Putting Down The Cheeseburger

(Mmmmm….food porn.)

Yesterday, Lor told me a delightful (/sarcasm) tale about a lunch date with two friends that hadn’t seen each other in quite a while. One party spent the majority of the luncheon complaining bitterly about her sister, who had recently had weight loss surgery because “she was a lazy ass who doesn’t want to put down the cheeseburger and exercise.” Towards the end of the meal, the complainer asked her friend how she was managing to stay so trim and fabulous looking.

“I had bariatric surgery, because I am a lazy ass who won’t put down my cheeseburger.” was the reply.

I would guess that lunch ended soon thereafter.

This story, paraphrased from a tale Lor found on a bariatric social web site, highlights the ongoing issues that we have relating socially after we have gone through bariatric surgery. The great misconception still exists that we have somehow created a trap door in our digestive system that allows us to eat whatever we want and suffer zero consequences from it.

Can I let you in on a little secret? I have to work twice as hard at maintaining my diet and exercise as a “normal” person. Every single thing I eat is analyzed, weighed, measured, and logged. My daily regimen is closer to that of a professional athlete than that of someone who just wants to stay fit. I live on supplements, protein shakes, and meals that would not pass muster as a salad on a child’s menu. And a single dietary mistake lands me locked in a bathroom for hours, expelling the material my rearranged digestive system didn’t agree with from both ends.

Those who choose bariatric surgery are accused of doing this because we want to be more attractive, as a sop to our poor self-esteem. But, the truth is, bariatric surgery did not turn Lor and I into Malibu Ken And Barbie.  I will admit, I no longer suffer from feeling unattractive due to my size. But I now feel unattractive due to the huge piles of deflated skin covering my body like flesh-colored Play-Doh. I don’t recognize my face in the mirror, which gives me some real existential crises. I had to shave my head due to hair loss, for goodness sake. (And, yes, the happy accident is that I actually like my shaved head. Thank goodness.)

And, through it all, I still deal with the lingering suspicion that I am somehow “not doing enough.” I should eat less, exercise more, hydrate better, sleep longer. Bariatric surgery has given me many of the symptoms that we would equate with an eating disorder.

Do I wish I hadn’t done it? Not for a moment. Societal mores had nothing to do with my decision. I took ownership of my own health, and control over my own body, by going through with surgery. But I still find it very frustrating that our society not only is focused on size as a metric for determining the worth of a person, but is even willing to judge those of us who strike out toward health via the method of bariatric surgery. In a nation where over 50% of the population suffers from obesity, calling those of us who required surgery “cheaters” is disingenuous at best, hypocritical at worst.

Yes, I “put down the cheeseburger”. Bariatric surgery was one of the tools I used to help me do so. The idea that this is somehow “cheating” is held by those who have not spend years (or decades) trying and failing to defeat obesity. To those who have not walked a mile in these shoes, I can only say the following:

Get Over Yourselves,

– Hawkwind

The Stupids

It was a day like any other. I got up at 5 AM, wandered through the darkened hallways, and sat in front of the PC. I looked over my writing tasks for the day and then decided to bang out my Tuesday blog post before I did anything else. I then worked through about 700 words, added a photo, attached some keywords, and then went about my other tasks for the day, with the warm and fuzzy feeling that accompanies the completion of a daily task.

The only problem is that I didn’t press the “Publish” button.

Welcome, my friends, to the world of “The Stupids”. First off, a definition:

Stupids (stoo-pidz), noun: A mental condition characterized by poor short-term memory and lack of attention to detail, frequently brought on by caloric deficit and substandard nutrition.

When you tack the effects of this condition on  top of my already fragile mental state due to my use of anti-seizure medications, you can have some profound results. I have been known to “lose” items that I was holding in one of my hands. I have been observed standing in front of a running sink washing dishes, not noticing that the sink is overflowing and running water is cascading off the counter onto the kitchen floor. I have been sent to the store across the street for an item, only to return with a backpack full of things we did not need, while missing the crucial piece that I was sent to the store for in the first place.

And, yes, I have written an entire blog post, and then forgotten to publish it.

The Stupids. Sometimes it is a state of mind, other times it is a new home I have moved into.

There are some solutions available. Nutrition is the big one: I have learned that when I do not eat 3 meals in a day, I will be affected. Forgetting to take a multi-vitamin will also do it. (Which leads to forgetting other important supplements, etc.) Not enough sleep is always a trigger.

But what about days like yesterday, when everything was pretty normal otherwise? No idea. Some days I just operate with only half a brain. It is frustrating, but after years of experience with epilepsy, I have learned to roll with it. For a person who has just emerged from bariatric surgery, experiencing this for the very first time, this must be frustrating and frightening. It must feel like you are losing your mind.

Take heart – you are not losing your grip on sanity. Your brain is responding to what it feels is a deficit of important nutrients (or sleep) by shutting down what it considers to be non-essential functions like remembering to flush the toilet after you are done. Once you have identified the problem, figure out what you missed. Take a nap. Take your meds. Eat a snack. Then wait for a while.

It is only The Stupids. This, too, shall pass.

This Time I Will Check The Blog Page,

– Hawkwind

The Self-Care Podcast

Over the weekend, we were invited to be the guests on a podcast run by a friend of ours, Nicolina Nicthe, a local artist and comedienne. Her weekly show is called Women, Wit, and Wine, and is a humor-tinged (and adult-oriented) podcast focusing on exploring women’s issues through the alcohol tinted haze of sampling local wines. I was honored to be accorded the status of “Honorary Woman” during the hour of our participation, which we spent discussing the subjects of Self-Care and Nurturing.

Lor and I went into the show expecting that our input would be largely focused on our efforts towards self-care via our bariatric surgeries this year. While we did touch on the subject briefly, it turned out that Lor’s training as a Massage Therapist quickly became our point of focus, and she was able to discuss a wide range of self-care topics with our host, while I provided mostly comic relief via my embarrassment as I drowned in a sea of estrogen. The topics ranged widely, from filling empty vessels, to stress-based illness, to the self-care value of artistic endeavors. While I would encourage anyone with 80 minutes to spare to hit Nicolina’s Facebook page to listen to the broadcast in its entirety, I thought a few points from our discussion stood out, and deserved to be repeated here:

1. Take ownership of your self-care before taking ownership of caring for anyone else: The subject kept returning to the subject of “pouring from an empty vessel” – the concept that a person can only pour so much out of themselves before they are tapped out and no longer able to provide for themselves, much less anyone else. If you want to be able to care for those around you (whether friends, a spouse/partner, or children), you need to have a renewable source of personal emotional energy.

2. Pursue your bliss: One of the best ways to care for yourself is to pursue your own interests. Don’t force yourself to try a diet/exercise plan/new life philosophy if you aren’t really interested in it. The most valuable self-renewal exercise is one that you will do – whether that is running a triathlon, or learning how to create pottery. Don’t embrace someone else’s passion – find your own.

3. Carve “me time” out of your schedule: The idea that we can find hours a day for self-care is laughable for most of us, given our busy schedules. So don’t start by looking for hours a day. Set aside a few minutes a day (get up earlier, take a shorter lunch, go to bed a little later) and sit alone and breathe. That’s it – simple as that. Your body will get used to the feeling and will start demanding more, inspiring you to find ways to create more self-time. But don’t start big – start small, and ramp up.

Thanks again to Nicolina for her invitation to participate in her exciting new project, and we look forward to watching as Women, Wit, And Wine expands its reach and audience over the new year and years to come.

Feeling Like Something Is Missing Since I Lost My “Woman” Status,

– Hawkwind

Playing Santa

As Christmas grows ever nearer (23 days as of this post), I have been fielding a few questions about Christmas gifts. What, people are asking me, does one get for a pre- or post- bariatric surgery patient? In the service of Christmas Gifts That Don’t Suck (TM), I would offer up the following suggestions:

1. Clothing: You’ve seen the complaints here on almost a weekly basis. As the weight loss starts happening, the clothes stop fitting. So quickly that many patients (myself included) just stop buying clothes entirely, out of frustration with the concept of wearing something once then giving it away. This eventually leads to sagging pants, tent-like shirts, and underwear that falls off. Some even suffer from the issue of shoes no longer fitting. (Not a problem I have had, but one that is driving Lor crazy, for example.) So, pay attention! Buy a piece or two that is a size below what your patient should be wearing currently. It will be snug for a bit, then it will fit for a glorious week or two, then it will sag and eventually be donated. If you are afraid to guess at sizes, a gift certificate to an inexpensive clothing store like Old Navy might be your best bet.

2. Supplements: It may not occur to many, but the post-surgery life is flooded in supplements. I, for example, am taking a Multivitamin, an Iron supplement, Biotin, and Osteo-Biflex (a joint health product). That is, like, every single day. Though the grocery bill does diminish a bit after bariatric surgery, the supplement bill goes right through the roof. So, get your patient a month or two worth of one of their supplements. If you aren’t comfortable picking brands, grab ’em a gift card to a local GNC or even a CVS/Walgreens type of store. This is the one time that buying a gift certificate to a drug store will not be viewed as a lame last-minute gift idea.

3. Dining Out: Our lives after our surgeries are filled with cooking 3 meals a day, every single day. We no longer go out to eat much, because we are afraid of wasting food. Also, the majority of the places we used to go are what made us obese in the first place. So, take your patient out for lunch or dinner – but take them somewhere they would have never gone before. No burger joints or salad bars, please: try places like seafood and sushi restaurants (sashimi is 100% allowable under most nutritional plans), steak houses, and barbecue pits are all great ideas for high-protein, low-carb dining. Your patient will get a meal with a loved one, plus leftovers to take home. (Trust me, there will be leftovers.)

4. Adventures: The great majority of bariatric patients are recovering from sedentary lifestyles where very little time was spent trying new things. Both physical health problems and embarrassment over their size kept them at home, on the couch. Now that they are taking steps in the right direction, help them out! Get them a hot air balloon ride. Take them to an ice skating rink. Buy a month’s worth of dance lessons. If you ever heard them wistfully wish they could try an activity while they were overweight, now is the time to strike – get them through the door of that studio/dojo/museum/whatever. Better yet, go with them – nothing defeats fear of the unknown like having someone to share new experiences with.

Hopefully, somewhere in here is an idea or two you can use for the friend or loved one that has gone through bariatric surgery this year. As they are trying to come to grips with this new life, free from the bonds of chronic obesity, you can show them you support their life-altering decision with nothing more than a thoughtful gift. But act quickly – you only have 22 shopping days left!

No Fruitcakes, Please,

– Hawkwind

All My Sleeve Wants For Christmas Is…

The activity on the bariatric surgery forums and message boards has been ramping up lately, which is great. I love to see new people joining the ranks, asking questions, and getting plugged into the community. However, any time you get a large number of new folks joining an online “community”, there are going to be questions. And, recently, I am seeing the same questions posted over and over and over again: all varying versions of “when can I have/why can’t I have (insert forbidden item here?)”

I get it – really, I do. Not every bariatric patient got to participate in the awesome nutritional counseling that Lor and I did with Albuquerque Health Partners. Some folks are forced to self-pay and end up getting their surgeries out of the country, meaning they might receive little to no nutritional info at all. So, in the interests of public service, I thought I would share a little information (and personal experience) about the forbidden foods most commonly asked about.

1. Bread/Pasta/Cereal: By far the most asked about food types on the boards, everyone wants to know why they can’t have their favorite go-to-in-a-hurry foods any longer. There are a couple of reasons. First, grain-based products tend to have a very poor protein to volume ratio – 2 ounces (2 standard slices) of bread, for example, contain around 20 – 30 grams of carbohydrates and only 4 or 5 grams of protein. Our lives post bariatric surgery are going to forever be focused on increasing protein intake and minimizing carbohydrate intake, to avoid malnutrition. So, sadly, grain-based products tend to be a non-starter for us.

Secondly, once ingested, bread can expand in the stomach for many of us post surgery (myself included.) This can lead to major discomfort, illness and leads to the inability to ingest anything other than a couple of bites, leading to even bigger nutritional deficiencies. Prepare yourself for life without sourdough bread, lasagna, and Rice Krispies.

2. Bananas: Apparently a very popular subject, bananas hold an odd place within the post-surgery diet. They are a fruit (which the great majority of diets want you to be eating), but they make many bariatric patients ill. What gives?

Bananas, as it turns out, are a natural repository of huge amounts of sugar: one medium banana is worth about 25 grams of carbs, over 15 grams of which is sugar. Strawberries, by comparison, only contain about 7 grams of sugar per serving. Though every patient is different, the higher the amount of “pure” sugar one takes in, the greater the risk of “dumping syndrome”: the rapid movement of food from your stomach to your small intestine. One can only find out where the tipping point is by experimentation, but I can tell you from experience that once you go over, you will wish you hadn’t. Any high-sugar food, even bananas, needs to be approached cautiously.

3. Soft Drinks: Not a day goes by that I don’t read on some forum or another “When can I start drinking cokes again?” Soft drinks may be the most evil and pernicious addiction the world has ever known. So, congratulate yourself, bariatric patients: you have kicked the habit. Because there ain’t no goin’ back.

Soft drinks, aside from being highly concentrated sugar delivery devices, are also repositories of carbonation, which can seriously compromise your reduced stomach size. How? Open a bottle of your favorite soft drink. Attach a balloon to the neck. Shake vigorously. See how that balloon inflates? That is what happens to your reduced stomach pouch any time you ingest carbonation. It inflates, just as it is designed to do, to accommodate larger-than-normal meals for our berry-gathering ancestors. Will one soft drink ruin your post-surgical condition? Probably not. But, I can tell you from personal experience, ingesting any form of carbonation will hurt like hell. You have been warned.

Now, pour your experimental soft drink down the drain. Don’t expose yourself to temptation.

4. Beer: My greatest bariatric surgery regret is that I will never drink Guinness again. It hurts me, deep in the secret places of my heart. But it is a sacrifice I was willing to make, and one that comes up frequently in our discussions with other bariatric patients. So, why no beer?

Firstly, see “no carbonation” just above. Beer is delivered in a carbonated liquid, with all the same drawbacks as soft drinks. (Though better taste, in my opinion.) As much as I love the stuff, I am not willing to inflate my new sleeve repeatedly until I can eat half a cow at one sitting again.

Secondly, beer contains alcohol. (Duh.) And bariatric surgery leaves us very susceptible to the effects of intoxicants – in short, we become cheap dates. I used to be able to put away a 12-pack of beer in the course of an evening. A twelve pack will now most likely put me in the hospital. A single drink of alcohol will have an almost immediate effect, and will then wear off pretty quickly as well. I have yet to start experimenting with this myself but have been able to watch it in others. Be wary of any alcoholic beverage, and avoid any delivered in bubbles.

5. NSAIDS: Post-surgery, pain is a big issue. And many patients are dismayed to find out that their favorite pain relievers are no longer allowed thanks to the changes to their digestive system. Those that have previously taken things like Asprin, Advil, Aleve, Motrin, and other Non-Steroidal Anti-Inflammatory Drugs are informed that these are entirely off the menu and that they need to switch to acetaminophen-based products. Those of us that can’t take acetaminophen (like myself) are basically just out of luck.

But, why?

The reduced size of the stomach pouch has many interesting side effects. The one that affects pain relievers is this: a smaller stomach pouch has a reduced size, meaning a smaller amount of stomach acid (for breaking down things like drugs) and a reduced amount of mucus (for protecting the stomach lining against the tissue-damaging effects of things like drugs.) This means that the corrosive side effects of NSAIDS can burn right through the reduced protective layer in your stomach and start directly affecting the walls of the stomach pouch, resulting in things like ulcers. In a large stomach pouch, the side effects are mitigated by the sheer amount of real estate. In our surgically reduced stomachs? Not so much. Switch to Tylenol if you can. If you can’t, due to medication interactions like mine, you will have to learn to grin and bear it.

Hopefully, this gives everyone a little clearer idea as to why so many of our favorite things have been seemingly randomly removed from our lives. Just remember – there are a host of healthy food items out there that you have likely not even tried yet. Instead of pining over the comfort foods you have lost, go out and discover some new, healthier ones. I, for one, was happy to trade chocolate chip cookies for the ability to walk several miles without being in pain. What are you willing to trade your favorite foods for?

Waiting To Trade Whiskey For Beer Next Year,

– Hawkwind