Tag Archives: Weight

 

<--- this pic is where I started

this pic is where I am now -->

I actually started this post back in March, when I was 7 months post-op.  Work, grad school (#gradSchoolSucks btw), family issues, etc. derailed my good intentions to start writing regularly again.

May 17 was my 9 month anniversary of surgery.  I met with my surgeon and my rheumatologist that week.  They were both very happy with my progress.

There are days when I wonder what the heck I did to myself. But they are few and far between, and usually right after I've eaten 1 or 2 bites too many, or eaten something that my sleeve disagreed with. Most days, I really can't complain, and would do this surgery again in a heartbeat.

My rheumatologist believes my rheumatoid disease (RA/PsA) is in remission.  She'll re-do all my bloodwork in August and see where it stands.  Right now, I still have some joint aches, but it's mostly minor.  I seem to have been right about the meds causing a thyroid issue, because all of the associated symptoms are gone.  I am now off my RA/PsA meds, we are tapering off the meds for fatigue, and I accidentally stopped the migraine prevention meds without tapering but didn't have any issues.  Since surgery, I have gotten off (or am currently tapering off) 5 medications, including all blood pressure medicine, the med for fatige, my RD meds, and my migraine preventative.

Back in March, I had to run out at lunch and get some new slacks for work. I had been able to get by through "shopping my closet" for pants I'd stored away years ago thinking "I'll get back into these someday". Well, someday came, and it's now long gone. Those pants from almost 2 decades ago had become too baggy to be respectable, so I took a chance on some lunch shopping.  I went from a 22/24 pant to an off the rack 16.  I couldn't find off the rack pants that fit the last time I was in a 16 as a teenager.  But now "curvy fit" pants are available, and they work for me, as I have a small waist compared to my hips.  I also didn't plan ahead, and did the shopping in 3" heels, without any issues.  That would have crippled me a year ago.

Now at the end of June, those pants are getting loose.  Not so loose that I have to replace them, but starting to look a little sloppy.  I'm now in an adult Large shirt from a 3X.  I bought skorts at Sam's the other day, which never could have happened when I was in plus sizes.  I have lost 102# as of right now.  My BMI is teetering on the overweight/obese line.  One more pound lost, and I will no longer be clinically obese.  I could stop losing weight right now and all of my docs would be thrilled.  But I'm not stopping.  I have another 30# or so to lose to get to my target weight, which I set by looking back to the weight I was the last time I looked and felt awesome.

I still haven't started exercising regularly again since the health issues of the winter/spring.  But I'm feeling good and it's only my insane time pressures with work and school that are keeping me from it.  I have a plan to ease back into the workouts so I can start rebuilding some lost muscle.

Life is pretty darned good from this side, I must say.

 

foodnotmoralThree weeks have blown by since my surgery day.  I'm now eating soft foods and working on getting my protein and other nutrients from food instead of relying on protein shakes.  I still have a protein shake every day for breakfast to get a good start on the day with about 1/2 of my protein goal right off the bat.  But through the day I'm working toward small regular meals with protein to meet my nutrition needs.  It's a slow progression, but it's been steady, and I still have no complications.  (knock on wood)

One of the things I found when I researched the gastric sleeve procedure is that most people lose their hunger drives and cravings.  I was convinced, however, that I would be the one person this didn't work for.  I'm happy to report that this was not the case.  I have to set reminders on my phone to eat and drink because I just don't get the same hunger signals I used to.  This has caused a sea change in the way I see food.

I wish I had grown up with a healthy relationship to food.  For a number of reasons, I didn't.  I know I’m not alone internalizing moral judgments about food - vegetables are "good," ice cream is "bad" for example.  And of course, the biggie - if you're overweight you're lazy, have no self-control, and are "bad".  There are lots of theories as to why our society imposes and reinforces these moral judgments about food.  I don't really care why, I just need to get those voices in my head to shut up.

Here's where the beauty of this procedure comes into play.  The messed up food voices are still in my head, but I no longer confuse them for physical hunger or cravings.  After I was cleared for soft foods, the Mister and I went to the grocery store.  Immediately, I was attracted to this amazing smell from the produce section and tracked it down to the nectarine display.  I have HUGE food issues going back to childhood and have severe anxiety when trying to eat anything out of my comfort zone.  I can't tell you if I had EVER actually tried a nectarine.  We bought a couple, and they were pretty good.  (They'd be better with granola or in a cobbler than by themselves in my book, but really pretty good.)  This is something that would NEVER have happened before.  Then we walked past the Little Debbie display.  Now, Little Debbies, specifically the honey buns, have been my downfall for a long time.  I'd clear out a whole box of them in 2 days before.  The messed up voice in my head said "oooh, Little Debbies.  That would count as soft foods.  We should get some."  Then the part of my brain that imagined actually eating one went, "eh.  Doesn't sound that good."  Walked by with no issues.  Same thing happened with the Pop Tart section on the next aisle.  (Chocolate Fudge Pop Tarts were another gotcha for me in the past.)  It was incredible.

I don't know if this effect will last forever.  But if it lasts long enough to help me establish a different relationship with food, it will be so very much worth it.  I think I could have gotten there with enough time and therapy, and admit that surgery is a drastic solution.  However, it's working so much better than I could have wished for.  It's still too early to say "best decision I ever made" but the evidence is racking up pretty fast for it.

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1345951608-rocky-no-easy-way-out-400x400I'm lucky that I haven't actually had someone say to my face "you're taking the easy way out". Mainly because I'd likely have to contact my attorney about defending me against charges of battery, and that probably gets expensive.

Or assault. I used to think I had the distinction clear in my head (assault is the threat, battery is the actual touching), but I've had people tell me that it's just assault. (But I digress.)

Right now I'm on my pre-op diet. The surgeon calls it a fast, but I do not think that word means what she thinks it means. (Any opportunity for a Princess Bride quote should not be squandered.) She has me drinking protein shakes 2-3 times during the day, and having a "healthy dinner" and can have "healthy snacks" if needed. MyFitnessPal informed me after I closed it out last night that if I continued eating like that, I'd lose 15 lbs in the next 5 weeks. Well, heck. I should just do that, then, instead of having 75% of my stomach cut out, right? I mean, isn't this really just a way to get out of having to have discipline and self control?

One of the things we've learned about dieting and maintaining weight loss is just how freaking HARD it is. Some of us are genetically programmed to put on weight easier than others. That's not an excuse, it's science. Then our bodies adjust to the new weight and fight like a cat in water to keep it on. This is what's commonly referred to as "Set Point". Our brains use a bunch of hormone signals to make us crave salty, sugary, fatty foods in order to maintain the weight the body thinks is correct. When we successfully lose weight, our metabolism lowers and our caloric intake decreases, requiring us to eat even less, all the while fighting against this tide of hormones. Food manufacturers know this, and create convenience foods that are full of the salt, sugar, and fat our bodies are screaming at us to eat. Culturally, we don't expend as much energy as our ancestors, and cram our schedules full so that eating home cooked foods is a struggle. Worse, the more weight you pack on, the worse this uphill battle gets.

Whew. And that's without even touching the emotional and mental barriers we face. Talk about the deck being stacked against you.

Yes, some people do successfully lose a lot of weight. And some of those are able to keep it off for a long time. And some of those are able to keep it off (mostly) for the rest of their life. It's possible. Possible does not mean realistic, though. It's possible for me to become a concert pianist. However, starting at the age of 46, it's really really damned unlikely. Likewise, it's possible for me to lose the 120-140 pounds I need to and keep it off without the surgery, but it's really really damned unlikely. Seriously. A 5% chance I'll keep *any* of it off past 5 years. Surgery raises that chance to somewhere between 50% and 70% depending on the study reported. Commitment to the lifestyle changes can bump either of those estimates up, certainly. The starting line is a little better at 50% or 70% than it is at 5%.

Wait a minute, didn't I just make an argument for it being the "easy way out"? Depends, I guess, on how you look at it. If I am running a race, and it's uphill, is it taking the easy way out to ditch the 50 lbs of sand someone put in my backpack? Is it taking the easy way out to buy good running shoes with good ankle support, or should I just go ahead with the 3" heeled pumps because that's what I was given? I'm choosing to equip myself better for the long haul. To me, that's smart, not cheating.

Let me talk for a minute about how "easy" this is. Once I made the decision to move forward with this, I had to schedule a string of appointments. A seminar with the weight loss surgeon. A one on one appointment with the surgeon. One with my cardiologist. Followed by a stress test with the cardiologist. One with a nutritionist. One with a psychologist to clear me for surgery. Three months of a supervised diet with monthly lectures from the doctor supervising me. Another with my primary physician to clear me for surgery. An upper endoscopy with my surgeon to check for ulcers and hiatal hernias. A follow up appointment with the surgeon about the endoscopy. Another appointment for the final preparations once insurance approved me. Pre-op testing, though I can skip the EKG since my cardiologist had to do a stress test. All totalled, I have spent almost $900 out of pocket for co-payments and co-insurance. I'll spend another $1,000 out of pocket over the next couple of months. (I'm grateful to have excellent insurance, without it I'd have to go to Mexico and it would cost me on the order of $5,000 plus travel, or some $10,000 to $15,000 to have it stateside.) That doesn't count the $1,200 I've spent so far with a therapist facing some of the food issues that would derail this process if left alone, because I'd have that expense if I tried to do this with just diet and exercise.

Now I'm on a two week "fast" and it's hard. The snack machine at my office tempts me every time I walk by to refill my water mug or mix up another powdered protein shake. The fast food restaurants taunt me as I drive by them. I want to EAT ALL THE THINGS because I'm starving, I have a headache, and I'm groggy. Oh, and I have to be off all of my PsA meds for the surgery, so I also have pain in my hands, my feet, my back, and my knees. I can't distract myself with crafts because my hands hurt. I can't take a walk because it feels like spikes in my arches. I'm on day 3 of 14, and I'm fairly miserable.

After surgery, I'll be on a full liquid diet for 1-2 weeks. Then I get to have pureed food for another week or two. Then I get to "graduate" to soft foods like eggs and tuna. It'll be 4-6 weeks before I can have "regular" food again. Even then I'll have to add foods one at a time and be very careful because my tolerances and tastes will have changed, and any given food - or too much or to fast - can make me very ill. I'll very likely be on a fairly restrictive diet for up to a year. Once my system recovers, and I'm at or near my goal weight, I'll get to add foods to my diet in a measured way. 18 months after surgery, my diet should look fairly normal, though with slightly smaller than normal portions.

Meanwhile, I'll have to get creative in order to stay clothed during this time. People report changing a size or more every week or two through this process. I should count myself lucky that it's culturally acceptable for me to wear skirts, because I forsee many months in drawstring maxi skirts. If I were a guy, this wouldn't be as easy, and that might be the first time (and likely the only time) I'll ever say that regarding fashion. Oh, and a lot of my hair might fall out.

But some will still say it's the EASY way out.

No. The EASY way out is to keep doing what I've been doing and not make any changes in my life. The EASY way out is to keep trotting out the tired and worn excuses as to why I can't do better. Not trying, THAT is the easy way out.

Anyone who is out there making changes to improve their health and life is NOT taking the easy way out. Choosing different tools to help make those changes is not taking the easy way out. Dietary changes are a valid choice. Exercise is a valid choice. Surgery is a valid choice. Medications are a valid choice. Any combination of the above and more is a valid choice. Each has risks and benefits that are unique to each person. Not one of these (or any combination of them) is the "easy way out".

So do me (and my attorney) a favor. Don't tell me I'm taking the "easy way out".

convenient-to-bring-wheyI started my 2-week pre-op diet today. 2-3 protein shakes plus a "healthy dinner" each day. Doc said I could have "healthy snacks" if I needed. She's not as strict as some surgeons about the pre-op diet, and I am grateful for that. However, I really need to try and stick to the pre-op diet. The goal of a pre-op diet is to get a little weight loss and shrink the liver, which sits in front of the stomach and has to be moved out of the way for surgery.

Honestly, this phase has scared me more than the surgery itself or the post-op diet. After the operation, it seems the vast majority of "sleevers" lose their cravings for food, and actually have to remind themselves to eat. That effect is what keeps me from worrying overmuch about the post-op diet that progresses from liquids to pureed foods to soft foods to solid foods over the course of about a month.

Before the surgery and the loss of appetite though, I worry about my ability to do this. When I try to restrict, I get incredibly fatigued and headache-y with brain fog, and find myself craving all sorts of things that aren't on the plan. Add to the stress that because of the surgery I'm off my meds which means my chronic pain level has gone up from a 3 or so to a 5-6 and I'm finding the pain causes cravings for comfort food (aka sticky pastries, chocolate, and anything else super carb-y and super sweet).

In light of this struggle, I thought I'd take Monday and Tuesday and do some "dry runs". Breakfast isn't a big thing, since I already substitute SlimFast or something like it for breakfast periodically. It's the 11am hungries that start the problems. For my "dry run" days, I ended up eating a protein bar for lunch. By about 2pm though I was hurting, starving, brain fogged, exhausted... and hit the snack machine.

Today I'm thinking positive thoughts. Drinking lots of water, and I have plenty of protein drinks standing by. I can do this... I hope.

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tom-Bathroom-scale-800pxLast week I got the insurance approval for my bariatric surgery which has been scheduled for mid-August. While I hadn't talked much about it before I started the formal process for approval, I've been thinking about and researching bariatric surgery for several years. There is a general attitude that the surgery is the "easy way out", and lots of people choose not to be public about their choice. While I respect that, I'm a "live out loud" kind of person, so I've chosen to share this with anyone who wants to know. (Kinda obvious since I'm posting it on the interwebs, LOL.) I'll write more about the "easy way out" in later posts.

I've been overweight most of my life, certainly since my teen years. I stayed pretty active though, sports and cheer-leading in junior high and activities like square dancing through high school. So while I was pretty healthy, it impacted a lot of things in my life. I always felt like the Ugly Duckling and didn't get a lot of male interest when I was younger. I never got cast as a lead in a play. I couldn't wear a lot of the fashion trends because they didn't make them in my size. I got teased quite a bit for my "thunder thighs". All in all, it wasn't as bad as some people have it, but things like that do change who you are as a person and how you see yourself.

My weight has been up and down throughout my adult life. I've had good success with diet and exercise for short periods of time - less than two years generally - but it has gotten harder to get the weight off with every lose/gain cycle. The time period after my second divorce and through nursing school is when my weight really got out of hand. I kept thinking that once I was doing nursing and on my feet for 12 hour shifts, the weight would start coming off. I didn't count on developing an auto-immune condition and the associated pain, or that night shift would make it incredibly hard to eat in a healthy way. I was able to stabilize my weight during that period, but I couldn't seem to make the changes needed to start pulling it back down. Then after I had to leave bedside nursing, my weight shot up and crossed the "shoot me if I'm ever that heavy" line.

I started thinking about surgery several years ago after a few friends of mine had gastric bypass and had good results. I was worried about such a drastic option - changing the way nutrients are absorbed didn't seem like a good option to me. I knew several people who had the lapband, their results were dismal and there were some serious complications. I didn't think much else about it until a few years ago when my sister had the vertical sleeve (VSG) done while she was living overseas. She encouraged me to think about it, but I wasn't ready for anything that drastic at that time. Every spring for the last two or three years, I've promised myself that I am going to change my habits and if I haven't lost some significant weight by my birthday in October, I would do the surgery. Needless to say, the weight remains. I still wasn't ready for the permanence of the solution.

Dealing with my auto-immune arthritis had brought the issue to mind again. I started researching it again in earnest after another friend had the sleeve and has had excellent results. I started working with a therapist about my odd food issues, knowing whether I had the surgery or not I would need to address those issues. In April, my diagnosis changed from presumed rheumatoid arthritis to psoriatic arthritis, and Dr. B started talking about biologics. I had done enough research to know that biologics create issues around surgery. Namely that the decreased immune system function caused to mitigate the auto-immune condition causes slower healing and more risk of infection. So I floated the idea to Dr. B, expecting her to say that surgery wasn't a good idea. She surprised me by being completely *for* the idea. What my research had not revealed is that the hormone changes that accompany the surgery - first with the loss of stomach tissue, then with the loss of fat cells - directly and positively impacts the inflammatory processes that are behind the damage with auto-immune. Later benefits of weight loss are less joint pain, losing the CPAP for sleep apnea, and a reduced risk of diabetes and other conditions that complicate auto-immune. The caveat was that sooner was better than later for the surgery, as once we started biologic treatment I'd have to have a much longer break from treatment in order to have the surgery than if we did it prior to starting.

That knocked me off the fence. I went the next night to a weight loss seminar with the surgeon Dr. B recommended, and started the process to get insurance approval. I've spent the intervening time with a series of appointments needed for a supervised diet period, my cardiologist's clearance, a psychiatric evaluation, and my primary physician's approval. My blood pressure has been steadily climbing since last year, but I hadn't considered it high enough to warrant treatment. My primary doc disagreed especially after it was found to be 160/110 in her office. So we had to get that under control before surgery. Being put on two blood pressure meds has only confirmed my choice in my mind. I'll likely be back off the meds by late fall, and potentially will be able to get off my CPAP this winter or next spring.

Two roads diverged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood
And looked down one as far as I could
To where it bent in the undergrowth;

Then took the other, as just as fair,
And having perhaps the better claim,
Because it was grassy and wanted wear;
Though as for that the passing there
Had worn them really about the same,

And both that morning equally lay
In leaves no step had trodden black.
Oh, I kept the first for another day!
Yet knowing how way leads on to way,
I doubted if I should ever come back.

I shall be telling this with a sigh
Somewhere ages and ages hence:
Two roads diverged in a wood, and I—
I took the one less traveled by,
And that has made all the difference.

-- Robert Frost