Surgeon wants me to crash diet before fleur de lis & vental hernia repair

I've been nursing a surgical incision wound since December after emergency surgery for small bowel strangulation. It was an ordeal, I almost died, and left the hospital after 10 days with my incision wide open with 3 super-infections...MRSA, Klebsiella & enter****al.

Eight months later, after a CT scan, I find out that the muscle under the still open wound has split and I have intestine bulging out. My wound hadn't healed because I have a massive pannus from being 456 losing down to 302---and most of my weight was in my belly---and the pannus pulls at the wound, not allowing it to heal properly. I've tried binders, support garments, etc. Doesn't help.

I saw a general surgeon and he wanted me to play the waiting game. So I found an abdominal reconstruction specialist for a second opinion.

She was awesome. Really went to great lengths to evaluate me, took photos, measurements, and is gathering a team to do a combo fleur de lis tummy tuck, which will completely eliminate the wound and a retro-rectus hernia repair. I couldn't be happier with this course of action.

The only requirement she asked of me was to watch the documentary Fat, Sick, and Almost Dead by Joe Cross and follow the principles in the documentary to lose as much weight as fast as possible to lower my BMI further and to be able to remove the maximum amount of flab. She said forget about protein, forget about wound healing diet, just lose weight.

The documentary promotes juicing, mostly green plants. No problem. I eat a mostly plant based diet anyway, with the addition of fish, a little chicken, yogurt, eggs and cheese. If I eat sugar I suffer from reactive hypoglycemia, which is common for distal RNY people after 2 years out. Even just the greens, without the fiber/cellulose, triggers the hypoglycemia. I can't do the juicing. I get very ill.

So I went to plant based soups. Broccoli, greens, okra, tomatoes, beans cauliflower, carrots, onions, garlic No added salt. I've been doing it for 10 days, along with a piece of fish or some Greek yogurt now and then. I haven't lost much weight. I know I'm getting enough calories---I track everything.

I also take prednisone for rheumatoid arthritis, but I don't take it every day. I wonder if it s making me hold onto the weight.

I don't drink sodas, use artificial sweeteners or eat processed foods.

I want to make this work, but I am afraid that my protein will be extremely low for healing by the time I do have surgery or that I won't lose enough weight. I can't seem to get below the 302. My weight has great fluctuations every day---one day I will be 307 and the next I'll be 322 and the next I'll be 317. It HAS to be water weight. I already take a diuretic every day.

I just needed to "talk" to people who understand.

Have you had blood drawn lately? I would worry about compromising your health which will lead to poor healing post-op. Can you get another opinion???

How many calories are you eating now? Do you measure your portions so you know they are accurate?

This is actually my second opinion. I am eating as close to 1200 as I can get. Yes, I do have a scale and weigh. I am very food conscious. I don't even do artificial sweeteners.

I haven't had labs since May. I know my albumin, which measures protein, is very low, even with all the protein I eat. My vitamin k and d are also scraping bottom of the barrel. I am slightly deficient on everything except B12. I see my PCP soon, so I'll get him to order new labs. I knew losing 5 ft of small bowel would cause malabsorption, but I had no idea it would be this bad.

Tammy, I understand about the surgery being able to take care of your current healing issue but if you deplete your body of healing proteins I fear that you might be setting yourself up for major healing issues from the FDL TT.  That is major cutting.  I had that surgery and I healed great but my protein was super high and I continued with high protein after surgery.  I can lose weight by upping my proteins and lowering my carbs below 50 a day.  I have not taking prednisone but I have heard others say that it made them gain weight/hold onto fluids.  I would definitely get my labs up before I would take this major step.  My PS would not have touch me without a good lab report.  I know it is frustrating to you about the healing issues but really research this to make sure this is the right move for you.  ((hugs)).

Thanks, Tess. The more I review the data, look at my own healing patterns, etc., I think I may continue on on a plan similar to my pre & post WLS--push high nutrient protein shakes and keep carbs below 50. My surgical report from my RNY stated that my liver was of normal size---so the 6 weeks pre diet to shrink it worked---I was 427 with a normal liver. I think that's the way to go. I know through the shakes that I can get the nutrition my body needs and lose weight. I take my handsful of vites just like everyone else. I will definitely have labs done. I know if I don't want the FDL TT to open up, I need to get that albumin up.

When I had the emergency surgery last Dec, my nutrition had been extremely poor because I had just had a long bout of pneumonia and the shingles at the same time. I just didn't eat. The surgeon who did my SBO surgery put in a feeding tube because my albumin was so low. I never had to use it because I drank the Ensure they pushed on me, but he made me keep it for 3 months, just in case. I still lost 33 pounds, even though I was told to try not to lose weight.

That sounds much healthier than the juicing. Good luck and keep us posted!!