Things are A Changin'!

May 10, 2017

At my pre-op appt yesterday I was weighed. I am now down approximately 26 lbs from my heighest weight. My medical records would say I'm down 34 lbs but I believe they recorded my weight incorrectly as being 378 instead of 368 at that time... I'm using 370 as my heighest weight. Regardless I'm seeing changes, significant changes.

  1. I walked from the handicapped parking spot to just inside the doors of Walmart (where I used a shopping scooter/cart). And when were done I walked back out to the car (supported by the normal shopping cart). I have not been able to do that for a couple of years or so.
  2. I am able to stand to brush my teeth (instead of slumped over the counter for support)
  3. I was able to climb the stairs (not ladder) up out of the water at the swimming pool without feeling like the weight of the world was on me.
  4. I already feel the need for a belt... bought one but it is a bit small still and my pants are falling down, just slidding so I think I'm okay for a bit longer.
  5. I am able to rinse my water bottle and drinking glasses in the bathroom while standing, walk to the dining room, them down and sweep up the spilt kitty litter and then go into the kitchen. I sat on my stool for a few moments then stoop up to measure the water and ice cubes to make my morning Optifast shake. This is the part that shocked me this morning... I stood to make the shake, pour it, rinse the blender and come to my seat... yesterday I sat down on the stool to do this. A month ago I would have needed to sit multiple times and I doubt I'd have been able to do the sweeping at all.
  6. My lower tummy feels squishier and is more fun to 'play with'.
  7. Again to my amazement... I took the bus to my appt. yesterday, was there for 4 hrs, bused home, ate, went right back out to go to a movie (cheapy Tuesdays), came home, stayed up another couple of hours before going to bed. HELLO a month ago I'd have been exhaused and wiped before I even left the appointment.

Walking is still painful but I now can do it without feeling death upon me at every step.

Emotionally there are some things going on too, as I'd expect because I believe every pound has a story, an emotion to share. AND I also believe allowing oneself the opportunity to hear, accept and validate each one is the key to permanent weight loss.

1. My wife is currently participating in an inpatient eating disorder symptom interruption program for 8 wks at a different hospital than the one I'll be in.

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Pre-Op Meeting

May 10, 2017

So I had my pre-operative meeting yesterday afternoon (took 4 hrs). It turns out being a complicated case and having an afternoon appt. means a lot of extra time. I'm really glad I brought a new book with me it made the time pass quickly. Knowing in advance it was going to be a very long appt. helped too.

The appointment included 3 interviews, one with a pharmacy tech, a nurse and finally with the anesthesiologist (actually two of them, a Resident and then a Doctor).

Pharmacy Tech
We reviewed all my current medications, how much, how many, why and when do I take them. To answer her questions I'd brought with me a current meds list produced by my pharmacy (one good reason to pick a pharmacy use it exculsively)

Then she asked me a lot of other questions that prompted me to remember a few other things that I've been taking... some of which were really important. The Metamucil fibre supplement and the occasional use of both Gaviscon and Immodium were remembered by her prompting.

Nurse
She ran through her list so fast that I barely remember it. Basically it was an overview of my diabetes, asthma, arthritis, MS, sleep apnea, allergies and surgical history. I had my blood work done when I had the surgical consult about a month ago so none was needed at this time. I thought an ECG (that's the one for the heart right?) might be needed but because I'd had a nuclear imaging test done last year which showed my heart was normal. This was as part of the process requested by the weight management team.

Anesthesiologist
First may I say I cannot, for the life of me, pronounce this word correctly! Anyway, my first interview was with a Resident Anesthesiologist so she was thorough in her questioning... have I been under before, what surgeries have I had (from a sedation/general anesthetic perspective), any family history of problems with anesthesia, etc.

Then she listened to my lungs and heart, did a manual manipulation of my neck, mouth and jaw, had me tilt my head back, etc. They need to know if you have any loose teeth or removable dentures, etc. Having a breathing tube inserted sometimes (rarely) can damage or chip teeth (sad, but makes sense).

She was all business with minimal bedside manner, but I suppose that is to be expected from a 'newbie' as they remember everything they have to investigate. She was completely thrown for a loop when I completmented her on her boots; it was as if I'd thrown a monkey wrench into her efforts to maintain her 'doctor' visage... she almost became a normal person again.

She did mention that I'd be going through all these questions again the day of surgery with the actual Dr. I'll have working with me. I now think of this interview as being a practice for the real one so I'll be better equipped to answer more completely and appropriately.

Did you know the Anesthesiologist manages all your medications on the day of surgery until released to your bed in the wards (after post-op recovery)? I didn't know that. They are the ones who tell you what meds you can and cannot take on the day of surgery... they monitor everything except the proceedure itself. I'd always thought the surgeon was the hero in the operating room but I've now reconsidered that opinion. The surgeon manipulates the body so one can have healing and life after the surgery but the Anesthesiologist keeps you alive and asleep during the surgery. (I know others may have a differing opinion which is fine, this one is mine).

Did you know (at least in some cases) when a doctor says a medication is based on your weight, they actually mean your height?? Through a few statements of what to expect on the day of surgery and a couple of my questions we got to the point where she told me "dose is based on your weight"

So I asked "I'll be weighed before surgery then?" Her response was a weird look on her face and "why? We have your weight right here?"


I attempted to explain I am on a 900 calorie diet for the next two weeks before surgery and will lose as much as another 10-15 lbs. She remained confused and implied that it wouldn't matter. Now I'm con-fucking-fused "If the dose is based on my weight, don't you need to know my weight at the time?" Her response was "No, we use your weight based on height".


As you can imagine I'm now like 'what-the-fucking-fuck' are you talking about, so I question her further... "what does my height have to do with a dose based on weight?" Her answer, and this is the good part, "your height tells us how much muscle you have because calculating for the dose doesn't include fat."... so basicially the best I've been able to figure out is they have some sort of formula (vaguely similar to the BMI formula maybe) to estimate my muscle weight not my total weight and that is based on height! Yet they call it based on weight dosing! With that I'll leave you to scratch your head like I am doing.

After a while she and the Doctor come back to the room, he's as calm and relaxed as a soggy lasagna noodle in stark contrast to her. Turns out there are concerns due to my small jaw and the fat pad at the back of my neck. There are three options for surgery and the day-of Doctor will determine which one they want to use.

  1. Do everything as normal. This means I am fully put under before they intubate me, using 'gadgets' they have available... this will be difficult and has the highest risk of tooth damage. (Post-op Edit: this is what was done, I'd lost enough additional weight and the Doc was a real pro - no damage done to teeth or throat)
  2. Instead of intubating me use a mask and manually controlled air bag. (I don't like that idea much). This is what they'll have to do if they fail at the first option.
  3. (My choice if I get one) Intubate me before I am put under general anesthesia. This means sedation, numbing my throat and gag reflex and inserting the tube down through my vocal cords while I am semi-conscious.

As aweful as it sounds to have a breathing tube while semi-conscious I figure it will be much like having an endoscopy. I don't remember anything from that proceedure and it was done under sedation not while completely 'out'.

So ends the appointment. NO further testing. NO further appointments. NO further interviews until the day of surgery. I'll find out on May 19th what time I have to be at the hospital on the 23rd (normally call the day before except it is a long weekend). The only thing, in the 'normal' range of expectation, that might get in the way of it now is if I get sick.

Amalilly

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Optifast Day 2 & 3

May 04, 2017

The journey so far...

Day 2:

I went to the swimming pool for a workout and had an easy time of it... did a bit of cardio but mostly focused on my arms, shoulders and core muscles... did a bunch of knee excercises to try to strengthen around the worst of my arthritic spots. Was at it for an hour. I love the water and one of these days I'll research how much 'weight' is lifted from your body due to the buoyancy. I'd like to know what 'this is what it will be like at 100lbs lighter'. okay so I stopped there and researched it - the answer is ??? don't know. There's a formula involving the weight of the displaced liquid and density. Nevermind.

I had a good day and was off to bed at a reasonable hour... but before bed I had my first Optifast poop... it wasn't solid and barely made it to the toilet. It was a very small poop, a bit darker than my normal. I'll give it a few more poops before I adjust the amount of fibre I take.

 

Day 3:

I woke up with energy this morning. This is a foreign experience for me and as I laid in bed contemplating what to do with the energy I found myself drawing a blank. I've realized all those little things around the house that you wish you could do or 'had the energy to do' need to be written down so on days like today I could have inspiration and options.

I did another poop first thing this morning... It was laughable how small it was (didn't even cover the bottom of the toilet). Again it wasn't quite solid and darker than my normal... still gonna wait a bit before adjusting my fibre.

After the swim workout yesterday I so wanted to go back and do it again today, however my logic and memory kicked in to talk me out of it. I am still so new to exercise that I need the rest day between sessions. My muscles, my MS fatigue and subsequent discouragement aren't worth rushing. I intend to go tomorrow before my PSW shows up for my shower.

I have found myself wanting food or maybe it is more like being tempted by visual cues. Watching a show where someone is eating potato chips or whatever. The actual sensation of hunger has been a bit more present today as is the odd 'dry tongue' sensation I have - it reminds me of the mouth feeling before throwing up or have bad reflux.

The 'hangry' irritability' I'd been expecting and pleasantly surprised by its absence showed up a bit this evening... I think it may have been triggered by a conversation with the officiant of my planned hand-fasting ceremony. She questioned the appropriateness of doing it now when my SO is in hosptial being treated for her eating disorder (which is much worse than either of us knew) and undergoing significant 'deconstruction' of her beliefs and I am on Optifast about to go into life altering surgery.

 

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Optifast liver shrinking meal replacement

May 03, 2017

So I'm now on day 2 of 21 of eating nothing but the Optifast MR (Meal Replacement) shakes until my surgery.

The Ottawa Weight Management Clinic uses this prescription meal reaplacement product in a few ways. They have an entire non-surgical program that uses it and then there is the pre-surgery use. Most people having Bariatric Surgery here in Ottawa will use Optifast for a minimum of 3 wks to minimize complications from the surgery by sufficiently shrinking the liver.

I know most people on this site are Yankee Doodles (no disrespect intended as I am ignorant of any nefarious meaning). And in Yankee Doodle land it seems many surgeons require a 10% weight loss before they'll operate... have you ever asked why? I'd always thought it was to 'prove' one had the will power to actually make change in their lives - which never made sense to me because, well, hello! don't you think if I could lose 37 lbs on my own I'd have done it already!!!!????? Duh!

But now that I've been asked to use this MR and told why I now belive (suspect?) it is for the same reason Yankee Doodles are asked to lose the weight - to protect the liver! BECAUSE here we are not asked to do the 10% weight loss thing. We are told to expect to lose weight as the MR program is just 900 calories a day. (Surgeon said men can lose 30 lbs in 3 weeks... she said it was extremely variable for women - which sucks 'cause I'd kinda like to know).

A few notes about using Optifast

  • Diabetics (such as myself) need to make changes to medications (pills and/or insulin) the day before and through-out using Optifast. As each person's diabetes treatment is different please talk to your nurse practitioner about what you'll need to do.
  • There are 4 packages of MR that must be consumed each day (per my prescription however based on everything I've read this is true for everyone)
  • NO FOOD, however the dietician said that if one absolutely has to crunch something A cerelery stick or A dill pickle would not hurt (on rare occassion - which means not every day).
  • Stop all supplements (in my case that was a multivitamin, a Vit. B complex, and Vit. D) the surgeon told me everything I need is in the MR - I almost forgot to do this as my pills were already in my dosette for the week
  • Drink a minimum of 2 litres of water a day (2 quarts? not sure of the conversion) above and beyond your shakes and fibre drink. I'm not 100% sure exactly why it's being stressed now but I am not going to risk finding out by not doing it.
  • There is no fibre in the MR so most folks use Metamucil sugar-free fibre powder. The product lable doesn't clearly state that it is sugar-free. One of two things tends to happen without it (according to the dietician) that is constipation and/or diarrea.
  • You will poop much less often because, well, hello! you're not eating food.
  • Oh, the best part you can have up to 20 calories a day - 1 cup of broth or 1/4 cup skim milk (for decaf coffee/tea) and sugar-free jello (and sugar-free water flavorings) AS LONG AS IT IS NOT SUGAR! (no candies folks!)

Making my first shake:
Was simple enough I just followed the instructions on the package and used a blender not a shaker.

Drinking my first shake:
- I needed a larger than normal glass to hold it all because I was too lazy (pain filled) to go back to the kitchen to refill the glass.
- I chose chocolate and it was really quite tasty although it has a bit of an after-taste, kind of a dry tongue sensation
- I was afraid of letting it sit too long so drank it quickly (as I have done for all the shakes since)

Shakes 2 - 4 (still chocolate):
- I experimented with #2 by adding a bit more water and three ice cubes - other than being colder I didn't notice any difference.
- I doubled up and had shakes 3 & 4 together, again with some ice cubes. I''d gotten home later than expected and was 'starving to death'

Observations from the first day include:

  • Rinse/wash the blender and drinking glass well as there seems to be a black residue that appears on the bottom if it dries before washing and, I had a heck of a time getting it off. I remember seeing this residue in my mom's glass when she was on the non-surgical plan years ago, so it seems to be normal.
  • At first I wanted to eat everything I saw, even the stuff I don't like and/or had never tried before. I figured this was my brain's way of dealing with the concept of 'never being able to eat whatever I want again' reality. Or at the very least of not being able to eat solid food again for 11 weeks (or more).
  • I had been very reliant on liquid meal replacements before now (I used the walmart brand equivalent of Ensure) so I found drinking my meals very easy and fulfilling. I suspect someone who's used to chewing every morsel of their food might have difficulty adjusting but I did not.
  • I needed to get some sugar-free water flavoring, jello and broth and after my earlier experience of wanting everything in sight I'd been dreading going to the grocery store. I guess a few hours was enough to adjust because I found the store to be LIBERATING. I saw all the food stuff and was able to completely ignore it, like totally see it, recognize it and then pay no attention. AND as a bonus, I actually found sugar-free Orange Tang (Tang was a real treat growing up so it is a coveted flavor I've not had for years because of the sugar). Needless to say, adding that flavoring to the fibre drink made it much more flavorful.
  • I did not feel any hungrier than normal (which seems really weird to me and may be unique to me)
  • It was a rather high pain day which means exhaustion so I couldn't really evaluate if I felt weak, will keep you informed as the days pass

Okay, that's more than enough for this post. Talk with you later.

Amalilly.

 

 

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Almost Surgery Time

Apr 26, 2017

After many years of consideration I decided in August of 2015 to move forward with a weight loss surgery proceedure. My first information class was in Dec of that year and now 20 months since my referral (17.5 months since class) I am about to start the Optifast meal replacement and have surgery. Starting May 2nd, 2017 I'll be on Optifast for 3 weeks to shrink my liver to minimize risks during my May 23rd laprascopic VSG proceedure. Standard for all the surgical patience at the Weight Management Clinic in Ottawa.

I have to say the process has been a long and at times a bit frustrating, however by the time I met one of the surgeons I'd realized every last moment of it has been necessary. I hear of folks in the States who decide to have surgery and within a couple months have had it. I can't understand how a person can be fully prepared that quickly.

I know many would be critical of the 12-18 month process here in Ottawa, I am not one of them. Do I wish I'd been closer to the 12 months than the 18, of course yet I know I needed the extra time. First I have many non-weight related issues that had to be checked on, secondly, it has taken me this long to get my mind around all the changes... the realities.

I am almost as prepared as I can be to maximize the benefits this tool will provide in my goal of having a life worth living. I wish I could be more physically active now and I am wanting to do what I can (notice I didn't say I was actually able to do it). I realize after a decade of sitting still most of the time (except when I'm laying still) it is going to take time and weight loss to build up to any degree of activity.

That's all for now. TTYL
Amalilly

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About Me
Ottawa,
Location
43.1
BMI
VSG
Surgery
05/23/2017
Surgery Date
Oct 30, 2016
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