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1 Week Post Op, How did I get so fat musings?

30 Dec

Well, I had my first week post op visit, it was pretty uneventful.  I had my staples removed, and the PA put on steri-strips.  Got a prescription for actigall, which I am supposed to start taking one month post op to protect my gallbladder.  Wish he had just pulled the darn thing at the same time 🙂  I only lost 2 lbs according to them, but my my home scale says I lost 6.  I think its somewhere inbetween.  I was wearing jeans and a sweater because I was cold, and that is a lot more than I’ve had on at past weigh ins.  Not exactly the huge amount I would have hoped for for having spent a whole week on clear liquids consuming less than 250 calories a day.  Hmm.  But I know it will start coming off.

So how am I feeling?  Pretty good!  I’m off the heavy duty pain meds, as of yesterday.  I still have twinges and pulls in my incisions, particularly when getting up, but I am walking about 5k steps a day so that is probably ok.  I need to gradually start increasing the walking.  I have not experienced any nausea or acid issues or vomiting or any of that stuff <knock wood>  I have had some things that kind of didn’t like going down, but the feeling passed quickly.  I do have a headache this afternoon, but all in all, not bad.  I miss my friend Advil, because that works so much better for me than Tylenol.  Boo.  My incisions all look good.  One was getting irritated, the top middle one, from my bra rubbing against the staples, but its much better now that all the staples are out.  The worst one is on the far right side, which is opposite of what most people say.  My doc said he does all the hard work through the one on the right because he gets a better angle on the stapler.

I was telling a fellow VSG buddy, FavoredOne, that I have this little stinkin’ thinkin’ thought that I will be the one person for whom sleeve doesn’t work, right?  Doesn’t everyone have these thoughts?   I have to step back and look at it and try to break it down.  I came home from the hospital having lost a bit, so its not that.  I spent a week on clear liquids with less than 250 calories a day.  I got in all my fluids and protein each day.  I did what I was supposed to do.  So I just have to wait and see, the weight has to come off sometime, right?

I started full liquids yesterday, and it is a lot better.  first day out, I went to P.F. Changs and got my favorite, hot and sour soup, and they blended it for me.  1 7 oz serving has 80 calories, 3 g fat, 9 g carbs and 7 g protein.  I love it.  I got the large bowl, and just measure myself out a small portion for lunch and dinner. One bowl that cost $5.95 will last me about….6-8 meals?  Amazing.  It fills me up really quickly.

I will admit to a couple of cheats and really weird behaviors.  I let two cella liquid center cherries melt in my mouth slowly on christmas day, and spit out the cherry itself.  I also had one tiny piece of potato chip and ground it to bits and let it go down with a drink of water.  then the weird(er) stuff.   I have chewed up some things that I liked, and spit them back out and rinse my mouth out with water after each bite.  I just wanted the taste and the sensation of chewing.  I can’t be the only person ever to do that. I know its stupid, but….I figure its better than actually eating it.  B

I find it interesting how different the advice on post-op diets are.  I am a member of verticalsleevetalk.com, and there is such a continuum.  I talk to people who are on clears for 14 days.  I talk to people released from the hospital on full liquids, and one who was released from the hospital on soft foods! FOr myself, I have 1 week of clears, 2 weeks of full, 3 weeks of soft and then by week 6 resuming to normal diet.

I read a great memoir last night, called ‘Designated Fat Girl” by Jennifer Joyner (jenniferjoyner.com) and it was really interesting, so many of the ways she described her food addiction, her thinking, her rationalization, her food binge choices mirror me.   It was a quick read and made me think.  She describes these behaviors as self-destructive.  which, ultimately, eating the way I have for all these years, is destructive.  I also have at least one other fairly socially accepted addiction that is self destructive, but I don’t make the link between why I have done what I have done/do what I do and wanting subconsciously self-destructive.  I just don’t get what my reasons for doing what I do are.  I don’t get it.  i have spent time in 12 step groups, but havent’ had a great enlightenment.  When does that come?

Yes, I have sexual abuse or molestation or whatever you might call what happened to me between ages 4-5, but on the scale of how bad those things can be, mine wasn’t as bad.  I have talked about it in therapy, I know its not my fault.

I always FELT fat.  When I was a kid, I was a little chubby, but not overweight.  teenage years as I shot up and was active in school stuff, I thinned out.  When I started college, I had an extremely obese roommate, and I think apart from major personality issues (she thought it was ok to have a 1.x GPA and never go to class, I was a “square” who had a 4.0 GPA that first year)  I think I was scared to look at her to know what I could (and have) become, as I already could binge like no one’s business.  That year, I didn’t gain the freshman 15, I lost about 10 lbs, because every time I would see her in our room, binging, often on my food, it disgusted me and I would go to the gym to exercise or run out on the trails.  I got married after my freshman year weighing 132 lbs and in a size 9, and still imagined that I was a fat girl.  What I would give to weigh that now!

My weight started to balloon up after I got married.  About a year after I had been married, I went to weight watchers for the first time.  I weighed 152 at that point (still, would kill to weigh that)  I gradually just gained and gained and gained.  A lot of people assume I can blame my weight on all the babies.  But nope. I was 250 before I got pregnant with my first, and have been bouncing up and down from that point for 15 years.

So I guess I am supposed to figure out why I do this.  I’m not sure, is it necessary to know why?  Will that keep me from doing it in the future or at least understanding it more?

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Day 1 of Liquid Diet

14 Dec

I now officially feel like I am going into a pre-op tunnel, getting more and more focused on what is to come with this surgery, with this whole thing occupying a lot of my background processing at any given time. 

Today is day 1 of my pre-op liquid diet, and I am fully prepared for this to be a bitch.  I am currently sipping a Costco Premier Protein shake for breakfast.  I have guidelines for what I can have, but I don’t have a calorie guideline to shoot for.  I’m going to have to check into that today to see what other people have as calorie guidelines.  The only sample schedule that is included in my guidelines shows a 4 oz protein drink for breakfast, lunch, dinner, evening, with 1-2 oz of other full liquids at breakfast, lunch and dinner. That is a ridiculously small amount of calories for someone pre-op, isn’t it?  Is that really what I should be shooting for?  Craptacular. 

Today I have my pre-op education class at the hospital.  I’m not sure what to expect at this class, I think its pretty focused on the surgery/hospital experience and immediate post-op experience.  So it should be interesting.

Approved!! Holy crap!

16 Nov

I know many have to wait much longer and jump through many more hoops, so I am very grateful.  My insurance approval for weight loss surgery came through quickly and without a hitch.   I had my last pre-op weight supervision appointment last Thursday, as well as a nutrition education session for post-op with a dietician (that was super depressing).  I got really cold feet about this whole thing after that appointment.  I wasn’t feeling too well that day, though, either, so I think that added to it. 

I found myself looking at the dieticians list of what I could eat after the initial post op period, and it was basically deli meat with eggs, deli meat with cheese, deli meat with deli meat….LOL.  I think I have to put it in perspective that they are trying to give some easy basic ideas, and that just because I am having wls, it doesn’t mean I can’t have interesting meals anymore.  @eggface, I must dig into your archives!  I also have  weight loss surgery cookbook for dummies on nook that I haven’t really looked into yet, hopefully good ideas there. 

I don’t have a scheduled date yet, because when I called her back, the scheduler had already left for the day and won’t be back until Thursday, so I have to wait until Thursday to get my date.  Unless the doc is going to extend his vacation, surgery on the 21st or 22nd of December looks like a good bet.  At my last appointment, she said that their sleeve patients are typically only in the hospital a day, 2 at most.  So even if i had it on the 22nd, I could be discharged and home on 23rd if things all go well, 24th if it were 2 days. 

The cold feet part of me is really struggling with the fact that I’ve lost 25 lbs in 3 months, and wondering if I could just continue doing what I am doing.  But the realist part of me says, I will not be able to keep it up without some additional tools to keep me on the straight and narrow, and that this will be a way to really keep me going the way I should. 

Also, I love my insurance.  My total for surgery, with my 5 pre-op doc visits and psych eval included, is $325, plus whatever I end up getting charged for the pre-op bloodwork and final tests, I suppose those will cost something too.  Wahoo!! not bad. 

 

 

 

 

Psych eval passed, Exploring behavior change, qotw thoughts

11 Oct

So first off, I had my required psych eval for weight loss surgery. I was worried about this not because of any extreme psych issues,addictions or inability to demonstrate that I understand what I am getting myself into, rather, where the line gets drawn between eating behaviors that would preclude me from being able to pursue weight loss surgery at this time. I did a lot of thinking prior to this appt and realized that I have changed a lot in the past year to get to this point. More engagement in good behaviors, more mindfulness of bad choices, attempting meditation, tracking my steps almost all year long with my fitbit, and in the last two months, fairly decent eating behavior change. Not perfect, but enough to result in about 16 lbs of weight loss in the last two months.

In case you are pre-op and want to know what the psych eval might be like, here is what mine was like. I was told to prepare to be there for 3 hours, I was there for 1 hr and 50 min. When I arrived, they gave mea first test called an eating inventory that was maybe 40-50 questions, mostly true/false. I didn’t like it, because it used the word hungry a lot, and was hard to answer with that word in there for me. It listed lots of circumstances in which I might be hungry, and I know that what I do is not hunger. It’s want, desire, not hunger. So that was hard. But quick.the second test was the MMPI2, and had over 300 questions. I actually thought it would be longer. It was easy.some weird questions, some of which made me chuckle…but not bad. Then there was something called BDI, I think, again fine. And a final one I can’t remember, but it was quick. I think that was all. I waited a bit, then got called back with the psychologist. He set expectations, and started in on interview, asking me about the procedure I wanted. We then discussed through all the typical areas, motivation, support, family composition and history, my existing gad and depression, etc. It was fine. He told me my Tests confirmed what we discussed, no major issues, confirmation of anxiety and mild social avoidance. Which of course I know. He also tried to probe more in my ADHD diagnosis to confirm, not sure if he agrees I have it or not.I am not sure I do or not, either. In the end he told me he saw nothing that would prevent me from moving forward, that he would be reporting back that I could move forward, assuming I stay on my meds and would recommend the bariatric centers support groups. He said it would take about a week to get back to my doc.

1st of 3 WLS Medical Diet Supervision Appt. – Southbeach?

19 Sep

I had my first of three required medical diet supervision appointments with my surgeon’s PA today.  She was smirky.  Glad I don’t have to see her too often. What I mean by smirky is, you don’t get a vibe of true passion for the plight of obesity.  Do you know what I mean?  I am not sure if that was because she had a student observer in there and she was not being normal, but I am not a fan of smirky.  Anyway, don’t have to love her, just have to meet with her once a month, and I can do that! 

She said that they would like to see me lose weight of course, but at a minimum, I can’t gain any weight.  According to their scale today, I am 270.9.  I really need to set my scale to match theirs.  I wonder how I do that? 

We discussed my current eating and activity habits.  I already have the functional knowledge of what is needed so our discussion was fairly short.  She handed me a handout based on South Beach Diet because she said that is most like what my diet will eventually be in pre-op (phase 2 of South Beach).  We talked through the handout.  She said I could either choose to do that plan or continue with Weight Watchers, but she definitely seemed like leaning toward the South Beach plan because it would better prepare me for post-op life, so I think I’ll be headed that way, but maybe still tracking with Weight Watchers, unless South beach has similar awesome tracking tools.

She said I would not have a pre-op liquid diet. She said occasionally, with sleeve patients, my doc might require a brief period of liquids only pre-op, but only if BMI warranted it. 

I asked her for her opinion on sleeve versus RNY for me, and she said if I have a problem with carbs/fats and craving them, that RNY would probably likely be the better way to go.  I think that is true, but I also really like the idea of losing all the grehlin-producing stomach, curbing my appetite.  So I remain torn, but maybe a skosh closer toward RNY if dumping might be a tool for me.  I wonder if sleeve would be enough to get me on the right road and build new habits, without the drasticness of RNY?  Of course, removing the majority of your stomach is pretty drastic too.

Surgery Consult and Next Steps

12 Sep

Boy, the consult was quick.  You kind of think about such a momentous decision maybe deserving a few more moments.  They took me in, took my weight which in the office was 270.1. Certainly a lot lower than it would have been if I had had an appt a couple of weeks ago, but still clocks me in with a rounded up BMI of 42, according to them. 

Met Dr. Doe, and he asked me some questions about my typical eating behaviors, and then he started talking about the pros and cons of my two favored options — Sleeve Gastrectomy and Gastric Bypass (RnY).  Reinforced much of what I’ve already learned about the two options. The points of note:

  • Sleeve gastrectromy is showing a similar initial weight loss trend as bypass in his practice, but doesn’t have long term results.
  • With sleeve, he says that typically patients on the lower end of the MO scale lose weight faster than patients with higher BMIs.  he didn’t say why.
  • While gastric bypass patients show an amazing reduction in appetite initially, it starts to climb back up as the stomach figures out how to restart grehlin production, however, malabsorption keeps intake in check somewhat.
  • In sleeve, because the stomach is mostly gone, while appetite suppression is not as marked initially, it stays consistent forever, because the stomach is gone and can’t produce grehlin anymore.  My question that I need to look up — is leptin produced in the stomach, too, and how is that impacted?
  • Sleeve doesn’t have the negative consequences of dumping and malabsorption, which is both good and bad.   Sleeve allows you to eat more like a normal person, just less of it, so it is easier to cheat, ultimately, but might be easier to manage in a normal busy lifestyle. 
  • Gastric bypass patients often do experience dumping, and dumping causes a definite negative consequence to keep you on the right path of staying away from sugars and fats. Gastric bypass, for some reason because of the bypass of part of the intestines, seems to have better outcomes for people with fairly entrenched diabetes. In my case, my diabetes is quite early in stages so sleeve would probably be just as reasonable.

My impression of Dr. Doe.  Nice enough, intelligent enough. Didn’t get any warm fuzzies, for sure.  He whipped through quickly with his pitch and questions and got up and started walking out to ask the admin staff about whether my insurance covers sleeve (which we learned it does) and kind of threw back over his shoulder if I had any questions.  not the ideal way to cover my questions.  Boo.  But I did ask him about his experience and mortality.  The website didn’t reference his experience.  He has done over 700 gastric bypass surgeries, 40 sleeves and about 60 bands.  What is typical? 

With the admin staff I covered next steps, and I have my first medical diet supervision appt next monday already, which is great.  We talked about my ideal timing, which would be somewhere around the 21st of December.  I know that sounds crazy, given holidays, but between forced vacation between christmas and new years, I can get a straight two weeks off and then some with minimal additional time off and need to discuss at work.  She said that my insurance is quite quick about processing the approvals, and that after my last diet supervision appt is complete around November 14th, they can submit.  She said Dr. Doe is scheduling about 3 weeks out, so its cutting it, and depending on his holiday schedule, maybe not, but there is a chance I could have it done in the timeframe I am hoping for.  Crossing fingers!

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