Post-Op Diet: Phase 1

For the first five days after surgery, you can have only clear liquids: water, coconut water, grape juice, apple juice, herbal tea, strained broth. (Gatorade-type drinks, flavoured water, and jello are also allowed, but I don't eat those.)

The key to this is taking small amounts, frequently. The guidelines are 3-4 ounces, sipped, not gulped, every hour. 

Today is Day 4. It's not bad. I already notice something that I know will be an ongoing adjustment. I open the fridge to get juice, and I see food -- and my head feels hungry, not my stomach. In other words, it's not actually hunger, it's a desire to eat. 

Your stomach "teaches" your brain: the hormones secreted by your stomach tell your brain that you're hungry. While this is happening, you look at food, think about what you want to eat, and your brain associates looking and thinking about food with hunger. Your brain learns that food makes you hungry. 

During Phase 1, 2, and 3 of the gastric sleeve diet, I'll be re-wiring that connection, listening to my stomach instead of my head.

Greetings from Self-Isolation

I'm home!

Because I was out of the country, the Government of Canada requires that I self-isolate for 14 days. This is a law, and it's enforceable -- they do check up -- but regardless of that, I take it quite seriously. The incidence of covid-19 in our area is very low, and the last thing I want to do is expose anyone to the virus.

Self-isolation is not a perfect system, as it was impossible for me to go directly from the airport to my home. I took extra precautions in that interim. Now that I'm home, A and I are sleeping in separate rooms, not touching, and distancing. I couldn't even hug him when he picked me up from the airport! 

A and I talked about it on the way home, and we both feel my chance of exposure was very low. 

- 100% of the time I was away, 100% of everyone around me was masked. Masks are mandatory in airports, on flights, and in the hospital.

- I practiced social distancing the entire time, with two exceptions -- the two crowded flights. And in those, the seat beside me was empty on both flights.

- I washed and sanitized my hands frequently.

- I was not in any restaurants, clubs, events, or even crowded stores.

Another thing -- and I don't know if or how this figures in -- is that I may have already had covid, in early March. While traveling for work, I became very sick, with all the symptoms. We don't know if I had it, and if I did, that doesn't mean I have immunity -- but it could.

I've been working at home, so even when I go back to work, isolating is not an issue. 

I'm counting the days, hoping I don't get sick.

Two Days Post Surgery: On My Way Home

This morning I had my last round of intravenous meds and a nurse removed the IV. The patient coordinator went over everything, and gave me a care package of instructions, medications, and supplies to clean the wound where the drain was. They also gave me copies of the bloodwork results, EKG, and all the medical info so it can go in my records back home.

I'm feeling OK and eager enjoy a week of rest and relaxation. 

A note about this blog. As I've mentioned, I'm writing this for myself and perhaps for anyone who might need this information from a firsthand source. Friends and family are very welcome to continue reading, but please feel no obligation, and not the slightest need to apologize if you want to stop reading. Deal?

A Big Improvement in a Short Period of Time

It's still the first day after the surgery, and I feel better and better as the day progresses. The doctor removed the drain -- ouch!! -- and soon the IV will come out and I can take a shower.

The hives are acting up, so they're letting me take my antihistamines now. 

This morning I thought, how am I going to travel on Thursday? But I already see that it's possible, and won't be so bad. I have to be super careful not to lift my suitcase, and to ask other people to lift it for me. And I have to walk slowly. If I do those two things, I'll be fine.

I wish I could go all the way home on Thursday! But alas, I can only get as far as Vancouver, then will fly to Port Hardy the following morning. Then I have an entire glorious week off work. Can't wait.

 

Recovery Day One: Time To Break Out an Old-School Cliche

Well, it's done! This morning I am thinking of that very old poster cliche, Today is the first day of the rest of your life. I've made this permanent change, and it feels daunting, but I will continue to take it step by step.

Monday night I was prepped for surgery, including an IV line for hydration and follow-up medication. Then yesterday I had visits from a whole slew of medical staff: the surgeon, the anesthesiologist, the doctor who coordinates my care, the patient coordinator who I've been emailing with, and a nurse. The dietitian even came by to say hi and tell me we will speak tomorrow.

They gave me a chest x-ray, an EKG (normal! whew!), compression stockings, and maybe some other things I've forgotten. 

Then I was wheeled off, needle, drowsiness... then I was in my room. Ta-da!

I woke up feeling like I'd done 1,000 crunches, with pain under my ribs. Apparently laparoscopic  surgery pumps you full of gas. Ouch. 

Once I woke up more fully, the doctor visited again, saying the surgery was fast (45 minutes) and easy. He told me to walk around as much as possible, as this will help the gas dissipate. Also, I have a drain (TMI?) that they will monitor, plus a breathing thingy to help facilitate deep respiration... also for gas.

So I spent the rest of the day alternating between sleeping, walking around the room and in the hallway, and having nursing staff come in and out putting various medications in my IV line -- anti-nausea, antibiotics, anti-gas, painkillers -- and giving me ice chips.

IV lines! Why wasn't this always standard?! When I was 12 years old, I had knee surgery. All painkillers and antibiotics were given by injection into my thigh. Always the same thigh. After a while, it hurt so much that I was crying, and preferred the surgical pain to the constant stabbing. It also caused nerve damage; the area was numb for nearly 20 years! Why didn't they use an intravenous line? One needle, and you're done.

I can tell that the standard of care here is very high. The staff is very methodical and deliberate, with great attention to detail. Perhaps this is a function of working in a private clinic without a huge number of patients? I don't know. But my experience in hospitals, either for myself, my partner, or anyone I've ever visited, has been that staff are very rushed, and if you don't advocate for care, it's easy to be overlooked. (Admittedly my experience is limited to New York City, where everything is always over-crowded and rushed, and the same, but slightly less, in suburban Mississauga.)

You may be wondering about a language barrier. The doctors all speak perfect English and are obviously fully bilingual. The people who seem to be the head nursing staff speak a lot of English; they also use translation apps on their phones, for both you and them to speak in. The aides don't have much English, but instead get someone for you who does. 

Everyone is friendly and so caring. It's like this in BC, too -- medical staff are unfailingly friendly and caring. I did not find this in NYC or Mississauga! I'm guessing, again, that's it's down to workload. It's hard to demonstrate caring when you're constantly rushed off your feet. 

So it's morning now. Today will be full of breathing tests, walking, drains, and other recovery business. The doc told me there are three different tests for leaks. If any are found, it's back to surgery to repair them. However, he informed me, his work never leaks. The hospital's complication rate is less than 1%, and his is zero. (Surgeons!)

To be honest, I don't know how I will be ready to travel tomorrow afternoon, but then again, that is more than 24 hours away. I already feel better this morning than I did yesterday.

One weird thing: I had an allergic reaction to one of the medications. My face and lips got swollen and puffy. No respiratory issues -- my breathing was not affected, only my face. My lips look like I tried to give myself silicone injections and didn't read the instructions. They gave me antihistamines, and will change both the nausea meds and the painkillers.

Greetings from Oasis of Hope Hospital

I'm here! Today, the day I was most dreading, was fine. It was even fun! I love to travel, and I love to travel alone, and it doesn't really matter where I'm going. Or, apparently, how little I eat! I've been so travel-starved from covid that just having a change of scenery and flying places was a treat.

The two-week semi-fast clearly changed my appetite. At one point today I ate a 100-gram Greek yogurt and drank a tiny box of juice, and I was almost uncomfortably full, wishing I had saved the juice for later in the day! That is crazy! 

This surgery will really change my eating habits around travel. Travel, for me, is almost always associated with unhealthy eating choices, and often overeating. I guess those days are over. It was fun while it lasted! (Readers who don't know me, that was said while smiling and laughing.)

 

Everything went smoothly today. Masks are mandatory and there was plenty of room for social distancing -- until the flight to San Diego. It was packed. I wasn't too comfortable with that. 

 

The driver picked me up in San Diego as planned, and we were very quickly at the hospital. I had a long wait until finally someone appeared with forms and took me to my room. There seems to be a lot of administrative confusion, I think because I arrived at night, when there are fewer people on duty. 

But everything got done eventually. I'm in my room, they've taken my vitals, I've filled out forms, and signed scary disclaimers. I am excited and nervous! Can't wait to be on the other side.

* * * *

You know you're a busybody when you ask more questions than the customs agent!

Where are you going?

Is it for work or family?

For how long?

Where are you staying?

Going shopping while you're there?

Did you take the hotel shuttle last night?

How much was the cab?

Where do you live?

Is the weather nice there?

 

This was the other person on the hotel's airport shuttle this morning!

Some of these are perfectly legitimate small-talk questions -- but some are inappropriate. And honestly, on an airport shuttle, do you really need to know anything about the other passengers? 

 

FYI, I did not answer truthfully.

Greetings from Vancouver

I made it through Day One of the almost-fast, and I'm doing fine. I say almost-fast because the diet came with an escape hatch: "If you are diabetic, hypoglycemic, or you feel dizzy or lightheaded, you may eat one of the following..." 

So yesterday, in the early part of the day I had a 4-ounce can of low-sodium vegetable juice, and when I arrived at the airport hotel, I had one hard-boiled egg. Other than that, I had only water or juice. I never thought I'd be able to do that!

Silver lining. The urticaria has a special torment: after I eat, there is massive stinging, burning, and itching over my entire body. The stinging is actually painful. It feels like being stung by an insect, dozens of times, all over. Fasting has removed this particular hell. I still have itching, and I'm taking the antihistamines, but getting rid of the post-eating torture is a relief.

Yesterday afternoon I flew from our little remote town to Vancouver. The flight is about an hour, and if it's not raining -- which happens occasionally -- you can see the snow-capped North Shore Mountains the whole time. Yesterday was beautifully clear. 

I caught a cab to the Coast Airport Hotel, and because I'm a Coast Rewards member, they offered me a free room upgrade. So I'm staying in "King Superior" room for the ridiculous rate of $65. Coast Hotels are not usually so budget-friendly! I guess they need to compete with the other airport hotels. Pro tip: don't stay in a Day's Inn when you can stay in a Coast for the same price.

It's a good thing I'm not relying on the hospital for nutritional support. The dietitian sent me the diet at the last minute (which caused quite a bit of stress, as I thought I needed to order Optifast... and that would take time where we live), then never checked in with me. Not one call or email. I thought that was pretty poor. Fortunately for me, I have the RD from our local primary-care health centre -- and she is amazing. We're actually speaking today while I'm between flights.

Today is the challenging day: fasting while traveling. But yesterday's experience has given me more confidence. Yesterday morning I was thinking, How am I ever going to do this?? and this morning I'm thinking, I am going to do this. 

I know at least four people are reading this and have been incredibly supportive. I am profoundly grateful.

The Final Countdown!

I've completed the two-week semi-fast. 

I found that after a few days, my appetite sharply decreased, which I know from past experience is from eliminating most carbohydrates, eating only a small amount of whole grains. (I have always found this to be true for me, but also found it challenging to sustain, and easily undone.)

I'm caffeine free. I miss coffee and I can't wait to drink it again. But I didn't get headaches or suffer any other ill effects.

Today begins the final 48-hour fast. I'm dreading it. But... I'm resigned.

I checked my flights, and they are not crowded at all. This was definitely a relief. In this case, the optimist sees the plane as half empty!

Later today I fly to Vancouver, where I'll stay in an airport hotel. I will miss one of my favourite little treats when I travel alone: room service dinner and a glass of red wine. Nope. Water and fruit juice are the only things on the menu.

I've gotten amazing, steadfast, and caring support from my friends who are reading this blog. Thank you all!

One Week to Go: What's on My Mind

The surgery is in one week from today! 

My current concern is the travel. 

In the final 48 hours before surgery, you're on a true fast -- liquids only. During this phase, there are no protein shakes, just water, juice, or clear broth. People with diabetes (no) or hypoglycemia (yes) can eat a small amount of protein, such as a hardboiled egg, if they feel dizzy or lightheaded. 

This scares me, and doing this while dealing with multiple flights and layovers, and everything that's involved with that, scares me more. I know I'll get through it. I'm just kind of dreading it.

In addition to fasting, the severe urticaria (hives) I've been struggling with is back in full force. It was 90% gone, and the fact of its reappearance is not a good sign. It likely means this condition is chronic and will come and go repeatedly. The antihistamines help, but at various (unpredictable) times during the day, my skin is on fire with itching, burning, and sharp stinging.

And of course, there's covid. I'll do my best to distance, and naturally I'll be wearing a mask and using hand sanitizer frequently. I can only hope the airports will not be crowded, and the flights not sold out. (The airlines now allow you to check what percentage of seats have been sold, and re-book at no extra charge -- but if you have a connecting flight and an event you are traveling to, that's not much help.)

Fasting, itching, and social distancing. I normally look forward to any travel, but this seems onerous. Maybe instead of counting the days, as I'm doing now with the semi-fast, I'll count the hours. I'm also telling myself that the anticipation is almost always worse than the event. 

(A reminder: I'm not freaking out. Just expressing my concerns.)

On the way back, I'll also be a liquids-only phase, but according to the dietitian, this will be much easier, as most people have very little appetite at that time. The surgery itself is laparoscopic -- that's why you can travel so soon after it -- but still, it is surgery, and I'll need to be careful.

Once I'm back, I'll have to self-isolate for 14 days, which will be very easy, as I'm working from home. I've taken two weeks off work for the surgery and recovery, but even after that I have no need to go anywhere while the quarantine period runs out.

Meanwhile, in the present, the semi-fast and caffeine step-down are going really well. It can be a bit challenging to open the fridge and see the food I've made for my partner... and pull out only the coconut water! But I'm doing it -- one glass of water, one protein shake at a time. 

Checking In: Pre-Surgery Eating Plan

Today begins Day Four of the two-week pre-surgery diet. It's going really well! 

The biggest issue, by far, is having to drink an enormous amount of liquids each day -- and the corresponding gazillion trips to the bathroom. I often feel bloated with fluids. Protein smoothies (2 @ 30 ounces), electrolyte drinks (16 ounces), vegetable juice (8 ounces), and water or other clear liquids (64 ounces), and I'm not even counting my standard four cups of coffee.

I am usually quite under-hydrated, even more so while working at home. (At work I keep a water bottle on my desk, but not at home.) When I was younger, I used to say, if it doesn't have caffeine or alcohol in it, why drink it? Ha! Although I've outgrown that notion, I've just never gotten in the habit of drinking a lot of water.

Fortunately for me, I never drink carbonated drinks of any kind, or anything with added sugar; both are off limits. I know for many people, that is a big adjustment, but for me it's a non-issue.

I can eat one solid meal each day, within the guidelines. I'm eating a green salad, and a small portion soup I made in the Instant Pot, with chicken, vegetables, and brown-rice pasta. I'm experimenting with having this meal at different times during the day, to get maximum bang for the buck. I think lunch works best.

The caffeine step-down is going pretty well. I often feel I'd like another cup, but haven't felt any desperate cravings, and so far, no headaches.

The liquids are a challenge. I'm working from home, and I know that if I'm in my home office, there will be a huge disincentive to continually go downstairs and get fluids. My workload is pretty intense right now, and I won't want the constant interruptions. To counter this, I'm working at the kitchen table, which has its pros and cons. 

On the plus side, I'm very near the fridge, with all the liquids I need. It's been cold lately, so I can make a fire in the wood stove and easily keep it going. I can let the dogs in and out all day, which is annoying when both Allan and I are upstairs in our respective offices. All good.

The downside is I've lost my great workspace. After two days using my work laptop without connecting it to my large desktop monitor, and sitting on a kitchen chair all day, I was already feeling the effects on my eyes and back. So yesterday we brought my great office chair and the monitor downstairs, and I set up a satellite workstation.

Also: fantastic timing, doing this while I'm working at home! I'm not sharing this with my co-workers yet, so I'm glad to have this privacy. 

I also weighed myself for a baseline weight. Then I asked A to hide the scale and give it back to me on December 1. I'm going to try monthly weigh-ins on the first day of each month. The number itself will remain private, but of course I'll post the amount lost each month.

How Will the Surgery Affect Life at Home?

When I was first considering bariatric surgery, one of the obstacles -- in my mind -- was how the major changes post-surgery might affect my home life and my relationship with my partner. I thought it might negatively impact our relationship, and obviously I wouldn't want to do that. 

Eventually I spoke with him about this concern, and he was very clear: don't let this enter into your decision. We've had many, many lifestyle changes over the years -- including many different ways of eating -- and we've always adjusted. Put it out of your mind as a variable. 

This was pretty wonderful to hear!

Now as I prepare for the surgery itself, with the pre- and post-surgical diet, I started thinking of how this would work in the short-term. In our world, I am the food person. I plan our meals, and I cook, and determine when I'm not cooking, and what we're doing instead. I enjoy this role and I have no wish to give it up.

A and I have a great division of labour, where we play to our strengths -- and he does a lot. Especially since we became homeowners after a lifetime of renting. He also does 90% of the food shopping, and whatever cookware doesn't go in the dishwasher. And of course, he works full-time and has plenty of his own interests.

I didn't like the idea of being on the pre-surgical fasting diet, or the post-surgical liquid diet, and just leaving A to fend for himself. He could, of course, but the idea made me uncomfortable,.

So last week, I did what I usually do every few weeks: I cooked a big batch of meals in the Instant Pot, put everything in Pyrex containers, and popped them in the freezer -- but this time, just for A. 

I never thought I'd do this! It's not like A is a helpless sitcom dad who doesn't know how to feed himself. When I go away for work or for conferences -- which I do on a fairly regular basis -- I don't cook for A in advance!

But this feels different. I'm making this huge change, and it requires a lot of support from my partner -- and I'm spending a lot of our money to do it. Making sure when he takes his dinner break that he has something tasty and nutritious to eat, ready to be re-heated and eaten, just feels like something I should do. If I didn't, I would feel selfish and somewhat guilty, and irresponsible.

I thought that cooking while fasting might be very unpleasant! So I cooked in advance, before the fast began. It should be enough for two weeks' worth of dinners (supplemented by takeout when he wants). Then I'll see if I can handle doing another round before I leave for the surgery, or else when I get back.

Also Starting Today: the Food Journal

Today also begins tracking all my food and liquid intake. This is considered mandatory. 

All studies show that people who track their habits -- any habit they are trying to develop and maintain -- have much more success than those who don't. Tracking keeps you honest, allows you to see your progress, and I find it can be a morale booster. Plus who can remember how much water you've drunk in one day? Tracking alleviates the need to remember everything -- worth it for that reason alone.

I already do a lot of habit-tracking for physical exercise, practicing piano, and all kinds of other things. (That's a post for another day.) But I haven't tracked my eating for a very long time. So I start today.

Many people prefer an app for this, but I am avoiding more reasons to use my phone.  

For habits, I use a spreadsheet (I'm a total spreadsheet geek), but that's more useful for something you do once daily -- for example, every morning, checking off what I did the day before. 

For this, I've decided to go old school: a paper journal.

Recently I was showing my partner two beautiful blank books I have, but have never used. 

One book was a memento from my trip to France with my mother in 2014. Throughout the week she was trying to buy me things, mostly crappy tourist stuff that I didn't want -- and didn't want her to waste money on. In the town of Rouen, we went into a beautiful paper-goods and writing store, the kind of store I drool over. There, I made my mother very happy by suggesting she buy gifts for both me and my partner (poor guy, home with the dogs*) from this store. 

The second book was a gift from a friend when I moved away. 

Both books are beautiful with artwork and interesting designs inside (examples here), and both are meaningful to me.

And because of that, I have never used them! In this respect I am my mother's daughter: they're too nice to write in. Ha!

Recently this came up in conversation with A, my partner -- how I have these beautiful books and would love to use them, but can never bring myself to write in them. He suggested using them for my surgery journal. And I'm going to!

----

* Don't feel too sorry for him: we went to London, Paris, and all over Spain the year before.

Pre-Surgery Diet Begins Today

Today's the day! I start the pre-surgery diet today. I've gone from dreading it to feeling excited about it. It's the next step in my journey, and this is something I've chosen to do, so why I should I dread it? I'm sure it will sometimes be difficult, but I'm going to do it. 

I used to be very disciplined about my eating, and I still am in most areas of my life. So now I will once again apply that discipline to my eating habits.

This is the basic diet I got from the clinic. 

Daily:

* Protein shakes - at least 2/day, can be more - large glass (10-16 ounces / 0.5 litre)
        -- whey protein, milk (any kind), one fruit

* water or other clear liquid - 2 litres / 64 ounces
        -- can be herbal tea, white grape juice, apple juice, flavoured water

* electrolyte drink - 0.5 litre / 16 ounces
        -- I'm using coconut water

* vegetable juice 0.25 litre / 8 ounces of vegetable juice (e.g. V8)
        -- I drink this anyway, the low-sodium kind

* non-fat yogurt - 225 grams / 8 ounces

* a light meal with protein, vegetables, and small portion of whole-grains - once daily
        -- small portion of chicken breast, tuna, tofu, or similar low-fat protein
        -- chicken broth
        -- vegetables (cooked or raw)
        -- small portion of brown rice, quinoa, whole-grain pasta
        -- many people like to have this as soup, as it can be more filling

* They recommend things like sugar-free Jello, which I cannot see eating for any reason! Perhaps some people find it helps satisfy cravings for sweets. 

My first thought: never be too far away from a bathroom!

Readers: Apologies if this is too much nitpicky information. This blog is (also) for myself, to have a complete record of my experience. 

When Is a Fast Not a Fast?

When it's a slow?

I don't know the answer to that riddle, but I now know that my pre-surgery diet is not a big deal at all. I have read that different surgeons have their own variations on what they prefer to see pre-op, and that an Optifast fast is not always required. But I didn't want to start hoping one way or the other.

This pre-op eating plan is a light, healthy diet, supplemented by protein drinks, electrolyte drinks, and a lot of water. There are fruits and vegetables, a small amount of whole-grain carbs, and a small amount of soft protein such as turkey or fish. No high-fat food regardless of the kind of fat -- no cheese, nuts, cream -- and no processed sugars. No alcohol, which is not a problem these days.

It's a mostly liquid diet, but not a completely liquid diet. So... I'm good!

It was a bit of an ordeal trying to get this information from the clinic. If I needed Optifast, I would have to order it, and things take a bit longer to arrive here. I was trying to explain to the patient coordinator that I needed to plan, and Monday (presumably the day I start the fast) is a holiday in Canada -- there's no mail and stores are closed. She seemed to think I was just being nervous. 

Today, finally, the clinic dietitian emailed the information. We may have to drive to Campbell River this weekend to have a choice of protein drinks, but we always have things to do there.

So one of the things I was most apprehensive about has been resolved. As usual, anticipation is worse than the thing being anticipated. I find this is almost always true.

All Systems Are Go: Surgery and Flights Are Booked

It is on!

My surgery will take place on Tuesday, October 27. I'm really excited. I'm nervous, of course, but at a manageable level. 

On Monday, October 12 (Thanksgiving!) I begin the two-week fast. I spoke to the RD about this, and she said for most people, this is the worst part. The post-surgery liquid diets are not as difficult, because by that time, the stomach is very small, and fills very quickly. The most difficult part of that phase is ensuring your protein intake. 

But the pre-surgery fasting will be challenging. I'll be drinking Optifast, a protein-shake meal replacement. I'm especially concerned about fasting while I'm traveling down to San Diego. By that time I'll be off the protein shakes and drinking only water. 

The fasting is done to shrink the liver, which makes it easier for the surgeon to visualize using the laparoscopy -- which makes the surgery safer. In other words: important.

Well, everyone who has this surgery manages to get through the fasting, so I will, too. One day at a time. I'll count the days... and probably write a bunch of complaining posts. You've been warned!

Several people reading this blog have been very supportive. I appreciate it more than I can express. It means everything to me. Many, many thanks.

I've Been Cleared for Takeoff

This week I had my bloodwork done and had an ECG. Yesterday I spoke with my doctor about the results, and she is writing a letter authorizing that I am healthy enough for surgery.

All my bloodwork was normal. I was very pleased that my fasting blood sugar levels have not worsened. They are still in the high-normal or "pre-diabetic" range -- which is what prompted my thinking about surgery -- but they have not gone over the line into diabetes.

Also this week, I got some fantastic news. I reached out to the dietitian in our health centre. Turns out she's had several clients who have had weight-loss surgery in Mexico, and she can do all my follow-up care! I was so happy about this! We're resuming our sessions as of this week. 

My next blog post should be that the surgery has been scheduled.

The Type of Surgery I'm Having and Why I Chose It

I don't think I've written about which type of bariatric surgery I'm having. 

There are three principal forms of weight-loss surgery. The oldest one is usually called "lap band" -- the full name is laparoscopic adjustable gastric banding. An adjustable belt is placed around a portion of the stomach, and tightened to make the stomach smaller. It restricts how much a person can eat, and it slows the movement of food to the small intestines.

The band can loosen over time, and people end up gaining back all the weight. It also did nothing to control appetite, so really, it's just a more extreme form of restricting. For these reason, it's mostly been phased out by good bariatric clinics. 

When this surgery was popular, my weight didn't qualify for surgery. But more importantly to me, I was never interested in this. I didn't like the idea of a foreign substance being introduced inside the body, without a lot of evidence about potential long-term effects. 

The second kind of surgery is the most extreme: gastric bypass. There are two kinds of gastric bypass, but they both function the same way: by re-routing how food travels through the stomach and intestines, which also reduces the hormones secreted by the stomach. 

Gastric bypass has the best outcomes, the highest percentage of excess weight loss. It also has the greatest risk of unwanted side effects, and it's more involved (and therefore riskier) surgery.

The third type of bariatric surgery is gastric sleeve. In this surgery, most of the stomach is removed, leaving a small pouch, around the size of a banana. There's no re-routing; the intestines function in the usual way.

Gastric sleeve has the advantages of gastric bypass -- small stomach, significant reduction in hunger hormones -- but the surgery is simpler, and recovery is less fraught with potentially scary side effects. 

The outcomes with sleeve are slightly less than impressive than with bypass, but overall the outcomes are still very good. 

This is what I've chosen. It seems like it's becoming the norm for bariatric surgery.

The Name of This Blog

Why is this blog called 85 percent thinking?

In my mid-30s, I was writing professionally, and had a run for a while writing about eating disorders. It was through that work that I first recognized my own disordered thinking about food and dieting. I reached out to one of the therapists I had spoken with, and worked with her for some time. It was difficult work and it had an enormous impact on my life.

One of my biggest pitfalls, something I've worked hard to recognize and reduce over years, is All Or Nothing thinking. All Or Nothing is a poisonous trap that prevents us from participating fully in our lives -- and it's often part of an eating disorder syndrome.

This therapist taught something she called 85 percent thinking. Whatever you're doing, whether it's eating healthfully, getting more physical exercise, or any other goal, if you're doing it 85 percent of the time, you're doing well. 

We're not machines that can be programmed to perfection. We're humans, with real lives, full of things we cannot control. That accounts for the other 15 percent.

To do anything well, especially to learn new habits, we need discipline and commitment and inner strength. But to be human, we also need compassion, and flexibility, and forgiveness -- and we must extend that to ourselves. For many people, especially women, it's much easier to be kind to others than it is to be kind to ourselves. That, too, is the other 15 percent.

That's 85 percent thinking.