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.