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I'm not sure if protein shakes and supplements are effective or not (don't know of studies), but I suppose they are because they are the foundation of all lose quick diets. 

So why don't I use them? 

1. They make me gag.
2. My surgeon told me not to

Is my goal the fastest weight loss possible or is it the healthiest weight-loss possible? Definitely healthy.

Do I want to lose fast (hyper protein) or do I want to fundamentally change the way I feed myself? Ah, well, some of both, but changing my ways is better.

Because I make those choices I put up with slowish loss. My surgeon and endocrinologists tell me my loss is fast, but I still have a lot to lose, and when I compare myself to others on Obesity Help I am slow, maybe 30 or 40% slower. So maybe being on OH sets up unrealistic goals in my mind, or maybe I'm the sucker who isn't going to lose it all.

But posts like "Lost 100lbs in 4 months!" scare me, but I see them frequently. Weeks when I lost 5 or 6lbs I actually made myself eat more because that was just too much. Maybe that means I'll never reach goal, but that would depend on what my goal is, isn't it? Healthy and toned. Then I've already made a lot of progress toward my goal.

Somehow (big shocker to all the parents out there I'm sure!) a lot of what makes me happy has to do with my daughter, so I am happy today. Kiddo has long light brown hair with natural blond and red highlights, very straight, lots of it. It's very pretty, but being down almost to her butt, it was painful to brush and it had become a daily fight between us.

She found some pictures of when she was a baby (very short hair), said look I was cute there too (how do you argue with that?!), and wanted to chop it all off. I always tell her she's the boss of her, but I really didn't want her to chop it ALL off. So I made a distant appointment with our hairdresser and started thinking. I am not the beauty consultant type, and didn't come up with anything for a long time.

One night as I watched Veronica Mars it hit me, kiddo has the length and the face for that kind of hairdo! So I showed her the picture and asked how would you like to look like that? She lit up instantly and was totally sold on it. So last night I took her to her hair appointment with a picture of Veronica in hand. Hairdresser did a very nice job, a little shorter than the model, but that's what we wanted. Kiddo is delighted.

You'll never guess what she did first thing this morning! She ran to the bathroom and looked at herself in the mirror before she peed!!! She has spent more time looking in a mirror than I ever remember, and she likes what she sees. She brushes constantly, keeps it out of her face, even paid attention to her outfit this morning whereas a few days ago she wanted to go to school in her  pyjamas!!! What happened?!!!

I guess it's all about self-esteem. Those who have it pay attention to their looks and it creates a nice feedback loop. I wouldn't be surprised if she dropped a few of her extra lbs now. I'll certainly encourage her in that direction. Praise Goddess and Veronica Mars' hairdresser!

My daughter is 9 and showing signs of early puberty. Her first cousin had the same issue and saw an endocrinologist, so off we went to the children's hospital. They did some extensive blood testing and determined she needed to be put on hydrocortisone, so we have done that. But they also determined she is technically obese and invited us to a day-long class on nutrition for kids and parents. We are going this week, I am very curious what they're going to say.

My daughter doesn't look fat, but she is a lot taller and a little bigger than her French peers. We can't buy her jeans in France, they are all too slim at the waist. We can buy her regular American jeans and those fit perfectly. What I'm trying to say is she isn't fat by American standards, yet she's "obese" by French standards! It hurts writing this, because I am determined that she will be better than me (and she is in every way without trying), but her weight is going to be a struggle and it's been on my WLS mind.

French doctors take one look at me and fear for her, and every doctor we've met has lectured us on proper nutrition, losing weight, etc. I could go off on how unpleasant that is, but I will refrain, it comes out of good intentions I think. 

As a super morbidly obese mother, I was ambivalent about telling my daughter when to stop eating. Besides, she was a preemie and needed all the food she could get for a while. As a baby she had food aversions stemming from being on a ventilator, so when she finally decided she liked food as a toddler, I let her eat whatever whenever. 

By age 7 when we moved to France she was clearly overeating, even I knew that, but at least in France she started making better choices, i.e. snacks of fruit and yogurt instead of corn chips and nuts, but still too many calories. Like I said before, she doesn't look fat because she's so tall, which I realize isn't going to last forever. When she stops growing up, her overeating habits aren't going to magically dissapear, so she'll grow wide instead. That's what happened to me also.

She realized by herself that kids in France are skinnier than Americans,  and that they are given strict food rules. She loves the food at school (tastes better), but she says she feels self-conscious eating as much as she'd like to. Kids don't tease her about being fat at school, a couple kids are bigger than her, but she worries if she gets any bigger they'll tease her next.

In most French families it's a deadly sin to snack before meals. That seemed a bit much to me, but when did I typically snack out of control? When preparing dinner. So it would be best for me to deny myself (and daughter) snacks before dinner. I'm hoping the nutrition class will help me enforce a new rule at our house.

French people do not overeat as a rule and they don't have a lot of reserves. When the time comes to eat they get grumpy if they don't get fed, just like toddlers! I always thought, why don't they just have a snack? Because it's against their rules. They'd rather feel the hunger and the grumpiness than break those societal rules. That sounds a little crazy, but it works out well for them.

So, after all this rambling, what are my thoughts about childhood obesity? For one thing, limits are good. Some kids (and I was one of them) eat out of boredom, or because they like having something in their mouths. That impulse needs to be controlled. It's not easy, but mastering that at a young age is probably going to help greatly. 

Kids--and this adult--probably need to recognize the urge to eat and learn to ask themselves is this hunger or is it something else? Just stop and ask the question. And then, it's also important to learn to either distract ourselves from food, or learn to deny ourselves, control the impulse. There's got to be some psychology to this, right? I'll have to find out about it.

I scheduled my follow-up with the endocrinologist for today (as it happens 3 months post-op exactly) and I'm really pleased how things went. First thing out of his mouth "you are looking well!" That's certainly not how he greeted me 5 months ago when I first met him! 

He asked how I felt and I said great 99% of the time. I exercise almost daily, I have more energy, and a more positive outlook on life in general. 

I'm 236lbs today, for a loss of 50lbs since he saw me pre-op. I said isn't that too slow? And he asked as compared to what? I told him people on the internet and he said not to believe what I read on the internet. So OH folks, I'm not supposed to believe you any longer!   Then he said something that I don't get. Apparently, the average loss with a bypass is 3.3kg monthly. I should have asked is that over a long time or right after a bypass, but I didn't. He says I'm losing great without feeling sick, so stop complaining lady and go on with your life.

He asked what supplements I take (maintenance dose of multi vitamin, iron, calcium, B12) he said not to change anything, that calcium supplementation is particularly important he pointed out, which I didn't know. He told me I don't need blood work for another 3 months since I feel and look good. OK, that's also a surprise, but I'll see my surgeon in 4 weeks, will ask him if I need to wait till Oct for blood work or do it now. But I do feel great, so maybe it's overkill.

I asked about hair loss, he said probably rapid weight loss, try to ignore it, it'll stop in a few months no matter what we do.

He gave me nutritional advice: all you can eat lean meat and veggies. 2 fruits per day. As little white carbs as possible, stay away from pastries and desserts in general. Wine and sodas for special occasions only. That's a bummer, I've been enjoying 3-4oz of wine almost every night, not sure if I'll follow his advice on that. 1.5 liters of water daily, not 3 or 4 liters as you'll read on the internet. Apparently he reads the internet too!

The main difference between the French and American way is that doctors here don't dictate what they want me to do. No oppressive rules like no chewing gum or no  alcohol or no bread, or how much protein I should eat, or how much water I should drink. They give me guidelines and let me make my choices, kinda like I'm an adult or something! And overall I make dang good nutritional choices these days, if I'd done that all of my life I wouldn't have gotten into this pickle.

Anyway, I'm extremely happy with having done this surgery, it's paying off big time, and I am changing my ways in very profound ways which I think will serve me well over time.

I've now lost 34lbs since surgery, and 45lbs counting my pre-op diet. To me, losing 45lbs in 3 months is absolutely stunning and I can't believe it!!! I had a 2 week stall at weeks 3, but other than that, it's 1/2lb to 1lb each day. I do some sort of exercise almost every day. Bike ride, or indoor bike, or free-weights, or a 3k walk. Pretty soon I'll add swimming to the mix as well, as soon as my sister's pool warms up! 

I've started losing some hair, no panic yet, but I need to try to get more protein in. I'm seeing the endocrinologist on July 2nd, he'll order a full nutrition pannel, I hope I've done ok on feeding myself. I eat so little it's sometimes unsettling. But I think what little I eat is smart choices, and I take my supplements as prescribed by surgeon, haven't forgotten once yet!

French nutritionist said protein supplements are not standard care here. I had them the first 3 weeks, but they taste nasty to me and make me gag. But am I really getting enough protein without them? Nutritional pannel will tell I'm sure.

I have a lot more energy, I am happy, I have no regrets. BUT it's not all peaches. I threw up 4 times so far, 3 of that self induced because I felt really sick to my stomach. I feel heavy, I feel the food churning in the pouch, but not exiting. This can go on for as much as 5 hours during which I have horrible back pains, nausea, and don't know what to do with myself. Only way to solve it is to upchuck or at least give the pouch a strong heave. On May 26 I had some thick oatmeal for breakfast (1/2 a packet) and it made me so sick I thought I was going to die, but it fixed itself as soon as I tried to throw up. Never threw up before, so this is a new one.

But nothing bad like that has happened the last 2 weeks. Nausea sometimes, but some water and a long walk fixes it. I can even eat out and not feel sick! Not that I do it that much, but it's good to have the option!

People who don't know I had surgery have said nothing about my weight. Either they don't see it (how could they not?!!!) or they don't want to imply what? That I was huge before?! Well duh! How did I let it get that bad, I don't know, but I did, and it's over now.

I am on the board of two organizations, met with both the last couple of weeks, not a peep from anyone. One person gave me that quick up and down look that told me she noticed, but said nothing. Come on people! Make my day, say something!!!

My husband and daughter have been incredibly supportive, they are very patient with me, and very sweet. My mother thinks I should have just starved myself, to which I reply, whatever...

One week ago I was trying to wake up from a long open surgery and I felt really really sick. Tonight I can move around pretty well, I can bend all the way to the floor, get myself out of bed alone, go without pain meds, and eat a little bit without feeling sick. I'm amazed anybody in their right mind is willing to open people up and rearrange their insides, gees, what if something goes wrong?!!! Never, right?!

So I just wanted to say I'm happy I'm officially one week post-op and I feel good!

How does a nice girl like me go in for a VSG and comes out with a bypass? The way I see it, it's all my mother's fault, yeah, really, and I have proof! 

You know what they say about when life hands you lemons, make lemonade? Guess what I'm drinking right now?!!! OK, more like Crystal Light with Unsure powder in it, but you get the point.

They don't call it medical practice for nothing. Surgery is not an exact science. Sometimes the surgeon starts cutting and realizes he's got to change plans because he's not dealing with the usual. I know I'm special already, husband tells me all the time, but in my case it extends to my insides. 

Last time I ran into trouble with abnormal insides (my unstrechy uterus) it killed my preemie twins. My doctors (in the US btw) couldn't do anything to keep them in my abnormal uterus. That loss just about killed me, but I got better a few years later. Got a fabulous daughter after I lost the twins BTW, she also came out way too early (28 weeks), but she was a singleton and had enough room in-utero. When the OB/GYN saw my uterus during the c-section he called it frankenutero. But I got to keep one child out of three and for that I am grateful. 

Sooooo, that's my view point. No VSG? OK, some other WLS will do.

Pre-op I wondered sometimes if my stomach may be a little bizarre as well. Had visions of a surgeon completely unable to close me up no matter what he tried because my stomach was freaky too. I told the surgeon about this fear pre-op, but he blew it off as irrelevant, uterus and stomach are not related. Today the surgeon said it's happened once to him before in his 7 years of sleeves and probably 15 years of visceral surgeries of all types. So I am quite unique indeed and thankfully.

So what happened? He got in laparoscopically as planned, put the 40F bougie in there and started cutting from the bottom. He'd made a couple cuts when he realized the staples weren't holding at all. "The tool wasn't working" were his words. So he considered his options. He said if he tried to close me up by hand the bottom of my sleeve would be so small I may not be able to eat hardly anything. Or worse, food would get caught in there. So he decided to go with a classic bypass because he could give me a proper calibrated opening into the intestines.

Trouble is, he also had to open my up from sternum to belly button so he could stitch me up by hand. I've had a c-section before and this is about the same level of discomfort, but you're also dealing with your insides trying to heal. It's worse than the c-section by quite a bit I think. 

When I woke up from surgery I had an naso-gastric tube, oxygen (and still gasped for air sometimes) two drains (oh my god the drains are freakish!) one IV, and both laparoscopy and open surgery scars. Lovely. At least I wasn't on a ventilator, right?

When the surgeon told me a few hours after surgery what happened, I was so sedated I could only keep my eyes open and somewhat focus for about 1mn at a time. The news really upset me and every time I woke up I felt very very sorry for myself. But what is done is done and I just wanted to get better and get out of there alive. From the way I felt at that point, I wasn't sure that was a given.

Spent all day in ICU Tues, didn't care for that much, but two nice nurses rolled me over on my side (which hurt like hell) and rubbed my back with oil (which felt so good), put in a urinary cathater (gently, didn't hurt), gave me a sponge bath, and then changed my sheets with me in the bed! The whole time being very nice and sweet about it. No idea who they were, but may they be blessed for their work of love. Tue night they took me to the "visceral surgery" area. Nice room, mostly I slept, not too much pain. I hit the morphine button quite a bit, but not to the max.

Tue night hubby and daughter came to visit and daughter was so shocked to see me like that she couldn't really look at me. I knew she was going to be shocked, but I didn't realize how much. She got really scared. I could hardly move, everything hurt, I couldn't talk much with the NG tube, and she just wanted to run away the poor thing. Hubby didn't bring her back to the hospital until Saturday when I felt 100% better and I could see the joy on her face. She apologized profusely for being scared, but trust me darling, I know what it's like to love and be scared all at once, I am a preemie mom.

Wed I felt better already, surgeon came to see me twice a day, my drains looked good, he was happy with my progress, said let's do the leak test tomorrow, then we'll take the NG tube out. 

Thu morning bright and early, off to radiology and the leak test. Yukky stuff in France too. Not easy getting around that table with all that gear, I couldn't catch my breath and the radiologist MD cranked up my O2 which helped me relax some. They gave me the nastiest breathing treatments twice daily after that too, so I suppose the radiologist told the surgeon what she saw. But I think I was just being asked to move too much so soon after open surgery and maybe a bit of asthma, and that freaking NG tube. All better now.

No leak, yeah! Surgeon does his morning visit and says no leak but where the intestines meets stomach (is that called the stoma?) it's still a bit swollen, so let's keep the tube in, give you some food and see if you keep it down. I drank a little (it's really hard to not swallow air!!!) ate 1/16 of a cup of applesauce and did not throw up or even felt like throwing up at any time. By the time the surgeon did his night visit he said it's great if you're keeping it down, let's take the NG tube out. Nurses didn't come around to do that quite as fast as I'd wish, but I'll forgive them some day. Getting the NG tube out is a very strange feeling, not painful, but gagged me, and it was coated with strange yellow goo that my body produced. Nasty stuff. I felt instantly better without the NG tube, could breathe better, wanted to pick my nose really bad since blowing hard into a tissue isn't an option when you're open.as soon as everyone left the room I went to work on that. They also took the cathater and IV out that day, it was a good day!

Fri, nothing much to report, feeling better slowly, sleeping better, dietitian came to visit, told me some stuff I already knew except for one. You CAN have sweets after a bypass, what you're not supposed to do is have something sweet outside of your meal because if you do it'll signal to your pancreas to produce lots of insulin which will take your blood sugar too low. So is dumping a low blood sugar situation or is it something else? I'll learn more about that soon. 

Saturday the drains came out. Oh my God!!! They don't call them "drains" in France, they call them blades. I thought, Edwards Scisorhands?!! Yikes! But no. They are about 1" wide plastic things with grooves about 2 feet long that sit inside the abdominal cavity and empty into plastic bags. Liquid works its way out into the bag as needed. The bag stays on the tummy with one stich and lots of soft glue (the kind you'd scrape off, it doesn't harden at all). My skin and my glue liked one another and it took the nurse a good hour to clean it all off. Getting the "blades" out is a strange sensation but it really doesn't hurt. It's absolutely filthy however, blood and gunk, and when they pull on it you feel something move inside, not like a baby moving, but something in that arena. I feel sorry for the nurses who do this work, it's really gross.

Well, that's it from me tonight, will probably write more tomorrow!

March 30, 2007.

Surgery in 3 days. I want to get it over with, I don't feel scared, but I hope things will go well of course. I think of surgery as a calculated risk. I've just got to lose the weight or I'll be dealing with much worse things health-wise soon because being morbidly obese is a very dangerous way to live. Not to mention tiring, bad for my self-image, limiting, etc.

I am very grateful to my husband and daughter for how calm they are about my choice. They want what's best for me and I love them for it. It's about love for life, love for them and love for myself. It is something I just have to do.

I accept that this surgery is not going to be the magic bullet to solve my food problem long-term. I couldn't lose the weight without surgery, but it's also a fact that within a few months of surgery I could choose to start snacking too much, and within a few years I may even be able to start eating big meals. Both overeating and grazing got me into this mess so I never want to go there again. No more day-in and day-out out of control eating for me. Surgery is my tool out of this rut, not my magic bullet. Thin people are careful about what they eat. They exercise even when they don't feel like it. Why should it be any different for me?

Pre-op diet is going well, I've lost 7lbs in 12 days without starving myself, which I know I couldn't do. Nothing but fish, veggies, fruit, and yogurt. It's low-fat and low carb and not a bad way to eat for a while as fish is quite tasty. 

Today my BMI is at 48.2, but it's been as high as 52 a few years ago and my average for the last few years has been around BMI 50. My goal is to get to 143lbs or 65kg. I remember when I was at that weight (early 20s) and I felt and looked fabulous. That would put me at the upper range of "normal" BMI. Lots of sleevesters have done it, and so will I!

Bye blog, next time I write I'll be a sleevester!

Jan 25, 2007.

I met a third surgeon today, doctor Liagre. He didn't come across as super friendly at first, but we warmed up to one another. He's done loads of sleeves the last 3 years and he thinks it's the best WLS out there, so he's my man! 

I asked him about my concerns about losing enough weight, he said if I can't make a big dent in my weight with the sleeve I probably can't do much better with the bypass, so I'd have to go to a DS. In other words, the sleeve is almost as good as the bypass as far as excess weight loss. 

Then I asked which surgery he'd choose for himself if he were me and he said sleeve, no doubt about it. It's easier on the body, yields good results, great quality of life, etc. Another point for the sleeve.

I also asked about reflux. He said within one year of WLS 80% of his patients don't have any more reflux, for the other 20% there is Nexium. I asked if a bypass would be better as far as reflux, he said no, all his patients get Nexium (well actually a no-brand French equivalent) the first year after surgery, even the one who had a bypass. So that shouldn't be a big consideration. 

Then he asked if I'd like to talk to one of his former patients and I said yes, maybe one who's had the surgery a while and had a lot to lose. He gave me a man's name and phone number (with permission) of someone who had his surgery Sept 05. I called him and we talked for a long time. He's 38yo and has lost 80kg (that's 170lbs?!) he says the sleeve is fantastic, no pain, great surgical care from the Liagre team, no complications, great quality of life, he doesn't get hungry, eats small portions of healthy foods, feels like a new man, no regain whatsoever. He doesn't like Coke any more. Gees, that may be a bit extreme, but he still likes some wine sometimes!

So now I have to do some blood tests, go see the endocrinologist again, meet the anesthesiologist, and submit my paperwork. We can't set a date until the approval has come through, but surgery should be March or early April. Out of pocket cost: €350. That's so incredibly affordable, I'm stunned! Everything else is covered by national health care, bless them!

Pre-op diet is kinda funny. Dr Liagre says that 3 times he's started surgery on someone who hadn't been put on a diet and when he goes to push the liver out of the way he gets a bleed. So he does something to fix the bleed (technical term that I didn't get), closes up, then puts the person on a strict diet for 3 weeks, and in that time the liver's much healthier. He compared it to foie gras (you know the goose liver French people eat as a Christmas delicacy?) So for 3 weeks pre-op he wants me to eat nothing but fruit, vegetables and yogourt. No restrictions on quantities, but those foods only. I think it'll be hard, but I'm going to do it. Will probably lose some weight just doing that.

Oh, I also asked about gall bladder. He said 15% of rapid weight loss patients need to have their gall-bladder out within the first year. He doesn't remove it because he doesn't want to complicate recovery, but it's a simple surgery if needed.

So I'm very encouraged tonight, I think I'm begining to see the light at the end of the tunnel, and that's a great feeling!

Jan 1^st, 2006

I've been fat most of my life and honestly I wasn’t too worried about it for the most part. I felt it was a flaw, but life was good anyway. But as my weight increased and as I got “older” things changed and I started to worry about my health. Currently my BMI is around 50 and steady. Over the last 5 years I tried phen-fen, Weight-Watchers, South Beach , Atkins, Phen-Pro, I've done diets under medical supervision, and some on my own. When I go on a diet I lose 20-40lbs, die of huger (excpet on Phen-Fen and to a lesser degree on Phen-Pro), then gradually get back up to 280-290. It’s like I’m stuck at that weight. I have the phen-pro pills in a drawer, but I don’t think I’d do myself any favors taking them so I won’t.

Normal life is exhausting, sleep is not restful, and I don't feel healthy. I used to think I was fat and fit, which I was for a while, but not any more. I can't keep up with a normal day of work and life and I make choices every day to do less and less. The trend is alarming and I want to reverse it.

So in June last year, for my 41 birthday, I got brave and told my husband I want to have weight loss surgery. Hubby isn’t thrilled, but he’ll go along and hope for the best. I don’t think I have a choice. I’ve dug myself into a very deep hole and I need help getting out.

I didn’t choose surgery lightly. I’ve been researching things for a year and I’m not likely to have surgery until March 2007, so plenty of time to think and consider my options. The VSG looks like a better solution to me than other WLS. I recognize that we don’t have long-term data on it, but I like what I’m seeing. Surgery risks are lower than with other WLS, results look about as good, and what wouldn’t I give for a chance to not be hungry all the time!

I wonder about two things still:

1.       Will I lose enough weight with the VSG? The surgeon I’m considering (Dr Anduze in Toulouse, ) doesn’t think the sleeve will be enough. He thinks my choices are bypass or full DS. But he’s willing to do a two stage DS, which means sleeve first then derivation a few months later. Just the thought of a DS makes me sick, so I really don’t want to go there. Call me crazy as lots of people do great with the DS, but that sounds like really risky long term as I see it.

2.       Will my heartburn get worse with the VSG? Again the surgeon says the bypass gets rid of heartburn and the sleeve will make it worse, but if I lose weight won’t the heartburn go away eventually no matter what surgery?

I’m a hybrid French-American, I have both passports, family in both countries, and I love both equally. I live in currently, but I’ve lived most of my adult life in the . One of the perks of living in is national health care. WLS is going to be almost free, yet I get to choose my surgeon and my hospital. The process is a little slow, information isn’t as free-flowing as in a competitive for profit medical environment such as the has, but I’ve been impressed with the medical care we’ve received in . Doctors are sharp, compassionate, and very willing to take time to talk to their patients one-on-one.

So here are my thoughts for this first day of 2007. I want to do this because I love life and because I’ve been disappointed in how little I get done these days. I’m going to have to change my love affair with food, but most French people love food yet they’re skinny. Eat well but not a lot, that’s the VSG too I think.