"Friends are honest with each other, even if the truth hurts." ~S. Dessen

So, are you ready for the numbers? I had several pre-op appointments yesterday and I was a bit surprised to learn that I have lost 18 pounds since I began meeting with the dietitian on August 8. On that date, I weighed 266 pounds. I had just been forced to purchase 2 new pairs of size 22 pants for work because everything else was too tight. Yesterday I weighed 248 pounds and I haven't been able to wear those 2 pairs of pants for several weeks. I have settled back into my comfortable size 20 pants and they are getting loose too. Now, telling you all of that was hard. It was the hardest thing I've posted in this blog so far and, as I typed it, I felt my heart begin to race and my temperature went up a few notches. In my head, I asked myself, "Are you actually going to post this?" Yes. I said I would and I am. Even the 266 pounds in August is not the heaviest I've ever been. During the darkest part of my marriage, just before I got fed up enough to file for divorce, I weighed 285 pounds. Like I said, it's been a lifelong struggle.

I have not set a goal weight. I have no idea how to do that. I keep saying that I'll know when I get there. I just know I want to get below 200 pounds and stay there. I had a great IM conversation with my cousin the other day and we discussed being able to ride a roller coaster. Normal sized people don't have to worry about that but, when you're overweight, the seat belts don't always fit. Same thing with airplanes. You can ask for a seat belt extension but that's embarrassing. I want to ride in roller coasters and airplanes without fear of seat belts not fitting around my middle. I want to weigh less than the men I date. And, I don't want to buy plus-size clothing ever again. When I can do all of those things, then I think I will be at or near my goal weight.

There are just five days to go until the surgery...I have a hard time wrapping my head around that...five days. 1, 2, 3, 4, 5...that's it. I've had all this time to get ready and there's still so much left to do. I have a shopping list of "stuff": three prescriptions from the doctor, so I have them ready when I get home; general household things like toothpaste and dog food that I don't want to have to ask my caregivers to run out and pick up for me; last minute holiday items; food for a clear liquid diet I have to convert to on Monday evening that I didn't find out about until yesterday; etc. Then I have a "to-do" list: laundry, clean house, finish tasks at work, see friends on Saturday, massage on Sunday, download books to my Kindle, pack my overnight bag, etc.

I won't know until Tuesday what time the surgery will be on Wednesday and that is completely messing with my OCD and my mom's OCD. We want to have all of the details planned out about where everyone will stay the night before (my house or my sister's house), what time we will leave for the hospital, and who will drive but we just can't do that yet and it's making us both mad. AND my mom is threatening to spend the night in the hospital with me. You can imagine how I feel about that. My dear, sweet friend Mary has begged me to cut my mom some slack. I'm trying, Mary, I really am, but she's still not staying!

"Shake it up." ~ R. Ocasek

Several people have contacted me to ask about the protein shakes I am drinking during the liquid diet. They are not anything special, meaning I didn't get them from the doctor or with a prescription or anything. They are the same shakes I have been drinking for breakfast for several months. The dietitian gave me criteria that I needed to follow for choosing a protein drink and she also gave me a list of suggested drinks to try. The rules are that they should have less than 200 calories, less than 30 grams of carbs, and at least 15 grams of protein. I have two that I like best: Atkins Advantage (11 oz.) and EAS AdvantEdge (11 oz.). Others on her list were:

Slim Fast Low Carb Diet (11 oz.)
Glucerna (8 oz.)
Nestle Carnation Instant Breakfast No Sugar Added (1 packet w/ 1 cup of Skim Milk)
Isopure Zero Carb (20 oz.)
Optisource High Protein Drink (8 oz.)
Boost Glucose Control (8 oz.)
Pro Performance 100% Whey Protein (1 scoop)
Designer Whey Protein Powder (1 scoop)

In addition to the two I mentioned that I like, I also tried (and liked) the Slim Fast drink but it tends to be slightly more expensive. I have been able to find all three at my local grocery stores and department stores. Luckily, I can also usually find the Atkins and EAS shakes at Sam's Club where I can buy 12 or 24 packs, instead of the small 4 or 8 packs they sell at the other stores.

The shakes, however, are not why I am not hungry. And, I'm not physically hungry at all. For several months, I have been taking a drug called Topamax as a migraine preventive. Topamax is also used to treat epilepsy, seizure disorders,  neuropathy, and OBESITY. The medicine acts as an appetite suppressant. It also makes some foods and/or drinks taste funny. For example, anything carbonated tastes flat, which has been very helpful since I had to stop drinking pop. I would never advocate for taking unnecessary medication but, if you have been struggling with weight loss, you may want to discuss Topamax with your doctor. I am amazed at how effective it is as an appetite suppressant.

12 more sleeps...

"You were always on my mind." ~ W. Nelson*

It is amazing how often throughout the day that I think about food. Last night I was watching TV and a commercial came on for Burger King, celebrating the 55^th anniversary of the Whopper. If you buy any Whopper, between December 6 and 9, you get an Original Whopper for 55 cents. I made a mental note and then scratched that mental note because I was starting my liquid diet today.

As soon as I got to work this morning, I busied myself with ridding my office of snacks. I gave away my chocolate pudding cups and my applesauce. I gave my colleague a can of soup, a sleeve of saltines, and a Reese’s Cup. I stowed my protein shakes and sugar free jello in the fridge and got to work and, although I wasn’t hungry, I thought about food all day.

On the drive home, I pass a lot of food establishments, one of them being a Zeppe’s Pizzeria. I have never, ever eaten at a Zeppe’s Pizzeria. Today, as I drove by, I thought, “I’ll have to try that place.” TODAY, of all days. Really? Sure. I’ll just put a trip to Zeppe’s on my calendar for, let’s say…April, 2013. Good grief.

I do find it very funny that food is ever present in my thoughts although I am not hungry in the least. I have had three chocolate protein shakes today, so far, and a cup of sugar free raspberry jello, along with water and decaf iced tea sweetened with artificial sweetener. I will have another protein shake this evening and, if I like, some more jello or sugar free popsicles – AS MANY AS I LIKE. Jealous?

Two weeks from today I will be recovering in my hospital room and hopefully planning to go home the next day. I hope every day until then continues to be as easy as today.

*disclaimer: The title of this post is a lyric from the song "Always on My Mind". Willie Nelson is not the songwriter, nor is he the original artist but, in my mind and opinion, his version is the most famous (and my favorite) and I chose to attribute the quote to him. The accurate information about the song can be found here: http://en.wikipedia.org/wiki/Always_on_My_Mind

"Planning is everything." ~ D. Eisenhower

After many months of planning for and thinking about surgery, things are starting to happen and this is getting real. Last week, the scheduler from the Cleveland Clinic called to let me know that my SEVEN pre-op appointments had been scheduled: a half day on December 13 and another half day on December 17. I am scheduled to have blood drawn in the lab, do something on the Healthquest computer program, meet with the nurse, meet with the surgeon, meet with another doctor who works with the surgeon, meet with the anesthesiologist, and then meet with admitting. My post-op appointments have also been scheduled through March, 2013. Additionally, I have already completed the pre-registration for my hospital admission online. Whew.

This Wednesday I begin the pre-surgery liquid diet. I am actually excited for this. I have been slowly saying my farewells to food over the last week or so. It’ll be about 2 months before I can eat regular solid food again and then I will have to reintroduce foods into my diet slowly and my eating style will change dramatically. So, as I type this, I am eating chocolate covered pretzels :) See ya later chocolate covered pretzels. My dear friend Mary Anderson asked me to go to dinner tomorrow – my Last Supper - and told me to choose where I would like to go. I chose Red Lobster. Several members of the high school Guidance Department will join us and I plan to say my farewells to crab legs and cheddar biscuits.

My friend David had his surgery last Tuesday. He went home on Friday and is doing very well. The texts I received from him while he was on pain meds were hilarious! More importantly though, I have been able to ask him all sorts of questions. He had some pain the first few days but is now up and walking around. He weighed himself for the first time today and he has lost 18 pounds…since last Tuesday…damn… I am so proud of him and I am glad we took this journey together.

So, now I’m working on getting all of my ducks in a row. My parents will arrive shortly before the day of surgery (they live out of state, in case you didn’t know). My nieces, ages 19 and 21, are preparing to provide dog sitting services while I’m in the hospital and post-op care when I come home. I am making my shopping list so the kitchen is stocked with the appropriate foods for my post-op liquid diet. And, in the unlikely case of complications with the surgery, I am, this week, preparing paperwork naming my sister, a nurse, as my health care power of attorney. Should I become incapable of making medical decisions for myself, she will make them on my behalf. I don’t foresee this happening but it’s the responsible thing to do.

Just because people continue to ask…Yes, I’m still sure I want to do this. No, I’m not scared. Sure, you can have my clothes when they don’t fit anymore ;)

“Don’t be afraid to give up the good to go for the great.” ~ J.D. Rockefeller

One month. Surgery is one month from today. I CANNOT WAIT. Am I afraid? People ask me that all the time. Am I getting nervous? Hell no. I am not afraid or nervous or anxious or worried. I am ready. 

 

In many ways, I feel like this is a decision I have been in the process of making my whole life. When you’re fat, you think about being fat all the time. You are reminded of your size in nearly every moment of your day. From getting dressed in the morning to making decisions about eating to worrying about fitting into spaces, you are confronted by your body and you think, “How did I let this happen?” It confronts you when you are going to school, when you are looking for a job, when you date. You think people are looking at you, judging you, talking about you…all the time. With every rejection, you wonder how much of a role your weight had in it. It becomes something that’s easy to blame so that sometimes you don’t have to face the real reasons why you failed or fell short. While I know my eating and exercising habits are choices I make, they really feel out of my control so much of the time. Choosing surgery was empowering. When I finally made this decision, I was relieved. So, am I scared? Hell no. And I don’t think about being fat all the time anymore. I am embracing my inner thinness :)

I have done the research I need to do. I understand the surgical procedure, the risks, and the benefits. I know and trust my doctor and his team; I am confident in their abilities. I am having the surgery in the best hospital in the world. I am surrounded by people who love and support me and will take good care of me as I recover. And, while I don’t often talk about my faith openly, I believe in God. He knows what the outcome of the surgery will be – this is part of the path He planned for me to take and I trust that He knows what He’s doing.

I’m not worried so you don’t need to worry. The only thing any of you need to worry about is whose job it’s going to be to make sure I dress appropriately once I am thin. I am excited for the rest of my life. My life thus far has been pretty amazing but my weight has always been the one obstacle I wasn’t able to overcome. That’s about to change…in 30 days.

“Food is an important part of a balanced diet.” ~ F. Lebowitz

“What will you be able to eat?” That’s the most frequently asked question these days.  People are shocked when they hear me answer, “Anything I want.” Remember, I said most people don’t know much about weight loss surgery. One of the reasons I chose this specific surgical option, the gastric sleeve, was because I would not be as restricted in my diet as I would be with the other options. I didn’t want never to eat a piece of birthday cake again. I didn’t want to forego my mom’s fried chicken for the rest of my life - those of you who have had it understand why. I wanted to have the flexibility to make those choices myself. There will, however, be weeks, possibly months, of an adjusted diet while I prepare for surgery, heal afterward, and then re-introduce food into my new, smaller stomach. This adventure officially begins on December 5, two weeks before surgery but, as you know from reading about my visits to the dietitian, I have already been making dietary changes.

On December 5, I will begin a two week liquid diet in preparation for the surgery: 800 calories a day, consisting of protein shakes, sugar-free jello, and sugar-free popsicles. The goal of this is to stimulate rapid fat loss from the liver. The liver sits atop the stomach and, since the surgery is done laparoscopically, can get in the way during surgery if it’s too fat. Slimming it down just before the surgery insures that the surgeon can move it out of the way and see what he’s doing while he’s operating. Fortunately, the new medicine I have been taking as a migraine preventative also works as an appetite suppressant so I am not anticipating much difficulty with the liquid diet.

If all goes well, I should only be in the hospital overnight but, while I’m there, I will be given a clear liquid diet. This consists of one ounce of water, unsweetened apple or grape juice, sugar-free jello, or decaf tea each hour. If I tolerate that, then I will advance to two ounces per hour. Doesn’t sound like much but there will be substantial swelling in the stomach and that’s all it will be able to hold.

When I go home, I will remain on a liquid diet for one to two weeks but the choices increase to include milk, strained low-fat cream soups, protein shakes, and yummy-sounding shakes and smoothies for which I have been given recipes. The key is to cram as much protein into my tiny meals as possible. Eating and drinking will become my full-time job for a couple of weeks. I will eat a quarter cup of something from my list every two hours and, in between meals, drink at least a cup of fluid. Protein and hydration are the key.

The third phase is the puree diet. This sounds the least appetizing to me. While I can now start to include meats, cheeses, vegetables, and starches into my diet, they have to be the consistency of baby food. Blech. And, I can’t eat baby food because it typically doesn’t have the amount of protein I need. So, I am really dreading this part, especially since it coincides with my return to work. I can’t even talk about it…

Phase four is soft foods…foods that can be easily cut with a fork. I can do this. Also, I’ll be gradually increasing the size of my portions but protein consumption and hydration will always be key to my diet.

I should be back to a fairly regular diet one to two months after surgery. Eventually, I will be able to eat about one cup of food at each meal. So, several small meals throughout the day, caloric intake between 800 and 1200 calories, minimum of 60 grams of protein, and  6 to 8 cups of water daily. Sounds like what the doctors tell all of us to do for a normal, healthy diet, right? Well, maybe they tell us to eat a few more calories than that but people ask why can’t  I just follow that diet without having the surgery. Trust me. I’ve tried. I literally need to be unable to fit any more food into my stomach. Truly. You may not have ever seen me eat a dozen doughnuts but believe me when I tell you I have done it. More than once. I need to be physically unable to do that ever again. Surgery will make that happen. If I try to eat more than my tiny stomach can hold, it’s coming back out. Just the threat of that makes me want to avoid it.

I think of this surgery as my “do-over.” It’s my chance to get a new stomach and do eating and nutrition the way I know it’s supposed to be done. Monday begins the one month countdown…

"I'd like to think the best of me was still hiding up in my sleeve." ~ J. Mayer

So it’s been a minute since my last blog. I’ve been busy. It’s hard to believe that it is November. Surgery is just a little more than a month away. Wow. For so long, it seemed so far away and now I need to start getting my “ducks in a row.” December 19 will be here before you know it. Now that most of you have wrapped your head around the idea that I’m really going to do this, I have been getting questions about the type of surgery I have chosen, the Vertical Sleeve Gastrectomy. I’ll admit – I didn’t know anything about it before I began this process but, ultimately, it is the choice that makes the most sense for my weight loss goals.

The Clinic basically offers four types of weight loss surgery: the Roux-En-Y Gastric Bypass, the Lap-Band, the Vertical Sleeve Gastrectomy, and Gastric Plication. The Roux-En-Y is the traditional gastric bypass and I knew I didn’t want that surgery because it is the most restrictive. Additionally, it is a more complicated surgery and requires a longer recovery time. I also did not want the Lap-Band. I didn’t like the idea of having a “foreign body” inserted into me and the follow-up necessary to maintain it. It came down to the sleeve and plication. They are very similar procedures, although the sleeve has been performed for a longer period of time. The plication is a relatively new procedure. Ultimately, I learned that my insurance would not cover gastric plication so my decision was made.

The vertical sleeve gastrectomy is a laparoscopic procedure in which the size of the stomach is reduced. Your stomach is normally the shape of the sideways view of a man's big old beer belly. This surgery cuts off the 'beer belly' section leaving just a banana-shaped stomach, or sleeve, in its place. In this process, the section of the stomach that produces ghrelin, the hormone responsible for causing you to feel starved when dieting (and certainly not starving), is also cut off. The new stomach is about 75% smaller than the old stomach. This video shows an animation of the surgery…

http://www.youtube.com/watch?v=IjxFjI69bEI

Patients who have this surgery can expect to lose 50-70% of their excess body weight so it is not intended to be a surgery for people who are morbidly obese. I am about 100 pounds overweight. If I could lose 50 to 70 pounds, AND KEEP IT OFF, I’d be a happy camper. The surgery is a tool, not a cure-all. The better you use the tool, the better results you will have. So, the surgery combined with healthy eating plus exercise can result in even greater weight loss which is ultimately what I am hoping for. I don’t have a set “goal weight.”  I’ll know it when I get there J

And, yes, I do plan to share all of my weight numbers with you…I’m working up to that. I’ve not willingly revealed my true weight to anyone in a very long time so that may have to wait until the very last post before the surgery, or maybe even the very first one after. I’ll get there. This is all about full-disclosure.