miles, mood and multivitamins

Well, this past week I hit a lot of new milestones physically. I use a fitbit, and reached my “500 mile” status, and I also yesterday had a long day of walking that for the most part was fun until we reached an area of our walk that was under construction which resulted in a long walk around and not so ideal walking conditions. But the whole walk yesterday was 8.25 miles. Amazing, and I don’t feel bad today, still managed to take another decent walk today. Yesterday was something like 23,000 steps. (also got my fitbit badges for 15k and 20k steps in a single day.) I would have never been able to do that even six months ago, and if I had walked that much (which I may have done at disneyworld or the like in the past) I would have been sore and miserable. I was fine today and we walked again today!

Yesterday we did a circuit to walk to breakfast then we walked to a craft store, then we walked up through neighborhoods to a grocery store for a bathroom stop and to buy some water, then we took off up further, visited a park where the kids played, and then up to lunch and to Target and back home again. Home again got a little overwhelming for the kids — particular my 11 year old daughter. She was whining the whole way so that made the walk home not so fun.

The scale isn’t moving though, which is just insane to me. Granted I am eating more calories than I was, but on an average day, my net calories are still around 800.. 1000-1200 consumed, and 200-400 expended in exercise on average. So wtf? Its been about a two week stall again at this point. I have to just figure that at some point the scale has to move again, doesn’t it?

This week was a really hard week, emotionally, and I had a visit to my regular doc to talk about medication adjustments. I’ve been noticing post-op that mid cycle and PMS time have gotten worse emotionally. This past week was really bad, it was all I could do to get out of bed, and get myself to do the things I need to do every week. The first day of the week was ok, fine and productive, and then I just got slammed on Tuesday with overwhelming tiredness and moodiness, didn’t want to do anything. Very hard. The doc said adjusting mood meds is more of an art than a science, so he upped the wellbutrin to 300 mg a day, thought that one would be a better one to try first because it also has an appetite suppressant effect and manages my ADHD, where as my other one tends to increase appetite at higher levels. overall though he was quite happy with my weight loss. He has no need to start me on diabetes meds again at this point, which is cool. I hope the increased meds helps.

I am having problems getting my multivitamin in FOUR times a day. Do other sleevers have to take a multi 4x a day? My nut is so emphatic about only two good options for bariatric multivitamins out there that I am scared to switch. I will say when I travel, I use opurity once a day vitamins, which taste like crap but at least I only have to take one a day. Normally I am supposed to take optisource vitamins, which are fine, but I almost always miss one dose a day. So I wish I could find an equivalent formulation to optisource that could be taken 2-3x a day.

tomorrow starts the next Mytinytank six week accountability group. I really enjoyed the first round. Tracy is an incredibly smart and nice person and is so far ahead of me down the road, a wise mentor. I really appreciate what she does for the WLS community. I have to decide today on my next six week goal and I am having trouble settling on one, whether I should continue with an exercise consistency goal, or whether I should switch it something around eating behaviors, as I am seeing more desire to eat bad foods. I am still getting my required protein in, and a reasonable number of calories (I think..is 1000-1200 ok? it seems a lot larger than what some eat, so maybe not)

I had a good appt with my therapist this week, I guess I’ve settled that its just nice to have someone who gets it to talk to. She is very down to earth and kind. I have another issue that is much more tender/emotion ridden for me and we talked about that as well as eating issues. I have a different issue that again is a “socially acceptable” sort of addiction, and I am trying very hard not to let that issue pop up and become an outlet. I swear, its like a game of whack a mole. All I can do is keep going one day at a time. A worn out expression but very true.

~11 weeks post ops and my first vomit

I really CANNOT believe I am posting about vomit, but this is the lengths I will go to in order to enlighten you, dear reader, into the life of being a post-op WLSer.  I have not had the “luck” of having a single episode of vomiting or nausea since surgery, but I learned tonight what happens if I push my sleeve too far.  yeah, well, I learned definitively that I cannot push my sleeve, because it will push right back.

We went out to dinner to a Japanese restaurant, and chose a Hibachi table for hubs, me and our two littlest, knowing they would enjoy the “show” of the hibachi cooking and knowing that since its basically pure protein and veggies, its the perfect WLS choice.  We split a dinner for two among the 4 of us, that included filet mignon, chicken, salmon, shrimp and scallops.  Even with 4 of us, it was a huge amount and we took a very large box full home.  I had 5 shrimp, 3 small cubes of filet mignon, and 3 scallops, and a few assorted pieces of veggies — zucchini, broccoli, mushrooms.  Ate everything slow and chewed well. Then the kids and hubs wanted to have dessert, so we ordered a fried banana and japanese fried ice cream. It did me in.  I ate a small portion and started to feel bad, crampy, like I needed to stand up or stretch out. I could feel stuff in my esophogus, I presume.

Paid for dinner, went out and got in the van, and was beyond thrilled that my overly puky/allergic 2 year old has caused me to store a supply of medical emesis ring/bag things in my glove box, because dessert came right back out.  ugh, and double ugh.  I now know why they call it “the slimes”.   Anyway, won’t do that again.  Shudder.

I am laying in bed, stretched out, typing this out while its still fresh.  What was curious is that I didn’t get my usual “tell” after the meat, which is hiccuping.  Usually as son as I am full, I get the hiccups, which is my clue to cut it out.  This time, I didn’t get the hiccups until after dessert, as we were walking out.

So my question to you — do you have a “tell” when you are full?  hiccups or sneezing?  Loved this episode of Bariatric TV that explains the hiccups and sneezing.

Now, back to the regularly scheduled update (well, painfully late update).  As time passes, everything settles into a new normal.  I’m about 11 weeks post op now, and I’ve lost close to 70 lbs.  I have about 60 lbs more to go. Its cool being on the “downhill” side, but there is still a loooong way to go.

In my accountability group via Tracy at mytinytank.net,(if you want to join the next accountability, group, which begins on 3/12, please contact Tracy via her website–I highly recommend it!)   I spent six weeks with a couple of great WLSers focused on my goal of getting more consistently active.  My goal was to be consistently averaging 6500 steps at least five days a week, tracking using my fitbit, by March 5th.  And I did it!  I have gradually moved into a place where exercise is now feeling more like part of my routine.  I have been able to do this at least once before, so part of me is still scared I’ll fall off the wagon, so its likely in the next six week curcuit for accountability I’ll still be focusing on exercise consistency and increase in some fashion again. Actually, by the last couple of weeks, I’ve been closer to 7-8k steps, which is still less than the 10k a day gold standard, but for someone who used to walk less than 2k a day most days, this is pretty good!

What benefits have i seen?  Definitely have more cardio endurance.  I’ve gone to zumba a few times in the last month, and enjoyed it, and could actually make it an hour each time without dying.  Sometimes I had to slow down and just march/move in place while sucking down water, but I always restarted again and got back to it.  I’ve traveled and been able to cruise through the airport without getting all sweaty and gross, and even decide to walk extra to get more steps in.  Crazy!

Overall I just feel better and like i have more pep in my step.  Some days, its hard to get myself going, but I always (always) feel better after I’ve done it.  I’ve made a habit of scheduling it into my day during weekdays, and planning for generally to be going to the YMCA and working out before i have to be there anyway to pick up my little ones who attend daycare at the Y, so its a good reason to combine the two.  That behavior is called “anchoring” in the behavior change world, I’d say, basically attaching a new behavior you want to do to something you already do regularly and have to do, so that it is easier to make the new behavior a habit.  i used to try to do things like try to get up early and exercise, and for me, that is complete and utter bullshit.  I hate the morning with a passion, and that just makes it worse.

So I do the opposite of what most people do, I go at the end of the work day, and its working out pretty good.  However, on the other hand, if I got in my exercise early in the day, I could get my step count even higher through the course of the day.  (because i would shoot to get 6-7k in via planned exercise, and then my normal steps would add on….as it is, I arrive at the Y at end of day, and tend to quit when I get to 6-7k, rather than do a planned 6-7k.

Anyway, change is happening.  You can see it in my face, which now sports a pointy chin with a cleft in it (who knew?).  I still hate what has happened to my nose, which I swear I attribute to CPAP.  my nose is way bigger than it used to be.  So rude. I used to have a cute nose.  Oh well.  i’m excited to have bought a top that was simply an “XL” and I fit into the first pair of Levis I have worn since I was a freshman in college.  So that is pretty crazy.  Granted, i think they make levis in larger sizes than they did when i was in college 🙂 🙂  So its not like I’m down THAT small yet.  Some day!!

6 week post op, Groundhog day, awash in behavior change options

Well, yesterday I was officially six weeks post-op. I am really surprised how fast the time went. The time sure CRAWLED to get to the surgery date and through the liquids phases of the post-op diet. At this point, I basically feel like me again. I don’t have any tenderness in my tummy, my energy level is pretty much back to normal, and I am allowed to have a full range of diet options. What does all that mean? It means I feel like I am teetering on the edge of my own personal possibility of groundhog day, of either spring coming early, or an interminable stretch of time ahead of me where I continue to battle darkness, personal choices and challenges. I want spring to come early for myself, and with it the possibility of change, new behaviors and new hope. I want spring to come and bring me new confidence, increased self-esteem and higher belief in myself that I can change my behaviors, tiny steps at at time, to develop a new normal.

This surgery is sooo not about the physical and mechanical aspects of all of this. I keep thinking of other analogies in life and none of them quite work but have parts that resonate. At first I thought, its like declaring bankruptcy. But that is long before I realized the truth of the matter about weight loss surgery, about how the day of surgery is really just the beginning of hard work. Up until the last while, I realized that even a part of me felt I was taking “the easy way” out. But this is not the easy way out. Just because my stomach is smaller doesn’t change my personality, my habits, my behaviors. It is easier to stick to the post-op diet in the early phases, ironically. Honest to god, I do think its like the “rehab” equivalent for a drug or alcohol addict. The radical change in behavior, supervised medically, to ensure you don’t hurt yourself and have a chance at a do over. You don’t feel like yourself, you feel very “medical”, you fear complications if you choose the wrong behavior. But I can see that as the medicalness fades, and the risk of complications decreases over time, its just me out there. Me and the things I choose to do next to make my life different than it was before.

I started with a therapist locally last week, and I was given two homework assignments. “Stay in Today” and think about what triggers me to eat. The first assignment is better for me right now, because I can do that. I know that I have the tendency to spend my life thinking about everything but the day in front of me, and making today the best day I can make it. Imagine what the world would be like if you lived each day just focused on today? Trying to do what I can, just in the day, to make it good. After many of those days, the past starts to become easier to look back on, and the future starts to potentially become something less to worry about, if you’re taking care of each day, one at a time. I know this cognitively, but it is hard to change the behavior of daydreaming about tomorrow, in particular. When I pay off this bill I can….when I get my tax refund I can….when I weigh 199 I will….when I am a size 14 I will….What a shame that I have been living my life in suspended animation, always holding off the good stuff for later. What is going to be good about today? What is going to be good about today for you? Think about that. Because that is at the core of this thing, I think.

The thinking about what triggers me to eat is much harder, particularly because I’m post-op and everything just feels kind of different right now, if that makes any sense. I think because i have gone through my six week rehab, whatever triggers there are aren’t working the same way on me, so its hard to pinpoint what they are. I did identify the ones about travel back in October or whenever that was, for sure. So that was good, but in day to day life, I’m not necessarily seeing it. I know that at the end of a work day, I can feel pretty mentally wiped out and lazy, and that its easy just to succumb to going out. That is still true, and we eat out a lot, even now, post-op, but I am able to make good choices still when I am out. It is easier now that I have a wider choice on the menu. When i was in liquids or softs, I felt pretty pissy about eating only what I could eat. Now I feel pretty happy that I can eat a good portion of protein and try some tastes of other things. My worry is, its a slippery slope? Do I valiantly NOT have any tastes of other things, to avoid sliding down the slope, or is it better to have the tastes and get some joy out of it, so that I don’t take a nosedive off the top of the slope at some point? My guess is, that answer is different for everyone, and we have to find that truth within ourselves. Shit, I hate that answer. 🙂

Another thing we talked about was fear being at the base of a lot of behaviors like addictions (and i consider that I have a food addiction) And she mentioned that for a lot of people with issues with food and money, that fear of lack is at the core of it. I haven’t been magically been able to put my finger on the reasons I am the way I am. Its like an elephant in the room that I truly can’t see. I know certain truths about my past that I can logically see have probably influenced my life, but I haven’t had that big “a-ha” moment that I feel like I should have.

I am working so hard right now on amassing my knowledge around behavior change. I am a researcher my nature, I love to know about stuff, and why it works. So that is pretty time consuming. I can’t blindly follow one methodology either, so I am in the midst of learning about several, including The Beck Diet Solution, Change Anything, and Tiny Habits. Honestly they all support each other, and have different steps to approaching the same thing, which is behavior change. I like comparing them and taking different ideas from them, but at the moment I’m feeling a little overwhelmed by it all. I wish God would just knock on my head and say, “here, this is the way, you’re making this way too complicated.” But honestly, I feel that I have to practice some critical new skills that come out of these methods to get to the other side and see it get easier. One of the things I liked hearing about in Change Anything is this idea of “being a scientist” — to try different approaches and after you try them, look at them to see why they worked or did not work. This is something that honestly happens in my work life all the time, so why this should be so novel to me in my personal life is kind of ridiculous, but I like the idea of framing that way. Because again, it takes out the “that was a failure, therefore, I am a failure.” thought process. It makes all of this an experiment to see what works and what doesn’t, and then a matter of assembling those things that work and figuring out how to hang them together to make a total program of change.

I have joined an accountability group for six weeks with Tracy from mytinytank.net and some other lovely ladies that hopefully will join us as we go along. The idea is to commit to a single thing we want to make a change around and be accountable to each other to report our progress, our successes and our challenges. We have a once a week brief call to report on this, and are free to reach out to the other members durign the week to ask for support at crucial moments or victories. I like this! I think two elements I’ve avoided in past attempts to change behavior is social support and exercise. So therefore, these are two areas I am focusing on the most right now to help with setting in new habits.

Phew. That was soapboxy. Thanks for reading.

Incision Troubles, the post WLS Blues

All in all, I should be super happy.  scale is dropping (48 lbs gone total), feeling mostly pretty good.  Two issues at this point.

First is I have an incision that is givign me trouble. The 2nd incision from the left (I incorrectly thought this was the one that was oozing a bit in the hospital, but it is not, now that I think about it)  is giving me some trouble.  It’s been fine ever since surgery, no issues.  A few days ago, it pops up open and lets loose some mostly clear ooze.  Hmm.  No fever, no real pus, minimal redness (a few millimeters) around the incision.  Call the on-call doc and he thinks its a seroma.  So basically fine, just pay attention if anything is worse.  Today, after a shower I look down at it, and the scab that had formed had fallen off and the incision is gapped open a bit, and seems redder, and has what looks like more serious looking goo, but maybe that is just from the scab falling off.

The pictures below are TMI, so if you are squeamish, look away!

Saturday:

Today 1/9/12 after shower — water must have loosened the scab off and washed it away?

So that is that.  Yum, huh?  At the moment, no one but me seems to be having kittens over it despite two calls to the doc.  I have a just in case appt on Thursday, in case it gets worse.  They told me to put steristrips back on it to reclose where it has opened in the middle.  So now it looks like this:

In other news, I’m wondering if I need to put a call into my primary care doc to up my antidepressant.  I’m not sure at this point if I’m just expecting too much in recovery or whether I am getting depressed, because I just feel like holing up and doing nothing.  Work feels like too much right now, everything is sorta blah.  I have anxiety, mild depression and SAD, so it could be I need to get more sunlight too.  I have a SAD light, maybe its time to use it again.  Hmm.

Day 1 of Liquid Diet

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.

Surgery in T-10; NSVs I am looking forward to

Surgery is on 12/21.  That is 10 days, OMG!  I was annoyed last night, we were having a joint family party for my two sons (for the extended family party, we do just one party….my oldest turned 13 on 12/5, and my youngest turns 2 on 12/15, so we split the difference with a party on 12/10.)  Anyway, i was mentioning that I was pleased that this week i was able to try on and successfully fit in clothes two sizes smaller.  That immediately caused my mom to launch into a “why don’t you cancel surgery and just keep doing what you are doing?”  I mean, I can’t say I haven’t had the same thought, but honestly, I know that I have not been able to ever sustain any kind of significant weight loss. How do you react to that.  Of course, it made me defensive. 

Tonight was my Christmas Eve dinner.  My liquid diet starts in 3 days, so I made my christmas cookies and had my two favorite christmas foods today.  I found it interesting that I didn’t really want a lot of it.  i gave myself permission for this to kind of being a final meal sort of weekend, but tallying up the damage, while it was more than I allot myself in myfitnesspal.com (about 1200-1500 cals a day right now), and today and yesterday were about 1800-2000 cals) but compared to how I used to eat…..still a whole lot less. 

What are your best tips for surviving the pre-op liquid diet?

I got a new toy yesterday that I am experimenting with, its an ‘Up” bracelet from Jawbone.  I already have a fitbit, so I am comparing between the two.  Whichever one I dont’ use, hubby will probably start using.  Anyone using “Up” yet?

On verticalsleevetalk, there was a great thread about what kind of things we are looking forward to….. here is my list of NSVs I am hoping are in my future:

1. I want to fit in an airplane seat comfortably without an extender.

2. I want to be able to not feel like i need to use the handicapped stall in the bathroom to have enough room.

3. I want hygiene to be easier. 

4. I want to chafe less if I’m really active. 

5. I want to be able to go skiing with my kids (we live 30 minutes from the slopes, haven’t skiied since I was a teenager)

6. I want to be confident I can fit on amusement park rides.

7. I don’t want to worry about whether a booth will be too tight.

8. I want to stop needing to use a CPAP, particularly not having to travel with one, as I travel  a fair amount for work.

9. I would like my diabetes to be gone, and get rid of all my assorted diabetes stuff.

10. I would like to not to have my primary criteria for shoes be ones that i can slip on.

11. I would like to be able to easily paint my toenails.

12. I want to have energy to play with all my kids.

13. I want to buy lingerie at victorias secret.

14.  i want my original wedding rings to fit again.

15. I would like to run a 5k.

16. I would like to join a dance class.

17. At church, I would like to be able to kneel properly without leaning back on the seat.

18. I would like my furniture and bed not to have sagging where I sit or lay.

Approved!! Holy crap!

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. 

 

 

 

 

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

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.

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

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

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!