RNY

How do you feel now?

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I am loving how the IIN Integrative Nutrition Health Coach program aligns perfectly with my own personal journey. I would imagine that’s the case for a lot of people. So many of the exercises and assignments are introspective and focused around personal goals and intentions, as you’ve heard. 

This week, there was a section called Simple Ways to Optimize Your Life. So many of them have become ingrained in my life already since I started making changes around this time last year in anticipation of my gastric bypass surgery. My gratitude practice is likely the one that has made the most impact. For this program, I have increased my daily gratitude acknowledgments from 3 to 5. And I’ve begun to articulate them to others, as well as in my journal. I have been particularly grateful to the coaches at Kaia Fit for helping me stay active and making modifications to workouts for my current knee situation. Just spent 20 minutes in a magnetic tube today and hope to have some answers soon about next steps for my knee. I am so fortunate to have people who look out for me. 

Another part of this section has to do with being in tune to how your body feels after eating a certain way or specific foods. This is something that came up in our weight loss surgery support group a few months back, aiming to help people connect with their emotional attachments to food. 

I feel like I have worked through my emotional eating issues since my primary cause of emotional eating was triggered by my dad. I have come to terms with so much of that since he passed, coming up on 2 years as of June 9. Heavy sigh. The fact that my appetite and cravings have been well controlled with gastric bypass is a big part of having this urge under control. But I have also practiced mindfulness in this area too. I took to heart the instructions about focusing on the taste and texture of food and listening to fullness signals after my surgery. I really do try to focus when I am eating. I enjoy my food and don’t pick anything that is just okay since I get so little of it. 

This week I have two things going on. One, I am experimenting with going more plant based in my diet. I have met some very passionate vegans who have been very helpful in identifying plant based sources of protein. I need to find a way to ensure I am absorbing sufficient nutrients because of my altered digestive system. I even asked my surgeon about it. I’m curious in general because there’s very little literature about vegan RNY patients and if I plan to be a health coach for WLS patients, I feel like I need more data. My surgeon said there is a medical grade plant based protein made by Unjury, but since the vegan diet is missing several essential amino acids, supplementation is also required in addition. 

I have been doing research about the inflammation caused by dairy and animal products and am seriously thinking I need to make some changes to see if they help with my arthritis and digestion in general.

So I signed up for Peel’d this week at Kaia, and will get soups, salads, juices, smoothies and quinoa bowls for next week. I will need to add whey protein shakes on top of that to get my recommended supplementation in, but otherwise will be trying to stick to plant based all week. I’ll be journaling throughout the process to document how I am feeling, whether inflammation and bloat are decreased, and my overall energy levels. It’s a great experiment and it ties in with my school assignments. I’ll be adding tempeh, fruits and veggies if I get too hungry. 

I am really starting to believe in the body’s capacity to heal itself if given the chance and using food as medicine. What better way to learn than through your own experience. 

So stay tuned for my food and mood report. 

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Thoughts about goal weight

Marilyn Clark1 Comment

I am 15 pounds from my goal. It may take me a while, but I am so sure I will get there. 

I have been thinking a lot about what getting to goal means. I’m really not going to change how I eat. I will never be able to go back to eating the way I did, and that doesn’t make me sad. It’s just a fact. 

In talking to my nutritionist about my goal weight last week, I told her I was thinking about making it higher because I wasn’t sure whether 15 more pounds would be too much. 120 is still at the top of the normal range for my height at 4’11”. She said that your body finds it’s equilibrium when you continue to eat following the program. 

I am definitely eating more. I can eat a cup of food now, although I try to keep my servings to 1/2 cup unless the extra is a salad or some other kind of raw vegetables.  I am experiencing various levels of hunger and trying to find the foods that keep my satisfied longer. 

Basically I am not going to worry about my goal weight. I am buying clothes one size down thinking by the time I am at goal, that’s where I will be. 

I am starting Kaia Fit on January 2 and expect that I will have good results in reducing my body fat some more. I am around 31% right now. I think 25% would be a reasonable goal. I am continuing to do my weekly measurements and seeing slow progress there too. 

I think the key now is patience and perseverance. 

I will continue to journal. It’s been great to go back and look at some of the things I said. Like when I ordered size 6 jeans and said they won’t fit for a while, and when they arrived in 2 weeks, they fit perfectly. 

I will not allow myself to be driven by clothes sizes. I have a range of things from 4-8 that I am wearing. I just want t feel comfortable in my skin.

Skin is a whole other issue. I have plenty of it. Hoping Kaia will tighten it up a bit, but I am thinking a breast lift may be in my future. Mike is saving his pennies. 

Wishing my readers a very happy holiday season, however you celebrate. Enjoy these cute pix of me and my pups. 

We are too cool for school. 😎
Me and the Nugget bug.

Mirror, mirror…in the backyard

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I have spent many years avoiding mirrors. And even when I am not avoiding them, I’m not very kind to myself. So, we don’t have a full length mirror in our house.

As I get closer to my goal, I find myself doing a double take when I catch my reflection in a storefront or see myself in a full length mirror. I don’t recognize myself. That’s why I’m taking weekly pictures — it allows me to let my mind catch up with the changes that are happening with my body. So much of this journey is mental, and my mind is a trickster.

Yesterday, while out with the dogs in the backyard, I caught myself in the reflection of our woodshed and decided I needed a picture to see what I was really seeing. I still don’t think this is me.

Going mirror shopping today. I have to learn to like that person.

“Support” Group 

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Before my surgery, I had to sign an agreement to go to the monthly support group meeting for a minimum of 6 months. I had every intention of checking it out before my surgery, but for whatever reason didn’t make it. 

My first time at support group was about 16 days after my surgery. I was leaving my house in actual clothes for the first time since my surgery follow up. 

The group was so unbelievably negative. One lady said to me “you don’t even look like you needed the surgery.” The last people I expected to judge were baritric patients. I remember this other lady walking in and talking about hot guys at her gym. I didn’t make it to the next two sessions…wonder why. 

The October meeting was different. I received an email, in advance, about the meeting and there was going to be a new therapist facilitating. I decided I would give it another go. Aside from the fact that it took me 90 minutes to drive there due to an accident and 5PM traffic, I made it. The meeting had already started when I got there and I guess they were doing introductions. There were two women who hadn’t had their surgeries yet so they were looking to hear about the experiences of the “veterans.”  This was hilarious. 

There was a guy, who I will call Mr. Lapband, who interrupted to throw in his completely unsolicited 2 cents providing horribly wrong information and the facilitator let this go on a while. My favorite input from him was about how he eats to much and throws up all the time but got used to it and it doesn’t taste bad. OMG — what kind of advice is that?  Then comes the woman who had gastric bypass and discovered she doesn’t get dumping syndrome while trying Halloween candy. Why would you do that???  

What’s my point? There are a lot of options for support in the bariatric community, including Facebook Groups where everyone is an expert ::sarcasm::  

You have to figure out where you need support and seek it there. I wouldn’t seek medical advice from anyone in these groups although it is interesting to see what other people are experiencing. And to hear how people who have been successful at maintenance have managed their lifestyle. 

Now I am curious. In November I am going back for more! 

Bored!

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I am so bored with my food choices right now. Since my serving size is a whopping 1/4 cup (that’s 4 tablespoons!), it’s hard to make exotic culinary delights for every meal.  And I end up with leftovers that are impossible to finish.

I can’t even eat a whole container of yogurt without having left overs.

Since my little setback surgery, my tiny tummy has been angry and bitter with me. I’ve gone back to the basics. Yogurt, cottage cheese — smooshy foods.

Need to revisit my Pinterest page to find some good recipes to spice stuff up.

I have a cabinet full of protein powder and I am bored with that too. I actually went to the evil empire of Walmart (the neighborhood grocery version) to get some Premiere Protein drinks to try.  They are technically on my doctor’s list of acceptable protein, but they don’t have whey isolate, they are whey concentrate.  So many rules!  Just thought I would mix it up for a week or so, because boredom leads to all kinds of bad habits!

A friend suggested that I have Adam Levine deliver my food to spice it up.  If only…

Goodbye Grumpy

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This is my Grumpy tank that has served as my sleepy-time garb for many a hot night over the past 15 years.  Bought this at Disney World when my little brother got married.  I love this shirt, but you know…it just doesn’t stay on. So it’s time to say goodbye to Grumpy. Maybe it will serve someone else just as well for another 15 years. Into the donate pile you go.

Rules for Rule Followers

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I need rules. When I have rules, I can be successful. That’s a big part of why I chose the Roux-en-Y gastric bypass over other procedures. 

One of the rules for gastric bypass patients is that you cannot eat anything with processed sugar (pretty much anything sweet like a jar of Nutella, birthday cake, or the crap they bring to work on Fridays) or fried or fatty foods. Eating these foods can cause what is called Dumping Syndrome, which sounds horrifying without knowing what it is. Sweating, nausea,vomiting, cramping, etc. Sounds like fun — not! I liked that there is a consequence for doing bad things, but that also means I need to be careful of people who say, “just this once,” “just a little,” “in moderation.” I don’t need saboteurs. 

Here’s some more rules:

  • Protein first
  • Don’t drink at the same time as eating
  • Wait 30 minutes after drinking before eating
  • Meals should take 30 minutes to eat
  • Wait 30 minutes after eating before drinking again
  • No drinking with straws
  • No caffiene
  • No gum
  • No NSAIDs – ever!
  • No soda or anything with bubbles
  • No alcohol
  • No bread, rice, pasta and other obvious processed carbs
  • Goals every day are for 60-80 grams of protein from supplement every day
  • Minimum of 64 ounces of fluid
  • 3 meals a day 2 ounces or 1/4 cup each
  • Exercise 30-60 minutes 6 days a week
  • Bariatric formulated vitamins every day

It’s a lot of things to think about, and I am sure I am leaving something out. But it is structure. It is totally overwhelming the first few weeks because it’s so hard to do. My teeny tiny stomach holds about 2 ounces, so in the beginning when everything is still healing and swollen, it can take an hour to drink a protein shake. Everything took forever. Over time, all of 3 months so far, it’s become more of a routine and isn’t quite so overwhelming. 

But there is more. Since my surgery, I have never been hungry. Like ever. I can go for days without eating I have discovered (more on that later), so I have forgotten to eat. Especially since I went back to work. I set timers on my watch to remind me to eat and drink because there is no real physiological trigger. Apparently this goes away at some point, so I am trying to get the most out of this “honeymoon” phase. 

Other surprises since waking up from surgery:

  • I can’t tolerate anything sweet
  • I’m a spice wuss. I hope this gets better for sure. 
  • The thought, sight, or smell of chocolate completely nauseates me. This is the saddest one, but definitely is playing into my goals. 

These are rules for life. Forever. This is a giant lifestyle change. And worth every sacrifice. 

The Referral

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At the beginning of this journey, I had absolutely no clue about the cost or insurance. They sent the referral to the surgeon in November 2015 and I was promptly denied by my insurance company. I called to talk to the doctor’s office to see about self-pay or financing options. Um, $36k was a little hefty of a price tag. Getting denied this first time was probably the best thing that could have happened. It gave me the time to do my research to understand what I was getting into, and the starting point was talking to my primary care doctor.

She’s been along for the ride with me since about 2004. When I told her I was referred for surgery, she seemed encouraging. She thought with all of my metabolic challenges (more on that later) it might be a good option, saying it’s a tool, not a cure. That’s a phrase you hear a lot in the weight loss surgery community. It’s just a tool.

She started working with me and the weight loss center to pull together all of the documentation of my ongoing (and expensive) medically managed weight loss efforts, plus documentation of all of my co-morbidities that needed to be present for me to meet the insurance qualifications for surgery. All of this documentation was submitted, then promptly denied.

I decided to file an appeal following the insurance appeal process and addressed bullet point by bullet point all of their reasons for denial. Within a week, I was approved to take a 2 session nutrition class, which was biggest waste of time ever, but it was a requirement. By this time, it’s March. Within a few days of attending the last class, I got a phone call from my primary care doctor saying she had met the surgeon they would refer me to at a presentation the surgeon provided for the staff in the office. They briefly discussed my case and following that, I was instructed to go to a seminar to learn more.

I attended her seminar April 4 and learned so much more about the genetic and metabolic connection to obesity. I got enough information to change my desire to have the sleeve surgery to having gastric bypass, and I got into the queue for an initial consult. Until they have approval from the insurance company, no  appointment. It was within the week that I heard back that I was approved for the consult only and scheduled it for mid April.

The appointment was over an hour. I was able to ask my big huge long list of questions and Mike was able to get some reassurances about safety and complications (more on THAT later). We talked about my history, my knowledge of high protein, low carb living, all the efforts and work I had done. At the end of the appointment, she said I was a good candidate, waived the requirement to do nutritionist supervised weight loss, waived the requirement to have a psychological evaluation and set me up with a number of pre-surgical tests pending final insurance approval for surgery.

As I worked through each of the tests and requirements, the doctor submitted her statement of medical necessity and I was approved for surgery at the beginning of June.

I am exhausted just thinking about all that I had to go through.

Where do I begin?

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I have an idea about what I want to do here, but how do you dive in to a story that has evolved over decades?

I am starting this blog as a departure from all other social aspects of myself, mostly revolving around my dogs. I want to tell the story of my lifelong struggle with obesity, a taboo topic. A topic that I have shared bits and pieces of over the years, celebrating the achievements and hiding during the setbacks. I’m going through something now that requires a lot of mental processing, and am hoping this will be a mechanism for that. And if I can help support or encourage anyone on their own personal journey –awesome! I’m hoping this will also bring some encouragement and motivation my way, too.

Here it is: on July 5, 2016, I had gastric bypass surgery.