May
15

Walking the Tightrope

If I could describe my first month of recovery, it would be akin to walking a tightrope on a roller coaster. How’s that for an image? ūüėČ

In all seriousness, I am actually thankful that recovery has been fairly smooth. I’m keeping food down, have minimal reflux problems, and although my stomach is still quite vocal (seriously, stomach, shut the eff up), have been pain free for weeks and am generally doing okay.

The main challenge has been staying hydrated and getting my protein. Which is harder than it sounds. In fact, the only (slightly) major hiccup in this whole experience so far has been doing what I swore I wouldn’t do: I got majorly dehydrated over the weekend.

The challenge is that now that I’m actually eating (huzzah!), I can’t drink fluids for 30 minutes before or after a meal or snack. And I’m supposed to eat 4-6 times a day. And get in 80 grams of protein and 64 oz of water. You do the math. It’s not easy. Oh, and add on the fact that I’m supposed to be getting about 600-800 calories a day … y’know, to sustain life and all. I’m barely getting 400, if I’m lucky. Sigh.

So this weekend after I advanced my diet to semisolids/pureed, I had trouble balancing the fluid versus food equation and got behind on my sips. So behind that when I woke up Monday morning I felt like pure hell. I knew I wasn’t going to catch up on my own and I knew that if I didn’t catch up I was in trouble. So poor Steve got woken up at 6:30 am by a pitiful little voice begging him to take me to the ER. Two boluses of normal saline later and although I was still tired, I at least no longer felt like I was going to die.

The other difficulty has been protein. Ah, protein, you are an elusive bugger. I know 80 grams daily is a goal and I’m not expected to be there yet, but I also know how important it is to my healing and energy levels (and continued weight loss, so my body eats fat and not muscle). I was WAY behind on the liquids because I was just so sick of …. liquids. The PA at my postop appointment gave me some helpful pointers that I will share with you in a future post, and that has helped, as has advancing my diet.

Speaking of which, I advanced to soft foods yesterday! Woohoo! It’s been a fun adventure re-experiencing new (old) foods and new combinations. It’s funny because whenever I reintroduce something into my diet, Steve gets a text from me proclaiming that what I just ate was the “best thing ever”. But seriously…to put actual, real food into my mouth, and taste it (and then chew the hell out of it). It’s just a divine experience. I have 4-5 weeks of soft foods and then I can slowly add “normal” food back into my diet. As I’m able to eat more volume, I’ll also be able to add back in more cooked veggies and complex carbs (gasp). Once I’m further into this soft diet phase, I’ll share with you some of my favorite combinations.

So onward we go… I go back to work next week, start my final (!) semester of NP clinicals, and generally resume a “normal” life again. Whatever that means.


May
07

Food, Glorious Food

It is the final day of my full liquid diet! Cue the party horns, streamers and balloons! I’m at the point that I am literally gagging on soup, even when it tastes good. I’m not normally a fan of semi-solid textures all by themselves (think: baby food), but bring on the purees!

It’s curious how I think about food¬†more¬†than I did before surgery, but in a completely different way. Rather than plotting how to satisfy my next craving, I’m more deliberate and careful. I know that planning ahead is the key to being successful in my new life and so I’ve become quite methodical. I’m not saying I no longer have unhealthy cravings…the other night I dreamt that I ordered the entire menu at Sonic and stuffed my face with corn dogs. I’m just glad the cravings stay tucked away in my dreams. ūüėČ But I digress…

Luckily the pureed phase only lasts a week and will allow me some creativity and variety (plus more protein intake, which is something I desperately need). I’ve created a “Pureed” Pinterest board (Pinterest has become my saving grace during this experience. It gives me great ideas.)

Basically these are some of the options I plan to rotate through:

  • Vegetarian refried beans
  • Mashed potatoes (with dry milk powder or protein powder)
  • Mashed cauliflower (see above)
  • Baked low-fat ricotta with tomato sauce
  • Plain nonfat Greek yogurt with mashed fruit on top
  • Poached eggs with mashed avocado
  • Eggs in purgatory (healthy version)

Considering that I can only eat 1/4 cup per serving, I should make it through the week without getting¬†too¬†sick of anything on the list. This is assuming that my sleeve can tolerate everything, of course. I may have some rude awakenings when I start feeding it more substance. I’m trying to be careful about not bombarding my system¬†with more than one new food item at a time.

Looking ahead to Post-Op Week 4, I’ll be attending a nutrition class at my surgeon’s office to discuss incorporating soft foods into my diet. And then the fun can begin! :-) I’m excited to start menu planning and trying new, healthy recipes. The good news is, cooking for two is now more like cooking for four/five – cooking one meal should last us a few days with the portions I’ll be eating. We plan to do a lot of crock pot meals to keep whatever meats I eat soft and tender (bonus points for stretching leftovers even further!), as well as A LOT of fish.

I’ll be on soft foods for about five weeks as everything continues to heal, and then I can return to eating “normally” (a new normal for me), with a few big no-nos: white/doughy breads, pasta, rice, sugar. Still no caffeine or alcohol either. To be honest, I don’t miss it.

As I’ve researched food options, I’ve come across some great bariatric-friendly blogs and websites. I’m sure I’ve barely scratched the surface, because there is a whole world of weight loss surgery websites out there, but these have become especially helpful:

It’s interesting that bariatric¬†postops have developed a diverse array of opinions about what is permissible in the world of bariatric living. Some use full-fat ingredients in tiny portions but completely avoid bread. Some adapt “comfort foods” into more healthy versions. Some still have a strong sweet tooth and have developed goo-gobs of sugar-free desserts. To each their own, I guess (it also varies based on how long ago their surgery was). But it’s reassuring to know that I can still enjoy eating after weight loss surgery.

Other resources and ideas that have¬†come up recently…

One thing is for sure… I am determined to not only eat LESS but eat BETTER.


May
04

Farewell, My Sweet(s)

First, the good news! I’m down 11 pounds since surgery and 32 overall! Woot woot! Recovery continues to go well overall and I’ve been lucky enough to avoid complications (knock on wood). I’m taking it one day at a time and letting myself move slowly.

Now, the less-fun news…

This is hard as shit.

Not that I was kidding myself – I knew it would be a long road and I’ve barely gotten started. But the full liquid diet is exhausting. It literally feels like a full time job to sit there and time myself while I sip fluids like a baby bird and try my damndest to squeeze in as much protein as I can each hour. My caloric intake is so low that I am tired and weak, although I’ll be damned if I let myself get dehydrated too.

My mom was here for a blessed week and went to work making delicious creamed soups packed with veggies. We bought some unflavored whey protein powder and started adding that to our soups as well, which has helped. My aunt had the genius idea to freeze the soup in ice cube trays, so our freezer is stocked with ice cube sized portions of soup (two cubes = two ounces=one serving).

Exhibit A

Exhibit A

 

There is enough variety here to keep things interesting, but I am so sick and tired of liquids.

One thing that has amazed me is how much my taste buds and food aversions have changed since surgery. For the first several days, nothing really tasted good but nothing tasted bad either. I had¬†zero¬†cravings and no sense of hunger. Slowly (very slowly), certain foods are starting to sound good again. Steve had a spoonful of almond butter the other day and when he leaned over to kiss me good morning, I wanted to eat his face off. The other night he was as sick of soups as I was, so he ordered takeout from our favorite pan-Asian restaurant and brought me home some miso broth (I strained out the solids). That might have been the most delicious thing I will ever put in my mouth (it’s all relative, people).

And my sweet tooth? Gone. It was starting to dissipate even before surgery, but it has officially flown the coop. Part of the problem is that a lot of artificial protein sources are made to be sweet in order to be supposedly more palatable. But they can’t use sugar, so they use sugar substitutes, which are absolutely cloying. I want none of it.

This does make getting my protein a challenge. All of the shake recipes I pinned before surgery now make me want to vomit. I’m trying to use real fruit and plain yogurt as much as I can to cut, rather than enhance, the sweetness of the protein powders. I tried 100% fruit juice today and almost gagged. And sugar-free Crystal Light? Just give me plain water, please (room temperature too – I used to love ice-cold water but now it makes my throat seize up). You better believe that once I can start eating actual food again, I’ll be getting my protein from eggs, low-fat dairy, lentils, quinoa and seafood/lean meats. No more mile-long ingredient lists for me!

I’m trying to take consolation in the fact that I only have four more days before I can move onto pureed food. Steve is looking forward to making me the perfect poached egg…and I’m looking forward to eating it! ūüėČ


Apr
29

All the Feelings

One of the surprises I have not been really prepared for is the gamut of emotions that I run through each day (often from minute to minute). I was warned during my preop phase that emotional ups and downs and insomnia were common after surgery. I¬†haven’t experienced any extreme mood swings or breakdowns, but I feel as if I am constantly processing this decision and its consequences, and it is exhausting on all levels. Fortunately over the past few days the emotions have become fairly predictable, but I’m still trying to figure out where to put them all…

Usually it starts when I wake up about 3 am and can’t go back to sleep. Often thanks to a bad dream that I’ve spiked a fever or experienced any number of postop complications (being a health care provider myself is both a blessing and a curse because I have already seen the worst outcomes). My mind starts racing and it’s all over unless I take something to help me get back to sleep. I’ve also noticed some early morning headaches, especially since I have had to discontinue my prophylactic propranolol for migraines (decreased blood pressure and heart rate do not exactly help to¬†promote circulation and healing).

Once I’m awake for the day, I’m usually pretty tired and slow to get going. I’ll sip on fluids and protein and then I’ll talk with my mom or my husband or get a supportive text or message from a friend, and I’ll start feeling pretty good about things. I’ll know that this was the right decision and that it is going to change my life for the better. At this point I’m motivated to go for a short walk or leave the house for an errand.

Sometime in the afternoon, I’ll check my fluid and protein intake levels (yes, there are apps for that), feel like I’m behind and start to get discouraged. If a family member calls to check in and wants to know exactly what procedure this was, or if I’m consulting my post-op instructions about a specific issue, it will hit me all over again…I just had 2/3 of my stomach lopped off and removed and my guts rearranged. This is permanent. This is it.

WHAT THE HELL WAS I THINKING?!?!?!?

Luckily for me, those moments of “patient’s remorse” are fleeting and not especially profound. They are usually related to underlying fears about complications or preoccupation about how to eat healthy and intentionally in a very unhealthy world. While I don’t have regrets, I think it’s important to acknowledge the doubts that accompany a significant life change. Denying that they are there can only cause me distress.

So I’m still working on all the feelings. And I imagine I will be for some time. But I’m thankful that I have this time and space to process them as they come.


Apr
27

POD #4

Today is POD (Post-Op Day) number four. So far it’s been fairly smooth sailing…hope the trend continues!

My surgeon was thrilled with how the surgery itself went. There were no complications and he felt really good about how well¬†it seemed to go – Steve said the surgeon was just about giddy when he came out to talk to my family afterward (and I got high compliments on my liver ;-). I did have some pretty severe post-op nausea in the PACU – I don’t remember much of that period except occasionally whispering “Help me, I feel so sick”. I knew it was pretty likely to happen since it’s happened before…didn’t make it any less miserable though.

The morning after surgery I went down for an Upper GI/barium swallow to test for leaks. They gave me some nasty Gastrograffin, followed by barium, and told me to gulp it down. No leaks, but I think I drank too much because I was miserable for the rest of the day. The stuff just would not settle into my new GI tract and move through. I ended up becoming extremely nauseous again and threw up more times than I care to count. The PA looked more closely at my Upper GI results and saw a lot of inflammation (not surprisingly), so they started me on IV steroids and Protonix, plus a whopping dose of Phenergan for the nausea, and I felt 200% better when I woke up a few hours later. I was able to keep down clear liquids that evening, although in baby 1 oz quantities. I had a PCA for pain control for about the first 24 hours, then they switched me to liquid pain meds once I was cleared to swallow.

Post-op day two featured increased fluid intake with no additional nausea. My gut slowly started to wake up and start moving. So they took out my drains and sent me home!!! :-) It was so therapeutic to be in my own house, sleep in my own bed, snuggle with my hubby and puppies and start my new journey. My mom is in town for the week… it is wonderful to have a walking buddy and somebody to help me get all this fluid and protein intake sorted out. Today I graduated myself from clear liquids to full liquids, meaning I can have protein shakes again. We are also trying out some low-fat creamed soup recipes this week.

Pain-wise, I really haven’t been too bad. I’ve only taken a couple doses of the liquid narcotic since I got home…I’m a little sore but nothing overwhelming. I’ve tried to plan an outing every day with my mom to get in a good walk and to get out of the house. One trip tires me out but I honestly haven’t been too fatigued overall.

I am not hungry whatsoever and it takes a lot of effort to get in the fluids and protein I need. Right now they are¬†more worried about my staying hydrated (dehydration is the number one complication of bariatric surgery), but increasing protein will be important for faster healing. My surgeon had mentioned that I would wake up after surgery and all of the old cravings would have disappeared…it’s so true. When we do grocery runs, every once in a while I’ll see food that I used to love, but I have no desire to taste it now or anytime in the near future. I’m hoping that I will get my enjoyment of (real) food back, just minus the cravings for processed sugars and junk. Right now I’m just glad that I can be around food without feeling deprived.

The oddest part of this whole thing so far has been the noises. Once my gut woke up, it apparently has had a lot to say. It is constantly grumbling and growling, especially at night. From what I’ve read, this is not unusual and does calm down after a while, but it distracting and kind of awkward. Here’s hoping things quiet down in that department…


Apr
21

Going Lean and Green

Although I am down to the five-shakes-a-day phase of my “liver diet”, I thought I’d share some of our favorite “lean and green” recipes that we discovered during the first two weeks. All I can say is thank goodness for the Internet (and Pinterest)! We were quite pleased with many of the dishes we made and I’ve¬†pinned them for future reference.

The whole experience was made extra special by the fact that Steve and I cooked many of these meals together (when I wasn’t working). He is definitely the culinary master in this family, but I have always enjoyed being his sous chef, and it was really fun to try new ingredients and combinations, and enjoy the whole experience of food prep. Our version of a date night ;-). Ironically, I’ve been¬†more¬†interested and involved in cooking these past few weeks, mostly because I am bound and determined to make sure that I can still enjoy food (just healthier versions of it). And I’ve been watching reruns of Top Chef like it’s my job – you would think it would be torture, but somehow it’s comforting.

As for the famous¬†shakes, my morning routine has been a splash of fresh-squeezed orange juice, a serving of frozen fruit, and vanilla protein powder, blended with a bit of ice. In the afternoons I’ll usually blend chocolate protein powder and water with a teaspoon of PB2, or vanilla protein powder and unsweetened almond/coconut milk with a teaspoon of cinnamon and a dash of vanilla extract (I swear it tastes just like a cinnamon roll). They’re actually not bad overall, I’m just tired of them.

The high protein snacks were so-so. I had to buy these¬†soy “crisps” that had different savory flavors – the flavoring left a bit of a chalky texture, but they weren’t terrible and it was honestly nice to eat something that¬†wasn’t¬†sweet. The protein bars they wanted me to get were just plain nasty, so I crowd-sourced on Facebook and discovered the wonder of Quest bars. These babies helped me pull through my afternoon slumps.

Next on my culinary to-do list: research pureed options that aren’t store bought applesauce/pudding/baby food. I’ll be on liquids only for two weeks post-op and then the pureed phase begins for a week.

Any suggestions? ūüėČ


Apr
18

The Final Countdown

Yes, I just referenced an ’80s hair band. ūüėõ

Pardon my weird humor, it’s this damn liver diet making me loopy. Yes folks, I’m less than a week away from surgery¬†and it ain’t pretty. As soon as I adjusted to my two shakes/two proteins/one lean and green meal regimen, it was time to switch gears again. To five (count ’em), FIVE shakes a day. Plus 64 oz of water. And that’s it. Thursday was my last bite of solid food for almost three weeks (including my post-op full liquid diet after I get home). It happened to fall on the day I had a professional nursing meeting at Ruth’s Chris, of all places. I ordered with Steve in mind, allowed myself a few delectable bites of filet mignon, and ignored my tummy’s angry howling for the rest of the meeting. The hubby and the dogs were happy at least.

I’m in hell and the only consolation is that it will all be over soon. That and I’m 15 pounds lighter (and down a pant size) from my highest weight last month. So it’s not¬†all¬†bad. ūüėČ But I don’t recommend this part of the process as a weight loss strategy. It’s wholly¬†unpleasant.

I’m not going to say that the shakes were the worst part of this experience because I haven’t had to recover yet. But I’m not a fan.¬†I’m foggy and exhausted and irritable all.the.time. Writing end-of-semester papers is an exercise in sheer willpower. I think the dogs are trying to hide from me. And Steve, wonderful, steadfast, loving Steve continues to take care of me because, well, he’s the best. Thank God for him.

As far as how I feel about this huge step, I have my moments of wondering what the hell I’m doing, but I know it’s the right decision. But my anxiety seems to be taking the subconscious route and last night I started having some CRAZY dreams, to the point that I woke up at 3 am and was afraid to go back to sleep. I have a prescription for benzos¬†to get me through the night before surgery, and I’m thinking I might need to start those a few days early. Nurse Teeny needs her sleep, preferably not riddled with nightmares about my surgeon having a crisis of confidence and begging me not to go through with this. Yikes, huh?

More than anything, I just want to do this thing. Enough waiting, enough shakes (blech), enough worrying. Just get me on that table so I can keep moving forward…


Apr
16

Have You Had Your Conversation?

Good morning! Today is the 8th annual National Healthcare Decisions Day (NHDD). NHDD¬†“exists to inspire, educate and empower the public and providers about the importance of advance care planning. NHDD is an initiative to encourage patients to express their wishes regarding healthcare and for providers and facilities to respect those wishes, whatever they may be” (source). It is an issue that I happen to be passionate about.

NHDD_logo

NHDD was started by an attorney in Virginia and went nationwide in 2008. The purpose is to focus attention on and provide information about advance care planning, and encourage folks to have conversations about their wishes with loved ones.

Steve and I made our advance directives several years ago. With surgery approaching next week, I rehashed some of the salient points with him, to make sure that if something went wrong he had my wishes at the front of his mind. Not to catastrophize, but sh*t happens and I’ve seen too many worst-case scenarios not to be prepared.

 

(Source)

ABC Breaking US News | US News Videos

Whether you’ve been intending to complete an advance directive or you’ve never heard of one, I encourage you to spend some time today and get additional information. You can even complete an advance directive online through an organization called¬†Five Wishes¬†if you live in one of 42 states where it is recognized. Yes, it costs $5, but I think it is worth every penny to have your wishes honored (which to me is priceless).

There are many, many resources about advance care planning, but here are some good places to start:

And please feel free to leave questions in the comments section of this post. I will do my best to get them answered!

advance_directives

 

Thank you for starting the conversation!


Apr
14

We Must Do Better

Dear Colleagues,

I have a request. And it isn’t a small one.

But it’s a crucial one.

You see, I work in an inpatient hospice unit. Inpatient hospice signifies that patients require a level of care that cannot be managed in the home setting. They must have active symptoms to qualify for inpatient care. It’s basically a “hospice ICU” in that we are constantly titrating drips and pushing meds and doing everything we can to keep our patients comfortable. We’re not trying to save lives but we’re certainly trying to make them feel better…and in a way, that’s saving lives too. It’s a busy, busy place.

I’ve been noticing that every so often (too often), I admit a patient from another facility whose condition is appalling. Not because they’re dying. Because they were made “comfort care” in a hospital two days ago and yet they arrive to us covered in defibrillator pads and EKG stickers. Because they were living in a nursing home or assisted living facility with visiting hospice care and they come to us with pressure ulcers because the staff deferred skin care to the hospice nurse who only comes once a week. Because they have been incontinent for days and sitting in their own urine to the point that their perineum is excoriated and putting in a Foley catheter to protect their skin causes excruciating pain.

I know being a nurse is exhausting. I know working on a hospital unit or nursing facility means a heavy workload and way too many patients. But I’m begging you to pay as close attention to the ones who are dying as you do to the ones you are trying to keep alive. I know the temptation is to assign your “comfort care” patients to the nurse who has the most difficult group of patients – I’ve actually heard charge nurses say out loud: “Oh they’re comfort care, so they won’t need anything. They’ll be easy and you can focus on your other patients.”

No.

The fact is that if your patient is comfort care and you are doing your job, you’ll be¬†more¬†busy. You’ll still be rounding on your patient regularly, remaining vigilant about any symptoms that need to be addressed.You’ll be providing compassionate care to families, acknowledging that even your worst day at work pales in comparison to their worst day ever. You’ll be advocating to providers for better pain control, or more interventions for dyspnea. You’ll be working your ass off to help your patients die with dignity and comfort.

I’m not trying to tell you how to do your job (but I kind of am). Please pay attention to those patients nearing the end of their lives. DNAR means “Do not resuscitate” – it does¬†not¬†mean “do not provide care”. Many¬†of them won’t make it to inpatient hospice. They won’t be stable enough to transport, or their families may not wish to have them moved if they are actively dying, or there won’t be a hospice bed available. We all have to pitch in. We all have to provide excellent end-of-life care, no matter where we work.

We can do better. We must do better.

Thanks for hearing me out.


Apr
08

The Liver Diet

With my surgery fast approaching, last week was the start diet for my preop “liver reduction diet”. The idea behind this diet is that obese people tend to have enlarged livers due to increased glycogen storage (thanks to all those carbs) and fatty deposits. By reducing overall caloric intake (carbs especially), the goal is to shrink the liver as much as possible because it has to be moved out of the way during surgery. The bigger the liver, the higher the risk of damage. The liver diet is also intended to mentally and physically prepare you for postop eating, which is reduced in volume and calories and features frequent high-protein meals. Plus, the liver diet also tends to result in more preop weight loss, which is always helpful during recovery.

Searching for these diets online, every bariatric program’s guidelines are slightly different, but the concept is the same. Here is my surgeon’s program:

  • Weeks 1-2: Two protein shakes a day, two high protein/low carb snacks, and a “lean and green” dinner. Shoot for 64 oz of water daily. I am also allowing myself one serving of fruit a day, which I usually mix into my morning protein shake for better flavor.
  • Week 3: Five protein shakes a day. Shakes and clear liquids only the day before surgery.

Overall, this has been rough going so far. Getting used to eating such small amounts overall has left me hungry and exhausted¬†– I feel almost flu-like. I’m sure as my stomach shrinks it will get easier, but I am so run-down. Working 12-hour shifts during this adjustment period hasn’t made it any easier, but I gotta make some money before I take unpaid time off. On the plus side, I’ve been doing this less than a week and I’m down four pounds. I know it’s not a healthy thing to do in the long-term but I am under the guidance of a physician and this is for a specific purpose. I just wish I wasn’t so darn tired…

I have been really strict about not “cheating” because I know myself and I know how easy it is to turn into a gorge session. Yesterday our manager ordered pizza for the staff working Easter and it took all I had to say no, especially when my co-workers said “just one bite” wouldn’t hurt me. Frustrating, to say the least. I’m realizing more and more how complicated my relationship with food has gotten over the years and how difficult it is to help people understand that just one bite is¬†not¬†just one bite for people like me.

In the process of going through this experience, we have actually found some really yummy “lean and green recipes” for dinners. The guidelines are similar to a ketogenic diet (except for the high-fat part – I’ve tried to find low-fat variations).¬†I’ll try to put together a list of some of our favorites.

So the verdict overall? This is really tough but it’s also temporary. And I’m setting myself up for a better experience during and after surgery.

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