How Will the Surgery Affect Life at Home?

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

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

This was pretty wonderful to hear!

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

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

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

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

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

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

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

Also Starting Today: the Food Journal

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

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

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

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

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

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

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

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

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

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

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

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

----

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

Pre-Surgery Diet Begins Today

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

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

This is the basic diet I got from the clinic. 

Daily:

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

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

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

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

* non-fat yogurt - 225 grams / 8 ounces

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

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

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

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

When Is a Fast Not a Fast?

When it's a slow?

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

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

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

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

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

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

All Systems Are Go: Surgery and Flights Are Booked

It is on!

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

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

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

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

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

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

I've Been Cleared for Takeoff

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Name of This Blog

Why is this blog called 85 percent thinking?

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

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

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

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

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

That's 85 percent thinking.

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.