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.

Greetings from Self-Isolation

I'm home!

Because I was out of the country, the Government of Canada requires that I self-isolate for 14 days. This is a law, and it's enforceable -- they do check up -- but regardless of that, I take it quite seriously. The incidence of covid-19 in our area is very low, and the last thing I want to do is expose anyone to the virus.

Self-isolation is not a perfect system, as it was impossible for me to go directly from the airport to my home. I took extra precautions in that interim. Now that I'm home, A and I are sleeping in separate rooms, not touching, and distancing. I couldn't even hug him when he picked me up from the airport! 

A and I talked about it on the way home, and we both feel my chance of exposure was very low. 

- 100% of the time I was away, 100% of everyone around me was masked. Masks are mandatory in airports, on flights, and in the hospital.

- I practiced social distancing the entire time, with two exceptions -- the two crowded flights. And in those, the seat beside me was empty on both flights.

- I washed and sanitized my hands frequently.

- I was not in any restaurants, clubs, events, or even crowded stores.

Another thing -- and I don't know if or how this figures in -- is that I may have already had covid, in early March. While traveling for work, I became very sick, with all the symptoms. We don't know if I had it, and if I did, that doesn't mean I have immunity -- but it could.

I've been working at home, so even when I go back to work, isolating is not an issue. 

I'm counting the days, hoping I don't get sick.

Two Days Post Surgery: On My Way Home

This morning I had my last round of intravenous meds and a nurse removed the IV. The patient coordinator went over everything, and gave me a care package of instructions, medications, and supplies to clean the wound where the drain was. They also gave me copies of the bloodwork results, EKG, and all the medical info so it can go in my records back home.

I'm feeling OK and eager enjoy a week of rest and relaxation. 

A note about this blog. As I've mentioned, I'm writing this for myself and perhaps for anyone who might need this information from a firsthand source. Friends and family are very welcome to continue reading, but please feel no obligation, and not the slightest need to apologize if you want to stop reading. Deal?

A Big Improvement in a Short Period of Time

It's still the first day after the surgery, and I feel better and better as the day progresses. The doctor removed the drain -- ouch!! -- and soon the IV will come out and I can take a shower.

The hives are acting up, so they're letting me take my antihistamines now. 

This morning I thought, how am I going to travel on Thursday? But I already see that it's possible, and won't be so bad. I have to be super careful not to lift my suitcase, and to ask other people to lift it for me. And I have to walk slowly. If I do those two things, I'll be fine.

I wish I could go all the way home on Thursday! But alas, I can only get as far as Vancouver, then will fly to Port Hardy the following morning. Then I have an entire glorious week off work. Can't wait.

 

Recovery Day One: Time To Break Out an Old-School Cliche

Well, it's done! This morning I am thinking of that very old poster cliche, Today is the first day of the rest of your life. I've made this permanent change, and it feels daunting, but I will continue to take it step by step.

Monday night I was prepped for surgery, including an IV line for hydration and follow-up medication. Then yesterday I had visits from a whole slew of medical staff: the surgeon, the anesthesiologist, the doctor who coordinates my care, the patient coordinator who I've been emailing with, and a nurse. The dietitian even came by to say hi and tell me we will speak tomorrow.

They gave me a chest x-ray, an EKG (normal! whew!), compression stockings, and maybe some other things I've forgotten. 

Then I was wheeled off, needle, drowsiness... then I was in my room. Ta-da!

I woke up feeling like I'd done 1,000 crunches, with pain under my ribs. Apparently laparoscopic  surgery pumps you full of gas. Ouch. 

Once I woke up more fully, the doctor visited again, saying the surgery was fast (45 minutes) and easy. He told me to walk around as much as possible, as this will help the gas dissipate. Also, I have a drain (TMI?) that they will monitor, plus a breathing thingy to help facilitate deep respiration... also for gas.

So I spent the rest of the day alternating between sleeping, walking around the room and in the hallway, and having nursing staff come in and out putting various medications in my IV line -- anti-nausea, antibiotics, anti-gas, painkillers -- and giving me ice chips.

IV lines! Why wasn't this always standard?! When I was 12 years old, I had knee surgery. All painkillers and antibiotics were given by injection into my thigh. Always the same thigh. After a while, it hurt so much that I was crying, and preferred the surgical pain to the constant stabbing. It also caused nerve damage; the area was numb for nearly 20 years! Why didn't they use an intravenous line? One needle, and you're done.

I can tell that the standard of care here is very high. The staff is very methodical and deliberate, with great attention to detail. Perhaps this is a function of working in a private clinic without a huge number of patients? I don't know. But my experience in hospitals, either for myself, my partner, or anyone I've ever visited, has been that staff are very rushed, and if you don't advocate for care, it's easy to be overlooked. (Admittedly my experience is limited to New York City, where everything is always over-crowded and rushed, and the same, but slightly less, in suburban Mississauga.)

You may be wondering about a language barrier. The doctors all speak perfect English and are obviously fully bilingual. The people who seem to be the head nursing staff speak a lot of English; they also use translation apps on their phones, for both you and them to speak in. The aides don't have much English, but instead get someone for you who does. 

Everyone is friendly and so caring. It's like this in BC, too -- medical staff are unfailingly friendly and caring. I did not find this in NYC or Mississauga! I'm guessing, again, that's it's down to workload. It's hard to demonstrate caring when you're constantly rushed off your feet. 

So it's morning now. Today will be full of breathing tests, walking, drains, and other recovery business. The doc told me there are three different tests for leaks. If any are found, it's back to surgery to repair them. However, he informed me, his work never leaks. The hospital's complication rate is less than 1%, and his is zero. (Surgeons!)

To be honest, I don't know how I will be ready to travel tomorrow afternoon, but then again, that is more than 24 hours away. I already feel better this morning than I did yesterday.

One weird thing: I had an allergic reaction to one of the medications. My face and lips got swollen and puffy. No respiratory issues -- my breathing was not affected, only my face. My lips look like I tried to give myself silicone injections and didn't read the instructions. They gave me antihistamines, and will change both the nausea meds and the painkillers.

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.