Weighty Matters

A week after doing my post on The Dreaded Stall, I fully expected to see some downward movement of the scale.  Nope.  All week long I was up two ounces, down two ounces, up two, down two.

This is so incredibly frustrating.  I want to do something so that I can break through it and get back on the losing track.  I’m not sure what will fix the problem.  Do I eat even less or does my body think it’s starving and that’s why it’s stalled?  Should I eat a little more calorie and carb-wise, since I can’t do more volume, and see if that shakes up my metabolism?  Go back to full liquids for a day or two?   Exercise more?  Well, that can only help in every aspect of this journey.

Welcome to the mind set of a recovering compulsive overeater.  All I want to do is control the uncontrollable, fix what is not in my power to fix.  Why isn’t it in my power?  Simple.  I am already doing what I am supposed to do and following the guidelines of my food plan.  Even with all of that, sometimes the body just stalls.  Every single person I’ve seen on ObesityHelp.com has shared that they’ve experienced stalls and that you just have to wait it out.  (Providing of course, that you really are following your food plan.  If you’re screwing around with it, then the recommendation is to get yourself back on track.)

It’s really difficult for me to process and accept that riding this out by sticking to my plan is as proactive as I can be in this situation.  I guess in its way it’s a reminder about the Serenity Prayer.  Grant me serenity to accept the things I cannot change — that I’m in a stall period not of my own creation.  Grant me the courage to change the things I can — step up the exercise and also be patient instead of this constant hamster-wheel obessing.  Grant me wisdom to know the difference — Hell, if I can’t see the difference, I’m an idiot.

Some of the obsession is fueled by small measures of fear and anxiety.  I had a dream the other night that I lost all of the weight that I wanted.  I was happy for a couple of months and then systematically began to gain the weight back pound by pound by pound until I returned to my pre-surgery super obesity.  I woke up from that dream horrified and completely freaked out.   I’m terrified that I’ll fail at this effort like I’ve failed at maintaining very other weight loss I fought to achieve.

The emotional and mental recovery I’ve been working so hard on are still too new.  It’s only been six weeks since the surgery and that’s like the honeymoon period.  How many times did I determinedly diet for six weeks and then, like someone flicked off the motivation switch, start eating again and gain back the weight?

I need to calm down about this before I work myself up emotionally to the point where I can’t retain that part of my recovery.  Finding ways to eat off of my plan will not help the situation.  In fact, it will only damage me in ways I don’t want to consider.  I will succeed.  I already am succeeding.  That success is not totally connected to the number on the scale.   I need to have faith enough to continue to each correctly and on plan for the next meal and the next and the next one still.  That’s the path that leads to weight loss and it will come.  Maybe not tomorrow, maybe not for several more days, but eventually the number will go down.

Faith is a good thing.  It can be stronger than the fear.

Introducing foods again isn’t all that easy.  Right now, my stomach and I are on a meet and greet with pureed and soft foods.   Even though I didn’t overeat last weekend, I might have reintroduced too many different foods in a couple of days and my system is rebelling by making me queasy in the morning.  It could also be that I’m dehydrating in the sleep hours when I’m not constantly sip sip sipping water.

It is also difficult for me to judge the line between consuming just enough food and taking that one extra bite that overfills my stomach.

Good things do not happen if you overfill the sleeved stomach.  The stomach then wants to send the food right back up again.  I’m not a fan of that action and am determined to avoid it as much as possible.  I don’t want to overeat but overeat has a new measuring stick in this life.   I’ve learned that I can tolerate about three spoonfuls of soup and then I have to put down the spoon.  A couple of half-forkfuls of that baked cheesy-tofu dish is my limit.  One half-forkful too many and I will have to struggle to keep them down.   Since such small quantities can be taken in at once, it’s necessary to space out our “meals” about three hours apart.

Liquids — like protein drinks, milk and water — slide down a little easier.  The good news is that I can start my day off with a protein dense drink for breakfast and it doesn’t take me an hour to consume.  The bad news, as I’ve discovered, is that it is more difficult for me to assess my own fullness after liquid.

The information and guidelines I’ve received suggest that we stop drinking about 30 minutes before any meal.  So there’s another aspect to the balancing act.  It’s important to stay hydrated with 64 to 100 oz of fluids a day.  To do that, we are told to sip sip sip sip regularly throughout the day.  However, we need to remember about halting all the sip sip sipping in time for our stomachs to empty enough to take in the small meal.

It’s a difficult thought process.  I mean, really, for over 50 years I’ve combined eating and drinking at the same time.  Now to have to totally adjust that thinking and experience takes some doing.

This morning I had an early dental appointment.  I got up, had my protein shake, and then filled up my 24 oz water glass so that I could commence the day’s sipping on my way to the dentist’s office (about 25 minutes from home) and continue when I went from there to work.  (About 45 minutes.)  I felt rather proud of my dedication to the hydration guidelines.

When I arrived at work, about three hours had passed since my morning protein drink.  I felt a little hungry and unwrapped a cheese stick.  I broke it into pieces and slowly chewed each piece, taking my time.

Unfortunately, I soon realized that I  hadn’t actually taken enough time between my last sips of water on the ride from the dentist and my snack.  Within a minute of finishing the cheese, my body telegraphed distress signals.  Without going into graphic detail, I’m sure you can imagine the symptoms that indicate your body’s about to revolt.   A friend was sitting talking with me in my office at the time.  I gracefully excused myself and got to the restroom in time.  Easy come easy go on that cheese stick.

Another lesson learned.  Drinking lots of water in a stream of sips does not mean that I will register that I’m full, so I really need to successfully balance the time between drinking and eating.   I need to learn my sleeve’s boundaries so that I find the balance between eating enough for good nutrition and eating too much in a way that makes me sick.

As I work on learning the physical parts of the balancing act, I also need to deal with the frustration of not always getting things right from the get-go.  It’s a process, and one that requires me retraining myself.  I’m leaving behind the habits of a lifetime and embracing a whole new way to do things.   I can do it, but I need to accept that it might take me a while to find my balance.

One of the keys to success is that I willingly make changes in my lifestyle and, particularly, my approach to healthy eating and weight loss.

Repeat after me:  The sleeve surgery is only a tool.  The sleeve surgery is only a tool.  The sleeve surgery is only a tool.

That’s so important for me to remember.   The sleeve limits the amount I can consume, but fixing my head is even more important.

I had my one-month-post-op appointment with my surgeon today.  He and I are both happy with my progress.  Food-wise, I’m now officially “advanced” from a full liquid diet to pureed and soft foods for the next two weeks.  At first I thought I’d have to do pureed foods for two weeks, then soft foods, so finding out I can combine the two stages has me psyched!

The information was also a wake up call.  My nutrition goals are to consume 60-80 grams of protein a day and drink 64 to 100 oz of water, plus stay in the 600-800 calorie range.    This is fairly easy to figure out when on a full liquid diet.  Every morning I mixed two scoops of a quality protein powder in 12 ounces of skim milk and sipped it slowly.  Verrrrry slowly.  That got me started with 50 g of protein.  I’d do some broth or a light creamed soup at lunch and some broth at dinner.  Somewhere in the day I’d drink some more milk or blend some Greek yogurt into a broth for added protein.

Now I have significantly more choices and with that comes the responsibility to stay within my protein goals.  The basic guidelines are simple.  Eat protein dense food first.  I can only eat a small amount at a time so I should aim for eating something every three hours.

Pop Quiz:  How many protein grams in 1 oz of fresh mozarella cheese?  How many protein grams in a single egg?

Did you know the answers without looking them up?  The answers are 5 g and 6 g respectively.

I adore fresh mozarella cheese, so after the doctor’s appointment I bought a container of bocconcini (very small balls of mozarella).  Three of those balls equals a 1 oz serving for 5 g of protein.  Three is about all that I can eat at one time — and then only if I eat them half a ball at a time.

Are you beginning to see the challenge?  Small stomach = limited food capacity.   How do I pack in that protein in small amounts?

I think at least one protein shake is going to be on each day’s menu, although I can cut down to a single scoop.

Think of everything you ate today.  How many different food items did you consume?  If you right now wrote down a list, would you be able to remember every single item AND list the nutritional breakdown?

Me either.

I’ve come to accept that I need to keep a food diary.  It’s the only way that I’ll be able to keep track of what I eat and how it fits into my nutritional goals.

I hate keeping a food diary.  I’m trying to process why I’ve resisted this step in the past.  Did I not want to face reality?  Did I resent the necessity?  I don’t have an answer and, actually, what I hated to do in the past isn’t important compared to what I’m willing to do in the present and the future.

I’m a daily visitor to www.obesityhelp.com.   On the forums, I followed a few conversational threads about this topic and saw that several people recommended a site called MyFitnessPal.com.  Turns out they have an app for the iPhone.  So, today I downloaded it (freebie!) and entered today’s food choices.   I’m pledging to myself, and stating it publicly here, that I will continue the practice every day.  Every day.

Consistency is the only way that I can build this into another useful and effective tool.  This isn’t just a helpful idea, it’s now a necessity.

In my new approach, eating is no longer a matter of filling my belly and satiating my hunger.  It’s about providing my body with the nutrition I need for a good, healthy life.

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Normally, I’ll announce my week’s weight loss on Fridays, but I count based on my home scale in the morning, naked and before breakfast.  (Is that TMI?  hee hee)  I wasn’t at home this morning.  While I don’t want to be inconsistent, I still want to report and a short week is better than giving myself an extra day.  So, as of yesterday,  I’d lost 46 pounds on the journey!

I’m still fighting with the scale or at least fighting with my urge to weigh myself every single day.  I justify it a lot by saying that I need to see the weight loss to keep motivated.  Honestly, I could still get that motivation if I cut back.  Focusing on the numbers is not healthy for me.  Sticking with the plan, the program, and retraining myself to the new way of eating matters the most.

So, I’ve decided to report my weight loss only once a week on Fridays.  As of this morning, I’m down 40 pounds!  That’s 40 pounds in five weeks.  Remember that I was on full liquids for two weeks before my surgery on January 25th and dropped 20 pounds.  They came back in the disguise of water weight and swelling with the operation so I had to lose them again in the following week.  However, since then another 20 have come off.

I feel terrific.  Even this change makes a difference in my clothes, my mobility, and my energy.

I’m increasingly more bored with the full liquid diet but now I’m counting down one more week before I can expand to pureed foods.  One more week, one day at a time.  I can do this!  The weight loss so far will remind me that it’s all worth the effort!

When losing weight it is so incredibly difficult to not focus on the number on the scale.  It’s like the entire measure of success is seeing that number steadily go down, down, down.  I’m obsessed with weighing myself every morning, buck naked and before breakfast.  If the number hasn’t moved sufficiently, my brain goes into wacky thinking like, “Maybe if I go to the bathroom again it will help.”

Seriously, that’s wack.

Logically I know the math behind weight loss.  A pound is equal to approximately 3500 calories.  Expend 3500 calories more than you take in and you will lose a pound.  Ingest 3500 calories more than you expend and you’ll gain.  Even if you lie on the couch immobile for days on end, your body burns calories by breathing, living and performing other bodily functions.  When you’re heavier, you burn more calories in the simplest movements.

However, the body has its own schedule and other factors figure in so even with all of the mathematical reasoning, the scale does not always move every single day.  Here’s a great case in point that should emphasize this in my head.  Prior to the surgery, I was on a full liquid diet for two weeks.  I lost 20 pounds in two weeks.  The math definitely added up.   My activity level was normal, for me, but my calorie intake had drastically dropped.  I switched to clear liquids the day before the operation.  Then I didn’t ingest anything — not even water — for 24 hours.  Once they let me have something it was only gelatin, Italian ice, and juice.  I was on IV fluids and dextrose around the clock, too.

Two days later I was released from the hospital and couldn’t wait to get on the scale at home and see how much additional weight had come off.  Imagine my shock when the scale said I’d regained those 20 pounds!  I must have shrieked because my sister-in-law, a nurse, immediately asked me what was wrong.  When I told her she wisely ordered me to back away from the scale and not get on it for a few days.  It was all water weight and swelling from the surgery, she advised, and would go away as quickly as it had come on.

It did, although not all that quickly.  It took a week but it finally went away and hasn’t been seen again since.

Focusing so much on a daily weight is not healthy for me.  It’s no more healthy than when I was overeating and avoided the scale for weeks on end so that I wouldn’t have to face that I was steadily gaining.  The key is balance.  I’m trying to wean myself away from daily weighing.  It’s like trying to cut back slowly on other addictions.  I can’t go cold turkey and reduce myself to once a week right away.  I weighed myself today and will now hold off until Thursday before weighing again and then skipping another day and not weigh myself until Saturday.  If I can maintain an “every other day” schedule for a week, I’ll put two days of not weighing in between my scale days.

I believe I can strike the right schedule to not obsess while also providing positive reinforcement for all of my efforts.  In the meantime I just need to remember the math of weight loss and know that, regardless of the number on the scale, I’m shedding pounds.

I hate to exercise.  I’m not sure if it’s an activity chicken/egg issue.  Do I hate to exercise because I’m inherently lazy and embrace sedentary living which adds to my poundage, or does my excess poundage make it more difficult for me to move and that’s why I hate it?  Since one of those reasons makes me sound like a jerk, I’m going with the second.  Today I choose to believe that the more weight I lose, the easier it will be to move, and the easier it gets, the more that I’ll like it.

I enjoy the feeling I get when I’ve done any exercise, that tiredness in the muscles that tells me they were worked with good intent.  I like the feeling of accomplishment that infuses my spirit after a water aerobics session or Tai Chi class.  I’m not setting any triathalon goals, but I am cautiously optimistic that I will learn to enjoy regular physical activity.

I really do enjoy swimming and exercising in the water.  I’m thrilled that I’m getting back into Tai Chi.  I practiced this steadily 11 or so years ago for four or five years and reaped great benefits.

At this point, I’ll be happy when I can walk more than a block without my knee and lower back hurting.  Zumba looks like a hell of a lot of fun and I’d like to try it in the not too distant future.

Right now I need to set some attainable activity goals.  Somewhere I have a DVD for Walking off the Pounds.  Following along with the instructor for even 15 minutes means we achieve a mile’s worth of exercise.  I can do that in the house regardless of the weather.  Seriously, even at my laziest, I can push out 15 minutes.  So I’m going to commit to doing that every day.

I also had a terrific realization yesterday.  I’ve lost enough weight that I can finally, finally use my Wii Fit system.  I think I’ve had it for two years but when I brought it home I found out that I was too heavy to use the balance pad.  Now I can!  That’s a victory.   Before the end of the week I’m going to figure out how to hook it up and check it out.  Fitness should be fun, right?

What’s on your activity list?  Do you work out regularly . . . sometimes . . . hardly never?  What does it take to motivate you?  What works for you in terms of motivation?  Any suggestions?

Welcome to Weighty Matters, a blog where I’ll talk a lot about obesity, dieting, weight loss surgery, body image and all kinds of fun stuff.

Some people might wonder why, and I’d be one of them, but for several weeks creating this blog and writing about my journey and experiences seemed like the right thing to do for myself.    If you and others get something from it, so much the better.  My intention is to be as honest as I can about every topic I post — brutally honest as necessary.  If there’s one thing I’ve learned in a lifetime of obesity, my ability to deny and lie to myself and others about my weight and body issues is limitless.  I’ve come to believe that “rigorous” honest is the real path to survival.

Why now?

That’s easy.  Two weeks ago, on January 25th, 2012, I had weight loss surgery.  Specifically, I had a procedure called a vertical sleeve gastrectomy.  Simply described, the surgeon cut away and removed 70% of my stomach, leaving me with a pouch about the size of a small banana.  At most, a stomach that size can hold about five to six ounces.  That’s less than a cup.  Highly restrictive and less food means less calories so I’m on my way to significant weight loss — for good this time.

Transforming from a life of unhealthy, destructive eating and excess weight to a healthy, more mobile and, yes, thinner Mary is going to be quite a journey.  Keeping this blog as a journal will help.  At least that’s the plan.

Although I’d shared my decision to have surgery with my family several months ago, and let me just do a shout out to them right now for their unqualified support of that decision, they didn’t ask me why I’d now made the decision.  My sister-in-law asked me right before my operation.  I was very clear on my reason.  I’m 54.  I don’t want to be disabled or dead by the time I’m 60.

My over-abundant avoirdupois has impacted me for most of my life, although the extent has increased in recent years.  I could function better at 30, carrying around the excess pounds.  Now, physically, my body’s beginning to break down.  It is more difficult for me to walk and even harder for me to go up stairs.  If I spend too much time on my feet, my joints complain for hours after.  Slowly, surely and without respite, being morbidly obese is compressing the normal, wonderful activities of life into a very narrow box.  There are increasingly more things that I can’t do at this size either because my own body can’t physically handle them or because external factors (think theme park rides as an example) aren’t equipped for the shape and load.

I have high blood pressure, high cholesterol and Type II diabetes.

Seriously, do I need any more reasons?  Of course not.

After years of resisting the idea of surgery, last summer I opened my mind and heart and started doing research.  I’d always feared gastric bypass and felt like the Lap Band option was something that I could find a way to eat around.  Still I was determined and if those were the only options, I would have picked one and continued on the course.  I’d not heard of the sleeve gastrectomy (aka VSG) and when I did, the more I read, the more convinced I became that this was the choice.

I asked my primary care physician to help me find a reputable surgeon in Miami.  I wanted someone with lots of experience, a doctor who didn’t view bariatric surgery as a sideline.  The South Florida television channels are alive with ads from a plastic surgery center touting same day lap band procedures and I flinch whenever one airs.  It just seems too much like some people could view bariatrics as a cash cow.

My doctor gave me a name.  I attended the surgeon’s next informational seminar and then proceeded to a one-on-one consultation.  Now comfortable with the surgeon, I started on the process of doing all I needed to in order to have the surgery in January.  Having come to terms with the decision, I told my family and my bosses.

The journey began and it seems like it’s been a long, involved trip.  Suffice it to say that before undergoing major surgery, one must first be poked, prodded, examined, tested, scanned, scoped and evaluated.  Luckily, with the exception of the conditions I mentioned before, all of which I’ve been treating for a few years, all of my tests came back positive.  The various doctors signed off and approved me for surgery and the countdown began to January 25th.

Now, two weeks later, I’m not in pain.  I feel stronger.  Best of all, I’ve lost 31 pounds.  There are many months and miles stretching out ahead, but at least I’m on my way.