Week 5: Beginning Phase 4, the Return of Coffee, and General Check-In

Yesterday was five weeks since my surgery. 

I began the Phase 4 eating plan, which means gradually introducing soft foods to the pureed-food diet. Yesterday, for example, in addition to my pureed food, I had a few slices of canned pears, a banana, and a carrot that had been cooked in chicken broth. I tried to eat each one very slowly and chew it to death. 

This phase will require a lot of prep, since I still need to have pureed foods on hand, and also need to get some non-pureed foods every day. We bought some additional muffin tins, so I can make the pureed foods in larger batches and freeze several weeks' worth of small portions.

Meanwhile, my partner has come to the end of the food I cooked and froze for him, way back here, before my pre-surgery fast began. So I have a lot of meal-planning and cooking to do.

I've also started drinking coffee again, several months before I'm supposed to. I just missed it so much! (85% thinking!) I've made a half-decaf blend and I'm going to try to hold my caffeine intake to three small (8 ounce) cups of half-caff. This will definitely be a challenge!

I am itching to weigh myself but waiting for the December 1, which will be the first of my monthly weigh-ins. I had my hair cut and coloured yesterday, and the stylist immediately exclaimed how much thinner I looked. She is a beauty and a gym rat -- who used to weigh 250 pounds, and lost it all through diet and exercise. She thinks that's how I'm doing it, too -- a topic for another post (one that I have been trying to write for a while). 

The only thing I notice is that my face looks much thinner, which I really appreciate. I spend a lot of my day in Zoom meetings, and I hated looking at my fat face! My slimmer face makes me less self-conscious and less camera-shy -- a nice benefit.

In general I'm feeling very good. I'm walking almost every day, often on the treadmill, because it's winter, but often because it just feels easier, like less preparation is needed. My new habit has been treadmilling at lunch, which has a huge added benefit of forcing me to take a lunch break. I'm working at home and tend to work long hours without a break. Having a walk in the middle of the day really helps me recharge.

I was having some discomfort -- sometimes real pain -- after eating certain foods, but I couldn't tell if it was caused by the food itself or by eating too fast. I took a chance and ate the same foods later in the week, consciously eating much more slowly, and had no discomfort. There's my answer. It's not easy for me to eat a tiny portion of pureed fruit slowly, or to eat soup so slowly that it doesn't stay warm. But it's obviously essential, and the pain is a reminder.

In order to eat properly and avoid pain, it's also important to properly space out food and liquid intake. I've adopted a little trick of having a timer on my phone set for 15 minutes. When I finish eating or drinking anything, I turn it on, and can't take in anything else until it goes off.

I sometimes have a weird feeling that I'm eating too much. I'm trying for the recommended six tiny meals each day, or three meals and three snacks. Sometimes I can't finish even the tiny half-cup servings that I'm currently up to, so I eat more than six times in a day -- which makes me feel unsure. 

When that happens, I do a quick-and-dirty calorie check, and I'm always right on track. I'm amazed at how few calories I'm taking in. The target for this phase is 700-1000 calories per day, including 70-120 grams of protein. Yesterday I felt like I was eating all day, and came in under 800 calories. A very bizarre feeling! 

A Word About Poop, Plus Better Information From Canada

I've left out part of my recovery and adjustment story: information about bowel movements. That's what happens when you know friends and family are reading! It's a bit embarrassing to share my poop stories with them!

But as I always say, this blog is for myself -- and it's also for anyone else who is considering or has had bariatric surgery, who might stumble on it. I've already heard from some readers who are in that category.

So with that in mind, here is a word about poop! Obviously if you are free to skip this part.

The part about poop... in case you want to skip it

When I caught up with WRD after the surgery, she asked, How are your bowel movements? And I answered, "I haven't had any, because I've been on a liquid diet for so long," as if this was the most natural thing in the world. I can't remember what she said... we just moved on.

Two days later, I had very intense gas pains and cramping, the worst I've ever experienced. Only then did it occur to me that I hadn't had a bowel movement in three weeks! Probably not good, liquid diet or no. (A friend who is a medical professional, and who has had multiple surgeries, told me that anesthesia can have that effect as well.)

This pain went on for hours. I was nauseated, sweating, just absolutely in agony. I had Gas-X, which the hospital had told me keep on hand, both before and after surgery, but it didn't do very much.

I sent my partner to the drugstore for Senokot, as I know that's supposed to be a natural product and more gentle than something like Ex-Lax. 

I took some Senokot, then was exhausted from the pain and went to sleep... and woke up in the middle of the night, racing for the bathroom. It was disgusting, but I did feel much better afterwards.

I told WRD about this, and she asked if I was taking my Colace. Say what now? 

She said that on the checklist for bariatric surgery (meaning the information from the Canadian province where I live), it says I should be taking Colace, a stool softener, every day. We bought some at our local drugstore and I've been taking it since. It's also a gentle product, and can take several days to work.

Since then, I've had two bowel movements, but I would say I am still constipated. This is definitely on the list of potential side effects from the surgery, so I will continue to monitor it. Another bit of data to add to my food diary! 

The part about the information

This experience brought up something else, too: I was missing information. 

Before my surgery, WRD asked if I had the information booklet from our public health care. I thought I did... but what I actually had was a booklet for the orientation process. It was more general "what you can expect" information. 

The Colace incident made me realize I did, in fact, have the correct booklet. WRD sent me the full provincial booklet -- and it was so much better than what I had from the hospital! This does not surprise me. It makes sense that a public health program is going to be much more detailed and have better information than a private clinic. 

On the other hand, the dietitian that works for Oasis of Hope Bariatrics, where I had the surgery done, seems not to understand the concept of advance planning. Pre-surgery, I had to practically beg her for the diet plan. If it had turned out I needed to order Optifast, as I thought I did, I could not have bought it in time. 

Similarly, she would not give me the Phase 3 diet until the day I was ready to start that phase! She said she does this so patients won't start early. But what about planning and shopping in advance?! The day I was supposed to start taking post-surgical vitamins, she sent me a link to where I could purchase them! 

The information from our province had a checklist of everything you should buy in advance, including the vitamins, so everything is on hand when you get out of the hospital.

WRD gave me the full run-down on vitamins, and I purchased some locally while I wait for a shipment from my preferred online vitamin store. This meant I started the vitamins five days late. I'm sure I won't become malnourished in five days, but it was disappointing.

The provincial booklet is also better all around -- more detailed, written more clearly, and better designed (more accessible). Again, this does not surprise me, but I'm disappointed I didn't have this all along.

If you're in the US and you end up having weight-loss surgery done privately, you'll want to advocate for yourself with the clinic's dietitian, or if you're able, get in touch with a dietitian on your own. 

More Phase 3 Food Prep

I've spent most of the morning preparing food for eating in Phase 3. 

I cooked and prepped these.
- tofu with garlic, ginger, and soy sauce
- chicken breast with Laughing Cow Lite cheese
- white beans with reduced-fat ricotta cheese
- canned salmon with greek yogurt, dijon mustard, and red-wine vinegar
- sweet potato, baked
- white potato, boiled, then pureed with a bit of butter and salt
- and last week, I made lentil soup made with a ham hock

I pureed each one, and transferred portions to either the muffin tin or tiny Pyrex bowls. 

I decided not to add protein powder, in case the cooking and storing breaks down the protein. I'll mix in a teaspoon or two of protein powder as I eat each portion. 

I also have applesauce, canned fruit (which can be pureed or mashed), and baby-food fruit.

We also bought some sugar-free pudding. I normally don't eat such artificial food, but it seemed like a good snack idea. It has almost no flavour, but it's sweet and the texture is nice. I don't think I'll make a habit of this.

I really understand why in Canada, anyone who qualifies for bariatric surgery must first transition to a healthy diet and demonstrate that you can maintain it. I've always said that the first requirement of healthy eating is preparation. If you're not accustomed to planning meals, shopping for what's needed, and cooking in advance, it's not going to work. If you want to eat healthy snacks, they have to be in your fridge or cupboard! 

I've been on board with this for most of my adult life. But for so many people, this means crossing many hurdles and adopting many new habits. If you started that for the first time after your surgery, your chances of success would not be good.

Quarantine is Over! Plus Some Fun Facts About Phase 3

Hurrah! Yesterday was my last day of self-isolating! I've had no symptoms, so my calculated risk of traveling through US airports during covid-19 was a good one. I promptly cashed in my rain checks for hugs and kisses, and moved back into our bedroom.

I also used the occasion to dismantle my alternative workspace downstairs and move back to my home office. We set up the kitchen workspace to encourage better habits during the liquid diets, before and after surgery. I'll have to be more vigilant about drinking water than I've been in the past, but I think I can do it.

The pureed food diet is going really well. I sometimes feel a bit burdened or discouraged when I'm starting the food prep -- then I do it and it's no big deal. I'm aiming for making three or four pureed foods at a time, and putting the pre-measured portions in a muffin tin. So far I've done:
- canned tuna, made with greek yogurt, dijon mustard, and pickle relish
- canned salmon, made with greek yogurt, red-wine vinegar, and dijon mustard
- tofu, garlic, ginger, and a touch of sodium-reduced soy sauce

Each one is pureed in the food processor with some protein powder, one teaspoon per serving.

For the tofu, I cooked the garlic and ginger in a little olive oil, added the tofu and soy sauce, cooked that for a while, then transferred it to the food processor. It had the thick texture of hummus, and was very tasty.

I'm also going to try:
- chicken and low-fat ricotta puree
- lentil soup puree
- white bean and ricotta puree

Here's an example of what I'm eating in the course of a day:
- smoothie made with 16 ounces of dairy milk, 1 cup of frozen fruit, and 1 scoop of protein powder (in 3 or 4 portions throughout the morning)
- can of tuna, pureed, protein powder added (broken up into 3-4 portions)
- jar of baby food fruit or vegetable
- very small portion of soft cheese, such as Laughing Cow Lite
- water, herbal tea, V8

I had a weird feeling that I was eating too much. WRD asked me to scan a few pages of my food diary, so she could calculate approximate daily calories. It turns out I'm eating too little, or at least the very low end of the suggested intake for this phase. Very strange!

Eating slowly is a big challenge, especially pureed food! I'm working on it, one muffin cup at a time. 

Hopefully this is not TMI: for years my ankles and feet have been (seemingly) permanently swollen. I take a diuretic for blood pressure, and I eat a lower-sodium diet, but puffy ankles and feet have been the reality. This is suddenly gone. I was putting on my socks and lo and behold, thin ankles with an actual shape, and smaller feet! 

I will ask WRD about this, but I'm guessing it's from not eating in restaurants (or take-out). I use very little salt when I cook, and we don't even keep salt on the table, but I was eating take-out two or three times each week. Perhaps that, plus a big increase in water intake, has given me back my thin ankles.

I'm still talking myself out of getting on the scale. As we get closer to our planned December 1 weigh-in, this will become more difficult to do!

My State of Mind: Checking In on the Dark Side of This Journey

I'm feeling very positive about this whole experience so far, but at the same time, I'm also working hard to keep my more negative concerns in check.

You may recall I was concerned about the surgery triggering past behaviours that were harmful to my mental health (here and here). Having bariatric surgery means being very attentive to food choices and portion size. It also means monitoring your weight regularly -- my single-biggest trigger.

These negative thoughts and behaviours are already percolating in the back of my mind. Over the past month or so, I've calculated and recalculated what my final weight may be. Healthy weight is expressed as a range, and the expected percentage of weight loss from surgery is also a range. I'd sit there using the calculator on my phone or computer: what if I lose this much, I'll be this weight, and if I lose this percentage, I'll be that weight -- in all different combinations, thinking myself in circles -- and all to no avail, since I cannot predict the future -- and since ultimately, I have no control over the numbers. You can stick to the plan 100%, but you can't control how many pounds you lose.

Thank goodness I can now talk about this and express it in writing. Eating disorders are almost always secret obsessions, layered in shame. The secrecy allows the disordered thinking to snowball without any other, more rational input. 

Eventually I disclosed to my partner that I was doing this. He immediately reminded me that I'm going through this process for my health, not for the number on the scale. And, he said, I'm also avoiding future weight gain. I hadn't thought of that! Even if my "percentage excess weight loss" is on the low end of the range, my weight will stabilize there. As long as I follow the guidelines, I won't continue to gain more weight as I get older -- which up until now, has been happening with each turn of the calendar.

This is also why I'm writing about this: to get it out of my mind. There's no easy solution to behaviours that harm our mental health. They require mental discipline, to recognize the obsessive thoughts as they creep in, and talk yourself out of them. And if I need more help, from WRD or a therapist, I'm totally willing to go there.

More About Phase 3 Eating

I had an excellent session with WRD yesterday, which really helped me understand the Phase 3 pureed food diet.

Two pieces about this phase seemed particularly challenging: the protein requirement and drinking enough water. And one instruction was confusing.

Protein

The hospital guidelines call for 60 grams of protein per day. That seemed like a high bar, but I was able to do it with a milk-based protein shake (protein from both milk and powder) plus small amounts of protein throughout the day, such as tuna or salmon salad. 

But... WRD told me that Health Canada says when you're recovering from this surgery, your requirements are much higher -- 70-120 grams per day. How on earth am I going to make that happen, at serving sizes of 3-5 tablespoons?

The answer -- as vegans and body-builders know -- is protein powder. I have unflavoured whey protein, and I can add it to almost anything. Depending on the food, it may change the texture slightly, acting like a thickener, but it doesn't change the flavour. This morning I pureed some low-sodium chicken-vegetable soup with a tablespoon of protein powder: 12 grams of protein. 

WRD recommends doing this for everything I eat. This can really increase the range of eating, too -- oatmeal, baby food fruit or vegetables, and soups can all be on my menu. Not at all once, of course, but over the course of the next couple of weeks. 

Water

The hospital instructions say I'm supposed to drink 2 litres (64 ounces) of water per day. I literally cannot do this. There aren't enough hours in the day to get both the protein requirements and drink that much water!

WRD thought 2 litres was excessive, especially considering I am also drinking a protein shake, V8, and soup. She feels that 1 litre (32 ounces) is adequate. I'll be able to do that without any trouble.

Pureed but higher-fat food

The hospital guidelines suggest hummus and smooth peanut butter as good go-to food for Phase 3. I enjoy both of those and would be happy to eat them (although I can't put them on a vegetable or cracker at this point). However, everything I read says to avoid high-fat food... so there's a contradiction there.

WRD recommended staying away from hummus and pb for another week, then trying in small quantities, and adding protein powder to the hummus. I've ordered some PB2 and look forward to trying it.

Vitamins!

Now is also the time to begin taking vitamins, which I will have to take for the rest of my life. Some people find this difficult or oppressive, but fortunately I have no problems with it. I already take several vitamins and supplements, adding a few more into the mix is no big deal.

The requirements are:

- A prenatal multi-vitamin that contains folic acid, zinc, magnesium, and iron

- Calcium citrate

- Vitamin B12

- A higher dose of Vitamin D (Everyone in Canada is supposed to take Vitamin D, and these guidelines double the recommended dose.)

 

Food Tastes Good!

I just had to pop back in to tell you that FOOD TASTES GOOD.

I whipped up some canned tuna in the food processor, with yogurt instead of mayo (I've seen it in recipes and thought I would try it), plus some Dijon mustard and pickle relish, which I always put in tuna.

I measured out 4 tablespoons into a one-cup Pyrex bowl and savoured it very slowly. I had no problem eating, and... I'm no longer hungry! Now I'm waiting the requisite 30 minutes before drinking water.

Eating one of these tiny portions and seeing how it is actually filling has given me a lot more confidence about this phase.

I Can't Stand This Anymore: Moving On to Phase 3

I'm moving on to pureed foods, two days early.

According to the hospital, I'm due to advance to pureed food on Wednesday of this week. From everything I see online, these are approximate guidelines. I cannot stand the liquid diet one more day! It's not the liquid that's getting to me, it's the total lack of variety. I need to taste something other than protein shakes, V8, and plain yogurt. 

The pureed food phase is a bit complicated. In looking for more information, I've discovered an overwhelming number of bariatric recipe sites. Most are like all recipe sites -- loaded with ads, floating video ads, stealth marketing, and the same recipes over and over again.

There are also myriad people advertising their services to be your "bariatric coach". I'm hoping I already have that in the WRD (I've added Wonderful in front of Registered Dietitian), but if I need more support I'm not adverse to finding it online.

Regarding the pureed food phase, there's a lot of conflicting information on what you can and cannot eat. These recipes look yummy, but they contain small amounts of some high-fat ingredients like tahini and blue cheese. I thought those were off-limits.

Do not worry: I'll stick to foods that the hospital says are safe until I can speak with WRD for more clarification. So far this means:

* Pureed tuna, chicken, ground turkey, eggs, tofu, and whole grain hot cereal are all OK. That's plenty to get me started! 

* Serving sizes are 4-6 tablespoons -- and this is supposed to take 20-30 minutes to eat! This will be my single greatest challenge. I eat too fast, and I will have to teach myself how to slow down. Waaay down.

* Food is put in the food processor rather than the blender.

* I'll use a muffin tin to separate and store portions.

* There are some restrictions. At this phase, your stomach is not ready for red meat or for any bread products. And you're not supposed to waste calories on high-sugar food. 

* You're supposed to drink a lot of water between meals, but not with meals. I'm finding the water guidelines challenging.

Here goes! I'll report back soon.

Post-Op Week 2 Progress Report

Things seem to be progressing very well. 

My wound care has ended, so I no longer have to peel band-aids off my torso every day. That's a nice change.

I had been experiencing pain or discomfort in my upper abdomen -- exactly where the highest scope wound is -- when I would swallow liquids. (This is normal.) It's occurring less frequently and less severely. Yay.

I can now drink six ounces of most fluids without pain or discomfort, as long as I sip them slowly.

I'm finding more ways to make a plain protein shake taste better. I didn't buy artificially flavoured protein powder or pre-mixed protein shakes. I usually don't like the taste of any flavoured beverages, and they are always too sweet for me. The plain (unflavoured) protein powder in milk (or coconut milk) was fine with a cup of frozen fruit blended in, pre-surgery. But I can't have fruit yet, and the plain taste was pretty dismal. 

I thought of these ingredients to bring flavour to the mix without adding anything I can't yet eat. I'm using combinations of:
-- vanilla extract
-- cinnamon
-- cacao powder
-- mint leaves
Huge improvement! I'm all kinds of pleased with myself for thinking of this on my own.

The wonderful RD also told me about PB2, peanut protein with all the fat removed. I don't know why I had never heard of this before? Perhaps because I'm not vegan, so I'm not actively looking for protein sources. I don't know if I can get it in our town or if I have to order it, but it sounds like a good option.

I'm walking every day. Only a little so far, but it feels good to get outside. 

I get a daily email from the Government of Canada, asking me to confirm that I am still isolating, and declare whether or not I have symptoms of covid-19. I've also gotten a phone call from a public health worker, asking about my self-isolating plan and how it's going.  

This morning I am cooking another batch of dinners for my partner. He did the shopping and he washes the Instant Pot insert in between dishes I'm cooking. It's not making me hungry, although I do have to watch the impulse to taste things, or even lick a spoon. 

While I'm cooking, I'm making chicken broth for myself, then re-purposing the chicken in a dish for A. This will be much tastier than the pre-made broth. I don't buy canned soups because of the high sodium content, and the broths made for cooking are not very tasty by themselves.

Post-Op Diet Phase 2: An Exciting Day: Yogurt, Plus a Short Walk

Eating a half-cup of plain yogurt should not be this exciting! But I was so happy to put some real food in my mouth this morning.

I can now add V8, plain yogurt, and a protein shake to my hourly intake.

The biggest change will be quantity. In phase 1, you are limited to 3-4 ounces per serving. I found that if I had even slightly more I didn't feel well. Now in phase 2, serving sizes are supposed to be 4-6 ounces. I'll have to approach that slowly to avoid discomfort and nausea.

Phases 1 and 2 combined represent the first two weeks after surgery.

In addition, I can start physical activity again. Pre-surgery, I had shut down all my exercise because of the urticaria. Vigorous exercise is a common trigger, plus for a long time I wasn't sleeping and felt like crap. Now, post-surgery, vigorous is off the table. I'll start today with a short walk on my street and see how that feels.

Post-Op Diet: Final Day of Phase 1

Today's the final day of the Phase 1 diet, and good riddance. Although it will be quite a while until I eat solid food, I am looking forward to a tiny bit more variety, plus some protein.

Phase 2, which starts tomorrow, includes a protein shake -- milk (any kind) plus protein powder, no fruit yet -- consumed over the course of the day. You can also eat small portions of Greek yogurt, and thicker juices such as V8.

Phase 1 and 2 combined are two weeks. For Phase 3, you'll have to keep reading. Ha! I'm kidding, but I'm determined not to look too far ahead. One day at a time.

Yesterday I learned why you are advised to use 3-4 ounce portions! I poured a tiny extra bit of juice, such a small amount, it seemed harmless.. but ugh, it hurt going down. I didn't do it on purpose, but I will purposely avoid that now.

Other than that occasional discomfort, I feel fine! No complaints.