Off with the Old: My Gastric Bypass & the Lessons I've Learned From the Process

On the eve of more changes!

2011-05-31T14:57:00.000-07:00

Time for an update!

It's been 9½ months since my gastric bypass surgery. It has been a bumpy ride right from the start. During my RNY GB surgery they found an 11-pound benign ovarian tumor in my abdomen that really messed with me mentally. I realize now that I allowed the tumor to be a distraction, and that lesson is very valuable to me even though I'm not certain today how I could have avoided worrying about it as much as I did. I also had to have a small hernia repair that my bariatric surgeon said she would repair (and didn't) during my surgery. Having 3 surgeries in 7 months was definitely a challenge, but trying to start an exercise regimen has also been very difficult.

Mollie Linden, 2010

As of today, I've lost 87 pounds and gained 6 (a net loss of 81 pounds as of today)! I'm no longer diabetic (my HgA1C is 4.7), or hypertensive (my BP is normally 110/60 - 106/56), and my cholesterol levels are all exactly where they should be. I'd really like to reach the "minus 100 pound mark" by my gastric bypass anniversary on 8/11/10. And, as my recently departed and much loved grand-mother Mollie would say, "God willing..." I'll be successful. Granny was wise and loving, and once told me that it didn't matter to her if I was fat or thin. She only wished, sincerely wished, for me to be happy. Considering how ill I was when my journey started, I feel lucky and (finally) very happy to be where I am. I do have to work daily to avoid falling into the trap of wishing I'd lost more weight at this point, and it can be challenging when I look at people who have lost more than me who started when I did. But my mantra of late, is "stick to modest and attainable goals".

One thing that's halped me immensly, is a change in doctors. I've moved my care to a really great bariatric clinic that specializes in weight loss and weight loss surgery. My new doctor is credited with bringing gastric bypass surgery to the Pacific Northwest, and has a long and impressive list of accomplishments, training and education. As important to me though, is having a kind, open and patient doctor to work with. Dr. P. is not only accomplished, but caring and warm. This is only my opinion, but as far as I'm concerned it wasn't too difficult to find a bariatric surgeon who is "good". It was a little trickier though, to find one who is good and also caring, kind, patient and professional.

Dr. P.'s kindness and warmth were especially evident when I expressed my concerns about my 3-month long "plateau" and weight gain of 6 pounds. I emotionally explained that my weight was stuck in between 6-pounds, and nothing I was doing seemed to make the difference. Evidently this is common, easily explained, and not abnormal. She said I was likely suffering from a still-slow metabolism, and that medications can help initially in speeding up the metabolism! Before my surgery my metabolism was only operating at 64% of predicted for my height, weight and age. She's sent me to have a bone density scan done and a metabolic study done. And now I find myself on the eve of my first meeting with one of Dr. P.'s partners, a bariatric endocrinologist and specialist in metabolic matters for post-op weight loss patients. Hopefully, Dr. R. will help me figure out the next step to take to move from stuck to GO! My fingers are crossed!

More to come...

All about Gas

2011-05-08T15:01:00.000-07:00

Not to be indelicate, but... there really isn't an easy way to launch into this topic daintily.

Gas (not the kind you put in your car, but the kind that originates in the intestines) is one of those topics discussed in the books, blogs, and support groups concerning gastric bypass. By the time we've had our surgery, most of us have been warned that things would will change for us post-op . At its best, gas is embarrassing for most of us to discuss even though we realize that it's a natural process. At its worst - in the months after surgery, some people experience gas as an extremely unpleasant, sometimes worrisome and occasionally incapacitating obstacle to manage. I've even heard of people who feel they can't leave their homes for fear of, well you know...

Every book written about gastric bypass and post-op expectations covers the topic of flatulence. When I began experiencing gas in a "new" way for me, I was mortified! Initially, I complained to my devoted and long-suffering husband until I realized that he was indeed suffering. For the comfort of my household, for my own edification, and for my readers who might also be experiencing this problem, I decided to research my options.

So - if you, too, need to learn more about gas and what to do about it, read on. I'll post here some excerpts from some of the best WLS-oriented blogs, along with links to some of the best documented solutions. So grab your can of Febreze™, and read on...

Where does gas come from?

Where does gas come from? This post was written on the Thinner Times Forum by user "Pekkale", with several small edits by me, and answers this question better than most.

The average person expels gas 14 times every day. The amount of actual gas released ranges from as little as one cup to as much as one half gallon per day. Gas is made primarily of odorless vapors such as carbon dioxide, oxygen, nitrogen, hydrogen, and sometimes methane. The unpleasant odor of flatulence comes from bacteria in the large intestine that release small amounts of gases that contain hydrogen sulfide (sulfur smell). Contrary to popular belief, women have just as many passages as men, and older people, have no more gas than younger individuals.

Flatulence occurs when a food does not break down completely in the stomach and small intestine. As a result, the food makes it into the large intestine in an undigested state. Lower intestinal gas is produced when bacteria in your colon ferment carbohydrates that aren't digested in your small intestine. The body does not digest and absorb certain carbohydrates in the small intestine because of a shortage or absence of certain enzymes.

This undigested food then passes from the small intestine into the large intestine, where normal, harmless bacteria break down the food, producing gases such as hydrogen, carbon dioxide, and in about one-third of all people, methane. As much as 80 to 90 percent of rectal gas (flatulence) is formed by bacteria. Eventually these gases exit through the rectum.

Certain foods produce more flatulence than others because they contain more indigestible carbohydrates than others. Beans are well known gas producers. The beans pass through the small intestine and arrive in the large intestine without being digested, which causes flatulence to occur.

Unfortunately, healthy foods such as fruits, vegetables, oatmeal and legumes (beans and peas) are often the worst offenders. That's because these foods are high in soluble fiber. Soluble fiber dissolves in water forming a gelatinous substance in the bowel. Fiber has many health benefits, including keeping your digestive tract in good working order, regulating blood sugar and cholesterol levels, and helping prevent heart attacks and other heart problems. But it can also lead to the formation of gas. In the colon the bacteria thrive on indigestible fiber. These bacteria are harmless but for those who have an intestinal gas or flatus problem it is probably best to avoid or carefully test soluble fibers to see if they are contributing to intestinal gas. On the other hand, the insoluble fiber found in wheat, rye, bran, and other grains does not dissolve in water, and is not used by intestinal colon bacteria as a food source, so these bacteria generally do not produce intestinal gas. Both soluble and insoluble fiber should be eaten on daily basis.

Sugars are known to create gas. Fructose is naturally present in onions, artichokes, pears, and wheat. It is also used as a sweetener in some soft drinks and fruit drinks. Sorbitol is a sugar found naturally in fruits, including apples, pears, peaches, and prunes. It is also used as an artificial sweetener in many dietetic foods and sugar-free candies and gums.

FOODS THAT CAUSE GAS*
Beans	Vegetables	Fruits	Beverages	Wholegrains	Packaged Foods
Dried Baked Canned Refried Soy beans Lima beans Seeds Nuts Peas	Cabbage, radishes, onions, broccoli, brussel sprouts, cauliflower, cucumber, sauerkraut, kohlrabi, asparagus, potatoes, peppers, corn, lettuces,	Prunes; apricots; apples; raisins; bananas	Soft drinks, fruit drinks Milk* *Milk products: Cheese, Ice cream, cottage cheese, yogurt	Whole wheat, Oat bran,	Look out for foods w/ lactose: Like bread cereals &, salad dressing Foods w/ Sorbitol: Like dietetic or sugar-free candy/gum

*Table by Lynn Falkow-Short

From an excellent and dynamic website, www.LiveStrong.com, I found this outstanding article:

5 Things You Need to Know About Excess Gas From Gastric Bypass

1. Clear a Crowded Room
Many people with gastric bypass surgery claim that the gas not only builds up, but that it slips out of the body without control. This type of reaction may be embarrassing but it is a lot better than pain that distention can cause from built up gas. Gastric bypass surgery does two things. It makes the stomach smaller, frequently the size of a walnut, and it removes a portion of the intestines so that the food goes through undigested.

2. Really Rotten

If the quality of air around you would not pass the clean air test, it may be for several reasons. The first is the missing intestines. Gastric bypass surgery may push food through the intestines without digesting it. This is because the surgery removed a portion of intestine. This is a part of the digestive system also. The food then moves on not digested and begins to decompose in the lower intestine. Decomposition causes gas to form. Gas forms and has to go somewhere.

3. Check the Food

You may not experience problems with gas all the time. Many people find that certain foods bring on gas attacks. Omit normally gaseous foods from the diet, like carbonated soda and milk products. The stomach is not working in full force and many of the digestive enzymes necessary may not be present. Try taking additional food enzymes and acidophilus for the gas.

4. Pop a Beano (or Gas-X Prevention) Before a Meal

Gas tablets and Beano® after a gastric bypass may become your favorite mealtime addition. If you find that enzymes and acidophilus work, go directly to the Beano or gas tablets to reduce the amount of gas you produce. Gas tablets are good after the fact for unexpected attacks. Beano used on a regular basis can reduce the gas created by the food.

5. Take a Walk and Eat Some Fiber

Exercise is one of the best ways to reduce the amount of gas after a gastric bypass surgery. The increased exercise pushes the additional gas through the system and out. Walking in the great out of doors is a super place to allow the body build-up to escape. Also, try a little extra fiber in the diet to keep the intestinal area clean and free of rotting material that can create gaseous expulsion.

Read more: http://www.livestrong.com/article/9550-need-excess-gas-from-gastric/#ixzz1CnaQInfX

Copyright © 2011 Demand Media, Inc. Use of this web site constitutes acceptance of the LIVESTRONG.COM Terms of Use and Privacy Policy. The material appearing on LIVESTRONG.COM is for educational use only. It should not be used as a substitute for professional medical advice, diagnosis or treatment.  

More information about Gas:

Products to Consider

It makes sense to consider the following products carefully, and proceed only with your doctors advice about taking any of the specific products listed below.

Beano® is a food enzyme dietary supplement manufactured by GlaxoSmithKline, that contains Alpha-galactosidase. Personally, I have found it to be exceptional in managing my particular gas-related issues. Beano Website (www.beanogas.com)

Gas-X Prevention™ is a product with the same active ingredient in Beano, and is made by the makers of Gas-x (Novartis). Each capsule contains twice as much enzyme as found in a capsule of Beano (but remember, everyone is different, and therefore more enzyme may not be better). Gas-x Prevention Website (www.gas-x.com)

Simethicone is a generic medication found in numerous over the counter preparations including: Phazyme; Flatulex; Mylicon;

Gas-X (not to be confused with Gas-X Prevention); Mylanta Gas,

and many more.

Phazyme

Mylanta Gas

Flatulex Information Hub

Addiction to food...

2010-12-12T22:00:00.000-08:00

So it turns out that I am addicted to food.

OK, so that might not surprise the people around me, but it came as a little bit of a surprise to me. One of my favorite weight loss surgery authors, Paula Peck, RN in her book Exodus from Obesity, starts a chapter with a quote from Anatomy of Food Addiction like this:

"....For some of us however, food is like a lifeline, as essential tool in our survival kit. It takes us away from stress, it numbs our fears an worries and it stops the world and lets us get off. It is a womb, a haven, a cave, an escape and a refuge.

Eating is an automatic response to feelings- so quickly applied without thought - that breaking this pattern takes tremendous sustained effort. If food has become a cornerstone and the cornerstone has been removed, an equally strong foundation must replace it.

With time, with an investment in your weight loss and with new habits of lifestyle, your mood lifts and life seems sweeter. The pain that eating has masked now is exposed and we no longer can use food to help us cope. The real work now, is in dealing with our pain without using food as an emotional bandage."

Anatomy of a Food Addiction

I'm finding this topic in the weight loss surgery books that I have come to depend on so much, to be the most difficult to address. I have learned that, "...The pain that eating has masked now is exposed and I no longer can use food to help me cope. The real work now, is in dealing with my pain without using food as an emotional bandage". For me, I am discovering that food has been my "essential tool... taking me away from my stress and numbing my fears and worries...". Right now I am working toward going back to work. Unfortunately, my original position was given away, and now nearly 11 months later, my department is suffering from the impact of the current economic down-turn and is unable to take me back or even keep the same number of positions that they had a year ago. I'm looking for work, and have found several exciting positions to apply for, but the stress of lookingy is effecting me. Even with a couple of potential employers scheduled to interview me, I still feel worried. I can tell when I begin to focus on all of the what-ifs that I see as related to looking for work - what if I don't find anything? What if I can't pay my bills? What if my fibromyalgia keeps flairing up and I can't go back to work? I could go on and on.

I have never been really emotionally solid as things relate to money. I worry. I always have as it relates to money. I seem to always want a little bit more of a cushion - a small stash of money that I know will be there in an emergency -- but now especially, while I've been "disabled temporarily" that cushion is not there.

At the same time, I know that things will be OK. They always have been, and often that's been true regardless of how much I worried, ruminated, stressed or freaked out.

::Sigh::
More on this topic later...

Rules of the Pouch

2010-12-12T06:33:00.000-08:00

Pouch Rules
Original article written by: Mason. EE, Personal Communication, 1980. Barber. W, Diet al, Brain Stem Response To Phasic Gastric Distention. Am J. Physical 1983: 245(2): G242-8 Flanagan, L. Measurement of Functional Pouch Volume Following the Gastric Bypass Procedure. Ob Surg 1996; 6:38-43 "Dummies" version rewritten by Sally Perez originally for a support group she was involved in.

INTRODUCTION:
A common misunderstanding of gastric bypass surgery is that the pouch causes weight loss because it is so small, the patient eats less. Although that is true for the first six months, that is not how it works. Some doctors have assumed that poor weight loss in some patients is because they aren't really trying to lose weight. The truth is it may be because they haven't learned how to get the "satisfied" feeling of being full to last long enough.

HYPOTHESIS OF POUCH FUNCTION:
We have four educated guesses as to how the pouch works:
1) Weight loss occurs by actually "slightly stretching" the pouch with food at each meal or; 2) Weight loss occurs by keeping the pouch tiny through never ever overstuffing; or
3) Weight loss occurs until the pouch gets worn out and regular eating begins or;
4) Weight loss occurs with education on the use of the pouch.

PUBLISHED DATA:
How does the pouch make you feel full?
The nerves tell the brain the pouch is distended and that cuts off hunger with a feeling of fullness.

What is the fate of the pouch? Does it enlarge? If it does, is it because the operation was bad, or the patient is overstuffing themselves, or does the pouch actually re-grow in a healing attempt to get back to normal?
For ten years, I had patients eat until full with cottage cheese every three months, and report the amount of cottage cheese they were able to eat before feeling full. This gave me an idea of the size of their pouch at three month intervals. I found there was a regular growth in the amount of intake of every single pouch. The average date the pouch stopped growing was two years. After the second year, all pouches stopped growing. Most pouches ended at 6 oz., with some as large at 9-10 ozs. We then compared the weight loss of people with the known pouch size of each person, to see if the pouch size made a difference. In comparing the large pouches to the small pouches, THERE WAS NO DIFFERENCE IN PERCENTAGE OF WEIGHT LOSS AMONG THE PATIENTS. This important fact essentially shows that it is NOT the size of the pouch but how it is used that makes weight loss maintenance possible.

OBSERVATIONAL BASED MEDICINE:
The information here is taken from surgeon's "observations" as opposed to "blind" or "double blind" studies, but it IS based on 33 years of physician observation.

Due to lack of insurance coverage for WLS, what originally seemed like a serious lack of patients to observe, turned into an advantage as I was able to follow my patients closely. The following are what I found to effect how the pouch works:
1. Getting a sense of fullness is the basis of successful WLS.
2. Success requires that a small pouch is created with a small outlet.
3. Regular meals larger than 1½ cups will result in eventual weight gain.
4. Using the thick, hard to stretch part of the stomach in making the pouch is important.
5. By lightly stretching the pouch with each meal, the pouch send signals to the brain that you need no more food.
6. Maintaining that feeling of fullness requires keeping the pouch stretched for a while.
7. Almost all patients always feel full 24/7 for the first months, then that feeling disappears.
8. Incredible hunger will develop if there is no food or drink for eight hours.
9. After 1 year, heavier food makes the feeling of fullness last longer.
10. By drinking water as much as possible as fast as possible ("water loading"), the patient will get a feeling of fullness that lasts 15-25 minutes.
11. By eating "soft foods" patients will get hungry too soon and be hungry before their next meal, which can cause snacking, thus poor weight loss or weight gain.
12. The patients that follow "the rules of the pouch" lose their extra weight and keep it off.
13. The patients that lose too much weight can maintain their weight by doing the reverse of the "rules of the pouch."

HOW DO WE INTERPRET THESE OBSERVATIONS?
POUCH SIZE:
By following the "rules of the pouch," it doesn't matter what size the pouch ends up. The feeling of fullness with 1 ½ cups of food can be achieved.

OUTLET SIZE:
Regardless of the outlet size, liquidity foods empty faster than solid foods. High calorie liquids will create weight gain.

EARLY PROFOUND SATIETY:
Before six months, patients much sip water constantly to get in enough water each day, which causes them to always feel full.

After six months, about 2/3 of the pouch has grown larger due to the natural healing process. At this time, the patient can drink 1 cup of water at a time.

OPTIMUM MATURE POUCH:
The pouch works best when the outlet is not too small or too large and the pouch itself holds about 1 ½ cups at a time.

IDEAL MEAL PROCESS (rules of the pouch):
  1. The patient must time meals five hours apart or the patient will get too hungry in between.
  2. Stay full by slowing the emptying of the pouch. (Eat solids. No liquids 15 minutes before and none until 1 ½ hours after the meal). A scientific test showed that a meal of egg/toast/milk had almost all emptied out of the pouch after 45 minutes. Without milk, just egg and toast, more than ½ of the meal still remained in the pouch after 1 ½ hours.
  3. The patient must eat the entire meal in 5-15 minutes. A 30-45 minute meal will cause failure.
  4. No liquids for 1 ½ hours to 2 hours after each meal.
  5. After 1 ½ to 2 hours, begin sipping water and over the next three hours slowly increase water intake.
  6. 3 hours after last meal, begin drinking LOTS of water/fluids.
  7. 15 minutes before the next meal, drink as much as possible as fast as possible. This is called "water loading," IF YOU HAVEN'T BEEN DRINKING OVER THE LAST FEW HOURS, THIS 'WATER LOADING' WILL NOT WORK.
  8. You can water load at any time 2-3 hours before your next meal if you get hungry, which will cause a strong feeling of fullness.

THE MANAGEMENT OF PATIENT TEACHING AND TRAINING:
You must provide information to the patient preoperatively regarding the fact that the pouch is only a tool: a tool is something that is used to perform a task but is useless if left on a shelf unused. Practice working with a tool makes the tool more effective.

NECESSITY FOR LONG TERM FOLLOW-UP:
Trying to practice the "rules of the pouch" before six to 12 months is a waste. Learning how to delay hunger if the patient is never hungry just doesn't work. The real work of learning the "rules of the pouch" begins after healing has caused hunger to return.

PREVENTION OF VOMITING:
Vomiting should be prevented as much as possible. Right after surgery, the  patient should sip out of 1 oz cups and only 1/3 of that cup at a time until the patient learns the size of his/her pouch to avoid being sick. It is extremely difficult to learn to deal with a small pouch. For the first 6 months, the patent's mouth will literally be bigger than his/her stomach, which does not exist in any living animal on earth.  In the first six weeks the patient should slowly transfer from a liquid diet to a blenderized or soft food diet only, to reduce the chance of vomiting. Vomiting will occur only after eating of solid foods begins. Rice, pasta, granola, etc., will swell in time and overload the pouch, which will cause vomiting. If the patient is having trouble with vomiting, he/she needs to get 1 oz cups and literally eat 1 oz of food at a time and wait a few minutes before eating another 1 oz of food. Stop when "comfortably satisfied," until the patient learns the size of his/her pouch.

SIX WEEKS:
After six weeks, the patient can move from soft foods to heavy solids. At this time, they should use three or more different types of foods at each sitting. Each bite should be no larger than the size of a pinkie fingernail bed. The patient should choose a different food with each bite to prevent the same solids from lumping together. No liquids 15 minutes before or 1 ½ hours after meals.

REASSURANCE OF ADEQUATE NUTRITION:
By taking vitamins everyday, the patient has no reason to worry about getting enough nutrition. Focus should be on proteins and vegetables at each meal.

MEAL SKIPPING:
Regardless of lack of hunger, patient should eat three meals a day. In the beginning, one half or more of each meal should be protein, until the patient can eat at least two oz of protein at each meal.

ARTIFICIAL SWEETENERS:
In our study, we noticed some patients had intense hunger cravings which stopped when they eliminated artificial sweeteners from their diets.

AVOIDING ABSOLUTES:
Rules are made to be broken. No biggie if the patient drinks with one meal - as long as the patient knows he/she is breaking a rule and will get hungry early. Also if the patient pigs out at a party - that's OK because before surgery, the patient would have pigged on 3000 to 5000 calories and with the pouch, the patient can only pig on 600-1000 calories max. The patient needs to just get back to the rules and not beat him/herself up.

THREE MONTHS:
At three months, the patient needs to become aware of the calories per gram of different foods to be aware of "the cost" of each gram (cheddar cheese is 16 cal/gram; peanut butter is 24 cals/gram). As soon as hunger returns between three to six months, begin water loading procedures.

THREE PRINCIPLES FOR GAINING AND MAINTAINING SATIETY:
  1. Fill pouch full quickly at each meal
  2. Stay full by slowing the emptying of the pouch. (Eat solids. No liquids 15 minutes before and none until 1 ½ hours after the meal). A scientific test showed that a meal of egg/toast/milk had almost all emptied out of the pouch after 45 minutes. Without
milk, just egg and toast, more than ½ of the meal still remained in the pouch after 1 ½ hours.
  3. Protein, protein, protein. Three meals a day. No high calorie liquids.

FLUID LOADING:
Fluid loading is drinking water/liquids as quickly as possible to fill the pouch which provides the feeling of fullness for about 15 to 25 minutes. The patient needs to gulp about 80% of his/her maximum amount of liquid in 15 to 30 SECONDS. Then just take swallows until fullness is reached. The patient will quickly learn his/her maximum tolerance, which is usually between 8-12  oz.

Fluid loading works because the roux limb of the intestine swells up, contracting and backing up any future food to come into the pouch. The pouch is very sensitive to this and the feeling of fullness will last much longer than the reality of how long the pouch was actually full. Fluid load before each meal to prevent thirst after the meal as well as to create that feeling of fullness whenever suddenly hungry before meal time.

POST PRANDIAL THIRST:
It is important that the patient be filled with water before his/her next meal as the meal will come with salt and will cause thirst afterwards. Being too thirsty, just like being too hungry will make a patient nauseous. While the pouch is still real small, it won't make sense to the patient to do this because salt intake will be low, but it is a good habit to get into because it will make all the difference once the pouch begins to regrow.

URGENCY:
The first six months is the fastest, easiest time to lose weight. By the end of the six months, 2/3 of the regrowth of the pouch will have been done. That means that each present day, after surgery you will be satisfied with less calories than you will the very next day. Another way to put it is that every day that you are healing, you will be able to eat more. So exercise as much as you can during that first six months as you will never be able to lose weight as fast as you can during this time.

SIX MONTHS:
Around this time, our patients begin to get hungry between meals. THEY NEED TO BATTLE THE EXTRA SALT INTAKE WITH DRINKING LOTS OF FLUIDS IN THE TWO TO THREE HOURS BEFORE THEIR NEXT MEAL. Their pouch needs to be well watered before they do the last gulping of water as fast as possible to fill the pouch 15 minutes before they eat.

INTAKE INFORMATION SHEET AS A TEACHING TOOL:
I have found that having the patients fill out a quiz every time they visit reminds them of the rules of the pouch and helps to get them "back on track." Most patients have no problems with the rules, some patients really struggle to follow them and need a lot of support to "get it", and a small percentage never quite understand these rules, even though they are quite intelligent people.

HONEYMOON SYNDROME:
The lack of hunger and quick weight loss patients have in the first six months sometimes leads them to think they don't need to exercise as much and can eat treats and extra calories as they still lose weight anyway. We call this the "honeymoon syndrome" and they need to be counseled that this is the only time they will lose this much weight this fast and this easy and not to waste it by losing less than they actually could. If the patients weight loss slows in the first six months, remind them of the rules of water intake and encourage them to increase their exercise and drink more water. You can compare their weight loss to a graph showing the average drop of weight if it will help them to get back on track.

EXERCISE:
In addition to exercise helping to increase the weight loss, it is important for the patient to understand that exercise is a natural antidepressant and will help them from falling into a depression cycle. In addition, exercise jacks up their metabolic rate during a time when their metabolism after the shock of surgery tends to want to slow down.

THE IDEAL MEAL FOR WEIGHT LOSS:
The ideal meal is one that is made up of the following: ½ of your meal to be low fat protein, ¼ of your meal low starch vegetables and ¼ of your meal solid fruits. This type of meal will stay in your pouch a long time and is good for your health.

VOLUME VS. CALORIES:
The gastric bypass patient needs to be aware of the length of time it takes to digest different foods and to focus on those that take up the most space and take time to digest so as to stay in the pouch the longest, don't worry about calories. This is the easiest way to "count your calories." For example, a regular stomach person could gag down two whole sticks of butter at one sitting and be starved all day long, although they more than have
enough calories for the day. But you take the same amount of calories in vegetables, and that same person simply would not be able to eat that much food at three sittings - it would stuff them way too much.

ISSUES FOR LONG TERM WEIGHT MAINTENANCE:
Although everything stated in this report deals with the first year after surgery, it should be a lifestyle that will benefit the gastric bypass patient for years to come, and help keep the extra weight off.

COUNTER-INTUITIVENESS OF FLUID MANAGEMENT:
I admit that avoiding fluids at meal time and then pushing hard to drink fluids between meals is against everything normal in nature and not a natural thing to be doing. Regardless of that fact, it is the best way to stay full the longest between meals and not accidentally create a "soup" in the stomach that is easily digested.

SUPPORT GROUPS:
It is natural for quite a few people to use the rules of the pouch and then to tire of it and stop going by the rules. Others "get it" and adhere to the rules as a way of life to avoid ever regaining extra weight. Having a support group makes  all the difference to help those that go astray to be reminded of the importance of the rules of the pouch and to get back on track and keep that extra weight off. Support groups create a "peer pressure" to stick to the rules that the staff at the physician's office simply can't create.

TEETER TOTTER EFFECT:
Think of a teeter totter suspended in mid air in front of you. Now on the left end is exercise that you do and the right end is the foods that you eat. The more exercise you do on the left, the less you need to worry about the amount of foods you eat on the right. In exact reverse, the more you worry about the foods you eat and keep it healthy
on the right, the less exercise you need on the left. Now if you don't concern yourself with either side, the higher the teeter totter goes, which is your weight. The more you focus on one side or the other, or even both sides of the teeter totter, the lower it goes, and the less you weigh.

TOO MUCH WEIGHT LOSS:
I have found that about 15% of the patients which exercise well and had between 100 to 150 lbs to lose, begin to lose way too much weight. I encourage them to keep up the exercise (which is great for their health) and to essentially "break the rules" of the pouch. Drink with meals so they can eat snacks between without feeling full and increase their fat content as well take a longer time to eat at meals, thus taking in more calories. A small but significant amount of gastric bypass patients actually go underweight because they have experienced (as all of our patients have experienced) the ravenous hunger after being on a diet with an out of control appetite once the diet is broken. They are afraid of eating again. They don't "get" that this situation is literally, physically different and that they can control their appetite this time by using the rules of the pouch to
eliminate hunger.

BARIATRIC MEDICINE:
A much more common problem is patients who after a year or two plateau at a level above their goal weight and don't lose as much weight as they want. Be careful that they are not given the "regular" advice given to any average overweight individual. Several small meals or skipping a meal with a liquid protein substitute is not the way to go for gastric bypass patients. They must follow the rules, fill themselves quickly with hard to digest foods, water load between, increase their exercise and the weight should come off much easier than with regular people diets.

SUMMARY:
  1. The patient needs to understand how the new pouch physically works.
  2. The patient needs to be able to evaluate their use of the tool, compare it to the ideal and see where they need to make changes.
  3. Instruct your patient in all ways (through their eyes with visual aids, ears with lectures and emotions with stories and feelings) not only on how but why they need to learn to   use their pouch. The goal is for the patient to become an expert on how to use the pouch.

EVALUATION FOR WEIGHT LOSS FAILURE:
The first thing that needs to be ruled out in patients who regain their weight is how the pouch is set up.
  1) the staple line needs to be intact;
  2) same with the outlet and;
  3) the pouch is reasonably small.

  1) Use thick barium to confirm the staple line is intact. If it isn't, then the food will go into the large stomach, from there into the intestines and the patient will be hungry all the time. Check for a little ulcer at the staple line. A tiny ulcer may occur with no real opening at the line, which can be dealt with as you would any ulcer. Sometimes, though, the ulcer is there because of a break in the staple line. This will cause pain for the patient after the patient has eaten because the food rubs the little opening of the ulcer. If there is a tiny opening at the staple line, then a reoperation must be done to actually separate the pouch and the stomach completely and seal each shut.

  2) If the outlet is smaller than 7-8 mill, the patient will have problems eating solid foods and will little by little begin eating only easy-to-digest foods, which we call "soft calorie syndrome." This causes frequent hunger and grazing, which leads to weight regain.

  3) To assess pouch volume, an upper GI doesn't work as it is a liquid. The cottage cheese test is useful - eating as much cottage cheese as possible in five to 15 minutes to find out how much food the pouch will hold. It shouldn't be able to hold more than 1 ½ cups in 5 - 15 minutes of quick eating.

If everything is intact then there are four problems that it may be:
  1) The patient has never been taught the rules;
  2) The patient is depressed;
  3) The patient has a loss of peer support and eventual forgetting of rules, or
  4) The patient simply refuses to follow the rules.

   1) LACK OF TEACHING: An excellent example is a female patient who is 62 years old. She had the operation when she was 47 years old. She had a total regain of her weight She stated that she had not seen her surgeon after the six week follow up 15 years ago. She never knew of the rules of the pouch. She had initially lost 50 lbs and then with a commercial weight program lost another 40 lbs. After that, she yo-yoed up and down, each time  gaining a little more back. She then developed a disease (with no connection to bariatric surgery) which weakened her muscles, at which time she gained all of her weight back. At the time she came to me, she was treated for her disease, which helped her to begin walking one mile per day. I checked her pouch with barium andthe cottage cheese test which showed the pouch to be a small size and that there was no leakage.  She was then given the rules of the pouch. She has begun an impressive and continuing weight loss, and is not focused on food as she was, and feeling the best she has felt since the first months after her operation 15 years ago.

   2) DEPRESSION: Depression is a strong force for stopping weight loss or causing weight gain. A small number of patients, who do well at the beginning, disappear for a while only to return having gained a lot of weight. It seems that they almost on purpose do exactly opposite of everything they have learned about their pouch: they graze during the day, drink high calorie beverages, drink with meals and stop exercising, even though they know exercise helps stop depression. A 46 year-old woman, one year out of her surgery had been doing fine when her life was turned upside down with divorce and severe teenager behavior problems. Her weight skyrocketed. Once she got her depression under control and began refocusing on the rules of the pouch, added a little exercise, the weight came off quickly. If your patient begins weight gain due to depression, get him/her into counseling quickly. Encourage your patient to refocus on the pouch rules and try to add a little exercise every day.

Reassure your patient that he/she did not ruin the pouch, that it is still there, waiting to be used to help with weight control. When they are ready the pouch can be used once again to lose weight without being hungry.

     3) EROSION OF THE USE OF PRINCIPLES: Some patients who are compliant, who are not depressed and have intact pouches, will begin to gain weight. These patients are struggling with their weight, have  usually stopped connecting with their support groups, and have begun living their "new" life surrounded by those who have not had Bariatric surgery. Everything around them encourages them to live life "normal" like their new peers: they begin taking little sips with their meals, and eating quick and easy-to-eat foods. The patient will not usually call their physician's office because they KNOW what they are doing is wrong and KNOW that they just need to get back on track. Even if you offer "refresher courses" for your patients on a yearly basis, they may not attend because they KNOW what the course is going to say, they know the rules and how they are breaking them. You need to identify these patients and somehow get them  back into your office or back to interacting with their support group again.

Once these patients return to their support group, and keep in contact with their WLS peers, it makes it much easier to return to the rules of the pouch and get their weight under control once again.

   4) TRUE NONCOMPLIANCE: The most difficult problem is a patient who is truly noncompliant. This patient usually leaves your care, complains that there is no 'connection' between your staff and themselves and that they were not given the time and attention they needed. Most of the time, it is depression underlying the non-compliance that causes this attitude. A truly noncompliant patient will usually end up with revisions and/or reversal of the surgery due to weight gain or complications. This patient is usually quite resistant to counseling. There is not a whole lot that can be done for these patients as they will find a reason to be unhappy with their situation. It is easier to identify these patients BEFORE surgery than to help them afterwards, although I really haven't figured out how to do that yet. Besides having a psychological exam done before surgery, there is no real way to find them before surgery and I usually tend toward the side of offering patients the surgery with education in hopes they can live a good and healthy life.

Gastric Bypass Hair Loss: Resources

2010-12-08T06:40:00.000-08:00

Gastric Bypass Hair Loss: Grow It Back With Scalp Massage
This is a great video from the wonderful website: Gastric Bypass Truth

Articles about Hair Loss for Post Surgery Bariatric Patients
Gastric Bypass Truth: Tips for Losing Less Hair & Regrowth

E Zine Articles: Hair Loss

Does Nioxin Work as a Treatment For Hair Loss After Gastric Bypass Surgery?
Link to the following article from Factiod.com

**The following article is from a great website called Factoids.com. To participate ask additional questions about this article, go to the link above, and scroll to the bottom of the page. Meanwhile, the product mentioned in the title of this article is a hair treatment called Nioxin. Scroll down further for links to the Nioxin website.**

You are most-likely aware that having Bariatric or Gastric Bypass surgery DOES cause you to experience some type of hair loss as you lose the weight so rapidly. Youve heard the rumors, and they are TRUE to the point that you WILL LOSE some hair but you will not be bald in the least! In all of my years attending a support group, NEVER have I seen one bald person yet! So rest assured that although you DO lose some hair, it wont be all.

Lets simplify this topic by putting it in a question/answer format:

Q: Why do we lose some hair?
A: As a pre-op person, you used to consume between 3,000 to 5,000 calories a day. But once you have the surgery, your caloric intake is drastically reduced to a mere 300-600 calories a day. This puts the body in an emergency mode as it thinks something is terribly wrong, and it begins to focus ONLY on supporting the vital organs that will sustain life. Hair has never been under the category of a life-sustaining organ; therefore, the body puts the hair on the back-burner until it is sure that the body is going to be okay enough to again send nutrients to the hair.

Q: When does hair loss begin?
A: It normally will begin anywhere from one month after surgery and last until about 6 months after surgery. Of course, this can begin during the third month or even extend beyond the sixth month. It varies from person to person.

Q: How much hair is lost?
A: Some will jokingly tell you that they could build a cat out of all the hair they lost, but that is not true. While you will notice some handfuls come out as you wash your hair in the shower, see more than normal in your comb or hairbrush, and perhaps even see some on your pillow when you wake up in the morning — this is nothing to be alarmed over. IT WILL STOP FALLING OUT once the body begins to feel that life is normal and it will trust that its okay to send nutrients to the hair again. Be patient and know that it DOES STOP in time.

There ARE some TIPS that will help you NOT experience so much hair loss, however..

DO NOT wear a hat, scarf, head bands, tight barrettes, ponytail holders or anything similar that will pull or tug on the follicles of your hair. Pulling and pushing on the hair weakens it when it is already eager to fall out. Avoid these items for at least the first six months after surgery.

DO NOT stress the hair with hot treatments such as hairdryers, curling irons, or hot rollers. Stand in front of a fan to dry your hair in a hurry and use good hair jells to create some curl if you want. Sprays are okay too. Even hair color is okay IF you do it sparingly rather than the standard automatic every 6 weeks. Try to go 8 weeks in between hair coloring. Perms are a bit more stressful, though some have had success doing them. Youll have to judge this for yourself as you evaluate this for yourself. You can always be confident in asking your hairdresser about it if you are not sure.

DO TRY a new hair style. As heavy people, we often relied on our hairs BEST looks to draw attention away from our extra pounds. But as you are losing, people arent noticing your hair anymore they are noticing the pounds falling off, which is a perfect time for you to consider totally changing your hair style IF it will help you manage it better and also keep more of it on your head. Long hair is a heaviness on the head, which does stress and pull at the hair follicles. So perhaps a shorter style would help your delicate hair stay ON the head. Just as your body is experiencing a makeover, why not consider your hairstyle as well. Especially if it will help you KEEP more hair?

DO TRY a product called NIOXIN that you can purchase from your beauty salon. Its a three-step process of a product that helps cancer patients keep more of their hair as it falls out. It strengthens the follicles. I personally used this product, and I fully believe it helped more of my hair stay attached than what might have happened had I not used it. I noticed a remarkable difference when I used this product. And I can tell you that others also have similar testimonials on this product.

DO TRY to remember that your hair is only falling out temporarily and it will soon STOP and STAY ON again! Some people have experienced that their hair soon becomes healthier than theyve ever had before! Sometimes the texture even changes. Sounds FUN, huh? It can be!

BOTTOM LINE: Have a GOOD ATTITUDE about your hair take care of it, baby it, and youll find that youll be out of that FALLING OUT Zone shortly! Todays hairstyles ARE more relaxed, and with the right cut, youll look just as glamorous as a celebrity! Dont despair. Just know that were NOT a group of baldies!

Nioxin Website

More Hair Care, Regrowth and Prevention info coming soon!

Hair, and the loss of it....

2010-11-23T00:42:00.000-08:00

Today is day 92 since my gastric bypass, and I've lost a total of 80 pounds.

I've been reading a great deal lately, in the book I mentioned in my last post, and also a book called Fat No More - Long Term Success Following Weight Loss Surgery by Gail Engebretson & Robert Magnan. What a great and oh, so reassuring book to read at this point in my process! Why, you might ask? Because I'm finally at the point when my weight loss isn't all singing and dancing with hardly any effort being exerted. It's suddenly gotten more difficult!

It all started a few days ago when I noticed more than the usual amount of hair in my brush. It happened the next day, and the next! When I washed my hair, even more was in the drain! I knew this normally could happen between the 4th and 7th month most often. I'm a little early (always the early bloomer), but there's no question - my decrease in hair is here. I'm telling myself that thinner hair is not as big a deal as walking around with 80 more pounds on me, and the health benefits are completely worth it, but geez.... my hair? ::Sigh:: bummer.

I'm also noticing that I'm hungry more often lately. I have been losing weight, but more slowly, and I am concerned that I've gotten lazy - I'm not calculating precisely the protein I'm eating, I'm more guessing. I'm eatting plenty I think - but I know I should be planning ahead, not counting backward and guessing at the protein amounts! Fortunately, Engebretson's book addresses these and many other obstacles that frequently befall post-weight loss surgery patients.

My plan: write it all down again before I eat it and think about the big picture, talk to (or write to the gang at the WMI online support group and get some online support). If I've heard it once, I've heard it (or read it) a thousand times: - "...we're all in this together, to improve our health and to let go of our old, harmful habits..." And, I have to admit that I have learned that identifying problems and not sharing about them isn't especially constructive. There's no questions that support is a key factor in weight loss success. So - back to some healthy habits with renewed vigor.

It's late - more later...
But I'll celebrate for a moment my successes - I guess it's helpful to identify that 80 pounds is pretty good! *high fiving my supporters who read this*

Good night.

Clothes, 80 pounds, and a smaller size

2010-11-19T01:01:00.000-08:00

We all have something about ourselves that we wish we could change.
Sometimes you can, and sometimes you can't.
The important thing is to try.
by Kris Carr,
from Crazy Sexy Cancer

Somehow these words really struck me. Of course, the documentary Crazy Sexy Cancer was also really great, but these words, spoken by Kris at the end of the show, were so powerful I felt I needed to share them.

I *am* trying to make my efforts at losing weight really count. I'm down a little under 80 pounds (Yes, I said 80!) since my efforts to lose weight really started in June. I now weigh about 275.

So I'm getting ready to actually rejoin the work world, assuming I find someone who wants to hire me, and I'm facing something I hadn't really thought of. Clothes! I need something to wear for job interviews, and this morning I spent all of the very generous gift certificate that my mom bought me for this very purpose. Now normally, spending money on anything - even clothes - is not terribly difficult for me. I *like* spending money. But I have never really loved clothes shopping. That's probably why I've spent more time online shopping rather than going into a store and actually trying clothes on. What this whole experience brought up for me though, was recognizing that I've suffered from a lot of emotional pain related to the clothes topic. The struggle about how much I weight, what size I am, and often not being able to find anything that fits even in the "Big Girls" section, (or the "Big Girls store) store doesn't go away magically just because you've gotten a gastric bypass, I've learned.

This morning I was uncomfortable trying to figure out what to order! I had a gift certificate from an online/catalog clothing store to spend. I could guess what size I am. But I didn't really know. It didn't seem real that I could have lost sizes even though there was plenty of evidence that I've lost two sizes minimum. Finally I went in the bathroom and measured myself. I sat down and sent off my order with at least a little more data in hand, and at least I have some baseline measurements for future reference.

I'll plan to mention this at the support group, but I'm really glad that I bought the book by Connie Stapleton, Ph.D. entitled: Eat It Up! The Complete Mind/Body/Spirit Guide to a Full Life After Weight Loss Surgery. I'll provide a review once I've read it, but I'm finding that there are some emotional issues that are lingering from my still-fat mind. I knew this was coming, or something like this, it still caught me off guard, however.

I'm back in the saddle again, writing and thinking about the blog. I've got a few topics percolating, but I'd love some suggestions. Anyone have anything to discuss? Drop me a line if you do...

More soon!

It's official: I'm really no longer diabetic!

2010-10-04T19:46:00.000-07:00

I got a note in the mail today from my doctor. In it, my recent Hemoglobin A1C, a test that monitors blood sugar over time, showed that my A1C is better than it has ever been -- 5.4%!

For monitoring glucose control, the Hemoglobin A1C (written as HgA1C), is reported as a percentage. It is recommended that diabetics aim to keep their A1C below 7%. A non-diabetic person will have a reading between 4% and 6%. A diabetic reading is 6.5% or higher. A reading of 5.7% - 6.4% is cautionary for pre-diabetes, and in this case ones doctor may want to suggest careful management of diet to bring the blood sugar down below 5.6%!

With a reading of 5.4%, I'm feeling pretty proud!

MORE NEWS...

✔ Want more information about lab tests? Check out this website: http://www.labtestsonline.org

✔ Interested in reading about Bariatric Food Products? Check out the page entitled Other Useful Resources (see upper right corner on Home Page).

My Progress So Far...

2010-09-29T00:55:00.000-07:00

So it's been almost 7 weeks since my gastric bypass. Lots of really exciting things have happened already as a result of my surgery (aside from the issues related to my cyst), and it seems appropriate to celebrate these accomplishments.

The initial list of medical problems that I suffered from that lead me to the Weight Management Institute was frightening. But look! Some improvements are already evident, and this is only the beginning.

High blood pressure:

I still suffer from high blood pressure, but "my numbers" seem to be improving!

Chronic pain from osteoarthritis in my knees, ankles and low back:

✔Dramatic Improvement in all areas have been noted!

Non-insulin dependent diabetes:

✔My blood sugar is consistently excellent, and I am no longer on medication for my diabetes!

Chronic heartburn from GERD (gastro-esophageal reflux disease):

✔My heartburn and GERD are cured! No more heartburn pain or need for medication since the surgery!

Severe sleep apnea requiring the use of a C-PAP machine at night:

I continue to need the CPAP at this time, however as I continue to lose weight my doctor's suggest that this will likely change.

Impaired mobility - I was having difficulty getting around without a cane:

I am much more comfortable walking, and already I can get around most of the time without a cane except for longer distances.

Periodic venous stasis wounds on my legs requiring daily wound treatment and aggressive compression treatment ranging from compression hose to the use of a lymphedema pump.

✔No wounds since the surgery. Minimal episodes of swelling in my lower legs, though I do wear a less unpleasant form of compression most of the time.

All in all this is pretty exciting news. Today when I saw my dietician for my routine visit, we did a body composition test showing that while I am losing both muscle and fat (which is to be expected), even with minimal exercise I'm losing a solid amount of fat. My ultimate goal is to lose 3 pounds of fat for every 1 pound of muscle. Today I am at 1.75 pounds of fat for every 1 pound of muscle. This gives me a goal to work toward.

Other positive information from the session with the dietician: I can eat most things now as long as I am cautious about the food textures (apple skins, stringy veggies, dry or overcooked meats, etc.). Of course I am eating really small amounts of food, still. I am supplementing my diet with the same protein powder I used for the months before my surgery when I was on the "partial liquid diet".

I have lost 50.7 pounds since I started the "partial liquid diet" on 6/4/10. I broke the 300# mark on 9/27/10. Follow along for continued progress, and please join me in celebrating these exciting improvements in my weight loss efforts. I admittedly have a long way to go -- but it all seems possible to me now when I consider the progress I've made so far.

For those of you in my "fan club" who have been supporting my efforts - thank you so much!

Weird Little Things During Week 6

2010-09-27T17:52:00.000-07:00

I want gum -- and a Coke. And what the f--k is with the dreams about food?

This doesn't seem too deep, this topic. I'm sure that cravings and intensely vivid dreams about food are "normal" at this point in the process. It's just a little perplexing to me that it's all happening at once!

Before I was even totally committed to the idea of getting a gastric bypass, one of the dietician made a suggestion to the group about breaking bad food habits and planning ahead. She suggested that we use the time we had (at that I was into the program for about 2 months, but secretly wasn't completely committed to the actual surgery) to begin looking at habits like gum chewing, drinking carbonated beverages, or drinking highly caloric drinks in the form of Coke or juices. For those of us who had virtually months to go, this didn't seem too difficult, even though I was a gum chewer and a carbonated, high-calorie drink consumer.

Happily, luck was with me. I was able to quit drinking Coke, juices and even carbonated items by the time I was ready for surgery. But now, suddenly, I am faced with cravings for things I thought I'd put behind me. None of these things are something I can enjoy again -- it's not really safe to drink carbonation, or chew gum (especially since I am a gum swallower) after surgery. I guess these issues may continue to follow me as I accept my new lifestyle. The learning process for this is not a straight line, clearly, but something that will take time to wholly become a part of me. More to come on this topic I imagine....

Weight Loss Update: I am down a total of 50.4 pounds since my Bariatric Surgeon put me on the liquid diet and initiated the requirement of a 30 pound weight loss as mandatory before I could have surgery. I lost 27 pounds at the time we scheduled my GB surgery.

Cyst Update: I am scheduled for another big surgery again on October 6th for the removal of my ovarian cyst. More on this later....

This Too, Shall Pass...

2010-09-21T18:22:00.000-07:00

Initially, when I planned for my Gastric Bypass surgery, I spent a lot of my time writing in this blog. I felt, I think, that my blog would help me to be accountable to friends and family members who were keeping an eye on my progress. In a family with divorced parents, I felt this would be an option for keeping everyone kept "up-to-date", and of course my friends have tuned in as well.

After I returned to my room following the Gastric Bypass I learned very quickly about my ovarian cyst. Even before the extent of the cyst was discussed in detail with me, I felt somehow cheated and put in a place where I had to pay attention to something other than my weight loss. I had wanted to revel in the excitement of my "new life". I wanted to blog. I wanted to succeed. I wanted to focus on the emotional and psychological elements of having a gastric bypass. I wanted to exercise. And finally, I wanted to fully commit to the next phases of my weight loss experience without looking back.

One thing that has perplexed me and served as a real source of confusion is the fact that I have had so much difficulty moving on from the cyst. I haven't wanted to blog. I've worried, and dabbled in anger, fear, and even some unproductive emotions while trying to "move on". But its time. I am ready to move on. We've scheduled the date for the upcoming surgery for October 6, 2010.

My goal now is to visualize a healthy and successful move forward, an uneventful surgery with no surprises post-op. If you care to help, please visualize success along with me!

I continue to feel supported by my amazing group of doctors who generously work with me and one another. Many, many thanks to Drs. D; L; W; and my newly added gynecologist, Dr. S!

☺

23 Days Since Surgery - An Update

2010-09-03T16:52:00.000-07:00

Today I am 23 days from the date of my surgery. At more than 3 weeks post-op, I’d love to be able to say that my gastric bypass surgery experience really wasn’t so bad, but there were some unexpected things that turned up during my surgery that created a difference in how I have experienced my post-op recovery. Shortly after they began my surgery, they discovered that I have a very large ovarian cyst that is the size of a watermelon, and fills my entire abdominal space. This cyst is large and painful, as they often are. In my case the diagnosis explained a few things that had bothered me for a few months prior to my surgery. Without going into great detail, I had though that I was suffering from a bladder infection though the symptoms were inconsistent and didn’t completely point to a urinary tract infection. Nevertheless, I moved toward my surgery date imagining that my weird symptoms were pointing to nothing important.

Post-operatively I was pretty excited to find myself beyond my surgery. All of the hard work, tons of research, months of appointments, and positive thinking had brought me here – to this point. I was excited until I remembered being told that there was a cyst. A what?!

I was able to do everything I needed to do to get out of the hospital. I walked, swallowed pills, and drank on command. But I was also really anxious – it was this cyst – the knowledge that something else was in there, and it needed some medical attention.

I’m scheduled to have an abdominal ultrasound done followed by a visit to my gynecologist next week. I’ve been focused on getting this matter dealt with, although I’ve had to cancel each appointment once because I was still experiencing some post-op pain.

So what was the hold up in getting back to writing about my experience? That’s been a tricky topic to tackle actually! In considering this carefully, I guess I’ve really struggled with the knowledge that something is still inside me needing medical attention. I’m still trying to get used to the idea that I still have another potential surgery still left in my future. It’s felt like a distraction from my weight loss goals and efforts. It felt incongruous, somehow - writing about my gastric bypass while I was so distracted by my cyst!

It’s taken a little time to screw my head on again, but I’m ready to resume my duties as a blogger.

Next time: Head Hunger. More about that nasty little urge to eat for reasons other than hunger…

A letter to my family and friends

2010-08-07T10:00:00.000-07:00

This is a letter that I sent to my dearest family and friends. I wanted to share it here, too, somehow as a part of the process and experience I am dealing with as I face this surgery. It is intimate, and honest.
Hi there, my beloved family & special friends,

I thought I would send a little update and reminder that Wednesday, August 11 -- less that one measly week away -- is the very big day that I will go have my gastric bypass, and hernia repair.

Since the beginning of this current adventure, back in November 2009, I began losing weight. Back then it was sort of informal. No one at the clinic focused too much on numbers of pounds, or even asked how we were doing with our weight loss. But don’t get me wrong- there was lots of talking about food, and feelings and portion sizes and food label reading.

By June things were a little different. On 6/4/10, Dr. H said,”You will have to lose 30 more pounds before surgery. I have lost 37 pounds total, Since Dr. H's requirement, I’ve lost 27 pounds – good enough to go forward, and enough for my “team” to be proud of my efforts. YAY!

So, Wednesday morning, at 5:30, I’m scheduled to check in at the hospital for my 2 - 2.5 hour procedure scheduled to begin at 7:30am. I’ll be at Good Samaritan Hospital and after a little while in Short Stay I’ll be moved to unit “6 Center,” to a specialty surgical unit for abdominal surgeries. I have heard that I’ll be cared for by specially trained RNs who have won awards for their outstanding care on 6 Center. I’ll have a catheter in place for luxury peeing, and a pain pump for luxury pain management.

So there you have it! Some might say the answer to my prayers, others might say this is something to be grateful for -- a second chance at life. I say: I am grateful and I do know that it’s going to be hard work, and that’s after the surgery! I’m looking forward to it!

Much Love,

Lynn, Lynnie, La, Ba, Noe (depending)

2010-08-02T09:49:00.000-07:00

Fortune Cookie Therapy-

The Best Way to Predict the Future is to Create It

Flip-side: Pick Your Battles.

I don’t think I could have picked a better slip out of the bowl in my therapist’s office if I would have tried, last Friday. The slip read: The Best Way to Predict the Future is to Create It. And for any of us planning to have a gastric bypass, or recovering from one. Those words should ring true in our ears!

I'm hearing that this is a time to truly envision my new life unfolding before me, and to concentrate on all of the steps that I know will make me successful in my endeavor to be healthier. Since I’m still waiting for my surgery date (coming 8/11/10)!, I can only plan, read, trust, and take on pure faith, that everything will be fine. I’ve been told that if I follow the steps my bariatric surgeon and her team have laid out for me, and I exercise, and eat carefully, and utilize all of the tools that have been shared with me, then I will learn to accept a new lifestyle and I will lose weight. It sounds so simple. Could it really be so simple after all of the efforts that I've made over the years? Weight Watchers, the Grape Fruit Diet, The Cabbage Soup Diet, Jenny Craig, and the others all made me believe that I would be thin and physically well, like all of the promises that were made?

The trick is in knowing that there’s a lot of hard work, episodes of “head hunger," and difficult times ahead. The tool — my gastric bypass — gives me that amazing leg up in managing my weight, my hunger, and my lifestyle.

I couldn’t be more excited — although a little nervous, still — finally the excitement outweighs the nerves! I realize that I am creating my future, and can predict success in my future because of what I’m learning.

Comments? I’d love to hear from you out there, lurking and reading along….

Exodus from Obesity book review

2010-07-31T23:42:00.000-07:00

Last week I decided to pick up a few things in anticipation of my upcoming surgery. I bought some baby spoons (to keep me focused on small bites and slowing down), and some very small containers with lids for a few ounces of this or that (since that's all I'll be able to eat). I also bought a digital food scale to weight foods as I learn what serving sizes look like. Just planning ahead (and really looking forward to something besides protein powder and Lean Cuisines to eat)....

This book is outstanding for several reasons. First, it is quite readable, and personable in its tone. There is a real sense of the writer’s experience, insight, and knowledge about gastric bypass from both a medical and personal point of view.

Another remarkable aspect about this book is the honest and sensitive way that Ms. Peck discusses those sometimes embarrassing and delicate circumstances that we’ve all experienced as obese people. An example might be needing to consider available accessible seating on planes, in movie, theaters, auditoriums, or even doctor office waiting rooms. I could relate to these and other examples because aside from needing to ask for a seat belt extender on airlines, I have also had to purchase a seatbelt extender for my car, and have even had to search for alternate seating in a lecture hall at a local hospital. These circumstances aren't all seating related, obviously, but they are very recognizable for most of us.

Ms. Peck writes about these and other emotional aspects of obesity with first-hand knowledge, and shares from this perspective her success since her Gastric Bypass in 1999.

Aside from Pre and Post-op experiences, and discussions about the basics of food choices and eating styles,re are a few of the more relevant topics:

· Relationship Changes After Gastric Bypass Surgery

· Dealing with Self Defeating Behaviors

· Sexuality

· Adapting to your New Image

· Preparing Emotionally for Weight Loss, & more...

I was so taken by this book, and so motivated and inspired by her sensitive and direct tone that I emailed Ms. Peck to share my feelings about the book and to ask permission to reprint several items for use in this blog. Much to my delight, she was willing to allow me to reprint the items that I thought would be helpful: a List of Protein Grams per Average Serving, and some general Sugar Information: listing substances that form sugar, contain sugar, are refined sugar, and the Quick Sugar Reference. Look for these items soon on the Useful Resources page.

Many, many thanks to author Paula Peck for her warmth and generosity (and written permission) in allowing me to reprint these wonderful resources on this blog.

Coming soon: Fortune Cookie Therapy -- The best way to predict the future is to create it.

Fortune Cookie Therapy from "The Bowl"

2010-07-26T05:54:00.000-07:00

From The Bowl:

Off with the old and On with the New
Flip side: Roll with the punches

I think I've mentioned that I see a therapist - a psychologist who I began to see in the hopes that my disability issues would become clearer. As time went on, she began to assist me with some of the emotional, and psychological issues around my weight and my pending surgery. At the core of it all was me beginning both to take responsibility for where I am today, and the ability to forgive myself and move on. I suppose that as time goes on and these issues begin to make more sense and to look clearer to me, we'll revisit them. In any case, GW has been very, very helpful to me.

One day, several months ago in my therapy, I noticed something that really caught my eye. A bowl. In this bowl were perhaps 100 little card stock weight papers slips in a pale yellow with phrases on them. As I picked on up I was delighted to discover on these little 3" x ½" slips that there were two phrases, one on each side! The phrases were sometimes credited if the author was known, but other times were not. All had a deep therapeutic concept in them, though not always for me, I frequently recognized a thread of something worthwhile in each slip. They were there to act as a little therapeutic fortune cookie - cosmic, randomly chosen inspiration from Dr. W's bowl to those who might partake of this form of fun "therapy."

You may have noticed that the name of this blog is “Off with the Old: My Gastric Bypass & the Lessons I've Learned From the Process”. It's no accident that I came up with the initial part of the phrase, and also found a slip in The Bowl that said, “Off with the old and On with the New”. I shared this with Dr. W in my last session with her, and I could tell that she was pleased that her bowl of inspiration had come to use in my therapy. Truth be told, every slip offers me something for the day, and for that reason alone I will share them with you, faithful readers. Sometimes I'll even try to tie into the posting a piece of the randomly chosen inspiration from The Bowl.

It's starting... "Head Hunger"

2010-07-22T13:59:00.000-07:00

... A seductive curl of steam rising from the plate
... Small yellow rivulets of butter dripping down the side of creamy mashed potatoes
... Tempting and crispy browned skin on a fragrant, succulent chicken breast
... A distant hint of something green? Spinach, green beans? Something green...whatever.

I'm siting here, thinking about food. Not bunny food, but "real" substantial food with butter, carbs, etc. Hmmm.... OMG! It's just a commercial! I haven't even had my surgery yet! ::sigh::

Well, they did warn me that there would be possible reactions to or experiences after weight loss surgery, including a preoccupation with food on television. For more information about additional reactions to or experiences after having weight loss surgery, see Appendix A under the Appendices tab.

I am definitely entranced when a commercial comes on TV parading some company's delicious foods in front of me every 10 minutes. It's not even that I feel especially deprived on the partial liquid diet they've put me on. I am getting plenty to eat, really. It's just a matter or having been raised in a culture that "Super Sizes" everything, and that celebrates "The late night Munchies" -- constantly!

My husband doesn't help, either. Big Bruiser is 6'5" and weighs about 300 pounds. At the ripe age of 50, he can still eat like a like a teenager - 2 large bowls of cereal at noon, and after diner, 2 great big bowls of ice cream, a handful of candy, whatever he wants, really. The fact is, for me losing weight *is* hard. The sacrifices, the commitment, and the focus that it takes to make the decision to change your lifestyle is significant. But this is the first time I've been really face to face with my "head hunger," the emotional element to losing weight, and one of the reasons that so many people find weight loss so very difficult. "Head Hunger" is the psychological part of how we feel about food, and what we think about food. It is highly personal, and highly individualized. For me, this preoccupation with food on television and my reaction to the images of food is like an itch that I can't scratch. I'm really struggling to stay focused and to put all restricted foods out of my head. I'm eating a medically supervised diet that is considered a partial liquid diet - high protein to prepare for my GB. HMR 70+ vanilla and chocolate pudding 4 times a day, high potassium veggies, and 1 high protein lean cuisine a day is the program for me. Not a lot of food really. I'd like to point out that I *was* eating a bit more than this before Dr. H. put me on the partial liquid diet. It's a little humbling when I think bout how much more I was eating before I started a plan of any kind. The truth is pretty clear: you have to keep your eye on the ball the whole time while you're getting ready for surgery, and afterward.

I'm trying to stay focused. I know that a new stomach/new plumbing will force the issue, and the "head hunger" will episodically be worse as I move through the process of understanding what makes me tick, food-wise. Regardless I'm feeling prepared (for the moment) to fight to good fight, and move forward - despite commercials with fast food that seem to call to me.

Next time... Fortune Cookie Therapy

OMG! I Have a Surgery Date!

2010-07-15T10:23:00.000-07:00

Finally!
So I got the call on from my clinic on Tuesday, 7/13. Even though I've been hoping, praying, planning, worrying, anticipating, expecting, and was generally filled with angst about it; I was completely surprised and caught off guard when Dr. H's, MA said, “The insurance has given me the go-ahead to get you on the books!” All I've though about was the surgery. But when she called me I was completely caught off guard. How weird is that?

OK, so I'll go to the hospital for surgery on 8/11/10. A week before, I have a whirlwind of other pre-procedure stuff to do: I am scheduled to have pre-op labs drawn, the pre-op class, and a final meeting with the nurse practitioner on 8/3/10. This is the time that they will weigh me for my 'final official weigh-in (although I *could* weigh-in on 8/10/10 if need be - very reassuring news for sure).

Since my official fan club (read family, so far) is using this blog to check in on the latest news, I wanted to review the specific procedure information. According to the Medical Assistant, I'll be having a Roux-en Y Gastric Bypass (pronounced roo -en-why).

Roux-en Y gastric bypass is a restrictive operation where a small pouch is made at the upper portion of the stomach, which can hold only 1-2 tablespoons in volume. This procedure helps you lose more weight three ways:

I'll eat MUCH less or it will come back up. The food has no choice. If you can't eat a lot, you will lose weight. Period.

Apparently my appetite (as well as my taste for sweet things potentially) will actually begin to change. After the procedure, most patients find that their body will not easily tolerate foods that are high in refined sugars and fats. This is called "Dumping Syndrome." Dumping Syndrome is a common side effect after gastric bypass and occurs when the contents of the stomach empties rapidly into the small intestine, especially if I eat concentrated sweets or carbohydrates. The feeling will be a combination of profuse sweating, nausea, dizziness and weakness. "Dumping" is actually a desired side effect of the surgery to discourage one from eating sweets. Unpleasant. Approximately 95% post-op Gastric Bypass patients suffer from Dumping Syndrome at least to a degree.

You actually absorb fewer calories. Keep in mind that your body's plumbing is re-worked. After a Roux-en Y, food bypasses part of your small intestine and digestion occurs in the lower part of the small intestine. This combined with the much smaller stomach, and reduces the amount of calories your body absorbs from the food you eat.

I’d be more fascinated if I weren’t shaking in my boots. I'm mostly reassured that my pain will be managed, and then I just have to focus of sipping, hydration, walking and staying mobile in the face of (probably) not feeling much like it.

I'm open to comments, reassurance or any other feedback (please).

Reflections on a Difficult Time - Going off on Medical Leave

2010-07-08T17:57:00.000-07:00

In January 2010 I went out on a medical leave. I had the support of my doctors, my family, and even my employer. I did have the small matter of some excessive absenteeism due my illnesses, and unfortunately this put me in a position without any guarantee that my position would be available if/when I came back. It didn't matter because I was just too sick to keep working at that time. My weight loss was one factor, and of course there was the matter of my fibromyalgia.

Making this change was incredibly traumatic. I missed my sense of purpose, my work, seeing my work partners and friends every day; and despite having some short term disability coverage, a full paycheck was also sorely missed. I found a great deal of support and comfort in working weekly with a psychologist (thanks, GW!), as well as important time to talk about some issues related to my weight. I continue to prepare for an eventual surgery date, filled with anticipation, trepidation, excitement, fear and hope.

Happily, my fibromyalgia is slowly improving. I'm bothered most by incredible fatigue from time to time when I have a flare. This does interfere with my ability to exercise consistently, but I'm making every effort to get some exercise in daily. I feel very lucky as I recuperate, to have the opportunity to focus on my upcoming WLS (GP- RNY, I expect) to make some long needed changes in my health and welfare.

I've been on a partial liquid diet using HMR high protein powder, lots of veggies, some yummy yogurt and some great high protein Lean Cuisines for 5 weeks now. Tomorrow I get to discuss the possibility of choosing a surgery date with my doc, the nurse practitioner and perhaps other members of my team.

My fingers are crossed...

Off With the Old

2010-07-06T07:23:00.000-07:00

Welcome to my blog: Off With the Old! My Gastric Bypass and the Lessons I've Learned From the Process

I started this blog at the urging of some of the members of my team, at the Legacy Health Weight Management Institute in Portland, Oregon. I am a patient at the Weight Management Institute (WMI) Since November 2009. Since then I have been virtually surrounded by a team of professionals assisting me in planning for success in finally achieving my weight loss goals. I want to say that my support team doesn't just include the Physical Therapist (PT), psychologist, nurse practitioner, registered dietitian (RD), and Surgeon (MD). I also consider my family, my Primary Care provider (PCP), and my personal psychologist to be just as important in my quest for lifelong weight loss.

My Story

I have been overweight for as long as I can remember. As a child, I was "the fat one" and I struggled despite my parents desperate and sometimes dysfunctional efforts to "make me thin". I say this with love, because despite the worry my weight caused my family, with the comments, the bribery, the begging and pleading - I know that this was because they love me. Nevertheless, it was difficult and often painful dealing with the pressures around my weight, whether it was a few pounds or many in question.

Last Fall I decided that enough was enough. It seemed then as if it happening all at once, but in retrospect it clearly happened over a matter of months to a couple of years. I was suffering from a multitude of medical problems that made work virtually impossible, and nearly all of my complications were related to my weight. I was suffering from:

Hypertension (high blood pressure)
Chronic pain from osteoarthritis in my knees, ankles and low back
Non-insulin dependent diabetes
Chronic heartburn from GERD (gastro-esophageal reflux disease)
Severe sleep apnea requiring that I use a machine called a C-PAP at night when I slept. This requires getting used to a face mask of sorts hat blows air into your airway to keep it open while you sleep
Impaired mobility - I was having difficulty getting around, and now had to use a straight or single point cane.

I agree that this is a lot of medical trouble, but that was not the worst of it. I also suffered from:

Periodic venous stasis wounds on my legs from leaking veins that were causing a need for sometimes painful daily wound treatment and aggressive compression treatment ranging from the "oh so fashionable" compression hose to mechanical pumping using a lymphedema pump. This pump machine is recommended for use for several hours a day to control lower extremity edema (swelling).
And the compression hose? They are as uncomfortable as they are ugly.

Suddenly it seemed that I was a mess and was heading toward disability very quickly. And that's why when I was diagnosed with Fibromyalgia, on top of all of the rest of it I knew I didn't stand a chance. Triggered by my many medical problems, my fibromyalgia flared out of control. I was missing a third of my scheduled work time, and I was facing issues at work due to my absenteeism. My job was on the line for the first time in my life. I knew then that I needed to go out on a medical leave. Fortunately, my PCP, Dr. D agreed.

More soon...