Thursday, July 24, 2014

Six weeks and forty pounds

That is my statistics after weight loss surgery. Until last week, I was on a liquid or pureed diet since the day before surgery. As a dear friend says, what goes in....comes out. My energy levels were low for the first month. Weight loss sugery is a significant surgery. It's not a quick nor easy procedure, like the surgeries I had last year are considered (and ironically both of those were part on in part because of my increased weight). So, recovery felt very slow. I was exercising as soon as two days after surgery, but sometimes thirty minutes of walking slowly around my house in ten minute increments was all of the exercise I could manage.

Today, I am nearly recovered from the surgical procedure, which is what I was most focused on getting through. I am slowly rebuilding my core strengthening exercise routine daily, and I am up to walking a mile a day as well. Four and a half months of non-stop sick this spring made me lose almost all of the ground I had gained in two years of consistent exercise, so while I have the pattern of a habit, I am starting over with building endurance.

However, there are things that are dramatically different already. I put on just over twenty pounds in those four and a half months of non-stop sick. By the time I was no longer sick and tried to talk, my entire body hurt and I was gasping for breath. I went from walking two miles per day to gasping with half a mile. That changed instantly after surgery. First, I lost that twenty pounds in the first week after surgery, and the other twenty pounds have come off in the last five weeks. That twenty pounds were not familiar to my body and it wanted them gone. As soon as they were gone, my body did not hurt as much anymore. I was able to move, and to walk again. I still have to build my cardiac endurance back up, but I was able to start at half a mile and in a month have built to a mile. Eventually, I intend to build to three miles, which is what I walked when I was in peak physical shape in college. I'm not a runner and I'm not interested in jogging or running, long, endurance walks are my style. I might attempt to retry speed walking, but that would be the most intense joint impact I would attempt.

Immediately after surgery, I was able to discontinue my maintenance asthma medication. I have only needed even my rescue inhaler once since surgery, and that was due to an allergen exposure, not an exercise induced attack. I had forgotten how great it feels to truly breath, it had been four years since I had been able to do that. I love filling my lungs with oxygen and being able to again.

I had to go off my Humira in order to have surgery, and I had to go off all NSAIDs as well. It was the first time since the joint symptoms started at Micah's death that I was off *all* treatments for them. We were able to confirm that I do, indeed, have Psoriatic Arthritis. My Dermatologist is fully aware of this and feels that since I started treatments prior to joint degeneration, he can manage this without having to send me to a Rhuematologist. He is not only board certified (unlike the guy in New England) but he spent a decade practicing Dermatology with the Navy in Betheseda Navy Hospital. He is top notch for the field, and I have high confidence in his skill. My surgeon also cleared me that I can take NSAIDs if necessary for the athritic pain, provided I use chewabale or liquid and I put something in my stomach with them. Once I restarted my Humira, the joint pain is back under control (but now it's not mysterious and I *know* where I have arthritic pain to watch for now) and my intimate psoriasis is cleared up. I still have the two patches on my head and one ear stubbornly keeps having small breaththrough patches. But, this is the most controlled my psoriasis has been since I developed it. The two patches on my head rarely bother me, though the ear situation can be painful but I continue to use ointment on it and I am hopeful that it is simply a stress response from surgery and will clear up soon.

The only medication I have been taken off of is the cholesterol medication. My surgeon felt that since I had just started it, and my cholesterol had not been elevated long-term, it was best to discontinue it prior to surgery. I am still on my blood pressure medication. However, the physcian who treated me when I first went on blood pressure medications felt I needed to lose to a certain level before I would come off blood pressure medications and I'm still forty pounds from that marker still. It seems to be common that most patients come off blood pressur medication around six months post-op.

I am down a size in clothes, and approaching a second size rapidly. It seems that despite my decision four years ago to remove all smaller sized clothes as not mentally healthy for me, I still have some in my closet. I'm wearing clothes I haven't work for a decade, and I look good in them. When I go for my on campus orientation for Nurse Practitioner school next month, I will need to buy some pants in what my actual size is. For now, I'm about to buy a belt and stubbornly wear baggy clothes, simply because I know I will end up smaller than this and I hate to spend money on clothes I will get less than four months of wear out of before I outgrow them.

I started solids in the last week. Yes, it's different than what I did prior to surgery. Unlike many patients, I am not on strict dietary requirements. I am required to take multi-vitamins, and to maintain a minimum of 60 grams of protein per day. However, beyond that I was cleared to simply eat balanced and healthy. For me, the surgery was about a metabolic reset more than anything. The reset is definitely working. I have noticed that if I consume less than 500 calories in a day, I do not lose weight, and I feel shakey and weak by evening. I typically hit around 500-600 in a day, but sometimes go as high as 800 calories. Long-term, as my body recovers, I will likely end up back where I was previously in calorie consumption, but that typically takes about three years to get there. I will have to pay attention to calories as I move into that maintenance phase, especially given that I was not getting sufficient caloric needs previously. I will need to find what calorie range my body will maintain weight now and then keep my lifetime caloric intake at that level.

The biggest dietary change I have made is my breakfast. Because I have to maintain such a high protein consumption, and have such a low volume capability, I need to consum protein rich foods prior to anything else I eat. However, I still need all of the daily requirements of fruits and vegetables. Those who maintain healthy and not suffer malnutrition after surgery accomplish that from getting a real food, balanced, healthy diet. Furthermore, I had this surgery to be healthy, not dependent upon supplements and gimicky foods. So, how do I fit in 5 servings of fruits and vegetables a day when I can only consume just over 500 calories and need 60 grams of protein? I drink a green smoothie for breakfast. I use protein powder and unflavored greek yogurt to ensure that the smoothie still gives me 20g of protein for breakfast, but then I blend at least 3 of my daily servings of fruits and vegetables in my smoothie that I drink. I can drink liquids far better than I can eat food options, so I can get a smoothie down for breakfast, though it generally takes me an hour to accomplish that. Truthfully, they are foul and disgusting--and I love fruits and vegetables normally. However, I don't drink them to enjoy them. I genuinely hope that I will acquire a taste for them, because they are really hideous right now. I drink them because that is how I get the majority of my fresh produce into me. On that front, they are priceless. There are days I only get one other serving of produce in the day due to my protein requirements. However, I figure four servings is still a strong start to meeting my daily nutrient needs.

When I was being discharged from the hospital, the Bariatric nurse coordinator informed me that I would absolutely regret surgery at some point, and that is normal. Thus far, she was wrong. I have absolutely no regrets for having taken this step to reclaim my health. Furthermore, at only six weeks out, I am seeing exactly the progress and positive response from my body that led to my decision that this was the drastic step I had to take to reclaim my health. It will take two to three years to see the full changes of this surgery, but the majority of them will be visible by the one year mark.

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