Dropping (1/20 of) a ton

Ten months out on my bariatric journey and I have left 105 pounds along the trail. It's been as startling and revealing as Cheryl Strayed 's "Wild" trek -- except I've gotten to keep all my toenails and at least 10 pounds of excess skin. 

There is no "normal" to go back to and no place to post a finish line. Reaching my goal is like playing "King of the Hill." I only get to stay in this lofty place if I'm willing keep taking on all daily challenges to the position. Failure to continue to count every bite and make every bite count will knock me on my ass (just like Lucille Ferraccio used to do in the old neighborhood). 

I had a Vertical Gastric Sleeve (removing two-thirds of my stomach) in March 2014. In the ensuing months my sleeve went from alien intruder to an able ally. I couldn't have gotten here without it. 

There is no universal experience for VGS patients, I can only address what my sleeve did -- and didn't -- do for me. 

• It did not restrict the quantity of high-calorie foods I could eat.  It would have no objection whatsoever to nearly any quantity of ice cream, potato chips, rich beverages and other "slider" food that move right through the restricted space to rest in brand-new, fatty pillows.  
• It never said no to rich, creamy sauces or fat-laden cheeses - that was my job.  It still wants pizza. So do I. I really miss pizza.
• It didn't care about caloric, fat or carb counts.  It left all the math to me. I'm still at 1000 calories, 80 grams of protein and minimal carbs daily. If I wander, so does the scale. 
• It didn't kill hunger. Some VGS patients boast about feeling full quickly and easily -- having to force themselves to get their daily caloric requirements.  I was never one of them. Even at its reduced size, my stomach will growl, grumble and beg for food. The surgery is said to reduce the hormones that create the sensation of hunger. Mine stayed. 
• It did force me to dramatically change what, when and how I eat in order to properly recover from a major surgery. 
• It will reward me with a full feeling if I eat the dense proteins that are the key to making it all work. 
• It will make me sneeze, feel uncomfortable and even toss my lunch if I eat too much of any dense food. 
• It did force to me to make everything I put in my mouth a clear and conscious choice. 
• It has convinced me that fried foods just aren't worth it. It's not crazy about white foods (breads pasta, rice ) but I'm still working on that one. 
• It functions really well if I help it out with regular exercise... and punishes me at the scale if I skip a few days. 
• It required me to honestly look at not only what I eat, but why I ate like I did. 

After years of pre-surgery research,  I know my experience was not as good as some, but not as bad as others.

If I had it to do again, I would make the exact same choice.  Yes, I had lost at least 400 pounds "on my own" over the years, but they were in easily disposable bundles of 10-20-30 or 40 pounds and were never too long gone. 

The sleeve got me to a place that's worth fighting to keep. 

I took a full-body "before " picture in tights and a sports bra and am not quite ready to do the "after" just yet. I do know that the head shots for my newspaper column, taken one year apart in the same place with the same perpetual bad hair day and lack of makeup,  show a difference. 

But no camera can show the real change. 

Thanks Sleeve. 

Where have I been?

The road to hell and most blogs is paved with good intentions.
Once I got up to our cottage this summer -- with no onsite internet and all of the best kinds of distractions I fell into promising to post on the perpetual tomorrow.
In case you need an excuse for the months after we got back to Texas -- the holidays ,of course.
Fortunately my work on the book has stayed right on track.
But the decorations are down. I'm down about 105 pounds.  And it's time to get back to work.

Beating the high cost of produce?

Our summer cottage comes complete with warm childhood memories, beautiful lake sunsets, friends and relatives I don't get to see any other time of year -- and no internet connectivity beyond our phones.
The nearest free wi-fi is Tim Horton's Cafe and Bakery -- the source of many of the pounds I am now working so hard to shed. It's right across the street from my gym making it an easy daily stop. I get to smell the bagels, watch others eat bagels and think hard about why I can't yet eat bagels every day.
When I finish my online catch-up and large herbal tea with one Splenda I invariably stop at the nearby grocery store-- famished.
It's a daily treasure hunt for the low calorie, low carb, high protein options I might have missed the day before.  Over the past three weeks, I've largely exhausted the possibilities.
But a new display appeared magically last week at the end of the organic food aisle, snack bags of a specially processed zucchini with only 30 calories a bag. There was no price on the bin but I grabbed a couple bags, already imagining the taste of a new guilt-free option.
The less-than-an-ounce, not-much-bigger-than-my palm, bag rang up at $1.69. A quick calculation told me I was paying more than $33 a pound for this stuff -- so it had to be good.
When I opened the bag that evening, the pieces looked like the stuff we sweep out of the corners and cobwebs of the cottage after a winter. The small curds of desiccated zucchini appeared to be mummified -- and tasted just like hard ancient zucchini. I swear I could see the word "sucker" in the folds of the bag.
In Western New York -- where I grew up and the location of our summer cottage -- the summer season has a changeless rhythm starting with strawberries coming in mid-June, then blueberries, then cherries by mid-July -- at that point everything starts appearing at roadside stands and tomatoes, sweet corn, melon and salads appear on our table daily.
With nothing but the local strawberries at this time, produce prices are absurd.  Crazed from a morning's work out, bagel sniffing and fruitless grocery attempt, I stopped at a nursery on the way back to the cottage to get my annual container garden tomato plants. With the memory of a rejected $4 cantaloupe still fresh, I added a few cantaloupe plants, some egg plant, cucumbers, sweet peas, green beans, onions, jalapenos, banana peppers, more tomatoes, chives, cilantro, catnip, rosemary, tarragon, lettuce, more tomatoes, and watermelon.
Of course I needed several new containers, a couple of trellises and ten bags of container soil. Nearly $200 later, I am ready to save money.
Financially and emotionally, the needs of my diet have me more invested than ever in my garden. I check the plants and soil moisture several times a day and have been known to run from the porch to sunny-side-of-the- cottage garden at the sight of a well-fed robin scoping out the scene.
Friends told me human hair clippings discourage varmints, so I've been calling salons trying to score. Not all of them hang up immediately.
I dropped my seedlings and weaker plants in a small patch in the backyard hoping to serve it up as enough of a feast for the raccoons, rabbits, birds and their friends to keep them away from the main event. I find myself silently rooting for the carnivorous coyote who prowls the night.
Irrational? Perhaps.
But no more so than paying $2 for a hothouse tomato.

Re-learning restaurants

It always startles me to hear someone say they don't like to eat out alone. Give me a book and a menu in any restaurant anywhere and I'm content.  In 30 years of going to an office, I can count the number of times I ate at my desk or in a lunchroom on my fingers. Even working from home, Charlie and I  still go out for lunch a few times a week.

Given the choice of eating out or doing dishes, I see no choice. I prefer to do my grazing on the open range. 

Yet almost three months since my Vertical Gastric Sleeve, I'm still re-learning how to navigate restaurants. 

Some bariatric patients carry wallet cards signed by their doctor saying they can't eat much and should be allowed to order from the children's or senior menu. While that may work for some,  I'm not comfortable with making my solution someone else's problem. (And my day for those senior plates will come soon enough)

My healthier choice for myself should not mean my waiter or waitress gets a smaller portion of their tip.  Having served my time as a waitress in high school, I know that there are few exceptions to the universal rule that people who order the lowest priced items also (on a percentage of bill basis) tip less. In a perfect world restaurant employees would make a living wage without tips, but that rarely happens. Diners have to hold up our end of the deal. 

So I order from the regular menu and take the remainder home for additional meals, which for me is actually more cost effective than ordering a reduced portion.

I had a pre-surgery brainstorm to order my own box of take out containers from an online restaurant supply company to make the process as easy (and Styrofoam-free) as possible.  There were hundreds of choices but I compared form, function, materials and price to come to a square, clamshell-type , microwavable container made of recycled matter and a lidded cup for soups. I compared features and price and ordered a box of each... without looking at the quantity. I  now have more than 1000 pieces of each item and will not likely re-order in this century. 

With a life-time supply of take-out boxes, a cooler in the back on my car and calorie/protein/carb counting programs on my phone -- I thought I was all set. 

Texas -- where folks still have the freedom to text and talk on their cellphones while driving, as long as it isn't in a school zone-- does not have nutritional reporting rules for restaurants. Federal law is pending requiring menu nutrition information be available on menus and in framed on-site display in any restaurant with more than 20 locations.  The industry is fighting it with the argument of increased costs for redoing menus. etc. I'd be glad to see something scrawled on a napkin by the cook -- as long as I can get the numbers I need. 

I treated Charlie to lunch yesterday at one of his favorite steak houses, which happens to be part of a a large Texas chain.  It was one of those days where I frankly could not face another piece of grilled chicken.  My phone gave me the calorie count for the tenderloin tips I was considering, but had nothing about the sauce served with it - which sounded awfully good and possibly within my range.  I asked the waitress for the menu nutrition information and she went to get her manager. 

"We don't have that. We have to keep it a secret or we'll ruin it for our customers," he said with an awkward, forced laugh. 

Could he give me a list of the ingredients in the sauce so I could ballpark the totals? He said they were not allowed to share their recipes. Again he laughed. I didn't. 

Yes, there are more than enough non-dieters in this world to keep their tables filled, but why turn away the rest of us over something so simple? 

The number of bariatric patients has increased 16-fold in the past ten years. Add in other people on diets or with other medical dietary restrictions and it makes no sense to turn away our dollars. 

I don't expect mom and pop restaurants to have numerical information, but there always seems to be an owner or cook who will gladly tell me about what's in a dish. 

Back at the steak house, I tipped the waitress well anyway. She had no control over the policies.

But my tip for management -- hospitality is more than putting food on a clean plate. 

I need a restaurant I can count on. 

Size matters

The clothes in front of the over-flowing bag  pictured will start a second bag for this run -- the seventh in the last month.
The first cull was easy - bad fashion choices made for the single reason that they fit and I needed a fill-in-the clothing-item-blank.  We were never close.
 Then came the size 22s. I thought I primarily wore 20s and only had a few 22s. They filled two bags. Again, only passing acquaintances.
The business attire wasn't hard because I primarily work at home now and liked the idea of sharing interview clothing with the Dress for Success program.  They actually need larger sizes.
Included in that bag were the self-deluded online slack, skirt and blouse purchases that came close enough to fitting that I didn't send them back. But now they are too big. In retrospect, I probably should have left the tags on.
At my end of the scale, clothing that fits OK is rare and wonderful. Clothing that looks sorta good is a treasure.  When I packed the first bag of "good stuff" I drove around with it in the back of the car for a week - passing the Goodwill donation center on a daily basis.  It's hard to say goodbye.
That bag did not celebrate the triumph of weight shed, but a stark and surprising fear of being on a greased high-wire with nothing to cushion the fall.
Eight years ago, I found a pair of black slacks that laundered well, hung reasonably on me and hid all but the most egregrious lumps.  I bought five pair and replaced them over the years as one would milk or eggs as they ran out.  When they were on sale,  I'd stock up. Yes, I realized that co-workers may have thought I was wearing the same pair of slacks several times a week, but those slacks were unremarkable in all the best ways.  They were the journeyman base for all those jackets, scarves and jewelery I "dressed" in. I held one pair back and apologized to the other six individually as I loaded them into that well-travelled bag.
That last black pair sits with the bunch now on the dining room table. These are my most forgiving friends --the workhorses that sometimes made me feel like I could dress like other people.  That pair of denim shorts on the top of the second pile fit every season since we bought the lake cottage. They are magic.
Over the past month, my husband Charlie started dropping hints that it was "time" for this piece or that. But I laundered them and put them back in the closet. When a stylish friend of mine gently offered her "high weight" size 16 jeans I thought she was being overly optimistic, but accepted them for "down the road."
I've read  hundreds of posts on bariatric support groups about big losers (in the best sense) still seeing their former selves. I thought it was bizarre. Although I'm only a medium loser at this point, it is happening to me.
The plus-sized section of most stores is a fraction of the "regular" clothing inventory.  The entire spectrum of  choice is reopened to me for the first time in 15 years.  Two weeks ago, I filled my arms from a "normal"  sales rack and dragged them into the fitting room to see if anything fit. It all did. I didn't buy a thing.
I took inventory of what I needed in transitional sizes for the summer and set out to Kohls and Steinmart to fill the list.  Both times I caught myself back in the plus-size area telling myself that sometimes things run small.
Over the years, more than one "helpful" salesperson has redirected me to the fat clothes when they spotted me in the "smalls and mediums" shopping for my daughters. My inner self says there is no way they are going to let me look at the L/XL for myself.
I love the sags and bags of wearing my older clothing today.  But  dropping the next 50 requires letting go -- in spite of the fact that my current prescription seems to be the opposite of rose-colored glasses.
I once worked on a location shoot featuring a national media figure. She flatly dismissed all the clothing the staff selected on site as too large or too small. A quick wardrobe person cut out the size tags before sending in the next bunch and told her they were all a size smaller than the actual size.
The star emerged all smiles in the "new" selections.
I don't imagine that would work if I did it to myself.

My drinking problem

Back before Earth Day -- when recycling meant giving your old bike to your kid brother  --  my father would carry a battered wooden crate of  a dozen glass quart bottles to our local bottler on Saturday mornings  and we would come home with a rainbow of filled, fizzy bottles we called "pop."

At Visniak's (pronounced Veesh-nock) these wooden crates were stacked twice as high as my first-grade self in a room I now realize was no bigger than my living room.  The first eight refill slots were a given: two root beer, two birch beer , two ginger ale and two cream soda, then the negotiations began for the remaining four. In a good week I'd get one cherry, in a really good week there would be two. Orange, grapefruit, cola and grape filled out the random remaining rotation. There were no diet versions, each bottle was fully leaded. If Mr. Visniak was there, I'd get a 7 oz. bottle of cherry of my very own.  My eyes started scanning the place for him the minute we opened the door. 

My family had pop with every meal we ate at home and usually when we ate out. Around junior high, I started paying attention to the advertisements and realized that if I ever wanted to wear a bikini and surf with really cool guys, diet soda was the way to go. Recognizing my natural level of activity was similar to that of a gerbil on an exercise reel on speed, I jumped on the caffeine-free bandwagon as soon as it was available. Eventually I discovered iced teas, herbal teas, and that  most everyone else calls the fizzy stuff soda rather than pop. 

I had a solid decade of diet soda behind me when I started gaining weight. Most diets encouraged you to drink plenty of low calorie liquids to keep that "full feeling." Fast food restaurants package meals with a soda included--  your choice is only which kind and how large. From my school cafeteria (cartons of milk) to the finest dining ( a perfect vintage) food and drink has been obviously and permanently paired. 

But not anymore.  At least not for me.
Tens of thousands of people worldwide make a good living just by telling people which drink will go best with their food, but for me it's time for food and drink to have conscious decoupling.
There is no chance for a reconciliation, at least where I'm concerned.
Every medical professional I've encountered on this topic has been clear from the start -- no drinking anything for a half hour before you eat and especially for a half an hour afterwards. This demo  makes the reasoning clear.
Two months after my surgery and I'm still struggling with dry eating. I do it. But I don't like it.
If you don't order a beverage in most restaurants various servers will repeatedly come back to make sure someone got your drink order, so I order a glass of water and move it as far away from my plate to prevent unconscious drinking.  Should I get involved in a conversation or even a book I am reading at the table, my hand knows how to find the drink before my mind can say no.
I did a small survey of those I found online who are struggling with regaining weight after surgery. Eleven of 12 said they started drinking with their meals within six months of the surgery.
Rationally, food and drink together are for me a near toxic combination. Emotionally, we've been such good friends for so long.  The balance between yearning and learning is not there yet.
But I'll get to that (parched, arid, desiccated) place eventually.
I was in the waiting area of a medical office this afternoon when my phone chimed. At the cue, I reached into my purse for a bottle of zero calorie, non-carbonated beverage and took a small satisfying slug one-half-hour from my last snack.
The sweet, older lady next to me reminded me that I didn't take a pill, only a drink.  I told her that a  drink was all I needed.
I hope she took that the right way.

I am not a cheater

Two months into my bariatric journey and I am already astounded by the number of people who need to punish and shame my nascent victory in favor of their own self-righteousness and misinformation.

Bariatric surgery is not a cosmetic, elective whim. One does not emerge instantly transformed as if from a day at the spa. It is not cheating. 

For nearly everyone involved,  bariatric surgery is a life-changing, life-long commitment to better health. For some of us it is a matter of life and death, for others it's a hard look at the quality of life inflicted by our co-morbidities. 

But issues with heart disease, hypertension, diabetes and asthma, you say,  are self-inflicted wounds brought on my gluttony and ignorance.  I have in total "lost" my highest body weight two times over. I can give you the calorie, carbohydrate and protein count of all common foods and an embarrassing number of esoteric items. 

I've spent enough on gym memberships and trainers over the last three decades to fund an advanced degree program from a private university. I can't recall the last time I ate a french fry or had a second helping of dessert. 

In most cases, obesity is not food addiction, but a disease recognized as such by the American Medical Society in 2013. My disease is a combination of genetic and psychological factors as well as not recognizing fast enough there is no comfort in comfort food.

I can't unring this bell alone. But I am neither weak nor stupid because I lack that capacity. According to the American Society for Metabolic and Bariatric Surgery these surgeries have increased 16-fold in the United States in the past 10 years as patients and professionals recognize better solutions to a growing public health issue. 

Yes, my decision is confusing for the "naturals" who can lose and keep weight off through diet and exercise alone. There are also people who can easily sing, dance or do calculus. I'm not one of them. 

Bariatric surgery, a Vertical Gastric Sleeve in my case,  is a treatment course that will fail without my full commitment.  It requires daily, life-long work.

Years of yo-yo dieting have battered my metabolism to the point that it is geared to require much more effort to lose much less than smaller scale or rookie dieters.  My surgery helped my body to reset to a workable metabolism.

A 2006 study in the "Annals of Surgery" showed the 10-year failure rate for the gastric bypass surgery is 20 percent of the morbidly obese and 35 percent for the super-obese. It provides the numbers to back up what every fatty like myself knows, the more you have to lose, the easier it comes back. 

But the study also shows that despite the weight return, 10-year mortality for the subjects remains a low 3 percent. This is why I, and likely most of my seriously scale-challenged brethren, have jumped through all variety of medical, insurance and interpersonal hoops to make surgery happen. 

My primary and specialty physicians all had to provide letters as to their belief that the surgery could and should result in a healthier me. A psychiatrist gave me a battery of tests to make sure my issues were not simply emotional and that I had the capacity to make my surgery work. 

I then had three months of dietician appointments and pre-surgery dieting to again demonstrate I had both the capacity and information to make the surgery work. Only at this point did my thick file go to my insurance company for review. Once my surgery was approved, there was a battery of further medical testing including an upper GI and EKG that could disqualify me for surgery in spite of everything that had gone before. 

At this point, I have graduated from liquids, to "squishies," to any food I choose. My stomach pouch will not prevent me from ingesting thousands of calories in one sitting if I so choose, but I carefully select menus that give me 600-800 calories daily with 80 grams of protein, 64 oz. of water and as little sugar and carbohydrate as possible.  I have become a master at eating low-fat, part-skim, string cheese by the string.

I know that I will always need to eat protein first and foremost, but will likely never tolerate dense proteins like steak. Carbonated beverages are off the list for life and my beloved New Zealand Sauvignon Blanc is benched until July - when in small quantities I will relearn my tolerances and weigh each 120 calorie glass against the other things I need to eat that day to stay on track. 

I will never be able to enjoy that glass of wine -- or any other beverage -- with my meal because I know I can't drink anything one half-hour prior to or post mealtime because it won't allow for the necessary absorption of protein and will leave me hungry for more food than I am allowed to eat. I am frankly struggling with unlearning 54 years of food-with-drink mealtime habit -- but I know the consequences of surrender. 

I am now 45 pounds down with 70 to go. I am not so noble as to say that being able to buy clothing from the "regular" size racks again is not a rush. But it's the three prescriptions I no longer have to take and the way that I can already crawl around on the floor with my grandson that fuel my commitment. 

My size did not prevent me from enjoying a wonderful career or the love and support of family and friends. But around the half-century point it struck me that the only resource we can't replenish is time. I am willing to very work hard to find better health and possibly a little more time.  

And I'm not cheating to do it. 

For more information on the myths of bariatric surgery go to the American Society for Metabolic and Bariatric Surgery misconceptions page.