Friday, December 30, 2011

Photographic Evidence

I avoid cameras like the plague. I hate pictures of myself, because although I'm painfully aware that I'm fat, my mental image of me still doesn't match up with the reality. We took this first set of pictures just before I started the 3-week pre-op diet, so I was down roughly 15 pounds from the starting point. These are absolutely painful to look at, but if I'm going to create a true record of this journey, I need to have them. Ignore the keening and weeping sounds, that's just me huddled in the corner in epic embarrassment.

Beginning of 3-week pre-op (November 8, 2011)

And 1 month post-op, taken just before we left for my follow-up with the surgeon.

I don't personally see a whole lot of change, though the pants are one size smaller. Ugh - you guys can look at these, I'll continue to close my eyes and sing "la, la, la, there's no pictures of me on the internet".

Thursday, December 29, 2011

Surgeon Follow-Up: Cleared for Solid Food!

Hooray! I saw my surgeon today, exactly a month after being admitted for my surgery. He was pleased with my progress, and we discussed several concerns I had - in particular the "Ack! It's an aneurysm!" incident, and my proclivity to burp after ingesting anything, including water.

I've also been feeling fairly weak the last 7 to 9 days, with some blood pressure readings lower than I'd really have liked to see. This morning didn't start out well in that regard, after getting up I took a hot shower, which normally is quite a treat - but suddenly I was feeling light headed, and starting even having a bit of trouble breathing. I hurried to finish rinsing the shampoo out of my hair, and as my vision started getting wobbly, I yelled for the Man to come help me. He got me out of the shower, wrapped up in my towel, and seated on the toilet until I came back around to normal breathing and didn't feel quite so woozy. After I was able to get dried off and into my robe, I sat down at my desk to check my blood pressure: 77/49 - um, not good. I drank some of my protein shake and about 10 minutes later I was at 92/67 - still not great, but 5 minutes after that I was up to 103/70 - normal, if somewhat low-normal. That wasn't fun, so we decided to put me to bed until time to leave for my appointment at the hospital.

One of the things I love about working with Wake Forest is that - at least in Dr. Fuzz's clinic - they're always so prompt. We waited no more than 2 minutes between the nurse's evaluation and Fuzz coming to the room. He was very pleased with my progress - quickly identified that my weakness and low BP issues were the result of dehydration (apparently I've been throwing off ketones like whoah - he could smell it on my breath just sitting next to me). He said to worry less about the "no drinking for 30 minutes before/after eating" rule, than about getting in at least the minimum 48oz of water, and preferably more toward 60-80oz until we get the dehydration under control. He also suggested I add a bit of juice to each bottle of water - just enough to get a small bit of sugar for the extra calories, which should help stabilize the woozies. They sent me on my to the lab (no results back yet) and to see the nutritionist, who gave me some suggested foods information and other materials. One interesting item was a laminated card that identified me as a bypass patient, asking any restaurant that I might choose to show it to, to allow me to order either off the children's menu, or perhaps be served a reduced portion. Any agreeable restaurants would be listed by the program as "bariatric friendly". Not sure I'll use it, but it's an interesting thing to have in your wallet.

We got home, and I tried to eat some left-over "strata" of sorts (not as fancy as most, but more than a scramble), that we'd originally made for breakfast on Tuesday. I'd been able to eat a very small portion then, but today - not so much. It immediately started feeling like it wasn't going to sit well, and unfortunately resulted in my second bout of vomiting. The Man was in the kitchen cooking up some squash for his lunch, and didn't immediately hear me in distress down the hall, but as my last heaves hit - so did the searing pain at the base of my skull again. Thankfully this time not the triad of death pain like last week, but excruciating none-the-less. I cried out several times, and heard the Man come rushing down the hallway. He helped me to bed, and asked if I needed any painkillers or what he might do. I decided on a half dose of the liquid lortab (hydrocodone and tylenol), and a bag of anything frozen we might have in the freezer (a dubious proposition in this house, we use fresh veggies almost exclusively). Amazingly he came up with a bag of peas, and so I knocked back the happy juice and laid back on the peas and hoped it would pass quickly. It took about 20 minutes to take most of the edge off. Our mechanic called while I was waiting for things to kick in; the Man's car was being serviced. Turned out he had a broken water pump - they promised to be finished by the end of the business day, so I snuggled in to watch TV and wait for the call that his car was done.

When the garage called back I was feeling much better. We packed up the presents for his brother, sister in law, niece and her 2 boys, and his nephew, and set out to pick up his car, and then continue on to his brother's house for a belated Santa delivery. Only his brother was home when we arrived, but we had a nice chat for a few hours, looked through a bit more of his mother's things (she passed away back in June), and selected a few of them to take home. As it was getting late, we decided to stop for a quick, cheap dinner - and settled in Chili's. This would be interesting - I went in thinking maybe a cup of soup, or something I could ask for a box to take the bulk of it home. After looking over the menu, I settled on their slider plate - 4 mini cheeseburgers (and fries and such that I'd not eat). I managed to eat one of the slider patties, and nibble a couple of onion strings. The waiter first gave me kind of a quirky smile when he saw me attacking the patty with a knife and fork after removing the bun from the first slider - but didn't say anything to me until the Man was clearly done with his meal, and I was slowing down. He simply asked if I needed a box, and I answered "Yes, please!" with a big smile, and the Man made sure he got a nice tip for not commenting on my eating habits. There's 3 sliders in the fridge - I might end up eating 1 or 2 more patties over the next 2 days, but that's probably it. As time passes, I'd definitely have been able to eat a bit different, and it felt silly eating so little of a $8 meal, but I'll get some more out of it than I did tonight, and I was able to successfully eat out with my husband, so that felt good.

Tomorrow's objective is to find some mini ice-cube trays - a friend suggested putting some of my dilute juice into ice cubes, so I can suck on them. That seems like a fun way of getting some of my liquids in, so I'm going to try and pick some up tomorrow if I feel up to going out.

So - mixed results on food today, but one day at a time, that's all I can do.

Monday, December 26, 2011

Exercise, Water, and Weakness

The nutritionist in my program has been very insistent on exercise 6-7 days a week. I managed that fairly well pre-op, but her expectation of post-op was daunting. Dr. Fuzz said even 10-15 minutes would be a start, but clearly her expectation was to be back up to 45 minutes to an hour a day pretty quickly. I've been working on getting back up there, both in duration and in speed (my exercise of choice right now is walking on a treadmill I've got set up in the basement). Today I did 28 minutes at 2 mph. I've been adding another minute every other session or so - I'll stop at 30 and work on getting the speed up a bit and once comfortable there, I'll gradually add more time. I've got the entire series of Battlestar Galactica to re-watch while I exercise, so I won't be bored for quite a while, which is good - my worry is more about strength. Part of that strength certainly has to do with water - if you're dehydrated, you're not good for much. I've been struggling to meet the expected minimum of 48oz a day. Pre-op, this was pretty easy, as after a work-out, I could practically chug 16 oz, and do so several times a day. But now - I can only get in 2-3 large swallows at a time. I've taken my water bottle down to the treadmill with me so I can drink while I walk, which has helped both the thirst and getting that first bottle of water consumed, but the remainder tends to be troublesome. Not only do I have to sip,sip,sip the water, but I'm not supposed to drink 30 minutes before a meal, nothing during, and refrain for 30 minutes after a meal. Given that the meal is expected to be stretched to 30 minutes too, there's at least 3 90 minute periods in a day that I can't be drinking. I honestly didn't think it would be this hard to accomplish, but it has been. Weakness, however, has been the major surprise. In some ways, it really shouldn't shock me - I'm consuming barely 500 calories a day, sometimes less. Granted, within that I'm getting the recommended amount of protein (the one major dietary component your body can't make for you), but still - that's less than a fairly standard single meal for most people. I knew from all the information they gave me that it would take some time to "completely" get my strength back - some people it takes months. But I didn't really think I'd be starting from this low of a point. My first adventure out of the house by myself came on the 23rd - I desperately wanted to get out and get the Man a few gifts for Christmas (his major gift is on an IOU - he needs to present to pick part of it - and we haven't had the time to shop together). The crowds weren't really an issue, I went pretty early in the morning, but just the act of driving about 8 miles to Target and Kohl's, and finding what I needed, literally wiped me out. I had to rest in the car between stores, and find a spot to sit in the shoe department at Kohl's as I felt I was about to faint a few times. When I got home, I had to have him take the bags in from the car - I hadn't the strength to carry anything more than my purse. I spent the rest of the mid-day and afternoon in bed, utterly knackered. In the days sense, I've felt just as weak - wrapping presents on Christmas Eve, sitting at the dining room table made me tired. I slept a decent amount that night, woke up about 8 and was asleep on the couch within the hour, napping for nearly 2 hours. Another nap in the early afternoon still didn't entirely cure the fatigue. Dr. Fuzz had asked that I pick up a home blood pressure monitor to determine if we should continue some medication I'd been on for being borderline hypertensive. I checked, and I was at 104/65 - the lowest reading I've ever seen on myself. It's still within the low end of normal range, so I wasn't overly concerned, but it did seem to give some credence to feeling so listless. My first follow-up with Fuzz is on Thursday, I'm composing a list of questions and concerns I have. I'm still less than thrilled that Aetna decided they know better than anyone, and I only deserved 4 weeks of short term disability coverage - and should be thankful that I got a bit extra because my follow-up appointment was later than normal due to holiday scheduling. I need to find out what Fuzz would need to do if he wants me out longer - they've got about 24 hours to process that request since I'm expected back at work Tuesday January 3 (the bank observes New Year's Day on January 2). As much as I'm not feeling completely up to sitting here working for 8 hours in a row, I also can't really afford to take unpaid medical leave either. This is going to be an interesting transition. Thankfully, my boss is pretty understanding, and as long as I don't have meetings I'd miss, he'd probably be OK with an extended lunch that could include a nap if necessary. What really gets me, is that if I had to commute to the office I used to work in, rather than work from home, I think I'd be wiped out by the time I got there (40 mile drive) and hiked through the building to where I used to work! Now, I have very good health coverage, and I know I'm lucky to have 100% short term disability coverage - but the strict actuarial decision making processes frustrate me - particularly the one that left me with 24 hours to get any modification submitted and approved. But most of all, I'd really just rather not be this weak. As of this morning: ~281 (guess I was a bit unsteady on the scale, it couldn't decide) Total loss: 57 lbs Post-op loss: 23 lbs

Tuesday, December 20, 2011

3 Weeks Out: Surprise Returns and Rubbery Legs

Sometimes this journey isn't pretty, and this is one of those times - if you're squeamish, you might skip the first couple paragraphs here. Saturday afternoon I had my first really nasty side effect of all this. I'd started the morning quite fine, but when it came time to have my first non-shake foods of the day, I quickly ran into trouble. I'd had a scrambled egg several times in the past week without issue - I cook them a little softer than I'd normally like, and then mush the heck out of them so I'm not trying to eat larger pieces. I took about 4 small forks worth - and immediately realized something was wrong. I felt a huge need to burp - but also had an odd twinge in my back - like I needed a good chiropractic crunch between the shoulder blades. Then, a sudden urgent need to vomit. Up came the eggs. Lovely - I hate to vomit. I'm sure it's not many people's favorite thing to do, but I'll do almost anything to avoid it, even though I know it will make me feel better in the end. Round two came quickly - but as it did, I felt the most oddly electric jolt between both temples and the base of my skull, like a nerve triangle. It nearly knocked me off my feet. It didn't stop - it was like a surging electrical overload of some-sort continuously connecting those three points on my head. I wondered quite seriously if I was having an aneurysm. I stumbled to the bedroom and called the Man at work - he got me to slow down, and suggested that I probably locked some muscles up as I vomited, and that was the pain reaction in my head. He stayed on the phone with me until I was able to relax a good bit, and then promised to call and check on me soon. He did, and I was much better - but I definitely was quite convinced even if it was just for a moment, that something awful had happened. Let's hope I don't experience that one again! I've discovered that the best time for me to get my exercise in is about 30 minutes after I finish my morning protein shake. If I wait until afternoon, I'm trapped between a mid-day pain killer dose (a decreasing dose, but still having some all the same), and being generally tired from a lack of energy. So today I took down a load of laundry to the basement, flipped on the Battlestar Galatica DVD (Season 1, Episode 3 - just getting started in my exercise watching marathon), and decided I needed to push myself a bit. I got up to 2mph, and I put in 25 minutes. Pre-op, I'd been doing an hour at 2.2mph, with a 1% incline, and was about to increase speed - so this is progress, but clearly not where I was before, but then again - it's only been 3 weeks. I finished with quite rubbery legs, but it felt good to get it done. Overall stats: Total loss: 51.8 lbs Post-op loss: 17.8 lbs

Saturday, December 17, 2011

The Tape Doesn't Lie

It's been an up and down kind of week - I thought I was making progress coming off of the painkillers, only to find myself in bed by mid afternoon doped up and trying not to whine too loudly. I've also struggled with getting non-protein shake food sources in as well - my stomach has been cramping at even the smallest inputs, so I've eased back into the liquid nutrition for a bit.

I did discover that taking my morning meds with a protein shake made them go down better than just trying to space them out with water - perhaps having something else in my stomach to digest helped prevent the cramping around them as they were breaking down.

I saw Libby on Thursday afternoon - she said she could already see some results in my face, and though I've lost nearly 50 pounds total on the program (15 post-op), my only real indications of loss have been that my wedding rings are spinning freely around my finger, and when I did put on my normal pair of jeans, that the back of the legs right under my butt were puffing out. But that certainly doesn't feel like 50 pounds of loss.

I had taken some measurements in mid-November, to help measure progress from a size perspective as well as a weight perspective. I'm rather shocked, because I don't see these changes, but apparently they are there - a tape measure doesn't lie when utilized properly:

Hips: - 4 inches
Waist: - 2.5 inches
Chest: - 3 inches
Bicep: no change (dang flabby underarms)
Thigh: - 3.25 inches
Calf - 2.5 inches

So lots of changes, though I still honestly just don't see it. I suppose when my incisions heal up a bit more and I feel safe trying on some pants that aren't knit/sweats, I may find myself in a size or two smaller that I'd outgrown before.
I think it's going to take a while before what my eyes see in the mirror catch up to reality - that should be an interesting journey.

Monday, December 12, 2011

Two Weeks Out - Still Healing

It surely seems obvious to someone just reading this, but the recovery period for this procedure is much longer and tougher than it was for my exploratory laparoscopy done several years ago. There, while they made similar incisions and poke around my innards, this time they actually cut and reattached things, and rearranged my guts, rather than just poking around. It should not be a surprise that recovery has been longer, and will continue for a good bit more. But somehow I find that I'm reminding myself of that nearly every day.

We've finally got the scale issue settled down - I wrote to Amber, the program nutritionist, last week and laid out my concerns - she said it was absolutely typical. After such a major surgery - and it was major, despite being done laparoscopically - your body does hang on to waste, water, and all sorts of things as it tries to figure out what it will need to heal. In just the day or two after I wrote her, I was steady enough on my feet and apparently my body got back in the grove, that I was getting steady readings on the scale again - and wow, it really is sliding right off of me. That too shouldn't be much of a surprise, given that I've gone above 500 calories in a day just once since my return home - and that was something like 517.

I'm still quite hot and cold with what I can actually eat (vs. drink). At least half of my protein is coming from a protein shake - mixed with 1% Lactaid milk I get 32g of protein for a 1 cup serving. With my protein goal of 60-65g, two of those would fill that need. However, I'm trying to get the remaining 28-33g of protein from pureed items. That's been a challenge - their guide of 1 to 3 tbsp of food at a time has truly been my limit - even half a spoonful more than that leaves me with uncomfortable pressure in my new baby stomach. The toughest challenge still is getting all my water in - minimum of 48 ounces is a lot when you can't chug it - I have to remember to reach for the bottle every 5 minutes or so and sip, sip, sip. The best I've really done so far is about 38 oz. That's what I'll have to work on most this week.

I had been chatting with my dear friend Erica a bit before surgery, about how I was anxious thinking about what this would do to my "foodie" tendencies. I'll clearly have some sugar and fat restrictions that I'll need to work around, and of course there's just no going into a restaurant and having a 3 or 4 course meal anymore. There's no reason I can't eat amazing food, I'll just have to plan very carefully to be able to enjoy bites of all the dishes I want to taste.  I'm also a pretty damned good home cook as well - I have several famous dishes that are always requested for the holidays, and am very comfortable putting on a dinner party for 6-10 people. Obviously during the puree and soon-after stages, I won't be making full gourmet meals, but as the months pass, I'll eventually be moving toward 800-1200 calories a day. I'll be able to eat a full, albeit small portioned, meal. I mused about writing a cookbook geared toward the bariatric eater - portions sized for our needs, fats and sugars balanced appropriately, and even hints for when an item could successfully be turned into a puree.

The more I think about it, the more committed I am to undertaking this project - I'll be working on recipes as I begin eating more regularly. Erica's husband "R" has offered to test cook for me, and I'm sure more of my friends will join in that endeavor. I'll be challenging myself to use ingredients that I may have passed over in the past (I'm not a big seafood eater, and have a textural aversion to mushrooms), in large part to be accommodating to palettes that are different than my own. Ironically, much of my television viewing these past two weeks has been on the Food Network and the Cooking Channel - something you'd think would create unsatisfying urges, but it's not been an issue for me. Something can look very tasty, but I can skip right by it without thinking I'm hungry, or feeling the need to go rummage in the kitchen for a substitute. I've been watching, taking notes on inspirations, and generally plotting how I might go about all this. It should be quite fun. As I begin, watch for pages dedicated to recipes to be added to this site - probably in about 2 months or so.

So finally - the dirty details of my progress:

Tentatively off high blood pressure meds - taking home readings until I see surgeon on 12/29 - but have been within normal ranges.

Insulin dosage down by half, still taking oral meds. I wish this was going away quicker, but it should adjust as I lose more. 

Getting the exercise in - today's treadmill jaunt will be 13 minutes at 1.5mph - going up a minute a day and .1 mph as tolerate until I hit 20 minutes and 2 mph as my initial goal.

Today's weight: 293.4 lbs
Total loss:            44.6 lbs
Post-op loss:        10.6 lbs

Go me!

Saturday, December 3, 2011

Apparently I said "ouch"

Thankfully - when I got the call for my surgery time, they told me I was Fuzz's first of the day - I had to report at 6am, surgery scheduled for 7am. We went in, had a nice chat with the anesthesiologist about my bad experience the last time I went under, and he promised that he'd be very explicit with me in what he was doing, and let me have control of some of the mask pressure (which he did - I need to get his name and write to the dept. chair and thank him).

Apparently the first thing I said when the Man walked into my room post-op was "Ouch" and passed back out. I suppose that was succint!

Doc says that everything went really well, no concerns or complications. Obviously I felt like I had been hit by a truck, but they had me initially on an acetaminophen product and morphine, so I was also quite stoned, and slept most of the day immediately post-op. I did get up and walk part-way down the hallway and back.

Things you don't think about #392: For women at least, you have to relax a lot of muscles to pee - you don't think that it would hurt to do that, it took a lot of concentration to be able to relax the right ones.

Overnight Tuesday, my pain levels had gotten pretty high - and the lortab they switched me to (vicodin and tylenol) was really only taking the worst edge off it, and not relieving much, so they switched me to oxycodone. That knocked me back out, but it made getting up harder, as being settled in the same position too long made the gas move around worse when I got up. The hospital had incredibly dry air, so between cotton mouth from not drinking much, I also had painfully dry sinuses to deal with as well. I was allowed 2oz of 50/50 diluted grape juice an hour, so that didn't do much to help the mouth, let alone hydrate me elsewhere.

I was a good patient and walked the halls a much as I could, and was definitely doing better at it by early Thursday morning. Fuzz came and saw me about 9am and said he would discharge me, and the residents would be around a bit later to remove my drain (something they glossed over) and get all the paperwork done. Finally about 2pm they came - and the resident removed the tape around the drain, then asked if I was ready - after nodding, he pulled - and the Man says I got a look on my face like "the alien is eating me alive from the inside" - because the dude pulled out nearly TWO FEET of drain tubing. I had no idea - and will definitely be suggesting that people be prepared for that. Yikes!

We got home about 4pm Thursday - and unfortunately the Man went on a wild goose chase trying to fill the liquid oxycodone prescription for me - nobody had it in stock, at least anywhere near the quantity prescribed (yes, I know it's a highly trafficked drug, particularly in pill form). But, we'd filled the post-op prescriptions before going in, so I had the hydrocodone at least, and have been relying on it until we can get the oxy (should I still need it by the time it comes in to our pharmacy).

Being at home on the sleep number bed has been much more comfortable than the very stiff hospital bed, but the head tilt feature there was certainly nice. The Man has been awesome in taking care of me  - getting my meds every 4 hours, making sure I have water in my sport-top water bottle, and generally making sure I'm comfortable.

He helped me take a shower yesterday afternoon, which while it felt good, apparently took a lot out of me, as I didn't feel well enough after to be upright, so I spent the rest of the afternoon/evening in bed.

Today I've been up and sitting on the couch with a tray table with my laptop and my knitting since about 9am, which is definite progress. I'll probably lay down again shortly (next pain dose is due in 15 minutes), but be up again for "dinner". Yesterday I struggled with yogurt as part of my "full liquid" diet, but today so far I've had a protein shake, and have finished about 3oz of yogurt without too much complaint from my new stomach. Should be able to get the 2nd shake in, we'll see about anything else - as long as I get that protein, I'm not going to push myself for sugar free jello chemicals.

So many of my knitter friends have been wonderful about checking in on me and offering kind words of support and encouragement - I love you all. I'm definitely going to take things slowly, and work on doing what's best for me over the next 5 weeks while I'm off work.

Oh - the Man has decided that the scale is possessed - it says he weighs 15-20 pounds more than normal (he's not overweight, fluctuates only with a 5 pound range). So he'll be getting new batteries, and we'll likely be getting that new mechanical balance scale I wanted, so no updated weight report, but I wouldn't be surprised if I'm down in the 2s when we get me on it.

Monday, November 28, 2011

Of Doubts, Fears, and Bloating

What an awful week. Coming out of the Event anniversary was emotionally loaded, and then we had Thanksgiving to deal with; now loaded with residual despair from last year. We decided to go ahead and make a holiday meal - with components that were as close to compliant to my eating plan as possible. We brined and roasted the turkey, I  made roast carrots and parsnips (that had just a bit of butter and honey in the whole dish), a cauliflower mash as well as traditional mashed potatoes, and my favorite onion gravy. I made a plate that had the appropriate amount of protein on it, plus the veggie serving allowed. I did add gravy and a bit of cornbread, but I think it was overall a very successful meal on a day when I would have traditionally cooked much more in terms of foods I shouldn't be eating on the 3-week prep.

In my last post, I mentioned the scale claimed I was up practically 6 pounds - it hung on to that all week, and generated all sorts of nasty fears and doubts in me. I suspected I might have been retaining some water - my wedding rings had started to really twirl around my finger the week before, and they weren't doing that any more. Pudgy fingers is the first sign of bloat for me - but I'm not used to it happening, I generally don't have PMS symptoms other than some cramping. But - I did recall that being on the surgeon required birth control now, that it may very well have changed how my body behaved. I was due for my Depo shot this morning, so last week was definitely "PMS" territory.

Of course, that didn't avoid a complete melt-down last night - the fear and anxiety of what the changes in my life will really be like has been building over the last 3 weeks, particularly as the hunger and dizziness really haven't gone away as many others in my program have said they experienced. I'd eaten my protein and veggie meal for lunch, thinking I'd transition into the liquids required of today - and when the Man came in and asked if I wanted him to cook me dinner, I lost it.

He told me if I was that afraid, there was still plenty of time to back out - and even if I thought I couldn't - I really could, we could just tell them we're not coming when they call today and give me my "report in" time. But, as I told him, I have to do this - not just because we want a family, but even if we don't get that, I want to be healthy as we grow old - to be able to go on cruises and not get pooped out in the middle of Helsinki again, and to be able to walk and tour more. Quite simply, I'm tired of being fat. 

So with the wonderful blessings of Ambien, I had a good night's sleep - woke up this morning as he left for work at 5am, and am in a much better frame of mind. I went shopping for my "clear liquid/full liquid" food items for when we return from the hospital, picked up my post-discharge meds, and am back doing the last of the housework that I'll be allowed to do for several weeks.

Despite threats of throwing my scale out the window (or hiding the batteries from me) - I found it intact this morning. And while it had a hard time making up it's mind, it finally settled on 304 - so all that "mystery" weight gone, and 3.6 pounds further down - which feels much more like it for what I accomplished this last week.

Just after I got home from shopping this morning, Libby called to wish me well tomorrow. I was surprised, but very pleased to hear from her. She's been thinking about me, and with as many clients as she has, I know that takes extra "effort" (not the best word, but I can't find the one I want to use) for her - it would be easy to leave all your clients issues at the office and not think about them afterward, so I'm thankful that I apparently have had an impact on her while she has been hugely impactful on me. 

So now I put some of my famous determination to work - I can do anything for a mere 24 hours - broth, thinned yogurt and sugar free pudding, and one more protein shake. Sometime tomorrow morning (they haven't called with my time yet) - I'll get wheeled into the OR, and hopefully this hunger will be gone for the next 6-12 months, and when it comes back - it will be much more manageable.

I'm still nervous - but I do believe I've been able to set aside the doubts.

I'll see you all on the other side. 

Wednesday, November 23, 2011

Take THAT Water Retention!

I'm either retaining fluid like a dehydrated camel, or PMS bloating or something, but the scale claims I'm up nearly 6 pounds, and my lovelies, it's not possible for me to have eaten that many calories - even with Saturday's hall pass. I have realized over the last few days that I've barely been getting 24-36 oz of water in, which is not quite half of what I should. Given the tiny caloric intake, I probably am holding on to that for dear life.

So, today I will absolutely get 64oz minimum of water - I'm 32 oz in for the day already. Plus, the Man finally hooked up the old TV and a DVD player down in the basement for me, so I can watch something besides the video I have on my iPod Touch - Battlestar Galatica exercise marathon here I come!

So.... take THAT water retention! Treadmill: 40 minutes, 2.2mph, 1% incline, 1.47 total miles - maximum heart rate 146.

Now it's time for more water - this time ON me, not in me - I stink!

Sunday, November 20, 2011

Pre-Op Appointments and Surviving One Year Post-Event

Friday I spent nearly the entire day with doctors. Not a horrible way to pass the time, usually, but today it began with my quarterly check-in with my primary care physician, who took blood for the usual labs, and updated some prescriptions for me. Then, it was back in town to see Fuzz and the anesthesiologist staff.

At my PC's office, my blood pressure had been up (158/82) which surprised me, given how light headed I'd been feeling. I'd honestly expected for it to read low as a potential explanation for the dizzy/woozies.The nurse at the surgical clinic got the same reading, so it seems it was correct; perhaps I'll chalk it up to stress?

The three-week-pre-op diet is doing it's thing though, I was down nearly 13 pounds, over 16 since they'd last gotten a recording at my last visit to the nutritionist. The PA put me on through without any issues, apparently the first of the day. Someone else got detoured back to Amber the nutritionist for not having lost any weight, someone else had missed an education session, etc. I signed a bunch of consent paperwork both for the surgery and for the potential to receive blood products in the unlikely event it became necessary, and then it was time for Fuzz.

Did I mention before what a hunk he is? Seriously, that's one of the first comments people make about it - is he's gorgeous. Sometimes I look at him and think 'You can't possibly be old enough to be out of medical school, let alone as accomplished as you are'. He's definitely got a bit of a baby face, but an amazingly handsome one at that. He came in smiling and shook my hand, am I'm just sitting there thinking 'You can cut whatever you want out of me, I'll just sit here and enjoy the view'. I suppose it can be comforting to have that distraction when you're talking about major abdominal surgery. But to business, Fuzz was very happy with my progress, and we're all set to see him in the OR on the 29th.

Next up? Pre-op anesthesia. My appointments were scheduled that I had almost an hour between them, but I went in early, filled out all the paperwork, and then sat in the consult room for over an hour before they came back to see me (kindle to the rescue!). When she finally arrived, I went over my health history for the third time that day, and thankfully got to describe in detail what to me was a bit of a misadventure in anesthesia the last time I went under. They had me fully prepped, and as strapped down as they do to you when they put you under general anesthesia, and the mask came over my face and suddenly, I couldn't breathe. I don't know what was supposed to be coming through that mask, oxygen, a mix of oxygen and some anesthesia agent to knock me out, or what - but if you're a scuba diver, you'll know exactly what I mean when I say that suddenly I was "sucking a dry tank". It felt like there was nothing coming through that mask. I know my eyes flew open in a panic, in my brain at least, I started flailing to get the doctor's attention, and tried to tell him I couldn't breathe - I only remember him putting the mask more firmly over my mouth and then passing out. I'd really rather not have that experience again. She looked up my surgical report from that day (procedure was done at the same hospital), and while there were no notes, she recorded my story in detail, and encouraged me to say something to the anesthesiologist in the OR as soon as he arrives. 

Finally - I get home about 5pm. It's a dangerous hour - by day of the week, if not the day on the calendar, a year ago on Friday night was the worst day of my life - the Event. I tried to distract myself with some video games and Warehouse 13 on Netflix, cuddled my husband and took an Ambien to knock my ass out and go to sleep - at home, comfortable in my own bed.

Saturday the 19th, by calendar, the anniversary of the Event. Today's mission was full-on distraction, and in order to do that, I planned that I was going to cheat on my pre-op diet. Not that I needed to eat specific foods that were not allowed, but instead I needed a day where I simply didn't have to think about it or worry about it.

I started by heading out to Catherine's, a local plus-size clothing chain. I needed a new nightgown or robe to take with me to the hospital. My comfy long winter nightgown/house dress thing has gotten a bit ratty - a few holes have grown from what were originally tiny kitty claw holes. I was happy to find both a long night shirt and a zip-up robe-like garment that I was happy with. I also dared to buy my favorite kind of jeans, but in a size smaller than the smallest one I have in my closet. I don't expect to be buying a lot of clothes on the way down, particularly while I still work at home, but I'll need at least one pair of pants that fit that can be worn in public, so I decided to be prepared with that pair of jeans - if the estimates are right, I could be wearing it by New Years!

I grabbed a pair of sesame bagels and cream cheese from my favorite indie bagel shop on my way home - and reveled in the yummy carbolicoiusness of them, with only a few guilt pangs. When the Man arrived home, we had about an hour to get changed and over to the movie theater for the afternoon showing of Tower Heist. Reviews had panned it as "over done", whatever that means, but I was really hoping for some light-hearted fun, and that's exactly what we got. A little fluff of a movie, with some great comic timing as always from Eddie Murphy, and Gabourey Sidibe - who knew she had great comic chops! It was the perfect choice out of the movies playing.

We then went to dinner at Vincenzo's, a local Italian restaurant built in the 60s, and that still looks like the Rat Pack might show up at any time and ask for the corner booth. I love the place. Unfortunately, it's not somewhere I'll be eating at again for quite a while. Post op, there are some choices that are higher in protein and not all pasta, but it will probably be well over a year before I get to go back.

We talked a little about the girls - the Man told me again that he wished he could teach me to compartmentalize things (box them away mentally), because he hates to see me in pain. In many ways I wish I could too. I don't want to forget - I could never forget, but I'm still working hard every day not to let it haunt me every day, and that's exhausting. He said he truly believes that things happen for a reason, and perhaps our role was to give J the best possible beginning she could have, get T out of her shell from the frightened nearly non-verbal child she was to the curious chatterbox she became - though troubled and having much work to do as she was. That as Fuzz offered, that once I reach an acceptable weight loss level, that he'll be open to an early attempt at getting pregnant (they normally want you to wait 2 years, but at my age, every month counts). With the help of Dr. Yalcinkaya (the reproductive endocrinologist at WFU we consulted before), we could actually have our own through IVF, or at least do IVF with donor eggs. The Man's not given up hope, he believes that maybe this is where we were supposed to be all along.

I don't quite yet have that strong of convictions, we went through hell over the last year, and if that's a trial put before me that I needed to pass, I'm not sure many other women have ever been tested so deeply in order to achieve motherhood. I survived it - I know some people think I didn't "pass", but they also don't know the full truth. I know I need to find a way to move beyond what happened, and I told the Man honestly, that I think I did as well as I did yesterday because I have the surgery and the hope of how life will improve immediately before me. If I didn't have that to focus on, I think yesterday would have been a very different kind of day.

And for that, I am thankful.

Tuesday, November 15, 2011

One Week Down - Two to Go

Yesterday marked the completion of one week on the pre-op diet. I'm not feeling as good as I'd hoped to by now, but some of the symptoms are gone; not as light headed or nauseous as I was before, but I still get hunger related stomach cramps, and have to be very careful in spacing out my oral medications, as too many pills at once will immediately cramp my stomach.

I saw Libby yesterday afternoon, and she was quite proud of me - I was telling her that the way I get through the treadmill sessions when I'm tired and feeling like I want to stop, is to repeat to myself "You can do anything for 10 minutes", or however much longer I have to go. She said I was one of the most determined people she's ever met; referring to this, but also all that I managed to do in the last year after the Event - still work, finish grad school in the face of hostile team mates, the death of my mother-in-law Virginia, and more.

I know it looks like sheer determination from the outside but from the inside, I had no other choice. I make twice what my husband does, and if I'd given in to the very real desire to curl up in a ball in bed and never get up again, we'd have quickly been in dire financial straights, I'd be paying ungodly student loans for a degree not finished, and all sorts of other situations that just could not be allowed to happen. So perhaps it was determination, but it feels to me more like self-preservation. Certainly a lot of purposeful denial went along with it, and there were more than a few times where I "phoned it in" on various tasks, but I made it through.

Looking back now, even I don't really know how I did it - I'm exhausted just from working and getting ready for all of this. I suppose it did teach me one thing, that I can live through just about anything. It won't necessarily be easy, and it certainly won't be pretty, but I can do it.

So two more weeks? Nothing to it - a little hunger isn't going to kill me (though that damned treadmill just might!)

This morning's stats:

Weight: 307.4 lbs
Pre-Op Diet Loss: 11.2 lbs
Total program loss to date: 30.6 lbs

Friday I check in with the surgical team for all of my pre-op testing and consultation. Should be an interesting morning!

Saturday, November 12, 2011

Three Weeks aka What in the Hell am I Doing?

My surgery date was scheduled for Tuesday, November 29 - which means I started the 3-week prep on Tuesday, November 8. I knew this was going to be tough, and while I'm currently just on day 5 of it, I'm really hoping it eases up a bit - and soon!

Here's what I'm allowed in a day:

  • 2 protein shakes (mixed with water or skim milk)
  • 1 serving Quaker Weight Control Oatmeal
  • 4oz sugar-free Jello
  • 4oz applesauce, or 3oz fresh fruit
  • 6oz Dannon light & fit yogurt
  • 3oz lean protein (chicken, turkey, or white fish)
  • 2 cups fresh veggies or 1 cup cooked
  • 1 tbsp light salad dressing
That's roughly 800 calories. In a day.

The thing is, I can't stand oatmeal. Am I allowed to substitute anything? Nope. Don't have to eat it all, but you can't switch anything up. Joy. So far, I've not gotten desperate enough to eat the oatmeal, but we'll see. 

Choosing a protein shake flavor has been an adventure. I'm a relatively picky person when it comes to "drink additives". I've never liked the Crystal Light type products, I'm not a big fruit flavor person, but beyond that they just taste like chemicals to me. So I started with some samples from Syntrax: chocolate truffle, cappuccino, and fuzzy navel, along with Unjury's chicken soup flavor. The chocolate truffle was pretty darned good, slight after taste for a while, but nothing too annoying. The cappuccino was a bit coffee strong for me at first, but it's grown on me. The fuzzy navel flavor, however, was an unmitigated disaster - I managed to choke down about 80% of it, but never again (shudder). I was mostly disappointed with the chicken soup flavor too, I was hoping it would taste more like regular chicken broth, but it was either slightly weak, or too salty, or something - just kind of "meh". I have a few more sample packs, so it might grow on me, but I suspect I'll be drinking lots of chocolate truffle and cappuccino, as I went and bought the giant barrels of those today.

Would you have thought? A de-boned chicken breast lasted for 3 dinners, since it weighed in at 8 ounces. (!!)

The goal of this diet is three-fold: lose a moderate amount of weight pre-op, shrink the liver which will make nudging it out of the way during the laparoscopic procedure easier, and finally - to measure your compliance to food regulations. They expect you to lose 3% to 5% of your body weight during this time. I don't think I'm going to have an issue with that, as that would be 10 to 16 pounds for me - and as of this morning (after 4 full days on the program), I'm already down 9. Eeek!

The hardest part of these 4 days has been the shift in energy. I've been walking around basically feeling light-headed all the time. I've been having to monitor my blood sugars very closely, as the combination of very modest food intake, and continued exercise (40 minutes on the treadmill), can cause some crashes if I'm not careful. I may have to adjust my insulin dosing tonight, as my waking BG was just 92 (it's dropped every day since starting), and lower than 80 would be a problem.

Others in the program say it gets better after 3-5 days, so hopefully I'm just about to turn the corner. But if not, I have just 3.5 days more at work before I go out - I'm burning some vacation time before going out on short term disability the day of surgery.

New Beginnings

Over the years I've had a couple different blogs, but I find myself at a point in life that I want to record all the changes that are happening, so I may actually stick with it this time.

You see, in 17 days, I'm going to have bariatric surgery; the Roux-En-Y gastric bypass. It sounds rather drastic to some people, but I've had it, and it's time for serious change.  I have been heavy all of my adult life - I gained about 45 pounds my last 2 years of high school, and it's gone steadily upward over the years. I had variable amounts of success with diet plans such as Weight Watchers, Atkins, following the Biggest Loser eating plans, and more - I'd typically lose 20-30 pounds, and then start putting it back on (usually plus a little bit).

A year ago next week, I had a major trauma in my life - it's not something I want to go into detail on now, those of you who know me know exactly what I'm talking about, new readers will inevitably learn bits and pieces along the way. The story of this blog is not about what happened, but instead about what I'm doing, in part, to recover from that. I see an amazing counselor, who I'll call Libby (not her real name), who guided me through the nightmare that we were living through (which I'll refer to from now on as the Event), while enabling me to continue grad school (I earned an MBA in August 2011), and keep working, at times where I just wanted to stay in bed forever. One of the conversations we had, was whether I felt discriminated against because of my weight - both in the Event, and in life in general - particularly in regards to employment matters.

I've fought very hard not to take on the mantle of "fat victim" in my life. Though I've never spent a huge amount of time on the dating scene, I've not been without male companionship, and have married twice while heavy. So far I've not felt an adverse impact on my employment, but as I work to rise up the ranks and make use of my MBA, that is becoming more of a concern. But sadly, where I think it probably did the most harm was in the Event - somewhere that it shouldn't have made an ounce of difference.

Libby asked me if I'd ever considered bariatric surgery. I told her I had, at many times over the years, but it honestly scared me. I'd seen several people go through it in the early to mid 90s, 2 with pretty amazing success, and one with moderate success - she seemed to be able to go back to poor eating habits (not just what, but volume) after about 6 months, and very clearly her weight loss stopped. And honestly? I'm a diehard foodie. One of the things my husband (heretofore known as "The Man") and I like to do is dine in at least one high end restaurant per destination when we travel - we hit Bobby Flay's Mesa Grill in Las Vegas on our wedding weekend, and Gordon Ramsey's Maize Grill in London when we were in Europe. I also love to cook - and I'm damned good at it. Did I really want to give all of that up?

No, really I don't. But at the same time I knew that if I were going to be around as long as I wanted, I needed to lose the weight, and if I wanted to have any remaining chance at having a family, I needed to get it off both to have a chance at IVF (long, boring background with infertility), and to be able to crawl around on the floor and otherwise keep up with growing kidlet(s). So I decided to check out the current state of weight loss surgery programs.

I'm very fortunate to live near Winston-Salem, home to Wake Forest Baptist Hospital. As a major teaching hospital, the facility has an excellent faculty and world renowned physicians in all sorts of specialties. The surgeon I chose to consult with is Dr. Adolfo Fernandez, affectionately known as "Fuzz" to staff and patients. I went to an information session where the staff spoke about the various procedures that are available in their program, their philosophies and processes, then two patients spoke about their experiences and results. After hearing their stories (and seeing their program photo albums) I was sold. I'd actually gone into the session thinking that I'd want to use the Lap-Band, in part because it's reversible if necessary, and can be adjusted as needed. After seeing a sample of it, and realizing what the access port (for adjustments) was going to be like, along with the lower success rate for that procedure, I went to my individual consultation with Dr. Fuzz thinking I'd choose the Roux-En-Y procedure.

Thankfully Fuzz agreed that I was a good candidate for the program, and that Roux-En-Y was the best choice in his opinion. After a few other formalities (a psych interview, insurance review, etc), I found myself in a nutrition education class with Amber Hoover, one of the program nutritionists. My insurance, Aetna, requires patients go through a 3-month "multidisciplinary supervised weight loss program" before being approved for surgery.  Ugh. But, as that would start in July, it would let me get finished with school and get other things sorted out before trying to go out on leave for surgery.

At that first class, they took our official starting weight - their scale weighed me in at 342, and I wanted to just curl up and die, that was my highest number ever. But I started the program, which really was a sensible regimen focused on  hitting approximately 60 grams of protein a day, and eating no items that had more than single digits of fat or sugar.

I lost modest amounts of weight doing this (hey, if I was a great dieter, I wouldn't be in the program!), and by the time I finished the 3 months and was cleared by the nutritionist for surgery, I'd lost 14 pounds. All that was left was to wait for my surgery date to be assigned, and then I'd find out when I needed to start the 3-week prep diet.