Friday, December 2, 2016

Playing Santa



As Christmas grows ever nearer (23 days as of this post), I have been fielding a few questions about Christmas gifts. What, people are asking me, does one get for a pre- or post- bariatric surgery patient? In the service of Christmas Gifts That Don't Suck (TM), I would offer up the following suggestions:

1. Clothing: You've seen the complaints here on almost a weekly basis. As the weight loss starts happening, the clothes stop fitting. So quickly that many patients (myself included) just stop buying clothes entirely, out of frustration with the concept of wearing something once then giving it away. This eventually leads to sagging pants, tent-like shirts, and underwear that falls off. Some even suffer from the issue of shoes no longer fitting. (Not a problem I have had, but one that is driving Lor crazy, for example.) So, pay attention! Buy a piece or two that is a size below what your patient should be wearing currently. It will be snug for a bit, then it will fit for a glorious week or two, then it will sag and eventually be donated. If you are afraid to guess at sizes, a gift certificate to an inexpensive clothing store like Old Navy might be your best bet.

2. Supplements: It may not occur to many, but the post-surgery life is flooded in supplements. I, for example, am taking a Multivitamin, an Iron supplement, Biotin, and Osteo-Biflex (a joint health product). That is, like, every single day. Though the grocery bill does diminish a bit after bariatric surgery, the supplement bill goes right through the roof. So, get your patient a month or two worth of one of their supplements. If you aren't comfortable picking brands, grab 'em a gift card to a local GNC or even a CVS/Walgreens type of store. This is the one time that buying a gift certificate to a drug store will not be viewed as a lame last-minute gift idea.

3. Dining Out: Our lives after our surgeries are filled with cooking 3 meals a day, every single day. We no longer go out to eat much, because we are afraid of wasting food. Also, the majority of the places we used to go are what made us obese in the first place. So, take your patient out for lunch or dinner - but take them somewhere they would have never gone before. No burger joints or salad bars, please: try places like seafood and sushi restaurants (sashimi is 100% allowable under most nutritional plans), steak houses, and barbecue pits are all great ideas for high-protein, low-carb dining. Your patient will get a meal with a loved one, plus leftovers to take home. (Trust me, there will be leftovers.)

4. Adventures: The great majority of bariatric patients are recovering from sedentary lifestyles where very little time was spent trying new things. Both physical health problems and embarrassment over their size kept them at home, on the couch. Now that they are taking steps in the right direction, help them out! Get them a hot air balloon ride. Take them to an ice skating rink. Buy a month's worth of dance lessons. If you ever heard them wistfully wish they could try an activity while they were overweight, now is the time to strike - get them through the door of that studio/dojo/museum/whatever. Better yet, go with them - nothing defeats fear of the unknown like having someone to share new experiences with.

Hopefully, somewhere in here is an idea or two you can use for the friend or loved one that has gone through bariatric surgery this year. As they are trying to come to grips with this new life, free from the bonds of chronic obesity, you can show them you support their life-altering decision with nothing more than a thoughtful gift. But act quickly - you only have 22 shopping days left!

No Fruitcakes, Please,

- Hawkwind

Thursday, December 1, 2016

All My Sleeve Wants For Christmas Is...



The activity on the bariatric surgery forums and message boards has been ramping up lately, which is great. I love to see new people joining the ranks, asking questions, and getting plugged into the community. However, any time you get a large number of new folks joining an online "community", there are going to be questions. And, recently, I am seeing the same questions posted over and over and over again: all varying versions of "when can I have/why can't I have (insert forbidden item here?)"

I get it - really, I do. Not every bariatric patient got to participate in the awesome nutritional counseling that Lor and I did with Albuquerque Health Partners. Some folks are forced to self-pay and end up getting their surgeries out of the country, meaning they might receive little to no nutritional info at all. So, in the interests of public service, I thought I would share a little information (and personal experience) about the forbidden foods most commonly asked about.

1. Bread/Pasta/Cereal: By far the most asked about food types on the boards, everyone wants to know why they can't have their favorite go-to-in-a-hurry foods any longer. There are a couple of reasons. First, grain-based products tend to have a very poor protein to volume ratio - 2 ounces (2 standard slices) of bread, for example, contain around 20 - 30 grams of carbohydrates and only 4 or 5 grams of protein. Our lives post bariatric surgery are going to forever be focused on increasing protein intake and minimizing carbohydrate intake, to avoid malnutrition. So, sadly, grain-based products tend to be a non-starter for us.

Secondly, once ingested, bread can expand in the stomach for many of us post surgery (myself included.) This can lead to major discomfort, illness and leads to the inability to ingest anything other than a couple of bites, leading to even bigger nutritional deficiencies. Prepare yourself for life without sourdough bread, lasagna, and Rice Krispies.

2. Bananas: Apparently a very popular subject, bananas hold an odd place within the post-surgery diet. They are a fruit (which the great majority of diets want you to be eating), but they make many bariatric patients ill. What gives?

Bananas, as it turns out, are a natural repository of huge amounts of sugar: one medium banana is worth about 25 grams of carbs, over 15 grams of which is sugar. Strawberries, by comparison, only contain about 7 grams of sugar per serving. Though every patient is different, the higher the amount of "pure" sugar one takes in, the greater the risk of "dumping syndrome": the rapid movement of food from your stomach to your small intestine. One can only find out where the tipping point is by experimentation, but I can tell you from experience that once you go over, you will wish you hadn't. Any high-sugar food, even bananas, needs to be approached cautiously.

3. Soft Drinks: Not a day goes by that I don't read on some forum or another "When can I start drinking cokes again?" Soft drinks may be the most evil and pernicious addiction the world has ever known. So, congratulate yourself, bariatric patients: you have kicked the habit. Because there ain't no goin' back.

Soft drinks, aside from being highly concentrated sugar delivery devices, are also repositories of carbonation, which can seriously compromise your reduced stomach size. How? Open a bottle of your favorite soft drink. Attach a balloon to the neck. Shake vigorously. See how that balloon inflates? That is what happens to your reduced stomach pouch any time you ingest carbonation. It inflates, just as it is designed to do, to accommodate larger-than-normal meals for our berry-gathering ancestors. Will one soft drink ruin your post-surgical condition? Probably not. But, I can tell you from personal experience, ingesting any form of carbonation will hurt like hell. You have been warned.

Now, pour your experimental soft drink down the drain. Don't expose yourself to temptation.

4. Beer: My greatest bariatric surgery regret is that I will never drink Guinness again. It hurts me, deep in the secret places of my heart. But it is a sacrifice I was willing to make, and one that comes up frequently in our discussions with other bariatric patients. So, why no beer?

Firstly, see "no carbonation" just above. Beer is delivered in a carbonated liquid, with all the same drawbacks as soft drinks. (Though better taste, in my opinion.) As much as I love the stuff, I am not willing to inflate my new sleeve repeatedly until I can eat half a cow at one sitting again.

Secondly, beer contains alcohol. (Duh.) And bariatric surgery leaves us very susceptible to the effects of intoxicants - in short, we become cheap dates. I used to be able to put away a 12-pack of beer in the course of an evening. A twelve pack will now most likely put me in the hospital. A single drink of alcohol will have an almost immediate effect, and will then wear off pretty quickly as well. I have yet to start experimenting with this myself but have been able to watch it in others. Be wary of any alcoholic beverage, and avoid any delivered in bubbles.

5. NSAIDS: Post-surgery, pain is a big issue. And many patients are dismayed to find out that their favorite pain relievers are no longer allowed thanks to the changes to their digestive system. Those that have previously taken things like Asprin, Advil, Aleve, Motrin, and other Non-Steroidal Anti-Inflammatory Drugs are informed that these are entirely off the menu and that they need to switch to acetaminophin-based products. Those of us that can't take acetaminophin (like myself) are basically just out of luck.

But, why?

The reduced size of the stomach pouch has many interesting side effects. The one that affects pain relievers is this: a smaller stomach pouch has a reduced size, meaning a smaller amount of stomach acid (for breaking down things like drugs) and a reduced amount of mucus (for protecting the stomach lining against the tissue-damaging effects of things like drugs.) This means that the corrosive side effects of NSAIDS can burn right through the reduced protective layer in your stomach and start directly affecting the walls of the stomach pouch, resulting in things like ulcers. In a large stomach pouch, the side effects are mitigated by the sheer amount of real estate. In our surgically reduced stomachs? Not so much. Switch to Tylenol if you can. If you can't, due to medication interactions like mine, you will have to learn to grin and bear it.

Hopefully, this gives everyone a little clearer idea as to why so many of our favorite things have been seemingly randomly removed from our lives. Just remember - there are a host of healthy food items out there that you have likely not even tried yet. Instead of pining over the comfort foods you have lost, go out and discover some new, healthier ones. I, for one, was happy to trade chocolate chip cookies for the ability to walk  several miles without being in pain. What are you willing to trade your favorite foods for?

Waiting To Trade Whiskey For Beer Next Year,

- Hawkwind

Tuesday, November 29, 2016

Where Has The Polar Bear Gone?

(Image courtesy of Exploratorium.edu)

Winter has totally arrived here in New Mexico - as I sit here (shivering) this morning it is a mind-numbing 27 degrees outside, with the wind chill further reducing conditions to 20. The poor ancient wall heaters in our home keep rumbling into life and trying to keep up, but the fact of the matter is: it is freakin' freezing in here. No amount of socks, sweatshirts, and jackets seem to take the edge off.

I have never in my life been this cold. Which is odd, because I have certainly been in temperatures that were colder. All my adult life, friends and family members have referred to me as a "polar bear" - I have been able to function in, if not exactly enjoy, really cold weather. So, what happened?

The problem, as it turns out, can be traced back to weight loss surgery. 

Part of this is a no-brainer: fat is a natural insulator. Since I have currently lost 29% (and counting) of my weight, I should expect to be 29% colder, right? But I don't feel like the temperature has dropped by a few percentage points. I feel like I am suffering through the heat death of the universe. So, what gives?

As it turns out, there is a second problem with the results of massive weight loss from surgery: the metabolism slows way down. Why? Because it is no longer having to work as hard in keeping blood flowing, oxygen moving, and digestive processes happening. The energy bill for a 3,000 square foot house is going to be much higher than the bill for a 2,000 square foot home. Since the metabolic process generates energy, it also produces heat as a by-product. (Think of how hot a saw blade gets when making a really long cut.) Less metabolic expenditure = less energy used = less heat generated. That's science at work.

The end result is that we now huddle around our heaters, cursing when they turn off. We shuffle around the house in multiple layers of winter clothing, topped off with ski jackets. And at night we huddle closer to one another (which is nice) and fight over who gets to use poor Vixen as a space heater (which is less nice, especially for Vixen.) At this point, I am not even sure that the end is in sight: some say this problem lasts for the first few months after surgery, but other sources claim we will be this way for the rest of our lives. Only time will tell.

In the meantime, we will just have to shiver, bundle up, and take really hot showers on an hourly basis.

On An Ice Floe Waiting For Spring To Come,

- Hawkwind


Monday, November 28, 2016

We Enter The Eye of the Holiday Storm


The ovens are empty, the dishes are (mostly) clean, and the family members have all returned safely home. As we enter the calm before the second chaotic storm that is the Christmas holiday, everything returns mostly to normal.

I had every intention of attempting to put up a post or two during the holiday. Honest, I did. I took my tiny laptop/tablet along with me and everything. But the driving to and fro, the assistance with cooking, the random tech support, and (most importantly) spending time with my nieces and nephews all conspired to keep my hands off the keyboard.

Now, on to the part you are all curious about - how bad was the damage?

Marginal, really. A little too carb heavy, but it was either eat carbs or eat nothing but turkey and ham. No meal weighed in at more than 6 ounces. Where I fell off the wagon was as expected - desserts. Berry, pumpkin, and pecan pies were all available, and I admit I indulged in small amounts of each over the weekend. To offset this we made sure to put in 2 miles every single day, even in the sub-40 degree Northern New Mexico wind.

The final result? I nudged upward 2 tenths of a pound, from 212.2 to 212.4. Nothing "statistically significant", as my father would say. Especially considering the fact that, over the weekend, I was given and fit cleanly into two pairs of 38-inch jeans. Essentially, I came out of Thanksgiving weekend with a smaller waistline than I went into it with. I will count that as a win.

Lor did even better: she actually lost a couple of pounds during the holiday. I ascribe this entirely to her participation in Black Friday - I am sure the crowds, the stress, and the rushing around madly did wonders for her metabolism. I was too cowardly to brave the crowds, and stayed home with my father in law and watched football.

We both are feeling pretty weighed down by the carb load, however, and will be starting a couple days worth of reduced carb eating, just to kind of reset things. Hooray. I fully intend to restabilise and then go into the Christmas holiday well under 210, and hopefully up to 3 miles a day. I have just under 30 days to make this stick. Then I can deal with the second round of Forbidden Foods.

P3s And Protein Shakes Await,

- Hawkwind

Tuesday, November 22, 2016

The Long, Dark Tunnel



Yesterday's article on "Fatbrain" led to some interesting discussions about how major changes in our health can lead to corresponding changes in the character of our lives. Whether the negative effects of a major illness, or the positive effects of recovery from a condition like chronic obesity, the wellness of our bodies has a direct relationship to who we are as people.

I probably have a better understanding of this phenomenon than most. 12 years ago, I developed adult-onset epilepsy. This led to some immediate physical changes, of course: seizures, diminished mental function, and the steep decline into my struggles with obesity, to name a few. But it also led to some very significant changes in who I was as a person. Where previously I was outgoing, I became quiet and reserved. I used to be a performer - a musician, in fact. Post epilepsy I lost all my creative impulse. I used to be fairly confident (some might even say arrogant) about my intellect. Spending years not being able to complete a coherent sentence cured me of that as well. The person that I was before my illness developed was entirely different - my entire personality shifted.

I have recently been able to experience the opposite side of that coin, as the results of my bariatric surgery continue to take hold. This time last year I spent probably 10 or more hours a day in front of my PC. Today that number is closer to 2 or 3 hours a day on average. I had no creative outlet for a very long time - today I am writing on a daily basis. Where I used to never leave the house, I now have a calendar filled with at least one social gathering every single week. Then, I did not exercise: now, I do not drive to any destination within two miles. Another sea change is taking place, once again changing not only my health, by but character - my identity, if you will.

I described the phenomenon to Lor as feeling like I am riding a train: 12 years ago, I entered a railway tunnel as a certain person. I was a musician, an IT guru, divorced, healthy, and financially well-off. Then the lights went out.

Twelve years later, I am no longer any of the things that I was when I entered. The person I will see when the metaphorical lights come back on will be a stranger to me, an entirely new person that I will have to get to know like I would any other new acquaintance. Sure, there is a little fear about this developing relationship. But I think I am more excited about its potential.

In short, the thing I am choosing to focus upon is not that I have been in the tunnel for so long. It is the fact that I can finally see a light at the end of it. And from what I can see as the lights get brighter, I think I already like this person better than the one I left behind all those years and miles of darkness ago.

Not All Change Is Bad,

- Hawkwind

Monday, November 21, 2016

Fatbrain



Welcome to Thanksgiving Week - the official opening of weight gain season for the majority of us here in the U.S. Great food, lousy weather, and depressed energy levels are a killer combination when trying to stay true to your weight loss goals. It takes determination, willpower, and great mental fortitude to succeed. And many of us that have gone through bariatric surgery find mental fortitude to be in short supply.

This problem is widely referred to within our circles as "fatbrain" - the phenomenon that leads us to still perceive ourselves as obese even when we have lost tremendous amounts of weight post surgery.  We don't look in the mirror and see steady improvement in our health and appearance. Somehow, what we see reflected is the same person that we were before we started the weight loss journey. We take the evidence provided by our measurements, our scales, and the feedback of friends and loved ones, and discard it. We still feel overweight, therefore we must still be overweight, despite any evidence to the contrary.

This phase of fatbrain is insidious, and very difficult to overcome. Logging is one of our greatest weapons here - if we know that last year we were able to down a super-sized extra-value meal, and that today we can only manage a couple of ounces of cheese and deli meat, eventually the light begins to come on mentally. We need to pick a metric - a measurement unit that we really understand, and base our progress on that. In my case, I picked a size of clothing that was impossible to fit into in  (38-inch waistline jeans) and kept checking. Amazingly, this last weekend I was able to get into them. I admittedly had to hold my breath to do it, but, hey, 9 months ago I couldn't even get them up past my thighs. Tough to ignore that kind of evidence.

However, I personally have now graduated to a new version of fatbrain - call it Fatbrain 2.0. I now look in the mirror and see the ghost of my previously massive self looking over my shoulder. I am somehow convinced that one bad day will rocket me 90 pounds back up the scale overnight. This sense of dread and paranoia never leaves me. When I don't exercise, I am convinced that I have failed. When I do work out, I am positive I have not done enough. If my weight loss stalls, I am sure that I am done losing weight. If I do lose weight, it must be a coincidence. The wheels inside my head never stop spinning, orbiting forever around the obese identity locked between my ears.

(Sigh.) Ah, well. A little paranoia probably won't do me any harm over the holidays. Whatever it takes to keep me close to the veggie platter and away from the pumpkin pies and whipped cream, right?

Watching Myself Like A

- Hawkwind

Thursday, November 17, 2016

Clothing: The Struggle Is Real



The ever-shrinking wardrobe problem continues: on a daily basis, Lor and I keep getting rid of clothing and not replacing the donated items. Finally, in desperation, we went shopping for clothes yesterday.

And left the store without a single item of clothing.

Here's how it went down: we had a small clothing budget, so we decided to diligently look through sale and clearance price items only. Lor was immediately faced with a supply problem: it seemed the only sizes available were Small and below, or XXL and above. After finally finding a couple of items that might work, she tried them on. Both were rejected and placed back on the racks.

My problem was a little different. I found a few items that would probably have worked, but they were either too expensive ($20+), or too hideous. Camo-pattern jeggings? Not in my closet.

I finally decided to just grab some sweats and call it a day. I found some lightweight sweatpants I could use for exercise going for only $6. And immediately met resistance from Lor, of all places.

Lor: "Those sweats are too small."
Me: "Too small? They are size Large! I am wearing baggy XLs right this second!"
Lor: "The ones you are wearing right now are old, and stretched, and have been worn more than once. The Large ones are too small."

I would've argued the case, but the Regrettable Haircut Incident was still fresh in my mind. Lor tends to be right, I tend to be wrong. It's a thing. So, I put the sweats back on the shelf, and we left the store.

Why didn't I just get a set of XLs, you ask?

Because buying an XL felt like a failure. It made me feel like I must still be "fat". (Word used on purpose, with all negative connotations accepted.) Even thinking about it now makes me feel like I am moving backward.

It is an astonishingly silly way to feel, I know. But I am still looking at my body and focusing on flaws. My previously beach-ball sized tummy has shrunk to about the size of a volleyball, but it is still there. Previously solid muscle still wobbles. And my hair loss...well, you all know what happened there.

After all I have been through, I am still focused on failure, and paying scant attention to progress.

I am not sure how to beat this, in all honesty. I have a very real fear at this point that I will get all the way down to my goal weight, look in the mirror, and think that it was a wasted effort. I simply can't shake my mental identity of obesity yet.

And meanwhile, thanks to the ongoing clothing drama, there is a very real threat that I will show up to Thanksgiving dinner next week naked. 

Now THAT ought to put a damper on everyone's appetite.

Combating Obesity Through Nudity,

- Hawkwind