Lose Weight - That's an Order!

by Marcia Purse

I am seriously overweight. Many people don't believe it, because so much of the weight is carried in my bowling-ball belly and I tend to wear disguising clothes. But if I tried to get insurance with Blue Cross/Blue Shield in my state, I would not pass their obesity guidelines ... my height is somewhere between 5'8 1/2" and 5'10" (yes, it varies), and I weighed, ten days or so ago, 182 pounds. Now, I grew up skinny. I got teased about being thin. My ribs showed. Being fat is as foreign to me as if I had suddenly become a Martian. I HATE it!

When I saw my pdoc, Dr. Meyer, the first week of June, we had a heart-to-heart about my weight. When I took a day job (a little over two years ago now), my walking-fiend co-worker and friend saw to it that I began walking 4-5 days a week after lunch, working up to about 1.5 miles a day. Even though I had been getting NO exercise before that, I've lost NO weight from this added exercise. None. Nothing. It HAS to be the meds keeping me from losing - what else could it be?

So we made a plan. First he switched me from Depakote to the weight-neutral drug Trileptal and told me to come back in a month. If I had no problems with Trileptal, we'd start easing off Celexa and introducing Wellbutrin, which is also weight-neutral. At least, that's what I thought he said.

At my physical in early June, my physician Dr. Lilly told me my blood pressure was too high (160/90) and that I needed to start taking medication to lower it. Because my heartbeat seemed fast also, she wanted to use an ACE inhibitor, Accupril, but was concerned because depression can be one of its side effects. The alternative was Triamterine, a diuretic. Now, my belly fat is so bad that it has herniated my navel, same way it happens to pregnant women. (I look pregnant.) It's uncomfortable as hell and bad for my low back. Since it seemed possible that some of the weight was due to water retention, we decided to start with Triamterine until I had a chance to talk to Dr. Meyer about Accupril.

I left a message for him, but his reply got lost - I never received it. So I just went ahead finished out four weeks of Triamterine the day before I had appointments with both doctors, one after another, but did not refill the prescription. Trileptal gave me no problems at all, fortunately.

Maybe Dr. Meyer and I got our wires crossed, but at this appointment he balked regarding Wellbutrin, saying he'd only agreed to my taking it IF I agreed to work on quitting smoking again. That was not how I remembered the conversation - so we had an argument. He insisted that Celexa, unlike other SSRIs, does not promote weight gain or interfere with weight loss. I pointed out that all the time I've been on Celexa - several years now - I may not have gained that much weight but I've been entirely unable to lose any, either. He finally agreed to have me reduce the Celexa dose from 30 mg a day to 20 and add 100 mg a day of Wellbutrin SR.

We went on to discuss the blood pressure issue. He suggested that instead of Accupril I might take a beta blocker called Atenolol, saying the latter does not cross the blood/brain barrier so will not cause psychological side effects. And because I'm now showing multiple physiological complications from overweight - high cholesterol, high blood pressure and rapid heartbeat (tachycardia), he ordered me to start dieting. He recommended a modified Atkins diet.

From his office I went straight to Dr. Lilly's office for a follow-up visit regarding blood pressure. This was down to 140/90 - some improvement, but not enough. Dr. Lilly agreed that Atenolol made sense but prescribed a variant, Tenoretic, which combines Atenolol with a diuretic. She supported Dr. Meyer's recommendation of modified Atkins.

This made my medication cocktail:

• Trileptal - 150 mg morning/noon
• Celexa - 20 mg morning
• Wellbutrin SR - 100 mg morning
• Tenoretic - 50/25 mg morning (Atenolol/diuretic)
• Trazodone - 25 mg bedtime
• Lorazepam - 1 mg bedtime
• Zocor - 20 mg bedtime (for cholesterol)
• Naproxen - 550 mg twice a day if needed (usually is) for fibromyalgia pain

And also these supplements:

• Multivitamin - 1 in the morning
• Fish oil with Omega-3 - 2 gelcaps morning/evening
• Calcium citrate for osteoporosis - 500 mg morning/evening
• Coenzyme Q-10 for heart health - 50 mg morning/evening
• Acidophilus to aid digestion - 2 capsules morning/evening

Anyway, that evening I went home and researched diets - and talked to Kimberly Bailey, my partner here at About Bipolar Disorder. It so happened that she had been ordered onto a diet just a few days earlier due to high cholesterol. She had chosen the South Beach Diet, so I took a close look at that. It seemed to me to be a healthier and more easily implemented diet than Atkins, so I signed up. Kim and I are now "weight loss buddies."

I guess I did this just in time. A few days later I got a letter from Dr. Lilly with my blood test results. My cholesterol was up to 235, and now I have to double the dose of Zocor.