Food and Thought - Adventures in Gastric Bypass Surgery

The Brain in Your Gut!

2010-10-24T09:47:00.003-04:00

This is really interesting. Hope you enjoy.

http://www.ted.com/talks/heribert_watzke_the_brain_in_your_gut.html

Chew, chew, chew

2010-04-05T10:43:00.004-04:00

The bubble blowing experiment is helping!

A few days ago, as I was returning home from a chiropractor appointment, I realized that I would driving past a grocery store. Suddenly, there they were, the urges to eat. So I popped a piece of Bubblelicious bubble gum into my mouth and started to chew, chew, chew. Now don't get me wrong, I still planned the binge in my head; what I wanted to eat, when I was going to eat it, how I was going to hide it from my husband, but somewhere I found the strength to drive past that grocery store. The fact that my mouth was already occupied with a flavour, the texture of the gum, the sweetness and the actual chewing motion really backed up my decision to not pull into that parking lot.

It may not seem like a big success, but I will celebrate each success as they come.

It's all about blowing bubbles

2010-03-25T23:10:00.004-04:00

So, I thought that I would update you on my little control experiment. Has my eating been any better? Well, yes and no. No, because I have not stopped binge eating. Yes, because I have been able, just a few times, to rethink and stop a binge session. But now that I think about it, any amount of success is still success! Yeah for me! The experiment continues.

Now for the interesting stuff. I have run across some research that has allowed me to develop a new coping skill. The first part of the research has to do with how highly refined our food is. Modern food (and I use that term loosely) is so highly refined that we no longer need to chew our food to the same degree that we once did. Previously, we had to chew our food about 20 times per mouthful. Now we only chew our food about 5 times before we swallow. Interestingly enough, there is a small muscle that attaches the lower jaw to the upper jaw, and it is the repetitive chewing motion of that small muscle that sends signals to the brain that tells us that we are full. So, (are you following me here) the more refined our food is, the less we chew, the less our jaw muscle has opportunity to send signals to the brain, the more hungry we feel, the more we eat. Conversely, the less refined our food is, the more we chew, the more our little jaw muscle works, the more full we feel, the less we eat.

Okay, so how does that help me? Gum, baby, gum! So now when I have the urge to binge, I chew bubble gum. I blow bubbles and crack it until my jaw hurts. It is usually by that point that I forget that I want to binge.

A good plan but, boy am I every pissing off my husband and friends, as I seem to be chewing gum all the time. Oh well. Suck it up buttercups. Anybody seen my gum?

To control or not to control: that is the question

2010-01-01T11:34:00.007-05:00

I recently had a very interesting conversation with my friend, Dave Whyte, on the issue of control and my eating.

It has given me a lot to think about. But first you need some facts.

Fact #1

Personality type of moi ~ control freak! I need to have a plan, and a contingency plan for my plan. I hate changing directions in the middle of a plan. I need information. I must look at all angles of a plan before I commit to a decision. I rarely like surprises. I like to feel that I have control. Spontaneity is not a easy friend.

Fact #2

From a philosophical perspective I recognize that I have absolutely no control over anything that I do. There is not a single "decision" or "action" that I take that is not the result of external pressure of culture (Italian & Canadian), class, sex, concepts of happiness, finances, work ethic, implied and implicate rules handed down by my parents, spiritualism, economy, current status of my relationships with friends, family and community, the need for safety etc. etc. Therefore, I am under no illusion that any "decision" that I make is merely a guided action based on external and perceived pressures. And each "decision" is made in an effort to benefit only my future self. Okay, so how does that jive with fact #1? See fact # 3

Fact #3

I must apply the illusion of fact #1 in order to believe that I make a difference in the world; that my presence makes an impact; that I exist for a reason. Or else I would go insane.

Okay, with those facts in hand, what was my conversation with Dave? Basically, after much table slapping, he asked two fundamental questions.

Question #1 What is the purpose of exercising so much control?

I have spent the last 6 weeks peeling away each answer to this question and I have come to the conclusion that I exercise so much control in all aspects of my life in order to control the one thing that I seek to control but cannot; my binge eating. Interesting enough, exercising control over my eating does not work. The more I seek to control my eating, the more radical and destructive my eating becomes. It is only when that I forget about eating that I eat "normally".

Question #2 Would I have more success controlling my eating if I did not seek to control the more mundane things in my life?

I don't know. I don't have an answer. So, what the hell! Why not try. For the next six months (or so), I am going to try to not plan to the enth degree aspects of my life. I don't know which aspects, but I will keep my intentions in the forefront of my thoughts and when it seems appropriate I will "go with the flow".

To those of you know who know me ~ DON'T LAUGH :)

Response from Dr. Whiting

2009-06-12T14:39:00.003-04:00

Dear Ms. Mancini,

Thank you for your interest in the Deep Brain Stimulation for Refractory Obesity Clinical Trial currently underway. This is a very limited trial in that the FDA approved only three subjects to be enrolled. We have closed the study to enrollment at this time.

We have been encouraged by the response of people who understand what our goals are in the study. It will be several years before we have any firm data to report publicly.

Thank you for your encouragement.

Sincerely,

Donald Whiting, M.D.

I am happy/surprised that my letter was acknowledged. Honestly, I thought that I would not have heard a response at all. I recognize that Dr. Whiting can't really give any advise, but I had hoped for more insight into preventing binge eating while waiting for the results from his study. So I weight (pun intended)

A Letter to Dr. Whiting re:Deep Brain Stimulation

2009-06-11T16:26:00.004-04:00

Dr. Donald Whiting MD

420 East North Ave., Suite 302

Pittsburgh, PA

15212-4746

USA

May 10, 2009

Dear Dr. Whiting;

You don’t know how ecstatic I was to read of the recent success you and Carol Poe have had with your research in deep brain stimulation as a means of treating obesity.

I, myself, have been on a life long struggle with my weight, and recently underwent gastric by-pass surgery. In an attempt to increase my chances of success, prior to the surgery I sought and completed 2 years of out-patient therapy to help me deal with my “eating disorder” of bingeing. My gastric by-pass surgery was a success and in the last two years I have managed to loose and keep off 147 pounds. So why, you much be wondering, is this woman writing me?

Quite simply, I am losing control. Over the last 6 months, I have been documenting on my blog (Food & Thought ~ Adventures in Gastric By-Pass Surgery www.letitia666.blogspot.com) my losing battle with my brain. How I seem to be hard-wired to eat; that the impulse to eat outstrips my cognitive abilities to not eat.

I am at a loss as to how to successfully move forward and even more, terrified, at the prospect of ending up back where I started or worse.

Thus, I come to the second reason why I am writing you. I recognize that your research is still in its early stages and will not likely be available to the public for some time. With this in mind I appeal to you, hoping for some measure of insight into the condition which deep brain stimulation is designed to combat and from which I obviously suffer. Have you, in the course of your research, uncovered any process or tactic which would provide me with the level of control necessary to allow me to successfully wait for your promising new treatment to become available? I would be every so thankful for some guidance.

And finally, Dr. Whiting, I am writing to say thank you. Thank you for taking that leap of faith and recognizing that weight loss cannot be as simple as calories in vs. calories out. (If it was, we would all be thin!) Thank you for providing the evidence that I am not crazy and the problem just may be “all in my head”.

Again, congratulations! Keep up the fantastic work and I look forwarding to reading more about your research.

Sincerely,

Letitia Mancini

Knitting for me

2009-05-16T11:17:00.003-04:00

Though I have been knitting for the last 6 years, I have never knit anything for myself - out side of a few pairs of socks. The main reasons were 1) patterns for large women are few and far between 2) patterns for large women usually look like crap and 3) the cost of the yarn was outrageous and I really didn't want to spend that kind of money on myself. Well I am proud to announce my first sweater for me.

Since I have lost most of my excess weight, I feel like I deserve nice clothes and making something beautiful for myself really makes me feel proud of my accomplishments. On top of that, I look good :)

Me and My Brain

2009-04-30T06:52:00.004-04:00

I have been talking a lot about how I feel that my brain is not wired correctly for survival in the Twentieth Century. Now it looks like there is research being done out there that proves my point.

Carol Poe always had believed her weight issues were controlled by the brain, so in spite of the risks she enthusiastically agreed to participate in Dr. Don Whiting's study of deep brain stimulation. This is a surgery that is commonly used to treat Parkinson's.

On February 3, 2009, Dr. Whiting, associate professor of neurosurgery and co-director of neuromodulation, did brain surgery on Carol to study the procedure's effects on obesity. Although the prospect of brain surgery scares people, Whiting said the procedure is not as dangerous as it seems. "Deep brain stimulation like we've been using for Parkinson's disease has a 1 to 1.5 percent chance of a serious complication such as bleeding, stroke, coma or death," he said. "Compare that to gastric bypass surgery, which has a 4 to 5 percent chance of a serious complication happening."

Not to mention the fact that gastric bypass surgery has no effect on hunger or the metabolism, both of which are addressed by deep brain stimulation, Whiting said.

The doctors of Ruby Memorial Hospital hope the procedure eventually will be widely available for obese patients like Poe who have made every other effort to lose weight.

See, I am not crazy. I think I feel another surgery coming on!

Feed Me! I'm Hungry

2009-04-08T16:29:00.002-04:00

Okay. This may be in bad taste, but as somebody recovering from a food addiction, it just really made me laugh! Just click on this and enjoy!

Feed Me! I'm Hungry!

Hard Wired to Eat

2009-04-06T03:02:00.004-04:00

I may have discussed this before, but it has become such an issue for me as of late, that I am blogging about it again. Over the last few months I have stared to put weight back on. This is to be expected. All gastric by-pass patients begin to increase their weight after the first 1 1/2 years. It has to due with the fact that the pouch has stretched out. thus accommodating more food, combined with the fact that most people begin to feel sensations of hunger again. In my case, it has to do with the fact that I have also developed a "grazing" style of eating. Basically I eat really small portions and I eat all day long. The end result of this behaviour it that I am consuming way to many calories.

I began to do some research into the proper amounts of food intake. My research reminded me, yet again, of how ridiculous the Canadian Food Guide is. It asks people to consume way to much food in a day. My research also lead me to understand the importance of creating muscle when exercising. So, with this information in hand, I have tried to reduce the number of times I graze in my fridge and increase the number to times I go to the gym with my modified routine which now incorporates weight training. "So what is the problem?" you may ask.

The problem is that, in spite of the gastric by-pass, my increased knowledge and my desire to maintain my weight loss, I just can't stop eating! I am not saying that I am binge eating again, rather I am just eating really small amounts of food every couple of hours and the accumulation of all that food results in my overeating! I am so frustrated!

I recognize that my brain is not set up for our 20 century constant access to food. (I would thrive as a Neanderthal!) I understand that I am hard wired to eat. But even armed with this knowledge, I just can't seem to control my food intake. I cannot believe how angry, frustrated and scared I am right now. I idea of gaining my weight back is terrifying.

So, yet another day goes by, where I resolve to do better, acknowledge each small success and try not to beat myself up with each failure.

Remnants

2009-02-16T16:31:00.006-05:00

BEFORE

AFTER

Freaked me out the first time I realized that half of my tattoo was missing, though it does give you an idea of exactly how much tissue was removed from my back.

Now there are a couple of things that I must point out. First, don't get overly concerned about the brown spot on the left side of my back. That is a mole. The mole itself was never inked over for medical reasons and is actually in the original picture, though very difficult to see.

As for the scar, well it has only been 7 weeks since the surgery and the scar is still a vibrant red. I expect the colour to subside to a pale pink or possibly white within the next year.

As for the tattoo it self, I actually planning to have a tattoo artist design a new tattoo and have them reink it over the old one. I really don't know what it will look like yet, but I want the feeling of "flowing" or "organic movement" to be part of the design. I will post a picture when it is done. But that won't happen for at least a year or two.

Home Again, Home Again, Jigity Jig

2009-01-03T11:55:00.004-05:00

I am home! I arrived back in Toronto on December 26, but didn't get home until December 27. Since we arrived in Toronto at 11:30pm (and were utterly exhausted and in much pain), Brenda and I crashed at the Sheraton Hotel at Pearson International Airport. The following morning Eric, Brenda's husband, picked us up and took me home. Brenda and Eric then proceeded to their home in Peterborough. My friend Mary has been staying with me and helping me out for the last week. (Did I mention that I have fabulous friends?)

I must confess that I have been doing nothing much but sleeping (and healing). I find myself tiring quickly. I have much more to blog about , but I just thought that you would like to know that I am home and well on the road to mending.

No Drains!

2008-12-22T12:59:00.003-05:00

Okay, I know that this is going to sound weird, but damn, I am happy to have those drains out! Let me backtrack.

After the Lower Body Lift, the surgeon places a set of duel drains under the skin that encircle the body. The drains are soft, flexible tubes, each 18 inches in length that act as a wick to remove fluid that accumulates between the skin and the muscle. They exit at the mons through two holes and the tubes are stitched to the skin to hold them in place. So basically, every time you move the drains shift a little, but the major movement happens at the mons where the tubes exit, pulling, not only the tubes but the mons as well. There is no way to stand, sit or lay down without being uncomfortable. (Just use your imagination.)

Today at 9:30am the drains were removed, a sensation similar to something sliding under your skin. Not really painful, but really disquieting.

I’m so happy!

New Math

2008-12-21T00:05:00.002-05:00

Warning:

If you don’t like potty humour, do not read further!

This is the new math

Iron supplements + Codeine = Constipation

Sleep

2008-12-19T03:44:00.006-05:00

I recognize the need for sleep. Just plain, old every day sleep. I certainly know the value of sleep when sick or trying to heal. In fact, to my understanding, one heals best when they are asleep due to the peak release of growth hormones. Therefore, I am in complete agreement with my surgeon's assessment that I should take sleeping pills to help me sleep during the first week after my Lower Body Lift (due to the fact that normal sleep is disturbed by pain). But this is my slippery slope.

I have a food addiction. I know, therefore, that I have an addictive personality. I know that my addictions have never spread to pain medication. However, my body responds to sleeping pills like Snow White responded to the Wicked Stepmother's poison apple. I drop, dead asleep. Man, do I sleep.

Once before, in a time of great stress, I asked my Doctor for sleeping pills and she gave them to me. Why wouldn't she? We both knew at that point that I did not abuse pain medication. She prescribed, Lorazepam, which did the trick. However, if I missed taking the pill even once, I would have psychedelic dreams that were certainly not conducive to restful sleep. So, I decided to kick the habit. It was not easy. In fact, to my surprise, it was impossible. I tried every trick in the book; taking ½ pill, taking the pill every second day, going from Friday to Sunday without. Anything I could think of to get off the damn things. Nothing worked.

Now luck was with me on this one because, over a years use of Lorazepam was wiped out by a week of a Morphine/Demerol cocktail that I was being given after my gastric by-pass surgery. I just didn't take the Lorazepam while I was in hospital. I was able to use one drug to kick the habit of the other. I believe happy was a good way to describe what I was feeling,

My sleep cycle went back to normal and I have not had a problem with it since. Until now. Yup, the sleeping pills that I have currently been given to help me sleep, included Lorazepam. I took them right after the Lower Body Lift. I confess, I needed them. The ability to sleep through the night had been completely stripped away by pain.

And now, one week later, there is a small plastic bag on my night table, here in San Jose that still holds several little white, harmless looking Lorazepam pills. I knew that I had to stop now. I already could feel that they were a problem and they are because, here I am, laying in my bed at 4:22am blogging.

The adventure continues.

It hurts! But not where you'd think.

2008-12-17T11:24:00.006-05:00

As you may recollect, the lower body lift is a removal of a "belt" of skin that encircles the waist. My belt ended up weighting 10lbs with the removal of another 2lbs by liposuction. (Brenda's husband, Eric, called it a body circumcision LOL). Not a small amount of tissue loss by any stretch of the imagination.

I really thought that the incision that encircled my body would be the thing that hurt the most, but I am here to swear to you that I don't even notice it. What is killing me is a combination of couching stitching and a deep cough that I have developed. Let me back track.

When they remove the belt of skin they liposuction away the extra fat that is between the skin and the muscle on the upper abdominal wall so that the new “tummy” lays flat. However, in order to make sure that the tummy stays flat (and to reduce the area in which fluids can build up between the muscle and the fat), the surgeon places hundreds of stitches holding the two layers together (kind of like when you see a pillow with a button holding both sides together). Now that alone doesn't really hurt either, and let's just say, I freely use my pain medication. The problem is that I have a dog allergy and the recovery centre has three dogs. I did not not know about the dogs until I got here (and really, it has been years since this particular allergy has caused me a problem). Anyway, my allergies kicked in; the itchy eyes, itchy throat, itchy ear canals, a runny nose and a deep, deep phlegmy cough. This cough is the killer because I am using the low abdominal muscles jut above the pubis that is all stitched to the underside of my skin! Let's see, on a scale of 1 – 10, when I cough I hit a nine.

I have started taking allergy pills and codeine (which is a natural cough suppressant) in efforts to control the coughing. I must say that this has been working. However, the other concern to me is not just the coughing. Because I am so sedentary and I have all this fluid in my lungs, I run the risk of phenomena, So I am trying to make sure that I cough, but in a more controlled way that doesn't cause so much pain. I will be seeing the doctor on Friday to confirm that all is going well.

In all honesty, I can say, to date, that this has been the most uncomfortable thing I have had to deal with. Count you blessings when the come, I say. It could have been a lost worst.

Alive

2008-12-14T12:20:00.003-05:00

We are alive, and speaking in coherent sentences. However, we are also falling asleep about every 30 minutes or so. The care here has been great and we both don't how we would have done this at home even with the help of loving families and friends.

Keep us in your thoughts and I will update you as soon as I can stay zzzzzzzz.

First Day Here

2008-12-11T10:48:00.003-05:00

So, Brenda and I got up early, 6am! Way to early for any type of real functioning. We grabbed breakfast at 7; sweet coffee, beans & rice, toast and a really neat tasting sweet butter. We ate outside, it was a little cloudy, but nice. Then Brenda went out for a little walk while I took a nap (since 5 hours of sleep doesn't work for me). We met up again for coffee at 9:00 and discussed what we are going to do for the day. And this is how it looks:
9:00 – 12:30 Hang out and chat
12:30 – 2:30 Pre-op appointment at the clinic
2:30 – 10:00 Going the Gold Museum, going to a Peruvian restaurant for dinner and preparing for tomorrow's surgery.

I am sure that there will be little bits of things to fill in later, but for now that is the plan.

By the way, we just found out that it is -13 in in Ontario. Ha-ha! It's a balmy 22 here.

First Day ~ Part Two

So where do I start? Okay, after our coffee break, Brenda and I packed our stuff that needed to go to Casa del la Mariposa (from here on known as Mariposa) and left for a walk. We trundled through a park that had these really cool trees that had no bark on the trunks. It's not that the tree didn't have bark, it's just that the bark peeled off and left a green tinge on the remaining smooth wood.

From there we went to Rosti Pollos (a Costa Rica version if Swiss Chalet) for lunch. We tried the Aztec soup and something else that was yummy (it was a hard, flat tortilla with refried beans, chicken and veggies), but we can't remember the name of it. We then headed back to the hotel to meet Andi, the owner of Mariposa. She and her driver, Charlie, drove us to the Mariposa to drop off our bags. We tried to pay her but ran out of US money. This was due to the fact that we were unaware that there is a 16% tax, plus a 3% tourist tax. But more about running out of money later.

From there we went to the Rosenstock & Lieberman Clinic (from here on know as R&L clinic) for our pre-operation appointment. They drew blood to have to typed and matched, just in case we needed a blood transfusion (which is $200/litre used). We then both went through the procedure expectations and costs. (pant, can't breath ...got to go)

I have just now finished hyperventilating. On top of the price quoted, I decided to have additional liopsuction done on my upper abdomen, thus increasing the cost of the operation by $1761.50 CAD. (Can't breath! Panic setting in! ......Okay)

After much consternation, Brenda and I left the clinic with Alvaro Mesen, a taxi driver/body guard/tour guide. He drove us around San Jose to the heart of the city where there tons of little markets, bakeries, restaurants, and banks (lots of very big banks). We saw some really cool stuff made of rose wood, but decided that, in our current financial situation, to buy nothing! By the way Alvaro was great. His English was excellent and he was not hard on the eyes either! I would highly recommend him if you are every in San Jose.

Now in reference to our running out of USD, we stopped at three different banks trying to get a cash advance. The first bank would not let us do it because we didn't have our passports (we had left them in the safe for safe-keeping). The second bank that Alvaro took us to, would not do it for us because we were using Mastercard and they only delt with VISA. The third bank would not do it because we didn't know our PIN. We spent a lot of time running around, going to banks, with no success. But that running around gave us a good chance to see a huge chunk of the pedestrian boulevard. We never made it to the Gold Museum, though we did walk by it.

We wandered around for a few hours and ended up at a restaurant called Nuestra Tierra (which is not the Peruvian resturant that we thought that we were going to). They made this great coffee that was filtered, in what looked like a sock, with hot milk. Damn it was good. We ordered a meat and vegetable soup and the sea bass. Both dished were fabulous Brenda really liked the beans & rice, and some kind of root vegetable, that there was no translation for , but her favourite was the pico de gallo. My favourite was the sea bass. We chatted and bolstered ourselves as best we could and eventually Alvaro's friend, Alex, picked us up at 7:30 and we headed back to the hotel.

There we prepped for the upcoming day, took “before” pictures, took sleeping pills, (because we a both really nervous) and are now getting ready for bed. We head out tomorrow at 6:45 to arrive at the R&L for 7:00. Our surgery should take place at around 7:30 – 7:45.

The First of Many Updates

2008-12-10T18:25:00.004-05:00

Brenda and I left for Costa Rica this morning at 10:30am. After waiting for a while at the Toronto airport, we flew without incident to Miami, which is where I am updating this blog from. Isn't technology cool!
Anyway, the trip so far has been without incident, however, I have discovered that I am a bit of a nervous traveller. (Brenda is laughing her ass off right now!) Brenda keeps threatening to drug me or give me more booze. Personally, I am going for the latter.

Stick around. It can only get better!

So it is 12:57am (local time) and we have finally arrived at Apartote La Sabana, 3 hours late. Aaaaggghhhhh!

Apparently there was a "problem" on the plane that was suppose to bring us to San Jose and since it was delayed, we were delayed. The best part is that the taxi that was suppose to pick us up at the airport was not there and, of course, everybody was trying to give us a lift. At one point two guys decided that we were a lost cause, lent us a phone to call the hotel to request a taxi. 15 minutes passed and still there was no taxi. By this time one guy had another fare and left. The other guy was still hanging around. I guess since Brenda and I looked tired (and the guy was sick of waiting with us) he popped us into some other guy's taxi and assured us that this guy knew where he was going! Can you tell what is coming?

You got it. The taxi driver had no idea where Apartote La Sabana was. He took us to the sister hotel, got directions and finally, after driving around in circles, got us to the right place.

We checked in, changed into our pj's, and remarked on how we were like two little old ladies travelling to Florida for the first time. We have a bed, we are tired and now we are off to sleep.
See you in the morning.

Second Thoughts and Thirds and Fourths and so on

2008-12-02T02:01:00.003-05:00

Nothing like a panic attack on Friday night to sharpen ones focus! Honestly, once the thought that I was spending way to much money on something so frivolous entered my head, I started to reel. If I could have found a way to cancel my flight and surgery, I would have bailed out sooooo fast!

It's not that I don't want to have the surgery done. Rather, it is the idea of spending so much money on it. In the grand scheme of things, $15,000.00 is not a lot of money. But damn, it is a lot of money! I just have to keep in mind that I have to amortize the total cost over the next 40 years of my life.

Right! Now where the hell did I put that paper bag.

San Jose, Costa Rica?

2008-11-02T07:02:00.015-05:00

So I am just going to lay it out for you because there is no good way to introduce this subject without people saying "Are you ******* nuts! You're going where?"

I am going to have my Lower Body Lift surgery done in Costa Rica. There I said it. So now let me explain how this is going to work.

It all started with the quote of $17,000.00 for the Lower Body Lift in Ontario. I knew that prices were high, but I did not expect it to be so high. With the inclusion of the excess skin removal of the upper arms and the inner thighs, the total became a whopping $ 31,000.00. Needless to say, I was acutely upset about the entire situation.

When I happened to mention this to my family doctor, she informed me of the Rosenstock - Lieberman Centre in San Jose, Costa Rica and the success of her procedures. Since Dr. Andrew has been my family Doctor for 17 years (and a good one, I might add) I decided to follow up on her suggestion and looked into the centre. I started with the web site Health Escapes. I filled in the questionnaire and was sent a quote from Nora Allen who is the Patient Coordinator at the Rosenstock - Lieberman Centre. For the Lower Body Lift and all it entailed the cost would be $10,000 (US) with a $500 (US) discount if I paid in cash.

Upon further research I found out that the flight would be $889.00 (CAN) and the recover accommodations at Casa De La Mariposa would cost a total of $975.00 (US). At the time the Canadian dollar was a lot higher and the exchange rate was a lot better, so I really believed that I was greeting a fantastic deal. Today, the Canadian dollar is not as good, but still. So in total I would be spending 13,600.00 (CAN).

I did all the research that I could on Dr. Rashi Rosenstock and Dr. Joseph Cohen and even joined a Yahoo Group that discusses solely the goings on at the Rosenstock - Lieberman Clinic. I still think that I am making a good decision.

The next entry will discuss the finer points of this adventure.

Bye-bye tattoo?

2008-10-17T07:44:00.005-04:00

In my mid-thirties, I celebrated an significant change in my life by getting a tattoo. It is on my lower back. I got it there long before it became fashionable. It is a design of my own creation, and though slightly flawed in it's execution, it holds great meaning to me.

As I began to consider the lower body lift surgery, I began to wonder; will be able to keep the tattoo? Even more basic that that; do I want to keep the tattoo?

I have decided to ask the surgeon to completely remove the tattoo, when be works on "lifting" my backside. Though the tattoo has a lot of meaning for me, I think that it is time to get a new one. Something that marks this momentous transformation in my life.

Now, I just have to talk about this with the surgeon.

Reconstructive Surgery ~ Part 2" (Belt Lipectomy).

2008-10-10T07:31:00.004-04:00

If you have been following this blog, you are well aware that "Reconstructive Surgery ~ Part 1 ~ Breast Reduction" is now complete. Let us now move to "Reconstructive Surgery ~ Part 2 ~ Lower Body Lift”

The Belt Lipectomy, more commonly referred to as the Lower Body Lift, offers the most dramatic transformation of the mid and lower body. It is truly a resculpting of the abdomen, hips, thighs, and buttocks. Broken into its components, the lower body lift includes a tummy tuck, a thigh lift, and a buttock lift. The body lift procedure is performed on post bariatric patients, like me, as well as patients who have not had weight loss. The body lift transforms patients that have experienced massive weight loss and have excess skin. The body lift has the advantage that it can be done in one surgical session, or in stages, depending on the patients needs. I will be doing the procedure all in one go.

What is involved in the lower body lift?

A lower body lift usually requires between 6 to 8 hours of surgery. I will be marked on the standing position just before the surgery. The excess skin is grasped at the level of the flanks with both hands trying to join each other, putting an important amount of tension. The horizontal lines of resection and the final incision placement are marked. These incisions are continued both anteriorly from hip bone to hip bone and posteriorly until they join with the markings of the contra lateral side. At this time areas that need to be sculpted with liposuction are also marked. These markings will guide us at the time of surgery and will make operative times quicker.

This surgery is carried out under general anesthesia and I will be placed on the operating bed on one side first and then on the other side. Incisions are made following the previously marked lines. The removal of excess skin and fat is performed at this time. There is a moderate undermining of the tissues inferiorly. Once this is done, liposuction is performed at the level of the upper lateral thigh, flanks, posterior trunk and/or other areas previously chosen. Then, the incision is continued at the abdominal area just above the pubic area, running from hipbone to hipbone and a second incision is made around the navel to loosen it from the surrounding tissue. After separating the skin from the abdominal wall up to the sternum and ribs, the separated muscles (rectus abdominus) will be pulled together and sutured from pubis to sternum. The apron of excess skin and fat in this area is removed and the navel will be repositioned. The tissues are approximated placing the highest-tension on the wound closure laterally at the level of the flanks, and less medially. Two to four drains are placed alone the incision lines to evacuate any old blood and prevent fluid accumulation. The incisions are sutured and a dressing is applied.

Anybody else nervous?

And the Boobs are done!

2008-09-14T08:18:00.002-04:00

I had my final check up with Dr. Sliwin the other day. He took a look at the final shape of my breasts and checked out the scars. He said that they look "fantastic" and that the larger scars on the underside of the breast will continue to fade away. He stated that I could stop using the scar cream, but I think I will finish the tube that I have.

Dr. Sliwin then asked what my final bra size was and was a little surprised when I told him that Secrets From Your Sister was fitting me with a D cup. He immediately went to his bag of bras (and I am not kidding about this. He had a briefcase full of bras. It was so funny watching him pull out bra after bra) and pulled out a D cup and asked me to put it on. Yup, I filled it out. Then he looked at my shape again and we both realized that I have a lot of excess skin in the arm pit area and down the side of my chest. What we realized was happening is that the skin from the side of my chest was moving into the bra as I shuffled the girls into the cups. Thus, I fill out a larger size, but don't really have D size breast.

Pinching the excess skin between his fingers, he announced "We have to get rid of that." I agree.

I wonder if he accepts payment in buttons. I have lots of buttons!

A pillow too!

2008-09-12T04:05:00.003-04:00

So there I am, at the Knitomatic Stitch & Bitch, knitting away, gossiping ... all the lovely things that one is suppose to do at a Stitch & Bitch, when I realize that I am squirming in my chair. For love or money, I just can't seem to get comfortable! The low and behold, it dawns on me ~ my butt is sore! And why is it sore? Because there is not enough fat on my butt anymore to make for a comfortable cushion! So there I am, squirming in my seat, thinking "Okay now, not only do I have bring a sweater with me every where I go, but I have to bring a pillow too!"

Ramona just laughed at me and said "Baby doesn't have enough butt fat!"

Cheater, Cheater

2008-08-10T15:18:00.007-04:00

There are two perspectives to every story, an inner battle that goes on with ones alter ego, no matter what action, decision, option, opinion or perspective one takes in life. My experience regarding the gastric by-pass surgery is no exception.

Darth Tish's Perspective

Darth Tish spends most of her time telling me really nasty stuff.

She calls into question my intentions; "You are lazy. That is why you had the by-pass surgery."
She calls into question my will power; "You are weak. That is why you had the by-pass surgery."
She calls into question my stamina; "You will fail and gain back all the weight."
She calls into question my self esteem; " You are narcissistic and that is why you are having 'reconstructive' surgery."
But mainly, she calls into question my ethics; "You cheated!", she accuses me. "You took the easy way out!"

Tish' Perspective

Cognitively, I understand how wrong Darth Tish is.

I am not lazy. I have always worked hard to obtain my goals. And, I have had the added challenge of chronic illness. I defy anyone to tell me I am lazy.
I have amazing will power and self control. Again, Crohn's disease and Diabetes does not allow for a lax disposition. Control and will power are an absolute necessity.
I am a force to be reckoned with. My ability to endure has never faltered.
My self esteem? Though I may never be a fashion model, I know that I am having the reconstructive surgery for medical reasons. Sure, there is some vanity, but what the hell is wrong with that? I have worked hard and I have a right to look good! Why should I not use all resources that are available to me?

But for me, the most disconcerting thing is Darth Tish's questioning of my ethics. How have I cheated?
I had a 1 in 100 chance of not making it out of the gastric by-pass surgery alive.
I have lost the ability to eat what I want, when I want and, even more challenging, how much I want.
I have to take supplements for the rest of my life just to have a normal, healthy body.
I have scars on my abdomen and breasts and will have even more scars around the entire circumference of my body, down my arms and on my thighs once all of the reconstructive surgeries are finished.
How have I cheated? What have I gotten away with? How is this the easy way out?

I tell you, in all honestly, if I could have lost 140lbs any other way, I would have! I made the best decision that I could, knowing where my strengths and weakness lay. I made a good decision, worked hard and came out of this alive, a better person, healthy and with a furious drive to live. I have not cheated!

There will be no talk of this ever again!

Brenda's Summerlicious Feedback

2008-07-22T02:37:00.003-04:00

Brenda also gave me permission to post her response to my Summerlicious blog post. Didn't I tell you that I have fantastic friends!

Hey Tish,
Just a thought:
No one can accomplish the high degree of control that you think you are lacking. None of us could stay vigilant 24-7. There is a myth in our culture that 'willpower' is a quality that some of us have and others don't. Failure of your 'willpower' does not reflect a personal failing, but is inevitable. At some point even the most vigilant will succumb to temptation. This is why setting up your environment is so important.

You are doing well--you have set up your friends to help--and some of them actually do this. The next step is to continue to spend time (especially when eating) with those friends who help and to avoid eating with friends who don't. Controlling your environment is much more important (and more reliable) than counting on your willpower.

The problem is, if you find it distressing--you will actually AVOID eating out with your friends who support you (and may actually start to gravitate to those who sabotage your efforts). Bad idea. Your next task is to acknowledge your distress and to put more supports in your environment. For example, here is what I have noticed (from your blog and our weekend):

1. Go out with people who will let you carry a conversation. Use your hands. Think of eating out as a time to talk more than a time to eat.

2. Don't go to "all you can eat" places, buffets, or places with too large portions (this will be hard on Chris!).

3. Wine bars and tapas places are ideal for you. The focus is on small bits and sharing rather than on a large plate of food that people dive into. This way, you don't have to compare what you are NOT eating on your plate to theirs. With a common plate(s) there nothing to compare to!

4. Physically remove the plate and move it out of reach at the first sign of 'doneness'.

5. Have people ruin your leftovers.

6. Start to have a policy where you MUST leave something from each selection on your plate (to counteract the 'clean plate' idea).

7. Don't eat with really hungry people, if you can help it. They will be too focused on the food and not on the company.

Mary's Summerlicious Feedback

2008-07-21T17:05:00.004-04:00

Mary, bless her heart, gave me permission to post her response to my last blog post. By the way, I have fantastic friends!

Hey Tish,
You know, you're kind of hard on yourself. One of the things I really value about your blog is how honest you are. That's not easy. I'm a little surprised that you are still reeling about your response to the leftover elimination at Summerlicious. From what I observed, you did the right thing.

1. You asked someone "safe" for help with an uncomfortable situation where you were conscious that your behavior was self-destructive. Not the easiest thing to do, but you did. Take a moment now to pat yourself on the back and give yourself a hug! Good for you!

2. Even though at the time you were inwardly screaming in dismay at my action, you maintained fair outward serenity (with only a bit of white showing around your eyes)...cool as a cucumber, babe!

3. You are cognizant of what's going on with your reactions. You know what you want to change. You're taking action to make change by trusting others to support your needs. Kudos!

4. You will eventually get to the stage where you can accept that you will likely still have knee-jerk reactions to food issues. You're already on the right track. Inwardly nod at the reaction and move on, happily giving yourself a gold star for self awareness!

This honesty, trust, and willingness to keep trying is inspirational to me.

Summerlicious & the "I can't believe you did that" moment

2008-07-20T23:41:00.005-04:00

Summerlicious; an event in Toronto when restaurants set a fixed price menu.

I had such a great time attending Summerlicious this year. I wasn't able to eat a lot, but I had the chance to try some really interesting restaurants at exceptional prices. However,the topic of today's entry, though it happened during Summerlicious, is not about Summerlicious at all. It's about my reaction to something my friend, Mary, did.

So here we are, at The Citizen. Mary, in the red t-shirt, Mya, in the white blouse and myself. We had a great time! The food was good and the conversation even better.

As the meal progressed and I became full, I pushed my bowl of pasta away from me. However, I really liked my meal and I began to pick at my food. I could feel my stomach become tight and uncomfortable and knew that I needed to stop eating, but could not bring myself to do so. Finally, in desperation, I pushed my bowl to the middle of the table, towards Mary and told her I was full and that she could finish my meal if she wished.

To my abject horror, Mary dumped another bowl of unfinished food on top of my pasta and pushed the dishes towards the end of the table for the waiter to pick up! Though I couldn't eat another bite, I could not believe my emotion response to Mary's destruction of my food. If she or Mya had eaten the pasta, I would have been less appalled! A day later I was still in shock at the event and decided to discuss it with Mary.

I told her about what was going on in my pointy, little head and conveyed my dismay and turmoil. To my surprise, I discovered that her actions had been prompted by the latest entry in my blog that discusses my need, at times, to ask others to "destroy" my leftovers. Well, Mary, being the friend that she is, went ahead and did exactly what needed to be done but I could not bring myself to do. In retrospect, I would have been more comfortable bringing the food home as leftovers and leaving it to rot in the fridge, before I threw it out! But, this experience has brought some really interesting (if not unpleasent) emotions to bare.

I am disturbed about the event for a few reasons

1) That I was not able to push my food away when I knew I was finished

2) That I had such a unwanted emotional response to Mary's actions

3) That there are still lingering waves of that emotional response that I haven't/won't or can't deal with as of yet

So, here I am. Stuck in a place that I am not comfortable being in and feeling a tad out of control, relying on others for strength and trying desperately to develop coping skills that I can act on.

Wish me luck!

Social Eating

2008-07-01T12:10:00.007-04:00

I am a huge foodie (didn't you guess that by now) and I still really enjoy the concept of eating out with friends and family. But since the gastric by-pass surgery, I have not enjoyed social gathers over lunch and dinner as much as I once did.

My friends and family know what I have been through and understand that I have a tiny pouch that is filled by 3/4 cup of food. They have a clear understanding that it is a huge waste of money for me to buy a full meal for myself. So we joke around and laugh when I eat of of other people's plates. (I mean, I don't eat off their plates. I have my own plate and everybody gives me a taste of their food.) And even though that behaviour in itself is somewhat uncomfortable, I recognize that I am with people who really love me and the behaviour becomes more acceptable.

However, the real problem for me is not when I am eating, but when I am full, which is about 5 minutes after the food arrives. What am I suppose to do with all of that time, while other people are "mmmmmming" and "yummmming" their way through dinner? The mouth hunger I feel is overwhelming and, I must confess, I have asked friends to ruin my leftovers so that I would not pick at them. I become uncomfortable, anxious, and feel out of place during the meal and often end up apologizing for my lack of stomach space.

This past weekend my good friend Brenda, came to visit me. We have been friends for 30 years!
Over dinner at the Red Violin (a place you have got to go to if you carnivore at heart), I tried to explain to her the traumatic emotions I was feeling. Casually, she said that I should use my hands more. "What?", you may ask. Well as we sussed it out, we concluded that I should talk more and, since I am Italian, I would then be using my hands more to talk. If I am talking, while others are eating, I am still participating in the social aspect of the meal and, at the same time, distracting myself from the fact that I can't eat. What a brilliant idea!

So friends and family, be prepared. I am going to be, goddess help us, talking more during dinner! Don't kill me!

Bra Fitting or Everthing you wanted to know about my boobs but were afraid to ask!

2008-06-21T09:50:00.007-04:00

I had my first bra fitting after the surgery! What a fun experience. I went to Secrets from Your Sister. The store is well organized and uncluttered, with displays of most of the bras available. I was put on a list for a fitting and when my name was called I was taken to a spacious fitting room by Erin.

As a sidebar, I must confess that I did tell Erin about my weight loss and the fact that I still had a considerable amount of excess skin around my tummy. I'm not exactly sure why I had to tell her that, but I think it was because I was uncomfortable undressing in front of her without some type of justification as to my shape (which I would liken to a wobbly pear). As much as I hate to admit it, all the extra (unsightly) skin on my body is bothering me and playing havoc with my self-esteem.

I was measured and my first bra was brought to me. It fit! Not beautifully, but it fit. And after trying on several bras we concluded that I am a 38D or a 40C, depending on the bra. (By the way, I have to tell you that the service was amazing. If you have to buy a new bra, I highly recommend having a fitting done at Secrets from Your Sister.) Truly, I had a great time. The first two that I chose were a no nonsense bra called Fit Fully Yours. I needed something super comfortable, easy to wear and care for due to my work with young children. I picked the bra up in black and beige. The next bra was a cute hounds-tooth number that fit so comfortably that I just had to have it. It was a model that they no longer carry so

Ta Da!

So now I have a fabulous collection of bras that feel and look great and the most wonderful part about the whole thing was the price. I paid so little for the bras. You have to understand that I am use to buy bras that are $160 a pop. There purchases came to $140! This has been the least painful experience so far!

So Sad

2008-06-20T13:50:00.003-04:00

I am extremely disappointed! In my latest adventure, I booked with Dr. Sliwin the body lift surgery for July 9. This procedure will cost (are you sitting down?) $17,000.00. I don't have that kind of folding money, so I applied for a loan. Unfortunately, I was awarded only $8,500.00. I don't have enough liquifiable assets to make up the remainder of the balance, so I had to cancel the surgery.

I feel really sad, disappointed, stalled, sick, frustrated..... the list goes on. I am going to rebook the surgery for December 2008 and hopefully,by then, I will have accumulated enough wealth (and I use that term loosely) to help cover the other half of the $17,000.00.

Picture Update

2008-06-03T22:17:00.004-04:00

June 19, 2007

June 3, 2008

It is almost one year. Need I say more.

Before & After

2008-05-31T17:47:00.012-04:00

Pictures say it all....

Before

After

Before

After

Hello Perky!

2008-05-28T22:24:00.005-04:00

It has been three weeks since I had the breast reduction, and of all the words that I can think of "perky" sums it up!

But I am getting ahead of myself. Let me start at the beginning. Chris and I went to Scarborough General Hospital on May 7 at 7:00am. I registered at the hospital and was prepaid (medical history, IV line, etc.) for Dr. Sliwin. At 8:30 I was wheeled in the the surgery room and after being drawn upon I was sedated and ..... well that is all I remember about that.

I woke up in a considerable amount of pain. On a scale of 1 - 10, I was at a 9. Morphine was on order and after being given my first injection I was still in a lot of pain. Three times the nurse gave me morphine and three times I told her that Morphine really doesn't work for me. She went and got Dr. Sliwin for a consultation but, unfortunately, he did not want to give me any other drugs. Finally, after I maxed out on the amount of Morphine I could take, I was given a bit of Demerol. Let me back track a bit. Morphine, Tylenol 3, and low doses of Demerol do nothing for me. Oxycodone, on the other hand, does wonders. However, oxycodone is highly addictive and is easily abused. Dr. Sliwin didn't want to give me oxycodone for good reason but he missed the most important point. My addiction is to food, not drugs.

Anyway, it took a few more hours until I was coherent enough to walk around and use the facilities and then I was off home. My oh my, is my bed comfy! Really, that is all I did for the next few days; slept (on my back) and took pain medication. Three days later I was taking about half of the pain medication I was prescribed and was feeling good. Tender, but good. Now I must point out here, that I was not allowed to shower. I just want you to know that after the breast reduction surgery you cannot get the incisions wet. Sponge bath, yes. Shower or bath, no. No water for a least one week.

On May 13 I saw Dr. Sliwin again. He changed the bandages, said I looked fabulous, could now take a shower and sent me on my merry way. I showered as soon as I got home. And for the first time I took a really good look at my new boobs. I must confess that I was taken aback by the amount, and colour of the bruising. Both breasts are bruised a muddy blue and there was a huge, black bruise under each arm. However, once the shock of the bruising wore off I noticed that they are perky! Small, for me, a C cup. Firm; much harder than I am use to; hard like a muscle, not soft and loose. The nipples are much smaller and, in my opinion, cute. I still seem have have a lot of sensation and am happy about this, though I was prepared for the possible loss of sensation. The incisions are big. Don't think that a surgeon's knife is fine. It is not. The scars are there and will always be there. To what degree, is really up to how my body heals. But I just thought that you should know. They are almond shaped. This is the hardest thing for me to get use to. They don't sag when my bra is off. They just kind of sit there, on the top of my chest, almond shaped and perky.

That week, still found me tender and bruised but in good spirits. I had to continue wearing a sports bra 24/7 and putting Poloysporin on the incisions three times a day. I rested, slept, healed and became bored with the television. The following Tuesday I visited Dr. Sliwin again because I thought I was developing an infection. Rather, as Dr. Sliwin explained, my body was just "pushing out" the stitches. He removed the offending stitches and told me to come back in two weeks.

Monday, May 26 I went back to work. Yes, I was sore. Yes, I was tired. Yes, I took a painkiller and slept for a few hours after I came home from work. But all in all, I am doing well. Work is becoming easier but I am still tender and and bruised. I can't really pick up heavy things or stretch to high without hurting myself. I am trying to be careful, but I am a bit impatient. Happy too! This was a good decision.

I just want to add one last note to this. I would have not been able to do any of this if it hadn't been for the support of family and friends. Most especially, my husband Chris. He has been with me every step of the way. He puts up with my helplessness, frustrations, anger, anxiety, hopes, aspirations, dreams, humour, excessive energy, and impatience. A good man is hard to find. I found one. I got lucky.

OUCH!

2008-05-11T10:47:00.001-04:00

Just a really quick update; The surgery went well. I am at home. OUCH!

Here They Go ~ Literally

2008-05-04T16:52:00.007-04:00

I have been waffling about adding this part to my blog, but I thought that, in keeping with the spirit of why I started the blog, I had better add this part. So here it is (or goes); pictures of my boobs!

This is what they look like with a bra (and camisole ~ just because I am a bit shy)

This is what they look like without a bra

The procedure, which will take about 3 hours long, will be removing about 2 - 2 1/2lbs per breast and perking them right up where they belong. The Girls will be going from a DD cup to about a C cup. There will be scars, but I am sure that I can handle that! Anything to get rid of this back pain!

Once the new boobs have settled into their permanent shape and position, I will add the before and after shots!

Is it saying goodbye?

2008-04-16T22:31:00.005-04:00

After a very short meeting with Dr. Sliwin to discuss the upcoming breast reduction and liposuction procedures, I went to the reception desk to check over my paperwork and pay for the surgery. I knew how much it was going to cost, and in fact the amount is reasonable. I just was not prepared for the emotional shock of dishing out that much money.

A lot of the feelings that had stated bubbling up during the last closet purge came to a head and as soon as I walked out of the office, I just started to cry. I felt angry, frightened, and drained. But I'm not clear exactly what is going on with my emotions.

As I thought about it, I began to wonder if part of the grief is related to saying goodbye to the person I was. The second a scalpel cuts my flesh, I will no longer be that"fat" girl that I had finally become comfortable with. That scalpel will mark the beginning of the new me, with all that it entails.

My god. The other day a man flirted with me and I had no idea it was happening until I left the shop! In fact, other than Chris, I can't think of the last person who flirted with me. And that is exactly what I am talking about. "Fat" Tish knew what to expect, when and where it was going to happen. This current model of Tish has no idea what is going on. I am just fumbling from one moment to the next.

Shelna tells me that I am moving to fast. That I need to slow down and breathe a bit. Now, I have never been good at slowing down to begin with, regardless of size, but now, I just want these surgeries done. I don't want to wait for my body anymore. I have to much to do! I know that it all sounds pat, but I tell you it is true. I have a body that can move and do and be and damn it all I don't want to wait anymore.

So for now, I am trying to play new tapes in my head that say things like:
"you are doing the right thing"
"this is reconstructive surgery, not mindless cutting"
"you can amortize the cost of the surgery over the next 40 years of your life"

You get the idea. Now, I just hope the new tapes work!

The closet

2008-04-14T18:55:00.005-04:00

All of my clothes, including those from my shopping spree

The last of my "big" clothes

Over the weekend I went through my closet for the last time to remove all the clothes that were to big for me. I was left with 2 pairs of pants and 3 shirts. I concluded that this was not a good thing. All the summer "large clothes" that I had saved were way to big on me. So here it goes, the shopping phase.

I know that this is suppose to be a happy thing; and I don't want to sound like I am complaining, but I am not enjoying this on so may different levels. First and foremost is ~ how the hell did I let this happen to me! How did I ever let myself get so big! Okay, I know how, but it doesn't make the question go away.

Second ~ what a waste of money. I mean, first there is the waste from the clothes that don't fit. Did you know that consignment stores do not take brands that fit large sized women? And if there are stores out there, I can't find them. Then there is the waste of money for buying new clothes! I don't have those kinds of funds. I am looking to second hand stores but still, what a waste of money. It's so frustrating.

And finally, I am not comfortable spending that kind of money on myself. It's not that I don't like to buy clothes, it just that I have to buy everything; socks, shoes, underwear, bras, coats, jackets, tops, pants, sweaters, gym wear, shorts, swimwear. Even my jewelry doesn't fit. My watch looks like I am wearing handcuffs it is so big. And because I don't have anything to wear, I am not leisurely wandering around the mall looking for something that I like. I am in panic mode because I need something now!

Besides all of the emotional turmoil, I am okay. I did buy a pair of shoes that fit. I found 2 pairs of Capri's and 1 pair of shorts. I have 3 new shirts that fit now and should also be okay for after the breast reduction. I guess I have to wait for the sales!

It's all about the numbers

2008-04-11T08:44:00.003-04:00

Since I was diagnosed with Crohn's 17 years ago, I have had to go in for blood work every three months. Once the diabetes developed, more test were tacked on to my already long list of things to check for. This may all come to and end! Do I hear a Whoo Hoo! coming on?

I have lost so much weight that my endocrinologist no longer thinks that I am a diabetic and has ordered a glucose tolerance test. Basically, I go to the lab and drink a very sugary drink. Then the technician samples my blood over a period of two hours. If my body is able to process the sugar normally, I am no longer a diabetic! As for the Crohn's, well, I am still in remission! I have stopped taking all of the immune suppressing drugs that helped control the Cronh's disease and so far there have been no problems. Since I am not taking any of the potentially harmful drugs, I no longer have to have the status of my liver checked. All in all, in a few months, I might only have to have blood work done only twice a year. Imagine that!

As for my current numbers (all without the aid of medication) they are:
HA1C was 5.36 normal is below 7
Blood Pressure 112/71 normal is 130/80
LDL was 2.9 normal is 2.5
HDL was 3.9 normal is 3.9

I am so normal! Brilliant!

Change of Date

2008-04-09T16:05:00.003-04:00

Well Ladies and Gentlemen there has been a change of plans. My Cosmetic surgeon has changed the date of the first surgery, which is now happening on May 7, 2008. Not a big date change, the event was only postponed by one week.
I am really excited about the breast reduction. I have been trying to think of questions to ask the doctor at my pre-operative appointment. I have a few, however, if anybody out there in web-land has a question that they think I should be sure to ask, send it to me.

Reconstructive Surgery ~ Part I

2008-03-11T22:24:00.004-04:00

On April 30 I will be having two reconstructive surgery procedures. The two procedures that Dr. Sliwin will be doing is breast reduction and liposuction of the inner thighs. The breast reduction is just that, a breast reduction. Dr. Sliwin will be removing about 5lbs of tissue so that I will have a C cup. I was amazed at the amount of tissue that will be removed. Five pounds seems like so much. But I am very happy about it. My back is killing me!

As for the liposuction, it is the first part of a two part procedure to remove all of the excess skin from my inner thighs. The excess skin starts at the leg/hip joint and goes all the way down to my knee. I inquired why this had to be done in two steps. Apparently, if the liposuction and the skin removal was done both at the same time, the trauma from the liposuction could cause the stitches to rip and, to account for this, the surgeon could not remove all of the skin necessary for a smooth inner thigh.

I have my pre-op appointment on April 16 and will keep you up to date.

We Meet Again, Darth Tish

2008-03-07T05:04:00.005-05:00

Well, Darth Tish has lost a few battles as of late and I think I have finally found a way of getting around her. It has to do with never going up the first set of stairs once I get home from work. Basically, what I have to do is pack all my gym stuff (and everything else I need for the day) and bring it down to the front hall by the door. Then, when I come home from work, I open the front door, pack the car with all my stuff and leave home to adventure afar. When it is time to go to the gym, I depart from my current adventure afar and go straight to the gym. When I am done my work out, I then drive home to rest for the day. So far, this insane method of expending energy seems to have worked. However, I am hesitant to claim that I am completely successful at thwarting Darth Tish, as she is a clever and a worthy adversary who may yet ambush me again!

Closet Shopping and Clothing Exchange

2008-02-05T22:11:00.001-05:00

Monday I got to go closet shopping! Say what?
Well, as I loose weight my clothes don't fit, right? And it makes absolutely no sense to buy a whole new set of clothes for each size that I shrink down to. So, besides the small sending spree I had recently with my friend Catherine, I haven't bought any clothes. However, much to my surprise, many of my friends have offered me clothes from their closet. These are clothes that no logger fit the original owner, but are in excellent taste and condition. So, Monday I went closet shopping! I got a few pairs of jeans, a couple of skirts and many much needed tops. For the next month I have clothes! WooHoo!

Now, my acquisition of clothing is not limited to closet shopping. Nope. I have also begun exchanging clothing with a couple of friends. As I shrink, I have given my clothes to others and as others shrink faster than I, they have given their clothes to me. It's all become, like, a fashion show/slumber party!

So many thanks to my friends Ramona, Mya and Mary!

New Clothes

2008-02-03T20:51:00.001-05:00

I had to buy new clothes. I just can't take this; floating around in stuff that is way to big for me. So my good friend, Catherine Dennison, (who was in Toronto to see the Spice Girls) helped me buy some new clothes (all on sale by the way). I just had to post this picture for two reasons; Chris loves this shirt and look, look, I have a neck!

By the way, I bought this stuff at Cotton Ginny Plus. I'm wearing a size 16 pant and a small, that's right, a small shirt!

Darth Tish's Temper Tantrum

2008-01-25T03:33:00.000-05:00

"But I don't want to" said Darth Tish, as she lay on the floor kicking, screaming, and red faced.

"What do you mean?" Tish asked.

"I mean, I don't wanna go and you can't make me!"

"Make you do what?" Tish inquired.

"Make me go to the gym!" Darth Tish said with such an emphatic pout that her bottom lip almost hit the floor.

"Well, I'm not making you go." Tish stated.

"But I should go," said Darth Tish.

"Should you?"

"Yup, I should. But I don't want to," Darth Tish said as she twisted her hair into a knot.

"Why should you go?" Tish asked.

"Because."

"Because why?"

"Because!" said Darth Tish stomping her foot.

"Because is not an answer," Tish said, "It is a question that requires an answer."

"Because it's good for me" Darth Tish admitted sullenly.

"Oh" Tish said, nodding her head in agreement.

"But I don't want to go"

"You look really mad. I mean, you certainly look like you are having a wonderful, full blown temper tantrum about this." Tish said.

"Well, I do do wonderful temper tantrums. You should see the ones I have about eating junk food." Darth Tish said with twisted half smile.

"Yes," said Tish, "but that still does not address why you don't want to go to the gym."

"Ya, well, I don't want to go because I don't want to go. Like, why should I have to make myself do something else? Haven't I already made myself do so much?" whined Darth Tish.

"Sure," Tish agreed, "you have done a lot. Waiting for surgery, surgery itself, all that vomiting, two dilation procedures and don't forget all that weight loss."

"Ya," said Darth Tish emphatically, "it has been a lot. And why should I have to do more? Why isn't there, like, a magic pill that I can take that makes all my muscles strong and kick-starts my weight loss again?"

"Well, science has not progressed that far," Tish explained. "But I'm sure that one day there will be such a pill. But in the mean time what are you going to do about this?"

"Well," Darth Tish drawled, "I guess I should go to the gym. But I am just having such a hard time getting there and I don't know why. I mean, I do have some fun. And I do like the way I feel after a work-out. And I do want to look better and feel stronger."

"Sometimes you don't have to understand why you behave in a certain way. What is really important is that you just change the behaviour," Tish said. "Does that help?"

"Ya, I know." Darth Tish agreed. "But it don't really change this motivation problem."

"No it doesn't."

"I guess I just have to do it, don't I?" Darth Tish said, as she frantically looked for an easy way out.

"Yup," Tish approved.

"Okay, I'll try again to get my butt to the gym today."

"Okay. I'll check in with you again tomorrow," Tish said.

"Alright," said Darth Tish, sulking, as she packed her swimsuit in her duffel bag. "We will have this conversation again tomorrow."

The Apron

2008-01-14T14:58:00.001-05:00

I am at the point in my weight loss adventure, where I have become really annoyed with all the extra skin that is now hanging around. Most disconcerting is the skin that is hanging off of my belly. It was there when I was 100 pounds heavier, but it kind of stuck out more and was away from my body. Now it just hangs, like an apron, and rubs against the skin underneath.

It is hot and moist under there. A happy place for bacteria and grossness. I recently have begun developing serious skin infections under the apron. It has become uncomfortable, unhealthy and I am generally unhappy about it. I have been washing, of course, and I have been using a cream to help keep the production of yeast down. But the skin itself has become very thin and splits easily. It's now time to start researching reconstructive surgery.

So I guess I will conclude this entry with two points.
If you ever decide to have this surgery
1) be prepared to be really grossed out by your weight loss
2) start saving now for reconstructive surgery

New Photos

2008-01-13T23:07:00.002-05:00

June 19, 2007

January 13, 2008

I finally had to go out and buy a pair of pants. Everything was just sliding off me. I didn't even have to undo the button or unzip the zipper! They just fell down. Yes, I am happy about it. The pants I bought are already to big for me so I am going to have to take them in a bit, but they sure fit better than what I had before.

Second Dilation Procedure

2007-11-22T20:15:00.001-05:00

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.

New Photos

2007-11-18T15:43:00.001-05:00

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.

Great Day!

2007-10-24T17:03:00.000-04:00

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

Scope Results

2007-10-19T12:21:00.000-04:00

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.

Rings

2007-10-16T21:00:00.000-04:00

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.

The Emergency Room

2007-10-14T17:06:00.000-04:00

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.

New Photos

2007-10-11T15:34:00.001-04:00

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!

Thin Inside, Fat Outside vs Fat Inside, Thin Outside

2007-09-23T13:47:00.000-04:00

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.

Now I see!

2007-09-22T10:31:00.001-04:00

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.

Picture Update

2007-09-12T22:29:00.001-04:00

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.

No Pasta High Today

2007-09-07T10:48:00.001-04:00

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.

I'm getting tired of it

2007-08-24T16:14:00.000-04:00

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.

What Happened to My Face?

2007-08-17T00:38:00.001-04:00

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).

Follow Up Appointment with Dr. Hagen

2007-08-10T09:15:00.000-04:00

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!

What The?

2007-08-08T10:09:00.000-04:00

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!

Six Week Update

2007-07-30T11:10:00.000-04:00

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!

Fat Plauge

2007-07-29T00:36:00.000-04:00

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.

Stalking the Woolly Buffet

2007-07-24T20:50:00.000-04:00

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"

2007-07-24T20:36:00.000-04:00

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.

Four Week Update

2007-07-18T15:39:00.000-04:00

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!

Starving Children in Africa

2007-07-16T08:24:00.000-04:00

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.

"Baby got less back"

2007-07-15T07:08:00.000-04:00

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!

Do I have to eat?

2007-07-11T20:09:00.000-04:00

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.

Insight into "The Science of Appetite"

2007-07-10T22:45:00.000-04:00

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!

Two Week Check Up

2007-07-05T09:31:00.000-04:00

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!

Change in Anatomy

2007-07-02T07:59:00.000-04:00

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.

Mouth Hungry

2007-06-28T13:25:00.000-04:00

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!

Where to Begin - Part 2

2007-06-26T06:55:00.000-04:00

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?

Surgery Day to Discharge Day

2007-06-24T13:20:00.000-04:00

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.

Things I have noticed

2007-06-18T13:07:00.000-04:00

I have been on the path of obtaining my surgery date for a while - 2 years actually. This process involved a referral to a gastric by-pass surgeon by my current endocrinologist. From there I had appointments with the gastric by-pass surgeon (Dr. Hagen), a heart specialist, a social worker, a dietitian, and another endocrinologist. All of these appointments took 1 year to complete. Upon completion, they, as a group agreed, that I would be a good candidate for the surgery. Then I was told the waiting list for a surgical date was another year.

While all this time was passing I participated in a few programs that I hoped would help me understand my eating. I was involved for several months with the Eating Disorders Program at Toronto General Hospital. {Toronto Hospital, Toronto General Division 200 Elizabeth Street Toronto, Ontario M5G 2C4 Tel: (416) 340-4156 Eating disorder - Outpatient service}
This program was geared towards people who suffer from bulimia and anorexia. Neither of these were my problem. I am a binge eater and thus the program, though it gave me some coping tools, did not really help me.

I also participated for six months in the Toronto Rehab program that focuses on healthy hearts. Since my relationship to exercise is directly related to my weight (and health) I thought "why not?".
http://www.torontorehab.on.ca/

I have been involved for several years with Sheena's place too, participating in programs that I thought would help me.
http://www.sheenasplace.org/

I have found that the culmination of all of these programs have brought me closer to understand what is going on. However, the most important thing that I have come to realise is that the "why" does not matter at all. Rather it is the "what do I do now?" question that becomes paramount. I may never understand why my relationship with food is the way it is, but as I understand its' influence over me, I can begin to take control over how I eat.

Now, since I have obtained my surgery date (Tuesday, June 19, 2007), I have begun to seriously consider whether or not I could help others who are going through the same thing. I have decided to post some of the internal work I have done in regards to my relationship with food. These are things about myself that have crystallized for me and I wanted to track them.

Pace
I have realized that the pace at which I eat food is directly related to a fear that my food will be taken from me. I know that sounds really bizarre because I am a grown woman and who really, in their right mind, would take food away from anybody. It is an irrational fear, but one that seizes me and dominates my behavior long before I actually realize that I am hunkered down and eating at an incredible rate. It is also tied into the fact that I am aware that I either should not be eating this item because it is an unhealthy food or that or that the amount is way too much. I have begun looking at behavioral tactics to deal with this.

Drive to Eat
I have realized that I have a drive to eat that is unrelated to the desires of my stomach. In other words. I eat when food is presented to me not out of impulse (because that would mean that I would have awareness and control over the impulse) but rather because of a reptilian drive to eat for survival.

Satisfaction and Satiation
I have realized that I usually eat without satisfaction and rarely feel satiation when I eat. This pushes two buttons. Without satisfaction, rather than stopping and eating something more satisfying, I continue to eat the same thing waiting for satisfaction to dawn on me.The second button is that without satiation, I will continue to eat until I feel pain. Outside of pain, I almost never know when I have eaten enough.

Portions
I have a screwed up mind's eye view on portions. I can measure out a half a cup of food onto my plate and know that it is a half a cup of food. But, when I look at it, it looks like the scrapings of leftovers that amount to no more than a teaspoon or so. The fear this vision instills borders on terror. Thoughts like "I will not have enough food' or "I am being denied food" send me into a tail spin of overeating.

Where to Begin

2007-06-18T11:04:00.000-04:00

As my 38th birthday approached, I discovered that I had also stumbleded upon my mid life crisis. I was not happy with the politics of my job (not the job itself) nor was I happy about my weight and the consequences of it. I began to map out a five year plan which included, upgrading my education, relocating to Nova Scotia, and losing just over half of my body weight. As the plan developed, the main focus was weight loss. This blog, though it will deal with many subjects, will mainly deal with the steps that I take to lose this weight,