Chew, chew, chew

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

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

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

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

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

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

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

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

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

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

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!

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

Warning:

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

This is the new math

Iron supplements + Codeine = Constipation

Sleep

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.

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

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

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

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

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?

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.