Monday, January 30, 2012

2 Months Down: 1 Endoscopy to Go

It's been an interesting month - back to work, struggling with dehydration, and now one more minor complication. I went back to see Fuzz Thursday afternoon - as you know I'd been having trouble with vomiting again, and was headed back into dehydration. Thursday morning topped it off with a 3-hour burp and gag session after trying to take some pretty small pills. Fuzz loaded me up again with 2 bags of IV fluids, and entered orders for an endoscopy. What they'll do is knock me out, put a camera down my esophagus and take a look at things - he believes I may be a bit "tight" after the procedure, which could be overly limiting what I was able to take in both in amount or size (technically this is called a stricture). Until then, I'm on liquids and soft foods.

I had expected to hear back from them on Friday, but I called this morning and was told that the department got the orders, but I needed to wait for them to call me to make the appointment. Annoying, but not life threatening, so I suppose I just get to wait.

I owe you pictures and stats at this point - I had the Man take pictures after we got back from the movies on Saturday (Haywire - good flick!). I look at these, and all I can think is "Damn, I have saggy tits". Odd what strikes you, isn't it?

So here they are - front and side view for 2 months post-op.

For comparisons - I've started a new page with just my photos each month.

Ugh, still not happy with this view at all. However, I can now see I've lost a bit of ass, and I can see my front flattening out. The jeans are a size smaller than last month, and probably could be even a size smaller still. I can tell I'm going to have flab arms forever - though that's something we can address with plastic surgery when the time comes (sigh). Here's the stats to go with it all:
Beginning weight: 338
Weight at surgery: 304
Current weight: 272.8
Total loss: 65.2

Wednesday, January 25, 2012

Was it the Carrots?

I think one of the most difficult parts of adjusting to solid foods again is figuring out what you can and can't eat. There are general guidelines that the nutritionist gave me: no bread, pasta, be careful not to overcook meats, etc. But beyond that, every person will have a different reaction to various foods. For example, some people can't eat chicken for quite a while (if ever), while for others that's a frequent and vital part of their weekly menu.

I've done pretty well after that "reboot" of my eating a couple weeks ago - that is, until Sunday. Sunday I sat down to a small plate of 2oz of rib eye steak, and a small serving of steamed carrots. I tried to be very aware of how fast I was eating, and to chew the steak very thoroughly. Unfortunately, I only got about half-way through the steak and had just 2 bites of the carrots when trouble arose. At first I just lost some of the carrots, but I ended up losing the whole meal. I really hate vomiting (that's probably not a surprise!).

I did think back to one of the previous times I'd been sick after eating beef, and it also had been accompanied by carrots - canned, that time, but still carrots. So the Man and I decided the carrots simply may have been too fibrous or  something, and that I'd avoid them for a while. But then Monday night - eating steak again - I was again sick. So was it the carrots, or the beef, or just bad luck? It's so hard to tell.

I'm going to avoid beef for a bit as well - at least rib eye steak. Then about the only choice I have left is to very carefully reintroduce foods one at a time, so that if I have a problem with something, it should be more apparent as to which meal ingredient it was.

Because I really, really hate vomiting.

Wasn't this one a fun read?

Saturday, January 21, 2012

Less is Not More

Since I was cleared for solid foods almost a month ago, I've been struggling to get the right combination of protein and fluids in - a balancing act that's been pretty difficult, as you know if you've been reading along. I think that I've finally found the start of balance to my eating for now.

I bought a small amount of roast beef sliced very thinly from the deli the other day. I'd been thinking about "sandwiches", and thought of a few things I could use make something similar for myself. I have been eating Kashi's TLC whole grain pita crackers with my egg salad and hummus. I added a thin layer of cream cheese, a slice of roma tomato, and then some of the roast beef piled on top. Each cracker of course took 3 or 4 bites to finish, but all of it combined felt like a real meal, instead of just eating a small portion of "protein". To top it off, it stayed down without argument!

The best impact to that meal, however, was felt this morning. I woke up and actually felt like I had some energy. I didn't have to drag myself downstairs to the treadmill - I felt pretty good! I'm really attributing it to eating more than just the required grams of protein, just enough extra to round it out into a regular meal. I'm going to do so again tonight (catfish with a citrus-saffron aioli and some broccoli) - and see if this continues.

Even with the "additions", my intake is still quite small - I've not yet topped 700 calories. A typical day's meals in the first 6 months post-op will be 800-850 calories, so I have some room to work still. Very excited!

Wednesday, January 18, 2012

I Can Do Anything For 10 Minutes

I've been back on solid foods for two days now, and happily I've not had any recurrence of vomiting. I'm willing at this point to give credit to the Prilosec, but it's probably also at least in part due to my careful adherence to the guideline of chewing each bite 30x, and resting a moment between bites. That way, there's no rush of food nor anything large enough to cause irritation or get stuck on the way down. We'll call this "so far, so good" for now!

Today, however, the struggle was with exercise. My energy level is just in the basement today, and it made me have to really push myself to get my treadmill session in. I've just started walking with a 0.5% incline, and am slowly increasing the time to 35 minutes. The incline adjustment doesn't seem to have impacted my heart rate at all, but I can feel the slight difference in my thighs as I walk. Instead of enjoying my Battlestar Galatica DVD marathon as I walked, I ended up really watching the timer. By 20 minutes in, I was wanting to stop; but I wouldn't let myself do it.

Before surgery, I had worked my way up to an hour on the treadmill, at higher speeds and more of an incline. I'd truly get a workout with that. Sometimes in the last 10 minutes of those sessions I really had to push, and I'd tell myself "I can do anything for 10 minutes" until the timer flipped another minute by, and then it became "I can do anything for 9 minutes", etc, until the workout was over.

Today I had to tell myself "I can do anything for 10 minutes" to get me through the last 10 minutes of my 32-minute workout. I did - and it's really just a way to distract myself from being tired or sore, but it always does seem to help a little bit.

Hopefully tonight I'll sleep deeply, and get a bit more pep back for tomorrow.

Friday, January 13, 2012

A Short Reboot - Fixing the Returns

I talked with the program nutritionist Amber on Thursday, and she made a few suggestions for me.

First, I'd not yet filled the prescription for Prilosec that they gave me to start 3 weeks post-op, in large part because my insurance was balking at covering it. After a lot of back and forth between them and the doc, they finally gave a firm "no". I just hadn't bothered to pick it up over the counter yet. She strongly recommended that I start that right away, while I haven't been having heartburn, excess or particularly strong stomach acid might be a contributing factor to the vomiting.

Secondly, she recommended dropping back to full liquids for a couple days to give my system a rest, then spend a day or two on purees before coming back to solid foods - and to start very cautiously with 1 to 3 tbsp at a time.

Yesterday went well on liquids, and doing OK so far today. The water today has been a bit of a challenge, I have slight bit of post-nasal drip and that always makes water taste so "yummy", but I'm really pushing myself to get it down. The Man has a sinus infection right now, so if all I get is a little drip and funny tasting water, I'll be over the moon (he usually shares his maladies quite readily).

So we're on a short reboot on the food plan, if at any time the vomiting comes back, they'll see me in clinic to make sure nothing else is going on.

I like having a plan, and this one feels sound.

Wednesday, January 11, 2012

Many Unhappy Returns

I've had it - calling in to Fuzz's office tomorrow. I've had just 1 day out of 9 that I've not barfed back at least one of my solid food "meals". I'm not sure what the issue is - we've tried to focus me on softer foods that would disintegrate easier (even though I'm following the prescribed "chew each bite 30 times" as best I can. But I can eat an item one day, and then the next it immediately comes right back up - I can't figure out rhyme or reason. The only possibility I can come up with, is that I haven't yet started taking the Prevacid they prescribed to start at week 3 as a heartburn preventative. My insurance denied the original prescription for it, and I hadn't yet picked up any over the counter to start taking (and I'm at week 6 now). I'll let them know I haven't had that yet - but I'm not sure that's a contributing factor.

I got 30 minutes in on the treadmill today - which will hopefully kick the loss back in gear, but I probably only managed to keep down 400 calories - if that, which has to be working against me. We'll see what Fuzz has to say. 

Friday, January 6, 2012

Dehydration 1, Annie 0

Well, the dehydration finally got the best of me. After seeing the doc a week ago, where he declared me dehydrated, I just wasn't able to make up the deficit in liquid intake. I gave up yesterday when I was weak, had low blood pressure, and the Man and I both noticed a small tremor in my left arm. We called my clinic's 24 hour triage nurse line, and had to leave a message (I wasn't entirely impressed with that). But, they called me back in a reasonable amount of time, and confirmed that Fuzz did want me to come in to the hospital. So, we made our way into town and got to the clinic a little after 3pm.

I was impressed that when we arrived, they were prepared with the special IV fluids they wanted to administer and were waiting for me. I got an electric yellow (nearly Mountain Dew colored) bag of saline mixed with all sorts of electrolytes and other goodies, and then a full second bag of standard saline solution. We were there for about 2.5 hours before it was all done, but I definitely felt better as we were leaving.

I was, however, admonished that just 40oz of water really isn't sufficient, and that I need to get into the 60-80oz per day range. I'll top 40oz today, I'm nearly finished with that right this moment (at 3:30pm), but 80?! holy cow. Water intake is as limited as food intake, just a little at a time - I already feel like I'm sloshing around as I walk up and down the hallway, I can't imagine doubling what I've been drinking - but I'll do my best!

Monday, January 2, 2012

First Recipe! Egg Salad with Avocado and Radishes

I've got my first recipe ready for you - looking at the picture results, I think I need some training in food photography and definitely a better lighting set-up, but it's a start!

My tolerance for solids has been a little iffy lately, so I wanted to make something that was reasonably soft, but wasn't the same old boring cottage cheese or scrambled eggs. Since the eggs had been going down well, I decided on an egg salad. Typically, I'd eat egg salad on that lovely squishy plain white sandwich bread from the grocery store, but bread is not on the menu these days. What else could I do with it? I thought it could use a little crunch - not too hard, but just enough to balance the smooth salad. Lettuce leaves! And with that, the salad came together.

First, hard boil 4 large eggs. I have an ancient Sunbeam egg cooker - probably from the late 50s or early 60s. It holds about a quarter inch of water in the bottom of the vessel, then a metal ring goes in that will hold up to 7 eggs on end. Put the cover on, flip the switch, and the water will boil away and the cooker turns itself off when all the steam has escaped. Perfectly hard cooked eggs every time. If you're not so lucky to possess one of these devices, use your preferred method of hard boiling eggs.

Once the eggs are cool, peel and place into a medium sized bowl.

I like to mash my eggs using a pastry cutter - it has larger spaces than between the tines of a fork, and leaves a reasonable size dice on the egg whites when you're done. Go to town, until the eggs are the consistency that you prefer.

I'll digress here for a moment, and let you know that normally I hate what I call "fake foods". Prepared products that have been modified to be low-fat, low-calorie, or low-something through the substitution of traditional ingredients with organic or artificial thickeners, flavorings, or other chemicals. Pre-op, I'd not have been caught dead using low-fat anything, but then again, look where it got me. This recipe (and others to follow), will occasionally use items like low-fat mayonnaise in order to keep the fat content of the finished dish at a reasonable level for the needs of a bariatric eater. I'll include notes on any necessary changes that should be made should you decide to use the "real" product instead.

Now, where were we. Mayonnaise. Add 3 tablespoons low-fat mayonnaise, and a squirt of yellow mustard (how much is a squirt? Probably half a teaspoon - how much you use is up to you, I like only a hint of mustard flavor in my egg salad). Add salt and pepper to taste.

Mix well to combine.

You may opt to cover and chill the eggs at this point - it will keep for 48 hours covered in the refrigerator.

Next we'll slice the avocado. If you've never worked with one before, they can be a bit daunting. Lay the avocado on your cutting board, and pierce the skin with your knife working length-wise.

Cut into the avocado until you feel the pit. Carefully moving your knife with one hand, and stabilizing the avocado with the other, cut completely around the fruit without pulling the knife away from the pit. When you've come full circle and met your original cut, remove the knife. Grasp the avocado in both hands, and twist each side in the opposite direction and pull apart - this will open the fruit and leave the pit in one side or the other.

Using a clean kitchen towel, pick up the side with the pit in it, and hold it in the palm of your hand, pit facing you. Take your knife (a good chef's knife is really the only tool to use here) and gently but firmly whack it directly into the pit - it should sink in a good half inch or more. This photo was taken after performing this procedure, DO NOT attempt to do this with the half just sitting on the board.

Still holding the avocado in hand, gently twist your knife, loosening the pit in it's hole. It should readily pull away from the flesh. You will be left with a pit hanging from your knife blade.

Carefully grasp the pit with the kitchen towel, then pull the knife out of the pit.

When I'm not going to immediately use the whole avocado, I prefer to slice or dice the flesh inside the skin, and then only scoop out the portion that I'll be using. I made length-wise slices in this half.

Next, very thinly slice 2 large radishes - if you have a mandolin with a paper-thin setting, you may prefer to use that, or you can simply slice them your knife. Add 2 thin slices of avocado to a lettuce leaf, and 3 to 5 radish slices down the middle.

For garnish we'll top these with a bit of chopped fresh chives - probably about 2 teaspoons in total.
Scoop  1/8 of the egg mixture on top of the radishes, then garnish with the chives and a sprinkle of paprika.

And there you have it! Egg Salad with Avocado and Radishes. For the bariatric eater, one or two leaves will make a serving. Other adults may prefer three or even four. Here's the ingredient list:

Egg Salad with Avocado and Radishes

  • 4 hard boiled eggs
  • 3 tbsp low-fat mayonnaise
  • 1 squirt yellow mustard (approx 1/2 tsp)
  • 4 oz sliced avocado
  • 2 large radishes, sliced paper thin
  • 2 tsp chopped fresh chives
  • 8 bibb or boston lettuce leaves
  • dash of paprika 
  • salt and pepper to taste
Nutritional information: Based on 8 wraps, 1 wrap = 1 serving. Calories: 139. Protein 7.2g, Total fat 10.2g (saturated fat 2.2g), Dietary Fiber 2.3g, Sugars 0.9g, Sodium 176mg.   Sodium content does not include any added salt.