2 years post-VSG

Aug 16, 2014

Yesterday was the 2nd anniversary of my sleeve surgery. I was so caught up in other stuff, I didn't even think about it until OH sent me a happy WLS anniversary e-mail.

I've now lost 117 lbs from my highest recorded weight. I'm almost half the size I was in the bad old days, and it's still hard to grasp that fact. My band surgery was almost 7 years ago, so I've been on this WLS journey for quite a while now and can tell you that Michelle/eggface is absolutely right when she says that the mental WLS journey takes longer than the physical one. When I shop for clothes, I try on a medium first, then a small...and finally I'm surprised to find that an extra small fits the best. When other people describe me as skinny or tiny, I want to look behind me and say, "Who are you talking to?"

So as my body has gotten smaller, I've been working on making my understanding of what's happened to me bigger. What's happened isn't 100% related to weight loss, and it's not all good news. Thanks to my sleeve, my body can no longer assimilate enough calcium, B12, iron, and zinc, so I take a lot of nutritional supplements. I still struggle with extreme insulin sensitivity, and dumping is still a threat if I eat too much or too fast. I haven't figured out all my new satiety signals, but I'm getting better at avoiding dumping. I'm somewhat resigned to feeling physical hunger during every waking hour.

Some consequences of weight loss are wonderful, though. One of the reasons I'm no longer active on OH is that my life is no longer focused on weight loss. I'm more outgoing, social, and active than ever before. I'm vice president of a local non-profit organization and spend a lot of time on projects related to that. I get more satisfaction from that than I ever did from overeating.

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Down, down, down

Oct 30, 2013

My weight keeps going down. I'm trying to eat more protein as suggested by my surgeon, but I'm now 18.4 pounds below my goal weight and wearing size 4-6. I feel like I'm eating constantly, which in fact is not a big exaggeration because I have to eat often to deal with the physical hunger I've had since my sleeve surgery. The exception is that I'm not allowed to eat or drink anything during my work shifts except during one 15-minute break. It's hard to eat anything solid in only 15 minutes without discomfort and/or dumping. Lately I've tried bringing a protein shake instead of real food to work. It does help make my shifts more comfortable.

It's very bizarre to be this small now. The clothes I bought this spring when I thought my weight was stable are now too big. I'm able to wear some of the size 8 pants with a belt...and wearing a belt to keep my pants up is yet another bizarre experience. I'm trying to enjoy being this size without obsessing about it. Fat Jean is always in the back of my mind, telling me not to get rid of any bigger size clothes.


One Year Later

Aug 16, 2013

Today is the one year anniversary of my VSG surgery. The good news is that I've lost 47.2 pounds since then. This morning I weighed 117.6 pounds (14.4 pounds below my weight goal, and 113.4 pounds down from my highest recorded weight) and recently I discovered that I can wear size 7 jeans. I can't remember ever wearing that size before. (I do remember that when I was in high school, I hated that I couldn't shop at a mall clothing store called 5-7-9. For sure, I wasn't smaller than a size 5 then.)

The bad news is that I still miss my band and I'm still finding it hard to live with my sleeve. But in a way, that doesn't matter. I've said in the past that if gastric bypass was the only bariatric surgery available to me in 2007, I would've had gastric bypass surgery despite the risks and compromises it might involve. Similarly, if  I was considering WLS for the first time today and the sleeve was the only procedure available to me, I would have VSG surgery, even knowing what I know now. I feel very lucky that I was able to have Lap-Band surgery. It set me on a path to a life of health and mobility that's more wonderful than I ever could have imagined.

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The Clean Plate Club

Jun 18, 2013

I belonged to the CPC (Clean Plate Club) for over 50 years, so I consider myself something of an expert on it (and I am, after all, The World’s Greatest Living Expert on Everything). I thought it was a lifetime membership, but my bariatric surgeon rescued me from the CPC Cult – oh, excuse me, Club - and deprogrammed me so that I’m able to function more or less like a normal person now. Here’s my story.

I was inducted into the CPC as a child, when I was too young to realize that the promise of going to heaven if I always cleaned my plate was a bit more complicated than it sounded at the time. All I wanted to do at the time was to please the cult leaders: my mother and my grandmother.

I have reason to believe that my grandmother, whom I called Dranny, was the original founder of the CPC. Orphaned as a small child, she was passed around the family like a piece of unwanted furniture, and she raised her own children during the Great Depression. Through the combination of those circumstances and her own peculiar (and wonderful) character, Dranny was a pack rat. She didn’t live in filth and disorder (just the opposite, actually), but she couldn’t bear to throw anything away, especially not food. If three green peas were leftover from a meal and she hadn’t been able to persuade someone to eat them, she would lovingly place them in a custard cup covered with a shower-cap style cover (this was in the days before Glad Wrap), and store them in the fridge, where they would remain until someone ate them (or my mother threw them out while Dranny was in another room).

I’m a lot like my grandmother in various ways, and also something of a pack rat. So after eating my way through hundreds of childhood meals with Dranny and my mom (who was not a pack rat, but who was offended by the idea of wasting food that she’d worked so hard to procure and prepare), I emerged into adolescence with warring impulses – part of me still wanted to clean my plate, and part of me wanted to starve so that I could lose weight and be as skinny as the British supermodel, Twiggy.  


Staying free of the Clean Plate Club has forced me to deal with a number of things I'd never given much thought to as a pre-op. One of my problems with meal planning and storage now is that it's hard for me to predict how much food I'll be able to eat at a future meal. Often I don't know that until I've eaten several bites. My basic strategy for dealing with this unpredictability is to keep my plate clean from the very start so that the food I leave behind doesn't overwhelm me or provoke an attack of guilt that could bring down Dranny's loving wrath upon me.

One way I keep my plate clean is to prepare smaller batches of food so I won't be tempted by serving dishes overflowing with food, or burdened with an excess of leftovers. I can't speak to recipes for baked goods (not my department), but most other recipes can be easily cut in half, thirds, or even quarters through the use of simple arithmetic.

Sometimes I prepare the whole recipe, subdivide it into 2 or 3 batches, serve one batch immediately and freeze the other 2 for future use. When we lived in the northeast, the elderly widow who lived next door was delighted when we shared excess food with her. Sharing food with family, friends, and coworkers can yield multiple benefits. When I'm craving a food or recipe whose leftovers would be a problem for me to store (or resist), I prepare a big batch of it for whatever social event is on the horizon and keep only one or two portions of it at home so that we get to enjoy it without having to worry about to do with all that food. I use cheap, recycled, throw-away packaging so that no one can insist that I take my corning ware, Pyrex or Tupperware container of leftovers home with me. 

Another way I've kept my plate clean has been to a portioning technique that I recommend for post-ops who are still learning their eating skills, food portion sizes, and stop signals. Here's how it works for me. When planning my day's food (which I commit to my food log and my accountability partner every morning), I might decide that I'll eat 4 ounces (by weight) of chicken thigh and 1/2 cup of barley and veggy salad for dinner. Come dinner time, I grab my small plate (a salad plate) and put half of my planned meal on it: 2 ounces of chicken and ¼ cup of the salad. If I'm able to finish that, great. If I'm still physically hungry when I'm done with it, I go back to the kitchen and dish up the remaining 2 ounces of chicken and ¼ cup of salad. At the end of the meal, I'll probably have only 1 or 2 tablespoons worth of food to save or throw out instead of a plateful of food, therefore much less guilt to deal with. 

When I do have a plateful of food leftover, I usually scrape it into a small plastic container that I can quickly grab and stick in my lunch bag when I go to work the next day. Fortunately, we actually like leftovers at our house, and arguments occasionally break out over unauthorized consumption of leftover food ("Who ate the rest of the eggplant Parmesan?!?"). The same approach works with restaurant meals. We're happy to take leftovers home in what used to be called a doggy bag (as if I'd share my Maryland crab cakes with a dog!). 

My sister-in-law used to scrape leftover food into a bucket to add to her garden compost pile. I have no idea if that's a good practice. We'd have to have a 40' high electrified fence dug 20' into the ground and topped with razor wire in order to keep dogs, cats, deer, rats, raccoons, and other critters out of that kind of compost pile. I've also known people (including my mother) who fed leftover food to their 4-footed garbage disposals (dogs & cats), another practice that we avoid because why would you want to cultivate a fussy eater? Our pets have survived eating (stolen) candies (complete with foil wrappers), latex paint, and kip tails (fishing flies), and at our house, a fussy eater will end up starving because someone else is always willing to clean your plate for you, sometimes long before you've decided you're finished with it. 


After over 6 years of post-WLS life, I'm now better able to detach myself from my emotional attachment to the food on my plate enough to throw out what's left. If it didn't taste right because my tummy was in an odd mood, if it caused me eating problems, if it wouldn't reheat or store well, I let it go. I haven't been struck by lightning for doing that, nor has God punished me with plagues, floods, or infestations (apart from the dog infestation, that is). 

Like many, I was raised to eat every meal while listening to a chorus singing the "Children Are Starving in (fill in the blank)" hymn. I agree that in world where so many children (and adults, and animals) go hungry, it is just plain wrong for an overfed middle-class person like me to waste or throw out food. But the fact is that me eating more food than my body needs (rather than throwing out) is not the solution to the problem of world hunger. The solution to world hunger, and to diminishing global food resources, is far, far more complicated than that. Working in your community (be it a village, a city, a country, or a planet) to solve that problem is a worthwhile effort, but you taking personal responsibility for causing the death of a starving, unknown child in India or Appalachia because you threw out a chicken wing and 5 green beans last night is (in my opinion) a misguided and foolish use of your energy. 

And you eating that extra bite of food just because you can't bear the thought of throwing it away is also foolish from a medical standpoint. If that extra bite causes you to PB, get stuck, or over-pack your pouch, it could lead to messy and expensive medical complications like esophageal or pouch dilation and/or band slips, especially if you eat that way on a regular basis. 

Finally, as long as overeating endangers your health through co-morbidities and through disrespecting your band, you may never be able to help deal with the hunger problem, whether on an individual, local, or global basis. So, first things first: make a top priority of eating sensibly for your own sake before you tackle the rest of the world!


MIA because of weird internet problems

Apr 20, 2013

I've been MIA from the forums for a few weeks because of a weird problem - haven't been able to type text into message, blog, or forum text fields. Finally fiddled with the IE Compatibility View settings and that seems to have fixed the problem even though I'm not exactly sure how. Glad that's over with.

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Good Eating Skills

Feb 23, 2013

Most WLS patients find that good eating skills are as important as good food choices. The fact that some side effects and complications can happen to even the most conscientious eater doesn't excuse us from doing our best to avoid them. And it's also important to know that good eating skills can ensure the early and prolonged satiety that we expect from our surgical tools.

The official Bandwagon® Eating Skills are:
  1. Don't drink while you eat or for 30 to 60 minutes afterwards.
  2. Take tiny bites.
  3. Chew, chew chew.
  4. Eat slowly.
  5. Eat the protein first.
  6. Learn your stop signals.
  7. Pay attention to problem foods.
  8. Eat only when you're hungry.
  9. Avoid liquid calories and slider foods.
  10. Use a small plate.
  11. Plan your food in advance.
  12. Don't watch TV or read while you eat.
  13. Don't put serving dishes on the dining table.
  14. Eat sitting down at the dining table.
  15. Follow the HALT rule (don't eat when you're too hungry, angry, lonely or tired).

You’ll find full explanations of each skill in Chapter 12 of Bandwagon, Strategies for Success with the Adjustable Gastric Band, by yours truly.


What size should I buy?

Dec 11, 2012

A lot of the customers I see at JCP at this time of year are looking for pajamas for Christmas gifts. We have pajama separates, folded sets, and hanging sets. Something for everyone. In the past week I had two NSV's while helping two different customers who weren't sure what size to buy. One of them said, "She's short like you, but thick." ("Thick" is the local way of saying "fat".) The other said, "She's little like you, so a size small?"

This morning I weighed 136 lbs. When I had my complete unfill in February 2012, I weighed 134.6. My goal weight was 132 and I got down to 130 in July 2011. It's beginning to look like the end is in sight. I'd like to get back to 130 so I have a little bit of wiggle room, but I'm happy enough at 136. I can fit into most of the clothes I wore last winter, but some are still tight, making me wonder if I lost some muscle tone somewhere along the way.


Back in the 130's!

Nov 20, 2012

My scale gave me a nice surprise this morning: I'm back in the 130's again, only a few pounds from my goal weight. I have to give credit where it's due: to my new sleeve, even though we're still not getting along together very well.

A few weeks ago I had an upper endoscopy because a hemoccult test revealed a gastric bleed (the possible cause of my anemia). My gastroenterologist found a polyp in my stomach, a "ring" in my esophagus (an artifact from the stricture I had dilated in May),  inflammation in my duodenum, and a well-healed scar from my gastrectomy. He biopsied the polyp, ring, and duodenum. Yesterday I saw his NP, Laura, who said all the biopsies were negative. I'm to continue taking omeprazole and go back for a follow up in 3 months. I asked her if taking a diabetes med called Precose could slow down my gut enough to prevent or reduce the rapid gastric emptying (or dumping). She said maybe, but that could also create a host of other GI problems.

I've also seen a PA at an endocrinologist in Memphis about the blood sugar spikes and dives that have been plaguing me since my sleeve surgery. He prescribed glucophage (metformin), saying it will help even out my blood sugar. I'm hoping that steadier blood sugar will take the edge off the crazy hunger, but he made no promises in that regard. Glucophage side effects are mostly GI problems (like diarrhea), so all the more reason not to add Precose to the mix. I haven't been taking it long enough to see any effect on my blood glucose, or any GI side effects. I'm so constipated from the iron supplement, I'm not sure I'd even notice any effects from the glucophage.

So I find myself in a more complicated medical situation at over 5 years post Lap-Band than I was when I was obese. I did appreciate it when Laura said, "Miss Jean, I know you're frustrated, but you've done so well with your weight loss. Obesity is a serious problem, and now you don't look like you were ever obese."


Micronutrients & the sleeve

Oct 18, 2012

Today is my 9-wk surgiversary. I've lost 19 lbs (go me!). Still struggling with constant hunger, but it seems a bit less ferocious than before. The iron supplement has restored my energy, thank God, so the next issue to tackle is why am I anemic. A hemoccult test showed blood in my stool. That happened to me once years ago and proved to be caused by internal hemorrhoids, but since my mom had colon cancer I have to take it seriously. Could hemorrhoids that give me no symptoms be bleeding badly enough to cause anemia? I have an appt with my gastro doc to talk about it next week. He'll probably want to do a colonoscopy (sigh).

I had always thought that only malabsorptive WLS procedures (RNY & DS) can cause vitamin & mineral deficiences, but a friend of mine who's looking into an RNY revision sent me a link to an article about a study that found vitamin & mineral deficiences (and excessive levels in some patients) in VSG patients. 43% of the patients in the study had iron, folic acid & B12 deficiencies. Other patients had issues with other micronutrients. The authors of the study theorize that removing most of the stomach reduces production of hydrochloric acid (needed for absorption) and also that food passing through the sleeve so quickly can prevent full absorption.

Reading the article certainly made me take vitamin and mineral supplementation even more seriously than I already did.


Feeling better

Oct 15, 2012

A blood test showed that I'm anemic.  We're not sure why - whether it's from low caloric intake, or a GI bleed. I had to do a hemoccult test that showed I'm bleeding somewhere in there, and since my mom had colon cancer, I have to take it seriously even though colonoscopies done after past positive hemoccult tests showed nothing serious. So I have an appt with my gastro doc next week, and no doubt he's going to want to do another colonoscopy. Oh, goodie.

I've been taking an iron supplement for a week now and already feel much, much better. Still struggling with the hunger, but it's easier for me to deal with that when I'm not exhausted. In the past week I've been able (occasionally) to eat a bit more than 1/4 cup of food at a time, and I'm hoping that when I get up to the 1/2 cup I'm supposed to be eating, my body will realize it's not going to starve to death and stop torturing me with blood sugar fluctuations.


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