My relationship with food changes forever and other misc thoughts…

So a departure from the nuts and bolts of the procedure and more on how things are changing in me.

Though briefly; I do eat small 2-6 oz portions even on this liquid diet.  I don’t feel hungry that often and I’m often not sure if its a real hunger feeling or my mental interpretation of hunger whenever I feel a twinge in the stomach.  But I really don’t ever feel ravenous.  Even psychologically I’ve come to grips with the changes I’ve started.  I’ve surprised myself by how little I miss my diet sodas (the one item I feared giving up).

Now, I take full responsibility for the mess I was in at the beginning of this adventure.  I was a willing participant (and often a cheer leader) in “Food America”, fast food heavily in my younger days and card carrying member of the “Food Network Nation” and other shows that glorify the big portions, hefty ingredients “The nothing wrong with Bacon Fat Mantra”, etc.   My philosophical dilemma is that I know I can’t eat like I used to, as we learned even Paula Deen, queen of butterfat couldn’t keep doing her old ways forever.  But neither do I want to be a “reformed” eater and chastise non-belieivers for their evil ways, or support Mayor Bloomberg of New York and outlaw things that some “board” deems bad for you.  Because the reality is we can get fat on most everything and outlawing “big sodas”  is only an attack on a symptom not the cause.   So where does this leave me, surprising, or perhaps not so surprisingly back to “Everything in Moderation”.  And my future Culinary efforts…also obvious in a bit of hindsight (thought of this a couple of days ago) its time to learn the secrets of Tapas (spanish style small plates!).

Today is July 30th, I hit a set of numbers I haven’t seen in years, and am now down 25 pounds!!!   People have begin to notice (yeah its a bit shallow but it does feel good) , all in all a great day.  Tomorrow is my two week checkup since surgery…

The Big Day.

So I know I haven’t posted since post-surgery, a few things got in my way philosophically.

First the good news with pre and post surgery loss, I’m down 20 lbs and in a set of numbers I haven’t seen in a while.

Surgery itself was not a big deal, I wasn’t nervous and after all those days of clear liquids it was like, yeah get it over so I can have something a bit more substantial (and just a bit).  

My doctor (Dr. Matthew Metz a great guy) and the anesthesiologist checked in to let me know what happening.  About 15 minutes later they wheeled me into Operating room 8 and I was being told about an IV  before the gas.  Next I remember I’m waking up in the recovery room and trying to sit up (my back was sore and for some reason trying to remove the oxygen thing in my nose.  My chest hurt. But they had me take some deep breaths, soon the chest pain subsided, I calmed down, and relaxed.  But not too long as I really had to pee.  So I took care of that and I actually weathered everything quite well.  I sat up on  the side of the bed for a bit and nothing was  that painful.  I finally got up to my room and they hooked me up to the pain pump. While I had an 8 minute timer between doses  I typically went 10-15 in the beginning and 30 minutes or so later on.  I was high in my blood sugar (IV Dextrose) and had been off the Metaformin for two weeks they gave me some insulin in the IV as well as potassium which I was low on.  

Beth-ann, Kira and Alec visited, and brought me a little gift a red windup Dr. Who Dalek, which was pretty fun and something to add to my collection of sci-fi Tchotchkes.  I was sitting in a chair and even took a spin around the hallway the first day.    So here I thank my parents for good genes, I was off Vicodin since last Thursday, haven’t felt sore in the one set of stitched Dr. Metz told me I was going to feel sore  for a while.  Everything is healing and I’m back to work.   I went home wednesday night!

When I got home I admit I had had my fill of 5 days of “clear” liquids and made a bariatric protein chocolate pudding mix I had (remembering to stock up on stuff before surgery).    I don’t feel hungry often the choices are kind of monotonous, my biggest tread  is that Beth-ann found out that 7-11 now has  sugar free Slurpees!   I started going back to work on Monday of this week (not my regular long hours but enough to be productive, 6 hours on Monday and 8 hours today.   So its been a week and for good or bad I’ve altered my life forever.  Next post thoughts on food.

The Big Day.

So I know I haven’t posted since post-surgery, a few things got in my way philosophically.

First the good news with pre and post surgery loss, I’m down 20 lbs and in a set of numbers I haven’t seen in a while.

Surgery itself was not a big deal, I wasn’t nervous and after all those days of clear liquids it was like, yeah get it over so I can have something a bit more substantial (and just a bit).  

My doctor (Dr. Matthew Metz a great guy) and the anesthesiologist checked in to let me know what happening.  About 15 minutes later they wheeled me into Operating room 8 and I was being told about an IV  before the gas.  Next I remember I’m waking up in the recovery room and trying to sit up (my back was sore and for some reason trying to remove the oxygen thing in my nose.  My chest hurt. But they had me take some deep breaths, soon the chest pain subsided, I calmed down, and relaxed.  But not too long as I really had to pee.  So I took care of that and I actually weathered everything quite well.  I sat up on  the side of the bed for a bit and nothing was  that painful.  I finally got up to my room and they hooked me up to the pain pump. While I had an 8 minute timer between doses  I typically went 10-15 in the beginning and 30 minutes or so later on.  I was high in my blood sugar (IV Dextrose) and had been off the Metaformin for two weeks they gave me some insulin in the IV as well as potassium which I was low on.  

Beth-ann, Kira and Alec visited, and brought me a little gift a red windup Dr. Who Dalek, which was pretty fun and something to add to my collection of sci-fi Tchotchkes.  I was sitting in a chair and even took a spin around the hallway the first day.    So here I thank my parents for good genes, I was off Vicodin since last Thursday, haven’t felt sore in the one set of stitched Dr. Metz told me I was going to feel sore  for a while.  Everything is healing and I’m back to work.   I went home wednesday night!

When I got home I admit I had had my fill of 5 days of “clear” liquids and made a bariatric protein chocolate pudding mix I had (remembering to stock up on stuff before surgery).    I don’t feel hungry often the choices are kind of monotonous, my biggest tread  is that Beth-ann found out that 7-11 now has  sugar free Slurpees!   I started going back to work on Monday of this week (not my regular long hours but enough to be productive, 6 hours on Monday and 8 hours today.   So its been a week and for good or bad I’ve altered my life forever.  Next post thoughts on food.

The Devil in the Details…and its becoming real.

So up to the pre-op exam or so the surgery was kind of not reality to me yet, while I did soul searching and made some objective decision before, it was kind of a mental exercise.

Now with two weeks until the big date, it was starting to feel pretty real.   I admit I started getting a bit of desire for “last hurrah’s”  while I didn’t totally pig-out I did find myself eating foods I think I would not be able to eat or not eat in the same way in the future.  So a steak dinner one night, some odd stuff like good fries and other carbs that I know I had to limit.  Visited a few favorite restaurants etc.  While due to my high-blood sugar  I have been avoiding sweets for the most part, I had an urge for ice cream and chocolate brownies.

One of the parts that surprised me as I originally planned on a “last meal” the weekend before.  But then I learned that to help the surgery go smoother they try and reduce the size of the liver (which lies over the stomach).  So 3 days before surgery all I can have is a “clear” liquid diet.  So I get water, sugar free drinks like crystal light, or sugar free juice, gelatin, sugar-free Popsicles, and broth (Yummy sounding isn’t it.).  Now this is the start, after surgery my stomach has to heal and I need to carefully determine what my stomach can handle.  So the first week after surgery I get a “full” liquid diet (nothing with chunks) so basically anything that can be blended or pureed.  But I need to get my protein, so protein powder is my friend.  I can have smoothies, protein shakes (no ice cream), soup/creamed soup (but nothing with chunks of anything, they have to be strained or blended).  So I get this for the first 2 weeks.  Week 3  I get the soft diet, so things like ground meats, canned tuna, ricotta cheese, scrambled eggs, peanut butter, tofu, canned fruit, milk, some soft cooked veggies, and cooked cereals, mushy mashed potatoes.

Ah and the other fun trick no beverages during a meal with solid food, meal first then wait about 30 minutes before drinking (if it isn’t a protein shake or similar).

5 weeks after surgery its my “regular” diet.  I can introduce foods as I see fit, but making sure I get 60-80 grams of protein per day first.  Also I need to start up my exercise.

Everyone is different and it will be 1-2 weeks before a regular work schedule, and can’t lift more than 10 pounds.  I will have a few small holes in me from the surgery, with one slightly larger one where they remove the stomach that was cut off.  That one will hurt I’m told as the stitches go though some muscle area. I will spend a day and 1/.2 in the hospital.

So I’m now on day 2 of my 3 day clear liquids and I’m doing ok.  I’m surprised there haven’t really been any second  thoughts about going through with this procedure, but I really want it to be successful, and the gains outset the no where near as important loss of some foods.

I will actually have some weight loss on this pre-op diet, I started on Saturday morning at 273 pounds or so.  I was down 5 pounds this morning (yes I know its probably mostly fluid loss). Though I’m wondering if the other reason for this clear liquid thing is that your thrilled to get the pureed stuff after surgery!

So 1 more day and then its Surgery.  So probably will not update until post-surgery and I return home on the 18th.

 

 

Choosing and the first step at the Doctor’s

After reading several things online, and weighing the pros-and cons I started leaning towards the vertical sleeve instead of the lap band.  But the first step was I had to go through a 2-3 hour consultation, at the doctor’s office.   This is a meeting with the bariatric surgeon, a nutritionist, and a counselor,  to be sure I’m a good candidate for the procedure, understand what I’m signing up for, verify I can physically and mentally handle the procedure and all the requirements afterwards.  Bariatric surgery is only a tool, its not a short cut to getting thin.  There is a lot I’m going to have to give up food-wise, due to the smaller portions (an average meal will be 1/2 cup to 3/4 cup of food),  its a high-protein diet with carbs that can be consumed after getting in the protein requirements in for a day.  Since the stomach is smaller and process food faster, you have to carefully test foods that will work and not work for you.   Alcohol is out for a year. Due to the ability to expand your stomach from the gas etc, Soda is also out.  This was one of the toughest for me, as it has been joked about, sell your Coca-Cola stock since it will go down after I stop consuming Diet Coke and Coke Zero.  Refined carbs  tend to be out.  Sugar etc.  (really components though of a healthy diet).  Certain fibrous foods like raw veggies, corn, etc take a while before you can eat them and lots of patients find there a foods they can’t tolerate.  You have to learn to chew real well (if your not that type now) as you need to give your stomach some help since it can’t process food as well as before.

So I go through all of this and make the decision to go ahead with the surgery.  I do settle on the Vertical Sleeve procedure, I felt that doing the lap-band was mentally a lack of commitment, that I needed to be full-in so to speak and that this had to be done for the rest of my life or I could easily return to the bad habits of old (thanks to Beth-ann my spouse for helping me see this in myself).   But my weight loss while high I felt wasn’t in need of the more drastic Gastric Bypass, it was the one most recommended to me by my doctor.

The first surgery date for me is July 17th, there are steps in between, I need some blood tests, cardiac clearance (to be sure I’ll be OK for a surgical procedure).  There is a class about the procedure and the nutritional requirements.  Here is where I get a bit of surprise due to a “blip” on my EKG I have to go for a full stress tests in order to get Cardiac clearance.  So I get to go to the cardiology center and get injected with some Nuclear Isotopes so they can track the blood flow.  Though I’m a  bit worried here as this is a chicken and egg thing my heart has developed an extra thickness from the high blood pressure (and having to work harder) now helping this condition is a big reason I need to get the weight off, but if its bad enough I might not be a good for surgery.  Fortunately there are no blockages, and I get the OK to go through the procedure.

July  3rd  I go for the pre-op exam/consult.  Everything is in order and I learn about the all that I have to go through pre and post surgery.

 

So what’s this surgery I’m doing….

As I said in my first intro I originally was interested in the lap band procedure.  So to clarify things let me explain the three types of bariatric surgery, that are commonly performed in the US.  They are Gastric Bypass, Vertical Sleeve, and Lap Band.

The Lap Band, is a device that goes around the stomach, and creates a small pouch so there is less food that can be consumed at any given time.  The stomach or digestive systems  itself is not surgically altered.   To create the optimal size pouch , the lap band is filled with a saline solution that can be added to our removed to tighten or loosen the device.  A small port for injecting or removing the saline is attached to the abdominal wall.  The attractiveness of this procedure to me was there was nothing permanent and theoretically at some point you could deflate the device or remove once I was successful (perhaps some wishful thinking).  The negatives are it is a foreign device in your body, and some studies have shown that it can slip or have other issues.  Also its provides the least amount of weight loss (about 50% of your required loss after a year), and for reasons I”ll explain later may not reduce hunger needed to live on the 600 to 1000 calorie diet most bariatric patients consume.  The oldest bariatric procedure is the Gastric Bypass.  This procedure the stomach is altered to create a small pouch also at the same time part of the intestine is re-routed to there is a shorter path after food is eaten.  Gastric bypass has the highest weight loss (about 85% of weight loss after one year) part of the reason for this is that that the procedure adds a Mal-absorptive component.   This means part of the weight loss happens because that digestive system can’t absorb all the calories and fats etc.  This is one of the negatives as their could be issues with absorption of medicines etc. Also Gastric Bypass patients might suffer from “dumping” which is where undigested material can get caught in the intestines causing significant pain.  The third procedure is relatively new, its call the Vertical Sleeve.  The stomach is turned into a thin tube but the intestines and all the connections are left alone.  About 80% of the stomach is removed.  In both the Gastric Bypass and Vertical Sleeve, the portion of the stomach the produces the hormone Ghrelin is removed.  This is the hormone that is in part responsible of feelings of hunger happen.  In fact in the beginning until patients learn all the signs, meals can be skipped if not careful since one is not feeling hungry.   The Vertical sleeve falls in between the lap band and the Gastric Bypass in weight loss rate.  All bariatric surgery patients need to consume, B vitamins, Calcium Supplement(Vitamin D), and a Mufti-Vitamins, as though they were medicines regularly each day. Lots of other dietary restrictions more on these in a later post.

The start of a big decision

So this blog is about my journey into getting thinner. I’m in my 50’s over 125 pounds overweight a BMI ( fat %) of about 45. I have high blood pressure, high cholesterol, and on the edge of type 2 diabetes. I get winded easily, and while fortunately I don’t have any blockage in my heart and arteries my heart is enlarged and under performing due to high blood pressure. I know I need to do something, I’ve dieted before. And have been both successful and unsuccessful. My best success was when I was about 1/2 my current age and joined Weight Watchers and reached my goal weight, back then I needed to lose the awful amount of about 45 pounds, I wish that was all I needed to lose today. But I got remarried two years ago and I want to be around in good health to enjoy this relationship. I also have two great kids and two great step kids who I want to help them head into adulthood ( they’re all in high school or college now). I have had a lot of starts and stops as I get older and the high weight is hurting my knees making it harder to exercise. I also plateau easier on a diet now that I’m older.

I had to get an x- ray after having had a fall. It was at a clinic by a hospital and I saw a sign for a seminar regarding bariatric surgery. I kind of scoff since first I didn’t think I needed that, and I’m not a big hospital fan and have been lucky enough that the worse thing I’ve had done to me is removing my wisdom teeth. But a few months later I switch jobs and reviewing the new health plan materials I noticed that bariatric surgery is covered! I think about that and remember the sign.
I decide to check out the seminar at the hospital. I surprise myself by considering that this may be the thing for me. At first I wanted the lap band, the procedure is outpatient laparoscopic and nothing is permanent I say to myself. So I go home to think about it.

To be continued