Exodus from Obesity book review

Last week I decided to pick up a few things in anticipation of my upcoming surgery.  I bought some baby spoons (to keep me focused on small bites and slowing down), and some very small containers with lids for a few ounces of this or that (since that's all I'll be able to eat).  I also bought a digital food scale to weight foods as I learn what serving sizes look like.  Just planning ahead (and really looking forward to something besides protein powder and Lean Cuisines to eat).... 

I also came across a really amazing book, Exodus from Obesity: The Guide to Long Term Success After Weight Loss Surgery © 2003 by Paula Peck, RN. ISBN 0-9728050-1. 

This book is outstanding for several reasons.  First, it is quite readable, and personable in its tone.  There is a real sense of the writer’s experience, insight, and knowledge about gastric bypass from both a medical and personal point of view.  

Another remarkable aspect about this book is the honest and sensitive way that Ms. Peck discusses those sometimes embarrassing and delicate circumstances that we’ve all experienced as obese people.  An example might be needing to consider available accessible seating on planes, in movie, theaters, auditoriums, or even doctor office waiting rooms. I could relate to these and other examples because aside from needing to ask for a seat belt extender on airlines, I have also had to purchase a seatbelt extender for my car, and have even had to search for alternate seating in a lecture hall at a local hospital.  These circumstances aren't all seating related, obviously, but they are very recognizable for most of us.

Ms. Peck writes about these and other emotional aspects of obesity with first-hand knowledge, and shares from this perspective her success since her Gastric Bypass in 1999. 

Aside from Pre and Post-op experiences, and discussions about the basics of food choices and eating styles,re are a few of the more relevant topics:

·               Relationship Changes After Gastric Bypass Surgery

·               Dealing with Self Defeating Behaviors

·               Sexuality

·               Adapting to your New Image

·               Preparing Emotionally for Weight Loss, & more... 

I was so taken by this book, and so motivated and inspired by her sensitive and direct tone that I emailed Ms. Peck to share my feelings about the book and to ask permission to reprint several items for use in this blog.  Much to my delight, she was willing to allow me to reprint the items that I thought would be helpful: a List of Protein Grams per Average Serving,  and some general Sugar Information: listing substances that form sugar, contain sugar, are refined sugar, and the Quick Sugar Reference.  Look for these items soon on the Useful Resources page. 


Many, many thanks to author Paula Peck for her warmth and generosity (and written permission) in allowing me to reprint these wonderful resources on this blog.  

Coming soon: Fortune Cookie Therapy -- The best way to predict the future is to create it.

Fortune Cookie Therapy from "The Bowl"

From The Bowl: 

• Off with the old and On with the New
• Flip side: Roll with the punches

I think I've mentioned that I see a therapist - a psychologist who I began to see in the hopes that my disability issues would become clearer.  As time went on, she began to assist me with some of the emotional, and psychological issues around my weight and my pending surgery.  At the core of it all was me beginning both to take responsibility for where I am today, and the ability to forgive myself and move on.  I suppose that as time goes on and these issues begin to make more sense and to look clearer to me, we'll revisit them.  In any case, GW has been very, very helpful to me.


One day, several months ago in my therapy, I noticed something that really caught my eye.  A bowl.  In this bowl were perhaps 100 little card stock weight papers slips in a pale yellow with phrases on them.  As I picked on up I was delighted to discover on these little 3" x ½" slips that there were two phrases, one on each side!  The phrases were sometimes credited if the author was known, but other times were not.  All had a deep therapeutic concept in them, though not always for me, I frequently recognized a thread of something worthwhile in each slip.  They were there to act as a little therapeutic fortune cookie - cosmic, randomly chosen inspiration from Dr. W's bowl to those who might partake of this form of fun "therapy."


You may have noticed that the name of this blog is “Off with the Old: My Gastric Bypass & the Lessons I've Learned From the Process”.  It's no accident that I came up with the initial part of the phrase, and also found a slip in The Bowl that said, “Off with the old and On with the New”.  I shared this with Dr. W in my last session with her, and I could tell that she was pleased that her bowl of inspiration had come to use in my therapy.  Truth be told, every slip offers me something for the day, and for that reason alone I will share them with you, faithful readers.  Sometimes I'll even try to tie into the posting a piece of the randomly chosen inspiration from The Bowl.

It's starting... "Head Hunger"

... A seductive curl of steam rising from the plate 
... Small yellow rivulets of butter dripping down the side of creamy mashed potatoes 
... Tempting and crispy browned skin on a fragrant, succulent chicken breast 
... A distant hint of something green? Spinach, green beans?  Something green...whatever.

I'm siting here, thinking about food.  Not bunny food, but "real" substantial food with butter, carbs, etc.  Hmmm....  OMG!  It's just a commercial!  I haven't even had my surgery yet!  ::sigh::

Well, they did warn me that there would be possible reactions to or experiences after weight loss surgery, including a preoccupation with food on television.  For more information about additional reactions to or experiences after having weight loss surgery, see Appendix A under the Appendices tab.


I am definitely entranced when a commercial comes on TV parading some company's delicious foods in front of me every 10 minutes.  It's not even that I feel especially deprived on the partial liquid diet they've put me on.  I am getting plenty to eat, really.  It's just a matter or having been raised in a culture that "Super Sizes" everything, and that celebrates "The late night Munchies" -- constantly!  


My husband doesn't help, either.  Big Bruiser is 6'5" and weighs about 300 pounds.  At the ripe age of 50, he can still eat like a like a teenager - 2 large bowls of cereal at noon, and after diner, 2 great big bowls of ice cream,  a handful of candy, whatever he wants, really.  The fact is, for me losing weight *is* hard.  The sacrifices, the commitment, and the focus that it takes to make the decision to change your lifestyle is significant.  But this is the first time I've been really face to face with my "head hunger," the emotional element to losing weight, and one of the reasons that so many people find weight loss so very difficult.  "Head Hunger" is the psychological part of how we feel about food, and what we think about food.  It is highly personal, and highly individualized.  For me, this preoccupation with food on television and my reaction to the images of food is like an itch that I can't scratch.  I'm really struggling to stay focused and to put all restricted foods out of my head.  I'm eating a medically supervised diet that is considered a partial liquid diet  - high protein to prepare for my GB.  HMR 70+ vanilla and chocolate pudding 4 times a day, high potassium veggies, and 1 high protein lean cuisine a day is the program for me.  Not a lot of food really.  I'd like to point out that I *was* eating a bit more than this before Dr. H. put me on the partial liquid diet.  It's a little humbling when I think bout how much more I was eating before I started a plan of any kind.  The truth is pretty clear:  you have to keep your eye on the ball the whole time while you're getting ready for surgery, and afterward.


I'm trying to stay focused.  I know that a new stomach/new plumbing will force the issue, and the "head hunger" will episodically be worse as I move through the process of understanding what makes me tick, food-wise.  Regardless I'm feeling prepared (for the moment) to fight to good fight, and move forward - despite commercials with fast food that seem to call to me.   


Next time...  Fortune Cookie Therapy

OMG! I Have a Surgery Date!

Finally!
So I got the call on from my clinic on Tuesday, 7/13.  Even though I've been hoping, praying, planning, worrying, anticipating, expecting, and was generally filled with angst about it; I was completely surprised and caught off guard when Dr. H's, MA said, “The insurance has given me the go-ahead to get you on the books!”  All I've though about was the surgery.  But when she called me I was completely caught off guard.  How weird is that?

OK, so I'll go to the hospital for surgery on 8/11/10.  A week before,  I have a whirlwind of other pre-procedure stuff to do: I am scheduled to have pre-op labs drawn, the pre-op class, and a final meeting with the nurse practitioner on 8/3/10.  This is the time that they will weigh me for my 'final official weigh-in (although I *could* weigh-in on 8/10/10 if need be - very reassuring news for sure).

Since my official fan club (read family, so far) is using this blog to check in on the latest news, I wanted to review the specific procedure information. According to the Medical Assistant, I'll be having a Roux-en Y Gastric Bypass (pronounced roo -en-why). 

Roux-en Y gastric bypass is a restrictive operation where a small pouch is made at the upper portion of the stomach, which can hold only 1-2 tablespoons in volume. This procedure helps you lose more weight three ways:      

•      I'll eat MUCH less or it will come back up. The food has no choice. If you can't eat a lot, you will lose weight.  Period.

•     Apparently my appetite (as well as my taste for sweet things potentially) will actually begin to change. After the procedure, most patients find that their body will not easily tolerate foods that are high in refined sugars and fats. This is called "Dumping Syndrome." Dumping Syndrome is a common side effect after gastric bypass and occurs when the contents of the stomach empties rapidly into the small intestine, especially if I eat concentrated sweets or carbohydrates. The feeling will be a combination of profuse sweating, nausea, dizziness and weakness. "Dumping" is actually a desired side effect of the surgery to discourage one from eating sweets.  Unpleasant.  Approximately 95% post-op Gastric Bypass patients suffer from Dumping Syndrome at least to a degree.      

•      You actually absorb fewer calories. Keep in mind that your body's plumbing is re-worked. After a Roux-en Y, food bypasses part of your small intestine and digestion occurs in the lower part of the small intestine. This combined with the much smaller stomach, and reduces the amount of calories your body absorbs from the food you eat.

I’d be more fascinated if I weren’t shaking in my boots.  I'm mostly reassured that my pain will be managed, and then I just have to focus of sipping, hydration, walking and staying mobile in the face of (probably) not feeling much like it.


I'm open to comments, reassurance or any other feedback (please).  

Reflections on a Difficult Time - Going off on Medical Leave

In January 2010 I went out on a medical leave.  I had the support of my doctors, my family, and even my employer.  I did have the small matter of some excessive absenteeism due my illnesses, and unfortunately this put me in a position without any guarantee that my position would be available if/when I came back.  It didn't matter because I was just too sick to keep working at that time.  My weight loss was one factor, and of course there was the matter of my fibromyalgia.


Making this change was incredibly traumatic.  I missed my sense of purpose, my work, seeing my work partners and friends every day; and despite having some short term disability coverage, a full paycheck was  also sorely missed.  I found a great deal of support and comfort in working weekly with a psychologist (thanks, GW!), as well as important time to talk about some issues related to my weight.   I continue to prepare for an eventual surgery date, filled with anticipation, trepidation, excitement, fear and hope.


Happily, my fibromyalgia is slowly improving.  I'm bothered most by incredible fatigue from time to time when I have a flare.  This does interfere with my ability to exercise consistently, but I'm making every effort to get some exercise in daily.  I feel very lucky as I recuperate, to have the opportunity to focus on my upcoming WLS (GP- RNY, I expect) to make some long needed changes in my health and welfare.


I've been on a partial liquid diet using HMR high protein powder, lots of veggies, some yummy yogurt and some great high protein Lean Cuisines for 5 weeks now.  Tomorrow I get to discuss the possibility of choosing a surgery date with my doc, the nurse practitioner and perhaps other members of my team.


My fingers are crossed...

Off With the Old

Welcome to my blog:  Off With the Old! My Gastric Bypass and the Lessons I've Learned From the Process

I started this blog at the urging of some of the members of my team, at the Legacy Health Weight Management Institute in Portland, Oregon.  I am a patient at the Weight Management Institute (WMI) Since November 2009.  Since then I have been virtually surrounded by a team of professionals assisting me in planning for success in finally achieving my weight loss goals.  I want to say that my support team doesn't just include the Physical Therapist (PT), psychologist, nurse practitioner, registered dietitian (RD), and Surgeon (MD).  I also consider my family, my Primary Care provider (PCP),  and my personal psychologist to be just as important in my quest for lifelong weight loss. 

My Story

I have been overweight for as long as I can remember.  As a child, I was "the fat one" and I struggled despite my parents desperate and sometimes dysfunctional efforts to "make me thin".  I say this with love, because despite the worry my weight caused my family, with the comments, the bribery, the begging and pleading - I know that this was because they love me.  Nevertheless, it was difficult and often painful dealing with the pressures around my weight, whether it was a few pounds or many in question.

Last Fall I decided that enough was enough. It seemed then as if it happening all at once, but in retrospect it clearly happened over a matter of months to a couple of years. I was suffering from a multitude of medical problems that made work virtually impossible, and nearly all of my complications were related to my weight.  I was suffering from:

• Hypertension (high blood pressure)
• Chronic pain from osteoarthritis in my knees, ankles and low back  
• Non-insulin dependent diabetes
• Chronic heartburn from GERD (gastro-esophageal reflux disease)  
• Severe sleep apnea requiring that I use a machine called a C-PAP at night when I slept.  This requires getting used to a face mask of sorts hat blows air into your airway to keep it open while you sleep
• Impaired mobility -  I was having difficulty getting around, and now had to use a straight or single point cane.  

I agree that this is a lot of medical trouble, but that was not the worst of it.  I also suffered from:   

• Periodic venous stasis wounds on my legs from leaking veins that were causing a need for sometimes painful daily wound treatment and aggressive compression treatment ranging from the "oh so fashionable" compression hose to mechanical pumping using a lymphedema pump.  This pump machine is recommended for use for several hours a day to control lower extremity edema (swelling).  
• And the compression hose?  They are as uncomfortable as they are ugly.  

Suddenly it seemed that I was a mess and was heading toward disability very quickly.  And that's why when I was diagnosed with Fibromyalgia, on top of all of the rest of it I knew I didn't stand a chance.  Triggered by my many medical problems, my fibromyalgia flared out of control.  I was missing a third of my scheduled work time, and I was facing issues at work due to my absenteeism.  My job was on the line for the first time in my life.  I knew then that I needed to go out on a medical leave.  Fortunately, my PCP, Dr. D agreed.


More soon...