Could it be?

Could it be that I have not posted in over a month, while both of you readers have been clamoring for more?  A thousand apologies!  To say it’s been busy would be an understatement.  Where to begin…

I had reached a plateau weight-wise.  My dietician told be to maybe add some calories, so I added more protein to the menu, and it seemed to jump start the weight loss. I’ll be honest, I’d love to be further down in numbers, but I keep self-sabotaging because I’m spending more time on the road.  I know, I know..I need to plan for that and make adjustments.  I do, and then I see those golden arches and I’m McScrewing myself.McSick

The nurse practitioner seems pleased with my progress.  She keeps asking me when my surgery is ballpark for, and I tell her September/October, because my insurance company seems to be fairly surly and unapproachable on this subject. I’ve registered in United Healthcare’s “center of excellence” program, and while Portsmouth Hospital is not one of their centers of excellence, it is in network, which is akin to not having Ebola, but a slight case of Zika instead.  In other words, to them, I suck but I don’t suck as much as the guy who is going to Bob’s Weight Loss Clinic of Duluth or something.

I have finished my behavioral health classes, which were great, and so now have the dietician and NP visits every month or so, labs, which I got done today, and a few other tests, then a short class a few weeks prior to the surgery, and I will attend the monthly pre-op support groups because I like them.  I kept saying if I lost all the weight I would;t get the surgery, but with the acid reflux, I feel like I have to.  That and separating my brain from my stomach are the two biggest draws.  Not to worry – I am not going to lose all the weight (see paragraph 2).  Think About It

I am going to buy a bicycle, a hybrid mountain bike.  Dick’s has a nice Diamondback I like for under $500.  If I can find the recommended model I read about in an online magazine, I may go to a bike shop to see of they have it or will order it.  A few more weeks and I’m on it.  Medically, my back has been giving me all kinds of trouble.  The lower back, on either side of the spine, out to the middle of either half of my back.  It’s almost debilitating.  I really need to see a chiropractor unless one of you has better advice (that is my plea to you to tell me what you think).  I got a FitBit a week or so ago, and it has already got me hooked.  We had a fire drill at work today, and my first thought was not, I wonder of this is actually a drill?”  No, it was, “Awesome!  I get to add some steps AND some stairs!!”  That is the right kind of thinking.  I unintentionally did 4 miles last weekend on my walk, and posted my best times per mile.  The times kept dropping with each successive mile.  I loved it.  I’m using the Map My Walk app, and I listen to Nikki Glazer’s Not Safe podcast, which is a riot, and lasts for just the amount of time I am supposed to be out.Dick's

That’s it of tonight, I think.  It’s late, my thoughts are scattered because I am writing a song and lyrics keep running through my head.  That’s my sign that it’s time to head upstairs, put the floor AC unit in and hit the hay.  Next time I will discuss the misnamed sleep study I took at the beginning of the month.

Questions?

The (Relational) Space Between Us

Hey, it’s not as bad as it sounds.  We had our third week of what I have begun to call “Fat Class.”  Week three is reserved for prospective bariatric patients and the support people.  It was a full room, and good for those people who brought someone.  There we were, the 5 or 6 of us who brought no one, in the back row looking at each other knowingly.  We live alone, some by choice, some not, and I am confident we’ll figure something out when the time comes.  I’m sure I could get a member of my family or a co-worker to come and sit with me to make sure I’m okay.  I’ll sleep downstairs to be close to everything relevant.  But this night, I was flying solo.  Come to think of it, if I were a pilot, flying solo would be a badge of honor; it’s something one has to graduate into.  Go me.

flying solo
from robynhobson.com

It was a good class, which surprised me, because it wasn’t as much about food as it was relationships.  One of my favorite sayings regarding the fairer sex comes, of all places, from Popeye: “It’s been proven through history that wimmenz a myskery.” Dr. W. was discussing the relational system, and how it needs 3 things from all involved to keep going

  1. Flexibility
  2. Adaptability
  3. Accommodation

    Feminist popeye
    The mystery is what the hell happened to her forearms.

If one of these things is missing, the system starts to break down.  To put these things into a diagram, draw a box, and write “ME” in it.  Then draw a large circle to the right of that box.  To the right of that, draw another box and write “YOU” inside.  That circle represents the relational space.  This is where things get worked out.  I pour in my thoughts, needs, hopes, and wants.  You pour in yours.  And from that we get our compromise.  We say, “When you ____, I feel ______, and what I really need is _____.”  Keep in mind, this means that we have to tell people what we want, and we have to be direct.  Now, write all the wants and needs in the circle.  Remember the Tinker Toy exercise, where we draw spokes off the circle and figure out how to get these things in the circle?  We are NEVER, EVER stuck in a problem!voodoo doll

Picture instead a fight. Arguments and fights happen when we don’t use the relational space, and instead go around it.  Draw an arrow from your box around the top or bottom of the circle directly to your partner’s box.  Admittedly, I have worn a path of fire in the area around the outside of the relational space.  Which is why I was alone on support night, let’s be honest.  Anyway, that path leads to the pyramid of escalation.  On the base, level 1 is discussion and compromise.  Level 2 is “Attack, defend, counterattack, retreat.”  Level 3 is the level reserved for goading and button pushing (you know who you are).  Level 4 is verbal abuse – demeaning, name calling ugliness.

Argument
Careful, lady.  I’ll bite that finger clean off.

And the tip of the pyramid is physical abuse.  If something comes at us from levels 2 or 3, we must always respond from Level 1.  We could say, for example, “Could you help me understand what some of your concerns are?”  It gets to what is happening in their head, not addressing the escalation.  Nothing good ever comes from anything above level 1!

Before the class  started, I was talking to a guy in the back with me.  He mentioned that he’s been doing the exercise, eating the way he is supposed to, and he still feels like he’s gaining weight.  I feel exactly the same way!  I met with the dietician Friday, and she thinks I’ve hit a temporarily plateau in my weight loss.  She thinks because I’ve been trying to stick to 1200 calories a day that my body thinks it’s starving and is slowing things down.  So we’re going to add a few hundred calories a day and see if that changes things up.  I also need to change what I eat every day for lunch to keep my body guessing.  Not the first time I’ve heard that.  So tomorrow I will spend time looking for other lunch alternatives.  I was only up a pound over a two week period, but I still see that as going in the wrong direction.  I mean, I wound up here by overlooking one pound at a time.  It eventually became 100.  As the saying goes, a nickel here, a dime there, and pretty soon you’re talking about real money.  At least I think that’s the saying.

Gain weight
Um…no.

I was approved for the in-lab sleep study two Wednesdays from now, so I’m (not) looking forward to that.  I mean, I sleep naked, so between having to wear something to bed and being in a strange bed on a weeknight, I may not sleep at all. Thing is, the in-home sleep study isn’t as comprehensive, and apparently many people end up needing the in-lab study anyway.  So no sleep, and I might get to come away from it with a stinking C-PAP machine.  And I get to go to work the next day.  Awesome.

No Sleep
Thursday’s warning to my coworkers

The Neurologist and the 4 Components of Functional Eating

What do the two have to do with each other?  Absolutely nothing.  It just describes my day.  Or perhaps a secret 8th Harry Potter book.  You decide.

I went over this afternoon to see the neurologist for a consult.  It was supposed to be for sleep apnea, common for us non-wee folk.   But it also became a consult for my migraines.  I bought my very first house in July of 2015.  bout 3 weeks later, I fell down the second floor stairs, and hit every damn step on the way down.  I was buck naked and holding an empty laundry basket at 6:30 in the morning.  When I hit the bottom, I thought I had broken my hip.   I decided that if I could put weight on it, it wasn’t broken.  I limped around the kitchen – not broken.  I had to go to work, so I hopped in the shower.  A burning went up my arm – it turns out I had a second degree burn on my forearm from the carpet.  I got to work and my eyes started going in different directions.  I left work after a few hours, spent the rest of the day in the Emergency department, and have had migraines since, including one Thursday that brought for the first time nausea and vertigo.  That scared me a little.  That was not my first concussion.  Far from it.  I am not a pro football player, but I was a boy, and I am now a man, and I find myself sometimes in situations that result in concussions.  Don’t ask.  And if you haven’t seen the Will Smith movie Concussion, see it.  Great movie.  Not really about football at all.

Anyway, the neurologist gave me the choice of what to treat first.  I decided to treat the sleep apnea.  My reasoning was that I have to sleep every night, and I do not have migraines every day.  Also, there is a chance that by taking care of the sleep apnea, it may take care of the migraines.  The reverse is not true, and could also result in more kids for me, the side effects of which did not seem particularly pleasant.  So the medical group will submit to the insurance company for preauthorization, and we’ll see if I can do the in-lab test because it’s more comprehensive and I want this taken care of.  I rushed back to work for three meetings, then got back in the car and went back to Portsmouth, literally across the street from the neurologist’s office, for the behavioral psychology sessions required through the bariatric program.

Tonight we discussed the 4 components of functional eating patterns:

  1. Portion regulation – have a strategy
  2. Food selection – read the labels!
  3. Interval eating – eat by the clock, anywhere from every 2 to 5 hours. Meal, snack, meal, snack, etc.
  4. Compensation – if you overdo it on food and possibly stretch your pouch, then its time to increase your exercise, reduce your calorie intake, or both.

Good stuff.  Next week we’re supposed to bring at least one of the people in our post-surgical support them with us to class.  I will be attending alone.  I have support, but they will only be here if I call them.  I kind of prefer it that way.  Perhaps I’ll feel differently when the time comes.  My family are the type that are always offering to jump in and help.  I love that about them.  There are a few others, a few people at work, and a few people outside of work, but they have their own lives.

Do any of you have any thoughts about this?  I’d love to hear them.  By the way, dear reader, if you are considering bariatric surgery, I strongly urge you to subscribe to two blogs I absolutely love: rny4me just had gastric bypass surgery and chronicles it warts and all, and banded carolina girl offers a fresh perspective and encouragement.  I’ve drawn a lot of strength from those two, and I likely have not told them in any way, shape, or form, but thank you.  You are keeping me on the path.

Is my fall a fail?

It feels like it’s been a million years. Not that I haven’t had anything to say; I just haven’t had the time to say it.  I’ve read elsewhere school has been crazy for people.  It’s been crazy for me too.  Thing is, I’m in too deep to quit now.At the bottom looking up

Along the weight loss narrative, I’ve met with the staff psychologist, who is an ex-Air Force vet and I really like him.  It was a quick one hour session to sort of point me in the right direction behaviorally.  He says that in order for weight loss surgery to be effective for the patient, they MUST make changes in their behaviors surrounding food and coping. Sounds pretty simple, right?  It isn’t.

I met with the dietician, which I may have written about.  Hydrate, add protein shakes.  400 calories for meals, 200 calories for snacks.  Something every two hours.  She’s nice but I wouldn’t want to cross her.Angry Woman

I met with the physical therapist, who only needed me for one pre-op visit.  She said because I have physical issues, all I need to do is walk, not for distance, but for time.  45 minutes, 5 times a day.  That’s been really hard.  I’ve been fighting migraines for a week now, and yesterday it finally won.  It made me sick for the first time, gave me vertigo for the first time ever, and strangely, made me eat, probably because I was so stressed about it.  I was worried it might be a vitamin deficiency.  I even stayed home from work because I was still feeling the effects of it this morning.  The good news is the I meet with the neurologist next week and can discuss it further with him then.Migraine

I’ve gone to a pre-op support group. That was interesting.  I am really not used to saying this at all, but I felt like I was being judged for being the skinniest one in the room.  It’s all relative, of course, but man did I feel out of place.  It was great though.  There were panels, questions from the audience, the psychologist was there, the dietician, and several former surgical patients to talk about their experiences.  It’s nice to know that we will get through this.

I also went to the first of 5 behavioral classes put on by the psychologist.  That too was good.  It wasn’t an hour and a half where they just read the book to you.  It was practical, it was useful, it was interactive, and I got lots of good information.I learned that y responsibility throughout this process is to keep on track regardless of what is going on around me.  I need to control my own environment.  I need to have confidence I can keep the weight off.  Dr. W talked about flight sim training for pilots, and how when they go inside, the people running the sim ill throw one thing in to knock them off kilter, then another, then another.  They make failure a virtual guarantee.  Why?  Because (and here is the take-away) smooth sailing is not your friend.  We need to learn how to course correct on our own.  Having everything go right is not the way to get that done.  We need to face the challenges in order to overcome them.  Finally, we cannot view our FALLS as FAILS.  We just need to chalk it up to experience and move on, like when Tom Brady throws a rare interception (not a word from you haters out there).  He knows he will get another chance to get back out on the field and turn the INT into a TD.  That’s all we’re looking for throughout this surgery process: a win.Brady TD

Lastly, I met with the nurse practitioner today, who is on her way to Hawaii right about now.  That was sort of ho-hum, even though I like her. I got to meet her dog too, which was great.  A 5 year old yellow lab who loves to be played with and pet.  I talked to her about the migraines.  She talked to me about staying hydrated.  It was straightforward, but she did say I am in a really good place.  I weighed in at 275, but I don;t need a lot of the attention most of the others need, medically speaking.  She said she wishes I could get the surgery now.  I told her I really needed the behavioral piece of this because there are parts I am not telling her or anyone.  Like how much I ate out last week and the week before.  How I cut out of there and went to McDonald’s after my visit.  Why?  No idea.  I wasn’t even really hungry.  I guess I just wanted the salty taste of the fries and the mixture of the hamburger and the cheese swirling around my tongue.  It makes me so scared that I am not going to be able to modify my behavior enough to have this surgery be successful.  Apparently not scared enough to stop, though.  McDs Weight

Bada-da-da-daaaaa…

Restaurant Eating is Going to be the Death of Me

I just balanced my checkbook and realized how much I ate out over the last three weeks. So rather than blog about my journey here (I really dislike the word and its overuse), I apparently went out eating.  So, sorry.  Like you were hanging on every word…

I have an appointment with the dietician tomorrow.  The conventional wisdom is that my caloric budget is going to be raised. I wonder if I’ll have the guts to tell her I’ve beat her to it and done it myself.  Friday I have an appointment with the program psychologist.  I’m looking forward to both visits.  It will be interesting to see what the next stages bring.

I got a very nice compliment from a co-worker today.  I walked in to my office, and my co-worker, who usually starts in with things to do before I even get my coat off (note to reader: NOT the way I like to start my day), says, “Hey, I don’t want you to get a big head or anything…” I was wondering where this was going.  She continued: “…but you really look like you’re losing weight. I can see it in your face, and your head is getting smaller.  You had a big ol’ fat head.”  Just take a moment and bask in the glow of that statement.

I have lost weight. My head is getting smaller.  I can feel my waistline shrinking.  My unused belt loops are seeing some action, which is fun for them.  I really need to be careful about doing so much eating out.  Not sure if I told you all, but I bought a diabetic cookbook at Barnes & Noble.  I’ve made two dishes from it and LOVE them!  Last night (and tonight) I had Chicken and Spinach Avocado Lime Salad.  Homemade dressing that is FANTASTIC…I can’t wait to have more for lunch.  Red, orange and yellow mini peppers, thinly sliced red onion, tomato…it is SO good.  Perhaps I’ll post that recipe, giving full credit to the publishers of course.

Time for bed.  I have an interview tomorrow for a promotion.  Not sure how good my prospects are, but I am cautiously hopeful.  If I don’t get it, I am not going to let disappointment drive me to the buffet table. I am gainfully employed, I have a great family, people who love me, and it’s time to make changes.  Those changes have to last for the rest of my life, regardless of what life throws at me.

Bring it on.

I’d Count Sheep, But I Can’t Breathe

Well.  I feel like it’s been a while!  I’m not sure if I warned you, but I have no concept of time, specifically days of the week.  I am rarely late, because I was in the military for almost ten years, and as the saying goes, “If you’re not 15 minutes early, you’re late.”  That being said, I may have forgotten to pick my niece up last Wednesday because…well, I had no idea it was Wednesday, and I put the reminder in my phone on the wrong Wednesday.  It was a nice night, and she was in good humor about it, so all is well.  I took her sister, my younger niece, to see Star Wars: The Force Awakens yesterday.  She is twelve and she loved it.  We talked about it through dinner, and I was able to relive my childhood a bit as I told her about the first three movies.  1977…seems like a hundred years ago.  But that’s not why I write this blog. Yet.

Star Wars Original poster
As I recall, this was the original movie poster and the cover of the book.

I had my first appointment with the Nurse Practitioner Friday afternoon.  It was a gorgeous day, much like today.  We did things a little backward, scheduling my second appointment with the NP and another with the dietician.  The psychologist and the physical therapist will be contacting me soon to schedule appointments, I was told.  I remember thinking that this was getting real.  As I waited,  I read your blogs to keep my mind clear (thank you!!).  Then I was being called in.  I got on the scale and due to some last minute cheating, I had only lost 6 pounds.  The more I thought about it, that’s two pounds a week, which is good!  But I could have done better.  Who has a problem with that type of thinking?  Speak up and let me know why, would you?Jealousy

The other thing I was thinking was that the NP was kind of cute.  Probably too young, but cute nonetheless.  I don’t ever want to make a play for someone on my team anyway, but it was going through my mind as she fiddled with her hair for an hour and change.  We went over in minute detail my application, which was essentially my health history.  She did say she didn’t think I would have a problem with the surgery and a successful outcome, because I am on the low end of the bell curve.  So…for a fat guy, I guess I am the skinniest. I’ll take it, because it made me feel good.talking-nonsense

We talked about the medications I am taking.  We talked about the need for a sleep study, to which she is referring me.  Apparently the guy will come to my house to do it.  It’s convenient and creepy at the same time.  It makes sense, though.  I don’t sleep well unless I am in my own bed.  I get my best snoring done there, apparently.  I would’t have mentioned the sore throats I wake up with if I hadn’t been told by a house guest somewhat recently that I stopped breathing during the night several times.  And I am an awful sleeper.  The NP told me the C-Pap would make a huge difference in the way I sleep.  My question was once I have the surgery, would the sleep apnea and snoring stop?  She said it likely would, but that there were two types of sleep apnea: obstructive sleep apnea, which according to the Mayo Clinic’s website, happens when the throat muscles simply relax and the added fat on the neck adds weight to the windpipe and suppresses breathing; and central sleep apnea, which is when the brain fails to send the proper signals to the muscles that control breathing.  In the words on my NP, if you’re central, you’ve always been central, and you’ve likely always snored.  But if it’s new, it’s likely obstructive and that can be dealt with.  As a side note, the Mayo Clinic lists a third type of sleep apnea, complex sleep apnea syndrome, which is the fusion of both types of sleep apnea.  It must be super-sized, to be a syndrome. Wow.

sleep-apnea-snoring-350
How do these people sleep with the lights on?

Anyway, we talked about family history.  It was at this point I realized that most of my father’s side of the family is dead, including him.  I have no way to get the information to answer those questions.  It hit me in that moment.  I am still a little adrift over that, but I am an adult man, and I have to be my own anchor, not count on my father’s family to be one for me.

Donkey adrift
*sigh*

We talked about support.  What type of support would I have post-surgically?  Does my PCP support this surgery?  Do I have supportive friends? My mother is willing to stay here for a bit, and be a frequent guest until I am up and running on my own again.  My sister is busy, but she might check in from time to time too.  Maybe a few friends from work would help after work and on weekends.  It almost makes me miss being married.  You know, having somebody there who helps, supports, loves, but is there all the time and doesn’t leave.    My doctor does;t really support having the surgery, probably because I’m on the skinny side of fat.  I’m “only” 100 pounds overly ideal weight.  I carry it pretty well because I’m tall, but it’s all in front.  The down side is that my PCP is also my mother’s PCP.  He is in favor of her getting the surgery, but she won’t.  She’s resigned herself to being a large woman, I think.  My doc is a great guy, he really is, but our paths diverge at this point.  And since I don’t need his blessing for the surgery, I am forging ahead.Hahahaha. Nope
Finally, I’ve only told a few friends about this plan. One, the one I work with, is really supportive.  She’s a little older than my oldest daughter, but we have more of a friendship…I don’t know.  It’s strange.  But she says if I need anything, she’ll be here, even though she has a husband and two young children.  But I have this other friend who really pissed me off this weekend.  I hadn’t spoken to her for 15 years.  She suddenly reappeared up here in New England after many years down south, and wants to resume a more active friendship, which is fine.  She’s had a couple small strokes over the last three or four years, but is still okay.  Her memory is just a little off.  She asked me to explain to her why I was getting the surgery.  I told her I had heath issues, and I needed help getting this weight off, and frankly the fear of dumping and/or death is a good motivator to keep the weight off.She jumped in and started challenging my decision to do this, asking me why in the world I wanted to undertake something so severe.  I got upset. I told her it was because I am fat, I am unhealthy, and I am close to being a 50 year old man who makes his own damned decisions and doesn’t have to  answer to anybody – ever. I said it in a tone that left no doubt I was pissed off and ready to go toe to toe.  She backed off (and spent the next twenty minutes apologizing needlessly) and the conversation went on, but I will not forget that any time soon.  I do not need people in my life that are less than 100% supportive of my decisions.  I don’t need brown nosing yes men, but I will no longer defend myself to someone else.  Whether I’m right or wrong, stand by me, offer me counsel if you must, but I will be making the decisions.decisiveness

Meet The Clinic

Thanks to those of you who stopped by to say help after my first post.  I appreciate it, and appreciate the opportunity to expand my blogosphere horizons.

I promised I would talk about how I came to the weight loss clinic I did. It was funny, in this day and age, that it was a highway billboard in New Hampshire that led me to the Portsmouth Hospital Weight Loss Clinic (http://portsmouthhospital.com/service/surgical-weight-loss-services).  I drive past it occasionally heading north, and finally decided to do something more than look at the big picture (pun absolutely intended).  I went online to do some research (I had already done the research about the type of surgery that fit my goals, so this was just to see what they had to say for themselves), and while I was there I registered for a free information session.  My mind immediately took me to when I was a kid, and my father, always on the lookout for free stuff or a good deal, would drag my mother, sister and me to these seemingly all-day timeshare sales pitches where you registered and got a free gift. Except the free gift at the weight loss clinic a) isn’t free, and b) isn’t a week at a timeshare in the White Mountains in the summer. It’s not even a toaster.  It’s the opportunity to change your life using surgery as a “nudge” in the right direction.

As I sat down in the front of the conference room, I made a great show of reading through the handouts, which included the PowerPoint, the application for surgery, and other facts and requirements.  I was really thinking, “Please don’t let me be the fattest one here tonight.”  I didn’t dare turn around.  The session was informative.  One of the surgeons spoke, the nurse practitioner spoke, the staff psychologist spoke, but the best part was when two former patients came up to talk and answer questions.  One, who now works there, even brought pictures of herself at her biggest.  She weight somewhere close to 425 pounds when the pictures were taken, and here she was looking all “normal.”

When it came time to go, I got my first look at the crowd of people being me. It turns out I was the thinnest one in the whole room!  Did I feel better?  No!  I still felt like Fat Bastard from the Auston Powers movies.  I felt like they were looking at me thinking, “Hey slim, why don;t you make way for those of us that really need this.”  In my shame I left, but with a determination I’d not felt before.  I knew I had to lose 10%  of the difference between my body weight and my medically ideal weight, which was 10 or 11 pounds, to even be considered.  But I had to go get my official weigh in at the clinic itself, bring the app, and call the insurance company to determine coverage.  The hardest part was the damned instance company, but I got there.  Fortunately I have a background in Human Resources and benefits administration specifically, so I was ahead of the game.  Let me just say this: if you are considering this surgery and have to have that conversation with the insurance company, have a pen and a piece of paper handy, and know what to ask.  If you need or want to, reach out to me.  I’ll let you know.  Be familiar with how your insurance works too.  That could save you lots of money, or at least help you plan.  I really recommend the full amount of Flexible Spending allowance on an FSA card if it’s available to you at work.  No sense in being silly about it.

I ran over to the clinic on a Friday afternoon on my lunch break, which was really convenient.  THat’s the thing about my insurance, by the way, and maybe yours too.  Not a whole lot is convenient for the patient.  If I want to only pay 10% in-network co-pay, I have to have my surgery an hour away from home, and get all my pre- and pot-surgical support there as well.  That means taking at least an afternoon off from work and driving an hour one way.  I elected to stay close, have support handy when I needed it, and only need to take a lunch hour.  I mean I t’s not like I’m going to be able to really eat much more than sit for six weeks anyway. (It’s not that bad – it’s a gradual progression in the volume).  The staff was great – very friendly and accommodating.  I had a nice chat with the Nurse Practitioner while we were getting set up to get weighed. She asked me questions, and it wasn’t an interview or interrogation; it was a conversation and a dialogue,  very comfortable and comforting.

I weighed in at 291 pounds, which was “better” than I thought.  There was no shame, just a “Let’s go schedule your appointment with the nutritionist.”  Gladly.  Made it back to work with a few minutes to spare.  Right on.Dead Sexy