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Well its only 4 more days until my surgery.  I am excited.  I am not nervous, at least about the surgery itself or my life afterwards.  I am mainly nervous about getting a list of things done that need to be done before hand.  Anyone want to venture a guess at what I will be doing today?  You've guessed it working on my to do list!

I received my packet of information in the mail about two to three weeks ago.  I read it several times but typically summarize things like this as it helps me to understand and retain it.  The packet contained information about my surgery and what I am to be doing before and after surgery (in all the stages).  To begin, my surgery is scheduled for 11/21/07 at 8:30AM.  I need to be there by 6:30AM that morning.  I cannot eat or drink anthing after midnight on 11/20.  I can expect to be in the hospital for 1 day (overnight).

Two weeks before surgery on 11/07/07 I was scheduled for a pre-surgical evaluation.  At that appointment they reviewed the information received in the packet, verified my medical history, and asked me some additional questions.  I also saw an anesthesiologist since I have had problems with anesthesia in the past.  After seeing the pre-surgical nurses and anesthesiologist, I met with Dr. to go over any questions that I had.

The day before my surgery my meals should be light and low in fat and not have anything to eat or drink after midnight. 

The morning of my surgery I need to be there by 6:30AM to register.  I am to wear something loose and comfortable.  I can bring some personal items but should leave anything valuable at home.  The paperwork says I should not take any medications that morning.  I will confirm that I shouldn’t take my blood pressure medicine or any vitamins that I am taking. 

I received a paper that I assume is a copy of what my actual discharge instructions will be including: 
-  Things to avoid like smoking, alcohol, and spicy foods
-  A description of how to eat and to avoid eating after the feeling of fullness
-  Pain medication and the number to call if the medication is not controlling the pain
-  How to care for my incisions
-  What activities to do/not do like beginning frequent walks and exercises, not crossing my legs to avoid blood clots, no heavy lifting, no driving until after my first follow up, and bathing daily 

The next paper was the acknowledgement and consent form where I will need to initial that I did the things listed or have been given the information by the surgeon.  Dr. and I discussed some of these as I felt better verifying some of the information (like where the after hours number is located). 

There was another copy of all support group meetings in 2007.  I will want to check to see if they have meeting dates already scheduled for 2008.

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The majority of the packet was about nutrition after the surgery.  There are dietary “stages.”  A description of each stage is below: 

Stage 1 (during the hospital stay):  Sugar-free, high protein, clear liquid diet.  I will only be allowed water; decaf coffee or tea; sugar-free gelatin; sugar-free popsicles; low-sodium broth; sugar-free drinks like Crystal Lite, Sugar-free Kool Aid, and Dasani flavored waters; and sugar-free sweeteners.  I will need to make sure to sip liquids slowly and frequently but to stop if I feel full.  I should not use a straw.  I need to work up to 64 oz. of liquids.  If I experience pain, nausea, or vomiting I should stop drinking, wait a few hours, and try again. 

Stage 2 (weeks 1-3):  Sugar-free, high protein, low-fat, full liquid diet.  I should have protein drinks like Carnation Instant Breakfast 0 Sugar Added, Unjury, Whey protein in various flavors, natural proteins in various flavors, GNC Whey Powder in various flavors, and GNC Pro Performance Soy Protein in various flavors.  The daily goal of protein is 60 grams from the liquids I am drinking.  I also need 64 oz. of clear fluids with no carbonation, no sugar, and no caffeine.  I can also have skim or 1% milk and low-fat strained cream soups or tomato soup made with skim or 1% milk.  I need to remember that when selecting a protein supplement that 1 scoop should equal at least 20 grams of protein and have 3 or less grams of carbohydrates.  I can add unflavored protein powder to protein drinks, low-fat cream soups, and tomato soups for extra protein.  If I have Carnation Instant Breakfast I need to make sure that it is the one in the blue box.  I can mix it would skim or 1% milk.  It is ok to add flavor extracts or sugar-free coffee syrups like vanilla, peppermint, and strawberry.  Blend fresh fruit (no skin or seeds) with the protein drink to improve flavor.  8 oz. protein drink – 20 grams of protein.  4 oz. protein drink – 10 grams of protein.  A suggestion is made to have a 4 oz. protein drink on the even hours from 8:00AM to 6:00PM. 

Stage 2 – Transition (weeks 4-5):  Sugar-free, high protein, low-fat full liquid diet with the introduction of semi-solid soft protein foods.  Continue with protein drinks.  Begin introducing semi-solid protein foods very slowly, bites at a time such as eggs and cottage cheese.  Mix the unflavored protein powder with sugar-free pudding, light yogurt, and low fat mashed potatoes. 

Stage 3 (begins week 6):  Sugar-free, high protein soft diet.  Cut back protein drinks to 1 or 2 per day until I can get in enough protein from solid food.  The daily goal of protein is still 60 grams.  Eat small meals and use a small dessert plate for meals.  Eat proteins first and then other foods.  Focus on protein foods like low fat cottage cheese, light string cheese, tuna, canned chicken, and lean luncheon meats.  Make sure to listen to my body and stop eating when feeling full.  Do not drink with meals.  Wait 30 minutes before and 30 minutes after eating to drink fluids.  I should have 64 oz. of water and low-calorie clear liquids per day.  Make sure to sip slowly.  At least 32 oz. (of the 64 oz. of water) should be from plain water.  1 oz. of meat or 1 egg = 7 grams protein.  There is a large list of “ok” foods and of “foods to avoid.” 

Stage 4 (begins after 3 month visit):  Sugar-free, high protein healthy diet.  Eat small meals.  Use a small luncheon or dessert plate for meals.  The daily goal of protein is still 60 grams.  1 oz. of meat or 1 egg = 7 grams protein.  Eat proteins first and then other foods.  Focus on protein foods like low fat cottage cheese, light string cheese, tuna, canned chicken, and lean luncheon meats.  Do not drink with meals.  Wait 30 minutes before and 30 minutes after eating to drink fluids.  I should have 64 oz. of water and low-calorie clear liquids per day.  Make sure to sip slowly.  At least 32 oz. (of the 64 oz. of water) should be from plain water.  My diet should contain foods that are low in sugar and low in fat, rich in fruits, vegetables, and whole grains.  A sample menu is shown. 

General dietary guidelines: 

1.  Eat 3-6 meals a day.  A meal should contain 2-3 oz. of protein and ½ cup or less of another food.  As my stomach pouch capacity increases, larger portions may be eaten and any between-meal snacks stopped. 

2.  Good, well-balanced nutrition is important.  Lean protein first (lean meats, poultry, eggs, seafood, low-fat/fat-free dairy products, beans, tofu).  However, for my body to use protein properly, I need to eat adequate complex carbohydrates as well.  Eventually my diet will include more fruits, vegetables, and whole grains.

3.  My body needs approximately 60 grams of lean protein per day.  Protein is needed for post-op healing, maintenance of body structures, and preservation of muscle tissue.  In the beginning, I may need to eat mostly protein to achieve an appropriate daily intake.  1 deck of cards = ~ 3 oz. cooked portion of meat/protein. 

4.  Fluids must be continually sipped all day long to prevent dehydration.  Goal is 64 oz./day of sugar-free clear liquids – at least half should be from plain water.  I should not drink 30 minutes before and 30 minutes after meals. 

5.  Eat slowly.  Chew slowly and thoroughly – at least 25 chews per bite.  Remember that the stomach can only hold 1 oz. after surgery.  Overeating or eating too rapidly may cause nausea/abdominal pain. 

6.  Become familiar with reading labels.  A label is a great source of information and gives me in-depth information about the product I am purchasing (such as the amount of fat, protein, carbohydrate, sugar, and fiber it contains).  Guidelines are as follows:  Fat – less than 4-5 grams per serving; total carbohydrate – less than 10-15 grams per serving; sugars – no more than 7 grams per serving. 

7.  Choose low-fat or fat-free products when available.  Fatty foods are high in calories and will hinder my weight loss if consumed in high amounts.  However, use caution with products labeled “fat-free” and “reduced fat” as they may contain more sugar and/or more calories than regular versions of these products.

8.  When cooking meats, use moist heat methods and do not overcook.  Moist heat methods include stewing, boiling, braising, and steaming.  I may also add small amounts of fat-free sauces to meats to make them easier to chew/swallow. 

9.  Remember that it is ok to get pleasure out of food.  Since I am restricted to small portions, I am encouraged to become a gourmet and only have the best.  Make my dish look appealing with beautiful tableware and enjoy the meal. 

There is also a listing of several foods with their portion size and amount of protein.  There are also sections relating to reading food labels and modifying recipes. 

Product recommendations for protein powder supplements: (various flavors for each brand listed)
-  Carnation Instant Breakfast – 0 grams Sugar Added (blue box)
-  Unjury (www.unjury.com) 
-  Snytrax – Nectar – Whey Protein Isolate (www.si03.com)
-  Snytrax – Nectar Naturals (www.si03.com)
-  GNC Pro Performance 100% Why Protein Powder (www.gnc.com)
-  GNC Pro Performance 100% Soy Protein 95 (www.gnc.com) 

The last portion of the nutrition packet is about vitamin and mineral supplements.  Since this procedure limits the amount of food I can eat a day, I may not be able to get 100% of the daily values of vitamins/minerals from food alone.  Therefore, I must take a daily multivitamin and 1000mg of calcium for the rest of my life. 

Multivitamin recommendations: 
First 3 months – Children’s chewable complete (example would be Flintstones vitamins).  Take one tablet twice a day, one with breakfast and one with supper. 
Starting with month 4 – Centrum or generic equivalent.  Take one vitamin tablet per day for the rest of my life. 

Calcium supplement recommendations: 
Calcium citrate plus vitamin D and magnesium.  This needs to be taken by itself and on an empty stomach.  Take in 2-3 separate doses to maximize the absorption by the body.  (500mg 2-3 times per day = 1000mg-1500mg).
First 3 months – Chewable calcium + vitamin D supplement/Viativ-Chew.  Take 1 chew 2-3 times a day.  1 chew first thing in the morning when I wake up; 1 chew mid-afternoon; and 1 chew right before I go to bed.  (example would be Caltrate 600 + D Plus Minerals Chewables).
Starting with month 4 – Citrcal Plus (or generic equal, Viativ-Chew).  Take 1 capsule or chew 2-3 times a day for the rest of my life.  Take 1 chew/capsule 2-3 times a day.  1 chew/capsule first thing in the morning when I wake up; 1 chew/capsule mid-afternoon; and 1 chew/capsule right before I go to bed.

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Well that sums it up pretty well.  It seems like a really long blog but hey the actual papers were a lot longer to read.  So I think I did pretty well.  So I am going to go get started on my to do list.  First off...get cleaned up and go pay my cable bill (yayyyyy...not).