Countdown Day 7

My feet feel skinnier.  Yeah, you heard it, feet.  You’re jealous, huh?  

In the morning I went to my surgeon’s office and met with the surgical coordinator, Mary Ann.  She made sure that all of the pre op procedures had been faxed to her: mammogram-check, ekg-check, abdominal ultrasound-check, blood work-check, chest x-ray-check, endoscopy-check. You’re really jealous now, huh? Prescriptions for Actigall, Norco, and Prevacid were prescribed for me to take post surgery.  Actigall is so that my chances of developing gall stones are reduced to 5%, Norco for pain management (which I hope as all get out that I don’t have much of), and Prevacid for stomach acid reduction which will help with my ulcers.

Disappointed that the gastroenterologist, Dr. Sidhom, (Yes, doc, you’re being thrown under the bus, feel that?) didn’t test me for the H. Pylori bacteria during the endoscopy, Maryann gave me orders to go to LabCorp and have a breath test done.  So far I’ve only been taking Protonix for the ulcers, but if it turns out that I test positive for the H. Pylori bacteria, I need to begin 1 of several rounds of antibiotics to get rid of it.  She did not think this would hamper my surgery date, whether I test positive or not.

The upside, and only upside, of this diet: 10 pounds of weight loss in 7 days.  It’s been so hard and I have a miserable headache today.

Mid-afternoon, I scarfed 3 Werther’s sugar free caramel cappuccino hard candies like a wild animal.  I just want coffee!  Just a little coffee flavor helped a little.  Just a little.  In an attempt to describe how hard this is, every time I smell food I want some, just one bite, please.  Oh, that salad looks SO good.  Oh, greek yogurt, looks so tasty.  Oh, that hummus looks so inviting.  Rice cakes even look amazing right now.  All those mouthwatering recipes on Facebook, you’re killin’ me!  Today when I walked outside, I thought I smelled corn chips.  Weird.  This is why I don’t diet.  It’s just ALL consuming for me.

In the late afternoon, my last appointment was a pre-op appointment at Huntington Memorial Hospital. I’ll be there again for a pretty awesome sleepover.  Now you’re really really jealous, right? Wanna come?

As Day 8 comes to an end, I’ll leave you with a couple of interesting Ted Talks weight loss and dieting. Peace y’all goodnight.  I’m gonna breathe out some of my weight while I’m sleeping.  You’ll understand if you listen to the Ruben Meerman Ted Talk.

He answers these fundamental questions: “When somebody loses weight where does it go? How does it get out of your body?”

Sandra Aamodt is a neuroscientist. “Your brain has it’s own sense of what you should weigh no matter what you consciously believe.” About 7 minutes through the end of the talk is totally worth a listen.  Her conclusion based on her research experience, “What if we told all those dieting girls to eat when their hungry? What if we taught them to work with their appetite instead of fearing it? I think most of them would be happier and healthier and as adults many of them would probably be thinner.”

 

Cold Turkey Countdown Day 13

Cold-Turkey-No-Chew-Diet-from-Hell, is what this pre-op diet should be called.  I like to chew my food more than I thought. There was very little chewing allowed, except for the popsicles.  I gave up starving myself long ago. Today totally felt like I was going back in time to my high school and college days of self deprivation.   Living with plenty is my way preferred way of living.  Some might say eating in plenty is gluttonous, and yes, sometimes it is.  However, the days of poring over a journal of calories and such is just…exhausting and drains the life right out of me.  Gastric bypass is the only way, for me.  I must have a near immediate consequence for eating this way.  Anticipating an outcome is all that is motivating me at this point.  Knowing there is an end in sight is all that challenges me to continue this cold turkey way of eating.

Today’s menu, if it can be called that: 2 commercial protein shakes (I use Pure Protein), Vitamin Water, Bai Cocofusion water, 2-8oz cups of chicken broth, 8oz cup of decaf tea, 2 sugar free popsicles, and sugar free jello.  Ugh.  So boring.  You may have noticed there are no real proteins, fruits, or vegetables allowed on Dr. Lamar’s pre-op diet.  I’ll be eating the same way 2 weeks post surgery.  The ONLY reason I’m sticking it out today is, as I’ve read, if you don’t follow this diet, surgery may be cancelled if your liver hasn’t shrunk to an appropriate size.  The liver must decrease in size prior to surgery to allow the surgeon to lift the liver and reach the stomach effectively.  This video is by another bariatric surgeon that explains why the liver must decrease in size.

Feelings check:  I have a terrible headache this evening.  No sugar and no caffeine have made today most unbearable.  I’ve been in and out of the house taking my kids to various activities and running errands. I’m marathon watching episodes of Downton Abbey and avoiding the kitchen.  If I knew I had to be this hungry indefinitely to lose weight and ultimately cure diabetes, I’d give up. I’d much rather be heavy and happy.  My heaven will be eating whatever I want, not gaining weight, and having no consequences as a result of what we eat.  I’m laying it bare here.  Did I say how much I hate diets?  12 days left until my surgery. 12 more days until the BIG DAY. Ba-dum-dum.

O*!sity- A Label

I love label makers. I love to categorize things and put them in the same drawer, take a collection of books and put them all on the same shelf, sort office supplies and place them in compartments in my desk.  I love searching the categorized aisles at the store find just the right product. We humans naturally label things. We naturally make patterns and put things in categories. We do the same thing with people. This label, obesity, is my most unfavorite label.

Feelings check: **Sigh** Every time I see the word, obesity, it makes me feel very sad. And I don’t just have morbid obesity, I have, wait for it—morbid (severe) obesity. I know it’s a label. I know it’s a medical term based on specific data, however, the word, obesity, carries a stigma. Unlike with other stigmas, mental illness, learning disabilities, being born into poverty; obesity, morbid obesity, morbid (severe) obesity all carry this unwritten inner dialogue, the unwritten inner dialogue is, “You made yourself obese. You could have prevented it. What’s wrong with you? Why can’t you control your eating? Why don’t you exercise more? You’re nothing. You’re fat. If only you were more disciplined.”  Sure, I can choose to not identify or agree with this inner dialogue, however I wear my label.  I can’t hide it. It’s there, in the rolls of belly fat.

It seems odd, but if I’m honest, one of the things I’m afraid of after my surgery, is being thin. Believe it or not, I remember days in my late teens and 20s when I was thin, and received compliments on my appearance and whistles as I walked down the street.  That objectifying, is the part of being thin that I’d like to avoid. I’ve grown to accept my ‘heavy mom’ identity. I’ve grown to love who I am in spite of how I look.  Embracing myself at any weight helps me to embrace others.  I don’t want to simply be loved for what I look like. These are qualities I treasure. These are qualities I cherish in other people. In a way being heavy, has made it so I have to love and reach out— in spite of labels.

So why not just stay obese?  Well, there are the complex effects of long-term obesity and comorbidities and specifically the effects of diabetes, that convince me to go ahead with Roux-en-Y gastric bypass (RYGB). There are many articles on the subject of Long-Term Mortality after Gastric Bypass Surgery at New England Journal of Medicine.  Diet, exercise, and medical therapy have not been shown to be effective in treating severe obesity in the long term” -see more at Long-Term Impact of Bariatric Surgery on Body Weight, Comorbidities, and Nutritional Status.

In my January nutrition meeting, the most impacting take-away was that I need to chew my food to applesauce consistency. What?  Have you tried this?  Whether you realize it or not, chewing and swallowing is pretty much involuntary.  We don’t think, “Oh, chew 1, 2, 3, 4…25…30, yup, applesauce consistency, swallow.”  No, we don’t think. We’ve learned from a young age, just how much we have to chew our food in order to not choke.  That’s it.  Simple. Chew. Swallow. Repeat.  There’s not a lot of mindfulness involved in that.  However, I’m supposed to change over 40 years of eating habits.  Here are the three steps of mindful eating: 1) tuning in to the physical characteristics of food (Oh, this salad is really crunchy. Mmmm.) 2) tuning into the repetitive habits and processes of eating (Sit at the table instead of standing or sitting in front of the TV.)  3) tuning into mindless eating triggers. (Even though you’re starving, Joy, wait until you get home instead of eating in the car.)  I definitely eat mindlessly.  Can I get a “Hells yeah!” from the moms in the audience? If we’re honest, most of us eat mindlessly. We are surviving this thing called Life…come on.  Can I get an “Amen?”

So back to label-making.  I’m going to think of it as what it is, a label.  I can rip off that label and make a new one, right?

Ain’t Nobody Got Time for That!

The-Time-Traveler-Surreal-art-by-Xetobyte

Foggy, unattached, surreal, this is how I feel about the surgery.  In the midst of all the Christmas preparations, there was a 4th nutrition appointment with Lori and a consultation with Dr. Troy Lamar.  When Dr. Lamar asked which surgery I’d like, gastric bypass or gastric sleeve, I said I’d like gastric bypass.  He said I am a good candidate & proceeded to tell me how the insurance companies calculate my ideal weight.  At 5 feet, 5 inches, my ideal weight is 125 pounds.  Then he said I’d realistically be between 140 and 160 pounds when I plateau at my weight loss goal.  This is where surreal comes in.  When I was in high school, I was starving myself to be thin, and before there were Fitbits, I walked circles in my National City  block obsessively, dozens of times a day to burn off all the calories I had consumed that day.  Yes, this same frame, once held a meager 109 pounds.  

Let’s be clear, I wasn’t healthy, in my head. I was miserable and desperately trying to compete with an imagined and completely unrealistic ideal. Now, 25 years, yes over 25  years later, I can’t believe I’m STILL revisiting this topic of weight loss.  I despise it, like cooked spinach as a side dish, or mildewed laundry, or whining children, this topic of weight loss is my nemesis.

Now I’m much healthier, in my head. Years of therapy and deep relationships have helped me get here. The time has come to help my body become healthier.   Feelings of ‘cheating the system’, come to mind.  I can’t help but feel like I’m taking the easy way out.  The ‘if I only’ song plays in my head, if I only had more will power, if I only ate more vegetables, if I only exercised more, if I only resisted the See’s Candy box.  Then I remind myself that I HAVE gained and lost pounds at different times over the past 25 years, and with none of these attempts, have I maintained significant long-term success.  So, I go full circle back to the research, “Back in 1991, the National Institute of Health, made a consensus statement, they said that basically anybody who as a body mass index that’s greater than 40 or greater than 35 with associated co-morbidities, the only long term solution to their weight problem is surgical intervention” Asok Dorasiwamy, MD, FACS.  (See video below.)  My BMI is below 40 but I have the co-morbidities of sleep apnea and diabetes which make me an ideal candidate for gastric bypass.  Moving forward, I know that for me, there’s more of a likelihood of weight loss success long-term, with gastric bypass, than continuing to simply ‘eat healthier and exercise.’  Continuing to berate myself for lack of willpower in the weight loss department will likely turn out to be another 25 years of unsuccessful weight loss attempts.  I’m too healthy and smart to continue down that road.  This has become one of my fav phrases to keep it real, when there just ain’t no more time for nonsense.  “Ain’t nobody got time for that!” 😉

This picture is exactly how Dr. Lamar looked in the consultation.  Here are more details about the differences in weight loss surgeries.

 

Identity of a…

fatty, lazy, slob, overweight, obese, chubby, portly, plump, large woman.

I am definitely not defined by the above mentioned descriptors, but we’ve all heard them.  I’ve worked through the pain of these descriptors since I was a young girl.  When I was in junior high in Whitehouse, Texas, I can remember it like it was yesterday, standing in the band room as I was TA for Mr. Gober, and looking at my side profile and shaming myself for having a big belly.  “Why do you have to look so awful with your shirt tucked in. You’re fat. You’re ugly. Why can’t you look more like Michelle Thum?” Michelle, my dear friend and fellow TA, of course, had a very flat stomach, and oh, how I wished I could look just like her.imgres

I have since learned that flat stomachs do not equal happiness. So, in this path toward gastric bypass, I am having to face my motivations and history of weight management or lack thereof, head-on.  Facing anything is a shit-starter, (as Brene Brown would say).  We all face different struggles in life, and for many of us, our greatest enemy is ourselves.

I am 1/3 of the way through the hoops I’m jumping through toward gastric bypass.  Many fears arise, like, “Will I be able to manage my starches and just have 6 a day?” “Will I be able to eat just 1,500 calories?” “Will I be able to consistently exercise?” I don’t know the answers to these questions, but I do know that beginning to lose weight will be an incentive to keep going.

At yesterday’s nutrition group, one of the women asked, “I want to know WHY I eat like this, and if I have the surgery, will I be able to change this?”  It’s a good question.  The nutritionist recommended a monthly group in Arcadia in which people at all different stages of the gastric bypass, those pre-surgery and those several years post-surgery, go for support.  For me, the reason I eat the way I eat, is years of practice.  Practice makes, PERFECT, or in this case, a whole lotta extra weight.  Will I be able to make this change? Stay tuned.

As I move through life at my current weight and post-surgery, I prefer these descriptors of me, as a person: resilient, resourceful, brave, kind, hopeful, compassionate, and gritty.

My First Nutrition Appointment: Hoop 2 Gastric Bypass

The office was surprisingly quiet as I was the only one in the waiting room.  The waiting room was pleasant with several ‘oversized’ chairs available for those whose hips wouldn’t fit comfortably in the regular-sized chairs.

Today I met with the nutritionist, Lorrie.  First, the weigh in and height measurement.  She walked me through what’s to come over the next few months.  At intake, she asked questions like, “When do you think you started creeping up to your current weight?” (Post pregnancies.)  “What’s your highest weight?” (I’ll decline to state at this time…here.)  “What was your lowest weight?” (109 lb anorexic-like at 17.)   “What weight loss programs have you tried?” (Weight watchers, Atkins, Curves Diet, Personal Trainer/eating plan, Oreo Diet at 17 years old: eat 1 oreo, because oreos are good and if I only eat 1 and NOTHING else in 24 hours, I’ll lose weight.)   After the overview of my weight loss history, the next step was, “Take me through a normal day of what you eat.” Oh brother, here we go.  Yes, I get to admit how bad I eat, can’t wait!

  • Here goes:  Morning- coffee with 1/2 n 1/2, 9:45 protein bar.
  • Lunch at El Pollo salad with avocado & dressing, beans, chicken, rice.
  • Snack time: worst time after school- hunger & stress- trail mix, piece of chocolate, whatever else I can find in my cabinet at school.
  • Before dinner dinner: Laughing Cow spicy chipotle cheese and gluten free crackers, Kevita or Kombucha drink, gotta get those probiotics in.
  • Dinner: Whatever crockpot meal I have prepared, usually some sort of chicken/protein and starch potatoes or rice, with a salad.
  • After 7 or 8pm: Yogurt with chia seeds or occasional ice cream.  I told *Lorrie, I know I don’t eat enough fruits and vegetables. She validated me and said, “Well that’s honest.  *She’s been through sensitivity training or maybe she’s naturally empathetic. It’s working, thanks Lorrie!

I’m tired, after just writing that bullet list.  Writing what I eat EVERY bite seems, just ridiculous, tedious, and life-sucking.  Yet, this is what I’ve had to do over the years to lose weight.  Yes, I know that journaling what you eat is supposed to make you more successful in the weight loss process. <<Insert Forrest Gump voice here.>> Not gonna do it, after sitting through Weight Watcher meeting after Weight Watcher meeting, I realized something… I really don’t want to be one of ‘those people’ that weighs her underwear to make sure she’s picked the lightest pair in her drawer.  I don’t really want to wear the same clothes to weigh in so I can MAKE SURE I don’t gain weight on my Saturday morning weigh in.  Letting the scale have power over my mood, my week, my outlook on life was just plain ridiculous and it goes back to that navel-gazing idea that I posted in my first post about being obsessed over what happens on the scale.  I don’t want to be 65, at a Weight Watcher meeting, banking points for the upcoming event so I can eat a few bites of birthday cake.  Is it just me, or is this just so, so, so depressing?  I want to eat cake, dammit.

Speaking of depressing, Lorrie, “So, you talked about trail mix, let’s look at the nutrition in trail mix.”  Serving size for an average sized back of trail mix: 6 servings.  Each serving: 150 calories. Multiply that by 6 and yes, mathematicians, you got it, a whoppin’ 900 calories. Collective, Ugh!  I just wanna eat trail mix, dammit. 3500 calories, that’s what it takes in deficit caloric intake to lose a pound of fat, so I need to cut back on the trail mix. Sometimes I just feel paralyzed.  What do I eat?

Movement was the next topic, move more.  Try to move at work.  Start with 10 minutes and move up to 30-45 minutes 3-5 days a week.

I asked about emotional eating &  post surgery, if I am emotional eater, will I actually feel hunger pains, would I feel full?  I’m so used to not feeling full. I just eat to satisfy the need to fill something.  I don’t eat because I’m hungry, I eat to soothe myself.  Lorrie said that I was asking good questions, that I would feel full after eating just a small amount because my stomach will be smaller.  She said we’d go over what to expect post surgery in our upcoming appointments.  We’ll be having our next 5 sessions in a group, with others who are going through this process at the same time.  If I do my part, she said, I’d probably be ready for surgery in February.

As far as ‘feeling full’ goes, I’ll believe it when I feel it.  Right now, I’m going to still eat trail mix and cake, just maybe a little less, and move a little more.  Hoop 2 jumped through.  5 more group nutrition classes to go.

August 5, 2015

The Symposium

How did I get here?  It sounds like a symposium should be in a gradual slanted college hall with a panel of experts arranged on stage.  Actually it was a room of rectangular tables and cushy conference chairs filled with people who were as unsure as I was.  Some with knee problems & hip problems. Many much older and much heavier using walkers to balance.  All of us with struggles with food and many beaten down by this struggle we call not-so-affectionately, obesity.

Hard facts: I qualify for bariatric surgery because I have a BMI over 35 and I have sleep apnea and diabetes. Many insurance companies will not pay for the surgery unless you have 2 other health issues in addition to a BMI above 35.  For example, high blood pressure, arthritis and other diagnoses would also be approved as conditions for becoming a bariatric candidate.  All that to say, my Darth Vader mask and inability to control my sugar have made it possible for me to have this surgery.  Blessings do come in unexpected ways.

Dr. Troy Lamar began his presentation with a short video of testimonials of 3 people who have had success with Gastric Bypass and how it changed their lives.  His presentation continued with many facts and details about what to expect with either the Roux-en-Y Gastric Bypass (RYGB) or Gastric Sleeve.  He does not perform Lap Bands, as the long term effects are not as effective for many reasons.

The fascinating and eye-opening fact that I did not know was how ghrelin, an appetite hormone, functions in our bodies.  “The normal response is that ghrelin levels are higher when you are hungry and they go down after a meal, but people who are diabetic or obese have the opposite response,” she said. “They tend to have lower fasting ghrelin levels and then after a meal ghrelin levels don’t go down like they should.” Ghrelin Article.  So basically, gastric bypass changes how this hormone functions.  This, in turn changes appetite and how your gut functions.  Over 200 gut hormones are altered post RYGB so the acid in the lower part of the stomach can no longer reach the top part.  Dr. Lamar referenced this article, Dr. Adams New England Journal of Medicine, on quality of life post-RYGB.  Another hopeful outcome post laparoscopic surgery is, many patients are back to work within the week.  I assumed the recovery time would be much longer.

How do I feel?  What are my feelings about possibly having this surgery?  I abhor before and after photos, especially the ones where the person is frowning at the heavy weight and smiling profusely in the ‘after’ photo. Sure, losing weight will help me fit in smaller sized clothing, but it won’t change my history with food, my feelings about often being the heaviest female in the room, or who…I…am.  I need to say this, my love for myself is not contingent on the number I am on the scale.  This has taken me MANY years to come to terms with how much I weigh.  I realized that navel gazing (literally and figuratively) is just that, navel gazing.  When you are constantly commiserating and wishing you could be something else, you’re rarely content.  I decided long ago to become others-centered rather than self-centered because that’s where the real ‘Joy’ is.  Another phrase that has always irked me is ‘letting myself go’.  “She let herself go,” you know you’ve heard it, or said it, or thought it.  Guess what, letting self go isn’t always a bad thing. The world might be a lot better if we let go of self.

That said, living longer and healthier is my ultimate goal in proceeding with RYGB.  I feel fine now, but I was able to look into a window of the future of what I might be in 20 years if I don’t have the surgery.

I’m on this path.  Symposium finished.  Next step, six months meeting with a nutritionist, following that a psychological evaluation and shortly after, RYGB surgery.