Tired of Talking About It

I'm just tired of talking about my surgery, my eating, my exercise, my problems and everything that goes along with having WLS. And I got the impression from a friend that others are tired of hearing about it too. I know that having this surgery is something I need to deal with for the rest of my life. But I'm tired of thinking about it so much. My friend asked me today how long it'd be before I can just be normal again and not have to worry about everything. He compared it to quitting smoking. He quit smoking and now doesn't think about it anymore and acts like a non-smoker. But WLS isn't like that, is it? My physical anatomy has been altered and that effects how I live my life in terms of food and nutrients. I can't just stop thinking about what is the best food to put in my mouth. I can't just stop being conscious of taking all my vitamins and supplements during the day. I dunno... maybe one day I'll get to the point where this life becomes a habit and I don't have to focus so much. But I can't imagine that day is coming next week or anything. So I'm just going to shut up about it for a while. At least stop talking about it to non-WLS people. We'll see how I feel about this topic in a week or so. ~Pam

Struggling with Weekends

So I've been having problems staying on-plan during the weekends. I sleep late which throws off my morning eating schedule, then lunch runs late and I find myself snacking instead of eating a normal meal... and it just goes downhill from there. It's the lack of a regimented schedule on the weekends that do me in. I do great during the week when everything is already planned out for me. Last week I challenged myself to have a "good weekend." I did very well and stayed on schedule and recorded my food intake and got my workouts in. But this weekend was another train wreck. And being a holiday weekend didn't help matters much. It's not that I eat bad foods. It's that I don't stay on my eating schedule. So instead of 3 meals, 1 protein shake and 1 snack that I'm suppose to do each day ... I might eat 1 or 2 meals, 2 or 3 snacks and if I'm lucky I'll get a shake in there somewhere. For instance, on Saturday my lunch was a serving of soy crisps and a couple dill pickle spears. Totally not "off-plan" -- in fact, it's a solid 10g of protein, but it's not exactly dense protein that sustains my hunger for 3 or 4 hours. So then after a lunch like that I'm ready for another snack an hour or so later. Grab a cheesestick and another pickle and I'm good for another couple hours. Dinner was better with a salad topped with grilled chicken, but I didn't eat it until 9:30 p.m. See.. not bad food. Just bad timing. If I let myself get back into those old habits of grazing on snacks and small lazy meals throughout the day, eventually I'll start putting bad food back into the mix. Bad idea! Right now I don't keep food in the house that is not on my OK'd list. So even if I'm snacking on stuff at the house, it's all healthy food if eaten in moderation. I need to work harder and stay more focused on the weekends. Nobody ever said this was going to be easy, so I need to buckle down and get my head on straight. Next weekend is packed with stuff to do (OH Conference on Saturday & flea market on Sunday) so I'm going to need to plan, plan, plan and stick to that plan. I'll let you know how I do. ~Pam

I'm not drinking enough water

I've just realized that I've gone over a week without hitting my water goals. I should be getting at least 64 ounces every day. I been drinking about 20oz. at work then on nights I was getting another 20oz or so. (I used to do two 20oz bottles at work.) But I haven't been drinking like I should be when I'm at home in the evenings. Need to work on that. ~Pam

What's on my Grocery List?

Salad fixings (There's always a big bowl of greens in the fridge for a quick salad) 
- mixed greens 
- matchstick carrots 
- baby portabella mushrooms/sliced 
- grape or cherry tomatoes 
- sunflower seeds 
- Kraft light zesty italian dressing 

Tortilla Pizza Fixings (I have a basket in my fridge with all this stuff in it, so it's easy to pull out and fix a pizza) 
- mini Flat Out wraps 
- pizza sauce in a jar 
- turkey pepperoni 
- use the mushrooms and tomatoes from above 
- mozzerella cheese - pineapple chunks (sometimes) 

Chicken Zucchini Casserole Fixings (I usually make this casserole once a week and eat it for lunch everyday) 
- frozen chicken tenders 
- cheapo italian dressing (for the marinade) 
- sliced mushrooms 
- baby zucchini 
- onions, garlic, seasoning 
- TGIFridays frozen artichoke spinach dip 
- Cheddar cheese 

Snacks, Mini Meals or Lazy Day Meals 
- Synders Soy Chips (or Trader Joe's Soy Crisps if I happen to get over there) 
- dill pickles 
- deli sliced turkey, chicken, beef or ham 
- SF Popsicles 
- 100 calorie bag popcorn and flavored seasoning salts 
- fresh fruit (apples, bananas, etc) 
- frozen fruit (for protein smoothies) 
- Wasa Crackers (for chicken or tuna salad) 
- Vanilla Bean Roasted Almonds (eat these sparingly) 
- Dry roasted edamame 
- frozen edamame beans 
- milk 
- South Beach Diet frozen dinners 
- baked tortilla scoops (fill w/ taco seasoned beef and top w/ cheddar cheese, microwave) 
- Sargento mozz cheese sticks (I hate every other brand) 
- Carb Master Yogurt (Kroger brand, 12g protein, 3g carbs) 
- Kashi Go Lean Crunch granola -- to top my yogurt with 

Protein Supplements
- Body Fortress Chocolate and Vanilla Protein Powder (from Wal-Mart)
- South Beach Protein Bars (chocolate, peanut butter or maple nut)
- Zone Perfect Snack Size protein bars

Just thought I'd share some of my shopping items. 
~Pam

My new favorite self portrait

This was taken with my camera phone a few weeks ago while I was out walking. As you can see, it was a beautiful, clear, sunny day. Love that I'm all in shadow -- just the image of me walking along doing my thing.

What are you doing right?

A thread on OH asked folks to list the things they are doing RIGHT. Loved this thread - lots of great stories from people and ideas for what I could be doing better.

Here's the list that I posted: --- Here's what I'm doing that's good:

1. I log all my food on www.fitday.com --- this keeps me accountable to myself and also helps me ensure that I get all my protein per day. It's also a reality check for me on some foods that I think are fine, but after logging them I discover I was mistaken (i.e.: brats for dinner last night was a no-no). Logging also helps me mid-day know if I need to adjust my eating for the rest of the day. If I'm low on protein I know it right away and can adjust accordingly. 
2. I'm training for a half-marathon. I still have a problem wrapping my head around that concept. In less than a year I will have gone from morbid obesity to a half-marathon... how is that even possible? But I can see the finish line in my head and I know I can get there. I signed up for a 20-week walking training program - at the 15-week mark I'll do a 10 mile walk, then 6 weeks later is the half-marathon. I'm walking nearly everyday and it feels great! 
3. I'm working on more than just the eating and exercise. When else in my life will I have the opportunity to make dramatic changes in my life? For the next 6 months I'm adding a new aspect of my health each month. Here's my schedule of goals:
1. May 13- June 13 Spiritual Health
2. June 13- July 13 Financial Health
3. July 13- August 13 Emotional Health
4. September 13- October 13 Relationship Health
5. October 13- November 13 Intellectual Health
4. Being the leader of my local support group really forces me to connect with other people. Before surgery I avoided other people and was content with being a homebody. Now I'm thrilled to be making new friends and helping others realize their weight loss goals. I've found some awesome, life long friends because of WLS.
5. Besides the support group that I lead, I also attend 2 other support groups. One through my surgeon's office and another in a nearby town. Again, more friends, which is great. But also the more people I meet who have had WLS, the more I learn and the better equipped I am to face my own journey and struggles with this new lifestyle. 
6. I'm supporting my community by shopping regularly at Goodwill. LOL! I'm keeping a running tally of how much I am spending on clothes since surgery... it'll be interesting to see what that ends up being. And everything I collect along the way (and all those clothes from pre-surgery) will be sold at a yard sale later this summer to raise money to buy a whole new wardrobe. 
7. I'm a big believer in "knowledge is power." If I see a question here on OH or read something interesting on a website ... I will dig deeper to learn what I can about that topic. I spend more time doing research now as a post-op than I ever did in any college class in my life. I've learned so much in the past year, I amaze myself. I try to share the things I've learned with others by posting on my blog and profile. 
8. I took a 10-week group therapy class shortly after my surgery through the psychologist's office who works with my surgeon. This class helped me identify exactly why I got fat in the first place, taught me about how to have a healthy relationship with food, helped me set goals for my future life after WLS and helped me develop coping techniques for cravings and negative self-talk. I wish every WLS patient was required to take a class like this after surgery - it's amazing what you can learn about yourself if you just take the time to look deep enough inside. 
9. Giving back. When I first started my WLS journey a lot of people helped me by providing information, advice and links to awesome resources. Now that I'm on the other side of the journey, I feel like it's my duty to give back to those who are just starting. Helping others is becoming a passion. 
10. A schedule is very important to me now. I eat and take my vitamins on a very specific schedule. If I didn't have this regimine I could quickly get off track and fall back into old bad habits. Using my cell phone's alarm feature really helps me remember what I should be doing. Most of the schedule is ingrained in my day already, but there are a few things that I tend to forget, so I've got those things programmed into my cell phone and an alarm reminds me what I need to do when.

That's all I can come up with at the moment. Thanks for posting this thread. So often we focus on the negative aspects and what we're doing wrong. But when we're reminded of what we are doing RIGHT, we know we're on the right track and can keep plugging along toward that finish line of success.

Pam

6 Months -- Goal Update

I hit the 6-month mark this week. On one hand I can’t believe it’s already been 6 months – it seems like surgery just happened a couple weeks ago and this whole lifestyle change is brand new and I’m still learning how to deal with everything. On the other hand I can’t believe it’s only been 6 months.

Sometimes it feels like I’ve been doing this thing forever and my memory of life before surgery gets foggy at times.

I feel normal and healthy and like this is how I’ve lived all along. I guess the reality must be somewhere in between those two extremes. At the beginning of this WLS journey I took a 10-week group therapy class that helped me focus on a whole life Wellness Plan.

In that plan I set specific goals for myself in various areas of my life. I didn’t want this journey to be only about eating and exercising – I wanted to take the opportunity for change and really work on any area of my life that I felt needed work.

• Spiritual health
• financial health
• intellectual health
• emotional health
• relationship health 
• vocational health 

Each piece is part of the whole. So how am I doing with all those lofty goals?

I’m doing great on eating and exercise – that seems to be a given at this point. I’ve lost 83 pounds, I’ve dropped five pant sizes, I’m wearing XL shirts (sometimes L) and people are calling me skinny (even though I’ve got a ways to go before that title is actually true).

I’ve joined the Crim Fitness Training and I'm training for a half-marathon - I’m exercising regularly, so I’ve got that part covered too.  But I feel like I haven’t been working on any of those other goals on my list.

Yes, I know that during the first few months after surgery that I can’t do much besides focus on eating and exercising, so I shouldn’t be too hard on myself. But these past few weeks I’ve felt like I’ve let myself down in some ways. I’ve been so driven to get physically healthy, that I’ve been ignoring the other areas of health I want to focus on. The thing that’s been bothering me for the past few weeks is that I feel like I’ve failed because I haven’t been working on those other goals. Got a lot of self-talk going on in my head lately. The devil side keeps saying how bad I am and what a failure I’m going to be because I can’t even accomplish the goals I’ve set for myself. “Bad Pam!” But the angel side reassures me that I’m doing good and how successful I’ve been so far and reminds me of what great things I have in store for myself. “Go Pam!”

So where do I go from here?

Well, I’m at the 6-month mark and I really want to deal with the rest of these goals in the next 6 months. There are 6 remaining goals to tackle. So I will focus on one single goal for each of the next six months. Each new goal will be added on top of the heap – meaning just because the month changes doesn’t mean I’ll abandon the goal from last month, I’ll continue working on each as I go along, just add a new task each month. So here’s my schedule:

• May 13- June 13 Spiritual Health
• June 13- July 13 Financial Health
• July 13- August 13 Emotional Health
• September 13- October 13 Relationship Health
• October 13- November 13 Intellectual Health

November 13th will bring me full circle to my 1 year surgery anniversary. So I’m pushing back the devil and listening to the angel.

I can accomplish my goals.
I will succeed!
I am brave enough.
I am stronger than myself!

~Pam

Is my nutritionist full or crap or is it me?

I posted this on the OH Forums and got a ton of responses. If you'd like to check out the discussion thread, here's the link. --- So I had my 6 month follow up appointment at the surgeon’s office yesterday and met with the nutritionist. I’m so frustrated today because she seriously doesn’t make any sense to me and when I ask for clarification she just brushes me off like I’m some stupid fat person who doesn’t know about nutrition or understand what my rules are. I’m hoping ya’ll can shed some light… First off – she never asked me what I was eating, what a typical meal plan is for me and she didn’t want to view my food journal. In fact, I was the one who brought up the topic of how many calories I’m eating, how many grams of protein and such. I told her that I’m getting in about 90-100g of protein with about 800-900 calories per day with 3 meals, 1 snack and 1 protein shake per day. I told her I’m drinking 1 protein shake per day and getting the rest from food. Here’s what she told me: She said: I should continue to follow the eating schedule they gave us right after surgery that shows we should eat 3 meals and drink 3 protein shakes between meals as a snack and we need to get 60-80g protein per day. She didn’t care how many calories we eat and wanted us to focus only on portion size. I asked for clarification: If I increase my protein shakes to 3 per day and still eat my 3 meals, then I’d be getting about 150g protein per day – is that what she wanted me to do? She said: You shouldn’t be eating that much protein at the beginning of the day all at once. You have to spread it out throughout the day. (This is when I sit there with my mouth hanging open not sure I heard her right… when did I say I ate 150g of protein for breakfast?) I asked again for clarification: Should I just drink a half a protein shake at a time so I’m not getting 30 grams at once? And what if I’m eating about 20grams of protein at each meal? Should I be eating less than that? She said: Just make sure you’re following the schedule of 3 meals and 3 protein shakes per day and don’t eat it all at the beginning of the day, spread it out from morning until bedtime. I gave up at this point. Obviously she wasn’t listening to me and I had no clue how to get a straight answer out of her. So that was the end of the discussion about my nutrition. At this point I plan to stick with my current eating plan. 3 meals, 1 food snack and 1 protein shake. Because doing it her way just seems way off base. Or maybe I'm the one who is way off base??? Is she really that full of crap and oblivious to reality? Or am I imagining this whole thing and I’m more dense than I realized? ~Pam

6 Month Lab Results

I just got a copy of my labwork results that I'll go over with my PCP and surgeon/nutritionist later this week at my doctor appointments. But, of course, I keep track of my own lab results in a spreadsheet so I can see for myself how things are trending. It's good to see all my results together in one place so I can compare the current labwork with past results and see if there are any trends I need to pay attention to.

So here are the highlights:

Vitamin D --- at 3 months I was deficient so my PCP put me on a mega-dose of Vitamin D (50,000IU) once per week. It seems to have done the trick because now I'm back into the normal range. It's still on the low side of normal so we'll see if he wants me to continue the mega-dose for a little while longer of if it's high enough to be able to keep it regulated at this point .

Vitamin B12 --- I have a reading of 894. It's at the high end of the normal range, but I am a bit worried about this. Here's why:

6 week B12 -- over 2000 (taking 1 pill per day)

3 month B12 -- 1098 (taking 1 pill per day except for the 3 weeks before these labs were drawn)

6 month B12 -- 894 (taking 1 pill 3 times per week only)

So looking at this 6 month report only, it might seem that my B12 levels are fine. But when you see the major downward trend in the readings over the past few months it's cause for alarm. I will most likely be increasing my current 3x/week dose to either every day or maybe 5x/week. I'll consult my doctor to get his opinion before I do anything though.

Cholesterol -- My total cholesterol is 135. That's down from 170 before surgery. WooHoo! Good job Pam! My HDL needs to be bumped up a bit though. It's at 40 and that's the low end of the scale -- this is the good cholesterol that increases with good diet and exercise.

Iron -- It just keeps going up and up. Last lab report was at 85, now I'm at 91. I'm not taking any additional iron supplements, just what's in my multi-vitamin. So I'm glad this is staying steady and I don't need to add extra pills. So many people have iron issues after WLS, glad I don't seem to be one of them.

So far so good, huh? I feel like I'm track with everything and I'm glad my Vitamin D is back up again. I'm sure it'll just continue to get better since I'll be out in the sunshine more often as the Crim Training intensifies.

More about my 6-month milestone later. Still gathering my thoughts on my progress.

~Pam

How Much Protein?

After WLS we are instructed to follow a high-protein, low-carb, good-fat diet. We're given a range of 60g to 80g of protein intake per day. But how did they come up with that number and is it right for every person?

And most importantly... what happens if we eat too much protein?

Let's so some digging into the protein needs of both "Normies" and "Posties". (Normal digestive folks and post-op WLS folks.) Obviously a Postie will need extra protein to compensate for the rapid weight loss and malabsorption of food and nutrients in an altered digestive system.

Here are the various recommendations for protein intake from health organizations around the world. (Calculations are based on *MY* ideal weight of 135.)

U.S. RDA - Recommended Daily Allowance (same as UK's RDA)

.8g of protein per 1kg of ideal body weight per day

(Equal to 49g protein intake)

World Health Organization (WHO)

.45g or protein per 1kg of ideal body weight per day

(Equal to 24g protein intake)

National Academies' Institue of Medicine

10% to 35%* of 2000-calorie/day diet should come from protein

(Equal to 50g to 175g protein intake)

*35% as the upper limit is currently being challenged by other organizations

Typical WLS Program Recommendation

20% to 35% of 1,200-calorie/day diet should come from protein

(Equal to 60g to 105g protein intake)

Can I eat too much protein?

Yes! And the consequences are not pretty, either. Here's a few things to remember:

• Protein sources have a high nitrogen level. Nitrogen is broken down in the liver and a biproduct of that process is is ammonia. Ammonia is poisonous and can be harmful to cells in the body.


• Stress on the kidneys can occur when the body has to process more than 2g of protein per kg of ideal body weight. (Which translates to 122g for my body.)


• High protein levels can decrease Vitamin B6 levels and cause deficiency.


• Increased calcium excretion has been associated with high intakes of protein from animal sources - leading to osteoporosis.


• Excess protein is converted to blood glucose in the body. Excess blood glucose is stored as fat. (Remember that the body also gets blood glucose from any carbs we eat, which is plenty of fuel for the body.)

But what about all the extra exercise I'm doing?
Studies have shown that professional athletes who do extreme strength training need only about a 50% increase in their protein intake. So for a 150lb man who is an avid body builder his normal need would be 54g of protein intake per day. Increase that by 50% and he'd only need 81g of protein.

Yeah, yeah, yeah.... that's not what THEY will tell you or what they even want to hear. They will say they need "1g of protein pre pound of current body weight." But I ask them to please check out that list I just wrote above about the risk factors for taking in excess protein. I really don't want to enter myself into that huge fight... so that's all I'm saying on that topic. LOL!

So there you go.... more information about protein then you ever wanted to know.

~Pam

A solution to mindless eating

Last night I found myself with the bag of mini caramel rice cakes. Suddenly I realized I'd eaten too many and was doing so mindlessly. I closed up the bag and put it down. When I got up from my chair and saw the bag sitting there, I realized I couldn't be trusted with those stupid mini caramel rice cakes in the house. I took the bag directly to the kitchen and dump it out into the trash. Then, just for visual effect I checked the fridge for something that needed to be thrown away and dumped it on top of those lovely mini caramel rice cakes. Yuck! No more mindlessly eating mini caramel rice cakes for me! ~Pam

I have a lot to say....

.... but can't seem to get my thoughts organized this week. I'm coming up on my 6-month mark and doing great so far! But I've been in a reflective mood lately and feel like I need to get my thoughts down on paper before my head explodes. ~Pam

Where are Nutrients Absorbed?

This diagram is from a medical nutrition textbook. You'll see the various sections of the digestive track have specifically assigned absorption points for micro-nutrients - vitamins and minerals. I've added the notations about the standard lengths of each section of your small and large intestine so you can calculate how much of your intestines have been bypassed based on your own surgical report (from the doctor). I've shaded a section that represents 100-150cm bypass, which is the standard length for most Roux-en-Y surgeries performed today. 


Any nutrient that falls within the shaded area of bypass will no longer be absorbed from the food you eat. Those absorption points are designed to grab nutrients from food as the food passes by - but if the food never enters that area again, no nutrients can be absorbed. This is why we must take supplements for the rest of our lives. 

Food for Today

Had a great support group meeting tonight. Met some new people and learned more about friends I already had. Food today was good.... Commute -- strawberry, diet V8 splash & vanilla protein smoothie Breakfast -- yogurt w/ granola Lunch -- part of a south beach frozen dinner thingie (turkey something or other) Snack -- 2 cheesesticks (knew it'd be a late dinner) Dinner -- tortilla pizza (turkey pepperoni, mushrooms and tomatoes) There are grapes in the fridge that seem to be calling my name. We'll see if I answer the call. Calories: 802 Protein: 91g Fiber: 14g Water: done Vitamns: done Exercise: skipped tonight for the meeting instead