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.
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.
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.
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.
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.
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.
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.
