Emotions

Walks are a good time for reflection. The past week has been a blur for me which I attribute to anesthesia and IV pain medication. But it's still hard to believe that all the waiting and preparation is over and the surgery is complete.

The thing I thought about the most during my walk is the fact that 85% of my stomach has been removed. And that thought introduced some interesting emotions. I'm not quite sure how to write them out but I am going to say that one of the emotions is a mild state of shock.

It's not shocking the surgery is over or the things I have to do to recover, it's the fact that most of my stomach is gone and never coming back. Some of the other emotions are pleasing. This mostly has to do with the fact that I will never be able to eat the way I used to again and that my portion size will always be from this point forward small. I will never sit down to eat the same way again. And another feeling I had was motivation. The pre and post-op procedures are enough to keep me on the straight and narrow for a while.

I think something has changed since surgery. They were right when they said you have no idea how your thoughts and feelings for food will change after surgery. At times before surgery I was preoccupied with what I would eat after surgery and how I'm going to handle this and that but in reality, it's been a chore to eat and drink.

5 days post-op

I was released from the hospital on Thursday evening. The surgery went well and the doctor estimates that he removed 85% of my stomach or leaving me with about two or three ounces. So far recovery has been progressing slowly but surely. Each day I feel better. I don't really have pain, it's more of a sore feeling in certain spots of my abdomen. I have used two pain pills since returning home. I'm not really a fan of them so the bottle sits there basically unused. However, due to the fact I decided on the VSG procedure I can take ibuprofen. I have been taking 400mg about every 6 to 8 hours and that really helps cut down on the soreness. I am able to sleep on my right side for the most part. I have never been a back sleeper and frankly cannot wait to sleep on my stomach again.

I'm not sure if this is a product of the pain medication, change in diet, or surgery itself but in the hospital my blood pressure was very normal. I believe the lowest reading was 112/57. I cannot remember my blood pressure being that low. So the doctor advised me to forgo the blood pressure medication and see what it is when I return for my 10-day post-op exam.

Since surgery my diet has consisted of clear liquids with the exception of milk for protein drinks. I looking forward to Tuesday when I can introduce "full liquids" into my diet. This consists of yogurt, thinned cream of wheat, blended soups and even blended chili.

Exercise has been progressing. Today I decided to hit the street and go for a walk. I'm disappointed I cannot bring the dog for another week but I'm sure he doesn't mind. His time at the doggy daycare wore him out. I'm not sure if I over did it today but I walked a mile. I guess I will know later. I think I'll do the walks in the morning since it's cooler at that time. However, I'm still not convinced I'll do any outside exercise when it's raining.

Pre-Op Photos

The pre-surgical diet

Last Monday I started my pre-surgical diet. This diet consisted of five days of eating 1000 calories or less and then three days of clear liquids. I'm currently finishing day number one of clear liquids.

My thoughts so far, the liquid diet is much easier than the food phase of my diet. I found myself very hungry at times when I was trying to eat 1000 calories or less. I attempted to eat high volume low calorie foods such as broccoli, green beans, and lettuce. I tracked my caloric intake and decided to established my own recipes and portions. I did not eat Lean Cuisine or other processed foods due to the nutrient depletion, preservative usage, and increased sodium content.

On the liquid diet, my choices are very limited. But I have made choices that I feel are best suited to my eating habits.

I recently reviewed Designer Whey's Natural French Vanilla flavor protein powder. I will reiterate that this stuff is awesome. It dissolves very well and has no aftertaste.

My first day of liquid dieting has consisted of the following:

64 oz. Swanson Chicken Broth (120 calories)
19.5 oz. Cherry flavor sugar-free Jello (60 calories)
40 oz. Whole Milk (750 calories) [considered a "clear" liquid]
3 scoops protein powder (300 calories)

Total calories: 1230
Total protein: 68g

Considering a bulk of my calories came from drinking the whole milk, I will use skim milk.

The one thing I find amazing is that I am sitting here not hungry and feeling very satiated. I believe the key to the liquid diet is consuming a lot of liquids. However, if I compare this morning to other the previous five mornings I was so hungry I was miserable. I'm very hopeful that today and tomorrow will be equally pleasant.

The Psych Evaluation

At 3pm on Monday, I sat down to fill out a five-page questionnaire examining my current psychological affect, and my feelings, emotional desires, and psychological triggers as they relate to eating and food.

I am pretty sure the questionnaire’s goal is to recognize poor habits and to recognize self-destructive thoughts and feelings.

Anyways, after I completed the questionnaire I met with the psychologist for about an hour. It was very informal and much like therapy the meeting was an ebb and flow of various topics. We discussed my psychological health, my food triggers (boredom), and my eating habits and patterns.

Boredom…

She was very interested to know how I overcome my boredom trigger.

I learned a long time ago that I like to snack when I am bored. Unfortunately for those who partake in this particular food trigger we usually go straight for the high calorie, high carbohydrate goodies like cookies, chips, breads and the like. It’s easy to kill time snacking and we really don’t realize that we’ve eaten the entire bag of chips until we reach for a few more and there are no more left.

I would not say I’m completely cured of this type of food trigger but I do know how to manage it pretty well. I simply don’t buy quick foods, snack foods, and junk food when I go grocery shopping. Well, with the exception of popcorn. But I have learned over the years that if I actually have to cook the food (i.e. defrost a frozen chicken breast or haul out the pots and pans) I will not eat and the trigger will pass.

I very freely admit, it’s very hard for me to pass up the quick things like cereal, snack crackers, pizza rolls, and chips but I take the advice of one of my favorite chef Alton Brown, “Just walk away.” Over the years, the battle has gotten considerable easier.

I’ve replaced a lot of my snacking items with fruit. I have found that I really enjoy certain varieties of apples and if I need to keep my hands busy I will eat an orange or two. I really do not limit my intake of fruits. I consider them to be an excellent aspect of a well-balanced diet.

So what was the conclusion the psychologist and I came to? I am a fairly well adjusted individual who is self confident, balanced, and doesn’t abuse food as a coping mechanism. I am ready to make the lifestyle changes necessary to be a successful weight loss surgery patient.

A change in thought...

I've had a reversal in thinking when it comes to the type of surgery I want to have. I was pretty set on having roux-en-y gastric bypass surgery but the thing that I kept in the back of my mind was the potential complications after surgery. I am well aware that an excellent surgeon makes all the difference in the world but you never know what adverse events might occur.

Recent studies have suggested that the weight loss from roux-en-y gastric bypass and vertical sleeve gastrectomy are almost identical and the rate of weight loss occurs at about the same pace. The caveat to this suggests that the patient's BMI be ~50 or less. My BMI is currently around 51 so I am confident that I will achieve the same success.

I have identified several distinct advantages of vertical sleeve gastrectomy (VSG) over roux-en-y gastric bypass (RNY.)

1. Patients feel the "full" feeling with VSG as opposed to a "pressure" type feeling with RNY. Patients must learn the "pressure" feeling and when to stop eating. Until this is achieved vomiting or pain may occur.
2. The portion of the stomach that produces the hormone ghrelin is removed. This is beneficial for reducing the desire to eat.
   
3. The incidents of gastric dumping is basically eliminated due to the fact the pylorus is preserved.
   
4. The overall complication list is drastically reduced due to the fact no anastomotic openings are created and the intestines remain unchanged and intact.
   

I also figured that on average VSG patients enjoy the same amount of weight loss as RNY patients. As with any surgery it is all about how the patient uses the tool (weight loss surgery) and how successful they are afterward. It is quite possible to lose 100% of excess weight after VSG but on average most patients lose 70% of excess weight. For me this translates to a final weight of 220 lbs. Granted this is still considered overweight but it is not morbidly obese at 360 lbs.

Here's the concept I needed to understand. WLS will not cure me from being fat, it will only give me a tool to lose the weight myself. My weight loss is directly proportional to my commitment to changing my lifestyle and eating habits. If I fail to do this the surgery will fail. This is true for any type of weight loss surgery today. Dedication and commitment are all it takes to be successful.

"If you eat fast food after surgery, you have already failed." -me

Also, there is the question of quality of life. Which surgery will afford me the best quality of life? I figure that after my surgery and I have lost the weight I will have a better quality of life with VSG over RNY due to the simple fact I won't have to worry about malabsorption and the other complications that might arise at any time after gastric bypass.

However, what I perceive as good for me may not be good for someone else. There are several different factors that my surgeon considered before recommending VSG:

• My reactive hypoglycemia has a strong potential to worsen after RNY
• My ability to consume Motrin is eliminated. Motrin is superior to Tylenol for treating musculoskeletal and considering my employment Motrin is a necessity.
• My pre-op drive to lose weight. I had already given up bad foods and made several changes to my lifestyle before setting foot in his office.
• My age, health conditions and medical history are all suggestive of achieving great success with VSG.
  

However, if for some reason the need arises to be converted from a VSG to a RNY I will embrace it and continue to live my life.

Supplement Research

Today I drove over to the health food market and picked up a few things for post-op.

In my WLS class they recommended trying a few things before surgery to avoid buy things that aren't good.

They mentioned the "protein bullet" as a good source of protein in a very compact form.

The IDS New Whey Liquid Protein comes in a 3.4 fl. oz. screw top container. It comes in fruit punch, orange, blue raspberry and grape flavors. It contains 42g of protein, 0g of sugar, and 0g of fat.

I mentioned previously that the body can only utilize at maximum 35g of protein in one meal. The nutritionist recommended 60g to 80g of protein a day. So that means 3 or 4 meals containing 20g of protein.

These protein drinks are the perfect two "meal" size. Theoretically I could drink half and then drink another half at a later time for two very quick protein meals.

Now, let's talk about the taste. It is sweetened it with sucralose and acesulfame. I generally find anything sweetened with sucralose too sweet and this product is no exception. I quite frankly would describe the taste, smell and texture as drinking sugar-free gelatin before it sets. It's quite thick and very sweet. I have found that cutting it with 3 parts cold water helped it become more palatable.

The next product I purchased was No Shot® Sub-lingual B-12. The bottle contains 100 very small red tablets. When I was at my local pharmacy earlier the sub-lingual b-12 they sold were large tablets that took several minutes to dissolve. The No Shot® brand promised a quick dissolve. And they are correct. I placed the small tablet under my tongue and within 30 seconds it was dissolved. It was nicely priced at 11.99 per bottle and the product works as described.

And the last product I purchased today was Designer Whey Natural French Vanilla flavor protein powder. I absolutely love their natural flavor powder but sometimes I don't have time to haul out the blender, frozen fruit, yogurt, bananas and milk to make my own flavored protein drink. Don't get me wrong this is my preferred method but seeing as how protein will be a major dietary concern after surgery I need quick options.

One scoop delivers 2g Sugar, 2g Fat and 18g of protein. The manufacturer recommends mixing 3 oz. of water or milk (I tried both) with one scoop of protein powder. Much like the natural flavor it dissolves very well with no grit or aftertaste. It has a hint of vanilla flavor and is not sweet. I liked it very much. I did not discern any taste difference between milk and water. Those that prefer sweet protein drinks will not favor this product or may need to add their favorite artificial sweetener. This product is sweetened with olgiofructose or inulin.

So this rounds up my current product research. I think I will continue to purchase all three after surgery.

My next plan is to attempt to make naturally flavored gelatin. I purchased some organic blueberry juice and will try my hand at that later on tonight.