Lift & Separate

It's amazing how many people in the "WLS Community" (that is, others who have had this type of surgery) are so supportive to total strangers! With my surgery date rapidly approaching, many have posted sweet, thoughtful messages on the message board that I subscribe to. I also have a buddy who is going to my surgeon, her date is 3 days after mine - but it's cool to have someone who will have the same process that I will to talk to (and, she just lives over in Ballard!).

More than that, of course, is the support of my family and friends. Michelle has been reading my message board, reviewing doctor's orders, making a list of things to take to the hospital, planning for afterwards, etc. - she really wants to 'get it' as much as she can so she can help me afterwards. (thank you honey). Outside of her, though, my parents, sisters, co-workers and friends have been so amazingly supportive and happy for me while also recognizing I'm freaked out by the gravity of the surgery itself, and the intense lifestyle change to follow. I'm grateful to all of your who've listened, gave advice, played devil's advocate, and pushed me to really think things through so I could feel good about my decision, knowing no stone was left unturned (you know who you are)...

So, onward. Just 12 days to go....

Uncle...I give...

Ok, so I'm freaking out about having scars on my already not-so-sexy stomach. Why? I guess because, as my good friend ck pointed out, we're all vain on some level. Well, I recall how I looked the last time I dropped 75 pounds or so - and I still had (and will have) a chubby tummy - and really, that's ok. But, somehow a chubby tummy with 5 "punch holes" and 1 scar that's about 1.5" smack left of center makes my stomach turn over (pun intended). Who cares? It's not like I'm ever gonna wear a bikini, right? Right.

Perhaps it's a reminder that I did this to myself, and moreso that I felt I had to do this to myself - because I can't do it by myself. I've accepted that fact on many levels - I mean, my God have I tried just about everything over the years! You who know me know this. But I think it's still an intense, reflective day when one throws up their hands as to say, "uncle...ok, ok, ok ...I give".

So, I give. And in return, I get....6 unwelcome scars to remind me every day forever more - though I'm sure at some point I'll embrace them as what got me to where I wanted to go.

Drained

So, day 1 of 40 carbs or less went ok. I suppose the first thing to be happy about is that I didn't screw it up - I had 38 carbs total, along with 117 grams of protein (holy cats!) and 63 grams of fat (ug! my inner-lowfat-child is writhing). Total calories, however, was a mere 1188, according to my food journal at fitday.com, a handy little tool actually! I now see how people lose weight doing Atkins, etc. - one can only chew on so much meat before becoming sick of eating...full or not, resulting in very few calories.

What I do find is that my energy level is crap. I am tired - but I did work out today and overall am doing my best to keep up. And, it's a little bit of a brain squeeze too - my head hurts a little from thinking so hard at work, etc. - but that's the idea, folks - squeeze all of the excess sugars and carbs outta every nook and cranny of my liver to shrink it down for a less complicated surgery.

I'm in, but man, I'm also glad this is only for two weeks.

The last supper...er, bagel

It's funny how some foods I've sort of been saying "so long" to over the past week - knowing that I'll be able to eat them again at some point once I adjust to the band, figure out its rules and boundaries and test things out. Other foods, however, it's a definite "goodbye" - food that it seems hardly anyone with a band can injest without consequences. Bagels fall in the latter category.

For breakfast today, I had what is likely the last bagel with cream cheese I'll ever eat in my life. Now, due to the significance of this for me, please indulge me for a few sentences...

My single most favorite breakfast is my usual - a poppy bagel toasted with veggie cream cheese at Roxy's deli, though the pumpernickel with feta dill cream cheese is a close second. So, I had "the usual" today, lucky for me my favorite cook, Jeff, was on hand to make it just right, as he always does. He wears a funny shirt that says, "I see dead people" which I like. Creepy though is just how often he wears it, but I digress... It arrived piping hot (you who know me know how I love my food hot) and I ate it, not thinking too much about it - I worked on my grocery list, talked to Michelle, etc. I honestly might have cried if I'd thought about it. This is a sad state, when one cries over a bagel. Food issues you say? Maybe, but really, this would be one of the 5 things I'd take to a desert island with me.

That all said, I don't suppose it's really about the bagel now is it? It's more the fear and significance of the permanent nature of getting the band - I mean, there's no room for error (re: cheating) here - eat a bagel and throw up. Oh, wait, actually, eat a bagel, have it get stuck, be in significant discomfort (re: pain), produce an inordinate amount of saliva for about 30 minutes (mmm, yum...), then throw up. Now there's some fun!

The good news here is that eating bagels is no longer more important to me than being healthy. Don't get me wrong, I'll mourn bagels forever more...might even try a bite at some point and suffer the consequences...but I'm choosing myself as more important than a bagel (whoa - now there's a good sentence to take outta context). But you get what I mean, eh?

Now I know how Eve felt....

We all want what we can't have...I mean, really, we can all distract ourselves, think about rainbows and sunshine, pray, etc. but at the end of the day, if someone says you can't have it, you'll want it a little bit more.

Well, that's me and carbs beginning Monday, up until my surgery date on 9/12. It's so strange - as I was planning my meals for the week, I had a blind spot the size of Canada! I could not think of a thing to eat that wasn't "unapproved" - which is ridicilous, really! So, I'm going to take the repeat approach so as to avoid any risk of failure (i.e., eating more than 40 carbs) and eat:

Breakfast: 1/2 c. cottage cheese + 1/2 cup strawberries (10 carbs)
Lunch: Tuna salad, 1 c. spinach, 1 oz. cheese + some soynuts (5 carbs)
Dinner: Some meat, 1 green veggie, 1 good'ole fashioned carb (20 carbs)

It's only two weeks for the love of pete, and God knows I've starved myself silly at times in my life eating much less than what is listed above! In the larger scheme of things, this is really not that hard. However, since the band is a huge, permanent change it's obviously a bigger thing that 2 weeks without carbs - it's the start of knowing that I'll never be able to just sit down and eat whatever again...I'll have to be thoughtful from now on. But really now, that is the whole point, isn't it?

Swimming Pools

So the one thing I will be reminding everyone of, myself included, is that *you don't lose weight with the band until you have adequate restriction* and that can take 3+ "fills" (fill, a term you should know = when they inject saline into my band to provide additional restriction via a small, flat, round "port" that will be sewn into my abdominal muscle during surgery, under the skin). These are done at 4-6 week intervals, the first being 6 weeks post-op, until you hit a point of losing 1-2 pounds/week without unreasonable hunger.

Many people lose some weight pre & post-op, however, often by the date of their first fill at the 6-week mark, they weigh about the same as they did the day they started. I saw a post on my lap-band message board yesterday that used an analogy that made good sense to me, and so I'm posting it here for mass consumption:

Post-op is just that, post-op. You have only had the band installed. Getting the band is just like getting a pool put in. You dream about how great it will be, can't wait to enjoy it, it is a big ordeal to have it put in, it will be the greatest thing! But, initially, you end up with a big beautiful hole in the yard that cannot be used yet. The pool needs a fill!!! Same with the band. Having the surgery to install the band is only the installation process. You can't enjoy it until you get it filled to the proper level. There is no possible way you can be a failure at this point - you've only just had the empty pool put in. Of course you cant enjoy your dream yet, you need the water!

The was a response to a poor girl whose parents call her daily to see how much weight she's lost, and she's only 2 weeks post-op! Note: Please don't do that to me, ok? ;)

sleep and stomach aches

I expect you'll be seeing some posts on the heavier side (no pun intended) regarding my upcoming surgery. Monday's start of the pre-op diet has kicked me out of denial and into a bit of panic - though it's not entirely conscious panic, mostly it seems to be manifesting as (1) lack of sleep and (2) a constant, low-grade nervous tummy ache.

While these two things aren't the end of the world, the constant lack-of-sleep exhaustion coupled with feeling a little like I might barf at any turn are constant physical reminders of what is coming soon. There's no question that I'm feeling an intense amount of stress. I think right now, the surgery part scares me more than the life after - though don't get me wrong, that's got my in knots too. But, somehow the gravity of the situation is flourishing in my subconscious... and at the same time, I am a strange place of quiet peacefulness with getting the band.

I know it's the right thing and that I've made a good, carefully thought-out decision. But, I wouldn't mind if the next two weeks could just sail past a little more quickly...

It pays to be prepared/farewell my friend, tortellini gorgonzola

Today I had my final pre-op appointment, laid out the cashola, and am 100% confirmed for my surgery on 9/12 at 9 a.m. Michelle got to meet my doctor, and we got all of our final questions answered. She of course was fascinated by the photos of the inside of my esophagus and stomach... Otherwise, the results of my pre-op testing were all just fine.

After this, I had my formal nutrition class which went over the three phases of the process - pre-op, transitional diet (post-op), and then finally the 'permanent' diet. Well, there were others there and I was at times surprised by their lack of knowledge around the whole process. I was quite pleased with myself in this moment with how much I did know. In fact, very, very little was news to me. So, in the end, I feel pretty well prepared. I think I learned that... (1) I am very well-informed regarding details, risks, challenges and (2) I'm really ready. I just am not afraid at this point of life afterward (though I'm a little afraid of surgery, but who wouldn't be?).

I followed this up with one of my 'last suppers' tonight - not that I am pigging out! But, we went to the (affectionately referred to) Italian Dump in our 'hood and had my favorite meal there. With a Diet Coke to boot. It was fun and made me happy, and I wasn't really sad that I'll likely never have that meal again - it was just nice to say a conscious goodbye to the tortellini gorgonzola :)

Um, yeah. This is actually hard!

Ok, you try to eat without drinking for a day. This is hard! I think right now, with no physical incentive, it's probably harder than it would be otherwise. But, I was successful at two of my three meals in this regard - chewing, not so much. But getting there. Tomorrow I have my final pre-op visit with my surgeon, which I'm excited about followed up with a nutrition education class regarding how I am to eat before and after my 'banding.' Monday starts the true "pre-op diet" of 40 carbs or less/day - that ain't many, folks. But, it's 2 weeks of my life. I've done worse.

For your entertainment, here are a few visuals:

Here is what my 'pouch' will look like once the band is installed. I keep thinking of a car, like having a stereo installed...anyhow, note the size and the limited "exit" that food will have. This is how it works - you fill up the pouch, which touches off your 'fullness receptors' and then the food has a slow drain, keeping you feeling full longer.



Now, here is what the band looks like unfilled (left) and filled up with saline (right). The point of the band is to give you restriction - so they fill it up until you're good and "tight." Remember, there is stomach tissue inside that band too - so the actual opening (er, exit) is pretty small. For perspective, I put two fingers inside the band they had for me to play with at my last appointment and the doctor filled it up all the way and it was TIGHT. This was good for me though - just to have a really good sense of how it will work.

I'm relaxing through the weekend, and then will have to become relatively hardcore as of Monday. Scary. But ok.

snap peas will never be applesauce...

Today I thought I'd start to apply "the rules" to see how I'd do. Well, I totally forgot for my first two meals (good work!)...and then for dinner I remembered. Here's the tale:

- made tofu and veggie stir fry, along with spring rolls
- did not have anything to drink
- chewed my food to high heaven (until the consistency of applesauce)
- ate a lot less as a result

What I learned was that:

- snap peas never liquify, ever
- broccoli either
- tofu is good when you chew it 4 or 5 times, it's gross when you chew it a billion times (hence i ate a lot less since the tofu became quickly unpalatable)
- the unhealthiest thing, the spring rolls, went down just great - having a sauce to dip in helped with the liquification
- high flavor foods, which i dig and have always tried to work into my diet to keep it interesting, taste better when you can cleanse your palate a bit with some water...the salty and spicey nature of my stir fry was downright overwhelming without anything tasteless (rice, water, etc.) to balance out the intensity. next time, i'll pull back on the flavor a little and see how it goes
- overall, it was odd, challenging, but not bad really

I suppose I've entered a space of realizing denial is futile. Time to start practicing the rules, because this will be my life soon without option. This is the time when one gets to realize this will be no walk in the park. But I knew that.

I shall not obsess...I shall not obsess...

It's hard not to think about my imminent surgery, though to be honest, I'm really not obsessing. I think I'm preparing - starting to try and think about eating differently both in terms of what I eat and how I eat. There are "bandster rules" you know...well, perhaps you don't know. Here they are, and they're on my mind - because most are way different than how I am today:

1. Never drink when you eat - First, doing so allows you to eat more food as you create a slurrey effect and push food through your pouch (that's the lingo for your "new" small stomach, about the size of an egg) faster allowing you to eat more (and lose less). Secondly, once your pouch is full, liquid can't get past the solids...which means it returns to it's place of origin (you spit up).

2. Chew your food insanely - Chew, chew and then when you can't imagine chewing anymore, chew more. Stuckage is an issue...so the more you chew, the less 'discomfort' (spitting up) you'll endure.

3. Cut your food into small bites, and eat as slow as molasses - You should never finish your whopping 1 cup of food in less than 20-30 minutes. Good lord! Today I slam a big fat burrito in 1/2 that time. Big changes (no pun intended).

4. Nothing carbonated, ever - This sucks. No Diet Pepsi, no Champagne...apparently, due to the small size of my pouch, the bubbles will feel very bad. Ouch. So, my plan is to try it once, like everyone does, and then be in pain, and then never do it again. Some people are ok with it, but I'm banking that I won't be...perhaps I'll be pleasantly surprised.

5. Know what you eat - Journal, follow a routine, whatever, but mind your protein intake (goal: 70-80 grams/day! holy cats!) and calorie goal (initially, mine is a mere 800 calories - again, that burrito mentioned earlier? 900 calories on its own...).

6. Eat whatever you want, but watch out! - Bread, tough meat, things that can ball up, get stuck or that are too fiberous are to be avoided - or they'll avoid you (spit up). White bread, well-done NY Strip, celery...these are things that across the board folks struggle with. That said, a nice rare Filet Mignon will likely go well, as will toasted grainey breads and plenty of veggies go down just fine (celery obviously isn't my lifeline, as evidenced by the width of my ass).

7. Avoid Liquid Calories - No matter how tight your band is, a milkshake, chocolate bar, mocha, etc. will slide on through. Ideally, outside of protein shakes, liquid calories are a rip-off. Spend those precious calories on foods that will fill up your pouch/fill up you!

8. For the love of God, be PATIENT - Bandsters, that is, those with a lap-band, tend to lose 1-2 pounds/week. That's right - after a year I may only have lost 52 pounds. The band works via restriction alone - that is, no malabsorption occurs in this WLS method - so the loss is slower. The band restricts more as it gets filled, and it can take 3-5 fills to hit your "sweet spot" of losing that 1-2 pounds/week - and fills are at least 6 weeks apart! It could be months before I'm truly clicking along. I'll be patient with myself, but for my audience: Please don't expect me to shrink by Christmas. I imagine I'll post a decent loss by then, but you never know...

So, feel free to kick my aforementioned wide ass if I get annoyingly obsessive about this whole thing. Well, actually, give me a month - a month once I start eating real food at the end of September - to figure things out. I'll put a little note on my calendar to shut my pie-hole on Halloween. Until then though, tell me if I'm annoying you and I will pick someone else to annoy instead.

Just a big hose down your throat, this won't hurt a bit!

Just a little report. Today I had my ultrasound, EKG, bloodwork and (ick) endoscopy. All went well though the endo showed that I have significant acid reflux disease! Who knew! I never have heartburn at all - I didn't know that was possible...but, alas, it is! My surgeon did the endo, which was nice in that I got to interact with him a bit more. He also took some biopsies to check things out. I also showed a hiatel hernia (sp?) which was "medium grade" according to him - he'll fix that up when he installs my band. He also said the band should take care of the reflux disease. Phew! I'm just glad it's overwith...it's never fun to awake lying in a puddle of your own saliva, or to have one's hair was soaked with it. Ew!

One other observation - living in Seattle, I was at first hell-bent on a big fancy in-city hospital. I've ended up at a smaller one up in Edmonds, and I have to say - what a delight! Every procedure today was done on time, they were expecting me, knew what I was there for, etc. - it was as pleasant an one could hope and I think a large part of that was due to the small facility factor. I didn't expect that really, but it's a good thing.

Found My Man

Yes, a strange thing coming out of my mouth, I know...anyhow, I'm referring to my surgeon! I found Dr. Billing located in Edmonds, just north of Seattle. He was my man! I liked the whole office and the entire plan that they have. In a nutshell, for my $17,000 self-pay dollars, I get:

- Surgery, including 1 optional night in the hospital
- 12 months of monthly nutritional visits
- 12 months of any needed Fills

The nutritionist is great and resonable - I think a lot of the doctors seem to me to just want to "sell surgeries" and make money. I think a lot of the seriously hardcore liquid diets for weeks before and after seemed extreme - and a way for them to say, "hey, my people lose 40 pounds in the first month" etc. - while that's great for some, I am not interested in starving myself thin. Melanie, the nutritionist, has a plan for 2-weeks of Atkins-level carb diet prior, 1 day of clear liquids after, 1 week of liquids and then 3 weeks of mushie/slushie food. Then, onto solids... to me, while I'd be thrilled to drop 40 out of the gate, I'd rather stay mentally balanced and sane and go more slowly, though I'm sure at times that will be frustrating...

The two biggest humps I had to get over were (silly..) never drinking a diet pepsi again and of course, the money. While I have access to the money, it's no small bit and it does wipe out a lot of savings that has taken years to accrue. This hurts - but so do my knees, ankles and hips... :) I got over both of those things the day I found the right surgeon, and I guess emotionally, I was finally just READY. And boy, when you're self-pay, things happen fast!

Pre-op testing on 8/19, final appointment and pre-op nutrition class on 8/24...starting low-carb diet on 8/29 and then surgery on 9/12 at 9 a.m. I'm scared, nervous, excited, happy all at once...but I'm trying not to worry. What good does that do?

Why the Lap-Band? Why now? Why? Why? Why?...

I have been heavy all of my life. I was on my first diet at age 5 and I still remember how proud I was of my 20 pound weight loss! I continued dieting throughout school, and into adulthood. I had a huge turning point when my grandmother died and my aunt sent me a slew of family photos - photos of generations of women built *just like me*! For the first time, I thought - my god, this may not be all my fault! It allowed me to stop beating myself up and start looking for ways to improve my weight that might actually work! I did some emotional work too via a therapy group for people with eating disorders and food issues - this was also a huge change for me. I stopped hating my body, and found a place of being at peace with my shape.

Then came along weight-related health issues - insulin resistance, creeping up blood-pressure, hip, knee and ankle pain...at 34! I decided that I had to do something. I did my research on both the gastric bypass and the adjustable lap-band and decided that, with a BMI of 40 and some other band-friendly characteristics (not a snacker/grazer, not a sweet-eater, more of a volume-eater, etc.), I decided the band was for me. I figured if I failed miserably, the bypass could always be done at a later time, right? But I think I'll be successful or I wouldn't be plunking down this kind of cash :)