Turned the Corner

 I am now seven weeks into the ten week night real estate class that I am taking.  The first part was kind of rough and took some getting used to. Likewise, I am three days into the seven day liquid diet leading up to my surgery this Friday.  And likewise, the first part was kind of rough and took some getting used to.

The liquid diet is just as bad as it sounds. It’s like the day before a colonoscopy, except there is no clean out required. So I guess that is a positive. The objective is to shrink the fatty tissue around the liver which makes the surgery more easy, or less complicated.  So far, I’ve lost 6.1 pounds in these past three days.

The liquid diet allows about five protein shakes per day, which includes these Premier protein drinks, or smoothies made with protein powder and either a half cup of fruit or milk.  I can also have soup broth, one protein bar which is the size of your thumb, and sugar-free Jell-O. So far, other than one beer Saturday night after my band’s gig, I have followed the liquid diet to a tee. I guess you could argue one beer should be an allowable exception on a liquid diet weekend.  I’ve tracked all my food intake in MyFitnessPal, and my calories have ranged from 575 to 996 over the three days. Carbs have been 54, 54 and 28, which is incredibly low compared to the usual reasonable goal of over 200.

Recently, my band Old Play got asked to play again at the local restaurant Sophie’s.  I was reluctant to do this because the gig was going to fall on Saturday night, which was day two of my liquid diet.  But we have been without gigs all year long due to Covid, and we played there three weeks ago and they liked us, and invited us back. So I wanted to support that if it all possible.  After all, I have played gigs while sick many times!

When I talked to my dietitian on Thursday, she warned me that the next two days would be very rough, with flulike symptoms.  And she said that she felt I would probably have a rough time doing the gig on the night of day two. She said it takes about that long to get to ketosis. But she said that I would likely wake up Sunday morning with a new feeling of euphoria.  Indeed, the first two days of the new routine were the worst. Actually the first 36 hours.

I started the liquid diet on Friday.  And by the afternoon I was starting to feel bad. Adding to this, on Thursday night I started to have allergy symptoms, with a bit of a stuffy head and feeling sort of blah. Apparently, the pollen count was quite high during this time. By Friday afternoon I felt awful and lethargic, and had to take a nap during the latter part of the day.  

I didn’t sleep particularly well Friday night, suffering through some restlessness as well as some headaches. I got up Saturday morning around 9 o’clock and practiced through the setlist.  I was thankful that we were only doing about 28 songs, compared to the 37 we did three weeks ago. Then I went back to bed for a few more hours, which was very unusual for me. Once I got back up I still felt a little tired, and decided to have a cup of coffee. I usually only have one cup of coffee a day, and I was trying not to drink caffeine that during this time, because that was advised. Anyway, the cup of coffee helped. That seem to invigorate me, my headache subsided, and I continued to feel a little bit better throughout the day.  

The closer we got to the gig, the better I felt. It was sort of a bummer to have to carry to the gig my cooler loaded with a Premier protein shake, Gatorade Zero, water, and a mug of warm beef broth soup.  All the wings everyone was ordering in the restaurant certainly tempted me, but I stuck to my regimen.  The gig went pretty well, and I felt pretty good throughout the evening. The allergy symptoms subsided, and though I did feel a little weak due to the lack of usual nourishment, I survived.  I was glad to be home, and get to bed, while my painful hip arthritis kept me tossing and turning that night.

Yesterday - Sunday - was a day of recovery. I stayed in and studied my real estate textbook and took some practice tests.  Of the three days, I actually ate less on Sunday than I did on Friday and Saturday. At the end of the day I realized I only had four of the five protein meals that I am allowed.  I guess because I’ve gotten used to eating less.  I did go to the pool and hang out with some friends, and even did a little real estate studying while at the pool. I even read a bit of Camino Island by John Grisham.  Lately, reading for pleasure during the day has been a rarity. I guess I took on a lot with the real estate class, while having a full time job and learning new songs with the band.  

The worst part about this phase is the boredom of the selection of liquid foods. Nothing is particularly satisfying taste-wise. But I know this is temporary and the reward will come later.

This Wednesday, I have my Covid test, which is required pre-surgery. Then I also have a dentist appointment. Then Thursday I meet with the doctor in a video call. And then Friday is the surgery. I’m hoping the week passes quickly and I’m glad I’ve turned the corner on the ketosis (and the real estate class).  I’m not sure I would call my current state euphoria, but it’s better than the way I felt Friday and Saturday!

It's About to Get Real

Well.  Here I am.  Age 55 11/12.  Cholesterol under control for many years due to taking a pill.  Moderate sleep apnea under control of an annoying CPAP machine and mask I wear nightly.  Both knees not too bad after laparoscopic meniscus surgeries a few years ago - but certainly not suitable for running.  And my right hip in pain if I use it for anything crazy like putting on my right shoe.  Otherwise, my health is not too bad.  Heart still working OK, and blood pressure still remaining under the acceptable limits, barely.  My weight has fluctuated from 300 to 280 over the past 3 years.  Up and down and up and down.  Just in the last 3 months, I've been up and down between 290 and 300 like 4 times.  As I review this blog I've written the last 13 years, I see 18 posts tagged as having mention of dieting in them, counting this one.  I even came across this memorable graph I made in 2008, showing my progress on one of the most successful of the many diets I've been on.  Look at that cyan line, how it dives down beyond the yellow and magenta lines! 

That year I went from about 280 to about 235.  I was preparing to apply to MBA school at Duke and was really motivated.  Side note: I did get accepted, but couldn't get funding from my company to pay for it.  But that's another story.

Then there was the Diet of 2010.  Lori and I both were using Metabolic Research, which was a costly program requiring all sorts of vitamins before each meal, as well as better eating.  Here's a photo of us during that time.   I think that diet costed about $4000-$5000.  I don't have my weight during that era graphed.  But even then, my BMI was higher than it should be.  In every picture of me, I am subconsciously holding in my gut.  :-)

Back then, I tracked my weight on index cards, and in Excel.  I even made this diet summary table once.  I should update this someday!

Soon after that I guess I started using MyFitnessPal to track my data.  It collects my weight every day that I enter it in, which was manual up until I bought a scale which updates it automatically.  Check it out.  In 2012, 260.  Up to over 270 in 2013.  Down to 255 in mid 2013.  Up to 290 in 2015.  Down to 260-something in 2015.  Up to 300 at the beginning of 2017.  

Most recently, in January 2017, I joined the UNC Wellness Center and became a swimmer.   I worked out or swam about 5-6 days a week for months and really improved my muscle tone.  This picture is actually from the YMCA in August 2017, but I really was getting some shoulder muscles then.  I felt great, even though the weight loss was only down to the 260s.  I really thought at that time, that I would be able to maintain.  But eventually, the workouts became 4 days a week.  Then 3.  Then 1.  Then barely none.  Life happens.  Taco Bell beckons.  Since then, I did a beeline up to over 300 regularly in 2019.  

What a difference 3 years makes.  Here I am 2 weeks ago with Lori, visiting my mom.  

I've never had much problem losing weight, though it has become more challenging as I've gotten older.  It's keeping it off that is the challenge, as I believe it is for most people who struggle with being overweight.  In addition to the aforementioned methods involving vitamins and exercise, which I've done over the years, I've also consulted with dieticians, weight trainers, psychiatrists and even a hypnotist to help me lose weight!  They all helped - for a period.

As I wrote in a 2008 blog post The Diet of 2008, 

To me, diets are like relationships. That's why I'm so reluctant to start each diet. Why start this new diet, when the last one just didn't work out? I really thought the previous diet would be my last. I invested time into it. I loved and cared for it. I had the right intentions. But then, I fell out of diet-love. Me and the diet went our separate ways. Perhaps I made some mistakes, but the diet did too. Will this new diet be "true diet", or just a "rebound diet" started too soon after the last diet ended, and after one feel-good night of better eating and a little casual exercise? Indeed, diets are like relationships.

People say I don't look that bad.  I look OK in some pictures.  I'm not "that" much overweight.  I'm one good diet away from looking like I did in 2008 or 2012 or 2017 all over again!  I am fortunate that I carry my weight pretty well.  Not that this is about looks.  But when the photo is straight on and someone is in front of me, I can say a picture of me is not too bad, like the one with Mom up above.

But then, there's the side view and it's not flattering at all.  Here I am a few weeks ago about to attempt a solo with my band.  I don't particularly like this angle of me.  

Anyway, it's not so much about how I look, though, that is important.  It's about other "cosmetic" things, like choice of clothes.  Most shirts come in a 2XL.  But not many come in 3XL.  And even those sizes can vary in fit.  Nothing more disappointing than finding that the new 3XL shirt I like has somehow gotten too tight to wear.  

But I digress.  This is not about my vanity, but about my health.  And while my health is not too bad (yet), I don't want to cross a line and end up with heart issues or diabetes or cancer, or whatever else it is that we fat people get that leads to an early death.  I don't want to live forever, but I would like to live long enough to retire and maybe have a grandchild or three.  Plus, I want to be able to do stuff without always feeling like I am fatigued or in pain.  Ever notice that the word fatigue starts with FAT?  This stops now.

So here I am, two days away from starting the pre-op process for the vertical sleeve gastrectomy (VSG) I am having on September 4.  According to Current State of Bariatric Surgery: Procedures, Data, and Patient Management, 

Bariatric surgery comprises a group of operative procedures designed to improve weight-related medical conditions.  Bariatric surgery is the only durable and effective way for most humans to lose a significant amount of weight, and see improvement in obesity-related comorbidities. It can improve quality of life, prevent a number of cancers, and decrease overall mortality. Bariatric procedures work through several avenues, including restriction of food intake, malabsorption of food calories, an increase in metabolic rate, decreased hunger, increased satiety, and a variety of other hormonal mechanisms. 

VSG is basically where part of the stomach is removed, leaving a banana sized pouch remaining.  Other procedures involve rerouting the digestive plumbing to bypass parts of the system in order to reduce fat absorption (ie. gastric bypass).  I'm going with the more basic and less risky VSG procedure, which comprises about 59% of all bariatric surgeries.  With any surgery, there is a chance of death and complications.  But I figure there is a pretty good chance of death sooner than later if I stay on the current yo-yo dieting path I've been on for the last 30 years... which always trends UP over the long run.  Lose 20, gain 30.  Lose 15, gain 25.  Lose 40, gain 60.  And so on.  And regarding complications, I believe a lot of those are due to patients not following directions, rather than doctors screwing up.  I can follow directions when I have to.

Because my BMI was 40, I was able to qualify for this procedure with my insurance.  I have spent the most part of this year working through the various hoops Aetna requires to be approved: gallbladder ultrasound, dieticians, more psychology, lab work, upper-GI, sleep study, and then a 12 session weight-loss program.  

Holy smokes.  Look at this beached mammal observed on the coast of NC earlier this summer!  Talk about stylish!  That poor chair.

I've always thought weight loss surgery was for really huge people who just didn't have the discipline to stop eating once they passed 300, 400, 500, etc., pounds.  I choose not to let it go further than it has.  But I know the struggle is real.  I love food.  A lot of it.  And it's not all good for me.  And it's not all bad.  But I need this tool because I've tried every other avenue with success, followed by failure, time and time again.  

It's easy to think of weight loss surgery as an easy shortcut.  People get fat and don't want to do the tough work of losing weight and maintaining it.  Just go to the doctor and have a procedure and voila!  Now you look great!  Well, I am afraid it won't be that simple.  For me, I have to be on an all liquid diet the week prior.  Some larger people require 2 weeks so I'm glad I'm a 1-weeker.  I'm thinking this will be like colonoscopy prep 7 days in a row - without the cleanout!  Yikes.  This starts in 2 days for me.  The goal is to get to ketosis so that the liver will get smaller which makes the surgery go better.  

Surgery takes about 2 hours and there will be one night of recovery in the hospital.  Then, 2 more weeks of all liquid... but this time they say that I will not be hungry so hunger will be the least of my worries.  The challenge will be getting enough protein in me.  I will be on vitamins the rest of my life after this surgery, but that's better than being on cholesterol pills, heart pills, etc.  During that 2-week post-op period, I can have yogurt, vegetable juice, sugar free puddings, milk, strained soup.  I was told it's like being a baby again and you have to re-acclimate your stomach to eating.  

In weeks 3-4 after surgery, I can have pureed food, scrambled eggs, cottage cheese, pureed fruit & veggies, yogurt, tilapia.  Yummy.  Weeks 5-6 includes chopped food, pot roast, any foods I can cut with a fork, string cheese, etc.  Now we're talkin'!  After week 6, I can eat mostly regular food again, though in much smaller portions because: 1) my stomach is smaller and 2) cravings will be reduced because the lower part of the stomach is removed and is believed to somehow be involved with driving cravings.

Easy as that.  Oh, and there may be some throwing up involved, though I have read about many people who never had such issues.  This will take some getting used to.  But I can do it.

Anyway, I'm doing this.  Because I've tried everything else.  More than once.  Bariatric surgery is not a quick-fix.  It is not a shortcut.  It is a pain-in-the-ass fix that I believe will yield years of positive results.  It is a tool.  An expensive and difficult - but effective - tool.  

I've read posts in bariatric Facebook groups from hundreds of people who have had massive success with bariatric surgery, losing hundreds of pounds.  I've seen before and after pictures.  More times than not, people wish they'd done it sooner in life.  There are some people who've had issues, but those are by far the exceptional cases.  

I had to write this because I wanted to document my thought process, as I've documented many of my other life experiences.  I can't say I'm not nervous about this.  I've spent the last week visiting some of my favorite culinary weaknesses, much like a groom having a bachelor party.  Longhorn Steakhouse.  Five Guys.  Jersey Mike's.  Taco Bell.  JJ China.  Wendy's.  Cereal.  I still need to have Lori's homemade lasagne one more time.  Not forever.  But for a while.  I'm also a bit excited about getting on with this.  I'm dreading the pre-op week probably more than anything.  I expect I will be HANGRY for a few days until I get used to it. 

My procedure will be done at Rex Hospital which is part of UNC Hospital system.  I trust them and I believe I am in good hands.  

Remembering Roxie

It's been about 2 1/2 days since we learned that our furry family member of 10 years had inoperable kidney failure.  We all gathered around while Roxie went "nite nite" one last time on Monday, August 10, 2020, around 6:45pm.

It's hard to believe what a difference losing her has made for us.  I know this grief will pass, but while the memory of her is still fresh, I wanted to make some notes.

Though Roxie was not particularly loud, our house now seems strangely quiet.  She never spoke words, though I always felt like she was on the verge of speaking English.  She rarely barked unless there was someone on "her" field.  We did hear her toenails clicking on our hardwood floors quite often, but in general, she just hung around wherever we were.  She seemed to always be present.  Maybe it was us who made the noise, talking to her like we would talk to one another.

"Hey Roxie, whatchu doin'?"
"Wanna go outside?"
"Make sure you sit in the shade if you go out there."  
"Need some water?"  
"She's a good girl."  
"Treat?"  
"You wanna go ride with Mommy?"  
"All the way out! ALLLLL the way out!" 
"It's steak night!  Roxie's favorite night!" 
"Cheese ball?"  
"Who's at the door?!"  
"I'm going to the grocery store to get some milk, tortillas, and yoghurt.  You need anything?  Be right back." 
"She's a good girl."  
"Oh here you come now that I'm cutting food!"  
"Let's go pee pee."  
"Ready to go nite nite?"  
"Want Daddy to help you up the stairs?"  
"Are you OK?"  
"She's a good girl."  

She never responded in words, though I know she would if she could.  She did respond with her eyes. And smiles.  And actions.  Always laid back, and never too uptight about anything.  Didn't really mind if other dogs came over and borrowed her stuff or food.  At least not once she got older.  Always present.  Loyal.  Always a look of concern when we were packing luggage.  And then disappointment if we left without her.  And much excitement if she got to come along.  She was the dog I always wanted.  One that would do all the things I described, including lay by my side while I read, or watched TV, or did work, or worked on a project.  She was truly a family member and friend.

Our patterns and routines are disrupted now.  Or maybe un-disrupted is the better description.  Other than our boring cat, and 2 sons still at home, there's no one really depending on Lori and me for food, shelter, and companionship.  Even our robovac has little to do now, whereas, before she filled her belly with Roxie-hair on a daily basis.  (Yes, our robovac has a name and personality)

We obviously still have one another, and someday we will get another (smaller) canine.  But for now, there is a void and an emptiness left by Roxie.  As it should be.  She was a good girl.

In a dog's life

A year is really more like seven

And all too soon a canine

Will be chasing cars in doggie heaven 

 

It seems to me

As we make our own few circles 'round the sun

We get it backwards

And our seven years go by like one      

              

        -- Neil Peart, RUSH