Rethinking rewards

This morning my good friend Sarah suggested I not reward myself for meeting certain pound goals — but rather that I reward myself for behaviors. She was hesitant to have the conversation, but she knows my motivation is my health, not being a certain size or weight. Sarah thinks rewarding healthy behavior is a, well, healthier approach. I think she's right.

So now I have a whole other thought process around rewards. What behaviors will I reward? 

Last night, I decided that my first reward, rather than a bracelet, will be a good pair of sneakers. I have two pair of sneakers; the newer ones are about 5 years old. I researched and chose the sneakers I want. The question is what are they a reward for? Maybe I'll take Sarah's advice and say I'll buy my sneakers after I finish 3 sessions with a personal trainer. 

Another reward definitely will be detailing my car. We want to go hiking and biking, and on walks and photography expeditions, and having my car clean will be wonderful for those trips. I want that to be sometime this spring, so how's this? When I go to the gym (which I joined today) 3 times a week for 4 weeks, I can have my car detailed. 

Yesterday I signed up for the Diva Dash, a 5K fun run/obstacle course. I've NEVER done anything like that, but I'm part of a team with other bariatric patients in Massachusetts. So after I finish the Diva Dash, on September 6, I'll definitely be rewarding myself — whether I manage (for the first time in my life) to jog or run, or whether I walk the whole course and skip obstacles. The focus is on the process, not the result. 


  

6 weeks post-op

Today marks 6 weeks post-op. I'm down 38.6 pounds from my highest last summer, more than 22 pounds since surgery. My clothes fit differently; I'm down one size in pants and expect to slide down another size soon. 

I've reached out to a personal trainer, who said she needs a doctor's note since my surgery was recent. I emailed my surgeon yesterday and, now that I'm back in my work schedule, will get started at the gym in the next week.

By the time I go back for my next nutrition visit on March 12, I'm supposed to be able to eat 2-3 ounces at a time. I'm slowly increasing my portion sizes; last night I ate 1.5 ounces of supper, up from 1 ounce. Yesterday I ate 48 g of protein in food — my record so far — and then had a protein shake to finish up my requirement (65-70 g). I find I can take slightly bigger sips, now, too. 

A diet of almost 100% protein doesn't encourage my GI system to work very smoothly. It's a common problem after surgery, and the support groups have been really helpful with tips. I've started taking fiber gummies and probiotics every day. 

As I close in on 40 pounds lost, I started thinking about ways to reward myself for different milestones. Last night, I brainstormed with a friend. For 50 pounds lost, I'm going to treat myself to a bracelet I've admired for a few years. For 75 and 100, I'm thinking of having my car (a furry, cluttered, dirty mess) detailed, which would tie in nicely with adventures this summer, and some time at a spa — maybe really splurge and have a facial and massage. It turns out rewarding myself with something other than food comes pretty naturally. Hooray for me!



 

Where I fell into a trap

Well, I did it. I fell into the "I only lost xx pounds" trap. I can't believe it. This past week, I lost 1 pound and phrased it as "only 1 pound" in my head — and immediately started to worry that the sleeve won't work for me, that the initial success was a fluke. Illogical. And powerful. 

As my therapist would say, "What's the data?" The data is I've lost 20 pounds in 5 weeks. The data indicates my sleeve is working. 

So where does this insidious "only" and worry come from? I'd like to say that part of it is osmosis — reading so many other people's posts about "only" losing so much, and doubting whether the sleeve is working for them. (A typical recent post: someone thought her sleeve wasn't working because she "only" lost 45 pounds in 2 months.) In all areas of my life, I'm careful about the energy I expose myself to. If I'm not strong enough yet to ignore the negativity, I might need to distance myself from the support groups.

But most of the worry, I think, comes from years of tried and failed diet attempts. I'm definitely carrying baggage, and I know I'm not the only one. In the past two days, two people in different groups have posted, "Am I the only one who thinks the sleeve won't work for them?" 

How do I move forward? I need to keep reminding myself that this is a new process. I'm 5 weeks out from major surgery, and my body still is healing and undoubtedly is in shock. I'm following my surgeon's plan, getting in all of my protein and fluid almost every day. I'm resting, focusing, working the tool.  

If that "only" slips again, I'll do my best to gently rephrase it in my head. "I've lost 20 pounds in 5 weeks!" is much more powerful than "I only lost 1 pound this week." And I did promise to claim my power. 

 

My baby tummy fusses

I think of my new stomach as a baby tummy: baby in terms of size but also in terms of newness. And just as babies sometimes fuss, my tummy sometimes fusses, too. 

It fusses if I swallow my medication pieces too quickly during the day. It fusses if I take my nighttime medications too closely together. That fussing is really unpleasant. I can get horrible heartburn, and then I excessively salivate — known as "sliming." Yeah, it's as pleasant as it sounds. I've tried walking it off, as I'm supposed to, but mostly I end up propped up in bed, holding my pink basin from the hospital — colloquially known as "the puke bucket" (sorry, parts of this journey aren't fun) — until the sick feeling passes. (Happily, the puke bucket has so far been an unneeded precaution.)

Sometimes, in conjunction with my taste buds, my baby tummy fusses about the food I try to eat. I've always been quite a picky eater, but since surgery, there's no pushing something that doesn't suit my taste buds. That's happened with artificially flavored yogurt, a scrambled egg slightly overcooked and made with light Swiss instead of light American, a turkey meatball that went down fine the night I made them but not as a leftover. 

This isn't as gross as sliming — the food just won't go. My tummy must tell my brain "no," and my brain obeys by making me stop eating. No drama there, but it's frustrating. I'm having a heck of a day today. I've eaten half a scrambled egg and half a turkey meatball. I'll make a protein shake soon to keep myself going.

Hormones and grief

The other frustrating thing is that as I lose weight, my body releases the estrogen stored in fat. That creates, among other things, mood swings. 
 
My mood isn't helped by the fact that we're close to having to say goodbye to our dear, dear Roo. Roo is 14 1/2 and has been with me since he was 1 year old. He was my first rescue and has been an amazing companion. I never thought I'd have the gift of this many years with him; when he was younger, he used to love to escape and explore — and I worried he would be hit by a car. Poor Roo is slowing down, and I think we're down to mere days with him. My heart is breaking. 

Food as fuel

I've been thinking a lot about my relationship with food. Years ago, my dear friend Thomasin told me she thinks of food as fuel. It was a revelation. I'd never thought of food as fuel. I thought of it as necessary, and generally something that tasted good and I enjoyed — but never as fuel. 

Surgery, of course, has completely changed my physical relationship with food. Because my focus is on my health (rather than on being a smaller size), I'm following my fluid and food guidelines. This means I eat protein and not much else right now. And frankly, protein has never been my version of comfort food. 

If this was before surgery and I was faced with losing Roo, I'd probably retreat to my bed with a bag of chips. Physically, that sounds repulsive — but the surgery didn't change my mind and my emotions. I need to learn new ways of coping, mentally and emotionally, since food really has become fuel for me. 

I told my therapist this week that 75% of me is thrilled and happy with my progress and the changes, but 25% is struggling. She replied that if I said I was 100% happy, she'd be worried I wasn't processing. 

I don't have answers yet. I'm just feeling my way forward in this new way of being. And that's a strange feeling for someone who usually puts her head down and charges forward. 

1 month post-op

Today marks 4 weeks since my surgery. It seems both longer and shorter.

I have lots to celebrate. The most important thing: this afternoon my primary care doctor took me off high-blood-pressure medication. I'm so excited! 

In terms of scale progress, I've lost 18.6 pounds the past 4 weeks, for a total of about 35. I've worked hard before at different weight-loss attempts (although never this hard), without results, and I was worried surgery would be the same. I'm relieved and grateful that my hard work is getting results.

What else? I'm exhausted. I worked more than a full day because it didn't make sense to go home between work and my doctor appointment. The alarms at work worked perfectly, though, and I'm on track for the day. I foresee an early-to-bed night — but a cheerful one. 

Knackered, or easing back into life

Last week, I was amazed how exhausted I was after my trip into Boston for my follow-ups. I was so wiped out I ended up not going into work the following day, instead staying home and resting. It doesn't help that I'm fighting a cold. 

Saturday, my mother-in-law, sister-in-law and two nieces came to visit. It was so nice to have company — and the girls (6 and 9) managed to tire out Daisy. Sunday started out fine, but late morning, I got terrible heartburn and felt like I was going to vomit. I'm still not sure whether I swallowed my medications too quickly and overfilled my pouch, or whether it was a quick little virus. I tried to walk it off, which is what I'm supposed to do, and when that didn't work, I propped myself up on pillows in bed. I fell asleep and woke feeling normal. Bizarre. 

We went to my in-laws' for Sunday afternoon dinner. I wasn't sure what it would be like being around people eating food I couldn't have. They had salad (no raw veggies for a while), ravioli (no pasta for a while), garlic bread (no bread for a while), sausages and my mother-in-law's homemade meatballs. I had a meatball with some tomato sauce, and my husband had the brilliant idea of opening up some ravioli and giving me the cheese inside. I ate about an ounce and a half and definitely enjoyed it. 

And it wasn't awkward not eating the things I couldn't. My baby tummy still is so new that the thought of most food turns me off. I approached the dinner as a social event rather than a food event, and that worked perfectly. (This time, at least.)

Sunday evening, I went into work for a few hours. I work in a church, and twice a year, they do a late-afternoon service called Choral Evensong. I've been wanting to experience it and also wanting photos of it; the most recent photos are from four years ago. This morning, I headed back into the office. I worked about three and a half hours, rather than my usual four. It was lovely to see my coworkers and parishioners and be welcomed back. Yesterday I said to my husband, "Tomorrow I go home." And it really does feel like that. 

I'm knackered, though — just wiped out. And between my nap yesterday and work in the evening, for the first time, I didn't get all my fluid and protein in. And today at work I didn't set my phone alarm like I intended, and sure enough, I'm behind on fluid. 

My pouch feels smaller today, too, like it's holding less. I've heard that variation is normal, so I'm not worried — but when I'm already sipping every waking hour, less capacity is an added challenge. 

So my reminders to myself: Sip. Find an app that makes half-hour alarms easy. Remember my most important job still is healing and taking care of my health. Try not to be stubborn and push myself too hard, too soon. Be gentle. 

~~~
This morning, I stopped at Whole Foods and treated myself to some hyacinths for my desk.
http://instagram.com/p/kPg8nNCWYj/#

First post-op follow-ups and stage 4 diet

This morning, I had appointments with my surgeon and dietician. It was my first post-op follow-up, and it went very well. By their scale, I've dropped 30 pounds (31 by my home scale) and 20% of my excess body weight since I started this journey. My blood pressure is down, still in the normal range, but low enough that the bariatric nurse told me to call my PCP to have my blood pressure med reevaluated. I love that my hard work is paying off, and I love that my health already is improving. 

Surgeon visit

My incisions are healing well, and the steri-strips are off now. I still need to be careful to not lift anything more than 10 pounds because I don't want to pop a stitch. 

I went in with a list of questions. When can I join a gym? (Now for cardio.) When can I lift weights? (4 weeks post-op.) Will I ever be able to take time-release medication? (Probably.) Do I need a medical alert bracelet? (No. If I'm in a horrible car accident and they put a tube down me, it should go straight into my smaller tummy.) What are the chances I'll need to have my gallbladder out? (7%, he estimated.) 

I asked the gallbladder question because in my online support groups, I see lots of people talking about having theirs out after weight-loss surgery. When you have rapid weight loss, from a crash diet, for example, or surgery, gallstones can form, necessitating removing the gallbladder. My surgeon has me on preventative medication, which they find very effective. Awesome news. 

And hooray! I got permission to cut in half and swallow my three smallest pills. That just leaves one a day, my migraine preventative, that I have to crush. Pleased as punch? You bet. Happy as a clam? Uh-huh.

Dietician visit

Then I saw my dietician, with another list of questions. Is there a supplement to prevent hair loss? (Many people take Biotin, even though there's not much research backing it up.) More background: Many people who have weight-loss surgery "shed" 3-6 months after surgery. Some people say eating all your protein and taking multivitamins help, some people say it's a reaction to the stress of surgery. For most people, hair regrows. Crossing my fingers if it happens to me, it's mild — but I went into this with eyes wide open. If my hair thins, it thins. At least I'll be alive to have my hair. 

Because I have less stomach acid now, my ability to absorb nutrients is compromised, and I have to take supplements for the rest of my life. I've been taking a multivitamin and mineral; that now doubles to 2 a day. I also take vitamin D, which has been low for the past few years. Now I have to add B12, sublingually (under the tongue), and chewable calcium citrate. The calcium needs to be taken twice a day, at least two hours apart from each other and from my multivitamin. I'll be creating a schedule of things to intake, to keep me on track. 

Then we went over my stage 4 diet, my second-to-last stage. Stage 4 is ground/soft/puréed food, with a heavy emphasis on protein, and carbs and healthy fats added in. The best news is that everything doesn't have to be puréed. Yippee! I wasn't looking forward to that texture. 

I begin by eating 1 ounce of protein over the course of 10 minutes, then add my carb. Eating slowly is extremely important, both so that I'm chewing well and helping my tummy digest, and so that I'm not overwhelming my new tummy with food. I have to stop drinking 30 minutes before a meal and wait to drink 30 minutes after I finish; I can't drink with meals because it could either stretch my pouch or wash food through, leaving me unsatisfied and causing me to eat more. Pre-surgery, I drank a lot with meals. I've been practicing not, and it's going okay.

I'm on stage 4 for 5 weeks. By the end of that time, I should be able to eat 2-3 ounces of protein in 20-30 minutes. 

Grocery shopping and first meal

On my way home, I went to the grocery store, for the first time in about a month (my husband has been doing all the shopping). I bought celery and chicken so I can make chicken salad (celery is okay in the salad if I finely dice it); shaved deli turkey and light American cheese; ground turkey so I can make meatballs (have to find a recipe without breadcrumbs) and no-sugar-added low-sodium tomato sauce; eggs; Laughing Cow cheese; shredded part-skim mozzarella; fresh bananas and canned peaches for fruit; and knock-off Wheat Thins from the natural food section. For now, I avoid bread, rice and pasta, all of which can swell in my new tummy. 

When I came home, I made myself a scrambled egg (my protein) with 1 teaspoon of light butter spread (my healthy fat), a very thin (.4 ounce) slice of light American cheese, and 2 crackers (my carb). I practiced mindful eating, chewing well, placing my fork down between bites, and listening to signals for when to stop. What was supposed to take me 10 minutes took me about an hour, with a break in between. I need to be careful of that, because spreading a meal too far out can lead to "grazing" and ultimately taking in more than I ought to, if my pouch has time to empty — but given that I didn't have breakfast, I decided getting down the entire egg was a good thing to do. 

Back to work

My surgeon recommended taking a month off from work. I've been doing some work from home, and it's been so good for my brain. I feel ready to ease back into it, so I'm heading in tomorrow for a few hours. My only worry is that I tend to get caught up in what I'm doing — and I need to stay on top of my fluid, protein, vitamins and medications. I'm going to be super-high-structure about it: I'm creating a schedule for when I do what, and I'll set alarms on my phone every half hour to make sure I'm on track. 



 

Three weeks post-op

Three weeks ago, I was in the operating room. I think. Maybe I was in recovery... I'm not actually sure how long the surgery lasted. Funny that I never asked. Funny, too, that I don't think I've mentioned they found during surgery that I had a hiatal hernia: part of my stomach was squeezed above my diaphragm. The surgeon repaired the hernia first and then did my sleeve. I have six incisions, which is standard for my hospital. I've heard of people having three to seven. My incisions are healing well; they're still covered with Steri-Strips, which I think my surgeon will remove on Thursday at my follow-up appointment. 

The up side

As of this morning, I've lost 30 pounds since last July: 7 pounds on my own, 9 on the pre-op diet and 14 since surgery. I'm floored. And excited. 

My husband and I both have noticed it's easier for me to get up from a chair, and this weekend, when we went for walks, my back and hips didn't hurt. I love that my health already is improving!

The down side

With that said, there are some frustrations. After three weeks of liquids (with a little yogurt, pudding, ricotta and cottage cheeses, and Cream of Wheat thrown in), I'm feeling ready for some solid food.

Cottage cheese doesn't want to go down, Cream of Wheat turned me off this morning, and even yogurt isn't appealing, partially because the yogurt I have right now is low-sugar and I can taste the artificial sweetener (yuck). I'm looking forward to moving away from artificial sweeteners soon. Usually I make it a habit to avoid them; I think that's healthier. 

I'm not sure what my tummy will think of solids — but I'm ready to find out. An egg sounds good, maybe soft boiled. 

Support groups 

I've found several support groups on Facebook. Some are general bariatric surgery groups, some are sleeve-specific and some focus on recipes. I've learned people have amazingly varied experiences: no complications, bad complications; no nausea, lots of nausea; slow weight-loss, fast weight-loss; no problems eating anything, problems eating almost everything. 

One thing that makes me cringe is "I've only lost xx." That "only" negates the hard work, takes away from the success and demeans the person. I hate it. And I see lots of people doing it. I will not. I will give myself credit for working hard, and I'll claim my success. 

Another thing that makes me cringe is reading stories about the horrid things some people have had said to them, things like "I knew someone who had weight-loss surgery and they died" or "I know someone who gained all her weight back." Here's how I think about it. If a friend were diagnosed with breast cancer, would you tell her about the people you know who died of breast cancer — or about success stories you know of? Wouldn't you cheer her on and hope for the best?

Yes, it's possible to die from weight-loss surgery — but the fact is, most people don't. Yes, it's possible to regain all of your weight — but not everyone will. I expect to carefully consider everything I put in my mouth for the rest of my life. Everything, every time. Does it support my health? Will it move me toward my goal? If not, what are the impacts and am I willing to live with the consequences? 

Maybe I'm wrong. Maybe all of my early hard work will pay off in creating habits that will last without effort — but I'm not counting on it. I'm prepared to work for my life, for the rest of my life.