Thursday, November 22, 2007

Second Dilation Procedure

That's what I said. A second dilation procedure. No, I was not to happy about it. However, this time I insisted that there was an anesthetist on the scene and that really made all the difference in the world. I don't recall waking up during the procedure and nor did I "fight" the tubes that were in my throat. Consequently, I didn't have a damaged throat like I did last time and I woke up feeling great. The connection between the stomach and small intestine had indeed begun to shrink again and Dr. Hagen was able to dilate the junction to 13.5 mm. Happy day! Hooray for solid food!
The only real problem was that Chris had just started his new job and he could not drive me to or from the hospital. I was very lucky that my friend, Kirsten, was able to lend me a hand. What would we be without family and friends.

Sunday, November 18, 2007

New Photos

June 19, 2007
November 17, 2007

So the really cool thing about this picture is the jeans. I have not worn jeans for the last ten years. They were never comfortable and I looked really bad in them. These jeans look okay. I bought them 2 weeks ago and they were tight. However, as you can see in the picture, they are way to big for me. I actually had to borrow my husband's belt to keep them up!
I am really pleased with the weight loss. I am hoping that I can reach my goal weight in the next 6 months.

Wednesday, October 24, 2007

Great Day!

Today is a great day! I woke up without that familiar feeling of nausea! That in itself was fabulous. Then discovered that I could drink water! Ye Ha! Had two crackers with cheese for snack around 10 am and because that went down so well, I actually had chicken soup for lunch! At 3 pm I had 12 almonds and that went down without a hitch!. I feel great. I am warm (for a change) and have lots of energy. All I want is for this to happen every day. I'm now off to eat a little dinner. Wish me luck for tomorrow

Friday, October 19, 2007

Scope Results

Since I spent most of last weekend in the emergency room, Dr. Hagen decided to move up my scope from Oct. 24 to Oct 17. So here are the results. Dr. Hagen found that the junction between the pouch and the small intestine had indeed become a stricture and had closed up to a "tight fit". (I think Dr. Hagen didn't want to tell me how much it closed up because I was extremely nervous about the whole procedure.) He was able to dilate the stricture to 12mm. This, I was happy about.

However, I was unhappy about the process. I guess my gag reflexes had become so sensitive that, even after I had been sedated, I kept trying to throw up the tubes that were in my throat during the procedure. I woke up several times gagging and keenly aware of a reddish/brown pool of liquid coming out of my mouth and collecting on the cloth under my face. It was not pleasant. After the procedure, I discovered that my throat had been scraped up quite badly and I have been having a really difficult time swallowing.

In regards to the success of the dilatation though, you will be happy to know that food (and water) are now staying down. Since I haven't eaten is so long I am having a bit to trouble with the sensation of solid food in my stomach. It feels really heavy and is uncomfortable.

As for the future, there is a possibility that the junction could tighten up again. If I begin to feel pain or begin throwing up again, I am to call Dr. Hagen and arrange to meet him at the hospital for a second dilation. Let's just hope that this does not happen. I would really like things to go a bit more smoothly from now on.

Tuesday, October 16, 2007


Because I have lost so much weight, I have not been able to wear my wedding ring for about 8 weeks now. I started going through my old jewelry looking for rings to fill the empty space on my finger. I happened across several during the last couple of weeks that have easily slipped back into place. However, today I came across something that I never thought that I would be ever be able to wear again. It is the silver and black onyx ring my parents gave to me upon my graduation from university. A simple and beautiful ring that holds a special place in my heart.

Mom, Dad, thanks for the memories.

Sunday, October 14, 2007

The Emergency Room

I have been throwing up now for 8 days straight. Yes, I have been to the doctor's and I do have a scope scheduled. So there is not a damn thing I can do. In the meantime, ever time I put something in my mouth I start throwing up. And not just once or twice. I throw up about every 20 minutes for 6 - 8 hours.

Last night it started again. I just could not face another night of agony and sleeplessness so I asked Chris to take me to the emergency room. I knew that they were not going to find anything, but I just really wanted them to make the vomiting stop. Eight hours later I got to go home. My blood pressure was fine and the black substance I was vomiting was not blood but acid from my gut. I didn't have any blockages in either my stomach or bowels. They gave me something to stop the vomiting and pumped 4 liters of fluids into me. They also gave me a prescriptions to stop the nausea at home while I am waiting for the scope. Not the best time in my life but at least today I can drink water and keep it down. Maybe tomorrow will be better.

Thursday, October 11, 2007

New Photos

June 19 2007

October 11, 2007
Total weight loss so far is 86lbs. And yes, I can finally see that I am loosing weight!
Unfortunately, the throwing up has not stopped and, in fact, has become worse. During the past week, I spent 5 days in a row throwing up. I was not even able to keep water down, let alone food.
I am scheduled for a gastroscopy procedure on Wednesday, October 24. Dr. Hagen will put a scope down my throat and take a look inside the pouch and just below it. He will be looking for any strictures or ulcers. If he finds a stricture he will attempt to widen it so that food will pass more easily from the pouch to the small intestine. There is a risk of perforation, but I really don't have a choice.
Wish me luck!
By the way, the pants that I am wearing in the most recent picture are a pair of jeans that have been sitting in my closet for the last ten years. I know that I promised that I would not buy any clothes until I finished losing weight, but these pants were the last pair of "too tight" clothes that I had put aside years ago. Chris has finally convinced me to drop into our local Value Village and Good Will to pick up some cheap clothes to tide me over until I decide to splurge on a new wardrobe. You should see what I look like in my winter coats!! I swim in them! Happy Days!

Sunday, September 23, 2007

Thin Inside, Fat Outside vs Fat Inside, Thin Outside

One of the biggest problems that I have faced over the last several years of weight loss and weight gain, has been the conflict between the internal body image and the external body size.

When I am heavy, I often find myself bumping into objects and not being able to determine where I "fit" within a defined space. It is as if I am completely unaware of my external body size. When this situation occurs, it is because my internal body awareness is that of a smaller body shape and size when physically I am not. In my mind's eye, I perceive myself to be the same shape and size that I was when I was in my mid 20's. During these times I feel thin inside but I am fat outside.

When I lose weight, as I am doing now, I have the opposite problem. When I look in the mirror or see a picture of myself, I cannot see the reduction of weight. Truthfully, I hardly ever look in the mirror because I don't like the reflection at all. I basically check to see if I have all of my teeth and whether or not my hair has fallen out. I don't ever look in a full length mirror. I ask Chris how I look. When I look in the mirror all I see are the lines, wrinkles and fat. What I feel is fat inside when actually I am thin outside.

So like every other person who suffers from an eating disorder, I suffer from a skewed perception of body image; when internal perception and external size do not coincide. How do I fix this problem? I don't know.

I think that there are two main influences that add confusion to this problem. The first being what society presents beauty. I look at magazines, billboards, TV ads etc. I see those thin women, with toned stomachs and wind swept blond hair wearing bikinis and I envy their beauty. Cognitively, I know that the images are an illusion and that I will never look like that (and that in fact, no one can), but I desire it! Therefore, any skewed perceptions I have of my body are further compounded by my desire for the illusion of optimal beauty.

The second influence is that of plastic surgery. I mean, if I could look younger, why the hell wouldn't I? Youth, or the appearance of youth is paramount in our society. And within that desire for youth, I carry all the memories of what youth held for me. I was able to expend huge amounts of energy and accomplish pretty incredible things without consequence. I remember the flexibility and stamina of by body and the silkiness of my skin. So, except for the constraints of finances, why wouldn't I strive to regain that youthful look. Who wouldn't trade just about anything to hold onto the memories they currently have and turn back the clock to recapture those airbrushed features that youth once held for us? And that is exactly what plastic surgery offers us. Youth under a knife and knowledge with out repercussion.

So my adventure, as I continue to loose weight, is to find a way to join the two parts of myself so that my internal perception and the external reality mesh into one whole person.

Saturday, September 22, 2007

Now I see!

Finally, I am beginning to see the weight loss!

Why am I not able to see it when I look in the mirror is the real question? I wonder if it is because I don't really look at myself. I am always so unhappy with my reflection that I no longer really look at myself, just a quick glance to make sure I still have all my teeth and my hair hasn't fallen out. I haven't really looked in a full length mirror for years. I usually just ask Chris if I look okay. I think the worst part about this is that when I do look in the mirror all I see are flaws. The lines and wrinkles around my mouth and eyes, and how fat I am. So even f I do try to be positive, all I can see is the negative.

This is going to have to change. Slowly, but it will have to change.

Wednesday, September 12, 2007

Picture Update

June 19, 2007

September 12, 2007

Okay, guys. I know that the scale says that I have lost 67lbs. But all I see is fat, fat, fat!. Talk about body image problems.

Friday, September 7, 2007

No Pasta High Today

I finally got around to making a batch of tomato sauce. This is no ordinary tomato sauce either. I make it with the tomatoes that Shelna and I canned ourselves. I use organic garlic, shallots, basil and parsley all lovely picked from my garden. I simmer it for hours and when it finishes cooking it is like the angels themselves have kissed it for just the right amount of sweetness.

So there I am salivating over the though of eating my first bowl of pasta tossed with my own sauce with delicate sprinkle with Romano cheese. I start to reminiscing as to how much pleasure I got when eating such wonderful food. Gingerly, I start to eat and wait for signs that my pouch is okay. No problem, and so I eat a bit more. I gleefully went through my 1/2 cup of pasta. And then I just sat there.

Suddenly I realized there the afterglow that I have always felt after eating pasta was not there. In fact, other than being pleased with the fact that I didn't throw up, there is really no sensation at all. Don't get me wrong, the flavour was out of this world, but the calmness and sense of satiation was missing.

I can't begin to tell you how disappointing it was. My favorite food had become mundane. There was no pasta high for me and I don't know if I will every have one again. I am so sad.

Friday, August 24, 2007

I'm getting tired of it

I am really frustrated right now. I keep having, what I call, "bad days" which include pain in my pouch, lower abdomen, constipation, acid reflux, nausea and vomiting. The vomiting can happen once or several times in a row.

Originally, it seemed like I was in a cycle of about 6 - 8 good days, where eating and digestion were normal, but I experienced constipation. Then, I would begin to experience pressure to have a bowel movement and, because I was constipated, I couldn't. The pain in my lower gut would be awful and then I would start vomiting. So, it seemed to me that the vomiting was somehow related to the constipation. I changed my diet; added more roughage and for about a week everything seemed to be working normally. My eating was good, as were my bowel movements. I thought for sure I had cottoned onto what was going on and looked forward to significantly less nausea and vomiting.

However, this past Wednesday, after drinking water, I started to vomit. I vomited a total of three time, about every two hours, and it was only bile and water. The acid reflux between the vomiting would be calmed by nothing and as the evening wore on I become more and more exhausted. Finally, at 2:30 in the morning, everything settled down and I went to bed.

Thursday morning found me exhausted and with a headache. My back was sore and my pouch hurt when I drank water. I concluded that maybe I was having difficulty because I had eaten "store packaged soup". Maybe my system is just to sensitive to eat prepackaged food. So after my loving husband cleaned the kitchen for me, I went about (on shaky ground) making myself split pea soup. By 7:00 that evening I was able to consume 1 cup of the broth from the soup and went to bed with a new plan of cooking all my food.

Today, I have been eating soup, drinking water and ate 2oz of tuna and 2 crackers. Really not the quantity of food I should be eating to maintain nutritional requirements, but everything is staying down.

I am getting tired of vomiting. I can't tell you how painful it is. It would be different if I was trying to get rid of food that was not chewed properly or food that my system couldn't break down, but this is different. There is nothing in my pouch. I am vomiting stuff that is so low in my intestines that my diaphragm hurts and I am breaking blood vessels in my eyes. It is a painful, disgusting, and spiritually exhausting experience and I am tired of it.

Friday, August 17, 2007

What Happened to My Face?

I have finally found something that I don't like about the weight loss. It's the winkles. Take a look at this picture.

This picture is a lie. I am actually having a great time with my nephew, but look at my face. It looks like I am either really pissed off or frowning! I can't believe how the weight loss has changed my face.

Since my cheeks are no longer "plump" I have two large creases that travel from the corners of my nose to either edge of my lips all the way down to the jaw line. The lines make it look like I am constantly frowning. And it doesn't change no matter what emotion I am expressing, unless I am smiling with an incessant grin.

When I brought this up with Chris he just kind of brushed it off and made a flip remark that my age is finally catching up to me. All I could think of is "Thank god for plastic surgery!". I can't even imagine what my face will look like after I reach my goal weight. I understood full well that I would have a lot of excess skin across the front of my body, under my upper arms and upper thighs, but I did not expect my face to go to hell in a hand-basket so fast!

Before the gastric bypass surgery I had contemplated plastic surgery from my belly and for my breasts, but I had not really considered it for my face. Well I can tell you that I have changed my mind. There is no way I am going through the rest of my life looking pissed off (even if I am).

Friday, August 10, 2007

Follow Up Appointment with Dr. Hagen

I saw Dr. Hagen yesterday. We discussed two specific items. The first was the results of the x-rays. Dr. Hagen noted that there was a small amount of narrowing at the junction of the pouch to the small intestine. The junction had narrowed to about 8mm. He was not concerned about this and did not feel that the narrowing had contributed to the two vomiting episodes. He had also expected the junction to narrow a bit at this time.

We also discussed the pain that I have been experiencing lately. His first and foremost thought was that I was going through an adjustment period and concluded that as long as food was moving through the pouch, I was having bowel movements, and passing gas there was nothing to worry about. The pain would eventually subside. He told me that should I begin to vomit with every meal, could not have a bowel movement and was in constant pain to come and see him immediately.

His second thought was that the pain could possible be attributed to the bowel being twisted during the original surgery. He felt that this was highly unlikely and really did not want to explore this any further at this time because it basically meant undergoing exploratory surgery.

So here I am at home, frustrated almost to tears with the whole situation. I guess I had expected (hoped) that I would have an easier recovery. I kept imagining myself becoming very active; riding my bike, going to the gym, gardening, and eating regular food with no consequences.

Instead, I constantly remind myself that things could be a lot worse. It has only been 7 weeks since the surgery and in reality I am doing very well. So maybe I am more tired that I had expected, and maybe I am not eating regular food yet, but I am not in the hospital and I am not dead yet!

Wednesday, August 8, 2007

What The?

Sorry if I have not been keeping up to date. For the last four days I have been suffering with intense abdominal pain. The pain seemed to be located below the pouch and more in the small intestine. However, the pain was so intense that I could not eat or take my medication. I was barely able to keep water down. Sometimes the pain would wake me up in the early hours of the morning. It was so bad, I would just lay in bed panting. I discovered that using a heating pad helped, but nothing really took the pain away. Trust me, I was unhappy and very cranky. Chris was really worried, as was my Mom. She called me twice a day to check up on me. Chris would not leave the house.

The good news is that I am feeling right as rain as of today and I do have an appointment to see Dr. Hagen tomorrow.

I have no idea why this happened. The only thing that I can think of was I spent a few days away from home and was not sleeping properly. I think the combination of exhaustion and stress just obliterated my body's ability to cope with my new digestive system.

I should have realized this earlier. I mean, before the surgery, if I became overtired or overstressed, I would have a minor Crohn's flair up. I guess my sensitivity to sleep deprivation and stress is even more precarious now.

I will have to be more careful in the future and make sure I get my 8 hours of beauty rest. As Chris says "Meditate baby. Be one with the world." Easier said than done!

Monday, July 30, 2007

Six Week Update

June 19, 2007

July 31, 2007

So, where are we now? Well, recently I went for an Upper GI x-ray just to confirm that there isn't any narrowing at the junction of the pouch and small intestine. I will be getting the results next week. My blood pressure is 120/70! Finally, it is down where it should be. I am going to consult with my new endocrinologist as to whether or not I can start coming off of some of my blood pressure medications. Woo Hoo! Ones less pill to take!

Chris and I have joined the Toronto Central YMCA and have been participating daily in Deep Water Aquafit classes together. (By the way, my bathing suit fits again!) I am feeling a bit sore, but enjoying the exercise buzz that I get. Chris and I joke a lot while in the pool, which makes the exercise part more enjoyable. I have also been participating in a weekly Tai Chi class and really enjoying it. My energy level seems to be increasing as well. I still have to take a nap around 2:00, but generally I am feeling good.

I am having less difficulty eating. Foods like tuna, cooked vegetables, cheese, soups, pancakes, crackers, milk, poached eggs and English muffins are easily consumed. I am considering including red meats in my diet during the next week. However, I still have difficulty swallowing pills. They just kind of sit in my stomach and make me feel heavy and full. Not a very pleasant feeling.

To date, I have lost 44lbs. I am still having difficulty seeing it but I am experiencing funny little reminders that the weight is going. The other day, while I was driving, I was having difficulty depressing the clutch and had to move my seat up so that I could reach the pedals. Another fun reminder took place at the movie theater last Thursday. When I sat down in the chair, I realized that I actually had shuffle room!

Sunday, July 29, 2007

Fat Plauge

I watched this program on TV the other day call "Fat Plague" and could not believe my ears. Instead of writing a synopsis for you I found an excellent article that summed it up. If you want more information, I suggest a Google search.

Could Fat be Catching?
by Jenny Bryan

Could a fat virus be responsible for the epidemic of obesity that is sweeping the USA and seems to be spreading to Britain? Obesity scientist, Dr Nikhil Dhurandhar thinks that it is and has some intriguing research findings to back him up. But he knows that other obesity specialists cannot believe it's that simple.

'The concept of a virus causing obesity is so far away from mainstream causes of obesity that it's going to take much more convincing and evidence simply because it's a very different idea. But we'll do it,' predicts Dr Dhurandhar, Wayne State University, Detroit, Michigan.
In the USA 61% of people are now officially classed as obese (with a body mass index, BMI, of over 30) or overweight (BMI of 25-30). The situation is scarcely any better in the UK, with about 20% of people obese and over 40% overweight.

If you look at a map of obesity in the USA, you can watch the epidemic spreading rather like a forest fire from the east coast to the west over the last 20 years. And it is this, says Dhurandhar, which suggests that there could be an infection.

It Started with Chickens …

Dhurandhar's story starts in Bombay in the 1980s with a mysterious epidemic that wiped out hundreds of thousands of chickens. The birds were found to be infected with an adenovirus called SMAM-1. Adenoviruses are very common. There are at least 40 types that affect humans and they cause about 1 in 20 cases of chest infection.

What was intriguing about the Indian chickens with SMAM-1 was not so much that they were probably killed by an adenovirus infection, but that they died plump, with a large pale liver and large kidneys. They weren't thin and emaciated as you might expect an animal with a virus to be.

Working in India, Dhurandhar deliberately infected some more chickens with the same virus and, sure enough, these birds also put on weight. He decided to pursue his research in the USA, but the US government wasn't keen on him importing a virus that had wiped out a large portion of the Indian chicken population.

Instead, Dhurandhar borrowed a human adenovirus, called Ad-36, from the US collection and set to work infecting first chickens and then rhesus monkeys and marmosets. Like the chickens, infected animals started to put on weight. Six months after they were infected, three male marmosets put on three times as much weight and doubled their body fat compared to three animals that were not infected. It was a very small study, but the results were still impressive.
It wouldn't be ethical to infect humans with Ad-36 to see if they got fat. But, as the virus does occur naturally in the human population, Dhurandhar decided to compare infection rates in people who were fat with those who weren't. He tested 500 people in three cities. Thirty per cent of obese people screened positive for the Ad-36 virus, compared with only 5 to 10% of those who were not overweight.

How the Fat Virus Might Work

Dhurandhar – and his critics – wanted to know how a fat virus might work. Dhurandhar showed that Ad-36 appeared to increase the size and number of fat cells in infected animals. In the laboratory, his experiments suggested that Ad-36 encourages pre-fat cells with the potential to become fat cells to do just that. Three times as many pre-fat cells became fat cells when they were exposed to Ad-36 compared with fat cells that weren't exposed to the virus.

Twin Studies

As part of his studies to try and convince other obesity researchers about the importance of the fat virus, Dhurandhar turned to a set of identical twins, Christyn and Beth. Born with exactly the same genes, there was no chance that one twin was genetically more likely to put on weight than the other. Until they went to college, the twins did indeed remain a very similar weight – as do nearly all sets of identical twins. But in the two years after Christyn left home to go to college, she became two and a half stone heavier than her twin. Blood tests showed that, while Beth remained Ad-36 negative, Christen had, at some point, been infected with the virus. Did the virus make her put on weight or did she just eat more and exercise less when she went to college? Who knows, but Dhurandhar blames it on the virus.

Others Remain Sceptical

'The idea that a virus may be causing obesity seems intrinsically unlikely,' says Professor Stephen Bloom, from Imperial College, London. 'Obesity has been growing at a constant rate for about 50 years and the causes are pretty obvious. People have been eating much more and taking less exercise. Why do you need to invent some strange story about a virus?'
Virologist, Professor William Russell, from the University of St Andrews, points out that adenoviruses have never been linked with a long-term illness, like obesity. They cause short-term infections and disappear. It's important to keep an open mind but, at present, the evidence just does not stack up, he says.

A Vaccine Against Obesity?

In the USA, some scientists are more prepared to accept that viruses could be involved.
'Viruses can lie dormant for many years and we've seen the crossover of the HIV virus, for example, from animals to humans. We may be seeing a similar thing now with the obesity virus,' suggests Dr John Foreyt from Baylor College, Texas.

'We really don't know why people get fat or why people are skinny. There's so much that is unknown and that's why we need new theories and people looking at why our bodies are the way they are,' he says.

One possible hypothesis is that, in the late '70s, someone working on a chicken farm in India had the Ad-36 virus and came in contact with birds with SMAM-1. The two viruses got together, exchanged genetic material, and turned into a hybrid virus capable of infecting humans and making them fat. There is nothing, of course, to confirm this series of events, but Dr Dhurandhar now has research grants to help him develop his theories. He has his sights set on a vaccine against the fat virus, but accepts that could be some way off:
'It would be absolutely fascinating to have a vaccine to prevent at least some types of obesity virus – that's my dream,' he says.

Tuesday, July 24, 2007

Stalking the Woolly Buffet

I have to tell you right off the top, that some consider me to be a "food snob". Personally, I don't see it. I am just as content to eat at a local "hole in the wall" as other people, but Chris often calls me a food snob, as does his dad I might add. I was originally very offended by this. It sounded derogatory. But I have come to the conclusion that it is not really a bad term at all. My slant on being a food snob is thus; I enjoy good food. What does that mean? I mean that the ingredients of a dish must be fresh, the food must be cooked correctly, and seasoning must be properly applied. The visual art of plating food and the service at a restaurant becomes increasing more important as the price of the restaurant increases, but I am a little flexible on these issues. (Chris would like to point out that that is exactly what he means by "food snob".)

Which brings me to restaurants. What an interesting place they are. As a food snob I go to all kinds, even ones that you might pass up, if you didn't know how delicious the food was. But since the surgery I have become even more fascinated by restaurants, particularly ones that have buffets and by the people who eat at buffets.

Recently, I went to a restaurant in St. Jacobs, Ontario called the Stone Crock, a fabulous place that served wonderful "home cooked" food and had absolutely brilliant service. The restaurant also offered a well set out buffet. As Chris and I sat down for dinner, I commented on how useless a buffet was for me now, since I can only eat a few ounces of food at a time. He agreed and we ordered dinner; I, a bowl of soup and he, pork schnitzel with fresh vegetables.

As we ate dinner, I began to realize that just about everybody who was eating from the buffet was overweight. I had never noticed this before. I was amazed. Couldn't these people see that by eating from a buffet they were eating past their "full signals" and were overeating? How had I not seen this behaviour in myself? Who in their right mind would do this to themselves?

Then to my horror I realized that, in fact, this behaviour was encouraged. All restaurants overfeed their patrons. What is even worse, we demand to be overfed! How many times have I gone to a restaurant and been impressed by the amount of food I was being served. Never once considering the consequences, I too would eat past my full signals and then recommend the restaurant to friends, ultimately encouraging the restaurant to continue doling out plates heaped with food.

What struck me next, is that we hunt these restaurants down. We actively seek out restaurants that give us more food for our money. In essence, instead of hunting down a woolly mammoth and gorging, we hunt down a buffet and gorge, the whole time rolling our eyes, unbuttoning our pants, and lamenting on how full we are!

I'm not sure if I am comforted or horrified.

Comforted, that we live in a country that has so much food or simply horrified that we as a society have taken to abusing food to such a degree. The more serious problem lies in the fact that once people are encouraged to overeat, society then turns its' backs on the results. We ridicule people who are fat as "lazy slobs". We say that they are people who have no will power and low self-esteem. We make fat jokes; laughing at them behind their backs and to their faces. We deny them medical benefits, access to comfortable furniture, large seats in planes, trains, buses, and movie theaters. We create public washrooms, restaurant booths and automobiles that are way to small for them to fit in. We have gyms, yoga studios and exercise programs built by, designed for, and populated by slim, fit individuals. Tell me, how is a person of size to cope with such adversity? They to turn to the very thing that made them the way they were. They eat to console, comfort, and bolster themselves. All the time recognizing that this is not who they want to be.

I don't have the answer. I can only tell you what is going on in my mind. To let you know that this was who I was just a little over a month ago. I am not suggesting that gastric bypass surgery is for every obese person. Rather, I suggest that we need to re-examine the way we use food and how we treat those who are lured by its easy availability and soothing effects.

"Well, that was gross"

Chris and I have been under a lot of stress lately. Me with my surgery, and Chris with a herniated disk; so our planned, 1st year wedding anniversary vacation came at the excellent time. We took a trip to Stratford, Ontario (a beautiful place and if you get the chance to go, do so and catch a couple of Shakespearean plays while you are there). We stayed at a fabulous Bead & Breakfast called Duggan Place Bed & Breakfast. If you like B & B's and are in Stratford, stay here. The house is beautiful, the rooms comfortable and immaculate, the food out of this world and the company entertaining. Though I could go on and on extolling the virtues of our vacation, that is not what I really wanted to write about today.

I wanted to talk about french fries. "French fries", you ask? Yes, french fries and the fact that I will not be eating these again any time soon. As you may well know, I am at the point in my recovery that I can eat "soft solid foods"; basically everything I want except for bread, pasta, and rice as long as I chew everything at least 25 times before swallowing.

While on our vacation I decided to try french fries. We went to a little place that specialized in them and, once served, I doled out a few for myself adding some vinegar and ketchup. I ate about 6 fries, chewing well, and sipping tiny amounts of water. Now let me clarify that these were skinny chips, not long, or noticeably greasy, and when I felt my chest muscles tighten ever so slightly, I did stop eating. In all honesty, I thought that I had done well.

Chris and I left the restaurant and decided to go for a walk. "This is great", I thought. "No difficulties so far". Boy was I wrong. About 1/2 hour into our walk I began to feel like I had swallowed a lot of air and began burping. About 10 minutes later my chest began to constrict. I told Chris that I needed to sit down and we found a little bench. Things only began to feel worse and after another 10 minutes I told Chris I definitely felt like I needed to vomit and wanted to be by myself. I left him on the bench and walked to the back of a parking lot where the garbage bins were and waited. Nothing happened and after a while, and several more burps, I felt fine. I went back to find Chris and told him that maybe I had just swallowed too much air while eating, That I felt OK and wanted to resume our walk. I pondered, as we walked, what could be the cause of this discomfort? I had not overeaten, potatoes were on my list of things I could eat, and I had chewed well. The only thing I could think of was that the potatoes had been deep fried, and possible I had consumed more oil than my stomach could break down.

Not more than a minute later an overwhelming weight began to close in on my chest. Pressure from my diaphragm pressed up toward my stomach, the tightness around my chest pushed my ribs in, and I experienced a gag reflex that seemed ready to remove my own throat. I could barely stand from the pain, and immediately sat at the nearest park bench. This bench was facing a road (that, thankfully, was not well traveled), and was situated amongst nearby bushes obscuring us from view.

Chris asked if there was anything he could do and I merely shook my head and indicated how much pain I was in. Moments later I felt my stomach turning inside out and all I could do was turn away from the road, hang over the back of the bench, and watch french fries leave me. All I could think of was "Well, that was gross", and Since there was not much food to begin with, the whole process took no more than 30 or 40 seconds. Once the deed was done, I felt wonderful. Like nothing had happened. In fact, I was amazed at how good I felt. I mean, usually when one vomits there is an overwhelming body soreness and exhaustion, But not this time. All I wanted to do was clean up, and continue with our walk.

So, why am I sharing this with you? Well, I wanted you to know that this is not an easy process. That along with my many successes (as indicated by the little train at the top of my blog), I do have some setbacks. But that is all they are - setbacks and I can wipe myself off (pun intended) and get back up again. I will not eat french fries again; at least for a month or two, but eventually I will try them. Who knows what the future holds. I may never be able to eat fries again but maybe I will. That is just part of the adventure.

Wednesday, July 18, 2007

Four Week Update

Four weeks have passed since the surgery. I have lost a total of 36lbs. I am feeling okay, though some days I feel weak. I have been assured that in another 4 weeks this weak feeling will go away. Generally, I am eating well but it still takes forever. On the other hand, I never get hungry. I am finally drinking enough water too. It really helps that we have had a relatively cool summer. However, I still have trouble swallowing all of my pills. To that end, I have switched my multivitamin and calcium to a chewable form.

June 19, 2007

July 17, 2007

I still can't see the difference. However, I am now wearing pants that I have not worn in 3 years. My tops are a bit loose but still wearable. In fact, I went through my closet and gave to GoodWill all the clothes that had begun to fall off me. My closet is so empty!

I am not going to buy any new clothes though. I have decided rather, to buy a couple pairs of "scrub uniforms". They are cheap and easy to keep clean. That way, as I loose weight, I can replace the bottoms cheaply and still work comfortably. Once I get close to my ideal weight, then I will go on lavish shopping sprees!

Monday, July 16, 2007

Starving Children in Africa

One of the hardest things that I must deal with is leftovers. I am not talking about the 3 cups of fresh tomato sauce that is sitting in a pot on the stove top, but rather the few tablespoons of dinner that I can't eat because my pouch has declared that I am full.

Pre-pouch - I would have just eaten everything on my plate. Fundamentally, this is one of the issues that lead me to being overweight. The internal dialogue that I face follows this logic; "Well there is only a little bit so I might as well finish it off" or "Mmmmmm, this is so good I don't want to stop eating" or "You have to finish the food on your plate" or "It is impolite to leave food on your plate" or " You do not throw food in the garbage" or "There is to little to save as a leftover in the fridge so I better eat it" or better yet "Eat your food. There are starving children in Africa". Consequently, I would overeat.

Where did all this crap dialogue come from?

Some of it is cultural. Have you ever been to an Italian's home for dinner? Each special occasion dinner is at least 6 courses; soup, pasta, meat & vegetables, salad, fruit and finally dessert & coffee. At a wedding add the following courses; appetizer, seafood and a second dessert at midnight.

So if invited to such an event, one must prepare. First, you must know the secret phrases that will halt the appearance of food on your plate or you are doomed. Second, you must starve yourself for at least 24 hours leading up to the dinner so that you are really hungry and ready to eat. To survive at the dinner you do the following; put very small portions of food on your plate so that you can eat all of the first serving while maintaining some room in your stomach. You will need this room for when your "Nonna" (grandmother) inevitably tells you to "mangia" (eat). At this point even if you are still a little bit hungry, you must say that you are full. That way Nonna will only half fill your plate. Then, after the second serving of food and you are full and couldn't eat another bite, you say that you are saving room for dessert. When dessert comes you eat as much as you can and leave some in your dish so that when Nonna tells you to mangia, you can point to the unfinished dessert and say you are stuffed. The key to all this is leaving food on your plate. If you don't leave food on your plate you will be served more food. In spite of all this you will be encouraged to eat yet again because it is inhospitable to leave food on your plate, so after much protest you must finish the dessert. Then, and only then, you be left alone - for a few hours.

So in my culture I was taught that food is important to celebrations and is an intrinsic part of happiness. I was taught that eating and overeating were okay. I was also taught that refusing food was an insult to my host. Now don't get me wrong. I would never suggest that the celebrations that I had with my family were not enjoyable, because they were. I wouldn't even say that I was deliberately taught bad eating habits. I would however say that the practices of my culture did reinforce my skewed perceptions of food, and helped form my own personal bad eating habits.

Some of the dialogue comes from my childhood.

22 years of working with parents and their children have led me to one certain truth; parents have a difficult time watching their children eat. The difficulty may show through in many areas. Some children choose mealtime to practice their ability to say "no" and simply refuse to eat. Some parents worry that their children are just not getting enough food. In both of these situations eating becomes a power struggle in which both parent and child come out as the loser. What inevitably happens is that the child is constantly "encouraged" to eat, often past their internal "full signals". The long term consequence being; children may grow into adults who are no longer able to detect their personal "full signals".

For myself I was encouraged to eat all of the food given to me with "starving children in Africa" statements used as a guilt motivator. One of the more unique things that I remember dealing with, however, was competition for food. This competition was not a result of having too little food, but rather the opposite. My mother is a fabulous cook and, as a youth, there were very few things that I did not like to eat, but I came from a family of six (two sisters, one brother, myself and my parents). If I liked something that mom had cooked, and I wanted seconds of it, I had to eat very quickly so that I could have more. I believe that this is where my distorted fears of somebody taking away my food, or of not having enough food, come from, not to mention my frantic pace when eating.

Some of the dialogue is self-inflicted.

After many years of not experiencing any type of full signals other than pain, I began to work really hard at measuring out normal portions of food and waiting for full signals to present themselves. Once I started becoming sensitive to these signals again, I would on occasion still choose to eat past them, for the simple reason that the food tasted so good. It is obvious to me now that this was a chemical response to the way food made me feel, but I was still unable to cognitively override my biological desire to eat, and instead ended up fabricating justifications for my overeating.

Where does this leave me today? Well, the problem is that after 42 years of eating, I have been conditioned not to leave leftovers, but because my pouch tells me when I am, in no uncertain terms, full, I often end up with leftovers. I end up with a conflict of emotions; one side telling me to finish my food and the other side telling me that I am full and that one extra bite will just make my life miserable. The worst part is knowing that if I try to put that little bit of food in a plastic container to refrigerate it, I will have it eaten before the lid is on.

The only solution that I can think of is to throw the food out. Something which has always caused me waves of panic. Again this has roots in my upbringing. My parents were raised in Italy from 1938 – 1958, and even prior to WWII both families had limited access to food. My grandparents rationed what little they had and no one was able to eat till they were full. Neither family had access to refrigeration; consequently my grandmothers only bought enough food to prepare the meals for the day. No snacking in their houses. My father’s family lived on a farm and though their food was limited it was at least quality food. My mother’s family fared worse. Her father took ill and was not able to work. Each day all five children went without breakfast, had bread with olives or cheese for lunch and had pasta with garlic and oil at night for dinner. Today my mother’s feelings towards food are that it is sacred; a blessing and a sin to waste.

As a result, my parents, out of a need for security, store food all around the house. They have two fridges, that in my entire life I have never seen even half empty. They have a deep freezer packed with food. They have three drawers crammed with canned goods and a closet full of dry goods. There is cold room in the basement that is jammed to the ceiling with home canned goods and they have a huge garden in the back yard that they insist on planting ever year even thought they do nothing but complain about weeding it all summer long. Again, I don't place any kind of blame on my parents for their need to store food. In fact, I understand it very well. Wouldn't you store food, if you grew up without? Rather it is the result of my own skewed perspective in combination with my upbringing that has lead to my aversion to throwing food away.

To be successful, I believe that I must learn to throw my little, itty, bitty, leftovers away, in spite of my feelings. So it is toward this goal that I now labour.

Sunday, July 15, 2007

"Baby got less back"

I love wearing pajamas. They are light, comfortable and I love buying them in outrageous colours and patterns. I often putter around in them all day long; if I can get away with it. So you won't be too surprised if I tell you that the other day, around noon or so, as I was getting a glass of water for myself I couldn't, for the the life of me, figure out why I was walking on the last 3 inches of my pajama bottoms. I shrugged it off and decided that they had just slipped a bit from the way I had been moving and thought nothing else of it.

About and hour later I decided to go upstairs to check my emails and as I began to climb the stairs my pajamas, yet again, started to puddle around my feet and trip me up. As I continued to climb I mused as to why , all of a sudden, my p.j.'s were now way to long for me. I mean I was suppose to be losing weight not losing height, right?

By the time I got to the fourth floor I had realized that because I had begun to loose weight around my belly and butt, my pajamas no longer needed as much cloth to cover those areas and as a result my pajama legs had lengthened! Thus the reason why my pajamas were now too long for my legs. An unexpected result of weight loss.

When I told Shelna about this little adventure her quip was, "Baby got less back". Less back indeed!

Wednesday, July 11, 2007

Do I have to eat?

I have become very frustrated with the way my pouch is responding to food. Let me see if I can clarify that.

Some days, eating my many small meals, is easy. My ability to measure out portions sizes is great, I don't experience panic attacks about not having enough food, the food goes down well, and I don't experience any pain. Today was not one of those days.

I woke up early in hopes of getting a jump on the day and toddled on downstairs for breakfast. For the past 4 days breakfast has been 2 oz of a broccoli and cheese frittata that I had made. Today was no different. I ate my 2 oz of frittata slowly and chewed it well. Then about 1/2 hour later, I started to drink my water and that is when the problem began. Once the water hit the pouch, I experienced terrible pain across my entire diaphragm and upper chest. I became queasy, really hot and weak. These are all symptoms that I had overfilled my pouch, but I had not done anything that I hadn't done for the past 3 days. The nausea got so bad that I actually believed that I was going to vomit and was wanting the relief that vomiting can bring. I didn't, but the pain across my diaphragm lasted for about another 1/2 hour.

Once the nausea subsided, I still had to drink my water. And, though I didn't feel nauseous, every sip hurt like hell.

Skipping to lunch, I decided to have a 1/2 cup of pureed soup. Soups have always gone down really easy and I have never experienced pain when eating pureed soup. Not today. There were no feelings of nausea, but as the soup moved into my pouch; my chest felt like it was being squeezed tighter and tighter. My diaphragm began to tense up and I developed the hiccups. (Have I said hiccups hurt?) The pain was so bad; it was actually difficult to breath.

"Alright", I said to myself, "let's shake this off with a walk". And really, I did want to go for a walk, but I guess that I was weak from not eating enough food and as the walk progressed my legs began to burn and my left knee (which has arthritis) began to ache. By the time I got home, my whole body felt like it had been hit by a bus and I was overheated to boot.

I drew a bath, sprinkled in some Epsom Salts and soaked for about an hour, cooling off and re-hydrating myself.

As you can guess, it was then time for dinner. Well the good news is that it went down well. I think my diaphragm and chest muscles relaxed in the tub. After dinner, I took a short nap, and I am actually, just now, beginning to feel like myself.

I am just really frustrated with the way my pouch sometimes responds to food. Eating has always been a pleasurable experience for me and now, it just seems like work. I mean, I know that that is part of what the surgery was suppose to do; shift the random desires of eating to eating only when needed. But this is ridiculous. I have begun to feel like it would be easier just not to eat at all and that in itself is just as dangerous as overeating. The scary part is that I know that I could do it. I mean, I never get hungry so why do I have to eat?

I know, I know. This is dangerous thinking. And I know that I will most likely not follow this line of thinking, but the point is - I am thinking it. This leads me to wondering about the underpinnings of what is happening. How can my thinking switch so easily from overeating and binging to not wanting to eat at all? Is it a result of the surgery and the few painful experiences I have had? Or is it that not eating is the flip side of overeating? Are my thoughts of not eating the same as an anorexic who denies themselves food?

I'm not sure what is going on in my head right now. I guess that this too, is part of the adventure. When I know, I will tell you.

Tuesday, July 10, 2007

Insight into "The Science of Appetite"

No kidding, there I was, in Dr. Hagen's office when I run across the June 11, 2007 edition of Time Magazine with a fantastic health article called The Science of Appetite by Jeffry Kluger. Anybody who has every experienced Mouth Hunger or just plain out of place hunger pangs has got to read this article. I have never run across such an in-depth article that delves into how we decide to eat and how our bodies trick us into feeling hungry even when we are not.

If you don't take a look at the article itself, let me break down the part that I thought was most helpful; "four ways to curb your appetite".

1) Eat fiber - Unrefined foods, especially those that are high in fiber, stimulate appetite-suppressing hormones and make you feel full.

2) Brush you teeth - Take a break from eating to brush. The flavour change helps you resist eating more.

3) Be consistent - Eating breakfast and regularly scheduled meals keeps hormone levels steady and quashes hunger pangs.

4) Slow down - It takes awhile for the brain to realize that the stomach is stretching. Eating slowly gives the brain time to catch up.

These are just four small points from the article. There is much more in it and it is brilliantly fascinating!

Thursday, July 5, 2007

Two Week Check Up

So two weeks have pasted and I thought that it was time for an update.

Tuesday, July 3 I visited my family Doctor, Dr. Cathy Andrew. She has been my family doctor for 16 years. We often joke about the complications that she has faced due to the myriad of medical problems that I present. What I really like about her is that if she doesn't know how to treat a specific problem, she refers me to a specialist. No humming and haawing. She just calls up the specialist's secretary and refers me that minute.

In regards to the gastric bypass surgery she tracks the following things; my weight, blood pressure, blood work (for my Hb1C, LDL & HDL cholesterol, triglycerides, random blood sugars, iron) and B12 levels.

At the appointment, Dr. Andrew gave me my B12 injection, and checked my blood pressure which is 130/70 (right on the money, but for a diabetic she would like to see 120/70). She ordered up the blood work and referred me to a new endocrinologist. (My regular endocrinologist, Dr. Pike, closed his office two weeks before my gastric bypass surgery, so now I have to break in a new one!)

Thursday, July 5, I saw my gastric bypass surgeon, Dr. Hagen. I had a few issues that I brought to the table, first and foremost being the pain that I have just below my sternum. It seems to be worse when I am sitting, and wearing a bra. However, it also hurts at times when I am laying down, eating, and drinking water. Dr. Hagen said that it was most likely due to the retraction of the liver during surgery. He asked me to keep track of it and inform him if it got worse.

The second issue was that one of the port sites that was used for the surgery was very sore and tender to the touch. Dr. Hagen said that that particular port site had an internal stitch in it and it was the stitch pulling that was causing it to be sore. He said in a few weeks, that too would diminish.

June 19, 2007

July 4, 2007

Now, I can't see and difference between the two pictures (except for the pink hair), but somewhere between the two, I have lost 30lbs. Chris and Shelna both tell me that my face is smaller, but like I said; I can't see it. What I can tell you is that my wedding band no longer fits. It actually fell off! So, I have put it away until I am down to my ideal weight.

Interestingly enough, people have also been asking me how tall I am. Apparently, when a person looks at somebody who is heavy, they also perceive height, and as I loose weight, I apparently appear to be shrinking. An optical illusion that is not in my favour since I am a mere 5'4" tall!

Monday, July 2, 2007

Change in Anatomy

So what exactly did I have done? Specifically, I had what is called a Roux-en-Y Gastric Bypass Surgery (RYBG). The RYGB procedure reduces caloric intake by altering the gastrointestinal tract two ways: through a restrictive and malabsorptive procedure. The Restrictive part of the procedure cuts down on the amount of food you can take in by tying or stapling off a little portion of the stomach, thus creating a miniature stomach, and leaving only a narrow outlet from which the food travels into the rest of the digestive tract and out in the normal manner. The stomach is reduced from a four-pint capacity to about a half-cup, and the lower outlet of the pouch is only about ½ inch in diameter.

The malabsorptive part of the procedure, also called gastric bypass, bypasses about two feet of the small intestine, the originally twenty-foot long tube where nutrient absorption occurs. Consequently, the food travels a shorter route, and fewer calories are absorbed. The lower end of the intestine, called the Roux limb, is brought up to the little stomach or “pouch” and attached to provide material with an exit. The other cut end is sewn back onto the intestine further down, to allow bile and pancreatic secretions into the small intestine so that digestion can proceed and nutrients can be absorbed. In essence most of the stomach if bypassed, all of the duodenum is bypassed, and the pyloric sphincter (the mechanism that controls the rate of entry of food into the small intestine) is bypassed.

What are the Gastric Bypass Surgery risks?
In general, the more extensive the operation, the greater the risk of complications and nutritional deficiencies. My procedure was done laparoscopically, thus reducing my risk, though the procedure is still considered Major Surgery.

Although RYGB is currently the most popular form of gastric bypass surgery, it does carry other risks. The risk of actually dying can be up to one percent, and the risk of serious complications is as high as ten percent. The leading cause of death is pulmonary embolism caused by deep vein thrombosis (a blood clot deep in a leg vein that breaks loose and travels to the lungs where it blocks a lung artery). This is something that I was worried about. To prevent this from happening I was initially required to move my feet and legs for a minimum of 10 -15 minutes every hour. On the day after surgery I was required to actually get up and take numerous short walks. As I have stated before, walking also helps move and dissipate the gas that is used to inflate the abdominal area during the surgery, but more importantly, it helps prevent blood clots. Finally, I was given Heprian, an anti-coagulant drug that is used chiefly in the treatment of thrombosis.

Gastric Bypass post surgery risks include abdominal hernias, which are the most common complication requiring surgery, but are much more common with "open" surgery where the procedure is done manually through a large incision.

Uncommon gastric bypass surgery risks can include the rare complications of: leakage from around staples or sutures, ulcers in the stomach or small intestine, blood clots in the lungs or legs, stretching of the pouch or esophagus, persistent vomiting and abdominal pain, inflammation of the gallbladder, and failure to lose weight (very rare).

More than one-third of obese patients who have weight-loss surgery develop gallstones. Gallstones are clumps of cholesterol and other matter that form in the gallbladder. During rapid or substantial weight loss, a person’s risk of developing gallstones increases. Gallstone formation can be lessened with medication taken for the first six months after surgery.

Since the connection between the stomach and intestines has narrowed, patients can experience vomiting and nausea after eating, though these are not universal side effects and normally only afflict a minority of patients, however vomiting and nausea are very likely to occur in patients who continue to eat highly refined, high-calorie foods, including sweets. Because many gastric bypass patients have poor dietary histories, this is considered a genuine risk.

Nearly 30 percent of patients who have weight loss surgery develop nutritional conditions such as anemia, osteoporosis, and metabolic bone disease. Because the small intestine is largely bypassed, minerals and vitamins can not be effectively absorbed from food. As a result deficiencies in iron, vitamin B12, calcium or magnesium can occur. These can be avoided if vitamin and mineral supplements are taken as recommended, on a continuing, life-long basis. Of those who do develop an iron deficiency, 50 percent develop anemia, a blood disease that can result in paleness and feelings of fatigue.

To avoid this and keep nutrition under control, doctors often recommend gastric bypass patients work with a dietitian to plan meals.

Another risk to consider involves what patients won't be able to have. A common procedure for early detection of gastric cancer is endoscopy, wherein a visual examination is conducted by passing an endoscope through a patient's mouth, down the esophagus and into the stomach and small intestines. The structure of the gastric bypass makes this procedure out of the question, thus adding another potential health risk for bypass patients.

Women of childbearing age should avoid pregnancy for 18 months to two years after surgery, until their weight becomes stable, because rapid weight loss and nutritional deficiencies can harm a developing fetus.

Non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen and many arthritis drugs that contain aspirin may not be taken after this surgery.

Smoking after weight-loss surgery may cause ulcers in addition to other known health risks.

Gastric bypass reversal is complex and is only performed if medically necessary.

Benefits of Gastric Bypass Surgery
Most weight-loss surgery patients will lose between 60 to 80 percent of their excess body weight with the gastric bypass procedure. Substantial weight loss occurs 18 to 24 months after surgery; some weight regain is normal and can be expected two to five years after surgery.

In addition to weight loss, surgery has been found to have a beneficial effect on many other medical conditions such as: diabetes, hypertension, acid reflux, sleep apnea, polycystic ovary syndrome (PCOS), urinary stress incontinence, low back pain and many others. Cleveland Clinic research has shown that 80 percent of their diabetic patients had remission from their diabetes (patients’ blood sugar levels were normal without medication). In addition, many patients report an improvement in mood and other aspects of psychosocial functioning after surgery.

After gastric bypass surgery, your overall quality of life is improved. Many weight-loss surgery patients express elation on being able to do things that may seem trivial to the non-obese person, such as going to the store, playing with their children, getting in and out of a car, riding a roller coaster, shopping for regular-sized clothes … the list is endless.

Typically, weight-loss surgery is performed laparoscopically (minimal invasive surgery). Patients will often experience shorter hospital stays, smaller incisions and quicker recovery periods.

Medical conditions that may be greatly improved after gastric bypass surgery include:

High blood pressure. At least 70 percent of patients who have high blood pressure, and who are taking medications to control it, are able to stop all medications and have a normal blood pressure typically two to three months after surgery. When medications are still required, their dosage can often be lowered, without reduction of medication side effects.

High cholesterol.
More than 80 percent of patients will develop normal cholesterol levels two to three months after the operation.

Heart disease. Although it can't be said definitively that heart disease is reduced, the improvement in problems such as high blood pressure, high cholesterol and diabetes certainly suggests that risk reduction is very likely. In one recent study, the risk of death from cardiovascular disease was found to be profoundly reduced in diabetic patients who are particularly susceptible to this problem. It may be many years before further proof exists, since there is no easy and safe test for heart disease.

Diabetes. More than 90 percent of Type II diabetics experience, usually within a few weeks after surgery: normal blood sugar levels, normal Hemoglobin A1C values, and freedom from all their medications, including insulin injections. Based upon numerous studies of diabetes and the control of its complications, it is likely that the problems associated with diabetes will slow in their progression when blood sugar is maintained at normal values. There is no medical treatment for diabetes that can achieve as complete and profound an effect as gastric bypass surgery — which has led some physicians to suggest that gastric bypass surgery may be the best treatment for diabetes in the seriously obese patient. Abnormal glucose tolerance, or "borderline diabetes," is even more reliably reversed by gastric bypass. Since this condition becomes diabetes in many cases, the operation can frequently prevent diabetes as well. Another recent analysis showed that 84 percent of those who underwent Roux-en-Y gastric bypass experienced complete reversal of their type 2 diabetes. Most of them stopped their oral medications or insulin before they even left the hospital, so the remission was apparently not due to weight loss alone. As a result, gastric bypass surgery is being explored as a cure for type 2 diabetes in normal weight or moderately overweight people. Recently, the RYGB procedure was used on two mildly overweight patients. Within a month post-surgery, these patients had dramatically lower fasting glucose, fasting insulin, and A1c's.

Asthma. Most asthmatics find that they have fewer and less severe attacks, or sometimes none at all. When asthma is associated with gastro esophageal reflux disease, it is particularly benefited by gastric bypass.

Respiratory insufficiency. Improvement of exercise tolerance and breathing ability usually occur within the first few months after gastric bypass surgery. Often, patients who have barely been able to walk find that they are now able to participate in family activities — even sports.

Sleep apnea syndrome. Dramatic relief of sleep apnea occurs as patients lose weight. Many report that within a year of gastric bypass surgery, their symptoms were completely gone, and they had even stopped snoring completely — even their spouses agreed. Many patients who require an accessory breathing apparatus to treat sleep apnea no longer need it after a surgical weight-loss procedure.

Gastro esophageal reflux disease. Relief of all symptoms of reflux usually occurs within a few days of gastric bypass surgery for nearly all patients.

Gallbladder disease. When gallbladder disease is present at the time of the surgery, it is "cured" by removing the gallbladder during the surgical weight-loss procedure. If the gallbladder is not removed, there is some increase in risk of developing gallstones after the surgery, and occasionally, removal of the gallbladder may be necessary at a later time.

Stress urinary incontinence. This condition responds dramatically to surgical weight loss and usually becomes completely controlled. A person who is still troubled by incontinence can choose to have specific corrective surgery later, with much greater chance of a successful outcome with a reduced body weight.

Low back pain, degenerative disk disease and degenerative joint disease. Patients usually experience considerable relief of pain and disability from degenerative arthritis and disk disease and from pain in the weight-bearing joints. This tends to occur early, with the first 25 to 30 pounds lost, usually within a month after gastric bypass surgery. If there is nerve irritation or structural damage already present, it may not be reversed by weight loss, and some pain may persist.

Thursday, June 28, 2007

Mouth Hungry

I don’t know how to tell this part of the story, so I will do my best and hope that it becomes clear by the end.

I’m not sure when it happened but over the last several years there came a division of the word hungry and all that it implied. There is the normal “Stomach Hunger” I feel when I need food. These hunger triggers come around 11:30am for lunch and around 4:30pm for dinner. There is the “Tired Hunger” that I feel when I am tired and don’t need food, but rather a nap. This hunger trigger comes around 3:00pm and 10:00pm. And finally I have a state that I now call “Mouth Hunger” which can strike at any time of the day or night, though it is always stronger in the evening. This is an eating trigger where my mouth is salivating and I have the desire to eat despite being full or having already had my meals for the day. This will often lead to binging, when my eating becomes frantic and uncontrollable.

"Mouth Hungry" has been happening to me for a long time now and I can trace it back to the last time I came off Prednisone. It also seems to come directly from the primitive Reptile part of my brain that says; “I must eat food whenever it is available”. Intellectually I know, and am aware of what I am eating, and when I am eating. I also know and understand when I am overeating or binging (again two different things), but the power to limit intake is simply overwhelmed. When "Mouth Hunger" occurs, it seems part of my mind is hijacked by it, and as a result, when I find myself overeating or binging, I can even provide rational justifications for it.

So how does this all tie in? Well, the surgery is the key. It is the tool that installs the limit. My stomach, which I will now refer to as the pouch, holds only 2 – 4 ounces of food. By the end of the first year, the pouch will hold 4 – 6 ounces. If my intake is larger than that I will experience one of the following consequences; vomiting, diarrhea or I will tear the pouch open. These are consequences that I do not wish to experience, especially the last. So the surgery puts into place the tool that allows me to limit my intake where I was unable to do so previously.

Does the surgery take away the hunger? Yes and No. I currently do not have any "Stomach Hunger" triggers for food; this has most likely resulted from the drastic change to my eating style.

The first thing I do when I wake up is start to drink water. I am required to get into my system about 1 ½ - 2 liters of water daily. Easy, for a normal stomach, but with my pouch being so small I start my day with drinking about 700ml first thing in the morning. This takes me about 1 – 1 ½ hours. Then I have to wait about 15 minutes before I eat my breakfast. Currently, my breakfast is about 1 cup of well processed, strained foods; ¼ each of cream of wheat, apple sauce, milk, and Minigo™ cheese. Eating this takes about 1 hour and most of the time, it is way too much food for me to comfortably eat. I say comfortably because a large part of this process is to bee keenly aware of “full signals”, and to stop eating when they occur.

Half an hour after I finish eating breakfast, I start to drink water again. My goal is to get about 350 ml down, 2 ounces at a time, until lunch. I try to have lunch between 12:00 – 1:00. I go through, the same process of eating about 1 cup of well processed, strained foods over the span of 1 hour. Currently, I am eating soups that my parents made for me, but eventually I will start cooking for myself again.

Half an hour after that, I try to finish the remaining 350ml of water and then, before you know it, it is dinner time. As you can see, there is really no time for my stomach to every really “feel” hungry.

As for the “Tired Hungry”, well I don’t feel that either. Again, because I spend most of the day drinking water, and grazing.

“Mouth Hunger” is a completely different story. I had my first experience with it last night around 10pm. I was getting ready for bed and, in my usually way, I was watching a bit of TV before settling in. Lo and behold, a commercial for Kentucky Fried Chicken came on. Now, first you must understand that I do not eat Kentucky Fried Chicken at all. In fact I can tell the last time was over one and a half years ago when I had a single Big Crunch sandwich. The commercial was showing Chicken Fries. Why did the Chicken Fries trigger this response? I don’t know, but my god, my mouth just started to salivate and I just wanted to crawl into the screen and devour it all.

I knew in my head that there was no way I had space in my pouch to even put one mouthful of that Kentucky Fried Chicken Fry in, but did I ever want to eat. In the past, I would have gotten up and had a snack, but this time I could not. The limits that the pouch placed on me convinced me that I should remain in my bed and suffer. And I did, suffer, that is. I could have been walking, reading, on the computer or any number of other things and I would have still been thinking of those damn Kentucky Fried Chicken Fries.

What does the future hold? I don’t know. I am working at developing a positive mantra that I can say to myself when I get "Mouth Hungry" and I will probably include some type of Behavior Modification, but I am not sure what it will look like in the end. That’s the adventure!

Tuesday, June 26, 2007

Where to Begin - Part 2

Where to Begin - Part 2

For some people there may be a question as to why I have put myself through such a drastic, life altering experience. I wish I could tell you that it was only because I was fat. Unfortunately, the answer is not that simple. For those curious enough - read on.

I was never a thin girl. Rather I was one of those “Botticelli” women, with the rounded hips, belly and full breasts. I started to gain weight in High School, but things settled out when I was around 25. By that time I was between 150 – 160 lbs. I went to the gym 5 days a week and did a 2 hour work out; one hour of weights and one hour of Aqua fitness. I looked good, felt great and was ambitious.

I had decided to move to Toronto to finish my Degree in Early Childhood Education and after 2 years in University and one working in a Day Care, I found my perfect job as a Parent Worker with the Toronto District School Board. However, the 6 months leading up to me landing the job was hellish. I experienced constant leg and joint pain. I either had extreme diarrhea or constipation. I was always nauseous and had little or no appetite. I went to the doctor’s office almost every week and they could not find anything wrong with me.

In January 1990, I woke one morning after having a terrifying nightmare. I had been dreaming that the doctors were amputating both of my legs due to cancer. I was in terrible pain and it seemed nobody believed something was happening to me. My partner at the time, Scott, took me to the Toronto East General Hospital and I swore that I would not leave that hospital until somebody found out what was wrong with me.

Once in Emergency, I waited there for 2 days while they ran every test they could think of; ectopic pregnancy, appendicitis, cancer, ovarian cysts, bowel obstruction, gall bladder stones, kidney stones on and on and on. Finally, they admitted me for no other reason than my white cell count had gone through the roof.

Then I developed a fever of 105°F for a period of 5 days. I don’t remember much about that other than the nurses bathing me, with what felt like freezing, water, then changing my sheets a lot, being really cold or way too hot, and just being really tired and wanting to sleep. I remember at one point thinking that it would be okay if I fell asleep and died. I was just too tired to fight anymore.

I guess the whole time this was going on the doctors were still running tests because one day the fever broke and I started to feel more like myself. My new partner in health, my gastroenterologist, Dr. Appell, come in one day and told me I had Crohn’s disease. I started to cry. He said that things would be okay, that Crohn’s was a treatable disease. I told him that that wasn’t it, I was crying because there really was something wrong with me, and it was not just in my head, and that now I would be able to get help.

What I didn’t realize was that the cure was just as bad as the disease. I was put on a drug called Prednisone, a steroid. When I was on the drug I would gain about 100lbs and when the Crohn’s would flare up I would loose about 60 – 80 lbs.

Eating while on Prednisone was bizarre. The drug made me so hungry. I am not talking about the “oh I think I am hungry” pains one gets but the “my god! I am so hungry, that if I don’t get food now I will eat my own arm” hungry. I had absolutely no sensation of fullness and while I was on the drug I ate almost constantly. I also retained lots of fluids and puffed up like a balloon.

A cycle of yearly admissions to the hospital began. Every year around January I would start to get sick and end up in the hospital in February on massive doses of prednisone. Sometimes the stays were short 1 - 2 weeks sometime longer; the longest being 6 months.

Now let me jump in here and tell you that the body does produce about 7mg of prednisone naturally. But I was taking 100 – 150mg a day for almost 5 years straight. The worst part is that when anyone takes the drug orally, the body stops producing it so when one tries to come off the drug one often experiences a flair up of the illness that the drug is treating.

Now you do the math. I was no longer 160 lbs. Rather I was close to 270lbs. My partner, Scott and I had separated. My life had changed too drastically for him to handle and both of us were miserable in the relationship. After the separation, I had my last major stay at Toronto East General and it was on this occasion that I was put on a new drug called Mercaptopurine. It is an immune system suppressant. The logic was that Crohn’s disease is in response to an overactive immune system - so the body attacks itself. If the immune system is suppressed enough then the Crohn’s become inactive, though a chronic condition that is still potentially fatal, with occasional flair ups. After a year of getting back on my feet, with the help of many friends (special thanks to Linda Watters), I faced the world wondering when I was going to get sick again.

I watched that February roll by without needing a hospital stay. Two years passed and I was still fine. I went to Dr. Appell and we agreed that I was lucky enough to have found a drug that put the Crohn’s in remission. The tests confirmed it. I had old scars in my large bowel, but no active Crohn’s Disease. I was ever so happy. I mean, there were still restrictions on the food I could eat (like no canned tomatoes, alcohol, fruits with high levels of citric acid) and occasionally I did experience flare-ups but basically I was healthy.

Then in the summer of 2001 I realized that I was experiencing excessive thirst and urination. I had found out in 1996 that taking prednisone could cause Diabetes and I suspected that that was exactly what had happened. I was right.

My then partner (one day husband) Chris and I went through the testing stage, the pill stage and the insulin dependent stage together. But it was only while I was on insulin that I started getting really good control over my sugar levels. Unfortunately, the medications I was adding to my regime plus the insulin were causing me to gain more weight. I began to struggle with high blood pressure, cholesterol and developed a heart mummer. Viral infections (like colds and flues) caused my body to become less sensitive to the insulin I was taking. Soon, I was taking huge amounts of NovoRapid (a fast acting insulin taken with every meal) and Levimer (a slow acting insulin taken once in the morning and once at bedtime) which controlled my sugar levels less and less.

I became really depressed and at 38 began to think of what I could do to get my life back. I had ideas, but nothing really panned out. At 39, I was so depressed that I confessed to my endocrinologist, Dr. Pike, that I was at my wits end and really didn’t know where to turn. I was close to 300lbs and just sinking emotionally. He suggested the gastric by-pass surgery. I ran with the idea.

And now you are up to date on how I got here, keeping this blog and explaining why I have gone through such a drastic, life altering experience.

“What was my weight before the surgery”? You ask. A girl should never tell, but I will. I was 312 lbs. It has been 2 weeks of preparation time and 6 days since the surgery and I am now at 290lb. I am no longer taking insulin and some of my medications. I’m on my way. Not bad, eh?

Sunday, June 24, 2007

Surgery Day to Discharge Day

I have finally been discharged from the hospital and arrived home on Friday, June 22 around 2:00 pm. The last four days have been a real adventure.

Tuesday, June 19 - Surgery day
I had packed all my bags the night before and though I was ready to go, I was still very frightened. If you were to ask me if I wanted to do this, I would have told you No. If you were to ask me if was going to do this, I would have answered Yes. The fear never left me and in all honesty, I don’t think that it leaves anybody.

Anyway, my husband Chris, my parents and I arrived at the Humber River Regional Hospital at 10:00am. I had expected to have some waiting time but that was not the case. Immediately I was taken in to the registration room where I was questioned about all the data I had given from all previous visits. They put an IV line in and it was at this time that they finally allowed Chris to see me again. I was feeling a bit shaky, but having Chris there to tell me jokes really helped.

My friend Jane had arrived while I was registering and since the nurses only allowed one person in the waiting area at a time, Chris left and she came in to say hi. It was really good to see her. Jane is one of those people that has an amazing outlook on life. She has the ability to laugh and carry you with that laughter.

My parents then came through, reassuring me and went back to the waiting room with Jane. I had been really worried about my parents being at the hospital. I was concerned that I wouldn’t be able to put on a strong front for them and I certainly did not want them to worry more than they already were. But it turns out my concerns were for nothing. Jane was able to keep them company and chat with them while Chris and I waited to be called down to the operating room.

When the doctor called me in, I did cry as I left Chris. I was afraid but at the same time sure that I needed to do this.

The operating room was cold, I guess mostly because I was dressed in a flimsy hospital gown, but the staff was great. I reminded them that I was the only one to be asleep during the surgery; an attempt at humor, one that, I’m sure, comforted me alone. They quickly put me out and I don’t remember anything until I realized that somebody had taken all the moisture out of my body and stuffed my mouth with cotton.

Apparently the first thing I asked for was “Ice”. I remember being very hot too. Later I found out that Jane and my Mom spent the next 4 hours cooling me down with cold face cloths.

I remember bits of conversation, me saying something and then Chris saying “Your right. That didn’t make any sense”. Apparently, after I responded to the conversation around me I realized that I was actually responding to something that was going on in my head and started making funny faces in response to my own comment. Chris, with his great sense of humor, was actually putting me at ease with his jokes. It may sound really weird, but the little jokes helped. I knew that people were around me and that they were listening to me.

I remember Jane kept saying that “You don’t have to talk with your eyes open”: Again, every time I tried to say something I would open my eyes and loll my head around because my eyes could not focus on anything.

Eventually everybody left and I continued to sleep. At 11:00pm I finally woke up enough to phone Chris and tell him I was okay. Then back to sleep I went. I slept solidly through the night except, of course, for the nurses waking me up every two hours to check my vitals.

Wednesday, June 20
Basically, I had two goals. One was to walk and the other to eat & drink water.

Walking does two things; it prevents blood clots and helps move the gas that they pump into the abdomen for the surgery out of the muscles. Once my family arrived, Chris took me on short walks about every 1- 2 hours. My body was sore but the painkillers helped. In fact walking itself didn’t feel to bad, standing up to start walking was the killer. There are five holes in my abdomen that they used to insert the tools, camera, light and gas. Two of the holes are about ½ inch long. The other three are about 1 inch long and heavily bruised. These were the areas that hurt the most when trying to stand.

I was given broth for breakfast, cream of chicken soup for lunch and cream of broccoli soup for dinner. I had absolutely no appetite, but I was able to eat about ½ cup of everything. The food was not too difficult to eat, but drinking water was a completely different story. Every time I drank water, whether it was cold, room temperature, or hot, I would experience pain just at the end of the esophagus and began burping water and then minutes later that would progress to hiccups. Hiccups hurt! That is all I have to say about that.

Dr. Hagen decided to keep me in for an extra day, until I could drink water without ill effects.

My friend Shelna came for a visit. Shelna is one of my closest friends. I have known her for over 10 years now. She has a great sense of humor and loves teasing me about my foibles. We have a lot of common interests; knitting, gardening, and cooking to name a few. We really work on having an honest and supporting relationship.

Shelna brought me a few gifts and then she too, took me on walks.

At around 8:30pm everybody left for home.

Another patient joined me in my room late in the evening, around 7:30 pm. She had had the same procedure done four weeks prior. However, she had developed a stricture at the bottom of her pouch and anything she ate or drank would cause her to vomit. When the doctors tried to widen the stricture, the pouch tore and she had to be operated on a second time. She was saddened by what was happening, but she, her sister and her husband were able to maintain a good attitude about it.

Thursday, June 21
In the early hours of the morning, my roommate began crying. I couldn’t blame her; in fact I was surprised that she had held out so long. She was in a tremendous amount of pain and knowing what she was going through, I would have been crying hours ago.

I am not one to sit with a “wait and see” attitude. So I got myself out of bed and told her I was keeping her company. That I would talk about my family to help her keep her mind off things. Now I don’t consider myself to be any kind of story teller. Shelna is much better at it then me, but I blathered on about my siblings, my parents, and life in general. She too, began to chat and soon the pain medication began taking effect and the nurses bustled around her and I went back to bed.

At 10:30am her family arrived with a small teddy bear for me and a card from the gastric by-pass support group that she belonged to.

My day progressed normally. My family returned to visit, I walked and tried to eat and drink, and even tried to play a couple of games of crazy eights. By 7:30pm I was exhausted and told my family to go home. I was so tired. I just wanted to sleep. However this was not to be.

By 8:00pm my roommate’s blood pressure had dropped and her temperature was going up. The doctor came in and increased her fluids. An hour later her blood pressure was still very low and her pulse thready. The doctor then opened the incision and tried to see if there was any leaking of the pouch into the abdomen. She was repacked with gauze and more fluid was pumped into her. An hour later, she had still not responded. The doctor then decided to take her into the operating room to open her up and see what was going on. At 1:30am she was wheeled away, and I only heard later that she was out of surgery and in ICU.

Friday, June 22
By 7:00am I was a wreck. I had not slept a wink and was emotionally devastated by what had happened to my roommate. I could not calm myself down and I just wanted to go home. Visiting hours were not until 11:00am, but I called Chris and asked him to come to the hospital and just sit with me. When he arrived, I just broke down and cried. Fear, doubt and abject terror filled me. I couldn’t do anything else but cry.

After I calmed down, Chris and I talked, walked, and I tried to eat – but I could only focus on waiting (impatiently) for Dr. Hagen to come in to discharge me so I could get the heck out of there. The irony of the situation was that every other morning Dr. Hagen had made his rounds by 7:30am. Today this would not be the case. Since he had been called in early in the morning to tend to my roommate’s problems, he would not return until 12:30pm. Finally he did give the go-ahead for me to be discharged, and then everybody who I had been waiting to talk to showed up at once. The Nutritionist arrived, as did the nurse who was to check my blood sugar, as did the nurse who was to check my vitals, as did my lunch. It took me another hour to get out of the hospital and I was ever so happy to leave.

I was to make an appointment to see Dr. Hagen two weeks later in his office. The Nutritionist was going to call me in two weeks to discuss moving my diet to pureed foods and my blood sugar was within normal ranges.

The drive home was hell. Take notice, if you every have this procedure done, ½ hour before you leave the hospital have the nurse give you painkillers for the ride home. There is just no way to get home without extreme pain if you don’t take something. (Oh, and a special tip of the hat to the city of Toronto for their extremely bumpy roads).

Once home, I took a bath and slept for an hour.

My parents were busy in the kitchen cooking all the food (soups) I would need for the next two weeks. It was a relief to know that I would not have to worry about it. The rest of the evening was spent chatting and discussing the best procedure to pound my medication into powders.

Saturday, June 23
I took my parents to see the community garden that Shelna and I work at. We didn’t do any work; I really just wanted to show off how big my garlic had grown. We returned home by 11:00am and my parents left immediately. Chris and I napped.

The day went well. I was in little pain and felt fine.

We had been invited to a party that evening but I was not in any shape to handle the ride or the late hour, so I gave Chris the cell phone and told him to go. He left at 5:00pm.

I watched my recorded episodes of Coronation Street and around 9:00pm I went upstairs to check my email. At 9:30pm I was overcome with chills and the shakes. I decide to go to bed and hoped that everything would calm down. By 9:45pm I was not any better and decide to call Chris and ask him to come home. He said no problem; he would be home in 45 minutes. About 10 minutes later I heard somebody in the house. I knew that it couldn’t be Chris and to my surprise, my next door neighbor Anneke shows up! Chris, realizing that it would take him a while to get home, had called our neighbors, Anneke and Neil, who are very good friends of ours, and had Anneke come over to check on me until he arrived home.

Once Anneke left, Chris ground up my painkiller medication and I took it with applesauce. I then started feeling too hot, so we began tracking my temperature. I had been given instructions that if my temperature went to 100° F I was to go to the emergency room at Humber River Hospital. My temperature fluctuated between 98°F and 99.7°F over the next few hours and when it finally dropped back around normal at 4:00am Chris went to bed in the spare room and I slept through the night.