Biking is Hard...

Today was a little on the windy and chilly side, but I was determined to do something today that made me feel as if I accomplished something. My wife's bike is "in the shop"...the chain kept flying off the sprockets when she downshifted and the real kicker came yesterday when we tried to go on a biking excursion and her quick-release hub assembly flew apart. We put it back together, but every time you locked it, the lever flew apart from the assembly. Something stripped? We couldn't tell. But the conclusion was a trip back to the store the bike came from, 3 year service plan in hand, telling them it needed repair. They said they'd have their bike mechanic look at it today and call us when it was ready. No phone call today.

So I filled this afternoon first with more weed whacking...quite of bit of that done...then we took my bike and my son's "Hot Wheels" bike (a little bike with training wheels) to a local school to ride around. My son decided to take off without us, and we yelled to him to stop and wait. He stopped, giggled, and took off again. I jumped onto my saddle and took off after him, but I was too late. He failed to brake in time and rode right off the sidewalk, falling onto the pavement.

He seemed okay with a nagging soreness to his arm. We were sure it was a sprain. His grandparents were sure it was a sprain.

A few hours later we took him to the ER. It was a green stick fracture on both bones, mid-forearm. Not a complete snap, but enough to proclaim it a fracture.

Silver lining: he's four. The bones, he said, would heal right up as long as they don't take another hit that would complete the fracture, and they'll heal straight. He should be just fine, although right now he doesn't like the feel of the splint and in a few days he'll have a cast put on.

He'll be fine. Poor little guy.

All of this after scouring the web for information on some sort of a "good" place to try riding. Long story short: good luck finding some. It's hard enough for adults to find a place to ride that wasn't in the road. To ride with a four year old on training wheels? The local school was the closest we could find to being a safe place to try riding. So much for that theory.

Society just doesn't seem to place importance on exercise outside of walking and fitness centers. Biking was a good, practical way to get some more exercise and yet it's relegated to having practitioners roll the dice and take their chances with getting hit by cars or have to use stationary equipment in gyms or basement workout corners.

That. Sucks.

Especially for noobs like me who are too out of shape to really ride on the roads or people, again like me, who have young kids who also want to try riding on a bike. Well, used to. I don't know if my little guy will want to ride for awhile after this incident.

Biking for Fun

My wife and I went to a park late yesterday to try breaking in the bikes a little. We first stopped at a grocery store and picked up a few items then headed out for a picnic and bike ride. Here's some of what we saw while in Eldridge Park...

I'm not sure how long the path is that circles the park; my wife thought we traveled a mile or mile and a half. Her knee...still injured from when the idiot dog pulled her off the porch many months ago (and she'll probably need surgery to repair it)...was bothering her after the first circuit around the park, so we packed up and headed out.

There was a band playing at the meeting area near the lake. The band wasn't bad, the weather was nice, the park was pleasant; it was a pleasant way to spend the late afternoon.

Doctors and Medical Myths

Quick article to share with others...

http://www.newsweek.com/id/199679

It explores some of the myths that many doctors apparently believe. A couple of docs as a side project wrote a paper exploring myths that pervade their profession and the results were kind of surprising...including having one guy harassing their office until they had to get a restraining order because, believe it or not, you don't need eight glasses of water a day. Yes, the guy was extremely upset that they would have the audacity to publish that.

Interesting, kind of scary that the people we trust with our health believe some of these myths when most of this information isn't new. But we sometimes need to realize that doctors are humans and it's their jobs, not the essence of their existence, when they're sitting there in the same room where you're only in your Superman underwear and they're examining you. They're fallible. We simply, without question in many cases, expect them to dole out miracles. They can be wrong. We need to remember that.

It's just their job to try not to be wrong and in the process keep you healthier than when you walked in. What do readers think?

Followup to 7 Week Followup: Blood Test Results

I got an email from my doctor this morning about my blood work (holy schnikes that was fast...I rarely hear about blood test results that quickly). She said that I was mildly low on iron, which is common for bariatric patients. I'm supposed to start on an iron supplement of 325 mg twice a day.

Iron can cause constipation so she said if it happens I can go on a fiber supplement as well, but I think I'll wait and see what happens.

Oh, yeah, forgot to mention that when I had my previous appointment the doctor gave me her email address for questions and concerns. So now I have two people on the support team that I can email with concerns if/when I have them! They are both younger medical staff too. Doesn't take much to see a pattern...the generation accustomed to technology are using it to their advantage in working with their patients. Soon they'll be using Twitter as a tool in the medical office.

I hope I can go off some pills soon. I have a rather large number I take every morning now and need to remember to take at night; hopefully I can get off the cholesterol/blood pressure stuff soon!

More On Skin Irritation and Loose Skin

Those dark, sweaty spots on your body from loose skin that people generally don't like to talk about (but, I've noticed, are increasingly used as comedy fodder...even saw it in a cartoon episode of Fairly Oddparents where all meals were comprised of dessert...I have a young son and he likes cartoons, okay?) like to form rashes and skin irritation. I wrote about a problem I was having with this yesterday.

I put Gold Bond Medicated Powder on it last night and again this morning and it feels better. Don't know if it'll solve the problem, but hey...anything to help. I have an appointment with my primary care physician towards the end of the month and will be asking her for some kind of prescription to cure this because it is driving me nuts.

Loose Skin and Rashes...

It happened before the surgery a couple times, and this is the first time since the surgery that I've noticed it.

There's some kind of a wet rash under the fold of a section of skin.

It's uncomfortable and annoying. I don't know if it's just a rash or some kind of infection...but I do know it's annoying.

I'm hoping some powder will help with it. Supposedly a few years down the road, if there are infections, I can try getting loose skin removed. As pointed out at weight loss surgery coach once you reach a certain point in weight gain the ability for skin to "snap back" is most likely lost...so exercise will not help this particular problem.

In all likelihood, the sweat and friction will make it worse.

Any other patients out there experience this and try home treatments that seem to work?

Milestone: 7 Week Followup, Plateaus in Diet And Some Potential Exercise

Today was my 7-week followup to the surgery. My wife came with me for information and support. There wasn't really much to it...a few question and answer things, primarily, and my doctor put me on vitamin B12 and B-complex pills now. I'm going to pick them up from WalMart soon.

I tried asking some questions about how plateauing works, but I don't know if I sufficiently communicated this idea to the doctor. I'm beginning to wonder if I can't get anyone to understand where my knowledge is insufficient for this. She primarily focused on how we...barry patients...no longer fit the profile of the typical dieter now because we have both smaller stomachs and malabsorption issues. I think I'm asking a very plain question, but either I'm not communicating clearly or I'm not understanding their responses.

I'm trying to ask this...if you view dieting as an engineering problem, the body is reduced to a bag. It's like when I was in school and had to balance equations in chemistry...you put food in, you burn energy and excrete waste. The in-processing matter is what comprises your mass, and on the planet that translates to your weight.

You drink a pound of water, you weigh a pound more. You eat a pound of food, you have a pound of weight added.

As you go through your day you sweat, you go to the bathroom, and you convert some calories into work...movement, heat, etc...and some food/drink is converted into other cells to repair the body while others are shed (hair falling out, skin shedding, internal cells are flushed out as waste...). This is weight lost.

You are a walking chemical equation. Now, if you figure out your basal metabolic rate, you'll find the approximate number of calories you burn if you didn't do jack squat for the day. Lay in bed, this is the number of calories you burn. These calories are used to keep you alive. Your brain activity, your organs functioning, etc. would burn this many calories. It takes calories to maintain your current weight, believe it or not. If you eat less than the BMR, you should lose weight. If you eat more, you gain weight.

If you figure out how many calories you add on to your BMR from exercise you can adjust accordingly.

Now, if you're taking in a very low calorie diet as I once did many moons ago...600 calories, more or less...there is no way I could be going over my BMR. I'm not putting more calories into the bag...my body...than were flowing out. Yet still I hit a plateau. In the current case if you follow the rules my doctor said that we should hit no more than 1200 calories a day; this is still below most people's possible BMR count.

Okay. Body needs...at my weight one time it needed over 3000 calories to maintain it's weight. I'm putting in...1000. Matter does NOT just appear. Matter does NOT become magical. The body needs 2000 more calories here, so something has to give. Normally it means you lose weight. So when you're plateauing...where is the energy coming from? I'm not putting in to the bag the amount it needs to maintain the weight level it is accustomed to. Remember, if you have fewer calories than BMR, you lose weight. Equal BMR, you stay the same weight. Over BMR, you gain. There's a 2000 calorie difference in this example...so how does it stay the same??

The answer I normally get is that the body is adjusting to the changes and lower calories.

That's not quite clicking to me. If I don't put gas in my car it doesn't just adjust. It needs fuel to run. Your body needs calories to run, and if it doesn't get them it will start shedding components...fuel stores in fat, or excess tissue, etc...to survive. The closest I could come to an understanding from my conversation today is that I should feel tired and sluggish as the body "conserves and adapts" by screwing with the rate at which it metabolizes energy stores.

Oh well. Seven weeks in and now I'm adding some vitamin B stuff. AAH! MORE PILLS! My doctor also gave me her email address to address concerns I may have or develop.

My wife and I also went out and she gave me a Father's Day gift from her and my son. A NEW BIKE! YAY ME!

I am not a bike nut. It is something I enjoy periodically, though...I'm not good at riding up hills, I usually rode around buildings on paved and generally flat surfaces, not running through the woods or along roads. It's one of two or three things that both I enjoy and are generally classified as exercise. Unfortuneately when I hit a heavy enough weight I just threw the bike into storage. I took it out over the weekend now that my son is trying to get a bike and found it to be rusty and generally in need of a tuneup.

I lamented to my wife that I was going to save some bucks to get a bike and she took me today to Dick's Sporting Goods just to look around. I ended up really liking a Diamondback Edgewood 09, and she said, "Happy Father's Day!"

She also bought herself a Diamondback Lustre 09, so we can both ride with the little dude. Yay us!

So that was my day for the most part. Not bad. Unfortunately I'll have to return to work tomorrow, but we'll not let that dampen spirits right now...

Adsense activation

I've been curious about this for awhile...I finally activated AdSense on my blog. I have been curious to see what Google would select to show for advertisements now that the search engine is finally showing signs of indexing the content and analyzing information from it; I've been hesitant because normally ads are SO intrusive and annoying. The account is free as in money cost, but there is an annoyance and user-friendliness cost when you're bugging readers to buy buy buy while hoping they'll read and get some information from the content of your words. The default was trying to stick ads in the sidebar and under each posting...I personally find that it interrupts my reading of a blog when it goes post-ad-post-ad, but that's me and I understand the idea that if you're trying to make money from your site you want to try sprinkling as much ad content as you can without annoying your readers.

In the end I opted to stick one hopefully unobtrusive bar just below the title of the blog. Readable, should get some attention, while not being too intrusive.

I hold no illusions that this will make me money. Maybe once a year I could buy a comic book or something.

At any rate if you have any opinions or feedback please feel free to leave comments. I'm still experimenting and with a small readership I'm pretty sure that the void AdSense will fill is my curiosity of what ads Google thinks fits my content rather than any void in my wallet.

Exercise and Dieting...Why I Hate Exercise

After much struggle with my own weight loss issues and a lot of reading on the topic as well as discussions with multiple doctors, the truth about weight loss boils down to a simple short sentence:

Losing weight means taking in fewer calories than you're burning.

In other words, eat less or burn more calories. Adjust as necessary.

Whenever my weight loss stalls or I discuss issues with other people they inevitably start telling me that I need to "Exercise more! You need to exercise!"

Somehow that's the magic cure for everything.

The depressing batwings forming under my arms? "Exercise will tone that up." No, it won't. If I had lost a little weight, yes. When I've lost over a hundred pounds, no. The connective tissue is damaged. It will improve slightly and building muscle will contribute to helping, but dreams of looking like a studmuffin on the beach will not be in the cards. Plus as I established in an earlier post you need to take in more calories than your "maintenance" metabolic rate in order to build muscle...that's kind of against everything we're currently working towards.

I am a person that also needs simple routine and I live in an area that has variable weather. We have snowy Winters, sweaty Summers, and chilly Falls. Perhaps most people can't understand this but I simply cannot stand the thought of getting into a routine of walking along a riverside path for 3 of 4 seasons then get stuck in the house for the Winter months. I'd fall out of habit and never get back on the saddle. It's my nature...look for the asperger label for more.

Of course there is the old standby that I just don't like exercise.

However the real reason is that I am looking for exercise to enhance weight maintenance, not as a necessity. How many people do you know hang up the walking shoes for Winter and gain weight, or stop some activity that's work- or hobby-related and over the next several months gain the pounds? A shift in lifestyle suddenly means they become a lot tubbier? See the kids that went from high school sports stars to college tubbers and write it off as "Freshman Fifteen"?

I need to find a caloric intake that will maintain a more healthy weight. Then exercise can help me while not damaging my mental state. I am not denying the studies that conclude exercise helps in other ways, such as enhancing mood, helping metabolism, etc...simply that I, personally, need to find and maintain a healthy relationship with food before turning to the religion of abs and glutes. Preferably without bandying about terms like carbs, abs, and glutes.

I'm a big believer in The Hacker's Diet; available free online. The author states that he supports exercise for the benefits it offers but not for weight loss.

Maybe it's the psychiatrist effect; it often seems that when a person goes to see a therapist, suddenly everyone needs a therapist. They start to evangelize how their friends and family could use therapy and encourage others because of how it works wonders for them. Perhaps exercise has the same effect on them.

That being said I burrowed into the basement last night and use the air pump to re-fill the completely flat tires on my old bike. My son is getting a Hot Wheels 16-inch training bike for his birthday...we had to order it from Wal-Mart online...and I thought it could be fun to try riding around with him at school playgrounds, plus I used to enjoy riding bikes. My poor old bike has rusted rims and a missing spedometer computer and probably will need a chain replaced and greased, and the brakes are probably not in the best shape after being in storage...I'm really in need of a new bike. I don't even know how to properly work the gears. I'm a total bikenoramus. I'd say ignoramus but I don't count myself as such since I'm aware of how much I don't know about properly maintaining my bike. I managed to ride it around the front yard for a couple circuits...my son chased me on foot giggling the whole way...before putting it into the shed to see if the tires hold the air pressure.

Now I just wait and see.

Bariatric Surgery and Death

We often go to McDonald's for a Sunday breakfast. It's a bit of a tradition thing for the family, a bit of a familiar routine in which I take comfort and the family accepts as a quirk of my own (although I think my son is simply a fan of the scary clown-man mascot).

We've been there enough that the morning manager knows us. But the sad parenting and horrible habits implied by a weekly trip to a fast-food joint for a meal notwithstanding this has led to finding yet another person with a connection to bariatric surgery.

When the manager found out I had had Roux-en-Y surgery she told us about her brother in law. He died four years ago the night after having the surgery.

We're told before the surgery that there are risks. We're warned about them, but I don't htink the numbers really don't sink in. We're bolstered as we hear about the success stories and meet many other people that we never suspected had the surgery...I mean, probably half of the nurses attending to my recovery in the three days post-op said they had the surgery and never regretted it.

This was the first time I had heard of a death of a patient from someone we know.

To be fair it was a complication of the surgical procedure that could have happened to anyone who had surgery. She said that he had sleep apnea, undiagnosed, and basically that night had vomited in his sleep and choked to death.

I couldn't imagine it happening in my case; I was hooked to monitors up the wazoo, I had nurses on rotating shifts checking every hour, I had excellent care fresh from surgery with a one-on-one nurse until I was transferred, eight hours later, to a room...

My wife said that this was four years ago and it's possible that in that time things have significantly changed in procedure, or maybe it was a per-hospital thing that made the difference, although this hospital where it happened is a rather big name for our state; one that if you lived in our state or in a nearby state I'd bet you've heard of them.

I was aware of the chance of dying. I think you'd be unhealthy not to have some fear of it going in...especially faced with the knowledge that someone is about to wrap his fingers around your intestines. Not even my wife can say she did that and we tend to have been pretty intimate with each other. But I also realized that if I didn't have the surgery I was facing a slower death from the comorbities of my obesity...diabetes, heart attack, stroke...all of which carry a greater chance that I'll die prematurely. Essentially there was a slim chance of death by surgery vs. the very high chance I'll die later but prematurely compared to a successful surgery.

I was also aware that the surgery carries a risk that there will be complications not just during and soon after the operation, but years down the road something could happen (such as twisting of bowel or blockage in the digestive tract); the more time that goes by the further from the woods I would get, and right now I'm probably in a pretty safe place.

So if you're considering the surgery you do need to educate yourself on the risks and at the same time put them into perspective. Things can and do happen. Bad things. And you'll definitely not have a necessarily simple path to follow. As I've written before here this isn't a magic bullet and it's not simple...even my own surgeon doesn't have all the answers on how this works with the body's reactions to food and weight loss, and now, nearly two months down, I'm still struggling with issues like figuring how in @#% I'm eating less than a cup of food three times a day and still my weight is "stuck" at a plateau (stupid body...fighting weight loss...retaining water?...but that's going off topic again).

Where was I? Oh yes. Educate yourself. Be aware that there are risks. But put them into perspective. Perspective was the saving grace that got me out of bed the morning of the surgery and told me not to run away down the hallway with my gown flapping in the wind before the doctor could pull his favorite scalpel out and get to work on me.

Red Bull Diet

Coolest...diet...ever...except for the possibility of death.

I just found this news story about a woman who went on a "Red Bull Diet". In eight months she dropped 45 kg...approximately 100 pounds!

The only side effect was a minor heart attack...

C'mon...you know you wanna try it.

Bonus: the drink was an appetite suppressant.

Nutrition Controversy for Skeptics

The cover story of the May/June 2009 issue of Skeptical Inquirer, a magazine that I rarely pick up unless the cover has a particularly eye-catching lead, held the headline "Science & Pseudoscience in Nutrition."

With a title like that, I had to take a look.

The article was actually titled Science and Pseudoscience in Adult Nutrition Research and Practice by Reynold Spector and started on page 35 and postulated that "Human nutrition research and practice is plagued by pseudoscience and unsupported opions. A scientific analysis separates reliable nutrition facts from nutritional pseudoscience and false opinion."

The article wasn't so much a debunking of various myths and ideas in nutrition as much as it was an analysis of the fact that such myths exist and why; it made me sad to see how much crap is out there more than clearing up some of the myths that exist. I suppose if it was an article trying to spread the truth of various myths then it wouldn't be much different from the articles you can find in most supermarket checkouts, though (except that one of the exceptional features of Skeptical Inquirer is that it does actually have reference notes in articles that take up more than two lines at the end of the piece...I was about to shorten the title to SI, but I really don't think Sports Illustrated is noted for putting in such footnotes).

The article sets out to answer four questions, paraphrasing:

1. What do we know about adult nutrition?
2. Is there an optimum body weight?
3. Why are there so many confusing or contradictory data and opinions in literature, media, and books, regarding things like whether certain foods even in moderation are harmful and are food supplements like megavitamins helpful?
4. Why are there so many erroneous or uninterpretable nutritional experiments...pseudoscience...in the literature?

The article is surprisingly readable and at 7 pages in length doesn't take long to get through and the conclusions were unsurprising to a cynic like me but may be interesting to the average Joe spending his day being assaulted by various weight-loss and nutrition headlines by magazines and news media. The sad part is that the conclusions won't be anything we want to hear.

Even a healthy skeptic like myself still woke up finding that I wanted to have a weekly trip to Red Lobster for my once-a-week fish serving because...vaguely...it's supposed to be healthy.

I suppose old habits die hard. At least I added a little more to my knowledge store.

Weight Loss Surgery - People Noticing?

I'm not sure how to take this...

If you followed previous posts, you know that my story for this year basically goes like this...

I got serious about the surgery after insurance decided to okay the surgery late last year. In January, I started losing weight in order to get the weight loss surgery (yeah..ironic...you have to lose weight to have weight loss surgery).

In April I had the surgery.

It's now the end of May.

I've lost approximately 120 pounds so far, about 40 of which (rounding; I posted a day or two ago more solid numbers but these are off the top of my head) have been since my surgery. That leaves 80 pounds pre-surgery.

For the past two days I've had a number of people suddenly comment on my weight loss. "How much have you lost?" "You've changed so much!" I had one person asking someone just how much was liposuctioned out of me (in case you're wondering, my understanding is that you'd probably die if they tried liposuctioning even 40 pounds out of you, but I haven't asked my doctor about it).

It's nice that people notice...for a long time I began to wonder if I looked any different. Living with this means that you kind of get used to just not fitting into seats and not being the first pick to the prom. But I had to wonder...where were these people during the first 80 pounds? I had one person ask me about my weight loss before the surgery. One. Eighty pounds.

Is there a social rule where you just don't comment on people's weight? I mean it's fairly obvious people talk about the fatty waddling down the hall to people other than the person they consider a fatty. It's a classic stereotype. A societal joke. It's socially acceptable to poke fun at the expense of the obese.

But while I was trying to lose weight before getting 80 staples in my front, where were the comments about people noticing anything then?

I don't know how to react. Right now I just say thank you, but really...how do I reply to it? Part of me thinks that they may not know the backstory...part thinks that they've heard the rumors of surgery. Are they playing dumb? Or do they really not know? Do they just think it's a socially acceptable thing to ask about on this particular day? All of these thoughts are racing through my head when they say something and I haven't a clue what to reply with that won't sound suspicious, trite, or unappreciative.

Then there's another thought that creeps into my head and makes me just...agitated. There are several warnings out there about people losing weight and taking delight in how people react more positively to them. Biases against the obese are put aside; you're one of "them" now, the normals. They don't necessarily stare at you as you walk down the sidewalk. They don't question how Tubbo can carry the heaped-up plate at the buffet anymore because they don't know you're Tubbo from several months ago. They don't assume you're lazy or slow-witted because you're not wearing the 6x t-shirts anymore. This ticks me off.

So are people being nice because I'm not Tubbo anymore? How exactly has their perception of me changed despite, to my knowledge, I'm still...me? I'm the same me that wanted to fit in with you before. The same me that wanted to go to the prom but didn't have a date, the same me that wanted to be the one to catch the eye of some cute girl walking along instead of the other way around.

These subtle rejections in life have helped shape the person I later became. I saw people's inner nature and behavior in ways that normals never did because they didn't experience these things; if you weren't the hot cheerleader, could you ever truly understand what it's like to have most people wrapped around your pinky, getting favors without even trying or conciously putting forward effort to get them? Don't tell me it's not the case; there are studies showing how people who are attractive "tend" to be more successful in life. Even Wikipedia has an article dealing with the subject!

Since I have a terrible time understanding other people's motives and behaviors I also have a terrible time knowing what response people are looking for when they suddenly tell me how great I look now compared to...I don't even know when they last noticed me.

This is something else to deal with, I suppose. I perpetually ask myself what's wrong with me that no one noticed until one hundred twenty pounds later that I'm losing weight. I question their sincerity. I don't know how to reply. And I'm angry, for lack of a better word, at the subtle shift in attitudes that go along with how a person is perceived as they lose weight despite the fact that I'm fully aware I have my own judgements passed on people for a wide variety of behaviors and appearances. I'm aware of it and try to be empathetic with that self-awareness as a reference from which to relate to them, but I can't deny I still feel stirrings of irritation at them for my having to be on the receiving end of the stick.

Maybe these are thoughts other patients don't normally dwell on. If you have experienced this and have some information or advice, feel free to comment...

Copay Confusion (Or: I Hate Insurance Bureaucracy)

I got a call from my wife. "I picked up the mail and there was a check from the hospital for two thousand dollars."

Um...okay.

Ordinarily I wouldn't question it. I'd cash it and we'd have a fun weekend away, especially with a three-day weekend coming up for us.

But seeing as this came from the hospital that a little over a month ago had cut me open and knowing that my copay for the operation was two grand, I thought this was a little too good to be true.

I called the hospital. "The insurance company paid your bill from us in full, so we mailed you the difference."

"They paid in full?"

"Yes. All paid."

Oooh...what was that feeling? Hope? I didn't eat yet...so it can't be an overeating pain, or a pain from something too dry trying to fit through the food hole of the stomach...must be hope. Much needed money!!

But still I've been alive long enough to know that these things don't happen to my family.

I called the insurance company and explained what happened. The nice service rep checked my benefits and information on the procedure, and came back and confirmed that yes, they paid the facility bill in full.

"In full?"

"Yes. But we're processing the provider's bill. It can take up to two weeks..."

"You paid the facility bill, but not the provider bill?"

"Not yet. We're processing the claim. So your copay may go to the provider, the surgeon. You should hold on to the check for two weeks until you get the explanation of benefits..."

Ow, ow...ow...oh, that feeling just drained away. Now I don't know if it was hope or gas.

This is a wonderful example of user-friendliness. To me, the end user, I owe money to some monolithic entity, the hospital. We give them money, they disperse it as necessary...I assume they employ the doctors and whatnot.

Apparently this implies that doctors are like consultants working for the hospital and as such there's two or three times more paperwork that snakes through insurance companies and the hospital, making it much harder to keep track of anything. This also means that two or three months later I'm still getting papers trickling in saying what is owed and what's paid and not paid.

I had paid my copay ahead of time so avoid hassles. Instead I've created another hassle for myself. @#$%#

Ideally the insurance would pay what's needed and the process would be streamlined to the point where I wouldn't need to track all these various places money is owed and who got what. I'd have a form or website for "medical" that would state where to send money, authorize the transfer on a certain date, and fwoom, done. I could get an instant update on where the money is and the status of bills, and maybe even have a link that I could click to send queries to service reps about questions.

It would be a wonderful idea but because of the bureaucracy involved in trying to get insurance companies and hospitals and doctors to work together it would be a monumental undertaking. I'd have better luck finding a way to get a live webcam broadcasting from the moon.

Anyway I'm now going to cash the check, set the money aside again, and wait until the bill comes so I know who to pay and my dreams of having a brief, relaxing vacation has been dashed as quickly as the hope rose in my chest. Or the gas. I'm still not sure which it was.

Panera Smokehouse Turkey Sandwich

My family had to get some last-minute items for my son's upcoming birthday party. While we were out we stopped at my wife's favorite dinner/lunch spot, Panera Bread.

Knowing that I can't eat too much anyway, I told her to get a Pick-Two soup and sandwich and just surprise me, since she usually remembers what I like better than I remember.

I was sitting with my son at a table outside and enjoying the warm early evening weather, listening to large gulls squawk and beg from other customers, when she came out with a small bowl of French Onion soup and a 1/2 Smokehouse Turkey sandwich.

Okay, here's the warning part...I picked off most of the crust, as that was kind of hard from the toasting, and I picked out a piece of bacon after I had pulled a couple pieces of gristle out from a slice I bit into. I focused on getting most of the meat eaten; the bread was relatively soft in the center and the cheese, a decent protein source, was pretty good.

But then it happened again...pain. Not as bad as the episode I had previously, but it was enough that I felt it. The pain probably wavered for about ten minutes and disappeared.

Was it something added to the bread or cheese, like an oil or butter of some kind? Was it just that the bread was overtoasted, too hard for my stomach to like? I don't know...what I do know is that next time, we're ordering it un-toasted.

I asked my wife about how much she thought I ate and she estimated it was around four ounces, which was close to what I thought it was as well after I had picked out bits of the bread and some of the meat. So I didn't consume over my limit...it was definitely something with the sandwich.

That's your word of warning for the day. It's not necessarily the quantity of something that'll cause pain. Sometimes it's the nature of the food!

My Asperger's Self

I have referred to myself as having Asperger traits. There are plenty of sites that describe the syndrome; there's really no need to rehash it (I even linked to the Wiki article for a nice jumpoff point of you're interested). I don't think I ever actually discussed why I think I have it, though.

Asperger's isn't something that you can test for in a blood test. It isn't something you can diagnose from a CAT scan or a DNA test. There's no physical symptoms to it; you see me walking down the street and you'll probably not suspect that's what's wrong with me. It's a spectrum disorder and much like being paranoid, you get evaluated by professionals and they will figure out if you have enough of the characteristics to declare that you have the disorder in question. At least, for now...as more research is being done maybe someday it will be as easy as a DNA or MRI scan to diagnose the disorder.

As part of the bariatric surgery requirements for my insurance company I had to start seeing a psychologist or psychiatrist. I discussed with him my concerns about having these traits, and he in my last session said that I have many of the traits and may very well have this disorder, perhaps a very subtle or mild form of it.

What I've noticed, plucked from a list from wikipedia that was linked above...

Aspergers and related spectrum disorders tend to appear in early childhood. I have always had these issues stretching back as far as I can remember.

Social impairments...I tend to overlook social cues. Understanding people is very difficult for me. I try to hide it at times by playing it off as the usual jokes such as how no guy can possibly understand women; underneath I have problems understanding people's motivations and behavior beyond the analytical evaluations. The more irrational you act, the more agitated I get.

I think I tend to avoid eye contact with people unless I'm analyzing you. Sounds creepy writing it so plainly like this; but often, if I'm looking you in the eye it's because I'm trying to figure out what you're talking about, I'm analyzing you, or I'm desperately trying to beam my thoughts directly into your brain. Otherwise, you bother me and I'm probably looking at something more visually interesting in the room.

I tend to be very pedantic in my speech. I irritate my wife with this...she thinks she's speaking clearly, I have no clue what the hell she's talking about because her word choice is quite vague or open to interpretation.

I use to flap my hands. I don't know how to describe it other than being a soothing feeling. My wife was irritated at it and insisted I stop so eventually I did.

I have to check some things repeatedly in order to imprint it on my memory that it's done, such as checking that the fridge is closed. This may have been exacerbated by having a teenager and a toddler in the house and I don't trust them to actually close it up when they're done, but I still check it two or three times when leaving the house. I also check doors and the stove. As a kid I would have a nightly check of my home making sure doors and windows were all closed.

I don't adapt well to change; my wife tends to wait to the last minute to make plans or flies by the seat of her pants. It agitates and frustrates me. I hate not knowing what's going on, and more often than not it ends up being a point of contention for us.

I need order. Another item that adds friction to the marriage...I prefer having certain things in order, or a place for everything and everything in it's place. My wife prefers putting something down and coming back to it much later...I can't see how or why her things are ordered the way she does it, and it causes anxiety for me, especially in spaces that in my mind are "shared space". This is simply the way my mind is wired. I try to work around it by creating pockets of order that are more or less just my things, my way of ordering things.

I tend to follow a set of ritual behavior. My day is usually pretty much mapped out. If something is very different it can cause me quite a bit of agitation to work around mentally.

I tend to have a limited focus on my interests. I like technical things, I can tell you obscure information about warp drives and computer viruses. My best friends are technology.

People wear me out. Interacting with people drains my energy, I recharge my mental batteries by being alone or with close friends only. This, of course, makes me rather...techy. I get short tempered with people that agitate me for small reasons when coupled with the stress that comes from having to interact with...tolerate...other people.

I have trouble with certain sounds and movements. For example: I cannot stand the sound of snoring. I become visibly agitated if I hear it even in a movie for more than three seconds. I also can't stand it when I see people "twisting" their feet; my wife does this all the time and I always ask her to stop. I cannot ignore it. It draws my eye immediately and becomes an immediate focus and almost physically hurts me to see, and I start wanting to just...reach out and break the foot if I could. I've never acted out on such impulses but it sometimes scares me to think of what would happen if I ever suffer some kind of brain injury or dementia where impulse control is muted; will I ever act on that impulse? Even thinking about seeing a food twisting around and back and forth makes me squirm in my seat. Sometimes I think my wife continues to do this on purpose to punish me or irritate me when she's mad for something I did that unknowingly wronged her...crazy thoughts? Maybe. But I still have them.

I also can't stand it when people chew with their mouths open. Gum chewers especially. Makes me want to ship them to Singapore for caning. I know someone whose jaw clicks when he eats and he likes to pop the cartilage in his chest, both of which drives me BATTY. I can't stand to be near him while eating.

I can't even stand to hear myself chew. I need white noise or distractions around me all the time to try to alleviate my focusing on such things...fans, the TV...something.

I'm probably forgetting some issues. Maybe I'll edit the post later, maybe I'll just ignore them if I think of them later, I don't know. These are the ones that stand out in my mind at the moment. I do know that for many people seeing this they'll think that this is not really a problem, or they don't understand why I don't just ignore XYZ. Foot twisting? Really? Yes, really. I'm wired in such a way that I cannot ignore it. I've tried. Believe me, after so many sleepless nights hearing my father snore as I grew up I tried whatever I could to ignore such things or cope. It just doesn't work. Just as some people are wired to be energized by social interaction, I'm wired to have the quirks I've listed above.

This is one of those things that unless you experience it, I don't know if you can understand it. At least not fully. Today I just try to cope and maybe reserve a sliver of hope that the psychologist can help me find a way to manage my "quirks" better...

Weight Loss Progress-May 20th, 2009

It occurs to me that I haven't said anything about my weight loss very recently. I think the last time I mentioned it I was stuck looking out over the valley from a very frustrating plateau and my doctor had basically kind of told me not to worry about it, just keep plodding forward. I don't remember when that was, off the top of my head...so I thought I'd post some info on where I stand right now.

Some dates and stats...
Today is 5/20/09. My weight this morning was 337.5 pounds.
I started dieting on approximately 1/5/09. Since then I've lost 120.5 pounds.
My surgery was 4/7/09. Since then I'm down 38.5 pounds.

My surgeon said that I should expect to lose, or aim to lose, 20 to 25 pounds a month on average but that's a sliding scale (it isn't linear...if you have suffered through semi-advanced math courses, you probably know this means that the weight loss is a curve, not a line).

So...think I'm on track. No guarantees, but I think so...

Bariatric Pain in the Gut: Good News!

I finally had something go wrong!

Well, not really wrong, per se. But it was unpleasant and wonderful!

Okay, here's the story...my wife had fixed some chicken breast fillets for dinner a few nights ago on the grill. They were small, probably four or five ounces a pop; I took one and cut it in half and the two pieces easily fit into a one-cup storage container with space to spare.

I reheated it in the microwave and began to partake in the protein goodness. I noticed that the edges were a little tough, dried out; I thought I chewed it adequately. I didn't.

I felt full before going through 3/4 of the breast fillet, so of course I stopped. The problem was that right about then the apparently too-tough-to-eat-easily part of the chicken hit my stomach.

The pain wasn't excruciating, but it was very uncomfortable. Every time the pain subsided and I thought it had finally passed another wave would hit me. I picked up the trash can in case I threw up; I was unsure for a few moments if that was what it was going to come down to.

The pains lasted for somewhere between 20 and 30 minutes. When it was over, I finally knew that yes, there is some of the warned negative feedback in my "new" stomach. All the times I had wondered if the surgeon had actually done anything to my stomach size was finally answered in one glorious bout of pain pulsating through my torso.

I don't know if this did any damage to my new pouch, stretching it or pulling it (for a few moments I worried that I had ripped something out). I of course am desperately hoping not. But now at least I know that it should be working to some degree the way the operation was described to me!

I know, it's weird, taking relief in this pain episode. But now I know for sure that maybe this surgery can help me. Plus I know that if meat isn't tender and juicy, if it can't be chewed until it is mush, don't eat it.

See? Negative reinforcement is working already!

Fear Of Success

I work in technology. To be more specific I work in technology support; if the users need software installed, corrupted profiles fixed, systems moved or mice cleaned I end up having to head out to fix it. I also monitor servers, configure servers, try to keep electronic point of sales systems running and field calls from users complaining about forgetting passwords or slow login times. Overall if it's plugged into the network and someone has an issue with it I may get the call for working on it in addition to maintenance chores on equipment users usually aren't even aware exist unless one of them malfunctions.

After many years of dealing with various issues that go with the job...often repeating myself over and over...hearing the same issues crop up every month...the job wears on you. Issues of satisfaction in the workplace are a whole post or two if their own.

What I have found myself doing, however, is wondering about what it would be like to switch careers. I have two or three other interests which I've seriously considered trying to move into and so far have not taken the leap. The problem is that there are always perfectly legitimate reasons not to pursue them; I make decent money for my area (although career guides say I'm underpaid for my job and education...it is a problem with the industry), jobs are difficult to come by now, I have become used to things like a roof and heating and food, change is hard..

All of these are, from what I can tell, legitimate reasons to hesitate moving to a different career.

But in my times of introspection I have asked myself if these are the real reasons I don't try changing. They are certainly factors, but the reasons I don't?

The answer I find myself wondering if it isn't the true bug in the soup is what if I'm afraid of finding out that I'm not good at those things?

I've failed to lose (and keep off) weight. I am not a big financial or social success. I worry constantly about bills and raising my kids correctly. I don't even know if I can lose weight with the surgery without failing at that.

If I don't try to do these other career pursuits then my fears of failing are just fears, not confirmation of my ineptitude.

As time passes though I have a little more reminder of why I consider a career change. At some point I may end up with more need to escape than fear of failure. Have any readers made career shifts voluntarily and not necessarily out of necessity? Where you scared to do it and if so how did you face and overcome those fears?

Coping with Head Hunger

If you have had weight loss surgery you are no doubt intimately acquainted with the fact that there's more to hunger than physical hunger; you quickly realize there are all sorts of little "head hungers" lurking in your mind telling you to eat when your body doesn't physically need a meal.

One of my hungers apparently hits during work hours. During the hours when the tasks are more drudgery than fulfilling work, I find myself looking at the clock and wondering if maybe it's time to take a breakfast or lunch break.

Of course, I have others,...but seeing as I spend five of seven days of the week at work, I am hitting this little demon more often than the others.

Do you have this "distraction hunger?" What do you do to cope? Hints? Tips?...

If you know of any other bariatric patients that roam the webbertubes please feel free to steer them this way if they may have hints or advice to offer. I'd love to get comments with hints and tips on dealing with some of these issues along the way (and of course, if you're already reading this which you obviously are, feel free to comment with your own hints too!).

Head hungers are probably the number one reason the surgery fails and is, at least for me, one of the biggest stumbling blocks on the way to losing weight. Between head hunger and controlling your emotions through the various changes your body must adjust to it's amazing how difficult a little task like "losing weight" really can be. Bariatric surgery is like ripping the band-aid off a whole slew of psychiatric disorders in one fell swoop and dealing with them is...remember the scene in Ghostbusters when the jerk turned off power to the containment unit? Yeah, that's what it's kind of like.

Lost in Thoughts on Portions, Emotional State

I am in an unusual place right now. I had a checkup with my surgeon today, and I'm just replaying in my head that conversation along with what I had previously understood from other information, sources, meetings with nutritionists (current and previous)...

The fact is that people are different in their reaction to this kind of surgery. So there is no clear-cut answer. My obsessive personality is coming up with two stumbling blocks in this journey. I keep asking for such answers, and their are none. I need one though. I need it spelled out. I need clear- cut guidelines.

The first is, how much do I eat?

I previously thought I was to find what was tolerable, to get in touch with my stomach's feedback, to realize when I was "full". I have been experimenting a little on that front. I am starting to find an amount where I start to feel some discomfort, and quit eating. I never packed more than a cup of food into my lunch/breakfast container (and since solid foods aren't usually a liquid form, even if you "filled" the container it was less than a cup by volume).

My wife said that, no, it was less than that that I was supposed to have. Only a half cup at most.

So, have I been screwing this up the whole time?

Stretching the stomach pouch? Ruining everything I've suffered a month for?

The second...if the food amount is only a quarter to half cup, what is the use in dirtying dishes and silverware and bothering to make anything? The leftovers, the waste, the effort...in my mind, just not worth it. I was told not to skip meals but it seems to be such a waste, and I am having a lot of trouble getting over this mental stumbling block justifying the work on making food that I'll essentially be barely doing anything wish. The time and effort would be better left to doing whatever would have been interrupted getting the meal in the first place.

Overall it just makes me depressed. The situation just makes me plain frustrated. Am I supposed to be trusting the body and trying to figure out, relearn, how the body is supposed to work so I'm eating and acting in a more normal manner? Doing that seems to be incorrect...the surgeon wants me eating essentially what fits into a dixie cup. Fixing food that fits in a dixie cup is hardly worth the time it takes to fix something. So why bother?

I guess there's some block in my head that says it would simply be better if I did nothing instead of wasting the effort in making a sandwich just to refrigerate three-quarters of it, and have another quarter later for another meal, and maybe another quarter that night. And have one left over for breakfast or end up throwing it out.

Another part of me tells me that this is temporary, these thoughts. I simply have to adjust. These thoughts that I'm dwelling on are simply another stage before acceptance and adapting.

It's the other voice that bothers me. The other voice tells me things like, "You stretched the pouch." "You screwed up again." "Another attempt to lose weight and you blew it."

So which voice is right? Or is it a mix of both? The rational feeds me some self-serving forgiveness, telling me to accept and adapt and move on. The emotional side tells me that...well, I said what it tells me.

I suppose these swirling thoughts have to be simply meditated on, so to speak. Tomorrow I'll hopefully find more of a rational place from which to approach this situation.

Milestone: Visiting the Surgeon

I just had an appointment today with the surgeon. I think this is the first I've seen him since operating on me; my wife saw him right after the surgery, but I don't recall seeing him until now. I have seen others, though, so I don't feel neglected or anything like that. When you trust someone with touching your organs and rearranging them I supposed you sort of get accustomed to the idea of letting them handle your care afterwards without too much question.

I think the appointment went fairly well. He wanted to follow up with me in a couple weeks. Bullet points:

• Stop using the protein supplement in water.
• Weight loss is expected to be 20 to 25 pounds a month on average, but it's a curve that gradually levels out.
• Meals should be dixie cup sized. More you eat, less you end up losing.
• Showers only still. He's monitoring the incision healing and said showing is sufficient...I'm going to look forward to a bath and being able to get into a pool, even if I'm still covered up anyway.
  

I had a few other bits of info but they're not of much use to people on the webbertubes unless you are in the immediate area needing support group information. I am off restriction (it's been about six weeks) from lifting things, but taking it easy still since there are times where yes, it does hurt, and even sneezing or yelling at the dog (AAAARGH!) causes me to feel as if something is tugging or ripping in my gut, presumably because it is indeed still healing.

I asked about how easy it is to stretch the stomach. He said that it wasn't too hard. To paraphrase, "If you eat until you feel full, then take a few more bites, that's okay at first. You eat until you feel discomfort, take another bite or two, then continue doing that...next day, day after...soon you'll find you can take four bites more instead of two. You're stretching the stomach. The stomach will get larger later on, that's okay. But not now. First you need to lower your weight, then level it out."

I still worry about it since I'm trying to learn what "full" feels like. I'm experimenting and figuring out portions and whatnot. I take some solace in the fact that I'm pretty sure I'm eating far less than I did before the surgery and not feeling bad about it. I just wish there were clear signs, like some flashing window on a heads up display telling me the fuel tank's full, time to stop!!

Okay. So right now my guideline is to avoid discomfort. If the discomfort feeling hits, I'm eating too much, back off.

Oh, and the weight rocking. He explained that for many patients it's not a smooth curve down. It's a series of steps. They're not sure why the body does what it does, but it seems to level out for a bit, then fall...level out, then fall....level out, then fall. So I'm on a slinky trend now. As long as I'm in the guidelines of 20 to 25 pounds a month for awhile I guess I'm doing well.

He seemed to think all was in normal ranges for my situation. Yay, me! As the other doctor has said of me...I'm just worrying too much.

Muscle Weighs More than Fat

Stop me if you've heard this one before. You're dieting and you watch the scale and see that you lose nothing despite your efforts, or worse, you're gaining weight. You complain to a friend about it and she says, "Well, muscle weighs more than fat."

Yes, there was a recent comment that said this, but that's not what prompted this blog post. I was thinking about this because while at Barnes and Noble the other day I found a book in the new releases discussing diet myths and this was one of them.

I didn't get a chance to read it or find out the "truth", but I saw the myth.

When I do get the book...it's cheaper online...I'll probably post something about it.

I did a quick check online for information on fat and muscle. The obvious answer I found was that they weigh the same. One pound of fat is the same as one pound of muscle, just like a pound of feathers weigh the same as a one-pound pile of sand.

I found some information at sites like MSN Health and Healthscience. A quick Google for "does muscle weigh more than fat" yields plenty of hits...just a word of advice: if you're looking this up because you heard this through the grapevine and want to find information on it, avoid hits that take you to forums where any yahoo is posting the same rumor over and over. It's often counterproductive.

Anyway the sites I read about the topic seemed to agree on a couple key points:

One, fluid levels vary your weight more than fat or muscle gain and loss.

Two, if you were gaining muscle without using the stuff that comes in bottles or syringes, you were taking in more calories than you needed to maintain your body weight. It is implied that if you're dieting and taking in fewer calories than necessary to maintain your body weight then you aren't gaining muscle mass since you need more raw material from which to actually build the proteins comprising muscle tissue.

Articles I found also implied that muscle is denser than fat, so it is possible to have a similar weight while losing inches. The only problem is that it takes time to gain significant muscle mass. So if you're gaining three or four pounds in a week, it's either water weight (or some kind of fluid weight) or you're just plain eating more than you think.

The healthscience site even said that "The amount of muscle someone may gain in a year on a truly healthy diet without supplements/medication and/or excessive protein, is actually quite small and for a women (sic) may be 8-10 lbs in a year and for a man a little more. Divide that by 52 and that is about what you may be gaining in a week, on average."

Like I said, I'll probably revisit this topic a bit if/when I get that book on myths for dieting. But I thought this would be a little food for thought. I know I've been thinking about it ever since I read that blurb on the book jacket.

Stupid Body

Every workday I get up and shuffle out to the living room and take my medications.

I pack up two 1-cup size ziplock containers, one for breakfast, one for lunch. I try to put a calcium and protein source into each; often this includes cheese and ham or some chicken. But these fit into 1-cup containers. If the foods were pureed they would end up taking up less than a cup.

At night I have approximately a cup or less of food. Sometimes a mini-sandwich, or some kind of a soup. Leftovers. Again, meat and cheese often fill the meal. With birthdays and such coming up we've been eating out and I've had a small portion of the food before packing the rest into a box to take home. Recently my wife and I were at Olive Garden for lunch and we had an entrée split between us, and we each ended up eating half of our meals and taking the rest home, so we had about a quarter of a lunch entrée as meals.

I drink water, I drink water with Kellogg's black-tea flavored protein powder mixed in, some milk during the day, no soda, no alcohol, no juices.

And yet for the past several days I gained a pound and a half and at this point have lost a pound of it. I have been taking my weight once every other day and since maybe the 7th or so I gained a pound and a half and slowly lost a pound of it. Maybe if I repeat it enough it'll make sense.

I'm eating a cup of food three times a day, no snacks, and I've gained weight. Huh?

How does that work?

How can I possibly have enough calories in me to sustain a 340-something pound body weight?

Is there food just slowly percolating through the intestines, thus adding weight?

Is there sodium causing me to retain fluids?

Is there some really screwing form of plateau going on, or the body adjusting to foods, solid foods, in the diet?

Am I really that screwed up?

I'm hoping this is something kind of "normal" in adjustment. I need to find a support group at my next doctor's appointment which happens to be coming up in two days. Am I supposed to just "stay the course" and hope the body finishes adjusting and continues losing weight? I can't see how, possibly, I can maintain my current body weight with my food intake.

If anyone else out there has had the surgery and knows what I'm talking about or has had this happen to them, please let me know. I'm a little over a month from surgery; a month and a week, almost, so why would I be plateauing now??

It's Just A Tool

I don't know if I mentioned this before, but there seems to be many people who think that Weight Loss Surgery is a magic bullet solution to obesity.

It's not.

When I was pre-bariatric, I never felt full. Well, rarely did I feel full. I think I could eat an entire pizza and not feel sick. A footlong hoagie an bag of Doritos was hardly a challenge. It just didn't stop.

But I could feel hungry.

Head hunger, physical hunger, wanting more...but not full. Like The Hacker's Diet postulates, it's as if the "full" side of the body's thermostat is broken. Maybe my stomach was stretched from years of abuse, or maybe it was a natural tendency to keep shoveling it in, I don't know. But I know that when your thermostat doesn't work right it makes dieting a lot more difficult than it is for the normals to lose a few pounds.

Weight loss surgery is a tool to help you learn new habits, a new lifestyle, by "resetting" your thermostat. It won't cure your mental issues. It won't be bulletproof. And because of individual differences, the effectiveness and side effects are all individual as well, so just because one patient may throw up from eating too much another patient may not feel any discomfort.

I have far less physical hunger. I have not had dumping. I haven't had a huge amount of extra gas which was a warned effect. I am still relearning what "full" feels like, and having to concentrate on chewing thoroughly and concentrate on portion size.

All the surgery did was give a timeframe...it's supposed to be about 12 to 18 months...in which to relearn how to eat properly without focusing your life on your hunger, your appetite. You're given a chance to change your lifestyle, which is really the only way to actually lose weight. Diets don't work because they're short term or unnatural. You need to change your lifestyle. If you can change your lifestyle in that timeframe, you should be on a road to success.

There are some people who, after all the recovery pains and issues, regain the weight. They think the surgery is a magic bullet and treated it as such...if your body tolerates it, you can still slurp ice creams and cakes, or graze on snacks, gradually building up calories over the day until you're still overeating. You will gain weight again doing that.

There are people who start losing weight and regain it because they use food as a crutch or emotional comfort and refuse to change such behaviors. They don't solve the issues, just relying on surgery to...again...be some magic bullet to solve the problem. Doesn't work like that.

If you're considering or facing surgery, MAKE SURE YOU UNDERSTAND...it's just a tool.

Deep Fried Madness

It's no secret that for many Americans foods can be improved simply by slapping a coating of breading on it and then dipping the food item in the deep fryer. If breading it isn't an option, creating a batter akin to a pancake batter and pre-dipping the food in that before the hot oil bath will usually do.

I thought it was interesting when I was at the local carnivals and would see just plain batter fried (doughnuts, funnel cakes). Then I was exposed to the next level of yummy with Deep Fried Oreos (three for five bucks! What a deal!). We even figured out how to make them at home.

I found sites on the Internet that listed different fried food items...and apparently if it can be forced into a fryer, it can be improved. I was shocked. Check these out, for example...I mean, Coke? It seems that if you can imagine frying it, it can be fried.

For some reason my wife thinks fried foods are unhealthy. I haven't asked the nutritionist about fried foods and bariatric surgery. I'm thinking maybe deep friend ham isn't really all that bad for you, is it?

Now I thought that usually something as plain and "unhealthy" as fried Oreos is reserved for people with simple tastes...carnival tastes. Y'know, the crowd that is happy with shopping at the mall or eating at McDonalds.

My wife and I went to Olive Garden yesterday while out in town picking up a web-submitted job to FedEx Kinkos (or whatever they're named now). Read this description of one of their new limited time food items: "Parmesan-breaded lasagna pieces, fried and served over alfredo sauce, topped with parmesan cheese and marinara sauce." It's called "Lasagna Fritta."

While looking at the menu together, my wife said, "It's deep fried lasagna."

"You mean like deep fried Oreos?"

"Yup."

Um...okay. Olive Garden isn't exactly like the restaurants where you spend seventy dollars for an entree, but it's definitely a step or two above McDonald's (or Panera Bread, for that matter, in price for a meal).

This Lasagna Fritta is a limited time appetizer offer. Fortunately, Olive Garden is one of the major chains that prints their nutrition info on their website, including for limited time offers (Applebee's SUCKS in this regard, but that's a rant for another day.)

Brace yourself. The appetizer has 1030 calories, 63 grams fat (24 grams saturated), 1780 mg of sodium, 77 grams carbohydrates but 9 grams fiber.

That's the appetizer. So I guess it's not so bad if you split it among a family of five. I think there's six bite-sized chunks of lasagna there.

I think it's a sign when foods that are considered standard fare for the unwashed masses become mainstream enough that they can be dressed up with such flowery language in a restaurant that charges ten bucks or more for an appetizer dish. Before the surgery I would tell myself that if other people were eating something, it must not be too bad...normals are eating it. How bad can it be?

That sign is saying that unhealthy is mainstream. We can't rely on mainstream menus and restaurant chains to be giving us guidance as much as they're giving us what they think we want to buy...and we want the bad stuff. So now it's socially acceptable to offer the things that make us pigs. Buffets may as well be offering troughs instead of bars to fill our plates.

Scary.

The Cost of a Tinier Stomach

Some may wonder how much surgery like this costs. My employer happens to carry insurance for me that took care of a huge amount of the surgery bills, but I did have a significant copay.

I recently had the insurance statements come in. If I totalled everything correctly...and no doubt this is rounded a little and doesn't include the consults and psychiatric evals and appointments and whatnot...the surgery and recovery in the hospital came to about $15,000.

Ouch.

Again, not out of pocket entirely except for my copay, but it amazes me how much hospitals charge to insurance companies and what small fraction is actually paid.

Is this average? Anyone else know what theirs cost, approximately, and is willing to share?

EDIT: another bill statement came from the insurance company. Adding this anesthesiologist's bill, the total is closer to $17,500...so far...

Weight Loss Surgery Regrets

I saw in an online support group forum someone asking if people who had undergone Weight Loss Surgery had regrets about doing so.

I hadn't really thought about this too much. With Roux-en-Y, once it's done, there's no going back; it's not like banding. I didn't think about the subject after the surgery because what's done is done.

But seeing that question made me think that if I'm keeping this, in part, to help other people considering the surgery, I should probably address this (or express my thoughts on it).

I was scared as the time approached. I really really contemplated telling them, "Hey, guys, ya'know what? Hows about we just sort of think about this a little longer...maybe, schedule it later this week? Yeah?" I even thought about running away down the hall with my gown flapping in the wind behind me, scared of the complications, the hardships, what if I missed something, what if this is a mistake, what if what if what if...plus my dieting had been pretty successful from January to April! I could just do that, see how that goes...

But I also knew that do not do it would mean a lot of hassle to try again. My insurance company, the time invested in me by the doctors and nutritionist, our own time and money for things like the hotel and the copayment to the hospital. My previous attempts to lose weight, some marginally effective at first, all ended up failing miserably. Statistics don't lie; this surgery can fail, but it is still the most effective tool in weight loss.

I write those feelings off to cold feet. I went through with it, fear and all. I suppose that couldn't be called a regret.

After the surgery there was one moment I started down the path of thinking, "What in Hell have I done?!"

That was the first night after the surgery. I was up every hour, hour and a half or so laying in a pool of blood. By five in the morning I was very groggy and tired and still in a bit of pain as the pain drugs waxed and waned in effectiveness, as well as my own panic at constantly feeling blood trickling down my abdomen from under giant amounts of dressings taped to me.

Since that time...no regrets. I can honestly say it hasn't been easy. I've written here about a lot of the challenges I've encountered along the way. But things get better. A little bit at a time, things get better.

Now I can eat proper portions and not physically feel hungry. I still have head and emotional hungers but after the surgery I could feel the physical hunger divorced from my other senses when I see food or mealtimes rolled around. It's a feeling that really cannot be easily described as much as it must be experienced!

If you're wondering whether the surgery caused regrets, no, at this point it has not. Never never mistake this as an endorsement for a magic bullet solution like you get on TV from pills and herbs and whatever is in magazines these days; it's not magic, it's not simple. It's expensive. It's a hassle. It's a transition and a change in lifestyle. And it forces you to try confronting the reasons you're fat and that is never easy. But it isn't something to regret because by the time you really are in need of considering the surgery option, you are really past the stage where you should regret going through with it.

Update: May 7th, 2009

It's been a little while, so I thought I'd stick in a quick weight check.

Since starting my dieting efforts in the name of the surgery back in January I have lost 117 pounds.

My surgery was on the 7th of April (hey! A month ago!) and I've lost 35 pounds since that surgery.

My friend...from whom I haven't heard again since challenging me to lose 60 pounds before he can lose 30 with a gift card to Amazon at stake...his challenge date has me losing 22 pounds. Although I'm still curious if he's going to drop the challenge soon :-) His wife and I both told him I had an advantage here and I told him there's no shame in dropping out of this. I think most bariatric surgeons would tell him that he would have trouble with this kind of friendly wager.

So...thirty five pounds since surgery a month ago...good? Bad? Average? Any other bari' patients care to share their one-month milestones??

Does This Thing Work?

I sometimes ask my wife if she's sure the surgeon actually did anything to me other than cut my abdomen open.

Another patient at the nutrition class/appointment said that he can barely drink anything without extreme caution and he's already had incidents of certain foods (or amounts at one bite) causing extreme discomfort.

I had a half-liter of water with a protein mix (I believe it was black-tea flavored). I was finished with it by the end of the meeting. The person to whom I was referring said it would have taken him hours to drink what I had just downed.

It worries me sometimes that I'm not really feeling an all-out discomfort or nausea or any other "reinforcing" side effects while experimenting with foods and portions. I just don't know if I'm doing something wrong, or if my stomach is as iron-clad as it was before the surgery. Then I begin to worry about whether or not I could be accidentally stretching the pouch out!

I mean...if I overdo it, is there a guarantee that I'll throw it up or feel as sick as a dog?

Please...I'm tired of not knowing, but I'm a bit too cowardly to sit down and snarf a giant brownie sunday with sugar sprinkles to find out what happens. I need to know how easy...or hard...it is to "accidentally" overdo it after Roux-En-Y surgery. The Physician's Assistant I normally see in followups tells me that I'm worrying too much. I take solace in that, but still the thought haunts me.

Fun With Richard Simmons!!

If you're over twenty and overweight, how can you not know Richard Simmons?

He is well known for interacting with people personally. As a matter of fact, Wikipedia has this in an article about him:

"Simmons is known for interacting at a personal level with the people using his products. This began when he started personally answering fan mail he received while a cast member of General Hospital. As a self-described devout Catholic, Simmons still personally answers emails and letters, and makes hundreds of phone calls each week to those who seek his help.He also talks to people on the air during his radio show, and holds weekly live chats in the "clubhouse" area of his website. His appearances also include a "meet and greet" time, so that people can speak to him one on one."

He always seems so friendly and inspiring that while I was still at home recovering from the operation I figured I'd go to his website and see if I could find contact information for him and send a message.

There was a webform for submitting an "email" to him. So I filled it in. I said that I had never heard his stance on weight loss surgery and was interested in knowing what he thought of it; I think I also plugged my blog somewhere in there too...okay, I really think I plugged the website. I figured it wouldn't hurt anything. Dude probably gets huge volumes of messages and mine was just one more bit of white noise in the background. That was weeks ago, I didn't think any more of it.

Today I opened my inbox and saw an email from "Richard Simmons."

The message said,
************
I am not a big fan of surgery as a weight-loss tool. However, I do make an exception when a person is so morbidly obese that their very lives are at risk. A lot of people who are not in that situation make the mistake of seeing surgery as a weight-loss tool believe it is going to be like some "magic bullet" and all of their weight-loss troubles will be over once they have the surgery. But the bottom line is that, even with the surgery, successful weight-loss is all about making important lifestyle changes for the rest of your life. You still have to do the work it takes to lose the weight and that's the bottom line. I do hope that you are still working hard reaching for your own goals and that you never give up on YOU!

Your Friend,
Richard
**************

I have mixed feelings about this. I think it may be him; he has a reputation for personally interacting with people struggling with weight issues. My wife immediately asked what I already suspected; what if this isn't really " The Richard Simmons"?

If I am to believe his public persona, his reputation, the long time that elapsed between sending the initial message and getting this one back as well as the vocabulary choice in the reply, I'm apt to believe it really was him. I hesitate because everything is spelled properly and sounds like proper grammar, which is normally a red flag that something is a boilerplate response; call it wishful thinking, but I would rather think he either has staff check for mistakes or he's just a smart guy.

So this time around I'm going to take a chance and believe this was him. It makes me happy to think so, makes me feel a little more inspired for the day! If it really was him, I think it speaks volumes about his character that he would take time out of his schedule to speak to some insignificant lonely voice on the Internet asking him an innocent question. Sometimes taking five minutes from your own schedule can make a big difference in someone else's day and make them feel as if maybe, just maybe, they're not as insignificant as they think themselves to be.

Thank you Richard.

Doctors and Email

The nutritionist I had been seeing just before my surgery left abruptly.

I don't know the details, I just sort of heard about it when I was recovering in the hospital. Apparently she and her husband had an opportunity to move back south, something they always wanted to do, so they took it.

I met the new nutritionist last Monday. She seemed nice, maybe a little frazzled; we had been told before that she's hard at work filling the void left when the previous nutritionist vacated the position. They had a lot of backlog with new patients as well as taking care of the post-ops. So a little frazzled can be forgiven.

The thing that I was impressed with was that she gave us her email address!

I rarely encounter that. I don't know if doctors...medical staff in general...are technophobes or just think that such information would be abused (which wouldn't surprise me). I very much appreciated it, though.

Two days later my daughter tells me there was a call from "a " with a number local to a city an hour away. It was late when I got home, so I didn't return the call...the next day I emailed her to see if it was her. She replied, I gave more information and she replied right back. Two quick emails. Quick and convenient!

I don't want to abuse the access to mail but I did let her know that I really appreciated being able to get quick access for a minor question without having to interrupt her (or myself) with a phone call.

I remember having one medical staff member tell me that they don't do that sort of thing because it wouldn't be billable. My thought is that if you can answer the question in two minutes with an email, it would be a far better use of your time than having to inconvenience the patient by scheduling an appointment for a quick question or having to waste the medical professional's time with the paperwork and hullabaloo of an in-person assessment for a five-minute problem.

How about you? Have you any experiences with doctors giving out their email addresses for questions, or have you found my experiences to be the norm?

With Star Trek Coming Out Soon...

...I started wondering...do you think Vulcans all just have Asperger's?

Perception of Portion

There's really no doubt that Americans have no perception of portions. We routinely gorge on super-sized meals and it's no challenge to find meals in sit-down restaurants that are well over a thousand calories.

But there is something that can help. Use smaller plate.

That's the whole idea behind the undiet book, The 9-Inch "Diet": Exposing the Big Conspiracy in America. The idea behind this book took root when the author and his wife purchased a rather old lake home and in the process of furnishing it went to the local We-Stock-Everything-Mart and bought new dishes. Upon returning home, he couldn't fit the dishes in the cupboard. At first he thought the cupboards were too small; he realized that the cupboards were the correct size for his grandparent's generation.

Since that time our portions gradually grew larger and larger. Today's dishes won't fit in yesterday's storage areas.

The book reads as a sad commentary on how large America has really become and how other countries, lagging behind our obviously advanced western culture, can't quite fathom how Americans can eat so much. The book reviews everything from airline seats (and weight surcharges and allowances because of our expanding waistlines, as well as challenges of Americans fitting on planes in the rapidly aging airline fleets) to movie theaters having trouble "packing them in" when renovations call for larger seats to fit expanding patrons. It even packs in several anecdotes like the one about a certain European company that rhymes with eye-tree-ah trying to figure out why they were selling out of vases when they opened a store in America.

Our portion sizes fit nicely on a 10 to 12 inch plate. Other countries that don't have the obesity problem we have in the US (although they are apparently starting to show our western influences) use plates that are...you guessed it...nine inches. This simple change fools our brains into thinking we're eating more than we really are! Over time the minor savings really adds up.

I definitely recommend reading this book. It is chock full of "food for thought" and is a very quick read. Whether you are dieting or just interested in food there's something you can take away from this book and it will leave you with something to think about next time you hit the buffet or walk by the concession stand at the theater.

Guess My Age

How old do you think this cheeseburger is?


If you said four years old, you'd be right!

This is a plain McDonald's cheeseburger, roughly four years old.

I keep it in a plastic container in my cupboard.

I read once that the preservatives in fast foods make them "nearly immortal". So one day on a lark I set aside a cheeseburger to jokingly find out what would happen. The burger didn't rot, it didn't really change color, it just dried out.

I didn't do anything special to it. It's just kept in a plastic container in a small cupboard shelf above the microwave. It even still has the original wrapper with it.

I don't know how many prepared foods can sit that long without growing mold or sprouting legs. Apparently McDonald's cheeseburgers can. How many of them are sold a day?

Tentative Steps to Eating "Normally"

I found exactly two 1-cup size storage containers in our big box-o-storage-bins in the kitchen this morning. I packed for breakfast:
one scrambled egg.
two thin strips of ham steak
one small slice of cheese from a HelluvaGood (is that the brand?) cheddar block.

I figure my meal is not to exceed one cup, no matter what, and these fit into the container without any problem. I also figure since these are solids these aren't actually filling the volume of the container...that one-cup storage size holding all those items would actually probably fill 1/2 cup if I pureed everything.

Maybe I'm being optimistic...I'm trying to be realistic (believe me, it still HURTS when I sneeze or cough, I can't imagine how much excruciating pain vomiting would cause so I'm trying VERY hard to avoid it!). This, I think, fits the guidelines for size of a meal. I also was aiming to fill some of the requirements of the meal as outlined at the nutrition class...calcium is a must (cheese!), protein is a must (ham...well, all of it...I even used a real egg instead of just egg white for my first meal to see how I'd handle it, plus some added nutrition from the yolk...).

I ate it very slowly. That less-than-a-cup of mass took me about an hour to eat. No vomiting! No pain! Yay!

I had a feeling after last night's dinner in my gut that came back after breakfast. I'm not sure it's fullness, per se, although it could be that and I'm just unaccustomed to it. It's not pain. It's not nausea. It's not hunger. It's hard to put my finger on...but for now I'll write it off as borderline satiety.

All I do know...that was good. If you ever want to appreciate food try eating Jell-O for half a month then try having a good tender piece of ham with a hint of cheese, maybe a small spread of dijon mustard on it...good stuff.

I'm still sore and can't take painkillers right now. I have aches. My gut has stiff pains at times, I think from scar tissue or healing. I get frequently lightheaded and dizzy, perhaps from low blood pressure. I have trouble remembering all the medications I have to take. I have trouble keeping straight what proteins I need to get, the minerals, the timing of how to take things. I get emotional and cranky. I still get freaked out by the weird hole in my stomach (it is slowly getting better, so far don't think it's infected) which oozes blood and I have to change it's stinky dressing twice a day. Waves of fatigue make it hard to focus and get through the day.

But that ham and cheese and egg...boy oh boy that was good.

And Another Milestone is Passed

I had my four-week nutrition meeting.

It was a little haphazard...there were tidbits here and there that seemed contradictory at times; for example, I am supposed to now go from pureed foods to "soft, moist foods". In the sample breakfast, 1/2 a piece of toast.

Unless drenched in butter I don't think I'd count toast as a "soft, moist" food.

After several notes on needing calcium supplements and watching protein, then doing some very vague notes on foods...I asked, "Basically, you're saying we can try whatever we want, as long as the meal is less than a cup or is about the size of my palm, and the stomach tolerates the food?"

"Pretty much."

So I guess I can eat what I want as long as I have three or four meals a day and keep the portion of the entire meal to a very small amount and I'm very very careful about signs that I'm about to yark or fill my shorts. And the foods must be "soft" foods.

So after this meeting my wife drove to Panera for dinner. I ordered a pick-two of French Onion soup and a Cafe Ham and Swiss sandwich on rye with dijon mustard. I ate a little bit of the bread...the mustard was to DIE for!...and the meat and cheese on the half-sandwich happened to be about the size of my palm ("a portion of meat you should be aiming to eat is the size of a deck of cards...", she said)...it took longer than usual to eat, but I ate the ham and cheese with no obvious discomfort. And again...the mustard was fantastic.

The flavor of the ham with that slice of deli swiss was utterly delicious. I probably could have eaten more of the bread, but I wasn't really hungry (wasn't really full either, at least not in a way that I was accustomed to feeling full). My wife picked up a take-out container for the soup and that was that. My dinner was a good sized portion of ham and cheese with delectable dijon mustard and just a touch of rye bread.

I'm confident that in due time an entire meal will be something like a sandwich or half a sandwich. It's fantastic to think that this will be enough for an entire meal, not a sandwich with XYZ together!

The gist of the meeting with the nutritionist is that my "dieting" lifestyle will be entirely focused on portion control. I don't avoid fats. I don't avoid carbs or whatever other fad diet is the current "thing". The only thing I avoid is sugar and I have to focus a little more on nutrition...eat proteins because I need it for muscles and body composition, for example, while breads will make me feel too full to get the nutritional part of my mealtimes. I need to limit my portions and not graze or snack.

The weight loss surgery is supposed to offer feedback; I am supposed to feel uncomfortably full if I eat too large a portion, or end up with the runs and chills and palpitations if I have sugars. I didn't get the uncomfortable feeling while eating tonight. But I don't feel hungry, and that was the other effect the surgery was supposed to have; my hunger should be head hunger and my physical hunger shouldn't really be a factor right now.

There are flavors and textures and experiences that I am looking forward to trying. I don't think there's anything wrong with anticipating this. I am going to be mindful to keep my portion sizes small because if the whole negative feedback thing isn't working in my particular case, I need to keep an eye on what I'm doing.

My stomach has always been made of steel. Maybe to some degree it still is. Maybe it is still hyper-tolerant of foods and such...I may be one of the rare ones that have to be pushed to have dumping syndrome or vomit from the introduction of foods. But I'm not exactly going to try pushing the issue.

So tonight was a good night! Now I just have to see how much of the waters I can navigate without hitting an iceberg...

Yay!

Interesting: How Much Sugar, and I Love Buffets!

I came across two interesting bits of information related to diets. The first one is a website that shows you, visually, how much sugar is in various food items. At the time of this posting the site is crawling because it is experiencing a sudden surge from being posted on sites like Reddit, but it should die down sometime tomorrow.

The second was advice on eating at all-you-can-eat buffets from a TV show on The Food Network called Food Detectives.

To summarize the advice, you have to remember: Survey, Face Away, Sit Far Away.

The guest on the segment discussed findings from studying people's behaviors at buffets. He said that distance played a role...sitting further away made it more inconvenient to get up and get that second or third plate, but also gave people time to reflect and ask themselves if they're really hungry or just want more from convenience. He cited the example of a study where a secretary with a bowl of chocolates ate something on the order of nine pieces when the bowl was on the desk, but four when it was placed six feet away.

Another observation: people who sat with their backs to the food were twice as likely to be thin in build.

He also identified two behaviors often found at the buffet; there was an overweight guy he called the "digger". If he liked the food, even kinda liked it, it was scooped onto his plate. He grabs a plate and starts going through the line, scoop scoop scoop, plop plop plop. The second type was what he called the "browser". The browser was kind of laid back in line, surveying everything first, looking at what was appetizing and what wasn't. After seeing what was available the browser would then go get a dish and start going through the line. In their studies, the browser was four times more likely to be thin in build.

So there you have it...survey, face away, sit far away.

One last bit of advice he shared...use the smaller salad plate as your entree dish. Without thinking about it you will eat less. The plate holds 20 to 30 percent less (which will be 20 to 30 percent less going to your waist) than the 12 inch plate.

So buffets don't have to be terrible things. You can go enjoy them. You just need to be mindful of what you're shoveling into your mouth.