Day By Day

It's been awhile again since I had blogged. The reason is simple; there isn't much to report on.

Bariatric surgery is something that takes intense retraining and relearning and introduces new coping challenges for a period of time; once you have met (or coped) with those challenges, life returns to some semblance of a new version of "normal" and you move on, with changes and checkups periodically interrupting your routine.

After a year post-surgery, what is there to talk about? I could complain about not being able to enjoy cakes or brownies or other fun foods that I used to enjoy; my son's birthday recently slid by and while family were stuffing their faces with heaping helpings of yummy-frosted cake I was eating...I think an apple or some mini-pretzels and nuts. I don't remember.

I could complain about missing the days where I could down large portions of food with nary a bit of side effect. I see shows like Man Vs. Food on the Teletubes and think to myself, "That challenge would have been nothing for me a few years ago..."

Now I see that show and wonder how he doesn't gain more weight while filming the programs.

Oh, there's always something to complain about. Complaining isn't a challenge. The challenge is moving on.

My most recent checkup at the doctor had them concerned because some of the weight had creeped up. I assured them that I just saw the surgeon and there were changes being made to my diet; I routinely monitor it (every Monday, Wednesday and Friday I record my weight in the morning), and I'm trying to make changes to trim out a few calories.

My biggest dietary challenge lately has been peanut butter. I love the stuff. And I eat way too much of it. I usually eat it with apples or even broccoli (I know it's strange, but it works for me.) I suppose a secondary challenge has been cashews; they're high calorie but good. Very good.

I resolved to trim back some calories here and there and see what the effect would be. Basically I'm aiming to change my routine enough to get into newer, better habits through small changes. First I trimmed back cheese in my wraps. I used to have a slice of white cheese (60 calories) with some shredded cheddar. Then I cut out the shreds and had 2 slices of the white cheese, so calories were easier to control. Now I cut back the slices to just one in two out of the three meals, for a savings of 120 calories a day or 840 a week, which can add up over time.

Then I swore off cashews during the week. Saturdays and Sundays I have some, but otherwise, no cashews. This saves on calories and the wallet.

Now I've reduced my peanut butter intake. Not a huge amount, but it's reduced. I'm having more raw apples instead of apples with some PB on them.

Basically I'm trying to trim some calories here and there and keep busy with other tasks rather than focusing on eating. When I stress, I eat. When I get anxious or angry, I want to eat. When I get annoyed or want to focus on something other than something that is driving me batty, eating keeps me from saying something that will no doubt do little but make other people irritated or angry. Even if I'm bored, I want to eat. And of course there's my regular routine times to eat, when I'm used to having a meal and Mr. Tummy starts getting irritated if it's not refilled at the proper time (I think I liked Mr. Tummy better when the nerves were healing post-operation).

I'm working on trying to stay busy, as I tend to not want to eat when I'm occupied with something I enjoy doing. For the past couple of weeks I was working on a video contest entry which took precedent over working on my manuscript for the novel. Once that's all submitted I'll be working on the manuscript once again (I'm actually pretty far into my pass on editing, and my wife is still looking at the previous section I gave her. By the time she's done with that I'll have something like 150 pages ready for her to go through again.) With summer approaching I'm going to have the occasional weed-whacking chores or maybe even excursions into the park for some nature walks with my son (or family, if they're game to join. I've learned through my readings for the surgery and watching my extended family age that the more activity you get into, the better off you are with preventing joint issues later on.)

I'm still out here. I'm still doing some posting on my tech blog and writing blog. I'm still trying to lose weight, and cope with my personal issues that helped contribute to my weight issues in the first place. And I'm still trying to write a novel that may or may not sell.

Still taking it all day by day.

One Year Followup

Today was my day to visit my surgeon/doctor in the bariatric department.

As I had already posted, April 7th was my one-year anniversary for the surgery. Now I periodically go in for followups.

So how I'd do? Well, he didn't give me huge kudos, but he didn't tell me how I screwed up either. He looked at some vitals and change in medications since last time, asked a couple questions (Pains? Digestive issues? Etc.,) and then said that it looked like I had plateaued. He asked about my eating habits, and my wife made sure I mentioned my snack of fruit/vegetables with peanut butter. To paraphrase:

"Okay," he said. "There's no problem with peanut butter. Or vegetables. But if you're going to break the plateau, you need to be careful about how much you eat. Patients sometimes learn to graze, and you can easily take in 3,000 calories a day just eating a little bit the entire day." Which, of course, will stymie the whole losing weight thing.

He suggested that something has to go. The snack, or a meal, but something had to be cut out. If I liked the snack, I could make it a meal.

Okay...

I said it was hard to not know what number I should be aiming for with my weight, since I've been stuck in the 270 to 275 range for the past couple months. He said, "Hang on..." and left the room, coming back a few moments later and saying, "230."

"230?"

"Three months out of surgery you should weigh 230. If you that number in two more years, you hit a home run."

I can do that. I'm sure of it. Two years to lose fifty pounds?

What I think I can do first is tweak my meal preps to trim excess calories there first. tweak here, tweak there. Trim calories. Trim some more. See what gradual changes add up to.

So now I'm super stoked about trying to lose weight until I hit my "target weight", not that I have one. The hard part will be adding in several small changes to tweak my caloric intake, then integrating them into a new habit, since it takes something like 21 days of consistently following a pattern to establish a new habit.

But the big thing to keep my eye on is that I now have a solid number, and a definite deadline by which to hit it!

The rest of the day was celebration. I had taken the day as a sick day, and my wife took the day to accompany me (I was going to the doctor and their lab for blood analysis and I didn't know how long it would take, so I took the day as a sick day. I was at the doctor. It counts.) We hit the Sam's Club, we hit the comic shop, the book store, and a few other errands. My wife even celebrated by giving me a couple of wonderful cards congratulating me on the progress I've made and giving me a $50 gift card to Barnes and Noble! I was really surprised by that. I couldn't even spend it when we stopped there because I really wanted to find something that just screamed, "IF YOU LEAVE WITHOUT BUYING ME YOUR PANTS WILL EXPLODE." Nothing screamed that to me. I'm saving it for a special occasion instead.

So that was my day. The doctor didn't yell at me, the lecture was set to minimum. I have to tune my eating habits a bit more. And I need to lose about fifty pounds. Not too shabby, all things considered!

Happy Anniversary to Me, Revisited

Yesterday was my anniversary of the operation. I was tired and said I'd post more about feelings on the whole operation journey today.

Perhaps weary is a better word instead of tired. I think there's a distinction between the terms.

So how does it feel to go from around 450 pounds to 270?

I don't know if I could ever put it into words that would properly convey what it's like for me. I've had to change so many habits and views in order to adapt to my weight changes and dietary restrictions that it's a very difficult thing to adequately put into terms that normals would understand.

The absolute most interesting thing in the surgery that I experienced only lasted a few weeks. Right after the surgery, as the stomach and intestine were healing, I had no hunger. Not just "not hungry", but my head was totally divorced from the feeling of wanting to eat.

I could look at the most sensational cakes, most mouth watering pizza, the most alluring tray of peanut butter and chocolate eggs and most aromatic array of deli delights, and fully experience all of the senses aside from taste in order to be drawn to these items, but I had absolutely no desire to eat them. Rather, I wanted to smell them. And I could smell them. I could pick out individual ingredients in mixtures of foods from smell, rather than just having the glut of a lump "food" hit my nose. I was surviving on a liquid diet of jello or some rather crappy broth and I didn't mind it one bit.

It was the most unusual sensation I ever had.

Of course as things healed up, my old hunger returned, my habit eating, all of that started to slowly creep back in. But for the first month of that recovery I had truly experienced how driven we are as a sentient being to the desires of chemical reactions in our heads and nerve triggers in the stomach and digestive system. If we could find a way to regain that sensation using just some miracle pill...wow.

I don't know if this is what it's like for normals; to see something that you absolutely love to eat, your favorite food, and have no desire whatsoever to taste it. To see it as an abstract thing that's just there instead of as a thing to be consumed.

I can't get clothes that fit. I guess I can, but they feel alien. I like my baggier clothes. I suppose part of me fears what would happen if I spent money on stuff that's supposed to be "my size." I guess it makes me look a little strange sometimes, with pants that flap in the breeze around my ankles. I sometimes wear socks covered in diabetic socks for additional cushioning in my shoes when the weather allows it. I still prefer going to the Salvation Army to look for pants that may fit me, and when I get shirts or items that my wife says are the "proper" fit, they feel too tight and constrictive, and I frequently worry that the seams are going to rip apart if I move the wrong way.

One change that has persisted involves how I view food and drink. I can't have anything that is primarily sugar or I risk getting very ill...I've pushed that boundary, barely, before, and it's not pleasant. I primarily wanted to see if the bariatric surgery had actually changed the way my stomach worked, and it did. I was told that I absorb sugars faster than before so I have to limit my sugar intake, and consequently most of my meals contain very little sugar and additives. Fortunately my own quirky nature means I don't mind having a repetitive diet while most people would balk at the notion of eating similar foodstuffs every day. Most bariatric patients have to carefully adapt to a "normal" diet, sans sugary stuff or carbonated stuff, in far smaller quantities. I just sort of adopted a few select items that I like and have those on a regular basis.

After the surgery I had to cut out the sweets, the carbonation, and in many cases the pre-packaged. I had to eat what health nuts always said was "healthier" for me, in portions we are supposed to eat but rarely do.

I also read about diets and the food industry. I started reading a lot. And it didn't paint a pretty picture.

The more I found out about what goes into fast food and prepackaged food, the less I really missed it. I didn't stop having the occasional hunger pang for it once in awhile, but I also know that it's not all that great for me if I did have it. You know, the zebra cakes, the cosmic brownies, the chain restaurant pizza, the huge portions of Mexican fare at Chevy's...mmm...fried artery clogging goodness! Unless you read the books that discuss what happens when you eat high fructose corn syrup or the burgers at various fast food joints doused in fats, artificial additives and sodium.

I'm still overweight. Probably still classified as obese. But I'm eating "healthier" than I ever have before.

I still see myself as the fat guy. I still avoid sitting in anything that doesn't look like it could support the weight of an F-150. I'll stand around sooner than sit on furniture risks a sudden snap or crack followed by the fat guy rolling on the ground like an abandoned turtle.

There are a few moments where I think I'm doing something that a year ago I wouldn't be doing. I remember walking the mall and feeling just plain wiped out afterwards; today, not so much. I am actually asking others to do more walking or moving around and they're griping that they don't want to.

I also tend to be a little more judgemental of people who indulge in the laziness that I use to wallow in. People who pull into a Quik-E-Mart and park as close to the door as possible, sometimes in spots that aren't even parking spots, so they don't have to cross any farther than they absolutely must to get to the doors. I wonder how many people are riding in those motorized carts at Wal-Mart because they couldn't be bothered to have listened to their doctor when they were told they needed to cut back on their food and lose weight. I see people eating the entire portion they're handed at restaurants and wonder if there are any ethical restaurant owners willing to feel even the slightest bit of remorse for their contribution to the obesity epidemic in America.

I am curious about people that are nearly too overweight to walk on their own power, or are in scooter carts, or have clear difficulty moving and yet are carrying pre-packaged fried fats or are indulging in a tray of fast food easily hitting a thousand calories in one meal. That was me...I could easily polish half a large pizza, if not the whole pizza, if I wanted to in one sitting. Although now if I ate two slices I'd probably regurgitate it or, not achieving that, lay in a puddle of pain for an hour or two as it slowly slithers through what's left of my stomach. Horrible agonizing pain. I guess I'm curious in that I'm fascinated with those people having been me at one point, so now I'm seeing myself through a slightly different set of eyes.

There's also the skin. I avoid seeing myself in the mirror as much as possible because I look horrible with the free-hanging skin. Large flaps hang under my arms, and my abdomen looks like it's melting in slow motion. If I move too quickly the flesh flops around and risks giving me a concussion. Consequently I keep a shirt on as much as possible, and usually try to wear shirts with sleeves long enough to contain my upper arms under fabric rather than leaving them free to slap around. The skin, along with the long thick scar in my midsection, are macabre reminders of my lifetime transgressions involving food and gluttony.

Bright spot: sometimes I can feel muscle in my legs now.

I've lost some weight. I'm pretty sure I should lose more. I've been fortunate in that side effects have been minimal; sometimes, yeah, I have discomfort after meals. It's a new signal to say, "Hey, Jackass, stop eating!" It doesn't happen often and it's minimal, lasting all of five to ten minutes. And it is less pain and more discomfort, and as long as it's just discomfort I guess I'm doing okay.

I'm still unsure of myself at times. I'm still having issues with my own image, and I am deathly afraid of regaining the weight. I've failed to lose weight too many times to think that this is a permanent fix.

I'll know more after my one-year followup next week...

Happy Anniversary to Me!

One year ago I was waking up in my hospital bed with a giant incision held together with giant staples.

I woke up in the morning one year ago in a hotel room, suffering from the after affects of a laxative meant to clear out my digestive system after a wonderful liquid diet regimen. Then I rolled into the hospital around five, was pushed into the operating room around eight. Many hours later I was waking up in recovery and forgetting how to breath.

I stayed up most of the night just bleeding. Bleeding and bleeding. Not much fun. But I did learn that the food network kept replaying the same few cake-backing episodes, which was good because I'd watch five minutes, doze off, and wake up an hour later right around the time the episode was repeated right near the point where I dozed off. That was pretty surreal after it happens four or five times.

When I finally decided to get serious about pre-op dieting, I weighed 458 pounds, and that was taken in January. The day I went in for surgery I weighed 376 pounds.

This morning after a lazy long vacation for the "Easter break" at my in-laws, I weighed 276.5 pounds.

If I am doing my math correctly, that means that I've lost nearly 100 pounds since my surgery and nearly 180 pounds overall.

Further estimates would say that I've lost 40% of my weight overall and about 26% since my surgery.

Depending on the weight charts you use I think I've lost somewhere in the neighborhood of 66% of my excess weight. I haven't talked to my doctor about it yet because my one-year followup is scheduled for next week (yipes!) and supposedly you're aiming to lose 75% of your excess bodyweight post-bariatric surgery. If I'm right and I've only lost about 60-some percent, then I'm either still off or there's more weight to lose down the road.

I don't know if I should expect to be chastised next week or congratulated. To be honest I'm nervous about hearing the doctor's assessment. I can picture him telling me that he's disappointed in my lack of progress or that I'm not doing something right.

It has certainly been quite the interesting trip. It's getting rather late here because to celebrate my anniversary my wife took me to my favorite restaurant since my surgery: Panera Bread. My wife, son and I had a lovely evening out shopping at Barnes and Noble, Target, Walmart, and Panera; my daughter decided she'd rather spend her time doing something else, but my four year old son told me to have a happy anniversary, so it wasn't so bad. Right now he's in love with a new Bakugan that Daddy helped pay for him as a treat.

Maybe tomorrow or in the near future I'll sit down and go over some thoughts about how things have changed and what has happened since and because of the surgery. So many things have changed, many other things have stayed the same. It's weird to look back on the journal and the blog to see how things have altered through the months following the surgery.

I was determined to put something up on the anniversary of my alterations. I got up the numbers. And later on I'll try posting something about the feelings from the surgery and further thoughts on the enormity of the changes that have occurred. No pun intended.

One year ago I was waking up soaking in my own blood. Today I'm reminded of that every time my skin wobbles and flaps, or I look down at the horrible rigid scar tissue. My branding for life to act as a reminder why I cannot and should not ever eat cake again, or what too much McDonald's can do to you, or what our fast food nation and culture of pre-packaged convenience foods have encouraged the population to indulge in.

Today I'm waking up in an alien body that doesn't quite fit anymore, and feeling more than a little weird when I can walk more than three hundred paces and not feel like I can't get enough air into my lungs. Our "local" Panera Bread is at one end of a strip mall anchored on the other side by a Target. My wife drove the car from Panera to Target while my son and I walked; we were about halfway there when my son spotted Mommy driving by in the car.

"Oh no!" he shouted. "Mommy is going to beat us!"

He took off in a fast trot down the sidewalk. I started jogging alongside him. Soon we were running, a still overweight thirty-something and his four year old son running down the sidewalk to get to the store entrance before Mommy did. We got there with time to spare; Mommy had just parked the car and was opening the door when we stopped at the front entrance. My son was beaming a huge smile, declaring to Mommy as she walked up that we had beaten her to the door. I was silently smiling because I could still breathe without gasping like a fish.

That was my night, one year after my surgery.

Doctor's Checkup for January

I had my six-month checkup with my primary care physician (not my bariatric doctor). The good news is that I'm still alive. The bad news is that I'm still not normal. The okay news is that I'm a little closer to normal than I was.

The doctors have cut my cholesterol medication and my blood pressure medication dosages in half. One of them has a side effect of damaging the liver; now that they think my weight may not be as big a concern with impacting the liver, they're going to see if my progress with my blood chemistry continues if they cut back on the medications.

Bloodwork came in today. My LDL ("bad") cholesterol was 89, and the normal range is 10 to 100 mg/dl. So now it's in the happy zone finally. I think my blood sugar is within controlled range as well, because my Glycohemoglobin A1C is 5.2 (normal range is 6.0%).

My ALT...something with liver function...is still high, however. 98, where normal range is 30 to 65. I don't know what the previous number was, but hopefully it's still falling. They had said, after all, that one of the medications could be elevating this number so now that I'm cutting back on them...maybe the results will fall more in 6 months when I have my next bloodwork battery.

Another number that's off is Ferritin levels, measuring 16 when normal is 30 to 300. Wikipeida says that ferritin is a protein that handles release of iron in the body. But my iron serum and iron binding capacity measures seem normal. The doctor didn't note it in the letter, so I guess it's not something to worry about?

Other numbers are apparently in "normal" ranges. I guess at this point that there has been improvement but there's room for a little more improvement. Again, I'll find out down the road.

One Year Later of Diet Changes

I was going to call this a year later, but it isn't a year since the surgery. That's coming up in April. No, I was one of the lucky overweights that had to "lose weight before weight loss surgery," and that meant making dietary changes months ahead of time or my surgeon was canceling the surgery and instead sending me to a more specialized facility that had the equipment to deal with heftier hefty people. I know. I never not point out the irony of dieting before weight loss surgery.

It's been a little while since I updated the blog. The last entry is dated Christmas. Why? Because quite frankly there hasn't been a lot to report on. I haven't had diet stories that struck my irony or ticked-off bone, and I personally have been plateaued for several weeks. I could either bitch about being plateaued, which I already did once or twice, or just stay quiet (and update the other blogs instead).

That said, it has been roughly a year since I started dieting. I suppose it's more accurate to say since I made a change in my dietary lifestyle, since "diet" has the connotation of being a temporary measure (which never works in the long run). I thought it would be a good idea to post an update after one year of the change.

First, weight. I started contemplating diet and exercise changes shortly after Christmas, 2008. My first implementation started in January. My first entry on the weight tracking chart is dated 1/5/09 and is "458 pounds".

My surgery was 4/7/09, and the day before I weighed in at 376 pounds, for a loss of 82 pounds through diet changes alone.

Today was a weigh-in day (I know, how coincidental is that?) and I am 264.5 pounds. That is a loss of 111.5 since the surgery, and a grand total of 193.5 pounds in one year.

Commentary...have you ever tried weighing someone who's 400 pounds without a truck scale? There are home scales that can do it. Unfortunately they cost a LOT. More than my budget allowed. Instead I had to play with physics...it involved two cheap scales, one for each foot, and doing additional math. Fortunately the laws of physics are additive when it comes to the force the planet exerts on your mass.

Second, exercise. I definitely increased my exercise levels. My normal schedule has me at the gym for an hour or so three times a week, and other days I'd be working on my (very old) recumbent stationary bike. I try weight lifting.

What have I found? For weight control, not much benefit. At least, not that I can tell. The importance of weight is for your health more than weight control. Exercise is good for the heart, your bones, your circulatory system, and your libido if there are cute people of the opposite gender who, by virtue of the fact that they may see you with a sideways glance, force you to pretend you're not in excruciating pain when doing those last reps with the barbell hovering inches above your skull rather than seeing you as a fat dork with no right to be in the same room as them. You end up proving that you really are the little train that could, only instead of the consequences being a backslide down the hill you end up having a concussion if you fail.

With the holidays being an insane time I have not been into the gym for a week or so. I have spent a lot of time on the bike though. I have been down there pedaling away for 13 to 15 miles three or four days; I didn't keep track. I just know I was burning (according to the onboard counter) 800 to 900 calories a pop.

I figure this means I have a good reason to work on a resolution to exercise at the gym more once my regular work schedule resumes after the holidays.

Exercising more? Yes. Exercising for weight control? Not really. The number one biggest influence on your weight, from experiences and from my own research into the topic, boils down to caloric intake. Second is what you're eating...additives seem to have some correlation (but it doesn't mean it's a causation!) to weight gain. Third seems to be exercise. You move, you burn calories. Exercise a lot, you'll burn more calories and yes you can lose weight. Professional weight lifters eat more than even the average American eats and still manage to stay in shape.

The average American manges to end up with seasonal complaints when you can no longer jog or bike because the weather is crap, schedule conflicts mean you're at a party instead of at the gym, basically your routine is broken. You can always control what you put into your mouth. Relying on exercise to lose weight isn't the best strategy. This is especially illustrative when you realize how many hours on the treadmill you must put in to burn off even a single average fast food meal.

So I don't rely on exercise, but I'm still trying to get enough exercise that my health and weight loss are augmented.

Third, mental health. I'm still seeing the psychologist. Psychiatrist? I call him doctor. It was mandated by the insurance company, but I'm only out the time and they're paying for it. They screw that up sometimes, but in the end they're still paying for it. I'm prone to depression, and part of the control for the depression was my eating; that's been taken away from me so it's either trying alcohol binging or seeing the nice doctor every other week. Since the insurance company is paying that makes the therapy sessions cheaper.

Those are the three key alterations in my lifestyle over the past year without delving into specifics of what I'm eating and doing. Am I happy? I'm still seeing a therapist. What does that say?

Seriously, I'm not content with the weight loss. I'm still far over the weight I'm supposed to be and my flab hangs off me to a degree that it's embarrassing. I have lost 190 pounds and I'm not content; I'm also stuck at a plateau. I can do better. My height supposedly states that I should be in the 180 pound range, and I'm at 260...way over weight. The doctor seems to think I should focus more on the accomplishment rather than where my goal is (the bariatric surgeon said he didn't think hitting sub-200 pounds was really feasible in the first place, and I should be content with where it is for now; he also said that plateaus at this point are to be expected and could last days, weeks, or months).

I know I'm told that. But there's a voice in my head that says I can fix this and do better. Caloric intake and expenditure is something I can control in my life. I have less control over my current financial situation, work stresses, family stress...I can only control my reactions to these things but the situations themselves are going to hit me no matter what. But food? I control what goes into the food hole. Eat less, lose more. I can do this.

To sum up; one year later, there's improvement. But I can do better. This year I'm resolving to be even less fat in time for my two-year check-in.

Plateaus Suck

For the past...oh, two weeks or so...I've been plateaued. I'd have to look at the numbers as they're listed, but for the most part I'm between 260 and 270 (I think I've actually been hovering around an average of 264/265 pounds), so I've lost somewhere in the range of 190 pounds.

I hate it.

Plateauing sucks. It means that I'm doing something wrong. I know that the formula is simple...calories in, calories out...so my broccoli and peanut butter habit is probably what is tipping this. The doctor (bariatric surgeon) said that this would happen (unless I've finished losing the weight, reaching my stabilization point); the body would lose weight, stop for anywhere from a couple days to a couple weeks, then start falling again until it hits another plateau.

So I've either leveled out or I'm plateauing and the only way to tell is...you can probably guess...wait. A weight waiting game. It's such a fun game to play, too. It's almost as much fun as being on of the last two people playing RISK and you're the guy with one country against the jerk that possesses all the other territories and just got his 200 armies to add to what is surrounding your one lousy territory. And it's his turn. And he decided to quit attacking after one roll because he's having just too much fun being a jerk.

But I digress. I don't understand the mechanisms behind weight plateaus. The venerable Wikipedia talks about this principle in vague terms of being regarded as a sign of weight loss success, and the only way to break it is to increase exercises and/or decrease portion sizes further. Ugh.

Fortunately budgeting issues gives some reason to further cut back on portions anyway. I can probably tweak my "food pellet" formula to include fewer things so that I don't need to purchase some of my habitual staples anymore, thus help curb our spending at the SamClubMart. You know...broccoli can be cut out, peanut butter, those alone should save twenty or thirty bucks a trip. Maybe cut out the peanuts, that's another ten bucks. Don't use tomato sauce to flavor the wraps anymore. That's another what...ten bucks or so? Maybe cut out some of the cheese and meat to make supplies last longer. Those things should help reduce the bill a little while reducing caloric intake.

The problem is that it takes what comfort I've become accustomed to in my routine and throws it into a bit of a tizz. I'll adapt, no doubt. I won't like it. Hopefully I'll find some other reason to enjoy something beyond my current schedule of trudging to my stressed out job during the day and coming home to look forward to the next day's rigorous schedule of...more work. What escape I had in my meals, small as they were, far smaller than pre-surgery, will just be a little...less. Again.

Cest la vie.

With any luck within the next couple weeks I'll break this plateau. When I do, it'll be more progress to report. Or I'll at least have broken out of this funky feeling...maybe it's just the joy of the holiday season getting under my skin.

Reflection on the Surgery

I started this blog for a couple reasons. One of the primary reasons was to document the bariatric surgery from the perspective of a patient and have a record to look back on, and to make those public enough for other people to look at if they were researching the surgery. All they had to do was just come here and click the tag "bariatric surgery" and voila'...a list of thoughts and hurdles encountered by me in the course of having and recovering from the surgery.

The whole ordeal has been quite a personal trip. What started as a strong recommendation from my internal medicine doctors to get weight loss surgery transformed into a month-long physical healing process, a diagnosis of depression and Asperger's, and a long series of therapy sessions to deal with my own demons and quirks as well as issues influenced by the surgery that lead me to fighting off an increase in stress from my day job.

I figured now would be a near appropriate time to reflect a little...over six months later...on my view of the surgery.

It happened long enough ago that I barely recall the recovery process. I have some vague recollections of how difficult it was to even sit up in bed. You have no idea how much you rely on muscles in your abdomen until you're unable to use them! Rereading old entries brings those memories flooding back.

I'm glad I had the open Roux-en-Y surgery. I couldn't stand the thought of having a little band strangling my stomach with the accompanying lifelong risk of erosion, or having a little "port" just under the skin where the band is adjusted in how much or how little it strangles your stomach. And while the open surgery had a much longer (and more...gruesome...) recovery, I understood that it benefited me in that the surgeon had far more flexibility in determining what he was doing and getting it done right. Laparascopic surgery is to benefit the patient; smaller scars, faster healing, etc...but it means your surgeon had to be at the top of his or her game and may have to cut corners while maneuvering around in your fat-laden abdominal cavity. Open surgery means that if he needs to lift part of your intestine to get that cut just right, he reaches in and does it.

Eating...well, here's what I can tell you. I am pretty sure that I could eat VERY SMALL quantities of something like pie or a brownie. I generally don't, though, because I'd rather not risk the dumping syndrome. Plus it runs against what the surgery was meant to help promote avoiding in the first place; eating foods that are unhealthy and against a healthy diet.

As a matter of fact I strongly believe that once the intestine and stomach heal there's very little that is "abnormal" about the dietary needs and tolerances. The change means you do run the dumping syndrome risk so you need to avoid sugars. Avoid them altogether? No. Look at food labels. You can't realistically avoid sugars altogether. And there aren't any evil foods; your body needs sugars and fats to function properly.

I could eat just about anything in moderation, in theory. I don't because I'm obsessive about routine. Because of my own habits my body doesn't like dietary changes that are abrupt anymore.

In addition to cutting down the sugar content there is one other thing that changed; I can't eat large quantities without pain. If I ever wonder if my "pouch" is still smaller than it was I could just try pushing my food intake a little more and I'll feel a big "blah" feeling, if not outright pain if I gulp too much food at once.

The smaller stomach gets full sooner. It's a good thing.

Those are the two big differences. Less sugar. Less food.

It's not a magic bullet because it can be actively sabotaged. I could keep eating until my stomach is bloated; gradually, it'll stretch. As it gets bigger I can eat bigger meals until eventually the surgery was essentially all for naught.

Or I could keep eating calorie-rich foods during the day, spreading out what was a large sit-down meal into an all day affair. That brownie I could have in small small quantity? Instead of popping it in my cakehole all at once, I could finish it off over the course of the day and avoid the sugar spill into my digestive system. All the calories and none of the immediate "oh dear oh dear oh dear" side effects.

So in my case the surgery has simply helped shape a new lifestyle of eating less. This means eating more like I should have been eating; smaller portions.

I also exercise more. I don't like it, but it helps with weight loss and supposedly makes me healthier. As weight reduces from my body the effort of moving isn't quite as high.

The last big benefit I know I've seen from the surgery and weight loss is the reduction in my other illnesses; sleep apnea, high blood sugar, cholesterol, blood pressure,...all those things are either reducing in severity or disappearing.

There are drawbacks though. I have had to deal with other issues that before I comforted through eating. Various stresses get to me even more. My Asperger traits seem to be getting stronger and asserting themselves more; little pet peeves are becoming really strong issues for me to deal with to the point where I can't stand being in the same room as people who are chewing with their mouths open.

I have folds of flesh that I can't stand looking at. I avoid mirrors whenever possible because I wince at the horrific sight of me melting. And I get a flare of anger at people who suggest I go to the gym and build a little muscle to fill the skin (are you @#% daft?! How much muscle do you think you'd have to develop to fill all this??)

I have to deal with my depression issues. They tend to run more deeply than I normally admit to others; I do wonder at times why I bother getting out of bed in the morning. Sometimes I think if it weren't for the huge bills I have to pay off then there wouldn't be a reason to get up some days. The hole used to be somewhat filled by looking forward to a tasty fudge brownie. Now...well, broccoli isn't quite as satisfying.

And there's the head hunger. The surgery cut back on physical hunger and for the first month or two there was a definite drop in the desire to eat. It was definitely freeing. Gradually, though, another hunger asserted itself. Head hunger. The emotional need to eat. Stress, boredom, anxiety, all the things that before were quelled to some degree with food now roar through me at the most inopportune moments. I fill the head hunger pangs with things that are generally more healthy...mixed nuts, activities, and broccoli (sometimes with some mustard or salsa on it). Generally low calorie items (okay, the nuts aren't low calorie; they were an energy pickup I used when I started going to the gym). No cookies. No slices of cheese or makeshift sandwiches or leftovers from the fridge.

There is also a bit of resentment. I miss some aspects of my old lifestyle, despite knowing that I gave them up for something that is supposed to be better for me. I don't have soda anymore. The doctor forbade it; the carbon dioxide fills the stomach pouch and I was told can stretch it or make it more difficult to eat the things I'm supposed to have. I am supposed to be more careful about when I drink, although I haven't noticed any side effects from when and how much I drink. I go to restaurants and wonder what it would be like to be like the old days; "mozzarella sticks look great! I'll have those!" This has morphed into, "mozzarella sticks! They're probably 300 calories apiece, plus they're fried so I'll get the craps, and I wouldn't be able to have any entree even if I did try them..."

A trip to a fast food restaurant has turned "cheeseburger" into "300 calories" when I see them on the menu.

There's the change in perception of other people and their habits. I see someone eating fries with their double cheeseburger and I think, "Do they know how much sodium they're eating?" "Why do you need all those fries with your burger?"

I have french fries once in awhile. Literally. I eat two or three sticks for a taste of the fry. That's the upper limit. I also eat the pickle off my son's burger-cheese because he doesn't like them. Otherwise, I start to obsess over whether or not it's going to get me rolling down the slippery slope of weight gain.

But I can't see other people out there with their eating habits and wonder how many of them bitch about not being able to lose weight but not see how much they're eating. Low fat foods don't equal losing weight (of course not...they're filled with other things to make up for the lost flavorings). Do you look at the calorie counts of the food you're eating? I think the majority of dieting issues would be taken care of if people were looking at their calorie expenditure and intake.

Of course, that won't help with the secondary effects of obesity, like emotional issues...but in the cut and dry, wanna-lose-weight-how-can-I-do-it approach, you cut down on calories and you should lose weight.

That is the heart of the whole weight loss surgery. It kicks you in the rear towards starting a healthier lifestyle.

There is another side to the surgery to consider. If you have an addictive personality (and let's face it, if you fill a need with food, you probably have some kind of addiction issue) then you might learn to transfer that addiction to another behavior. Some surgery patients move to alcoholism. Due to the physiological changes in your digestive system it supposedly takes a lot less alcohol to make you drunk. I haven't tested it yet, but I guess a glass of wine is supposed to be a real hoot post-surgery.

Or you become more obsessive about losing weight. I've always been like this; it wasn't the surgery that triggered it, but I live in perpetual fear that the surgery will "fail". Or as it was put to me, the surgery doesn't fail, I fail the surgery. I watch my weight. If it levels out I get worried. If it goes up, I stress. If it climbs for a week, I...don't know. It hasn't happened yet. But it very well might. I lost over 200 lbs before, about six years ago, and thought I wouldn't go back to the Fat Life. After a plastic surgeon more or less laid out to me that the skin folds were permanent (no amount of exercise was going to fill that, the connective tissue is far too damaged...by the way it's considered cosmetic surgery so you'd have to pay for it yourself) I was more depressed and saw less reason to maintain my restricted calorie lifestyle. Life moved on, I went back to old habits, I got fatter again.

These memories of my first time in "Skinnierville" leave me with the fear that this weight loss is temporary and that no matter what, the fatman is still inside these folds of flesh. And the head hunger reminds me that he wants out. My response to this is to monitor my weight periodically during the week. I keep to a routine to limit my portions growing out of control or hopefully limit the amount by which my stomach stretches. I obsess over getting a certain amount of exercise in each week.

I keep my old belt with me as a reminder. The belt was with me at my fattest and I wear it every day. I am still saddened that it doesn't reach around me twice yet. I sometimes add another notch to the band as I notice that the pants aren't holding up properly, but it's slow progress.

The surgery has been a mixed blessing. It was an aide, and it may be something to help my case if the insurance company is every to try paying for skin removal. Essentially that was another big reason for the surgery; the insurance company would never okay skin cutting if I lost the weight on my own like I did the first time around. So I had to have a really expensive surgery to do it first. Who says there's waste in healthcare?

The surgery has helped by giving me a fear of going off the lifestyle...I can't have cake and cookies, for example, and I'm in a habit now that while I could have a slice of cheese as a snack I won't for fear of what it could do to derail me. It has given me permission to be different in some ways.

The surgery has hurt in that now I have to face my other issues that promoted the weight gain. I have the sense that my Asperger's habits are asserting themselves more. My depression symptoms sometimes seem worse. And I miss the ability to go out to eat or try other things without hearing all the fears and worries and food-related anxieties swirl around in my head.

Can't say I regret having the surgery. For me, six and a half months out, it's been worth it. Everyone's mileage varies, though.

Progress Update for November 4th, 2009

After another plateau period I am down a pound today from my November 2nd weight level. Quick stats...
Weight: 263.5
Weight loss since surgery (4/7/09): 112.5
Weight loss total (1/1/09): 194.5

Most lost since January: 195.5

So I'm a pound away from my lowest weight (so far?)

My bariatric doctor said there's no way I'd hit the "healthy weight" in the sub-200 pound range in his experiences. Bariatric surgery patients just don't get into the "normal" range. They lose (for Roux-en-Y) typically lose somewhere in the neighborhood of 60 to 70 percent of the excess weight.

I don't know what exactly is going to happen, but I looked at the weight chart for the past 12 months on Fitday where I've been tracking my weight to find possible trends...

You can see how the chart starts off strong with a large drop, then bucks a little near April (when I had the surgery), then starts falling again. But the slope of the line is dropping, meaning that the rate at which I'm losing weight is slowing down.

The doctor had reiterated that what typically happens is a big loss then a gradual loss of weight as the body readjusts to the new calorie intake. What usually happens is the heavy nosedive turns into a series of "steps" (known to we fat people and chronic dieters as plateaus) where, as he said, the body will level off or gain a slight amount of weight for about a week or two then suddenly drop down anywhere from a pound to five pounds and level off again.

I wanted to believe that it wouldn't happen to me. The difference between kids (and teenagers) and cynical adults is that I understand that wanting to believe isn't the same as reality, so could it be that my irritating, frustrating, and demoralizing "plateauing" stage is coming due? Or would a change in my diet habits create another set of weight drops?

I guess I'll have to just keep an eye on my weight over time and see what happens.

Weigh-In Progress: 10/28/09

My birthday will be coming up soon and I've hit another low in the downward trend of weight loss, and I thought I'd share again since it's been nearly a month (I think) since I shared progress.

To recap, I started losing weight in January to prepare for the surgery (how many times have I mentioned that as silly as it seems, you have to lose weight before having weight loss surgery?)

I started tracking on January 5th, 2009. I was 458 pounds. The doctor told me I needed to be closer to 400 pounds due to insurance issues with the hospital...basically, the equipment wasn't rated for someone in the over 450 range and if something happened and went boom while they knew I was over the weight range then...well, they weren't operating. They would send me to another facility a few hours away to do it instead.

So I started working on the weight loss thing as a New Year's resolution and had the surgery on April 7th of 2009.

That brings me to today. I am currently 262.5 pounds, I've lost 195.5 pounds since dieting in January and 113.5 pounds since the surgery in April. According to FitDay, that puts my BMI at 36.61 and (according to that site) a BMI of 30 to 40 is classified as "Obese", so I'm still on the high side of the obesity classification.

My birthday is coming up this weekend. My hope is to hit a magic "200 pounds lost" before then. It's a nice, round number, and just "feels right". Next weigh-in is Friday! Here's crossing some fingers...

6-Month Followup to the Surgery

Today was my six-month followup. I had my surgery, open roux-en-Y, on April 7th. I met with my surgeon today to see how things were going.

So far things seem to be progressing just fine.

He said that skin removal isn't something to consider for another couple years. "If you jump the gun and get it removed too soon then continue losing weight you'll have more excess skin, and two operations get quite expensive," he said. Which, of course, is true. Disappointing, but true.

I saw a chart on the wall for BMI that put me at very obese. There was still a high label of fathood that I no longer fell under, but it said I wouldn't be at a "healthy weight" until I reached 165 pounds. Ugh!

In the conversation with the doctor he said he didn't see me reaching below 200. I don't know if this is a challenge or not. I knew that bariatric surgery isn't meant to lose %100 of the excess weight; Roux-en-Y enables most patients to lose something like %70 of the excess weight, so you're still fat, just not as fat.

Still that was kind of disappointing to hear though.

He said that my weight loss from when I started out has been enough that I should be seeing many increased benefits already; mobility, comorbities like sleep apnea and related health issues should have dropped, my risk of joint diseases, heart disease, certain cancers, etc. should all have dropped significantly, he said.

The entire weight loss shouldn't stabilize for another year or so. Until then...just try to stick with exercise and eating sensible portions.

That's my progress update for the surgery. Six months later, still alive. Still very stressed. And still seeing the insurance-mandated psychologist to help in dealing with my food-related...and life-related...issues and try to head off the depression and stress that life entails now that I really don't have my old friend "Big @#$ Pizza with Extra Extra Cheese" to console me.

Tomorrow will be weigh in. I hope that it will bring good news.

Weigh-In Progress: 9/11/09

Today was another weigh-in day. I usually will try weighing myself on a Monday-Wednesday-Friday schedule or on a Tuesday-Thursday, alternating on the days of the week depending on how things kind of work out. Believe it or not this is actually the least anal-retentive way for me to do this...I used to be more obsessive about doing it more often and having small mental fits of beating myself up if I missed a day. I'm trying to change a habit by alternating like this on a less intensive schedule.

Anyway it's been awhile since showing my progress. This week...I suspect something is wrong with my scale or my eyes. I can think of no other reason since I'm really careful about taking my readings; no clothes, first thing after using the restroom in the morning, and I get on the scale, take the reading, get off and zero it, get back on. I repeat on the scale until I come up with a consistent number at least twice in a row and it can't keep oscillating between two readings. But this according to my trends has been quite a loss for one week.

This morning I weighed in at 276 pounds. Since my April surgery that means I've lost 100 pounds, and since I started dieting on January 1st I've lost 182 pounds. It's all on the spreadsheet right here.

But for the week...my weight on 9/7, Monday, was 280.5. I've lost four and a half pounds in one week.

Maybe this isn't as unusual as I thought. I'll have to look at the chart statistics to see if I've lost like this in weeks past. Most of it is probably from water retention on various weeks; days where I had too much salty foods at just the wrong time.

Someday I'll sit down and compile some statistics on the weight loss trends. For now I'll just keep trying; FitDay tells me that my BMI is still a staggering 38.5. Ugh. It likes to remind me: "Your weight is 96.8 lbs above the healthy range."

Time to get ready for work...

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...

Weight Loss Progress for July 24th

Time for another update, I suppose. I weighed in this morning and I'm now at 300.5 pounds.

I've lost:
157.5 pounds since January.
75.5 pounds since the RnY surgery in April.
62.5 pounds since my friend challenged me to lose 60 pounds before he lost 30.

As I've said before I don't think he's tracking his challenge anymore; I'm not pressing it with him. If he checks in periodically he can do what he wants with it, but to tell the truth I don't know if he does read the blog.

Moving on, I am told that losing that much weight is really good. At the same time weight loss is so individual that no one can tell me how good or average this weight loss is. So I'm not sure where that leaves me.

I also have a lot of excess skin. I wish it could be removed, but even if the insurance company covers it:

1. I don't have the $1,000 copay right now
2. I may need to have medical evidence that it's not for "cosmetic" reasons; my wife insists that the skin removal is part of the surgical coverage for our insurance, but I refuse to underestimate the maliciousness and utter confusion that an insurance company can unleash.
3. I am told they won't even consider such surgery until at least a year has passed.

I sometimes wonder how much extra weight that skin constitutes. I constantly think about how ugly it looks, though.

So that's my quick and dirty update for my weight loss status for today.

Weight Loss Progress

I just realized that the last time I posted an update on my weight loss was on the 23rd of June, and here it is the 14th of July. Weight loss seems to take so long and yet I look at the entries here on the blog and realize how time seems to slip away; must be relative to the subject at hand.

As of the 23rd of June I weighed in at 321 lbs. This morning I weighed in at 306 lbs. Since the surgery I lost 70lbs (April 7th); since the beginning of the year I've lost 152 lbs.

Oh and since the time my friend had issued his 60 lbs weight loss challenge I lost 57 lbs. I did hear back from him in a short email a week or two ago; he didn't say what his weight loss numbers were but he did say something about being under a lot of stress and a couple other things so he wasn't losing what he was supposed to be losing (I don't know how dire your situation is...you haven't said...but believe me. You're not the only one with these problems. I can While I'm not facing homelessness there are more than a couple thousand in taxes and insurance bills due now and I'm really not going to be able to pay without some form of @#$ added debt...I can relate to the worries). I have no idea if that means he hasn't been losing or he's been gaining or what it means exactly. Dude...if your goal was to have motivation to do something you have to follow through with the motivation part. I don't know if he's been keeping up with the blog here at all but I do post information on how things have been going; if you just issue the challenge in hopes it'll kick your butt in gear then go off to resume your habits without actually checking up, whether this would have helped you or not doesn't matter. You would have had no idea how I was doing compared to your progress (or lack thereof), so I suppose I don't see where the motivation was supposed to try factoring in. That doesn't just apply to dieting either; without measureable goals, how can you know how you're doing, whether it's diet or your job or just about anything else you try to achieve or excel in?

But that's a different lecture.

To be fair maybe you just wrote it off as maybe it was a bad idea like everyone tried telling you (he wanted to lose 30 pounds in the time it took me to lose 60) to "race" a bariatric patient's weight loss. Or maybe it went from a motivation thing for you to a convenient excuse when you found that it wasn't enough to get you to follow through. That's something only you would know.

I've been semi-plateaued for the past week or so, again. On the 6th I was 307. measuring every other day, I then went to 306.5, 305, then 306 and today 306. Water retention? Salt? Just another adjustment? I don't know. I think this has happened before. Here's a 4-month graph of my weight loss (which only covers since April, not since my weight loss efforts started in January):
You can see a couple blips where things leveled out. I hate it when it happens but the doctor said that this would happen; you don't slide down the scale, you stair-step. I keep telling myself that to try and stave off the anxiety that maybe this is it, that maybe my weight loss has come to an end.

Today's also a gym day. Once I finish this and take my pill regiment I'm off to see the Nautilus machines for an hour then back here to get cleaned up and face the day. I have a busy schedule so I'm trying to get the gym work in early. Yay!

Bariatric Followup for July

I just had my followup with the bariatric team this morning. It was a cursory thing...it seemed that the office was running late, since my appointment was scheduled for 9:30 and I didn't get in until about a quarter till or ten til ten.

The doctor said that I'm doing well. Went over medications, some of what I'm eating for meals, etc. and commented on the weight loss.

I told her about the pain in my waist and she said that it is probably scar tissue; she didn't seem to worried about it so I won't be worried. Just have to wait and see if the pain improves. Not that it's much of a burden, since the pain only seems to happen when I sneeze. Weird. Must be just right to trigger the stretching of whatever is scarred.

I need to get bloodwork done to test my vitamin and mineral levels in my blood since last time I was iron deficient. Other than that...progressing nicely, according to her. I still think I'm not changing fast enough. But that's an issue for the psychiatrist, I guess.

This isn't just me though. Notice that people in society just sort of treat fat people as if they're supposed to be able to remove fat like a shirt? It's as if you just woke up and did something stupid, deciding to be fat for the day, then normals turn around and are shocked that you'd choose something so stupid. It's not like your daughter dressing like a whore and being told to go change before leaving the house...look at all that fat! You know you should be skinny! Go change right this minute! What will the neighbors think!?

In our society impatience is valued over patience, and immediate gratification is almost expected as the norm. So when it's taken from January until now to lose 151 pounds. That's not what is in the doctor's records, but I tracked without my clothing on to reduce variables...so on my records I lost 151 pounds since the beginning of January.

So that's the progress for the day. Or month. I have to go back in October to talk to the surgeon...and before taht I'll probably hear back from the doctor about my blood test results.

Time to See My Doctor

I had an appointment this morning to see my primary care physicians. I had bloodwork started on Friday so today was my "results day".

They didn't test my cholesterol because they had done it two months ago. At that point my "good" cholesterol was low and my "bad" cholesterol was high. Don't ask me which is which, I always have to Google it.

Blood pressure was on the high side of normal, but not flagged. My liver function was still over 100; lower than it had been, but it's supposed to be near 60, I believe they had said. They think it's fatty liver side effects. I had an ultrasound before to check the high numbers and nothing abnormal other than fat deposits had shown up. It's a wait-and-see.

Overall I have one item--liver function--flagged this time around. Better than usual.

Unfortunately it means I'm staying on my medications for now. I was hoping to trim one or two out of my routine. Thirty-something years old and I'm on nine pills in the morning, two at night, and two blood pricks a day to test blood sugar. Oh, yeah, blood sugar levels have done well since I took myself off my diabetes medications too. The docs said that was fine.

I go back in 6 months now for another checkup and in 3 months I go in for labwork, and at some point they're going to put me in the sleep lab for observation to see if I really don't need my CPAP anymore (I stopped using it shortly after the surgery because I had stopped snoring and didn't have the same side effects I was having before...the pseudo-narcolepsy thing...felt like I was sleeping okay. At the time I stopped because I was having trouble with my mask and just got fed up and stopped using it a couple nights in a row and still felt fine.) (I know, it's not a good patient thing to do, to just decide I don't need it and stopping without getting it checked first. I don't need that lecture. I simply had enough hassle with it for awhile and...hey, if you followed the blog, you know some of the troubles I was having. I decided to reduce my problems by one.)

How Long is it Supposed to Hurt?

Here's an interesting question.

For the most part I have healed up since my early April surgery. I have a nice big scar on my tummy but I now have the proper number of orifices in my flesh. I stopped feeling the periodic dizziness and have enough energy to move around for the day as well as now being able to get up out of bed without moving at a turtle's pace while gritting my teeth and having a voice in my head keep urging me to push through excruciating pain in my side or abdomen. In truth these achievements have been checked off my "wellness list" for awhile now.

Except for one thing.

I just sneezed and felt like someone slashed me with a scythe across my belly.

Every @#$% time I sneeze I feel a pain that runs along my waist, horizontal to the ground, strong enough that I squeeze my eyes shut for a few moments to collect my wits back about myself.

I asked my wife how long a Cesarean Section is supposed to hurt. She said, "Six to eight weeks." Hmm...more than that time has passed.

I still feel some discomfort around the scar, but I figured it is because the scar tissue isn't as flexible or pliable as unscarred flesh. but why does sneezing hurt so damn much still? Doesn't matter if I let it fly or try stifling it either. Both ways hurt for about three or four seconds as a brutal pain that explodes at my midline.

Is this just in my head? I can move and breath and get around without problem...so far just sneezing gets me. I'm beginning to wonder what the heck is wrong with me!