the HAES® files: HAES Consideration Self-Applied

by Health At Every Size® Blog

by Dana Schuster, MS

Zimmer_knee_replacement10C (1)For the past two months I have been recovering from bilateral knee replacement surgery. Yep, I did them both at once—a decision that has been described by some as “crazy” and others as “really smart.” In all honesty, I think both opinions have merit.

I know many friends and colleagues who have been thwarted by doctors in getting cleared for joint replacement surgery because they were fat. Outright denial of these procedures or “requirements” to lose significant poundage in order to be even considered, have kept them from being able to secure these treatments which just might change their lives for the better. I was very fortunate to have the first surgeon I consulted NOT respond in this restrictive manner, and when he told me to “lose as much weight as possible” in a pre-surgical consultation, my quick and definitive statement that “that’s not going to happen” was accepted by him, and weight was never mentioned again.

Although at first my post-surgery accomplishments seemed extremely encouraging and satisfying, I have to admit that the last couple of weeks have been much more of a struggle for me. I am usually pretty good about listening to my body and honoring what it tells me about movement and rest, without judgment. Yet I have recently been feeling very frustrated with the limitations I continue to encounter with my range-of-motion, mobility, sleep, and patience. My natural tendencies towards holding myself to very high expectations have not been sitting well with my actual daily or weekly progress.

In the midst of my self-directed chastisement that I was neither doing enough nor meeting the performance expectations of others, it occurred to me that I may not be quite as good at self-applying the HAES model as I am at encouraging it with others. There is an underlying level of compassion and a lack of judgment inherent in the HAES paradigm that I realized I just might not be practicing when dealing with my current physical challenges. So I decided to review the HAES principles and the core concepts behind them to see if they could help me get myself back on track. The primary ideas that jumped out at me in this process were:

  • Individually appropriate
  • Acceptance
  • Respect
  • Multi-dimensional

I believe the HAES approach is founded on a kind thoughtfulness and consideration that embodies the “Do No Harm” mantra. I realized that in my physical struggles I was somehow forgetting to start with the concept of my INDIVIDUAL needs and experiences and instead was looking far too much at what the outside “measurements” of my progress might be suggesting. How could I have let go of the knowledge that I can only do what I can do and accept that as being just right in the given moment? My levels of self-acceptance and body respect eluded me in the midst of my rehab process, perhaps in part because I am not adept at asking other people for help without feeling somehow less-than. My unaccustomed need for a pain medication that was beginning to muck with my mood might have also pushed me in this direction.

Without a doubt, the knowledge and experience of the healthcare professionals who are members of my rehab team have an important place in facilitating my recovery. My doctor knows how to watch for the healthy healing of an incision; the physician assistants have expertise in medications; and the physical therapists have skills to maximize the progression of mobility. I benefit from and am grateful for all of their input. But what I’d somehow forgotten in recent weeks was that I am the only one who actually inhabits this body and experiences the range of physical, mental, and emotional reactions to the activities these professionals prescribe. The value of trusting the multi-dimensional elements that comprise my overall sense of wellbeing had also somehow slipped away from me as I tried so hard to push my functionality forward.

Revisiting the HAES principles and thinking about the way in which they encourage positive consideration and acceptance of one’s own body knowledge and needs, has been just the right medicine for me. This process has allowed me to get past the heaviness of my self-judgment and frustration and move ahead in a more positive manner. By going ‘back home’ to my HAES beliefs, I feel as if I am once again centered. I have made a promise to myself that I will listen to and trust my own body experiences first and foremost, and let them be my primary guide, as I continue to go through the months of rehab that lie ahead.

10 Comments to “the HAES® files: HAES Consideration Self-Applied”

  1. Bravo, Dana! Your candid description of self-assessment that motivated revisiting your HAES beliefs will strike deep chords in many of us. I’m keeping your post and adding it to my HAES “first aid” kit, I know for certain it will come to my rescue one day. And whether smart, crazy or both to opt for bilateral knee replacement, you are one brave woman to go for it! Here’s looking to the day…however much time it takes…when you achieve the mobility you’re working toward.

  2. Reblogged this on The healthiest beauty.

  3. Thanks so much for posting this! It reminds me of my own struggles to compare “within not between” — looking for progress as measured against myself and not compared to others. It’s wonderful that you were able to embrace the “kind thoughtfulness” of the HAES philosophy. You are an inspiration!

  4. Reblogged this on One Day at a Time: Thoughts on Getting Out of B.E.D. and commented:
    My readers might recall me occasionally writing about the “Health At Every Size” movement. Here’s the latest posting from their blog and it includes some wonderful reminders about tuning in to our bodies and being gentle with ourselves when progress on a goal seems slow.

  5. Hi Dana – I also had both of mine done at once. Well, two days apart, actually about 5-1/2 years ago (age 44). It’s not easy (not even close). Sounds like you are doing your very best. It’s tough to keep your mind on track, especially with all of the anesthesia you had and perhaps pain meds. Those always throw me for a loop. Keep up with that rehab. You are on your way to feeling so much better. It’s a long haul, no doubt, but you will not believe how much better you will feel. My biggest problem was that the head of the rehab dept. in the rehab hospital I went to after surgery, didn’t bother to take into account that, as a 300+ pound woman, my legs were bigger than average and I do not, even in ordinary circumstances, have the range of mobility of a thin person. He pushed my left knee too far and to this day, it does not bend as far as my right one. I had an awesome surgeon and medical team who did not require a weight loss and I am so thankful for that. My previous ortho doc/surgeon had his assistant tell me to stop eating burgers and fries from Hardees (at that point in time, a french fry had not passed my lips for over 5 years – this is before I knew about HAES). We moved to a new state and found a wonderful orthopedic doctor/surgeon in Tallahassee, FL. The only thing that worries me at all is since I had it done so young, I may have to do it again someday and that’s not something you really want to repeat. The HAES principals will serve you very well as you progress with your recovery. Best to you!

    • Hi La,
      I certainly am there with you about not wanting to think about a repeat – and yet, if that is in the cards for either of us we will once again conquer the challenge I am sure. So glad you found a doc and team that worked with you to become bionic without weight bias!

  6. Wow Dana – must be the season for total knee replacements. I was scheduled to have bilateral replacement in December but on the morning of the surgery was informed that the surgeon had decided to only do one. I was extremely disappointed as I really only wanted to have one lot of recovery and rehab but was powerless at that point to change anything. I therefore had one total knee replacement done (and consequently spent Christmas in hospital) and some cleanup work on the other.

    I had the ‘lose some weight first’ conversation with the surgeon a year earlier and told him the same thing as you – not gonna happen. Likewise he never mentioned it again. However when I was in rehab one day not long ago, the head orthopaedic surgery nurse casually advised me to lose some weight and that would help with my rehab. Of course I gave him the same talk as I had given the surgeon, and subsequently followed up with an email about how it was unethical for him to be recommending weight loss. I also sent him the Bacon-Aphramor paper and volunteered to do some training for his staff. I saw him again last week and he thanked me for the paper, but hasn’t take up my offer for training yet.

    With respect to my own recovery, I am totally with you on the need to really genuinely revisit the HAES principles. I have caught myself (and I’m definitely not proud of this), surreptitiously comparing myself to others in rehab who had the surgery around the same time as me, instead of just focusing inwards on my own individual recovery. And I have to constantly pull back from the feelings of how much I “should” be able to do now, and just acknowledge and respect the fact that my body is healing as best it can.

    I’m sending you all my good healing thoughts and hope one day soon we’ll be able to dance a little jig together.

  7. Hey Dana, I had a RTKR in December 2012 and finally started feeling better at the three month mark. My surgeon didn’t hesitate to tell me “one at a time” because I have a few other health issues that were of concern. One, fibromyalgia, and two..I had a lot of other problems with my right leg namely my psoas and IT band. I’ve been blogging about my experience as well.

    The one thing I’ve learned from this whole experience is to focus on what you CAN do and not worry about benchmarks or what others do. Everyone heals at a different rate, and trust me, I am a SLOW healer! I STILL have a lot of swelling in my knee and it’s been 5 months since my surgery. My surgeon gave me an invaluable piece of information and I hope you take this to heart. It takes 6 months to one year for a TKR to feel “normal” and it may never feel totally “normal”. I laugh using that word and so does my husband because he would not call me normal! LOL!

    I hope this made you chuckle a little. You will come out of this. It does take awhile though but you will!!!

    Sending healing prayers and white light!

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