ER

Yesterday I went to the emergency room. I called my surgeon and told him about my extended nausea. Because it had been so long since I had been able to keep anything down, he told me to go to the ER and get fluids, and an upper GI to make sure there wasn't a leak.

Looooong story short, there was no leak, and I was discharged 8 hours later after receiving two liters of IV fluids and nausea medications - one of which I had an allergic reaction to. I now have anti-nausea medication to take if the nausea reoccurs. I am taking today off of work because the doc told me to, but I am trying to get some schoolwork done in the meantime to prevent me from falling even further behind.

I feel much better today, but I haven't tried to eat anything yet. I've been drinking fluids.

Hopefully my boss doesn't get fed up with me about all of this.

More adjusting...

I have been battling nausea for the last three days. I haven't been getting my fluids in, and on some days, not even my protein. I have developed a problem in taking my supplements; they are simply too large, and they make me sick when I try to take them. I threw up today after taking my mid-morning vitamins.

The result of no fluids, no supplements, and little to no protein? I've GAINED two pounds. What the hell? How on earth is it possible to NOT INGEST ANY CALORIES WHATSOEVER for three days, and gain two pounds?!?!?

To remedy the supplement problem, I found my B-complex in a liquid form online, and ordered that. I found my calcium in both a powdered, water-soluble form and a chewable form. I ordered one of each to try. I will still have to take my vitamin E in a monstrous pill, but everything else is reasonable in size and I should be able to handle it. We shall see. Until that shipment comes in, I won't be taking anything but my chewable supplements, because three days of nausea just SUCKS.

I am trying hard to do my protein and drink my fluids, but it's just hard when your stomach feels awful. I'm hoping that it's related to the supplements, and that by not taking the pills, my stomach will settle down. **fingers crossed**

Oops.

So, yesterday I went back to work, a week after the surgery. I pushed it a bit too far, and ended up going home halfway through the day. Yay for pain medicine!

I'm back at work today, taking it easy, and taking my pain meds to keep up with it.

Some of my adjustment issues: I dislike taking my Calcium and Vitamin E supplements, because they are HUGE capsules. And I have to take a total of 6 of the Calcium a day and 2 of the Vit E a day, so it can get difficult to choke them down. I'm looking into some Calcium chewables I found on Vitalady. They cost a bit more than what I'm currently taking, but it really is hard for me to choke these things down 6 times a day. The only issue is that my current Calcium caplets also include Magnesium, while the chewables don't, so I'd have to take a Magnesium tablet to make up for it. But even WITH that, it would be six chewables a day, and one Magnesium tablet, instead of 6 capsules that I can barely swallow. And the Magnesium tablet is much smaller than the Calcium, so I wouldn't have a problem taking it. But now I have to justify spending money on the chewables when I've already bought the capsules! Hmmm...

I don't think there's anything I can do about the Vit E. I have to take the dry, powder variety of Vit E, and it's hard to find in that form. I have to take it how I find it.

I'm still on the pureed diet. I can't eat solid food. I confess, I've cheated a couple of times. One night, my husband had broccoli for dinner, and it looked and smelled SO good that I couldn't resist. I LOVE broccoli. I stole a few little crowns and just made sure I chewed them to death before swallowing. I was fine for those. I've also tried Velveeta Shells and Cheese, carefully chewed...my stomach didn't take too well to that. My husband made some pasta the other night with these tiny little round rings of pasta - called Salad Pasta - and he spiced it up the way I've always loved, with the dry ranch dressing mix. I had a couple of spoonfuls, and that went down just fine. Encouraged by these successes, I did something stupid yesterday. I've been craving fries and cheese something fierce...so I went to McDonald's. I got a small fry and a cheeseburger. I can't eat the bread, so I took two small bites of the meat and cheese, chewed carefully, and swallowed. Everything seemed to be fine. I ate five fries and chewed them to death. The flavor was divine!

About an hour later, I got sick. That was not pleasant, and I think I'll be staying away from burgers and fries for a while. I should probably just stick with the pureed diet...I mean, it's only another ten days before my follow-up appointment with my surgeon, when I'll be cleared for solid foods.

So, I'm 9 days out from the surgery, and 22 pounds lighter! It's coming off so fast!

Adjusting...

Well, the pain is subsiding quickly. I am still on the oxycodone, but I have decreased the doses, and I am able to go for longer times between doses. The irritation and pain in my pouch is decreasing, and it is becoming easier to get my protein in. I am still working on getting all of my liquids in; it is very difficult to drink 64 ounces of water a day when you can only drink an ounce at a time. The important thing is that I AM working on it.

I still have not experienced hunger, but I am definitely battling cravings. I see commercials with fatty foods and my mouth waters. I have become a member of several Yahoo groups dealing with weight loss surgery, and on one of them, the members have been posting like crazy about all their favorite foods that they can't eat any more. They describe these horribly greasy foods, and my mouth waters. Even if I could eat these foods, I'd be able to have like two bites before I became full. Like I said, I'm not hungry, I'm just craving the flavors. I am craving fries and gravy in particular (one of the foods being discussed on the board).

I am going back to work tomorrow. I'm feeling pretty good about it, and they need me. Now I just need to plan things out so that I will have my protein there with me. I guess if I just take a tub of protein to work and leave it there, I'll be set. I've been mixing my protein in a regular water bottle and just shaking it, so all I need is the protein, a funnel, and the bottle. I already have a pill planner all filled up with my supplements, so I'm set there.

I kept up on schoolwork, mostly because of all the working ahead I did. Now I am at the same pace my classmates are at. Hopefully I can keep up the faster pace, because I liked being ahead!

Dang, I'm REALLY craving cheese all of a sudden, and I don't have anything cheesy that I can eat. Hmmm...

Ow.

I have been struggling with pain ever since I came home. I have two pain medications, a tablet form of Dilaudid, and a liquid form of oxycodone. I can take the oxycodone every three hours as needed, and I can vary the dose anywhere from 5ml to 15ml. I'm supposed to take the Dilauded in between the oxycodone doses if the pain is coming back.

Well, the Dilaudid doesn't do squat for me. The oxycodone is INCREDIBLE, but it only controls all my pain if I take the full 15ml dose. For the past two days I've been varying my doses, trying to take as little as possible, because the oxycodone knocks me on my butt. It's very strong. The pharmacist said that it's the strongest narcotic that you can get by prescription, and I believe it. When I take a dose, I'm out cold within fifteen minutes unless I fight it. If I manage to stay awake, I'm very woozy and out of it. I don't like feeling that drugged, but if I don't take the full dose, I hurt all the time. My pouch is still healing, and it gets irritated very easily. If I eat or drink anything without having taken pain meds, I feel like I've been punched in the gut.

Also, because I'm having to take the full dose, I'm going through it like it was candy. I have enough for tonight and part of tomorrow, and then I'm out. I called the doctor earlier, and he said that pain at this stage is normal. As long as I'm not having a fever, and my wounds aren't oozing or inflamed, then there's nothing to worry about. I just need to continue to control the pain until my pouch heals more. I just hope that my pain starts to decrease in the next couple of days, because I canNOT work or drive on this pain medication.

After discussing all of this with the doc, there are two options. He could either get me another prescription for the oxycodone, or he said we could try a liquid form of vicodin. He can call in the vicodin to any pharmacy; the oxycodone has to be prescribed at the hospital, and I'd have to drive down to Bellevue to get it. I've been on vicodin before, and it doesn't knock me out the way that the oxycodone does, so I said I wanted to try that first. He called it in, and I'll go pick it up tomorrow and give it a try. If it controls the pain, awesome! If it doesn't, we'll drive down to Bellevue and get some more oxycodone, and I'll likely be out of work longer than I thought.

I really hope the vicodin elixir works, because at my current drug level, I can't DO anything. I haven't gotten a lick of schoolwork done since I came home from the hospital. Even typing this update has been hit-or-miss, because I keep making mistakes. It's probably full of mistakes, even though I hope I caught them all. :)

I guess I just expect too much out of myself. Most other people would be enjoying this time off of work, and certainly enjoying the pain medication (that stuff really IS incredible). I'm starting to feel like a slacker. I would also like to see people, to hang out and visit. I'm used to talking on the phone all day at work, and then talking more for classes. I miss chatting.

Oy to the Vey.

;)

Post-op

The drive down to the hospital was uneventful, and we got down there fifteen minutes early. They took us back to pre-op, where I got to answer a bunch of questions about my health history, my family’s health history, and previous surgeries. I got weighed on the hospital scale (312.2 lbs), and I got mistaken for Joe’s mom. Yes, the nurse asked if Joe was my son. :P She got all embarrassed after she looked at my chart and realized that I was younger than she’d thought. I got to put on a lovely open-backed cotton gown, and then another nurse came in to put in my IV. My veins did not cooperate, and after five pokes, she decided to leave it for the anesthesiologist. He had to try twice, and got one in the back of my hand.

After that, we said our goodbyes and good lucks, and they took me back. The operating room was very bright, and very cold. They had me on this inflatable mattress thing, and they inflated it, which enabled them to slide me right over to the operating table. Then, they put some medicine in my IV, and had me count to five. I made it to three.

I woke up in recovery nice and toasty warm. I don’t recall feeling much discomfort at that point. They kept me in there for a little while, asking me questions every now and then, before they moved me to my room. I don’t recall much of that. I did have a strong reaction to the anesthetic, in that it made me very nauseous. They had to keep giving me an anti-nausea medication in my IV. I dozed in and out all day Tuesday. I had a patient-controlled analgesic (PCA), so I was able to press a button every time I needed pain medication, and some dilaudid would be delivered through my IV. Because of that, I kept my pain very well controlled.

Something that did catch me by surprise is that they were constantly checking my blood sugar. Four times a day I got stuck in the finger, got my sugar levels checked, and got an insulin shot. The surgeon said that was normal after a surgery of this nature, and that I didn’t need to start checking my blood sugar at home. The insulin shots themselves didn’t hurt at all – I seriously couldn’t even feel them going in – but I have some nifty bruising from them!


Wednesday morning, I noticed that my hand was swelling up pretty badly around the IV. They called the IV nurse in, and she immediately turned off the IV, and then spent half an hour trying to get another line started. I got poked another five or six times, on both arms, before she finally found a spot. I still have a nasty bruise in one of the spots she tried!


Here is my swiss-cheeze tummy. I have six holes that you can see, and one in my belly button that you can't.


I was feeling so well by the second day that the surgeon said I could go home in the evening on Wednesday.

In preparation for that, we took me off of the IV meds and started giving me oxycodone in an elixir. Apparently that dose wasn’t large enough, because I started to HURT soon after that, and we couldn’t get back on top of the pain. The doc also had me start drinking fluids, which gave me gas, which was EXCRUCIATING. I could feel exactly where my new pouch was, and where the intestine had been cut into. At mid-afternoon on Wednesday, I was at a pain level of 8 out of 10. It took until nearly midnight to get my pain meds figured out and to get back on top of the pain. They finally gave me an IV push of dilaudid, and then tripled my dose of oxycodone. In between doses of oxycodone, they could give me a half a tablet of dilaudid if my pain was coming back. THAT finally worked. That brought my pain levels down to a four, which was manageable for me. I still had the gas, and that was causing pain, but I was up and walking as much as possible to try to work that through to relieve the pressure.

I am so glad I didn’t go home on Wednesday night! I would have suffered.

On Thursday, I was finally able to pass some gas, which relieved some of the pressure a bit. I got to come home on Thursday morning. We left the hospital around 10:30. Later that afternoon, I was finally able to pass gas in a quantity sufficient to provide some relief. Never thought I’d ever cheer because of a fart, but both Joe and I did!

Now I’m home, and taking it easy. I started taking my supplements this morning, and ate some applesauce with protein powder. I’m working on that VERY slowly. I don’t want to strain my pouch again and develop more gas! Apparently it’s safe for me to take something like Gas-X, so I’m going to send Joe to the store around the corner to pick some up for me.

Oh, and the best news of all: I just weighed myself, and I’m below 300lbs! I’ve lost 13 pounds since Tuesday morning!

I haven’t felt hungry ONCE since I woke up in recovery, and that is an incredible feeling. For someone like me, who ALWAYS felt hungry (unless I had JUST eaten), that is remarkable. I’m beginning to get an inkling of just how much my life is going to change…

Off to see the wizard...

Here we go! We're heading out to the hospital in just a few minutes. I packed last night, so as to be all prepared, and I actually slept pretty well, considering. I didn't want to wake up when the alarm went off!

3 hours and counting...

Less than 24 hours...

I'm as prepared as I am going to get. I have read everything I can, done all the research that I can, ordered all the supplements I need, stocked up on the foods I can eat, and now there's nothing left to do but wait.

I found an EXCELLENT site last week called Vitalady. The owners of the site have both had gastric bypass surgery, and they sell all the supplements that a bariatric patient needs. They're formulated specifically for bariatric patients, and she even put together a schedule for what you need to take and when. There is a whole lot of info about the supplements that I had no clue about. For example, the iron must be taken with Vitamin C, or it won't absorb properly. Also, you can't take any of your other supplements with your iron, because the iron will prevent you from absorbing them. So, you need to take your Vitamins A, E, and D, calcium, zinc, and the multivitamin at a different time than the iron. Also, you can only absorb 500mg of calcium at a time, so you need to space your calcium out throughout the day. It's also very important to take Calcium Citrate and not Calcium Carbonate (stuff like Tums). The carbonate cannot be absorbed by a bypass patient.

I didn't know about any of that! So, I now have a daily schedule for my supplements to make sure I'm getting all the nutrients that I need. I take iron and Vit C first thing in the morning, then my Vit A, D, B-12, B-complex, calcium, and multivitamin at mid morning. Then B-complex, Vit E, calcium, multivitamin, and zinc in the evening. Then Vit C and calcium again at bedtime. All this will cost a little over a dollar a day - but I have to take them. Because of the bypass, I will be unable to absorb certain nutrients from my food, and I will be eating so little food that what nutrients I do absorb won't be enough.

Vitalady also had sugar-free chocolate syrup, so I can still get my chocolate fix, and a large variety of sugar free flavoring syrups. I ordered the variety pack to try them all. That way I can decide my favorite flavors, and just order those in the larger sizes.

I can't do any more to prepare. Now if I can just get my nervous stomach to settle down!

22 hours and counting.

A week from today...

I'm starting to get nervous. I have the utmost confidence in my surgeon; he has an excellent reputation and track record, and he has done thousands of these procedures. I'm just getting the jitters. This is a major surgery, and the possibility exists that something could go wrong. I'm not expecting complications, but they could happen...and that scares me.

This is not something to undertake lightly.

I looked around online today to see if I could find a blog by another bypass patient, and instead I found a blog by the Fat Acceptance Society, which was rabidly and blatantly anti-weight loss surgery. The things said in that blog and in the comments on it were vicious and cruel. These people were saying that gastric bypass is a "diet craze" and that it is completely unnecessary...that this surgery is the easy way out, and that all an overweight person has to do is stop overeating.

If it were that easy I wouldn't be overweight! I wouldn't be suffering from arthritis, and hobbling around in pain every day! I will readily admit that I have contributed to the problem, but my eating habits are NOT the entire problem. I have done the research, I have searched my heart, and I honestly feel that this surgery is the best answer for my long-term health. I was NOT pushed into this by any surgeon. This is MY decision, not anyone else's!

The people on this blog had many other cruel things to say that do not bear repeating. It bothered me that other people who have weight problems could be so nasty about something that affects heavy people. I can understand that they don't approve of the surgery for themselves...but why attack others who make that choice? It's hurtful, damaging, and uncalled for.

This surgery is most certainly NOT the easy way out, and anyone that thinks so hasn't done their homework.

**getting down off soapbox**

Behavioral Modification Project

I'm in my final quarter of college. One of my classes is Analysis of Everyday Behavior, and as part of the class, we're doing a quarter-long project about behavior modification. We have to choose a goal we want to meet, identify the behaviors that we need to change to meet that goal, draw up a plan, and then try to modify the behavior.

This project fits quite nicely with the upcoming surgery, as there are a lot of eating behaviors that I will need to drastically change. I am going to post parts of my project, both for myself and for my readers. I also need to keep a daily diary of pre-surgery behavior as a baseline to compare post-surgery behavior to.

Initial Target Behaviors

Decrease caloric intake to approximately 700 calories a day

Meeting this goal will be problematic, as my stomach will be one ounce in capacity. I will have to eat many very small meals throughout the day, and according to what I’ve been told by other gastric bypass patients, I will have no appetite and will have to remind myself to eat. I actually anticipate eating too little for this goal, especially at first.

Increase water consumption to 2 liters a day

This goal will also be problematic, for several reasons. The small size of my stomach will allow me to only drink a sip or two of water at a time, so I will have to sip all day in order to drink enough water. I also cannot drink for a half hour before or after I’ve eaten anything, as the fluid will wash the food out of my stomach and cause me to feel ill.

Begin taking daily supplements of calcium, iron, B-12, and a multivitamin

I have a hard time taking pills, mostly because I have a very strong gag reflex, and I usually have to wash them down with a gulp of water. I won’t be able to do that any longer, so I think chewable or dissolving tablets is the best option for me.

Monitor changing weight on a daily basis

This goal shouldn’t be too difficult for me. I don’t currently own a scale, but I will be purchasing one, and it is important that I be able to see small changes in the numbers to help encourage me.

In one of the readings, I found an excellent section dealing with unhealthy eating habits that pinpointed a few issues I knew about, and a few I didn’t know I had. The section spoke of behaviors that overweight people tend to have, such as keeping fattening foods in the house, eating to avoid waste, putting too much food on their plates, eating rapidly, eating while watching TV or reading, and eating while emotionally upset. I do most of these. I did figure out a while ago that if I didn’t buy the food and keep it in the house, I wouldn’t eat it. For example, I have a weakness for potato chips. I love their salt and their crunch, and I will eat most of a bag without realizing it. Because of this, I don’t keep potato chips in the house, and when I do buy them to satisfy a particular craving, I buy small bags. As a result, I avoid the problems of having fattening foods in the house.

I did notice very recently (as in, within the last month) that I do eat to avoid waste. My husband pointed it out to me, and it really opened my eyes. I was raised to finish all the food on my plate, and I will eat it if it’s on the plate, even if I’m no longer hungry. I do put too much food on my plate, which exacerbates the problem of finishing all the food on my plate.

I also tend to eat quickly. I’m always in a hurry, and when I eat, it’s in between tasks, so I tend to stuff and run. Related to this is my problem with fast food. Fast food requires little to no thought or preparation on my part. I don’t have to think ahead and plan my meals, because I can just stop at some fast food restaurant to pick up something in the drive-through. I don’t even have to stop to eat, I can eat while I drive. I will be physically unable to do this after the surgery; eating high-fat foods will literally make me feel very ill. I am going to have to restructure my life in order to accommodate my new eating requirements. If I don’t plan ahead for this, I strongly suspect that I just won’t eat at all – and that is exactly the wrong way to deal with this.

I do eat dinner while watching TV. My husband and I both do this. There’s a simple explanation: we don’t have a dining room to put a table in. We eat sitting on the couch, using our coffee table for our plates. Our dinner time is also during our favorite shows, so we combine the two. I don’t see this habit changing anytime soon. It will be a while before we can afford a larger place that has a space for a table for meals.

I do sometimes eat while emotionally upset. When stressed, I want something fast and comforting. This usually translates to junk food or fast food. I am going to have to devise techniques for coping with stress to avoid this problem, because I simply won’t be able to physically eat what I’m used to after the surgery.

After reviewing this section, I realized that I have several more target behaviors that need to change. Eating to avoid waste and putting too much food on my plate are strongly related, and I will tackle those with a single target behavior: Eating no more than one ounce of food every hour. I will have to measure my food at first to make sure I’m staying within the limit. Sticking with this goal won’t be difficult, as eating more than my stomach will hold will cause me to vomit. I am not going to track this behavior as part of the project, simply because the changes made to my digestive tract will enforce the goal, and won’t actually require very much effort on my part.

Eating fast food because of lack of planning is going to have to stop. I have no choice. I will have to start planning my meals, or else I’m afraid I just won’t eat. At first, this will be simple. For the first three weeks after surgery, I am limited to foods no thicker in consistency than applesauce. I intend to purchase baby food in jars that are the proper size, and just carry those around with me. After I’m back on solid foods, I am going to have to plan ahead and pack my meals to carry around with me. They will have to be foods that can be eaten quickly. For example, I could make a sandwich and cut it into quarters, and eat the sandwich one quarter at a time. That would be four meals. The target behavior for this problem would be to plan and pack the following day’s meals in the evening before I go to bed.

As far as eating when I’m stressed, I need to identify other behaviors that will help me deal with stress, since I won’t be physically able to eat the types of comfort foods I’m used to. I could try a different food that is healthier to use as a “treat” when I’ve had a bad day, such as a pre-packaged Jello pudding, or yogurt. To do that, I will need to identify something that I enjoy that will make me feel as if I’ve had a treat. My husband and I have also recently adopted ferrets, and I love taking them out of their cage to play with them, and that is a great stress release. There’s not a lot in the way of exercise that I am capable of at this time, but as some of the weight comes off, there should be less stress on my joints and I should be able to start working out. This will help both my stress levels and my health.

When I make mistakes

I anticipate several mistakes. One is that I will forget to plan and pack the next day’s meals, and so won’t have anything available to eat, and then I will just not eat. I think I will actually keep a one or two day stash of food at work for this contingency. Another mistake I anticipate is that I will forget to take my supplements. Until this becomes part of my daily routine, I will carry some of the tablets with me, and take them when I remember. I will also keep a small supply at work for the same reason. I don’t anticipate too many problems with water consumption; I have already recently increased my water intake to 1 liter a day by keeping a bottle with me at all times and constantly sipping. I flavor my water with Crystal Light, which I enjoy, and that helps me to drink the entire bottle easily. I’m not sure if I will simply fill my bottle twice in order to get to the 2 liters, or if I will get a larger bottle. As far as taking my weight daily and recording it, I don’t think I will have a problem with this either. I already keep a blog about my upcoming surgery, and I intend to make a daily update including my weight a part of that. If I don’t take my weight or update for a particular day, I’ll do it the next day. I have a lot of people reading the blog that will help to keep me accountable. I am also viewing the blog as a potential resource for others who are contemplating this surgery, and so I feel I have a larger audience that I have a responsibility to.

In tempting situations

The only situations in which I feel that temptation might be a problem is in not wanting to plan and pack the next day’s meals, or not wanting to weigh myself on a particular day. I’m sure I’ll also have to deal with the temptation of eating something high in fat or sugar that will make me feel ill. To prepare for the temptation of not wanting to pack my food for the next day, I will keep a stash of food at work. If I decide I’m just too tired and I don’t want to deal with preparing, I will allow myself to not prepare, and will manage on the food I’ve set aside. I will also enlist my husband in reminding me of the need to prepare. As far as not weighing myself, I will also enlist my husband in this, to help remind me. It’s also important that it’s ok to fail every now and then, and so if I do forget, I just don’t plan to make a big deal out of it. If I find that weighing myself every day is just too much to deal with, I’ll alter my plan and start weighing myself every other day instead. I think in order to fight the temptation of eating something high-fat or high-sugar, I’ll just go ahead and do it a couple of times. I’ve read and heard the descriptions of what dumping syndrome feels like, and I imagine that after just once or twice, the knowledge of what it feels like will be enough to keep me from being tempted!

Final Target behaviors

Decrease caloric intake to approximately 700 calories a day

Increase water consumption to 2 liters a day

Begin taking daily supplements of calcium, iron, B-12, and a multivitamin

Monitor changing weight on a daily basis

Plan and pack the following day’s meals in the evening before I go to bed

React to stressful events in a way that doesn’t involve unhealthy food

Self-observation

Caloric intake: keep a daily diary of calories consumed

Water consumption: include fluid intake in the diary

Daily supplements: include whether supplements were taken in the diary

Weight monitoring: include weight measurement in the diary

Plan and pack meals: mark in diary if meals were packed; if not packed, record why not

Reaction to stress: record each time I crave comfort food, why, and what I did instead

7 days and counting...