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.