Oh yeah, the weight loss thing...

There's not much of note to report on that front. I have continued to eat well and religiously take my vitamins and supplements. I keep my portions small, paying close attention to how full I feel--occasionally I worry about that because I am able to eat more now. Last night, I determined that I have to be wary of the bulk candy at work--they have M&M's and Jelly Bellys in big jars that we can help ourselves to. (I've still never full-on dumped from sugar, but if I eat too much of it, I definitely don't feel too hot--it can result in an unpleasant headache and things have the potential to get stinky--both good deterrents!) They also have protein bars sometimes, which makes me very happy, and we are provided lunch or dinner every day as well. The food is above-average quality, healthy and good for you; it isn't all stuff I can eat, but there is always salad available and at least one type of cooked veggie if I can't tolerate the meat entree (I couldn't last night, for example--it was some kind of Thai pork in peanut sauce and way too spicy for me). I haven't gained any weight, which is all I hope for at this point because I haven't been working out. I feel like things are in a holding pattern because of the swing shift schedule. I don't sleep all in one block of time; I often wake up relatively early and then doze on and off through the morning, setting my alarm clock for noon so I don't oversleep. I know that's not a great way to function, but we only have one bedroom and Mr. Salted is on day shift so it's hard to avoid. The swing shift thing is only going to last another month, so it won't be like this forever. Since I know where I'm going to be working, I can at least find a conveniently located pool I want to use. I'm also not sure about classes this quarter--there is one on two Saturdays that I could do, and two that are online I could possibly do; I need to call the instructors to be sure.

Puree Day 1

I consulted my nutritionist instructions, and it turns out today is the day I can start puree. I had some baby cereal (it was Beech Nut whole wheat with raisin) and it was pretty good (I put some Splenda in it). That was fine.

A couple of hours later, I tried to eat some lunch meat--thin-sliced--and immediately got sick after about four bites. I think it was a mild dumping episode, and it was miserable! Nausea, sweat, dizzy, praying to the porcelain God (and I don't have the knees I used to when my lifestyle necessitated frequent prayers to the P.G.). That will teach me not to look at the label--I bet it had sugar in it. Bleargh.

Overall, I feel somewhat sore and still very tired. The worst of the bruising is beginning to heal and turn interesting colors in the interim, but I can't take any of the bandages off the incisions until I see the surgeons on the 13th. I'm just not up to doing ANYTHING, so most of the time I stay horizontal. Books, TV, and the laptop are keeping me from losing my mind. I feel like I should be doing more, but Mr. Salted says, "You just had major surgery. Just rest." It's hard, though. I hate for him to have to work all day and then come home and do all the chores too.

My ankle surgery has been tentatively scheduled for October 1.

Nutritionist appointment, 5 months in

This picture is from my girls' night out last weekend, not the nutritionist...these were Derby Punches, in honor of the Kentucky Derby--bourbon and lemonade from someone's grandma's recipe. The cool glasses had all the Derby stuff on them and you could buy them for a buck and keep 'em, so I bought mine. I have always wanted to go to the Kentucky Derby just so I could wear the big picture hat, but in reality, I think I just want the hat.

***

I saw my nutritionist Monday. She was very encouraging and told me what a great job I was doing, which felt really good...I just feel like I'm treading water so much of the time. I had lost a couple of pounds, which surprised me because I haven't been exercising (my ankle is still popping and sore--my regular doc is sending me a written referral to have it looked at; one of my tasks for today is to find an orthopedist my insurance covers and to make the appointment). I've stayed within five pounds of what I was when I first went in to see her, but I still weigh less than I did at the beginning.

She praised me for using my time well by joining this group and really trying to get to the bottom of everything within me so I can succeed in the long run, and also complimented me on my food journal--its detail and follow-through. All of this just felt really good; too often, I am caught up in feeling guilty for being unemployed/not productive enough, not to mention overwhelmed by all the emotional stuff I'm working through. She kept saying things like how I was "on it" and "ahead of the game". This was my five-month appointment with her, meaning the six-month one is next month (June 12!) and the pre-op stuff can really begin then, if not before. (Another task for today is to contact the surgical center and see if I need to anything to start the ball rolling, as I know there are some pre-op procedures that need to happen--an abdominal ultrasound, bloodwork, etc.)

We talked about what I would be eating as surgery gets closer. I do not have to do a liquid diet prior to surgery as I had previously thought, but I do have to go to a very low-carb diet two to three weeks prior in order to shrink the liver. Low-carb in this case means a total of 40 total grams of carbohydrates per day. Fiber content can be subtracted against the carbohydrate amount. She gave me a couple of sample menus. The daily fiber goal is 25g, and the daily protein goal is 50g prior to surgery, but 60-80g after.

Thirty days prior to surgery, I will need bloodwork done. I also need to make sure my medications can either be crushed or will be available in a liquid form, and that I have vitamin supplements on tap for after--she recommends Bariatric Advantage.

I thought about getting a book on making baby food for afterward, but she referred me to a pureed diet on the Web through University of Pittsburgh Medical Center under "info for patients". She also said netwellness.org was a good resource for pureed foods information, and lent me Susan Maria Leach's book, "Before and After: Living and Eating Well After Weight Loss Surgery". Apparently this book is like the Bible of weight loss surgery, and the author also has a very comprehensive-looking website--I believe it is bariatriceating.com.

We talked a bit about sugar. I have been fairly successful in giving it up and just using artificial sweeteners. While a lot of programs suggest giving those up as well, I don't think it's realistic for me for any number of reasons. My diet is restrictive enough (and going to be even more so)--I don't want to set myself up to fail. I am not keeping it in the house, which seems to be a key point. Times like this weekend, I am always aware that this could be my last piece of pie or my last whole martini, and I have been enjoying those things in moderation and feeling fairly serene about it.

(Apparently the magic amount of sugar that usually causes dumping syndrome is just over 5g, though she cautioned me that this is not an absolute--some people take one bite of cake and that's it.)

I am going to have to discover all the natural stores in the area, which is previously uncharted territory (except for Trader Joe's). I need to start stocking up on healthy protein drinks, for one. Muscle Milk is one she likes, and Pure Protein drinks is another.

I have been using nutritiondata.com for a lot of my nutritional information for the food journal, but my nutritionist also recommends calorieking.com.

Nutritionist appointment

Just got back from nutritionist appointment #3. I lost (get ready for it) ONE (1) WHOLE FREAKIN' ENTIRE POUND. Two months = five WHOLE FREAKIN' ENTIRE pounds. To spare the expense of paying for a skywriter, whoomp! there it is. A concrete illustration of the reality of insulin resistance, sleep deprivation's effect on the cortisol hormones (I did not sleep one minute last night, fyi), and why I need medical intervention. 60 !@#$%^&* days, and I would say I deprived myself of anything that tasted really good for at least 55 of them.

I do like the nutritionist. She's easy to talk to, reasonable, and realistic. I forgot to turn my phone off and got a text during the appointment--the text ringtone is "Bust a Move", so she started dancing to it in her chair and we had a giggle. She didn't give me too much guff about that ridiculous craving assignment--she said a lot of people didn't even try to do it, at least I had tried. (I didn't try all that hard, it took all my energy to hold back the bile, but she didn't have to know that. I take my positive strokes where I can get 'em.)

She praised my food diary, which I have kept faithfully (grumblegrumblegrumble) and added caloric content when I had it. She recommended a couple of websites, calorieking.com and fitday.com, that have calorie counts on them. The new assignment is to incorporate more protein into the diet and begin to calculate that.

Protein becomes extremely important because immediately after surgery you are only taking in 400-600 calories per day. Post-bypass, the recommended protein intake is 60-80 grams of protein per day, which is a LOT. You're supposed to eat all the protein you need in a day before you eat anything else. I think the low-sugar Instant Breakfast and I are going to become even better friends than we already are. Apparently Atkins makes some protein drinks, and there is one called Muscle Milk that they sell at Costco and Super Supplements. SlimFast and Ensure have too much sugar (I thought I was the only person in the world who gained weight on SlimFast; now I know why I did). Milk, yogurt, cottage cheese, meat, tuna, tofu, peanut butter, nuts, beans, peas, lentils, cheese. She gave me a protein foods list with happy Clip Art illustrations of happy, happy food. Happy.

We talked about the water-drinking requirements for post-op. I'm drinking enough water, it's just how I drink it that is going to be different. You have to drink 16 ounces of water half an hour before eating, not drink anything while you eat, eat the protein first, drink 16 ounces of water after you eat.

We discussed the dreaded dumping syndrome, or specifically, sugar and dumping syndrome. I'll have to post more about dumping syndrome when I have the fortitude to research it further and make an articulate blog entry with some good information in it. Basically from what I gather, if you eat too much sugar, fat, and grease post-gastric bypass, you'll get violently sick. People don't know what foods are going to trigger dumping until they've had the surgery, though some have proven to be universal, and sugar is one of them. Simple sugars are apparently a huge culprit, so even the sugar-free chocolate isn't so hot because the sweeteners used in making it--the sugar alcohol derivatives, such as sorbitol--are catalysts for dumping syndrome. Splenda and aspartame sweeteners do not pose a problem.

She told me I won't be able to use chocolate to cope anymore. She wasn't mean about it, it was just a statement of fact. I told her I seriously thought I was going to need some kind of rehab. She gave me a food addiction website to look at and some sample questions to ask counselors if I got to the point where I could afford to see one. Since money is an issue, maybe a support group would at least provide some balm. It's not the amount of food or even the type of food I eat; it's the relationship I have with it. It sounds so trivial and silly, but it's a very real concern.

Tomorrow, the exercise physiologist. I'm so thrilled (NOT). It looks like I have to see him every time I see her, so, once a month. I'm not doing any more than I have to, and I told them that today.

Re: the disputed psych eval payment--I had to eat the $220 written report fee, but the billing person spent a good half hour on the phone with my insurance while I was there, who are now "reprocessing" the claim for the remaining $300.

Oh yeah, and it's snowing. WTF?