Could it be that I have not posted in over a month, while both of you readers have been clamoring for more? A thousand apologies! To say it’s been busy would be an understatement. Where to begin…
I had reached a plateau weight-wise. My dietician told be to maybe add some calories, so I added more protein to the menu, and it seemed to jump start the weight loss. I’ll be honest, I’d love to be further down in numbers, but I keep self-sabotaging because I’m spending more time on the road. I know, I know..I need to plan for that and make adjustments. I do, and then I see those golden arches and I’m McScrewing myself.
The nurse practitioner seems pleased with my progress. She keeps asking me when my surgery is ballpark for, and I tell her September/October, because my insurance company seems to be fairly surly and unapproachable on this subject. I’ve registered in United Healthcare’s “center of excellence” program, and while Portsmouth Hospital is not one of their centers of excellence, it is in network, which is akin to not having Ebola, but a slight case of Zika instead. In other words, to them, I suck but I don’t suck as much as the guy who is going to Bob’s Weight Loss Clinic of Duluth or something.
I have finished my behavioral health classes, which were great, and so now have the dietician and NP visits every month or so, labs, which I got done today, and a few other tests, then a short class a few weeks prior to the surgery, and I will attend the monthly pre-op support groups because I like them. I kept saying if I lost all the weight I would;t get the surgery, but with the acid reflux, I feel like I have to. That and separating my brain from my stomach are the two biggest draws. Not to worry – I am not going to lose all the weight (see paragraph 2).
I am going to buy a bicycle, a hybrid mountain bike. Dick’s has a nice Diamondback I like for under $500. If I can find the recommended model I read about in an online magazine, I may go to a bike shop to see of they have it or will order it. A few more weeks and I’m on it. Medically, my back has been giving me all kinds of trouble. The lower back, on either side of the spine, out to the middle of either half of my back. It’s almost debilitating. I really need to see a chiropractor unless one of you has better advice (that is my plea to you to tell me what you think). I got a FitBit a week or so ago, and it has already got me hooked. We had a fire drill at work today, and my first thought was not, I wonder of this is actually a drill?” No, it was, “Awesome! I get to add some steps AND some stairs!!” That is the right kind of thinking. I unintentionally did 4 miles last weekend on my walk, and posted my best times per mile. The times kept dropping with each successive mile. I loved it. I’m using the Map My Walk app, and I listen to Nikki Glazer’s Not Safe podcast, which is a riot, and lasts for just the amount of time I am supposed to be out.
That’s it of tonight, I think. It’s late, my thoughts are scattered because I am writing a song and lyrics keep running through my head. That’s my sign that it’s time to head upstairs, put the floor AC unit in and hit the hay. Next time I will discuss the misnamed sleep study I took at the beginning of the month.
It feels like it’s been a million years. Not that I haven’t had anything to say; I just haven’t had the time to say it. I’ve read elsewhere school has been crazy for people. It’s been crazy for me too. Thing is, I’m in too deep to quit now.
Along the weight loss narrative, I’ve met with the staff psychologist, who is an ex-Air Force vet and I really like him. It was a quick one hour session to sort of point me in the right direction behaviorally. He says that in order for weight loss surgery to be effective for the patient, they MUST make changes in their behaviors surrounding food and coping. Sounds pretty simple, right? It isn’t.
I met with the dietician, which I may have written about. Hydrate, add protein shakes. 400 calories for meals, 200 calories for snacks. Something every two hours. She’s nice but I wouldn’t want to cross her.
I met with the physical therapist, who only needed me for one pre-op visit. She said because I have physical issues, all I need to do is walk, not for distance, but for time. 45 minutes, 5 times a day. That’s been really hard. I’ve been fighting migraines for a week now, and yesterday it finally won. It made me sick for the first time, gave me vertigo for the first time ever, and strangely, made me eat, probably because I was so stressed about it. I was worried it might be a vitamin deficiency. I even stayed home from work because I was still feeling the effects of it this morning. The good news is the I meet with the neurologist next week and can discuss it further with him then.
I’ve gone to a pre-op support group. That was interesting. I am really not used to saying this at all, but I felt like I was being judged for being the skinniest one in the room. It’s all relative, of course, but man did I feel out of place. It was great though. There were panels, questions from the audience, the psychologist was there, the dietician, and several former surgical patients to talk about their experiences. It’s nice to know that we will get through this.
I also went to the first of 5 behavioral classes put on by the psychologist. That too was good. It wasn’t an hour and a half where they just read the book to you. It was practical, it was useful, it was interactive, and I got lots of good information.I learned that y responsibility throughout this process is to keep on track regardless of what is going on around me. I need to control my own environment. I need to have confidence I can keep the weight off. Dr. W talked about flight sim training for pilots, and how when they go inside, the people running the sim ill throw one thing in to knock them off kilter, then another, then another. They make failure a virtual guarantee. Why? Because (and here is the take-away) smooth sailing is not your friend. We need to learn how to course correct on our own. Having everything go right is not the way to get that done. We need to face the challenges in order to overcome them. Finally, we cannot view our FALLS as FAILS. We just need to chalk it up to experience and move on, like when Tom Brady throws a rare interception (not a word from you haters out there). He knows he will get another chance to get back out on the field and turn the INT into a TD. That’s all we’re looking for throughout this surgery process: a win.
Lastly, I met with the nurse practitioner today, who is on her way to Hawaii right about now. That was sort of ho-hum, even though I like her. I got to meet her dog too, which was great. A 5 year old yellow lab who loves to be played with and pet. I talked to her about the migraines. She talked to me about staying hydrated. It was straightforward, but she did say I am in a really good place. I weighed in at 275, but I don;t need a lot of the attention most of the others need, medically speaking. She said she wishes I could get the surgery now. I told her I really needed the behavioral piece of this because there are parts I am not telling her or anyone. Like how much I ate out last week and the week before. How I cut out of there and went to McDonald’s after my visit. Why? No idea. I wasn’t even really hungry. I guess I just wanted the salty taste of the fries and the mixture of the hamburger and the cheese swirling around my tongue. It makes me so scared that I am not going to be able to modify my behavior enough to have this surgery be successful. Apparently not scared enough to stop, though.
I just balanced my checkbook and realized how much I ate out over the last three weeks. So rather than blog about my journey here (I really dislike the word and its overuse), I apparently went out eating. So, sorry. Like you were hanging on every word…
I have an appointment with the dietician tomorrow. The conventional wisdom is that my caloric budget is going to be raised. I wonder if I’ll have the guts to tell her I’ve beat her to it and done it myself. Friday I have an appointment with the program psychologist. I’m looking forward to both visits. It will be interesting to see what the next stages bring.
I got a very nice compliment from a co-worker today. I walked in to my office, and my co-worker, who usually starts in with things to do before I even get my coat off (note to reader: NOT the way I like to start my day), says, “Hey, I don’t want you to get a big head or anything…” I was wondering where this was going. She continued: “…but you really look like you’re losing weight. I can see it in your face, and your head is getting smaller. You had a big ol’ fat head.” Just take a moment and bask in the glow of that statement.
I have lost weight. My head is getting smaller. I can feel my waistline shrinking. My unused belt loops are seeing some action, which is fun for them. I really need to be careful about doing so much eating out. Not sure if I told you all, but I bought a diabetic cookbook at Barnes & Noble. I’ve made two dishes from it and LOVE them! Last night (and tonight) I had Chicken and Spinach Avocado Lime Salad. Homemade dressing that is FANTASTIC…I can’t wait to have more for lunch. Red, orange and yellow mini peppers, thinly sliced red onion, tomato…it is SO good. Perhaps I’ll post that recipe, giving full credit to the publishers of course.
Time for bed. I have an interview tomorrow for a promotion. Not sure how good my prospects are, but I am cautiously hopeful. If I don’t get it, I am not going to let disappointment drive me to the buffet table. I am gainfully employed, I have a great family, people who love me, and it’s time to make changes. Those changes have to last for the rest of my life, regardless of what life throws at me.
Well. I feel like it’s been a while! I’m not sure if I warned you, but I have no concept of time, specifically days of the week. I am rarely late, because I was in the military for almost ten years, and as the saying goes, “If you’re not 15 minutes early, you’re late.” That being said, I may have forgotten to pick my niece up last Wednesday because…well, I had no idea it was Wednesday, and I put the reminder in my phone on the wrong Wednesday. It was a nice night, and she was in good humor about it, so all is well. I took her sister, my younger niece, to see Star Wars: The Force Awakens yesterday. She is twelve and she loved it. We talked about it through dinner, and I was able to relive my childhood a bit as I told her about the first three movies. 1977…seems like a hundred years ago. But that’s not why I write this blog. Yet.
I had my first appointment with the Nurse Practitioner Friday afternoon. It was a gorgeous day, much like today. We did things a little backward, scheduling my second appointment with the NP and another with the dietician. The psychologist and the physical therapist will be contacting me soon to schedule appointments, I was told. I remember thinking that this was getting real. As I waited, I read your blogs to keep my mind clear (thank you!!). Then I was being called in. I got on the scale and due to some last minute cheating, I had only lost 6 pounds. The more I thought about it, that’s two pounds a week, which is good! But I could have done better. Who has a problem with that type of thinking? Speak up and let me know why, would you?
The other thing I was thinking was that the NP was kind of cute. Probably too young, but cute nonetheless. I don’t ever want to make a play for someone on my team anyway, but it was going through my mind as she fiddled with her hair for an hour and change. We went over in minute detail my application, which was essentially my health history. She did say she didn’t think I would have a problem with the surgery and a successful outcome, because I am on the low end of the bell curve. So…for a fat guy, I guess I am the skinniest. I’ll take it, because it made me feel good.
We talked about the medications I am taking. We talked about the need for a sleep study, to which she is referring me. Apparently the guy will come to my house to do it. It’s convenient and creepy at the same time. It makes sense, though. I don’t sleep well unless I am in my own bed. I get my best snoring done there, apparently. I would’t have mentioned the sore throats I wake up with if I hadn’t been told by a house guest somewhat recently that I stopped breathing during the night several times. And I am an awful sleeper. The NP told me the C-Pap would make a huge difference in the way I sleep. My question was once I have the surgery, would the sleep apnea and snoring stop? She said it likely would, but that there were two types of sleep apnea: obstructive sleep apnea, which according to the Mayo Clinic’s website, happens when the throat muscles simply relax and the added fat on the neck adds weight to the windpipe and suppresses breathing; and central sleep apnea, which is when the brain fails to send the proper signals to the muscles that control breathing. In the words on my NP, if you’re central, you’ve always been central, and you’ve likely always snored. But if it’s new, it’s likely obstructive and that can be dealt with. As a side note, the Mayo Clinic lists a third type of sleep apnea, complex sleep apnea syndrome, which is the fusion of both types of sleep apnea. It must be super-sized, to be a syndrome. Wow.
Anyway, we talked about family history. It was at this point I realized that most of my father’s side of the family is dead, including him. I have no way to get the information to answer those questions. It hit me in that moment. I am still a little adrift over that, but I am an adult man, and I have to be my own anchor, not count on my father’s family to be one for me.
We talked about support. What type of support would I have post-surgically? Does my PCP support this surgery? Do I have supportive friends? My mother is willing to stay here for a bit, and be a frequent guest until I am up and running on my own again. My sister is busy, but she might check in from time to time too. Maybe a few friends from work would help after work and on weekends. It almost makes me miss being married. You know, having somebody there who helps, supports, loves, but is there all the time and doesn’t leave. My doctor does;t really support having the surgery, probably because I’m on the skinny side of fat. I’m “only” 100 pounds overly ideal weight. I carry it pretty well because I’m tall, but it’s all in front. The down side is that my PCP is also my mother’s PCP. He is in favor of her getting the surgery, but she won’t. She’s resigned herself to being a large woman, I think. My doc is a great guy, he really is, but our paths diverge at this point. And since I don’t need his blessing for the surgery, I am forging ahead.
Finally, I’ve only told a few friends about this plan. One, the one I work with, is really supportive. She’s a little older than my oldest daughter, but we have more of a friendship…I don’t know. It’s strange. But she says if I need anything, she’ll be here, even though she has a husband and two young children. But I have this other friend who really pissed me off this weekend. I hadn’t spoken to her for 15 years. She suddenly reappeared up here in New England after many years down south, and wants to resume a more active friendship, which is fine. She’s had a couple small strokes over the last three or four years, but is still okay. Her memory is just a little off. She asked me to explain to her why I was getting the surgery. I told her I had heath issues, and I needed help getting this weight off, and frankly the fear of dumping and/or death is a good motivator to keep the weight off.She jumped in and started challenging my decision to do this, asking me why in the world I wanted to undertake something so severe. I got upset. I told her it was because I am fat, I am unhealthy, and I am close to being a 50 year old man who makes his own damned decisions and doesn’t have to answer to anybody – ever. I said it in a tone that left no doubt I was pissed off and ready to go toe to toe. She backed off (and spent the next twenty minutes apologizing needlessly) and the conversation went on, but I will not forget that any time soon. I do not need people in my life that are less than 100% supportive of my decisions. I don’t need brown nosing yes men, but I will no longer defend myself to someone else. Whether I’m right or wrong, stand by me, offer me counsel if you must, but I will be making the decisions.
There aren’t any good jokes about this subject. I was hoping there were, so I could start out with one or two. But alas, I must research this instead. You may notice I went a little hyperlink happy today. These are all short articles that apply to today’s topic. They’re good, and as far as I know, virus-free. They will all open in a new window so you won’t lose your place in this riveting blog.
Dumping – It’s Not Just For Breakfast Anymore
University of Rochester Medical Center, in an online article reviewed by Joy Fincannon, RN, MN, say healthcare providers don’t really understand why dumping happens. Dumping happens when the solid part of the food we eat gets automatically dumped undigested into the small intestine because the stomach is now too small to handle the food. It can result in a serious nutritional deficiency which can have long-term effects on your health. Dumping syndrome affects 15 – 20% of post-surgical gastric bypass patients, and a small amount of people can’t get rid of the syndrome once they have it. So if I’m understanding them correctly, it’s like herpes of the stomach. Are you reading it the same way?
Dumping syndrome is broken up into to categories: early dumping and, you guessed it, late dumping. Easy dumping happens anywhere from 10 – 30 minutes after a meal, and late dumping happens 1 – 3 hours after eating. I’m reminded of Cosmo Kramer in the Seinfeld episode The Pilot. Elaine asks Kramer, who is backed up and resistant to an enema, if he is going to the taping of Jerry and George’s “show about nothing” pilot. Kramer says, “No. No. I’m gonna stay home.I want to be close to my home base in case there’s any news from the front.” Great episode, and you can read the script here.
Anyway, it’s enough to scare some people away from gastric bypass altogether. Typical symptoms of early dumping include bloating, sweating, abdominal cramps and pain, nausea, facial flushing (is that an intentional pun?), stomach growling or rumbling, an urge to lie down after the meal, heart palpitations, dizziness or fainting, and eventual diarrhea. Eventual. Like you’d be praying for the relief that diarrhea brings. I don’t know. It sounds like the moments after a meal at Applebee’s to me.
The treatment includes splitting your caloric intake into six smaller meals, not drinking any liquids until 30 minutes after the meal, and lying down for 30 minutes after you eat. Like I have time for that. “We’re cleaning up. Where are you going?” “Um…I have to lie down for a half hour.” Yeah. Let’s see how that plays in Peoria. Complex carbs can help, and watching what you eat is the best way to avoid dumping. Dr. Fred Pescatore says avoid the surgery totally, thinking it completely unnecessary and a quick fix by us fat folk. Read his thoughts on the subject for yourself and tell me what you think. I think dumping is worth the risk.
Causing a Flap: The Excess Skin Problem
Excess skin, on the other hand, is absolutely going to happen. It is a natural byproduct of rapid weight loss, and the one that really gives me pause. Think Adam Sandler in the dream sequence in Click. Boston Medical Center sees it as an inevitability, and even says exercise won’t shrink it because most people of the size to be considered for gastric bypass have already stretched their skin to the point it will never tighten. Read the article here. Here’s the other thing: you can get plastic surgery, but insurance typically won’t cover it. One of the speakers at my information session said she saved and took out a small loan to pay for it, and it was completely worth it for her. She said it cost about $10,000. Leslie Alderman writes in The New York Times (2010) that the costs can reach $20,000 or higher. Perhaps that’s a good article for another time.
It should be noted that I met a gentleman a few years ago who lost somewhere along the lines of 400 pounds through diet and exercise. He had to have two skin removal surgeries. For the record, he looked great, so it does do the job. Just do yourself a favor and find a highly qualified plastic surgeon. Do your homework. We’ve all seen the pictures and the shows on TV.
I think you’ve reached your limit for this today. If you’re curious, I ate with some coworkers at Applebee’s today. I was not good. 2 Chicken Won-Ton Tacos (255 Calories), Chicken Caesar Salad (side-320 Calories) and a lunch size of the 4-Cheese Mac & Cheese (640 calories). It was cold, snowy and I wanted comfort food. I have to stop “slipping.” Really it’s falling. And it’s intentional. I don’t know why I would want to sabotage myself. It’s stupid and dangerous. That is the kind of mental space that leads to dumping! And we’ve now come full circle. Here’s a picture to show how dangerous it is to ride the fence.
Good evening, kind reader. I don;t have long. I’ve wasted a good part of the night buried in spreadsheets making sure there’s enough money left at the end of the month. OK, so maybe it’s not a waste. Anyway, I’m tired, and my laptop battery is almost gone.
That pizza I ate the the other night still seems to be making me feel full, like I’m carrying it around still, which I decidedly am not. Good Lord did I feel sick after eating that thing. It wasn’t even that good, which makes me feel better, like maybe I’m losing my taste for pizza. But the carb overload just made me feel sick, and sick I got.
Now the issue is Easter candy. I like the quick burst of energy chocolate gives me. My boss happens to keep a bowl of Cadbury Dark Chocolate Mini Eggs on her desk for the team. Her boss brought in Girl Scout Cookies: Samoas and Thin Mints. Fortunately I’ve been able to restrain myself when it comes to those, because I am a Tagalong man. I’d be lying if I said I haven’t had a few though. The good part is that they are at the back of the room, where I seldom go. But it’s like they are calling out to me. With the cookies and the candy it’s like a confectionary Scylla and Charybdis. I won’t weigh myself until Saturday, so there’s time. Well, a day and change. I had a few graham cracker squares with low fat peanut butter for dinner to come in under my calorie budget today. I feel full still. It has to be the pizza.
On a non-food related note, my debit card was compromised the other night. I’ve been surprisingly unstressed about it. I had added an Uber app to my phone and entered in my card information, and took one ride, to a bar with a buddy of mine on a guys weekend. And really, if I’m being honest, we had to use Uber because he’s pissed off every cab driver in the greater Portland area. Anyway, two nights ago I get a text from an Uber driver telling e he’s here, and is the hotel the right place? I told him he had the wrong number. He cancelled the call. not 5 minutes later, he texts back asking if I just ordered another ride. I told him someone was messing with both of us. I opened my app, checked the map and he was in Scranton/Wilkes-Barre, PA! I fired off an angry email to Uber telling them to cancel my account, refund me the $31 and close my account. They were gracious in defeat and did all I asked them to. I called my bank, not wishing to see more money come out (because I just got paid, got a student loan refund, and a tuition reimbursement from work). They shut my card down immediately, refunded me the $31 (I assume they will get their money from Uber’s refund to my account), and shipped me a new card 2 day air and waived the fee because I keep no credit cards nor do I bank elsewhere. So I can go…nowhere this weekend, but still. It was surprising. We just can’t assume anything is safe anymore, and it makes me a little sad. And angry at those who would steal the money others work so hard for, like we can afford to give it away without a fight. Grrrrrrr….
OK, I’m at 10% now and my eyes are getting heavy. Time to put the peanut butter away, brush, floss and sleep. Next time, let’s talk about two side effects of gastric bypass : dumping and excess skin from rapid weight loss. Fascinating, right?
Thanks to those of you who stopped by to say help after my first post. I appreciate it, and appreciate the opportunity to expand my blogosphere horizons.
I promised I would talk about how I came to the weight loss clinic I did. It was funny, in this day and age, that it was a highway billboard in New Hampshire that led me to the Portsmouth Hospital Weight Loss Clinic (http://portsmouthhospital.com/service/surgical-weight-loss-services). I drive past it occasionally heading north, and finally decided to do something more than look at the big picture (pun absolutely intended). I went online to do some research (I had already done the research about the type of surgery that fit my goals, so this was just to see what they had to say for themselves), and while I was there I registered for a free information session. My mind immediately took me to when I was a kid, and my father, always on the lookout for free stuff or a good deal, would drag my mother, sister and me to these seemingly all-day timeshare sales pitches where you registered and got a free gift. Except the free gift at the weight loss clinic a) isn’t free, and b) isn’t a week at a timeshare in the White Mountains in the summer. It’s not even a toaster. It’s the opportunity to change your life using surgery as a “nudge” in the right direction.
As I sat down in the front of the conference room, I made a great show of reading through the handouts, which included the PowerPoint, the application for surgery, and other facts and requirements. I was really thinking, “Please don’t let me be the fattest one here tonight.” I didn’t dare turn around. The session was informative. One of the surgeons spoke, the nurse practitioner spoke, the staff psychologist spoke, but the best part was when two former patients came up to talk and answer questions. One, who now works there, even brought pictures of herself at her biggest. She weight somewhere close to 425 pounds when the pictures were taken, and here she was looking all “normal.”
When it came time to go, I got my first look at the crowd of people being me. It turns out I was the thinnest one in the whole room! Did I feel better? No! I still felt like Fat Bastard from the Auston Powers movies. I felt like they were looking at me thinking, “Hey slim, why don;t you make way for those of us that really need this.” In my shame I left, but with a determination I’d not felt before. I knew I had to lose 10% of the difference between my body weight and my medically ideal weight, which was 10 or 11 pounds, to even be considered. But I had to go get my official weigh in at the clinic itself, bring the app, and call the insurance company to determine coverage. The hardest part was the damned instance company, but I got there. Fortunately I have a background in Human Resources and benefits administration specifically, so I was ahead of the game. Let me just say this: if you are considering this surgery and have to have that conversation with the insurance company, have a pen and a piece of paper handy, and know what to ask. If you need or want to, reach out to me. I’ll let you know. Be familiar with how your insurance works too. That could save you lots of money, or at least help you plan. I really recommend the full amount of Flexible Spending allowance on an FSA card if it’s available to you at work. No sense in being silly about it.
I ran over to the clinic on a Friday afternoon on my lunch break, which was really convenient. THat’s the thing about my insurance, by the way, and maybe yours too. Not a whole lot is convenient for the patient. If I want to only pay 10% in-network co-pay, I have to have my surgery an hour away from home, and get all my pre- and pot-surgical support there as well. That means taking at least an afternoon off from work and driving an hour one way. I elected to stay close, have support handy when I needed it, and only need to take a lunch hour. I mean I t’s not like I’m going to be able to really eat much more than sit for six weeks anyway. (It’s not that bad – it’s a gradual progression in the volume). The staff was great – very friendly and accommodating. I had a nice chat with the Nurse Practitioner while we were getting set up to get weighed. She asked me questions, and it wasn’t an interview or interrogation; it was a conversation and a dialogue, very comfortable and comforting.
I weighed in at 291 pounds, which was “better” than I thought. There was no shame, just a “Let’s go schedule your appointment with the nutritionist.” Gladly. Made it back to work with a few minutes to spare. Right on.
I decided about two years ago to look into gastric bypass surgery or some sort of bariatric surgery. I knew I would need to seek some sort of psychological support, so I saw a therapist for compulsive overeating. I was a lot thinner…once. I lost 100 pounds…once. Then I got hurt on the job and the weight started to go on. That was 11 years ago. Counseling was good. I had some real breakthroughs and after my therapist left for warmer climes, I decided it was time to move forward.
I want to use this blog as a diary of sorts, as I go through this process. Perhaps it will offer some comfort or assistance to others in the same boat. Perhaps it will serve only me. I have no idea. What I do know is that after 10 days of eating a 1300-calorie a day diabetic diet, I was craving the hell out of a pizza tonight. I called my mother, who happened to be at a pizza place, to talk me off the ledge. After a half hour, I got what I was really looking for, I think: permission to order a pizza. I realized that the problem was that I didn’t have a firm meal plan for the evening. I have the groceries in the house. It was a lack of a plan. I’m reminded of the old saying “Nobody plans to fail; they only fail to plan.” Bingo.
I still ordered the pizza and I feel awful. I’ll pay for it later with a jump in weight, or acid reflux tonight. I’ll feel guilt and shame, and hopefully I’ll get back on track tomorrow. Speaking of tomorrow, hopefully I’ll have a chance to talk about the folks at the weight loss center and how I got there.