9 MONTH "SURGAVERSARY"

Today it is 9 months since I had my BPD-DS weight loss surgery.  I have lost 126 pounds and am 4 pounds from my original goal.  I think back to the day I went to Mexico and remember being excited - not nervous at all.  I was sure this was the right thing to do then and so grateful that I had the opportunity to have it done. (Thanks Christina.)

Tom and I went for a bike ride last Sunday and as we were leaving a neighbor I don't often see came over and asked if I was "disappearing". Like many others she asked how I was doing it and I said diet and exercise.  I feel right saying that - I am dieting and exercising.  The surgery was a tool.  My tiny stomach makes me eat less and I am very careful about what I eat.  I am more open with some people about the procedure and answer direct questions more factually - but for most people I simply say I don't eat much and that is the truth.

I occasionally want to say something to obese women I see, especially the ones out and about with their kids.  This has been such a liberation for me and I wish I could confer it on others.  I don't say anything to these women but I wish I could find a way to let them know the value of this, and if their insurance would cover it (unlike mine) urge them to consider it.  I wish I had been able to have it done years ago.

It is not easy.  There is no easy.  But as difficult as things are sometimes and as restrictive as my diet can be, I am so happy that I had the surgery.

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.

4 MONTHS POST - OP WEIGHT LOSS SURGERY

Next week I will be 4 months out from my surgery. I basically feel much more "normal" in that I am not so tired, I am exercising and I can eat a larger variety of foods.  My weight is already down 63 pounds since the surgery and 83 total.

What follows may be TMI for many people, but as I know I have readers looking for info on the post-op experience from the BPD-DS, I may get a bit personal!

I had purchased the 60 day DS kit of vitamins and recommended supplements from Vitalady before the surgery, but whenever I tried to take them I threw up.  The chewables have gotten me through as I healed but I am trying out the "real" stuff this week.   I have 4 packets to take each day, they need to be taken with food in my stomach (I learned that lesson the hard way when I waited too long after dinner to take them the other night.)  Since they are capsules and tablets of all sizes and shapes, it does take many, many sips and swallows to get them all down.  Difficult to manage.  Then comes all the burping and stomach discomfort. Everyone says it gets easier and I am counting on that but I really miss the ease of the chewables!

My doc had me go back to the lab to re-test all the areas where I was low, especially the potassium and I am all good now!  In fact, I went in on Saturday morning, sailed through the lab quite quickly, walked over to radiology and lucked into a walk-in appointment for my mammogram.  Wow - what a great difference having smaller and less dense breasts makes for that particular annual event! 

I am adding  (I can't believe I am saying this knowing how hard it is to take all the stuff I am taking now) a pro-biotic to my regimen to try to get my bowels in order.  I know that all the diarrhea I have been experiencing is not good for maintaining my good nutrition levels and I have read that the pro-biotics can help. I am not sure what is causing the bowel issues.  I keep my dairy pretty low.  I am afraid it may be the salads which is sad because I so enjoyed having them.  I promised myself I would not have one this week to test it out - so we'll see.

Otherwise, I am tolerating meats much better, I even had some thin slices of rare skirt steak the other night.  Eggs still make me gag as do homemade protein drinks.  I need to be VERY mindful when I am eating to go slow.  I usually violate this when I am eating at my desk at work - I get pain from stomach to throat which feel like the food is stuck.  It takes 15-20 minutes to subside. If it happens at home I can lay down which helps.

My portions are still in the 1/2 cup per meal range so I rely on high protein snacks to boost my protein up to the 100 g range each day.  I will post some food logs later in the week to show what I am eating and how it all adds up.

BRA SHOPPING - I DIDN'T NEED TO SEE THAT

For the past month or so I have put off shopping for new bras.  As we know, gaining and losing weight are bra shopping occasions and I have lost a lot of boobage.

I went out this weekend and was professionally measured.  My bra size didn't change all that much, but I was probably wearing them too small in the first place.  I tried on about 15 bras at Penny's and not one fit.  I went down the mall to Lane Bryant and tried about 7 more.  None fit.

I was a distressed and sweaty person so I went home.

The reality is this.  I have a lot of loose, saggy skin hanging around my armpits. It needs to be contained.  And those padded, push up bras make my breasts look puckery.  Not a good look.  I like a simple, unpadded bra.  I don't care if my nipples might show.  When did everyone get all weird about nipples?

I was disheartened and tried to explain to my husband why I came home in such a state.  He was really sorry he asked.  He didn't want to think about the saggy, armpit skin thing.  Ever.

I braved another shopping trip this evening and got lucky at Kohls.  The key to dealing with sudden weight loss saggy stuff is an Olga bra. There were several of them that fit very well and managed to manage the flesh.  Plus they were BOGO1/2 off.  Nice since I suspect I'll need new ones again in a couple of months.

ONEDERLAND



Not past this sort of attitude - but on my way...

 My body is in onederland.

That is fat speak for making it out of the 200 pound range into the 199 and lower range! 

It is the promised land for many of us.  And a place I have not seen since the early 1990's.  Now let's see if I can make it to a weight I have not seen since the 1980's...

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...

TURNING THE CORNER - POST-OP DAY 13

Okay now.  I feel like I may just make it after all.  First of all, I had managed to misunderstand the instructions about taking the antacid medicine and should have started it right away.  Oops.  The first time I took it I felt terrible, but now that I have taken it for 4 days - well, it may be the reason I feel so much better, or it may be because it is just 4 more days into the healing process.

Today is the first day I have managed all of my fluid and 46 oz of protein.  Whoo-hoo.  I would still rather not eat at all, but I am doing it.  In a couple of days I will try adding in some of the whey protein again.

HOLA!

I am here in Mexicali Mexico, sitting in a very nice hotel room with CNN on the TV so I can watch the debate!

I flew to San Diego this morning from San Francisco - it was pouring rain, the first of the season.  It created some challenges, but I made it to the flight on time.  I was worried that things were off to a bad start when my credit card was turned down at the check-in counter.  (Of course I only brought one with me so I am going to have to call the bank when I have cell service,)  I got on board and found the flight full except for the seat next to me - hurrah.  I could put the divider up and be comfy without upsetting someone with taking up more than my fair share of space...

I had my pre-op tests at the hospital, met the 2 surgeons and got the news that I could eat dinner.  I was shocked!  They seemed a bit surprised I was sent a liquid diet to follow this week.  Oh, well.

So I had 1/2 a very tasty hamburger with mushrooms and 4 french fries.  Whoo hoo.

These are some photos of the hotel:

 Pretty tile in the bathroom.

 This is what they brought for turndown!

I will probably be out of it for a day or two before I report in from the hospital, and I promise not to take pictures of my incisions!!

THE LAST CHEW

My dinner tonight will be the last one I chew - at least for a couple of weeks!  I am going to have salmon cooked on the grill and some zucchini.

Tomorrow I go off the 2 protein drinks and a "lean & green" meal to liquids only. The only positive thing I can say about this change is no more sweet flavored protein drinks.  I just don't care for sweet drinks and a month of them has been too much for me.

I took the opportunity to experiment with with different protein powder samples. Since protein supplements will be a lifelong commitment, I need to find what works for me. One I tried is "unflavored", though when I stirred it into V-8 it was pretty bad.  I can see stirring it into soup or yogurt or something already sort of thick.

Nector brand protein powders come in fruit flavors in addition to the usual chocolate/vanilla/strawberry. The grapefruit was actually quite good, tart and natural tasting.  I ordered a bunch of that. 

When I look at the choices I have for the next 5 days I realize how picky I am.  I am supposed to have sugar free jello for dinner, but I don't like most jello flavors.  I know I can flavor up the broths to make them interesting and palatable, but I can't choke down chamomile tea.  Yuck. 

The first couple of days I can have "drinkable yogurt." I have yet to find any fat free versions, so I may have to go a bit off plan and use the low fat version.  And, of all things, grape juice is the other allowed item.  That I can do, I remember having grape juice and Lorna Doone cookies in the hospital after giving birth and it tasted wonderful!

I am down 14 of the 20 they wanted off pre-op - so I am right on track at 5 pounds a week.  The last couple of days I have been hungry but before that I have sailed through.  Wish me luck for this liquid diet - a new experience for me...

NO MORE BREAKS!



Site of many cocktails...

 We had a really nice trip to Yosemite last weekend.  It's funny how we occasionally slipped into talk of the future, post-surgery me.  Partly because I spoke aloud some of my "last time" thoughts.  Last time I would be drinking a rum and tonic or having wine with dinner (for at least 6-12 months). Last time I would try the bread put on the restaurant table - maybe forever.  And next time I would be able to hike longer without my knees hurting so much.

I admit I did a couple of things this anniversary trip that I have not done in YEARS. Now - get your mind out of the bedroom and back to the table...I actually ordered lunch with the homemade potato chips!  I always order the "healthier" side dish or ask for no side dish.  But homemade potato chips with BBQ seasoning?  I went for it. Actually,  I made the server take my plate away before I would eat them all.  They were amazing!  I'm glad I ordered them because as good as they were, as memorable as they were - eating them did not set off some sort of need to have more chips.  which is good to know. 

This is something I have admired about Cammy of Tippy Toe Diet.  She makes room in her plan for "treats" and they don't trigger her to  overeat.  Seems like I may be on my way to that, too. 

COUNTING DOWN THE DAYS

In twenty days I will be having my weight loss surgery.  Sometimes I feel so elated that I am surprised to hear others on the forums expressing their fears.  I know it is going to be painful and hard while recovering and I know it is going to be life changing but I feel as if I am being given a second chance.

This made me laugh.

My husband and I talked about it the other night.  He has now had time to absorb the idea and do a little of his own research.  We talked about some of the restrictions - beyond the pre-op diet I am currently following - he was pouting a bit about my not having cocktails when we were out.  We talked about how some people go through weight loss surgery and then don't change their habits or pay attention to the restrictions, which confounds me.  He said that in the 30 years he's known me I am such a healthy eater that he didn't think I will have a problem. Isn't it nice that he sees me that way? 

Many people assume if you are really big, like me, you must eat entire pizzas or order for 2 in the drive-thru and then eat it all. I have never been able to eat a lot at a sitting. Buffets are wasted on me. Plus, I hate to feel full.  I know I eat more than I should - even healthy foods have calories and they can add up.  I snack and nibble too much between meals.  I go on the occasional candy or baked goods bender.  But my new "plumbing" will prefer small meals through the day and the candy or whatever simple carbs I might want will give me gastric distress.  Good incentive to avoid them!

The duodenal switch surgery is the best for long term "getting back to normal" eating.  From what I can tell, the amounts remain small for life, the need to fill protein needs and take vitamins are first priority and the rest is pretty individual.  Some people can't tolerate dairy, some can, same with sweets and alcohol.  Some people even say their taste buds are different.  Foods they loved  don't taste good anymore.  Interesting how tied in all of our organs are!

So, 20 days to go.  I am down 7 of the 20 the surgeon wants me to lose, but I admit I am going to take a few days off from the protein drinks this weekend while we go to Yosemite for our 28th anniversary!

MOTIVATION

I got word today that I am set to have my surgery on October 23.  I also received a very strict diet to follow prior to surgery and a suggestion from the doctor that I try to lose 20 pounds before then. He wants my BMI down 3 points!

The diet is basically 2 protein shakes and a "lean and green" meal, preferably at lunch. The week before surgery is a little different; more variety in the protein and as few carbs as possible. I feel confident that I can do that, with the exception of the weekend getaway we have planned for our anniversary. 

That trip actually had a lot to do with my making the decision to go ahead with the surgery.  Tom was talking about going hiking and bike riding and I felt so bad and embarrassed that I have gotten to the point that I can't do those things.  At least not for long and not easily.  My knees have gotten so painful that I can't sleep well some nights and my gait is really different.  I miss being graceful.

I have been wearing my gym shoes to work every day and walking for 5 minutes here and 10 minutes there throughout the day.  I need to build up my stamina and strength, both for the trip and for the surgery.  More than anything - and I mean this- I look forward to being able to exercise.  I have always liked my gym time, hard as it may be to fit in.

I like the idea of looking better and shopping in regular stores, too,  but I have no illusions that this old body is just going to snap back.  I am going to get Tom to take some "before" pictures this week to put aside. I have taken my measurements already, bought my post-op vitamin and mineral supplements and some samples of high protein foods and supplements.

Making this happen.

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.