1 YEAR SURGIVERSARY

A year ago today I was in Mexicali, Mexico.  I was spending the night in a hotel after finishing some tests  Dr. Alberto Aceves was my surgeon.  He and all of his staff are very thorough, helpful and accessible.  The care I received was excellent and I would recommend the option of undergoing bariatric surgery with him in Mexico to anyone.
and interviews with the Bariatric surgeons at the Hospital Almater.

My experience with weight loss surgery has been chronicled here in the past year.  I did great in the hospital but after a week or or at home I started having some problems with tolerating foods.  I went as slowly as I could introducing different soft foods and then more options into my diet to meet my nutrition and protein needs - I had a difficult time for about 3 months but slowly found the foods and vitamins that worked for me.  There was, and in some ways still is, a certain sameness to what I eat each day.  I remained as patient as I could and put up with bouts of nausea and gastric distress when I strayed from what my body could handle. Having those outcomes in mind makes it a lot easier to stay on the straight and narrow - believe me!

My weight loss has been quite swift and I suppose to people around me, pretty shocking. My kids never knew me at the size I am now - for my husband it was a distant memory!

 It may seem like fast = easy.  In some ways I guess it has been.  When you have a physical barrier to overeating it does make it "easier."  Though I've worked  hard to do it right:  get my vitamins, protein, liquids and exercise - just like all the other times I have "dieted."  Except now this is my life and not a diet I can safely stray away from on a whim.  To maintain lifelong health - I have to stick with these requirements.

I am proud that I have done so well in this first year and I believe I can safely maintain my new found healthy weight and lifestyle.

I want to thank my good friend Christina for making this possible and all my friends and family who have been cheering me on!

A YEAR OF LOSS - NOW MAINTENANCE

I am now a year from the start of my weight loss.   Last year I was on my pre-op liquid only diet for the
week leading up to my BPD-DS weight loss surgery. I was asked to lose 20 pounds in the month between the time I scheduled my surgery and when it occurred - and I did it.  A lot of people said why did I need surgery if I could lose 20 pounds in a month?  Clearly people who were not aware of just how many times I had lost that 20 pounds (or 80 pounds) and gained it back!!

I reached my goal to lose 130 pounds last month.  I am working on a maintenance diet now - I lost a few pounds and gained a few - so I guess I am doing it right.  My latest labs are just coming back and I see I still need to work on my supplements and protein intake - that's why we keep up with the labs every 3 months.  Even though I can eat more, my body is still adjusting to these changes and I need to keep my awareness up with regard to what it needs to remain healthy.

I made a mistake in switching to a different potassium supplement - the quality must not have been good because my potassium really dropped down, even though I was taking it every day.  I went right out and got the one my doctor prescribed.

I am still struggling with my protein intake.  The same old song.  I feel like I eat all day long and still can't get enough grams of protein in.  I am going to have to get more creative.

If I get too heavy on the carb side of the food pyramid,  my body certainly reminds me.  No just the gassy kind of reminder, but I get diarrhea, too.  I don't mean to get gross, but simply to inform as I know there are people wanting to get the real picture of this whole life changing surgery.  While I can carefully and selectively eat carbs - there is a consequence of going too far!

 I am happy to say that I get to enjoy a few cocktails when we go out.  Wine is hard on my stomach and I can't drink enough of it to get tipsy - but a good martini goes down easily and has yet to give me grief!

I have been getting to the gym less which is not ideal.  I need to get back  to  weight workouts.  I know that building muscle is important and will make me feel and look better, too.

We ride bikes every weekend and I can tell I am stronger and faster as time goes by.  We also started taking dance lessons - Western Swing dancing to be specific.  Two nights a week we are dancing for a couple of hours.  Fun, good exercise and another great activity for us to do together.

So that's the physical side of things - more on the emotional side coming up.

GOAL

I have mentioned that I have been close to my original weight loss goal for or some time.  My weight has been fluctuating and hovering just above that goal number but this weekend I got on the scale and found I had reached it.  Goooaaaalll!

When I was on vacation my sister was having me try clothes on from her closet - a new experience for me.  She gave me some capri pants and I wore her swimsuit for a couple of days.  Mine is still a big old plus size one.  swim suits are just so expensive and I didn't want to invest in one until I am at a stable size... We also tried on clothes at a consignment shop and I bought a few things in smaller sizes than I ever thought I would wear.  Pretty cool.

 I am now actively working to keep my weight at the current level.  Not just because my husband is calling me bony butt (we both miss my former JLo-ness) but because I think I have lost enough.  I have a lot of extra skin and a pretty major poochy lower stomach which can all be covered effectively with clothing.  I don't want to go further and get beyond my current "issues."  My sister is very into me getting plastic surgery to remove the excess skin (and weight) but it isn't something I am interested in spending money on in the foreseeable future.

I also can't keep buying new clothes!  I mean, I like shopping and buying clothes, I always have.  But now I want to buy clothes which will last in my wardrobe.  I  have too many things I have bought and worn a few times and now find are too big.  I am looking for a local consignment store (with a better attitude than than the ones in my town which are very snobby) and hope to make some trades with my too big clothes.

This week will be 10 months since weight loss surgery.  I continue to increase my capacity to eat but still have to be careful not to eat too fast or too much. I still count my protein every single day and aim for 100 grams.  I am vigilant about taking my vitamins.  I am exercising.

I had my first real cookie last week and had no problem with the carbs backfiring on me.  That will not be an everyday occurrence but it is nice to know I can indulge now and then with no major ill effects.  I am also enjoying a cocktail or two most weekends and used some Advil this weekend with no stomach upset.  So the things I was promised would heal and become more "normal" have happened.

Now I am adding more fruits, vegetables and whole grains back into my diet.  When I was in Idaho I bought some Huckleberry Jam at the Farmer's Market and have been using it on my peanut butter sandwiches - heaven! So sad it is almost gone...

A BARIATRIC SURGEON SPEAKS OUT - NOT THE EASY WAY OUT

I just read this great article written by a Bariatric Surgeon.  He is tired of people commenting about his profession - that he is an "enabler" for lazy, unmotivated fat people taking the "easy way" out of obesity.

He lists not only the difficulties of losing weight and maintaining that loss, the hoops people have to jump through to even get surgery and the fact that the AMA this year has declared obesity a disease and not just the cause of other diseases.

As a life long exerciser, a healthy eater and someone with knowledge of nutrition and of my own psychological issues - I can attest that it is not just a matter of eating less and exercising more.  Yes, for many people there is an issue with eating poorly and not exercising.  For many more of us it is far beyond that simple formula.  No one can really explain all the factors involved but the medical researchers are gaining awareness of the multiplicity of factors which affect different people.

Just as some people can smoke cigarettes all their lives and not get lung cancer, some people live long lives on a high fat diet and others drop dead in their 30's following a spartan diet and running marathons.  None of it is simple.

I had wanted to try weight loss surgery for over 10 years before I was given the opportunity.  As soon as I was aware of the Duodenal Switch I knew it was the solution for me.  I have never been a volume eater.  I have generally been a healthy eater - yes I have binged like pretty much anyone, for the most part I have been eating a high protein, low carb diet for 15 years so I knew I could maintain the dietary requirements.  When people "fail" following weight loss surgery and gain weight, it is probably because they didn't learn enough or know themselves well enough to commit to what it takes to be successful.

The surgery is a tool, not the final solution to the problem.  After all, we still have to eat!

Seven Months Post Op Weight Loss Surgery

This week I enter my seventh month since my BPD-DS surgery.  I have lost 113 pounds. I've been working hard on my supplements and my protein intake which was slightly deficient in my 6 month labs.

This means I rely on pre-made protein drinks and bars for 60 plus of the 90-100 grams of protein I need each day.  Right now I am enjoying the Premier Protein drinks and bars and can buy them in bulk at Costco.

There is such a disconnect between the reality of trying to eat 100 grams of protein a day (with a stomach roughly the size of a banana) and what people think - including my doctor who e-mailed me a note about increasing my protein.  He pointed out that there are 7 grams of protein in a meat or cheese serving roughly the size of a pack of cards.  Apparently he didn't think about how many of those servings I would have to eat to reach 90-100 grams a day! 

My little treats and beyond protein extras are things like a few bites of strawberries, raspberries, broccoli, spinach, tomatoes, salads and this weekend - 1/2 of a scooped out potato skin.  Woohoo!

I'm tired of eating the same lunches over and over so I searched the store this weekend for some new ideas and found a bread  from Alvarado St. Bakery which is 15 carbs per slice with 5 grams of protein.  It is pretty dry, but since I can eat mayo to my heart's content, I slathered some on a slice, added some mustard and 4 oz of cheese.  Tomorrow morning I am going to toast a slice and put almond butter on it for breakfast!  Pretty exciting stuff!

MAKING CHOICES

I had a job interview after work today and Tom offered to take me out to dinner.  I realize from the foods he is craving and wanting to have when we go out that he is missing some of the pasta dishes I used to make!

I ordered an appetizer, which is my new entree these days.  Two nice fat crab cakes arrived.  I ate about 3/4 of one of them and took the other one home to have for lunch tomorrow!  Sometimes I am frustrated by how little I can eat.  That old "mouth hunger" is still there and something I need to be mindful of because as time goes by, my stomach will be able to handle more food.  I am lucky that I had already been well educated about and for the most part living with a high protein/low carb diet.  For many people it is a big learning curve - so different from what they have been taught about the best way to lose weight.

In many ways it is so much easier to make good choices when there are specific limits in place, things that are good and others that are bad.  For me, tracking my foods with limits or levels in mind for my carbs, fats, proteins, etc. gives me that structure to work within. 

Tom and I went to the Farmer's Market the other day and he stopped by a bakery stand to get something and was upset that I wasn't going to get something, too.  But I knew I would be able to find a snack that worked for me and just a few stands away I bought a packet of almonds which I enjoyed. In the past I would have felt let down that I "couldn't have" a yummy pastry, but right now I am happy with the better choice for my health and my goals.

TYPICAL DAYS

 I mentioned in my last post that I would list a typical day or two of eating at 4 months post op.

I start each day with about 1/4 cup of grape juice with my potassium supplement mixed in.  Then I usually have a protein hot chocolate and a protein bar.  I make my own and I have an assortment of them from different companies. I try to make sure they are at least 10 g of protein. So usually my breakfast is between 20-30 g protein.

This is what the taro one looked like!

Mid-morning I have a snack, right now I am enjoying Trader Joes Protein Banana Muffins - 7 g protein but 22 g carbs, so I don't eat them too often! Otherwise I might have some sunflower seeds, nuts or finish my protein bar from breakfast.

Lunch is when I get the most variety and opportunity to experiment.  Costco had a good price on Bay Shrimp so I bought a few pounds and portioned them into baggies and put them in the freezer.  If I take one out the night before, it is thawed enough to add some chopped celery, mayo and seasonings.  I have been putting it in a container with 1/2 avocado and it makes a great lunch with some Wonderslim crackers - 19 g protein. I also look for soups with higher protein and add the protein pretzels or crackers to up my intake.

The other day my boss took me to lunch at a Dim Sum place (I managed to get a customer to finally pay off a $10,000. bill he had owned since last April!) I had almost 4 pieces of Dim Sum.  I am terrible about the names, but one was shrimp in a translucent wrapper, two were minced shrimp and pork dumplings and one was taro with something in the middle.  It was great and I was thrilled that I could eat so much.  I suspect the "wrappers" added up carb wise - but what the heck.  It was a treat!

In the afternoon I sometimes have a protein bar/chips depending on how much I ate for lunch and when I managed to take a lunch break.

Dinner, for some reason, is the meal that I have trouble with.  By the end of the day I am hungry but my stomach is easily upset.  I usually have a small portion of chicken and few bites of veggies.  One recent dinner I added about 1/4 of a potato skin (potatoes scooped out but with butter and salt!)  I have been trying out a lot of recipes from low carb cookbooks to expand my dinner menus. If my protein isn't adding up to 90-120 g for the day, I have a protein drink or another protein hot chocolate.

For a treat, I love to have my red grapefruit sections.  The other night I was wanting something different so I melted some semi-sweet chocolate chips and put roasted almonds in the melted chocolate, spread them out on wax paper to harden and broke them into pieces.  A few of these nuts is a nice treat with hot tea at the end of the day.

3 MONTHS POST OP WEIGHT LOSS SURGERY

I finally hit the 3 months mark this week.  I don't know why it feels like such a milestone, but it does.  I guess it is the point where most post-op's feel more settled in, get the labs done and the mystery of how the body is handling things is illuminated.

I feel settled in some ways, but my bowels are still a daily question.  I have been trying to decide if I am lactose intolerant and can't determine an answer.  I have yet to determine the issues behind the days I am in the bathroom repeatedly vs. the more normal days.

I managed to eat two bites of beef stew meat* but then last night some roasted chicken upset my stomach.  I can only eat a couple of bites of egg and many foods still set off my gag reflex.  One day I can eat smoked salmon with a little cream cheese and the next day I can't.  I did have a couple of salads this week - it was so great to have that fresh, clean crunch again.  The salads may have been behind the gastric distress - but they were worth it! So each day is still an adventure.

The small amounts I can eat also pose issues.  I made a batch of "protein pancakes" on Sunday.  The entire  batch is a serving - 6 little pancakes.  I could eat 2.  So the breakfast I had hoped would be 19 grams of protein was only 6.

I finally got my special order potassium supplement from the pharmacy and started it on Friday.  It is just awful stuff.  "Fruit flavored" stuff to mix into water or whatever and it is sour and gross.  I experimented with adding it to different things this weekend with little success.  It is going to be a hard thing to take every single day...

But I am focused on the pleasures.  My grapefruit, more salads, a little pile of sunflower seeds I munch at my desk.  Not to mention that I am down 78 pounds.  My closet is pretty empty and I can't even believe the stuff in there fits me - it all looks so small!



* I make all kinds of things for my husband's dinner, including beef which is not yet advised post-op.  I tasted a couple of bites for tenderness...

AN OLD LOVE IS BACK IN THE DIET

One of the many things I did to prepare for my weight loss surgery was to get off the prescription drugs I had been taking for atypical migraine and for high blood pressure.  Those medications restricted me from eating grapefruit - which I have always adored.  So for about 13 years I have not had grapefruit - until today. 

I was in the produce section of the store and saw these little cartons of red grapefruit (unsweetened) and it suddenly came to me that I could eat it again!  I bought one little container to see how I tolerated it, and it was heaven.  I thought about it all day and stopped on the way home and bought a big container - equivalent to 10 grapefruits. 

I just had some more for dessert!

YUMMM!

Just had this soup for lunch and I am thinking I might run out to the store to get more...so good.  It is two servings which I ate about an hour apart - so I got a whopping 18 grams of protein from this meal.  I especially liked the crunch of water chestnuts.  The mushrooms are a bit few and far between but there are some nice big carrots and other tasty veggies and chunks of chicken. The broth is super delicious...okay - going back to the store for more!

FOOD NOW

I was on You Tube looking at some videos a friend directed me to - nothing to do with weight loss or surgery - but I saw there were also some videos done by weight loss surgery post-op people so I clicked over.  Guess those Internet cookies do hook people in...

Anyway.  there was a young woman talking about her experience 12 weeks out from surgery. She sounded very sad and I can relate.  While it is exciting to lose weight at such a fast pace, to hear the compliments from others - having your world turned upside down is difficult.  For many people, food is a pleasure.  Planning meals, cooking and eating is a big part of our lives. Those of us who indulge in too much food have a set of problems that people who can enjoy without going overboard don't have.

One of the little talked about effects of weight loss surgery is that you not only lose your appetite, you lose your enjoyment.  Things taste different, things you liked to eat not only don't taste the same they make you feel bad when you eat them.  And I am not talking about indulgences - I mean things like eggs or yogurt or chicken.

The young woman in the video was sad about this, worried that it wouldn't change back and she wouldn't achieve her dream of becoming a chef because of it. I worry , too.  I struggle to get the 800 calories a day I am supposed to be eating.  Most days I don't.  It is hard to eat when you feel bad and nothing tastes right. 

I went to the movies the other night and took a chance on a small bag of popcorn. I felt pleasure in food for the first time in 10 weeks.  It tasted good.  I nibbled slowly and made it through almost half the bag in the 3 hours I sat there.  I am not "supposed to" be eating carbs - but  it was worth bending the rules to know I could feel that pleasure again. Then yesterday I was cutting up a pineapple and I ate 3 chunks of it - oh, my.  It was so good. 

So the old pleasure is there to be had - right now not in the protein foods I need to be focused on, but it's there waiting for me to be healed and healthy again.

BUILDING A ROUTINE

I finally updated my statistics to show my yo-yo activity of the past few months.  I hated putting a gain for December because I had started off so strong and had been losing until the end of the month when it all reversed! 

Working 5 days a week is really helping me stay on track.  I have breakfast and a good sized lunch and then pack my dinner to take with me to work at 3.  This keeps me out of the kitchen during the hours I am most likely to snack and otherwise run my calories up.  I have gotten past feeling hungry when I get home after 11 by breaking my dinner into 2 parts and having the second part around 8 pm.  Then when I get home a cup of tea is enough to help me relax before bed. 

Lately I have been relying on the "protein pretzels" from Lifestyle for part of my dinner.  I can dip them into hummus or eat them with some string cheese or Laughing Cow soft cheese.  I have a couple of carrots and celery sticks and a little tomato and I am full.  My second dinner break favorite has been 1/2 cup each of strawberries and vanilla Greek yogurt -   kind of like a dessert.

I have been managing my calories at 1200-1350, and I am back to losing 2 pounds a week.  Next step is to up the exercise intensity and hope my knees continue to feel strong.

Plus, 2 more days and I get a manicure!