Grateful

Well, 2011 is almost at an end. What a year it has been. I've not accomplished much this year to be honest.

I started to run...but fell off the wagon with my iron levels falling off.

I got rid of some regain, gained some back, got rid of some, gained some, got rid of some. Some progress over all but still want to lose another 15 lbs.

Work is work, is work is work....nothing new to report there.

But the big news of 2011 definitely has to be my husband's surgery and how he is doing now. I'm sooooo looking forward to an amazing 2012 with him, being more active, doing more things in partnership and being happier and healthier over all.

Hubby's surgery went "extremely well" to quote his surgeon. Textbook pretty much. Within three hours after surgery he was argueing with me to call his employer. LOL =) Within 9 hours, he was on facebook. The next day he was more than raring to go and walk the halls. He hasn't stopped since.

He's been in pretty good spirits considering that this is probably the hardest time to have the surgery when food is every where. He's positive, happy and already seeing results on the scale and in the clothes. He lost a significant amount of weight before surgery, quite a bit on Optifast and already he's into clothes he hasn't warn in a long time just over a week after surgery!

Bring on 2012!

Dawn

Hubby's Surgery

Hello friends!

Well it is a very exciting time for me in my life right now. Hope all is doing well today! I just have to share my news with everyone.

Here's a back story for people that don't know me (I don't post on here that much). I had my gastric bypass surgery (RNY) 5.5 years ago when health concerns started to arise. At that time, I had a very supportive hubby who was worried for me. He was also overweight but not nearly so much as me - but he had many comorbidities that would have warranted surgery.

Anyway, throughout my process, hubby was nothing less than supportive but he never really wanted to pursue surgery. I always kind of hoped it would be something we'd pursue together and lose weight together but it was never something he felt he needed to do and continued to try to lose weight on his own terms.

Two years later, I was doing great - more active and very busy doing lots of activities outside - walking, hiking, geocaching etc but hubby's mobility was becoming more limited due to his health. I could never convince him to have surgery despite him watching me go through the surgery.

Anyway, a year and a half plus ago, his endocrinologist (Who also happens to run the Windsor Clinic) told him that he NEEDED surgery. He finally started the process. Throughout the process, I've always found he's interested one minute and then not so sure about surgery. (I've always said that until I get him on that table, I'll never quite know if he'll go through with it!). But now he's resolved that this is the change he needs to restart his health. FINALLY!!!!

So now we are in the final stretch of hubby's surgery and he's had his PATS, is doing amazingly well with Optifast and is now committed to surgery! We have been walking together and are making plans to be active when he is post surgery. I get to be his coach. LOL :)

I'm so excited for his new life -- so excited to have a new walking partner in the new year. We've already discussed how we are going to start some 5Ks in the Spring - for him to walk and me to run hopefully! I'm SO EXCITED about having a new life together. It is truly the best Christmas present that I could get this year!

At the same time, a million thoughts are running through my head as he does have many comorbidities and Im worried about his surgery. I am not sleeping well although terribly tired from all this iron issue I'm going through, I can't seem to turn my worries off at all at night.

I could really use your positive thoughts and even a few prayers that everything goes amazingly smooth for him. It's weird being on the other side (not the patient but the supporter) and I'm honestly far more worried about his surgery than I was about my own...but at the same time, I have a TON of faith in Dr. Reed and the amazing staff at Guelph - who have been just phenomenal thus far!

Thanks so much!

Fifth Year Bloodwork and Status

One thing I always did initially after surgery when I've gone for my bloodwork is that I've always asked for a copy of my results. Initially this was because I always needed to bring my bloodwork to my follow up appointments(just as a backup in case they don't get sent the files through a fax). Well over time, of course, I slacked off on that. So this time after the iron issue, and talking with friends and not knowing which actual reading was a 5, I asked for a copy of my bloodwork.

Using www.labtestsonline.com always was a help to make sense of the numbers.

Here's some of my levels post op and the reference ranges (what's considered normal)

Vitamin B -- 149 (RR=133+) Never deficient in this despite not being good with supplementation.

Albumin -- 34 (RR-35-48) A little low - one to watch.

Cholesterol -- 5.48 (RR 3.8-5.2). A little high which is surprising to me but not a worry - my LDL makes up for it - as I've always been high in LDL. (and is the reason why I never had a real cholesterol problem despite my 290 lbs).

Fasting Glucose -- 4.4 (RR 3.6-6)

Sodium -- 136 (RR=135-146)

Everything in the Hematology part is normal :)

Vitamin D -- 56 (RR=75-250). UGH low. Starting to get lower so I am starting to supplement this one. Hopefully January's bloodwork will reveal higher levels :)

Ferritin -- 5 (RR= 11-307. Huge reference range so I have to compare what MY "normal levels" are. They are usually 100-120 so obviously a 5 is really low and fits the category of "iron deficient".

So next bloodwork will be at the end of January and then I will see my doctor to follow up on that and decide if we need a referral to a Hemotologist for the iron issue to be resolved.

In the meantime, I'm trying to eat more red meat. Trying! LOL :)

As for weight, 5.5 years out. It's a struggle every day and I'm trying to lose right now which is hard with how much exercise is tiring me out. My lowest was around 139-140. My highest was back up to 167 in a very stressful time in my life. Right now I'm standing around 152 and am hoping to get back to under 200 by the new year or shortly thereafter.

Dawn

Iron

So I've been feeling not so hot the last few months. I've been feeling extremely LAZY. In July, I felt fairly good, walked all over the damn city including some days with 10 miles and even lost 10 lbs. (Which I've re-found of course over time) It was pretty good...but then in August I just felt like crap. I assumed it was one of my "funks" of the summer. I tend to get in a funk during the summer time due to lack of doing things (like work) and then get a little depressed and lazy around the house, not knowing what what to do with myself. Then eventually I get myself busy and get passed it. I figured that instead of having this years funk in July, I just had it in August. Couldn't get my butt off the ground to do much exercise and just attributed it to pure laziness.

In September, got busy with work and it was a real whirlwind. So I figured that's why I was tired of course. In October, I did my Detroit half marathon and did it in a record time so I felt fairly good about that despite my current laziness and of course, was extremely SORE afterwards due to not prepping hard the last few months before the race but did it anyways. (NOTE TO SELF: book a massage every year after the marathon in the future!).

So in late October, I got my annual blood work done, not really thinking anything of it. Du-huh -- note to self #2 - when you are feeling this way, clue in and don't just think you are being lazy.

Got results back and finally had follow up with my doctor. Typically my iron is 100 or over in the result numbers. 100. My iron is 5. Quite the difference, n'est pas?

So oh boy - two months to try to eat and supplement to get iron levels back up to something decent enough or I'll go for iron infusions after next bloodwork in late January. Ugh! Blah! Sucky.

Talking with a lady I know who treats anemia patients - it sounds like I will be getting iron infusions regardless. She doesn't think I'll get it up significantly without IV. Ick.

Fun times.

Dawn

Stomach Acid and Absorption

There is a bit of a myth that we don't have any stomach acid to break things down. This is not true. Let me remind you of our surgery.

You have two "stomachs". Your old stomach is called your "remnant stomach". Your remnant stomach is always functioning, creating stomach acids or juices and is spitting them out. Your new pouch produces very minimal stomach acid. That is why you must chew and chew your food, to help break up your food since your food will no longer meet up with the acids in the stomach for a long period of processing. Your food travels down and meets up the stomach acid where the two join up in the intestines.

So yes your food does mix in with stomach acids - but for a far briefer time than before and in a different place than before. So yes, it is possible that you still suffer from any reflux after surgery. For most, RNY helps decrease it and for many it is no longer an issue...but for some, yes reflux can be a problem still.

When it comes to absorption, we don't absorb until later in the intestines. We completely bypass the duodenum which is responsible for absorbing most minerals and vitamins a b d and k, iron and calcium. (Hence the tendency for us to be low in these). The old stomach also produced a substance called "intrinsic factor" that helped us absorbed b-12 and now we no longer have that as well...so hence constant supplementation of b12. Thats' a basic in absorption for you.

Here's a great picture for you!!!

Dawn

Help!! I Hate Eating!

Recently I have seen lots of posts on a board that I read that go along these lines:

I am about 10 weeks out from surgery. Weight loss is good - I hit the 50lb mark today....yay me! But...and it's a big 'but'...I am totally struggling with food. I just do not want to eat; it's almost like I've developed an aversion to food. Nothing tastes right and after a few bites, I just stop eating. I'm getting in 2 protein shakes a day but even those are a challenge because after drinking about 1/2 of it, I feel like I'm done. I'm not in pain, no discomfort; just no desire to eat. I feel full all the time. I don't have any cravings, even for the 'junk' I used to eat. Last night, my husband made steak on the BBQ. It smelled heavenly and looked great. The first 2 bites were wonderful; after that, I wanted to push it away. I forced myself to eat about 1 1/2 oz. of it and I was done. I'm wondering if this is normal? The irony is I used to pray for the day I wouldn't want to eat. Now it's here and I'm worried. Has this happened to anyone?

This was my response:

To me this was the whole BEAUTY of surgery. You are changing your whole relationship with food and are no longer living to eat but rather you are now eating to live.

Food is no longer your enemy. It no longer controls you or defines your life.

I felt this was the most powerful and amazing thing about surgery. Embrace it!!! Relish in it. Eat for nutrition. Say no to cakes and goodies that you are offered. You have the most amazing power right now.

Dawn

Her response was:

OMG...what a lightbulb moment! I had never thought about it in that way. Here I am worried that I don't want to eat, when that was the point of this whole process. I've spent so many years thinking about what I'm going to eat next and I am now - finally - at a point where it doesn't matter to me. I wasn't seeing it as powerful but I'm going to try to now. Thank you.

*****

Gosh, the way surgery initially changes your life is amazing. For three weeks, I had to do full fluids (liquids) and surprisingly for the first time in my life, it didn't kill me to do something as tough as that. It literally was my job to take in nutrition every day and work towards my protein and water goals and it was amazing that I did not get hung up on food.

I was probably different than most - I continued to cook full meals for hubby at the time and it didn't bother me.

I became obsessed with "food porn" as I called it and began to just love watching food on the Food Network and it didn't bother me at all. I convinced myself that I could just enjoy and relish in the look of food. It was such a bizarre experience! I remember watching the sugar sculpture food awards where they created these sculptures out of sugar and it didn't bother me a bit. Watching desserts but not eating them was my new past time! LOL!

I always say when you go through this stage, let your power guide you. Say NO to stuff that you don't need nutritionally. If it is "gee I don't care whether I have that or not" -- damnit, say NO and mean NO and take pride in the fact that food no longer controls your decision making!

Eat for health. Eat for nutrition. Eat what your body needs, not what your head needs.

Think of yourself as being SUPERWOMAN or SUPERMAN and enjoy this new super power of yours :) To be in control over food is a WONDERFUL THING!!!!

Self Sabotage

Dear Self:

Why is it that when you decide to go hardcore on program and adjust your eating and exercise accordingly, and do really well to lose excess weight again, that once you get to a certain number, you decide that self sabotage is needed?

Why do you let the number on the scale dictate your happinesss and your worth every day and then once the scale gets stuck once yet again, do you feel the need to throw in the towel, do a complete 180 and start going on crazy binges yet again?

Why do you give up when you are so close to a goal that you can taste it and feel the need to eat and eat until you feel sick and the scale goes up, up and up.

Are you scared of seeing a number? Are you afraid that you won't be pretty when you are thin? Are you hiding from someone? Are you hiding from yourself? Do you need fat on your body to feel hidden from the world and to fall into oblivion?

Why do you insist on doing this to yourself, making yourself miserable and digging yourself deeper and deeper into a hole? Into a funk?

Why?

Why do you sabotage your own success? Why do you continue to ruin your chances to feel good about yourself? Why do you punish yourself constantly? What exactly are you afraid of?

UGH.

And every time, I have to pick myself up and dust myself up and pick my self-esteem up from the toilet do you have to whisper "What is one more cookie? One more ice cream?". "Why can't you just eat and eat and eat?".

This ghost of addiction is haunting. It's destructive. It's depleting. It's frustrating.

It takes every ounce of strength I have to pick myself up, dust myself up and begin again.

To not let the scale solely define me.

But every day is a new beginning, isn't it?

Dawn

"Why Are We So Misinformed?".

I read a post on a board this morning and it was entitled "Why Are We So Misinformed?". Here's what the poster said:

The more I read the more I get bothered for us all about how much we dont know before and after surgery.

I, myself, dont even know when my surgery is(I had to put in a date when I listed my surgeon?), I dont even know who to ask since it seems we all meet many different people throughout all this.

It really is getting frustrating. There are so many people on here that dont know what to eat when they get home, what to do, or even before WLS, they have many unanswered questions.

Is anyone else frustrated and bothered by how little we dont know, and how noone even tells us who to ask???

And I'll be honest. The post IRKED me to no end. Basically this person is EXPECTING other people to tell her about surgery. I find this is often the case in my support group too. People come in with no information. They don't want to be advocates for themselves. They go strictly by the information given by the doctors and are like sheep just following the masses, waiting to be told things on a need to know basis.

While I realize that there are some people that perhaps don't have a skill set that may allow them to access information (perhaps not online, illiterate etc) I believe that most people should have the skill set needed to investigate, to ask, to research, or in the very least, to read a couple of books about Weight Loss Surgery. I believe that everyone should at least own a copy of a book or two. I always suggest Weight Loss Surgery for Dummies as a good beginner tool. I know that most people are not going to be as crazy as me and read study after study, but I do think that with a life changing surgery, everyone should be doing some reading to learn and study their surgery.

There should almost be a test on terms, basic ideas of surgery, basic complications. I shudder when I hear people, 3 weeks out say "What's a stricture?". In this day and age there is SO MUCH out there. All one has to do is LOOK FOR IT!! To Google it for goodness sakes.

This topic reminds me of the conversation that I had last night with my friend and walking buddy from my support group. She is a quiet gal, who doesn't always say much at our meetings  but here's the thing, she had surgery 11 flippin years ago.

11 years ago!!!

I can tell you that five years ago, information wasn't as easily available as it is today to come across. Back then, when I had surgery, there were literally a handful of books to buy and some sites - not a ton of personal ones though - about bariatric surgery. Thank goodness for obesityhelp.com because that one at the time was the best (and still is in my opinion!).

Anyway, when my friend had her surgery 11 years ago, she got nothing in the way of information. Basically the information was to stay away from "Sugar, fatty foods and pop". She had no instruction on post op care, no information of complications (she had no idea of strictures until she came to our group many, many years later). They did not tell her to stay away from NSAIDS. They did not tell her to take any vitamins. There was very little information given to her.

And yet, she did amazingly well. 11 years out and she'd like to lose a few more pounds but she is still in a good place with her weight and eating. She was a success DESPITE her program and I'd venture to say that probably a lot of patients back then were not as successful.

She's amazed by how much information newbies get. She wishes she'd had the supportive network that they have. She never had any kind of follow up care. She's envious that there are so many great resources for newbies to have now when she didn't get any. Not even a support group in her area when she was out. She was like an "island" and the only person that she knew after surgery that her surgery was HERSELF!

I'm in awe of the woman for this reason.

But this day and age, no one has a reason to be uninformed. It is now a choice. This is the INFORMATION AGE. Use it. Study your surgery, know it inside and out. Know every term from strictures to foamies to NSAIDS. Learn about reactive hypoglycemia (so you can catch it if you get it), all complications (especially those that are common), vitamins, exercise, strength training and all things to do with physical fitness (basal metabolism, learn about the different types of surgery and what is covered in your area because some surgeries are better for different people than others. YOU MUST BE AN ADVOCATE FOR YOURSELF.

Don't assume that your doctor is going to remember the "no nsaid" rule everytime s/he gives you an NSAID.

Don't assume that doctors are going to procedures that are in your best interest. (Like the lady who 2 weeks out was going to get a scope had she not stood up to her emergency room doctor and said, "I can't have one this early out!".

LEARN, READ and learn some more ;)

So my only response to the lady who asked the question "Why are we so misinformed?".
is very simple.

It's a choice. I wasn't. Are you?

Dawn

The Myth of the "Call your surgeon!".

When you have surgery and ask questions or have problems afterwards, you will find people saying this simple statement "Call your surgeon!" or "What does your surgeon say?". This is a bit of a confusing response that I feel the need to explain.

When that phrase is used, what most of us really mean is "what does your surgeon's team say about that?". You see there is a bit of a myth that goes along with surgery - that you'll constantly be in contact with or need to see your surgeon every time a problem erupts.

It is true that if you are having major issues like strictures (not keeping things down) or issues with the mechanics of surgery that you will need to actually see your surgeon, but for the most part, you have to realize that your surgeon is an expert in the mechanics of surgery. Your surgery is not necessarily an expert in your aftercare such as diet, nutrition or psychological aspects that go along with surgery. That's why it is of the utmost importance to make sure that your surgeon has an excellent aftercare team comprising of experts like a dietician, social worker or psychologist, and so forth. These are the people that you will need to talk to the most after surgery. If your surgeon is isolated and has no team behind him/her, I would seriously think of a new surgeon. You need after care. After care is critical to being successful with WLS.

Recently, a lady in my support group was upset because she was having pain and the bariatric team told her to go to emergency. Another lady I know was upset when at her 6 month follow up, she did not see the surgeon but rather "just the dietician and social worker".

Any time you have pain, it will not be the surgeon that you will not see. Again, his/her duty is over. You would go to emergency and they would decide by tests whether it would be something like your gallbladder, kidney stones, or appendix. Your surgeon again is the expert at the surgery he performed on you. If you cannot hold things down and have a stricture, s/he would fix that because it is a direct issue with surgery. But otherwise you will see the inside of the emergency department when you have pain, not your surgeon's office.

As well, the surgeon's last job really is to check that your incisions are healed. When that's done, his/her job is pretty much done and that's when you need the other specialists - dieticians etc to help you with your aftercare. The surgeon does not necessarily read the latest studies on how many grams of protein you need or what studies say in terms of the latest vitamin info.

So remember when we say "see your surgeon!" that it means call your surgeon's office and contact that after care team. That's what they are there for and they are worth their weight in gold :)

Dawn

Why I Hate My Scale

One year post op gastric bypass and five years post op are two very different animals. One thing that I LOVED my first year out was my scale. It was my best friend. It gave me validation practically every day as I would get on and the numbers get smaller and smaller. It was a thrill to step on. It was an amazing feeling to know that I was in the next ten pound range. What an amazing feeling. When I got to ONEderland (out of the 200 lb range), I practically wanted to kiss the scale. My goodness how much I anticipated that love affair with the scale! Along with the compliments from friends and family, it made me feel like a million bucks almost every day. And then new clothing sizes! Can you say: HIGH!! Who neededs alcohol or drugs when you have the scale, compliments and a size medium? They are the "crack" of weight loss.

But then after a year or two, the scale stops. No more validations. Compliments eventually stop coming. You stop and you stay the same (called maintenance) and there's no more new sizes, no more new numbers, no more rewards).

Then temptation starts, food calls out to you more and more and ta-da, as quick as an instant, the scale can start to creep up again.

That's the 2-3 years out range that it happened for me. Gosh, that was a hard year!! All of a sudden I didn't like the scale. If it was down one day, I'd be happy, excited and thinking "yay I'm doing great" but then the next day, it could be up two pounds for no particular reason.

I'd want to weep. I'm not kidding. I'd want to cry. What did I do? I didn't eat anything different. I exercised and did everything right. WHY WHY WHY?

Realistically, the scale does this especially being out a long time. Take for instance, yesterday when I ate very healthy and exercised. Here's my day in recap:

Breakfast: Veggie Omelette with low fat cheese, 1 piece toast, light becel
Lunch: leftover cabbage casserole (1 cup).
Dinner: Piece of pork chop (deck of cards size, 1 small ear of corn, 1 tbp butter, 1/4 cup of potato salad).
Snack: apples and 22 almonds.
Exercise: Walked 10 miles.

Pretty good day. Eating was fairly good - even the potato salad (made by my mother in law) was "low cal, no salt and "healthfied" as much as possible). And those 10 miles - c'mon on!!

Yet, I'm up a half of a pound today.

What power that little scale has over me. It made me feel totally worthless this morning as I was sure I'd have a loss and I was up. So automatically the thought/mindset does this:

"Those 10 miles weren't worth it".

"Why bother watching what I'm eating if I'm just going to gain anyway. I should have had the chips (or chocolate or whatever I am craving at the time).


The scale is no longer my friend. It beats me up. It validates if I'm doing a good job (even if I just happen lose despite eating poorly) or if kicks me in the rear when I don't see the results I want. It either starts my day feeling like a million bucks (if I'm down) or feeling like a dog's breakfast (if I'm up on the scale).

I hate it. I love it.

Dawn

There are no guarantees with WLS.

I'm a die hard realist and for that reason, I always like to express how there are no guarantees with weight loss surgery. I see and talk to a lot of people being that I run the local support group and I see a variety of attitudes within the group. Most people have very realistic expectations but once in a while, I run into people that make a lot of assumptions about surgery - only to disappoint themselves when they don't get the results that they want. Realistically, we need to go into this surgery with the mindset that we do this for health. Here are the statements that I hear sometimes that worry me:

~ "When I get to a size 2, I will....".
~ "When I'm smaller than my sister, I will....".
~ "When I lose all my weight, I will....".

I worry about these because even though I was positive I had realistic expectations, I know that there was somewhere deep inside of me, where unconsciously I was certain that I'd end up being an 18 year old, blonde bombshell who was too small for a size 2.". LOL!! I think everyone subsciously has this desire to turn into Britney Spears with rock hard abs and a killer body. LOL!

Then we are disappointed to end up as a scraggly, wrinkly 40 year old like myself who looks good when I dress myself appropriately upscale but looks haggard in a pair of shorts and tank top. I'm serious here.

And I barely got to a normal bmi despite the fact that I exercised like a mad fiend my first year (I walked a half hour to work and home and then jumped on my treadmill for four more miles after that!).

I ended up not a size 0, not a size 2, not a size 4...but a size 10. I mean I had coworkers who were size 0 after having three kids!! It was devastating!

Realistically though I know that I'm bigger boned in many respects. I didn't even change a shoe size after WLS whereas many people can change and lose 2 or 3 sizes in their shoes.

The Bariatric Centres of Ontario often quote that a 50-60% loss of excess weight is what they consider a success with WLS. I surpassed that easily my first year. But then hit bounceback and, still went higher than that amount. Even with bounceback I've lost more than 50 - 60%.

So what does that mean? That means that they are being absolutely conservative in their numbers and well, they have to be. Knowing that people's genetics are all different, people's metabolisms vary greatly, mobility varies and definitely the amount of weight to lose. Most people that are 400 lbs will not see a number in the 100s. Some do - but they are few and far between. That means that being 400 lbs, you won't necessarily be guaranteed to be 150 lbs by the time two years are out. Can you be happy with 200?

That's the concept that people need to grasp. There are no guarantees that you will ever be a size 2, that you will lose *all* your excess weight, or that you will ever be smaller than your sister.

Mindset is key here because where you end up will be determined by *YOU*. If you don't reach a certain size or a certain weight (yes you can keep trying!) will you define yourself as a success or a failure? For me, because I was a 10, for a LONG time I defined myself as a failure. Now I'm changing that attitude and seeing that life is SO MUCH MORE than just a dress size or a number on the scale.

So be sure to measure your success by NON SCALE VICTORIES. Make lists of things you can do after surgery that you couldn't before. Keep those biggest pair of pants to remind you were you were and where you are now.

Remember my friends, attitude is EVERYTHING!

Dawn

10+ Expectations for Newbies: LONG POST!!

10 Expectations for Newbies Having Gastric Bypass

Remember to always go by the instructions of your surgical centre. I am not a surgeon and do not give medical advice. This is a rehash of what I talked roughly about at my last WLS support meeting:

1.Expect to lose a lot of weight your first year.

The first year is crucial for how you will do. It is a predictor of your success. The more you follow the rules, the better off you'll be and generally the more you will lose. The more you cheat and go off program early out, the more you'll probably struggle down the line. Your first year will have your greatest loss and is called your “window of opportunity”. Typically after that weight loss does dramatically begin to stop. Most people lose their lowest weight at the 1.5-2 year mark. After that your body is “just like everyone elses” and you may possibly gain a little “bounceback” due to the loss of malabsorption.
Expect to minimally lose 50-60% of your excess weight.
If you are 100 lbs overweight, it means around 60 lbs.
If you are 150 lbs overweight, it means 90 lbs.
If you are 200 lbs overweight, it means 120 lbs.


These figures are conservative. Some people lose more, some lose less. If you want higher numbers, you'll need to work at it more (think: exercise), watch the processed food (you should be primarily eating “clean” from the outside of the supermarket: dairy, fruits and veggies & meat. Protein first generally, veggies second and carbs generally last (smaller portion). Work your new “tool” the first year and you could be one that has a huge payoff losing 80-100% of your weight.

2. Expect to come off your medications but also expect to supplement religiously for the rest of your life.

Most people right away come off medications, even diabetes medication from the day that they have their surgery.

But you will trade this for a lifetime of vitamins and supplementing for the rest of your life. Most common are all b vitamins, iron, vitamin a, d, calcium etc.

Expect to get your bloodwork done regularly – usually every 3 months the first year, at least one or twice a year after that. Supplement according to your surgeon. You can always choose to supplement more – but be VIGILANT with your blood work. That's the key!!! Get tested every 3 months the first year out and at least 1-2 times a year for life. If you go through a period of feeling especially tired or draggy, then get it tested too.

Blood work is CRUCIAL. Playing “catch up” with a nutritional deficiency can be an awful thing and may even require you to take off time from work! So you need to be SUPER VIGILANT about your blood work and following your surgeon's program. All you have to do is talk to one person that has had a SERIOUS deficiency and you'll know why it is so important to deal with your issues in your blood work right away!!!As well, it is a good idea to get a bone density scan at the year out mark to make sure your calcium levels are good especially if you've been on medications that predispose you to bone issues such as Depo Provera.

3. Expect that you may have a complication at some point.

The term “complications” always brings up scary thoughts doesn't it? A complication doesn't have to be a total nightmare. Expect them and be pleasantly surprised if you don't experience them.

Most Common: Infections, strictures, ulcers, gallstones, kidney stones, bowel obstruction, reactive hypoglycemia. We rerouted our natural plumbing – so expect issues now and again. You should be familiar with what all these things are – there are lots of great books such as WEIGHT LOSS SURGERY FOR DUMMIES that give you great basic info. If you expect and watch for issues, then you will be ready for them mentally when they occur then if you are oblivious to them (education goes a long way with surgery!).

If you don't have any issues (and many ofpeople don't) you'll be pleasantly surprised!

ANOTHER KIND OF COMPLICATION: The other “loss” is often relationships change, friendships change. But be prepared to lose a friendship or two or to have one or two family members tell you that surgery is going to be a terrible thing for you.
BE AWARE THAT THE MORE PEOPLE YOU TELL ABOUT WANTING TO HAVE SURGERY, the more negative you will hear before surgery. Most people tell people after they've had surgery.

EXPECT TO DO SURGERY FOR YOU AND NO ONE ELSE!!! BE PREPARED TO HAVE DEFICIENCIES AT SOME POINT IN THE ROAD. BUT BE PLEASANTLY SURPRISED IF YOU DON'T HAVE PROBLEMS.

4. Expect to have a hard time eating and expect to have dumping syndrome.

Surgery changes our relationship with food. Everything we did before surgery will be different after surgery.

We used to wolf down food. Now we have to chew, chew and chew.
We used to eat a lot of carbs. Now it's protein, protein, protein.
We used to drink while eating and we could get a lot of food stuffed in there.
Most of us ate a lot of carbs that helped us gain weight, now it's all about focusing on protein.

For most people eating after surgery is not a fun activity. It is NOT enjoyable in the least. It is your daily duty and your daily job. That sums it up!! You must force yourself to eat even on the days that you really aren't even remotely interested in food. Yes, that is often the case!!!!!

Early out, you may find that foods that you liked before surgery, you no longer like or they do not agree with you. This is extremely common as your “taste buds” seem off. It doesn't last forever. Think of this as power over food. Your first year is amazing for this. If you can “take it or leave it” leave the junk food off your plate as long as you can. It's a powerful thing to say NO!

In addition, some things may make you vomit, some may make you feel ill. You may become lactose intolerant. Expect the unexpected – a food you have one day can totally not agree with you the next.

Expect to read labels of every food you eat.

Dumping syndrome is basically a negative reaction to high levels of sugar and fat in your diet. Know your limits well and do not test those limits. The people that have the most success with surgery are generally those who eat like they “dump” - ie. They avoid simple sugars. They eat very little processed foods. Don't test the waters too much especially your first year.

You'll experience much more success (and weight loss) and you'll avoid the constant craving for carbs if you keep the simple sugars away. Most people do who dump do so only in their first year and it is a terrible terrible thing if you've experienced it. Eat within the sugar guidelines as suggested by your dietician. Set yourself up for success as much as possible!

Surgery changes our relationship with food especially for the first year (unfortunately it doesn't last forever!). It may mean for the first time in life, you don't like eating anymore. It becomes boring, regulated, the joy is gone. Eating becomes our job. It becomes not exciting anymore. It is routine and boredom. Some days you'll have to force yourself.

It's changing from live to eat, to eat to live.

Many people for this reason have “buyers remorse” - they experience depression after surgery – they have lost their best friend. Some people feel great after surgery, others feel like they have been hit by a mack truck. For some people it will take 6 weeks before they feel 100% back to normal and they feel like the food issues are more tolerable.

Remember that your water and protein goals are only goals and you may not consume enough for a while. Some people get in only half their protein and water initially. The key will be pushing yourself to take in a little more each day and eventually get to the point that you are reaching goals.

Also: your pouch will make a lot of noise especially initially out from surgery. (mine does to this day). You'll hear lots of gurgling inside. Do not confuse this with the “growling” of hunger as many do. It's gas and air.

5. Expect that your journey will be different than others.

You will lose different numbers than others even if you had the surgery the same day! You will lose it from different places. Your body is a very unique thing. As a general rule of thumb, the older you are the slower your metabolism may be. The more you lose before surgery, the slower your loss may be (just initially) and men tend to lose faster than women due to their muscle mass.

EXPECT STALLS! It's normal. First one usually at 3-6 weeks out and then every so often on your way. Absolutely normal and be prepared: Some stalls can last a month or more!

Don't compare – your journey is your journey.

Don't EXPECT TO LOSE THE WEIGHT OVER NIGHT. Remember 2, 3 and 4 lbs a week over time adds up!!!!!!! Remember losing 2 lbs a week x 52 week in a year is 104 lbs!!!!!!!

When the scale, stops use alternate ways of measuring success. Keep a log of all the things you want to be able to do – make it while you are pre op. Then cross them off the list as you do them (Eg. Cross your legs). Use the tape measure to measure your success too. As well keep one of your biggest shirts and pairs of pants. It's a great thing later on to try them on and “see” where you have come from. Take a lot of awful “before” pictures – trust me, you'll learn to love them later!


6. Expect to be your own advocate.

You need to read, read and read some more. Studies abound online, there are many books. Do not depend on the bariatric centre to tell you everything and hold your hand during this process – you will need to do reading beyond what they give you. You should spend as much time researching your surgery and reading about your surgery as you can.

You need to be an expert in your new body.

You will need to also do your own research. There is a HUGE LEARNING curve with surgery and the more you know, the more successful you'll generally be in the long term. You need to embrace this surgery, and study your surgery– and know everything about it.

You should know that you had a ROUX EN Y GASTRIC BYPASS. Not an RYN and not a “gastric bypass”. You need to know the name and what you had done!You need to ask every time a doctor prescribes you something “is that an NSAID?”. To make sure that it is not. Never assume they'll remember!


You may want to invest in a medic alert bracelet or necklace your first year out or at least a “fake” that way your information will always be on you your first year.   Although some programs recommend them, it's generally overhyped.  Just put your surgery type and date on it.  Please see my post about medical alert bracelets as there are some things I would never put on mine that many do.

You NEED TO KNOW THE INS and OUTS of this surgery. THE INS and OUTS of how to read a label. If you are online, there are many sources of great information. Www.obesityhelp.com is one of them.

7. Expect to have a surge in confidence.

The first year is amazing – you'll learn to love clothes shopping, looking in mirrors, seeing the weight come off, and you'll generally feel empowered and ready to take the world on at your one year out mark. (Yes the first few months can be tough but the pay off is big by one year out).

Be careful though about assuming that your surge of confidence is going to be forever. Be careful especially if you are on medications for depression. Some people take themselves off medications during this “high phase” only to come crashing down at a later date. Please don't take yourself off of medications – only do so when a doctor tells you and make sure you are being monitored closely. Losing weight does not mean that your hormones and body is going to fix itself even if you are feeling in a somewhat “good place” with your weight loss.

"Bariatric surgery does not cure depression, and these patients need treatment for depression," --There are studies that warn about this because there can be a high rate of suicide for these people. You may find that after a while old issues come back, you are struggling with your food addiction and may need therapy after a year or two. This is quite normal for many of us that have been overweight for a long time. Seek help from the support group if you need resources in your community or consult the experts at the Bariatric Centre.

The high of the first year or so will dissipate once you start having issues with food again. Your issues WILL come back. Surgery fixes our body, not our head.  Please look into your eating issues before surgery. 

8. Expect to attend support group meetings

Zirui Song, et al published an article in the ASMBS publication Surgery for Obesity and Related Diseases (SOARD) in 2006 entitled: "Association between support group attendance and weight loss after Roux-en-Y gastric bypass."

Results: Patients who attended more than 5 support meetings within the first year lost 55.5% of their excess weight. Patients who attended less than 5 meetings lost 47.1%. So by attending meetings, they lost an additional 8.4% of their excess weight.

In real world numbers that would mean:300-pound pre-op weight, with 135-pound ideal weight = 165-pound excess weight
>>  47.1% EBWL = 77lbs lost
>> 55.5% EBWL = 92lbs lost

Why support groups important:
network with people going through issues
you refocus yourself and your thinking
you are reminded constantly about what constitute success
you get feedback, suggestions from others
it is “you” time. It's about refocusing on your journey again.

And yes sometimes its hard to do!!!!!!!!!!!!!!!! Sometimes the hardest thing to do is come to meetings when you are ashamed or struggling. Trust me everyone has been there. We all struggle with our weight EVERY SINGLE day even those who have gotten to a normal weight. You'd be surprised how many people struggle with still psychologically feeling fat or with their body image. You are never alone in this journey.

9. Expect to exercise regularly.

You don't need to belong to a gym once you have surgery. Walking is generally free although I highly suggest buying a GOOD pair of properly fitted shoes – well worth the investment.

Exercise should be a part of your life from the time you get home and start walking. Within a few weeks, you should be regularly walking. Try to find a walking buddy and even if you feel like sitting on the couch, you need to find someone to push you off that couch! Recovery will be faster if you push through the feeling of “blah I want to sit on the couch”. Push yourself through the tough time and tell your supporters not to baby you but to encourage you and walk with you.

The Bariatric Centre wants you moving as much as you can.

That doesn't mean kickboxing or Tai Kwon Do.....but just walking and moving your body. As long as you are moving it doesn't matter what pace. Go slow and when you can, adjust accordingly. As Nike says JUST DO IT!

Expect to need cardio and strength training. (toning). Toning won't necessarily make that skin look beautiful but it should make you a little less jiggly!

In a 1999 study of successful gastric bypass patients: Successful patients exercised regularly to maintain their weight an average of 4 x a week for at least 40 mins. Patients reported exercise as a key factor in their ability to maintain their weight after the initial loss.

10. Expect to deal with your addiction again and the possibility of bounceback/regain.

Eventually the weight loss stops, the scale stops moving, the craving comes back...you are going to need to deal with your addiction at some point again. That's when you might consider therapy, overeaters anonymous, BANA, private counselling, and even support groups again like Weight Watchers. That's when you need to make a point of coming back through our doors again.

Most patients hit their lowest on the scale at 1.5-2 years out.

Most gb patients regain 10 – 15% of their weight loss in 2nd- 3rd year out from surgery. (“bounceback”). Be careful of the phrase: “x amount of lbs gone forever” because they can come back.

YOUR WEIGHT LOSS JOURNEY DOES NOT END WITH THIS SURGERY.

Eventually the weight loss stops, the scale stops moving, the craving comes back...you are going to need to deal with your addiction at some point again. That's when you might consider therapy, overeaters anonymous, BANA, private counselling, and even support groups again like Weight Watchers. That's when you need to make a point of coming back through our doors again

Some people are just not successful with surgery. You've heard about them too -A study in 1999 The most common was lack of exercise, poorly balanced meals, constant grazing and snacking, and drinking carbonated beverages. The first postoperative year is a critical time that MUST be dedicated to changing old behavior and forming new lifelong habits.

I see people often bragging about what they CAN eat the first year out.  "Hey I just ate two tacos!!" at a month out.  Okay, just because you CAN eat it, doesnt mean you SHOULD.  Often these people down the line are the ones saying "OMG I stretched my pouch!!!!!!".  You need to preserve the pouch as much as possible.  Keep it small. Try not to let your eyes get in the way of your stomach.  Respect the smallness of the pouch as much as possible.  It's a tool that CAN BE UNDONE.


A FEW EXTRAS :)

1. Expect Gas.

I found gas extremely painful initially after surgery. They pump you full of fluids too so there's lots of gas floating all over your body after surgery. I found the shoulder to be particularly painful. My pain meds were used for that more than for an incision! Gas X strips are really great. The other kind of gas (flatulence) is also extremely common. Yes, you might not know initially – but you'll find as you add carbs that's often where it comes in. A few hints: “Just a drop” is found at Walmart and is great for those post-toilet smells.

2. Expect to be cold.

It's true. It doesn't happen overnight that you'll be cold...but you may find that a month, or two or even after 6 months, you'll find that you are always cold. This is normal. Remember how when you were at your heaviest weight, you tended to overheat? It's the reverse for thin people. They are usually often cold. Welcome to the polar bear club! Bring lots of extra sweaters!

3. Expect to lose hair.

It is very normal. At about the 3rd-7th month will be the big period of hair loss. Things should slow down after that. Unless you have very thin hair to begin with, you should be fine. I was the only one who noticed my hair loss. Sure people will notice your hair in the bath tub, in the shower, in the pool....but they won't necessarily notice your lack of hair on your head. They'll just know you are shedding by your evidence that you leave. Many people swear by supplementing Biotin or by using Nioxxin shampoo or Maxxi Hair (found at Betterhealth Nutrition in the US). I just rode it out. I found I had a lot of breakage and did choose to do the chop to a bob hair cut so as to avoid more loss from breakage (I have very coarse hair that tangles easily so just combing I'd lose some hair). The bob cut really helped. Hey, isn't it great to update your look anyway?

Dawn

Went to Surgical Class Today

Going through the process of surgery with hubby is a pretty neat thing. Now that I have 5 years of life post op behind me, revisiting the process is a pretty neat thing. I attended class with him today, learned some new things, remembered some old things that I forgot (hey it's been a while!) and found out some interesting statistics. I wrote a few notes and so I'm going to share them here with you today.

I always knew about the fluid that they pumped into you before surgery. I gained 11 lbs in the hospital because of it....but I never really thought of "why" they do it. They basically pump you full of extra liquids because they want to make sure that you don't get dehydrated your first few days. It is a preventative measure.

I never experienced it but many people do complain about numbness at one of their surgical sites. (incisions). The numbness can last 6 months to a year. If it lasts more than a year, you'll experience that numbness forever.

As you are recuperating in hospital, check both your temperature and blood pressure if you can if you are experiencing problems to see if there are any signs that your body is experiencing a complication.

One of the biggest causes of weight loss failures are those that drink way too many high sugar and high fat drinks. So put the Tim Hortons Ice Capps and Starbucks drink away. You still should be primarily drink water.

At the 9 month mark is where they offer a class with the social worker because they find that at the 9 month mark is where people start to have "trouble" with their eating and drinking choices again (making bad choices).

If your Optifast is too thick, add ice or water. Freeze to make slushies.

Guelph patients tend to have a quicker recovery turnaround. They "bounce back" after surgery than patients from other surgicial centres. Thought to be attributed to the longer time on full fluids than other surgical centres.

Guelph wants you to take a prenatal vitamin, calcium with vitamin D. They don't want you to worry about your vitamins though for the first few weeks as it's just one thing to have more trouble with. They want you to focus first on fluids and food first so that you can recover and then you can worry about vitamins at the 3 week out mark.

Guelph does not have you do protein shakes.

I really enjoyed the whole talk. One thing that I really really liked was how Kristine the dietician used lots of real life examples of bad choices people make and things that people do erroneously. I liked how she emphasized that it is going to be a life long struggle. The last part of their slide show mentioned that the most important thing is to "keep up the battle" for the rest of your life.

Amen to that.

Dawn

Running, Part Deux

So I ran two 5Ks - One in April and one of May of this year and was disappointed to say the least. I realized very quickly that I am not an endurance runner of any sort and did not do extremely better on the 2nd one than I did the first. As well, I still felt like I was doing far more walking than running. Never really got into a grove of any kind.....so I kind of started off to fall off the running wagon so to speak.

I just got frustrated with myself and I have always been one to quit rather than to struggle, to give up rather than perservere.

Hey, at least I'm honest about it right?

So after my last 5K, I decided that I would sign up for the Moon in June 5K in June of course as you can tell by its name...but put off actually signing up...and put it off...and put it off....

Until, fastforward, it is now the Tuesday before the race (which is Saturday) and my friend Joanne at the support group asks me if I am going to do it. I waiver...I hmmm...and I haw...and I finally give in and say OKAY.

Well I made a few errors going into this run.

Error 1 - I underestimated the weather. Wore capris and a regular tshirt (dri weave) when I really could have gone for shirts and sleeveless (I am not a fan of sleeveless but I'm all about pushing myself out of my comfort zone). But I was okay despite this error but I could have dressed better for sure.

Error 2 - Depend on your last pair of contacts to get you through the week...then of course, drop and lose your contact and therefore have to wear glasses for the race when you would have far preferred sunglasses to regular glasses.

It was neat though because as I got to the facility where the race was run, I ran into all kinds of people I know from my running class, facebook, students, coworkers etc. I felt like it was kind of a community. Wherever I turned, I bumped into someone I knew.

Well here's the synopsis of the run:

First of all, I felt weird starting the race for the first K and literally after 5 minutes of straight running, I walked for a while, then did this one other time. Then this amazing thing happened - I fell into stride with these two runners ahead of me. They were slow runners and I figured that their pace was good enough that I could do that pretty much the whole time. So I just decided to join behind them and pace them for the race. It was perfect! For the rest of the race, I kept at a slow jog but consistently ran the rest of the race.

So basically, I RAN. I RAN. I RAN!!!! I didn't stop! I kept consistently running and I could do it for the whole rest of the race. I had endurance. I was slow but steady :) It was really, really good. As we were waiting for the race to start I downloaded some music into my IPhone and found a perfect original mix of 80s music to get me going. At about a half K to go, I did pass these ladies though and I booted it to my favourite song of the moment. It was really good :)

The race itself was HUGE by the way. I've never been to a bigger race - HUGE!!

Anyway, I can honestly say that this is the first time that I have felt even remotely like a runner.

Disappointing though - even though I ran most of the event by far...I ran the slowest time of all my races. WHY? Because I ran and well running is FAR harder for me than walking. I am a fast walker. It has very little impact so I can go far faster as a walker than as a runner with high impact on my joints...but I figure if I can keep running, I can definitely improve my time, right?

Yesterday I was so inspired I ran to my friend Lisa's apartment (she's about 2.5 K) away and then I walked for a total of just over 10 miles :) WOOT!!

Dawn

"You are too thin!".

A recent post I read on an RNY board was the following:

HELP! My family is driving me crazy. I've lost about 100 lbs. I still have around 40 more too go but my family is driving me crazy with the "you are getting too thin comments. I don't know what to do. I am not anorexic by any means. I'm not unhealthy. Why do they think I am getting too thin? I don't get it.

I hear this comment alot. Right away, what usually happens is that most people start with the "they are just jealous" responses. I often have a different response to this reaction. Here's what I wrote.

*****

I know that it is an annoying thing when it happens because it happened to me. People often commented that I was getting too thin, looking gaunt when I got down to my lowest weight. At that point, I was just at the top of my "normal" bmi so I was no where near being too thin or anorexic myself. But here's what I think is happening for most people. These are the people that love you (a jealous friend might be different) but when it is people that you love making these types of comments, this is what I gather is happening:

Chances are if you have gone for surgery, that you have been overweight for quite some time. I know that for me, I'd been over 200 lbs since I was out of high school so that was a good twenty plus years.

For twenty plus years, people were used to my face structure and my body structure. My facial fat, especially my fat cheeks were pretty much the essence of me. In every picture over the last 20 years, my face was larger, puffier, cubbier. That's just how I was because of the weight. Although I was an "unhealthy weight" no one was really saying I was "sick at the time" so this to many people was "normal" for me.

After losing a huge amount of weight, the fat disappeared from my face. My face toned, and all of a sudden I went from having chubby cheeks to having dimples, to having facial lines (okay wrinkles), to having the "fat" almost sucked out of my face.

So what people had known as "me" for twenty years changed immensely. I now had cheekbones, collar bones, and the like. I was very different. People hardly recognized me. That's the whole point - what I looked like changed immensely. The features that everyone associated with "me" were now gone.

Talk about a complete change.

I now was much thinner.

Let's face it, when you lose a lot of weight - people often do associate this with being ill. Gaunt.

So how shocking it must have been for people to see me change from this big ol' puffy thing to something with wrinkles, lines, and dimples!! My very essence of me changed. I now looked so thin and pale. So many people started to worry because the change was so dramatic. I am sure that this is a very natural reaction for most. It took 20 years for people to get used to me. Now it might take another 20 for them to get used to the "new me".

It took a while for people to get used to this new me. Luckily it really didn't take them 20 years. A couple of years went by and my hubby often commented saying "I don't really remember you fat". :)

Dawn

Get Real

Before you had surgery were you accountable for what you put in your mouth? I wasn't. I admit it. I ate a lot. I earned every pound I put on my body. I earned every size I went up. I'll be real here. I'm not proud of it at all.

Dinner before surgery was often fast food. I grew up in a house where regular meals were not the norm. Once I got my first job, my pocket money was spent on food. I'd even stop sometimes on the way home from work in the evenings and pick up fast food just for snacks. Before surgery, Thursday nights were spent watching Survivor or Apprentice, inhaling a container of Haagen Daz Caramel Cone Explosion ice cream. The whole container. My hubby was trained that if I had a very stressful day at work, that was he was to go to the corner store and get that for me.

As well, before I had surgery, I started to hide food from hubby. I'd sneak in ice cream bought on the way home, eat it, hide it and then put in the garbage (with other stuff on top to hide the evidence). I could eat normal meals but chips, chocolate and junk food, particularly McDonalds were a regular part of my life. I'm not proud of it but I'm honest.

Incidentally, I did buy a container of it when I was at about the three year mark. It made me sicker than a dog after less than half a cup. I pretty much poured the rest down the sink.

Now, if I have a "sundae" it is a one scooper. Anything more pretty much makes me sick. A chocolate dip cone is a once in a while treat but even that is a small. I tend to be more "purist" when I have ice cream - all the "stuff" that they add to it now (caramel, pieces of stuff, chocolate chunks -- all that just makes me sick and my reactive hypoglycemia can only handle little bits of that at a time. One cone is the maximum now and again. I pretty much go out for the one scoop. I don't bring ice cream into the house much - I'm well aware of my limits that way.

I see a lot of people going through their journey that are not honest with themselves and I wonder when they are going to develop a sense of accountability for their weight.  I over ate.  I ate a lot. I didn't exist on salads.  I won't lie about my habits.  I gained weight because of the choices I made.  It worries me when people say "I barely eat", yet I weigh 300 lbs.  There has to be something else there. 

Seriously? I cannot help but worry about people who aren't honest with themselves and their eating habits.  I grew up on crap. I had a mother that didn't like to cook. We had weird eating patterns at our house. No one ever ate a meal together.  We only ate potatoes and corn as vegetables. I swear I was in my 20s before I tried broccoli.  We don't get to be 200, 300, 400 lbs for nothing. I was 290 lbs at my heaviest, I had some meds that were known to cause weight gain but I'm also well aware that I just did not make the healthiest choices either. I LIKE food. I ate too much of it. I ate some healthy foods as well but even when I ate that, I ate too much. I would have 3 chicken fajitas (fairly healthy) but I'd also slather them in sour cream. (yum!). I'd eat a Tim Horton's muffin for breakfast which didn't seem like a ton of food but of course, when you read the stats for the muffin on calories or fat alone, they are pretty horrific.

This other lady online that I know eats Tim Horton's muffin for breakfast every day. She is 6 months out of surgery. You might not think it can happen but YES you can lose track of what you are eating even after surgery if you are not held accountable in some way. The longer out of surgery you are, the more "skewed" you can get about what you are eating. That's why you'll often hear "I'm 5 years out and I've gained 50 lbs". It's EASY!!! Far easier than you can imagine!

Do the Weight Watchers points plus system for one week and you'll see how much you eat. It's a great way to be accountable. You get 29 points a day ---- if you have the muffin it is 11 points! That's A LOT of points out of a daily total. Then you get to see just how not "healthy" they are. Worse yet a medium ice capp is 12 points and this is only a drink!  It is amazing how you can easily lose track of yourself even out of surgery. Eventually you get a 'skewed' sense of reality again of what you should be eating.

And while the first year, you'll lose pretty much no matter how hard you screw up....the second, third, fourth year....they are not nearly as forgiving. So if you feel like you are getting further down the road and you are getting off track, find a way to measure what you are doing. Find a way to keep yourself in check because it is very easy to get off track.

If that happens, it's time to go back to Overeaters anonymous, Weight Watchers, or getting out the old Canada food guide or counting calories again. Scary how quickly we can lose our sense of touch with food again even after surgery!Or do the Canada food guide, measure, weigh and see where you stand. You have to get a REAL idea of what you are doing wrong before you'll make great strides in making in right.

Dawn

New Article on Bariatric Surgery

New Data on Weight Gain Following Bariatric Surgery

The following is a reprint of an article that has been "in the news" lately and my thoughts are following the article...

Gastric bypass surgery has long been considered the gold standard for weight loss. However, recent studies have revealed that this particular operation can lead to potential weight gain years later. Lenox Hill Hospital’s Chief of Bariatric Surgery, Mitchell Roslin, MD, was the principal investigator of the Restore Trial – a national ten center study investigating whether an endoscopic suturing procedure to reduce the size of the opening between the gastric pouch of the bypass and the intestine could be used to control weight gain in patients following gastric bypass surgery. The concept for the trial originated when Dr. Roslin noticed a pattern of weight gain with a significant number of his patients, years following gastric bypass surgery. While many patients could still eat less than before the surgery and become full faster, they would rapidly become hungry and feel light headed, especially after consuming simple carbohydrates, which stimulate insulin production.

The results of the Restore Trial, which were published in January 2011, did not confirm the original hypothesis – there was no statistical advantage for those treated with suturing. However, they revealed something even more important. The data gathered during the trial and the subsequent glucose tolerance testing verified that patients who underwent gastric bypass surgery and regained weight were highly likely to have reactive hypoglycemia, a condition in which blood glucose drops below the normal level, one to two hours after ingesting a meal high in carbs. Dr. Roslin and his colleagues theorized that the rapid rise in blood sugar – followed by a swift exaggerated plunge – was caused by the absence of the pyloric valve, a heavy ring of muscle that regulates the rate at which food is released from the stomach into the small intestine. The removal of the pyloric valve during gastric bypass surgery causes changes in glucose regulation that lead to inter-meal hunger, impulse-snacking, and consequent weight regain.

Dr. Roslin and his team decided to investigate whether two other bariatric procedures that preserve the pyloric valve – sleeve gastrectomy and duodenal switch – would lead to better glucose regulation, thus suppressing weight regain. The preliminary data of this current study shows that all three operations initially reduce fasting insulin and glucose. However, when sugar and simple carbs are consumed, gastric bypass patients have a 20-fold increase in insulin production at six months, compared to a 4-fold increase in patients who have undergone either a sleeve gastrectomy or a duodenal switch procedure. The dramatic rise in insulin in gastric bypass patients causes a rapid drop in glucose, promoting hunger and leading to increased food consumption.

“Based on these results, I believe that bariatric procedures that preserve the pyloric valve lead to better physiologic glucose regulation and ultimately more successful long-term maintenance of weight-loss,” said Dr. Roslin.

As per the original article:

Dr. Roslin and his colleagues theorized that the rapid rise in blood sugar – followed by a swift exaggerated plunge – was caused by the absence of the pyloric valve, a heavy ring of muscle that regulates the rate at which food is released from the stomach into the small intestine.

This is a theory - so it would have to be proven to be valid. There is also a theory of over insulin production by the pancreas in terms of reactive hypoglycemia. (That's often why extreme cases get a portion of the pancreas removed). It would be nice if people did more studies on that to determine if it is pyloric valve related or pancreas-induced.

Monitoring and completing long term studies would be a good start in terms of regain and different surgeries specifically VSG since there's an absence of good long term studies.

However, when sugar and simple carbs are consumed, gastric bypass patients have a 20-fold increase in insulin production at six months, compared to a 4-fold increase in patients who have undergone either a sleeve gastrectomy or a duodenal switch procedure. The dramatic rise in insulin in gastric bypass patients causes a rapid drop in glucose, promoting hunger and leading to increased food consumption.

That's why maintaining blood sugars, eating regularly and AVOID simple sugars as much as you can is important. You are going to reignite the hunger monster. I'm like that - if I eat crappy, I crave more. When I'm eating clean, i feel better and don't feel so hungry all the time.

That's why often we say the mantra, "EAT LIKE YOU DUMP ALREADY" or be careful about opening Pandora's Box.....because once you start, it's hard to stop. Pandora's box is full of sugary treats...I encourage newbies even to skip the ice creams, the cakes and cookies - even sugar free, eat clean as long as you can because once you start triggering your carb cravings, it gets really, really challenging for most of us. I think in the respect those that dump and are excessive dumpers actually have an advantage...they avoid sugar and don't give into treats as they just know that they can't. We all should eat like that! :)

Just my two cents and of course, it is only my opinion.

Support Groups

An interesting article I recently read contained the following paragraph:

Join and participate in a good bariatric surgery support group – patients who actively participate in support groups have about a 10% lower body mass index than patients who do go it alone.7

Participation in an online weight loss support groups or forums is helpful, but it doesn't replace the need for the kind of one-on-one or in-person group support mechanism which every bariatric surgery patient will need for the rest of his or her life to maintain and maximize the benefits of the surgery. If your doctor or hospital doesn't provide a support group, START ONE.


There's nothing like the comraderie of finding friends in your local support group. Just having one or two people to go to, to talk with, to say "have you ever experienced this?" or to share experiences, become fitness partners with ...etc is a huge help with the war on weight loss.

It can be a daunting task to go up to someone and say "Hi...my name is __. Can you tell me about your surgery"...at a local support group. As obese people, we are often the last to want to draw attention to ourselves or to be in a crowded room but we have to remember that when it comes to the struggle of obesity, we are all in the same boat.

I cannot say enough about finding a support group in your area or starting one if you cannot find one.

Dawn

Reactive Hypoglycemia

Reactive hypoglycemia is commonly diagnosed after Roux-en-Y gastric bypass surgery. It is far more common than many deficiencies are post op so it is very important that you read about, learn about it and watch for signs of it as you progress through your journey. For most symptoms will develop after the first year, going into the second year post op. Some people do not get diagnosed though until later. Recognizing symptoms is key.

Serious/severe cases of reactive hypoglycemia can requires removal of parts of our pancreas. For most of us however, the symptoms are not that severe and we can just monitor our diet, make simple changes and monitor times when we may be high. It took me some time before I pieced together my own symptoms.

The first symptoms I noticed were at work, after I had a carb heavy lunch. I would feel "all floopy" (a quote from FRIENDS. LOL!), get a little lightheaded and VERY chatty. I really didn't think much of it to be honest.

At these times as well, I'd get a little shakiness of my hands and I felt a 'little out of it'. It wasn't until watching television one night that I really clued into what was happening. I was watching Friends and was getting a little annoyed because the people on the show seem to have lost their chins. I kid you not. It seemed as though all the charactes had these long and pointy chins. I was crabby too. I realized at that point that something weird was going on asked hubby to get his blood sugar monitor (he's diabetic). He took my reading and said "Wait! That cannot be right. It says 1.1". (In Canada we have our own system for blood sugar - that would be around 18 I believe in the American system).

He scratched his head. He did the test again. Yes, I was THAT low. This is low enough that I could have had a seizure or passed out. He immediately called his Mother who was a nurse and asked what to do. He gave me 1/4 cup of juice. Within 15 minutes, my sugar came up.

This is the scary part of hypoglycemia. If you get too low you could pass out (doing almost any task or have a seizure).

Reactive hypoglycemia - also known as Postprandial hypoglycemia (low blood glucose after meals), is a medical term describing recurrent episodes of symptomatic hypoglycemia occurring 2–4 hours after a high carb meal. Symptoms may include:

Mild Hypoglycemia:

* Increased or sudden hunger ( I don't get this one)
* Feeling shaky, dizzy or nervous (YES)
* Pounding heartbeat (NO)
* Drowsiness, feeling tired (SOMETIMES)
* Sweating (cold and clammy) (YES)
* Numbness or tingling around the mouth (YES)
* Headache or stomachache (NO)

Moderate Hypoglycemia

* Symptoms above plus:
* Headache
* Irritability
* Confusion
* Slurred or slow speech
* Coordination difficulties

Severe Hypoglycemia

* Any of the above mild or moderate symptoms, plus:
* Loss of consciousness
* Seizures and/or convulsions
* Death (not common but possible)

Most doctors will want to do a "Glucose Tolerance Test" on you to find out if you officially have reactive hypoglycemia or not. If you can avoid that, do so. My doctor really wasn't in the know and she suggested it. Dummy me agreed. Well I passed out about 5 minutes after taking the orange drink. Not so much fun. If your doctor insists that you take it, take someone with you. Prepare to dump possibly too. What you can do instead is log your foods, and your blood sugars after them. Note the carbs/sugar in each product, write down your blood sugars at the 1 hour after and 1.5 hour after and 2 hours past eating. Look for trends. You'll need to find out YOUR triggers are, and what foods work best to bring you back from a crash. You'll find what you should be carrying in your purse to bring you up from a crash whether its crackers & peanut butter, glucose tablets, juice etc. The key is to learn when you feel like you are going to crash and to deal with it then BEFORE you actually have a crash. Write down everything. My blood sugar monitor went through a huge workout until I could figure out what works for me.

Also be sure to:

*Eat according to the "rules" - protein first, moderate complex carbs and healthy fats.
*Never eat a carb without a protein or fat.
*look for lower GI breads.
*Avoid simple processed sugar products.
*If you have something high in sugar, be sure to eat something else at the 1 hour mark to avoid a crash.
*When symptoms start, take your blood sugar. Be proactive.
*Write down everything!
*Eat according to a schedule.
*Swap white bread for whole grains
*Eat before you exercise.

Dawn

My First 5K

I admit it.

I was the last one picked in gym class and I still haven't gotten over it.

It's true. I have always been the overweight child and going into high school, I was not exactly eager to take Gym class. Unfortunately for me, the government sort of mandated that year that everyone had to take ninth grade gym class. I was not amused.

I was teased incessantly, ridiculed about my weight and of course, was indeed the last one picked in gym class.

Today I had my first 5K. I still felt like the last one picked in gym class. As the runners were all gathering, waiting for the race to begin, I couldn't help but feel like I was out of my league. I didn't belong. I was the one who was sorely out of place.

And unfortunately, I really wasn't prepared. When I set my sites on this 5K, I was in the middle of doing my Couch to 5K program online that told me that I would do well on a 5K and be able to run it straight by the time I was done. Unfortunately, in the middle of a long, cold Canadian winter, I was training on the treadmill and found out later, that baby, it's a whole different thing on the treadmill.

Once done my Couch to 5K training (google it if you want to for the program), I was sure that I would make the treadmill to transition rather easily. I could now run a straight 30 minutes on the treadmill and so it would be easy? Right?

Not on your life.

My goodness! I couldn't even do a straight 2 minutes on the pavement! Eek!

Luckily, I signed up to do a Running clinic where once a week everyone begins at their level and runs together accordingly. I had the option to start at the beginning level which offered running/walking intervals (much like I'd done with the Couch to 5K program on my treadmill). Luckily, I signed up in advance because I couldn't back out. I was ready to completely throw in the towel on my running, feeling so super frustrated that I was starting right back at the very beginning yet once again!

So that's where I stood until I remembered that I'd also joined up for my first 5K this weekend. (some friends had said they'd do it - but no one ever really said that for sure they were going to do so....so it was looking like I wouldn't have to be accountable...and maybe, just maybe, I could bow out....).

On Friday, my coworker came to me and said "Hey good luck on your 5k this weekend!". Oh Yah. I forgot. How did she remember? (As I'm thinking: I can just back out, no one will remember...."). It happens that my race coincided with the weekend of the Boston Marathon (which she was doing as well) so she couldn't forget.

*ugh*. Someone would keep me accountable?

So of course, Saturday's forecast predicted rain, rain and more rain. And oh yah, some pretty heavy wind action as well.

LOVELY!!!

Even the morning of the 5K, I was not exactly sure if I was still going. The original plan also called for my hubby to go with me, but having started a new job he was working this day, so no hubby support either. No friends that I knew of doing it as most had put on their facebook that they were going shopping or some other clearly not running-related activity.

So yes, I dragged my butt to the racing site. Started chatting with a lady near me who said she was the world's slowest runner. She'd been running for 2 years. She was super nice and kept the boredom factor low.

Then all of a sudden, Joanne comes into the pavillion! It's like an angel appearing with the ray of light. Joanne is in my WLS support group and she and her boyfriend Bill have been super supportive with my running. (Bill has gone hardcore after losing his WLS weight as well - now gearing up for triathalons even!). Joanne is a soft runner. She tells me that she's still fighting an injury but she decided to come out and even if she "has to take it slow. It is still better than sitting on the couch!".

She keeps me company the whole race. She stops when I stop. She walks when I walk. The rain stays away. It's cold and windy. It's miserable but we keep plowing through. I clearly suck at running. I am not able to get my breath when I am running. I walk alot.

But I still do it.

I am the slowest runner/walker in the race. I am still trying though. Joanne stays at my side the whole time, talking to me, encouraging me, pausing when I pause. The wind is killing me.

I finish in 43:40. Embarrassing slow. I could literally WALK faster. But Joanne is still by my side and hubby is at the very last turn of the race, encouraging me as well. It's a good day and I can see the finish line and it's done.

Definitely not marathon type standards but I can say that I did it. I have a starting place. I know what I can do. I know where I can go from here. I know that I am capable and that I can better. I am trying not to be discouraged, but hopefully. Everyone starts with one small step.

This is only the beginning of my next journey.

Dawn

Children and Food

As a Kindergarten teacher, it can be disturbing for me at times to see children that are already showing signs of being overweight. It can also be somewhat upsetting to see what the children are eating. In my class, we have two eating times: one is a "snack" time and the other is a "lunch" time. It's really interesting to see the variety of foods that come through the door. It's also, at times, alarming.

Growing up, I was immersed in a processed food world. It is no wonder to me that I struggled with my weight and became an obese adult. Meal times were irregular at my house and we never sat down to eat a family meal. My Father ate his meal regularly and it often consisted of the same thing: meat, potato (often fries) and corn. He was a shift worker so he ate at all hours of the day. My Mother (who also battled a weight problem) rarely ever sat down to eat a whole meal and mostly, grazed throughout the day. If she were to sit down with me, it would be for a meal of takeout, Chinese and pizza. My Mother *hated* to cook.

Dinner for me was often junkfood: toasted bacon sandwiches (I kid you not), hotdogs, Kraft dinner, hamburgers, takeout etc. We never really ate vegetables other than potatoes (fries mostly) or corn. The only time that we really even kind of sat down for a meal was on Sundays when Mom actually cooked a roast. But often that involved her and I eating in front of the television.

Is it no wonder that I struggled with my weight growing up?

I see a variety of trends with my students. I've been pushing "brain food" the last month like fruits and vegetables. It's starting to help a bit. My one boy student who struggles with attention issues (hmmmmm....diet changes might help) is forgoing the junk food and brought a banana today. I had a child today who brought in kiwi (the other children gathered, flabbergasted by this strange green fruit).

I see too many lunchables. With children it is a sad status symbol. I see a TON of processed carbs (granola bars, nutrigain bars, 100 calorie packs, cookies). I see lunches that consist of these all thrown together with no protein at all! Scary! I see a ton of juices laden with sugar (have also been promoting water as the best drink ever), and koolaid jammers (ick!). I've seen parents coming in and bringing KFC, MCDonalds etc. Thankfully they seem to know it is a treat and don't do it that frequently.

But on the positive side, I've seen children eating some nice garden salads!! Real yogurt, fruit salad, strawberries, etc. I am seeing more and more fruit coming in! I can see already that for some children, it really does make a difference.

I have a real problem with these companies that dumb down their products. Think of KD, who introduced Kraft dinner made out of cauliflower. Sounds healthy right? Not til you read the package. I hate that the local Macs store is carrying those stupid milkshakes that have no nutritional value whatsoever. I wish our society would be more critical of these products.

Oh well, rant over :)

Dawn

Probiotics and RNY

To be a successful RNY patient, there are different things that you can do to "up" your losses. One of them is exercise that will tone your body and of course, help you lose a wee bit more in the long run - especially the last 20 lbs. One often underlooked other advantage can be probiotics.

So what are probiotics? They actually sound rather disgusting when you think of the actual concept. They are basically healthy microorganisms. These microorganisms may help with digestion and offer protection from harmful bacteria, just as the existing "good" bacteria in your body already do.

Probiotics can be added to your diet through nutritional supplements or foods such as yogurt, fermented and unfermented milk, miso, and some juices and soy drinks. When reading a label you would be looking for a statement that the product contains "live and active cultures," such as lactobacillus.

Although more research is needed, there's encouraging evidence that probiotics may help:

* Treat diarrhea, especially following treatment with certain antibiotics
* Prevent and treat vaginal yeast infections and urinary tract infections
* Treat irritable bowel syndrome (IBS)
* Reduce bladder cancer recurrence
* Speed treatment of certain intestinal infections
* Prevent and treat eczema in children
* Prevent or reduce the severity of colds and flu

In a study published in the July issue of the Journal of Gastrointestinal Surgery, the Stanford University School of Medicine and Stanford Hospital & Clinics, showed that patients who take probiotics after the gastric-bypass procedure tend to shed more pounds than those who do not take the supplements. Probiotics are the so-called “good” bacteria found in yogurt as well as in over-the-counter dietary supplements that help in the digestion of food.

The researchers followed 44 patients that had RNY from 2006 to 2007. Patients were randomized into either a probiotic or a control group. Both groups received the same bariatric medical care and nutritional counselling, as well as the support of weight-loss study groups. Both groups also were allowed to consume yogurt, a natural source of probiotics. In addition, the probiotic group consumed one probiotic pill as well.

The study showed that at three months, the probiotics group registered a 47.6 percent weight loss, compared with a 38.5 percent for the control group.

The study also found that levels of vitamin B-12 were higher in the patients taking probiotics — an important bonus since patients often are deficient in B-12 after gastric-bypass surgery. So an added benefit that they didn't expect as well!

Morton (the surgeon that lead the study) said the study was prompted by the fact that some patients have problems eating after gastric-bypass surgery. “For some reason, the food doesn’t go down right,” he said. When no anatomical reasons could be found for blockages, he hypothesized that a build-up of bacteria in the intestine — bacterial overgrowth — might be the culprit.

“Bacterial overgrowth can be bad in that it changes your motility, how you empty,” Morton said. “A lot of people aren’t aware that we all carry about a lot of bacteria in our intestines and that they’re extremely helpful in aiding digestion. And I thought, ‘Well, if we give these patients probiotics, then maybe we can improve these symptoms.’

“Part of the obesity puzzle may be due to the kind of bacteria you have in your intestine,” he said.

So how can you get in probiotics - yes you can look for yogurts or foods with added cultures but as well, many supplement companies offer probiotics in a little sleeve (much like the packages of Crystal Lite Singles) that you just add to your drink or to regular yogurt. I've purchased them at Walmart, made by Jamieson Labs.

The Inevitable First Stall

At last month's support group meeting, I only spoke for a half an hour to intro the group and do the "round robin" around the room. But I let something slip that got a lot of reaction in the room. I can't even remember WHY I said it but it was like an "a-ha" moment across the room. It slipped out for the tiniest reason but hit home with a lot of the newbies in the room.

I keep forgetting that so many people go into surgery not knowing as much as I did when I went into surgery. I need to remember this and remind the members of things that they might not know in the future.

When I was going through surgery, I was ready for and expecting the inevitable 3rd to 7th week stall. I often forget that some newbies don't know to expect it. They should. You should be expecting it when it happens so you know that it is coming and you are mentally prepared for that period when the scale doesn't budge early out.

(and don't forget to take your measurements every week early out too so that you have something else to measure yourself by other than the scale).

When your body first goes into surgery, it knows shortly afterward that it is starving. It needs food but you are taking in such little nutrition after surgery that it tries to sneak your glycogen stores. Glycogen stores are the "quick energy" stores that allow you for instance to run out quickly if a mouse is on the floor. It's your "instant energy" in your body.

So your body thinks "hmmm...it's just a little hurdle, I'll get my energy from the glycogen stores".

Well after a few weeks of this, your body realizes that this is not a short term thing anymore. It realizes that using energy from your glycogen stores isn't very efficient and very long term. So it has to THINK a bit.

(This is where the stall comes in).

Then it says "A-hah!!!!". It realizes that it has a lot of fuel on your body - your fat stores, so it's going to start burning some energy from there and shrink those fat cells.

Then the body will resume into full burning mode and guess what? The scale will start moving again.

This is a GREAT things when it happens. Although it sucks that the scale doesn't move, it means that is going to start burning the stored fat you have (especially the stuff in your butt! LOL!).

So be happy about that inevitable stall - it's fat burnin' season!

Dawn