The Further Adventures of Deluzy

Full to the gills

Go figure the food thing.  I can't.  I'm coming up on my period, and as is typical since WLS, my appetite shrinks drastically in these few days before it hits.

Only as I've said, I'd swear it's not just my appetite but my actual stomach that shrinks: I get that backed-up-in-the-throat, full-to-the-neck feeling that I used to have in the first 6-8 months after my DS when I got full very easily.

Today it happened after my husband and I had gone out for a late Mexican breakfast. I had a small cup of tortilla soup for starters (I ate around the tortillas and took the broth, vegetables, a little melted cheese, and the stewed chicken) and then chile verde. I ate only the stewed pork (which was tender and delicious) and left the rice and beans.  Protein only, in other words.

An hour later, as I was strolling around a local arts and wine fair that's held annually, sipping a bottle of water to stay hydrated, and thinking about walking home, I realized I had that gaggy feeling at the back of my throat. 

WTF?  I was full, certainly, but I hadn't overeaten, eaten too quickly, or not chewed my food thoroughly. 

However, just topping it all off with about half a bottle of water less than an hour later put me over the top.  I made my way home (about a 30-minute trip), walked in the door, and headed directly for the bathroom.  The water came back up immediately, rather as if I were a human fountain, but the meal stayed down. (Fortunately. I wanted to hang on to that protein, thankyouverymuch!)

At other times of the month I can be a bottomless pit and put away large quantities of food, though not as much as I used to.  But right now?  Well, let's just say that I'm sipping a protein shake so as to make sure I hit my protein minimum for the day because it's not going to happen through food alone.

Weight Loss Surgery Without Incisions?

Link: Weight Loss Surgery Without Incisions? It's a First in San Francisco.

StomaphyX™is for patients that have undergone either gastric bypass, vertical sleeve gastrectomy or the duodenal switch and have not reached their goal weight due to setbacks ranging from an expanded pouch to post-operative complications. It is already gaining popularity due to its advantages. "Not only can patients go home the same day, the procedure is approximately 30 minutes and much safer than traditional surgery. There are no incisions inside the organs or outside the skin", according to board-certified Dr. Cirangle, adding "Patients don't have to worry about the complications of the more invasive revisional surgery, such as incisional herniation, infection, adhesions and scarring." Most patients can return to their normal daily routine the next day.

Interesting that this is being marketed toward WLS patients who have either regained or not lost as much weight weight as they want. 

Wonder what the stats are for complications. And for its possible potential to deemphasize the importance of making real changes in eating patterns and lifestyle following any form of WLS in order to achieve long-term success.

I also wonder how many WLS patients will seek out this procedure.

Weekend musings

I've had a relaxing and mildly productive weekend with my husband away on an overnight hang-gliding trip (yes, I worry -- but he used to go every weekend when we first met, and lately he hasn't been in over a year: I think the fact that a fellow hang-glider pilot he knew fell out of the sky and died a couple of years ago, leaving a wife and two little ones, inspired him to scale back -- that, and the fact that he now has a home life that he enjoys with me and the kitties.)

In my husband's absence, I enjoyed having the house to myself (though I'll enjoy having my husband home safe and sound more).  I did a (very) little light house-keeping, tidied up, worked a little (as I am also doing today), and then last night I settled down with a couple of DVDs to try out our new 50" plasma TV screen.  My husband is the one who pushed for it, but I have to say it was kind of wonderful to watch the ever-fabulous Now, Voyager (1942) on it, and even last year's The Invasion, a riff on the 1956 classic Invasion of the Body Snatchers, was more interesting than it would have been on a smaller screen.

Today I've had another reasonably relaxing day, minus the DVD-watching.  Mindful that my PCP told me my protein levels are low, I began the day with a protein shake and a latte, both of which I drank while sitting in the back yard in an Adirondack chair and enjoying the morning sunshine.  Then I threw together a beef stew in the crockpot for dinner tonight and for additional meals later this week.  Protein Central.

Moreover, I've decided it's time to cut out the refined sugar carbs except for an occasional treat once or twice a week -- n minimal amounts -- and to scale back even the  non-sugar carbs.  Popcorn, okay; popcorn and chips, not okay. And so on. I'm serious as a heart attack about not taking my DS and its benefits for granted, and I need to recommit to the basics of DS eating.  I gave myself a B+ the other day on that front -- but I'd like to shoot for an A instead.

Too much information -- seriously

Okay, here's the monthly routine:

• A few days to a week before my period, my weight drops to its monthly low, whatever that happens to be.  Not only do I not feel like eating that much at such times, I feel as if I literally do not have as much room to hold food in me as I do during the rest of the month.

• Directly after my period, I'm constipated. For a few to several days. Minimal shitting, if it occurs at all.  (Most fellow DS patients will understand that this is, er, odd, to say the least. Particularly for me, as I shit like clockwork, each and every morning, usually several times within an hour of getting up.)  Hence, my weight soars, sometimes by as much as 5 or 6 pounds.

• (During my first year out from surgery, I worried that I had an intestinal block at such times. Now I know that it's part of my pattern -- though if I'm feeling stressed and neurotic, I can still whip myself into a frenzy over the possibility.  If I'm not stressing over that, I stress that I'll skyrocket my way back to 280 within, oh, 5-7 days.)

• To add insult to injury, my appetite returns.  I can eat a man with a hollow leg under the table.  Well, almost

• In desperation, I'll occasionally take a dose of a laxative -- Miralax or, rarely, ExLax. No, not because of what the scale says -- that's not my particular trip, though the rapid rise in weight does scare me --  but because the poop's in there, damn it, and surely I'll feel less bloated and stuffed if it comes out.

• Which it does, a day or two later following said dosing of said laxative.

• At which point, my body returns to its regular scheduled programming for the next three weeks or so until we lather, rinse, and repeat a month later.

I so do not remember this particular pattern from my pre-DS days.  However, I was pretty out of touch with my body at the time, and I could gain or lose 5 pounds without blinking an eye. Perhaps it happened then, too, and I just didn't notice the monthly pattern.

These days I notice.

For the record, I'm at that point this month where my appetite has -- presto, change-o -- returned. I have a date with that man with the hollow leg.  Oh, and my body gave up its monthly load of crap today.  Finally.

(See? I told you it was TMI.)

Two data points

Getting to altogether new lows in weight can be scary, I think -- I mean, it's great for someone who's been morbidly obese for the vast majority of her life, but it felt like such unfamiliar territory that I found it unsettling. I think my lowest weight on this WLS journey (for a nano-second only, mind you) was 152-point-something. I stared at that number on the scale as if it were an alien from Mars and felt simultaneously elated and frightened.

Now, of course, I'm in the low 160s (i.e., a few pounds above my stated goal of 159), and I'm just trying to feel my way with that. There's often a well-known "bounce" of up to 20 pounds that happens with my form of weight-loss surgery after initial weight loss and the equally initial period of stabilization (I suppose the actual amount depends on one's basic size and other variables).

Is my current gain part of that? Or not? Is it avoidable? Is the gain okay with me? Is this amount okay, but more would not be? I've lost the hysteria I'd feel when the scale showed 159+.  Is that a Good Thing (in that I'm OCD) or a Bad Thing (in that my OCD kept me in check) -- or, simply Is It, without any kind of value judgment attached?

(How very Zen of me.  How extremely unlikely and unconvincing of me.  I haven't a clue, really, how I'm feeling about this as I write this morning.) Right now I'm simply asking myself where I'm at with the gain (but also obsessing about how I can be more or less newly in a size small in some tops, despite a gain of several pounds?!)

Best not to get too obsessed with numbers, I guess, is one message I need to focus on. The scale is one data point, clothing sizes are variable (notoriously so for women, according to era, fashion, maker) and another set of data points, and then there's fitness (poor), labs (um, gulp -- still need to do those!), and probably others as well.

As with everything else since my DS surgery in December 2005, I'm going to have to feel my way through this phase to see where I'm at and how I feel in my head, my body, and my clothes. I hate that.  I'm a control freak, and I like to  How I Feel and What I Should Do About It.

Whatever "it" is.

Kudos to two WLS bloggers

I've done this before, but as I'm in the mood to procrastinate writing a proposal for a conference paper that's due by the end of the day, I thought I'd do it again -- and that is to point folks in the direction of WLS bloggers whom I consider amazing people and whose blogs are well worth visiting.

I have such admiration for Tia, who began her weight-loss journey at 500+ pounds and has, to my mind, been a model of how to work with her DS surgery to maximize weight loss and health. She blows my mind in her determination and follow-through, and she also seems like a really interesting, successful, head-on-straight kind of person in the rest of her life.

And Jen -- another amazing woman, who had successful RNY weight-loss surgery and then found herself confronting the demons that drove her eating disorder of bulimia.  (Losing the weight really is only the first part of the journey, and I think most WLS patients come to realize that sooner or later.) Jen's a beautiful writer, a creative soul, and she writes from a place of honesty that's bedrock-solid.  That woman is made of damn fine material, and I watch her journey with awe -- a real person going through real shit and coming out real strong in the process.

Check them out if you haven't already.

Blogging about weight-loss surgery

This is one of those days when I've spent the latter part of the afternoon avoiding real work by tweaking my blog -- and bloggers of all varieties out there know what a time-sink that can be! 

Today I'm torn because I don't really think of this blog as being specifically about weight and weight-loss surgery anymore (despite the fact that ultimately it dates back two and a half years and covers my fight for surgery, my experience of surgery itself, recovery, and developing new lifestyle habits for a post-WLS  existence) -- and yet recently I decided to join a few webrings that are specifically focused on weight-loss surgery. (I made this decision just before I found out that the first WLS surgery webring I joined was going belly-up, so it was good timing!) For me, joining webrings about weight-loss surgery  is less about driving traffic to my blog than it is about making it easier for those who are seeking information about WLS to find it.

Still, I worry about it a little. I devoutly hope that people out there don't rely on blogs for their sole -- or even main -- source of information when it comes to weight-loss surgery. (They shouldn't rely on newspaper columns or talk shows or other casual sources of information, either, because good lord the ignorance and inaccuracies that circulate in those arenas are distressing!) Blogs are good providers of anecdotal information, but reading blogs should augment, not replace, the hard work of doing the necessary medical research and determining the choice -- to have surgery or not, to have a particular kind of surgery -- that's right for each  individual.

One of the reasons I have so few photos on this blog (though I do hav a few -- you can click on a link in the left-hand sidebar) is that I myself rarely looked at before and after images when I was researching weight-loss surgery.  Believe me, being a size petite (er, which I'm not, even now!) was not what it was all about for me -- it was about getting a chance to live out a normal lifespan.  At 45 I had out-of-control Type II diabetes, blood pressure, and cholesterol; I was on 9-12 medications (I forget exactly), and they weren't effective; moreover, one of them (the evil Actos) made me gain 30 pounds in three months.  At 5'6" and 280 pounds, I was a walking time bomb, and I was terrified. Was my choice for surgery really all about my health? It sure as shit was.

Now, I won't say that I don't enjoy the change in my looks that has come with the weight loss -- that simply wouldn't be true.  But unlike many who lose lots of weight, I still recognize myself very readily in old photos, even as I recognize myself at my current weight (which is around 160 right now). I didn't hate what I saw in the mirror when I was fat, and I don't love what I see in the mirror now that I'm a normal weight -- I simply see me, though admittedly there are times when I do struggle with seeing myself accurately.

My hesitation in declaring this a weight-loss surgery blog at this point in time has to with the fact that  not only do I write about other matters here, but I also don't like to think of myself as someone who is defined by weight or having had weight-loss surgery -- so in keeping a blog that addresses that experience, am I, in fact, defining myself in that way?  I guess the most accurate answer would be one I don't particularly like -- namely, yes, I am, at least in part.  Weight's always had an impact in and on my life, fat or thin, and the ramifications and health issues that go along with WLS of any kind will be with me for the rest of that life. That's simply a reality.

What I don't want to be is someone who regards her greatest success as having lost weight. You know? That's just so sad and fucked up.  I don't want to be That Girl who apologizes for her former fat self or gloats over her present-day thin self. I don't want to be a WLS patient who's fat-phobic or appearance-obsessed.  Those folks are out there, believe me; some of them are blogging, and they truly sadden me. Sometime they see their own issues clearly; sometimes they don't, and as I've written before, reading their blogs can be like watching a train wreck because sooner or later you know that something else besides weight is going to bite them in the ass -- hard.  Weight -- in excess or in healthy amounts -- simply isn't these people's problem; it's the very least of them, actually, and it always was.

Ah well.  I've certainly had Train Wreck moments in my life -- indeed, for extended periods -- but the issues I refer to here?  They're not mine. I'm neurotic, I'm a tad OCD, I'm insecure and messed up about a lot of things -- but it's with a sense of genuine gratitude that I can say that being fat made me more compassionate, not less, toward myself and others. It's just not a moral issue, not an indicator of worth or self-worth. It's another fact of life -- and sometimes, with a lot of work, help, and luck, facts can be changed.

Eating disorders

Link: Eating disorders not otherwise specified.

I realize this may not be a particularly popular view and also that I'm basing it entirely on anecdotal evidence, casual reading of medical literature, and personal experience -- but I'm coming to believe that the majority of women who battle morbid obesity suffer from clinical eating disorders. Those disorders don't always take the form of anorexia or bulimia -- hence, ED-NOS, or "eating disorders not otherwise specified" -- but they're just as real.

(Actually, this is not a new position for me: I've always believed this.)

Further, those disorders generally don't go away with weight-loss surgery or with the excess weight.  They remain, or they morph into some other variant to accommodate the surgically tweaked body -- but they're still often very much present, and they're usually tied to other, larger issues having to do with control/lack of control, and so on.

Me? I fall into the vague DSM-IV category of "binge eating disorder." even before it existed as a diagnosis.  I do far less binge-eating now than I did prior to surgery, but my point is, the urge is still there and sometimes I still do it, mostly when I'm under stress or in need of comfort.  My choice of foods to binge on has changed somewhat (once in a while I can actually get myself to binge on protein!), as has the quantity -- but when I'm of a mind to do it, I can still put away a considerable amount of food, and I will pay the price the next day (no, not with purging -- that's not my particular form -- but with a surgically tweaked body that will rebel against excess carbs and fat and force me to spend lots of time on the pot).

Like an alcoholic, I suspect I'll always be in recovery from this particular disorder; for me, it's a condition that, like Type II diabetes, goes into remission but isn't cured. (I know, I know: folks say that the DS and other forms of WLS "cure" diabetes.  You'll find that most doctors use the term "remission" instead, and I think that's a more realistic way of looking at it.)

But you know what? That's okay. "Recovery" and "remission" are terms with which I can live and which, to me, imply compassion for human frailty and the vicissitudes of human existence.

Recovery and remission are reasons for hope, not guarantees. And hope is priceless.

A new blog discovery (for me)

Wow.  Dances with DS -- which I clicked onto from Sharon's blog: at 6 years out from her DS, Jane is a great success story, and posts like the following illustrate why (I've taken the liberty of bolding her main points):

A good set of workable boundaries will automatically act as a ‘damage limitation’ structure. ‘Automatic’ is what we should be heading towards because if we feel we are continuing to make huge efforts longer term , it indicates that we may not have given things enough thought.

Here is my workable set of  boundaries which I still live by today:

• Always eat breakfast.
• At any meal: eat my protein FIRST then my veggies, then if I still wanted a simple carb I’d have it.
• Make my protein as tasty as possible. I started using lot’s of different spices and herbs and sauces to give my protein extra zing factor.
• Find out what head hunger is vs real hunger. ( I starved myself for a day to find out what real hunger felt like and boy is it different from the head stuff!). Once you feel it, you will know the difference.
• No food is utterly taboo, but I can only have sweet simple carbs after 8pm in conjunction with a ‘buffering’ snack such as nuts or a bit of cheese. A buffering snack is a way to evade a direct sugar hit on my insulin. Recently I use cinnamon sometimes, as it has been shown to help slow down release of blood glucose.
• Try to figure out my cravings & start to use less harmful food replacements. Chocolate can be replaced with hot chocolate milk. Processed cereals can be replaced with a muesli made of :organic oats, spelt flakes, rye flakes, seeds and nuts. Bread can be replaced with rye bread, or soya-linseed loaves. Desserts can be replaced with hot fruit & creamy yogurt or low fat(for those who follow low fat) ideal milk concoctions that include sugar free jellies perhaps.
• Taking vitamins and minerals is NOT a choice.  It’s a non negotiable daily fact for me. Point blank.

These are really wonderful "workable boundaries," as Jane calls them, and ones that I put in place for myself as well. I've slipped a bit in recent weeks, however, and so her guidelines are a useful reminder.

They're also an illustration of how livable the DS is.  In most cases there are really very few restrictions -- just more or less productive ways of maximizing the results of the surgery itself.

One more reason to be grateful.

There's really only one time when I'm not interested in eating

And that's for the few days before TOM.

This is a new development since weight-loss surgery, I might add. Either that, or I'm much more tuned into my body since my DS (well, that's certainly true) because you pretty much have to be in order to work whatever surgery you choose to its greatest advantage.

Not that I'm a poster child for WLS, by the way: I still screw up plenty with my eating, and in fact I'm using these few days just before my period this month to help me get back on a healthier, more productive DS eating track -- more water and protein, fewer carbs, more exercise.

My weight drops a few pounds during this time each month (that's new, too), and actually I don't think it has to do with the fact that I'm eating less -- I think the weight loss itself is purely hormonal), so between that and the much-diminished appetite (it's not just that, though: it's that I literally cannot eat as much during these few days), it's a good window of opportunity to get back into the groove of good habits. I don't like TOM, mind you, and I will welcome menopause (I'm pretty sure), but I'm grateful for these brief few days when it's easier to reestablish the momentum of good WLS eating habits (and the nature of those habits will vary a bit from surgery to surgery).

It reminds me, on a smaller scale, of the first 6-9 months following the DS itself, when one simply isn't interested in eating that much. For one thing, one can't eat much at the beginning; one's tastebuds change for a period after surgery, and one's too busy adjusting to the surgically tweaked body and learning how to eat again and get in the absolutely necessary nutrition. Even at the time I was very aware that this period was a wonderful opportunity to lay down newer, healthier habits and to establish a firm foundation for later times when old tastes and older habits threatened to return.

And so each month I have a mini-stretch of days where a kind of similar thing happens, and for that I'm very grateful.