Six months ended today.

My day began auspiciously by discovering I had been "friended" by an old high school classmate on Facebook first thing this morning. I no sooner hit "confirm" than he IMed me and said, "Hey honey! You are so beautiful!" Let's just say that is never, ever a bad thing to hear from a charming gentleman--even if he is going by the well-lit, Photoshopped, cropped version of what you allow the world at large to view, and physically recalling you with your skin (and weight) of 20+ years past.

At 10 a.m., I had my six-month nutritionist appointment. In summary: in the last six months, I lost seven pounds. Without consistent exercise, that is not bad at all. (Interestingly, it was 2-1/2 pounds less than I weighed in on Wednesday; I think irritation makes me retain water.) I like my nutritionist. She is nice, knowledgeable, and she listens. (Why is that such a hunted-to-extinction quality in medical professionals?) My low-carb jail immediately prior to surgery will be 40g per day, not 30. (It's still less than the average coleus plant can live on and not bust a cap in a neighboring plant's ass, but whatever. It's only a couple of weeks. I asked how much my liver was really going to shrink, and she laughed and said they could definitely tell. I mumbled some Yosemite Sam phrases and moved on in the conversation.)

We chatted about various protein shakes and powders. I can do the baby food, but only the chicken and meat-based ones--the rest have too much sugar. She gave me some samples of Bariatric Advantage protein powders to test-drive and wrote down what I'd eaten in the last couple of days. She was very positive about my food journal, my consistent protein and fiber intake amounts, and the fact that I speak up and tell people, "it's hard for me to be around that food" (to coworkers) or "we can't have cookies in the house anymore" (to spouse).

She started to comment about my exercise routine not being up to par and then stopped herself, saying, "Oh, that's right! You have that foot thing!" Lo and behold, some single-spaced typed chart notes about "that foot thing" were in my file. I asked if the exercise physiologist had seen them, because he hadn't as of Wednesday, and she said she thought he would have gotten them because she was just cc'ed and he was the main recipient. I thanked her for sharing that with me--"one less doctor I have to bitch out today".

Coming out of the parking garage area under the building so I could cross the parking lot to the surgery center, a nice couple was down there with no less than four button-cute Charles King Cavalier spaniels. They were so cute, and so sweet! It was a wonderful random canine encounter that would have pleased any dog lover. I chatted with their people--the dogs were two pups, their mother, and an older, deaf one--the aunt, I think their person said--and I stroked all of their velvety ears, told them how pretty they were, and felt like I'd had some much-needed therapy after doing so. The effect animals can have is amazing.

I went over to the surgical center and handed my contact there the blessing letter and the-decade-of-BMI-charting letter from my primary care doctor. And now--I wait. Stick a fork in me, I am so DONE with that blankety-blanking food diary until the carb counting starts. I wrote, "I'm done with this bullshit until further notice" on today's page.

I stopped at Big Lots on the way home--my nutritionist thought she had heard they might have Muscle Milk--but they didn't. I did find some good low-carb broth and some baby cereal--I'm stocking up on that type of food for when the time comes, especially when it is at a good price. I looked over their jars of baby food, and it all looked positively vile. The "spaghetti dinner" had that orange-looking sauce. (Is it Chef Boyardee, or just botulism in bloom? You make the call.) They didn't have any meat-based baby food there at all. They did have some Jell-O sugar-free chocolate pudding mixes for a buck, and I bought several, knowing I can add protein powder to them post-op.

They have really good deals on DVD's at Big Lots. I bought a $3 one about Frida Kahlo's life called "The Ribbon That Ties the Bomb". For $6 each, I picked up "Blades of Glory", "The Queen", "The Darjeeling Limited", "The Pursuit of Happyness", "Into the Wild", "Stop-Loss", and "The Holiday". I loves me a good bargain.

Chocolate milk

Little tiny things can make, break, or just help get through a day sometimes. Grocery shopping today, I was cheered by the fact that Nestle Quik comes in sugar-free. I bought some and got to have a guilt-free glass of chocolate milk this afternoon. Protein is going to be increasingly important after surgery, so milk, string cheese, yogurt, and cottage cheese will remain my close companions. Adding up my protein grams every night as well as the calorie count has been crazy; most days I make it to the 60-80 gram range where they want me without a problem, but a "bad day" it hovers at maybe half that. The nutritionist said protein would help me heal after surgery, whatever that means--the inside of my stomach, I guess, since this is going to be laproscopic surgery.

There is something incredibly comforting about a glass of chocolate milk.

Protein and exercise

I saw the exercise physiologist today, and it actually wasn't bad. 20 minutes on the treadmill, strength training, talking about our cats. I only have to see him once a month, which is good.

Keeping track of the protein content in what I eat has already proven interesting. Cottage cheese has an insane amount of protein in it--13 grams per half cup. I hope my system is going to tolerate all the dairy, beans, etc. The only day I exceeded the 80 grams (high end of the post-surgery spectrum) was the day we had fish for dinner. I have a feeling we're going to be eating a lot of fish--it's never really been my favorite, but as with most of the other food, it is growing on me and I'm getting used to it.

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?