Result: One Week Post-Travel

I did it.

I did it!

I went on vacation, and was more relaxed about food choices. Upon returning home, I immediately returned to pre-vacation habits. 

Result: I did not re-gain any weight.

I am beyond thrilled about this -- for the present, and also for the future. I feel like I've passed a major mental hurdle. It was not difficult to go back to proper eating and exercise. I made it a priority, really focused on it. I don't know why this was so difficult in the past, but it's not anymore.

I said I was going to wait two weeks to weigh myself, but I made it one week before asking my partner for the scale. I also returned it to him: no way I am keeping it in my bathroom at this point.

First Travel Experience Post-Surgery

I've just returned from our first vacation post surgery and since covid started.

In the past, travel has been a major obstacle to healthy eating and exercise for me. On vacation, I would eat whatever I wanted, gain weight, then have a very hard time losing it when we returned. It could take me a full year to lose the weight I gained on one trip. In addition, when travel interrupted my exercise routine, it would take me a very long time to get back to  the regimen. This was the pattern throughout my life.

So planning and taking this trip brought a certain amount of concern. I wasn't extremely anxious or worried. But it was always a concern in the back of my mind.

Obviously I don't want to re-gain any weight! But I also don't want to feel that I must be strict and disciplined every single day of my life. Vacations give us a break from our paid work, but they should also temporarily relieve us from our emotional work. While we were away, I tried to find a balance between these two needs. It was challenging.

First of all, I decided not to track my eating while we were away.

I also decided to loosen the reins on my food choices. I ate more cheese and more meat than I normally do, ate chips (in controlled quantities), more bread. 

I did both of these intentionally, which feels better than just mindlessly losing the discipline.

I can't overeat in a single meal. That's just not possible. But I could -- if I weren't careful -- eat the wrong foods every few hours, and in the course of the day, overeat. I did this while we were away, although not every day. Maybe one-third of the time.

Now I'm home. Here's what I've already done and my plan for the immediate future.

• I immediately resumed tracking my eating, and returned to all the healthy food choices. 


• I asked my partner to hide the scale. I don't want to weigh myself until I've been home for at least two full weeks.


• I plan to exercise today (our second full day home) and to put myself right back to my exercise routine. This will be the most challenging part. 

I'll report back.

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A List of Good Things that Have Happened Since my Surgery

For the first time since making the decision to have bariatric surgery, I'm struggling. That in itself is pretty good. I decided in September 2019, so it's been nearly a year and a half with no significant issues. 

I can't and won't deny the issues I'm having right now, but a comment from my friend and blog reader "mkk" made me stop and take stock.

Up to now, any negatives I've experienced were physical, such as pain from eating too quickly, or nausea from eating too much, or the dreaded constipation. I expected things like this and -- although yucky while they are happening -- they're not a big deal.

The negatives I'm experiencing now are mental and emotional, and we all know those kinds of issues can be much more difficult and persistent. There are two issues.

• I am obsessing. Obsessing on calories, portions, weight.
• My appetite has hugely increased. This is very concerning to me, because if this whole process becomes an issue of willpower... it will not be sustainable. More about this in a future post. I'm not ready to talk about it yet.

Here are the positives that have taken place so far.

• I was terrified of the pre-op fasting, and it turned out to be fine. 
  
• I traveled to the surgery and back -- multiple flights and hotel stays -- with zero problems.
• My experience at the hospital in Mexico was excellent. 
• I traveled to the US and Mexico and back and did not get covid!
  
• Throughout my recovery, I was on paid work time, and working from home, so it was easy to work with the post-op eating plan and other self-care.
• A month before the surgery, I received a check in the mail -- out of the blue, totally unexpected -- that covered the full costs of the surgery! We ended up paying only for transportation, which was very manageable.
  
• My physical discomfort while recuperating was minimal.
  
• I've lost 39 pounds. This includes a sneak-peak at the scale in mid January. Without this surgery, losing almost 40 pounds was completely impossible.
• I'm comfortably wearing t-shirts that haven't fit me in 10 years.
  
• My low-back pain has returned to levels I experienced in the early 90s -- easily dealt with with a few stretches.
• My knees feel much better.
• An issue I was having with my bladder has disappeared. 
• My ankles and feet are no longer swollen -- a condition that was chronic.
• I am less self-conscious about my appearance in video-conference meetings (Zoom, Teams, Hangouts). This feels really nice.
  
• I'm still enjoying food! I was afraid that the surgery would rob me of this basic enjoyment, and that has not happened. This is wonderful.
• I'm still enjoying cooking, and my partner and I are eating mostly the same food.
  
• I'm able to eat almost anything in small quantities. I'm choosing not to eat unhealthy food, but if I wanted to have a small portion of something on my "avoid" list, I could. Having choices rather than being told what I can and cannot eat is important to me and much more sustainable.
  
• With my knees and back feeling better, I am already more physically active, and I'm feeling the rewards of that every day.
  
• And this is all without knowing the results of any bloodwork. I have my first post-op tests in early February.  

 Really great. 

The two issues I mentioned above are real, and they are troubling me. But they are not the whole story.

Eating Less, Exercising More

As the days and weeks go by, something strange is happening: I am eating less. Not just less compared to pre-surgery -- that's been happening every day since I started the pre-op fast in October -- but less than when I first started to eat real food. 

When I look back at my nutrition tracking, I see fewer days when I hit the upwards limit of calories, fewer days that I exceeded the range, and more days when I'm towards the lowest end of the range.

A regular bariatric diet is in the range of 1000-1300 calories per day. (Don't try this at home!) When I first started tracking calories, most days were in the 1300 range, and a few days were around 1500. I considered that a good start. I wasn't concerned about going over for a few days, as the amount I was eating was still well below what I had been eating before surgery. 

But more recently, I never have days over 1300, and am usually well below. On a few days, I needed to add a snack to avoid being under 1000 calories!

I think this is coming from a combination of factors.

• Eating real food. This gives me more variety and enjoyment from the food I eat, which is important to me.
  
  
• Choosing foods that give me more bang for the buck. Peanut butter, for example, is very healthy, but also packed with calories. I'm using less per serving and eating it less often.
  
  
• 85% thinking! One night last week, my partner was having breaded chicken strips and hash browns for dinner, both from frozen. This is convenient, yummy, reasonably nutritious (if you choose the right brands) but higher in fat and sodium, and not something we should eat too often. But I wanted some, too! So I made sure that breakfast and lunch were on the low-calorie end, and asked P to make a specific amount for me (frozen foods are his domain). I had 3 chicken strips and 4 hash-brown discs. (The discs are about the size of a loonie, the Canadian one-dollar coin.) I'm not going to eat this food frequently, but it was a nice treat on a night P was working, and I was still well under 1300 calories for the day. Having the occasional indulgence is going to help me stay with this for the long run.
  
  
• Planning, planning, planning. Plan the meal, plan the day, plan the week. Perhaps I'll write a post with tips for planning eating and exercise.
  
  
• Eating more slowly, then waiting at least 20 minutes before eating or drinking anything else. This is still quite challenging, but I am making progress.

The increase in exercise is down to one simple change: I've discovered I can read on the treadmill. 

I'm a voracious reader, and like many readers, I never have as much time to read as I would like. I can't read at night, and it's often difficult for me to concentrate on a book, when a big to-do list is always waiting.

Most people I know watch Netflix or other TV while they exercise at home, but I have never enjoyed that, and I certainly don't need any more screen time in my life. I normally listen to music.

Two weeks ago I decided to try reading -- and it worked. This has been motivating me to get on the treadmill more often and stay on it longer. I feel all the other positive effects of exercise, but it's no longer boring. Big win!

Eating and Enjoying Real Food; Sustainable Self-Discipline

One of the things that concerned me most about weight-loss surgery was the idea of losing the enjoyment of eating and food. I heard and read that this would not happen, but there's a difference between knowing something in your mind and seeing it in practice in your life. 

Now I am eating. And enjoying. And this is a great relief! For the last 10 days, my partner and I have eaten the same food for dinner almost every night. If we didn't, it was because we got takeout and ordered different things.

"Eat protein first"... not really

Some of this concern was about cooking. All the info on bariatric diets advise you to eat protein first, then vegetables, then if you are able to eat more, a small portion of whole grain or complex carbohydrates. I cook mainly one-pot dishes. Whether soup, stew, stir-fry, sheet-pan, or casserole, the protein, vegetables, and grains are all cooked together. The one exception to this is grilling in the summer. Other than that, I'm combining simple ingredients in various ways. How was that going to work with "eat your protein first"? 

WRD explained that this "rule" really means to make protein the focus of your meal. You want to make sure you are meeting your protein requirements, and if you fill up on carbs, you won't be able to do that. Then why don't they say so?

For a one-pot cook, this means adjusting the ratio -- bumping up the protein, reducing the carbs. That's easily done. I might change the ratio when I'm cooking, or I might do it only when I serve myself. Either way, it's not difficult.

Sustainable self-discipline

Despite the tiny stomach, the bariatric diet still requires discipline and self-control. Although I can't eat a lot at once, I could eat small amounts that would add up to too much. If we're binge-watching something on Netflix, I could easily have a small snack every half-hour, and/or I could snack on the wrong food, filling up on empty calories. It's possible to do.

The difference is that the tiny stomach makes the discipline sustainable, because I'm not hungry all the time, or if I am hungry, a small amount of food is all I need.

When I was doing the pre-op fast, someone mentioned that I was proving that I could modify my eating behaviour. But behaviour modification was never my issue; my long history of dieting demonstrates that! I was overweight because I had consciously given up on dieting, and I was always hungry. Now, because of the surgery, I can eat a very calorie-restricted diet, without being hungry. Sustainable self-discipline.

85% thinking

Using an app to track diet and exercise can really run counter to 85% thinking. Calories eaten, calories burned, calories left to eat for the day... it has the potential to cultivate some very unhealthy thinking. But tracking my intake is really important right now. So I have to do it, and stick to it, but at the same time I have to give myself leeway and not give in to all-or-nothing thinking. It's a challenge!

Using an App to Track Nutrition and Exercise: Pros and Cons

Most people who track their diet and exercise use an app on their mobile device. I decided to track everything manually, beginning with the first day of the pre-surgery fast.

I have a beautiful blank notebook that I had never used. It was a gift, associated with a very special memory. (The book was a gift from my mother, a souvenir of our trip to France together in 2014.) I decided that this huge life decision deserved this special book. 

In the notebook, in addition to diet and exercise, I've included my questions for the dietitian, notes from my dietitian sessions, any pain or discomfort I experience, any milestones, challenges, and so on. It's a record of my bariatric journey. 

I really like having a record of all this on paper, and associating it with a very joyous memory. I'll continue to use the book to record notes from my dietitian sessions, and any other issues (qualitative rather than quantitative evidence, as we say in the information biz).

But now that I'm moving into a permanent bariatric diet, I realized an app would be very helpful. I chose SparkPeople, and I signed up for the "premium" (paid) version right away.

The paid level has many good features, but the reason I'm using it is to eliminate advertising. Something I use every day, both on my computer and my phone, cannot be plastered with ads. I'm fortunate that I can easily spend another $5/month. Not everyone can, and there are free versions of all the weight-loss apps.

There are many advantages to using a mobile app for nutrition and exercise tracking. However, for me, there are also disadvantages. In some ways it makes my life easier... in other ways it makes things more challenging.

Advantages

The advantages to using an app are obvious.

1. When you enter the food you've eaten, it automatically enters the nutritional value -- calories, protein, and anything else you might be monitoring, such as carbs, fat, vitamins, and so on. No need to look up anything.

2. It tracks and calculates your totals daily, weekly, monthly, and all-time. No need to look back through your week or month, no need to add anything. 

3. Once you've eaten a food, and entered it into the app in a way that reflects your habits (brand, portion size, method of cooking), the next time you eat it, you just tap or click on it. Easy.

4. You can group foods and ingredients that you eat together. For example, I grouped "milk, 1%, 16 ounces," "frozen berries, 1 cup," and "protein powder, whey, unsweetened, 1 scoop" into "protein smoothie". I'll do this with everything I cook, too. 

For me, these are the advantages. The app saves me time and repetitive work.

5. If you are not accustomed to tracking your habits, using an app would make it easier, and hopefully increase the likelihood that you'll continue tracking.

6. If you need more support, the popular apps offer articles, blogs, recipes, workouts, and so on, and also have communities that support and encourage each other. Goddess knows there is no shortage of any of these things online! But it does put everything in one place, which might help you focus. 

Disadvantages

The disadvantages to using an app are less obvious, unless you already have a good awareness of eating disorders.

1. Most apps track your exercise against your eating. They encourage the idea of exercise as a way of eliminating calories: "I walked 30 minutes today, now I can eat more!" 

This can be the first step down a very dangerous road. 

- We do not only expend calories when we exercise. We burn calories every moment, with every breath, all day, even when we're asleep. 

- There are so many reasons to get regular physical exercise, for both your physical and mental health. Exercise lowers blood sugar, lowers blood pressure, reduces the risk of heart attack, stroke, and diabetes, combats fatigue, helps regulate mood, boosts metabolism, and more. A life that includes regular physical exercise is a healthier, happier life than one that does not. Weight-loss apps encourage you to think of exercise solely in terms of calories burned.

- Tracking exercise against eating can very quickly lead to feeling that you have to "burn off" everything you eat -- that eating anything without exercising afterwards will lead to weight gain. 

Have you ever excused yourself before eating something by referencing your exercise? As you're about to take your first bite, you say (either out loud or to yourself), "It's OK, I'm going to the gym later today." 

Maybe you say it once as a joke. Or maybe you think it all the time. Maybe you privately believe you don't deserve to eat unless you have exercised. Or that eating food without specifically pairing that food with exercise will cause you to gain weight. This is called exercise bulimia. In this case, the purging associated with bulimia takes the form of exercise.

In the paid level of the app I'm using, you can turn off the "track exercise against eating" function. I've done that... and now the app tells me "Calories Burned: 0".

2. The app tells you "calories left to eat for the day". 

Tracking calories over time is useful and important. I get that. Post weight-loss surgery, it would be very easy to eat a tiny bit more every day or every week, gradually increasing your capacity -- and ultimately preventing or even reversing your weight loss. 

However, basing your food choices on "calories left to eat for the day" could also create a dependence on the calorie counter, rather than learning how to assess your own hunger. Last night I noticed the app told me I had 250 calories left to eat for the day. But I was done eating. I had no interest or desire to eat anything else. 

The previous night, I had minus 300 calories left -- that is, I ate 300 calories too many. I had been genuinely hungry, and ate too fast (my ongoing challenge), not giving my brain enough time to register the food intake. 

In the second example, calorie tracking was very helpful. I can look at the daily total and remind myself to continue trying to eat more slowly. In the first example, tracking would encourage me to eat when I wasn't hungry.

* * * * *

I plan to continue to use SparkPeople, both on my computer and on my phone. But I want to stay aware of these pitfalls. I'm hoping awareness, plus my own discipline, is enough to keep me from falling into them. 

But honestly, I'm a bit nervous about it. My January 1 weigh-in is coming, and thinking about stepping on the scale, I'm already getting anxious. I'm not freaking out or anything close, but this is nagging in the back of my mind. 

Week 9: Arriving at a New Almost-Normal

I seem to be naturally segueing into a bariatric diet, meaning a new way of eating that I'll continue for the rest of my life. The frequency of stomach discomfort is way down, at most once or twice per week. I'm finding more things that I can eat. And I'm gradually figuring out how to prepare food for our home -- some for me alone, some for my partner alone, and some for both of us. 

New stuff I'm eating (or not eating)

- I had sushi and sashimi this week. Sushi is one of my favourite foods -- actually it might be my very favourite food at this point -- and it was wonderful to eat it again. Portion size will be a challenge, but on the other hand, I can eat it regularly.

- I also had soup from our local Chinese restaurant, a "house special" wonton soup that they make with bits of roast pork, shrimp, chicken and vegetables. I separate the broth, which keeps the vegetables crunchy and hugely reduces the salt content, as I eat a very minimal amount of broth. 

- After the liquid and pureed phases, I was really missing eating something with crunch. In the past I would get that from raw vegetables -- and yes, the occasional chips -- but both those categories are off-limits right now. This week I started eating the whole-grain (brown) rice cakes that we always have on hand, with a small amount of peanut butter spread on. Healthy crunch!

- I've given up my decades-long habit of having strong black tea in the afternoon. I'm trying to limit my caffeine intake, so I've switched to herbal tea. Previously I've only occasionally gone for herbal tea, but now it's daily. I'm not sure if I can keep this up long-term. I've never liked decaf black tea, but if I could find a good brand, I'd try that. 

- I'm going to try different later-stage foods a little at a time, randomly, as I feel like it. I think as long as I eat slowly, it will be OK.

Things I've learned

Calculating the grams of protein I eat every day has led to some interesting insights. I've always paid attention to nutrition, but as most dieters know, it's also easy to fool yourself.

- We've always eaten a lot of seafood, and I've known that it is very high in protein and sometimes rich in healthy and important fats. Looking at the actual numbers has really reinforced this. Seafood is pure protein, a big bang for your protein buck. We eat tuna and salmon, both fresh and canned, trout, halibut, Pacific cod, scallops, shrimp, and probably a few others. 

 (I often joke that my tuna consumption is turning me into a thermometer. That's the big but of seafood... and why I switched to Skipjack (or "light") tuna, from Albacore (or "white") tuna. Skipjack is also less dangerous to marine mammals that die in driftnets.)

-  I've always thought that hummus is a healthy food and imagined it was rich in protein. Nope! As a spread or dip, it is certainly healthier than mayonnaise or sour cream, but it's not high in protein. Hummus, at least the commercial variety, really doesn't qualify as a protein source at all. 

- Much to my surprise, tofu is not very high in protein either -- nothing like chicken, fish, or meat. You would have to eat a lot of tofu to meet daily protein requirements. I realize that different people have different protein needs, but this partly explains why, when I was a vegetarian, I was so unhealthy.

Cooking for two, or 1.5

My partner and I have never eaten the exact same food, but normally any dinner I would cook would be for both of us. Now this has become a challenge. 

So far, as you may have read, I've been doing advance cooking for him, which we save for the nights he is working. At first these meals were 100% for him. Now I'm including some meals that I can also eat, or eat in a modified way, such as giving myself more meat and less rice. 

I'm also still cooking ahead for myself, and putting portions in muffin tins. This has turned out to be so useful for me, both for portion size and variety, that I want to continue it. 

One positive piece of this is that I'm eating food that my partner doesn't like, foods I had stopped eating at home, because I didn't want to bother making them just for myself. A large sweet potato -- baked until it's completely soft, almost syrupy -- lasts me almost a week. That's just one example of several.

All this has led to a great deal of food prep, and it sometimes feels burdensome, especially when I'm working long hours. This week my partner did a lot of prep for me -- cleaning, chopping, mincing, and leaving everything in tiny pyrex bowls in the fridge. That made a huge difference, but I don't want to make a habit of it. (Well, I'd love to make a habit of it, but I won't.)

This is something I'm going to have to feel my way through and make changes as I go along. In the past, anything I couldn't completely plan out in advance was very challenging for me. I'd feel anxious about having too many unknowns. But these days I'm much better about living with unknowns, and adjusting as needed.

Every day I see evidence of how weight-loss surgery is really a tool for people who already understand nutrition, who have had experience dieting and monitoring their food intake, who are mentally stable enough to deal with a lot of change, and who have support. Without those factors, it would be much more difficult to succeed.

Week 7: Protein Requirements, the Tiny Stomach, Clothing

I've been introducing soft foods into my diet in a totally random and haphazard way. 

I'm still eating the pureed food I prepared. We bought more muffin tins, so I was able to make larger batches, fill the cups with half-cup portions, and freeze several tins. But I'm also eating canned fruit, oatmeal, soup that has not been pureed, well-cooked sweet potato, a scrambled egg, peanut butter, and so on. 

I'm gradually weaning myself off the pureed foods, but I will probably keep some of that in my diet for a long time.

Getting enough protein

I'm completely sick of smoothies, but without them, it's very difficult to meet the protein requirements while not overeating -- even while adding protein powder to foods like soup or oatmeal. Some days I give myself a break from the smoothies, but when I calculate the grams of protein on those days, it's always borderline. 

Experimenting with different flavours in the smoothies hasn't helped. I'm sick of drinking so much frothy liquid. But I must do it. 

Once I'm done with all the transition phases, and I'm on a regular post-bariatric eating plan, the protein requirements will be reduced. Still a lot, and still very important, but the difference between 70-120 grams/day (post-surgery) and 60-70 grams/day (regular bariatric diet) is significant. 

So, for now, smoothies it is.

The tiny stomach

Learning to eat more slowly continues to be a painful challenge. 

Last night, for example, I wanted the 16 ounces of milk that I normally use for a smoothie, mixed with this turmeric "golden mylk" blend. It was late and I wanted to finish it up and go to bed. Instead of sipping the milk, I glugged about half of it. 

The results were agonizing -- sharp pain, nausea, bloating -- and lasted more than two hours. 

Looking back through my food diary, I see this is happening less frequently, so I've made some progress. I guess I just have to keep trying.

Clothing

A few readers have asked me about buying new clothes. I'm not rushing to do that any time soon. Like many women, my history with chronic dieting and body image can make buying clothes a stressful and unpleasant experience. 

This has improved a great deal by shopping online, and by my hard work at self-acceptance. But even so, I don't want to buy clothes in a smaller size until I am sure I can maintain that size. Honestly, clothes shopping is not something I even want think about yet.

However... there are some clothes at home that I'm thinking about.

I have a large number of graphic tees -- the kind I wouldn't wear to work, but generally wear all weekend and while working from home -- that I really like, that haven't fit for several years. These are shirts with logos of a certain sports team, from social-justice activism, and so on. I never got rid of these. They were already larger than I liked, and were in good shape... so I just hung on to them, and tried not to think about them.

Now I am gradually starting to wear them again. That's pretty cool. 

The other exception is a collection of professional wear, especially beautiful jackets (the kind some people call blazers or suit jackets). 

Beginning a new career in 2013, I needed new clothes, first for interviewing, then for working. Making peace with my body -- at that time largest I had ever been -- I found a great store that sold plus-size petites. I know that sounds like an oxymoron, but when you are short and heavy, this is an incredible lifesaver. They also made shopping easier, with salespeople you can book in advance, so you can shop by yourself, but still have someone going back and forth to get different sizes and ideas for outfits.

This store's clothes were exactly the right mix of dressy and casual, and I started building a new professional wardrobe. The jackets were especially brilliant -- really stylish, but still classic, and they fit beautifully. 

I wore these jackets for several years. I must admit, dressing well and having clothes that fit nicely increased my confidence. 

Then one day I noticed with horror that the jackets no longer fit as well as they should; they were too snug. Then no longer fit, full stop. I kept them, but stopped wearing them.

A couple of years ago, my partner and I relocated, and these jackets are now too dressy for my present situation. I bought some sweaters -- long, open-front cardigans -- to wear over dressy t-shirts. This let me change my look and buy larger-size clothing without feeling awful about no longer fitting into those jackets.

Now I am looking forward to putting on these jackets, and buttoning them, and feeling that I have reached a goal -- not the final destination, but a landmark along the way. However, I don't want to go near the jackets until I am certain that they will fit. So I'm waiting.

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! 

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!

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.

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.