Two Week Check-In

HW: 254 SW: 243 CW: 225

So I hit a big of a stall. Tomorrow will be the fifth day if I am still stuck at 225. A lot has played into the past two weeks, though. I started back at work, which was tough at first, but I survived. Each day I felt as though I was gaining stamina.

Problem came with the protein shakes. Everyone is different. Everyone will have some things that are harder for them than others. Some people breeze right through the diet. Some people struggle significantly. My main issue was that, being a picky eater, the only flavor of protein shake that I like is chocolate. Now I'm not sure if it was the powder, the milk, or a combination thereof, but my chocolate shakes were making me very ill. I tried to buy different brands and even bought vanilla to mix it up, but nothing was working. I got sick from both ends, and it resulted in a lot of physical exhaustion.

I sought help from my support group message board, I doctor, and friends and family. However, I think everybody thought I was just being picky and having a tough time dealing with the strictness of the diet. It finally got to where I knew I had to do something, though. So I took one day and just stopped drinking the shakes. I still made sure that I was getting lots of protein through other means, but did not drink the protein shakes. That day was yesterday. I felt like a huge illness had just been cared. I still don't know what it was about the shakes that did not sit right with me, but I know that they were making me very sick.

Now that I have figured it out, though, I went to GNC nutrition stores today and bought myself some unflavored protein. I mixed some with a tomato bisque soup and some reduced fat sharp cheddar cheese on top and it was amazing. It is good to know that I have figured out some methods that are working a little better for me. I would encourage anyone having an issue with the diet or anything related to talk to your doctor, but don't let your self give up just because somebody thinks you might be over embellishing. There's no reason you should have tofeel lethargic, exhausted and so sick that you have no energy. You are on a path to getting healthy.

So, I am about 10 days out from my next phase. I'm very excited to get to introduce fish and most other soft foods into my diet. I am definitely seeing a physical difference. My face has lost so much weight, every time I look in the mirror I am almost a little bit startled.

Made it!

Sorry for not posting from the hospital. I was so whooped from all the meds that I didn't want to deal with anything but what was going on in the moment. 

The surgery went well, without any complications! On the downside, I got severe nausea. Since there was no food in my body, I kept dry heaving, which made for an even more painful stomach. Due to the nausea, I was kept an extra day in the hospital for observation.

As the hours passed, though, I began to do better and keep more fluids down. So, finally, they let me go home. My incision points for the laparoscopy were bandaged up nicely. I was told to sip fluids frequently, and get up & walk to promote healing. 

Tomorrow will be exciting as I go from the  liquid diet to the puréed food diet. Soups and cottage cheese and all of the yummiest I haven't had in awhile. Of course, I still have to get down 3 protein shakes per day, but it's worth it.

From this point on, any posts will be updated with HW & CW. In Bariatrics land, these stand for Highest Weight and Current Weight. We use these to celebrate our progress. Currently...

HW = 254.0

CW = 236.7

Will update more soon! If you ever have questions, leave a comment and I'll reply as soon as I'm able.

Tomorrow! Tomorrow! It's only a day away...

Tomorrow is the big day! I'm pretty nervous, but stoked all the same. I know that the first few weeks will be very challenging both physically and emotionally as I am in pain, returning to work, only drinking liquids and eating puréed food - but what's three weeks for a lifetime of health and happiness?

Today I had to have clear liquids only, which seems pretty standard for any major surgery. So I'm indulging in decaf green tea, crystal light, chicken broth and lime jello. So far, it's actually not so bad. It helps to have such a huge motivator to get through it. I'm sure tonight I'll be trying to justify how steak juices are clear liquids, too. lol

I have to be at the hospital at 6:00 am, so I will post updates as I can! Keep me in your prayers and I'll see you from the Losers Bench!

Motivation!

There are so many motivators for the surgery. 

Things I won't miss?

1. Clothing stores that don't have a section for women my size.

2. The sheer terror of swimsuits.

3. Backaches!

4. Seeing how my sisters belt fits my thigh, not my waist.

5. Having to grab my sock to hoist my foot up to tie my shoe.

6. Feeling invisible.

7. Getting fat sweat. Yes, it's as traumatic as it sounds.

8. Not being able to keep up with my kids.

9. Hindrance to intimacy with my husband.

10. Seat-belt extenders.

11. Feeling extra squished at movie theaters or concert halls.

12. Not being able to see my feet.

13. Having no trendy clothes in my shopping section.

14. Exceeding the weight limit for certain activities.

15. Not being able to enroll in the military or police academy.

16. Having to 'shove the chub' in bed to get comfy.

17. Not pursuing acting or theater opportunities due to exclusion from good roles.

18. Getting asked how far along I am in my pregnancy.

19. Knowing that if zombies invade, I'm toast.

20. Feeling so ugly.

Things I look forward to?

1. Belts!

2. Dresses!

3. My back feeling better.

4. Running my first 5K.

5. Increased energy!

6. Not being limited in my career and hobbies due to my body shape.

7. Not being depressed.

8. Getting to shop for cute clothes!

9. Knowing I've added years onto my life.

10. Playing football with my son.

11. Not being afraid of swimsuits.

12. Having my husband teach me to scuba dive.

13. Being a healthy example for my children!

14. Confidence.

15. Being able to walk without so much pain.

16. Being an example to others suffering from the obesity disease and considering surgery.

17. No longer being the fat sibling.

18. Running with my youngest child.

19. Having boots fit over my calves again.

20. Feeling beautiful for my husband and self.

I Dumped Him...

Today, I broke it off with the one who's been my crutch, my addiction, for so many years. I said goodbye to Diet Coke. After having not had one for well over two weeks now, and knowing that after tomorrow I can't have one for quite a long time again, I decided to treat myself to a 12 ounce can from the vending machine today. 

Instantly, I felt guilty for having bought it. I didn't even want to open it. But as he always does, Diet Coke enticed me enough that I popped the cap open and took a sip. Something strange happened this time, though. It didn'tfill any craving or satisfy any taste. In fact, it didn't even taste the same as it used to. I tasted some syrup–like tastes that I did not really enjoy. I took one more sip, to make sure that it wasn't just me. But it wasn't. 

Diet Coke and I just were not meant to be together anymore. So I turned the can over, and poured it out. I'm not his girl anymore. It was a telling moment, letting me know that I really am ready for the surgery. But I really am committed to the changes that I need to make.

Day 5 Pre-Op: Carb Withdrawl

So today is day five of my 14-day pre-op diet. I truly thought I'd be dead or completely gone crazy by now having to give up carbs, sugar and soda all at once, but my body has been responding well, so it's helping. 

I am amazed that I don't miss the Diet Coke at all. I figured that'd be the biggest challenge, but cutting back the past month and having my body go into confusion over the denial of multiple things at once seems to have put Diet Coke Withdrawl on the back burner. I'll take it!

The biggest challenge so far has definitely been the carbs. I'm a huge carb fan. I love me some potatoes, bread and butter, rice, noodles. That's the best, but not when prepping for bariatric surgery. Right now, they're as evil as a Snickers Bar. So, how do you cope?

My biggest tools have been to, drink, drink, drink. My protein shakes have a lot of protein and that also helps tide over my hunger, but also by drinking lots, I'm feeling fuller. I bought sugar-free drink packets (my favorite being Crystal Light's Pink Lemonade) to flavor the water so it doesn't get monotonous and it's helped a lot. Finally, stay busy. The worst is when you're bored and you want to go get snacks, but you can't. Keeping busy helps keep the mind off of it.

I have to say, my family has eaten out three times and al three times I avoided the carbs. It's not been easy, but it goes to show how much I want this. Eating out on restrictions will be in another blog entry. For now, wish me some resiliency! 9 days until surgery! I can do this and so can anyone who wants a healthier life.

The Pre-Op Diet

Today I begin my pre-op diet, which is to be primarily carb and sugar free, and substituting a high protein shake for two meals. The hardest part is definitely going to be not grazing. I'm a snacker, so I keep looking around for a snack but I purposefully didn't bring any. I know this will get a lot easier once I get all the sugars out of my system, but it's definitely going to be a challenge.

I talked about my surgery with my dad last night and was pleasantly surprised with how interested and supportive he was about it! He was asking all sorts of questions and kept professing how proud he was of me for making such a bold move to get my health back in control and how happy he was for me, knowing that I was going to feel like a whole new person six months from now. He knew Bariatrics wasn't the easy way out but talked about how much faith he had in me. I definitely didn't expect it, but was happy to have the encouragement the night before my pre-op diet started.

So, today will be interesting. HW is 254.4. CW is 251.8. I'll probably be ravenous by dinner time, but oh will I be happy to see that broccoli!

Dream Vacation

If I lose 100 pounds, I want to go to Jamaica.

Save the Date!

So, I got my date!!! I'm super stoked. They called on February 6th and asked if I could do it on the 25th, with my pre-op classes and such on the 20th. Totally threw me off, since I didn't think they were going to be able to get me in until April. Unfortunately, as I'm currently training for my new job, I had a mandatory training day on the 20th. She had another slot open for surgery on March 4th, though, so I took that one. It is probably for the best, though, as I would have had to start my pre-op diet almost immediately and I didn't have all the stuff for the protein shakes, etc. yet. I was able to go online over the past few days and get the stuff ordered.

Supplies have begun to arrive, and it's exciting as they come. As many know, protein shakes end up being a big part of your life during Bariatrics, so having the right products can make a world of difference. We are allowed to buy Whey Protein or Whey Isolate, but since Isolate is absorbed easier by the body, I went with that. Torani Brand has a huge line of Sugar Free syrups that can help keep you from getting bored with the standard chocolate and vanilla you're otherwise stuck with. And while I've also heard good thing about the vitamin brand Bariatrics Advantage, I chose to go with doctor-approved Celebrate Vitamins which taste as good as the others and cost less.

25 days to go!

APPROVED!

Well, it's now February 1st! I called the insurance company the other day to find out if my doctor had requested authorization for the surgery yet, and much to my excitement, I found out that not only had they requested authorization, but that I was APPROVED! I almost couldn't contain my excitement. I wanted to tell the whole world, but I knew there was still waiting to be done.

At this point, once the doctor receives hard-copy proof of the approval (the insurance company sends it to them), then they will send it over to the hospital scheduling department. I am anxiously awaiting their call.

Having just started a new job last week (yay me!), I was told that the company would be issuing us five shirts. We had to pick which colors we wanted and list our size. Of course, to rub it in, it was my luck that the shirts supposedly run a little small, so I had to order 3X's. I told the secretary, in confidence, that I was going to be having the surgery soon and she said not to worry, that I would be able to trade the shirts in as I shrink.

It was actually nice because mentioning it to her made her open up about how she wants to explore bariatrics for herself and her 340 lb. husband. I told her of all the amazing success stories I keep hearing of, and how everyone consistently appears nothing but completely apprehensive before the surgery, but then raves about how it saved their life and it was the best decision they ever made after the surgery. It was yet another reminder of how the stigma of this much-needed disease treatment is keeping people sick and ill.

My husband and I took some 'Before' shots this past couple of weeks. They were pretty much humiliating, but I am proud of myself for having taken action and am feeling secure knowing that I will be getting rid of this painful disease soon, with the help of amazing surgeons and some hard work on my part, couple with the loving support of my family.

A friend recently showed me this photo and it's provided more inspiration than anything I have seen so far. So, I will leave you with this and look forward to talking to you all more soon!

Check Your Head

It's been a few days since I've posted. Today, I went to the psychologist. I was nervous about this one. Mainly, just because I did not really know what to expect. My surgeon had recommended a couple places for this pre-surgery requirement, and I confirmed with this selected doctor that they took my insurance. Luckily, they were able to get me in with only about a week and a half notice.

I think it's important to understand that you don't have to be nervous about this appointment. First off, it's no mystery to the doctor why you're there. There's no weird, awkward silences. Secondly, they're not there to judge you, or to determine if your reasons for wanting the surgeon are virtuous enough. What I learned quickly, is that it was simply an insurance requirement for the psychologist to gain information from me about my lifestyle and motivation for the surgery, to just deem whether I am mentally stable or not. They are trying to rule out any major mental health concerns that could have someone seeking such a surgery for unhealthy reasons.

After talking to the doctor for about fifteen minutes in a relaxed atmosphere, he sat me privately in a small room where I took approximately thirty minutes and answered ~160 True/False questions that were part of a personality test, of sorts. Again, it sounds worse than it was. The test actually went quite quickly, and the questions were along the lines of - "True or False: I often think I am not worthwhile of my family's affections," or: "True or False: I have one or more friends I can turn to in times of need." Now, those aren't verbatim, but they give a general idea. As you can see, it's easy to discern how they are likely trying to disseminate whether someone is suffering from major mental health concern or not.

Doctor said he'd write up my results over the weekend and send them over Monday! Easy-peasy!

Next up is my Nutritionist visit on Monday. I am super excited for this appointment, as I know it's going to be the best insight so far into what I will be expecting after the surgery, and as I move forward with my weight loss.

Start the Tests!

After my first consult, I went ahead and scheduled all of the tests and consultations the doctor required. My first ones were bloodwork, an EKG to ensure my heart is healthy and an ultrasound to check out my liver, gallbladder and the like to ensure those are good also.

For those who have never had to have an EKG or ultrasound, let me comfort you in knowing that both are painless procedures. An EKG involves a medical professional placing several stickers connected to wires around different spots on your body. Now, for females, you may have to lift a breast as two stickers do have have to go near the upper left rib cage area. Then they scan you and a fancy machine prints out your heart results. They remove the stickers and you can leave. Start to finish, it took me all of five minutes.

The ultrasound requires you to lie on your back while wearing a hospital gown. The doctor let me keep all undergarments and my pants on. They did not make me remove the hospital gown, just leave it open them back. After you lay down, the technician puts a warm jelly-like substance on you and presses around with a smooth handheld device. It does not hurt at all. Sometimes they may have to add a little bit more of the warm jelly. This did take a while. I believe this part of the procedure took about 15 minutes, and then she had me lay on my left side where she did about five more minutes of scanning. After that, I sit up, she left, and I was able to put my shirt on and be done.

Honestly, the hardest part of everything was getting my blood drawn. I'm not a huge fan of needles. I don't have a phobia, per se, but I'm very hard to poke. Luckily, my hospital was awesome and had a very skilled phlebotomist who was able to get me on my first try. All in all, I spent about three hours at the hospital. Most of that time was in waiting rooms. I did not experience any major pain and was able to drive, and did not need anybody with me. If you want somebody there for moral support, though, just make sure they have a good book!

When Diets and Exercise Aren't Enough

The closer I get, the more confident I am becoming that I have chosen the right path. A publication given to me from my doctor stated the following, and it is such a summary of my fight against weight loss and many of my family members who I've seen battle with it their entire lives:

"WHY DIETING AND EXERCISE MAY NOT BE ENOUGH TO FIGHT OBESITY
 
Because your body works to defend it's set point, dieting and exercising are rarely effective in helping people with obesity achieve and maintain a healthy weight long-term. When you go on a diet, your body thinks its being starved and its survival instincts kick in. As a result, your body stores energy-rich body fat, and you can't lose weight easily. A landmark Swedish study found that, on average, a 200-pouind patient fighting obesity with diet and exercise alone would only be able to achieve a sustained weight loss of 4 pounds over 20 years.
 
UNFORUTUNATELY, YOUR BODY'S HORMONES ARE WORKING AGAINST YOU
 
When weight is lost, lower body fat levels trigger hormones that encourage the body to get back to it's previous weight set point. A New England Journal of Medicine study showed that while dieters may initially lose weight, their bodies change levels of hormones that encourage weight regain in response to the weight loss. These hormones increase appetite, decrease feelings of fullness, and slow down metabolism. The study also found that these hormones had not returned to pre-diet levels even 12 months after the initial weight loss, meaning their bodies were still encouraging weight regain a year after they stopped dieting. This is a powerful defense mechanism and may explain why the majority of weight loss attempts fail.
 
BARIATRIC AND METABOLIC SURGERY CAN RESET YOUR SET POINT
In order for a person with obesity disease to achieve significant long-term weight loss, the body's weight regulation system must be reset so that the body will stop storing excess fat. By altering the complex relationship your body has with food and its metabolism, bariatric surgery helps reset your body's ability to effectively manage weight. New research indicates that some types of bariatric surgery (gastric bypass, sleeve gastrectomy, and billiopancreatic diversion) have metabolic impacts that enable a new, lower set point, allowing the body to return to a lower body fat level. By altering the anatomy of the stomach and/or intestine, these surgeries affect hormonal signals, resulting in decreased appetite, increased feelings of fullness, increased metabolism, and healthier food preferences. These positive changes allow your body to lose weight without the internal fight to return to the higher set point.
 
Bariatric and metabolic surgery is the most effective treatment to date, resulting in sustainable and significant weight loss along with resolution of weight-related health conditions in up to 80% of people. Bariatric surgery has been also shown to resolve diabetes, sleep apnea, joint pain, high blood pressure and high cholesterol."

Initial One-on-One with the Doctor

So, today, I met with my doctor and we had a major change come up. He indicated that due to my age, he did not know if Roux-En-Y would be the best choice for me because of how drastic it changes your digestive track, as well as the fact that you have to be on a strict vitamin regimen for the rest of your life. He suggested I have the Gastric Sleeve done, and after having explained the differences to me, he sold me. It will take more self-regulation of not eating sweets or other high calorie food, but overall, I think it's going to be a far better choice for me. It involves the Restriction without the Malabsorption. The valve and small intestine are completely kept in tact, and there is a far shorter recovery time.

They had me meet briefly with the insurance consultant who gave all the orders for the supplemental testing and meeting I needed to have to qualify. I scheduled appointments to meet with the nutritionist, psychologist, and get my blood work, EKG and ultrasound completed. These are all standard and need to be done by all candidates for the surgery. They check to make sure you're of healthy mind and body before going into bariatric. So, I have several appointments over the next week and a half or so, but I'm excited to get the ball rolling!

Here is a great side-by-side comparison I got from http://www.gastricsleeve.us/gastric-sleeve-vs-gastric-bypass.html about the difference between the Sleeve and the RNY. You have to choose what's best for you after discussing with your own doctor.

Weight Loss Procedure	Gastric Sleeve	Roux-en-Y Gastric Bypass
Approach to Weight Loss	Restriction Limits food ingestion Controls hunger sensations	Restriction & Malabsorption     Limits food ingestion Reduces food absorption
Changes to Stomach	Stomach size reduced 75-80% of the stomach is cut away along the greater curvature and removed from the body	Stomach size reduced and new stomach outlet (stoma) created     Stomach is separated into two and stoma is created in the smaller upper pouch; lower remaining portion of the stomach is bypassed
Changes to Small Intestine	Kept intact	Cut and rerouted     Small intestine is cut in the middle; upper section is bypassed and lower section is attached to the stoma
Changes to Pyloric Valve	Kept intact	Bypassed
Average Operating Time	1 to 3 hours	2 hours
Average Hospital Stay	2 to 3 days	2 to 3 days
Average Time off Work	2 weeks	2 to 3 weeks
Average Recovery Time	3 weeks	3 months
Causes Dumping Syndrome	No	Yes
Dietary Guidelines	600-800 calories per day, during weight loss period 1000-1200 calories per day for weight maintenance Meals should consist of high-protein, low-carbohydrate and low-fat foods Drink 6-8 cups of water or other low-calorie liquids per day	800 calories per day during weight loss period 1000-1200 calories per day for weight maintenance Meals should focus on protein-rich foods and nutrient-rich fruits and vegetables Drink 6-8 cups of water or other low-calorie liquids per day Chew foods thoroughly into a pureed consistency
Eating Habits	Eat five small healthy meals each day Do not eat and drink at same time Do not overeat, skip meals, or snack between meals	Eat three small protein-rich meals each day Do not eat and drink at same time Chew foods into a pureed consistency Do not overeat, skip meals, or snack between meals
Problematic foods	Not many problematic food as the stomach continues to function normally, but high-calorie and high-fat foods and drinks must be avoided and daily calories limited for weight loss to occur	Foods that are dry, sticky, or fibrous can cause discomfort or blockage, including tough meat, bread, pasta, rice, raw vegetables, nuts, popcorn, and skins of fruits and vegetables, and chewing gum Sweets can cause Dumping syndrome Carbonated beverages can cause bloating High-calorie, high-sugar, high-fat foods and beverages will ruin weight loss efforts
Nutritional Supplements	Multivitamin Calcium Vitamin B12	Multivitamin Calcium Vitamin B12 Iron
Average Weight Loss	Studies show greater than 60% excess weight loss at 12 months after surgery and a maintained excess weight loss of 53-69% at 5 year follow-up.(1)	Rapid weight loss during first 6 months Weight loss settles 18 to 24 months after surgery 70% excess weight loss at 1 year 60% excess weight loss at 5 years

REFERENCES

1. ASMBS Clinical Issues Committee, "Updated Position Statement on Sleeve Gastrectomy as a Bariatric Procedure," Surg Obes Relat Dis. 2012 May-Jun;8(3):e21-6. doi: 10.1016/j.soard.2012.02.001. Epub 2012 Feb 10.
2. Bethany J. Slater, Nina Bellatorre, and Dan Eisenberg, "Early Postoperative Outcomes and Medication Cost Savings after Laparoscopic Sleeve Gastrectomy in Morbidly Obese Patients with Type 2 Diabetes," Journal of Obesity, vol. 2011, Article ID 350523, 5 pages, 2011. doi:10.1155/2011/350523.