Tailbone Pain after Bariatric Surgery

After I had my surgery and went back to the office (read: a more sedentary lifestyle), I noticed a very unusual and uncomfortable symptom developing.

Lower back/tail bone pain.

The pain comes on quick at about an hour after sitting down. It is terribly uncomfortable, and unfortunately seems to be a common complaint not just from WLS patients, but also people who have lost a lot of weight.

When I started telling friend about this pain, the joke became that I'm losing my "padding" on my bottom. However, I never exactly had a lot of padding down there. I would love to understand why this happens, but I would like to take a few minutes to share my coping mechanisms that I'd started and will start in the near future.

1. My Fitbit vibrates every hour. I have a Fitbit Blaze and one day last spring, it started vibrating at 10 minutes to the hour. I looked into my app, and there were now hourly goals. Most hours, I remember to get up as I start to feel the familiar tenseness, but there are times I get wrapped up in my work and that vibration is a reminder to get up and give myself just a few minutes to get moving. This feature is NOT available on all Fitbits, such as Fitbit Charge, Fitbit Charge HR, Fitbit Flex, Fitbit One, Fitbit Surge, and Fitbit Zip.
2. I got a cushion. We were visiting friends in Upstate New York and spending hours around a fire when I started to shift in my seat a lot. One of my friends noticed and gave me a cushion that he had gotten for his car, but he is very tall and his head was hitting the ceiling of the car. I can't tell you how much mine cost, or even what brand it is, but it has made my bottom much happier.
3. Standing Desk. This is still in the early stages. I was going to do the IKEA hack but I was encouraged to ask for my job to provide me with a standing desk and it was really easy. I got a doctor's note, and less than a week later I was approved. Due to budget issues, I need to wait until October to actually get it but I'm sure it's going to help this situation.

August 24, 2017: Three month post-op visit

I should start with addressing two issues: first, this appointment was 12 weeks and 1 day post op for those of you paying attention to the dates. Secondly, the three month appointment really started 10 days earlier.

On August 14, I went to the lab to get my bloodwork done for my upcoming appointment. To help anyone going through this in the future, the phlebotomist took seven vials of blood and it took two arms to get this job done. The good news is that this is not a fasting blood test so I didn't get woozy or anything. I could list all of the blood tests they did, but highlights included a standard CBC, protein checks, B12, Vitamin A, Vitamin D, and electrolytes.

Between August 14 and August 24, I got to see my blood tests come back using the MyChart feature Johns Hopkins provides to all patients. Everything was coming back beautiful.

Finally on August 24, I had my appointment which, thanks to nasty traffic, I was nearly late for.

I sat down with my Nurse Practitioner and discussed how the last three months had gone. I told her about a burning sensation I had under my ribs the previous week, but changing my diet and certain routines things had gotten better. She then told me that she thought the best idea was to re-prescribe Protonix, which I would have asked for if she hadn't brought it up. We began going over my average daily diet and I apologized for my diet sounding bland, but I had adjusted my diet to address that burning sensation, which I assumed to be heartburn. She said "I'm already giving you back your Protonix!" jokingly.

I am doing one thing bad: coffee. I was completely off the sauce prior to the surgery but I found coffee to be a helpful part of my daily routine at preventing constipation. I told her this and we addressed changing my constipation prevention routing. The new routine is:

• 1 colace 3 times a day
• 1 Senna at night (was 2)
• 1 serving of Metamucil at night (new)

Then we went over the bloodwork, which as I had seen was great. One deficiency was in Vitamin A, but it was minimal, so they are going to watch and see how it goes for the next three months.

Finally the surgeon came in and she did the standard pain check by touching my stomach, which went fine.

These post op appointments are so important no matter how far out you are. I think I would be hard pressed to find someone who skips an appointment so early, but there are people who just don't want to go to the doctor when they are feeling well. However, bariatric patients, for the most part, have been trained better than this.

Living on a budget (vitamins and protein)

It is no secret that eating healthy is more expensive than not eating healthy. 

I can go to Little Caesar's and get a medium pizza that will feed both my husband and myself for $5.99 or go next door to Panera and spend over $6 for each of us to get a salad. All of this is situational seeing as I'm gluten free by medical necessity.

I'm not going to go over this fact again as many blogs and sites have done it themselves.

But Bariatric surgery has an added level of complication. Post-op, patients need to buy protein supplements and vitamins. These can add up to astronomical levels. Some say that the money you're saving on food can help balance the budget, but I haven't completely found that to be true as I am still feeding my husband.

Let's start with saving money on protein:

Addressing once again that I'm one of the cheapest people I know, I will remove a little satisfaction from my food to save significant money. That is exactly what I do with Pure Protein. I have had better brands with better flavors, but Pure Protein is $17.98 for 29 servings. That means I go through one of these every four weeks.

Going on to vitamins:

I decided to use Celebrate vitamins when I started this process simply to take less vitamins any given day. But, does this add up to savings at the register? I'm going to compare two options at prices for every thirty days. All vitamin intake must meet these minimum standards.

1. Daily intake of 65mg Iron
2. Daily intake of 1500mg Calcium Citrate
3. Daily intake of 800mg Folic Acid
4. Daily intake of 3mg Thimine
5. Daily intake of 2mg copper
6. Daily intake of 3000IU Vitamin D3
7. Daily intake of 500mg B12
8. Preferably has selenium and zinc 
9. Oh, and chewable only for the first 6 months
10. AND you can’t take gummy vitamins

One option that many seem to take is to take Flintstones Vitamins and then supplement what else they might need. Looking at our list, if you use the iron minimum to decide how many vitamins to take, you must take six Flintstones a day (and this is with enhanced iron). At six Flintstones a day, you meet the requirements for Iron, Folic Acid, and Thimine. This means you are still missing Calcium Citrate, Copper, Vitamin D3, Vitamin B12.

Some quick math on walmart.com showed me that:

• Best value for Flintstones was $27 for 180 pills (or $27 for 30 days)
• Best values for Calcium Citrate (includes part of daily supply for D3) was $15 for 155 pills (or $12 for 30 days)
• Best value for Copper was $7 for 300 days (or $1 for 30 days)
• Even with the Calcium Citrate in this scenario, you still need one D3 which was $13 for 240 pills (or less that $0.50 for 30 days)
• Best value for B12 sublingual $4 for 200 days (or $1 for 30 days)
• Total vitamins daily: 12 (6 Flintstones, 1 Copper, 1 D3, 1 B12, 3 Calcium)

Flintstones come to about $41.50/30 days to meet all requirements. 

At first, I thought it was going to be more expensive to buy the special brand name bariatric vitamins for my needs. Due to the values of the needed minerals and vitamins, there is no need for extra supplemental items to buy. Let’s see how they measure up:

• Multivitamin chewable (without Iron) is $42 for a 90 day supply ($14 for 30 days)
• Iron supplement (chewable): The price discrepancy is significant depending on how much you need. I’m on the high end as I had gastric bypass and I still have my period. The cost range is $21.50-$35 for 90 days (or $7.17-$11.67 for 30 days) 
•  Calcium is interesting because this vendor offered soft chews, which taste better and have a better texture, but in my (cheap) opinion is not worth the extra price. The cost comes to $45 for 90 days ($15 for 30 days) 
•  Total vitamins daily: 6 (2 MV, 1 Iron, 3 Calcium)

Going with Celebrate Brand means less work organizing your vitamins weekly. This is something I spend about 10 minutes a week doing to get me set up for a full 7 days. 

Celebrate Brand vitamins would cost $36.17-$40.67/30 days. This means that a patient would save a little less than a dollar to go the Celebrate route.

When Food gets Stuck

It happened again on Monday night.

My husband makes this dish called "Poor Man's Meal" which is basically cut up potatoes, cut up hot dogs, some tomato sauce, and cheese. Not the most nutritionally sound thing in the world, but he could make a lot worse.

So, I was under my calorie goal for the day and above my protein, so when I came home from my knitting and crocheting group, I figured I would have a little bit of my husband's creation.

As I put the first bite in my mouth, I started talking to him, and swallowed before I was done chewing properly.

Before anything happened, I knew I did something wrong.

The advice to chew for 20 seconds (or 30 times, whatever your nutritionist tells you) is not only to slow you down, but to have your food better prepared to go into your stomach. First of all, I'm only 10 weeks out so my stomach is pretty much still recovering. Second, the point where the stomach passes food into my small intestines is the size of the tip of my pinky finger. Normal people's stomach to small intestine passageway is the size of a quarter.

When I saw my nutritionist for the first time, she didn't say this might happen, but that it would happen. I was told to not drink, because that wouldn't help "de-clog". Drinking would only make the situation worse (I had to learn for myself).

And that's the point of what happened on Monday.

I wasn't careful in chewing and swallowed without thinking and completing my chewing. Immediately I knew simply not puking would be a gold star for the evening. I quickly put the remainder of my bowl away, and went upstairs to start my night time routine. I felt better after my shower, but I knew I couldn't drink or even take my last vitamins for the day.

Sometimes I have to throw up to feel better after a clog. On Monday night, I stayed vertical a little longer than usual and I was able to fall asleep without vomiting. I did however skip my vitamins which would not be recommended.

The moral of the story is that chewing is important. I find myself trying to make meal time about meal time and not about talking to someone else which does not make me the best for dinner company. That adds into my attempts at not socializing around food.

Which is another entry for another day...

Stigma, Judgement, Myths, and Misconceptions

I'm going to start with this fact: I applied for my weight loss surgery in October of 2016 and I was not too open about my application. I would like to think that I wasn't open about it because I honestly had not made a decision, and wanted this decision to be mine and mine alone. I told my family, but I did not tell my husband's extended family so when one of them came for a visit in the spring and I was well into preparations, it took her by surprise. After all, I had not mentioned anything over Christmas.

As the process continued, I was open with people I spoke to and saw every day. But there was an audience that was in the dark about this decision: my extended army of Facebook friends. Now, I personally know all of my Facebook friends, and I occasionally go through and delete people that I don't see myself getting back in touch with. I had a tentative surgery date of June 14, so I decided I would tell the greater Facebook community on April 14, two months to the day when I was to go under the knife.

The support I got was amazing and I wondered what took me so long to tell more people what I was going through.

Before becoming a bariatric patient myself, I always wondered why people would decide to make the decision to have weight loss surgery. As I developed my own reasons for the surgery, I gained a new respect for friends that had taken this path before I did. I never thought as surgery as an easy way out, I just thought it was extreme.

The other night I came across this article written about a woman who has had bariatric surgery and denies it when people ask her how she lost weight. The stigma that surrounds weight loss surgery patients is deep and complicated. Bianca mentions an article, published in the peer-reviewed medical journal Obesity Surgery. In the study, individuals are shown before and after pictures of individuals who had lost weight and rated them based on their opinions of the pictures (Vartaniam and Fardouly, 2013). Then, the individuals are told which ones had weight loss surgery. The opinions of the individuals in the study towards individuals who has the surgery dropped dramatically. Further more, the individuals who had weight loss surgery were seen as "significantly more lazy and sloppy, less competent and sociable, less attractive, and having less healthy eating habits" as compared to those who lost weight using more traditional methods having less harsh descriptions.

I had a hard time wrapping my head around this idea that people are judging me negatively based on this decision I had made. After all, I'm still watching what I eat and going to the gym. Only rarely does my stomach dictate how much can go in, I usually stop eating well before that pressure reminding me that my stomach is the size of an egg begins.

Ultimately, the overwhelming opinion is that everyone will lose weight if you eat less and move more. Most bariatric patients will tell you that is not the case. There are nutritional considerations to make, and types of exercise to consider. The solution is not a one-size-fits-all situation.

I have surprised many with the depth my journey took me before having my surgery even scheduled. The design of the Johns Hopkins program is to get you ready for surgery by starting to develop good habits beforehand. Like most stereotypes, if someone took the time to get to know someone going through it, many misunderstandings will go away. Which is a big reason why I started this blog. If you have the time to want to understand the process, I'm hoping this blog can help.

I'm going to end this with two stories of resistance I've met in the last year:

During my pre-op diet, I found great success. But, I knew I usually lose between 40-60lbs and then maintain it for about six months before gaining it back. Several people asked me why I would get the surgery when clearly I'm able to do it on my own, and I would explain to them that I've never been able to keep it off. One person went so far as to treat me as if I were in hysterics and told me "we are going to do this together, without surgery". The message I had to tell her was that I don't think her less for not wanting the surgery, but this is a decision I have made because the time is right and it's time for a change.

The second story is from December, right after I had applied and I hadn't told anybody outside of my immediate family. My husband's family is mostly in Texas and I had strongly considered not telling them and surprising them with our next visit. When we were at one of the houses on our circuit, my husband's uncle came up to him and commented (note that his verbal filter has been eroded by years of substance abuse) "not getting any smaller, why don't you get that gastric bypass?" My husband was so mad just knowing the process, not living it as he would within two months' time.

To overcome the overwhelming feeling of stigma, attending in-person support groups as well as online ones can help a lot. There are so many people involved in those groups, when I look at my newsfeed these days, I wonder how many people on my newsfeed have not had weight loss surgery.

Like all choices in life, we are judged. I don't judge people who don't get the surgery because insurance and time off can make that tough. I just hope that my decision to get the surgery warrants the same respect.

Weekend of August 5-6, 2017 (With Ratatouille Recipe)

As life continues on its path to a new normal, I'm finding the need to schedule more things into my day that I had before.

Saturday I woke up with the idea of going to the gym, but I didn't want to until I ::cough:: moved my bowels. (I promised you a real account of life post WLS so there you have it). I woke up, put on my gym clothes, made coffee, and no dice. Drank a liter of water, and still no dice. So I started to move around and do some chores and it finally happened, but not with enough time to go to the gym and make it to our afternoon plans.

Our afternoon plans were a buffet lunch with my husband's family, some of which were in from out of town. I walked to the buffet and chose the smallest serving I could get of some cauliflower, vegetable korma, some Nepali potato dish, and a little rice. After hardly looking like I made a dent in my plate I was full.

So when we were getting ready for bed on Saturday night (afternoons with my husbands family go well into the night), I told my husband that I was getting up for the gym first thing in the morning.

Yea that didn't happen.

So after attending a church service, then teaching the Kindergarten-1st Grade class, I went right to the gym and did my workout, which took nearly two hours. I'm trying to pick one weekend day to do a longer run, so today was that day. Then I worked out two muscle groups, which is also trying to become habit.

After that I did my first individual swim lesson since the surgery.

I ran an errand on the way home and then upon getting home I promptly took a nap.

When I woke up, I made an old recipe out of an old family cookbook. It's called "Ratatouille" but its a very simple recipe.

Makes seven (7) half-cup servings

1 zucchini
1 eggplant
1 bell pepper
1 cube of chicken bullion
1 can of crushed tomatoes
1 can of tomato paste

Put it all in a pressure cooker and set it on Soup for 20 minutes. Once it finished and I let it naturally lose its pressure for about 15 minutes, I had a tasty, easy-to-digest meal.

Workout:
45 minutes on elliptical (4.3 miles)

Shoulders:

• Upright press (4x10 @5lbs in each hand)
• Upright rows (4x10 @ 20lbs)
• Lateral raises (3x12 @ 5 each hand)
• Front raises (3x12 @ 5 each hand)
• Shoulder shrugs (3x12 @ 20)
• Read delt (3x12 @45)

Back

• Rows (3 of each of the below bullets. Called a "drop set")
• 1x10 @37.5
• 1x10 @30
• 1x10 @22.5
• Lat pull downs
• 1x10 @37.5
• 1x10 @30
• 1x10 @22.5
• Row at 45 degrees (I was standing up and a cable was at about my knees, I took a step back and pulled)
• 1x10 @30
• 1x10 @25
• 1x10 @20

August 1, 2017: Eight weeks, six days

Today was back to the office, but only for three days. Not a terribly eventful day. I had a project that really tied me to my desk, so I didn't get to tell stories about our vacation to my coworkers. But I did catch up on my podcasts.

I had a lunchtime workout followed by my "meal planning" of another slice of leftover pizza.

One thing about sitting all day for 8 hours was I found the need for a standing desk to be much stronger than it had been in the past. I spoke to some people in my office to see about getting the ball rolling and plan to write a message to my surgical team agreeing with my need for a standing desk. I also got the blessing to put an IKEA standing desk hack on my desk for the time being! Yay projects!

Food journal:
Breakfast:
Protein shake

Mid morning:
Banana

Lunch:
Slice of pizza
Leftover beet salad (like a quarter cup...two months ago I would have thrown that out but now...different story!)

Afternoon snack:
Oikos Triple Zero

After workout snack:
Slice of Cheese

Dinner:
18 medium grade shrimp
Cocktail sauce

Workout Journal:
Lunchtime:
3 miles in 30 minutes

After work:
Chest:
Pec Fly 4x12 @40
Assisted Dips 1x10 @175, 2x8 @ 160 (lower the weight the more body weight you're pushing)
That badass move where you're between the cables and using two machines making a hulk motion 3x12 @ 15 each arm

PF360
Chest pull with upright cable
Russian Twists with 6lb ball
Shoulder pulls
Box Jumps (level 2)
Rope shuffle
TPX Squats (w/jump first time w/o jumps second)
Kettle Bell alternates with 15lbs

July 31, 2017: Eight weeks, 5 days

Today was the first day back at work since our road trip. Getting back into routine is always a little tough so I mixed up the routine a bit.

First, I went to the Army Wellness Center, as civilians are allowed to do, and got my Body Fat Percentage through a very accurate tool called a Bod Pod. The only comparisons were from about 15 months ago, and 34 pounds lighter than my actual high weight. Still though, I dropped 4% body fat as well as 9 lbs of muscle. Obviously we want to see the body fat drop more than the muscle.

During lunch I did the 30 minute PF circuit and it worked out well.

After work I walked with my friend while she walked her dog then we went out for dinner. I had two bites of a beet salad along with a single slice of gluten free pizza.

Food journal:
Breakfast:
Protein Shake

Morning snack:
Banana

Lunch:
Swiss cheese (2 slices)
1 serving of Halo Top

Dinner:
A couple of bites of a beet salad
A single slice of pizza

Workout journal:
30 minute circuit class during lunch
Mile or so walk after work