Thursday, December 3, 2009
Monday, October 19, 2009
Saturday, October 17, 2009
More Food Discoveries
I recently had a friend who had gastric bypass. Her partner has been quite helpful in finding high protein food.
Jimmy Dean’s D-lights breakfast bowls have 23g of protein and 230 calories.
Chobani Greek yogurt with it’s impressive 18g of protein, 130 or less calories, and serving size.
Jimmy Dean’s D-lights breakfast bowls have 23g of protein and 230 calories.
Chobani Greek yogurt with it’s impressive 18g of protein, 130 or less calories, and serving size.
How I'm adjusting 4 months out
To further follow up on how I’m adjusting to my surgery the progress is slow but steady. Here are some of the things I have realized over the last month. I am learning to listen to my body and when to stop eating. I have also learned that if I choose to eat dense food like meat I will get full quickly. I have continued to avoid bread. Protein is vital and because I have a very reduced capacity for foodstuff I simply cannot justify eating bread as opposed to or along with protein. I do not think I will eat bread until my protein needs are not so high. However, I didn’t really eat bread before my surgery so this really isn’t a big deal for me.
Psychologically, I think I’m making progress but it’s much slower. My self-image issues are still a problem. When I look in the mirror, I still see the person I was before surgery. However, when I look at pictures of me I can clearly see the difference and when I look at pictures of myself before surgery I frankly don’t remember being that big. Socially, things are improving. I really don’t feel the pressure of food anymore when I hang out. I eat what I can and anyone who expects anything different is politely told their expectations are impractical.
Psychologically, I think I’m making progress but it’s much slower. My self-image issues are still a problem. When I look in the mirror, I still see the person I was before surgery. However, when I look at pictures of me I can clearly see the difference and when I look at pictures of myself before surgery I frankly don’t remember being that big. Socially, things are improving. I really don’t feel the pressure of food anymore when I hang out. I eat what I can and anyone who expects anything different is politely told their expectations are impractical.
How to calculate percent of excess body weight lost
To calculate excess body weight lost is simple.
The reason this number is important is that most surgeons will say that a specific surgery usually results in 75% of excess body weight lost.
From my research here are the generally accepted amount of excess body weight to lose is:
Lap-Band: 40%-60%
Sleeve gastrectomy: 60-75%
Gastric bypass: 75-85%
However, sleeve gastrectomy is a relatively new procedure and long-term statistical data is still being developed. My surgeon has stated that he sees sleeve gastrectomy patients and gastric bypass patients lose weight at the same rate and generally enjoy comparable weight loss. Returning to my results, so far I agree.
- Using a BMI chart simply identify the weight that takes you from overweight to normal. For me that weight is 177 lbs.
- Using your starting weight subtract your ideal weight.
- Next, divide the number of pounds you have lost by the number of pounds you need to lose in order and this will tell you the percent of excess body weight you have lost.
The reason this number is important is that most surgeons will say that a specific surgery usually results in 75% of excess body weight lost.
From my research here are the generally accepted amount of excess body weight to lose is:
Lap-Band: 40%-60%
Sleeve gastrectomy: 60-75%
Gastric bypass: 75-85%
However, sleeve gastrectomy is a relatively new procedure and long-term statistical data is still being developed. My surgeon has stated that he sees sleeve gastrectomy patients and gastric bypass patients lose weight at the same rate and generally enjoy comparable weight loss. Returning to my results, so far I agree.
4 months out
Friday the 16th of October marks four months since surgery, today I got on the scale, and it read 272. I did not anticipate losing one hundred pounds within the first four months. Before surgery when I was doing my research, it was fairly common to lose one hundred pounds in six months. However, I knew this is just a number the real number that matter is the percent of excess body weight lost. So far, I have lost 51% of my excess body weight.
Today also marks the day I completed my second goal. My first goal was to weigh less than 300 lbs. and my second was to lose 100 lbs. Now I’m working on my last goal which is to lose 75% of my excess body weight or to weigh 225 lbs. The one goal I am not setting for myself is to weigh 177 lbs. or to lose 100% of my excess body weight.
I have two reasons for this, the first being my surgery is guaranteed to help me lose 75% of my excess body weight and the second is I'm not sure I want to be that thin. I have a feeling the dietary and fitness changes I'm making will gradually keep propelling my weight downward but at this time I'm not setting a goal to lose all of my excess body weight.
Today also marks the day I completed my second goal. My first goal was to weigh less than 300 lbs. and my second was to lose 100 lbs. Now I’m working on my last goal which is to lose 75% of my excess body weight or to weigh 225 lbs. The one goal I am not setting for myself is to weigh 177 lbs. or to lose 100% of my excess body weight.
I have two reasons for this, the first being my surgery is guaranteed to help me lose 75% of my excess body weight and the second is I'm not sure I want to be that thin. I have a feeling the dietary and fitness changes I'm making will gradually keep propelling my weight downward but at this time I'm not setting a goal to lose all of my excess body weight.
Wednesday, September 23, 2009
Surgery has Improved Me
Hello World, meet the new and improved Kevin.
I am happier, more positive, and enjoy a better outlook on things. I definitely was not a negative person before surgery but as impossible as it may seem my personality has improved.
Allow me to elaborate.
I have changed A LOT since surgery. My personality is definitely not the same as before I had the surgery. This past week I have came to the realization I have changed. And to be honest, I hope these changes are permanent. I asked my work partner if she has noticed a changed in me since surgery because I feel like I have changed. She told me that I'm happier and a lot more positive. The unimaginable thing is that I think I'm even more outgoing.
The only thing I am taking for granted right now is the fact I don't feel run down and tired all the time. However, even though my overall mood has improved, I don't necessarily think my overall personality has changed. When I look in the mirror I still see me weighing 372 lbs. I still have the same self image that I had before surgery. My brain has not caught up with my physical changes.
I have seen people who have negatively changed since surgery and those are the people who put on the fake act to compensate for being overweight. When it comes to how I interact with people I would like to believe I'm genuine. I'm definitely not nice to people just to make them like me. I believe I learned at an early age that if someone doesn't like me then it's their loss. I think the big the biggest factor is that I never saw myself as a 'fat person'. I didn't let my weight define who I am now or what I can do with our lives. For me, it has gotten in the way but it never defined who I was. Also, I think the biggest thing resisting change is the fact that I liked myself before surgery. I think the ones who change hated themselves before surgery.
Like I said above, when I think of myself, it's like the new and improved Kevin and not the Kevin that became Jack after surgery.
I am happier, more positive, and enjoy a better outlook on things. I definitely was not a negative person before surgery but as impossible as it may seem my personality has improved.
Allow me to elaborate.
I have changed A LOT since surgery. My personality is definitely not the same as before I had the surgery. This past week I have came to the realization I have changed. And to be honest, I hope these changes are permanent. I asked my work partner if she has noticed a changed in me since surgery because I feel like I have changed. She told me that I'm happier and a lot more positive. The unimaginable thing is that I think I'm even more outgoing.
The only thing I am taking for granted right now is the fact I don't feel run down and tired all the time. However, even though my overall mood has improved, I don't necessarily think my overall personality has changed. When I look in the mirror I still see me weighing 372 lbs. I still have the same self image that I had before surgery. My brain has not caught up with my physical changes.
I have seen people who have negatively changed since surgery and those are the people who put on the fake act to compensate for being overweight. When it comes to how I interact with people I would like to believe I'm genuine. I'm definitely not nice to people just to make them like me. I believe I learned at an early age that if someone doesn't like me then it's their loss. I think the big the biggest factor is that I never saw myself as a 'fat person'. I didn't let my weight define who I am now or what I can do with our lives. For me, it has gotten in the way but it never defined who I was. Also, I think the biggest thing resisting change is the fact that I liked myself before surgery. I think the ones who change hated themselves before surgery.
Like I said above, when I think of myself, it's like the new and improved Kevin and not the Kevin that became Jack after surgery.
Self Image
I've never been one to hate myself for being overweight. And even when I was 372 lbs I never thought I looked that heavy. Basically stated, I never let my weight define who or what I was or am.
I'm not sure if it's this attitude causing the delay in my brain recognizing the changes or if it's other factors but when I look at myself in the mirror I really do not see a change. However, if I see a reflection of myself in a window or some other surface where it's not a direct image I do not recognize the man I'm seeing.
I am thinking my brain will catch up and that the change is happening so fast it's having a hard time catching up.
Literally, the only time I see the rather stark progress is when I look at my before photo and the most recent photo.
I'm not sure if it's this attitude causing the delay in my brain recognizing the changes or if it's other factors but when I look at myself in the mirror I really do not see a change. However, if I see a reflection of myself in a window or some other surface where it's not a direct image I do not recognize the man I'm seeing.
I am thinking my brain will catch up and that the change is happening so fast it's having a hard time catching up.
Literally, the only time I see the rather stark progress is when I look at my before photo and the most recent photo.
Why do I post shirtless pics?
The answer is simple. I'm hoping someone will find my journal and see real life expectations. Everyone looks great with clothes on but I don't want to hide anything. Plus, it really lets me see the progress I'm making. Enough said.
3 Months Post Op
According to the Wii Fit I now weigh 287. That makes for a weight loss of 85 lbs since surgery. Since my last update I'm now wearing a size 2xl uniform shirt. This is down from a very tight 3xl shirt. I'm not sure if I trust the Wii Fit's weight estimate. I return to the surgeon tomorrow for my 3 month check up and we'll see how accurate it really is.
Sunday, September 6, 2009
Eating...
I'm two and a half months out and I've been facing quite an odd psychological battle.
Feeling full.
Let's face it, if I felt full when I would eat before the surgery I would not be in the position I am in today. For the past few years I could eat a lot of food in one sitting and not feel full. And if by some miracle I actually would feel full I would feel guilty because the realization of how much I just ate would set in. Through classical conditioning the feeling full eventually led to feelings of guilt.
Over the past two months things have changed so fast that my brain is still trying to catch up with my physical changes. And now when I eat half a cup of food and feel full I first feel guilty and then I realize I just ate half a cup of food and I'm feeling full for a very different reason now. However, in some corner of my mind I still feel guilty.
I have done much better in learning my limit of food intake. My big helper has been Weight Watchers Smart Ones and Stouffer's Lean Cuisine. Their portions are perfect for me. I can spread them out over two meals and they are quite tasty. I am also not too worried about the sodium content because they are my only real source of sodium throughout the day. I have also slacked off on the protein shakes and have started trying to get all of my protein through meals.
Considering my new stomach can only hold 3-4oz of food I am forced to make every meal count and not eat crap. I try to make smart choices by eating high protein foods or fruits and vegetables.
Socially, I am still having a difficult time adjusting to my new stomach. So much of my social life revolves around food. I really have to work on slowing my eating down. That way I can pace myself with everyone else. The other thing I have decided is that when I go out to a restaurant I will share an entree with whomever I'm with. This really takes the pressure of eating off.
All in all, I'm slowly working on things and each week is better than the last.
Feeling full.
Let's face it, if I felt full when I would eat before the surgery I would not be in the position I am in today. For the past few years I could eat a lot of food in one sitting and not feel full. And if by some miracle I actually would feel full I would feel guilty because the realization of how much I just ate would set in. Through classical conditioning the feeling full eventually led to feelings of guilt.
Over the past two months things have changed so fast that my brain is still trying to catch up with my physical changes. And now when I eat half a cup of food and feel full I first feel guilty and then I realize I just ate half a cup of food and I'm feeling full for a very different reason now. However, in some corner of my mind I still feel guilty.
I have done much better in learning my limit of food intake. My big helper has been Weight Watchers Smart Ones and Stouffer's Lean Cuisine. Their portions are perfect for me. I can spread them out over two meals and they are quite tasty. I am also not too worried about the sodium content because they are my only real source of sodium throughout the day. I have also slacked off on the protein shakes and have started trying to get all of my protein through meals.
Considering my new stomach can only hold 3-4oz of food I am forced to make every meal count and not eat crap. I try to make smart choices by eating high protein foods or fruits and vegetables.
Socially, I am still having a difficult time adjusting to my new stomach. So much of my social life revolves around food. I really have to work on slowing my eating down. That way I can pace myself with everyone else. The other thing I have decided is that when I go out to a restaurant I will share an entree with whomever I'm with. This really takes the pressure of eating off.
All in all, I'm slowly working on things and each week is better than the last.
Saturday, August 15, 2009
I like this one better... haha.
It's kinda funny, I don't think I look that goofy anymore when I smile. I guess I can start doing that for pictures. :)
2 Months Post-op Thoughs
So it's two months after surgery and things are still going well. At my last doctor's appointment which was a week and a half ago I was 315 lbs. I have not weight in the three-teens since 2002. It's a good feeling to know that in a few months I'll never see the three anything again.
The hardest thing for me since the surgery has been adjusting my social life. I never noticed how much people and social gatherings revolve around food. I am still adjusting to this change but I think over time it will not be so odd because my friends will know that I simply cannot eat in quantity and I won't have to explain to them why.
I'm still battling with the eating one bit too much thing. The chopsticks help tremendously with eating slow and taking smaller bites. Needless to say I have some mad chopstick skills now.
The last thing I've noticed lately is muscle aches are on the increase. Most notably in my back and groin area. I think my back is adjusting itself to not carrying around so much weight and my groin is sore because I'm sure my gait is different and I'm using muscles that I haven't used before.
But all said, I'm still happy I had the surgery and I do not regret it. Socially it's a pain in the butt but otherwise I'm very happy.
The hardest thing for me since the surgery has been adjusting my social life. I never noticed how much people and social gatherings revolve around food. I am still adjusting to this change but I think over time it will not be so odd because my friends will know that I simply cannot eat in quantity and I won't have to explain to them why.
I'm still battling with the eating one bit too much thing. The chopsticks help tremendously with eating slow and taking smaller bites. Needless to say I have some mad chopstick skills now.
The last thing I've noticed lately is muscle aches are on the increase. Most notably in my back and groin area. I think my back is adjusting itself to not carrying around so much weight and my groin is sore because I'm sure my gait is different and I'm using muscles that I haven't used before.
But all said, I'm still happy I had the surgery and I do not regret it. Socially it's a pain in the butt but otherwise I'm very happy.
Thursday, July 16, 2009
Thursday, July 9, 2009
The Ups and the Downs
I want to end this on a positive note so I'll write about the bad first.
Really, I only have two complaints. They both revolve around food.
I'm three and a half weeks out and I'm still having issues with a lot of foods. I've had to purge myself four times in the past two weeks. I've discovered my stomach holds two tablespoons and not a drop more. I've vomited more in the last two weeks than I have in most of my adult life. It's not terrible but it's very discouraging.
Since I had such a terrible day yesterday I'm doing full-liquids today. I think that is a good policy.
And my second gripe, I'm still not able to figure out my portion size. Some days 1/3rd of a cup is just perfect, others it's excruciatingly too much food. I still think I'm eating too fast.
OK... now that that is over here is the good!
I've discovered Worldwide Pure Protein Shakes. It's so easy to get my daily protein. I have a shake for breakfast since I'm not much for food and I have a shake before I go to bed to give my body something to gnaw on while I sleep. The good part... 70g of protein is easy. I'm totally in love with the cookies and cream flavor. To me it tastes more like coconut than anything else. I also like the banana flavor.
My bowels are basically back to normal. This is very encouraging. The diarrhea was driving me nuts. I think they should warn patients pre-op that they will have rather significant diarrhea.
And my healing is still progressing rather well. Some days I have a slight twinge and others nothing at all. The bruising is 90% gone and my incisions are glue free.
But taking the bad in consideration with the good, I still do not regret what I have done. My habit is to consider the future is far more significant than the present and hopefully with enough time and "training" I will know my limits.
I do not regret this...
Really, I only have two complaints. They both revolve around food.
I'm three and a half weeks out and I'm still having issues with a lot of foods. I've had to purge myself four times in the past two weeks. I've discovered my stomach holds two tablespoons and not a drop more. I've vomited more in the last two weeks than I have in most of my adult life. It's not terrible but it's very discouraging.
Since I had such a terrible day yesterday I'm doing full-liquids today. I think that is a good policy.
And my second gripe, I'm still not able to figure out my portion size. Some days 1/3rd of a cup is just perfect, others it's excruciatingly too much food. I still think I'm eating too fast.
OK... now that that is over here is the good!
I've discovered Worldwide Pure Protein Shakes. It's so easy to get my daily protein. I have a shake for breakfast since I'm not much for food and I have a shake before I go to bed to give my body something to gnaw on while I sleep. The good part... 70g of protein is easy. I'm totally in love with the cookies and cream flavor. To me it tastes more like coconut than anything else. I also like the banana flavor.
My bowels are basically back to normal. This is very encouraging. The diarrhea was driving me nuts. I think they should warn patients pre-op that they will have rather significant diarrhea.
And my healing is still progressing rather well. Some days I have a slight twinge and others nothing at all. The bruising is 90% gone and my incisions are glue free.
But taking the bad in consideration with the good, I still do not regret what I have done. My habit is to consider the future is far more significant than the present and hopefully with enough time and "training" I will know my limits.
I do not regret this...
Saturday, July 4, 2009
10-day check up
I forgot to post about my 10-day check up. The surgeon says I am progressing well and he removed the drain I had sticking out of my side. That was a rather weird experience. Not necessarily painful, just a very odd sensation.
I weighed 31 pounds lighter as well or better stated I have lost 11% of my excess body weight. My weight loss really didn't sink in until about a week later when I had a thought come to me as I was walking through Walgreens.
I will never gain those 31 pounds back again! That was a very good feeling.
I weighed 31 pounds lighter as well or better stated I have lost 11% of my excess body weight. My weight loss really didn't sink in until about a week later when I had a thought come to me as I was walking through Walgreens.
I will never gain those 31 pounds back again! That was a very good feeling.
Learning my limit
I'm 2.5 weeks out from surgery and things are going reasonably ok. I'm no longer sore from the surgery and my incisions are healing well.
On Tuesday I was able to progress to phase three of my diet which is "soft foods". I have been having a hell of a time with this phase. This may sound gross but I never knew I could make myself vomit until I tried to eat eggs. According to other WLS folks, eggs are notoriously hard to eat and it may take as many as five or six months before I can tolerate them well.
I'm having a difficult time learning the limits of my food intake. I'm constantly eating too much and it always seems like I'm eating one or two bites too many. I'm guessing I'm eating too fast and my stomach cannot tell my brain I'm full until things are literally backing up. So far I can eat about two or three tablespoons of food. Or it could be I'm eating the wrong foods. I'm not sure. I'm certainly not a fan of vomiting.
I ordered a food scale that should be arriving this week coming up. I'm really hoping this helps me measure my food intake and things.
Tomorrow's strategy: Measure out 3oz (1/3 cup) of food and see if that helps.
On Tuesday I was able to progress to phase three of my diet which is "soft foods". I have been having a hell of a time with this phase. This may sound gross but I never knew I could make myself vomit until I tried to eat eggs. According to other WLS folks, eggs are notoriously hard to eat and it may take as many as five or six months before I can tolerate them well.
I'm having a difficult time learning the limits of my food intake. I'm constantly eating too much and it always seems like I'm eating one or two bites too many. I'm guessing I'm eating too fast and my stomach cannot tell my brain I'm full until things are literally backing up. So far I can eat about two or three tablespoons of food. Or it could be I'm eating the wrong foods. I'm not sure. I'm certainly not a fan of vomiting.
I ordered a food scale that should be arriving this week coming up. I'm really hoping this helps me measure my food intake and things.
Tomorrow's strategy: Measure out 3oz (1/3 cup) of food and see if that helps.
Sunday, June 21, 2009
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.
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.
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.
Tuesday, June 16, 2009
Sunday, June 14, 2009
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.
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.
Tuesday, June 2, 2009
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.
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.
Wednesday, May 27, 2009
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.)
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:
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.)
- 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.
- The portion of the stomach that produces the hormone ghrelin is removed. This is beneficial for reducing the desire to eat.
- The incidents of gastric dumping is basically eliminated due to the fact the pylorus is preserved.
- The overall complication list is drastically reduced due to the fact no anastomotic openings are created and the intestines remain unchanged and intact.
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.
Saturday, May 23, 2009
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.
The EGD (Endoscopy)
I had the EGD on Friday morning. It was a piece of cake. All they did was start an IV, give me three drugs, perform the procedure and then I went home. I think I was there for a total of 2.5 hours.
Here are the drugs they used:
He said everything looked normal but decided to give me a prescription for Prilosec. It helps strengthen the esophageal sphincter. This is good for gastric bypass patients because it will help to reduce vomiting.
My PCP should get the results in a few days and at that time I will also pick up my surgical clearance and take them to the surgeon.
Here are the drugs they used:
- Robinul - to dry up my mouth and pharynx
- Versed - for relaxation and sedation
- Diprivan - to put me to sleep
He said everything looked normal but decided to give me a prescription for Prilosec. It helps strengthen the esophageal sphincter. This is good for gastric bypass patients because it will help to reduce vomiting.
My PCP should get the results in a few days and at that time I will also pick up my surgical clearance and take them to the surgeon.
Friday, May 22, 2009
WLS Class 2 and beyond...
On Wednesday I attended the second half of the mandatory WLS class. The room wasn't quite so full this time.
We reviewed the post-op diet again and then we covered the topics of supplements, the day of surgery, the hospital stay and subsequent discharge, and post-op exercise.
On average WLS patients spend two nights in the hospital. I was very surprised at how busy I will be after surgery. There will be frequent five minute walks, a leak test, and another type of test that I am not remembering at this time... Hey! It's 4:30am and I'm tired... and hungry but more about that in a few.
Regarding post-op supplements I learned quite a bit.
They offer an eight week exercise course with an exercise physiologist for $128.00. I am not sure if I will participate in the program. It definately is not the cost because that is exceedingly cheap. I made sure the participants in the class were well aware of that. My employer offers an exercise program through their exercise facility for employees. I think I'll check into this program first before participating in the program offered by my surgeon's team.
So why am I so hungry??? I have my pre-op endoscopy this morning. I'm not quite sure what to expect. Everyone says it's not terrible and they don't usually remember it due to the drugs. I believe they will use versed and fentanyl to sedate me but if they don't I'll update it here. These are the most common drugs used.
So what's left to do before surgery?
We reviewed the post-op diet again and then we covered the topics of supplements, the day of surgery, the hospital stay and subsequent discharge, and post-op exercise.
On average WLS patients spend two nights in the hospital. I was very surprised at how busy I will be after surgery. There will be frequent five minute walks, a leak test, and another type of test that I am not remembering at this time... Hey! It's 4:30am and I'm tired... and hungry but more about that in a few.
Regarding post-op supplements I learned quite a bit.
- The body can only utilize about 500 IU of Vitamin D at a time.
- WLS patients regardless of gender need 1500 IU of Vitamin D daily.
- Regarding protein, I have read that people recommend adding it to hot coffee, hot soup, and other types of hot meals. I specifically questioned this practice. In theory, it sounds like a great idea and an easy way to get 20g of protein in a meal. Well... it really doesn't work that way. As we all know, heat breaks down protein. This happens when we fry an egg and the originally clear egg whites turn white or when we cook meat and it goes from red to brown. Heat will do the same thing to whey protein. The dietician recommended allowing the heated liquid to cool to below 120 degrees. My coffee maker will heat coffee to above 150 degrees so that is out of question. And I love HOT soup... so again, out of the question... However, I do plan to come up with some creative protein ideas (which I will post here.)
They offer an eight week exercise course with an exercise physiologist for $128.00. I am not sure if I will participate in the program. It definately is not the cost because that is exceedingly cheap. I made sure the participants in the class were well aware of that. My employer offers an exercise program through their exercise facility for employees. I think I'll check into this program first before participating in the program offered by my surgeon's team.
So why am I so hungry??? I have my pre-op endoscopy this morning. I'm not quite sure what to expect. Everyone says it's not terrible and they don't usually remember it due to the drugs. I believe they will use versed and fentanyl to sedate me but if they don't I'll update it here. These are the most common drugs used.
So what's left to do before surgery?
- Chest x-ray
- Psychological evaluation
- Pre-op shopping
- 8 day 1,000 calorie pre-op diet
- Submit short-term disability paperwork to human resources
- Receive my surgical clearance from my PCP
- Visit the kennel for the dog
Thursday, May 14, 2009
Weight Loss Surgery Class 1 of 2
Today from 4 until 6 I was required to attend a class covering the weight loss surgery.
The room was completely filled by the time I got there and extra tables and chairs had to be brought in to accommodate everyone. It was slightly obnoxious. I can understand bringing your support person but your entire family? Not necessary. I was expecting maybe 20 people tops, not fifty.
It was mostly middle-aged women and younger men. I was very surprised at the amount of VSG type surgeries scheduled. It was about 50/50. Which kind of leads me to believe that the surgeon is pushing VSG when RNY is just as acceptable. I have basically been beating myself up over why the surgeon would recommend VSG over RNY for me but from what I'm seeing that is his preference.
Here are some interesting statistics I learned today concerning VSG:
The class covered the general differences between surgery and what the patient needs to do to be successful with minimal complications. Strict adhearance to the post-op diet plan seemed to be the number one way to reduce surgical complications.
Here are the new things that I learned today:
The next class is supposed to cover vitamins, exercise, and post-operative recovery.
Here are some questions I would like answered during the next class:
The room was completely filled by the time I got there and extra tables and chairs had to be brought in to accommodate everyone. It was slightly obnoxious. I can understand bringing your support person but your entire family? Not necessary. I was expecting maybe 20 people tops, not fifty.
It was mostly middle-aged women and younger men. I was very surprised at the amount of VSG type surgeries scheduled. It was about 50/50. Which kind of leads me to believe that the surgeon is pushing VSG when RNY is just as acceptable. I have basically been beating myself up over why the surgeon would recommend VSG over RNY for me but from what I'm seeing that is his preference.
Here are some interesting statistics I learned today concerning VSG:
- If the patients BMI is 45-49 weight loss results are the same for RNY and weight loss occurs at the same rate.
- The size of the sleeve after the surgery is about two times the size of a drinking straw.
The class covered the general differences between surgery and what the patient needs to do to be successful with minimal complications. Strict adhearance to the post-op diet plan seemed to be the number one way to reduce surgical complications.
Here are the new things that I learned today:
- The body can only utilize/absorb 30-35g of protein per meal.
- RNY/Gastric Bypass basically eliminates diabetes for 85% of patients following surgery.
- There will be no more chugging water.
- NSAID's are not allowed after surgery because of their ulcer causing potential.
The next class is supposed to cover vitamins, exercise, and post-operative recovery.
Here are some questions I would like answered during the next class:
- In their experience how long does it take someone to modify their eating habits (e.g. portion size, bite size, and frequency?)
- Do they recommend using a scale to measure food portions?
Tuesday, May 5, 2009
First consultation complete
had an appointment today at 4pm to meet with the team at the center. I walked away accomplishing everything I needed to.
I have a date for surgery: 16 June. That's seven weeks from today... I was very surprised I could get it scheduled so soon.
I have a few steps to accomplish before the surgery.
1. Chest x-ray, blood work, and an endoscopy I will schedule tomorrow.
2. I have an appointment with the psychologist on 1 June.
3. I have two mandatory classes that I need to attend.
The mandatory classes I need to attend is the only snag in the entire process due to my summer college course conflicting with the class. I will have to see how the course is when I begin it next week and determine if special arrangements need to be made.
The surgeon recommended gastric sleeve but I'm not entirely sure I'm sold on the idea. I am more sold on the bypass. I'm pretty sure the surgeon recommended the sleeve due to my health insurance but it could have been because of clinical indicators i am not aware of.
I will have a recovery time / vacation from work for four to six weeks. That will get me through the post op dieting at home, which is most beneficial.
I will also have an 8 day pre-op diet which will consist of eating less than 1000 calories a day.
I'm frankly very satisfied with the experience I had with the program director, the surgeon, and the nurse. Everyone was very friendly and very informative. I definitely did not feel like I was being run through an assembly line type process or hurried along.
The nice thing about the staff at the office is three of them are RNY patients.
The next major thing is the Endoscopy. I'm seriously hoping it's not horrible. :)
I have a date for surgery: 16 June. That's seven weeks from today... I was very surprised I could get it scheduled so soon.
I have a few steps to accomplish before the surgery.
1. Chest x-ray, blood work, and an endoscopy I will schedule tomorrow.
2. I have an appointment with the psychologist on 1 June.
3. I have two mandatory classes that I need to attend.
The mandatory classes I need to attend is the only snag in the entire process due to my summer college course conflicting with the class. I will have to see how the course is when I begin it next week and determine if special arrangements need to be made.
The surgeon recommended gastric sleeve but I'm not entirely sure I'm sold on the idea. I am more sold on the bypass. I'm pretty sure the surgeon recommended the sleeve due to my health insurance but it could have been because of clinical indicators i am not aware of.
I will have a recovery time / vacation from work for four to six weeks. That will get me through the post op dieting at home, which is most beneficial.
I will also have an 8 day pre-op diet which will consist of eating less than 1000 calories a day.
I'm frankly very satisfied with the experience I had with the program director, the surgeon, and the nurse. Everyone was very friendly and very informative. I definitely did not feel like I was being run through an assembly line type process or hurried along.
The nice thing about the staff at the office is three of them are RNY patients.
The next major thing is the Endoscopy. I'm seriously hoping it's not horrible. :)
Tuesday, April 28, 2009
OK'd by PCP
I am just getting home from the my regular doctor. We discussed her writing a letter for me and her feelings about WLS. She supports me but also cautions me to view this is a serious lifestyle modification. She has had 6 patients in her practice that have ate themselves through a gastric bypass. She frankly put it, mashed potatoes and cheeseburgers won't cut it.
I explained to her that I have done extensive research over the last year and that this is probably the most informed decision I have ever made in my life.
She seemed comfortable with everything and will have my letter ready on Monday.
Next step, consultation with the surgeon on 5 May.
I explained to her that I have done extensive research over the last year and that this is probably the most informed decision I have ever made in my life.
She seemed comfortable with everything and will have my letter ready on Monday.
Next step, consultation with the surgeon on 5 May.
Thursday, April 16, 2009
Questions
Here is my list of questions for my consultation. I will add to this list when I think of additional topics that I feel need to be addressed.
1. What are the various recovery times from surgery? (Hospital discharge, return to school, return to work...)
In general this takes three to six weeks but on average one month.
2. I have already given up soda in preparation for life after surgery, do I need to give up coffee as well?
No, just no coffee for the first two weeks after surgery since the caffeine will slow healing.
3. What about spicy foods such as Indian and Thai?
No problems at all but not until I am on regular food.
4. Is there a support system for adjusting to life after surgery?
They have a support group that meets once a month at the hospital as well as the nutritionist, psychologist, and staff at the center.
5. How soon after surgery can I start exercising?
Walking up to one mile a day is greatly encouraged and after six weeks all routines and activities may be started.
6. If I have surgical related complications that would require a trip to the ED, can I go to my hospital or do I have to go to St. Mary's Hospital?
I can go to my hospital but if it is a serious complication, it would be best if I went to their ER.
7. Due to the often strenuous nature of my profession, should their be additional recover time to prevent possible injury?
I shouldn't need more than six weeks off work.
1. What are the various recovery times from surgery? (Hospital discharge, return to school, return to work...)
In general this takes three to six weeks but on average one month.
2. I have already given up soda in preparation for life after surgery, do I need to give up coffee as well?
No, just no coffee for the first two weeks after surgery since the caffeine will slow healing.
3. What about spicy foods such as Indian and Thai?
No problems at all but not until I am on regular food.
4. Is there a support system for adjusting to life after surgery?
They have a support group that meets once a month at the hospital as well as the nutritionist, psychologist, and staff at the center.
5. How soon after surgery can I start exercising?
Walking up to one mile a day is greatly encouraged and after six weeks all routines and activities may be started.
6. If I have surgical related complications that would require a trip to the ED, can I go to my hospital or do I have to go to St. Mary's Hospital?
I can go to my hospital but if it is a serious complication, it would be best if I went to their ER.
7. Due to the often strenuous nature of my profession, should their be additional recover time to prevent possible injury?
I shouldn't need more than six weeks off work.
Tuesday, April 7, 2009
The stigma
I know I have always viewed people who had weight loss surgery with a certain amount of stigma. I think most people look at people who have had weight loss surgery as weak. Weak physically, mentally, and psychologically.
If they weren't weak they would be able to lose their excessive weight!
Well, I am a hypocrite.
Here I am, three weeks away from my consultation with a bariatric surgeon. I really think there is a cycle that prevents people who diet and exercise from maintaining their efforts and weight loss results.
For me, I have never been able to get past the wall. Anyone who has, they are better than I am.
So this leads me back to the stigma of weight loss surgery. Do I tell my family, friends and coworkers? Or do I just state, "Diet and exercise" when asked. Everyone always wants to know what someone did to lose weight. I also know that when people talk about someone who has had weight loss surgery it usually isn't very positive.
I think I will eventually tell some people in my life but I think I will leave a majority believing it was diet and exercise.
If they weren't weak they would be able to lose their excessive weight!
Well, I am a hypocrite.
Here I am, three weeks away from my consultation with a bariatric surgeon. I really think there is a cycle that prevents people who diet and exercise from maintaining their efforts and weight loss results.
For me, I have never been able to get past the wall. Anyone who has, they are better than I am.
So this leads me back to the stigma of weight loss surgery. Do I tell my family, friends and coworkers? Or do I just state, "Diet and exercise" when asked. Everyone always wants to know what someone did to lose weight. I also know that when people talk about someone who has had weight loss surgery it usually isn't very positive.
I think I will eventually tell some people in my life but I think I will leave a majority believing it was diet and exercise.
Choosing a surgery
I decided to start investigating weight loss surgery months ago. I never allow anyone to make decisions for me and I truly believe in (self) informed consent. When I attend my consultation appointment with the surgeon I want to already have an idea about which surgery I feel is the best fit for my life and what questions I want to ask.
According to my extensive research there are generally three surgical options offered: gastric bypass, sleeve gastrectomy, and adjustable gastric banding. I have reviewed each option, their advantages, disadvantages, complications and results.
By far the most common surgery is gastric bypass specifically roux-en-Y stomach bypass. This option has demonstrated to be the most successful tool used to reduce weight. Basically, the stomach is reduced to the size of one ounce or two tablespoons and the new small pouch is connected to the small intestine bypassing several inches of small intestine limiting caloric absorption. It is the latter half of the surgery that concerns me. Along with limiting caloric absorption, vitamin and mineral absorption is also limited. I feel this will be a problem for me. Plus the other side effects I find less than desirable. Some of the side effects that concern me the most are bowel obstructions, ulcers, and dumping syndrome. The nutritional deficiencies are also concerning. Deficiencies in calcium, iron, vitamin B12, thiamine, and vitamin A are all things that lead to serious problems. However, it seems all of these problems can be managed with supplements.
The next most common form of surgery is adjustable gastric banding. I heavily considered this option after learning about all the potential complications of gastric bypass. This option allows for slower weight loss and no malabsorption issues. However this form of weight loss surgery allows for the least amount of excess weight loss. I find the side effect profile for this surgery bothersome as well. First, what is called the lap band may become dislodged, it may cause gastric erosion, and certain foods have a high propensity to become stuck in the opening. This surgery is by far the safest but considering I weight 365 lbs I do not think it is the right choice for me.
The least common form of surgery is sleeve gastrectomy. This surgery preserves the pyloric valve and does not cause malabsorption issues since there is no small intestine bypassed. However, the suffix –ectomy means removal and 85% of the stomach is removed which makes this surgical procedure irreversible. The new stomach size is about two ounces or four tablespoons. Because a majority of the stomach is removed the production of a hormone called ghrelin is significantly reduced. This hormone is responsible the feeling of hunger. The side effects of this surgery are ulcers and gastric leakage. This surgery also may lead to inadequate weight loss or weight gain from overeating, which causes the new stomach to stretch. The weight loss results and ultimately success is heavily dependant on the size of the stomach after surgery. This depends on which size bougie the surgeon uses during the surgery. Most recommendations state the use of a 32-french bougie results in superior weight loss but some surgeons may use a bougie as large as 40-french. This surgery has the potential of achieving the weight loss results of gastric bypass.
Because of everything I have learned, I am heavily considering the sleeve gastrectomy procedure. I will only consider this surgery if the surgeon uses a 32-french bougie. I do not want a stomach that is bigger than two or three ounces. If for some reason this surgery cannot be performed to these specifications then I will choose gastric bypass.
According to my extensive research there are generally three surgical options offered: gastric bypass, sleeve gastrectomy, and adjustable gastric banding. I have reviewed each option, their advantages, disadvantages, complications and results.
By far the most common surgery is gastric bypass specifically roux-en-Y stomach bypass. This option has demonstrated to be the most successful tool used to reduce weight. Basically, the stomach is reduced to the size of one ounce or two tablespoons and the new small pouch is connected to the small intestine bypassing several inches of small intestine limiting caloric absorption. It is the latter half of the surgery that concerns me. Along with limiting caloric absorption, vitamin and mineral absorption is also limited. I feel this will be a problem for me. Plus the other side effects I find less than desirable. Some of the side effects that concern me the most are bowel obstructions, ulcers, and dumping syndrome. The nutritional deficiencies are also concerning. Deficiencies in calcium, iron, vitamin B12, thiamine, and vitamin A are all things that lead to serious problems. However, it seems all of these problems can be managed with supplements.
The next most common form of surgery is adjustable gastric banding. I heavily considered this option after learning about all the potential complications of gastric bypass. This option allows for slower weight loss and no malabsorption issues. However this form of weight loss surgery allows for the least amount of excess weight loss. I find the side effect profile for this surgery bothersome as well. First, what is called the lap band may become dislodged, it may cause gastric erosion, and certain foods have a high propensity to become stuck in the opening. This surgery is by far the safest but considering I weight 365 lbs I do not think it is the right choice for me.
The least common form of surgery is sleeve gastrectomy. This surgery preserves the pyloric valve and does not cause malabsorption issues since there is no small intestine bypassed. However, the suffix –ectomy means removal and 85% of the stomach is removed which makes this surgical procedure irreversible. The new stomach size is about two ounces or four tablespoons. Because a majority of the stomach is removed the production of a hormone called ghrelin is significantly reduced. This hormone is responsible the feeling of hunger. The side effects of this surgery are ulcers and gastric leakage. This surgery also may lead to inadequate weight loss or weight gain from overeating, which causes the new stomach to stretch. The weight loss results and ultimately success is heavily dependant on the size of the stomach after surgery. This depends on which size bougie the surgeon uses during the surgery. Most recommendations state the use of a 32-french bougie results in superior weight loss but some surgeons may use a bougie as large as 40-french. This surgery has the potential of achieving the weight loss results of gastric bypass.
Because of everything I have learned, I am heavily considering the sleeve gastrectomy procedure. I will only consider this surgery if the surgeon uses a 32-french bougie. I do not want a stomach that is bigger than two or three ounces. If for some reason this surgery cannot be performed to these specifications then I will choose gastric bypass.
What has lead me to this point?
My story is much like the others I have read. All of my attempts to lose weight have been refractory. I’ll discuss my dieting attempts first.
I have tried the conventional methods of caloric restriction and exercise. I did lose weight but when I would stop exercising or dieting I would regain weight with little effort. I found this extremely disheartening because I wasn’t over eating, gorging on sweets, or eating excessively large meals. However, the failure of caloric restriction was always due to hunger and guilt. It’s easy to understand where the hunger came from but the guilt? Anytime I would engage in eating that I perceived as failure, i.e. restaurants, family gatherings, or any environment where I couldn’t control what I was eating I would feel guilty about what I considered to be a failure.
I found the low carb diet to be very interesting, especially the cravings. I am not the type of person who eats high carbohydrate foods such as breads and pasta often and I never crave them. However after about two weeks into the diet all I would think about would be bread or pasta. It would consume my idle thoughts. I can vividly remember fantasizing about eating plain spaghetti. I would rapidly lose weight with little effort but I found the diarrhea and carbohydrate cravings discouraging.
My most recent attempts at dieting were more of a food revolution. I stopped eating processed foods especially processed meats and started eating whole foods, real meat, and vitamin, mineral, and antioxidant rich fruits and vegetables. This diet had profound effects on my health. I no longer have to take blood pressure medication and my cholesterol levels have normalized. I figured my weight would reduce as well but it has only maintained. However, I continue to eat this way today.
This brings me to talking about my exercise. I have never been a lazy person and I have never allowed my weight to affect my activity level. With that said, my weight has limited my choice of activities. I have received compliments concerning my endurance level. My weight has never slowed me down. As the saying goes, I can keep up with the best of them.
Over the years, I have noticed increasing amounts of back and joint pain that I can only attribute to my weight. Which presumably will only get worse with age.
I have a dream of being the type of person who can run. I definitely have the endurance but my weight has always been a stopping factor. My weight also stops me from doing other things that I love such as roller coasters, shopping for clothes, skiing, and any other thing that causes me to think, “Am I too big to do this?”
I have a gym membership. I have tried to regularly workout however my weight has made me feel very self-conscious at the gym. Also this is where the feelings of guilt play an important role. If I would not match or exceed my previous workout or if I skipped a workout then I would feel guilty and this was a major source of failure. I also find my weight embarrassing when I am at the gym.
The psychological impact of being overweight is profound. I find my weight, weight gain, limitations and almost every weight related issue depressing. I would not say my weight has lead to major depression but it does lead to negative feelings and anxiety.
And the amazing part about what I just wrote, it is only a small amount of the actual thoughts and feelings that have lead me to where I am at today.
Everyone has their own experiences and reasons why they decide to lose weight and maybe from everything I have just written may help anyone reading this understand my struggles and why I have made the profound decision to alter my anatomy as a tool for achieving permanent weight loss.
I have tried the conventional methods of caloric restriction and exercise. I did lose weight but when I would stop exercising or dieting I would regain weight with little effort. I found this extremely disheartening because I wasn’t over eating, gorging on sweets, or eating excessively large meals. However, the failure of caloric restriction was always due to hunger and guilt. It’s easy to understand where the hunger came from but the guilt? Anytime I would engage in eating that I perceived as failure, i.e. restaurants, family gatherings, or any environment where I couldn’t control what I was eating I would feel guilty about what I considered to be a failure.
I found the low carb diet to be very interesting, especially the cravings. I am not the type of person who eats high carbohydrate foods such as breads and pasta often and I never crave them. However after about two weeks into the diet all I would think about would be bread or pasta. It would consume my idle thoughts. I can vividly remember fantasizing about eating plain spaghetti. I would rapidly lose weight with little effort but I found the diarrhea and carbohydrate cravings discouraging.
My most recent attempts at dieting were more of a food revolution. I stopped eating processed foods especially processed meats and started eating whole foods, real meat, and vitamin, mineral, and antioxidant rich fruits and vegetables. This diet had profound effects on my health. I no longer have to take blood pressure medication and my cholesterol levels have normalized. I figured my weight would reduce as well but it has only maintained. However, I continue to eat this way today.
This brings me to talking about my exercise. I have never been a lazy person and I have never allowed my weight to affect my activity level. With that said, my weight has limited my choice of activities. I have received compliments concerning my endurance level. My weight has never slowed me down. As the saying goes, I can keep up with the best of them.
Over the years, I have noticed increasing amounts of back and joint pain that I can only attribute to my weight. Which presumably will only get worse with age.
I have a dream of being the type of person who can run. I definitely have the endurance but my weight has always been a stopping factor. My weight also stops me from doing other things that I love such as roller coasters, shopping for clothes, skiing, and any other thing that causes me to think, “Am I too big to do this?”
I have a gym membership. I have tried to regularly workout however my weight has made me feel very self-conscious at the gym. Also this is where the feelings of guilt play an important role. If I would not match or exceed my previous workout or if I skipped a workout then I would feel guilty and this was a major source of failure. I also find my weight embarrassing when I am at the gym.
The psychological impact of being overweight is profound. I find my weight, weight gain, limitations and almost every weight related issue depressing. I would not say my weight has lead to major depression but it does lead to negative feelings and anxiety.
And the amazing part about what I just wrote, it is only a small amount of the actual thoughts and feelings that have lead me to where I am at today.
Everyone has their own experiences and reasons why they decide to lose weight and maybe from everything I have just written may help anyone reading this understand my struggles and why I have made the profound decision to alter my anatomy as a tool for achieving permanent weight loss.
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