thin skin

some days, i feel a careful separation between me and what the world thinks of fat people. and other days, that separation seems to have evaporated into thin air. i find myself on edge after seeing or hearing an insensitive comment and i feel a generalized sense of malaise. it's frustrating, though not surprising, that external things can sometimes feel so personal.take for example, the douchebag asshole on facebook who apparently has a very sophisticated sense of humor. the photos above and below are his two most recent status updates. asshole. unfriended asshole, that is.

i thought about sharing some parting words before i unfriended him, but really, why? what would it get me? 

then in the much more evolved but still upsetting realm, i read an article about a woman who lost 120 lbs by cutting out processed foods, etc, which i think is great. what put me in a bad mood was the way she dismissed gastric bypass surgery, which she had considered and then decided against. 

i get that people sometimes think it's the easy way out, though i stopped having that notion as soon as i understood what it entailed for life. the part that bothers me is the notion of doing it "on your own" and it's what stopped me from considering the surgery earlier (read about how i decided to do it here). for me, doing it "on my own" wasn't as important as DOING IT, and i arrived at the fact that if i knew how to do it, i would have done it already, a hundred times. if the woman featured in this article can do it "on her own," then i'm happy for her. so whatever, i can brush that off. 

but what left me feeling uneasy and sad was the casual mention of how many people gain the weight back. why does that bug me so much? probably because i know it's true and i have the deepest, most intense fear that it will happen to me.

bottoms up

so i was cleared to try alcohol in advance of my sister's wedding last weekend. it's supposed to be a year from the surgery, but i asked for special dispensation about three weeks shy of the one year mark. dr. b and sophie (his PA) granted me permission, warning me to go slow and that i would get drunk fast. they suggested one drink. partly, it's because gastric bypass patients tend to have a lower tolerance for alcohol post-surgically. that's partially because we absorb ethanol at a faster rate because the tiny stomach dumps the alcohol directly into the jejunum which has a large surface and absorbs the alcohol quickly. also,  we a) weigh less and b)haven't had a drink in sooo long.

drinking presents challenges - no sugar, no carbonation. so there goes wine and champagne, my two drinks of choice before (really only sad to see champagne go...). so vodka seemed the answer. can't mix it with tonic or soda, or juice...diet snapple it is. so last wednesday night, i tried a half of a shot of vodka mixed with some diet snapple. i definitely got that initial taste of tipsiness on the fast side, but it didn't escalate quickly at all. i felt fine. and it was fun!

so for the festivities surrounding molly's wedding, i sipped vodka. i didn't have diet snapple handy, so i mixed it with a little crystal light and water one night (that was good!) and with water and fresh lemon juice the rest of the time. i actually think it's probably a good thing to mix it with water and lemon juice because it sort of goes down slower than something that tastes like candy. 

mitchell was a little nervous and watching what i drank pretty carefully, but overall, i enjoyed having a couple drinks, and i look forward to doing it again on appropriate occasions :) 

i didn't feel like i got particularly drunk, and it didn't make me want to eat a lot or the wrong things, which i'm very pleased about. i will be very sure, though, to manage my drinking habits...i am well aware that so many weight loss surgery patients experience cross - addiction and addiction transfer, and i have to be mindful about my susceptibility to that. if i find myself looking forward to a drink in the middle of the day, i have to be committed to getting off that train.

i also have to manage my tendency from long ago to want more and more of what's making me feel good (as in: pizza, lo mein, sandwiches, cigarettes, coffee, alcohol...can't i feel that way about the gym?) i need to get used to enjoying the feeling of being a little buzzed and not wanting to feed it with more alcohol that will make me uncomfortably, and perhaps dangerously, intoxicated. i guess i'll be working on it at the same time as i get used to tasting a little bit of something and having that be enough. they're more than a little connected.

image

the long, slow binge

one of the reasons why gastric bypass surgery was so right for me is that binging has always been at the core of my problem, and the surgery makes it literally impossible to binge. i am totally certain every day that my ability to binge needed to be removed so that i could heal and recover from what is most certainly an addiction, a disorder, an illness. i often liken it to a drug addict who needs to be forcibly removed from drugs in order to withdraw and participate in any kind of meaningful therapy or healing or recovery. it's the exact same thing with binging for me. although the obvious metaphor for the drug is food, it's not so for me. my drug was never food, it was binging. i realized in the road leading to my surgery as i explored why it was so hard to let go of food in that way, that i was not addicted to food...i was addicting to eating -- to the sheer, merciful, numbing act of eating. binging was the ultimate form of eating...stuffing myself so full and often so fast that it was a total paralysis...in the best, and worst, of ways. so when people ask if i miss food...i don't. there isn't a single food i truly, truly miss. pizza smells good sometimes, bagels sound delicious. but it's not temptation, and there's no sadness. what i do miss is the way the food made me feel and what it did for me. clearly it did a lot of things that weren't so great too, but it worked. i don't think i would have done it for so long that way if it hadn't.

so i can't binge. and thank god. as grandmothers everywhere would say...kenahara. AND HOW. 

what i can do, though, is graze which is basically a long, slow binge. one of the cardinal rules of weight loss surgery success (and probably with any weight loss success, period) is not to  graze. several small meals a day, yes. snacking throughout the day, NO. i'm learning i have to be careful not to do this, because the few times i have found myself eating a little here and there, i've found that it's a way to numb myself just a little here and there. it's in no way the way it was before, and definitely doesn't achieve the same wonderful, horrible effect, but it does it's own kind of work, and i've learned quickly to be mindful of it. 

so much of the appeal of the binge was the anticipation...the looking forward to it, the mental rehearsing, the blissful moments right before, and then the moments of actual consumption...of course afterwards it was all downhill, but that didn't seem to matter. so if you look at those components..the anticipation, the mental rehearsing, the moments of actual consumption...they all exist in grazing, and can exist every hour on the hour since i can only eat a little at a time. i could see how a binger could become a grazer...it's like beating the system and it's not okay for a few reasons...first, because you could easily consume enough calories to GAIN weight rather than lose, even with a stomach the size of an egg. and second, and most importantly, because it's not a behavior and a need i want to allow forever. 

i need to learn to make choices...if i'm in the mood for a pb&j and also a shrimp and veggie salad, i have to be okay with choosing only one, not choosing instead to have the shrimp salad now and have a taste of peanut butter later. even if it's calorically okay for me, it's not behaviorally okay. 

it's a long fucking road.

a day in the life

one of the things i wondered about most when i was pre-op was what my day would look like in terms of food. one on hand, i felt embarrassed by the idea that i was having weight loss surgery, about to change my life so drastically forever, and yet what i was thinking about was the food. but that's the reality for so many people considering the surgery - in some ways, it's the mentality that got us here, and it's not easy to break just because you've made the decision to have the surgery. if we were able to overhaul that way of thinking, we wouldn't need the surgery...and the cycle continues.

i was afraid to ask people online, in my support group, even my nutritionist what a post-op day of food looked like because of that shame, so i wanted to share it with you. i figure i'll do it once a week or so, so you can see the variety of foods i eat, the amounts, the times and what my feelings/thoughts are about each meal and snack. i know it would have been helpful to me beforehand, in fact one of the best message board threads i came across on this site was about what foods you were afraid you'd miss once you had the surgery and how you feel about it now. it was such a relief to me to see that other people had food fears and thoughts beforehand and that i wasn't alone. so i hope these posts can offer some comfort to people who need to know what their new life will look like. 

in broad strokes...

• between 80g and 100g of protein daily is non-negotiable. 
• i try to stay between 1000-1200 calories a day, closer to 1000 if it's not a day i'm working out. also, if i am working out, the extra 200 calories should be mainly protein. 
• carbs should be around 45 net carbs daily or less; nothing white, must be WHOLE grains
• sugars are minimal...i never eat more than 9g sugar at once, and i try to stay lower. 
• i use the website sparkpeople to track all of the above everyday

okay here we go...and as you can see, it's always a work in progress and a learning experience.

6:30 AM

before my shower, i went downstairs and had a kashi trail mix bar even though i wasn't particularly hungry...i ate it anyway because for the past two days, i didn't eat in the morning because i wasn't hungry and i had a bloated, gassy feeling all day which i think was from taking vitamins on an empty stomach.(you can read more about my up and down hunger here). i thought about adding a light mini-babybel cheese for some protein but really couldn't eat more.

140 cals, 5g fat, 4g fiber, 6g protein, 6g sugar, 16 net carbs

after my shower (having waited the recommended 30 minutes since eating), i had iced coffee with skim milk (a few of them, if i'm honest, which totals one cup of skim milk for the day).

86 calories, 8g protein, 12 carbs  

-these carbs are milk sugars, and don't really factor in heavily in terms of carbs...sort of abstract but my nutritionist and i have it down

12:40 PM

for lunch, i had five ounces of the tofu peanut stirfry i made over the weekend. it's a mixture of tofu (which didn't turn out as firm as i hoped, any suggestions?), edamame, mushrooms, scallions, crushed ginger, peanut butter, broccoli, cauliflower and soy sauce. oh and some rice vinegar and sherry (i've made it without those two ingredients and it tastes exactly the same). i also throw in some cumin, curry powder and chili powder. it's good - better than it looks, and sort of hits that chinese food spot. i've made it with chicken too. 

so this i measured out into 5 ounce portions after making it, and i was feeling like although it was physically comfortable to eat all 5 ounces, it was starting to look like a lot to me, portion-wise. and this is a tricky thing...there's one school of thought that says never to eat more than 4 - 6 ounces at once, and then there's another that says you have to find the limits of your "pouch" so that you're satisfied...i do a combination, while never eating more than 6 ounces if that makes sense, and some foods (like chicken) are denser and fill me on less than others (like nuts and cheese and sugar free desserts...go figure). i ran into a friend in the kitchen at work while i was reheating the tofu who was shocked at what a small portion it was. that made me feel pretty good.

approx 268 calories, 13 carbs, 19g fat, 17g protein

-this is a little high in fat, i think i have to find a way to go lighter on the peanut butter, but overall it's okay, just have to balance it later in the day

1:35 PM

another iced coffee as mentioned and accounted for above, but i added a scoop of pure protein powder to bulk up my protein intake for the day since my breakfast was a little light in that department.

50 calories, 12g protein (milk in coffee counted above)

3:40PM

2 hard boiled egg whites, 1/2 oz gorgonzola cheese, 7 small black olives, 7 grape tomatoes (no reason for the 7's, just coincidence)

i love snacks like this...it's a good mix of textures and tastes, and it all feels healthy and whole. i'm a little uneasy because i didn't weigh it, but i think it's about 5 ounces all together...egg whites are heavy. i need to get a scale for my office.

approx. 140 calories, 4 carbs, 8g fat, 13g protein

4:06 PM
hungrier than before i had my snack, just waiting to drink some water which might help. this still happens, this hunger. some people have the experience of never being hungry, but i'm not having that experience. sometimes i feel like it would be a lot easier if that happened for me. but my nutritionist asked me "do you want that experience?" and i guess i don't. that doesn't seem like a healthy relationship with food either. 

6:25 PM

on the train home and needed a snack...had 2 mini sugar free reese's pb cups...these are somehow not a trigger for me, and work well as a pretty low calorie (considering) sweet bite when i need one. admittedly a little crappy as food goes, but i'm okay with it if it's not all the time.


68 calories, 5g fat, less than 1g net carb, 1g protein

worked out at around 7:30 and actually wasn't really hungry afterwards for a while. that's unusual for me, usually i'm starving after working out. so i drank some iced tea and waited until i felt a little hungrier. i think somehow the reese's really filled/satisfied me.

8:45 PM

had 2 ounces of ground turkey with taco seasoning, 2 tablespoons of an herbed sour cream i made (scallions and chives, and i like to call it "herb crema" cause i'm fancy), 1/4 cup of cajun black beans, some chopped scallions and 1 ounce of smart puffs. that's the part i feel not so great about. but they're really tasty, pretty healthy and surprisingly, not a trigger for me. i buy them in the individual bags and they take a while to eat and i really enjoy them. it's another "as long as they don't replace real food" situations.

307 calories, about 20g net carbs, 14g fat, 18g protein

DAILY TOTAL: 1,059 calories, about 50g net carbs, 51g fat, 74g protein

ASSESSMENT: OKAY. 

calories - i could have had some more calories since i worked out, but didn't want to have snackfoods (like a granola bar or more smart puffs which i definitely wanted)...i would have had to have more meat or cheese and that would have increased the ounces of my dinner. if i had waited a while and eaten more after dinner, it would have been too close to bed. 

i could have... had another ounce of turkey with dinner and skipped the beans, or added some more protein powder to my coffees, or had a more protein-heavy snack on the train.

carbs - a little high on the carbs...the granola bar for breakfast didn't help. better to stick with things like eggs and cheese and turkey/chicken for breakfast. also, the smart puffs are high in carbs. i think a granola/protein bar are an either/or situation with the same day.

i could have...had a better, more protein-focused breakfast

fat - also a little high...peanut butter needs to be reduced in that tofu recipe, but i'm over that recipe for a while now anyway. 

protein - almost! it's hard to keep the calories down and the protein up, which is where the shakes do come in handy...

i could have...if i had added another scoop of protein, would have been fine. or i should have made sure that my snack in the afternoon had more protein.

was this helpful for anyone? it was for me! it was really interesting to me to see how much my hunger fluctuated throughout the day. i always think that some days i'm hungry and some days i'm not, but by writing it all out, i see that actually that happens several times within a day.

does it look like more or less than you expected?

alert!

this is one of those things that makes me wonder about all the info out there...apparently, i really should have a medical alert bracelet, which now that i think of it (or that the message boards i read thought of it) makes total sense. i can't take NSAIDS, i can't have sugar and i now know i definitely can't have a blind NG tube...didn't even know what that was until yesterday. it's a feeding or intubation tube that would ruin my pouch and cause many potential problems.

thanks to lauren's hope, there actually exist pretty medical alert bracelets. this rose gold option is the one i'm considering, although the rose gold tag only comes with a red medical alert symbol. i might go with a silver tag with the rose gold bracelet to mix it up and have a better set of color options. oh, the problems. i rather like this engraved, colorless tag style which i suppose i could order separately and pair with the rose gold bracelet, but i worry that something so subtle might be too...subtle, and emergency personnel might miss it. and then what would be the point in having a bracelet in the first place?


hmm...what to do, what to do.

image

the morning after

BYPASS COMPLETED! dr. b was able to do the bypass, though i needed a drain which he didn't expect. basically that means there is a turkey baster hanging off of my stomach which drains the fluids from inside...not sure what they are, don't really want to know. basically, he got in fine, checked out my liver and went ahead with the "bottom connection," committing him to a bypass. but when he got up to the top one, my liver ended up being larger than expected and proved complicated to retract (part of the reason they put you on liquids before is to shrink your liver so it can more easily retracted during surgery to avoid obstructions and a nicked liver - EW!)

since he was already committed to the bypass (i think mentally too, since it was definitely my best option), he went ahead and all was fine, but just as an "insurance policy," he did the drain, meaning that if there was a leak, it would make me less sick by not leaking into my body. okay that's enough of the gross stuff.

after being wheeled through the hospital in bed to a different wing, i had my swallow test which confirmed that there were no leaks, so i finally got to have some water - an ounce every hour. thanks a lot. my mom and i pathetically rationed each ounce into four tiny sips - one every 15 minutes - so that i wouldn't run out before my next ounce. you could have set your watch to my time - every hour at the exact moment the second hand hit the 12, i buzzed the nurse and asked for my ice cold ounce of water. in between, they brought me refrigerated packages of lemon glycerine swabs to keep my mouth and lips wet. they were a lifesaver.

the pain is okay...especially with my self-controlled morphine pump. the thing that hurts most is getting up and sitting down, but my mom and i have discovered that the best way to do it is to lay flat on the bed and let the motorized movement do the work of propping me up or lowering me down. i take walks down the hall as i'm supposed to (starting at 2 in the morning at my own insistence) and the reward is a pretty view out the window at the end of the hall - some fall-colored trees and a church with a steeple - a glimpse at the world beyond the hospital walls. a world i would soon enter in a new way.

image from wikipedia

day of days

today is the day. my nerves are calmed, my mind is resigned to the fact that i won't know which procedure is done until i wake up. of course i'm still praying it's the bypass, and i'm wishing to god i could have a fucking sip of water (nope, not since midnight last night and the surgery isn't until 1 this afternoon!)

i smell coffee in the hospital waiting area and feel a longing sense of wonder - will i ever be able to have coffee again? the friend of a friend i spoke to a few days ago said she's never been able to have it comfortably again and she's seven years out. take my chinese food and pizza and and cupcakes, i've given it all up...even the cigarettes i said goodbye to five years ago, but please don't take my coffee. (the benefit of hindsight allows me to share that as i transfer my handwritten notes to this page, i'm sipping my delicious, beloved coffee with no problem at all).

it feels surreal this morning, definitely, but also peaceful. it's like the fear has drained out of me and now it's just about moving forward. i see dr. b in the hall of the hospital who asks if i'm ready. i say yes, and wonder aloud if he is too. he's ready. it's on.

i tell everyone who will listen that although i feel like i have to go to the bathroom, i can't. the nurse is about to strangle me because she's told me not to worry, but i just feel like it's only fair to let the people who will be handling my intestines know. dr. b laughs and says it's not him, maybe the nurses who will be impacted. no pun intended. any time someone asks me how i'm doing, i tell them i'm thirsty. i am SO thirsty. i ask when i can have some water, and they tell me tomorrow. they're not joking. curiosity killed the bypass patient.

with everyone aware of my bowel situation, my mouth a desert, and all the forms signed and sealed, i say goodbye to my mom and mitchell who have been amazing all day keeping me comfortable and laughing, and i am being wheeled in to my future, all alone. it might be the "martini" the anasthsiologist set me up with once i signed everything away, or the swirling realization that my life was about to change, but it's like i'm in another world, on another plane, and i drift off to sleep amid a slurred conversation about the nurse's favorite TV show...

image from www.newsweaver.co.uk

the day before

had my last appt with dr. b today who was charged up and ready to cut. i can tell he’s at his sharpest and strongest when he’s in surgical mode which i guess is a very good thing. he's happy with where my weight is going in (about 30 lbs down from the liquid diet) and tells me that he's 90% sure he'll do the bypass but that if its unsafe, he'll do the gastric sleeve. EXQUEEZE ME? i think upon hearing that i would have thrown up if there was anything in my body to throw up…smart to put me on liquids before dropping that bomb. somewhere in my racing mind, i suddenly remembered him saying this months ago - that they don't truly know what they're going to do until you're on the table because each person's anatomy is different, but...EXQUEEZE ME?

he further explains: if my stomach wall is too thick or my liver is too large, he'll go for the sleeve, a better option for higher risk, higher bmi patients. he assures me that he's done the bypass on patients heavier than me and with a higher bmi than me and it's all been fine, and he that he doesn't think it will be a problem, he just has to say it. have we met?

this causes me anxiety - obviously - not only because its uncertain, which i despise, but also because i had recently started to wonder more about the sleeve, which i had previously ruled out because it's results, statistically, aren't as profound as the bypass – it’s less invasive and while it’s restrictive like the bypass, it’s not malabsorptive. but my nutritionist had told me she knew of lots of people choosing the sleeve, which had had me wondering in the few weeks leading up to the big day. so when it came up that day, i mentioned it and dr. b said that insurance was approving it a lot these days, and that's the reason for the surge in popularity. he confirmed that the bypass was indeed the gold standard and the best option for me, and again reassured me he thought it would be fine.

the curve ball of this new possibility sent me into high anxiety mode where i wondered if i should take some more weight off via liquids and reschedule the surgery for a month or two later, though i feared that route because my presurgical nerves were already frayed and i worried that given an out, i might chicken out of the whole thing. sophie, dr. b’s PA reassured me that another 20 or 30 lbs would make no difference – it’s not really a matter of the weight, but more a matter of where you carry it, in my case, in my midsection. with that, i had no choice but to resign myself to the notion that whichever procedure it turned out to be would be the right one for me at that moment, and that i would make the very best of whichever one it was. dr. b assured me that although statistically the bypass had the best overall results (with the sleeve next in line, and then the lapband below that), nothing would stop me from achieving the same with the sleeve. nothing except me.

in a way, the added stress of dr. b’s unexpected announcement did me a favor because it became my distraction from the other nerves that were starting to mount, forming a painful lump in my throat as i plowed ahead, unable to see what was beyond tomorrow, beyond the blind curve ahead, because truly, by this point i know that no amount of preparation and reading and thinking and talking could possibly prepare me for what comes next.

most disturbing news of the day was this thought: if dr. b thinks it’s a good idea to lose some more weight and reschedule for a couple months down the road, i could have a solid meal tonight. what would i want?

OY.

image from trish berg

technical difficulties

i really thought the hardest part was over since i felt so much better today. but the cravings are getting stronger and about ten minutes ago i found myself wondering if i was going to be able to survive this period - the lead-up to the surgery.

mitchell, himself feeling weak right now, did the exact wrong thing by asking if i thought having one meal tonight would help me to be able to move past the cravings, so of course that sent my mind spinning into a world it doesn't belong right now...sushi, pizza, chinese food. just the thought of even "just one meal" makes me angry at myself - how could i do that? although it kind of sucks, right now what would stop me is the idea that when people ask me how it's going, i'd have to lie if i said I've been on liquids since wednesday. very similar to when i quit smoking, the thought that if i went back, even for one, i would lose all the days of being smoke-free that i was so proud of.

i think the thing killing me about this horrible challenge mitchell unwittingly posed is that technically, it would be okay because tomorrow marks the two week mark, which is the official date by which I need to be on all liquids. but for me, that date was a week ago tomorrow because that's what Dr. B told me to do. so technically nothing. i have to rise above this. this is the moment i have to make it happen. i need to go into the surgery knowing in my soul that i did everything I was supposed to do.

what would ordering pizza get me tonight? reflux, a headache at 4 AM and a sinking feeling that i am not who i think i am. it's over, this nonsense. i'm not losing to that voice.

circle of trust

tonight, i attended my first support group meeting at the office of the surgeon who will be doing my gastric bypass surgery. i was surprisingly quiet in the room, highly unusual for me. it was nice to be sitting in a circle of people (literally, the chairs were arranged in a circle) who were all in the same boat, not a common occurence for me in the rest of the world. it was nice to not feel like anyone was looking at me for my size, and the chairs in their office are generously sized...comfortable. i suppose that's no coincidence.

it's amazing to think that one day, chair size might not be an issue for me at all, nor will other peoples' stares. i have only the vaguest of memories of that life when i lost 130 pounds on weight watchers and weighed 197...for about five minutes.

it was interesting the way i felt tonight - on one hand, i was very comfortable and felt totally accepted. on the other hand, many of the people in the room had already had their surgeries, so i was a little on the outside. as opposed to my weight watchers meeting where i feel totally on the inside, but not fully understood, since at 370 pounds, my weight problem is different than most of the people there.

i think this support group will provide a cushion for me when i inevitably have to say goodbye to weight watchers. i'm happy i'll still have a circle to be a part of.