he fed into, as most predators find the Achilles in their victims. He would also become the most violent after I confronted him. One time he got so mad he punched the wall and broke his hand. (served him right) He had to go to the hospital and get it cast.

But he also isolated me. He even admitted he did this when we were going through his divorce. He would do horribly embarrassing things when we were with my friends. And my friends could not stand him. So in short order, the only girlfriends I was allowed to be with were the wives of his friends. I was very blessed that my dearest friend forgave me for the period of time when I did not see her and we have become close again. Other friends did not hang in there. The women who I was in relationship with were very nice, but, I would not befriend them now. There were too many differences, especially with his closest guy friend and his wife. She was a simple woman whose whole world was her family. She had no children of her own, which was horrible for her. But without being condescending, she was also not the brightest woman I have ever met. I have not heard anything from them since the divorce either. The rest of the women were in the same predicament as I. One lady, Linda, had been with her man for ten years. He had another woman, Carol, who he saw every Sunday. He also spent time with her as he pleased leaving Linda crying in the house they shared. We were never sure who he would bring to a party. He cheated on Carol, when he met Linda. One gentleman died “in the saddle” of girlfriend #2. It was such a joke they called her Killer. I am sure his wife laughed all the way to the bank when none of the three girlfriends got anything and he was very rich. There was one guy who kept bringing this woman to our house and events and I made the faux pas of calling her his wife. Nope; girlfriend for over ten years and the wife knew all about it. She preferred to stay home with their children. This list goes on. They all were not cops, but many were. And this is not to say that all cops cheat, but in my permitted circle it was the norm. Most of the women were not highly educated and although some worked, none had management jobs. Some were secretaries, or hygienists or in medical offices. This sounds highly condescending, but they were not interested in anything else. None had outside activities except going to shooting matches with their men. I am serious. Some actually shot. Conversations were about house- hold cleaning products or television. I was even ostracized even within this circle because I believe in gay rights and was called a Feminazi because I was a feminist. It added to the depletion even more of my self-esteem. I had to get out of that circle to figure this out. Many of his circle of friends divorced when the cop husbands retired and they ended up with much younger wives. Very sad. But the real tragedy is what this constant degradation of the wife and the humiliation that goes with being treated that way does to the woman. It strips away every drop of self-esteem you have. Many did not leave because of children, but I found out later, many also were subject to mental and physical abuse. I joined a divorce support group and one of the members turned out to be the wife of a cop I knew only by name. What he did to her was criminal. Being married to a cop has many challenges as the Blue Code protects some and hurts many others.

Now back to my dream. I will preface this also with the facts I am married now to a man that fidelity is not an issue. My husband is the most faithful and loyal person I have ever met. The reoccurring dream is one where I am still married to the ex and he goes through a string of behaviors that flaunt his connection with another woman. The dreams started when I was still married to him. I would wake up crying and humiliated and also very angry. When we divorced, the dreams increased in frequency. I would wake up stressed and upset. Eventually, in the last two years, the dreams would change at the end to me beginning to fight back. There was a couple where I flayed on him. He was a big man so it was futile. It only added to the frustration. More recently, the dream resolves where I am starting to tell him to go f**k himself. Most times I don’t get it out as I become inarticulate and I wake up.

This morning I slept in and the dream came again. Just as I was about to have to face this woman picking up my ex-husband and I to go to some event, yes all three of us in her car carrier truck,…it’s a dream but the other woman always is more macho in activity or had children (we could spent a whole month of that) and I go WHOA…..”you’re an asshole”….and I am about to rip into him and tell him how I feel about this and my current hubby opened the bedroom door to allow our little peanut doggies to wake me up. I was so close.

I have been divorced for 13 years. I have not spoken to him since then. I wrote a letter once but of course never sent it. It helped with some of the anger. The anger I have now is not at him. He was a pathetic jerk and so were his friends. None of them deserve anymore of me. But I am angry and frustrated at myself for not being able to resolve all this in my dream world. It gets to the part where I pull up my big girl panties and I am about to invalidate him and I fail. I am sure there is a whole mess of psychoanalysts who can tell me what this all means. What is very weird is that I have not really talked about much of this period of my life to anyone except in my writing. I think I am still grappling with the humiliation and the fear of retaliation that was so pervasive for almost thirty years of my relationship with this man. He began his isolation and exclusion of me from his life almost from the moment I met him. There is consolation that I am getting closer to speaking up in the dream. In the real world, my self-esteem and self-worth is still pretty fractured. If you couple my childhood years with this period it is 47 years of pure hell. I guess I need to give myself a lot more credit for being able to even have some peace now.

Although I celebrate the New Year on October 31st, I am sending everyone a blessing for the upcoming year of 2015 to be one of great healing and recovery. I hope we all get a bit stronger and fight for help for all the people who are impacted in some manner of trauma to become the Spiritual Warrior they are meant to be. I cannot help but believe there is a reason we all are here. And those who have had some huge battle with the evil of the world, whether it is on a battlefield or in our own homes, we are here to stop it from happening in the future. I really see and feel in my deepest regions of my soul there is goodness and light in everyone and we are not meant to hurt each other. I struggle every day with the whys and what ifs. But the future is where the change can occur, so I wish for it to be a better world for us all.

Trauma induced Obesity…. Really? No Sh*t!

rain clouds'

I actually wrote a whole different blog last night. I decided to sit on and not publish. In the morning, I reread and tweaked it and thought I would send it out anyways later. But in going over my emails, I found this email from a friend and therapist who sent me a blog article. I did not get to read it until later in the day. I had taken a break from work and decided to read through. I sat there at my desk crying.  Fortunately no one was around much. I have a heater fan running so hopefully no one heard me sniffling. I stopped and mopped my face up and decided when I got home to reread the blog and then write. Oh…. I was going to write.

I spent time tonight working on house stuff, laundry and the sorts and just sat down a little while ago to read the blog again. I was actually not thrilled about facing it again. I then went to the site and looked at some of the older posts. It took my breath away. It is so overwhelming to the point it knocked me out of writing what I wanted to. I am just ….and I am not sure the right word is that I am. I am mad because there is so much statistical information out there on trauma induced illness and yet it is so unknown by practicing clinicians. I had written about the ACE study before in my blog. If you have not done an ACE study, do so. And then read the implications. It is enlightening.

http://acestoohigh.com/got-your-ace-score/

But now as the night has progressed and I spent it reading instead of writing, I am going to let the blog speak for itself. It is quite a collection of information. I am going to share the one line that made me cry. And it is terrible. The author is sharing the story of how the doctor who was working in creating an obesity clinic was upset because he was not successful. He went on to dig into many of the (obese) patients’ history and found a resounding amount of them had some form of childhood trauma. That is not what made me cry….it made me slap my head and say out loud, “Really? No shit!” This is right from the Dr.’s story after he had given his results to a body of educated physicians and clinicians.

So, if you were Vincent Felitti, whom would you pick as your first audience to reveal your stunning findings? A group relatively informed about obesity that would greet the new information with extreme interest, praise and applause? Natch. So, in 1990, Felitti flew to Atlanta to give a speech to the members – many of them psychologists and psychiatrists — of the North American Association for the Study of Obesity. The audience listened quietly and politely. When he finished, one of the experts stood up and blasted him. “He told me I was naïve to believe my patients, that it was commonly understood by those more familiar with such matters that these patient statements were fabrications to provide a cover explanation for failed lives!”   http://acestoohigh.com/2012/10/03/the-adverse-childhood-experiences-study-the-largest-most-important-public-health-study-you-never-heard-of-began-in-an-obesity-clinic/

……..A fabrication to cover FAILED Lives?   Oh man did that stick in my craw. Truthfully it makes me furious. So again, because someone is obese (and I hate that word with a passion) the presumption is that (1) they lie and (2) their life is a failure. If you think this is an exaggeration, you are not in the world of being overweight. The reason I was crying is because it happens a lot. To read someone with such credibility admit this was overwhelming to me. It is pervasive in the medical field and I face it every day at my job. That is exactly what people, doctors and other clinicians have projected to me. I have heard other large people tell about me about their discrimination. A person I know just died because they refused to give her a liver transplant because she was overweight. Prime personal example: years ago, I had gone to have some work done up to find out why my a1c had spiked. I had the Chief of the Endocrinology department tell me I was a waste of time, that I would never be able to lose weight or exercise like HE did and so he was going to march me down to bariatric surgery immediately and get me fixed. (I have to breathe deeply every time I think of this) He never looked at my chart. If he had he would have seen my blood sugar had spiked in three months after a life time of low to normal readings. It took me having to read and discover that the prednisone and other drugs they slammed me on for the PsA all raised blood glucose. AND when I went off, it came back down. I went to see a nephrologist after one of my kidneys failed. Again, he never discussed anything but the fact that I was overweight and he wanted to bet me, BET me, that I would NOT be able to lose weight. I think he thought he was challenging me. Again, no one ever told me for a year my right kidney had failed…first concern…and that I had developed stones and they were a by-product of the PsA…it took me eight years to find that out and I should have been medicated then, eight years ago, to reduce the creation of more…which happened. No one can see past the weight. I am a non-person.

That last statement about being a non-person is very telling. I am going to stop tonight and let it just sit out there. I hope you will skim through the blog article: http://acestoohigh.com/2012/10/03/the-adverse-childhood-experiences-study-the-largest-most-important-public-health-study-you-never-heard-of-began-in-an-obesity-clinic/