Monday, February 27, 2012

Lesson learned

I had my weekly weigh in tonight and was taught my lesson in why Kaiser only wants me weighing once a week on their scale.  The one I had at home showed I lost more than when I weighed in on the scale at the clinic.  So when it said that I lost 9.5 lbs this week (yay!), I was disappointed rather than elated.  Who wouldn't be thrilled with a loss of 9.5 after losing 19.5 the week before?  Then I had to remember, different scales.  That loss is great and I am extremely grateful.  My life has changed so much in just a matter of 3 weeks.  It's incredible how fast that weight that is now gone has impacted my life in a completely positive direction.  I feel good and my spirits are really uplifted.  My support system is completely wonderful, too, which I'm super excited about.  They are all my cheerleaders.  God has really blessed me.  So three weeks in, 35.5 pounds lighter.  Yippee ;-)

Saturday, February 25, 2012


I saw a friend today, one of my dear friends that I have known for a good 20+ years.  She hasn't seen me since I started Optifast, but I did text her after my last weigh-in.  So, she was up to speed on how I was doing.  The first thing she said to me when she saw me today was, "How bad are you starving?"  She thought she was being funny, but it rubbed me the wrong way.  I love her to death, but why did she need to be negative?  I'm not hungry any more, otherwise it would have really bothered me.  Then I caught her eyeing my body up and down, as if to look for the weight that has left me.  That bugged me, too, because she didn't make a comment except to ask me if I notice any changes, which was code for me that she didn't notice anything so I needed to convince her.  I know, I know, I'm reading way too much into every freaking thing.  It's true and I admit it.  When you don't eat any food, your emotions are right on the edge (at least mine are).  As a result, I don't have a buffer right now.  I think the thing that bothered me about my friend's reaction - or non-reaction to be more accurate - is that I cheated.  Not by eating food, but by getting on a scale.  They told us only to weigh when we are at the clinic, so I felt like I was having an affair with this "other" scale.  It said 380, which means I have lost 37 pounds since February 7th, about two and a half weeks ago.  So, in my mind, my friend should have clearly been able to see a difference in my body.  Even I, who is always so critical of my body, could see a difference in my face when I look in the mirror. 

The dilemma that I need to talk to my Optifast counselor about is how I will be able to take communion next weekend.  I am following the program to the letter because I want this to work.  The Optifast program I go to through Kaiser is very successful, having ushered something like 25,000 people through the program since it's inception in the local San Diego area alone.  So if they tell me to do something, I want to honor that.  If I talk to my counselor and he says I can't take communion while on the program, do I defy his instructions in just this one instance (actually, it would be one instance every month), or do I really not take communion?  As a Christian, it's an important practice for me.  However, I also have to remember that it is symbolic and perhaps what matters most is what is in my heart.  I can see not taking communion because it could set me up for wanting to eat outside food or have sugar (since the grape juice that stands in for wine is pretty sweet).  I really need to pray about this one to see what it is I need to do, but first I need to talk with my counselor about it.  I'll be going to group Monday night, which is my official weigh-in night.  No more sneaking off on secret scales.  Bad girl.

Friday, February 24, 2012

Am I on a diet too?

I met a friend for "breakfast" this morning.  When I say breakfast, it's me drinking tea while she has breakfast.  We met at a local family restaurant in town ... down home cooking, oil in everything and a smell that gets into your clothes somehow.  I've been thick in that food before and loved every bite of it.  I arrived, didn't see her yet, so I decided to just get a table and order my tea.  The waitress gave me a paper to read while I waited for her.  It was actually quite lovely to just enjoy my warm tea and read about the goings-on around my home.  I was  not bothered for even a second of everyone eating around me.  Hmm, very surprising.

When my friend arrived, she talked for a while about the diet she's on.  She is the one calling it a diet, not me.  She's basically eating hardly anything and it doesn't sound like she's getting in her basic nutrients, but I can't judge her.  Some people call what I'm doing crazy in that I don't even eat food, just drink everything.   Touche!  Anyway, she asked me how my "diet" was going and I have to tell you it was like hearing fingernails on a chalkboard.  Diet.  Die-et.  Diet.  She told me she could never, ever do what I am doing.  More fingernails.  So I explained to her how the entire program works and that it's not really dieting more than the beginning of finally getting healthy.  I could tell I was trying to convince her, so I shut up about it.

Vanilla Optifast shake made with
Key Lime Sparkling Water and
lots of ice in a blender.  Yummo!
I thought about it and wondered, do I really consider this a diet or do I really believe it when I say this is a beginning to getting healthy?  The truth is that you just don't go this route for a few pounds to lose.  It is a major lifestyle change and it really does take commitment to be successful.  Had I tried Optifast at a different time in my life, I know I would have already been cheating by now.  I would think of each shake as a punishment and count the days until I can get off of it.  Yet, that's not the place I am coming from today.  I am in so much gratitude for how God is blessing me and taking care of me through this.  I am finally feeling alive and, as each day passes, I am definitely feeling healthier.  Granted, I haven't been doing it for long, but for me with all the problems I have had in sticking to a program, this is major

So, as I watched my friend pick at her oatmeal and raisins and have a bite or two of her sourdough toast, I became so grateful for my shakes.  Eventually food will come back into my life and, I pray, I will be able to handle it appropriately when the time comes.  In the meantime, I can enjoy the nourishment I do get and that feeling of the pounds melting off my body.

Thursday, February 23, 2012

Changes I already am experiencing

It is hard to believe, but I am already seeing and feeling differences in my body even after just a couple of weeks in.  First of all, the hunger that I was experiencing the first week has gone away, thank you God!!  The hunger I now feel is because it's time to have another meal (aka shake).  I have heard other people mention, who are currently on Optifast or have been, that the taste of the shakes are awful, that they just pinch their noses and down it as fast as possible.  Personally, that has not been my experience at all.  That might be because I don't just have them plain and most of the time I make them frothy in a blender.  I also put an ounce of Torani Sugar-Free Syrup in each one.  So today my shakes have been:  vanilla peach, chocolate caramel, vanilla orange (made this one with Diet Sunkist) and chocolate black cherry.  Why make it a punishment?  I love my shakes and feel full.

So far I've lost 26 pounds after two weeks, which isn't a lot when I have so much to lose (I know, that seemed like a ridiculous statement just now ... losing 26 pounds after two weeks isn't alot?  Come on!).  So I thought I wouldn't notice any sort of difference for a while.  How wrong am I!  I already notice the distance between my tummy and the steering wheel is further apart.  I tried on jeans yesterday that I couldn't get over my hips before and now I can zip them up, without even needing pliers.  I have more bounce in my step.  Then there's the really big difference I see ... I have sleep apnea and have been battling falling asleep with the CPAP machine.  No matter what position I am in, I just can't fall asleep when I was using their test machine before ordering mine.  As a result, my ability to fall into a deep sleep was practically non-existent.  I was getting maybe 4 hours a night and a really awful 4 hours at that.  The next day I would be behind my steering wheel and feel myself trying to nod off.  Don't worry, I never did.  I would drink coffee, chew gum, lower the windows, grip the steering wheel tightly - anything to prevent it from happening.  I didn't want to kill myself on the road, let alone anyone else.  This was occurring for months every single day.  Now it has not happened even once since dropping this weight.  I don't have the machine yet (still in the process of ordering), but I am feeling fully rested and with lots of energy. 

As much as society is against a program such as Optifast because of the judgements they put on it, I am glad I made this decision already.  I feel grateful I have a great support group and medical personnel who are helping me along the way.  My personal doctor, who isn't even part of the Optifast team, has been my biggest cheerleader.  And, the support I have from practically everyone in my life sure does make this so much easier than I thought it as going to be.  It's not easy, don't get me wrong, but just easier than I imagined.

Wednesday, February 22, 2012

Want to find out what's eating you? Then put down the food.

Part of why I put off this journey with Optifast and losing the weight is that I just knew in my heart that it was going to be challenging with emotions that I could no longer stuff away with food.  When a person gets to be significantly overweight, not just 20 or 30 pounds, then there is something more to it than just enjoying the taste of food, I don't care what that person says.  I am not saying that I don't welcome this challenge because the truth is that I do.  I don't want to be that 417 pound person living to eat, hiding away from the things that hurt and putting on a smile, assuring everyone around me that I am one hundred percent happy all the time.

This last year to year and a half of my life has tested every sense of strength I thought I had, and even challenged me to see that I'm stronger than I imagined.  I have gone through a work-related injury that has been tough to deal with; a breakup with a boyfriend that broke my heart in a way that words can never begin to express; and, the discovery of cancer in my body, followed by procedures and surgery to remove it that left a scar more than half the size of my back.  I also continued to work full-time and go to school full-time during all of this. Was it emotionally draining?  Yes!  As an example, from the time I had the surgery in my hand (from the work injury) until about 1 month after that, I somehow managed to gain 30 pounds.  How does a person do that, in one month?  I was sick as a dog after the surgery, got sick from the operating room, with a horrid cold and bronchitis, but still.  Obviously I was going through stuff and not talking about it, but managing to eat a ton over it.  I'm embarassed to actually admit that, but I'm here for healing.

All of these things, not to mention Type 2 diabetes along with the everyday pain of living in such a large body, led me to taking care of myself by starting Optifast.  Which brings me back to the emotions part I was discussing in the beginning of this post.  Today I was scheduled to have 3 MRI's - one in each hand and one in my neck.  I went to the office where it was to be performed and got myself prepared.  I climbed on the table, laid in position, but they could not fit me through the tube.  Actually, they could, but the position I would need to be in for 20 minutes made it impossible because I was stuffed in the machine.  The scheduler who made the appointment knew my size, so I was pretty surprised he sent me to the closed machine (as opposed to the open one).  So they said they couldn't do the MRI's because I was too big.  Boy, that was a stinger.  Didn't he know that I'm working on it and how humiliating this moment was for me?  Seriously, can I just crawl into a ball now or what?  The technician was certainly kind enough and sensitive to my feelings, but he couldn't take away how it made me feel.  As I was driving home in my car, I started thinking about my ex-boyfriend, probably because of one of the songs on the radio reminded me of him and I was feeling very alone in the moment.  I started to cry and all I wanted to do was find food.  In that moment, I was really missing food.  I knew in my heart, though, that I wasn't missing the actual food - I was missing what food did for me, which was to numb me out and help me believe things would be better somehow if I lost myself in it.  What a lie!

So where does that leave me now?  First, I did not pick up any food and I'm very proud of myself for that.  I have been praying so much to God, especially since I started Optifast, to just give me strength.  Sometimes I pray for strength to get through the moment and sometimes it is because of the uncertainty I feel about being in a smaller body someday.  For someone who has always had weight issues and been obese for most of my life, being thin is an absolutely terrifying world that I just don't know how to manuver.  Prayer does help me tremendously.  I know feelings are going to come up and I have to find a better way of dealing with them.  No matter what, though, I am absolutely committed to not picking up.  I don't want to be this obese person any longer, I want health and sanity in my life when it comes to food.  This is part of why I have this blog in the first place - to get out what I need to so that I won't feel the need to pick up.  I just don't want to live in an existence anymore where food becomes more important than anything else.  For a long time, sad as it is to admit, that's exactly what had happened to me.  Just writing this post has helped tremendously.

Monday, February 20, 2012


I had my Optifast group meeting tonight, which starts with a weigh-in.  Hold on to your hats... I lost 19.5 pounds this past week.  Wtf???  Turns out I was the biggest loser in the class.  Holy smokes.  So I've lost 26 pounds within the last two weeks.  Now I know this is not about the numbers, that the focus shouldn't be that, but I have to say that those numbers tell me something is working.  It made me feel so good and I really was near tears when we were doing some visualization exercises in class, just thinking about what is possible.  One of the exercises we did was to visualize our last binge and compare it to what we see our healthy bodies at 5 years into the future.  The comparison of the two was ridiculous - how does a plate with fried chicken, macarooni & cheese and coleslaw compare to the smile on my face on top of a healthy body?  It's like night and day and that is what was so special to me.  So anyway, off to a great start and I'm so grateful for God.  He is helping me stay in the moment and have much gratitude.

I'm still soo hungry

I have been trying to figure out if the hunger feeling I have been having is actual physical hunger or emotional hunger.  It truly is physical, there's no mistaking it.  It's certainly better than it was the first couple of days.  At least when I get hungry now, I know that another shake will be coming soon since I have one every three hours.  It's just hard when I have that empty feeling in my tummy with the grumbling and accompanying headache.  However, I am determined and I am pushing through.  I can already see the weight loss on my body, so I have a feeling I lost a lot this week.  I find out tomorrow night when I do my weekly weigh-in at group.  What is concerning is my blood sugar is high in the morning.  They took me off all my meds, so I don't know if it's supposed to normalize after a period of time.  I suppose that's a question I'll ask tomorrow when I go to group.  However, after being at this for almost a week, I can say that it's going better than I initially thought it would.  I do miss food, but I know that this is not forever at all.  And when I do go back to food, it will be good choices that I'll be making.  This is probably the hardest thing I've ever done in my life.  Having survived cancer last year as well as child abuse and rape when I was younger, that's saying quite a lot.  Yet, this is the most emotional and vulnerable I have ever felt in my life.  I am constantly talking to God, asking for His guidance and reaffirming my faith that with Him all things are possible.  Even this.  I just want to be healthy so badly.

Thursday, February 16, 2012

Freaking starving!

I'm almost done with day 3.  We were warned the first days are going to be hard, but then things will be so much easier ... the hunger and headaches go away.  Hasn't happened for me yet and today was particularly challenging.  Yet, I am a determined girl so I leaned on my friends for support.  The headaches I can even deal with, but it's the hunger feeling in the pit of my tummy that is tough for me.  It's so confusing, too, because I'll have one of the shakes, make it extra frothy with lots of ice and it is tasting sooo yummy going down.  But then about a half an hour later, I feel very hungry.  Thankfully I'm allowed, and expected, to have a shake every 3 hours because of my diabetes. 

Beyond the hunger, I have been feeling a lot emotionally, which I know is part of what happens when you put down the food.  Towards the end before beginning Optifast, I really was binging a lot and now, not eating food, I'm hyper aware of just how bad it got.  It makes me sad that I got to this place of getting so into the food that I never realized I hit 400+ pounds.  How does a person do that and not see it happening?  Well, I guess it's possible if you avoid mirrors and keep buying bigger clothes.  I am pushing through this hard physical time because I have the reminder that I don't ever want to live in a state of not caring about how big I get.  I know this is just the beginning of realizing what I had done to myself with poor choices, but I have relief knowing God is on my side and always will be if I just reach out for help.  

Wednesday, February 15, 2012

Day 1 down

I'm happy to report that I made it through day one just fine.  I was super hungry, but we were warned in our group that the first three days are very hard to get through.  I felt like the shakes were very filling when I would have them, but then about an hour and a half later, I felt ravenous.  So I did drink a lot of fluids, mostly water, to get myself through.  I also need to watch the clock a bit more because I went just a little bit too long between shakes.  But, for my first day, it was pretty good.  One thing I noticed is that it is going to take a little time for old habits to change.  I had a doctor's appointment and the thought was in my head to pick up something for lunch on the way back to the office and then the realization hit me that I am not eating food, so I can't do that.  It will just take time and I get that.  I do have to say, though, I am grateful I made the decision to tell people what I'm doing because the support I have received has just been utterly amazing.  I can't imagine doing this without having that support.  It would really be impossible, especially during those times when it may seem easy to give in to the urge to eat.  Anyway, off to start my day.  Bring it on!

Tuesday, February 14, 2012

Goodbye syringes

As I get up and look at starting my day, I was looking at the basket of prescription medication I have.  It's a little basket I have to keep everything in one spot.  This morning I get to remove all of my diabetes medications - Glucophage (pills), Glyburide (pills), fast-acting and long-last insulin, syringes and alcohol swabs.  One of the biggest joys Optifast is bringing me is the ability to say goodbye to diabetes.  Who knows if that is forever, but it is possible to either reverse the diabetes or certainly keep it at bay.  Regardless, beginning with today, I get to start the process of letting it go.  I can't tell you how much that means to me.  Sometimes when I am in church and our pastor talks about the fact that when we go to heaven, our bodies will be like new with no disease and no pain.  Every time I hear that or think about it, tears come to my eyes.  I live with so much pain every single day of my life, and diabetes is definitely a major contributor to that.  Now, here I sit, on the brink of waving it away.  No more bruising on my tummy because I injected in the wrong spot.  No more getting the shakes from having my blood sugar dip too low or too high.  No more fear of losing limbs because of this disease that has ravaged my body and I was keeping there.  Instead, I feel freedom this morning and such an awesome sense of empowerment.  If you are reading this and have never experienced diabetes or any other chronic condition, consider yourself fortunate.  And if you have, do know that I know where you're coming from.  This morning, I'm on the road to so much healing and I'm incredibly grateful for that. 

Monday, February 13, 2012

Bring on the shakes

We received the program shakes tonight in group, so I'm ready to go in the morning.  We got a pep talk about keeping everything as positive as possible.  It was great, too, to find out the science behind all of this with the shakes.  A good explanation of the nutrition, ketosis and everything in between.  The first few days will be difficult until my body goes into ketosis, then it's supposed to be great.  Other people in the group talked about being so satiated with the shakes that they wouldn't ever go back to food if they could.  Interesting.  I'm looking forward to that feeling.  Also good news, I go off of all my diabetes meds.  What a dream!  I'm posting my stats on the right and will keep them up as I go through weight loss.

Sunday, February 12, 2012

Gave it all away

Since I'm going to be Optifast for quite a while, I've given away all of my food that is not allowable while on program.   My mom and other people are getting everything in my cupboards and fridge.  I'm guessing I'll be on the full fast for about a year or so, depending on how fast I lose the weight, and it will be harder to have food here so out it goes.  I did buy some ingredients to give flavor to the shakes, like extracts, Torani sugar-free syrups, diet soda, sparkling water and Spenda.  The price for Torani is soooo much better at Smart & Final ($3.99/bottle) vs. World Market ($6.99/bottle).  I'm determined to not treat this time as a death sentence, but am trying hard to stay positive and enjoy my nutrients.  I think positive thinking is important in life as a general rule, so much more so when facing tremendous challenges.

Saturday, February 11, 2012

That was an unexpected feeling

One of my friends at work has a blender in her office that she wasn't using, so I bought it from her.  I thought it would be nice to keep one at work to make blending the shakes easier.  Because of injuries in my hands, I'm trying not to manually shake the product if I can help it.  Anyway, when she brought all the pieces of the blender to me, I had a nervousness develop in my tummy that I hadn't felt at all up to now in regards to starting Optifast.  It actually threw me off a little bit.  Where did that come from?  I haven't been mourning the loss of food up to that point, but I suppose it made it really seem like all of this is going to happen.

Tomorrow my mom is coming over for a visit and I told her she can take all my food if she wants to.  Since I'm a single person and have no reason to keep food in the house, I want it all gone.  Why tempt myself needlessly?  I suppose there's finally an advantage of singleness that I never saw before ... I won't have to deal with triggers that other people with families will have to face.  I can imagine the vulnerability that I am going to feel will be hard enough to deal with, I don't have to add more.  Still feeling very good about my decision and just trying to mentally prepare myself.  As a Christian, I have found that I am more aligned with God and spending much more time in prayer than I have been before this.  I realize I am going to need to lean on God to help me put one foot in front of the other more than I ever have before.

Wednesday, February 8, 2012

Moving forward

I have finished my final medical clearance to begin Optifast product next week and went to the first group meeting.  For the group, you are with the same people for the next 20 weeks, then you can switch groups or continue with your current one.

After I checked in, I went to the nurse's station so they could monitor my levels and then it was on to group.  I was laughing to myself because a woman behind me, who had already started the program, was telling her friend what the first week was like after you start the product.  She said the problem isn't being hungry but it's dealing with your head and the emotions that come with it.  She said, "Girl, I was praying to Jesus a lot during those first few days!"  That was the same talk that occurred in our group from the 5 people who were continuing on from the 20 weeks they just completed.  But, overwhelmingly, they talked about the fact that after the first week, it becomes really easy.  In fact, the feeling I got was that there was some sort of freedom that comes with going on the full-fast because you just don't have to deal with the dynamics of food.  It's pretty black and white.  I must admit that I do like that.  This is going to be such a life-changing process that perhaps not having to deal with food will allow me to be much more present. 

So, next week I will be receiving the product and then beginning it Tuesday morning.  Since I'm diabetic, they want me drinking product every 3 hours, which means I may have to add an extra shake depending on how early or late I'm up.  After the first week or two on product, my blood sugars will normalize.  They are taking me off all of my diabetes medications, which is a combination of pills and insulin injections.  I can't tell you what that right there means to me.  No more sticking needles in my tummy, no more shaking from high blood sugars or low ones (I suffer from both).  And I will be coming off more meds as I progress further in the program.  They are adding a potassium pill for me because of my iron levels, but I can handle that.  I'm really looking forward to starting.

Saturday, February 4, 2012

Feeling emotional

In preparation for starting the program on Monday, my assignment is to do some reading and then write what I eat in a food journal with specific questions to answer each time I write something down.  Seems simple enough, but then all these emotions are coming up for me surrounding that.  I'm really seeing in black and white how much of an emotional eater that I am.  I mean I always knew it on an intellectual level, but not in my heart I guess.  And I do have to admit that I was getting a little resentful when I was in Costco today.  I have always been a little annoyed by the food carts that give out free samples in practically every aisle, but I was hyper-aware of it today.  I watched this one woman go from aisle to aisle, eating her way through Costco.  She wasn't shopping, didn't even have a cart, just was grabbing samples at every station.  I resented her.  I bet she doesn't have to write down what she eats in a food journal or do a medically supervised weight program.  Of course, you can never judge a book by its cover - she can be a bulimic or someone who purges.  I guess, for me, she just represented normal-sized people, the fact that they don't have to go to extremes around food, they just eat it and then move on.  This is not to say that I won't do it or that I hate it, just resentful of the fact that I feel like I'm being singled out for being a bad girl around food my entire life.  Things will get better, I know they will.  It's just tough right now, but that's okay, too.  I have so much support in my life and I know I can lean on any of my friends to see me through the rough patches while on Optifast that will invariably come up.

Thursday, February 2, 2012

Body assessment

Today I had my body assessment, which is where my measurements were taken.  Very interesting visit.  It was one on one with a nurse.  I wasn't prepared for the emotion that would come out of me as I was telling her my story when she was preparing my paperwork.  She asked me if seeking this medically supervised weight-loss program was my idea or if it came from my doctor.  I explained to her that while my doctor supports this decision completely, this was all me.  I got emotional as I told her that you reach a point in your life when you are done and you are either going to completely just give up or you are going to fight for yourself and do whatever is laid out before you.  That's me ... there is still a lot of fight in me.  But the journey to get here has not been easy.  I was physically abused as a child at the hands of my mother, raped at 13 and just grew up in a situation that was rough and hard.  Last year, I had cancer.  Surviving that really changed a lot for me in my life.  Things that seemed so very important before meant not as much after cancer.  The things that we, as a society, deem life or death really are laughable in the face of cancer that if left untreated has a mortality rate of 100%.  As I was telling her my story, I realized I have been through so much and come out the other side that being heavy was not going to break me either.  Along the way in my life, I certainly have had times where I didn't feel strong enough to combat what was going on, but God shows me through my faith in Him that I, in fact, am very strong. That doesn't mean I don't feel things deeply or get scared.  What it does mean is that I am going to get through whatever comes my way because I trust in Him that I do not walk alone.  It makes me feel so special to know my name is written in God's palms.  What could I possibly fear with Him by my side? 

So I started looking at the materials I was sent home with.  One book, called Maximize Your Body Potential:  Lifetime Skills for Successful Weight Management is all about not just the physical side of losing the weight and keeping it off but the reasons we eat in the first place and tackling that so that the weight doesn't come back on.  The other book I have is a workbook that takes us week by week through the process with a group of other people who will be doing this with me.  I will be starting the group this Monday, having my final medical clearance done on Tuesday and then starting the shakes the following Monday.  So my first assignment is to write down all of my food for the next 7 days using a food journal they gave me.  As I skim through the workbook, I am so excited in looking at the things we will be tackling.  The things that made me eat in the first place will be front and center in this journey, but there will be some really positive things that we'll be doing, too, like adding joy into my life, living the best life I can here and now and so much more.  Right now, I am in the right emotional space to be starting this part of my journey, even though I'm also scared, too.  "Scared" may not even be the right word for it.  I will be dealing with things that I have been reluctant to talk about like how I can live in this world and have a relationship with my mother that beat me for so many years as a child or how I died inside when I was raped at such a young age or how having cancer showed me how much I really do want to live.  That's not to say I ever had thoughts of ending things, but I suppose if I continue to live in an extremely obese body, things will end sooner than they should anyway.

I have so much I want to say and share.  And I know I will do that in time, but all I can say about the present moment is that I am all in and committed to being a healthier person - physically and emotionally.