Should vs. Want

The other day, a dear friend of mine and I were discussing motivation.  She was helping me understand the difference in should vs. want.  Basically, if we are motivated by what we think or know we should be doing, our motivation will wane pretty quickly.  We really won't make significant changes until we want to.

I had my three month follow up with my bariatric surgeon a couple of weeks ago.  I am doing great health wise.  As far as weight loss, I have lost about 30 lbs. since surgery and 50 lbs. since last year.  the doctor wanted to tweak a few things.  They think I may be snacking too much.  They also think that my 10 hours of water aerobics a week isn't enough exercise.  Because I am teaching, they feel that I may not be getting my heart rate up enough. 

Before the visit, I knew I was in a weight loss stall.  I just wasn't ready to do much about it.  After talking to the doctor, I was in a state of thinking what I should be doing.  It really wasn't appealing to me to give up snacking.  I'm eating so little at meals, that I really want my snacks.  I get hungry and don't make good choices with my meals if I don't snack.  How can my 10 hours of exercise not be enough?  Granted, I know I'm not always working at a hard level, but it's just not fair that I have to do more! 

These were my thoughts all last week during Thanksgiving.  I was definitely in a place where I SHOULD make changes, but I didn't WANT to yet.  I had the week off from work and really was a glutton in my food choices.  (My surgery prevents me from being a glutton in the quantity of the food I eat.) 

All of a sudden this week, I wanted to make changes.  The things I had been railing against seemed easy all of a sudden.  I decided to add some Tae Bo workouts to my schedule.  I love kickboxing and it was easy to find a time to fit in a couple of half hour workouts.  On Wednesday, I decided to take a mile walk.  I usually don't enjoy taking walks, but I called my sister and before I knew it, the mile was over.  I reviewed my snack choices and realized that my snacks had turned into little meals.  Instead I chose to change my afternoon snack to an actual snack and my bedtime snack became a handful of nuts.  What had seemed so hard and painful when I was in a "should" frame of mind became easy and fun when I was in a "want" frame of mind.

I think it's important to be honest and gentle with ourselves.  Obviously we should pay attention to what we should do, especially when it's for our health, but the trick to lasting change is to get to where you WANT to make the changes.

Defining your happy

What do we all really want out of life?  The usual answer is health and happiness, but what does that mean? 

A few years ago, I was trying to decide what I wanted to do with my life.  My kids were getting older and were in school later.  I love my part time job, but should I be working more?  Did I want to keep being primarily a mom or should I develop a career?  In my daily devotional, there was an exercise in imagining your perfect life.  It was probably one of the most important exercises I've done.  I sat down and imagined my perfect life with the career I was considering.  What were the highlights?  What was the impact on my family?  Then I imagined my life with taking care of the family as my primary goal.  What would be the cost to my self-esteem?  I ultimately decided to keep my part time job and focus on family.

Once I realized how important this tool was, I started using it to make all kinds of decisions.  Every couple of months or so, I sit down and let my imagination go wild.  What is my perfect life?  What is my idea of a perfect family, perfect marriage, perfect job? 

How can we move toward what makes us happy if we don't even know what happy looks like for us?  I invite you to go ahead and dream your wildest dreams.  Write them down if that helps you.  Spend some time with yourself and figure out what will make your heart sing and your spirit soar.  From there you can build a roadmap that will get you to your dreams.

Day 11 post-op, the protein powder wars

I am doing really well.  The chiropractor fixed my neck, so that was a big deal.  I forget my Tylenol often, so my pain level is really low. I've been out and about a bit. My biggest thing is my doctor has me on clear liquids until day 15.  That has been the hard part right now.  I am getting less than 500 calories a day.  I'm not necessarily hungry, but I have low energy and feel empty.  Every doctor is different. It's been hard getting on support forums and seeing that a lot of people are already doing purees.  I won't hit purees for over 3 weeks.  I am completely looking forward to it.

For my doctor, clear liquids means broth, water, sugar popsicles, and protein powder mixed with water.  This surgery means lots of protein powders.  Before surgery, I heard a lot of people having problems finding protein powders they like.  I thought how great it was that I was already using powders I like.  What I didn't realize is that chocolate and vanilla get very boring after awhile.  I bought some sugar free Torani syrups to help mix it up, but it is very different gulping down a protein shake versus having to sip on it for awhile.  Finally this week I found a brand that has fruit flavors like lemonade, peach, etc.  They are Nectar by Syntrax. They have been a life saver.

I have been finding that my blood sugars are getting higher each day.  I'm currently not taking any medicine because most people see their sugars drop when they aren't eating any carbs.  My surgeon said she hadn't seen this before.  What I learned from trying to lower my a1c pre-op suggests that my body needs some carbs to process in order to produce enough insulin.  I've contacted my endocrinologist to help me decide on some medicine until I start full liquids.  We will see what happens from there.  Regardless, I am confident that this surgery will improve my health and possibly cure my diabetes.

Post op

When I was pregnant with my first child, the birthing coach had us watch birthing videos.  There was one where the woman had an orgasmic birth. This is exactly what it sounds like it would be.  She had no pain, no pain meds, and really seemed to enjoy her experience.  Even though I knew it was unrealistic, I thought, "That's what I want!" Of course, I had the more traditional birth experience, pain even with pain meds and it wasn't quite as enjoyable until I got to see the baby.  Luckily for the population, pain fades and I even went on to have a second child.

You would have thought I would have learned from this experience, but frankly, I'm not that smart.  When I was looking into having my surgery, I was totally believing the stories where the people had surgery on Friday and were ready to go back to work on Monday.  I had one guy tell me he was at the gym on day 4!  I am not trying to scare people off, but I was completely unprepared for my level of pain.

Surgery - Day one:
I got to the hospital super early and was looking forward to the calming juice I was supposed to get in my IV.  The anesthesiologist told me that I had to be coherent to talk to the surgeon.  By the time I talked to the surgeon, everything went super fast and no calming juice for me.

After surgery was a blur.  Everything went well, but my hernia repair was more extensive than they thought, so surgery time was double.  That first night was awesome.  My dream had come true.  There was so very little pain.  Why hadn't I done this sooner?

Post op - Day one - All was well until the nurses told me that they were switching off my pain pump and switching me to oral medicine instead of IV.  I wasn't really concerned.  I was a model patient.  I had even been up and walking several times.  By that afternoon, reality set in.  I really think most of my pain was due to the gas they had pumped into me to expand my belly.  I never knew gas pain could be so bad that the thought of dying wasn't scary.  I really had to think about my kids to want to keep going on.  I only broke down and cried once, but I think that was just because I was so focused on the pain that I had no energy to cry.

Post op - Day 2 - The nurses kept telling me that this was going home day.  I knew better, though.  There was no way my surgeon would send me home when she saw my pain level.  Of course, I was wrong again.  The doctor told me how great I was progressing.  I figured she was lying since I wasn't at the hospital she had her practice at and didn't want to make the trip on a work day.  When I started questioning why I had done this to myself, one of the nurses reminded me that I would have eventually had to do the hernia repair anyway.

The first night at home was hard.  I ended up taking myself off the Vicodin and switching to Tylenol.  I know Vicodin slows your bowels so I figured it wasn't helping my gas pain.

Day 3 - I took out my pain pump they put it my belly.  My ab muscles started hurting like I was stabbed 6 times in the gut. Oh yeah, I was!  I also had this horrible kink in my neck giving me a migraine.  Maybe they positioned me weird?

Day 4 - Today has been much better.  I feel human again.  I've taken several walks outside. Short ones of course.  I am even alone for a couple of hours.  My husband is only 5 minutes away.  I've gone to the bathroom by myself and have had bowel movements.  I still have pain in my neck and abs, but I am using arnica gel and heating pads. I've gotten all my protein drinks in and most of my water.  Finally, today, I may tell you that the process wasn't too bad.  Thank God our memory of pain fades and thank you all for your prayers and support.  It really got me through the worst of it.

One Day Pre-op

Surgery is tomorrow morning and some nerves have crept in.  Nothing serious, just a tiny bit of, "What in the heck am I doing!". I would hope it would be natural to feel that before any major elective surgery.  I have reminded myself that although the next two months will be difficult, I need to remember the long term goal.  The fact is, I've done EVERYTHING I can to lose this weight.  It's been effort after effort for all my adult life. I've done radical diets, major dietary changes, tons of exercise...I have lost weight only to regain when I stop being extreme.  Even though I eat healthy and exercise, my blood sugars are creeping up.  What a miracle it will be to cure my diabetes!  There is a very good chance that today could be the last day I take diabetes medication.  I know this is the solution for me to take the weight off, keep it off, and improve my health.

So the pooping juice hasn't been too bad.  I would say that the clear liquids have been harder.  I'm only allowed protein powder three times a day.  The rest is broth, water, and sugar free popsicles.  I am hungry, lethargic, and have a headache.  It is completely bearable.  I have pre-op at the hospital today and surgery first thing in the morning.

I did it! Two days pre-op.

It has been a saga, but I am cleared for surgery in to days.  My a1c is 7.4.  I was able to lower it .3 in 12 days.  I went in yesterday morning at 7am to get a blood test.  The lab is independent from the doctor's office.  They said it would be 3-4 hours.  At 11:30, I called the doctor's office.  They told me I needed to talk to the MA, but she was with a patient then going to lunch. At 2:30, the MA said she hadn't heard from the lab and would call them.  At 4, I had a message from her that the only people who could process my lab worked the night shift.  We wouldn't know until morning.  Finally this morning after calling constantly for 15 minutes, waiting for them to switch the phones on, I got the news.  The MA almost cried with relief for me.

So, I am two days pre-op. I started a clear liquid diet.  I had to take magnesium citrate (I call it pooping juice).  It wasn't as bad as I feared.  The trick is drink it ucold and with a straw.  My stomach has been gurgly and unsettled.  It started working about 1 1/2 hour after taking it.

Tomorrow is clear liquids and my pre-op at the hospital.  I will try to keep everyone posted.

Lowering a1c

My surgeon's office called me late last week to tell me that my a1c was higher than where the doctor needs it to be for surgery.  A1c is a three month measure of your blood sugar.  Mine was 7.7.  It needs to be 7.5. 

I frantically called every medical professional I could think of to help.  A nurse at the insurance company told me that she didn't think I had a chance of lowering it.  The endocrinologist's office said that they didn't think .2 of a point mattered.  They were not going to change any medication, but they could write the surgeon a note saying the .2 didn't matter to them.  Real helpful! 

A dietician at the hospital was the one who was able to help me.  First of all, the goal is to get the sugar down.  Second of all, labs can vary by .2 on the same day.  Her theory is that I dropped my carbs too low.  Since I wasn't eating carbs consistently throughout the day, my body was confused about producing insulin.  When my liver dumps sugar at night, my body didn't make enough insulin to counteract.  The dietician's suggestion is to eat one carb (15g) at each meal four times a day.  I also need to do 10-20 minutes of hard exercise after each meal.  I have been following her method.  I am sore and tired, but my fasting sugar has dropped 45-50 points!

The surgeon's office has given me until Tuesday to do what I can.  I go in Tuesday morning for a blood test.  I will know by the end of the day.  If it is a go, I start prep on Wednesday and have surgery on Friday.

So, what exactly is a1c and can I really change it that much in just under two weeks?  We all, diabetics and non diabetics have some glucose floating around in our blood stream.  Some of our red blood cells pick up the sugar and become glycated (real word, I swear).  If you are not diabetic, about 5% of your red blood cells are glycated, meaning your a1c is 5.0.  Red blood cells live 120 days.  Therefore, a1c is a 3 month reading of your blood sugar control.  Obviously not all of your red blood cells regenerate at the same time.  I have read that 50% of your a1c is based on the last four months and more heavily weighted on the last two weeks.  So there is hope for me.

I have learned a lot from this.  Thank you to my friends who have helped me with these realizations.  My surgeon may seem like an obstacle to me, but really she is my protector.  Not all surgeons are this strict, but not all have her success rate either.  This is all for my best health.  My intent of having surgery is to lose weight and lower my blood sugar.  If surgery is delayed a few weeks, it isn't a delay of my goals.  I will continue to lose weight and lower my blood sugar until I have surgery.  God is on my side always.  The timing will work for my best benefit.

So Tuesday will be a very long day of waiting for me.  If you know me at all, you'll understand that having the plans up in the air stresses me out (of course I have to try not to stress because that raises blood sugar).  I will take all the prayers and well wishes I can get.  I'll update when I know.

If you can lose weight, why choose surgery?

Different doctors have different ideas on a pre-op diet.  The reason for a pre-op diet is to shrink the liver to make surgery easier.  I know a lot of doctors have you eat your normal diet and then two weeks before surgery you go on a liquid diet. My doctor doesn't do it this way.  When you start the program, you are asked to lose 5% of your body weight before surgery.  You are placed on a restricted calorie diet, usually under 1200 calories a day.  In addition to various classes you are required to attend, you meet with a dietician who helps you adjust your diet. You are also asked to start changing your habits.  No straws or carbonation. The air bubbles can expand your new stomach.  No drinks with meals. Your new stomach is so small that you need all the room for fuel.  Limit caffeine.  Caffeine dehydrates you. Getting enough water will be a challenge with your new stomach.  Eat high protein, low carb, low fat.

I've already been doing most of these, but I found that 1200 calories is a lot less than you think.  I started using a calorie tracker app.  It was a big shock to me.

So if I can lose weight on a diet, why choose surgery?  Well, first of all, did you catch that 1200 calories is a lot less than you think?  I can sustain dieting this way for a short period of time and lose 20 or 30 lbs., but than either I hit a plateau or a holiday or party or something.  As soon as I eat more than 1500 calories a day, I gain weight.  Before choosing surgery, I thought back on my dieting life.  The only time I have lost weight is at 1200 calories.  If I eat 1500 calories, I maintain.  More than that, I gain.  I can't seem to exercise enough for it to change my calorie count, although I am sure that if I exercised less I would gain.  The only time I can really eat whatever I want is when I am at Disney and walking about 10 miles a day.  See, I should just move there and life would be perfect!  Once I hit a plateau or other event and my calories go above 1500, I gain.  If you are a chronic dieter, you know that 1500 isn't a whole lot either.  This is why Weight Watchers and other programs haven't worked out for me.  Once I lose my weight, the surgery will still keep me at low calories which will help me not gain it back.

I think each person needs to learn to listen to their body and find what works for them.  Some bodies do well vegetarian.  Some of us need more protein.  How many calories does your body need?  What kinds of exercise do you like?  Really all of us need to figure out what works and what we can sustain.  If I need protein, becoming a raw vegan may not be my best option.  Yes, I've tried that too!

I have met several people who have had weight loss surgery and have had a hard time with it.  Some have been successfull, but feel like if they learned what their body needed before surgery, they could have lost weight without it.  Some have not been successful because the waited until after surgery to change their lifestyle and found they couldn't sustain it.

I went to the doctor yesterday and was up 2#.  Truthfully, I can lose or gain 2# in water a day.  I was frustrated because the doctor questioned my committment to the program and I had to defend myself, but really, don't I want a doctor who will make sure I am ready for this huge lifestyle change?

Healthy, not thin

Since today is the day my surgery was originally scheduled for, I thought it appropriate to blog.  First off, God blessed me by having the surgeon's office need to reschedule.  Last week I was hit with a horrible cold.  This week we have been battling a sometimes working air conditioner.  Yesterday it hit 105 here.  Everything is working now, but I can't imagine how stressed both my husband and I would be if I also was having surgery.

People keep telling me that I don't look heavy enough to have this surgery.  I think it is partially because I am fit, but partially that we all compare ourselves to others.  The surgeon told me that we don't know what normal looks like anymore.  Teaching water aerobics means that I have a lot of muscle mass.  Unfortunately, I also have a lot of fat on top of it. 

The other question I get is how much weight do I want to lose or what is my goal weight.  Honestly, I am not sure.  It seems so far away to me right now to choose a number.  Really, what I want is to get my body fat percentage down.  A number on the scale doesn't take into account if those pounds are fat or muscle.

It's interesting to note that a lot of the focus is on how I look now and how I will look later.  My goals are more based on health.  My main reason for choosing surgery is get rid of diabetes and sleep apnea.  The physical things I pray for are health and vitality.  I want to have more energy.  I want to not be afraid of physical activities.  I want to be able to go up the stairs at a waterpark 10 times in a row and not have my blood sugar plummet (or have my knees creek, or have my thighs scream, or be huffing for breath).  I feel like, my body will settle wherever is best for me.  Looking good will be a bonus, but being thin is not my goal.  My goal is to get this body strong and healthy. 

All for the best

I came home from vacation this Monday to a letter from my insurance company.  Apparently the doctor's office and the insurance company had a misunderstanding of when my surgery could take place.  The doctor's office can't even submit a request to insurance until July 10.  Last time I checked, July 10 is AFTER June 28, so no surgery June 28.  The doctor is already booked for July.  My new date is August 2.  Needless to say I was extremely disappointed.  Was, you say?  Well, a few hours after talking to the doctor's office, I started getting a tickle in my throat.  Now it's turned into a full blown nasty cold.  I have hopes I will be better next week, but I am sure it's probably better that I am not having surgery next week. 

I truly believe that God has a plan that is better than mine.  Even though I feel like my plan has less stress attached and it was a better time table, God has me covered.  When I recover from this cold, I now get to call subs for my classes again (most are vacationing in August), work out arrangements for the girls (dance team kicks off the end of July), and figure out how  to recover during the beginning of the school year; but I definitely feel it all happens the way it is supposed to.

Firsts and lasts

First: My surgery is scheduled for Friday, June 28.

Last: I just bought hopefully the last refill on my diabetes medicine.  I didn't even get a full month.  The doctor is very confident that I won't be taking it when I leave the hospital.

Three types of weight loss surgery - A lay person's perspective

Keep in mind that I am not in the medical profession and in fact am a bit squeamish. This is all from my perspective.

There are three common weight loss surgeries these days, lap band, gastric bypass, and gastric sleeve.  Here is a brief description of each with pros and cons. If I was more blog literate, I could post illustrations, but let's face it, I'm not.

The lap band is basically a big rubber band that is filled with liquid that is inserted around your stomach. The more liquid, the tighter it squeezes your stomach.  You can adjust depending on how much or little you want to be able to eat.  I have heard of people abusing this by expanding their band so they can eat more on vacation.  This surgery used to be very desirable, but a lot of surgeons don't do them anymore.  There have been a lot of problems with the bands getting clogged up and/or slipping down the stomach and causing problems.  Studies also show that lap band patients are actually hungrier than non-surgical people.  So basically you are hungrier than before and can't eat much.  A lot of band patients have their band removed for various reasons.  The band patients average a loss of about 35% of their extra weight in the first year.  Vitamins should be taken because of limited food intake.
Pros: Reversible, least invasive. Cons: Still hungry, problems, least weight loss success

In a gastric bypass, the doctors form a small pouch in your stomach and re-route part your intestines to the pouch.  With a gastric bypass, part of the digestive process is bypassed.  The part of the stomach that isn't being used contains hunger hormones so you aren't hungry.  The pouch is small and can't hold much food.  Some patients report that their tastes change.  I think it has something to do with how the pouch goes straight to the intestines.  Because the process of digesting sugar has changed, bypass patients can have what is called dumping syndrome.  Basically if they eat a high sugar or high fat meal, they may get light headed and their heart may race.  Then the food is "dumped", resulting in a very quick run to the bathroom.  Because the way sugar is digested has changed, this surgery reverses diabetes in over 85% of patients.  In fact, studies are being done to perform the surgery without the stomach pouch in normal weight patients to reverse diabetes.  The way they do this surgery has changed from the early years.  Apparently in the beginning, too much of the digestive process was bypassed resulting in malnutrition.  The way this procedure is performed has changed.  There is still malabsorption, but the surgery is much safer.  Bypass patients can expect to lose 70% of their extra weight in the first year.  Vitamins should be taken because of limited food intake. 
Pros: Reversible, most weight loss, not hungry, can reverse diabetes.  Cons: Most invasive, dumping syndrome, taste changes

The surgery I opted for is a gastric sleeve which is kind of in between the lap band and gastric bypass.  Basically, doctors lop off 85% of the stomach and sew it back up.  The stomach is then a small tube about the size of a banana.  The digestive process is not disrupted.  The sleeve started as a pre-surgery to the bypass in patients that were very large or too at risk for the bypass.  The sleeve would help the patients lose enough weight so that the bypass surgery could then be done.  Studies found that a lot of patients were so successful in losing weight with the sleeve that they opted not to have further surgery.  The part of the stomach that is removed has the hunger hormones so you are not hungry.  The stomach is small and can't hold much food.  No studies have been done to see how many diabetics are in remission from this surgery, but it does cure diabetes in a lot of cases.  This is thought to be due to weight loss and not the digestive process like it is for the bypass.  Sleeve patients can expect to lose 60% of their extra weight in the first year. Vitamins should be taken because of limited food intake.

Pros: Not hungry, normal digestion, might reverse diabetes.  Cons: Not reversible.

Choosing bariatric surgery

After many, many years of eating healthy eating, exercising, and trying every diet plan in history, I've decided to have a bariatric sleeve operation.  I was always hesitant to do surgery. I fully supported other people choosing to have the surgery, but for me it felt like admitting defeat. It felt like I would be saying that I don't have enough willpower or knowledge. If only I tried harder, I would find the perfect combination to losing weight.

A few months ago, I was talking to my endocrinologist (I have diabetes, an under active thyroid, and a gluten allergy) about having trouble losing weight.  I told them that I really didn't want to have surgery. They told me that they were having great success in the surgery putting diabetes in remission.  A few weeks after that, I was seeing a new primary care physician.  We were having a similar conversation and she told me that losing weight would be very difficult for me with my conditions and that if I ever did decide on surgery, one of the best surgeons in the country is in my suburb. So... The journey started.

My surgeon is very strict.  There are a bunch of diet and exercise classes and support groups you must attend along with a psychiatric evaluation and extensive bloodwork. You also need to lose 5% of your body weight to make the surgery and recovery easier.  This process has helped me learn a lot about myself.

While at a bookstore today, I learned that there really aren't any guides for this out there.  A quick internet search only came up with a couple of blogs.  Hopefully, I can help other people by sharing my journey.  Buckle up and join me as I share my thoughts, recipes, and other musings.