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.