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!

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.

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

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!