Greetings from Oasis of Hope Hospital

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

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

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

 

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

 

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

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

* * * *

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

Where are you going?

Is it for work or family?

For how long?

Where are you staying?

Going shopping while you're there?

Did you take the hotel shuttle last night?

How much was the cab?

Where do you live?

Is the weather nice there?

 

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

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

 

FYI, I did not answer truthfully.

Greetings from Vancouver

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

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

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

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

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

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

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

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

The Final Countdown!

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

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

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

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

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

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

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

One Week to Go: What's on My Mind

The surgery is in one week from today! 

My current concern is the travel. 

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

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

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

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

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

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

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

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

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

Checking In: Pre-Surgery Eating Plan

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

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

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

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

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

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

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

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

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

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

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

How Will the Surgery Affect Life at Home?

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

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

This was pretty wonderful to hear!

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

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

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

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

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

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

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

Also Starting Today: the Food Journal

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

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

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

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

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

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

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

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

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

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

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

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

----

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

Pre-Surgery Diet Begins Today

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

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

This is the basic diet I got from the clinic. 

Daily:

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

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

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

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

* non-fat yogurt - 225 grams / 8 ounces

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

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

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

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

When Is a Fast Not a Fast?

When it's a slow?

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

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

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

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

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

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

All Systems Are Go: Surgery and Flights Are Booked

It is on!

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

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

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

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

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

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

I've Been Cleared for Takeoff

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

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

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

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

Another Step Forward: Primary Care Doctor Checklist

I saw a primary care doctor in our town today. We don't have a family doctor; they are in very short supply in rural and remote areas. I really dislike not having a family doc, but we can always see a doctor with very little waiting. There is one young female doctor who I've seen several times, who I like. I always request her, and so far that has not been a problem. It's not the same as having a family doctor, but it's better than seeing a different doctor every time, walk-in-clinic style.

So today I told Primary Care Doctor that I've decided to get the surgery done privately in Mexico, and I need a few things in order to move forward. PCD ordered the blood tests and an ECG. After that, we'll do a physical, and if everything is OK, she'll write a letter that I'm fit for surgery.

She asked about the services that the private clinic provide: is there follow-up, a dietitian, an endocrinologist? I told her that I have the booklet (more like a manual) from the bariatric clinics here in BC, and I am hoping that I can work with the dietitian here at the primary-care centre. In addition, I am good at doing my own research and following an eating and exercise plan. Those things are not new to me.

PCD encouraged me to tell the BC bariatric clinic that I'm having the surgery, and see if they will do follow-up with me. It seems like a good idea to do both.

I'm getting the blood work done on Monday, and should have everything in place next week! I'm happy and excited.

Right now, the thing that's bothering me the most is flying while covid-19 is still active. It's a risk, and I wish I didn't have to take it.

Concerns About the Surgery

I want to write about some of my fears and concerns about the surgery, but I feel the need for a preface. 

I am comfortable with my decision to have bariatric surgery. But the way I see the world, nothing is perfect. The best experiences have downsides, and usually even the worst experiences eventually bring some silver linings. Everything is a trade-off. If the downside is occasionally annoying or troublesome, that doesn't mean the decision is wrong or a mistake. And it doesn't mean we have to pretend the downside isn't there. 

I have certain fears and concerns about what my life will be like post-surgery. I'm not freaking out, I'm not losing sleep, and I'm not having second thoughts about my decision. But the concerns are there. I need to write about them, in order to think about them and process them.

* * * *

I have three major concerns about the surgery:

- the pre-surgery fasting,

- my enjoyment of eating, post-surgery -- and forever, and 

- having to weigh myself, and this possibly triggering unhealthy patterns.

Fasting before the operation may seem like a silly thing to be concerned with. You drink Optifast or something similar for nutrition, and you don't eat. This shrinks the liver and makes the surgery safer. Most patients do this for two weeks. Some morbidly obese people are told to do it for a full month.

I'm not good at fasting. I have hypoglycemia, and when I am hungry and my blood sugar drops, it is very unpleasant. I get headaches, cannot concentrate, feel irritable and shaky. Perhaps drinking the Optifast prevents the blood sugar from dropping. 

I know it is temporary and short-term, but I am nervous about it.

The post-surgery terrain is long -- it's forever! -- and it's much scarier. I love good food and I love to eat. I think eating good food is one of life's most basic pleasures. Will I still have this pleasure in my life, post-surgery, or will it be a thing of the past?

Perhaps my love of good food will become part of my past, and I won't miss it. I can think of many things that I really loved and enjoyed while I did them, but when my life changed, I didn't miss them. My partner and I used to love to go to high-end restaurants when we lived in New York City. We spent a lot of money going out for dinner, and I never regretted a penny of it. When we left NYC, we stopped doing this, and I never missed it. I still enjoy going to a great restaurant as a treat, but that's not a regular part of my life anymore, and that's totally fine.

I can think of several other (non-food) examples of this. Will my love of food fall into this category? Will that leave eating boring and colourless? 

Of course there are huge upsides to this piece. Many people say after the surgery, they have to remember to eat. I am almost always hungry. No longer having that in my life would be incredible.

Lastly, and most importantly, is my dread of having to weigh myself and track my weight. Many of the behaviours that people are supposed to adopt before and especially after bariatric surgery are exactly the behaviours that signal eating disorders. 

There are no quick fixes for this. It's going to take a lot of willpower, and mental energy, and maybe some therapy, to track my progress without becoming a slave to the scale. I've written about this before, and I'm sure I'll revisit the topic many times. 

Of course looking at the downsides on their own leads to a very negative conclusion. Presumably, along with these concerns, there will be a significant reduction in my weight, and improvements in my health, and those together will lead to many positive benefits.

Clinic Approvals, Timing

Endo Bariatrics, in Piedras Negras (near-ish San Antonio, Texas), approved me for surgery almost immediately. They are now bombarding me with marketing emails, especially from their patient coordinator, a former patient herself, who used to weigh 400 pounds. I don't want to unsubscribe until I'm approved at the other clinic.

Oasis of Hope, in Tijuana (near San Diego), has asked for additional information -- a blood panel, an EKG, and a letter from a primary care doctor clearing me for surgery. Unfortunately, like most people in our town, we don't have a family doctor, but there is a primary care doctor that I see more often, the same doctor who referred me for the surgery in BC. I have an upcoming appointment to see her, and presumably I'll be able to tick the boxes soon after that.

After that, I can schedule the surgery anytime in October or November. There will be the two-week fast before surgery, which I have concerns about. But the big takeaway: it's happening soon.

Real Answers to All My Questions: Forums

Last night I told my partner I was still unsure about whether or not to have the surgery done in Mexico. I need more independent information about clinics and doctors. That's what it's all about, right? The competence of the surgeon and the quality of the clinic.

As we were talking about it, I suddenly realized what I needed: a forum. Message boards. 

A quick search turned up many forums about bariatric surgery. Naturally people are posting and sharing about every aspect of the surgery, from the initial decision, questions about specific issues during the life change, and the inevitable progress reports. 

Every forum includes a board specifically on surgery in Mexico. There's a lot of discussion about which surgeon to choose, and reviews by people who went to this or that surgeon. 

This is exactly what I need to make an informed choice. 

Getting Ready for the Referral

I asked my doctor for a referral for bariatric surgery. I told her I was reading a lot about it online and think it's for me.

She explained that a referral would be not for surgery, but for the bariatric program. Once in the program, it would be decided whether or not I would get the surgery. She also recommended I see the registered dietitian at our health centre, while I take care of other prerequisites.

I had some bloodwork, an electrocardiogram, and an in-home sleep apnea test. And I made an appointment with the RD.

RD was wonderful. Maybe they're all wonderful, I don't know, but I really enjoyed meeting her and working with her. We talked about goal-setting, motivations, how we make change in our lives. She had some great resources that I wouldn't have known about.

RD made a few suggestions on how I might be able to be less hungry, and how to put healthy snacks back in my daily routine -- something I used to do, but fell out of the habit.

I saw her once a month for four meetings. My work with her led to several changes.

• I bought this blender.
• I am drinking green smoothies.
• I bought this awesome container and bring four healthy snacks to work daily.
• I am making these babies which are delicious and so filling.
• I'm no longer eating pre-sweetened fruit yogurt, or eating them only occasionally as a treat. I was relying on them for convenient snacks, but they are very high in sugar. This was not a big deal to give up.

Meeting with the RD also gave me an opportunity to talk about my former eating disorder with someone who understands. But I learned that if I'm accepted into the bariatric program, I'll see a specialist RD who works only with bariatric patients. She's based in the city where the surgery will take place, a seven-hour drive from where I live. I don't know how many of those meetings will be in person and how many can be by videoconference.