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.

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!

STALLED ON THE BRINK

For two weeks I have been waiting for those 2 pounds to drop.  When that happens,  I

will have lost 100 pounds since I started my BPD-DS journey.

It has come to this.  I have stalled.  It always happens.  It happens to most people on weight loss plans.  Our bodies settle in, find equilibrium or whatever it is called.  That and I am probably eating too many carbs. 

I love fruit and have gone from eating very small amounts of grapefruit or berries a couple of times a week to munching on grapes and mango and even some kiwi. Sigh.

I also bought some whole wheat bread for my daughter when she was home and ate 2 pieces of it, toasted, with peanut butter and honey.  Now the bread has been sent to live in the freezer until the next time she comes home.

Further transgressions came in the form of Dark Chocolate Covered Almonds from Sprouts.  Even though I only had 5-8 per day, they are now banished. I bought them after I tasted a sample, then I checked out the nutritional info on the website and there is more added sugar than I expected considering the taste and that it is made with dark chocolate.  A deceptive little treat.

The last sin against my low carb diet is - I made risotto.  And it was good.  I could only eat about half a cup of it, including the added chicken and arugula - but we are talking white rice here. 

So for the past two weeks all I have lost is more hair! 

I have learned my lesson - back to logging all my meals and snacks on Sparkpeople. I'll hit the scale again next week.

STOP FRETTING OVER FAT - SUGAR IS THE KILLER

Dr. Nancy Appleton, author of Suicide by Sugar, actually lists 146 reasons why sugar is ruining your health. Here are just a few of them:

(1) Sugar is a cancer cell's favorite food. Even without having cancer, we all have a few cancer cells floating around.

(2) Sugar creates glucose spikes that force the pancreas to produce insulin more often and beyond it's normal capacity. This wears the pancreas down, limiting insulin production that leads to diabetes. Type II diabetes is insulin resistance, which is preceded by metabolic syndrome at least partly attributable to high sugar intake.

(3) A depleted pancreas can't provide sufficient proteolytic enzymes to bust open cancer cell walls and render them defenseless from the immune system's killer cells.

(4) Processed sugar and fructose are stripped of all mineral content and wind up leeching minerals from our bodies, including our teeth. They also inhibit mineral absorption, including magnesium. Magnesium is a commonly deficient and vitally important for over 300 metabolic processes.

(5) Sugar is addictive. It stimulates central nervous system neurotransmitters dopamine and serotonin, giving you a pleasant buzz to crave more and promote overeating of processed foods.

(6) Many nutritional experts attribute the rise of obesity and cardiac problems to higher refined carbohydrate and sugar consumption. And the condensed fructose in HFCS is absorbed first by the liver, which cannot metabolize it all and has to store accumulated fructose as fat creating fatty liver.

Obesity, diabetes, and heart disease became epidemic after low and no fat diets were introduced while sugar and HFCS were increased in processed foods and beverages.

Chobani Blueberry Greek Yogurt

When manufacturers took out the fat from many of our foods, they added sugar to make up for the flavor and texture that was lost.  For example, (and this is a great illustration) read the labels on the non-fat yogurts we all think are so healthy.  They are full of sugar!  Just try to find a flavored yogurt on the market that has little or no sugar...

And honey?  That's sugar, don't let the name of the sugar fool you.  There are now dozens of names for sugars.  Read the Carb portion of the label to get the totals,  the ingredient list can be misleading.

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.

DOWN 10 MORE

This is hard to explain but sometimes I worry that I will just keep losing weight until I disappear.

Don't take that to mean this weight loss is easy.  It isn't.  I work hard to meet my nutritional needs every day.  I have to take a lot of nasty vitamins and supplements 4 times a day. My diet doesn't have a lot of variety and while I am experiencing more hunger, most of the foods that sound good are off the table either because they are carb heavy or because when I go to eat them they don't taste good or feel good in my stomach.

I am loving being down 90 pounds!!  I am actually down  119 pounds from my highest weight a couple of years ago. I intend to lose at least 40 more.  Maybe 60 more.  That would get me to the weight I worked really hard to maintain in my 20's, so it seems unrealistic - but maybe not!

I had a good session with the trainer at they gym and have a long list of exercises geared to make me stronger and, with any luck, help fill in and take up some of the slack skin.

I don't think I'll disappear - but I am working to be a new, improved model of myself.

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.

A BIG DECISION - A LONG POST

In the weeks prior to our high school reunion, I was e-mailing back and forth with my good friend.  I was talking her into coming to the event (she has been my date for all the previous reunions) plus it is pretty much the only time I get to set eyes on her.

 Suddenly the topic changed and she asked me if I had ever considered weight loss surgery.  I told her I had gone pretty deep into the pre-op planning about 8 years ago before we lost our coverage - why?  Well, turns out she would like to help me pay for it.  It was one of those "life turns on a dime" moments.  I said I would look into it and we would talk.

Turns out my insurance company not only doesn't cover it - they won't cover anything at all related to it, ever.  They were very emphatic!  Wow.  I got the feeling they had put me on a watch list just by inquiring!

So then I looked into the options.

Eight years ago I had planned on  the Duodenal Switch which is a reduction of the size of the stomach itself and then a re-routing of the intestines which creates a "malabsorption" effect.  It is considered the riskiest, most complicated surgery but the life long weight loss, maintenance and reduction of other weight related problems is the best. It is the only surgery which allows, over time, for me to eat somewhat normally, drink alcohol and take Nsaids. Considering my arthritis - I need that! There is a significant vitamin regimen and certain foods will likely cause distress - like refined carbs and sugar. But apparently it is different from person to person.

They also offer the "Sleeve" which is just the reduction of the stomach size but leaving the pyloric valve, which some of the other surgeries, like the popular Roux en Y, removes.  The new popular one is the Lap Band which is an inflatable band positioned at a spot around the upper stomach.  It can be inflated or deflated to alter the size of the pouch for food to be digested and slipped through into the rest of the stomach.  It is the easiest and least expensive surgery but there are lots of issues with the way you can eat and what you can eat and it requires frequent adjustments (ongoing costs).  There also seem to be a lot of ways to circumvent its effectiveness - not that I would set out to do that...

Anyway, I researched and went on weight loss forums and blogs and learned more than I wanted to know about the different types and how they have affected people and I came back around to the DS.  The DS costs between $30,000. - $40,000. Hard to pin down  (and why the range?), but that is the way our health care works in this country.

My friend and I talked and the amount of money she is offering is not going to cover my surgery of choice.

More research, and the answer has been found. They call it "Medical Tourism."  Going out of the country for medical care which is priced much higher here. 

I am communicating with two surgeons in Mexico and the cost for the same surgery plus a longer hospital stay is  $11,000 and $13,000.  Both are highly rated, very experienced surgeons working out of hospitals.  I have communicated with a dozen of their previous patients and read, probably 50 testimonials and blogs and other writings about them. Can't find anything bad about them - no complaints; more than I can say about some of the US surgeons and hospitals.

Plus, by circumventing all the BS that the US docs do (which runs up the costs) I can get a surgery date in weeks instead of 6-12+ months.

I also discovered a number of post-op people who have taken to YouTube to chronicle their experiences.  YouTube seems to attract a certain kind of person, at least on this subject.  Let's just say they like to hear themselves talk.  There are glimmers of good info, but for the most part - not so much.

However, the benefit of YouTube is the visual. For the topic which concerns most of us very large women it is:  what happens after the weight is lost?  What remains?  Answer:  Lots of skin.  The women brave enough to show it prove that it is not pretty.  In fact, it gave me great pause.  The likelihood of being able to afford plastic surgery is slim to none. 

That shut me down for a couple of days.  No - in truth, I went on a bit of a binge.  After all, when stressed - eat.  How crazy is that?

And yes, I know that having this surgery will mean big changes to that particular issue of mine.  I have given a great deal of thought to it and also read a lot about it.  I know that there are people like Carney Wilson who managed to circumvent the surgery and gain weight back and I don't want to be one of those people.  This is my opportunity to make the changes that need to be made.  Like one guy said on a forum: "I went into surgery a fat guy and I came out as a skinny guy.  I decided to live that way the rest of my life." 

The surgeon required a low carb, low fat diet for at least the week or so before surgery.  I had pasta for dinner tonight and that is going to be the last time for a long time.  Maybe forever.  It will be worth it.

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!