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Thursday, July 11, 2013

Things To Do While Waiting For Gastric Bypass

 A question on the OH Ontario board today has lead to this post today....

Here in Ontario, we have typically a wait of anywhere from 9 months to 2 years for surgery.  Most patients get through in just over a year.  Often I hear "how can I fast track through the process?".  I had a very honest lady in my support group spend a meeting discussing how she was one to think this and now that she's gone through the surgery, she realizes that she was the one who held herself back.  Rather than embracing the help from the Bariatric centre, she thought she could "talk her way to the front of the line".  She realized that this is what actually held her back in the process and made her wait even longer.  I admire her for her courage to tell the group about this and how her thinking has changed now that she's had her surgery.   Kudos to her.

The things is (and I know this all too well) you become somewhat obsessed with surgery once you've decided that you are going to go through with it.  It's understandable because we know that it's going to be an amazing change especially after seeing so many of our friends go through this surgery.  Quite frankly, we are also a society where we have very little sense of delayed gratification - we want what we want NOW.  So I'm here to shed a little understanding on WHY the wait is crucial.

You need to reframe your thinking on the whole process. This is not merely a set of hoops to jump through.  To be a success with gastric bypass you are going to need to make some drastic changes BEFORE surgery.  There's so much to learn, to know, and to understand that there needs to be a process.  Recently I've seen some turnarounds for surgery at 3-6 months through Humber River Hospital and to be honest, I'm SCARED for most of these patients.  This is a HARD road.  This is not brain surgery people.   That's the problem.  We get our bodies rerouted but we still have the same fat brain.  That fat brain will want to sabotage us along the process.  We have to outsmart it with education and by establishing some positive habits now. 

We have SO much to learn through this process in order to be a success that I often suggest to people that they EMBRACE the time as preparation time for what is going to be the most amazing (but often challenging) time of your life.  So start preparing now:

Prepare your Resources:

Begin by preparing your resources for surgery.  I would suggest that most people read at least two good books on surgery to understand the basics.  I've seen so many people not read a thing other than the handouts given by the surgical centre.  There's barely any information there to be honest.  The best resource I suggest is Weight Loss Surgery for Dummies.  Truly I think it should be mandatory reading for anyone preop.   Some other ones I like are the Real Skinny on WLS (Janeway)   and the Complete Weight Loss Surgery Guide and Diet Program by Sue Ekserci.

Start a binder with ALL your resources given by your hospital.  If you can get a copy beforehand, get a copy of your eating plan through your surgical centre.  Start creating meal plans according to each food stage.  Make a shopping list.  Know your eating stages like the back of your hand.  Try a few shakes but don't get carried away as your tastes may change.  If you see any samples, buy them to try after surgery.  Remember protein is key.  Learn what makes a good quality protein shake.  Don't get fooled by people you know that might want to try and sell you their inferior shake that "worked for them".  Learn and read! Collect recipes and calculate nutritional info if possible. 

Write down a list of complications and what to watch for.  Learn and read your message board on OH every day.  See what it is like as a new post op after surgery.  Learn the differences between foamies, things getting stuck and dumping syndrome. 

Research your hotel options and travel options for your spouse.  I did this months ahead for my hubby so that I knew where we would stay, routes and even shopping areas in Guelph.  Loved ones will benefit from your thoroughness. 

Document every visit to your dietician, social worker etc.  Keep your homework.  Write down your responses and document what you've learned as you go through.  You'll appreciate your thoroughness later!

Oh did I mention that you could go in expecting to get a Roux En Y (If you are asking what that is, you need to research!) and you may come out with a VSG.  Again research!!  You need to know these things.  Learn the difference between dumping syndrome, foamies and things getting stuck.  Read about a stricture, hypoglycemia, slider foods, plateau/stall,  NSAID (we cannot have them), malabsorption, restriction, why carbs matter, vitamins, etc.  Read and read and then read some more! (Seriously!). Read about what dumping syndrome is and why you cannot count on having it.  Learn what the expected loss rate is.  Learn about things that you can do to increase your rate of loss.  The bariatric centre won't tell you all things.  Some people lose 50 lbs, other lose 150...find out the differences to their level of success. 

Prepare Your Mind:  

I have always said that the mental aspects of this surgery are the hardest.  While the six months to a year are fairly easy (albeit the first 6 weeks can be TOUGH), after that this surgery is going to be hard.   Explore the issues that have lead you to this point.  Look into whether you have an eating disorder,  learn about what your patterns are and why you've gotten here.  What are you replacing with food?  Are you a binge eater? Emotional eater? Boredom eater?  Start working on these issues now because some time after a year, it is no longer going to be a constant high and the amounts that you'll be able to eat will be greater.  I'm going to be honest here and say that there is a failure rate for surgery.  Some people do gain all or most of their weight because they have not dealt with these issues.  You need to know that and really start to explore your eating issue.  Do you just "like food"?  Is it instant gratification? Then it's time to start teaching yourself about delayed gratification.  Yes, it's going to be about willpower again certainly after a point.  Start to teach yourself about discipline, putting off a craving, finding other outlets for emotions and stress.  I know this sounds preachy but my surgical centre did nothing about this and I really wish they'd did.  At 2 years out I had to find therapy in community and was lucky that I had it.

Utilize your centre's dietician and social worker for these changes.  Start making big changes now.  You can only benefit from this.  Start exercising. Start getting rid of all the negatives in your life.  Time for a positive change. Get rid of the baggage.

Prepare Your Family or Spouse:

There may need to be some changes in your house.  Although you cannot DEPEND on your family to go through all the same changes as you, you will need their support and their help especially for the first 2-4 weeks.  Time to prepare everyone about what you'll be needing and what they'll need to do to pitch in to make your recovery smoother.   Remember too - if you are keeping your surgery a secret, you need to draw boundaries with your family as often the "secret" gets out.

Track other people's journeys:

As you see some people preparing for surgery that will have surgery before you, watch their journeys.  Read how they manage the first month out.  Look at what they struggle with, how they solve their problems and record and write down what you learn.  You'll only benefit from what you learn.

Find Mentors: 

Find a mentor - whether online or in person.  Find someone that wouldn't mind you emailing them if a question should arise.  You might be feeling panicky after surgery or you might not want to post everything to the masses online.  Find that person who you've learned from and respect and who will give you quality, sound advice.  Find someone who is stable and secure.   If they seem flighty or highly emotionally charges, stay away.  Find someone who seems to give helpful advice and is willing to answer your questions.  Find someone you relate to.  Actually, if anything, find MORE THAN ONE mentor.  Sometimes people fall off the face of the earth or they might get to a point that they are struggling themselves and might not respond.  Always nice to have a backup.

Find a Support Group:

Look for a support group in your area.   Many communities have them.  If you can get to one in a nearby community, I think it is just as valuable and worth a trip. Bring your spouse if they are a bit leery of surgery or bring a friend who is willing to support your surgery.  Face to face contact is important.  You have to be careful who you trust to be a mentor and seeing people in person may help you find someone.   Don't be hestitant to email someone in your support group, they probably will be more than happy to help you.  Even go out for coffee if they are willing.  It helps to settle the nerves when you have a one on one talk.  Go to meetings.  Sometimes newbies feel a disconnect from the people in their support group.  To quote one of the members in my support group, "Suck up every bit of information" from people that you can learn from, especially from people that have been there, done that.  Experience is an amazing teacher.  Taking advice from someone who has not gone through the surgery can be iffy at best.  Learn from others.  This is by far the most valuable piece.  Make connections of support.  Some times that means "putting yourself out there" and it is worth the risk!

I wish you well in your journey.  Embrace the time you have now.  You may find that before you know it, you'll feel a sense of panic because surgery "has come so soon!".   It can be a funny thing!

Good luck, my friend!


Saturday, July 6, 2013

Keep It Real

If you know me, you know that I spend a lot of time online.  Recently on one board I belong to, there was a bit of a discussion about the aspect of "Keeping it real".  Someone started another board entitled that name for those that didn't want to be coddled about some of their decisions post op.

Here's the thing:  I'm a big believe in keeping it real (and see the discussion below that follows for what I believe in regards to that) but I'm also a big believer that there are many wls patients that completely struggle due to the head issues, the mental aspects of surgery and the fact that they are trying to overcome an addiction.  It is well documented that wls patients often have a mental health issue.  Some are dealing with depression, bipolar, and various issues.  Not all of us are though.

Previous to surgery, I have not had any detected mental health issues.  No history of depression or anything like that throughout my life.  But now that I am long term post op, I can see how much of an addiction I have to food and how I use it to cope, to distract, to deal with stress and well, just to get pleasure from.  I still have my FAT HEAD.  I'm now realizing that I'm every bit an addict.  I am a binge eater and I didn't even label that before surgery.  I just thought I "liked food" too much.   So I understand how when we deal with patients who are failing that we also have to consider that they may have some mental health issues.  Sometimes we have to have compassion and not just attack people for their food choices.   So I try when someone is failing to encourage them to pick themselves back up right away, to get back on track asap and to seek mental health resources if they are struggling.

But we also have to KEEP IT REAL and by that I mean we have to acknowledge what is written in our plans, our diet given from our surgical centres and we need to try to adhere to them especially in the first year or two of the "magic window" of loss.  So we also NEED to have the frank discussions about things like 100 calorie snack packs, cookies, chips etc. not being a regular part of our diet.  Often new post op people are running out to buy "protein chips", "protein cookies" etc and well, protein bars. I have not seen these in Ontario's Bariatric centre instructions.  They are still crap plus protein. Processed foods.  

I hope that every centre will start to push this more as well as a rule about how many sugars.  I see many people that seem to have the understanding that rules for sugar only apply to avoid dumping.   That's so not true.   I have seen a new post op eating Clif Builder bars that have something like 20 grams of sugar!!  Seriously, sugar is the enemy.  If you are eating highly sugary things at two months out, what will you be craving in the next 6 months?  I find that scary.  Really scary.

Programs need to push the fact that people need to be eating natural, wholesome food and avoiding processed foods at all costs to maximize loss.  Even though it says this in their plans, I think they need to directly say "avoid this and this" because people seem to run out for sugar free this and sugar free that and have the understanding that because the chocolate bar is sugar free - it's "on their plan".  Egads.  It's very easy over time to start to rationalize foods we shouldn't be eating.  If you get too hooked on sugar now, what will you be eating later?  Get it out.  Trick your senses into getting sweet from fruit.  Avoid the processed stuff as much and maximize your loss.  Once you open Pandora's box of sugar, it's very hard to close it.  I struggle with it daily at 7 years out and I did not venture off course much at all early out.  I didn't buy any bariatric foods.  I ate all regular food - lots of veggies, chicken and fish.  Boatloads.  But now I can get so obsessed with carbs and sugars.   They make me feel like crap but I still crave them.  Sugar is the bane of my existence.  I feel like a crack addict when it comes to sugar.

I hate the bariatric food industry.  I think there are waaay too many people sucked into products they don't need.  Factory produced food that's fake but given a label of "bariatric" so it must be okay.  Whole food is so much better for you.  I hate that something like 80% of new products marketed are simple carbohydrates, crackers, cookies, etc.  It is frustrating as heck.  Sugar is highly addictive.  I know.  I am an addict.

The problem is that after a long time out, we get to be so good at not keeping it real with our selves.  We become experts at justifying our food choices even when they are way out of whack with what we should be eating.  When we start making poor choices, it is easy to spiral and make other poor choices.  The key is to pick yourself up back right away and get back on track.  As you can tell, I'm doing this right now and feel very powerless over food.   Again, I have to keep myself real too.  

If you can have a friend to help you keep it real throughout your journey, that's a good thing.  I think those that keep it real will be survivors.  I worry for those who get really good at kidding themselves.  Your thoughts?