Follow by Email

Saturday, January 29, 2005

The Devil is in the details

Originally published Jan. 29, 2005, in the Tracy Press

A little over a month ago, I began writing this column with the idea that I would have gastric- bypass surgery sometime between March and August of this year.

It’s amazing to me how so much can change in what feels like the blink of an eye. It turns out that in just four short weeks from now, I will go under the knife to have my digestive system rerouted to facilitate rapid weight loss — to the tune of about 100 pounds in the first year — in the hopes of overcoming obesity-related infertility.

It’s almost surreal as I think back to how this occurred.

A few weeks ago, I was crying in my soup about how the holidays were a little too festive for me. I talked about how I needed to get back on track because I was meeting with the hospital bariatric team’s medical director, and I wanted to make a good impression by not gaining weight. I succeeded in that. Turns out my scale at home was closer to the hospital scale than I realized, and I weighed in four pounds lighter than in early December. Not too shabby for having a one-week detour around Christmas.

The medical director and I hit it off instantly. We discussed my weight history and the eating habits I learned as a child. She explained her take on my experiences. We talked a bit about my medical history.

And then she said it: “So, Tonya, when would you like to have surgery?”

Stunned, I said, “March?,” thinking she wanted to give me some sort of timeline.

Instead, she said, “You got it.”

I almost couldn’t speak. I managed to stutter, “really?”

Her answer knocked my socks off.

“Well, you’ve lost weight, you’re making life changes, and you don’t have any medical conditions barring you from surgery. You’re a good candidate. Why should we postpone it?”

It’s one thing to believe you’ve earned something, but it’s an entirely different feeling to have the person in control of your reward validate it.

It turns out that March didn’t exactly work out, and I now have a Feb. 24 surgery date. I wasn’t sure whether to jump for joy or burst into tears.

My poor husband wasn’t sure how to take it either. I was so frazzled by the news that I couldn’t even fill out my pre-op forms. He had to do it for me.

Walking out of the office, into the elevator, down four floors and out of the building seemed like a dream.

I don’t think the magnitude of what just happened hit me until the drive home. And then it just exhausted me. I couldn’t stop thinking of everything that needed to be done before surgery.
Some things were little, but everything seemed like a huge boulder of effort.

As soon as we got home, I went straight to the bedroom to lie down. I slept for four hours. The only time I can ever remember sleeping like that was in college the night before I had five difficult finals in the same day. It’s that heavy, drugged sleep your body goes into when your brain is so full of information that you have to be nearly comatose for it to be assimilated.

When I awoke, I was groggy, and everything was still jumbled in my brain. I decided to make myself a late dinner and watch a dumb movie with my husband. I can’t even remember what we watched.

Then, we went to bed. He fell asleep, and I took out my information binder that I was given at my pre-operative orientation in October. I read the entire three-inch binder word for word. Then
I went back to sleep. The next day, I freaked out a little more, repeatedly rattling off everything that had to be done before surgery — balance the checkbook, request time off from work, inform my staff of my upcoming month-long absence and about 50 billion other things I can’t mention here. I must have sounded like Dustin Hoffman in “Rainman,” as I muttered under my breath.
Finally, I took a friend’s advice and made myself a list of everything that needed to be done. Many people have offered to help me, but I’ve yet to take anyone up on it.

After this week, I’ll have three more columns to publish before the day of surgery, and I’ll have to prewrite at least two for part of the time I’m recovering. That gives me five chances to tell readers about my preparations. It doesn’t feel like nearly enough but I’ll give it my best shot.

Saturday, January 22, 2005

What I miss

Originally published Jan. 22, 2005, in the Tracy Press

Last week’s column discussed everything I’m no longer allowed to eat as I prepare to have gastric-bypass surgery. I’ve begun living as if I’ve already had the surgery, which includes abstaining from a host of no-no foods.

When I was considering surgery about a year ago, I realized that I needed to make sure I could live without all my favorites. If I couldn’t live without food that would be verboten, then there was no point in having weight-loss surgery.

I made myself a list of the foods I didn’t think I’d be able to live without forever, and I proceeded to test them. I would prepare the item or order it in a restaurant and reflect on it. I’d take a bite and see if it really tasted as good as I thought it did. I’d see if it felt good on my tongue and whether it felt generally good to eat it.

Surprisingly, most things haven’t been that hard to give up. But I think others will be a challenge for the rest of my life. I’m willing to take the challenge because I believe the benefits of surgery are worth it.

Here’s a rundown of what I found:

What I don’t miss

• Soda — I hadn’t really liked soda as a child, so giving it up was easy.

• Carbonation — As much as I love mineral water, I don’t miss it.

• Gum — I still think Dentyne Ice is the best remedy for after-lunch breath, but sugar-free breath mints will suffice.

• Coconut — The only time I eat coconut is when it’s in candy or desserts, and those are already forbidden (more on that later).

• Beef jerky — Since I don’t eat beef, it’s a non-issue.

What I do miss

• Alcohol — Drinking water at a party seems to make more of a spectacle of me than the drunken girl who dances topless on the bar.

• Fast food — I don’t actually miss the flavor of fast food (except for the grilled-cheese sandwich at In-N-Out), but I do miss the convenience of hitting a drive-through window when I’m short on time.

• Bread — The only reason I miss bread is because it’s very hard to make a sandwich without any.

• Pasta — As if I can imagine going to The Olive Garden and ordering anything else. I really don’t like minestrone soup, so this may be a restaurant I don’t eat at after surgery.

• Rice — Tofu curry from the Thai Café on Central Avenue just doesn’t taste good when it’s not combined with jasmine rice.

• Spicy food — Mild salsa just doesn’t enhance Mexican food as well as the hotter varieties.

• Desserts — This is almost deserving of its own column. I love desserts. Anything sweet and creamy has my vote. Cover it in chocolate and I consider it unbeatable.

I have to be honest: That list I made about a year ago specifying all the foods I wanted to see if I could live without consisted almost entirely of desserts. Sure, the In-N-Out grilled cheese was on the list, but it only took one bite for me to realize that I could live the rest of my life without eating another one. The chocolate mousse cake from Fabio’s, on the other hand, took three tries before I could resign myself to the idea of living without it (Yes, it really is that good).

I couldn’t begin to discuss my love for rich desserts, particularly when paired with a glass of vintage port wine. No dessert has ever been too rich for me — not even the decadent chocolate truffle pie at Magellan’s.

Even fast food — which I subsisted on for at least five days a week — wasn’t as hard to give up.
The deciding factor for me going through with gastric-bypass surgery is the realization that food is fleeting.

Yes, I love Marie Callender’s pies and the blended Carmelo Sensation at Zizzo’s on 10th Street. But I love the idea of fitting into the seats on amusement park rides so much more. The idea of climbing up the rock formations at Mount Diablo with my husband is as intoxicating as any ice cream creation at Cold Stone Creamery.

And the best feeling I can imagine is becoming pregnant and giving birth to my own child. And I know that won’t happen for me without surgery.

When it comes to the idea of having a baby, the richest dessert in the world holds no comparison.

Saturday, January 15, 2005

What not to eat

Originally published Jan. 15, 2005.

I mentioned last week that I have to start living my life as if I have already had gastric-bypass surgery. This means, I must exercise regularly and eat differently.

Exercising regularly is a no-brainer. I’m expected to exercise at least 30 minutes a day, six days a week. This will help get my body in shape to recover faster from surgery. Exercising regularly now also means that I’ll be more able to increase my workouts after surgery. Most patients I’ve spoken to exercise one to two hours a day, six days a week.

Having spent much of my life trying to control my weight, I’m familiar with exercise.
I like doing yoga and lifting weights. Pilates is fun, but I have trouble completing an hour-long session. Cardio is my least favorite form of exercise, but I have grown to enjoy using an elliptical cross-trainer at the gym. The zero-impact motion is easy on my knees without being too easy on the rest of me.

I’ve been told cardiovascular exercise will help my body better handle the effects of anesthesia, though I have yet to confirm this with a surgeon; however, doctors have told me that strength training now will help me to preserve my muscle mass during recovery. Building my stomach muscles should also help my abdominal wall heal from the incision wounds faster.
Aside from needing to be better about scheduling my workout as if it were any other unbreakable appointment, I’ve gotten the exercise component down pat.

The more difficult aspect of preparing for surgery is eating differently. I’ve grown accustomed to my new eating habits and am comfortable with them now, but that wasn’t the case three months ago when I received my pre-operative eating requirements.

Except for the week of Christmas, I’ve diligently followed my prescribed 1,200- calorie-a-day eating plan for the past 12 weeks. As I touched on last week, though, there is a lot more to my new plan than just watching calories.

Limiting myself to 1,200 calories a day and making sure I consume 80 grams of protein, 133 grams of carbohydrate and no more than 40 grams of fat is easy. But there’s a whole list of rules accompanying that seemingly easy meal plan that is more difficult.

The rules are there to prepare me for life “on the other side.” As such, they don’t make a lot of sense for my body now, but I’m getting ready for when they really do matter.

Here’s a rundown:
No snacking — I’m supposed to fully fill my pouch at mealtime three times a day. Doing so will enable me to go about five hours between meals with little feeling of hunger.

No fast foods — Healthy food can be found at fast-food restaurants. But the sights and smells of McDonald’s and Jack In the Box are triggers. For many of us, it’s hard to walk in or go to the drive-through window and only order a salad.

No caffeine — The stomach pouch has little to no stomach acid. With no acid to dilute it, caffeine could very quickly ulcerate the pouch.

No carbonated beverages — Carbonation will add gas to the stomach pouch, which can stretch it and enable it to hold more food. Not so good if the idea is to restrict the amount of food consumed in one sitting. Stretching the pouch is also bad because if it’s done too soon after surgery, the staple line could rupture.

No fluids with meals — This is another rule to help keep the pouch full as long as possible to maintain the feeling of satisfaction. If fluids are consumed with meals, the pouch may empty faster, which means I could eat more in one sitting.

Avoid starches — Bread gets doughy in the pouch and can clog the outlet, which would be very uncomfortable and could require medical attention to clear.

Because the opening from the pouch to the intestine is only the size of a dime, food must be chewed to the consistency of baby food. Some foods, however, are too difficult to chew that well. These foods include coconut, popcorn, corn and skins and seeds of fruit.

When I first encountered all these rules, I remember thinking that there was no way I could go through with the surgery. There were too many foods I’d have to avoid that I swore I could never live without. But I’ve managed for the last three months, and I don’t miss many of the things I thought I would.

How did I accomplish this? That’s what next week’s column is about.

Saturday, January 08, 2005

Getting back on track

Originally published Jan. 8, 2005, in the Tracy Press.

As the first week of the new year comes to a close, I have to say I spent it like most people — making up for the sins of the holidays.

What many refer to as a New Year’s resolution is a means to an end for me. I need to lose about 30 pounds to be cleared for gastric-bypass surgery through my insurer. I was given that weight goal at my pre-operative orientation in mid- October. Between that day and my visit with the program’s dietician in early December, I had lost nine pounds. The dietician seemed impressed, especially considering that I met with her the week after Thanksgiving.

Unfortunately, the week of Christmas brought a setback. It’s never the day of the holiday that gets me. With plenty of people to visit with, I find myself too distracted to overeat. What seems to be my downfall is the time preceding a holiday, when I’m too scatterbrained to pay attention to what I’m putting in my mouth. And I tend to lose my resolve at work.

Holidays are a tough time in most offices — everyone is doing extra work to make up for the shorter workweeks or to fill in for those on vacation, not to mention dealing with the seemingly endless supply of treats dropped off by clients or brought in by co-workers.

After giving in to a truffle, it became easier to say yes to fudge, cookies and gourmet coffee drinks. And the easier it was to say yes, the harder it was to say no. And that’s why I spent Christmas night realizing that the jeans that had been so loose the week before now protested every time I tried to lift the zipper.

I spent much of last week thinking about how I was going to get back on track. It felt like I had all the time in the world — until I pulled out my 2005 calendar and realized I had a little more than a week before my next weigh-in.

As you read this column, I will be on my way to San Francisco to meet with the bariatric program director at the hospital where I’m expected to have surgery.
The director has the power to schedule my surgery for two weeks — or even two years — from when we meet. Showing up with a 10-pound gain is not the way to convey that I’m serious about having surgery.

I’ve had to kick my butt into high gear. I know fad diets don’t work, so I haven’t spent the week fasting or eating nothing but cabbage soup.

I’ve gone back to the preoperative eating plan prescribed by the bariatric team in charge of my case.

Yes, not only do I have to lose weight before surgery, but I’m expected to do it a certain way. The hospital’s way consists of eating 1,200 calories a day in the form of three balanced meals.
Calories aren’t the only thing I have to watch. The bariatric doctors want me to begin living life as if I already have had the surgery. Doing so is meant to prevent me from having transition difficulties after surgery, because not following the dietary rules could kill me.

Within my 1,200 calories a day, I need to consume between 75 and 90 grams of protein, up to 40 grams of fat and no more than 133 grams of carbohydrates.

Though this plan is low in carbs, it’s not a low-carb diet in the traditional sense, because fat and calories are also limited. It’s a low-calorie, low-carb, high-protein and moderate-fat plan.
For the first year after surgery, I will eat anywhere from 500 to 900 calories a day.

Cutting my consumption down to 1,200 now will be a good way to get my body used to reduced nutrients.

The anatomical limitations I’ll have after surgery will prevent me from digesting starchy foods very well, and cutting carbs is better done now than later.

As I’ve explained before, protein will be my main concern after surgery, and it’s best that I focus my energy on lean sources now so I’ll have an easier time later. Not eating red meat or poultry makes it more of challenge, but I’m working on it.

I’m also expected to replace one meal a day with a sugar-free protein supplement that I’m allowed to mix with either milk or water.

Other rules meant to prepare me for surgery include no carbonated beverages, no caffeine and no alcohol.
I’ll tell you a little more about what I can and can’t eat next week. But for now, I need to head to the gym — more on that later, too.

Saturday, January 01, 2005

What makes this time different?

Originally published Jan. 1, 2005, in the Tracy Press.

I ask myself that question all the time. As I mentioned last week, the immediate answer I come up with is: because it has to be.

But that doesn’t really answer the question of what it is about surgical weight loss that makes me think it’ll work when every other diet on the planet has failed.
I hate to sound cliché, but there’s a lot to be said for the journey making all the difference in the world.

I consider myself in a fortunate place right now. I found myself abruptly switching insurance providers last summer just as I was exploring the possibilities of surgical weight loss.
My new insurer is a health maintenance organization with a five-year-old program devoted to weight-loss surgery.

Though weight-loss surgery has been around since the 1970s, few insurers actually have programs in place for members seeking it. It seems more common that insurers require nothing more than a doctor’s referral and leave surgery preparation up to the bariatric specialists with whom they contract.

Every member of my HMO seeking WLS must submit to a process that takes anywhere from 12 to 18 months. The process includes nutrition classes, psychological counseling and lab work — and that’s just to get a patient’s foot in the door.

Once that happens — meaning the HMO’s bariatric program agrees to accept the patient as a surgery candidate — there is still more work to be done.

Everyone must attend a bariatric orientation class at the hospital where he or she will have surgery. The orientation includes a weigh-in and a series of presentations by the hospital’s bariatric team. Patients are told the specifics of gastric-bypass surgery, its pros and cons and the most common complications. A large portion of the day is spent with a nutritionist explaining the vast differences between what patients can eat before surgery vs. after surgery.
The staff also lays down the rules for the program. The most common is a requirement for pre-operative weight loss.

I know it sounds silly, but my insurer expects all bariatric patients to lose 10 percent of their pre-operative weight before they can be cleared for surgery. I’ve heard different justifications for this requirement. Some say that weight-loss shrinks the size of liver, which is very close to the operation site and could be nicked during surgery. Others say it’s necessary because weight loss will reduce belly fat, and the amount of belly fat a person has determines whether surgery can be done laproscopically.

My opinion is that the surgery is expensive, and the HMO doesn’t want to invest its money in patients who aren’t willing to work at being successful. Requiring pre-op weight loss is a way to weed out those who are less than committed. I also believe that the insurer hopes that after losing about 30 pounds — the average patient weighs between 280 and 300 pounds — the patient will change his or her mind about needing surgery.

Some patients remove themselves from the program after orientation either because they don’t feel they can meet all the requirements or because they no longer believe that surgery is the right choice for them. Those who don’t are required to attend further meetings with bariatric nutritionists, psychologists and specialists to make sure they have realistic expectations of surgery and that they are good candidates for surgery. Being a good candidate for surgery, according to my insurer, means the patient is likely to survive the procedure.

As one surgeon told me, “If we’re going to operate, we’d like to be at least 90 percent certain that you’ll wake up when we’re done.”

Apparently, having patients die doesn’t make surgeons very happy.

It’s only after losing 10 percent of their weight and submitting to about a dozen different appointments that patients are truly cleared for surgery and a date is scheduled.

I’m in the midst of this process, and though it can be daunting, I find it comforting.
As someone who has spent thousands of dollars on diet programs, books and pills, I like the fact that I have to work at this. And every obstacle I pass in this process validates that I’m making the right decision.

I attended orientation in October and am now focused on losing about 30 pounds. I did really well in November, dropping nine pounds.

However, the stress of Christmas got the better of me, and I put a bit of that back on.
When I visited the bariatric nutritionist in early December, she told me I was an excellent candidate for fast-tracking, which means I could have the surgery sooner rather than later. She predicted I may have surgery as early as March.

However, I have an appointment Jan. 8 with the program’s medical director. She’s the one who determines whether I get put on that fast track. If I don’t have at least 10 pounds lost by the time I see her, my chances of being fast-tracked are slim.

My focus now is getting back on track. That’s not easy after two weeks of absent-minded indulgence, but it’s a challenge I’m ready to take on.