Monthly Archives: January 2013

Sisters Weekend and the New and Semi-Improved Me

My baby sister Jenny lives in Minnesota.  Well, this weekend, she was in Pittsburgh visiting my mother.  My other sister Sandy lives not far from me.  We carpooled up to PA to visit with my mom and our baby sister.  None of us have seen Jen since her wedding, (see previously posted pic of us at her wedding).

We were all very excited to get together and have all the girls together again.  I wanted to get my hair done before going to town.  Jen is a hairstylist.  I did not want to go to see her with that mess of a hairdo I have been sporting since the surgery.

Photo on 2013-01-21 at 21.09

She called me before the trip and told me she was bringing hair cutting supplies with her and she wanted to celebrate my 73 pound weight loss with a new hairstyle.  She also planned to stop by a beauty supply store and pick up some professional hair coloring to cover up my gray hair.  She also wanted to do Sandy’s hair.  Neither one of us are fashionistas like Jen, so we really appreciate her bringing us up to speed.

In addition to being a hairstylist, Jen has her certification as a Master Colorist.  Impressive.  As a funny aside, the day she received her certificate, she was so excited.  When I found out I called and left her this voicemail message:

“Jen, I have a serious problem and I need the help of a professional.  What two colors do I mix together to make purple?”

Yeah, I was teasing her, but that’s my job as a big sister.  We older siblings reserve the right to torture our younger siblings for being the youngest and getting all the things we were not allowed to have like their own room with a phone and lax rules for staying out on weekends.  Granted, the rest of us had moved out by the time she was a teenager, but that’s no excuse.  But I digress.

Nonetheless, Jen did not miss a beat and came back with, “You have a pen handy?  Write this down.  Red and blue make purple, crazy girl!”

In addition to getting my hair done, she and my mom wanted to take me clothes shopping for new pants since all of my pants either do not fit me at all or are starting to feel a little big, even the new jeans I bought in December.

We went to the mall on Saturday and checked out many stores.  We walked so much, we wore my mother out, which takes a lot.  We were all kind of tired except for Jen who can keep going forever, I think.  I went to many normal clothes stores with them.  Of course, there was nothing for me.  I did see a lot of clothes that I can wear after I lose a lot more weight, but nothing that I can wear now.

So, then we went to Kohls and Target on Sunday to try to find pants for me.  I do not know why we did not hit Lane Bryant or The Avenue while we were at the mall, but we did not.  I also did not want to spend a lot for pants since I will be losing more weight over the next few months.

We went to Kohls first and we could not find the plus sizes anywhere.  We finally found the section upstairs way in the back.  One or two walls filled with the ugliest clothes I have ever seen.  The only “activewear” pants they had were made from velour.  Not happening.  We were hoping to get some more yoga pants.  So, we left there and went to Target.  Again, very difficult to find the plus sizes.  Then one tiny corner of semi-OK clothes.  I did get a pair of cute purple pants, size 22!  And one pair of yoga pants in a 1x.

In December, my new jeans were a size 24.  The purple pants fit me perfectly.  The yoga pants fit me perfectly in a 1x as well.  For those of you who do not know, a size 22 is the equivalent of a 2x.  A size 1x is about an 18/20.  I am still wearing a 22-24 in tops.  I also got a light spring jacket, which my Jen insisted that I had to have since my purple jacket and winter coat are way to big for me.  The jacket is a little small, but it will fit me in a month.

As we were walking away from the plus section in Target, Jen said to me, “No offense, Colleen, but the clothes for plus sizes suck!  You get the teeniest section with the worst looking clothes.  Geeze even fat girls want to have cute clothes!”

I responded with, “Don’t I know it!  Welcome to my world!”

She went on with to say that somebody should do something about that.  I told her to let me know when she gets that fixed.  And while you’re at it, please let the clothes makers know that not all fat girls are nine feet tall.  Even the petites go down over my shoes much of the time.

My mom treated me to new pants and Jen did my hair.  I think she did a great job on my hair.  I was not in Pittsburgh for very long, but I sure had a great time!  Please enjoy the before and after pictures of me and Sandy.

I love my new hair!  It is a little Marlo Thomas-esque, but very cute.  Sandy went from gray to platinum blonde.  A true Targaryan if I ever saw one!

Me and Jen BEFORE

Me and Jen BEFORE

 

Me and Jen AFTER

Me and Jen AFTER

Sandy and Jen BEFORE

Sandy and Jen BEFORE

Sandy and Jen AFTER

Sandy and Jen AFTER

Colleen Jen and Sandy looking good!

Colleen Jen and Sandy looking good!

Advertisements

Fatty Fatty Two-by-Four

Do not like fat people?  Think they are ruining the health of this country?  Bully them!  So says prominent bioethicist Daniel Callahan.

OK, to be fair, he does not use the word bully, but I see little difference between what he is recommending and bullying.  He calls it “stigmatization.”  He tries to compare it to the successful stigmatization campaign against smokers to reduce smoking in this country.  He justifies his theory thusly:

It will be imperative, first, to persuade them that they ought to want a good diet and exercise for themselves and for their neighbor and, second, that excessive weight and outright obesity are not socially acceptable any longer. 

Really?  Excessive weight and obesity are not socially acceptable any longer?  When, pray tell, was being fat ever acceptable?  I would like to know when he thinks that is.  I have been battling poor self-image all of my life because even when I was thin, everyone told me I was fat.  I have faced social ostracization,  mean comments uttered both aloud and muttered so that just I could hear them, and mockery because of my weight.  I have been held back professionally because of my weight and my weight also affected my dating life.

So, when exactly, does he think it became cool to be fat?

Here are some of his suggestions for bringing social pressure to bear on fat or on their way to being fat people:

I do not know what is scarier, the fact that he is promoting bullying as a useful tactic in the fight against obesity or that he thinks that overweight people do not know what so-called thin people think of us.  Yes, I stand by my term bullying because that is exactly what this kind of social pressure is.

The worst part of all of this?  Mr. Callahan makes many other astute and valid points in his thesis.  He talks about bringing government pressure to bear on the food industry, taxing high caloric, high fat food, changing school lunches, finding ways to address childhood obesity.  All excellent ideas.  But those ideas are completely overshadowed by his promoting negative social pressure.

He spent a lot of time comparing fat shaming to smoking shaming.  He also tried to address what he views as the reasons other people do not think fat shaming will work.

Why is obesity said to be different from smoking? Three reasons are common: it is wrong to stigmatize people because of their health conditions; wrong to think it will work well, or at all, with obesity; and counterproductive with the obese because of evidence that it worsens rather than improves their condition. Ethically speaking, the social pressures on smokers focused on their behavior, not on them as persons. Stigmatizing the obese, by contrast, goes after their character and selfhood, it is said, not just their behavior. Stigmatization in their case also leads demonstrably to outright discrimination, in health care, education, and the job market more generally. The obese are said to be lazy, self-indulgent, lacking in discipline, awkward, unattractive, weak-willed and sloppy, insecure and shapeless, to mention only a few of the negative judgments among doctors and nurses.

These are the wrong reasons.  I am not saying that he does not have a point with some of these reasons, but he is missing the bigger point.

The differences between smoking and eating are this.   One, we need to eat to live.  People need to consume calories, protein, vitamin rich food every day or we starve.  We do not need to smoke to live.  Two, smoking affects the health of the larger community through second-hand smoke.  Obesity generally only affects the health of the obese person unless that person is pregnant or may become pregnant.  Also, there is no evidence that social shaming and ostracization keeps people from gaining weight or makes fat people lose weight.  It only makes them feel bad about themselves and encourages fat discrimination.

Finally, we will never really find a way to combat obesity in this country as long as many people live in poverty, lack access to healthy food, and lack access to health care.  Also, as long as losing weight is seen as part of the “diet industry” and a way for business to make money off of people who want nothing more than to be healthy we will not adequately be able to address the obesity problem.  People need real knowledge on how to become and stay healthy.

I have no problem with some amount of social pressure to encourage people to be healthier.  I just think that the pressure needs to be positive and encouraging not shaming and negative.  I think most people want to be healthy.  Most every woman I have ever met has dieted or tried to change their diet to lose weight and improve their health.

I imagine that on many issues concerning obesity, Mr. Callahan and I are much closer together than we are apart.  I just cannot agree with his fat-bullying campaign.

What we do not want to do is create a world where it is OK to harass fat people and create such stress that it drives many people into eating disorders to live up to negative social pressure to meet seemingly untenable goals set by people who do not have their best interest at heart.

Wait…what?

Are You Dating A Fat Chick?

So, I saw this interesting article on Yahoo today about mixed-weight couples.  Obviously, I had to check it out because it is a subject with which I have some experience, but more on that later.

One of the assertions put forth in this study was that when there is a relationship between a thinner male and an overweight female, there are more relationship problems than with people of similar weights or a thin woman/obese male combo.  Then I read this sentence in the Yahoo article and I nearly lost my mind.

“The overweight partner might feel insecure, judged, and angry, which could ultimately contribute to a power battle around food and eating in the relationship,” the researchers wrote. 

So, you’re saying that if there is conflict over dining together or relationship stress, it’s because the overweight woman feels insecure and judged?  I was like, wtf?  It certainly could not be because maybe he’s an ass and makes her feel bad for being overweight to make himself feel superior, could it?  I was ready to hop on here and rail against this study.  Then I decided to actually read the abstract on which the Yahoo article was based.

The reason for relationship stress was actually much more nuanced than the Yahoo article implies.  I am going to sum up here.  Basically, they said that if the healthy weight partner was not supportive, there was stress in the relationship.  Overweight women did one of two things.  They either spoke their mind and there was fighting, or they suppressed their feelings and ate more, thus compounding the problem.  On the other hand, if their partner was supportive of healthy choices and was encouraging, there was less conflict in the relationship.

I highly recommend reading the abstract.  They reached some other interesting conclusions, but I will leave that for you to read.

I think it is interesting that they focused on mixed weight couples, but it has been my experience that many men are overly concerned with their partner’s weight regardless of whether that partner is actually fat and regardless of whether they themselves may be carrying a few extra pounds.

When I was in college, I weighed maybe 130-135 at my heaviest.  Granted, I probably could have lost a good 10-15 pounds, but I was not fat.  I was dating a guy who was 6′ and about 200-210.  I wasn’t a stick, but neither was he.  He often talked about my weight or made derogatory comments about it.  More than once, he placed his hand on my abdomen and said, “Shouldn’t you do something about that?”

Meanwhile, I never said anything to him about his weight.  Would he have looked better at 185-190?  Maybe, but I was not concerned.  He apparently thought about my weight and what other people thought about it a lot and often mentioned it.

This is just one example, but I did a quick search of the internet and found the following:

Men’s Health: How to talk to her about her weight

Huffington Post: Half of men say they would leave a partner who gained weight

Science Nordic: Men say women weigh too much

I know that there are also many examples of women who treated men badly because of their weight, the money they make, or any number of things.  Women are not totally blameless in bad relationships.

I just really think that it is important to remember that if there is something you want to change in your partner, like their weight, being supportive and caring goes a lot further than insults and guilt.

I think also, it is important to learn the difference between a little bit of extra weight and being obese.  We have a distorted view of what is considered overweight.  I hate it when I watch commercials and they show a picture of someone who is at least 75 pounds over weight next to some skinny chick and the skinny chick says, “I followed this diet and I lost 30 pounds.”  No, honey, you didn’t.  Not if that picture is actually you.  No wonder women have such a distorted view of what our bodies look like.

I have often thought of putting out a book with pictures of women’s bodies at different heights and weights and including their measurements.  I know that is probably nearly impossible because women come in all shapes and sizes and weight can be carried in many different places on different people.  But I still think it would be important for both men and women to see real difference between 30 pounds of extra weight and 75 or 100.

Nonetheless, in my opinion, if you feel your partner is putting on too much weight and that weight is causing health problems, obviously you should talk to them.  For instance, if they have gained considerable weight, say 15 pounds a year every year you’ve been together, that might be a problem if you’ve been together for 5 or more years.  That can start causing some health problems.  If they are obese or morbidly obese, obviously something should be done.  If you want your relationship to work, approaching the situation from a place of love and concern is the way to go.

I suggest doing the following:

  • Look in the mirror and evaluate your own health.  Do you need to lose some pounds?  Do you have other health concerns you want to address?
  • Talk to your partner about addressing both or your health problems because you want to have a long, healthy life together.
  • Ask your partner what health goals they want to set instead of making it about what you want for them.
  • Suggest that you both develop a health plan together and come up with ideas.
  • Support and encourage each other’s healthy choices.
  • Allow for mistakes or cheat days for each of you because nobody’s perfect.

However, if your partner is only a few pounds more now than when you first started dating and that extra weight is not actually causing them any health problems and they see no reason to address it, you might just need to learn to live with it.

The Dilemmas of Rapid Weight Loss

I do not know if this is a problem that everyone has or if this is specifically my problem, but it is serious.

I am running out of wearable pants.

I know, I know.  I bought two pair of jeans in a smaller size just last month.  Well, guess what?  They are becoming too big.  So, I have one pair of stretch pants that were originally too small, but I have had them for years and they are all stretched to the end of creation, two pairs of jeans that are bigger and bigger every day, and that is it.  I have several pair of shorts that work, but the temperature in DC is in the teens today, so they are not really helping me at all.

I bought a pair of yoga pants yesterday so that I have some exercise clothes.  They are stretchy so I bought them a size smaller since I know am still losing weight.  But that still does not really solve my problem.

I tried to go to my favorite fat chick store yesterday and that location was closed down.  I went to Target thinking I could get some cheap pants, but their collection sucked, except for the yoga pants.  They had one wall of plus size clothes and they were the ugliest clothes I have ever seen.  Well, except for one gorgeous purple cardigan that was more money than I wanted to spend for something I am only going to wear for the next two months and that still did not solve the fact that I have no bleeping pants!

I am going to do some searching online, but if all else fails, I will have to go to the mall.  I hate the mall.  Well, not hate exactly, but  I do not relish it.

There is also the financial impact of having to buy new pants ever month.  Clothes are expensive.  My sister suggested getting pants at the Goodwill for now until I get down to a stable weight. I might just do that.  I hate buying plus sized clothes at second-hand stores.  They do not always have the greatest selection of clothes for larger women.  In addition, I’m short.  It is hard enough finding plus sized clothes for short ladies in a regular store let alone second-hand.

Oh, in other news, I had to replenish my supply of panties.  I am sure everyone was dying to know that, but after losing 71 pounds, it was time.  I made sure to buy a pair smaller than I actually need so they will last me a couple of months before I have to restock again.

I am going to check Kohls and a couple of other places online to see if I can find some pants that see me though one or two more sizes.  If not, I think I will take my sister’s suggestion and try a second-hand store.  I will keep you posted.  Until then, the search for pants continues.

I have some updated photos of myself that I took yesterday.  I added a bunch more on my Facebook page.  Check them out.

Photo on 2013-01-21 at 21.09Photo on 2013-01-21 at 21.12Photo on 2013-01-21 at 21.36 #2

 

 

 

 

President Obama, Martin Luther King, Jr., and My Father

Today we celebrate the second Inauguration of President Barack Obama.  This is a historic day for many reasons.  One because we are celebrating the second Inauguration of our country’s first black president.  Second, we are celebrating it on Martin Luther King Day, who led the civil rights movement that helped make Obama’s rise to the presidency possible.  This is truly a day worth celebrating.  But for me, January 21 will always be my father’s birthday.

My father passed away in October 1996.  Unfortunately, he never lived to see the election nor the re-election of our first black president.  I think he would have liked to see that.

He saw so many amazing historical events in his life.  He was just five years old when WWII ended.  He saw the beginning and end of the Vietnam war.  He saw the election and assassination of JFK.  The Civil Rights movement.  Martin Luther King’s March on Washington.  The resignation of Richard Nixon.  The rise and  fall of the Berlin Wall.  The collapse of the Soviet Union.  And the end of the Cold War.

He also saw the explosion of technology; everything from transistor radios and microwaves to supercomputers and home PCs.  He even had an email address before he died.  He would call me from Pittsburgh to Maryland every single time he sent me an email, but he had an email address nonetheless.

He was married, divorced, and married again.  He owned his own business at one time.  He witnessed the births of his four children and he watched them grow up.

I sometimes think about all that he’s missed since he died.  Monica Lewinsky. Clinton’s impeachment hearings.  September 11. The wars in Iraq and Afghanistan.  The election and re-election of Barack Obama. Laptops.  iPods.  Smart phones. Bloggers.  Facebook. Me and my sisters receiving post-secondary degrees. My sisters’ and my brother’s marriages.  The birth of his granddaughter.

Some of it I’m glad he did not live to see.  Some of it, I know he would not understand.  But when something momentous happens, I wish he were here to celebrate with us.

Happy Birthday, Dad!

dad 3

What Is Gastric By-Pass Surgery Exactly?

So, I have had some questions lately from friends.  Some people have asked me to describe what is involved in a gastric by-pass surgery.  Not what I have to do to get ready, but what the doctor actually does to your insides that helps you eat less and thus lose weight.  I have also had people who are considering different procedures and ask my opinion, because you know, I’m an expert, right?

OK, you can stop laughing now.

But seriously, unless you are researching gastric by-pass surgeries because you want to have one, you may not be aware of what actually happens when the doctor performs the surgery.  I know I was not aware.  And if you are considering the surgery, the best thing to do is to reach out to people who have had one of the procedures and ask questions.  Each procedure is different and each person reacts differently to the results after the surgery.  Oh and yes, there are several different types of gastric surgeries one can consider.

I want to spend some time today discussing some of the different surgeries and the doctor does.  I will also include some YouTube videos and other links that will describe the surgeries better than I can.  This post might be kind of long.

What is Gastric By-Pass Surgery?

Gastric By-pass surgery is when a surgeon somehow creates a much smaller stomach and re-routes your digestive track to that smaller stomach.  This will help an obese overeater eat less and help them lose weight.  There are several ways to achieve this smaller stomach.

The surgery can either be an open surgery or a laparoscopic surgery.   An open surgery is exactly what it sounds like.  This is a traditional surgery where the doctor makes a long incision to operate.  A laparoscopic surgery is when a series of small incisions are made and tiny surgical tools are used to perform the surgery.

The different types of Bariatric surgeries are the Roux-en Y gastric by-pass, the lapband, the gastric sleeve, the lapband and gastric sleeve combo, and the duodenal switch.  The Mayo Clinic has an excellent site with pictures and vivid descriptions of each of these surgeries, but I will give a brief description here.

Roux-en Y Gastric By-Pass

This is the surgery where a small pouch is made and the rest of the stomach is cut off and then the intestines are rerouted to the small pouch.  An alternate version of this is to staple the larger stomach off from the pouch.  This is the surgery that I had.

bariatric-surgery-4-162-2col

This YouTube video further describes the procedure if you’re interested.  It is not graphic and does not show a live surgery, but uses pictures to show what he doctor does.  I could not watch videos of live surgeries.   Too gross for me.

The Lapband

The lapband is when a small band is used to create the small pouch instead of stapling.  Sometimes the larger part of the stomach is reduced to create a gastric sleeve.  There are a couple of different bands.  One is a metal band that stays in your stomach.  The other is an adjustable band that occasionally needs to be filled back up with fluid to keep it firmly tight around the pouch.

bariatric-surgery-2-162-2col

Gastric Sleeve

A gastric sleeve is when part of the stomach is removed to create a smaller narrow sleeve type stomach.  This can be done on its own or in combination with the lapband.

sleeve-gastrectomy-2col

Duodenal Switch

This is the most drastic surgery.  Usually, the stomach is left in tact or this procedure can be done in combination with gastric sleeve and the digestive tract is rerouted to by-pass most of the intestines.  This is very drastic.

I am not very good at describing this surgery, so I am going to refer you to the YouTube video and the link I provided above.  This was not a surgery that I wanted to have.  Too drastic for me.

These are the primary procedures.  Each surgeon has their own speciality.  You will need to work with your surgeon to decide which procedure is best for you.

Advice

As far as my advice, I am happy to listen to anyone who wants to ask questions.  I will happily answer them.  If you have decided you definitely want one of these procedures, great.  I have all kinds of advice and ideas.

If you are on the fence, my advice is to think about this some more.  Go back to the drawing board.  Talk to your doctor.  Join a gym, try a new diet plan.  Buddy-up with a friend.  Seek counseling.  Join a support group.  Try to lose weight the traditional way through diet and exercise.  Do not rush into a procedure because you feel helpless.

If after you feel you have tried everything and you feel surgery is your best option, go for it.  Just remember, the surgery is a tool, not necessarily the answer.  You will still have all of the problems you had before the surgery.  The desire to eat or overeat is still there.  Any depression or self-doubt persists.  Laziness is still a problem.  So, unless you are willing make those changes as well, the surgery will just be one more, albeit very expensive and drastic, short-term fix.

Don’t get me wrong, I have no regrets.  I learned a lot about myself and my health, both physically and mentally, through this process.  I am glad I did it.  I could not, however, have done this before I was ready.

Approaching Three Months

I can hardly believe that it has been nearly three months since my gastric by-pass surgery.  To date, I have lost 69 pounds.  One pound away from 70.

I am amazed by how much weight I’ve lost.  I feel a little like I’m moving backwards in time as I am able to fit back into clothes that I have not worn in years.  It is kind of strange.

I am slowly working my way up to about 1200-1400 calories per day.  I am supposed to be in that range at about the six month mark.  Right now, I am up to around 900 calories per day.  I have a calorie tracker.  I put in all of the food I eat including my protein shakes.   I noticed this week I have been a little bit hungrier than normal…well normal being redefined in recent months as not really hungry at all.  That is probably why I’m up to 900 calories per day.  I thought that by increasing my caloric intake from 400-600 calories per day over the first few weeks to 600-800 after that and now to 900 would have slowed down my weight-loss, but that has not happened.  I am still steadily losing weight.  I am still taking in well under the normal, healthy intake of calories, which is around 1200-1400 per day.  Not to mention that 1200-1400 calories per day is waaaay less than what I was eating before the surgery.

The calorie counter that I have on my iphone tells me that for healthy weight-loss that I should be taking in over 1700 calories per day.  Yeah right.  There’s no way I could eat that right now.  I may never be able to eat that many calories in one day again.  Of course, the calorie counter has no idea I had gastric by-pass surgery.  I am just using it to keep track of what I am eating and to count the calories that I am taking in.

I have moved onto the re-introduction of solid foods phase of my diet. Hoo-freaking-ray!  The pureed food phase was really horrible. The soft food phase much better, but still not quite fine eating.  Real food.  I am excited.

I still have some restrictions.  No read meat, starchy foods, or fruits with a skin for three more months.  I can have fruits with a skin, I just have to peel them first.  It’s the skin I cannot have.

I am not a big red meat eater, so I am not too stressed out about not having beef.  I can manage just fine with turkey burgers or turkey meatballs, etc.  But the starches…omg.  I have been craving bread and potatoes for the past couple of weeks.  Well, bread, potatoes, and pizza.

I love pizza.  I could probably eat it for every meal. Not the healthiest diet I know, but I could…thus the reason I had to have gastric by-pass surgery.  It doesn’t help that I haven’t been able to eat pizza for years.  In fact, that has probably made it worse.  Combined with the no bread for six months surgery I just had, I’m totally fixated.

I have dreams that when I am finally able to eat bread products that I will be able to reintroduce pizza into my diet.  I doubt that I will be able to, but still, I dream about it.  I would be fine with vegetables on it.  A thin crust, obviously.  Just one slice, I promise!

A good friend of mine teases me because I’ve apparently taken to talking about pizza quite a bit.  Every time we are together, in fact.  We laugh about it a lot.

Now that I am onto the solid food phase, I have been experimenting a little bit.  I’ve eaten at a few restaurants too.  I went to a mediterranean restaurant.  I had half a lamb burger and asparagus spears instead of fries.  The burger was a bit heavy and I had some constipation afterwards.  I may hold off on lamb for a few more months.  A little too rich, I think.  I went to a mexican restaurant and had chicken with a tomatillo sauce, refried beans, and steamed vegetables.  Clearly, I took most of it home, but I didn’t suffer any ill effects.  I’ve also tried chinese food, kung pao chicken, no peanuts, Szechuan green beans, no rice.  I did OK with that.  I’m still only eating a very, very small portion, but it’s nice to have somewhat normal food again.

Anyway, I hope everyone has a wonderful President’s Day weekend.  I might try to go hit some sales to see if I can get a new shelf.  I was also thinking of making my way to downtown DC on the Mall for the Inauguration on Monday, but it depends on the weather.  It’s supposed to be 39 degrees and I’m not sure if I can handle that.  It also depends on what time I drag my lazy butt out of bed.  The swearing-in begins at 11:30am, but one must arrive there several hours in advance.  It’s not supposed to be as crowded as 4 years ago, but I still think it would be cool to go.  We shall see.

Living in the DC area is kind of cool when you can go to events like this.

Happy President’s Day!

 

Scan