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