One Year Post-Surgery

It's coming on a full year since I had gastric sleeve surgery. It's been quite a momentous year for me.

My weight holds steady at minus 50 pounds. It fluctuates within 2 pounds in either direction, but no more than that. I weigh myself sporadically, about twice each month. When I get concerned that I'm eating too much, I weigh myself and feel reassured.

According to the charts, I've lost 70-80% of my excess weight. This is in line with what all the medical literature says about this surgery. This means, of course, that I still have excess weight. I'd look better if I was 10 or 20 pounds thinner, but I don't worry about that. This is where my weight loss plateaued and stopped, so this is my weight. Even if I could lose more weight -- which I highly doubt -- I'd never be able to maintain it. I'm not going down that road.

I frequently feel hungry, just as I always did. But now when I am hungry, I have a very small healthy snack, and I immediately feel sated. The most important thing is to not let myself get too hungry. If I wait too long to eat, I end up eating too fast, and have a lot of discomfort. 

All my health indicators have greatly improved. My blood sugar levels are normal, and I've been able to drop one blood pressure medication. 

I'm more physically active than I've been in 30 years. I walk 5K either 5 or 6 days each week, and usually once a week walk about 7-8K. It feels great. 

And, although I didn't have the surgery to improve my appearance, the change in my appearance does feel good. 

I've gotten the hang of eating in restaurants. It's a bit frustrating, because I'd like to eat more! I wish I could save all my food for the day and have it all in one meal. But that is simply not possible. So I orderly lightly, bring most of it home, and get at least another meal out of it, often two meals. Drinking wine with dinner means eating even less... but dinner is better with wine! So these are things I have to constantly navigate. 

One fun little side benefit: I feel free to eat "fattening" foods when I want to, because the portion size is automatically controlled. In the past, if I decided to eat fries or chips, I would eat a lot, with seemingly no "off" switch. Because of that, I was always struggling to completely avoid those foods. Now if I want a few fries, it's no big deal. 

In general, I feel great. I'm super happy I had the surgery, and also very happy I had it done in Mexico rather than waiting yet more years to have it done in my province.

I haven't shared this story with anyone I work with. No one asks, as it's now considered impolite to comment on anyone's change in size in any direction. Only two people have mentioned my weight loss. One person wanted to know if I'm OK, or if I'm losing weight because of a health issue. The other person is a much older woman, who I think is probably not aware of this current norm. I'm very glad I decided to be more private about this locally. I would not enjoy the attention -- or being the subject of gossip.

Thank you to everyone who has supported me through this journey. It has meant so much to me!

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.

PS: If you would like to receive an email when this blog is updated, please use the form on the right sidebar.

Update: One Month on the Minus-50 Plateau

It's been a month. Lots of good stuff has been happening.

• I'm still tracking my eating, and I feel like I'll be doing that for a long time to come. It gives me more peace of mind, and is very easy to do, so it's a very worthwhile habit. 

• I bought a whole bunch of new clothes! It feels wonderful to put them on. 


• I'm walking 5 kms 5-6 days/week, and usually once each week I walk a 7-km loop around our little town. It takes me past the bay, where there are eagles and herons, and snow-capped mountains in the distance. 


• I've discontinued one of two blood-pressure medications. I still take several other meds, and my goal has never been to discontinue any of them. But it's still a nice little perk.


• All my other bloodwork is normal -- blood sugar, liver enzymes, etc.

I'm weighing myself too often, but I'm trying hard not to obsess.

The last time I was the weight I am right now, I thought I was a fat oaf. I dieted obsessively, weighed myself constantly, hated my appearance, and was desperate to lose 25 pounds or more. 

Yet this is the weight at which my weight-loss settled. My post-surgery weight-loss gradually slowed and then stopped. So I feel that this must be my new normal weight, the weight that I can comfortably maintain.

However, the medical establishment and the weight-loss industry do not agree with me. According to BMI calculators, I am still obese. 

Now, I am not skinny. You might say I am "chubby" or "somewhat overweight" or similar expressions. But I could not rightly be called obese. 

Those same calculators say that my ideal weight is a minimum of 30 pounds less than I am now, giving a range of 30-50 pounds less! At current weight minus 30, I would be quite thin. Even if I could reach that weight (which is highly unlikely), I would never be able to maintain it. Current weight minus 50 is ridiculous. That would be my weight when I was 17 years old. 

From another perspective, the caloric intake per day needed to maintain my current weight is -- supposedly -- almost double what I am eating now. According to the information above, based on my size and what I am eating, I should be losing a pound per week. But I'm not. I'm maintaining my supposedly obese weight.

Something is seriously amiss.

I understand that being very overweight is not healthy. I get that. But the guidelines of what is supposedly healthy is conveniently aligned with the diet industry and all the other consumerism that feeds off people's unhappiness and insecurities.

When I say, above, The last time I was the weight I am right now, I thought I was a fat oaf, I can also say: today, at this weight and size, I feel great.

Feeling Really Well: Increasing Daily Calorie Target Range and Allowing Myself a Mid-Month Weigh-In if I Want One

I am feeling really well! 

You may recall, I had a little freak out a couple of weeks ago (here, here, and here), and with the help of friends and readers of this blog, and a meaningful session with WRD, I was able to get back under control. 

Now it feels like that little earthquake threw me into a new place. 

I'm ticking off all the boxes on my healthy habits checklist almost every day, and days when I can't or don't, I can accept it: 85% thinking.

I increased my daily caloric range by 100 calories: from 1000-1300 to 1100-1400. This slight adjustment makes it much easier to stay within the range every day, which means it's probably what I need. 

WRD suggested I de-emphasize the calorie target in favour of mindful eating, but I don't feel ready for that. I still feel the need to track my food daily, and that means checking portion sizes, grams of protein, and calories. It's like wearing a seat belt -- a simple act that takes very little time and keeps you safer. I'm still working on mindful eating (driving under the speed limit?) (enough of this metaphor), but tracking my eating decreases my anxiety, increases my peace of mind.

After excellent advice I received from you all, I'm also letting myself hop on the scale an extra time or two, if I feel the urge. Once my weight hits a plateau, weekly weigh-ins are a good idea, and I'd like to be able to do that without going back to daily or more-than-daily weight checks. We'll see. I'm willing to experiment with this one.

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!

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 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! 

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.

After That Shock, Next Steps

It's taken me a few days to get past the shock and disappointment of learning that bariatric surgery is years away. Now I'm left with serious concerns about my health.

The RD in our local health centre showed me that the best way to reduce my blood sugar levels is to increase my exercise. And of course increasing exercise is good for so many other reasons. I'm 58 years old, overweight, and there's cardiovascular disease in my family. Enough said.

The habit itself is not the issue. An exercise routine had always been part of my life, until about 10 years ago. I'm motivated and ready to change that.

The issue is what and how.

One of my goals or desires has been to spend more time outdoors, which is not always easy when you're a bookworm and completely non-athletic like me. I love to walk and hike, and I've been trying to maximize that.

But walking is so weather dependent! I thought I would buy good rain gear and walk in all weather, but that just hasn't worked out. I just really don't like being out in the rain. Plus, for a good portion of the year, at my preferred time to exercise, it's dark outside.

I'm swimming again, but until/unless the pool in our tiny town opens early in the morning, that's only once or twice a week, at best -- and many weeks, not at all.

There is a gym in town, so that's an option.

Right now I think getting some exercise equipment for our own home is the best option. In the past, at different times we've had a cross-country machine, and a manual treadmill, which I used to rotate with swimming. I'm going to start investigating.

As far as writing this blog... I'm not sure what I'll do.