11 Years Post Op Update

Well...it's amazing but it has been more than 11 years now since I've had my roux en y surgery!

11 years ago I laid on an operating table in a different country USA - Michigan (I'm in Canada) and allowed some stranger to slice and dice my insides in hopes to be a healthier, smaller me. I was taking a huge chance - I had very few comorbidities - and was the healthiest fat person I knew. Would I be making a change for the better...or for worse? 

My first year was an amazing ride! I waited for the horrible dumping and vomiting but in actuality, my post op life was, quite frankly, a breeze. Life was good. Reflections in mirrors gave me pleasure when I saw my smaller frame. I felt like I could conquer the world.

I was amazed to know that I conquered obesity! Life was normal and I was a normal sized person! I knew that no one could stop me. I would never ever go back. 148 lbs gone forever!!

Or were they? 

Flash forward year 2 when the weight loss roller coaster found me again. Twenty pounds added to my frame felt like a hundred. I felt like I had failed. I wanted to smack my head against the wall. I was failing and my binge was back. I felt out of control and cried on the scale. How did obesity beat me again I wondered!? Time for therapy...

The next year, 5-10? pounds lost. I felt like I had the key to the "get the pounds off" mystery. I had control again. I was going to kick butt again. I would win. 

Well you can repeat this whole gain-weight -and -lose weight cycle about a million times and then you'll know where I currently stand at year 11. I've gone as high as 31 lbs over my goal (just as recently as about four months ago) to about 5 over my highest (maybe 5 years ago?). Where I am at on the scale can vary at any given moment.....

One thing I know is that weight loss surgery has not solved my weight problem. It did not stop my food issues. I continue to battle the binge from time to time. I go through cycles of being perfectly on plan to imperfectly in self destruct mode. Eventually the scale keeps me grounded, kicks my butt and tells me to stop wasting my gift, to act like a bariatric patient again and to get back on program. 

The key for me will be to always keep trying to renew my journey. I cannot afford to give up on myself. I have to keep trying to reinvent me. I must keep telling my truth and sharing my truth with others. I have to keep talking about the reality that life is not perfect post weight loss surgery, that the battle continues and that regain is real and not a sign of weakness. It's a sign of a battle that we are often still engaged with. It's a sign that we are human and that we are still dealing and coping. 

Overall, weight loss surgery had been an amazing gift. I would not ever go back to a life of obesity. I have been blessed a thousand times over with the ability to be more mobile, to be medication free and to stay amazingly healthy. But it does not mean that life is easy or perfect and that weight is never an issue again. 

So every day I get into my suit of armour and prepare to wage the war against my obesity. Most days I win. Some days I fall down, hard. But I always pull myself up, dust myself off and get back on track. There is no magic, no miracles. It's just hard work, discipline and choices made. 

And it's quite frankly: One... day...at...a....time.

Happy 11 to me. :-)

Thanks for all of those who have supported me, befriended me and have provided support, kind words or friendship. I couldn't have handled the ups and downs without you all.

Please continue to SHARE YOUR TRUTH!!!

If you need any support in your journey and you feel like I could help you please feel free to add me. Just message me though so I know you aren't a spammer.

8 Years Post Op RNY

Wow. I'm 8 years post op RNY already. Often I have people ask what life is like post op as a long timer and so this post will be a wrap up about my life, the good and bad, post op.  I can finally say that I'm getting the "hang" of this whole maintenance thing finally. It's taken a while for me to get the hang of it.  I didn't realize until I was around 2 years out that I was a binge eater and had an eating disorder. That's why now, I highly suggest that everyone preop examine the reasons they eat.  It made life quite difficult past the first few years but now I feel like I am getting the hang of it finally.  Let's just say that getting off the weight of surgery is EASY PEASY.  There you go, I've said it.  Yes it can be full of struggles - I remember being terrified of drinking and eating initially as if I was going to burst my pouch - but after you get past the first couple of months, it generally becomes much easier.  But long term, it is a challenge to keep off the weight. Your metabolism becomes far more sluggish and it takes way more work to lose even a simple pound long term. Again, that's why I say so often to use your first year well and get to goal with no regrets!

At 8 years out, life is pretty good.  Like everyone I have my great days and difficult days with food.  I battle my FATHEAD every day trying to make healthy choices and to CHOOSE to exercise.  It's a choice.  Everything is a choice now.  I either get off my butt or I watch the scale creep up.  If I get off track with my eating, I see the scale creep up, and back I go, down to a back or basics eating plan. I still suck at moderation most days and if food is there, I will eat it.  There's no magic to keeping it off. I know what works - lots of protein and exercise, very low carbs.  Hard to sustain.  

Medically no big issues other than the ones that I've known for years. Osteopenia of the spine that developed at year one (wrong form of calcium - we need citrate friends) but has stayed the same since.  Anemia - always battling ferritin but haven't had it bottom out yet with hemoglobin.  Always supplementing.  Low vitamin D (Hello? I'm Canadian) and of course, Reactive Hypoglycemia (which I've managed well the last few years).  That's it.  They sound scary but other than watching my sugar intake and taking a few extra supplements, they really impact my life very little.

Positives - Life is GOOD.  I fit in normal clothes.  I range between a M-L in shirts, 9/10 or 11/12 in pants.  I   coach basketball and still walk like crazy.  I did 5 half marathons and am calling a break until maybe Spring when I might consider taking up running again. Always undecided lol.  I could end up doing bellydancing instead...who knows? Lol.  I fit in backseats of cars, am not afraid of turnstiles or passing by groups of teenage boys, I do fit in one size fits all, I can shop in virtually any store, I can easily do all physical tasks and well, life is normal :) 

The biggest change for me this year has been my attempt at resolving my body image issue. Although I know at times that I'm normal sized, I'm also at times very critical of my body.  So well, it was time to pursue plastics.  My tummy really has bothered me forever.  It was time to fix this.  So I finally decided to go for my tummy tuck.  I was lucky enough to get OHIP to pay my panni portion and so out of pocket, it cost me $4080 to upgrade.  I had a fleur de lis tummy tuck which includes a vertical incision in addition to the horizontal hip to hip cut.  (This helps fix skin above the belly button as well).  Dr. Matic in London removed four pounds of skin from my abdomen.  I'm very pleased with results and hope that this well help me like my body a little more especially when it comes to summer time.  It will also alleviate rashes and prevent hernias hopefully from happening in the future.  

There's my life in a nutshell.  Any questions? Just message me diminishingdawn @cogeco.ca (no spaces)

Treating Reactive Hypoglycemia

Hypoglycemia After Gastric Bypass Surgery

What is hypoglycemia?

Hypoglycemia refers to low blood glucose or blood sugar.  While "dumping" is a result of too many sugars and makes you sick 20-30 minutes after eating,  low blood sugar caused by reactive hypoglycemia can make you feel bad and it can be dangerous, since your brain requires a certain amount of glucose to function normally. Severe low blood glucose levels can cause passing out (loss of consciousness), seizures, car crashes, or other more serious outcomes. In people without diabetes, glucose levels are typically above 70 (3.8 Canadian) first thing in the morning, before eating and usually range from 70-120 (3.8 to 6.6) at other times of the day.  (although it spikes shortly after eating). 


The main organs in your body that are important for maintaining normal blood glucose levels are your pancreas and your liver. The pancreas makes and releases insulin into the blood stream. Normally, when you eat a meal, the pancreas makes insulin and the insulin helps to keep blood glucose levels from rising above normal.  People who have high blood sugar, often having a problem with their pancreas.

The liver is also very important to help maintain blood glucose levels. The liver makes glucose, particularly between meals and overnight when you are not eating, so your vital organs can get the glucose they need to function normally.  The liver ships out glucose to other body parts and is the distributor for your body.

There are two broad categories of hypoglycemia:

(1) Fasting hypoglycemia - refers to low blood glucoses in the morning, or when no
food has been eaten for many hours.  You may wake up hungry, moody or feeling faint.  Some people have to keep something by their bedside to consume before getting out of bed (but this is rare)

(2) Postprandial hypoglycemia (also called after meal or reactive hypoglycemia) - refers to low blood glucose levels within a few hours after eating.  It is "reacting to food".  The food is what sets off the chain of events for your blood sugar to go up and down like a roller coaster.  It's "what you eat" that is usually the problem and so, you must take steps to eat differently with your RH in mind.


Postprandial hypoglycemia is also referred to as Reactive Hypoglycemia.  It is a result of how your body is adept at processing sugar.  If you eat something high in sugar or carbs, a lot of insulin is released in response to eating, and the insulin removes too much glucose from the blood.   The insulin's job is to bring blood sugars back down but because it is getting all the sugar in the blood stream at once it is pumping out too much and bring blood sugar further down than expected.  (When you had your pyloric valve sugar was slowly released and then insulin was also slowly released).  Because the valve is gone, the sugar spikes you up fast and the insulin is released too fast.  In some cases, this may be very severe i f the pancreas is making too much insulin.

Most often, reactive hypoglycemia shows up around the 1-2 year mark post gastric bypass...but can occur anytime really after the first 6 months, when the sugar response in gastric bypass patients becomes 20x as strong.


Symptoms:
You may feel some or all of the following syraptoms within 1 to 4 hours after eating:
Weakness
Racing or rapid heartbeat
Nausea
Extreme hunger
Headaches, especially first thing in the
morning (may indicate a low blood
glucose has occurred overnight)
Dizziness
Sweating
Difficulty concentrating or thinking
Nightmares or bizarre dreams - may
indicate a low blood glucose while you
are sleeping
 Importantly, you may have no
symptoms, but others may notice that
you are staring, not paying attention,
seem less attentive, or are "not looking
quite right."  Much like a brain fog. 
Some also have a numb mouth or tongue. 

Treating Lows:

It is critical to treat a low blood glucose quickly so that your brain has enough glucose to
fimction normally and to prevent you from passing out.  An important tool is a glucose meter or blood sugar metre used by diabetics.  They can be costly but if you have the coverage, get one.  It will make it much easier for you to figure RH out.  Keeping a journal with blood sugar readings and foods, will help you greatly to learn what affects you and how it affects you.  Most patients have a dropping point when their blood sugar starts to drop and will eventually become critically low.  You need to know when that point is by testing at the 1 hour mark and every 10-15 minutes there after. 

 When your blood glucose is toolow, you need to eat food with sugar in it to bring your glucose level up quickly. You need to eat food with sugar, even though you may experiencing dumping syndrome (abdominal
cramping, lightheadedness and diarrhea),

1. Stop what you are doing - sit down.
2. Test your blood glucose, i f possible, to make sure that it is low.
3. Eat 15 grams of sugar in the form of one of these "hypoglycemia treatments":
a small juice box works great)
- 3 tsp sugar
-3 tsp jelly
-small box of raisins
-3 glucose tablets or 4 dextrose tablets >
- 7-8 lifesavers (chew and swallow)
-5-15 jellybeans (sugar content varies from 1-3 grams per bean - check label)


4. Retest your blood glucose after 15 minutes. Repeat treatment if glucose is under 80.
5. After you treat the low glucose, eat a protein food (but not low fat ones) to prevent
the low from returning - this is a critical step.  You want protein to keep it sustained.  Otherwise you will keep going low, high, low, high.  Always carbs plus a protein:

Some examples of protein foods to have are:
a. roast beef (1 ounce).
b. regular cheese (1 ounce)
c. regular cottage cheese (1/4 cup)
d. regular ricotta cheese (1/4 cup)
e. peanut butter (1 tablespoon)
f. nuts (1 ounce)
g- whole milk (1 cup)

6. Keep glucose tablets or glucose gel with you at all times. These are available at any pharmacy and do not melt or require refrigeration. Keep some in your pocket or purse, next to your bed, and in your car for emergency use. You don't want to take the time to search for a sugar food when you are having a low blood glucose! You may also find that 4 ounce juice boxes are convenient for the car.  Honey packets work well too.  Never ever drive when you may be feeling like you are having an issue.  You could easily cause an accident and kill yourself or others. Stop and pull over if ever you feel like your blood sugar may be affected.  Eat and test. 



Being Proactive

It is really smarter to be proactive rather than reactive to lows.  Every time you pass out from reactive hypoglcyemia it may lead to permanent brain damage. You must treat it seriously.   Working to prevent a low is always better than to reactive to contant highs and lows.  Plus, being reactive rather than proactive can also lead to cycles of eating when you are not supposed to and can easily lead to regain!

1. Modify your diet.  Chances are that it was a food that caused the problem to begin with.  What did you eat?  Learn what  your marker time is for your blood sugar to dip.  For instance, for me it is at the 1 hour, 15 minute mark.  If I dip, I need to know that is when I need to eat preventatively.  But again, if you can avoid a low by changing what you eat that's always better. 

• At meals, eat controlled portions of low glycemic carbs.  Add fat to your eating.  Many protein foods have fat in them and the fat in the protein food also slows the digestion of the carbohydrate. This will lead to less of a "spike" in blood glucose after you eat and result in less insulin secretion (which is what you are trying to avoid).
• . Carbohydrates that are high in fiber are typically slowly digested. Read labels and look for whole grains rather than "enriched" flour, which has much of the fiber removed.
• Avoid high glycemic carbohydrate foods 
• Avoid eating only carbohydrate at a meal or snack   Always eat a carb with a protein. Always!
• Avoid eating carbohydrate in excess amounts (stick to 25 garms of carbs per meal.  Remember, it's not just sugar --but it's also carbs because carbs turn into sugar!). 

AVOID some fruits: bananas, pineapple, • • • •
watemelon, raisins, cantaloupe, grapes, plums
all finit juices
refined cereals, such as Corn flakes. Rice Krispies
regular pasta and rice rice cakes or popped com
Refined crackers, such as Saltines, Ritz,
white bread, rolls, bagels
pretzels
starchy vegetables: potatoes, corn,
winter (orange) squash
sweets: candy, cakes, cookies, ice
cream, syrups, soda
alcoholic beverages

• Avoid sugar alcohols, such as sorbitol or mannitol.
Include a high protein food with each meal and snack. High protein foods
include fish, chicken, turkey, meat, eggs, cheese. Look into paleo/primal eating.
• Include healthy fats with each meal, such as soybean oil, olive oil, canola oil,
olives, nuts, nut butters, seeds, soybeans, and avocado. Fish, such as mackerel,
salmon and blue fish, not only contain high quality protein, but healthy fats also.
• Include high fiber, non-starchy vegetables with most meals. Examples are
romaine lettuce, broccoli, asparagus, summer squash (yellow, zucchini & spaghetti
squash), tomatoes, carrots, turnip, spinach, kale, collards, cauliflower, eggplant,
green beans, cabbage, and cucumbers.
• Try eating 6 small meals a day, rather than 3 larger meals. If you eat snacks
between meals, choose non-carbohydrate foods, or select a snack from the attached
snack list.
• Before exercise, eat carbohydrate with protein, such as whole-wheat crackers
with whole milk, regular cottage cheese, or peanut butter.
• Drink liquids primarily between meals. Water or decaffeinated, unsweetened
tea/coffee are best.





Many reactive hypoglycemia patients have had excellent results with a paleo or primal diet.  You can google the terms for a shopping list.  Mostly, you need to cut out the carbs and focus on proteins.  If you bake, use alternative flours (coconut, almond etc) and add fats.   These types of baked goods will affect you far less than goodies made with traditional white flour and sugar.  Read and learn.  marksdailyapple.com is a good source for information!

Mix-and-Match Snacks
Remove all tough skin and chop seeds and nuts

1. Hummus and pita
1 oz whole-wheat pita with 2 TBS hummus
2. Extend Bar (www.extendbar.com)
These are made with uncooked cornstarch, a very slowly absorbed carbohydrate,
and can prevent low blood glucose levels. It may be useful to eat one at bedtime (to
prevent low blood glucose in the middle of the night) and one in the mid-morning
(to prevent low in late afternoon).
3. 4 oz light low fat yogurt topped with 1 TBS chopped nuts
4. 1 medium apple and 1 TBS peanut butter
5. Toasted cheese and tomato on wheat
Top 1 slice whole wheat bread with 1 oz cheese or avocado and 2-3 slices tomato.
Toast in toaster oven.
6. Cottage cheese and berries V2 cup strawberries or blueberries and V2 cup cottage cheese topped with 1 TBSchopped soybeans. Sweeten with Splenda if desired.
7. Veggies with dip1-cup raw baby carrots or broccoli florets and 1/3-cup cottage cheese vegetable dip
8. Top an 8-inch whole-wheat tortilla with cup refried beans, V4 cup shredded
cheese, and 1 TBS salsa. Microwave for 15-20 seconds and roll.
9. Celery and peanut butter
4 - 3 inch raw celery sticks and 1 TBS peanut butter

10. Ricotta cheese dessert
cup part skim ricotta cheese mixed with 1 packet sugar substitute. Sprinkle with
cinnamon and 1 TBS almonds.
11. String cheese and crackers
1 mozzarella string cheese and 1-2 RyVita or Wasa whole wheat crackers
12. Tuna salad pita
1/2 (loz) whole-wheat pita filled with V2 cup tuna, 1 TBS mayo, and alfalfa sprouts
13. Tomato and cottage cheese
1 small tomato cut in wedges topped with V2 cup cottage cheese and sprinkled with
chives
14. Smoked salmon and cream cheese
1 slice whole-wheat bread topped with 1 TBS cream cheese, 1 thin slice red onion
and 1 oz smoked salmon
15. Egg and spinach salad with chick peas
1 sliced hard cooked egg, 1-cup baby spinach, cup canned chickpeas, 1 TBS
olive oil and balsamic vinaigrette. Toss spinach with vinaigrette, place in serving
dish, sprinkle with chick peas and place sliced egg on top.

8 Years Post Op RNY

I know that when reading many blogs for RNY, people get upset because the journey ends at a year out or two, and many don't write posts on how they are doing after many years.  For that reason, I like to update my blog so that people can get an idea of what life is like many years post op RNY.  Now, I've always been a bit abnormal in some ways - easy peasy recovery, very few issues....but we all know that the experience of surgery is different for everyone.  So here, I'll update you about how things are and tell you about anything new I've learned or experienced:  

The Good:

-Life is pretty typical - I continue to be very active and to walk 5 to 10 miles a day is not unheard of for me.  I am active and busy and still enjoying life without having to worry about turnstiles, getting in the backseat of a two door car, that one size won't fit all, and all the typical stuff of morbid obesity.  I can say that I've sideswiped many possible health issues and I can confidently say that I know that I won't ever go back to being morbidly obese.  While I definitely have my challenges most days with my eating, I am pretty confident that I understand how to manage my weight now.  Hopefully there won't be any obstacles with this and I can keep doing what I'm doing.  

-My deficiencies seem to be okay.  Not much different than before.  Not improving much, but not getting terribly bad either.  I'm still osteopenic (since year 1) but it is the same - no worse/no better and I'm okay with that.  Iron still sucks but not enough that I need infusions.  Still vitamin d deficient (aren't most Canadians? yes!).   Other than that I'm holding my own and that's a good thing!

-While I go up and down on the scale (I can be as close as 5 lbs to my goal weight or as high as 20 lbs over - and then I get my act together and work on it) I'm staying fairly the same.  That's a good thing even though I can really beat myself up over it.  

-The clothes in my closet are one of two sizes.  I've bumped up one size from my lowest so I guess in the scheme of things that isn't too bad.  I am still working on getting down. 

The Bad:

-I beat myself up over regain constantly.  

-There are days that my eating is out of control.  I am still a slave to sugar.  Some days sugar wins, and some days I win.  It sucks.

-I still want to get back to goal and it's a bugger to control the eating most days. 

The Ugly:

-The skin.  Hoping to get a tummy tuck come Fall/Winter.  I have OHIP approval for a panni so I'm just having to save money for the upgrade.  

-Some days my reactive hypoglycemia kicks my butt but I'm far better at managing it now.  I had two pass out incidents but for the last few years manage it fairly well without problems.  I understand it much better now.  

Really there's not much in the way of ugly to be honest.   No big complications or problems.  Have never been in the hospital overnight since my surgery.  No horror stories at all.  

Dawn

WLS is Like Baking a Cake

"Please help me!  I'm only 2 months out and I've ONLY lost 30 lbs."

I see these posts all the time on just about every board that I read.  A sense of panic that someone has not lost all their excess weight in a manner of minutes, hours and days.

*sigh*.  Big giant sigh!

You need to wrap your head around realistic expectations.  You did not gain 50, 100 or 150 lbs over night.  You will NOT lose it over night.  This takes time.  This takes the right ingredients.

WLS is like baking a cake.

When you decide to bake a cake, most of us just can't go into any cupboard, grab ingredients and within a matter of minutes, have a cake baked, done and frosted.   Weight loss (even with wls) takes time, balance and the RIGHT ingredients.

Before we decide to bake a cake,  most of us have to read and find the right recipe.   We might have to research a bit before something seems to be "just right" for us to make.  We have to find a recipe for success.   It may take lots of consultation, lots of reading, talking to experts until we find the right recipe for the occasion.

Then we have to go shopping for all the right ingredients.  We have to make sure that we have all the right food ingredients as well as pots, pans and utensils.  Measuring cups guarantee success.  Without that careful measurement, our cake may not rise or may be a total disaster.  Planning is key.

We might even take a "dry run" and practice that recipe before we actually make it for that special occasion.  We know that skills are not innate, they are practiced.  We might even find that the recipe needs a "little something" so we may consult others for advise.  We may talk to other baking experts about that one missing ingredient.  We may even tweak the recipe accordingly and find that our recipe is better than the original!

The day of the big event, we are prepared in all ways for the task ahead of us.  We know that a good cake will take some time.  We give ourselves plenty of time so that we can slow down and be exact with our measurements.  We know that being rushed won't help make the cake better.  It's about exact measurement and precision.  We don't just throw together ingredients.  That doesn't work.  It takes time.

Once we carefully measure, mix and pour, we wait.   We wait some more.  We wait some more.

Even the best cakes don't come out of the oven in 60 seconds.

That time waiting is precious.  It's exciting anticipation of what is to come.  We know that it will be totally worth the wait.  We know that the cake is worth waiting for.  Even though we have to wait, we don't question that we will have a cake when the process done.  We know that we've prepared the cake the way we need to.

We know that we are set up for success.  We added all the right ingredients.  We know that we have had good practice.  We know that we have all the ingredients and all the right tools.  We know that in 40 minutes our cake will be done and it will be a success because we've set it up that way. 

And even, when you take your cake out of the oven, there is more time to wait before you can frost it.  Patience is required.   It will take time, more time and even more.  

Stop thinking that your cake will be baked in 3 minutes. If you've done all the planning, followed the rules and set yourself up for success, you have nothing to worry about.  Everything worth waiting for takes time. 

Know and believe that it will be worth the wait.

Realistic Expectations

I put this on my webpage7 years ago and it has made its way through cyberspace on many, many blogs.

REALISTIC EXPECTATIONS!

While you will lose weight in the first few months after bariatic surgery, you reach your maximum weight loss in 12 to 18 months.  Here is what you can expect to lose post op!

For patients weighing 200 to 250 lbs.
10 lbs. in first 10 days
15 to 25 lbs. in 6 weeks
25 to 35 lbs. in 3 months
35 to 45 lbs. in 6 months
60 lbs. or more in 1 year
70 lbs. or more in 18 months

For patients weighing 250 to 300 lbs.
10 to 12 lbs. in first 10 days
15 to 25 lbs. in 6 weeks
25 to 35 lbs. in 3 months
45 to 60 lbs. in 6 months
80 lbs. or more in 1 year
90 lbs. or more in 18 month

For patients weighing 300 to 400 lbs.
10 to 30 lbs. in first 10 days
25 to 45 lbs. in 6 weeks
35 to 55 lbs. in 3 months
50 to 80 lbs. in 6 months
100 lbs. or more in 1 year
120 lbs. or more in 18 monthsee

(The error above is often copied on pages lol).

 For patients weighing 400 to 500 lbs.
10 to 30 lbs. in first 10 days
25 to 45 lbs. in 6 weeks
35 to 60 lbs. in 3 months
50 to 90 lbs. in 6 months
120 lbs. or more in 1 year
150 lbs. or more in 18 months

The Phrase I Hate

There's not a lot that irks me in the online world.  I spend much of my free time lurking on OH and reading and admining various wls specific groups on Facebook.  I understand the differences between newbies and oldtimers like myself and the different ways that we see the world.  There's generally not that bothers me, but there is one phrase that bothers me and I'll explain why today. 

When people post their weight loss, I often see the phrase "100 lbs gone forever".  This is the phrase that bothers me.  It might seem strange but I feel that when we engage in talk of forever that we are taking something for granted.   We are taking our weight loss for granted.  Early out in the honeymoon period, we get this sense of invincibility because life is smooth, temptations are low and hunger is low.  We think that life is going to be that way forever. 

Tis not so for most of us.

I've gained back 10 lbs.  15 lbs, 20 lbs, 25 lbs.  I know that it is not necessarily FOREVER.

This is DAMN hard work.  It is hard to keep our mind always on what we should be doing. It is difficult to keep our demons away.  It is hard to stop eating emotionally when you've done so for 10, 20 or 30 years.  It's not all rainbows and unicorns.

Eventually you realize that this is WORK.  For the rest of your life nonetheless. 

And it is easy to slip into old habits.  Very easy.

It's very easy to become unfocused, to be unaccountable and to avoid the scale.

This is FOREVER, not just for one year.

And hunger returns.  And life goes on.  The compliments stop coming.  Motivation wanes.

I want to scream and shake people and say "Don't say FOREVER.  You don't know how EASY it is to do!!".

Don't take anything for granted.  Don't think that you can just do "moderation" when you sucked so badly before at it.  KEEP THE TRIGGERS OUT. 

I want to say that dessert shouldn't even be in your vocabulary at 4 weeks out.  You shouldn't be having a cookie! If you think it's a challenge now, wait until year three or four or eight or twelve.  Keep it out. 

When you are a long timer, you see so many people struggling early.  You see people that are failing. You want to reach out and say "Don't go there!!!!".  Stay the course. Don't give in yet!! Get to goal.  You want people to succeed.  You want people to do better than you and not to struggle with food demons.  It's hard.  You know what it's like when after a year, you started having goodies again.  You see people digging into Pandora's box far, far too early. 

But then you shut up because you know that newbies won't understand.  They'll think that you are just being mean and not letting them enjoy a "small bite" of everything because they think that their small pouch will keep them in line forever.  *sigh*. 

It's a different mindset. 

At 7.5 years out, and around 15 lbs up at the moment over my goal, I'm frustrated.  I'm angry. I'm pissed that I have to get back to all the incredible hard work it takes to lose the weight now at this juncture.  It's not the same as the first year.  It's a huge ass kicking to even lose a lb or two now.  It blows the mind how much effort it takes to lose when a gain can be acquired from a bad weekend.

Feeling a little down...but I've done it so many times before - pick myself up, dust myself off and begin again. It gets a little tiring though to be honest.  I just want to know how to do this whole damn moderation thing successfully after many years of yo yo-ing up and down the same 5, 10, 15 etc pounds. 

What a pisser :(

Ah well.  Here's to new beginnings yet again....

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!

Dawn

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?

Reading Labels

If you know me in person, you know that I'm a HUGE fan of myfitnesspal.  Recently, I had a person ask me why I use this program being 7 years out.  Aren't I a natural at figuring this all out?  Not at all.  I was never good at balance and moderation before my weight loss surgery.  Nothing comes naturally to me in this regard.  I suppose if I had been a normal person who perhaps gained pregnancy weight that I might have a "normal" relationship with food....but I don't and never have.  I can remember as a teenager having a friend who could eat a single serving bag of chips and keep half for later.  I never could.  So this is a constant thing I have to work on.  I MUST be accountable for what I put in my mouth on most days.  That doesn't mean that I will record every day but you better believe when I'm trying to get back on track, I make it part of my regimine again.

Which brings me to a topic that I see a lot of newbies struggling with and that's not reading labels.  I recently talked to a newbie who was only a few weeks out and she'd had a Starbucks Iced Chai Tea Latte and wondered why she wasn't feeling good after having one.  She wondered if maybe she had an ulcer.  I asked her if she'd read the stats on it before drinking it.  She had not.  I explained to her that it's no wonder she didn't do well with it.  Her guideline said no more than 10 grams of sugar and this drink had over 40. 

One of the best things that you can do for yourself as a weight loss surgery patient is to read labels and to read them incessantly.  Stay far away from sugars, watch the calories and carbs.  Be sure to get your protein goals met.  The best thing you can do in your first year by far...and well quite frankly, a necessary evil if you want to KEEP it off long term.  If you get too hooked on sugar early out, you are doomed to regain. Seriously.  It's way tougher later on.

I have a non wls friend that I recently met for coffee and she is one person that I know that is always complaining about her weight.  When we went out, she'd had a Maple French Toast bagel with butter.  Now, while I love a carb now and again, she ruminiated again and again over what to eat and pronounced that the bagel was a far "healthier" option than something like a cookie.   Little did she know that the cookie or even a donut would probably have been a bit of a better choice.

Her totals for her bagel were:  420 calories, 12 grams of fat, 67 grams of carbs (!!!) and 10 grams protein.
A peanut butter cookie was:  280 calories, 16 grams of fat, 27 grams of carbs, and 6 grams of protein.

At least the peanut butter cookie would be more of a "snack" (100-200 calories) than a meal.

Label reading is HUGE.

You'll find now that the advertising is now devious when it comes to healthy and unhealthy foods.  Just because something is "lite" or made with (my personal favourite) "Whole grains" does not make it healthy.  I love, love, love sites that debunk "healthy" products such as:

Nutrition Unplugged

Nutrition Action

Do you have a good blog to share? EMail me it!!

 

Emotions After weight Loss Surgery

Many people find that the first few months after surgery can be very emotional for them.  Many books and websites fail to mention this and so, after explaining it to many people, I decided to do a post on it.   I find that when people understand what is going on it is less overwhelming to them.  There are a few reasons for some people being highly emotional after surgery and here are just a few:

First off, for most of us, the journey to surgery has been a very long road.  A very emotional road no less.  It's like we spend months and months working towards this goal of surgery with the preop diet, the lifestyle changes, Optifast and the like.  It's a constantly build up and sometimes flood of emotions. It hits us to the core in so many respects.  Once we have surgery, often there's the sense of "What now?".  It is not that we expect to really wake up thin but sometimes our brain works this way that we are subsconsiciously expect this big post op change and really for most of us, the days preceeding surgery do not have a lot of change with our weight, our size and our body image.  It takes a while before we start to look different, before we start to feel different and before the payoffs of surgery start happening.  So we often wonder or question "is that all there is?" and "what now?".  Pretty common and typical response.  Many of us feel no different and wonder if truly we've been operated on.

Others, can be overwhelmed by the change with their relationship with food.  Food is no longer a quick solution to an emotional problem.  For most of us, it is no longer pleasurable and quite frankly, for many of us the pleasure of food is a huge key aspect with our relationship to it.   Eating is not pleasurable for may of us.  It's labourous at best with the amount of chewing, the restrictions, the sometimes vomiting, etc.  So this is a very different feeling for us.  There's no more pleasure in eating and that's a big issue for many of us until we start to reframe our brain that it is a good thing because we now have power over food.  Many, many new post ops, miss food, miss the sensations, miss the taste and go into a mourning period.  The trick at this time is to remember that this is a HUGE step in redefining your relationship with food for the better.  You are no longer living to eat, you are now eating to live.  If you are not hungry, embrace it and eat to fuel your body nutritionally and to reduce the "crap" in your diet.  Eat clean, get faster results and get off the weight quicker. It's a good thing once you learn to retrain your brain on this!

Another issue with food can be the fact that it is around us.  It is hard to avoid and hard to resist.  People may find social situations tricky for a while.  I tell people it is not uncommon to "take a break" from social situations that involve food....and if that's what you have to do, to stay on program, then really you need to do it for you!  Going to birthdays may be a tricky thing.  It may put you in a position that you are resentful of others, that you are tempted to cheat etc.  It's okay to give yourself a break.  For others, it's not a problem.  I went to a barbecue 2 weeks post op, and sucked my shakes down happily thinking the whole time how powerful it was to resist. It's whatever works for you!

Here's the thing as well - as you are losing, your hormones are also all over the place.  Some hormones are stored in fat. As you reduce the size of your fat cells, these hormones can be released in amounts higher than you're used to. This can cause mood swings for some people and can be really odd and difficult.   Some people find that they are just more over emotional and cry at the drop of the hat while others find that they are a bit more snippy to people around them.  Others are unaffected.  Depending on your age and how much it's disrupting your life, you might want to see your doctor if it becomes unbearable.  

One more key item to mention is for those of you who may be on medications for conditions such as depression.  With your newfound malabsorption with RNY, your meds may not be absorbed properly.  This is very, very common.  Make sure that they are not time-released meds too.  It's a good idea to talk to your doctor or psychiatrists as you may need an alternate form of meds or an increase in dosage since you may not be absorbing your medication completely anymore.  Whatever you do, do not take yourself off depression meds after surgery thinking that your depression will be cured with "losing weight".  That can be a very dangerous assumption.  The rate of suicide is higher for those that have had gastric surgery and this is one possible reason that has been speculated upon.  Make sure you have a friend to keep you in check with your moods.  

Typically, people who do become emotional as a new post op, find that a few months in, things start to calm down as life resumes more normally, as the new diet changes and routines are in place and when they see the pounds start to drop.  If you are having trouble with your emotions, contact your doctor.  If you are just noticing the changes, be patient and know that it WILL get better! Seek professional help when you need it.  This is a big challenge for many and give yourself any supports that you need. Good luck!

Protein For RNY Folks

I get really frustated when I read about protein shakes and wls people that are drinking protein shakes of poor quality after surgery.  Unfortunately, many people think that a protein shake is a protein shake is a protein shake.  This is not true.  There are protein shakes that are better than others, provide us more digestible protein and are a good bang for the buck.  Why would you settle on a crappy inferior protein shake that you may not be absorbing properly, that is more calories and sugar than you need and could impede your weight loss? I don't understand it sometimes.  I find that even many nutritionists give poor recommendations for weight loss folks.

The reason for taking protein shakes is because we want to preserve muscle mass as much as we can while losing.  Consuming adequate protein in your diet will help you maintain muscle mass and heal as you lose weight. It can take up to 6 months for all parts to heal properly.  Long term, you may find that protein is essential because protein helps you lose weight, whereas too many carbs in your diet tend to slow weight down.  As a long timer, I can tell you that to lose weight, I tend to need double the protein in my diet to carbs to lose.

Form is Important

The recommendations for protein shakes and powders ideally that they are WHEY PROTEIN ISOLATE OR CONCENTRATE based.  These are two forms that we absorb well and are high quality proteins.   They are the best of both worlds with isolate being the top one.  As a result, you will find that powders that use isolate will indeed be more expensive.  It's a purer, cleaner form of protein.

The higher the PDCAAS score the better the quality.    The higher the price does not neccessarily mean the higher the quality (although I have found that the ones that taste best are pricier.)

Roughly (although there are lots more protein choices):

Collagen      PDCAAS:  0.08 

Soy              PDCAAS:  1.0


Milk Protein  PDCAAS:  1.0


Casein          PDCAAS:  1.0


Whey Protein PDCAAS: 1.0
 
You will see many, many people using the protein "shots" or "tubes" but those are made with a blend of different proteins, most of which is cheap collagen protein which as you can see above has a very poor rating. Even many programs do not have nutritionists that know this which is sad. You'll also see some bariatric sites selling this crap.  Why? Money. It's cheap to make and it's cheap to market and sell.  More profit for everyone which I find is just wrong!

Bioavailablity is Important too!

Another reason for whey isolate is because it is not only good quality, but it is digestible for us.  Some types of protein, like collagen cannot be absorbed well either.

Many programs also say no casein protein because of the higher calories.

Look at the Breakdown of Protein/Fats/Carbs

For the best stats of a shake you typically want isolate or concentrate and the following:

Typically you want around 150-200 calories in 30 grams scoop or a 400-500 ml serving.
You want AT LEAST 20 grams of protein.
You want no more than 5 grams of sugar/carbs. Look at BOTH of these numbers.  Carbs turn into sugar.  No more than 5 grams.

These carb/sugar numbers change the breakdown of protein and carbs in your shake. The more percentage of protein, the better your shake.  I personally won't do less than 70% protein or more than 20% carbs.  The lower the percentage of carbs, the better.

Here are some popular shakes: (using chocolate flavour).  This is their ratio of protein/fat/carbs.


Premier Protein.         72% protein, 16% fat and 12% carbs.
Muscle Milk Light.     53% protein, 24% fat and 23% carbs.
Pure Protein               85% protein, 5%  fat and 10% carbs.
Shakeology                44% protein, 12% fat and 44% carbs.  
Profit (Itworks)          59% protein, 13% fat and 28% carbs.
Body Fortress Isol.    80% protein, 14% fat and  6% carbs.
Body By Vi               56% protein, 11% fat and 33% carbs.

*** if you have a protein shake, you'd like me to add to this list - just message me at diminishingdawn@cogeco.ca
      

Watch the Add-Ins Too!!!

The other issue that seems to crop up are the add-ins.  Once you start adding too much into your protein shake, then the less of a "pure" protein shake it becomes.  Then you start to change the nature of your shake to more of a 'carb and protein' shake.

For example, let's take a commonly used protein powder.  In this case, 1 scoop of Body Fortress - Super Advanced Whey Isolate, Chocolate.   Make that with water and ice and this shake is:  80% protein, 14% fat and 6% carbs.   That is pretty awesome.  You want the bulk of your shake to be protein.   140 calories.

Now add, a cup of skim milk and the stats change to:  64% protein, 10% fat, and 26% carbs.  226 calories.  (Hmm...notice how the carbs are going up).

Add a half a banana to this and it changes even more:   52% protein, 8% fat and 40% carbs.  279 calories.

So although you are indeed getting the SAME amount of protein, you are getting far more carbs than you need and far more calories.  Personally my cut off is no less than 70% protein.

Although some people will say that they are still losing, they will still lose on those...but can they slow down your losing? Yes and you wouldn't even know it.

Oh and if you have to add in MORE PROTEIN to your protein shake there is something wrong with this picture.  Get a good quality one that has enough protein in it to begin with without having to add milk!  Water and ice should make a good protein shake alone.  But if you can't handle it, find a powder that has a lot of protein in it alone and try almond milk which will change the composition of your shake only minimally.

You will find a lot of "sellers" of protein through various MLM companies like Shakeology, Body by Vi and Itworks.  They will tell you that it "worked" for them but quite frankly, they are making money by selling them to you, so I doubt that they would tell you anything negative about their product. 

As well, do not count on any of the "supplement" or "vitamin" facts for any shake or powder.  DO NOT STOP TAKING YOUR VITAMINS.  The supplement industry is not tightly regulated.  Do not count on these for your vitamin needs. 

6 Years Post Op: The Good, The Bad and The Ugly

Well it's time for that post – six years since I've had surgery and time to be grateful for my journey, the friends I've made and the things I've learned about me. This is going to be a long post. I'm wordy – I admit it. I thought I'd give you an overview of my victories and my challenges along my journey. I imagine that some people will not take the time to read such a long post, but I put it out there for those that want an idea of what one person's struggles are post op after six years in the journey. I have to say that this journey does not stop when one gets to goal. It truly is a life long journey. Don't rush it. It's going to be there for the rest of your life.

I'm hoping this post won't come across as too negative and whiney...but it just might. I want people to know that there are not always rainbows and unicorns in our journey. There are issues of all kinds after surgery and after you've been out a while.

I had surgery on July 5^th, 2006. Back then many of us went to Michigan My care there was great, after care really sucked. But my surgeon was wonderful and I had very few problems with my surgery itself. The only complication was a nicked artery. I lost a bit more blood than most patients but recovery was fairly easy. I was at the mall my second day home. It truly was easy breezy!

My first year out was GLORIOUS. I have no other word to describe it. It was so wonderful. Although I was a slow loser (my surgical centre gave us no guidelines on carbs and I do think that slowed me down compared to others) I did fairly well. I started at 290 lbs before surgery and ended up being less than half that by goal. My first year I followed the rules very well and made exercise a huge part of my life. I made a point of walking to and home from work every day 3 miles and then would jump on my treadmill at home for another 4 miles. I was pretty motivated, highly focused and felt so strong and powerful. I remember feeling so strong and powerful – I was now eating to live and not living to eat. I loved feeling that power over food! The first year is a CONSTANT high. We long timers wish we could bottle it and have it back. LOL It's purely magical!

Early deficiency of iron and osteopenia developed by the year mark. Started supplementing.

The second year was pretty good too. I still had that high...but the binges started to creep in now and again. Those of us who are binge eaters do tend to struggle post op. I'd binge and then cry about the binge. I hated myself for doing it. I was even planning binges in advance...and then feeling like a failure a half hour later when I felt like crap. I started to gain. It started to freak me out to be honest. Five pounds up. Feeling a bit daunted. People actually commented that I was too gaunt earlier and that I was looking better...but I did not feel that at all. The mental struggle was beginning and the feelings of being out of control and feelings of failure were terribly powerful. I was starting to feel powerless to food, no longer so powerful.

When I got to goal, no one really taught me what it meant to eat in moderation. I'd always been overweight. I always had a problem with food. I was never that person that could eat a small bag of chips and put half of it away for later. Not even as a teenager. It was a foreign concept. Portion sizes were starting to get larger. It started to get scary. I could eat more and binges were bigger. It was getting downright scary. Feeling out of control, feeling worthless.....up 10 lbs...

I ended up as a size 10. I was devastated. People I worked with were size 0 and 2 after having children. I started to obsess and do the 5 day pouch test....then cut carbs completely, then bingeing. I'd repeat the cycle again and again only to have the same results. I'd work hard for a week and lose only 1 lb but then binge on a bad weekend and gain double that. The weight was no longer falling off like it once did. I felt like 10 lbs could have been 100. I know it sounds strange but that 10 lbs was totally overwhelming to me.

I started feeling like a failure because I didn't get to size 4 or 6. I was still “big”. I felt like a failure. I know that it seems so foreign that you'd consider yourself a failure being a size 10 or size 12 after being size 26/28 at your heaviest...but the mind is a strange thing. I became too obsessed with comparing myself to others. Not realizing how far I'd come. The reality is that some of us have bigger frames, some of us will be a size 2, some will be a size 10 or a size 18 or any size really. We are all so different. Again, the worst thing you can do is to compare yourself to others.

I decided I had better get into therapy. I went to our local eating disorder place for 6 months of therapy. They cater to binge eaters, over eaters, bullemics and anorexics. I learned a lot about Cognitive Behavioural Therapy which many of us benefit from post op to deal with the head issues. I learned to try not to base my happiness on a size or number on a scale. I'm still not ready to throw out my scale like they suggest. A funny thing happened at therapy though – I also became obsessed with how skinny the anorexics look so while I made some progress, I think head issues were still skewed. Again head issues are a strange thing post op. More issues with anemia.

Year 2 was also when I discovered that I had Reactive Hypoglycemia. I never had diabetes or had issues with blood sugar so that required a lot of reading and learning on something new. I diagnosed myself, took the information to my doctor and yes, it was confirmed. I managed it fairly well. Sugar is the enemy. I wish I didn't have an issue with sugar – that I could keep it out of my life completely but sugar is my struggle always. Managed the RH fairly well this year. No problems with it other than a few lows.

Years 3 and 4, I continued the same skewed thinking while creeping up and up on the scale. I had a lot of issues going on in my personal life that lead to a lot of emotional eating. At one point, I ended up 27 lbs above my goal. I kid you not. SOOOO easy to do when your mind is skewed. I struggled. I had a few comments said to me that made me feel like giving up and running away. I would battle dark days of hating me, hating the scale and feeling like a total failure. It's very hard to run a support group for weight loss when you are going through the issues but I continued to do it. It was embarrassing to be up at the front when you were feeling like a failure. I lurked more on OH, poking my head in now and again, but feeling like a lost puppy. Didn't really fit in with the “rah rah” of the newbies and feeling like I couldn't offer any thing to anyone when I was struggling with myself. Up to size 12 and then closer to a 14.

Year 5 was better. Feeling like I started to make peace with my bounceback. Do I like it? No. But I managed to get off around 15 lbs of it and felt more in control. Still working on the self image and positive talk but feeling more like I'm a survivor in this thing called WLS rather than a failure. Realizing that I'm not the only person that struggles. I'm not alone in this journey. Back to size 12 but still working towards 10.

So here I stand at year 6, feeling more at peace. Again still a work in progress but trying to like myself more. In my head, I am still big and still relate to the large people in the room than the “skinny minnies”. Constantly have the feeling that I'm still a size 26. Regain is all in my stomach and butt and makes me feel constantly bloated and feeling like I look pregnant. I never feel like clothes fit like they did when I got to goal. I can tell that my body composition has changed with regain. Lost a lot of muscle mass. More wobbly bits than before.

This year again, anemia is still kicking its ugly head. Some low vitamin d for the first time. RH is kicking my butt more this year than ever before. I've had two issues in the past 6 months of passing out from it. (One time I put off symptoms when I shouldn't have – the second one, I attributed the symptoms to being sick from the heat versus RH). That's been scary but both times I really should have known better.

Food issues are still there. I call it my FAT HEAD. I am constantly struggling with my fat head – emotional eating, boredom eating, stress eating and bingeing. It's a constant struggle not to give in and sometimes I do. I am one of the few that can honestly eat anything. There is nothing that disagrees with my pouch – nothing. And I can eat large amounts. It would scare most people how much I can eat. To this day, I've still never vomited once, had things stuck or had the foamies.

I've learned that I have to just keep picking myself up and dusting myself off and set new goals. I'm a work in progress – for the rest of my life. Surgery did not fix my head in any respect.

I still have around 10-12 of regain to get back off. I'm starting to make peace with that though. It's not the end of the world if I stay where I am at. I'm starting to strongly believe the issue of set point. My body is pretty resistant. So I'm trying to make peace with the fact that I may still carry some extra weight with me and that it's not the worst thing in the world if I do. It could be far worse. It could have easily slipped to 40, 50 pounds had I not caught it earlier when it started to spiral. Some days I feel in control of my eating and other days I still feel overwhelmed. For me, it's day to day...one day at a time.

I'm grateful for many things:

Other than the RH issues, I'm healthy. Anemic still but no other problems. Healthy is a good thing. I'm strong. I'm mobile. I'm active. Life doesn't pass me by unless I want it to. I've coached swimming, baseball, basketball. I've done walked three half marathons in Detroit. I've met many nice people in the WLS community. Running a support group has helped me be accountable to myself and others. I cannot put my head in the sand and ignore the creeping weight. I need the support group as much as others.

I see my parents struggling with their obesity and I'm so glad that I made the choice that I did to have surgery. Both of my parents can barely walk a block without being terribly winded, my Mom is at the point that soon she'll need a cane or a scooter. I'm not there. I'm not going to have a heart attack at a young age like my mother did. I still have my life and quality of life. It's really a wonderful thing.

My goal is to keep working on the head issues. I highly encourage newbies to examine these issues before surgery. The head stuff can be brutal for many of us. You will see me on this board talking about regain/bounceback quite frankly. I think we need to start taking the shame out of it. It happens and most surgeons do expect it. I think by beating ourselves up we are not doing ourselves any favours. I wish people had given me more of a heads up on it to be honest. Then maybe it wouldn't have been so devastating to me.

Anyway, there's the good, bad and ugly of my surgery and my life post op. I know that my experiences are not the same as everyone else's but I'm sure I'm also not the only one to go through such a range of emotional issues and head issues after surgery. So I thought I'd put this out there for anyone who may relate to my story or anyone that wants to chat about any of these issues. Sometimes feeling like we are not alone in this journey is a very powerful thing.

Newbies: WLS is an absolutely amazing gift. It's a wonderful gift but also a big responsibility to use it wisely and there may be many times that you struggle along this journey. Please don't waste the wonderful gift you've been given. Get to goal your first year, keep your triggers at bay and work towards getting off the most weight you can while you can. Despite the head struggles, I would still do surgery all over again. It's truly a wonderful gift!

Have a good day,

Dawn

Medic Alert Bracelets

After surgery, it is quite common for the WLS community members to rush out and get a medic alert bracelet.  I was told that this was a must for any RNYer shortly after surgery. Even surgeons still recommend them. Many facilities are now staying NO to medic alerts - at least to putting a lot of information on them and rightly so.  Many facilities are finding that the messages written on them are now causing more problems with hospital treatment rather then helping.

I encourage you to really give the purchase of a medic alert bracelet some good thought.  Think about each thing you choose to put on it and what the benefits (and risks) could be.  Rather than go blindly by common statements that people will tell you to put on them, please consider all the aspects of what you put on the bracelet.  Today's post is going to take some of the common statements put on bracelets and explain why they can be a good and bad thing.  I've read this on various boards, talk to some medical personnel and heard some of the following information.  I admit I blindly went out and bought mine just based on what others told me to do.   Ultimately the decision is up to you, but I thought I would at least share what I've learned over the years that has changed my mind on the whole medic alert issue..  

Remember that medic alert bracelets are for times of unconciousness - when you cannot speak for yourself.  They are designed for FIRST RESPONDERS - paramedics.  Realistically, most of the time when we do go to the hospital - even those of us who had RNY and have complications come up, we are totally capable of speaking when we go in.  Those of us who do go in to the hospital often have caregivers that do the speaking for us.   A well educated colleague, spouse or family member will go much further than having a bracelet speak for us.

So here's the top message that typically RNYers put on their bracelets:

No blind NG tube
RNY Gastric bypass
my surgeons name
ICE phone #
no NSAIDS and no sugar

So let me take the time to explain WHY these messages can cause more harm than good.

First of all, if you are going to get a bracelet be sure to put your surgery type and date on them.  Not simply "gastric bypass". It is called a Roux En Y.  (Not RYN as I see so often!).  Putting your surgeon and your surgery date might help although chances are he's not going to remember you much unless you are fresh out of surgery.  But it is never a bad thing if your surgeon talks to anyone and explains the surgery to them.  That's always a bonus.   

As for NG tubes:  They are inserted in patients immediately after major surgery to help keep the stomach empty and prevent postop vomiting and used to feed and administer meds in critically ill patients. In addition, nasogastric tubes are routinely used to collect gastric contents for lab analysis and to aspirate the gut in case of a GI bleed or a drug overdose. The chances of you needing a NG tube are pretty slim but it may be necessary. There's a myth that when put into you, the medical personnel will push and push the tube through and burst your pouch.  That is untrue.  Medical personnel are trained that when they feel resistance of any kind, they stop. 

The ICE information is always good - in case of emergency call.....

But here's the other thing I see put so many times on RNYer's bracelets that scares me - no aspirin or no NSAIDS. While it is true indeed that we should not be on them long term, there may come a time when I will gladly open my arms to aspirin!  If I were to have a heart attack, PLEASE PLEASE give me aspirin!!

Most heart attacks develop when a cholesterol-laden plaque in a coronary artery ruptures. Relatively small plaques, which produce only partial blockages, are the ones most likely to rupture. When they do, they attract platelets to their surface. Platelets are the tiny blood cells that trigger blood clotting. A clot, or thrombus, builds up on the ruptured plaque. As the clot grows, it blocks the artery. If the blockage is complete, it deprives a portion of the heart muscle of oxygen. As a result, muscle cells die — and it’s a heart attack. Aspirin helps by inhibiting platelets. Only a tiny amount is needed to inhibit all the platelets in the bloodstream; in fact, small amounts are better than high doses. But since the clot grows minute by minute, time is of the essence.

Since my own mother had a massive heart attack at age 59, I definitely will risk an ulcer in order to treat a heart attack!!  Remember, it's generally a long term use (2 weeks or more) that NSAIDS cause ulcers.

Here's another BIG issue that I want to bring up.  The no sugars statement really seems pretty harmless doesn't it? Not so. It could be dangerous.  It is a common side effect for many of us after our first or second year post op, to develop reactive hypoglycemia .  It's been quoted from 1/4 of us to 3/4 of us will get RH.  When you have RH, you bottom out in your sugars and get extremely low. Dangerously low. Guess what you need? Yep, sugars.   You need to raise your sugar up back to a healthy level.  It is much like people with diabetes having a low.  We can appear drunk, wobbly when moving around and having a low.  Like diabetics we can become unconsciousness.  If I were at the mall and someone noticed this and I started to pass out and they perhaps recognized the signs as being low sugar and were going to treat me, I'd hate for them to look at that bracelet and see "no sugars" and not treat me.   Is sugar going to kill me? No.  Could not getting sugar kill me? It potentially could.

The thing is that first responders aren't generally going to start giving you food and start feeding you sweet tarts.  They are not going to make a point of feeding you - that's what happens at the hospital and that's not til you are stable and they've figured out the medical problem.  That's when your family member would tell them about your restricted diet -- or quiet honestly, you will because you'll be conscious by the time the ordering menu comes around and you need to place a meal. No one is going to start feeding you sweet tarts, apple pie or hot fudge sundaes in an emergency situation.  

So give these aspects some thought before you decide what you'll put on your bracelet if you even decide to buy one.  Sometimes like they say, less is more.

Oh and do I wear my bracelet? No.  It sits in my jewellery box.

Dawn