My last day of work pre-op was yesterday. Everyone was very sweet. People keep asking me if I'm excited, but I don't know if that's the right word. I'm a whole lot of things--freaked out, scared, resigned, hopeful. The potential of a good outcome excites me, but really, it's hard to be excited at the thought of getting your intestines re-routed and living on liquids for several weeks. A couple of people have given me cards, which I appreciate. I know I will look at them when I'm feeling gross and they will cheer me up somewhat. People are either acting like this is something horrible or just ignoring the significance of it, never the twain shall meet, it seems. It's interesting. I don't want to plan much of anything for the next few weeks because I just don't know how I'm going to feel, and then I have the ankle surgery and CAN'T plan anything.
It has been insanely hot for the Pacific Northwest, in the triple digits at times. It was 105 in my car yesterday on the way home. I did the pre-op phone call with the hospital and my first question was "is it air-conditioned?" They don't want me wearing even my wedding ring to surgery, which I don't like, but I guess I understand their reasoning. I can always have Mr. Salted hold it for me and give it to me when I'm in the room, after the procedure. It's a simple band--no one is going to shake me down for it.
I've been stocking up on everything, and trying to think of everything in advance. I need to order some more vitamin supplements. I went and put in the prescriptions for the post-op drugs in at Walgreen's--I think it was Valium, Dilaudid and Prilosec/omeprazole. I get Valium and Dilaudid because I'm allergic to everything with codeine or synthetic codeine, so I can't do Percocet, Vicodin, Oxycodone, Hydrocodone, Darvocet, etc. I have to wear a scopolamine patch for 24 hours before surgery; that's to offset nausea, apparently.
I decided--given the very real possibility of hair loss--to go back to my natural color, so I'm having that done tomorrow. I'm not thrilled about it, but it will be one less thing to worry about, and I want to see what my hair is going to do before I dye it any more. (I just hate my natural color because I think I look more like my father when I have it, so maybe it will be a good lesson in self-acceptance for me.) I also bought about six bandannas at Walgreen's--99 cents each, what a bargain! (A friend of mine told me to buy some cute scarves and rock it like Rhoda. That's the plan.) There is a lot of baldness and alopecia in my family, and a lot of thin hair. I'm one of the latter.
I have not done real well on this low-carb thing. They told me 40g per day, but good days have been more like 50 or 60 carbs. I *totally* blew it yesterday--that was the only day I really have. Someone brought in a huge bag of peanut M&Ms, and I probably ate thirty of them before I could make myself quit. (I don't know how I'm going to leave that stuff alone--I'm hoping that knowing I will get violently ill is going to do it.) All I wanted for dinner was mashed potatoes, so I had some with crumbled bacon in them. (They were sooooo good.) But I haven't eaten any bread or cake or rice or pasta this whole time, and I'm trying to maintain the low-carby thing for the today and the next three. I have actually lost about five pounds just in the last week and a half. (No wonder I'm so tired.)
I gave some of my extra-big clothes away. That felt good. I'm looking forward to getting rid of more of them.
Showing posts with label pre-op diet. Show all posts
Showing posts with label pre-op diet. Show all posts
Thursday, July 30, 2009
Tuesday, July 21, 2009
Pre-Op Nutrition Class
Talk about information overload. A lot of it was review for me, but I took Mr. Salted and I thought the poor man's head would explode. We both felt he needed to be there, though. I'll hit the highlights:
1) I have to limit sugar to 5 grams or less per serving to prevent dumping. In milk and yogurt, sugar must be limited to 12 grams or less per serving. I asked why this varied, and the nutritionist said the sugar was different--natural--and was processed differently by the body.
2) I am now in low-carb hell until my surgery date (August 3), when I just don't eat at all for a few days, they give me IV nutrition, and I drink a lot of fluids. Today's forecast: abject terror with scattered feelings of panic. If I go over my allotted 40g of carbs per day for the next two weeks--which I don't think even a beetle can live on for any length of time--I am to do it in the nonstarchy vegetables category. Nonstarchy vegetables include green beans, beets, broccoli, carrots, cauliflower, mushrooms, spinach, zucchini and tomatoes.
3) I can only have one serving of fruit per day because it has so many carbs. (One serving of fruit = at least 15 carbs. Sigh. I already had a banana this morning, so that's it for today.)
4) Clear liquids start the day of surgery and the following day. At first, I will probably only be given water in a medicine cup. This gives the stomach time to recover from surgery. The best fluids are liquid at room temperature and do not contain residue, sugar, caffeine or carbonation--sometimes room temperature is just easier to take than cold. I will need to sip continuously, but slowly, and not use a straw. Hydration is extremely important, and my post-op liquid intake goal is to drink one ounce over a 15-minute time span, and the equivalent of 48 ounces or six cups per day. I can have water, ice chips, broth, sugar-free Jello and popsicles, and beverages like Crystal Light, Diet Snapple, and Diet V-8 Splash as long as they are caffeine-free and non-carbonated.
5) Full/liquids will be the week following surgery. All of these timelines will vary depending on doctor's orders. The goal of full/liquids is to transition between clear liquids and pureed diet. I will need to take 2 Bariatric Advantage multivitamins and one sublingual (dissolves under the tongue) B12, which aids the intrinsic factor and promotes proper digestion. If there is any numbness or tingling in the feet and hands, I'm supposed to let everyone know ASAP. My recommended daily allowances (RDAs) are 60-80 grams MINIMUM protein, low fat, sugar free or reduced carbs, and 48-64 ounces, or 6 to 8 cups of fluid per day. The foods I am allowed during this period include protein drinks such as Zero Carb Isopure (GNC carries them), Atkins shakes, Pure Protein shakes (they sell these in cans at Trader Joe's), Matrix, Nectar (available at bariatriceating.com) and Unjury (unjury.com), which also carries a high-protein chicken broth. I can have fat-free or 1% milk, Lactaid milk, and soy milk such as Soy Slender (available at Albertson's). I can have reduced-fat cream soups except for tomato and should add nonfat dry milk powder or unflavored protein powder to them. I can also have light, low-carb or plain yogurt if it has no fruit pieces or sugar-free pudding if it has been thinned with a little extra milk. I need to blend and/or strain any soups so they do not contain particles.
6) Some people develop lactose intolerance after this surgery. In this case, I should choose soy protein, spirulina types of protein, or whey protein ISOLATE. Whey protein CONCENTRATE contains lactose and should be avoided. I went ahead and bought a big can of protein powder made with whey protein ISOLATE at Trader Joe's yesterday, and the price wasn't bad--$12.99.
Protein drinks need to be low in sugar, calories and fat.
7) Getting protein and fluids in are my two main goals. I won't know what I can tolerate until after surgery, so I have to roll with it in many cases. Things I like now might be disgusting to me afterward. I also learned that I might have hair loss (the good news keeps on coming), so pushing the protein can help with that.
8) About 10 days after surgery, the pureed diet begins. The goal of the pureed diet is to transition between full liquid diet and the mechanical soft diet. Calcium and magnesium becomes very important and I will need to take in 500/600 mg three times per day. Tropical and Lifetime are two of the brands she showed me for liquid supplements of this nature, and Bariatric Advantage has some chocolate calcium citrate chews that I like. All food should have the consistency of baby food, and the suggested portion size to start with is 1/4 cup. The fluid intake goal rises to 8 cups per day during this phase, and the RDA of protein remains at 60 to 80 grams per day. (Now that I've heard about that hair loss thing, I'll be doubling it, fear not.) This is also where I need to keep beverages separate from food--no liquids 20-30 minutes before or after solid foods.
The nutritionist discourages scrambled eggs during the pureed phase; meat can be pureed with broth or gravy and added to soups, though red meat should be avoided. Small-curd cottage cheese is okay or yogurt without fruit pieces. Nothing should contain nuts or seeds. Strained or pureed vegetables are fine, but peas and corn should be avoided as they do not puree completely and may get caught in the pouch. Malt O' Meal, Cream of Wheat, or Cream of Rice is okay, as is baby cereal, but no oatmeal, rice, or pasta. Mashed potatoes should be okay. Recommended foods include: pates, hummus, refried beans thinned with broth, pureed chili with melted cheese, pureed sloppy Joe mixture over mashed potatoes, unsweetened applesauce, or fruit smoothies with protein powder. Bariatriceating.com has many good recipes, including pureed foods.
9) The mechanical soft/mushy diet starts two weeks or so after surgery and continues until the end of the August. This phase includes foods that are tender and easy to chew. They don't need to be pureed, and may include such things as ground meats, moist tuna salad, egg salad, chicken salad, bananas, and steamed fruits. Sugar and fats should still be avoided, and protein needs to be eaten first. Stringy foods like broccoli, celery and asparagus stalks need to be avoided, as does red meat. Texture examples include eggs scrambled with milk, soft ripe fruits without skin or seeds, and crackers. A meal is somewhere between 1/4 cup and 1/2 cup of food and should take 20 to 45 minutes to finish.
10) About a month out from surgery, many of the same guidelines apply. I can begin to eat salad, but need to continue to keep liquids and solids separate and eat protein first to ensure I have room for them. I also need to start with softer raw vegetables and work up to crisper ones. I need to avoid crisp or sharp edges on meat, and teriyaki or barbecue sauces, as they contain sugar. It may be hard to tolerate fruits with stringy membranes such as oranges, and juice and sweetened beverages will need to be avoided for the rest of my life. When choosing grains and cereals, I need to steer toward whole-grain carbs (wheat crackers, brown rice). Saturated fats will need to be limited, and simple sugars are always to be avoided. Carbonated drinks should be avoided permanently as well. They cause bloating and studies have shown that people who continue to drink them tend to lose less weight.
11) I will need to take something like Prilosec for the first couple of months. Taking vitamins with coffee or tea interferes with their absorption.
The basic guidelines to follow are:
Slow down, chew everything to the texture of applesauce
Eat protein foods first
Separate beverages from food 30 minutes before and after eating
Take all vitamins and supplements
12) Regular bone density scans are suggested if possible.
13) Dumping syndrome is a reaction to sugar, sugar alcohols, high fat foods, or alcohol after gastric bypass surgery. The symptoms may include abdominal cramping, sweating, nausea, dizziness, headaches, diarrhea and weakness, "Early" dumping syndrome may occur within 15 minutes after eating and is often associated with diarrhea. "Late" dumping syndrome can occur up to 4 hours after eating and feels more like having low blood sugar. Acceptable sugar substitutes include Splenda, Equal, Sweet 'n Low, aspartame, saccharin, and Nutrasweet.
14) Food intolerances vary from one person to another, and what tastes good before surgery is often different from one tastes good afterward. Using the baby utensils can help with remembering to take small bites and chew them well. If vomiting occurs, it may help to return to clear liquids for a couple of days. Don't avoid healthy foods that cause vomiting--wait a week and try the food again. (Oh joy!) Try food at different temperatures, and add a meat tenderizer to meat or poultry if it is not being tolerated well. Constipation may occur, and no fiber supplements are allowed until six weeks out from surgery. Milk of magnesia, stool softener, or Probiotic pills (available at Walgreen's) can be helpful. Beano and Gas-X can be used for gas. Bad breath can occur from the body being in a state of ketosis post-op, and if this happens, gum should be avoided (in case it is swallowed accidentally). Bad breath typically improves over time as the diet becomes more varied.
15) Don't drink with a straw. Stop eating when you feel full. Don't lift anything heavier than a grocery bag, and no swimming for 4-6 weeks when the incisions heal.
Now that I have summarized all that, I think I need to go lie down. No wonder Mr. Salted's eyes glazed over...damn! I have my final pre-surgery consultation with the surgeons today.
1) I have to limit sugar to 5 grams or less per serving to prevent dumping. In milk and yogurt, sugar must be limited to 12 grams or less per serving. I asked why this varied, and the nutritionist said the sugar was different--natural--and was processed differently by the body.
2) I am now in low-carb hell until my surgery date (August 3), when I just don't eat at all for a few days, they give me IV nutrition, and I drink a lot of fluids. Today's forecast: abject terror with scattered feelings of panic. If I go over my allotted 40g of carbs per day for the next two weeks--which I don't think even a beetle can live on for any length of time--I am to do it in the nonstarchy vegetables category. Nonstarchy vegetables include green beans, beets, broccoli, carrots, cauliflower, mushrooms, spinach, zucchini and tomatoes.
3) I can only have one serving of fruit per day because it has so many carbs. (One serving of fruit = at least 15 carbs. Sigh. I already had a banana this morning, so that's it for today.)
4) Clear liquids start the day of surgery and the following day. At first, I will probably only be given water in a medicine cup. This gives the stomach time to recover from surgery. The best fluids are liquid at room temperature and do not contain residue, sugar, caffeine or carbonation--sometimes room temperature is just easier to take than cold. I will need to sip continuously, but slowly, and not use a straw. Hydration is extremely important, and my post-op liquid intake goal is to drink one ounce over a 15-minute time span, and the equivalent of 48 ounces or six cups per day. I can have water, ice chips, broth, sugar-free Jello and popsicles, and beverages like Crystal Light, Diet Snapple, and Diet V-8 Splash as long as they are caffeine-free and non-carbonated.
5) Full/liquids will be the week following surgery. All of these timelines will vary depending on doctor's orders. The goal of full/liquids is to transition between clear liquids and pureed diet. I will need to take 2 Bariatric Advantage multivitamins and one sublingual (dissolves under the tongue) B12, which aids the intrinsic factor and promotes proper digestion. If there is any numbness or tingling in the feet and hands, I'm supposed to let everyone know ASAP. My recommended daily allowances (RDAs) are 60-80 grams MINIMUM protein, low fat, sugar free or reduced carbs, and 48-64 ounces, or 6 to 8 cups of fluid per day. The foods I am allowed during this period include protein drinks such as Zero Carb Isopure (GNC carries them), Atkins shakes, Pure Protein shakes (they sell these in cans at Trader Joe's), Matrix, Nectar (available at bariatriceating.com) and Unjury (unjury.com), which also carries a high-protein chicken broth. I can have fat-free or 1% milk, Lactaid milk, and soy milk such as Soy Slender (available at Albertson's). I can have reduced-fat cream soups except for tomato and should add nonfat dry milk powder or unflavored protein powder to them. I can also have light, low-carb or plain yogurt if it has no fruit pieces or sugar-free pudding if it has been thinned with a little extra milk. I need to blend and/or strain any soups so they do not contain particles.
6) Some people develop lactose intolerance after this surgery. In this case, I should choose soy protein, spirulina types of protein, or whey protein ISOLATE. Whey protein CONCENTRATE contains lactose and should be avoided. I went ahead and bought a big can of protein powder made with whey protein ISOLATE at Trader Joe's yesterday, and the price wasn't bad--$12.99.
Protein drinks need to be low in sugar, calories and fat.
7) Getting protein and fluids in are my two main goals. I won't know what I can tolerate until after surgery, so I have to roll with it in many cases. Things I like now might be disgusting to me afterward. I also learned that I might have hair loss (the good news keeps on coming), so pushing the protein can help with that.
8) About 10 days after surgery, the pureed diet begins. The goal of the pureed diet is to transition between full liquid diet and the mechanical soft diet. Calcium and magnesium becomes very important and I will need to take in 500/600 mg three times per day. Tropical and Lifetime are two of the brands she showed me for liquid supplements of this nature, and Bariatric Advantage has some chocolate calcium citrate chews that I like. All food should have the consistency of baby food, and the suggested portion size to start with is 1/4 cup. The fluid intake goal rises to 8 cups per day during this phase, and the RDA of protein remains at 60 to 80 grams per day. (Now that I've heard about that hair loss thing, I'll be doubling it, fear not.) This is also where I need to keep beverages separate from food--no liquids 20-30 minutes before or after solid foods.
The nutritionist discourages scrambled eggs during the pureed phase; meat can be pureed with broth or gravy and added to soups, though red meat should be avoided. Small-curd cottage cheese is okay or yogurt without fruit pieces. Nothing should contain nuts or seeds. Strained or pureed vegetables are fine, but peas and corn should be avoided as they do not puree completely and may get caught in the pouch. Malt O' Meal, Cream of Wheat, or Cream of Rice is okay, as is baby cereal, but no oatmeal, rice, or pasta. Mashed potatoes should be okay. Recommended foods include: pates, hummus, refried beans thinned with broth, pureed chili with melted cheese, pureed sloppy Joe mixture over mashed potatoes, unsweetened applesauce, or fruit smoothies with protein powder. Bariatriceating.com has many good recipes, including pureed foods.
9) The mechanical soft/mushy diet starts two weeks or so after surgery and continues until the end of the August. This phase includes foods that are tender and easy to chew. They don't need to be pureed, and may include such things as ground meats, moist tuna salad, egg salad, chicken salad, bananas, and steamed fruits. Sugar and fats should still be avoided, and protein needs to be eaten first. Stringy foods like broccoli, celery and asparagus stalks need to be avoided, as does red meat. Texture examples include eggs scrambled with milk, soft ripe fruits without skin or seeds, and crackers. A meal is somewhere between 1/4 cup and 1/2 cup of food and should take 20 to 45 minutes to finish.
10) About a month out from surgery, many of the same guidelines apply. I can begin to eat salad, but need to continue to keep liquids and solids separate and eat protein first to ensure I have room for them. I also need to start with softer raw vegetables and work up to crisper ones. I need to avoid crisp or sharp edges on meat, and teriyaki or barbecue sauces, as they contain sugar. It may be hard to tolerate fruits with stringy membranes such as oranges, and juice and sweetened beverages will need to be avoided for the rest of my life. When choosing grains and cereals, I need to steer toward whole-grain carbs (wheat crackers, brown rice). Saturated fats will need to be limited, and simple sugars are always to be avoided. Carbonated drinks should be avoided permanently as well. They cause bloating and studies have shown that people who continue to drink them tend to lose less weight.
11) I will need to take something like Prilosec for the first couple of months. Taking vitamins with coffee or tea interferes with their absorption.
The basic guidelines to follow are:
Slow down, chew everything to the texture of applesauce
Eat protein foods first
Separate beverages from food 30 minutes before and after eating
Take all vitamins and supplements
12) Regular bone density scans are suggested if possible.
13) Dumping syndrome is a reaction to sugar, sugar alcohols, high fat foods, or alcohol after gastric bypass surgery. The symptoms may include abdominal cramping, sweating, nausea, dizziness, headaches, diarrhea and weakness, "Early" dumping syndrome may occur within 15 minutes after eating and is often associated with diarrhea. "Late" dumping syndrome can occur up to 4 hours after eating and feels more like having low blood sugar. Acceptable sugar substitutes include Splenda, Equal, Sweet 'n Low, aspartame, saccharin, and Nutrasweet.
14) Food intolerances vary from one person to another, and what tastes good before surgery is often different from one tastes good afterward. Using the baby utensils can help with remembering to take small bites and chew them well. If vomiting occurs, it may help to return to clear liquids for a couple of days. Don't avoid healthy foods that cause vomiting--wait a week and try the food again. (Oh joy!) Try food at different temperatures, and add a meat tenderizer to meat or poultry if it is not being tolerated well. Constipation may occur, and no fiber supplements are allowed until six weeks out from surgery. Milk of magnesia, stool softener, or Probiotic pills (available at Walgreen's) can be helpful. Beano and Gas-X can be used for gas. Bad breath can occur from the body being in a state of ketosis post-op, and if this happens, gum should be avoided (in case it is swallowed accidentally). Bad breath typically improves over time as the diet becomes more varied.
15) Don't drink with a straw. Stop eating when you feel full. Don't lift anything heavier than a grocery bag, and no swimming for 4-6 weeks when the incisions heal.
Now that I have summarized all that, I think I need to go lie down. No wonder Mr. Salted's eyes glazed over...damn! I have my final pre-surgery consultation with the surgeons today.
Wednesday, May 6, 2009
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.
Subscribe to:
Posts (Atom)
About Me
- Salted with Shadows
- Seattle, WA, United States
- This blog focuses largely on a personal journey to and through weight-loss surgery. It's also about reading, writing, animals, photography, love, humor, music, thinking out loud, and memes. In other words...life.
