Progress Update

Today started out well and ended on a sour note. But oh well...some days are like that. Get up, brush off, hope tomorrow you don't end up on the ground again.

I had a small milestone pass. I broke the 270 barrier. I weighed in this morning at 269, for a loss of 189 pounds since January (and 107 pounds since the surgery in April). Right now I'm just really anxious waiting for Friday's weigh-in to see if I at worst am even-keel at 269 or if I'm going to hit 270+ again as my body is wont to do sometimes.

I'm also working on the first draft of the novel and last night it broke the 30,000 word mark. From what I understand, 50,000 words is generally considered a novel-length. Roughly. I've heard some say 80,000 to 100,000, and I've heard some say that longer first novels don't sell from unknowns (has to do with how much ink and paper publishers will use up in trying to push an unknown author to the public...we can't all be J.K. Rowling, I guess...)

So I dropped below 270 and passed 30,000 words. My two big milestones for the day. I remind myself of this when I have bad days, so right now I'm kind of in a melancholy mood. It all evens out, I suppose.

Someone's Considering the Surgery

I am just finishing up compiling a series of posts into a document to give to someone that are tagged with "bariatric surgery" from the blog.

I was recently stopped by a coworker and she asked me several questions about the surgery. Apparently she's been struggling with her weight for awhile and has lost a large amount of weight on two occasions; one, she had an aneurysm on her pancreas that went undiagnosed for a long period of time, and the second time was a brain tumor, and in the course of trying to remove the tumor the doctors apparently had to break her jaw and that put her on a liquid diet.

She's apparently contemplating the surgery because she'd like to find a way to lose the weight that doesn't involve a serious medical trauma. Can't say I'd blame her.

It did put me in a bit of a bind though. See, while I put this blog up to educate others considering the surgery in addition to acting as a bit of a soundboard and public "journal" of my life, I never really wanted to have people personally associate me with the blog. A few people I trust were made aware of the blog. But coworkers? What if they become ticked at something? Read too much into something? Take something personally?

The last thing I need is someone getting all ticked over something stupid. I edit the blog heavily and pass much of it through what "offensiveness" filters I have built over time in addition to having my wife read the entries so she can alert me to potentially "bad" things. I don't advertise the blog to people.

I guess it boils down to I don't mind people close to me knowing about the blog and perfect strangers knowing about the blog. I don't know how casual aquaintences and coworkers would react to some of the information here despite all the filtering and care I put into it so I don't let them know.

So when she started asking me questions, direct questions, about the surgery and my experiences I thought that the blog would be the best resource. At the same time...I didn't know her well enough to trust her with that information.

That left two options. Reveal the blog's details and let her in on my "dirty little online secret" or go through by hand and filter the entries listed for the surgery into a word processor and try cleaning it up a little bit and printing it for her.

The first was easy. The second takes time. I should know because I did the second one.

I wish I could trust everyone with knowledge of the blog but I just don't feel that I can risk it. I can't risk someone getting bent out of shape over something stupid.

The document was formatted with 1/2 inch margins on all four sides and came out to be 68 pages long with nearly 39,000 words. Wow. And that's not including this entry.

I also noticed the gradual dropoff in entry frequency regarding the surgery. That's a good thing, I think. That's why I listed this with a tag of "milestones". It's a reflection of my healing process, and the fact that my life shifted focus gradually towards something other than a bariatric patient. It means that even though I've gone through a life changing event I'm not completely defined by it.

I'm dealing with other issues; my bouts of depression, my Asperger's, my debts and everything that I put into the blog. I occasionally stick in updates to my bariatric progress but it's simply not an everyday concern for me.

I don't think I put anything in about the Walk from Obesity that I attended. That's when I realized that this truly was becoming a footnote in my life; my wife and I pledged some money for the Walk from Obesity charity event and we walked around a nearby park on a course that was a little over a mile. And I didn't blog about it.

It was a wonderful event. It had free health screenings and some fun swag, and I won a candle as a door prize. The weather held out nicely with a cool breeze and a little sun and we got t-shirts for registering. Best of all I saw my nutritionist and surgeon along with several other doctors I'd seen around the hospital during my consults and time in the hospital. The only one I noticed that was missing was the physician's assistant that had been so helpful with so many appointments after my surgery and during my recovery time.

And I didn't blog about it.

It was...a footnote. A few fun hours one day over the weekend. We had fun. But I didn't blog about it.

I have an appointment, my six month followup, coming up with my surgeon in less than a month. Another milestone. That one I will blog about.

So much has changed. I see it in my skimming of the material as I go through and change the arrangment of the entries (such a pain...the blog wanted to present everything in reverse-chronological order. Ugh.) It's amazing to me to see how things have shifted focus from the beginning to this point, and the things I've forgotten, the little details.

So while I'm handing over to her the virtual keys to finding this blog and blowing my own cover, at the same time I'm glad I've kept the records. I see it as an amazing journey chronicling events in the life of an otherwise unremarkable and insignificant person existing on the planet. I've had comments from people that five years ago I'd never have thought I could have had an exchange with; Mur Lafferty, Paula B, even John Robison have visited this site for a brief time and some continue to drop in. They have no idea how much they made my day and what impact they've had on some stranger with a blog. I look forward to hearing from Lee as I drop in on his own blog, as well as Lorraine with her Renewal blog.

I have blogged my progress with writing stories for The Writing Show, prompting me to continue with an effort to write a draft of a novel which while I'm not tracking progress here I have been making progress on. If you're curious I'm closing in on 22,000 words with it so far...far enough to not make it worth my while to simply quit now without crossing the finish line and then trying to edit it.

All the while I'm still trying to lose weight. I'll hopefully cross a milestone soon that will prompt another worthwhile update on that front too.

All of these things came from keeping a blog about getting my gut sliced open.

Simply amazing to me.

Weigh-In Progress

This morning was another weigh-in day. I clocked in at 286 pounds.

Since January, I've lost 172 pounds, and since the surgery I'm down 90 pounds.

The reason I'm posting a progress this morning is because I saw a small milestone go by. When I first started dieting in January, the nutritionist at the time that was assigned to me suggested a free website called FitDay.com to track my nutrition stats...it's an online food diary with an array of features, essentially (one of the most successful tools for people trying to lose weight involves keeping a food diary, by the way).

After surgery the orders were to not track calories or nutrition so much as protein intake; I no longer kept track of my nutrition profile (bloodwork periodically taken was supposed to track that, from what I understand) but I still go there to track my weight. One of the things that the online site does when you put in your information and your weight is give you your estimated BMI.

Inaccurate or not...BMI is of course controversial as an indicator of fitness for a variety of reasons...the site finally told me I broke the 40 barrier.

It told me that between 30 and 40 is obese. Above that is...super obese? Morbid obese? Well my current classification on the site is just obese, coming in at 39.89. According to them, a healthy weight at my height is 132.6 to 179.2, and that I'm 106.8 above a healthy weight.

So if I went by that, it means I "should" weigh slightly less than 180 pounds.

It's a little depressing to see how much further I'm "supposed" to go. I guess I'll have to wait and see how far the current exercise/diet regimen will take me.

Progress Wrapup (Or, Diet and Exercise Sucks)

There were a couple comments about my progress since the surgery. Ironically, I had queued up an entry for today that dealt with a topic from going to the gym, but I bumped it ahead a day to put this in.

First, some info on weight.

I had my surgery back in the beginning of April, on April 7th. It's now August 19th (technically 18th as I'm typing this). That means it's been a little over four months; I've been tracking my weight since roughly Christmas (I actually recorded starting in January what my weight was).

In January...the entry is dated 1/5/09...I started at 458 pounds. At that point I began the quest to lose weight in earnest; it turns out that you have to lose weight in order to have weight loss surgery.

I know. It's stupid.

I was told it was insurance issues. The place I was supposed to have the surgery supposedly only deals with patients less than 450 pounds, and that was a close cutoff. They wanted the patient to be closer to 400 pounds. Otherwise they ship me off to a medical center in Rochester where I'm told they are better equipped to handle morbidly obese patients. The doctor said it was due to insurance; the equipment wasn't rated for higher weights, and if something happened such as the table collapsing and they knew I was over the weight cutoff the insurance company will crap a brick.

As much as I'd love to see the insurance company get ticked instead of the usual routine...you know, the customer getting ticked because they're getting hassled and put through the wringer...the way the explanation was framed made the hospitals stance understandable if not a little silly. I mean...c'mon! You have to lose weight because you're too fat for weight loss surgery?!

But I digress.

I weighed 376 pounds the day before my surgery. That was 82 pounds from 1/5 to 4/6.

I just weighed in this morning. My weight on 8/18 is 290 pounds, meaning since surgery I lost 86 pounds and my overall weight loss is 168 pounds.

Yeah...at a little under six feet tall, I'm still morbidly obese. I've also gained a lot of flabby skin. Supposedly it can be removed for another thousand dollars worth of copay at some point, but it can't even be considered until I'm at least a year out from the surgery. It's uncomfortable; I wince when I see the batwings under my arms. I sting from infections under the apron of what was my stomach; I need to periodically powder it now that the weather has turned humid and hot, so sweat accumulates and makes it break out.

Oh. Yeah. Quick warning that I'm mentioning something kind of disgusting, so if you have a weak stomach don't read what I just wrote.

I spend a lot of time trying to just cover up the flab and flesh. On the plus side, the vicious scar running vertically in my midsection from the open Roux-En-Y surgery isn't quite as visible. The fat and flesh kind of caves inward in the front, hiding the purplish scar tissue deep in a valley of fat and excess skin.

But I'm not too concerned about the scarring. If I were, I'd not have used the surgeon I did; I went into this knowing he only did open RnY. Other surgeons today often use laproscopic RnY for reduced recovery time and far less scarring; I went full scar so I alway have a reminder of the painful month of recovery and memories of the bleeding and the memory of what I had done to myself in getting so rotund in the first place. That scar won't be going away for a long time.

Quick story. While recovering I happened to be in a place where a teenage girl I didn't really know was whining about the total intense pain she felt after giving blood at a Red Cross blood drive at her school. Oh, the band aid, oh, the pinching, oh the bruising, whine whine whine...

I was recovering. I could get around by then; it was a couple weeks after the surgery, but with open RnY, I was stapled, bloody from leaks, bandages that had to be changed periodically...in general, it wasn't pretty, and I was still struggling just to manage to get out of bed without assistance, and while she was chugging juice and cookies to compensate for her boo boo I was eating puree'd Chef Boyardee from baby food jars.

After listening to her whine, I got a little fed up. She commented on how much it hurt.

I looked at her and calmly said, "No, this hurts," and I lifted my shirt. Just enough to see the train tracks of staples, the deep bruising, the dried clotting clinging to some of the staples in the line...you get the picture.

Her eyes were like softballs. They snapped so wide I wondered if it was possible to sprain her eyelids.

She didn't complain any more.

Anyway...

I started exercising. The doctors and support people were telling me I needed to exercise. I rode a stationary recumbent bike in the basement, but it's a pain in the butt. Not as much as a stationary upright bike, but it's still a pain. I got pretty good at it though. I typically rode 10 miles a day eventually.

Eventually my parents bought me a year membership at a local gym. I started going every other day, but lately I've been going almost every day. I started out kind of slow...I mean, I don't know the first damned thing about "working out". I was very much the guy who was anti-gym and anti-exercise. Still am most of the time.

Learning what to do in gyms is a full time job. If you want to build muscle you do one thing; if you want stamina, another. Cardio this, weight train that, this many reps and this many sets to do this and achieve that. It's hard. Really hard. And get this...if you want to gain muscle, you have to overeat. That SUCKS! How am I supposed to gain muscle mass if I can't even eat much to begin with post-surgery?

Lately my routine has become alternating "upper body" machines one day and "lower body" the next. I start out with a 1/5 mile walk on the treadmill at various inclination; takes about 10 minutes. Then I typically end with another 1/2 mile on the treadmill. Those two walks alone burn usually around...well, today it was 348 calories together.

In an attempt to gain some muscle mass, from what I've pieced together, you're supposed to do fewer reps at a higher weight, basically pushing yourself closer to your tolerance for moving weight. Toning and stamina comes from more repititions at a lower weight, muscle bulk comes from fewer reps at a higher weight. At least that's what I've pieced together. I don't have a trainer and probably couldn't afford one if I wanted to. So right now I'm usually 2 sets of 5 repetitions at the following weight in pounds, in case you're curious...
compound row: 200
lat pulldown: 165
pec fly: 185
vertical chest: 100
lateral raise: 125
overhead press: 95
bicep curl: 80
tricep extension: 80
lower back: 205 (10 reps each)
abdominal: 120 today
leg press: 400
leg extension: 130
seated leg curl: 195, usually 190
abd/adduction: 200

I have no idea of this is good or bad or just neutral. One person told me that doing 500 pounds on the leg press is considered really good; I'm assuming that was a typo in the email since the machine at the gym only goes up to 495 pounds. Perhaps this would mean more to someone who knows more about working out in the gym; my eyes glaze over when I look at the list, and I have to fill in the bloody form every day I go.

The rough part is that I don't know how much good it really does. I was told that the biggest results are in the first 30 days; it's been about a month and so far no one will think I can rip phone books in half or lift small cars. That weird wriggling crap under my skin? I don't know if that would look this way if I didn't go to the gym. I don't know if it wouldn't, either.

Someone asked me not long ago how much weight I was supposed to lose, what weight I was going to stop at. I honestly don't know. I don't know how I'm supposed to look or appear, or what number I'm supposed to aim for. I'm just losing weight. Or at least I keep trying to. I figured it would stop when it wanted to stop. I'm still obese so regardless it appears that I'm wearing a small tent. I'm the one that would end up shirtless if our boat is marooned on an island because the professor needs a sail to use in building a new boat. It's still my lot in life. I deal with it.

I was told that the surgery is supposed to knock off something like 70% to 75% of the excess weight; so if you are 100 pounds overweight, the RnY is supposed to knock off about 75 pounds when all is said and done, meaning you're still overweight but not quite so much.

Oh...other changes...I'm off diabetic medication. The surgery means supplements...lots of them...every day. But I'm hoping to get off some of the pre-existing medications this year. Each morning I take: iron, B100/complex, B12, a multivitamin, something for blood pressure, something for cholesterol, a medication to cut down on stomach acid (prilosec? doesn't matter, I go off it in October), and calcium with vitamin D. Oh, and vitamin D. Some supplements are just lifelong because of the surgery...RnY introduces a deficiency in your digestive system from shortening the intestine, so you don't take in as many calories but you're also not absorbing the nutrients you need. Other pills...the cholesterol and blood pressure medications...are doc-prescribed until they see improvement in my test results.

Nine pills in the morning.

At night, I take another multivitamin, a B12, and iron.

But I went off byetta and metformin. My blood sugar has been diet controlled, sticking around the 100 mark in the morning and night. Another plus.

So that's been my progress. I have a nice scar in my abdomen to remind me of my bodily transgression as well as a really long belt that I've had for years in which I add more notched holes when I need to tighten it more. I blogged about the length before. It's...pretty darn big. It's my reminder of what I've done. And a symbol of hope for what I will achieve. Plus it makes a really loud thunderclap sound when snapped against itself like some kind of Foley soundstage sound effect tool.

This pretty much sums up my changes since the surgery. Or even before the surgery, technically. Now I spend my time at work, the gym, and trying to get a writing show entry completed...I think my gratis editor is almost done with the second draft suggestions. I'm really hoping that sometime later today will be an update on the status of that story!

So until next time...um...any suggestions for a good exit tagline here?

Weigh-In Progress

I thought I'd put this in since I kind of hit another milestone of sorts. Of course, it could change in a couple days if it goes the wrong way, but at least it hit a milestone for one morning.

This morning my weight came in at under 300 lbs. 298.5, actually. That's 159.5 pounds since January lost, 77.5 since my surgery in April.

Like I said, it could all change with water weight or one of the fates getting angry with me for doing $DEITY-knows-what. With any luck it'll continue to fall (or worse case, plateau...I could live with that for a couple days...) but only time will tell!

I had gone to the gym again today too. I'm still not sure I'm doing things correctly or "well", but at least I'm doing something. I changed my end-workout routine so that instead of doing the treadmill twice (just before, just after) I do the treadmill to warm up and a stationary upright bike for 20 minutes to "cool down."

I'm still trying to figure out what the reading on the treadmill and stationary bike is that is labeled "mets", though...

Holes in Me Tummy

One last note on my gaping wound in my stomach...I think it's safe to declare that it's closed up now.

It has some nasty looking scar tissue and it's definitely still healing...sneezing hurts...and I feel this weird crunch when moving in a certain way or picking heavier things up but I no longer see an opening and don't notice any "leakage" of fluids. I'm hoping my next followup will mean I can take baths and sit in a pool!

To be honest it's probably been closed up for a few days now. I just have difficulty in bringing myself to look at it, let alone poke lightly to see if it's really closed or has some goo covering it. I had that before at one point...I'd lightly dab with a cloth to clean dried blood and crud from the wound which looked mostly closed only to find a thin layer of...something...which would promptly start bleeding. The doctor I went to said, "um...don't do that."

So I avoid doing that.

But right now I'm going around without a bandage over the wound. Touching the scar tissue is uncomfortable still and I have the pains I already mentioned. But progress is progress!

"Just keep swimming. Just keep swimming. Just keep swimming, swimming, swimming. What do we do? We swim, swim."

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!

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...

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.

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!

Another Milestone and a Half-Step Back

Had my doctor's appointment yesterday; she removed the last two staples. I was kind of excited at this since the one that ripped out was no longer dangling half out of the wound site; the staple had re-embedded itself in my incision site.

*shiver*

Yeah. That stuff bugs me.

She also looked at the wound a little, made a passing statement that it wasn't really healing quite as quickly as they'd like, so here I am waiting for a ride to the hospital to get a CAT scan this morning.

She reiterated that there was nothing to worry about, she sees nothing wrong, they just want to get a better picture of what's under the surface.

Oh, and I have tape burn.

I haven't stared much at the new look of the wound, staple-free yet. I just quickly changed the dressing this morning and went about the routine they directed of drinking my "Banana Smoothie" (I'm not an idiot. I know what the Barium Sulfate on the label meant. As a side note, dose one didn't taste half bad.)

She did confirm that yes, the hole is healing (just slowly), it will seal up just fine. You know in movies when the mutant or alien has a hole blown in them and it heals superfast, pulling the edges together like it's pulled by an invisible zipper? Well, that's what happens here, only it happens in super slow-mo.

My other question had her confirm that the lack of feeling full after eating my purees is normal too...liquids tend to swoosh right through the pouch. Which also confirms that is how people cheat the pouch. "It'll all change when you have solid foods. Don't worry!!"

My ride's here. Time for me to head to the hospital for my tummy scan...

Another Surgery Followup

Another milestone reached! I had my two-week dietary followup today.

What does that mean?

It means I am on a "full liquid" diet.

The name is misleading, though. Really it's more like "full slurry diet" or "if it slides easily with little resistance off a spoon you can try putting it down your gullet diet".

I can have creamed or pureed soups without lumps or chunks, smooth yogurts, very very thin hot cereals like cream of wheat and grits, sugar free pudding and sugar free hot cocoa with skim milk, and sugar-free protein powder. I'm supposed to try having things with protein in it as it's important to prevent muscle loss at this point. She also suggested baby food in small jars since it's a good portion size and has good flavor to it. This may be very convenient for meals on the go.

I'm also supposed to have my chewable vitamins now. Two a day. One in the morning, one at night.

A serving size right now is recommended to be 1/4th to 1/3rd of a cup per meal, and she said not to exceed 1/2 a cup. My first "meal" in my newly graduated diet level? A pudding cup! Chocolate pudding! It tastes pretty good so far. I've been picking at it for 26 minutes now (I'm in the middle of doing this entry and a couple other tasks at the desk at the moment too) and it's not even halfway gone. Turns out these snack cups are about 3.5 ounces, which comes to a little over four-tenths of a cup of snack. So one snack pack, if I tolerate it, is a good meal size. Unfortunately the pudding has no protein (well, the chocolate has less than 1 gram). This does have some added energy from carbohydrates and fats, so I'll be a little more energetic. My first meal is an indulgence. Can you blame me?

The person heading the dietary class said there were people in another gathering of people recently who were arguing and complaining about, "Why can't I eat XYZ?" and "I had ABC and it was fine..." and...I'm wondering if this was an exaggeration or example...had someone say they had watermelon in the car they were eating. Are you kidding me?

It floors me to think that this early on people would go through all the hassle I've been going through only to intentionally break the diet guidelines. Maybe doing the surgery laproscopically is really much easier on your system than open RNY...maybe the person or persons doing that had lap-banding instead of RNY, and perhaps that is even kinder on the system than what's happening to me. But still. You go through something rather radical to correct your obesity and at this stage of the game it should be the simplest time to be able to stick to the eating rules. You're healing. You're hopefully not hungry, physically. You just paid (or cost your insurance company) thousands of dollars and probably feel like crap over the first two weeks. Already you're breaking the rules? WHY?!

I kind of wish I had a larger group of people so I could ask them what they are thinking when they do this. I won't even chance a stolen teaspoon of cake or icing for fear of dumping syndrome. Quite frankly I'm not that hungry anyway so it's not too hard to resist, even though I do sometimes miss the flavor and texture. The closest I see myself coming to breaking the rules right now is drinking too soon with the meal.

Not all is totally rainbows and gummy bears. After my dietary class I met with the physician's assistant that in our previous adventures had removed the grenade tube from my gut (don't get me wrong; I stifled a number of not so nice expletives at the time but I really do like her. She's a nice and knowledgable young woman and has treated me wonderfully in spite of the Tube of Death pulling some of my innards out). She removed some more staples but left two in, saying that I'm healing well but it's just not quite ready. I still have two staples in my skin.

She also couldn't get more of the clot out. The result? I go back next week for her to followup on the clot and staples, and the following week I have to have another dietary followup to see if I'm ready to graduate to regular food!

These are my new milestones. Next week I'm returning to work...desk-bound...and in the middle of the week trying to get my staples out. The following week I'm trying to graduate to full food. When I get a chance to go to the supermarket I'll be getting some protein powder to add to my foods and I'll also try getting some of the baby food purees.

Aside from coming home to the dog having chewed up more things she's not supposed to be chewing on, today has been a good day. Yay!

Another Appointment

Troi: "How do you feel?"
Picard: "Almost human...with just a bit of a headache."
*********
That exchange was from the Star Trek: The Next Generation episode The Best of Both Worlds, part 2, after Jean-Luc Picard was assimilated into the Borg collective and then was rescued and his crew had started the operations necessary to remove all the cybernetic implants. I am often reminded of that scene since I think of waking in the hospital with all those wires and tubes melded to my flesh.

I've mentioned that I can't seem to track time the way I used to anymore...breakfast, lunch, dinner, an snacky time...so I've taken to measuring my short-term medical progress by removal of various items implanted on my person.

Today was another milestone day. I had an appointment to see Angie at the clinic. She examined my progress and...drumroll!...removed my drainage grenade AND most of my staples! Most of the staples, not all, but I'll take what I can get.

No grenade and 90% fewer staples! Yay me!

I've been bleeding since I got home last Friday. Not a torrent, but enough that the gauze is pretty red by changing time in the morning and at night. Angie clarified that this was normal; I basically have a clot under the skin near the incision. As the clot breaks down and is re-absorbed into the skin it will, she said, ooze blood. Perfectly normal. I just have to keep it clean, take a preventative antibiotic she prescribed, and change the gauze every day. If something goes very wrong, I am to call them or go to the ER (depending on the severity).

How did the drain get removed? She first had cut the sutures securing it to my skin. It kind of reminded me of the Thanksgiving turducken the father-in-law and I had twined a season or two back...snip! Then she started prepping for pulling staples and in mid-conversation, when I was concentrating on some Percocet-inspired shiny on the wall, waited until I wasn't paying attention and deftly plucked the grenade right from my abdominal cavity without skipping a beat.

No warning. No pause.

There was a wet hissing bubble noise as the grenade sucked air in and exited the fleshy hole in my chest. I felt a weird sensation of something moving inside of me accompanied by a slightly dull pain. Then done.

I was wearing my Simpson's pajamas. It has a bright yellow shirt with Homer's face on it, stuck in a perpetual yell, mouth open, tongue wagging. My wife said I had a look on my face that closely resembled that face on the shirt for several minutes after the tube had wriggled free from my body.

I was still stifling the colorful metaphors for describing the young lady who pulled the tube free as she began plucking the staples from my incision with her perky disposition and a little metal tool.

I'm very glad the appointment showed progress. The doctor seemed to think I was progressing well too. She felt that my incision was doing very well, not "splitting" as much as she thought it would as the staples were removed.

I bet it's all the milk I've been drinking.

She said she'd remove the remaining staples next week when I see the dietitian group (yes, a group of us from the operation time I was at the hospital are all coming in for a group session, apparently) and then...we "graduate" to a full liquid diet!

I don't know how much it will matter since as I type this sentence it's 4:10 PM and I don't remember lunchtime going by. Whoops.

Progress, progress, progress. Still hurts as I move around, but I resemble something more human. I can't wait for my little dude to come home and see me...he was asking me last night, "How's your boo-boo, Daddy?"

Now I can show him the incision, bandaged instead of stapled, and reply, "A little better, dude. Daddy is feeling a little better."

Home At Last

This has been one H*#@ of a journey.

I'm home now. Sitting on the couch. My own couch in the living room. I left this room Monday afternoon to trek to the nearby town where my wife and I stayed in a hotel, and now I'm finally back the following Friday.

I hurt quite a bit. Right now I have a small arsenal of staples in my gut and a rubbery plastic "grenade" sticking out of me. Every time I try to move I feel the staples pulling on my abdomen. These pains have been...challenging.

I managed to use the bathroom twice; once I needed help standing, once I managed to do it on my own. I can't get up from the couch without help yet. I have managed to stand from my chair on my own.

So...it's extremely frustrating. But it's getting better. A caregiver told me that this will be the hardest month of this change, and this first week will be the hardest of that month. I believe it...I'm already looking forwards quite anxiously to Tuesday, when I expect to have the staples and drain removed. I can't even think of what is going to go on this weekend...I just hear the word "Tuesday" echoing in my head.

I've come a long way. Tuesday I had the surgery, so early in the morning; I woke up in extreme pain in the Recovery area of the hospital, bleeding and crying for something to alleviate the pain coursing through my stomach. They gave me more drugs and slowly, slowly, slowly, the pain faded. but then I wasn't breathing properly. A side effect of the epidural, I was told. I'd start to doze or nod off slightly and then an alarm would sound...that alarm became quite the close buddy over the next few nights...telling the nurse that I wasn't breathing. They'd feed more oxygen to me and it just didn't seem to be helping enough. I was in Recovery for eight hours. The nurse assigned to me...there is one on one nursing in Recovery...became somewhat attached to me in our limited exchanges. She said that normally a patient would be in recovery for much less than an hour; wake up, ship off to ICU or another ward. I was an exception that day. I was to be closely watched because of these complications for, well, eight hours. We'd talk a little then I'd be jolted back to a fully awake status by her voice telling me to breathe.

Then I'd bleed. A doctor was consulted; he come into the curtain for a cursory examination and then proceeded to add three more staples to stem the bleeding. Not much pain, but thank the deities that I had the epidural in my system.

My wife was already debriefed by the surgeons about my breathing issues and that I was in Recovery, despite the operation being a rousing success. She was the first one in the Day-Surgery waiting room and the last one to leave while waiting for me to leave Recovery; I can't imagine how she felt waiting for an update when she was supposed to see me after just a couple hours.

Finally I was moved to the second floor and into my single-occupancy room. I was so glad to see her and relieved at my luck at having a single room. Unfortunately, while I was mostly stabilized on the breathing issue after reducing my pain killers and increasing O2, the bleeding wasn't stopping.

All night, about every hour and a half to two hours, I'd be woken up from my pained, fitful sleep by the trickle of blood that was overflowing the mounds of sponges and gauze taped to my midsection and had begun pooling around my hips on the bed. Every time the nurses would change my dressings and again change the sheets and mats, forcing painful shifting of my position or standing in order to make the alterations. I had earlier been taken on my promised walk of the hallway for recovery, but it was cut short when the nurse realized I had a trail of blood on the floor following me.

Early in the morning...I don't remember if it was near four or five...I became aware that I was starting to lose it. I remember asking the nurses what was wrong with me. I wanted to cry. I felt weak, I was tired, and I had watched handfuls of clot-covered gauze by the fistful being pulled off my sleep-addled body. I was becoming miserable, wondering what the hell I'd gotten myself into.

A doctor came in that morning. I successfully stemmed the bleeding problem by applying (painful) pressure to the specific point where I was bleeding from the incision. He had me hold that point for ten minutes after he packed on some specific chemical-laced gauze from the surgical wing and it just stopped bleeding. He "milked" the clot-stuck drain, one which was removed before I came home, and since then I began making progress in recovering.

Every day things have become a little easier to do. I'm pulling muscles because I'm straining to get up using my side instead of my abdomen; I even strained my neck muscles and I'm not sure how I did that.

Now I need to adjust to recovery here. I have a constant fear that either the dog...an 80 pound doberman with the brain of a sponge...or my four year old boy will hit or leap on me. My little guy already forgot once in and leaned on my, hand outstretched, to crawl on to the couch with me, forgetting completely that daddy has a gaping wound on his tummy. Fortunately I bit back the yelp that would have scared him half to death. He also was playing with a toy that went wild from his hand and, of course, bounced off my stomach. Of course I add to my own stress by having to bite back sudden emotional frustration when the children or the dogs or just anything in life is making me want to scream. Quite frankly, the recovery process itself has shortened that tolerance considerably, and my wife will tell you it wasn't that long to begin with.

I just need to hang on a little while longer. And the first SOB that says this was the "easy way out" for losing weight is going to get a bat to the face, because so far I'm not finding the easy part in all this.

I Live

I'm done with the surgery and sore. Soon I'm supposed to head out for a walk in the halls. Fortunately my complicatipns to this point have been minor...bleeding, extra staples needed, things of that nature.

Pretty tired...can't sleep yet, though. At least they have the scifi channel.