If you participate in any form of social media, you know you're friends tend to fall into groups. If you're in your early to mid thirties like most of my friend group you have a little from the following:
The Mommies
The Nerds
The Harry Potter Fans (insert other fans here too)
The Crafters
The "Always at the Gym"
So when one of my dearest friends put up she was interested in doing a half marathon, I thought "Well this is unexpected". So I commented something along the lines of "Really?"
Then the text conversation started.
A few minutes later, both of us were signed up for our first half marathon. I wish there were more to it but it was really as simple as that.
This happened on Saturday night, but Sunday morning she was putting me to shame by already going for a run and telling me that she was going to do the leg workout I did on Saturday on Monday morning. But she didn't have a lot of guidance.
At this point, most half marathon plans I've found run for 12-13 weeks, which gives us two months to get to that point.
Until then, I made a plan for us to increase time by 10% every week to two weeks and get three runs in at first, then move to four. I will be sharing this math on my Instagram (@jackienelli) seen in the upper right corner of my page.
I've run since essentially my peak weight, so running is nothing new to me. However, since I started running post-op I've noticed an adjustment was needed for nutrition. No longer can I have a carb filled dinner the night before.
I ran the 10K Across the Bay a few weeks ago and finally got a 10K PR for myself. I attribute part of my success to taking Gu Packs every 40 minutes or so. This will likely be continued in a blog post as training continues.
Anyway, we're both very excited for this run. I'll be posting many of my workouts to Instagram and I'll put some summaries on here from time to time.
Showing posts with label bariatric. Show all posts
Showing posts with label bariatric. Show all posts
Tuesday, November 21, 2017
Tuesday, September 5, 2017
Presurgical Shopping List
I remember getting ready for my surgery and thinking to myself how different life was going to be as soon as I got home from the hospital. I was nervous, excited, anxious...so many emotions at once.
I was well prepared, the program at Johns Hopkins had gotten me ready and I was more excited than anything to get the petal to the metal. Hopkins even makes their guidelines available to the public, if anyone would like to read over the material.
The weekend before the surgery, I went shopping and got two sets of the below list. I got two because I was going to be spending nights at my house, but would be spending most days at my parents' apartment since my mom works from home and is an RN. This list was derived from the guidelines linked above:
The biggest key however is getting at least that 64 ounces of water in daily. Before discharge I got a water bottle from the hospital that had increments of 2 hours to get 8 ounces of water in. If I started at 7:00am, and I was consistent, I would get my 64 ounces in by 11:00pm. I still use the one from Hopkins, but I found inspiration here. But, even taking a standard 32oz Nalgene with a Sharpie would work, but you would have to remark it fairly regularly.
Finally, I made a paper chart with goals based on the timeline in the guidelines attachment. I would include all of my new vitamins and medications on this list as well. I don't have any copies of these left, but it looked something like this:
I was well prepared, the program at Johns Hopkins had gotten me ready and I was more excited than anything to get the petal to the metal. Hopkins even makes their guidelines available to the public, if anyone would like to read over the material.
The weekend before the surgery, I went shopping and got two sets of the below list. I got two because I was going to be spending nights at my house, but would be spending most days at my parents' apartment since my mom works from home and is an RN. This list was derived from the guidelines linked above:
- Protein powder
- Lowest fat cottage cheese
- Plain Greek Yogurt
- Dannon Triple Zero Oikos
- No sugar added pudding pops
- Sugar free popsicles
- Fairlife skim milk
- Ricotta Cheese (lowest fat)
- Pudding (powder)
- Jell-O
The biggest key however is getting at least that 64 ounces of water in daily. Before discharge I got a water bottle from the hospital that had increments of 2 hours to get 8 ounces of water in. If I started at 7:00am, and I was consistent, I would get my 64 ounces in by 11:00pm. I still use the one from Hopkins, but I found inspiration here. But, even taking a standard 32oz Nalgene with a Sharpie would work, but you would have to remark it fairly regularly.
Finally, I made a paper chart with goals based on the timeline in the guidelines attachment. I would include all of my new vitamins and medications on this list as well. I don't have any copies of these left, but it looked something like this:
- 7:00am: Protein Shake made with Fairlife and AM pills
- 8:00am: Water
- 9:00am: Greek Yogurt (make sure water goal is met), Lovenox shot
- 10:00am: Water
- 11:00am: Fudgepop (make sure water goal is met)
- 12:00n: Protein shake made with Fairlife and Noon pills
Tuesday, August 29, 2017
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:
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.
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)
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.
Tuesday, August 22, 2017
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.
- Daily intake of 65mg Iron
- Daily intake of 1500mg Calcium Citrate
- Daily intake of 800mg Folic Acid
- Daily intake of 3mg Thimine
- Daily intake of 2mg copper
- Daily intake of 3000IU Vitamin D3
- Daily intake of 500mg B12
- Preferably has selenium and zinc
- Oh, and chewable only for the first 6 months
- 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.
Tuesday, August 1, 2017
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
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
Monday, July 31, 2017
Abdominal Binder
Today I want to talk a little bit about the abdominal binder. Some people have asked questions about this tool and how it can help after bariatric surgery.
I was about three hours out of surgery when I met my good friend, the abdominal binder. It looks similar to a back brace, but the support it provide is more spread through the wearer's core.
The nurse put the abdominal binder on me when I stood up for the first time post op (with the help of three people). I immediatley felt relief and the second time I stood up, I was able to walk around much longer than the first time.
By the end of the night, I was asking for a half dose of my heavy duty pain meds. I attribute all of this to the binder.
I wore the binder all day every day for two weeks. Luckily, my parents had one in the same size from a hospital stay of my dad's, so I was able to wash one while wearing the other.
After about two weeks, I started wearing the binder only if I left the house. This was because one day I went out without it and my energy levels were tanked. I think this only lasted about a week.
A lot of the questions I see about the binder start with "what is this thing and where can I buy one?" I recommend to people to wait until you're in the hospital and they will more than likely give you one. Then, you can look at the tag for the size, and buy a second one if you need it.
Some people respond that their doctor's don't want them wearing the binder, or not wearing it that much, as to not become dependent on it. My non-medical opinion of that is that thinking is not right. I'd rather be hooked on compression on my abs than hooked on oxy or other opioids.
I was lucky enough to have seven small incisions all held together with surgical glue, so putting the binder right on my skin felt fine. Some people have staples, and they suggest putting a t-shirt between your skin and the binder.
I will say this about the binder is that its hot. It's a thick fabric and it was unforgiving in the June heat right after my surgery.
Ask your doctor or nurses if the binder will be right for you!
I was about three hours out of surgery when I met my good friend, the abdominal binder. It looks similar to a back brace, but the support it provide is more spread through the wearer's core.
The nurse put the abdominal binder on me when I stood up for the first time post op (with the help of three people). I immediatley felt relief and the second time I stood up, I was able to walk around much longer than the first time.
By the end of the night, I was asking for a half dose of my heavy duty pain meds. I attribute all of this to the binder.
I wore the binder all day every day for two weeks. Luckily, my parents had one in the same size from a hospital stay of my dad's, so I was able to wash one while wearing the other.
After about two weeks, I started wearing the binder only if I left the house. This was because one day I went out without it and my energy levels were tanked. I think this only lasted about a week.
A lot of the questions I see about the binder start with "what is this thing and where can I buy one?" I recommend to people to wait until you're in the hospital and they will more than likely give you one. Then, you can look at the tag for the size, and buy a second one if you need it.
Some people respond that their doctor's don't want them wearing the binder, or not wearing it that much, as to not become dependent on it. My non-medical opinion of that is that thinking is not right. I'd rather be hooked on compression on my abs than hooked on oxy or other opioids.
I was lucky enough to have seven small incisions all held together with surgical glue, so putting the binder right on my skin felt fine. Some people have staples, and they suggest putting a t-shirt between your skin and the binder.
I will say this about the binder is that its hot. It's a thick fabric and it was unforgiving in the June heat right after my surgery.
Ask your doctor or nurses if the binder will be right for you!
Saturday, July 29, 2017
July 28, 2017: Eight weeks and two days
Our first full day back from vacation and I was ready to get back to normal. Normal eating, normal drinking, and normal working out.
I woke up and did a fasted workout (if I eat before a workout, my colon won't let me finish). It was a PF 30 minute class and a PF 360 class kinda morning. I got home, had some protein and some coffee and planned on doing some laundry and housework and then going back to the gym at about 2:30.
Well...life had other plans.
I got my running shoes on and had my headphones in my pocket (and two bags of clothes that are too big for me now ready for a donation) and I was ready to go! But the landscapers were blocking our driveway. I could have asked them to move but there was a lot of drama yesterday with them, and our condo needed the landscaping. So I went back upstairs. An hour later I looked outside and this time they were blocking the driveway AND blocking my car with their heavy equipment. Also this whole time it was pouring and I'm not that hardcore about my run yet.
Finally it was 4:30 and my husband was due home any minute so I didn't want to look like I was avoiding him ("Oh, so glad you're home from your long day at work, I'm going to the gym byeeee"). I ran out to get rid of those too-big clothes and came back home.
We went out for dinner to Panera so I can finally try that salad and it went down great! I'm so happy to have lettuce back in my life.
Another great thing that happened today was that I crowdsourced some topic ideas for this blog from my friend list and the response I got was amazing. There are so many things that non-bariatric patients are interested in and I'm so glad I can try to help them out.
Food journal:
Breakfast:
Protein Shake
Morning snack:
Banana
Lunch:
Corn Quesadilla
Afternoon snack:
Applesauce
Dinner:
Half a Greek Salad from Panera (no added meat)
Evening snack:
Protein shake (was less than 50g of protein by this point so I needed it more than I wanted it)
Workout journal:
PF 30 minute circuit (one day I'll take good notes on each exercise to help loyal readers)
PF360
I woke up and did a fasted workout (if I eat before a workout, my colon won't let me finish). It was a PF 30 minute class and a PF 360 class kinda morning. I got home, had some protein and some coffee and planned on doing some laundry and housework and then going back to the gym at about 2:30.
Well...life had other plans.
I got my running shoes on and had my headphones in my pocket (and two bags of clothes that are too big for me now ready for a donation) and I was ready to go! But the landscapers were blocking our driveway. I could have asked them to move but there was a lot of drama yesterday with them, and our condo needed the landscaping. So I went back upstairs. An hour later I looked outside and this time they were blocking the driveway AND blocking my car with their heavy equipment. Also this whole time it was pouring and I'm not that hardcore about my run yet.
Finally it was 4:30 and my husband was due home any minute so I didn't want to look like I was avoiding him ("Oh, so glad you're home from your long day at work, I'm going to the gym byeeee"). I ran out to get rid of those too-big clothes and came back home.
We went out for dinner to Panera so I can finally try that salad and it went down great! I'm so happy to have lettuce back in my life.
Another great thing that happened today was that I crowdsourced some topic ideas for this blog from my friend list and the response I got was amazing. There are so many things that non-bariatric patients are interested in and I'm so glad I can try to help them out.
Food journal:
Breakfast:
Protein Shake
Morning snack:
Banana
Lunch:
Corn Quesadilla
Afternoon snack:
Applesauce
Dinner:
Half a Greek Salad from Panera (no added meat)
Evening snack:
Protein shake (was less than 50g of protein by this point so I needed it more than I wanted it)
Workout journal:
PF 30 minute circuit (one day I'll take good notes on each exercise to help loyal readers)
PF360
- Ropes-10 seconds arms together, 10 seconds arms alternating
- TRX suspension: Lunges
- Upright rows (17.5 lbs)
- Wall squat with a chest pass (6 lbs ball) against the trampoline
- Kettle bell side touches (15 lbs first round, 20 lbs second round)
- Hip bridges with elevated legs and 10 lbs on stomach
The first three were done three times and the second three two times.
Friday, July 28, 2017
Lady Concerns (Consider yourselves warned)
Frequently, online I see people asking questions about how this surgery affects a woman's unique health issues. I would like to take more time and words than a comment on a post about this and what my experiences have been.
From the start, the surgeon told me to get off of my estrogen-based birth control method of choice. The estrogen puts individuals at a higher risk for blood clots (as does obesity) so it had to go, and I completely understood.
Also, I was told to not get pregnant for eighteen months. This was actually a deciding factor in getting the surgery since 16 months from now (that I'm two months out) our personal finances will have recovered from a step back for better job security.
The need for non-estrogen based birth control and the year and a half wait made an implant make more sense.
About six weeks after the initial surgeon appointment I finally got in to see my gyno. We discussed the implant options and decided the Nexplanon implant would be best. Nexplanon goes into the upper arm and I can check to make sure it hasn't moved whenever I want.
On May 1 (T-30 days before surgery) I got the implant. It was a five minute process once the doctor came into the room. They did a pregnancy test to make sure I wasn't pregnant, numbed my arm, and in the Nexplanon went. I barely experienced any bruising, the pain was nothing an Advil wouldn't help, and I couldn't lift weights with my arms for a week. But, I was good for birth control until May 1, 2020. Overall, a very positive experience.
About two weeks later, I experienced a normal period on my regular schedule.
On May 31, I had my surgery and the next day, June 1, I started to experience some discharge that could almost be described as a period. This discharge did not stop.
Two weeks later, I experienced a real period, again right about on schedule. Once that stopped, I again went back to the stranger discharge. At that point I had another gyno visit scheduled and I went for it. I go to a practice and am not picky about who I see. So I was seeing this nurse practitioner for the first time. I explained my history and she said what I was experiencing was nothing to be concerned about. After all, I changed my hormones AND underwent a major surgery, so I should cut my body some slack.
I again had a normal cycle about on schedule, and now, eight weeks later, the discharge is finally ending.
Now that's my story. From this point on are my theories.
I admit that part of the reason I had this surgery was for fertility. My husband and I had about two months of actively trying to get pregnant before our situation changed. We weren't discouraged by two months of no luck at all, but increased fertility certainly made the surgery that much more attractive. Also, its not just the getting pregnant and having a healthy pregnancy, but also chasing a baby around, then doing the whole thing again with a second pregnancy and a second baby. I couldn't imagine being able to do that over 300 pounds.
The whole having my period for basically two months was really annoying. But I didn't really cramp. I did however bloat and weighing myself every day would get discouraging at times. That was when I decided to not weigh myself every day. From things I read online, I knew not to be concerned, but getting in with my provider made me feel a lot better.
From the start, the surgeon told me to get off of my estrogen-based birth control method of choice. The estrogen puts individuals at a higher risk for blood clots (as does obesity) so it had to go, and I completely understood.
Also, I was told to not get pregnant for eighteen months. This was actually a deciding factor in getting the surgery since 16 months from now (that I'm two months out) our personal finances will have recovered from a step back for better job security.
The need for non-estrogen based birth control and the year and a half wait made an implant make more sense.
About six weeks after the initial surgeon appointment I finally got in to see my gyno. We discussed the implant options and decided the Nexplanon implant would be best. Nexplanon goes into the upper arm and I can check to make sure it hasn't moved whenever I want.
On May 1 (T-30 days before surgery) I got the implant. It was a five minute process once the doctor came into the room. They did a pregnancy test to make sure I wasn't pregnant, numbed my arm, and in the Nexplanon went. I barely experienced any bruising, the pain was nothing an Advil wouldn't help, and I couldn't lift weights with my arms for a week. But, I was good for birth control until May 1, 2020. Overall, a very positive experience.
About two weeks later, I experienced a normal period on my regular schedule.
On May 31, I had my surgery and the next day, June 1, I started to experience some discharge that could almost be described as a period. This discharge did not stop.
Two weeks later, I experienced a real period, again right about on schedule. Once that stopped, I again went back to the stranger discharge. At that point I had another gyno visit scheduled and I went for it. I go to a practice and am not picky about who I see. So I was seeing this nurse practitioner for the first time. I explained my history and she said what I was experiencing was nothing to be concerned about. After all, I changed my hormones AND underwent a major surgery, so I should cut my body some slack.
I again had a normal cycle about on schedule, and now, eight weeks later, the discharge is finally ending.
Now that's my story. From this point on are my theories.
I admit that part of the reason I had this surgery was for fertility. My husband and I had about two months of actively trying to get pregnant before our situation changed. We weren't discouraged by two months of no luck at all, but increased fertility certainly made the surgery that much more attractive. Also, its not just the getting pregnant and having a healthy pregnancy, but also chasing a baby around, then doing the whole thing again with a second pregnancy and a second baby. I couldn't imagine being able to do that over 300 pounds.
The whole having my period for basically two months was really annoying. But I didn't really cramp. I did however bloat and weighing myself every day would get discouraging at times. That was when I decided to not weigh myself every day. From things I read online, I knew not to be concerned, but getting in with my provider made me feel a lot better.
Wednesday, July 26, 2017
Remembering Meds and Vitamins
The deeper I get into life as a bariatric patient, the more I truly believe the mantra of "failing to plan is planning to fail".
Someone, please buy me a bracelet.
Everything, from the gym, to food, to what the meat of this post is about, medication and vitamins, are carefully planned out. In just three months, this has become routine.
But lets turn our focus to strictly medication and vitamins. And lets start with storage. I use this pill holder. It's literally called "Lazy Me" and was the biggest one I could buy. Each day is broken up into four sections, which is exactly how my nutritionist said to pace things. I like it because I can pop one day out and take it with me all day. It's also just big enough for my biggest pills. I just have to worry about one little box all day.
Every Thursday night, I take my pill holder and all of my meds and put them into the proper days and times. In each section, I place the following:
I plan on updating my meds and vitamins very soon. (Updated: 8/11/2017) The change will be taking out protonix and splitting my multivitamin and my iron. The flavor of those tablets make me really nauseous and I want to try splitting them up. It will end up costing me about $30 more every three months if I decide to keep the change.
Someone, please buy me a bracelet.
Everything, from the gym, to food, to what the meat of this post is about, medication and vitamins, are carefully planned out. In just three months, this has become routine.
But lets turn our focus to strictly medication and vitamins. And lets start with storage. I use this pill holder. It's literally called "Lazy Me" and was the biggest one I could buy. Each day is broken up into four sections, which is exactly how my nutritionist said to pace things. I like it because I can pop one day out and take it with me all day. It's also just big enough for my biggest pills. I just have to worry about one little box all day.
Every Thursday night, I take my pill holder and all of my meds and put them into the proper days and times. In each section, I place the following:
- Morning
- Afternoon
- Celebrate Calcium Citrate
- Colace
Protonix(completed regimine)- Evening
- Celebrate Calcium Citrate
- Actigall
- Colace
- Bedtime
Two chewable Multivitamin plus 60 iron tablets(changed to splitting the MV from the Iron due to nausea issues)- Two chewable Mutltivitamins
- One Iron 60 chewable
I think one key to my success in remembering my meds and vitamins is to take everything in that section of pills at the appropriate time.
Speaking of appropriate times...this is a good time to share how I remember to take my pills.
My four times I get reminders are 5:45am, 11:30am, 2:30pm, and 6:00pm. I set these reminders through Baritastic but at three months I really don't need them. They've been great while I've been away though! The most important thing to remember is to space the calcium tablets out by at least two hours. So if I take my first section before leaving the house at 6:00am, and I look at the clock and it's 9:00am, I know I'm safe to go ahead and take it.
June 21-26: Seven weeks, two days to eight weeks
My husband and I are currently on a whirlwind road trip that took us from our Maryland home up to Toronto. On the way up, we stopped to see some of my family and some family friends before finally reaching Toronto.
The first day of the road trip went right according to plan. The one difference was going out to eat, but of course I had leftovers.
The second day of the road trip took us past some family, who put a lot of thought into what they served us for lunch (I had tuna salad). For dinner I had the leftovers from the night before.
The third day we went to the Baseball Hall of Fame which included a lunch out. Our gracious guests grilled up some burgers and hot dogs and I had half of each.
The fourth day was about 6 hours of driving. First we went to Niagara Falls, where I had a lunch that did not sit well with me. Upon arriving in Toronto, we went out to dinner and bought one meal to split between the two of us, and I think my stomach was already not doing too well since lunch so I spent about an hour vomiting during the first night we were finally at our destination.
The fifth day (and day one in Toronto) went great. My husband had a class all day so I spent the day wandering around the city myself. I made sure to pack a water bottle and a protein bar, and that sustained me through the day. For dinner, we went out with some of his classmates and I had some of the appetizers (oven baked nacho chips with vegan toppings), but by the time dinner came I had to put it all away to take home.
The sixth day was day two in Toronto. I spent time in the city again today and packed my protein bar and water again.
This was the first big trip we took since the bypass. I had spent a few days in Wildwood but the added complication of whole days in the car made this trip more difficult. This is what I've learned:
The first day of the road trip went right according to plan. The one difference was going out to eat, but of course I had leftovers.
The second day of the road trip took us past some family, who put a lot of thought into what they served us for lunch (I had tuna salad). For dinner I had the leftovers from the night before.
The third day we went to the Baseball Hall of Fame which included a lunch out. Our gracious guests grilled up some burgers and hot dogs and I had half of each.
The fourth day was about 6 hours of driving. First we went to Niagara Falls, where I had a lunch that did not sit well with me. Upon arriving in Toronto, we went out to dinner and bought one meal to split between the two of us, and I think my stomach was already not doing too well since lunch so I spent about an hour vomiting during the first night we were finally at our destination.
The fifth day (and day one in Toronto) went great. My husband had a class all day so I spent the day wandering around the city myself. I made sure to pack a water bottle and a protein bar, and that sustained me through the day. For dinner, we went out with some of his classmates and I had some of the appetizers (oven baked nacho chips with vegan toppings), but by the time dinner came I had to put it all away to take home.
The sixth day was day two in Toronto. I spent time in the city again today and packed my protein bar and water again.
This was the first big trip we took since the bypass. I had spent a few days in Wildwood but the added complication of whole days in the car made this trip more difficult. This is what I've learned:
- Don't test the waters with food while away. Have what you know works
- Make time to sit down and drink water
- Order one entree to feed two people. The leftovers we had floating around got tough to manage on the road
- Start the day with a protein shake even if there is a free breakfast at the hotel. On day five I had probably one egg and a single bite of sausage from the hotel breakfast and was stuffed (and unable to drink for 30 minutes). This was only 10g of protein at most. on day six I had a protein shake and things went better
- "Failing to prepare is preparing to fail" has basically become the mantra of how we travel.
As for workouts during this time, I got 15K and 10K steps in Toronto but besides that I was mentally and physically exhausted from driving. I can't wait to get back to the gym on Friday and get back into my routine.
Friday, July 21, 2017
July 20, 2017: Seven weeks, one day
Today was a day where a workout was just not going to happen. I'm still on the fence about workout out during lunch as this heat wave is upon us, but today was also a potluck for lunch (my first post-op) so that decision was made for me today.
For the potluck, I made a really simple deviled egg recipe. I've decided this will be my go to for potlucks and church events.
We're also going away tomorrow, and I had to buy stuff to make this road trip as successful as possible. I went to WalMart right after work hoping they sold a particular brand of protein powder and they did! And at the same price as Amazon!
Directly related to my needs for the trip, I bought the following (for the record I don't get any money/kickbacks from any company):
Chocolate and Vanilla Pure Protein
Quest bars
Applesauce packages
Think Thin bars
Beef Jerky
Already made Premier Protein Shakes
So...no lunch, not right after work, and I had support group. Prospects for working out were not good.
AND there was traffic galore. To the point where I nearly didn't go to support group, but as always I'm glad I did. The topic of discussion was hydration, which has been a struggle, and I was also the most recent post-op patient and plenty of pre-op patients had questions for me which I was glad to answer.
Food journal:
Breakfast:
Celebrate Protein (1.5 servings)
Lunch:
3 deviled eggs
Afternoon snack:
Oikos triple zero yogurt
Dinner:
1 serving of corn pasta with tomato sauce and quarter cup mozzarella cheese
For the potluck, I made a really simple deviled egg recipe. I've decided this will be my go to for potlucks and church events.
We're also going away tomorrow, and I had to buy stuff to make this road trip as successful as possible. I went to WalMart right after work hoping they sold a particular brand of protein powder and they did! And at the same price as Amazon!
Directly related to my needs for the trip, I bought the following (for the record I don't get any money/kickbacks from any company):
Chocolate and Vanilla Pure Protein
Quest bars
Applesauce packages
Think Thin bars
Beef Jerky
Already made Premier Protein Shakes
So...no lunch, not right after work, and I had support group. Prospects for working out were not good.
AND there was traffic galore. To the point where I nearly didn't go to support group, but as always I'm glad I did. The topic of discussion was hydration, which has been a struggle, and I was also the most recent post-op patient and plenty of pre-op patients had questions for me which I was glad to answer.
Food journal:
Breakfast:
Celebrate Protein (1.5 servings)
Lunch:
3 deviled eggs
Afternoon snack:
Oikos triple zero yogurt
Dinner:
1 serving of corn pasta with tomato sauce and quarter cup mozzarella cheese
May 31-June 1, 2017: Surgery and Hospital Stay
6:30am
The first thing I had to do this day was re-wipe myself using the instructions from my pre-op appointment. Since part of this involved my back, I woke up before my husband left for an appointment to help me out. I put on a new set of clothes, and went to bed.
8:15am
I woke up again and drank a bottle of Gatorade given to me from the pre-op appointment. I was told to have this done by 2 hours prior to my appointed arrival time of 10:30am. I got up, made sure everything I needed was in my bag, and my parents were due to arrive at about 9:30am to bring me.
In my bag, I packed:
2 pairs of underwear
2 pairs of comfy pajama or workout shorts
2 t-shirts
iPad
Charger (extra long)
Yarn and a crochet hook
Folder with all of my papers I got so far
Wallet
A hoodie in case I got cold
I wore comfortable clothes to the hospital. Something worth noting was that all of the clothes I brought were clothes I wouldn't mind losing. I kept the charger, my phone, iPad, and wallet in a place where someone would not easily be able to sneak in and grab them. Everything else stayed out of arms reach on a windowsill.
10:30am
We arrived at the hospital a few minutes early but soon enough they brought me into the back. First thing was first, they needed to make sure I wasn't pregnant. I remembered not to pee from the gatorade knowing this was coming, so I gave them my sample and came up negative. I changed into the hospital gown, and got my final pre-surgical weight.
Then, I got my first of 63 Lovenox shots that I would get or self-administer over the next 30 days. The nurse put a motion sickness patch behind my ear to help with nausea, and took a couple of tubes for testing. Then, they started the IV and hooked me up.
At that point my parents and husband were allowed to rejoin me. I was by far the least nervous person in the "room" if that's what you want to call it. It was probably about 11:30am by this time. I was due to go in at 12:30pm. Then the parade of medical professionals started. I don't remember the order, but that's probably not important. The surgeon stopped by to answer any questions my family had and I signed a consent for the surgery. The anesthesiologist stopped by to see how much I could open my mouth, and confirm what he already knew about me. Another anesthesiologist stopped by (there were two on the team) to introduce herself, and its a good thing she did because she was who I really talked to once they rolled me into the OR.
At around 1:00pm, the team came out to take me back. I gave my glasses and phone to my husband (taking off my glasses is my least favorite part of any procedure). I got rolled into the OR and shifted myself onto the table. The anesthesiologist got me positioned and explained that they have found that just a few minutes of CPAP therapy has proven to help patients going into surgery. The OR nurse strapped my legs into machines that pumped air into stockings to prevent blood clots. A few minutes passed by as they got me ready, and suddenly the time came where they instructed me that I would taste a metallic taste, smell something metallic, and possibly feel a burning sensation at the IV point.
5:35pm
The next thing I remember is waking up in the Post Anesthesia Care Unit (PACU) and the first feeling I felt was absolute nausea. A nurse was right by me and she was able to push Zofran to help with the nausea and was able to call out to my family that they could come back. In a few minutes I was reunited with my glasses (yay!) and they held me there for about 2 hours as I got more and more aware. The PACU is the only place I got inject-able pain management, but my pain was only at about a 5/10. My nausea on the other hand needed a second type of drug to finally get controlled.
7:45pm
Finally, a room became available and they rolled me up. For context of how well I was doing pain-wise, I was told immediately that I could have 10mg of oxy if I wanted. But I wanted to walk and use the rest room first. It took my husband and a nurse to get me out of bed, and I walked to the bathroom. I was able to do everything behind the privacy of a bathroom door, which was unexpected. My husband however had to help me put my underwear on. Once that was on, they gave me a second gown to use as a "cape" and cover that gap. I went for a walk, two laps around the floor I was on. Before he left for the night, he helped me put shorts on, so I wouldn't need to put the cape back on. The nurse then hooked my legs back up, and gave me my oxy and tylenol to take orally.
I was shocked. I was awake for a little more than two hours after a surgery that drastically changed the size of my stomach, and here these people were telling me to take drugs orally. They gave me water and the pills, and I took them. Immediatley I started dry heaving, but nothing produced and the feeling passed. A few minutes later I took another sip without any trouble.
And I quickly fell asleep.
Overnight
This was the four hour pattern I went through the whole night
6:30am
I was woken up by two surgeons to check my incisions and ask how my night went. The nurse said I was training for a marathon all night. Right after the surgeons left, the phlebotomist came in to take blood.
9:00am
When my mom came back the next day (dad and hubby had to work), I was walking when she got there. She literally could not believe it.
I'm going to stop the timestamps here, as the day filled with activity. I had a dietician come in to visit and remind me how important the post operative diet is. At this point, I had only had water, and Vitamin Water Zero, and I knew how important protein shakes were, so I asked for a protein shake to make sure I was okay drinking that before my discharge. The dietician helped me out by getting me a protein shake and made it for me. I had no issue getting this protein down.
Another surgeon also stopped by, and apologized for my surgeon as she was stuck in hellish traffic (by this point I had heard how bad traffic was from a few nurses and my mom). She stressed what the dietician had already said, and was willing to answer any questions. She had also heard I was up and about all night and confirmed I would be going home some time today. A case manager stopped by to ask me questions about my home life. She wanted to make sure I had support, asked if there were stairs, if anyone hurts me at home, etc.
Finally, the head nurse came in to start the discharge process. She had a whole pile of information she had to go through before I could leave, but most of it I knew already. My mom was told to go and get the car and bring it to a certain door, and I would meet her there as they had to wheel me out.
And just like that at about 1:00pm, about 24 hours after being rolled into the OR, Johns Hopkins Bayview was in the rear view mirror.
The first thing I had to do this day was re-wipe myself using the instructions from my pre-op appointment. Since part of this involved my back, I woke up before my husband left for an appointment to help me out. I put on a new set of clothes, and went to bed.
8:15am
I woke up again and drank a bottle of Gatorade given to me from the pre-op appointment. I was told to have this done by 2 hours prior to my appointed arrival time of 10:30am. I got up, made sure everything I needed was in my bag, and my parents were due to arrive at about 9:30am to bring me.
In my bag, I packed:
2 pairs of underwear
2 pairs of comfy pajama or workout shorts
2 t-shirts
iPad
Charger (extra long)
Yarn and a crochet hook
Folder with all of my papers I got so far
Wallet
A hoodie in case I got cold
I wore comfortable clothes to the hospital. Something worth noting was that all of the clothes I brought were clothes I wouldn't mind losing. I kept the charger, my phone, iPad, and wallet in a place where someone would not easily be able to sneak in and grab them. Everything else stayed out of arms reach on a windowsill.
10:30am
We arrived at the hospital a few minutes early but soon enough they brought me into the back. First thing was first, they needed to make sure I wasn't pregnant. I remembered not to pee from the gatorade knowing this was coming, so I gave them my sample and came up negative. I changed into the hospital gown, and got my final pre-surgical weight.
Then, I got my first of 63 Lovenox shots that I would get or self-administer over the next 30 days. The nurse put a motion sickness patch behind my ear to help with nausea, and took a couple of tubes for testing. Then, they started the IV and hooked me up.
At that point my parents and husband were allowed to rejoin me. I was by far the least nervous person in the "room" if that's what you want to call it. It was probably about 11:30am by this time. I was due to go in at 12:30pm. Then the parade of medical professionals started. I don't remember the order, but that's probably not important. The surgeon stopped by to answer any questions my family had and I signed a consent for the surgery. The anesthesiologist stopped by to see how much I could open my mouth, and confirm what he already knew about me. Another anesthesiologist stopped by (there were two on the team) to introduce herself, and its a good thing she did because she was who I really talked to once they rolled me into the OR.
At around 1:00pm, the team came out to take me back. I gave my glasses and phone to my husband (taking off my glasses is my least favorite part of any procedure). I got rolled into the OR and shifted myself onto the table. The anesthesiologist got me positioned and explained that they have found that just a few minutes of CPAP therapy has proven to help patients going into surgery. The OR nurse strapped my legs into machines that pumped air into stockings to prevent blood clots. A few minutes passed by as they got me ready, and suddenly the time came where they instructed me that I would taste a metallic taste, smell something metallic, and possibly feel a burning sensation at the IV point.
5:35pm
The next thing I remember is waking up in the Post Anesthesia Care Unit (PACU) and the first feeling I felt was absolute nausea. A nurse was right by me and she was able to push Zofran to help with the nausea and was able to call out to my family that they could come back. In a few minutes I was reunited with my glasses (yay!) and they held me there for about 2 hours as I got more and more aware. The PACU is the only place I got inject-able pain management, but my pain was only at about a 5/10. My nausea on the other hand needed a second type of drug to finally get controlled.
7:45pm
Finally, a room became available and they rolled me up. For context of how well I was doing pain-wise, I was told immediately that I could have 10mg of oxy if I wanted. But I wanted to walk and use the rest room first. It took my husband and a nurse to get me out of bed, and I walked to the bathroom. I was able to do everything behind the privacy of a bathroom door, which was unexpected. My husband however had to help me put my underwear on. Once that was on, they gave me a second gown to use as a "cape" and cover that gap. I went for a walk, two laps around the floor I was on. Before he left for the night, he helped me put shorts on, so I wouldn't need to put the cape back on. The nurse then hooked my legs back up, and gave me my oxy and tylenol to take orally.
I was shocked. I was awake for a little more than two hours after a surgery that drastically changed the size of my stomach, and here these people were telling me to take drugs orally. They gave me water and the pills, and I took them. Immediatley I started dry heaving, but nothing produced and the feeling passed. A few minutes later I took another sip without any trouble.
And I quickly fell asleep.
Overnight
This was the four hour pattern I went through the whole night
- Oxy
- 90 minute nap
- Slow wake up
- Called nurse to disconnect my legs
- Walk
- Play on phone
- Repeat list
6:30am
I was woken up by two surgeons to check my incisions and ask how my night went. The nurse said I was training for a marathon all night. Right after the surgeons left, the phlebotomist came in to take blood.
9:00am
When my mom came back the next day (dad and hubby had to work), I was walking when she got there. She literally could not believe it.
I'm going to stop the timestamps here, as the day filled with activity. I had a dietician come in to visit and remind me how important the post operative diet is. At this point, I had only had water, and Vitamin Water Zero, and I knew how important protein shakes were, so I asked for a protein shake to make sure I was okay drinking that before my discharge. The dietician helped me out by getting me a protein shake and made it for me. I had no issue getting this protein down.
Another surgeon also stopped by, and apologized for my surgeon as she was stuck in hellish traffic (by this point I had heard how bad traffic was from a few nurses and my mom). She stressed what the dietician had already said, and was willing to answer any questions. She had also heard I was up and about all night and confirmed I would be going home some time today. A case manager stopped by to ask me questions about my home life. She wanted to make sure I had support, asked if there were stairs, if anyone hurts me at home, etc.
Finally, the head nurse came in to start the discharge process. She had a whole pile of information she had to go through before I could leave, but most of it I knew already. My mom was told to go and get the car and bring it to a certain door, and I would meet her there as they had to wheel me out.
And just like that at about 1:00pm, about 24 hours after being rolled into the OR, Johns Hopkins Bayview was in the rear view mirror.
Thursday, July 20, 2017
May 30, 2017: Day and Night before surgery
May 30 was the day before the big day. As mentioned in the nutrition post, I was to follow a "full liquid" diet this day to not put much more into my intestines.
I was able to work from home this day and my husband had a day off. On his days off, he teaches ukulele lessons, so the house had people in and out all day which was great to break up the day. Our pastor also stopped by.
For food that I ate that day, I basically followed the liver shrink diet with a protein shake for dinner instead of a somewhat normal meal.
As I got ready for bed, I had specific instructions. I was to take a normal shower, then not apply any lotions or powders, then wait two hours, and wipe my arms, neck, and torso in a specific fashion using wipes provided at my pre-op. I was also to clean my belly button out with a cotton swab.
My instructions were also to sleep on clean sheets and wearing clean clothes this night as well. And, without pets in the room, which both kitties were NOT happy about. We had kicked them out a few nights earlier to make it less traumatic for us.
Then, I slept. Probably better than my husband.
Next up: Surgery day and joining the loser's bench
I was able to work from home this day and my husband had a day off. On his days off, he teaches ukulele lessons, so the house had people in and out all day which was great to break up the day. Our pastor also stopped by.
For food that I ate that day, I basically followed the liver shrink diet with a protein shake for dinner instead of a somewhat normal meal.
As I got ready for bed, I had specific instructions. I was to take a normal shower, then not apply any lotions or powders, then wait two hours, and wipe my arms, neck, and torso in a specific fashion using wipes provided at my pre-op. I was also to clean my belly button out with a cotton swab.
My instructions were also to sleep on clean sheets and wearing clean clothes this night as well. And, without pets in the room, which both kitties were NOT happy about. We had kicked them out a few nights earlier to make it less traumatic for us.
Then, I slept. Probably better than my husband.
Next up: Surgery day and joining the loser's bench
Wednesday, July 19, 2017
May 2017: Pre-op appointments
After I finished all of my pre-surgical requirements, I let the office manager for my doctor know so she could submit to insurance. Besides the initial appointment, I had the following to complete:
Just a few days later, I was told my surgery would be May 31. Less than a month away. I literally couldn't believe it and all the sudden everything was in motion. The office sent me a pile of papers of all of my appointments before and after surgery along with a reminder about the pre-surgical diet, and reminding me to get a pre-op with my PCP, which would include a blood draw, and a chest x-ray.
For the sake of readers who don't actually know me, my PCP does not actually have an x-ray on premises. So one day I had the afternoon off for a clinical trial I'm in (its super cool and I can't wait to share about that), I asked her to send the request in for my x-ray so I could get it while I had time off.
Chest x-ray...check
I had my visit with my PCP lined up for a few days later. She looked at the chest x-ray with me and basically gave me a physical including an EKG. It was uneventful but exciting because after months, this meant I was getting very close. After the EKG I got my blood drawn, so I was done with that step.
Finally I had to go see the surgeon for a pre-op. I asked why, and they said I had not been to the clinic hours since my initial visit in January and there was special stuff they had to give me. I went to the visit and the nurse practitioner on my surgeon's team was thrilled with all the progress I made (by this point I was teetering at 35lbs lost since January). She gave me two bottles of gatorade, special pre-surgical wipes, and a pretty blue bag. More details on all of those (including the pretty blue bag) later.
That was May 19. Next up was the big day.
I write this post because I see a lot of people online getting very nervous about their pre-op and the bottom line is, its just a physical. The doctors on your team need to know as much as they can about what's going on in your body before they put it through the incredible stress of surgery. For example, every other provider I've met claims I'm an asthmatic. I personally think I just get sick badly in my lungs for a longer period than others (something my cat Finn must have gotten from me), but the chest x-ray showed literally in black and white, something resembling asthma. Seeing as someone, namely the anesthesiologist, was going to be controlling my breathing for about four hours, this is an important detail.
Next up: May 30, 2017
- Four appointments with my Primary Care Provider known from here out as PCP (or three appointments at JH Bayview)
- An appointment with a Nutritionist (here I covered vitamins and here I covered food)
- An appointment with a Psychiatrist
- Attend a Group Support session
- Have an EGD done
- Have a sleep study done
Just a few days later, I was told my surgery would be May 31. Less than a month away. I literally couldn't believe it and all the sudden everything was in motion. The office sent me a pile of papers of all of my appointments before and after surgery along with a reminder about the pre-surgical diet, and reminding me to get a pre-op with my PCP, which would include a blood draw, and a chest x-ray.
For the sake of readers who don't actually know me, my PCP does not actually have an x-ray on premises. So one day I had the afternoon off for a clinical trial I'm in (its super cool and I can't wait to share about that), I asked her to send the request in for my x-ray so I could get it while I had time off.
Chest x-ray...check
I had my visit with my PCP lined up for a few days later. She looked at the chest x-ray with me and basically gave me a physical including an EKG. It was uneventful but exciting because after months, this meant I was getting very close. After the EKG I got my blood drawn, so I was done with that step.
Finally I had to go see the surgeon for a pre-op. I asked why, and they said I had not been to the clinic hours since my initial visit in January and there was special stuff they had to give me. I went to the visit and the nurse practitioner on my surgeon's team was thrilled with all the progress I made (by this point I was teetering at 35lbs lost since January). She gave me two bottles of gatorade, special pre-surgical wipes, and a pretty blue bag. More details on all of those (including the pretty blue bag) later.
That was May 19. Next up was the big day.
I write this post because I see a lot of people online getting very nervous about their pre-op and the bottom line is, its just a physical. The doctors on your team need to know as much as they can about what's going on in your body before they put it through the incredible stress of surgery. For example, every other provider I've met claims I'm an asthmatic. I personally think I just get sick badly in my lungs for a longer period than others (something my cat Finn must have gotten from me), but the chest x-ray showed literally in black and white, something resembling asthma. Seeing as someone, namely the anesthesiologist, was going to be controlling my breathing for about four hours, this is an important detail.
Next up: May 30, 2017
April 26, 2017: Nutrition Visit (Food)
In a previous post about nutrition, I realized this single visit was a huge amount of information. I covered vitamins previously with the promise to cover nutrition.
I feel now is an appropriate time to again remind readers that I'm a patient, not a doctor or dietician. I have a history degree, not a medical degree. I do however read everything put in front of me, which I highly recommend, and I take advice from outside of my surgical program with a big grain of salt.
I'm going to break up the nutrition by day and week and only until the point I'm at now. I'm sure I'll have nutrition updates as my diet expands.
Two weeks prior (really thirteen days, see below): Pre-surgical "Liver Shrink" Diet
A little known fact about most obese individuals is that their livers are swollen with fatty liver disease. It's a medical fact of life.
In order to perform a successful laparoscopic surgery, the liver must be as small as it possibly can be. In order to do this, surgeons assigns a special pre-surgical diet.
Starting two weeks out, my diet looked like this:
Breakfast:
Protein Shake
Mid morning snack:
Fat free yogurt or fruit
Lunch:
Protein Shake
Snack:
Fat free yogurt or fruit (usually whatever I didn't have earlier)
Dinner:
3-4oz of lean meat/fish with 1c. steamed veggies OR 1c. salad with 1 TBSP of low fat dressing
It was hard at first, I'm not going to lie. But I knew that this was still A LOT of food compared to what my life was going to look like post op. Also, I knew following this diet to the letter was the difference between a laparoscopic surgery and an open surgery. Open surgeries require a much longer recovery time.
One day prior: Full Liquid Diet
One day before it's time to make sure you have as little in your digestive system as possible. This day looked very similar to the previous two weeks, but just yogurt twice instead of fruit, and dinner was also a protein shake.
One week after: Full liquid diet
For the full liquid diet, there were more options that one would think. I was able to have yogurt, ricotta cheese, cottage cheese, pudding, jello, and frozen treats such as sugar free popsicles and fudge pops.
The most important parts of this week is to get the 60-80g of protein in daily and to get at least 64oz of water daily. This would become quite the challenge, but it should literally be the only two things your focusing on.
Weeks two, three, and four: Puree
This was an annoying part of the diet. Honestly I just bought baby food for the most part to get veggies and fruit in. There were also little baby food treats that I treated myself to. For meat, I discovered that chicken did not work for me, but ground beef that was then put into a food processor worked great. Tuna (pureed) also worked great.
Weeks five, six, seven, eight: Soft foods
This is my current place. I can basically eat anything except for the skins of vegetables and fruits, rice, and some other stuff that doesn't come to mind but I don't miss it. Take a look at any of my food journals to get an idea of what I'm doing these days.
I will say this, through this whole process, foods should be fat free or low fat as much as you can. A little fat is healthy to get into a diet daily, but do look for the lower fat items when given options.
Next up: Pre-op
I feel now is an appropriate time to again remind readers that I'm a patient, not a doctor or dietician. I have a history degree, not a medical degree. I do however read everything put in front of me, which I highly recommend, and I take advice from outside of my surgical program with a big grain of salt.
I'm going to break up the nutrition by day and week and only until the point I'm at now. I'm sure I'll have nutrition updates as my diet expands.
Two weeks prior (really thirteen days, see below): Pre-surgical "Liver Shrink" Diet
A little known fact about most obese individuals is that their livers are swollen with fatty liver disease. It's a medical fact of life.
In order to perform a successful laparoscopic surgery, the liver must be as small as it possibly can be. In order to do this, surgeons assigns a special pre-surgical diet.
Starting two weeks out, my diet looked like this:
Breakfast:
Protein Shake
Mid morning snack:
Fat free yogurt or fruit
Lunch:
Protein Shake
Snack:
Fat free yogurt or fruit (usually whatever I didn't have earlier)
Dinner:
3-4oz of lean meat/fish with 1c. steamed veggies OR 1c. salad with 1 TBSP of low fat dressing
It was hard at first, I'm not going to lie. But I knew that this was still A LOT of food compared to what my life was going to look like post op. Also, I knew following this diet to the letter was the difference between a laparoscopic surgery and an open surgery. Open surgeries require a much longer recovery time.
One day prior: Full Liquid Diet
One day before it's time to make sure you have as little in your digestive system as possible. This day looked very similar to the previous two weeks, but just yogurt twice instead of fruit, and dinner was also a protein shake.
One week after: Full liquid diet
For the full liquid diet, there were more options that one would think. I was able to have yogurt, ricotta cheese, cottage cheese, pudding, jello, and frozen treats such as sugar free popsicles and fudge pops.
The most important parts of this week is to get the 60-80g of protein in daily and to get at least 64oz of water daily. This would become quite the challenge, but it should literally be the only two things your focusing on.
Weeks two, three, and four: Puree
This was an annoying part of the diet. Honestly I just bought baby food for the most part to get veggies and fruit in. There were also little baby food treats that I treated myself to. For meat, I discovered that chicken did not work for me, but ground beef that was then put into a food processor worked great. Tuna (pureed) also worked great.
Weeks five, six, seven, eight: Soft foods
This is my current place. I can basically eat anything except for the skins of vegetables and fruits, rice, and some other stuff that doesn't come to mind but I don't miss it. Take a look at any of my food journals to get an idea of what I'm doing these days.
I will say this, through this whole process, foods should be fat free or low fat as much as you can. A little fat is healthy to get into a diet daily, but do look for the lower fat items when given options.
Next up: Pre-op
Tuesday, July 18, 2017
April 26, 2017: Nutrition Visit (Vitamins)
Nutrition is the biggest, longest part of this pre-surgical process.
It also has the potential to be the most confusing.
Hopkins' program is a single, 90 minute meeting with the nutritionist about a month before surgery. I made the appointment in February assuming my PCP visits would stay on schedule. Sure enough, everything stayed on track and I was able to have my appointment.
There was a book that the nutritionist went through, but it can be summed up into two parts: vitamins, and food. This post will focus on vitamins.
Vitamins were deceptively easy. I have decided not to talk numbers as to not confuse any readers from what your program's nutritionist may have said. When in doubt, trust your own nutritionist and now some power-hungry blogger.
I will say this about vitamins that I have found other patients in other programs concur with. First, there is no swallowing of vitamins for the first 6 months or so, so everything is chewable. Also, no gummies that are so popular right now. The new gastric bypass stomach cannot handle a gummy.
I was given options with regards to brand, and she said if I found a new vitamin, to look at the goals she was giving me that day, and make sure it lined up. She also gave me some samples to help my purchasing decision.
This is what I've decided to take (again, this works for me, it might not work for you):
By 6:30am:
Celebrate Calcium Plus 500
By 8:30am but no sooner than 2 hours after first pill:
Celebrate Calcium Plus 500
By 2:00pm but no sooner than 2 hours after second pill:
Celebrate Calcium Plus 500
In the evening, at least 2 hours after final calcium pill:
Celebrate Multivitamin with 60 Iron (2)
I was told that Calcium Citrate is harder to purchase in regular stores, so I decided to go through Celebrate for those. I have since found out that a chewable calcium citrate is sold at WalMart and I have yet to investigate for myself.
I decided to buy Celebrate for the Multivitamin as well, because Celebrate was the complete package, including Biotin for hair, and my daily iron. Since starting, sometimes the multivitamin makes me really nauseous. For my next order, I decided to separate the multivitamin from the iron to try to help this nausea. The total cost for my first three months of vitamins was $96.
A quick note on my iron intake: bypass patients require a higher amount daily as do pre-menopausal women. So I won on both fronts.
In the past couple of months, I have heard so many stories about vitamins. I'm glad my vitamins are so streamlined, even when I do separate the multivitamin from the iron. Also, while $96 feels like a big purchase when I buy it, it lasted me ninety days, so that's a hair more than a dollar a day.
I ordered the next batch and it went up to $121, but it might be worth it to not end my day with sometimes overwhelming nausea.
Successful vitamin intake has shown to prevent hair falling out, bone issues, and more successful pregnancies than those who do not take vitamins. I also ordered this oversize pill holder on Amazon that has been perfect for me. I pop the "day" box out and carry it with me all day.
It also has the potential to be the most confusing.
Hopkins' program is a single, 90 minute meeting with the nutritionist about a month before surgery. I made the appointment in February assuming my PCP visits would stay on schedule. Sure enough, everything stayed on track and I was able to have my appointment.
There was a book that the nutritionist went through, but it can be summed up into two parts: vitamins, and food. This post will focus on vitamins.
Vitamins were deceptively easy. I have decided not to talk numbers as to not confuse any readers from what your program's nutritionist may have said. When in doubt, trust your own nutritionist and now some power-hungry blogger.
I will say this about vitamins that I have found other patients in other programs concur with. First, there is no swallowing of vitamins for the first 6 months or so, so everything is chewable. Also, no gummies that are so popular right now. The new gastric bypass stomach cannot handle a gummy.
I was given options with regards to brand, and she said if I found a new vitamin, to look at the goals she was giving me that day, and make sure it lined up. She also gave me some samples to help my purchasing decision.
This is what I've decided to take (again, this works for me, it might not work for you):
By 6:30am:
Celebrate Calcium Plus 500
By 8:30am but no sooner than 2 hours after first pill:
Celebrate Calcium Plus 500
By 2:00pm but no sooner than 2 hours after second pill:
Celebrate Calcium Plus 500
In the evening, at least 2 hours after final calcium pill:
Celebrate Multivitamin with 60 Iron (2)
I was told that Calcium Citrate is harder to purchase in regular stores, so I decided to go through Celebrate for those. I have since found out that a chewable calcium citrate is sold at WalMart and I have yet to investigate for myself.
I decided to buy Celebrate for the Multivitamin as well, because Celebrate was the complete package, including Biotin for hair, and my daily iron. Since starting, sometimes the multivitamin makes me really nauseous. For my next order, I decided to separate the multivitamin from the iron to try to help this nausea. The total cost for my first three months of vitamins was $96.
A quick note on my iron intake: bypass patients require a higher amount daily as do pre-menopausal women. So I won on both fronts.
In the past couple of months, I have heard so many stories about vitamins. I'm glad my vitamins are so streamlined, even when I do separate the multivitamin from the iron. Also, while $96 feels like a big purchase when I buy it, it lasted me ninety days, so that's a hair more than a dollar a day.
I ordered the next batch and it went up to $121, but it might be worth it to not end my day with sometimes overwhelming nausea.
Successful vitamin intake has shown to prevent hair falling out, bone issues, and more successful pregnancies than those who do not take vitamins. I also ordered this oversize pill holder on Amazon that has been perfect for me. I pop the "day" box out and carry it with me all day.
Monday, July 17, 2017
March 9, 2017: Group Support Session
Another item on my list to attend was a group support session at Johns Hopkins. They are offered twice monthly, and I'll admit I put it off. I didn't know what I would learn from a room full of people when I have doctors and the internet to look to. I didn't need another "Weight Watchers" type meeting.
I walked in expecting to just check my box, but what I found was so much more.
I came to find out that each session (held twice monthly) has a theme, such as surgical, nutritional, and behavioral. Each are led by a representative from that department.
At first I was hesitant to go (although I knew I had to), because I've been to enough meetings about losing weight or trying to lose weight. This was a different approach, a surgical approach, and I didn't see how a meeting would help.
I was so wrong.
In this usually full room, it is full of people that share a journey with me. There isn't anything said perceived as too weird ("Does anyone else have really smelly gas all the sudden?"). Everyone in the room can either guide you down the road, or you will become a role model for someone else in the room. I have several friends that went through the surgery, and this room has become a room full of friends no matter how many times they have walked through the door.
I can always tell the first timers, feeling the room out seeing if the size of the attendees matches their expectations of the meeting. As the meeting starts, we all introduce ourselves and say if we're pre or post op, what type of surgery, and how much we have lost (if applicable). The first time I went I took tons of notes, but now I listen. And that has been so much help.
Don't get me wrong, I have an amazing support system. My husband, parents, and in-laws are all local and unbelievably supportive and have made sacrifices through this journey. I also have friends an coworkers who are supportive and hear about what I'm going through.
It's not the most convenient place for me, its about a 40 minute drive from my house twice a month after a day of work. But I make the time to go to these meetings because they are so supportive.
Next appointment: Nutrition.
I walked in expecting to just check my box, but what I found was so much more.
I came to find out that each session (held twice monthly) has a theme, such as surgical, nutritional, and behavioral. Each are led by a representative from that department.
At first I was hesitant to go (although I knew I had to), because I've been to enough meetings about losing weight or trying to lose weight. This was a different approach, a surgical approach, and I didn't see how a meeting would help.
I was so wrong.
In this usually full room, it is full of people that share a journey with me. There isn't anything said perceived as too weird ("Does anyone else have really smelly gas all the sudden?"). Everyone in the room can either guide you down the road, or you will become a role model for someone else in the room. I have several friends that went through the surgery, and this room has become a room full of friends no matter how many times they have walked through the door.
I can always tell the first timers, feeling the room out seeing if the size of the attendees matches their expectations of the meeting. As the meeting starts, we all introduce ourselves and say if we're pre or post op, what type of surgery, and how much we have lost (if applicable). The first time I went I took tons of notes, but now I listen. And that has been so much help.
Don't get me wrong, I have an amazing support system. My husband, parents, and in-laws are all local and unbelievably supportive and have made sacrifices through this journey. I also have friends an coworkers who are supportive and hear about what I'm going through.
It's not the most convenient place for me, its about a 40 minute drive from my house twice a month after a day of work. But I make the time to go to these meetings because they are so supportive.
Next appointment: Nutrition.
March 3, 2017: Gynecologist
When undergoing the process to get such a life-changing surgery, you never know what doctors will be on your to-do list.
At the first appointment, another item that was brought up was the need to change my method of birth control. I was on the tried and true hormonal pill option, but the extra hormones increase the risk of blood clots. Hospitals as a whole have increased concern about blood clots, and obesity is one strong factor, so I could understand why they required me to change.
Second, it is suggested to not get pregnant for 18 months after surgery, so getting a non-hormonal implant increased the effectiveness of pregnancy prevention. It takes out the human error of remembering to take the pill at exactly the same time every day for most effectiveness.
Finally, dropping so much weight so quickly makes women particularly fertile. So in order to reach that 18 month goal, patients need to be very careful.
I made an appointment with a new gynecologist, because my current one decided to leave her practice. Luckily, I was able to stress the importance of getting the ball rolling with this appointment so they were able to get me in pretty quickly.
At the appointment, we discussed my options. One was an IUD such as Mirena. I was not a fan of Mirena or other IUDs as I did not want another pain to worry about. Gastric bypasses does affect your intestines, and there are all sorts of things to worry about in that regard (hernias, blockages, etc). I wanted to not have to go through a longer process to arrive at a potential diagnosis for lower abdominal pain.
Another option was a non-hormonal birth control pill, but she told me she would not recommend that to me. It is proven to not be effective in obese women.
Finally there was the Nexplanon insert. It is inserted into the upper arm in an quick, in-office procedure. It took nearly two months from the appointment to get Nexplanon inserted, and it ended up happening thirty days before surgery.
To get the Nexplanon inserted was relatively painless, and my experience didn't even involve much bruising. The doctor numbed the area, and then inserted it, and voila! I'm good for up to three years. I am told that for most women there is not much time needed between removing the implant and being fertile again.
Next appointment: Support Group
At the first appointment, another item that was brought up was the need to change my method of birth control. I was on the tried and true hormonal pill option, but the extra hormones increase the risk of blood clots. Hospitals as a whole have increased concern about blood clots, and obesity is one strong factor, so I could understand why they required me to change.
Second, it is suggested to not get pregnant for 18 months after surgery, so getting a non-hormonal implant increased the effectiveness of pregnancy prevention. It takes out the human error of remembering to take the pill at exactly the same time every day for most effectiveness.
Finally, dropping so much weight so quickly makes women particularly fertile. So in order to reach that 18 month goal, patients need to be very careful.
I made an appointment with a new gynecologist, because my current one decided to leave her practice. Luckily, I was able to stress the importance of getting the ball rolling with this appointment so they were able to get me in pretty quickly.
At the appointment, we discussed my options. One was an IUD such as Mirena. I was not a fan of Mirena or other IUDs as I did not want another pain to worry about. Gastric bypasses does affect your intestines, and there are all sorts of things to worry about in that regard (hernias, blockages, etc). I wanted to not have to go through a longer process to arrive at a potential diagnosis for lower abdominal pain.
Another option was a non-hormonal birth control pill, but she told me she would not recommend that to me. It is proven to not be effective in obese women.
Finally there was the Nexplanon insert. It is inserted into the upper arm in an quick, in-office procedure. It took nearly two months from the appointment to get Nexplanon inserted, and it ended up happening thirty days before surgery.
To get the Nexplanon inserted was relatively painless, and my experience didn't even involve much bruising. The doctor numbed the area, and then inserted it, and voila! I'm good for up to three years. I am told that for most women there is not much time needed between removing the implant and being fertile again.
Next appointment: Support Group
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