Trail Breaking

Later on this morning, we will head over to visit the folks at ABQ Health Partners Bariatrics for Lor's 6-month post surgery follow-up.

6 months.

Wow.

It does not feel like 6 months ago that we sat nervously in the waiting room, watching the clock as the minutes ticked down to 7:30 AM. The folks from ABQ Bariatrics are nothing if not efficient. By 7:30 we were already in pre-op, getting consultations from an endless series of medical professionals, including Dr. Sanchez. A few minutes later, she was gone, rolled off into surgery to start her new life. 

It all happened so fast.

Today her nightly insulin injections are a thing of the past. She is down 91 pounds and still dropping. Where she used to worry about how inactive we were, she is now concerned that 30 minutes of cardio a day is not enough. She has changed the clothes she wears, changed her hairstyle, changed her life.

I could not be prouder of her.

Though we say we went through this together, in truth Lor was 6 weeks ahead of me the whole way. She was our trailblazer, the pioneer who discovered what was waiting on the far side of each hill and mountain. She was the one who learned the hard way about hydration and nutrition post-surgery. She was the person who tried so hard to get active again after surgery that she injured herself and had to return to bed for several days. She was the one who explained to me about how it felt having doubts about the results of the procedure after it was all said and done.

It has been commented on, by Lor and others, that my surgical experience seemed like smooth sailing compared to Lor's. Well, of course it was. I got to watch first-hand everything to expect in a few weeks. The dark corners that she had to peer into were fully lit and empty by the time I showed up. Every trail had been blazed, every trap in the path ahead had already been sprung and safely pushed aside. If I was successful, it is because Lor showed me how to succeed.

In truth, we don't expect a whole lot of earth-shattering news from today's visit. Maybe some new info on her A1C levels, maybe some additional tweaks to her diet. But, for the most part, the heavy lifting has already been done.

Thanks for breaking trail, babe. It takes courage to go first.

Though I Do Wish The Appointment Wasn't So Early,

- Hawkwind

The "Expanded" Menu

Image courtesy of Marinela Wood

There has been quite a bit of discussion in our household over the past few weeks about the results of my surgery vs. the results of Lor's. For the first two weeks post-surgery, Lor was unable to drink protein shakes consistently, had trouble staying hydrated, and was extremely uncomfortable. Heck, it took her three weeks of recovery before she was even able to finish a single container of yogurt.

I, on the other hand, have had no such restrictions. I was able to down a full yogurt container the day after I got home from the hospital. I am able to drink an entire water bottle in under 10 minutes (if I am not paying attention) without any discomfort. I even re-started several oral medications a few days early (with my surgical staff's permission, mind you), again, without any kind of feeling of blockage.

Being myself, I developed a fabulous conspiracy theory: I had not actually undergone the surgery. They had just taken me back to the operating room, punched 5 holes in my abdomen, pumped me full of gas, and then left the OR for an early lunch. It was the only reasonable explanation for why I was having none of the diet-related side effects I had been warned about (and that Lor was experiencing.)

Silly conspiracy theories aside, it was obvious something was different between the two of us, so I went into yesterday's appointment full of confidence and optimism. Maybe I wouldn't even have to go through the soft foods phase since I was doing so well! They might put a little gold star on my chart and release me into the world of steak and lobster!

Turns out Dr. Tyner was not so impressed with my abilities to power through liquids like a boss. His theory was that I was being affected by luck, not extraordinary healing skills. People's internal organs swell at a different rate post-surgery, and while he thought Lor had gone through a normal "swelling" phase, I had gone through a reduced amount of swelling, giving enough room in my innards for liquids to shoot right through the system, I was going to run into a serious roadblock the minute I tried solid foods, even soft ones.

I left the doctor's office with the clearance to start on soft foods and a firm admonishment by our nutritionist to really bear down on protein intake - things had gone so easily for me up to this point, I was really going to have to change my thinking about intake. I left with my head held high, confident that my previous experience of the last 2 weeks was going to repeat itself, that no matter how much I ate, I would be able to handle it.

Turns out that there is a reason that I am not a doctor and Dr. Tyner is.

My first soft-foods meal, 2 tablespoons of scrambled eggs and ricotta, with a tablespoon of mashed banana, had the exact effect I anticipated - no problem ingesting, no feeling of fullness. I began to privately speculate about potentially ingesting more than the mandated "3 Tablespoon" meal size.

Then dinner arrived. 2 tablespoons of salmon, and 2 slices of avocado. I obeyed all the rules, putting the fork down between bites, chewing thoroughly, waiting at least a full minute between bites. I noticed immediately that the salmon had some texture and density to it that my first meal hadn't. 2 Tablespoons took me over 20 minutes to eat. But I still wasn't full! Gleefully, I dove into the avocado.

2 bites in, I suddenly had a problem. I literally felt as if someone had pushed a cork into my esophagus, right where it enters the stomach. I instantly was aware that, not only could I not have taken another bite, but it was going to take some serious focus to not revisit the last 20+ minutes worth of work heading the other direction. So, apparently, I had undergone the surgery after all. Bummer.

To complete my disheartening discoveries, I punched in my day's intake into my Bariatastic app and found out some really bad news. My new "soft food" diet had resulted in only 35 grams of protein all day long. Epic fail.

I guess protein shakes and I haven't broken up yet after all.

Not Entirely The Results I Was Looking For,

- Hawkwind

Time To Get A Move On!

Photo Credit: One Candle Photos via Compfight cc

In the midst of preparing for my exit from the all-liquid diet in a couple days, I have also noticed a curious impatience within myself - not necessarily to start eating again (though that is a major factor), but to be done.  Not to be finished with my new lifestyle and eating patterns, mind you - unless I fall off the wagon and stay there, these changes should be life-long. But to actually feel like I have accomplished something.

I know, I know - I have already dropped 60+ pounds. My clothes are falling off my body as I walk around the house. I haven't needed my knee brace since I came home from the hospital. These are all positive and laudable things. I get that.

But, when I look in the mirror, nothing looks any different to me. When I look at Lor, I can see major positive changes to her body. (Hoo, boy, can I ever.) I look at myself in the mirror and see only that my face is showing more wrinkles and I am losing my hair. I mean, seriously  - at 240 pounds, I am still 80 pounds overweight. So, yeah. I am starting to get a little impatient.

The surgical recovery period isn't helping my mental state any. I am still not permitted to move anything heavier than 10 pounds, and boy does it show. My arms and legs have never been flabbier. My sleep patterns are shot. (I started working on this article at 3 AM, for example.) And my blood pressure, which we had really hoped would be addressed by the surgery, has skyrocketed the last few days, and I am back on blood pressure meds. Very disappointing.

The walking is getting better, at least. Last night should've been our first 1-mile walk since our surgeries, but we were interrupted by rain and a power outage across the neighborhood. Even so, we managed half a mile of walking just running errands and grocery shopping, so the day wasn't a total loss. Today we'll get a mile. By the beginning of next week, we'll probably be up to a mile and a half a day. (We're adding about a tenth of a mile every day.) But even yesterday, unloading groceries from the car (one bag at a time, mind you), I could feel twinges from my incision sites. The fact that everything is not healed up yet is really frustrating to me, despite the fact that I am only 2 weeks out from surgery today.

In a way, it is reminiscent of being a child and counting down that last month until Christmas or Summer vacation - every hour that passes takes a day, every week that passes seems like a month. I am so ready to be able to eat real food, to work out, to look in the mirror and actually see someone different. Encouragement from everyone around me has been awesome - but there is still my personal sense that I am only wearing the Emperor's New Clothes. I am ready for something more tangible.

Let's Get This Show On The Road,

- Hawkwind

The Return of the Five-Toed Sloth

Photo Credit: Michelleyyy via Compfight cc

10 days out from surgery, and today I am a complete wreck. I am hunched over as if I were 92 years old with osteoporosis. My shoulders burn as if I threw a 100+ pitch baseball game last night. The top of my abdomen radiates pain whenever I walk or shift in my chair.

I must've really hit the weights yesterday, right? Started my new ultra-marathon workout a few weeks too early, tried kayaking for the first time, or something of equal exertion to have this kind of physical reaction the next day?

Yeah, actually I walked 3/4 of a mile last night.

Now, mind you, this is an improvement from the previous night, where we only covered .65 of a mile. But still, man. I can not believe that 2 months ago we were walking 2 miles every day and were discussing ways to disengage the dog from our walks so we could really start stretching things out. Even after Lor's surgery, I was still managing 1+ mile walks with the dog every day, even during the pre-surgical "all liquids/no-calories" phase. Now after two days of walking back-to-back, I am ready to take pain meds, call the chiropractor, and sign up for reconstructive surgery. On my entire body, mind you.

We fail to understand (at least I did) just how important the "core" muscles in our midsection really are. There is a reason baseball players, marathoners, divers, etc. pay so much attention to things like pilates, yoga, and other core-strengthening exercises. Those muscles which are currently hunching me forward are the attachment points for all the other musculature in the body - the things that enable us to synergise what is happening in our lower bodies with what we are doing with our upper bodies and arms. And, now that I have 5 slowly mending holes in those core muscles, I am feeling the effects everywhere else in my physique as muscles that used to be gaining traction from elsewhere in my body are being forced to "go it alone" as it were. Isolation exercises, but not in a good way.

The speed is the really depressing part. Right before our back-to-back surgeries we were just a few seconds off from averaging 20-minute miles. It may not sound like much to the athletes among you, but for mere mortals like me sustaining a 3 mile-per-hour pace over multiple miles is really good. Now I am back to managing only three-quarters of a mile in 22 minutes. I have a loooong way to go. Even the dog is starting to look back over her shoulder at me, wondering why I am taking so long to get anywhere.

I originally had grand visions of heading straight back into the gym in 3 weeks, right after my 1-month post-op appointment clears me for resistance exercise. Considering how my arms and shoulders feel today, from the mere effort of moving them back and forth as I walk around the neighborhood, I may have to reconsider that notion. My sagging pecs, drooping triceps and shrinking quads are making me think that I might go in to set my max reps on the first day and fail to move a single weight. After leaving the gym in shame, I will be reduced to lying on the living room floor and bench pressing handfuls of lint I find under the couch.

But, on a positive note, I have not yet given into temptation and eaten the dog. So there's that, I suppose.

Six Days 'Til Scrambled Eggs,

- Hawkwind

Are We There Yet?

Image courtesy of NPR.

Now that the chaos and madness of the closing have passed, and Lor and I are officially home owners, we can return to the subject that really matters to me currently: food.

Specifically, the lack of it.

I am 8 days out from my vertical sleeve procedure, and I must admit that the "no chewing" thing is really getting old. I have been fortunate enough that I have not fallen into hating protein shakes, like many other bariatric patients do, but getting 100% of my nutrition in liquid form is really starting to wear on me. You know things are bad when you are feeding the dog and are speculating about the taste and consistency of her hard dog food.

See, that's the thing - I am not really hungry, per se. I am not craving food so much as I am craving texture. I want so badly to actually chew something, not just drink it. If I was given a handful of cucumber slices or almonds to chomp on currently I would think I had died and gone to heaven.

Following which I would probably end up in the Emergency Room of the closest hospital, of course. 8 days isn't enough time for your internal staple line to have healed up. I am not saying there isn't a reason for the "liquids-only" restriction. I am just saying that it is slowly driving me crazy.

I have started leaving the room whenever Lor eats her meals during the day - not because it bothers me to see her eat, but because the way I am staring intently at everything she puts in her mouth is making her uncomfortable. She is designing beautiful small meals filled with deli meats, cheeses, and fresh vegetables, and I am sitting there working on my 26th Muscle Milk shake in a row. (Believe me, I counted.) She cooked half a pound of bacon the other day and the smell filled the entire house. I almost ate a pillow to keep from crying in frustration.

But the real injustice of it all is this - Lor got to have her 2-week post-op appointment (the one where you "graduate" from shakes to soft foods) exactly 14 days after her surgery. Due to scheduling issues, mine will not be next Monday, as it should have been, but will instead be next Wednesday - 16 days after my surgery! I will be forced to spend 2 extra days sucking down protein shakes instead of moving on to semi-solid foods like scrambled eggs, refried beans, and Ricotta cheese. 

The injustice of it all is unbearable.

For those of you shaking your heads at me in amusement, go eat nothing but protein shakes for 22 days in a row. Then we'll talk.

If I See One More Sugar-Free Popsicle I May Scream,

- Hawkwind

I Made It Out Alive!

The breakfast of post-bariatric surgery patients!

We have officially made it through surgery!

After 6 months of waiting, diet changes, and emotional roller-coasting, at about 9 AM local time yesterday, the greater curvature of my stomach was removed. The struggle made manifest, the dream is real, and any other pithy sayings I can come up with may be applied, In short: we are done,

The surgery itself went pretty well, i am informed by my surgeon The aftermath was a little chaotic, though. In recovery I was in agony from gas pressure from all the various gases pumped into my body during the procedure. My inflated abdomen was so distended that it was pushing on my incisions from the inside out. In my post-surgical logic, I asked both Lor and the recovery nurse for a pen or pencil, so i could put my own hole in my abdomen to release the painful gasses. They declined my request.

The incisions themselves are not nearly as dramatic looking as Lor's were. I don't look like i have been in a knife fight - I look more like I made poor life choices involving climbing a barbed-wire fence.  The holes themselves are still very painful, but the nursing staff here have kept right on top of administering pain meds, so the majority of the time I just don't care about the pain.

My surgeon has already been in to see me, and informs me that i could be released as soon as tomorrow morning if i stick with the program here. Doing everything i can to get home soon is foremost on my mind. Though the staff here are awesome, it is still a hospital, and I do not like hanging out in them. The sooner I get home, the better.

The real mind-blower came while visiting with my parents yesterday. Apparently, Dr. Tyner went out to meet my family after the procedure was done, and made the observation that since I had done so well in my weeks of prep before the surgery, he would not be surprised if I lost 100 more pounds post-surgery.

Let that number sink in for a minute.

Another 100 pounds down would leave me at 148 pounds. This is what i weighed at 16. Pretty sure that, whatever my "goal weight" ends up being, it will not be that low.

But, boy, the concept of weighing in at 180 at the end of this all? That is pretty remarkable.
Sorry for the later than normal update today. I have spending most my time walking around the hospital or sleeping, We will catch you all again on Thursday!

Now, How Long Before I Get Back To Solid Foods?

- Hawkwind

The Mathematics of Post-Surgery Diet

Photo Credit: Rain Rabbit via Compfight cc

The joy over getting to eat "real food" again didn't last very long here, now that reality has set in. And the reality is: 2 Tablespoons of protein based food and 1 Tablespoon of "Other" does not a meal make.

Consider the simple mathematics here. One of our favorite dishes has been the "Frittatas" that Lor has been making for a couple months now. Essentially crust-less quiches, they are little baked disks of egg that I originally discovered at The World According To Eggface. These tasty treats can be filled with any number of things, making them a perfect post-surgery food.

However, when they contain nothing but egg and cheese (all that is allowed in Stage 3 of post-surgery recovery)...their nutritional value drops pretty dramatically. Consider the numbers: One large egg works out to about 6 grams of protein. One cup of shredded "Mexican Blend" cheese contains about 24 grams of protein. A frittata recipe calls for 4 eggs (24 grams of protein) and 4 ounces of cheese (12 grams of protein). This mixture is then ladled into a mini-muffin pan, containing receptacles for 24 mini-muffins. 36 grams of protein, divided by 24 frittatas works out to around 1.5 grams of protein per frittata.

A recently surgically reduced stomach can handle usually 1, maybe 2 of these little guys.

Have you spotted the problem yet?

3 grams of protein, multiplied by 3 meals per day = not nearly enough protein intake for the day. A full day's worth of protein for Lor, measured in frittatas, would work out to 42 of them. No way to handle THAT load post-surgery.

OK, so let's just do the egg stuff for breakfast, instead of all day. How about we have some canned chicken for lunch instead? A serving of canned chicken, happily, is 2 ounces - just about the amount a post-surgical tummy can handle. 2 ounces of canned chicken works out to 9 grams of protein. You can dress it up, maybe, add some mayo or some chopped celery or something, but at the end of the day, 9 grams of protein is what you are going to get.

So, Breakfast of 2 frittatas = 3 grams of protein. 2 ounces of (hopefully decorated) canned chicken = 9 grams of protein. That brings us to 12 grams for the day. Dinner had better bring it hard.

So, let's select something that we are always reading about as a "natural super-food": Salmon. Surely, some canned salmon for dinner will totally get this daily diet done, right? Let's see...a serving of canned salmon is...3 ounces. Ouch. That is never going to work, not immediately post surgery. Let's cut that number in half then, try to work our way through 1.5 ounces instead. A full serving of canned salmon would be...hey! "17.5 grams of protein"! Excellent!

Oh...right. Right. We're only eating half a serving. OK, so 8.75 grams of protein for 1.5 ounces. Less than canned chicken, then. Depressing. So Breakfast was 3 grams of protein, Lunch was 9 grams, Dinner is 8.75 grams. 20.75 grams of protein, total. 

So, that was depressing. Where else can we get some protein...oh, right! Snacks!! We get two yogurts a day, too! So, let's grab a yogurt for each of our snacks during the day. Each of our Dannon Greek yogurts is worth...12 grams of protein. So, 2 yogurts works out to 24 grams of protein! Which brings us to a total of...44 grams of protein for the day. Out of a requirement of 60 grams a day for Lor.

Well. That sucks.

Guess we are not done with those freakin' protein shakes just yet after all.

Wondering How I Am Going To Manage 100 Grams A Day When It Is My Turn,

- Hawkwind