Choices

Last week, I was chatting with a super-supportive friend on Facebook. Renée commented on my strength in making such a big decision. I disagreed, saying having a child (which she has done and I haven't) is a much bigger decision that takes more courage. 

She replied, "You made a decision that affects your everyday life. I mean, eating is comforting so to decide to change what you eat and how you eat so drastically is way more of a commitment than having a kid. Dieting is hard enough but to give yourself no other option — that is wicked."

"I'll still get some comfort from eating, though," I said. "I'll be eating much less, and therefore have to make nutrition part of my decision making, but the ultimate diet has lots of room for creativity and comfort. Lean protein, veggies and fruits, whole grains, low-fat dairy, healthy fats. I think it'll mostly be very doable. And if I go off plan occasionally, it will be in a small amount.

"Don't get me wrong, I'll miss pizza and fried food and chips... But I'd rather be healthy and alive for longer. And for me, it came down to that choice."

And it really did. I could have stayed the path I was on, which very possibly would have resulted in an early death. Or I could choose to make changes. Is weight-loss surgery drastic? Of course it is. That's why you have to meet requirements, jump through hoops and prove you've tried several other ways of losing weight. But for some people, for some morbidly obese people like me, it's the right choice. Medical intervention, I truly believe, is saving my life. 

I've heard from so many people who've been told "Surgery is the easy way out." I beg to differ. Nothing about the process, the decision or the reality has been easy. I expect there will be rough times ahead (learning to eat in a group of people, for example, who eat things I can't, or tackling cravings for things that don't support my health), but I'm committed. I choose myself, I choose my life, and I choose my health.

 

 

15 days post-op

I'm grateful for where I am today.

I've made some online friends who've also chosen weight-loss surgery, and found some support groups, too. I'm able to walk around, drink my fluids and get in my protein. I'm slowly expanding the foods I'm taking in to include more on my list (this week I added a few low-fat smooth soups, butternut squash and pureed broccoli cheddar, along with blended low-fat cottage cheese and part-skim ricotta). It usually doesn't hurt to get up or sit down, and I'm able to feed the dogs without much discomfort. 

I've figured out how to take all my meds — crushed in sugar-free pudding — except one. And the last med... well, it's one of my antidepressants. I used to take the 300 mg time-release version, but before surgery, the psychiatrist's office switched me to a crushable 100 mg pill three times a day (no time-release meds, at least for a while; there's not enough stomach acid to break them down). I've been managing once a day. The manufacturer adds ingredients to stop people from crushing it to get high — so it tastes AWFUL and numbs my mouth. 

Yesterday I called back the bariatric nurse, and she gave me permission to quarter the pill and swallow it. Thank goodness, because I started to feel a slide into depression. Not my brightest handling of something... but I caught it, and I'm back on track. 

Lessons

That's been one of the real gifts of this journey — and I mean my 21-year struggle with weight. Each weight-loss attempt has taught me something important. I've learned that each food choice is separate from others; if I make one unhealthy choice, that has no affect on my next choice. Each time I choose food, it's a chance to be healthy. From a company that supplies all your meals, I've learned that overly processed foods don't suit me and my body. And I've learned to be gentle with myself, to notice things and collect information without judgement. 

Scale and non-scale victories

The scale shows I'm down 27 pounds from where I started last July. One more pound, and I'll have lost what our puppy Daisy weighs. I really like that kind of visual; it makes things concrete for me. 

I have a non-scale victory (NSV), too: I tried on a few rings in my jewelry box that haven't fit for years — and they slid on my right ring finger. Woohoo! 

Hives!

A few nights ago, I was horribly itchy. I thought it was dry winter skin and showering less than usual. The next morning, I noticed little bumps all over my arm. The itching was insane. My first guess was my microwave hot pack, which has been a staple in my life post-surgery. It's filled with grains and sits around my neck, keeping me warm and loosening my muscles. Saturday, I left it in bed after a nap, and that evening, we found Daisy had chewed a hole in it, spilling grains into our bed. I vacuumed it up. 

That night, I didn't sleep in bed; our dog Roo had surgery Friday night, and I slept with him in the living room Saturday. Sunday we forgot to wash the sheets... So Monday morning, after the hives broke out, I hopped in the shower while my husband stripped the bed and carried the linens down to the laundry room. 

As soon as the pharmacy opened at 7 am, I went and bought Children's Benadryl (and I'm getting smarter about children's meds — no liquids this time, but chewables instead). One dose helped the itching, but the hives kept spreading. I called the doctor and went in. She thinks it was probably the hot pack, too. Another possibility is the gallbladder med prescribed after surgery — which is why I'm including this long story here. It has a 2.6 percent report of rash with use. 

(And just so she doesn't feel left out, here's our third dog, Becca.)


 

10 days post-op

New tools: FitBit and MyFitnessPal

Last summer, when I asked my primary care physician for help with my weight, one of the things she recommended was a FitBit. I've noticed lots of people in surgery support groups talking about a FitBit, and I finally looked it up. It's a little gadget that tracks steps, floors climbed, calories burned, etc. Bonus for me: it also tracks your sleep. I have obstructive sleep apnea, but haven't had my follow-up appointment at the sleep center. 

FitBit has a handful of models. The most obvious difference is how you wear them: some clip on while others get worn in a wristband. I narrowed down my choice to two models and then compared reviews. One reviewer bought a Flex and a One and wore them simultaneously and then compared the results. She found the Flex, which you wear on your wrist, counted steps when she was sitting talking with her hands. Half-Italian, I talk with my hands a lot, and since I ultimately decided a wristband would drive me batty, I ordered the One, a model that clips on.

Several years ago, when I worked at L.L.Bean, the company gave free pedometers to employees who wanted one. I remember making different small everyday choices when I was wearing the pedometer: parking farther away at the store, walking to the further bathroom at work, getting up to talk to someone in person instead of sending an email or calling. I'm excited to use a pedometer again and see how many steps I can get in. 

FitBit wirelessly uploads your stats, and has a website and a mobile app. It connects with other apps, including MyFitnessPal, another tool I see lots of people talking about. I created a free account at MyFitnessPal. You can track activity and what you eat and drink, and I figured out how to customize my goals to enter my very specific caloric and protein needs. Neat!

Finding recipes

Both FitBit and MyFitnessPal allow you to connect with friends, too, adding a social aspect. And MyFitnessPal has another cool tool: you can create recipes, enter ingredients and amounts, and it calculates nutritional info for you. That's how I spent much of yesterday and today: researching recipes, modifying some (replacing regular cheese with low-fat or fat-free, replacing oil with cooking spray, cutting down carbs, etc.). I'm keeping recipes in two places: MyFitnessPal, which stores the ingredients, and a Word doc with full instructions; I also copy the nutritional info into the Word doc.

One genre of recipes that I can modify is Paleo. Paleo recipes are often higher in fat than I'll be allowed, but the focus on high protein and low carbs is a good foundation. I'm also, of course, searching for bariatric recipes. I'm on liquids for at least two more weeks, but when I'm able to cook, I'll have a variety of recipes, with nutritional info already calculated. And a bonus: I've found myself a project, just as I started to get bored at home. 

Getting out

And speaking of home, I finally got out of the house yesterday. I'd been thinking of driving to the pharmacy for a pill crusher but decided not to. Then, in the middle of the afternoon, I noticed Roo's growth was swollen and bleeding, in spite of his antibiotics. I called the vet and took Roo in. Happily, my mother-in-law was here visiting, and she helped me get Roo in the car.

Being outside after a week inside was a little odd (it's been so frigidly cold this past week that I haven't been tempted to go out), but I was focused on Roo. The vet decided to operate immediately (delaying his Friday evening — our vet is wonderful!). 

When I got home, our neighbor texted to see if Daisy wanted a play date, so I bundled up again and went outside. It was good to watch the dogs play and get some fresh (cold!) air. Last night, though, I was exhausted, and think I might have pushed it a little too far in one day. Today I've taken it easy: I worked on more recipes, had a great visit with my sister-in-law and then had a good nap. Onward, friends! 
 

A typical food day, second week after surgery

Right now, I consider my job to be healing, and within that, to drink my fluids and eat my protein. For women, Beth Israel recommends 2-3 liters of decaf, low-sugar, non-carbonated fluids a day and 60-80 grams of protein. 

I'm getting 1.5-2 liters a day, from water, SmartWater (with electrolytes added), herbal tea and Crystal Light. Most of my protein comes from protein shakes. BI recommends whey protein isolate, a more expensive but higher-quality protein. The dietician said patients give Unjury and Syntrax Nectar positive reviews for taste, so those are the brands I went with.

My typical protein shake choices are

• 1 cup almond milk (1 g protein) with 1 scoop Unjury vanilla (21 g protein) 
• 8 oz water with 1 scoop Nectar pink grapefruit (23 g protein) 
• 8 oz chicken broth (1 g protein) with 1 scoop Unjury chicken soup (21 g protein).

I just ordered more Unjury, a starter variety pack and strawberry sorbet, to prevent what BI calls "flavor fatigue."

Other protein choices are 

• half an envelope (1.5 g protein) of Cream of Wheat, soupy, with half a scoop of unflavored Unjury (10.5 g of protein)
• half a container of light Greek yogurt (6 g protein). 

Two shakes, Cream of Wheat with protein powder, and half a Greek yogurt brings me to 62 grams of protein per day, and I'm picking up another 2 grams of protein in sugar-free pudding (1 twice a day to take my meds). 

Physical check-in

Physically, I feel quite well. I finally took off my remaining bandages this morning and now just have something called Steri-Strips covering my incisions. I have abdominal discomfort — it feels as if I've stretched my muscles — but not pain. I haven't taken Children's Tylenol in a few days. 

I'm having some insomnia, which is a bother, and I can tell I'm feeling much better because I'm starting to get bored. I'm not scheduled to leave the house until a week from today, when I resume appointments with my therapist, but I might drive to the pharmacy tomorrow and get a pill crusher. 

An interesting thing happened last night: I woke up in the middle of the night, about to roll on my side. That hasn't happened since surgery. As I've mentioned, I'm a side sleeper, and I'm so tired of sleeping on my back. Since it hurts my abdomen to lie on my side, I'm sticking with the back... but maybe that's coming to a close.

Challenges with medication

My biggest challenge so far, once the nausea subsided, has been taking medication. Both because the stomach is much smaller and because it might not have enough acid to break down medication, all my meds must be liquid or crushed for at least three months after surgery. 

In the months before surgery, I spoke with different doctors about the medications I regularly take. My biggest concern was antidepressants. My depression is quite severe, and I take three medications. Two come in liquid form, and the third comes in a crushable form; it would taste horrible, my psychiatric nurse practitioner told me. "No problem," I said blithely. 

I intended to switch to my liquid and crushable meds a week or two before surgery, but I didn't. The morning of surgery, I carefully measured the two liquids and squirted them in my mouth. And staggered. Pure alcohol taste that burned my mouth and made me sick to my stomach. I spared myself and swallowed the third pill. 

That was Tuesday the 14th. I wasn't given my antidepressants in the hospital; when I was released on Friday the 17th, they told me to resume my meds. I couldn't face it. Monday the 20th, I called my psychiatrist's office and got permission to crush my meds instead of taking them in liquid. My nurse practitioner told me to do them one at a time so I would know if one of them was especially wretched, but again I forged blithely ahead and crushed my three antidepressants plus my high blood pressure pill. I added the powder and chunks to some heated unsweetened apple sauce — and asked Paul to get my pink bucket from the hospital. It was awful. The taste was incredibly bitter and made me nauseous. 

The next morning, Tuesday the 21st, with the memory of the crushed meds fresh in my mind, I decided to try one of liquids again. Paul suggested I drink it down quickly, and I did. It was horrible — absolutely horrible. Paul got my pink bucket again, and I sat with it for awhile, hoping to not vomit. I ended up feeling queasy for two hours and lousy the whole day. That meant I wasn't hydrating or getting enough protein. I called my surgeon's office. 

Erin, the bariatric nurse I've worked with, called me back. I told her my troubles and was hoping for permission to swallow my pills. However, she suggested trying the pills crushed with yogurt. If that absolutely doesn't work, she gave me permission to cut the pills into small bits and swallow them — but explained between the lack of stomach acid and sharp edges on the cut-up pills, it's not ideal. She also gave me her direct number in case I have more problems.

My wonderful husband went off to the store again, this time for flavored low-sugar yogurt and sugar-free pudding (suggested in an online forum). I planned to try yogurt or pudding the following morning. 

Meanwhile, I also take medication at night to help with muscle tension in my neck and prevent migraines. I haven't had that in more than a week, either, and my poor neck is getting tighter and tighter. After a few hours of sleep tonight, I woke with a lot of neck tension and quite a lot of pain. Paul massaged it for a while, and finally I got up, reheated my moist heat pack, and crushed a pill and sprinkled it on pudding. It was bitter, but I got it down — without getting queasy. This is the most success I've had with meds post-surgery, and I hope it keeps getting easier.

1/18 -1/20: First days home

My first days home, I focused on a few things: sipping water, drinking my protein shakes, resting and, conversely, increasing my time out of bed. 

The most memorable thing about Saturday, 1/18, my fourth day after surgery, is that I asked Paul to call the doctor and request nausea meds. The doctor who responded to the page (not a doctor I'd worked with in the hospital) didn't want to prescribe anything over the phone. He said nausea was normal the week of surgery, and if I really wasn't doing well, Paul should bring me back to the hospital — but I knew I didn't have to be readmitted. He also said the pain med could be causing nausea, and I could try plain liquid Tylenol instead. 

Joe went off running errands (in a snowstorm) and came home with Children's Tylenol. It turns out I'm really struggling with liquid meds. They either taste like pure alcohol or are sickeningly sweet. There doesn't seem to be a middle ground. Still, I was grateful to have an option that wouldn't contribute to my nausea. 

Noisy tummy

My new stomach — the size of a banana rather than a football — made lots of noise the first few days I was home. It was surprisingly loud, gurgling away each time I took a tiny sip of water (which was almost constantly). It mostly felt okay, though, except sometimes after drinking protein shakes.
 
Friday night, I sipped a protein shake made with Unjury vanilla powder and 1% milk, and ended up feeling queasy. Saturday morning I had Syntrax Nectar grapefruit mixed with water, and I felt fine. Later, I had an Atkins Advantage shake, which I'd been having pre-surgery, and another Unjury vanilla with milk, and got queasy both times. I started to wonder if I've become lactose intolerant from the surgery. I knew that could happen, but I love dairy — so I somehow didn't think it would happen to me. Still, three times feeling queasy and I decided to try avoiding milk. 

Stage 3

Stage 3 post-op diet at home involves lots more choices than in the hospital, and Paul went grocery shopping Sunday afternoon while my mother-in-law sat with me and Joe reorganized my kitchen. (Joe created an herbal tea station, organized all the protein powder, cleared off the butcher block shelves and organized ramekins and little Pyrex containers in baskets, and organized all our plastic containers. Woohoo!) Paul came home with almond milk and Lactaid so we can test the lactose-intolerance theory, SmartWater (which has electrolytes added), Crystal Light, Cream of Wheat, no-sugar-added Edy's fruit popsicles and fat-free Greek yogurt.

I'm supposed to drink 2-3 liters of liquid a day. Water counts, as does flavored water, herbal tea, clear broths and gelatin. Since I haven't worked my way up to 2-3 liters, I decided to drink some SmartWater to help prevent dehydration. I also had some chicken broth heated up with Unjury chicken soup flavor added, and learned that microwaving protein powder is a no-no; it creates a chewy, lumpy mess. I also learned heating it on the stove top isn't good, either; the trick seems to be heat the broth first, then take it off the heat and stir in the powder. **Note: I read Unjury's directions (belatedly), and they suggest not adding to liquid that's hotter than 130F.**

Sunday the 19th I had a popsicle, and it tasted really good. I tried an almond milk protein shake, which worked well, and a little plain Greek yogurt, too, but was worried about feeling queasy. Monday the 20th, 6 days after surgery, Joe made me some soupy Cream of Wheat for breakfast. It was the closest thing to real food I've had in about a week. It was bland (I forgot to ask Paul to pick up artificial sweetener) and a little rough going down in spite of the slow, tiny sips I took, but it sat well. I was able to drink more water — about 2 liters — and spent most of the day out of bed.  

1/16 and 1/17: Days after surgery — and home!

1/16, continued

In the afternoon of the 16th, two days after my surgery, it was time to move to post-op diet stage 2. Stage 2 is still sipping water, and adding in chicken broth or Crystal Light. I'm not a fan of diet drinks, so I opted first to try some chicken broth. It was the saltiest thing I've ever tasted. Keep in mind I love salt... but five spoonfuls and I was done. My nurse gave me credit for what I ate and tried me on some Crystal Light lemonade flavor. To my surprise, I enjoyed it. 

Other things: I took a longer walk in the hallway, about twice as far as I'd gone the day before. I was still dragging my IV pole around, but moving around was easier. I asked my surgeon if I could tear anything getting myself out of bed; he said no. Great, that was all I needed to know. 

And I forgot about the heart and oxygen monitor I wore constantly. My left middle finger had an oxygen monitor that was connected to my heart monitor, which was a series of pads on my chest and tummy. The whole monitor sat in my johnnie pocket, and they came in a few times a day to check and/or change the battery (another one in the long line of interruptions). 

1/17

Friday, three days after surgery, I woke up to learn I'd been advanced to stage 3 diet. That meant it was time to start drinking protein shakes — and as soon as I could prove I could tolerate the shakes, I could go home. Woohoo! I drank water and Crystal Light that morning, followed by Carnation Instant Breakfast (low-sugar or sugar-free, I don't remember which). I sipped slowly, and it went down well. 

Late in the morning, they disconnected my IV and started me on liquid oral pain medicine. Now I could walk without dragging my IV pole with me. Around noon, I think, I was cleared for discharge. Paul helped me dress, and we walked downstairs together. (I'd thought maybe they'd make me ride in a wheelchair, but they didn't. I kind of wanted one but didn't ask, deciding I could walk. Yeah, stubborn.)

Paul pulled the car around while I sat and waited, and he drove me home. Since it was the middle of the day, traffic was light and we made it home in great time.

Home! And Paul runs around...

Poor Paul. He'd mentioned that one of the dogs had a growth that had started bleeding, and that he'd bandaged it as best he could. As soon as I walked in the house and saw Roo, I told Paul that we had to get Roo to the vet. Paul tucked me in bed, where I tried to lie on my side (boy, that didn't work) and then went to drop off my prescriptions at the pharmacy. (I was sent home with prescriptions for liquid pain medication, liquid Pepcid to prevent heartburn, and a capsule to protect my gallbladder. The pain medication is as needed, the other two are twice a day.)

After Paul picked up my medication, he took Roo to the vet while I crashed. I woke up a few hours later to my medications lined up, Roo bandaged and on antibiotics, and my wonderful husband taking care of me. Soon after, the doorbell rang; my dear friend Joe had come down from Maine to help for a few days. 

The three of us sat on the bed, me propped on lots of pillows, and caught up. Joe got to meet Daisy, our 9-month-old Border Collie mix puppy, and immediately fell in love (as everyone does). We brainstormed what we'd do over the weekend, and it was lovely to be home.   

1/15 and 1/16: Days after surgery

1/15: Day after surgery

The first hours the day after surgery are a blur. I kept asking for more nausea medication. Since I get motion sick, they'd told me ahead of time the anesthesia was very likely to cause nausea — but they treated me proactively. I wore a patch behind my ear, and they gave me more medication in my IV. The operation itself can cause nausea, too, so I was seriously slammed. I kept fading in and out, drifting into sleep. 

The interruptions felt constant — my IV alarm going off, someone coming to check my vital signs, a nurse giving me Heparin shots twice a day, needing to get up for the bathroom, and then all those things for my roommate, too. Still, I couldn't stay awake for long. It was a blessing. 

At some point in the middle of the morning, I walked with help into the hallway and got in a wheelchair. They wheeled me down to radiology, where they did a swallow test. I took two or three big gulps of some concoction, and they watched it go through my system to make sure my new stomach wasn't leaking. Good news: no leaks. Bad news: the test caused more nausea. Back to bed. 

At some point, I went for a walk in the hall that day, dragging my IV pole with me, and was pretty good at getting up and getting myself to the bathroom. I needed help; someone had to unplug my IV from the wall, and also unplug my leg booties. They were wrapped around my calves and plugged in; they'd fill with air and compress my legs, keeping circulation going and reducing the risk of blood clots. 

The staff kept telling me to use my pain button — but some people said the pain med could be causing nausea. I later found out I could have pressed the pain button every 6 minutes; instead, I pressed it once or twice an hour. (Stubborn? Me?) 

I'd told Paul to go to work that day, and he did, but he left early. I was so damn happy to see him when he showed up. I could tell he was worried about me, but there wasn't anything I could do.

1/16: Two days after surgery

I'd hoped to go home on the 16th, but that morning, it was abundantly clear that wasn't happening. I think that was the day they finally had me start sipping water. My new stomach is so much smaller that I have to take very small sips. They poured water into a little 1-oz. plastic medicine cup, and told me to drink it over the course of 15 minutes. Tiny, tiny constant sips. That was stage 1 of my post-surgery plan. 

The nausea was easing a little, and I found it best if I sat up in bed as much as possible. Having an adjustable bed was so helpful, and I was able to pull myself up using the rails. I was finally starting to feel like myself again, and Paul was so relieved. 

1/14: Day of surgery

The morning of surgery, Paul and I woke up fairly early. We were supposed to report to the hospital at 10:30 for surgery at 12:30. Around 8:20, we got a phone call from Beth Israel, asking if I could come in earlier since my surgeon was available earlier. 

I jumped in the shower and, like the night before, washed with a special anti-bacterial soap the hospital had given me. I wrote and posted instructions for feeding the dogs (our neighbors helped out by caring for the dogs), and then I grabbed ear plugs, lip balm and my Kindle, and off we went. Traffic was pretty heavy, but we finally arrived — only to discover we were in the wrong building. Oops. 

Beth Israel Deaconess Medical Center, which I always incorrectly abbreviate as Beth Israel or BI, is split into two campuses: East and West. I'm sure they told me which building to report to, but it didn't click. So back in the car for a little drive, then a little walk, and finally we were in the right place. 

We reported to the 5th floor surgery waiting room, and after a few minutes, a nurse came to get me. She took me back to the pre-op area, asked me some questions, and left me so I could change into a johnnie. And I felt scared. 

I was alone, separated from my husband, in a completely foreign environment. Rapidly, I reviewed my decision: Did I really want to go through with this? It's irreversible. Was I sure? I took a deep breath. Yes, I was sure. 

A variety of doctors and nurses started streaming in, and at one point, they got my husband. I was so happy to see him, my eyes teared up. One of the anesthesiologists put an IV in my hand; I expected it to hurt, but it didn't. The doctor said that would be the roughest part of my day. (Boy, was that patently untrue.) I got a Heparin shot (blood thinner) and a pneumonia vaccination. My surgeon, Dr. Schneider, stopped in. He asked me how much weight I'd lost so far, and I was proud to say 16 pounds. 

Almost immediately, they wheeled me away towards the operating room. It was a strange feeling, being wheeled on a bed. I met more nurses and doctors in the OR, scooted myself from the bed to a gurney, and then they placed a mask over my mouth and nose. 

The next thing I knew, it was over. I vaguely remember seeing my husband in the middle of the afternoon, and then again in my room on the nursing unit, hours later. I felt horribly nauseated and in pain, and was mostly out cold. Paul finally left after 11 pm. I slept.  

Day before surgery

I've been reading blogs by other gastric sleeve patients and was struck by a woman who said she hadn't listened to the doctors when they said surgery is just a tool, and that she hadn't thought about life after surgery. I was amazed. Partially because, if anything, I overthink things, and partially because I so much want this to work, I've thought lots. And lots.

Finding a therapist

Even before I started the surgery process, I wanted to find a therapist who specializes in food issues. I didn't know how to go about it, so I asked at my ob/gyn's office, figuring a medical office for women would have resources. Nope. I asked at the breast care center. No luck there, either. It wasn't until I after I started the process and met with the social worker at Beth Israel that I found a tool. If you go to psychologytoday.com, you can use their "Find a therapist" tool. You enter a zip code and, if you want, a focus area, and they serve up results for you to review. 

I figured that to be as overweight as I am, I must do lots of emotional eating. One of the first things my therapist, Julie, had me do was keep food journals. Each day, I wrote down the time and what I ate, along with any strong emotions. And I learned something fascinating: I'm actually not much of an emotional eater. Most of the time, I choose food based on what tastes good. 

Clearly, that's not good enough criteria. Taste matters, but so does nutrition — and that has to become a factor in my choices. That will be even more true when most of my stomach is gone, because with less capacity, I'll have to focus on getting enough nutrients. 

Tweaking the behavior

But I had a brainstorm one day. As far back as I can remember, I've picked at my fingernails and the skin around them. A couple of years ago, I finally managed to break the habit and grow my nails. Still, I futz with my fingers — I just don't pick them. Ultimately, I didn't completely reinvent my behavior, I tweaked it. What if, I wondered, I could do the same with food? And that's my goal. Instead of only thinking about what tastes good, I'll think about what tastes good and what provides my body with what it needs to function healthfully. I think that will work. 

Day before surgery

The day before surgery, Beth Israel asks you to eat your "real food" meal for breakfast or lunch. I had my usual shake for breakfast and a Healthy Choice meal for lunch — my last solid food for a while. It seemed like it should have been momentous in some way — but it wasn't. 

I've been thinking lots. Am I sure I want to do this? Yes, I am. It's a huge, serious step, but it's the right one for me, and I'm as ready as I can be.

Last summer, I started a "healthy successes jar." Each day when I did something healthy, I wrote it on a slip of paper and put it in an old mason jar. Sometimes it was going for a walk, sometimes drinking more water, sometimes ordering a salad instead of something fried. My plan was to build the positive, healthy energy, and to compile healthy decisions so I could review them if I was struggling. 

Tonight, my husband and I will start another jar. On little slips of paper, we'll write activities we want to do when I'm healthier (kayaking, hiking, gardening, etc.) and place them in another mason jar. Later this year, we plan on working our way through them. I think that's the perfect energy to carry me through my last night before surgery.




 

Last-minute prep

Recipes

Last night I bought a cookbook with post-surgery recipes, and since I bought the Kindle version, I was able to look through it last night. 

My post-surgery diet has five stages.
Stage 1: Water, 1 oz. per hour. This starts as soon as I'm able to swallow after surgery and lasts less than a day. 
Stage 2: Low-sugar, decaf, non-carbonated clear liquids, 2-4 oz. per hour. This also lasts less than a day. 
Stage 3: Low-sugar, high-protein modified full liquids, 4-8 oz. per hour. This starts before I leave the hospital and lasts at least until my three-week post-op appointment with my dietician. 
Stage 4: Lean soft or ground food. I don't have much information about this stage yet, since they don't want you to self-advance your diet. I'm guessing this begins at my three-week post-op appointment, and it lasts 4 or 5 weeks.
Stage 5: This is my lifetime maintenance: lean protein, fresh fruits and vegetables, whole grains and legumes, healthy fats and low-fat dairy.

The cookbook I bought last night was written with stages 4 and 5 in mind — meaning the recipes should taste good pureed. This morning, I've searched for more recipes online and bookmarked several sites. 

The guest room

My dear friend Joe is coming down from Maine, staying Friday through Monday. There are lots of positives and just one little drawback: we have to clear the guest bed, which is where our clean laundry lives. Yesterday while I was at work (getting as much done as possible for my month away), my husband Paul worked on laundry. I have an overflowing basket of clean laundry waiting for me to put away.

Railings

Last night Paul called his father and asked for help putting up the railings on our stairways. They were taken down for painting before we moved in two and a half years ago. Our house is a multi-level, with half a flight of stairs going up to the bedrooms from the living room, and half a flight going down from the kitchen (and then another half flight going down to the basement proper). As I sit typing away, Paul and my father-in-law are finding studs and hanging railings so I'll have something to hold onto after surgery.

 

Bumps in the road

Well, I knew it was bound to happen, and this week it did. Things got bumpy. 

It started Thursday afternoon, ironically on the way home from my therapist. We'd talked about how ready I am, mentally, emotionally and physically. How I'm doing well on the pre-surgery diet, looking at it as an investment in the rest of my life. How my husband and a good friend are alternating taking off days from work so I won't be alone for a week after surgery, even when I'm home. How I have a jigsaw puzzle set up on the kitchen table to distract myself. 

And then, on the way home, I wanted to pull in the Burger King drive-through. 

I thought about it. I considered. And I decided not to: I wanted to fight through it to show myself I could. So I did, and as far as bumps go, it was a minor one. 

The next day on the way home from work, hunger struck again. "McDonald's?" I thought. (Yes, fast food is a weakness.) "Ooh, a small pizza." Again, I seriously considered, and this time, I came close to caving. Instead, though, I got home and made myself a protein shake. 

Too damn sweet!

Part of the problem, I think, is that I haven't been eating on schedule so I'm getting hungrier than I should. A chocolate shake for breakfast, a chocolate-peanut-butter bar for lunch and a chocolate-caramel bar for snack is too much sweetness for me. This means I'm avoiding my bars and not eating on schedule. I've decided to forgo the bars for the next day or two and have shakes instead. 

I ordered two brands of whey protein isolate recommended by my dietician at Beth Israel: Unjury, which I ordered in vanilla, unflavored and chicken soup flavors, and Nectar, in pink grapefruit. Unjury vanilla mixed with 1% milk is sweet but not terribly so, and Nectar pink grapefruit mixed with water isn't at all sweet.

After work yesterday, my husband went grocery shopping, came home and cooked me dinner. We split a steak (our food scale is dead, but we think I ate 5 ounces of meat instead of 4), cauliflower that he mashed with fat-free Greek yogurt and a tablespoon of fat-free sour cream, and spinach sauteed in water with garlic. I had a small glass of wine, too, about 4 ounces. It was SO good, and even though I was slightly off plan, I really enjoyed it. My husband takes care of me in so many ways, but he really stepped up, without me asking, and it was wonderful. 

I was up 2 ounces on the scale this morning (down a total of 14 pounds from my highest in July), and I'm okay with that.

Support

My husband, though nervous about my surgery, totally supports me. He's eating protein bars and shakes with me, with Lean Cuisine or Healthy Choice meals for dinner, and he's mostly given up coffee. We talk about things we want to do after surgery: kayaking (by the time I was interested, I was worried I wouldn't fit in one), gardening and hiking (which I used to love but haven't had the energy for in years), riding my husband's Jet-Ski (right now we surpass the maximum weight). That's why I chose surgery: I want to live a long time, and I want to LIVE. 

 

 

One week before surgery

Over and over, the staff at Beth Israel has said that weight-loss surgery is a tool. It's not a magic solution — it's just another tool in the box.  

I've heard of a hospital requiring patients to lose 30-40 pounds before weight-loss surgery. Beth Israel asks patients to lose a very modest amount, just 5-10 pounds, to prove you can follow a healthy eating plan and use the tool wisely. 

From July to December, I worked hard and lost 10 pounds. I cut back my wine with dinner, bought a community-supported agriculture (CSA) farm share so I'd have fresh vegetables to cook, ate more fruit, drastically cut back on fast food, drank more water and incorporated healthy snacks. I tried to eat on a regular schedule, and I walked. I also found a therapist who specializes in food issues (more on that another time) and kept food journals that we reviewed each week.

In December, I regained 3 pounds. I tried to be gentle with myself; it's just 3 pounds, after all. But, another part of me said, it's 30 percent of what you've lost; imagine if you lost 100 pounds and regained 30 percent of that! Well, yeah, that's true. Still, it wasn't 30 pounds. It was 3. 

Happily, I've lost those 3 and a little more so far in my pre-surgery diet. And man, it feels good. My jeans are a little looser, and it's awesome to see the number on the scale going down — knowing as the number decreases, my health increases.

Caffeine update

As of today, I'm back off caffeine. I did that one day cold-turkey and then did about a week of half-caf. Now, the last week before surgery, I'm off completely. I had a mild headache today, but nothing bad. 

Pre-admission testing

Late Friday afternoon, a nurse from pre-admission testing called. In 20 minutes, we went over my health history and medications. And a funny thing happened: I got nervous. So many people have asked if I'm nervous, and the honest answer has been "no." Until Friday evening. I didn't have a lot of time to dwell on my nerves, though, since Saturday we drove to New York for a funeral. We returned last night, and this morning I had a pre-admission testing appointment at BI. 

After a slightly stressful drive (my Google Maps app decided to take me off the highway and onto a route I wasn't familiar with), I arrived early. And they took me early! First someone drew blood, and then a nurse practitioner anesthesiologist went over my history and did a brief exam. She was reassuring, and my nerves disappeared. 
 

Comprehensive process

The weight-loss center at Beth Israel includes a multidisciplinary team and several steps. 

The process begins

First, my primary care doctor referred me to the weight-loss center. I called and was asked several questions to ascertain if I qualify: How overweight am I? How have I tried to lose weight in the past? Do I have conditions like high blood pressure or diabetes? 

Then, I watched an online information session that talked a bit about BI and the three surgeries (Lap-Band, gastric bypass and gastric sleeve) that they offer. Next, I went to an in-person group session (which my husband attended, too). A bariatric nurse and dietician presented, and the administrator gave an overview of the process and made appointments. I also had to attend another in-person information session (and my husband came to that one, too).

Appointments and tests, round 1

Next came the appointments and tests: blood work; abdominal ultrasound; EKG; meetings with a nurse, registered dietician and social worker who specialize in bariatric surgery; an overnight sleep study since my answers on a questionnaire indicated I likely have sleep apnea (I do); and a meeting and check-up with the medical director.

The medical director, in looking over my health history, said, "Oh, you're on antidepressants. They can cause weight gain." I nodded. "But this much?" I asked. "Double my weight?" He didn't shake his head yes or no, just shrugged a little as if to say, "Could be." (This makes me nervous since I expect to always need antidepressants.)

Throughout the process, I had to prove I understand the difference between the surgeries, and that I'm knowledgeable about basic nutrition. Information was repeated to me and by me again and again — but I'm okay with that. I'd much rather deal with an abundance of caution, especially when it comes to my health.

Team Discussion

After my initial tests and appointments were complete, I eventually came up for Team Discussion. Everyone who had met with me discussed whether I was a good candidate for surgery. After my Team Discussion, I needed to see the dietician again, with a food journal, since when I first saw her I'd only just begun making changes. We had a great meeting, and she was pleased with the changes I'd made to my eating and drinking, and the activity I'd been doing. And finally, two months after my last test was complete, I got my appointment with the surgeon. 

Meeting my surgeon

I really liked him — which is excellent considering I've committed to at least 5 years of follow-up with him. (BI requests a lifetime relationship but requires 5 years.) We went over my medical history again, what kind of surgery I want and why I chose it, and he did an exam. His nurse told me a little about what to expect in the hospital, both before and after surgery. At the end of the appointment, my surgery was scheduled.

Being treated well

For me, it's equally important to be treated well as a patient and a person. As I've said in another post, I carry lots of shame about my body. I'm happy to say that no one I've interacted with at BI has made me feel uncomfortable or ashamed. They really get it, down to things like not having too narrow chairs in the waiting rooms. I appreciate walking in knowing I'll be treated with respect. 

Free foods, and good to go

For these two weeks before surgery, if the three meal replacements and one "real food" meal don't satisfy me, I can choose from a list of "free foods." It has things I'd expect: herbs and spices, and a bunch of veggies, among other things. 

The first night, I snacked on some raw carrots. The second day, I sliced up grape tomatoes with fat-free dressing (which I can have in limited amounts). But since I'm not a great fan of fat-free salad dressing and since it's winter, I decided to make a veggie soup for when I'm hungry.  

I sprayed the bottom of my pot with Pam and then sauteed onions and garlic, adding some low-sodium chicken broth (another "free food") when the Pam ran out. I added chopped celery and carrots, a bunch of chicken broth, herbs (parsley, basil and thyme), chopped pepper and summer squash, fresh spinach and finally a can of tomatoes. It's been lovely the past few days, as New England has been in a cold snap (it's 3 degrees as I type), to have warm soup to eat.

I'll tell you that I'm generally not one to believe that eating veggies fills me up. It's like telling me to drink water when I'm hungry — that's never worked for me. But the soup really has helped, and as I'm mostly eating shakes, bars and frozen dinners, it's really wonderful to eat something homemade. 

It's a matter of perspective, I think. Normally I'd turn up my nose at a cup of half-caf coffee — but after my first day of no caffeine, I decided weaning was the way to go. I add less than a tablespoon of fat-free half and half (which I confess isn't on my list of approved foods), and I'm good to go. Notice I didn't say "happy" or "content" — because that would be a lie. Normally, I love my caffeine, and I use a liberal amount of cream in my coffee. But I'll take "good to go." It moves me forward, and that's what this is all about.

Depression and weight gain

As a teenager, I thought I was fat. Most girls do, I suspect. I was a size 10 or 12, but I remember having a hard time finding pants that fit well; most seemed geared for straight body types, not my curvy hips. 

Twenty-one years ago, when I was 19, I had what I call my breakdown. I wasn't functional. I was in college and more often than not didn't make it to class; I must have made it to work sometimes, but I don't remember. Eventually I was diagnosed with major clinical depression and prescribed an SSRI, a selective serotonin reuptake inhibitor. 

My journey with depression could be a whole other blog, but there's one very important piece for now: over the years, my weight more than doubled. 

Off and on meds

About a year ago, I had a new nurse practitioner at my psychiatrist's office, and he asked me to go over my medication history. The sad truth is, I'm not sure I remember all the meds they've tried me on over the years, nevermind the dates, but first there was Zoloft, then Paxil (or vice versa). Then I went off meds for a few years, and when my depression spiked again, my MD worked with me to try St. John's Wort. When the maximum didn't help, she referred me to a psychiatrist. 

It was one of the best experiences of my life. The psychiatrist was warm and caring; she made me feel normal without diminishing my depression. She was the first to put me on a cocktail of meds: Wellbutrin, Effexor and trazodone. That psychiatrist closed her private practice, so I saw a new doctor who eventually changed the Effexor, which was raising my blood pressure, to Zoloft. 

For most of the past several years, my depression has been stable and pretty well controlled with meds (except for my hormones — which could be yet another blog). There have been exceptions, times when the depression was so severe that I went on disability. At the best of times, I would try to lose weight, with varying degrees of success. 

Weight Watchers, round 1

My most successful attempt at losing weight was my first. I was 24, and my mom and I joined Weight Watchers together. We walked every morning (we were living together), and I went from a size 20 to a size 14. 

I think that my first Weight Watchers attempt might have overlapped with the time I was off meds, but I just don't remember. I don't remember what changed, either: why I stopped Weight Watchers or how I gained back the weight — and then some. I do know by the time my mom died when I was 28, I was a size 26. And by that time, I was carrying some serious shame about my body. 

Other attempts, and asking for help

I've tried Weight Watchers several times since, Jenny Craig, and both homepathic and injectable HCG. I walked, I joined Curves, I walked. I haven't been below a size 22 in years. A few years ago, my doctor prescribed high blood pressure medicine. Eventually, she suggested weight-loss surgery. Partially because I was so upset, I switched doctors. 

In 2013, I turned 40. Suddenly I was noticing obese women in their 50s and 60s who used canes or were confined to wheelchairs. I got a rash, partially from heat and partially from weight. I asked my new doctor for help. 

She said there were two options: medication and surgery. The medication is contraindicated because of one of my anti-depressants, so that left surgery. Desperate, I asked for a referral. 

The option of surgery had been in my mind for years, even before my previous doctor suggested it. My husband's aunt and uncle had surgery three years ago, and I saw the difference it made for them. Most importantly, I realized I'd been struggling with my weight for 21 years — more than half my life. I'd tried smart ways of losing weight and more desperate ways. I finally accepted I couldn't do it on my own.