Post-Op Week 25 Progress Report and the Way I Sleeve

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This week saw a slight gain.  Am I disappointed?  Slightly.  Am I discouraged?  Not a bit.  Let me explain.


I know what I ate and drank, and I know how much I moved.  I hit my protein and fluid goals each day but Mother Nature and her hormones were just a bit more powerful than even my best efforts could have been this week.  It’s not even a pound, and only the second time during the past six months that I’ve gained anything at all.  I guess the biggest blow is that it happened during the holiday week!  I’m trying really hard not to be bummed about the fact that this gain coincided with the holidays, but that’s a tough one.  I refuse to chalk this gain up to holiday eating, like so many others do.  That kind of behavior got me to 440 pounds.  I’m trying like hell to avoid that behavior, so what did I do?  I looked at all the data I had, and eliminated what I knew could not have been the cause of my gain, and am laying the blame squarely on hormones, as Aunt Flo’s visit ends tomorrow.  Once she’s gone, I fully expect that things will get back to normal…for the next 3 weeks, anyway.  And then it’ll start all over again.

Besides, I had a 7-pound loss last week, so I can’t be too upset about this little burp in my overall weight loss.  The last time this happened to me (a gain), it just so happened to be right at the tail end of my period as well, and then was followed by a good loss.  So I’m not worried.  I’ve just got to do what I know to do, and what I’ve been doing has worked so far, so I’m going to continue that.

I have two six month follow-up appointments this week so I am hoping for good news at both doctors’ offices. I am pretty positive my surgeon will be thrilled with how I’ve done so far–I mean, who loses 134 pounds in 7 months?  I did tell him at my consult that I was above average, so maybe that’s it.  Yeah…that’s what I’m going with.

I am most worried about my bloodwork, because at my last PCP appointment in October, my iron levels were low (37 mcg/dL, just looked at my lab report) and I was told to start supplementation, which I do every night before bed.  I hope that has helped boost my iron levels to a healthy level.  I’m also concerned about my triglycerides, because at my last appointment, they were lower than they were pre-op, but still higher than normal.  I’m afraid they will still be high, which tells me that genetics is involved and that I’ll be stuck taking Tricor the rest of my life.  I was put on Tricor 7 years ago by my cardiologist after I had a scare–two of my cousins, both under the age of 30 had died of massive heart attacks.  They were in better shape than I was, yet had completely occluded coronary arteries that led to their deaths.  Scared that I might be next, I asked my PCP for a referral to a cardiologist, who then did a full workup on me, determined that while I had no blockages and that my heart functioned perfectly normally, my family history of heart disease was cause for concern and thus I was put on a regimen of Tricor.  I’d hoped that perhaps I might be able to stop it, but I fear it may be the one medication I take the rest of my life.  That, and Pepcid.  I guess I’ll find out on Friday when I see my PCP.

Speaking of doctors…we FINALLY got the bill for the surgery from our surgeon’s office.  Mind you, my surgery was in July, and hubby’s was in August.  But the first bill finally arrived (WTF?  6 months later!), and it was about what I expected it to be.  Because we’d both met our deductibles and hit our out-of-pocket max for the plan year the day we each had surgery, the remaining balance worked out to a little over $3100 for both of us combined.  Not bad at all.  We’re looking to write all our medical expenses off on our taxes for the year, so hopefully we’ll recover some of that come tax time since we racked up quite a lot in medical expenses this year, not including the surgery.

And now…what you have likely been waiting for:  the thing I’ve been promising to write about that I’ve finally gotten organized into something I hope is worth reading.

THIS IS HOW I SLEEVE

I want to first start off by saying the following:

    • I am not a medical professional.  Neither are half the folks who have had WLS.  Any advice given by me or by them is purely anecdotal.  Do not take it as gospel truth.
    • Your doctor/dietician has his/her plan designed the way they do for a reason, so do mine.  I follow my doctor’s/dietician’s plan, with slight modifications for increased protein and fluid intake.
    • I am by no means a WLS veteran.  I am just shy of 6 months out from surgery and still consider myself a newb at all this.  I’m still learning my way with this awesome tool I’ve got and have a feeling I’ll be learning the rest of my life.
    • Keep in mind that I have a sleeve, so some of the things I eat might be a no-no if you are a bypass patient.
    • What is right is not always popular, and what is popular is not always right.
    • Your mileage may vary.

I have pretty strong opinions about some prevailing thoughts about post-op nutrition and food related behaviors.  My approach to life with a sleeve may not work for everyone, but it works for me.  In my opinion, there is no such thing as a one-size-fits-all approach to weight loss or nutrition.  The one-size-fits-all approach assumes we all come to the operating table with the exact same pre-op health issues, bodies, and metabolisms.  And this simply isn’t the case.

But the way that I see some folks preach (and it is preaching) to those who are either newly post-op or who are prospective WLS patients is that there is only ONE way to be successful at this post-WLS life.  And if you don’t DO post-op that way, well then, you can’t expect to have any modicum of success.  You certainly won’t get to 100% EWL (excess weight loss) if you don’t DO post-op this way.

At least that’s how it comes across.

This attitude is what keeps me from posting about anything I do or eat to the VSG forum that I frequent.  I don’t post there often, except to add the occasional comment or answer to someone’s question or to ask a question I have no idea how to answer (like the last time I posted about the gurgling action I have going on with my tummy, wtf?).  I know that my views on how I (and many others) sleeve are unpopular because it’s not the way that the grizzled vets who rule the roost do things.

And what way is that, you’re probably wondering?  Well…here’s the method:  600-800 calories daily, with most folks sticking closer to 600; 60-80 grams of protein; less than 20 grams of carbohydrate; and a minimum of 64 ounces of water daily.  Mind you this only accounts for the nutrition aspect of the plan and not the exercise component.

I will say this:  if this works for you or has worked for you, then bully for you.  But please don’t go around preaching that it is the ONLY way that someone who has had WLS can be successful!  I tried this method, I really did.  And do you know what happened?

My losses were small, I was sluggish and exhausted all the time, and I had absolutely no energy.  This method did NOT work for me.  When I told my doctor’s PA about what I had been doing at my last appointment, the first thing she said was, “You’ll wreck your metabolism by eating so few calories.”

Then she said, “If you eat between 800-1000 calories, your weight loss will happen a lot faster.”

I was skeptical, but I decided to give it a go since the 600-800 plan was just not doing it for me.

I also chatted with a friend of mine at work who, in another life, is a dietician who quit that gig to teach high school anatomy.  We had a conversation about carbs, and how many carbs I should be consuming on a daily basis.  When I told her I was getting 20 grams or less a day, she said, “You really need to increase your carbs to a minimum of 50 grams a day.  Your brain requires carbs to function, and you’ll eventually have memory loss and brain fog if you keep doing what you’re doing.”

Again, I was skeptical, but I thought, well, she’s got far more expertise in nutrition than I do and has counseled WLS patients before, so why the hell not?

I changed things up a bit.  I increased my calories to at least 800, and tried to split the difference most days, getting at or around 900 calories daily.  I tweaked the protein requirement to a minimum of 80 grams daily, but not going over 100 grams too many days (my dietician told me it would be overkill especially since I am not an athlete), and I drink water like a fish anyway so getting enough fluids were not a concern of mine since I do this pretty well anyway.  I also increased my carb intake to keep it at 50 grams or less each day, but generally between 30-50 grams daily.  Never more carbs than protein, though.

And do you know what happened?

The weight has flown off.  Like faster than I expected it to.  I was more energetic, but still tired (later discovered my iron was low, and that went away once supplementation began).  And the sluggishness disappeared.

I realize that I’m saying all this during a week in which I’ve gained 0.6 pounds.  But I assure you, the weight really has flown off.  The month in which I lost the least was the month in which I tried the popular 600-80-20 plan.  The months in which I have lost the most are the months in which I’ve followed my doctor’s/dietician’s plan.

Unlike so many others, I do NOT believe that carbs are the devil.  They don’t make me crave more of them, they don’t send me into fits of frenzy where I simply MUST HAVE MORE CARBS.  I don’t get that way at all.  Do I recognize that some of my trigger foods are carb-laden?  You bet your ass I do.  And do I have a plan in place to avoid these as much as possible?  You bet your ass I do.

I believe carbs are necessary, especially those derived from whole plant sources, like steamed veggies, salads, and the like.  Fruits, I can take or leave because I wasn’t really a fruit eater before I had surgery.  They are good, but too sweet for my tastes, really.  I am a veggie girl–give me broccoli, zucchini, yellow squash, peppers, onions, asparagus, all that stuff, and I’m a happy camper.  I love how they taste, and the fact that they are loaded with phytonutrients and fiber is an added bonus.  I am trying to squeeze in as much plant matter every day as I am able since there simply isn’t room in the inn, so to speak.  And do I eat starchy carbs?  YES I DO.

Yes, I eat potatoes (on occasion).  Not often, but I am known to eat mashed potatoes or roast potatoes every once in a while.

Yes, I eat bread (on occasion).  I even eat crackers every once in a while.

But do I eat these things in large quantities?  No.  For starters, I can’t.  And second, I generally look at my nutrient balance for the day before deciding whether or not to eat these things.  If I’m low on calories and carbs but have met my protein goal for the day, then I give myself the okay to have a little bit.  Or I just plan to have those things, period.   Imagine that, planning! 

It is as I said the other day:  this weight loss phase is temporary.  I recognize that.  I also recognize that during this time I also have to learn how to eat for the rest of my life.  My opinion of the 600-80-20 plan is that it is extreme, involves deprivation and is not sustainable in the long run without some adverse side effects, most of which are behavioral in nature and lead to the behaviors that helped many of us become obese in the first place.

There, I said it.  This view may not make me popular among some post-ops, but I don’t aim for being popular.  This is simply a way to sleeve post-op that does not work for me, and as I said above, your mileage may vary.  If this works for you, great.  Keep doing what you’re doing, and I’ll keep doing what I’m doing.  Your way is not the only way and neither is mine.

The eating I will do for the rest of my life will not exclude vegetables.  It will not exclude legumes, popcorn, tortillas, bread, or oatmeal.  This is simply not how the real culinary world exists, and it is not how my culinary world exists.  I refuse to forgo eating vegetables in favor of relying on a laxative agent to have BM’s each day.  Do I eat these things now?  Yes, but in very small, controlled quantities, and not very often.  For me, a taste is enough.  I also make sure I account for these things in my daily eating when I do eat them, just as I account for everything I eat.

The way I choose to work my sleeve has worked for me thus far.  I also believe that the way I have chosen to approach situations in which food is involved has worked pretty well for me so far too.  In the past week I’ve read desperate posts by folks at various stages of the WLS game who have been faced with parties and other such social situations where food is involved and who are freaked out about how to handle these things.  Some of the advice I’ve seen people give concerns me because they advocate not going to these parties at all so that the food situation can be avoided altogether.

Running away from the situation is not the way to solve the problem.  Here’s the way I see it:  parties will always happen.  Get-togethers will always happen, and food will likely always be involved.  Food is the common denominator at these gatherings, and that will never go away.  Instead of running away and hiding out–because let’s face it, a lot of us did that when we were pre-ops because we didn’t want to be the fattest ones there–face the problem by meeting it head-on.  Think about what is causing the source of anxiety for you, and think about ways to relieve that anxiety.  Why are you going to the party in the first place?  Is it to eat?  Running away from the situation does absolutely no good.

Strategies for dealing with food at parties have to be learned and put into place so that anxiety is lessened and the party can be enjoyed without food being in the forefront.  Being a Rotarian, I had to learn very quickly how to navigate social situations and food since our weekly meetings are at a restaurant.  No getting around that one!  Instead of freaking out and skipping every meeting because OMG THERE WILL BE FOOD THERE AND SOMEONE MIGHT MAKE ME WANT TO EAT, I went to my first post-op meeting, abdominal binder and all, just a week and a half after my surgery.  I went because I knew that this was something that would happen week after week, and that staying home every week would not be an option.  I also knew that I’d have many, many more situations in which food would be involved and that I had to learn how to get along in those situations by not letting the food control the situation.  Running away from that situation would not have helped me learn how to navigate my faculty holiday luncheon, or my department’s holiday party, or Thanksgiving, or Christmas.  And running away from that situation would not have provided me with the mental and emotional tools I will need in maintenance, still 90 pounds away for me.

I am learning how to get along in a world where people will offer and have offered me chips and salsa, cake and cookies, candy and other things that are not beneficial to my weight loss process right now.  I am learning and have learned behaviors that will help me assert my need to avoid those things right now.   I can also learn to plan carefully for those things if and only if I want them.  I don’t need them, and it is important to remember that wants and needs are two completely different things.  And I can also go through thought processes that determine whether or not I really want/need those things as well.

I refuse to run away from situations that are not absolutely perfect for me and my weight loss process. 

The world is not made for those of us who have had WLS.  Instead of expecting the world to conform to our needs, we have to learn to adapt to what the world gives us and learn to make it work to our advantage with the tools we develop for dealing with our post-op lives.  This is true whether it is the nutritional aspect of our lives or the behavioral aspect of our lives.

This tool we have asked our doctors for only works as well as we allow it to, not as we allow the world to have it work for us.

I realize that I’ve rambled quite a bit, so here’s what I ate today.  Lots of leftovers eaten, and made.  I was low on protein today at 73 grams.  I wasn’t hungry until around 1 pm, and normally by that time I’ve eaten breakfast and a mid-day snack but today I just wasn’t feelin’ it.   And yes, I ate carbs.  And a salad.  🙂

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Today’s food choices, from upper right: one-egg omelet and bacon strips; almond-crusted tilapia filet (only ate half of what is shown) and mixed green salad with croutons; citrus herb roasted chicken breast (no gravy but bbq sauce instead); leftover filet mignon (nothing else in the picture of the filet Oscar was eaten today, only the leftover filet was brought home); Tillamook cheese snack; multivitamin and calcium supplements x2, iron supplement.

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6 responses to “Post-Op Week 25 Progress Report and the Way I Sleeve

  1. Woohoo! Preach it sister!
    o
    You had some great things to say and were dead on. Severe deprivation diets do not work before WLS, I mean they work temporarily, but in nearly 100% of the situations you get it back. I think that’s true of extremely low carb or extremely low calorie. I really believe the reason they don’t work is that when you severely deprive yourself of something you really love, you eventually get a taste of it again, and when you fall off the bandwagon you fall off hard. Even with WLS, if you get that severe, when you fall off you are going to gain back.

    What is interesting is that even the mother of all low carb diets, Atkins, doesn’t recommend such severity in carb restriction. They do not recommend depriving yourself of vegetables even. That’s a huge misconception out there. They do have you start off at 20 grams or less, but that’s just in the first few days. Once you get rolling, 50-60 grams a day is quite acceptable. On top of it all they don’t count carbs quite the same. A serving of celery for example has 4 grams. But it only counts as 2, because you count net carbs (carbs – fiber). So, when you’re talking about being even more restrictive than Atkins… that’s extreme.

    It was interesting doing research on Alzheimer’s for a class and seeing how integral insulin is in the way your brain functions. Which is really pretty new information because it wasn’t that long ago they thought insulin had no function at all in the brain. They are finding that insulin actually is what triggers the chemical reaction in neurons that fires the synapses. So if insulin is too low OR too high (leading to insulin resistance) you can get that fog. In the end, of course that kind of deprivation is going to lead to fogginess because your brain cannot function as well.

    I think you’re right that everyone responds to things differently when it comes to metabolism. Which always makes me laugh when someone feels like because something works for them it’s the only way that can work. There is too much of that in all aspects of life, and we really don’t need the kind of stress people like that bring in anyway, so if you end up not being too popular with that kind of crowd that’s probably a good thing.

    • “Severe deprivation diets do not work before WLS”

      Exactly! So why are people so apt to try them AFTER they have WLS? That’s what I don’t understand. What I wonder is what percentage of the folks who follow this 600-80-20 plan experience regain?

      The other question I wonder about is this: if the tenets of the Atkins diet do eventually have the follower include non-starchy veggies into their eating plan, then why do those who attempt to follow it fixate on NO carb eating rather than LOW carb eating? I have never understood that line of thinking.

      • I don’t know why they do that. My theory would be that the ones who get the most preachy about it tend to be very black and white with things, and it’s easier to say none at all when you’re black and white than to say good or bad. It’s the lazy man’s approach.

        My experience has been that the times that I hear someone saying it’s NO carbs, it’s usually those arguing against the diet, the straw man technique. I did Atkins years ago and it worked great as long as I was on it. Once you get past the initial stages, it was typically 40-60 carbs that they recommended. The problem is, at least it was for me – once you rediscover bread and bready stuff, you fall and fall hard and gain it all back and then some. But I think that’s true of most diets, look at how many people on the Biggest Loser gain it all back.

        • Or as my husband and I both like to say, “There’s no zealot like a convert.”

          I too once tried Atkins, and it worked for a short while. What got the best of me was the hunger, not the starchy carbs being rediscovered. I just couldn’t stop being hungry. Now that most of my ghrelin production has been suppressed, I still feel hunger, but not at near the intensity that I did pre-op. There are some days when I have to remind myself that it’s time to eat, which is why I try to adhere to scheduled mealtimes. Otherwise I’d flat out forget to eat some days.

  2. Hello, Ms. Newbie! As an 8-year post op, I continue to learn from you! Awesome, well-thought out post – for any WLS post op to consider! Love the way you “Sleeve”! As an RNY’er, my focus is on protein first, then veggies, then whatever else … and how my body absorbs nutrients … that being said, you make so much darned sense!

    • Thanks! I too focus on protein first, because I know that’s my primary goal every day–to get a certain amount of protein in before I stop eating around 9:00 most nights. Then I eat my veggies, and then if there is room, I eat my starches. I really do try hard to get those veggies in first before the starches, though, because the fiber is important to me.

      I’m glad I am able to teach you…I am still learning so much about this new tool I’ve got, and like I said, I’ll be learning it the rest of my life.

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