I used to think that food journaling was a tedious task and that it didn't help me stay on track. That may have been true prior to my surgery, but these days, it's one of the most critical pieces to my continued success. For starters, because I can't just crack open an entree and eat the whole thing, it means I save a lot of time in having to log things because I've already got the other half of said entree on another page from the day before or whatever. But more importantly, I find that when I look back at how I used to track things, I was being so complex! That's why it was so tedious!
These days, I keep a very simple journal in my purse at all times and I simply list the time, the items I ate, the calories and the protein. That's it. All I really need to know is whether I am eating at consistent times throughout the day and make sure that I'm getting some variety since post-op it's easy to fall victim to malnutrition. Perhaps at some point I'll be better at photographing what I'm doing since the visuals may help, but for now, here's a peek into the last few days' worth of my pouch:
Tuesday
8:00 AM - 2 oz. cottage cheese with 3 stone wheat crackers
11:00 AM - 2 oz. chicken salad with 2 stone wheat crackers
12:30 PM - 1 Colby Jack cheese stick
3:00 PM - 1 sesame torte with artichoke hummus
6:30 PM - 1/2 cup chicken chili with 5 saltines
8:00 PM - Jamba Juice yogurt and sorbet bar
Total calories: 815; Total protein: 48 grams
Wednesday
8:00 AM - 1 egg, scrambled with Laughing Cow chipotle cheese and 1/2 sandwich thin, toasted
10:00 AM - 1/2 banana with 1 TBsp peanut butter
12:00 PM - 4 oz. chicken breast, grilled
3:00 PM - 1 mini Babybel cheese with 5 saltines
8:00 PM - 2 cheese ravioli in a bolognese sauce
Total calories: 787; Total protein: 64.2 grams
Thursday
6:30 AM - 2 oz. cottage cheese with 3 stone wheat crackers
10:00 AM - 1/2 banana with 1 TBsp peanut butter
2:00 PM - 3 pieces vegetarian sushi
5:00 PM - 1 oz. mixed nuts, raw and unsalted
8:00 PM - 2 oz. chicken salad with 2 stone wheat crackers
Total calories: 791; Total protein: 41 grams
I now find writing everything down a bit cathartic. What I need to get better at doing, especially as I'm gearing up to go back to work is planning what I'm going to eat. I think one way I'm going to do this to write down the next day's plan in pencil and check off in pen where I've actually followed it so I can see where/when/why I've deviated.
I guess all of this is to say that with not a lot of effort, you can start to take control over the thing that used to control you. I went to the support group last night and for the first time was able to sit on the post-op side and let me tell you, it was like a two way mirror back to myself when I was sitting there. A lot of the things that people on the post-op side would say sounded like a dream: "You won't be hungry"; "People will have to remind you to eat"; "You won't crave sweets", etc. But now that I'm on that side, I see just how true it is.
A friend who is dieting told me she finds it difficult to stick to 1,200 calories a day. She also has a normal sized stomach. I found that impossible pre-op. In fact, I used to have trouble sticking to 1,600-1,800 a day which was my target. But now, even 1,000 calories seems like too much to me. I simply can't eat that much unless I'm eating the wrong foods (i.e. high in fat/sugar, low protein, high carbs, etc.)
I realize it won't always be this way. That at some point, I will be able to eat a plate of food and that I can stretch my stomach again if I'm not careful. But this time, immediately post-op, where I can really focus on what 'full' feels like, how much is enough and getting into the habit of simply listening to my body tell me what it needs, is invaluable. For those of you playing along at home, I am down 22 pounds in 2.5 weeks. I am a pound away from shifting from 'morbidly obese' to merely 'obese'. I am fitting back into the clothes I'd grown out of pre-surgery. I chopped off my hair yesterday because I could. I've gone from tight 1X clothes to comfortable XLs and the L's are making an appearance and while some of them even fit, I'm going to give it another 15 pounds or so before I wear them anywhere.
The next thing on my to do list is to sign up for a local 5K in the fall so I have something to work towards on the exercise front. Who's in?
Surgery Morning - 7/6/11 July 17, 2011 (Down 19.6 pounds)
In this particular post, I think it's important to show what I hadn't even noticed until my husband took this second photo today before we headed out. I wasn't actually posing; I was waiting while he checked this other camera to make sure it worked before we headed out to Rockport, MA for the afternoon. That's my I'm an Impatient Bitch stance.
When we got home and I was downloading photos from the camera, I came across this one and decided to compare it against the one from just prior to my surgery. It's only been two weeks so I didn't expect there to be much of a difference yet, but, well...the proof is in the photos.
The shorts I'm wearing today haven't fit me since I bought them in April and I suspect that by next week they'll be too large in the waist as they were a bit loose this morning. In the last 11 days, I've lost 19.6 pounds - far more than anyone led me to believe I'd lose in even the first month since my BMI was at the low end of the range to qualify for the surgery in the first place.
My days are starting to become more 'normal' now even though I'm just under the two week post-op mark. This week, I've added eggs, cottage cheese, shredded chicken, crackers, various cheeses (ricotta, boursin, Laughing Cow cheeses and feta) and veggies (tomato and cukes raw, potatoes, carrots). I'm able to space out my meals to every 2.5-3 hours or so and I've gone out to restaurants twice - the first time ordering chicken and rice soup and today, I ordered a Greek salad but only ate the tomatoes, cukes, olives and feta cheese.
A typical breakfast is an egg (either scrambled with 1 oz. of cheese or hard-boiled and made into an egg salad with a tiny bit of low fat mayo, mustard and paprika). If I make it into an egg salad, I'll put it on two crackers. That's all I can have right now before I'm full. Around mid-morning I'll have a mini Babybel cheese as a snack. Lunch has been shredded chicken salad (sometimes with BBQ sauce, sometimes with a little mayo and some relish) on a few crackers. Dinner is more of the same, though last night I had a half of a Boca veggie burger on a half a sandwich thin and that was enough. I am averaging less than 800 calories a day right now, but by next week when I can start to add back in more protein, veggies and starches, my target is 1,000 a day. In addition to eating less, I am moving more. I'm walking at least 30 minutes a day - usually more - and even on days when I'm stuck at home throughout the rest of my medical leave, I just put on some music and dance for a while at a time.
When they say that weight loss surgery is a tool, and only that, they're right. I've still got to make the right choices when I'm eating and I've still got to move and get this body active.
I thought that having had other surgeries would have prepared me for what I was getting myself into. But honestly, I now think that nothing other than a comparison to a C-section is a real look into what the first week has been. And I've never had a C-section, but the pain described by the people I've met who've had them pretty accurately describes what my first week has been.
Surgery Day - Wednesday
On surgery day, I was nervous, but also excited (silly me!). I kissed my husband goodbye before I was knocked out and wheeled to the OR. When I awoke in the PACU, I felt no pain. I was surrounded by a flurry of people and all was well. I was eventually moved to ICU and my husband came by to check in on me. I was so out of it that it didn't make sense for him to stay. But eventually, I started to really "come to" and I realized how uncomfortable I was without anything to even rinse my dry mouth with.
Later in the evening, I asked for something to swab my mouth with and my nurse took that as a sign I must be feeling better, so rather than getting what I asked for, I instead got to stand up out of bed for what felt like an eternity. Oh, and I never got that swab. I did get a mouthful out to one of the nurses though when she told me that the "worst of it is over now." Oh no...I may have been medicated, but I still spat out, "Don't you dare tell me the worst of it is over until you're where I am right now!" I ended up texting my husband, who called his mother, who immediately came over with his sister to see me and straighten things out with the nurses and the surgeon. I am so thankful she was there because she talked to them about my anxiety levels (Ativan!) and that I needed to continue resting and not be aggravated (Trazodone!). After they left, I slept very very well.
Day One - Thursday
On Day One, I made it out of my bed and around the ICU floor with the Physical Therapist twice. When I got back to my room, I opted for the recliner rather than the bed. I had a lot of pain, so I was laying on the PCA (the only pain meds you're given with this hospital is through a self-controlled PCA pump that you can hit every 6 minutes). I was nice and toasty and fell back in the chair, asleep, when I was roused by what felt like the entire floor jerking me up, making me stand, smacking my back and telling me to breathe. "Okayyyyyyyyyyyy," I yelled out dramatically, "I'm breathing!!!!!!!!"
All the while that they're frantic, I'm listening to them discuss How This Could Have Happened; my not breathing and getting my oxygen levels to coma-inducing levels, that is. Someone blamed the nurse for not plugging the oxygen back into the wall. Another blamed me for hitting the pain pump so many times, "You effin' told me I could hit the button every six minutes and I wouldn't overdose. If you don't want me hitting it that often then maybe YOU should change how often I can hit it or what dose it doles out!" They told me to stop yelling and cursing and well, you don't tell a fire ant to cut it out after you've stepped in their ant pile. I had a few choice words for the staff and lo and behold, they found me a room ASAP on the post-ICU floor. Go me! Self-advocacy is really a bitch, especially when you're medicated because then people don't find you credible.
Day Two - Friday
I did much better on Day Two in the main part of the hospital with the nurses that are specially trained to work with my surgeon's patients. I had much more responsibility for using the Incentive Spirometer (to keep pneumonia at bay) and getting myself up and around to walk the halls. I was finally allowed to have more than just clear liquids - upgrading to protein shakes and tomato soup felt like a dream - a fairytale land where these things were like liquid gold being poured down your throat every few hours.
A friend showed up unexpectedly to keep me company and it was so nice to finally have someone to talk to during the day and to spill the floor's secrets. My catheter (whoever says they don't like a Foley is lying, I promise you that) was removed and I had to use the restroom on my own. I also had to give myself my own sponge bath - not like the ones I was given gratis in ICU. But I did all of this and they released me to go home.
Day Three - Saturday
On Day Three, I want to die. I was home, which was nice, but if I just could've died, I would've been happy. I can hardly walk on my own. I can't do anything for myself. I can't rearrange my pillows, go to the bathroom by myself, or even get up and prepare anything for myself. How do single people do this?
Day Four - Sunday
I still want to die, but maybe I am just overreacting. My parents sent me flowers delivered by a tiny Asian lady and I swear the flowers are as tall as she is. I'm not racist, but the meds are really doing a number on my vision. I am still Team Vicodin's number one player.
We discover (well, first we discover that I don't have any shame) that all of the walking helped reawaken my digestive system. I won't go into detail, but I will tell you this: I wish someone other than my mother warned me about this particular bit of nastiness. If you don't have someone you really, really trust, hire yourself a nurse 'cause honey, you aren't going to be able to clean the back door. No really, I mean it. I'm not exaggerating. Unless you're some weirdo with really long arms and a short torso, you're in danger here. You know we never fully believe what our mothers say, so it would've been nice to have this little bit of nastiness reinforced elsewhere. It wasn't and OMG IT WAS TRUE!
I have a crying fit because I'm appalled that I cannot care for myself. If this is what it's going to be like to get old, I may sign up for the Kevorkian Special.
Day Five - Monday
My friend who visited me in the hospital promised me she'd come over to help me a few days this week and her company really lifts my spirits. We talk for hours about things not related to weight or the surgery and it completely takes my mind off the fact that I hadn't had any Vicodin today.
As we get ready to take a shower, my husband notices that my dressing has a lot of pooled blood in it. I discover that it's warm and squishy and I almost pass out. I have another crying fit and insist he takes me to the ER to get it checked out. The surgeon calls us on the way in and tells us he's onsite so he'll see me there. Turns out it was just "leakage" - a fine word that basically means mix a lot of water with just a little blood and this is what oozes out of your incision. Apparently, you're supposed to want this to happen so that the blood doesn't pool under the incision. They get me cleaned up and tell me what to do going forward and send me on my way. Before we left, I had a motivational chat with the surgeon that set me on the right path. He also made my day when he told me I could add cottage and ricotta cheeses to my daily routine now.
Day Six - Tuesday
I am back to checking my Crackberry, but finding it actually relaxing to not be so engaged in work right now. I can't imagine having the pressure to be back in the office quickly after something like this and for once, I finally appreciate all of the urgings of my bosses and co-workers that I really take all the time I need and come back strong.
My friend comes back to visit and this time we take a trip to Walgreens for some essentials and walk a bit around my apartment complex. I am now able to shower by myself (at first, even standing that long and with assistance was really hard due to nausea). I can even almost fully dress myself but still need help with the abdominal binder. When my husband gets home, he wants to cool off in the pool. I'm in a purple dress, about knee-length and I decide that while I can't go in, it would be nice to sit with my feet in the water. While I'm there, I meet a woman who had gastric bypass 16 years ago and who gave me a ton of encouragement and advice.
Sometimes, when I feel afraid to tell people what I had done (calling it 'stomach surgery' versus what it really is), it's times like these where I'm glad I chose the brave path. I am finding much more support and encouragement than I'd expected. I am no failure and this is not an easy path by any means.
One of the things I'm hearing a lot of as I speed closer to my surgery date (4 days, but who is counting?!?) is that we should prepare our fridge so when we come home, there's less thinking we have to do. The food choices become automated by already having the correct ones there for you.
For the next few days, I'm going to enjoy the things I know I'll have some trouble with later - like sweets (see, at least I'm admitting it!) and we're going to a brunch (buffet!) tomorrow as well. But Monday (yes, I'm aware it's a holiday) and Tuesday are really about prepping for the surgery and to help give my body at least a few days to rid itself of the horrors of the last 33.57 years, I'm planning to be on all liquids.
I will not be able to eat anything after midnight on Tuesday as my surgery is scheduled for 7:30 AM on Wednesday morning. They've already warned me that I won't be allowed to eat or drink anything Wednesday at all (with the exception of a few ice chips if my mouth is too dry). By Thursday I will be on clear liquids only - broth, sugar free jello, etc. and on Friday I will be able to start on other liquids - non-clear soups like a tomato bisque, pudding, protein shakes. When I come home, I'll be on these types of liquids for the first week, then I can start to incorporate soft foods - eggs, cottage cheese, yogurt - for the second week. In the third week, I can start to introduce small amounts of pureed vegetables and small amounts of lean protein.
To prepare for this, we went to BJs and stocked up on:
Eggs (2 dozen)
Skim milk (1 gallon)
Jamba Juice Fruit Boost (Low-cal fruit cups that are fortified with additional vitamins and minerals)
100-cal Cottage Cheese doubles
Colby Jack cheese sticks (60 calories each)
Carnation Instant Breakfast (30 packs)
Calcium + Vitamin D chewables
Multivitamin chewables
Water Pods (those little 11 oz. water bottles)
Jamba Juice Fruit Sorbet and Yogurt bars
I had a lot of anxiety this week around things like will I remember how many ounces of food I can have at a time? and How am I really going to get as much protein as they want me to get when I can't eat as much as I used to?
I'm not going to lie, I've been extremely stressed out and an emo nightmare. They say that the emotions straighten themselves out after a few months. I hope my husband has the patience to wait that long!
I've been reading a lot...and while you probably can't tell from this blog which may seem abandoned (but I assure you is not), I've been learning a lot about what to expect in the days, weeks, months and years post-surgery. Not just about what life will be like - counting grams of proteins, taking miniscule bites, avoiding buffets like the plague - but about the things people wish others had told them before they were wheeled into the operating room.
So, on a lark, I decided to write about what I've set myself up to expect. I probably have a strange sense of humor (fine, yeah, I do), but I think it will be funny and interesting to come back here, to this moment, and find out if I was on target or if I really had as little a clue as just about anyone else standing where I am at the moment.
I'm pretty sure that some of my relationships are going to change. I'm not just talking food here, people. I mean relationships with friends and family where interactions that were primarily based around food and the act of eating probably won't be as much fun for me anymore. Marathon sessions at the buffet won't be an option and I'm sure I won't be popular when fat people complain about their weight because, ya know, there are options - and this one may not be right for you, but it just might be.
I'm both excited and nervous about what's underneath all of this junk in my trunk. You ever clean out the junk in your actual trunk and discover things that you'd forgotten were there? How exciting when you pull out that old band t-shirt that slipped into the spare tire well! But what about when you're cleaning it out and find that greasy rag from the time you sprung a leak and now it's moldy and gross and you don't want to touch it but it's right in front of your face and now you've got to do something with it? Not so much fun anymore. 'Fat' has been something that has insulated me - not just from the cold weather - but maybe even from myself. While I'm excited to see what's beneath there, it's also a scary place because what if I discover that I don't actually like myself and now I've got nothing with which to cover that up?
I wonder if I'm prepared for the shift in the way society will perceive me. I may not be able to get away with starting so many of my diatribes with, "Well, I'm not what society deems to be attractive, so I don't have that problem." I wonder if more doors will open for me, and if they do, will that change me or will I appreciate the boost that I believe thin women get. There have been scientific studies that infer that overweight women are viewed as slow, unintelligent, less talented - even though that isn't how we really are, it's just how people perceive us. How will I deal with having to set the labels aside and learn to graciously acknowledge the shift in perception while working hard to change it?
Celebrate the small, incremental changes too. It's not all about skydiving in San Diego or hiking the entire Appalachian Trail. Am I really prepared for how good it's going to feel to walk up a flight of stairs without both of my knees about to buckle? Am I prepared to see my feet and not just take the compliments on my shoes at face value? Am I ready to stop hearing, "You have such a beautiful face, but..."?
It's okay if I really do not like yoga. I don't have to. But I should at least try to remember what it's like to contort my body in such ways. Will I regret not continuing with gymnastics? Or will I remember why I didn't continue doing cartwheels in the first place?
Despite not being hungry in the first few weeks or months, it won't always be that way. And eventually, I will feel hungry and I will also be able to eat. Not like I do now, but still, a lot more than I can immediately post-op. I've got to establish good habits now so that I can continue to lose the weight when I won't have the help of not feeling hungry.
When people tell you how "easy" it is for you, just smile and walk away. Lots of people think that gastric bypass is the easy way out. Let them continue thinking whatever they want, because no amount of trying to educate them is going to make them change their minds. When they're ready, they'll search for the answers themselves. Let them see how "easy" it is if they decide to do it for themselves - all of the appointments, preparing, remembering all of the rules, setting up your support system, getting into exercise and eating routines, the actual experience of the surgery and all of the post-op pain...and on and on and on.
It's going to take time to remember that I'm not as fat as I used to be. I'll feel like I really succeeded when I stop going to plus size departments by instinct.
Resist the urge to measure success by the successes of others. I won't lose weight at the same rate as everyone else. So I should count my losses as my own and not worry about how I'm stacking up against everyone else.
Save now for any cosmetic surgeries you may need or want down the line. Don't let 'not having the money' deter you from being able to be fully happy and comfortable in your own skin (and in less of it!).
My surgery is officially scheduled for next Wednesday. All of my clearances were received. The insurance company didn't delay in approving me. I've had my pulmonary functions tests, met with the anesthesiologist, picked up my post-op prescriptions and am literally getting my house in order before I'm admitted next week.
