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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.

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QOTW=Cognitive Behavioral Therapy for Weight Issues; Study on Sleeve shows it comparable to RNY

26 Sep

Well, first off, my research and topic exploration of the week for me is the use and role of Cognitive Behavioral Therapy to assist in changing behavior around eating and exercise to help in achieving a normal weight.  I’m very familiar with the concepts of Cognitive Behavioral Therapy, due to some of my past projects at a past employer.  I have the intellectual concepts down pretty cold.  However, I have a hard time putting it into practice.  I’ll be looking at this week how therapists might be working with wls patients using cognitive behavioral therapy to learn new ways to respond to the typical negative tapes and stressors that come up in our lives, and seeing if there are any cool tools for CBT for weight loss out there.  To the crickets out there reading this, if you have great suggestions for resources, I’m all ears and will include your suggestions in my summary post at the end of the week.

For now, if you want to play along at home….*

Think of a typical situation that might make you feel bad about your weight loss efforts.  Take a moment to write out that situation right now. What happened to make you feel badly? What was your reaction?  What did you do?  How did it affect your weight loss progress?

Now, ask yourself whether your thoughts about the situation were completely true and accurate.  how else might you think about/frame what happened?

Finally, rescript the situation.  What could you have told yourself that would have been more supportive and accurate, when the bad situation occurred?  Try it now, how does this new response make you feel about your weight loss progress?

Ok, now a quick poll regarding head hunger and how you approach it.

Okay, topic #2.  I am very interested in this study that WLSHelp has on their site about a 3 year study comparing vertical sleeve gastrectomy with roux-n-y bypass.  I have been flopping back and forth on which procedure to choose, and have been lacking the evidence-based data my mind desires to spell out some of the outcomes.  What is still missing is long term outcomes.  As in, does something creepy happen 10 years out to sleeve patients that no one expected? How long have sleeves been done in other countries, and what are the outcomes there?  This is the knowledge my brain seeks.  Ultimately, I think I would like the sleeve first, in the hopes that I can reprogram myself in portion size and feelings about eating effectively, but still occasionally be able to have a tiny portion of something without worrying about dumping.  I know many feel dumping is overrated, but I think about the little things, being able to have a little tiny piece of cake at a birthday party.  I know its a slippery slope though, so that is where I wrestle.  Do i need the RNY to keep me honest?  Surgeon said I could always revise to RNY later, but I’d just as soon only have to do this once.  And I would like my life after the initial weight loss to have the opportunity to be normal relative to other normal people.  I also think the appeal of losing all the grehlin production is awesome to me. if it would long term eliminate hunger signals, how awesome is that?

* I am not a doctor nor do I play one on twitter.  Check with your therapist for the best interpretation of CBT.

Hair Loss after Weight Loss Surgery – Question of the Week results

23 Sep

So I said the topic of the week was hair loss as a result of weight loss surgery.

Here is what I have learned.  Disclaimer, these are my learnings and my perspectives.  Your mileage may vary!  Besides, no one is probably reading this anyway.  😀 😀

So it sounds like a lot of you have experienced hair loss after surgery. Some people will experience a lot, worrying that they will go bald, while others experience minimal loss.  What people notice is a lot of hair coming out in the hair brush or going down the drain when you wash your hair.  It can begin fairly soon after surgery, and I’ve read can go along through the active weight loss phase, so like for the whole first year.  Eeks.

Causes:

  • Trauma of Surgery

    Just having surgery is a shock to the system, and our hormones go a little wonky (or a lot wonky) after this surgery. In reference to hormones, I think about postpartum hair loss a lot, and wonder if it will be similar to that, because after you have a baby, all the hormones go wacky (and in my case, csection surgery) and I lost a lot of hair after each kid, but it stabilized. I am praying for something similar.

  • Inadequate nutrition/protein due to drastic decrease in calorie and nutrient consumption

    Not getting enough protein in, particularly in the early phases of post-op recovery, apparently is the biggest culprit.  The body needs protein and nutrients to repair itself after surgery and maintain the body, and it diverts the protein to more important body functions to make sure we stay alive, apparently hair just isn’t critical, who knew?

What’s a wls patient to do?

  1. breathe deeply.  chances are, you won’t go bald.  Even if you lose a lot a hair, it will grow back.  People don’t go bald from having weight loss surgery, I suppose unless there were other underlying issues in the first place (of course in my world, I fear the relationship of PCOS and weight loss in general.)
  2. protein, protein, protein.  Get it in, you already know its the priority, but shooting for at least 60 grams a day.  Myself, I’m thinking that those 42g protein bullets as pretty key to my early post-op life.  Although I have seen some comments that the kind of protein in those bullets is not as good as other forms?
  3. scalp massage — a great video is here.  Your inclination may be to stop washing your hair, avoid brushing it, but actually, scalp stimulation is needed to get blood flowing to the scalp and encourage regrowth. My hubby is WONDERFUL about giving me head massages, so I guess that will continue 🙂
  4. Supplements to promote hair regrowth.  According to Dr. Alvarez’ book, “Successful Weight Loss with the Gastric Sleeve”* a potential regimen for supplementation to prevent or slow hair loss is:
    • Co-Enzyme Q/10 — 25-50 mg per day
    • Biotin: 300 mcg per day
    • Flax Seed Oil: 1-2 grams per day
    • Zinc: 50 mg per day
  5. Topical products to promote hair regrowth.  I’ve seen Nioxin mentioned a few different places.

My plan

All in all, my plan is to hopefully begin the supplement regimen noted above BEFORE surgery, to allow for a significant strong healthy head of hair.  Since I already have some thinning up front due to PCOS, I don’t want to have a disaster, so hopefully if those things are at good levels pre-surgery, maybe it will help afterwards.  Just my hope!

Resources

My favorite blog source of information for my ruminations today was Gastric Bypass Truth. Definitely check her out.  Adding her to my blogroll.

Bariatric Times article on WLS and hair loss with references (by Dr. Jacques)

Obesity Action article on WLS and hair loss (also by Dr. jacques, but a little easier to read for some reason)

* if you are considering gastric sleeve surgery, this book is really good.  I am usually a freak for evidence-based medicine, and I’m not sure I see enough of that here, I still really feel that based on Dr. Alvarez’ personal experience, he has a lot to share around this, so consider it a valuable resource in my new library of weight loss surgery books as I am learning and waiting for my surgery.

Before photos; Hair Loss after WLS is Topic of the Week

17 Sep

Gulp.  This is not fun.  I’ve posted my Before and After Photo Page, but currently only has Before photos.  Technically i’ve already lost 12 lbs, but its close enough.   I hope to be able to be posting great “afters” at some point.  I’m always curious, do the people who DON’T have great success post their afters?  I don’t think i have seen a #wls blog or pages with people who didn’t lose much. 

I am going to be posting my question of the week, and will be researching this topic through the week, and compiling the results of my research on this topic at the end of the week, along with a conclusion of how I feel about it. 

Before I begin my fears around hair loss are pretty big.  I have lots of thick long hair, BUT because of PCOS, I can tell it is thinning in the front in the bang area.  because I have so much elsewhere at the moment its not as noticeable that this is the case, but it makes me nervous to think about losing a ton of hair.

So what I am seeking to find out:

  • What can I do to minimize hair loss after weight loss surgery?
  • Does one type of weight loss surgery see greater hair loss than another?
  • When should I expect it to start falling out?
  • Do women with PCOS have a worse time with hair loss and/or hair regrowth AFTER the loss?
  • Will the hair loss be similar to what happened post-partum?
  • What is the best post-surgery protein/vitamin/supplement routine to get things back to normal?
  • Are there any topical products that will help with this?
  • What are the best ways to “hide” the hair loss while its happening?
  • Are there any women who have gone completely bald due to this?

 

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