On the eve of more changes!

Time for an update!  

It's been 9½ months since my gastric bypass surgery.  It has been a bumpy ride right from the start. During my RNY GB surgery they found an 11-pound benign ovarian tumor in my abdomen that really messed with me mentally.  I realize now that I allowed the tumor to be a distraction, and that lesson is very valuable to me even though I'm not certain today how I could have avoided worrying about it as much as I did.  I also had to have a small hernia repair that my bariatric surgeon said she would repair (and didn't) during my  surgery.  Having 3 surgeries in 7 months was definitely a challenge, but trying to start an exercise regimen has also been very difficult.

Mollie Linden, 2010

As of today, I've lost 87 pounds and gained 6 (a net loss of 81 pounds as of today)!  I'm no longer diabetic (my HgA1C is 4.7),  or hypertensive (my BP is normally 110/60 - 106/56), and my cholesterol levels are all exactly where they should be.  I'd really like to reach the "minus 100 pound mark" by my gastric bypass anniversary on 8/11/10.  And, as my recently departed and much loved grand-mother Mollie would say, "God willing..." I'll be successful.  Granny was wise and loving, and once told me that it didn't matter to her if I was fat or thin.  She only wished, sincerely wished,  for me to be happy.  Considering how ill I was when my journey started, I feel lucky and (finally) very happy to be where I am.  I do have to work daily to avoid falling into the trap of wishing I'd lost more weight at this point, and it can be challenging when I look at people who have lost more than me who started when I did.  But my mantra of late, is "stick to modest and attainable goals".

One thing that's halped me immensly, is a change in doctors.  I've moved my care to a really great bariatric clinic that specializes in weight loss and weight loss surgery.   My new doctor is credited with bringing gastric bypass surgery to the Pacific Northwest, and has a long and impressive list of accomplishments, training and education.  As important to me though, is having a kind, open and patient doctor to work with.  Dr. P. is not only accomplished, but caring and warm.  This is only my opinion, but as far as I'm concerned it wasn't too difficult to find a bariatric surgeon who is "good".  It was a little trickier though, to find one who is good and also caring, kind, patient and professional.

Dr. P.'s kindness and warmth were especially evident when I expressed my concerns about my 3-month long "plateau" and weight gain of 6 pounds.  I emotionally explained that my weight was stuck in between 6-pounds, and nothing I was doing seemed to make the difference.  Evidently this is common, easily explained, and not abnormal.  She said I was likely suffering from a still-slow metabolism, and that medications can help initially in speeding up the metabolism!  Before my surgery my metabolism was only operating at 64% of predicted for my height, weight and age.  She's sent me to have a bone density scan done and a metabolic study done.  And now I find myself on the eve of my first meeting with one of Dr. P.'s partners, a bariatric endocrinologist and specialist in metabolic matters for post-op weight loss patients.  Hopefully, Dr. R. will help me figure out the next step to take to move from stuck to GO!  My fingers are crossed!

More to come...
  

All about Gas

Not to be indelicate, but... there really isn't an easy way to launch into this topic daintily.

Gas (not the kind you put in your car, but the kind that originates in the intestines) is one of those topics discussed in the books, blogs, and support groups concerning gastric bypass.  By the time we've had our surgery, most of us have been warned that things would will change for us post-op .  At its best, gas is embarrassing for most of us to discuss even though we realize that it's a natural process.  At its worst - in the months after surgery, some people experience gas as an extremely unpleasant, sometimes worrisome and occasionally incapacitating obstacle to manage.  I've even heard of people who feel they can't leave their homes for fear of, well you know...

Every book written about gastric bypass and post-op expectations covers the topic of flatulence.  When I began experiencing gas in a "new" way for me, I was mortified!  Initially, I complained to my devoted and long-suffering husband until I realized that he was indeed suffering.   For the comfort of my household, for my own edification, and for my readers who might also be experiencing this problem, I decided to research my options.  

So - if you, too, need to learn more about gas and what to do about it, read on.  I'll post here some excerpts from some of the best WLS-oriented blogs, along with links to some of the best documented solutions.  So grab your can of Febreze™, and read on...

Where does gas come from?

Where does gas come from? This post was written on the Thinner Times Forum by user "Pekkale", with several small edits by me, and answers this question better than most.       

The average person expels gas 14 times every day. The amount of actual gas released ranges from as little as one cup to as much as one half gallon per day. Gas is made primarily of odorless vapors such as carbon dioxide, oxygen, nitrogen, hydrogen, and sometimes methane. The unpleasant odor of flatulence comes from bacteria in the large intestine that release small amounts of gases that contain hydrogen sulfide (sulfur smell).   Contrary to popular belief, women have just as many passages as men, and older people, have no more gas than younger individuals.

Flatulence occurs when a food does not break down completely in the stomach and small intestine. As a result, the food makes it into the large intestine in an undigested state. Lower intestinal gas is produced when bacteria in your colon ferment carbohydrates that aren't digested in your small intestine. The body does not digest and absorb certain carbohydrates in the small intestine because of a shortage or absence of certain enzymes.

This undigested food then passes from the small intestine into the large intestine, where normal, harmless bacteria break down the food, producing gases such as hydrogen, carbon dioxide, and in about one-third of all people, methane. As much as 80 to 90 percent of rectal gas (flatulence) is formed by bacteria. Eventually these gases exit through the rectum.     

Certain foods produce more flatulence than others because they contain more indigestible carbohydrates than others. Beans are well known gas producers. The beans pass through the small intestine and arrive in the large intestine without being digested, which causes flatulence to occur.

Unfortunately, healthy foods such as fruits, vegetables, oatmeal and legumes (beans and peas) are often the worst offenders. That's because these foods are high in soluble fiber.  Soluble fiber dissolves in water forming a gelatinous substance in the bowel. Fiber has many health benefits, including keeping your digestive tract in good working order, regulating blood sugar and cholesterol levels, and helping prevent heart attacks and other heart problems. But it can also lead to the formation of gas. In the colon the bacteria thrive on indigestible fiber. These bacteria are harmless but for those who have an intestinal gas or flatus problem it is probably best to avoid or carefully test soluble fibers to see if they are contributing to intestinal gas.  On the other hand, the insoluble fiber found in wheat, rye, bran, and other grains does not dissolve in water, and is not used by intestinal colon bacteria as a food source, so these bacteria generally do not produce intestinal gas. Both soluble and insoluble fiber should be eaten on daily basis.

Sugars are known to create gas. Fructose is naturally present in onions, artichokes, pears, and wheat. It is also used as a sweetener in some soft drinks and fruit drinks. Sorbitol is a sugar found naturally in fruits, including apples, pears, peaches, and prunes. It is also used as an artificial sweetener in many dietetic foods and sugar-free candies and gums.

FOODS THAT CAUSE GAS*
Beans	Vegetables	Fruits	Beverages	Wholegrains	Packaged Foods
Dried Baked  Canned Refried Soy beans Lima beans Seeds Nuts Peas	Cabbage, radishes,  onions, broccoli, brussel sprouts, cauliflower, cucumber, sauerkraut, kohlrabi, asparagus, potatoes, peppers, corn, lettuces,	Prunes; apricots; apples; raisins; bananas	Soft drinks, fruit drinks Milk* *Milk products: Cheese, Ice cream, cottage cheese, yogurt	Whole wheat,  Oat bran,	Look out for foods w/ lactose: Like bread cereals &, salad dressing   Foods w/ Sorbitol: Like dietetic or sugar-free candy/gum

*Table by Lynn Falkow-Short

From an excellent and dynamic website, www.LiveStrong.com, I found this outstanding article:

5 Things You Need to Know About Excess Gas From Gastric Bypass

1. Clear a Crowded Room                                                           
Many people with gastric bypass surgery claim that the gas not only builds up, but that it slips out of the body without control. This type of reaction may be embarrassing but it is a lot better than pain that distention can cause from built up gas. Gastric bypass surgery does two things. It makes the stomach smaller, frequently the size of a walnut, and it removes a portion of the intestines so that the food goes through undigested.

2. Really Rotten                                                                               

If the quality of air around you would not pass the clean air test, it may be for several reasons. The first is the missing intestines. Gastric bypass surgery may push food through the intestines without digesting it. This is because the surgery removed a portion of intestine. This is a part of the digestive system also. The food then moves on not digested and begins to decompose in the lower intestine. Decomposition causes gas to form. Gas forms and has to go somewhere.

3. Check the Food                                                                         

You may not experience problems with gas all the time. Many people find that certain foods bring on gas attacks. Omit normally gaseous foods from the diet, like carbonated soda and milk products. The stomach is not working in full force and many of the digestive enzymes necessary may not be present. Try taking additional food enzymes and acidophilus for the gas.

4. Pop a Beano (or Gas-X Prevention) Before a Meal                                                    

Gas tablets and Beano® after a gastric bypass may become your favorite mealtime addition. If you find that enzymes and acidophilus work, go directly to the Beano or gas tablets to reduce the amount of gas you produce. Gas tablets are good after the fact for unexpected attacks. Beano used on a regular basis can reduce the gas created by the food.

5. Take a Walk and Eat Some Fiber

Exercise is one of the best ways to reduce the amount of gas after a gastric bypass surgery. The increased exercise pushes the additional gas through the system and out. Walking in the great out of doors is a super place to allow the body build-up to escape. Also, try a little extra fiber in the diet to keep the intestinal area clean and free of rotting material that can create gaseous expulsion.

Read more: http://www.livestrong.com/article/9550-need-excess-gas-from-gastric/#ixzz1CnaQInfX

Copyright © 2011 Demand Media, Inc. Use of this web site constitutes acceptance of the LIVESTRONG.COM Terms of Use and Privacy Policy. The material appearing on LIVESTRONG.COM is for educational use only. It should not be used as a substitute for professional medical advice, diagnosis or treatment. 


More information about Gas:  

Products to Consider

It makes sense to consider the following products carefully, and proceed only with your doctors advice about taking any of the specific products listed below.  

Beano® is a food enzyme dietary supplement manufactured by GlaxoSmithKline, that contains Alpha-galactosidase.  Personally, I have found it to be exceptional in managing my particular gas-related issues.  Beano Website  (www.beanogas.com)

Gas-X Prevention™ is a product with the same active ingredient in Beano, and is made by the makers of Gas-x (Novartis).  Each capsule contains twice as much enzyme as found in a capsule of Beano (but remember, everyone is different, and therefore more enzyme may not be better). Gas-x Prevention Website (www.gas-x.com)

Simethicone is a generic medication found in numerous over the counter preparations including:  Phazyme; Flatulex; Mylicon; 

Gas-X (not to be confused with Gas-X Prevention); Mylanta Gas, 

and many more.

       Phazyme

       Mylanta Gas

       Flatulex Information Hub

Hair, and the loss of it....

Today is day 92 since my gastric bypass, and I've lost a total of 80 pounds.  


I've been reading a great deal lately, in the book I mentioned in my last post, and also a book called Fat No More - Long Term Success Following Weight Loss Surgery by Gail Engebretson & Robert Magnan.  What a great and oh, so reassuring book to read at this point in my process!  Why, you might ask?  Because I'm finally at the point when my weight loss isn't all singing and dancing with hardly any effort being exerted.  It's suddenly gotten more difficult!  


It all started a few days ago when I noticed more than the usual amount of hair in my brush.  It happened the next day, and the next!  When I washed my hair, even more was in the drain!  I knew this normally could happen between the 4th and 7th month most often.  I'm a little early (always the early bloomer), but there's no question - my decrease in hair is here.  I'm telling myself that thinner hair is not as big a deal as walking around with 80 more pounds on me, and the health benefits are completely worth it, but geez....  my hair?  ::Sigh::  bummer.


I'm also noticing that I'm hungry more often lately.  I have been losing weight, but more slowly, and I am concerned that I've gotten lazy - I'm not calculating precisely the protein I'm eating, I'm more guessing.  I'm eatting plenty I think - but I know I should be planning ahead, not counting backward and guessing at the protein amounts!  Fortunately, Engebretson's book addresses these and many other obstacles that frequently befall post-weight loss surgery patients. 


My plan:  write it all down again before I eat it and think about the big picture, talk to (or write to the gang at the WMI online support group and get some online support).  If I've heard it once, I've heard it (or read it) a thousand times: - "...we're all in this together, to improve our health and to let go of our old, harmful habits..."  And, I have to admit that I have learned that identifying problems and not sharing about them isn't especially constructive.  There's no questions that support is a key factor in weight loss success.  So - back to some healthy habits with renewed vigor.


It's late - more later...
But I'll celebrate for a moment my successes - I guess it's helpful to identify that 80 pounds is pretty good!  *high fiving my supporters who read this*


Good night.

Clothes, 80 pounds, and a smaller size

We all have something about ourselves that we wish we could change.
Sometimes you can, and sometimes you can't.
The important thing is to try.
                                           by Kris Carr, 
                                           from Crazy Sexy Cancer


Somehow these words really struck me.  Of course, the documentary Crazy Sexy Cancer was also really great, but these words, spoken by Kris at the end of the show, were so powerful I felt I needed to share them.


I *am* trying to make my efforts at losing weight really count.  I'm down a little under 80 pounds (Yes, I said 80!) since my efforts to lose weight really started in June.  I now weigh about 275.  


So I'm getting ready to actually rejoin the work world, assuming I find someone who wants to hire me, and I'm facing something I hadn't really thought of.  Clothes!  I need something to wear for job interviews, and this morning I spent all of the very generous gift certificate that my mom bought me for this very purpose.  Now normally, spending money on anything - even clothes - is not  terribly difficult for me.  I *like* spending money.  But I have never really loved clothes shopping.  That's probably why I've spent more time online shopping rather than going into a store and actually trying clothes on.  What this whole experience brought up for me though, was recognizing that I've suffered from a lot of emotional pain related to the clothes topic.  The struggle about how much I weight, what size I am, and often not being able to find anything that fits even in the "Big Girls" section, (or the "Big Girls store) store doesn't go away magically just because you've gotten a gastric bypass, I've learned.


This morning I was uncomfortable trying to figure out what to order!  I had a gift certificate from an online/catalog clothing store to spend.  I could guess what size I am.  But I didn't really know.  It didn't seem real that I could have lost sizes even though there was plenty of evidence that I've lost two sizes minimum.  Finally I went in the bathroom and measured myself.  I sat down and sent off my order with at least a little more data in hand, and at least I have some baseline measurements for future reference.  


I'll plan to mention this at the support group, but I'm really glad that I bought the book by Connie Stapleton, Ph.D. entitled:  Eat It Up! The Complete Mind/Body/Spirit Guide to a Full Life After Weight Loss Surgery.  I'll provide a review once I've read it, but I'm finding that there are some emotional issues that are lingering from my still-fat mind.  I knew this was coming, or something like this, it still caught me off guard, however.


I'm back in the saddle again, writing and thinking about the blog.  I've got a few topics percolating, but I'd love some suggestions.  Anyone have anything to discuss?  Drop me a line if you do...


More soon!

My Progress So Far...

So it's been almost 7 weeks since my gastric bypass.  Lots of really exciting things have happened already as a result of my surgery (aside from the issues related to my cyst), and it seems appropriate to celebrate these accomplishments.  


The initial list of medical problems that I suffered from that lead me to the Weight Management Institute was frightening.  But look!  Some improvements are already evident, and this is only the beginning.

• High blood pressure:
• I still suffer from high blood pressure, but "my numbers" seem to be improving!
• Chronic pain from osteoarthritis in my knees, ankles and low back: 
• ✔Dramatic Improvement in all areas have been noted!
• Non-insulin dependent diabetes:
•  ✔My blood sugar is consistently excellent, and I am no longer on medication for my diabetes!
• Chronic heartburn from GERD (gastro-esophageal reflux disease):
• ✔My heartburn and GERD are cured!  No more heartburn pain or need for medication since the surgery!   
• Severe sleep apnea requiring the use of a C-PAP machine at night:
• I continue to need the CPAP at this time, however as I continue to lose weight my doctor's suggest that this will likely change.
• Impaired mobility -  I was having difficulty getting around without a cane:
• I am much more comfortable walking, and already I can get around most of the time without a cane except for longer distances.
• Periodic venous stasis wounds on my legs requiring daily wound treatment and aggressive compression treatment ranging from compression hose to the use of a lymphedema pump.  
• ✔No wounds since the surgery.  Minimal episodes of swelling in my lower legs, though I do wear a less unpleasant form of compression most of the time. 

All in all this is pretty exciting news.  Today when I saw my dietician for my routine visit,  we did a body composition test showing that while I am losing both muscle and fat (which is to be expected), even with minimal exercise I'm losing a solid amount of fat.  My ultimate goal is to lose 3 pounds of fat for every 1 pound of muscle.  Today I am at 1.75 pounds of fat for every 1 pound of muscle.  This gives me a goal to work toward.


Other positive information from the session with the dietician: I can eat most things now as long as I am cautious about the food textures (apple skins, stringy veggies, dry or overcooked meats, etc.).  Of course I am eating really small amounts of food, still.  I am supplementing my diet with the same protein powder I used for the months before my surgery when I was on the "partial liquid diet".


I have lost 50.7 pounds since I started the "partial liquid diet" on 6/4/10.  I broke the 300# mark on 9/27/10.  Follow along for continued progress, and please join me in celebrating these exciting improvements in my weight loss efforts.  I admittedly have a long way to go -- but it all seems possible to me now when I consider the progress I've made so far.  


For those of you in my "fan club" who have been supporting my efforts - thank you so much!

This Too, Shall Pass...

Initially, when I planned for my Gastric Bypass surgery, I spent a lot of my time writing in this blog.  I felt, I think, that my blog would help me to be accountable to friends and family members who were keeping an eye on my progress.  In a family with divorced parents,  I felt this would be an option for keeping everyone kept "up-to-date", and of course my friends have tuned in as well.


After I returned to my room following the Gastric Bypass  I learned very quickly about my ovarian cyst.  Even before the extent of the cyst was discussed in detail with me, I felt somehow cheated and put in a place where I had to pay attention to something other than my weight loss.  I had wanted to revel in the excitement of my "new life".  I wanted to blog.  I wanted to succeed.  I wanted to focus on the emotional and psychological elements of having a gastric bypass.  I wanted to exercise.   And finally, I wanted to fully commit to the next phases of my weight loss experience without looking back.  


One thing that has perplexed me and served as a real source of confusion is the fact that I have had so much difficulty moving on from the cyst.  I haven't wanted to blog.  I've worried, and dabbled in anger, fear, and even some unproductive emotions while trying to "move on".  But its time.  I am ready to move on.   We've scheduled the date for the upcoming surgery for October 6, 2010.  


My goal now is to visualize a healthy and successful move forward, an uneventful surgery with no surprises post-op.  If you care to help, please visualize success along with me! 


I  continue to feel supported by my amazing group of doctors who generously work with me and one another.   Many, many thanks to Drs. D;  L;  W; and my newly added gynecologist,  Dr. S! 


☺

23 Days Since Surgery - An Update

Today I am 23 days from the date of my surgery.  At more than 3 weeks post-op, I’d love to be able to say that my gastric bypass surgery experience really wasn’t so bad, but there were some unexpected things that turned up during my surgery that created a difference in how I have experienced my post-op recovery. Shortly after they began my surgery, they discovered that I have a very large ovarian cyst that is the size of a watermelon, and fills my entire abdominal space.  This cyst is large and painful, as they often are.  In my case the diagnosis explained a few things that had bothered me for a few months prior to my surgery.  Without going into great detail, I had though that I was suffering from a bladder infection though the symptoms were inconsistent and didn’t completely point to a urinary tract infection. Nevertheless, I moved toward my surgery date imagining that my weird symptoms were pointing to nothing important.


Post-operatively I was pretty excited to find myself beyond my surgery.  All of the hard work, tons of research, months of appointments, and positive thinking had brought me here – to this point.  I was excited until I remembered being told that there was a cyst.  A what?!


I was able to do everything I needed to do to get out of the hospital.  I walked, swallowed pills, and drank on command.  But I was also really anxious – it was this cyst – the knowledge that something else was in there, and it needed some medical attention.


I’m scheduled to have an abdominal ultrasound done followed by a visit to my gynecologist next week.  I’ve been focused on getting this matter dealt with, although I’ve had to cancel each appointment once because I was still experiencing some post-op pain.  


So what was the hold up in getting back to writing about my experience?  That’s been a tricky topic to tackle actually! In considering this carefully, I guess I’ve really struggled with the knowledge that something is still inside me needing medical attention. I’m still trying to get used to the idea that I still have another potential surgery still left in my future.  It’s felt like a distraction from my weight loss goals and efforts.  It felt incongruous, somehow - writing about my gastric bypass while I was so distracted by my cyst!  
  
It’s taken a little time to screw my head on again, but I’m ready to resume my duties as a blogger.


Next time:  Head Hunger.  More about that nasty little urge to eat for reasons other than hunger… 

A letter to my family and friends

This is a letter that I sent to my dearest family and friends.  I wanted to share it here, too, somehow as a part of the process and experience I am dealing with as I face this surgery.  It is intimate, and honest.
Hi there, my beloved family & special friends,

I thought I would send a little update and reminder that Wednesday, August 11 -- less that one measly week away -- is the very big day that I will go have my gastric bypass, and hernia repair.

Since the beginning of this current adventure, back in November 2009, I began losing weight.  Back then it was sort of informal.  No one at the clinic focused too much on numbers of pounds, or even asked how we were doing with our weight loss.  But don’t get me wrong- there was lots of talking about food, and feelings and portion sizes and food label reading. 

By June things were a little different.  On 6/4/10, Dr. H said,”You will have to lose 30 more pounds before surgery. I have lost 37 pounds total, Since Dr. H's requirement, I’ve lost 27 pounds – good enough to go forward, and enough for my “team” to be proud of my efforts.  YAY!

So, Wednesday morning, at 5:30, I’m scheduled to check in at the hospital for my 2 - 2.5 hour procedure scheduled to begin at 7:30am.  I’ll be at Good Samaritan Hospital and after a little while in Short Stay I’ll be moved to unit “6 Center,” to a specialty surgical unit for abdominal surgeries.  I have heard that I’ll be cared for by specially trained RNs who have won awards for their outstanding care on 6 Center.  I’ll have a catheter in place for luxury peeing, and a pain pump for luxury pain management. 

So there you have it!  Some might say the answer to my prayers, others might say this is something to be grateful for -- a second chance at life.  I say:  I am grateful and I do know that it’s going to be hard work, and that’s after the surgery! I’m looking forward to it!  

Much Love,

Lynn, Lynnie, La, Ba, Noe (depending)

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.