Enjoying Summer as a WLS Patient

For the past 12 years, or so, I have been part of the planning (and graphic design) of a golf outing that happens in June every year. It's turned into a huge event that takes a lot of work. Because of the amount of work that I put into being a part of that planning committee, I typically lose out on the first part of my summer. June is shot and summer begins in July. At least the "relax at the beach or go on vacation" part of summer. 

So here it is the July 4th weekend and I'm finally feeling like summer has arrived for me. Lately I've been thinking about how my life is different after WLS compared to how it is now. 

I'm usually stuck being the camera, so having photos of me at the golf outing is not normal.
Here I am in 2006, a year before my surgery and in 2011, four years after my WLS. 

Before my weight loss, the golf outing was a major ordeal. A 14-16 hour day on my feet, in the hot sun, running around handling committee details where I was needed -- it took me days to recover and get my energy back. This year's outing was the same grueling routine but I was back to normal the day after the outing. Of course, the 60-70 hour workweeks leading up to the outing itself contributes to the overall exhaustion, so it's not just a one day thing. 

But it's officially my summer now and I'm in full blown SUMMER mode! I have a goal of being at the beach or in the water as much as possible. In fact, this weekend I'll be joining my family at the campground where apparently they are planning to go tubing down the river. I went kayaking last summer and I am itching to go again. My favorite beaches are calling me, as usual. And I'd like to take a couple long weekend mini-vacations to the west side of Michigan to enjoy the shoreline there. 

Since losing 100 pounds of excess weight, I'm more active, obviously. But I'm also more open minded about adventures and trying new things. I have more friends and enjoy doing things with them that I wouldn't have done 6 summers ago. But, of course, I didn't need to wait until I lost 100 pounds to do all this. I was moderately active and outgoing before my surgery... it's just that now I'm more apt to jump in the car and go do whatever I want without worrying about how much energy it would take to accomplish. 

So I'm off to enjoy a beautiful holiday weekend in the sun. What's your favorite thing to do since you had WLS? 

~Pam

The Scale Game Update

I'm here for a report on the scale situation I told you about a month ago during my 5 year post-op update. I am working to drop the extra 5 pounds that made an unwelcome visit.

Here's what I've done so far:

1. Began tracking all food eaten and logging all calories. 
2. Began wearing my Body Media Fit again, renewed my online subscription and religiously ran my reports to track the number of calories I burned.
3. Increased my consciousness of protein intake, carb moderation and a focus on healthy fats. 

I did #1 and #2 for two weeks so I could get a clear picture of where I was starting. I wanted to see if I was on track with what I believed was happening or if I'd learn something new. Let me explain...

Calories In:

On the calorie intake side... I discovered two main things: 1) I was too carby in my nutrition balance with an average of 50% carbs, 25% protein. I quickly corrected that with a few minor tweaks. And 2) I wasn't eating enough calories and was averaging around 1,000-1,200 calories per day. Once I discovered I was low on calories, I started adding a snack as often as I could remember (yes, I still forget to eat even after 5 years). 

Calories Out:

In the past several months I've been working a lot -- which means sitting at a desk. I've also been going to school 3/4-time -- more sitting at a desk. I've also been carrying a fair amount of stress with an overloaded task list at work and some side design business. Plus, I have not been sleeping as much as I should be. So I was expecting the BodyMedia Fit to tell me that my calorie-burn figures were down from the average I established back in 2010 when I wore the armband for a year. 

But my assumptions were wrong. I am still burning an average of 2,300-2,500 calories per day on a fairly sedentary day with a slight boost on days when I was "up and about" more often (shopping, running errands, housework, etc.). I have not been doing any type of formal exercise program, so I don't have a recording of an exercise day. This calorie-burn range was surprising to me because it's in line with where I was during a fairly active time in my life when I had a formal exercise program in place.

SIDE NOTE: Remember back when I bought my BodyMedia Fit armband and paid around $260 for the whole system? Well I just checked Amazon and you can buy one for $99!!

Calorie Deficit:

So if you've done the math you'll see that the calorie deficit is around 1,000 to 1,400 per day. That deficit is WAY too high and I had probably thrown my body into a semi-starvation mode where it was hoarding energy. I've probably been sitting on this type of deficit for about 6 months or more, so it was inevitable that I'd be in danger of weight gain because my body was in a survival mode. 

(There's a lot of science behind all this and I won't get into all of it here. But just realize that a "too-large-deficit" does not apply to new weight loss surgery patients, so don't freak out. This mostly applies to long term post-op and regular-gutted people who have never had WLS.)

The Strategy:

I increased my calories to be a solid 1,400-1,600 per day so that my calorie deficit sits around 750-900 calories per day. I focused on This seems to be my body's comfort zone for maintaining my weight (yes, I know I'm an anomaly and normal people would be losing weight at this range, but my body maintains, so that's what I'm doing for now).  So that's what I did for about 2 weeks and the scale showed some movement and dropped 2 pounds -- so I was well on my way to losing those pesky 5 pounds. 

The Wrench in the Gears:

I've said it before, but I'll remind you again: "I'm a stress-non-eater." Which means when I'm under an extreme amount of stress, I lose my appetite and any desire to eat. In fact, when I do attempt to eat, my stomach seems to reject food and I get sick. (Anger is my emotional eating trigger, so that's a whole other story.) A couple weeks ago I suddenly came under a big load of emotional stress in my personal life that I'm still struggling to get "fixed" but unfortunately most of the fixing is out of my control (and you all know how much of a control freak I am!). I'm purposefully being vague because I don't plan to share the details, sorry.

So yep, you guessed it.... I'm having problems with the calorie deficit thing again. And the scale is back to that 5 pound mark again. I'm highly conscious of the fact that I'm not eating properly right now and I'm making an effort to get myself back on track. Yesterday I ate three complete meals and today I've done fairly well too. It probably doesn't hurt that I shared this situation with my good friend Nikki and she basically kicked my butt and put me on her "list." 

Still Working:

I'll continue to work hard in dropping these extra 5 pounds until they are solidly gone ... and then work on the other 10 pounds that'll drop me to the low end of my comfort zone weight. I'll keep you posted on the progress. 

~Pam

The Bariatric Life is Forever

Yes, the bariatric life is forever. We all knew that going into surgery and we all signed on the dotted line, agreeing that we were committed to following the rules and changing our lifestyles forever --- whatever it takes to get healthy and be able to finally live our lives. In the first couple years after surgery this is easy. In fact, we're all too thrilled to follow rules and change whatever the WLS teams tells us to change because we're seeing dramatic change in the scale, in how we feel and in our other people treat us. But once that shiny new toy starts to lose a bit of its shine, we are faced with the reality that "this is my life."

This isn't a bad thing. In fact, this is a positive aspect of WLS if you let it be. Let me explain where I'm coming from on this whole deep-thought blog post.

Today is an officially scheduled "day of reflection" for me. My longtime readers know that every August I set aside one day to drive back to the beach were I first made the decision to have surgery back on August 6, 2006. In a couple hours I'll be heading out on my annual pilgrimage. I take along my journal, a pen and my beach chair ... and not much else. It's a time for me to reflect on the past year of my life, the goals I set and how I'm doing at achieving them and what adjustments I need to make in my journey to work toward the new goals I want to accomplish. It's also a time for me to reflect on my bariatric life and make sure that I really am on track and doing everything I should be doing for this lifestyle I've chosen.

In the past few weeks I've been contemplating the notion that "the bariatric life is forever." I remember back before I had surgery that when I would start a new diet I would do great for a little while ... but then when some special event came along or even just when I got tired of the diet, I could just "go off" the diet for a day or forever. If I wanted to indulge on a decadent dessert while out to dinner with friends and eat the entire thing all by myself, I could do it and then be back on my diet the next day - no big deal. If I wanted to start the cabbage soup diet and eat broth and cabbage for every meal, every day for weeks on end - no big deal, my body would figure out a way to get what it needed despite my stupid food choices and I wouldn't get sick or malnourished.

But that's not how it works anymore, is it? I can't just turn off my surgery if I have a big family picnic to attend and want to indulge in Aunt Linda's grape-and-marshmallow salad (OMG!) or decide to skip the protein in favor of ice cream or "not bother" with my water and vitamin routine or decide I don't have time for exercise right now, so I won't find the time. No. I don't have that luxury anymore. None of us do. The rearranging we asked our surgeons to perform in that operating table is a permanent and now a part of who and what we are forever. This is how weight loss surgery is suppose to work. It's a good thing. It helps us to enforce those lifestyle changes we signed up for originally.

http://pamtremble.blogspot.com/2006/08/day-at-beach.html

In the past year my day-to-day life has changed a lot. I'm in the midst of a career change with a lot of changing duties at work, I'm about to graduate with a degree I've worked very hard for, I've started a new graphic design business with three other very cool people and still, I remain a WLS patient. If my schedule gets too hectic, the surgery doesn't care, I still need to be a WLS patient and follow the rules and live the changes I signed up for in my life.

Yesterday I put in a nearly 22-hour day. Yikes! I was out of bed at 5:00 a.m. to get ready for work. The day was packed with knocking a million things off my task list, then I attended a seminar in the evening and when I got home I spent 4 hours doing school work and finally got to bed around 2:30 a.m.

Was I a good little WLS patient yesterday? Nope. Not at all. I had one dose of vitamins in the morning and forgot the rest. I drank about 40 ounces of water (along with a 32oz diet coke and about 40oz of coffee). I missed breakfast because I forgot to eat and probably ended the day with an intake of 30g of protein.  I sat on my butt all day (at my desk, in a conference room or in the car) and didn't get any exercise in at all unless you count the number of times I ran to the bathroom because I drank too much frickin' coffee. I didn't get quality sleep and I didn't bother nourishing my spirit with time to relax or refresh.  Unfortunately, days like this, lately, aren't unusual with my unreal schedule right now.

Since today is my "day of reflection" and a time of "butt-kicking" --- I'm here to kick my own butt. I signed up for this surgery and the rules and the changes. So I need to do a better job of honoring my commitment.  A commitment to myself to live a healthier life and do what is right for my body.

I'm glad that WLS is a part of my everyday life and I'm reminded often that I'm not like everyone else. I'm glad that my surgery still works (my pouch reminds me of it's presence often). This Bariatric Life was the best decision I ever made for myself and I'm a better person for it. It's been five years since I made my decision to sign on the dotted line and I'm so excited to see what the next five years will bring.

~Pam

Chained to my Keyboard

I've been chained to my keyboard lately. But apparently I haven't been typing blog posts! My Spring term at college seriously kicked my butt (how many times have you heard that about other various terms at school?) and my annual involvement in the boss' golf outing as the resident graphic designer added to the butt kicking. Put in a month or two straight of 90+ hour weeks and you'd be ready for a break too. I've taken the past week as a chance to catch my breath, dig out my house of weeks of neglected housework and tried to do some sun-worshipping and beach-sitting.

And now I'm beginning the Summer term at school and looking at my schedule is making me shudder. 15 credit hours? What was I thinking?! Wish me luck as I try to test out of a couple of those classes. If I survive this summer's class load... I will be an official college graduate on September 15, 2011.

For the past several months my life has revolved around becoming a graphic designer. Many of my new tasks at work have a lot to do with designing and school obviously is all about design. Plus I'm working on a new group project venture that is throwing me into the deep end of the graphic design swimming pool.

It's interesting how WLS is your whole life in the first couple of years after we have surgery. We can't seem to imagine a life without having everything revolve around being healthy and losing weight and living this new life. But eventually there's a switch that gets flipped and you find yourself smack dab in the middle of "real life" again and WLS is no longer the center of your universe. Right now my world seems to be revolving around finishing school and doing everything I can to be the best graphic designer I can be so I'm ready for a career change in the next year or less. It's exciting. It's exhausting. But mostly, it's exciting.

So a couple things I'm sure you have been wondering about regarding WLS ...

• No, the book isn't done yet. I estimate I have about another 12 to 18 hours of solid work to put into it. It's 100% written, but the edits need to be applied and the bibliography needs to be transcribed from a pile of notes and some charts/tables need to be created within a couple chapters. At this point I see no clear light at the end of the tunnel. This project has officially taken me 6 months longer than I thought it would and I'm officially tired of not having it done. I promise it'll be done eventually, I just don't have a publication date for it yet. 
• Even with all the stress and hectic schedules going on I have maintained my weight (oooo... big surprise, huh?). Poor eating or excellent eating doesn't seem to make the scale move. Unfortunately the eating hasn't always been perfect, but overall it hasn't been too bad. 
• I could definitely do a better job of taking all the doses of my vitamins and drinking more water than coffee. 
• My reactive hypoglycemia is pissing me off right now. I had a pretty bad blood glucose crash about a week ago (that scared me a lot since it happened in the middle of the night) and my body still hasn't recovered so I keep having mini crashes for no logical reason. So I'm dealing with some emotions I don't like very much right now regarding the RH. Hope it passes soon. 

I could promise to do a better job of updating the blog but I know that the next couple months are going to be hectic --- more hectic than normal, I think. So all I can do is promise to do my best to keep ya'll updated on what's going on in my WLS world. Connect with me on Facebook and Twitter to hear my ramblings there too. 

Talk to you soon!

~Pam

Gastric bypass and alcohol article

I found this article today in the Los Angeles Times online and wanted to make sure you saw it too. The information is amazing and important for all bariatric patients to know. This study used the same group of patients to measure breath alcohol content -- from pre-op through six months post-op. At 3 months out, alcohol content is double than pre-op. But at 6 months out, that number triples. But the "feeling" of being drunk in that same time frame seemed to drop among the patients studied. 

Read this carefully and follow the links in the article. Then share this information with your WLS friends. 

---

Gastric bypass and alcohol: mix with caution

Melissa Healy, Los Angeles Times

March 10, 2011, 4:35 p.m.

Alcohol can be a minefield for anyone trying to lose weight. But for bariatric surgery patients, drinking can become increasingly problematic, a new study has found.

Changes in the way the body absorbs and metabolizes alcohol after gastric bypass mean these patients need less alcohol to register intoxication on a breathalyzer, says a study published recently in the Journal of the American College of Surgeons. After drinking a single 5-ounce glass of red wine before their surgery, the study's 19 subjects had an average breath alcohol content of .024% -- well below the level at which most states consider a driver intoxicated.

Three months after surgery, the same glass of red wine resulted in an average breath alcohol content of .059%, and six months post-surgery, the group averaged .088%, which surpasses the .08% widely recognized as the legal threshold for intoxication.

It also took longer for patients to return to complete sobriety in the wake of that drink: Pre-operation, it took subjects 49 minutes to return to complete sobriety after a glass of wine; three months after the operation, it took  61 minutes for that to happen, and six months after surgery, it took 88 minutes.

The study -- the first to compare the same group of subjects pre- and post-surgery -- found a potentially insidious change, as well, in how patients experienced alcohol consumption. Before surgery, 58% reported a feeling of euphoria after a glass of wine -- a number that shot up to 88% at three months post-surgery, and then dropped to 50% at six months on. Sensations of dizziness and warmth -- rare before surgery -- were commonly reported six months after. At that point, one in four subjects also reported experiencing double-vision after drinking a glass of wine--a sensation none reported before. 

The researchers, from Stanford University School of Medicine, expressed concern that bariatric surgery patients' different experience of alcohol consumption might result in confusing signals. "Patients feel different effects of alcohol intoxication postoperatively, and this can lead to over-indulgence to achieve the same symptoms of intoxication that they experienced before surgery," the study's authors wrote.

There are lots of reason to forgo alcohol in the wake of a gastric bypass the authors warned: Bariatric patients that have unresolved binge-eating issues, in particular, are at risk of "transferring" their food addiction to other substances, including alcohol. And even those without such issues raise their risk of weight regain after surgery, and of deficiencies in thiamine (vitamin B-1).

After obesity surgery, patients should never drink and drive, wrote the authors. They should also limit their alcohol consumption to a maximum of 1 unit of alcohol (a 5-ounce glass of wine, 12-ounce beer, or 2-ounce serving of distilled alcohol) in any two-hour period.

Copyright © 2011, Los Angeles Times

Alcohol and Gastric Bypass

The information below is a repost from two outstanding resources in the WLS world. The words below are from Beth - Melting Mama - as she wrote on her blog a couple weeks ago and again on Obesity Help the other day. I actually missed the original discussion thread but found the reposting on Rob's blog - Former Fat Dudes - when he published it here.

Drinking alcohol after gastric bypass surgery is very serious and being educated about the biological, medical and emotional risks is essential. I love that this heavy topic with very deep scientific information is still so "Melting Mama" in the way she presents it. Having met Beth in person, I can tell you that she speaks the same way she writes ... with passion!

This post is very long with many outbound links to medical reviews, articles and research. But please read it all.

Melting Mama Wrote:

A few month gastric bypass post op writes 

“Can I have a glass or two of wine? I used to have a few glasses when I had a drink, would it be okay to just have one, or two now?”

No. 

(Bold for impact here. You DO NOT NEED ALCOHOL AT TWO MONTHS POST GASTRIC BYPASS.)

I won’t pussy foot around and say, “You’re going to do what you want, but always listen to your surgeon! How about a sugar free cocktail?”

Can I drink alcohol after weight loss surgery? – Dr. Garth Davis

We recommend waiting one year after surgery before consuming alcohol. Then, with your surgeon’s approval, you can enjoy a glass of wine or a small cocktail. Remember to be careful because even the smallest amounts of alcohol will affect you differently after obesity surgery.

That is obviously not working for us.

*Disclaimer - “But, MM! You’ve been photographed with The Drink! How dare you preach about the drink! I’m going to drink it anyway! Nanananana!” Yes. I have. There are lots of photos, mostly Facebook-style, one time taking one sip and having a seizure! The others? Totally product placement. I did not drink. Do as you please, but here is my truth. I am nearly seven years post gastric bypass, and I choose to have a sip or three on social occasions. This includes: weddings, uh, once a year, and perhaps a drink at an event. I typically regret imbibing even a sip or three quite immediately. But, just like food: I have selective memory. I get the “just a taste won’t make me sick” idea and it fails me, my gut, my brain. Are we clear? And, to be clear as mud, the more I learn, the more I know, and opinions change. Also, I will sip. I am SEVEN YEARS post gastric bypass. 

Absurdity, n.: A statement or belief manifestly inconsistent with one’s own opinion. (Ambrose Bierce)

“Why can’t I have a drink, MM?”

Because I said so.

Imagine if curing addiction were that easy? I’d like to see it done this way -

Early post op, you absolutely, positively do not need alcohol coursing through your new, altered guts. There is NO excuse for it. Zero. None. Zip. NADA. (I left out Zilch, ’cause that’s a product for mixing sugar-free alcoholic drinks.)

This should be common sense.

You just had your intestines surgically re-arranged. You have a fresh stomach pouch that needs to heal. Do you really want to send alcohol through your raw piping? You wouldn’t send certain foods through there, why would you consider something so caustic as alcohol?

Seriously, “OMG! I totally swallowed a piece of gum, will I die?” But, “Tequila is low carb!”

The months pass, and you’re no longer a newbie, and make you feel like you can handle a little drinkie-poo.

“I am an adult! I deserve it! Damn it I am going to drink if I want to, I had this surgery to be normal!”

You might start researching drinks, you might hit up the Google for “sugar-free alcoholic drinks” wondering what’s good.

You may ask your pouched peers when they had their first drink, and what it was, and did they “get sick?” You might consider, “What if it makes me dump? What should I drink so I won’t dump? How much should I have?” completely ignoring the actual nutrition of most alcoholic beverages.

You decide it’s time.

Because, it’s “Christmas! And, I just saw this great recipe/idea on a WLS website so it must be okay for Bariatric patients.”

This is where MM has the DUH realization (again) that people do take advice from the internet. BLINDLY. EVEN. “So and so said it’s good for me, so I will do it!” It doesn’t even MATTER if the information sucks.

Please do not take advice or suggestions from non-professionals on the internet. We are typically only patients, peers, bloggers or sales people with zero medical expertise. You are a big girl, you can make your own decisions. People on the internet with big mouths can only offer suggestions, but you must make solid, rational decisions based on what is GOOD FOR YOU. What is good for you must include input from your doctors, nutritionists, and your COMMON SENSE.

You’re feeling a bit powerful, ’cause you have a TOOL. And since you had WLS, you HAVE POWERTOOLSMM! This means you are magically cured from any and all prior addictive personality traits! You may feel that you “never had a problem with food anyway,” so you will maintain FULL control of yourself when tempted. You might tell folks you were never an addict, and you were just an over-indulgent eater. Super.

Your pouch and you head to a holiday party and you are at least, partially successful in avoiding the 12 foot buffet table filled with pastries, and then you see the libations.

You are socializing and talking, and fill your little cup up with some wine, maybe even half of what you might have drank pre-op, you sip. The first sip hits you like a bomb, it burns all the way down into your pouch. You feel like you swallowed a Brillo Pad, if even for a second.

Then, maybe your ears get hot, maybe your face flushes. In the average non-WLS person, alcohol takes ONE MINUTE to hit the brain. You have a straight shot from MOUTH > SMALL INTESTINE, guess how fast it hits your brain?

INSTANEOUSLY.

Whee. “I think I already feel it. Holy shit, two sips and the room feels a little, whoa….”

“When consumed by the gastric bypass patient, alcohol readily passes through the stomach pouch largely unimpeded and into the jejunum where, due to its large surface area, it is rapidly absorbed. Research has shown that gastric bypass patients—even those that are three or more years postoperative—have a more rapid absorption of alcohol and a peak in blood alcohol content that is considerably higher than that of someone with normal gastrointestinal anatomy. (Bariatric Times)

You might “like” this. This might be tipsy, tipsy might be good. It might feel really good.

For some people it doesn’t feel good at all, and they are quite turned off by alcohol post WLS. (Ironically, this feeling now bothers me, because it feels like an oncoming seizure.)

Perhaps you enjoy it and soon, you’ve finished that glass and “Maybe just a little more?”

The buzz you had a short time ago, feels like it’s gone, even if the alcohol is still coursing through your blood. You are still drunk. You might drink more to reach tipsy again.

Patients should be warned about drinking alcohol too quickly because even relatively small amounts of alcohol, such as two small glasses of wine (0.3 g kg−1) might produce unexpectedly high BAC shortly after the end of drinking. Also when other surgical procedures are performed on the gut such as gastric resection and gastrectomy, a more rapid absorption of ethanol can be expected. The present experiment with alcohol as a model substance might have implications for the absorption and pharmacological effects of other drugs or when prescription drugs are taken together with alcohol. (Wiley Online Library)

This effect of alcohol on our post bypass systems is dangerous. We may not have ANY IDEA how DRUNK WE ARE, until we are passed out, in a coma, or driving home and crashing.

“You’re too dramatic, Beth, that won’t happen to me.”

Sure it won’t.

We aren’t talking about binge drinking here (although it happens), this can occur with relatively SMALL amounts of alcohol. I am pointing to the casual drink or two that hits too hard. I could potentally kill myself with one martini. There is NO WAY that I can drink hard liquor in one sitting. MM + Martini = Fun Down The Escalator! BOOM!

...Gastric bypass surgery may enhance alcohol sensitivity by altering the rate that alcohol is absorbed or metabolized. Such changes in alcohol sensitivity and clearance significantly increase the risk for alcohol toxicity and its deleterious consequences (i.e., liver disease, cardiomyopathy, loss of muscle mass and strength, neuromuscular and cognitive defects, gastritis, pancreatitis, acid reflux, and specific vitamin deficiencies) (Bariatric Times)

You’ve stopped drinking, either because you’re toasted, or you are AWARE you have had enough and made a choice to stop. Make sure to give a warm welcome to hypoglycemia!

Alcohol use may also adversely affect the health of the bariatric patient by increasing the risk for hypoglycemia and its potentially negative influence on cognitive function and neuromuscular control. (Bariatric Times)

Recognizing and treating hypoglycemia with a gastric bypass is hard enough, and it is a known side effect of the surgery. However, recognizing a low blood sugar and treating it effectively while you aren’t AWARE of it? That is “fun.”

Drinking, especially binge drinking, can cause hypoglycemia because your body’s breakdown of alcohol interferes with your liver’s efforts to raise blood glucose. Hypoglycemia caused by excessive drinking can be very serious and even fatal. (Islets of Hope)

Those of us with diagnosed reactive hypoglycemia post roux-en-y gastric bypass probably shouldn’t drink at all. The risk of dropping our glucose levels so low, and not being aware enough to fix it? Sure a couple glucose tabs and crackers will help you, but again, NOT IF YOU AREN’T AWAKE, dear.

Another problem with hypoglycemia due to the excessive consumption of alcohol? HYPOGLYCEMIA LOOKS LIKE DRUNK. I live with this, I know this.

Generally, symptoms of hypoglycemia include:

Mild Hypoglycemia

• Increased or sudden hunger
• Feeling shaky, dizzy or nervous
• Pounding heartbeat
• Drowsiness, feeling tired
• Sweating (cold and clammy)
• Numbness or tingling around the mouth
• Headache or stomachache

Moderate Hypoglycemia

• Any of the above mild symptoms, plus:
• Headache
• Personality change
• Irritability
• Confusion and/or difficulty concentrating
• Headache or stomachache
• Slurred or slow speech
• Poor coordination

Severe Hypoglycemia

• Any of the above mild or moderate symptoms, plus:
• Loss of consciousness
• Seizures and/or convulsions
• Death

You make it through the holiday season, and navigated your way through a few drinks, and you seem to be okay with handling yourself and alcohol. But, maybe you find a new craving for that “glass of wine with dinner,” and it becomes a pattern. Two or three nights a week, you’re having a glass of wine (other libation…) and soon you’re having it nightly.

Maybe then, you feel that a little “mommies’ sleeping pill” might help in addition to dinner, and you’re sipping wine to help you fall asleep. But, remember, you are still a gastric bypass patient, and maybe you feel normal, look normal.. but… this behavior may quickly NOT be normal. 

BIG RED FLASHING WARNING SIGNAL HERE.

Bariatric patients with pre-existing addictive behavior toward food could, with food restriction, transfer such addiction to alcohol. All of these observations point to the likelihood of alcohol use having a more negative influence on health status postoperatively than was previously recognized. (Bariatric Times)

Research is limited, but I implore you to ask around and find peers you can trust to discuss this issue with. Your friends are addicts. Old statistics, one via an old episode of Oprah stated 30% of us “find a new drug” post operatively, but I would bet my $15Kworkneededteeth that it is vastly understated.

Weighty Secrets -

I drink because it keeps me from eating. I look forward to eating and it has become the high point of my day. I know exactly how much to eat now before I get sick. I’m gaining weight and just keep telling myself that all I have to do is quit drinking to lose it. I'm lying to myself and I know it. Hate myself. Go figure. Life just sucks ass huh?

I would say that this issue, of alcoholism (and the whole myriad of addictions… drugs, shopping, gambling…etc.) in the post op community is not discussed, nor researched enough at this time.

“…lifetime rates of substance use disorders among candidates for bariatric surgery are substantial, but rates of current substance use disorders prior to surgery are low.” (American Journal of Psychiatry)

There isn’t much research to say, either, but what is seen in our communities is enough to warrant a larger scale look. For instance – studies show that WLS patients are less likely to die from the co-morbid diseases of obesity, BUT, have a higher rate of death from accidental deaths and suicide.

“Reports reveal that a substantial number of severely obese persons have unrecognized presurgical mood disorders or post-traumatic stress disorder or have been victims of childhood sexual abuse. Data on the association between presurgical psychological status and postsurgical outcome are limited. Some centers for bariatric surgery recommend that all patients undergo psychological evaluation and, if necessary, treatment before surgery and psychologically related surveillance postoperatively. Although research has shown an improved quality of life after gastric bypass surgery, certain unrecognized presurgical conditions may reappear after surgery. The results of our study suggest that further research is warranted to explore the optimal approach to evaluating candidates for surgery, including the possible need for psychological evaluation and psychiatric treatment before surgery, and aggressive follow-up after surgery. (NEJM)

Transfer addictions are real after weight loss surgery, and can stem from the innocent (Hello internet!) to illegal drugs.

What Causes Addiction Transfer and Cross Addiction?

Psychologists originally developed the phrase “addiction transfer” because of a trend they observed: Drug addicts and alcoholics in treatment recovered from an addiction to one form of drug only to swap it for another type of drug or other compulsive behavior. Because these patients still feel a void or haven’t fully addressed the underlying reasons for their addiction, they find new ways to escape or numb their emotions. For those who thought life would be perfect if only they could overcome an addiction, the reality sets in that life is still at times difficult, boring and hard to manage. 

Addiction transfer also has a neurological basis. Research suggests that the same biochemical processes are at work in multiple types of impulse-control disorders, such as compulsive eating, alcoholism, smoking, compulsive gambling and drug addiction. Each of these behaviors triggers the same reward sites in the brain, resulting in cravings that are difficult to resist.

Addiction is a brain disease, and the brain is immensely complex. “The brain may be the most difficult puzzle in the universe,” says Graham. “The brain is hard to study, and it gives up its secrets slowly. This is the main reason that neurology and psychiatry have not necessarily kept pace with the progress of other areas of medicine.” (Drug Addiction Center.com)

Everyone has an opinion on how much is too much alcohol after weight loss surgery. But, only you know what you’re really doing. All the explaining in the world does not discount the fact that alcohol is dangerous for you with your new anatomy. Trying to validate WHY you have to have it doesn’t change anything.

Ask yourself why you have to have alcohol. Do you really require a cocktail at dinner every single night — or to bed — and on the weekends — and? Are you prepared to pay the consequences of your actions? Are you aware that the consequences might involve you, blacked out, on the floor with no help? Yeah. That’s sexy. You did this for your health, right?

RESOURCES:

• Weighty Secrets - Addictions, Alcoholism
• Weighty Secrets - Video Posts from 20/20 Moms and Alcoholism
• Intervention - Amber, Eating Disorder and Alcoholism
• Is Alcoholics Anonymous for You? 12 Questions Only You Can Answer:Alcoholics Anonymous asks drinkers to honestly answer 12 questions about their drinking habits. If you answer “yes” to four or more questions, alcoholics recommend seeking help. 
• Rethinking Drinking is an outpost of the NIAAA where drinkers can assess their drinking habits and learn to spot warning signs.
• What’s Your Drinking Pattern? Find out how your drinking habits compare to those of other adults in the United States at the institute’s website.
• NIAAA’s Cocktail Content Calculator can help you keep track of how much alcohol is in your drink. How strong is your mixed drink or cocktail?

RESOURCES - GETTING HELP:
More than 1 million people submit to detox and rehab programs for alcohol addiction every year in this country.

• National Drug and Alcohol Treatment Referral Routing Service provides a toll-free telephone number, 1-800-662-HELP (4357), where you can find information on treatment options and facilities.
• For local information on treatment available in your city and state, check out the Substance Abuse Treatment Facility Locator through SAMSA.gov.

Reporting In

It's been one week since I confessed my bad behavior of not faithfully taking my vitamins. It's actually been two weeks since I've gotten myself back on track though (Vocabulary Lesson was the start of my recommitment). I'm just reporting in so that I'm accountable to you, my readers, as well as to myself.

Since December 7th I have taken nearly all of my vitamin and calcium doses. There was a couple days when I was short one of my calcium doses, but otherwise I've been on track with my vitamin routine each day. It's still a struggle and I still have to give myself a stern talking to sometimes - but it's becoming easier each day. I believe it will take another couple weeks of sticking to the routine before I feel fully comfortable in saying that I'm 100% back on track.

I'm actively using the alarm system from My Med Schedule and I'm getting text messages sent to my phone at my scheduled times throughout the day. It helps to remind me of my commitment.

What else do I need to do better on?

• Getting that final 20oz bottle of water into the end of my day (just grabbed a glass of water)
• Getting to bed earlier (said as I write this post at 11:35 p.m.)
• Eat more vegetables (do dill pickles count?)

Thanks for your support!

Pam

A 3 year battle with the scale

The photo I took on the morning I hit the
100-pounds-lost mark. August 19, 2008 - 10 months post-op.

Recently, on ObesityHelp.com, I was asked about my weight loss story -- or more accurately, the story of my lack of weight loss.

So often we don't hear the stories from WLS folks who never meet their goal weights. We never hear the stories about how science doesn't always work like it's suppose to. We never hear the theory debunked about "calories in vs. calories out" and we continue to believe the lies that it's the only way to lose weight. Sometimes it doesn't matter what your calorie deficit is, your body does whatever the heck it wants to do. But the diet industry doesn't want you to know that. So I'm sharing a summary of my weight loss journey with some links to more in depth information about pieces I mention.

My journey toward weight loss has had many twists and turns in the road. But my journey is not unlike many, many other people who are on the same road I am. There are lots of us who never reach the goal weight we thought we'd achieve. Below is my story:

---

I stopped losing around the 10-month mark - right in the midst of the period in time when I was training for a 10-mile race followed shortly by a half-marathon. The scale played games with me for a little while after that, but essentially the weight that I was at 10-months out, is the weight I'm at today. About 190-195lbs.

I had my 1 year follow up appointment about a month late, so at that point I'd been stalled for 3 months -- but my Nut and PCP didn't seem concerned and figured I'd start losing again any day. I got the standard speech about following the rules and sticking to the plan as prescribed (which I was).

I had my 2 year follow up appointment and the scale had then been stopped for 1 year and 3 months. Over the previous year I'd been wearing the GoWearFit, been experiementing with calorie intake (higher amounts, lower amounts) and nutrient content (more protein, less protein, more carbs, less carbs) and had switched up my exercises (walking, cycling, weight training). Nothing made the scale more either up or down. My medical team was baffled. My PCP said to me: "You are doing everything right. I don't know what else to do for you." So my PCP sent me to an endocrinologist who instantly put me on a Rx diet pill. After 3 months of pure hell, I went off Adipex without any significant change in the scale (lost a few pounds, but they came back as soon as I stopped taking the pills). Then the endocrinologist fired me as a patient.

About 6 months into my second year post-op I finally figured that I needed to work on the mental side of things and find a way to accept the weight that I was and beating myself up about it. My body had a mind of it's own and it was going to do whatever the hell it wanted to do -- and I had no control over it whatsoever. I'm still dealing with that emotional and mental battle but I feel like I'm in a much better place today than I was 6 months ago.

And now, here I am 3 years after surgery. Next week I have my appointments with my PCP and surgeon's office. The scale still hasn't moved even though I was a very bad girl for several months this year. I hate that bad behavior is not punished with added pounds. I don't expect anything earth-shattering to happen at these appointments. I don't expect the scale to move and I've stopped trying to make it move -- I'm just working on maintenance at this point. I've had to learn that following the rules isn't about seeing rewards on the outside or on the scale ... it's about doing what's right for my body so I'm as healthy as possible on the inside.

Yes, its frustrating when we can't make our body do what we want it to do. It's frustrating when we realize that we're not in control of stuff (I'm a control freak, this part pisses me off big time). It's frustrating when our doctors don't have the answers and when science kicks us in the butt with it's nonsense.

So at some point we have to make the change from beating ourselves up over meaningless numbers on a plastic machine that lives in the bathroom next to the toilet -- and learn what it means to accept ourselves for the amazing women we are.

~Pam

3 Years Ago Today

Photo by Terry King, Action Leaders

The 3rd year of my post-RNY life had a rocky start but it has ended much better.

And today as I reflect on my journey in the last 3 years – technically it’s been 4.5 years since I made the decision – I can honestly say that I’m happy with where I am (most days) and that I’m a happier and healthier person for what weight loss surgery has done for me.

My longtime readers will remember that when I hit the 2 year mark I was at the height of my frustration with my weight loss – or lack thereof. I was stuck and I couldn’t get unstuck. I was following the rules and working as hard as I could to lose the last 30 pounds but my body was not cooperating. I asked my medical team for help – the surgeon’s office didn’t do much, my PCP ran a bunch of tests and got frustrated because he couldn’t figure it out and sent me to an endocrinologist. The endocrinologist drama turned into a fiasco of diet pills, accusations of non-compliance and emotional upheaval. Eventually, I had to come to terms with the fact that my body is boss and I didn’t have much control over what it wanted to do. It became a battle of emotional bullheadedness against emotional acceptance. Acceptance finally won.

Today I weigh 195.6 – a weight that’s been steadily in the same 5 pound range since my one year anniversary. The number fluctuates regularly between 194 and 198 which gives me a total weight loss of about 105 pounds. Sometimes the scale kisses the 190 mark for a day or two and sometimes it kisses the 200 mark (which freaks me out more than I care to admit). But always it settles back into its normal range of about 195-ish. Essentially I am still stuck. I can’t seem to lose or gain weight, no matter how good or bad I behave. I guess in a way that’s good, right? But technically it’s pretty bad because bad behavior is not punished by higher numbers on the scale… but neither is good behavior. So I have to “behave” for behavior’s sake, not for any type of reward or positive reinforcement. Yeah, that part is really hard and kinda sucks. However, I’ve come to accept this scale silliness and I’ve moved beyond worrying about it too much.

So often when we’re newly post-op (within the first 2 years) we hear veterans tell us how easy we have it – how much harder life is when we get to maintenance and have to live the rest of our lives like normal people. We buck those comments because we think things will forever be like they are in the first couple years after surgery. But now, sitting at the 3 year mark I’m beginning to understand what they meant. Life gets harder. Making the right choices all the time relies on my own will to be healthy rather than the surgery dictating my behavior. I have misbehaved more in the past 6 months than I have in the previous 2.5 years and it tends to screw with your head when you realize you can’t be perfect all the time. But the difference between misbehaving now vs. misbehaving before WLS is that your brain screams at you when you make poor choices – the key is to listen to it more often than you tune it out.

Maintenance is damn hard people! Establish really good and really strong healthy habits in the first year post-op and they will carry you through for life.

The Comprehensive Holistic Wellness Plan has been with me since I was about 4 months post-op. I set specific goals for all areas of my life – my physical, spiritual, financial, emotional, vocational and intellectual health.

• I’m still mostly centered on the intellectual and vocational goals and will be until I finish school – I should graduate with my Associates degree this year, then I can work toward my Bachelors – and do a switcheroo with my career path. 
• My financial health is on the right track too. I’ve been debt-free for a couple years now (let’s not talk about student loans just yet) and in the past year I’ve bumped up my efforts in saving for retirement. 
• My spiritual health is taking off these days - I’ve started attending a new church and I’ve fallen in love with the radio station K-Love (it’s national; check it out in your area). 
• I continue to work on my emotional health day by day and I feel that I’m a stronger person for all the work I do in that area. 
• If any of my life goals have suffered in this past year it’s been my physical health. I haven’t exercised as much as have in the past because I’ve been tied to this computer writing “The Book” and I’ve picked up a few bad eating habits that I’m working hard to nip in the bud. But otherwise I’m moving along and I’m happy with where I am right now with my goals in life.

Speaking of The Book – it’s not done yet. I set a goal to have the book released for sale on my anniversary date. Obviously you don’t see a for-sale sign posted anywhere today. Ha!. But it’s close to completion. I could easily have released it on time, but it wouldn’t have been up to the quality that I wanted, so I had to decide to hold off for a bit longer. I'm in final editing and formatting phase and in the next week or so I'll have copies ready for my "self-appointed editors" to review before final changes are made and it's sent off to the publisher. Soon folks… very very soon!

One thing that surprises me every day in my post-op life is this blog. Seriously! Who would have thought that when I wrote that first blog post almost 4.5 years ago proclaiming to the world that I was taking charge of my health that I’d still have stuff to talk about all these years later. And the notebook I carry with me everywhere has a long list of article ideas that I still need to write – so I can’t imagine I’ll run out of material anytime soon. Plus you guys keep sending me ideas every day in the form of your questions, suggestions or comments. I’m grateful to you, my readers – my friends, for sticking with me through my ramblings.

So what will this third year look like for me? I hope that I can say I’ve maintained my weight loss again next year – this is the typical time in most post-op lives when the regain starts to appear and I pray I have the ability to stay the course and keep my weight in the maintenance range. In the coming months I will get my minor misbehavior under control (poor eating choices sometimes, skipping vitamins sometimes, lack of regular exercise) and get back to a place where I’m happy with the healthy choices I’m making. I am looking forward to graduating from college this coming year (although that only means I'll be ready to start working on my bachelors degree, but at least I'll have one graduation under my belt, right?). I’m looking forward to a new career path in graphic design- whether as a day job or as a freelance job. I’m looking forward to the release of my book and can’t wait to hear feedback from my readers about it.

Life is good and it just keeps getting better and better. Happy Anniversary to me!

~Pam

Free Days

Once in a while I plan a "Free Day" or "Free Meal."  These are specific days or specific individual meals when I give myself permission to NOT worry about every calorie that sits on my plate or the nutritional balance of the food I will eat. It's a completely guilt-free experience.

Sounds wonderful, right?

It is pretty awesome. But it certainly took me a while to get past the guilt part of having free days. But now I am able to plan for specific meals or whole days and not even bat an eyelash -- and when it's done, I usually forget I even had it because I've moved on from the experience and gotten right back on track.

For the past three months I have been on the "straight and narrow" with my eating and water and vitamins. (You'll remember my bout of rebellion this past summer.) And when I say "straight and narrow" I don't mean that I've been perfect every single day - but my goal has always been to be on track at least 90% of the time. And that's where I've been since I called off the Rebellion.

But that 10% of not being on track might be a planned free day every once in a while (not every week, but maybe once a month at most) or if not a full day, then just one single meal. That single Free Meal events are usually special occassion meals like the family reunion potluck this past weekend. If I go a week or two without using that 10% freedom, then I can roll it together into a whole day of freedom.

But this freedom has some rules:

1. A Free Meal can only be one meal. All other meals of the day must be on track and perfect and protein-heavy.
2. A Free Day must still meet my protein goals So whatever food I decide to eat must still give me 80-100g of protein. After that, anything goes.
3. After a Free Meal or Free Day I must get right back on track with the healthy eating plan.
4. No guilt allowed.
5. If it gets out of hand, all bets are off and Freedom is revolked.

NEWBIE WARNING -- this plan is not a good option for anyone who is less than one year post-op or is still trying to lose weight. During that first year life is all about restriction and learning new habits and training your brain to have a healthy relationship with food.

So let me tell you a little story...

This past Tuesday I ate a cupcake. Yes, I'm still savoring that moment. It was not an impulse decision, it was a decision I made in light of day's eating so far and what was planned for the remainder of the day. It wasn't a planned treat, but when I gave it some thought, I decided I could afford it in light of my caloric budget.  I knew that I'd been "on track" for the past few months and that I'd been eating well, so I had the cupcake and had no guilt.

So then later that evening I was talking about the cupcake and said that I'd been eating well for several weeks and it was an indulgence that I had because it fit into my planned calories. My mother happened to be in the room when I said that and her comment was: "Well, except for Sunday." Mmm.... what was Sunday?

Yep, I'd had a Free Meal on Sunday at the family reunion, but by Tuesday evening I'd forgotten about it. During that Free Meal I had eaten a fairly healthy array of food, but then I'd had a sampling of some of the desserts. A sugar cookie, a bit of a couple different dessert salads and a small brownie over the course of a couple hours.  But after that one Free Meal I had moved on with my life and didn't give it a second thought - so when my mom called me out on the indulgences it had honestly not even entered my mind. In fact, when I realized what she was talking about I even said: "Oh, that doesn't count."

So when I said "that doesn't count" I really meant it. I had a Free Meal and I'd moved on without guilt. Each day is it's own decision. Free Meal guilt doesn't carry over into other days.  Free Days are different, they are few and far between, so those need to be planned in advance and taken in context of when the last Free Day was.

So there you go... that's how I stay sane with the regemin of staying on track 90% of the time.

~Pam

The Rebellion is Over

In the past couple months I've talked about a Bout of Rebellion I've been struggling with. It took me a little while to get over my bad behavior -- had an update on my progress a month ago. I've worked hard to get myself back on track, but I feel like I'm finally in a good place right now.  Whew!  It feels good to be back!

Some key things I've done:

• I came across this old blog post - What it means to be on track - and it reminded me that I wasn't being kind to myself and I wasn't loving myself enough to make the right and healthy choices for my body. I needed to get that love back. 
• I made some adjustments to my vitamins.  Changed some chewables to swallowables. Changed some lower dose things to higher doses so I had fewer pills to swallow. Switched on tablet that was causing problems (didn't hold up in heat of summer) to a capsule instead.  And a couple other minor changes. So in the end my vitamins are "easier" to deal with and less daunting to take.  Still the same number of doses, just fewer pills and in better forms for me. 

• I bought a new little pill box. Nikki said this pill box revolutionized her life - so I had to try it! It's at GNC for 99-cents and it has 5 slots inside to keep our pills separated.  So I put my main pill dose in one slot, calcium in 3 of the slots and iron/Vitamin C in the other slot.  I don't know why, but it seems to make it so much easier to deal with the day's worth of pills with this thing. 
• I downloaded a new app for my phone called "Do it Again" -- you can set up alarms to go off based on a number of variables. I basically set it up so that when it was time to take a vitamin dose, the alarm wouldn't turn off until I physically turned it off.  Then the second level of this is that my alarm can be named whatever I want it to be.  So instead of it just saying, "take your vitamins" --- it says "no more screwing up!".  Tough love, huh?
• I cleaned the house of any trigger foods, junk food... or even healthy food that I was treating in an unhealthy way. 
• I got that cool new 64oz water bottle. That has made getting my fluids in much easier. 
• I am making a conscious effort to be more active. Some formal workouts but mostly just doing more in my life that requires me to move more.  Doing some major decluttering and furniture moving at the house ... walking in the sand on the beach enjoying the surf on my ankles instead of just sitting in my beach chair and watching the waves .... parking further away .... I know from my GoWear Fit wearing days that being active in life is just as beneficial as doing formal exercise. So that's my goal these days.

I've had folks ask me about the scale during this rebellion phase.  It's basically the same as it's always been. I gained a few pounds while on vacation a couple weeks ago --- but is now gone and was probably just excess water weight from the over-abundance of simple carbs during that week.  The scale doesn't move for me.  Up or down or sideways.  It's actually quite annoying because bad behavior isn't punished with gained pounds, but neither is good behavior rewarded with lost pounds.  Instead I need to focus on my overall good health and made decisions for feeling the best I can and not on what the scale tells me.  

But right now I'm in a good place.  I feel healthy again and I feel like I'm doing all the right things for my body. It feels good to be back on track. 

Thank you for hanging in there with me.  Sometimes I feel like I'm letting you, my readers, down when I screw up like I have been  lately.  But the outpouring of love and support have helped me kick my butt back in line.  You guys are awesome!

~Pam

No Drinking Allowed

Almost two years ago I wrote an essay explaining Why We Don't Drink with Meals. It has now been updated (click the link to be taken to the original page with the updates). I've fixed some typos, added some additional information and organized the content a bit better.

Plus I've laid out the information in a two-page handout that can be printed and distributed at your local support group meetings. Download it here.

Enjoy!
~Pam

Overwhelmed with Clothes After Gastric Bypass

In the early months after surgery, you'll find that you will be overwhelmed with clothes.  Clothes that are too big and clothes that don't fit yet (either packed away from your skinnier days or donations from friends and family).  You'll stand in front of your closet searching for anything that fits... just one thing, please!  It's frustrating and exciting and amazing all at the same time.  


You honestly will not believe how FAST you shrink out of clothes after surgery. Something will fit you one day and be clown pants on you the next day.  You'll buy something new and it'll only fit for 2 weeks.  It's a good problem to have, but it's also frustrating and overwhelming. You thought this was going to be the exciting part so you feel bad for being frustrated.  LOL!  But it's normal.  And I'm here to help!

So as you're faced with moutains of clothes (yes, literally mountains!) you need a system to get it all organized.  Here's the system I used.

Get a BUNCH of boxes. Big ones with 4 or 5 of them being all the same size and a bunch of other boxes or big trash bags. Block out a solid 3 or 4 hours on your schedule to devote to this process.  Get help if you can.  Once you're set up.... now let the sorting begin!


Pull everything out of the closet and dresser drawers. Yes EVERYthing. You might need to move to the living room or some place with lots of floor space if you don't have room in the bedroom. 


Start putting clothes into piles by size. 20's, 18's, 16's, etc. Do the same with the S, M, L, XL stuff too. (here's a chart if you don't know which size goes with which). Stuff that's too big for you doesn't need to be sorted... just put all those in one huge pile off to the side.  No need to be neat about this right now -- just stand in one spot and pitch each size into its own pile across the room. 


Now... let's say you're in size 18/20. So put that size back into your closet. But first try stuff on if you have any doubt that it might be too big.  Pitch any item that's too big into pile of "too big" stuff. Only put back into the closet or dress what actually fits you right now.


Leave the 16's for now and skip down to the 14's, 12's, 10's, etc. In those big same-sized boxes you're going to pack one size of clothes for each box. Write on the side of the box which size is going into it, then fold everything in that size pile and pack it away. If you come across anything that you don't really like the looks of (out of date style, color you don't like, etc.) - put that into the "too big" pile too.  Once you have your boxes packed, put the smallest size clothing box on the bottom of the pile, then continue piling each larger size box on top.  (That gives you easy access to your next clothing size when you're ready for a wardrobe change.)


Ok. Back to the size 16's. You might be surprised to find that some of those 16's actually fit right now. So try that stuff on too. Any 16's that fit go to the closet. Any 16's that "almost" fit and will probably fit within the next couple weeks... can also go in the closet so you don't forget about them until it's too late (believe me, this happens a lot!). All the rest of the 16's that don't fit yet, pack them in a box and add that box to the top of the pile.

Now it's time to tackle that pile of clothes that don't fit any longer or were rejected based on their style.

FIRST you need to record every stitch of clothing that's in that pile. The easiest way to do this is to sort this big pile into smaller piles by type of clothing. Jeans, Slacks, shorts, skirts, blouses, sweaters, etc. Then count how many of each thing is in each pile and write it down.


After you're done counting you can pack all this stuf up into the leftover boxes and garbage bags. Then take these things IMMEDIATELY to your car so it's out of the house. Next trip to town you'll drop this off at your local Goodwill or Salvation Army or the Women's Shelter.  Get a receipt for your donation.

That last directive sounds pretty simple right?  Just pack up your wardrobe and donate it.  Sure, it sounds easy on paper (computer screen) -- but this first donation might be the hardest one of all.  We have an emotional attachment to those clothes.  We're afraid to get rid of larger clothes... just in case.  We've been through so many diet successes only to gain weight back that we've come to expect it's going to always be that way and we'll need those big clothes again.  BUT - this time it's different.  WLS is different than all those failed diets.  And we're not going to need those big clothes ever again. 

HARDER THAN IT SOUNDS - This little act of donation can be an enormous emotional step that is going to take some strength and faith to accomplish. It's a lot harder than it sounds like it'll be.  Don't feel silly for these emotions - it's normal and a lot of us go through the same thing.  But I promise you, when it's done and you are rid of those clothes, you're going to have this sense of freedom you never expected. And the next time you have a load of clothes to donate, it's easier and even something you'll look forward to because you know how good it feels to unburden yourself from those ties. (Plus whenever you stop at Goodwill to donate some boxes, it's like a permission slip to go in and buy a few new things to add to your wardrobe.)


Ok... donation boxes are in the trunk (or already to the charity), now it's time to make some new clothing-fund money!  Go to It's Deductible -- it's a website where you can keep track of your charitable donations. They have various categories of donation items so you can keep track of everything you donate throughout the year (household stuff, clothing, cash, etc.). Set up a free account and then start recording the things on your list and watch your tally grow. This website is tied to Turbo Tax, but you don't have to file your taxes with TT for the website to work. You can print a report of your donations and take it to your accountant with the rest of your tax stuff.  If you file taxes with Turbo Tax it uses the info to automatically populate the forms you need to file for itemized donations.  Any annual donation over $500 needs to be itemized. Some people just do a flat rate per bag of clothes, but I find that you get double or triple the value if you take the time to record what individual items are actually donated. (Note:  You may want to take pictures of your piles of clothes and boxes in case you need proof of your donation in the event of an IRS audit - plus it's fun to look back and see the mountains of clothes!)

That first year after my surgery when I got rid of my entire wardrobe --- just from my clothing donation alone I got an extra $800 in my refund check from Uncle Sam. $800 goes a long way toward a new wardrobe, huh?


Alternatives --- Of course, there are alternatives you might consider rather than donating  to charity and that's up to you.  Some people sell their clothes on Ebay or Craig's List and do well with the effort.  Or you could try a yard sale.  I actually did the yard sale thing that first summer after surgery and sold a lot of my clothes. I made about $200 - but that $200 cost me about 3 weeks of pricing and prepping clothes for the sale, then a long 3-day weekend sitting in a lawn chair with my family manning the sale (not a great hourly wage, huh?).  Yard sales are a huge amount of work for not much payoff.  And when I realized that Uncle Sam paid me about twice what I was selling my clothes for I decided not to do the family yard sale the following summer.   You could also give clothes away to other bariatric patients coming behind you or participate in a clothing swap with a group of other people (support groups often do this).  The decision is yours, of course... but I've found that donating the boxes immediately and getting that stuff out of my house is the best form of therapy and it pays for itself at income tax refund time.


MAINTAINING THE HABIT -- you need to keep doing this as you grow out of sizes. But it won't be as huge as this first time. When you go to your closet and notice something is too big, don't put it back in the closet. Start a new donation box (keep a notebook next to it to keep track of what items you put in there) and when that box is full, it needs to be taken immediately to the car for your next trip to town. When you remove that box, make sure you've got another empty box to put in its place so the routine continues. And when it's time to open a new box in a new size -- Oh Boy! -- it's like Christmas morning and SO much fun.


By the way, when I was shopping at Goodwill during that time of rapid size changes, I'd buy whatever I liked in whatever size I thought I'd eventually get into. So if I saw a killer blouse in a size 12 that was on sale, I'd buy it and add it to my size 12 box. That way when you realize all your clothes are too big, you've alraedy got new stuff waiting for you in the next box.

As a side note.... it is seriously the most surreal experience to be shopping at your local Goodwill store and notice your own "too big" clothes hanging on the rack for sale.  First time it happened to me, I took a picture of it.  It used to be one of my favorite jackets.  


Have fun!
~Pam

2 Years Ago Today

Early this morning as I was driving to work I reflected on the morning of my RNY surgery two years ago. I wasn't nervous the morning of my surgery... or in the weeks leading up to the big day. I was impatient and just ready to start the new phase of my life. I remember the nurse asking me if I needed some medication to help me relax and I declined it because I already was relaxed. My mom was more nervous than I was.

When I started my goal was to hit 150lbs by 18 months post-op. To wear single-digit clothing. To be healthy and athletic and full of energy. I wanted to use my vacation time at work for real vacations and not just doctor appointments to treat my obesity-related-ailments. And somewhere in the back of my mind I imagined myself in a relationship with a man I was crazy about. There were other lofty goals too, but these are the big ones that have stuck with me.

When I named this blog "Journey to a Healthier Me" -- I don't think I fully realized what a journey it would actually be. When we start this WLS thing we all seem to have a preconceived notion of how things are going to go. Which steps we'll take, what things come next and how it's all going to be in the end. At the beginning we believe there will be a finish line, but somewhere along the way we realize that this is not a journey that has an end. 


This is a journey of a lifetime. It's a journey that IS my life.

So when I think about all the goals I have not yet achieved I struggle sometimes. As you know I am still not at the weight I want to be - another 30 pounds would ideal in my mind. And it's not for lack of trying that the weight isn't coming off either. I AM healthy and athletic and energetic. Sorry, no hot man on my arm, so that goal is also unachieved. LOL! I think the lack of weight loss is what bugs me the most. But you knew that already, right?

Remember the Comprehensive Holistic Wellness Plan? The goals I set for all areas of my health -- physical, emotional, spiritual, financial, vocational, intellectual, etc. I haven't forgotten them. I think this is something that is a lifelong plan rather than something, again, with a finish line. I guess right now my whole life seems to be revolving around the intellectual and vocational goals -- going to college full time (while working full time) is taking up so much of my life that there's not much room for anything else. Once this big one is achieved, I'll be able to focus on more of these goals later.

I'm proud of where I am today.

It's taken me a while to accept the weight issue. To realize that my success in this weight loss journey is not tied to the number on the scale, but is based on how I feel about myself and how comfortable I am in my own skin. That post a few weeks ago about seeing myself in a photo of a crowd of people and being a normal size -- things like that go a long way for me in realizing that I'm a success even if I haven't gotten to 150lbs. 


I AM a success. I AM proud of myself. I AM amazing. 


And I have the rest of my life to work toward whatever goals I still want to achieve-- there's no hurry, it'll all happen in its own time.

Many people say "I love my RNY" and give all the credit to the surgery itself. I don't really share that attitude. Yes, the RNY was the springboard for my weight loss and resetting my body's screwed up system to allow the weight to come off. But it was ME who fought the fight and lost the weight. So instead of saying that I love my surgery, guess I need to say: "I love myself!" The surgery was great, but ya know... I worked my butt off for these 113 pounds and I'm damn proud of myself!

~Pam