18 Month Post-Op Appointment

Yesterday was my 18 month anniversary. I had an appointment at the bariatric clinic and met with the PA and Nutritionist. There are changes on the horizon and I've still not fully digested everything that was talked about yesterday.

LABS
The PA said that for an 18-month patient that my labs are outstanding! Yeah me! However, there were a few key areas she had concerns about. Enough concern that she's requested a re-draw of labs in 4 weeks after some changes. Her biggest concern was my

Prealbumin - it's too low even though it is within the normal range, she wants it higher. (Result is 24 on a scale of 18-38.) This is a measure of my protein intake and how the body is utilizing it. I already get 120g protein per day. I'm bumping that up for the next 4 weeks to see what that does. (Below I talk about the increase in protein shakes during the day... the lab result is the reason I'm going along with it.)

She also didn't like my Ferritin number. She's having me stop my iron supplements to see if the iron is screwing with the ferritin. This really doesn't make logical sense to me, but I'll do it and see what the results say next month.

I personally am concerned about my Vitamin D. But the response I got was that results in the 30's was typical of WLS patients and they were fine with that number. But from my own research I know that anything under 50 indicates that my body is simply using the supply as fast as I'm taking supplements. It's only after I maintain a level of 50 will the body actually start to store Vitamin D for use later. I'm doing the 50k, once per day regimine for 30 days, then backing off ... I'll have a redraw for Vitamin D next month too. We'll see.

Copper / Zinc interaction. I'm still reseaching this because it doesn't really make sense to me - but the Nut said that I need to keep my zinc and copper doses far apart from each other. So I'm now taking zinc in the morning, copper at night. Somehow they interfer with each other, but I need to understand this better before I'm convinced its true.

EDITED: Yep, copper and zinc don't like each other - so I'll separate the doses as recommended.

FOOD
This is where the big changes are happening. I know I've posted about my nutritionist before and I'm not always thrilled with her advice. In fact, the advice I got yesterday is the exact same advice I've gotten since I was 2 months post-op. As you all know I've been struggling with really, really slow weight loss. Since August last year I've lost 15 pounds and 5 of those pounds came off in the past 4 weeks. So in an attempt to figure out how to make me lose weight faster and have a "more predictable" amount of loss, the Nut has suggested going back to the same plan I was suppose to be following when I was 2 months post-op. Here's the plan:

• 8am - breakfast
• 2-4oz dense protein
• 1/4-1/2 c. veggie/fruit
• (suggested meal: 1-2 egg veggie/cheese omelet and 1 slice melba toast)
• 9am -12:30pm - fluid time
• 16oz water
• 8oz protein drink
• 1pm - lunch
• 2-4oz dense protein
• 1/4-1/2 c. veggie/fruit
• If not full... 1 additional side item (veggie/fruit/starch)
• (suggested meal: wrap sandwich w/ 1oz turkey, 1oz cheese, lettuce on 1/2 tortilla)
• 2pm - 5:30pm -- fluid time
• 16oz water
• 8oz protein shake
• 6pm - dinner
• 2-4oz dense protein
• 1/4-1/2 c. veggie/fruit
• If not full... 1 additional side item (veggie/fruit/starch)
• (suggested meal: 1-3oz grilled chicken, 1/4-1/2c steamed broccoli, 1/4-1/2c cantaloupe)
• 7pm - bedtime - fluid time
• 12oz water
• 8oz protein shake
• 2 popsicles

Ok, so my Nut wants me to change things up and give a new eating plan a try for two weeks. (EDITED: I'm re-thinking this... might not try it, we'll see.)  

She's banned yogurt and any slider foods (even though I didn't complain about getting hungry after a yogurt meal.) I'm not allowed food-based snacks anymore, she wants all snacks to be a protein shake instead. She said some days I might only get 600 calories, but some days might be 1100... and that was just fine, but to worry about portion size rather than calories or nutrient grams. (Even though I don't believe I have any issues with staying within my portion size requirements and if I don't eat enough calories, I know my body revolts and I have a tendency to binge on crap.)

At one point she asked me: "Can you eat 2-ounces of dense protein AND 1/2 cup of vegetables in the same meal?" .... as if my pouch was still 1-ounce in size and that eating 4-ounces at a single meal might not be possible for someone who is 18 months post-op. I was flabergasted, of course, because the amount of food I eat now (8-10 ounces/meal) is expected and typical of someone at my stage. How can she not know that?

EXERCISE 
So the Nutritionist also said my exercise routine wasn't anything out of the ordinary and simply met the minimum recommendations. I am now doing 6 days, 60 minutes per day. Apparently the minimum recommendation is 4-6 days per week, 30-60 minutes each. So even if you're at the top end of the scale, it's still only the minimum apparently. "When I start doing more," then I will need to adjust my eating to accomodate the added exercise. (Meaning when my half-marathon training keeps me on the road for more than 60 minutes per session.) Life is not "The Biggest Loser." Normal people don't have 4 or 5 hours every day to spend in the gym. It's very difficult for me to understand that 6 hours of exercise a week -- walking/running 25-30 miles a week -- is not enough to be more than the minimum expectations.



What's Next?
I've got some thinking to do. Planning and rearranging. And I need to figure out how to have peace with some of the stuff the Nut has told me and advised me to do. I need to do some research on the vitamin and mineral stuff to see how true the information is that I've been given. I need to come up with a food plan that I can live with that won't make me feel like I'm on a diet. Thankfully I have yoga class this afternoon. At least that will give me the chance to focus on my center... relax a bit and let all these issue melt away for an hour.

~Pam