weight loss surgery – p i x e l s c r i b b l e s

A new name for pseudotumor cerebri; plus, old statuses

I have a friend who is concerned they might have pseudotumor cerebri, except when they told me about it they called it “idiopathic intracranial hypertension,” and that’s how I learned it has a new name! I suffered from this in 2010 and 2011 (and it possibly actually started all the way back in 2007; it’s unclear due to heart medication side effects) and it’s the ultimate reason I got weight loss surgery.

In looking back on my posts on this subject, I discovered that there seem to be a lot of gaps. I didn’t write about the diagnosis at all, as far as I can tell. Blog posts for September, October, and November 2010, the months when I first noticed the problem and started seeing doctors about it, are extremely sparse. So I went back through my oldest Twitter account and my exported posts from my now-deleted Facebook account and pulled together some statuses about my eye. I figured I’d archive them here for my (and my biographers’) convenience. You can check out the pseudotumor cerebi tag for more context.

My weight loss surgery experience

On September 26, 2011, I had weight loss surgery.

Here I am right before the procedure. That day I weighed in at 257 pounds. I wore a size 26W (4X).

And here I am being released from the hospital a few days later, at 253 pounds.

After three months, I was already below 200 pounds. Here I am in November:

Over the next 15 months, my weight dropped precipitously, bottoming out at 127 in December of 2012. I was able to fit a size 6 at that time.

Around two years out from surgery, my weight stabilized in the 140 to 145 range. It’s stayed there ever since, and I now wear around a size 10.

I had struggled with obesity since I was a teenager. The most I’d ever been able to lose on my own was 50 pounds. I started investigating weight loss surgery in 2009 after recovering from congestive heart failure, but it took another health crisis to convince me to finally do it. In August of 2011 I was told, point-blank, that if I didn’t lose weight, I would go blind in my left eye. A buildup of fluid was pressing on my optic nerve and would soon block out my sight. I posted on Facebook:

Even though I knew it already, the doctor felt the need to repeat “IF YOU DON’T LOSE WEIGHT, YOU’LL GO BLIND” until I started crying.

Things were bad at that time. We had moved to Atlanta for Sean’s new job just months before, but he’d been shifted into contractor status, so he wasn’t guaranteed regular pay or health insurance. Meanwhile, I hadn’t yet found employment. I posted in a comment on the above status,

I am looking for a job and trying to eat healthier and work out more, but if being terrified into losing weight worked permanently, it would have happened back when I had congestive heart failure.

The health insurance we’d had through Sean’s job would expire in a month, and that insurance flatly refused to cover any form of bariatric surgery for any reason. I could prove it was a medical necessity, but they didn’t care. I felt so, so stupid for letting pride keep me from pursuing weight loss surgery back when I had insurance that would have covered it.

In this time of despair and desperation, extraordinarily generous family members came to my rescue. I’m not sure I can ever repay them.

I had the duodenal switch procedure done at Pacific Laparoscopy (PacLap) in San Francisco. Due to my circumstances, I was able to go through the approval process fairly quickly. I had to fill out a lengthy health and weight history questionnaire; undergo new tests (blood tests, chest X-ray, EKG, echocardiogram); have my GP, my neurologist, and my cardiologist sign off on the surgery; and have a psychological evaluation. We started the process on August 31 and managed to get everything done by September 14. Mom and I flew in on September 21, the pre-op appointment was September 23, and the surgery happened on September 26.

My relationship with food

Immediately post-op, I could only take in three sips or bites of clear liquid at a time. That first day I had broth, jello, a popsicle, decaffeinated tea, and juice. The next day, soft foods like cream of wheat, applesauce, mashed potatoes and yogurt were added to my tiny meals. After that, I was able to eat more solid food. But it was very difficult for me to eat. I could barely take in two or three bites, and I didn’t enjoy eating. I had to force myself to eat, and I had to be careful not to have even one bite too many, as that would have caused me to throw up.

Those first few months, eating right wasn’t very difficult for me. I couldn’t eat much at a time, and I hated eating and never felt particularly hungry, so it didn’t really matter to me what I ate. I’d grill a chicken breast and just eat that. A few hours later I’d eat a bowl of plain Greek yogurt. Later, I’d have a bowl of peas. Small frozen dinners were a mainstay. I have many pictures from restaurants demonstrating how very little I was able to eat. In this picture from September 2011 I’m taking home a piece of quiche and three links of sausage from J. Christopher’s; I had managed a couple bites of quiche and one bite of sausage:

The next time I went to J. Christopher’s, in October, I simply ordered the three sausage links and nothing else. I made other allowances when eating out as well, such as eating the fish and leaving most of the rice when I ordered nigiri, turning down side salads, and skipping dinner bread. Food choices were relatively easy; I had to focus on getting protein. My next priority, if I had any room left, was vegetables, then whole grains. Simple carbs were something to be avoided, and in the beginning, it was fairly easy to do so.

Over time, though, I gradually became able to eat more and more. Most of my stomach is gone, so I will never be able to eat as much as I used to, but I can eat a decent meal in one sitting these days–the size meal health and diet experts usually say you should be eating. I have also regained my enjoyment of food. I remember in the beginning wondering why other weight loss surgery patients were eating food that was bad for them, when it was so easy not to. Around the two-year mark, I understood. Food was delicious again. It was no longer a simple matter to avoid bad foods. This is something I’m still struggling with. While it is likely impossible for me to ever be obese again, I can still make unhealthy food choices that have an impact on my health.

Along with only accepting decreased portion sizes, my body reacts a little differently to food now. I can’t usually handle having sugar in the morning. If I have it, I end up feeling awful for about two hours. If I have a dessert in the evening, I generally choose something far less rich than what the old me would have gone for, for similar reasons. Eating really rich desserts doesn’t give me the pleasure it used to. Sometimes even a simple ice cream cone is too much.

I also don’t enjoy eggs the way I used to. There was a time when I absolutely loved eggs over-easy. They are still delicious, but I feel strange while and after eating them. The effect is short-lived, but it’s odd enough to make me seriously consider whether or not I want eggs. This is kind of a shame, since eggs are such a good source of protein.

Of course, the most notorious food effect of the duodenal switch is gas due to malabsorption. This has been a struggle for me. According to PacLap, foods that cause gas include white flour, white rice, sugar, beans, vegetables, some fruits, milk and milk products, and processed foods. I can avoid white flour with minimal effort. White rice is more difficult for me, but I haven’t found it to be particularly gas-inducing. Sugar, of course, is a challenge. I should be avoiding it anyway, as my surgery doesn’t affect the absorption of sugar. It’s hard to know what vegetables and fruits to avoid; I haven’t really figured that out. As for milk, I love having a bowl of cereal every now and again, but it may not be so great to do so. The big one, processed foods, is difficult to avoid in our packaged-food culture. Now that I’m working full time, I rarely feel like cooking, so I’m sure I’m eating a lot of things I shouldn’t be.

Thanks to the surgery, I am realizing more clearly that I have a strange relationship with food. When I am at a restaurant I love, I feel bad that I can’t eat everything. I want to enjoy the different dishes all at once. It’s as though I believe each particular visit is my last chance. I’ve found it frustrating to have to choose, and also to have to eschew foods I used to really enjoy because they will have ill effects on my stomach.

At the other end of the spectrum, there was a time when I would eat and eat and eat out of boredom. I can now pretty easily tell when I’m doing this, because I’ll be full and still trying to eat. During these times, it used to not matter to me so much what I was eating. Now, if the food doesn’t have enough protein, or if it’s too carby, I’ll get irritated by it, which I consider a good thing–it’s like a knock upside the head telling me to make better choices.

Exercise

Immediately following the surgery, I was encouraged to walk as much as I could without over-fatiguing myself. I was also encouraged to walk up and down stairs. I did pretty well in both regards. While I do spend a lot of time at a desk or on a couch, I tend to get antsy if I’m in one place too long. I like to be up and moving.

At first it was very frustrating how quickly I would get tired. I also wasn’t allowed to reach over my head or lift heavy objects, which was quite annoying for someone as independent as me. Sean was a huge help during this time.

Recovery took about three months. At that point I was able to pretty much go back to normal. I remember the first time I did an exercise video after having surgery; I was shocked at how easy it was without all the extra pounds weighing me down.

During the rapid weight loss period, I kept walking, did workout videos at home, and joined a gym. Unfortunately, after awhile these efforts dropped off, especially after I started working full time again. Now, at nearly three years out from surgery, I’m not particularly active. I do try to take the stairs at work, at least in the parking garage, and I go on photo hikes on the weekends…but I really need to do more, for the sake of my cardiovascular system. I’m considering taking up running again, or trying to ride my bicycle to work.

I can say that thanks to the surgery, I have plenty of energy, and if I feel like spending an entire day walking around, I can do it with no problem. This is not something I could say before this dramatic weight loss.

Next steps

Weight loss surgery helped me with the hardest part: losing over 100 pounds. It’s up to me to take advantage of this opportunity, to make good choices for my health. It’s something I have to work on every day. My fight to eat better and be physically active will never end.

There is one other thing I might do to make my transformation complete, and that’s reconstructive surgery. After losing this much weight, there’s a lot of skin left over. While I’m not unhappy with the way I look, the skin can be irritating to deal with. I don’t feel comfortable wearing sleeveless shirts, for example, and certain articles of clothing don’t seem to fit right. Health insurance generally only covers this in cases of medical necessity, so I would have to pay for it out of pocket, which I’m not sure is going to happen. Still, it’s something I keep in the back of my mind.

Final thoughts

Simple pride kept me from seriously pursuing weight loss surgery until it was almost too late. I felt that I should be able to lose weight on my own, and that if I couldn’t, it just meant I was weak. In other words, I was too proud to accept help. Eventually it got to the point that I had to choose between being proud and blind, or humbling myself and keeping my sight. It seems like such an obvious choice in hindsight, but when I was going through it, it was a struggle.

The lesson I’ve learned from this is that accepting help does not make you less of a person. It doesn’t mean there’s something wrong with you. It just means you’re making smart choices.

Every day I look in the mirror and like what I see. Every day I pull on clothes I never thought I’d fit into. Every day I feel healthy and strong.

I am so happy that I had weight loss surgery.

140525-800

More and more

To start my new tradition of working out when I get up, I just did the TurboJam 20-Minute Workout. I chose that video because I wasn’t sure I could make it all the way through Cardio Party, which is about twice as long. But I found myself doing the entire video “high impact”, jumping around, punching and kicking full force, positively overflowing with energy. I sweated and got a little out of breath, but I never felt like it was too difficult or that I couldn’t finish. If anything, I felt like I could do more.

This stands in stark contrast to my previous experiences starting up this video series. I always found it challenging and had to build up to where I could finish a workout at low impact. I never did an entire video high impact, not even the 20-Minute Workout.

My weight loss surgery has given me an amazing gift. Losing those 120 pounds has made me able to accomplish things I never could before. It’s given me a huge leg up in physical fitness. I feel like I can do anything now!

Not everything is going to come this easily, and I will have to keep planning and working toward my goals step by step. But today’s workout showed me just how far I’ve come, and how much I have to be thankful for.

My new old relationship with eating

As time has passed since my duodenal switch surgery (it’s nearly been a year!), the rapid weight loss I was experiencing has declined to possibly nothing. This was anticipated, and as I’ve reached an excellent weight of 136, not unwelcome. However, there is still the possibility of losing a bit more weight before the slight rebound I’ve been told to expect. If I can manage to lose a bit more such that I rebound to about where I am now, that would be great.

Things have become more challenging, though. In the beginning, I hated eating and had to force myself to do it. When I did, I could only stand certain foods. Over the weeks and months since, though, my tastes have started to go back to where they were before the surgery. My perspective has flipped right back to loving food and wanting to eat all the time. And I’ve become accustomed to the amount my small stomach can take in, such that I am able to pace myself and potentially overeat if I don’t pay attention.

Due to malabsorption, I should not be capable of becoming morbidly obese again so long as I don’t go crazy with my food choices, but there’s nothing keeping me from being overweight but my own willpower. This surgery, after all, is not a magic bullet. It didn’t do all the work of weight loss–I had to eat right and exercise–and it will not do all the work of keeping me at a healthy weight. My need to get enough protein has made me a label-reader; I must keep up that habit. Further, I am working to limit processed foods as much as possible, as this is the best way to keep my sugar intake down. This is very difficult now that I have a taste for sugar again. My ideal is to get my sugar fix through fruit, but when I want an actual dessert, I try to at least go for items sweetened with Splenda, honey, or real sugar rather than high fructose corn syrup. And of course, I don’t drink sugary filler.

Beyond eating right for health, I will also have to manage the side effects of this surgery for the rest of my life. One very unromantic side effect is that white bread, white rice, and normal pasta make me gassy. In the beginning I just didn’t eat those things at all, but now that my tastes are pretty much back to normal, I’ve been craving them. So I buy 100% whole wheat/grain bread products (not “multigrain”), and I try to only eat brown rice.

Pasta has been a different animal, though. Sean and I make a lot of use of those Knorr noodle packets, because they’re simple and fast. But they don’t come in whole wheat varieties. There was a whole wheat version of the Alfredo noodles at one time, and we tried it and didn’t care for it…and that must have been the general consensus, because I don’t see it anywhere these days.

I recently bought a bunch of plain whole wheat pasta in various varieties, but I haven’t made much use of them. That will require finding good sauce recipes and keeping those supplies on hand, and I haven’t figured all that out yet. I do still plan to try, but some days I consider it a victory just to leave the kitchen clean!

Luckily for me, the last time I went to the store, I found a 50% whole grain version of Kraft Dinner. Obviously this isn’t a perfect solution–at 50% that means there’s still gas-inducing content–but it tastes great and so far doesn’t seem to affect me nearly as badly as the regular dinner. Sean and I love macaroni and cheese, so this is an excellent solution until I get to the point where I can make my own pasta sauces.

I started some work as a temporary on-site contractor a couple weeks ago. I’d forgotten how the office environment encourages my boredom-eating. Having nothing to do but the work I’m there to do is good, obviously, but my creative, multitasking mind tends to get antsy. I like flipping back and forth between tasks; it lets my brain refresh itself and promotes my creativity. I’ve realized since going back to an office environment that I’ve used eating as a “task” to reboot my brain. I’d take a break to grab a snack and then munch on it thoughtlessly while working. This is obviously not a habit I want to get back into, so I’m working on replacing it with something else, like going to refill my water bottle or standing up at my computer.

Happily, I’ve taken advantage of working in a skyscraper to use the stairs. Four flights up and down! Unhappily, working full time outside the apartment has made it impossible for me to meet my personal trainer during the week. I’m trying to figure out what to do about that.

Weight goal: achieved! Sort of.

As of today I am at the weight at which I said I’d be content, 138 pounds. I look good. I feel great. At this point I could just say “mission accomplished” and go on with my life.

But there’s more to these life changes than meeting an arbitrary weight goal. The post-surgery weight loss period lasts up to two years, and I’m just now ten months in. There’s a whole year left in which I can work to sculpt away my remaining flab. And after that, it’s not like I’m going to go back to eating and living the way I did before. My food tastes have changed, and I am loving how energetic working out is making me. I’m looking forward to maintaining a healthy lifestyle forever.

I mentioned before that I wasn’t going to be paying as much attention to weight. And I haven’t been; I rarely weigh in. But I’ve decided that when I do, I want the various trackers I use to reflect my current reality. I’ve reached one goal. Now it’s time for a new one.

Today is my new “start date”. Based on my weight loss slowdown, I decided a pound a week was a reasonable rate. I put in 125 as my goal weight; two programs tell me I can reach that weight by the end of October.

I don’t know if I’ll actually get there–muscle weighs more than fat, and I expect to gain more muscle as I continue working out–but it’s nice to have a modified plan with a fresh goal line to start with.

Here’s how my SparkPeople goal line looked originally. As you can see, the deceleration of my weight loss caused my tracking line to approach the goal line (click to embiggen):

Here are my weights from April until now, showing the approach more dramatically:

And here is the beginning of my new goal line!

I’m pretty excited to start with a new plan and goal, and I’m looking forward to seeing how things play out in the next three months.

Cottage cheese conundrum

I have always loved cottage cheese, and I’ve always been a little picky about it. Since having weight loss surgery, I’ve depended on cottage cheese to help me get enough protein. Unfortunately, I have trouble finding a brand I really like. There seem to be too many things that can go wrong with taste and texture. Here’s a breakdown of all the brands I’ve tried.

Brand	Rating	Notes
Great Value, large curd, 4% milkfat	passable	Walmart’s brand is the best I’ve found so far in terms of taste and texture, but it doesn’t bring me joy.
Great Value, small curd, low fat	gross	Small curd is too dry for me now.
Kroger	bleh	I can force myself to eat this, but it’s tasteless.
Breakstone’s	disgusting	Dry, tasteless…why anyone would do this to themselves is beyond me.
Dean’s	okay	Dean’s is actually better than Walmart brand, but I haven’t found it sold locally, so it doesn’t really help me much.
Mayfield	yuck	Way too salty. I didn’t think cottage cheese could be salty!
? – Hyatt Place breakfast bar cottage cheese	awesome	I don’t know where they get their cottage cheese, but I want it.
? – Steak ‘n Shake cottage cheese	awesome	Another delicious cottage cheese of mysterious origin.

I think Dean’s is the brand I used to eat back in Kentucky. I found it in Augusta the last time I visited; it was the first time I’d ever seen it there. Naturally I bought some and tried it, and it was good. But since I’ve been home I haven’t found it anywhere. Le sigh.

Will the perfect cottage cheese continue to elude me?!

Weight loss surgery challenges

I am currently over eight months out from duodenal switch weight loss surgery. In that time I have lost 109 pounds and gone from size XL blouses to size M and size 26W pants to size 10. My shoe size has also gone from around 8W to 7, and I’ve had to have my wedding rings resized.

For the first few months of this process, my biggest challenges were emotional. As my body changed rapidly, I started to lose my sense of identity. I never realized just how much I identified as “the fat one” until I wasn’t anymore.

Now, though, the weight loss has decelerated, and I’m quite pleased with who I see in the mirror despite some lingering trouble spots. My biggest challenges have shifted to complacency and boredom.

You see, while I was focused on the rapid weight loss, while I could tell I still had plenty of weight to lose, I was very motivated to eat right and exercise. I thought at the time that the surgery was some sort of miracle cure for food addiction; I didn’t really crave anything, and though I got tired of eating the same high protein foods over and over, it didn’t really bother me because I had a goal, and because food wasn’t nearly as important to me as it once was. And I also knew that I had to make sure to work out during the rapid weight loss, so I would lose fat rather than muscle mass. While I wasn’t quite as dedicated to exercising–I never have been–I still did a lot of walking and spent more time at my apartment complex workout room than I normally would have.

But here I am, basically happy with my weight, not losing quickly anymore…and suddenly really wanting to enjoy eating again. I’ve slipped. I’ve had cookies. I’ve had sugar-laden sauces. I’ve eaten too much bread. I’ve gone for fried food–and fries. Thanks to my smaller stomach and rerouted intestines, I can’t eat or absorb as much food, but eating too much of the wrong kinds of food is still bad. It’s just so much harder to keep that in perspective when I feel good and look good and just want a snack. When I see TV characters eating these huge, delicious-looking meals, and I wish I could eat them too, and I know I could never finish those portion sizes. When I start to mourn the me who could enjoy a big slice of cake.

I’m in danger of slipping back into my old patterns of emotional eating, eating when I’m not hungry, eating just to eat.

The thing is, eating these bad-for-me foods doesn’t really give me any joy. They taste better now than they did a few months ago, possibly because I’ve been eating them more and my taste buds have readjusted, but they’re not really satisfying. And then there’s what happens later. Too much sugar gives me severe abdominal pain. Too much fried food gives me diarrhea. Too much white bread or white rice gives me gas. There are compelling physiological reasons not to eat foods that are bad for me. But the delay between the eating and the punishment is just long enough that I can trick myself into thinking it’ll be okay, that the food will be worth it. It usually isn’t, but my emotions don’t remember that. I just want the food because I want it.

I must reiterate that until recently, maybe three or four weeks ago, I didn’t even have this problem. It’s like all of a sudden my food cravings woke up, raring to go…and now every meal choice is a struggle.

Then there’s the exercise. For awhile there I was taking pretty regular walks. Now, they’re intermittent. I spend most of my time sitting or standing at my computer, or lounging on the couch. Errands do take me up a flight of stairs, which is great but not enough. And I’m not doing any strength training. No toning at all.

My forearms look pretty good after all this weight loss. My upper arms do too, if you look at them from the correct angle. But then I raise my arm and you see the huge dangling flap of fat and wrinkly skin. Might this have been avoided if I’d actually committed to working out properly?

I look pretty good in a pair of jeans these days. But take them off and what do you get? Folds of butt skin. Disgusting.

And I still have fat to lose, on my stomach and thighs. Now that my body is smaller, it seems more striking, though I’m able to conceal it pretty well with clothing.

I said before that I’m pretty happy with how I look, and despite what I just described, I am. If this is where my weight loss is going to stop, then that’s probably okay (though I might have cosmetic surgery on my arms and butt).

But as I mentioned in my post about the weight loss deceleration, I still have over a year left to lose weight. It’s possible I could get rid of more fat, and maybe even tone up.

Being complacent about what I’ve already achieved isn’t going to get me there.

So, frankly, I’m a little scared. I’m scared that my boredom over food will continue to impact my meal choices. And I’m scared my complacent opinion that my body looks okay as it is will mean I’ll pass on exercise that not only might help me look better, but would keep me in better health.

I don’t want to give up so soon. I don’t want to say “That’s good enough.” I didn’t expect this hurdle, here in the end game where I really only have about 25 pounds to lose, if that.

So I’m making a different commitment. Before, when the surgery’s effects were new, it was relatively easy to change my lifestyle to adjust to them. Now I’m used to my new gastrointestinal system and will need to put more effort into staying on top of things. This means I will keep my apartment free of things I shouldn’t be eating, and make Sean’s treats off-limits to myself. I will think of the protein first every time, as I should have been doing all along. And I will try to come up with some method of meal planning that isn’t actually meal planning, because I hate meal planning. (I may just go to the store every day for awhile rather than trying to work out a week’s worth of dinners.) As for exercise, I am going to start looking into joining a gym and/or hiring a personal trainer. But while I explore my options in those areas, I’ll get back to doing workout videos that exercise all the muscles, and resume going on regular walks.

These steps should result in a healthier me, and if they also result in further weight loss and toning over the next year, then that’s great too.

When I chose to have weight loss surgery, it was out of medical necessity, but I was also committing to a lifestyle change. I’m not giving up on that change.

Deceleration

This morning I weighed in at 149.8 pounds. Into the 140s at last! This puts my total weight loss since surgery at 107.2 pounds. In just a couple more pounds I will hit 147 and a BMI of 26, which I was told is the average BMI at which patients of the duodenal switch end up.

I have noticed that my weight loss seems to be decelerating, as evidenced by this graph from my SparkPeople account:

Weights from September 26, 2011 through May 20, 2012 (click for larger size)

My weight goal in SparkPeople is set at 125, to be reached on August 28, 2012. The yellow line shows what it would have looked like if I’d had consistent weight loss since my surgery to get to that goal. As you can see on the blue line of actual weigh-ins, right after surgery there was a huge weight drop, and then for awhile my weights went along roughly parallel to the yellow goal line. Now, though, they seem to be drawing steadily closer to it, indicating a slower rate of weight loss.

I don’t know if I’ll actually reach 125; this was an arbitrary goal I put in based on the mid-range of what is considered a healthy BMI for my height. And I don’t know if I’ll end up at 147, which is where I would stay if I was exactly average. I’d love to get below 141, which would push me out of “overweight” and into “normal weight” territory, but I just don’t know what’s going to happen.

I already look and feel so good that it seems like I should be almost done with my weight loss. But this process can take up to two years, and I’m only just shy of eight months out from surgery. I’m not even halfway there yet, so it won’t do to get impatient. I may yet have more weight to lose; it just might take longer than it has up until now. Based on the rate of deceleration, I should be prepared for the possibility that my actual weight loss line will cross my goal line–that I won’t reach 125 by August 28, if I reach it at all. This should not be discouraging, because the goal was arbitrary; I put it in purely for the sake of analysis, not as something I was actually striving for.

And so I am leaving my final weight in the hands of fate. I’ll do what I can do be healthy by eating right and exercising, and then I’ll see where I’ve ended up on September 25, 2013.

Six months out

I recently had my six-month phone checkup with the office that performed my weight loss surgery. They’re very pleased with my progress, my protein levels look good, and I’m getting enough of my other nutrients; on the other hand, my cholesterol might still be an issue, and we’re waiting until June to see if my pseudotumor cerebri has improved. Still, everything generally seems to be dandy.

While I had them on the phone I inquired as to how much more weight I might expect to lose. They told me that on average, their patients reach a BMI of 26. For me, that would mean a weight of 147.

This is consistent with my high school weight range, but it’s a little higher than I was hoping for. A BMI of 26 is still considered overweight, for one thing. For another, at 167, I don’t really feel like I’m all that far from 147, and I’m not sure I’m prepared for this to be done in just another 20 pounds. Now that I’ve lost so much excess weight, I’m painfully aware of all my sagging flab, and I want it gone too. I don’t think 20 pounds would do it. I almost feel like I have 20 pounds of flab just in one thigh!

So I’ll keep eating right and working out and letting the surgery do its thing, and we’ll see what happens. And I’m going to really try not to worry!

Sayonara, unajuu

One of the strangest things for me about weight loss surgery has been the change in my reactions to food. Some foods I used to adore are now too bland for me; some foods I didn’t really care much about have gained extreme importance. Of course, there are foods I’m supposed to be avoiding, but even when I cheat and let myself have a small bite, I often discover that I don’t like it enough to warrant the cheating.

One example of how things have changed: I am very picky about meat products now. Most ground beef dishes, like burgers and meatloaf, are too dry for me. I tend to find them flavorless and unpleasant. I have also grown tired of eggs, no matter how they’re cooked; I’ll eat them if they’re what’s available and I know I need the protein, but they no longer give me any satisfaction. (Part of me wonders if I might find farm fresh eggs more palatable. I’ll have to give it a try sometime.) Ham doesn’t thrill me, but it gets the job done…but I love a good pork chop. And of course, steak is marvelous. I eat them rarer than I used to, because that way they’re nice and juicy and soft. We’ve started going to Ted’s here in Atlanta, and I’m addicted to bison steak. Fish also makes me happy. I love a good grilled or broiled salmon fillet, and I’d eat sashimi every day if I could–but it has to be good sashimi. If it’s possible, I’m even pickier about sashimi now than I was before.

I still enjoy cottage cheese, but I have become even pickier about brands. There was once a time when I could eat a non-favorite brand and be okay with it, but now, unless it’s Walmart brand, I can’t stand the stuff. I don’t know what it is about how Walmart makes their cottage cheese versus the way the other companies make theirs, but something is different to my now overly sensitive palate.

Then there’s sweets. I always had a sweet tooth before. Cookies, pastries, brownies, cakes, chocolate candy, anything chocolate really…I’d gobble it all up without heeding quality or quantity. Now, of course, I’m almost completely off sugar, except in cases when it’s unavoidable. There are times when I let myself have some sugary snack–usually when traveling, because I don’t keep that sort of thing in the house–but when I do, it never meets my expectations. It always feels pointless. The taste doesn’t do anything for me. I can vividly remember how eating sweets used to make me feel, but now, after having weight loss surgery, eating them will never make me feel that way again. It is such a strange feeling…almost a feeling of loss, until I remember that this change is what has allowed me to drop 100 pounds.

That brings me to unagi.

In 2001, I went to Japan for the first time. It was an amazing trip that changed my life. While I was there, I had unagidon, barbecued eel over a bowl of rice, for the first time. I promptly dubbed it my favorite dish in the world and sought it out thereafter as much as possible. Towards the end of my homestay in Yatsushiro, my host mother, noting how much I adored unagidon, made me a huge bowl with a double helping. I ate it all.

Since then I’ve found unagidon and its sister dish unagijuu (also called unadon and unajuu, respectively) in various restaurants in the US, including my former favorite Augusta Japanese restaurant (which unfortunately seems to have gone downhill in recent years). Here’s some delicious unadon I had there in 2008, complete with onions.

I hadn’t had unadon or unajuu since the surgery, until the other night at Haru Ichiban in Duluth. I was trying to go for something with plenty of protein, since it’s easy to mess up and maximize carbs in a Japanese restaurant. I didn’t even think about sugar. Here’s the unajuu:

Look at that sauce. Unlike the unadon above, this unajuu is saturated. Apart from sopping it all up with a napkin (which I didn’t think of until just now), there really was no way to avoid the sauce. And, unfortunately for me, that sauce is sweet.

I mentioned that when I eat sweets like candy or cookies they don’t really do much for me. Because of this, I usually don’t continue eating them. On the rare occasions that I do, though, I get this really nasty feeling in my chest, between my neck and my stomach. It’s this weird gurgling feeling, highly unpleasant. And it only happens when I eat sugar in high concentration.

Let me tell you, that unajuu made me miserable after just a few bites.

I stopped, ordered some salmon sashimi to get my protein, and spent the rest of the evening trying not to throw up. I was successful, yay! But that put the nail in the coffin of my once passionate affair with unajuu…and perhaps unadon as well, if it’s made with that same concentration of sauce.

Goodbye, unajuu. I loved you once, and somewhere inside I love you still, but it’s no longer meant to be.

No longer obese

As of yesterday morning, I weigh an astonishingly low 166.6 pounds. That’s a hundred pounds less than the highest weight I ever reached, and 90.4 pounds less than I weighed on September 26, 2011, the day I had weight loss surgery. Now, six months out from that surgery, my BMI has plummeted from 45.5, class III obesity, to 29.5–toward the top of the “overweight” range.

I am no longer obese.

I am no longer obese.

I knew this was coming. Whenever I saved my weight in Weightbot on my iPhone, it would tell me my BMI, and I knew that as soon as I hit 29.9 I would no longer be obese. I felt like I was in the 30s forever. I thought about checking to see what weight I’d need to reach to get out of the obesity range, but I somehow never got around to doing that. This month I ended up traveling a lot and didn’t have access to my scale…so while I usually try to wait a few days to a week between weigh-ins, yesterday’s came after a far longer data-free period than usual.

I didn’t even really realize it had happened when I tracked my weight. I saw the 29 and it just didn’t register. It was only this morning, when I weighed in on the Wii Fit, that the truth resounded in my ears: a different, higher in pitch humpty-dumpty “you’re fat” melody, and the Wii Balance Board character, who for years has admonished me, “That’s obese!”, chirped instead, “That’s overweight!”

I don’t know how much more weight I’m going to lose. I’d need a BMI of 18.5 to 24.9 to be considered in the “normal” range; for my height, that would mean a weight between 104.5 and 140.5. I’m really not interested in weighing 104.5. My mid range, a BMI of 21.7 at 122.5 lbs, seems about as small as I’d want to go. I don’t really know what I’d look like at that weight, because in high school, at my most fit, I weighed around 145 to 150.

I don’t even really know what weight I want to be. I used to say I wanted to go for 125 and that I’d be happy with 140, but I can’t imagine what I would look like at either weight. I’m actually pretty happy with how I look now, although I’d like to get rid of some flab. I hope I don’t lose so much weight that my natural curviness goes away.

Regardless, I am extremely pleased with the results of my hard work so far, and I hope I can continue refining my body and becoming even more healthy. I updated the comparison photo I made three months after surgery, and included clothes sizes this time. It’s amazing to me to look back at the changes. (Click to embiggen.)

I’m wearing the same shirt in the first two photos, and I thought about wearing it again in the next two, but once a shirt is too big for you, it starts getting unflattering. I did put it on this last time, though; here’s a picture. Rather than hiding fat, the ruffles now hide my lack thereof, which defeats the entire purpose! ;)

Fat dream

Last night I dreamed about going to some sort of meeting. I don’t really remember what the meeting was about, just that there was a guy who seemed to be the leader who said several things that he’d already said in the email he sent out when he called the meeting. I was glad to be there; I felt I was with like-minded people and that we could perhaps accomplish something, though I don’t remember what.

What I do remember about this dream is catching sight of myself in a mirror and being taken aback by how fat I looked. I was wearing jeans and a pink-purple sweater, an outfit I’ve worn before, and I was sitting down, which is the worst way to see yourself when you’re obese. I didn’t look the way I look now. I wasn’t 179 pounds. I was probably 260.

I looked something like this:

me at approximately 260 pounds, June 2011

It was really jarring…and yet really familiar. I recognized myself. I wasn’t happy, but I wasn’t horribly depressed. I had a sort of resigned acceptance, like, “Yeah, that’s me.”

The thing is…that’s not me. I don’t look like that. I look like this:

And there’s another weird thing. I can’t recall ever identifying as obese in my dreams before. In my dreams, I always just identified as me. I kind of assumed that my dream self embodied my ideal self.

Maybe my subconscious is confused now that my real body is transforming into something closer to my ideal body than to my obese body, so to keep the existing balance, it’s just flipping the roles. But I really don’t want to think of myself as obese when I’m not. (Technically, I’m still obese, but I won’t be forever.) I want to have a healthy understanding and acceptance of my body as it is. I don’t want to wish for an impossible ideal or long for my known, comforting blubber.

I’ve been thinking more about how I’ve used weight as a shield. I’ve used it as an excuse not to bother learning how to do hair and makeup, because why bother to try to look pretty when you’re fat? Only now when I want to look cute or beautiful, I don’t know how. I’ve used weight as a security blanket, irrationally believing that no one would want to rape me because being fat made me unattractive, and this is now leading me to irrationally believe that I’m turning myself into a target by losing weight. I’ve used my weight as a way to avoid fundamental questions I’ve been having as to what it means to be a woman–the fatter I was, the less feminine I felt. (The infertility contributed to that, too.) I’ve quietly used my weight as an excuse as to why I’m not a social butterfly, why I don’t get invited to parties, why people all around me seem to instantly forge connections while I struggle to make one good friend. That “people would like me if I was pretty” feeling defined my high school existence and sent ripples out into my adulthood, even though I knew the real reason was that I’m simply not an extrovert. I felt comfortable getting fatter and fatter because I could use it as an excuse as to why no one ever called or texted me.

Thankfully, in recent years I have begun to deal with that last problem, so I probably won’t be shocked when I become thin and the world doesn’t come rushing to my door. I have friends, good friends, relationships that I have worked to maintain. I may not be clubbing or partying or whatever, but that’s not who I am. I’m happiest when I’m learning, discussing, hearing someone’s story, appreciating beauty, exploring. And I’ve found friends who also love those things.

But that still leaves all the other things, and perhaps more issues I haven’t identified yet.

So, right now, I reject the idea that my obesity and infertility make me less of a woman. Hell, I reject the idea that womanhood can be so easily defined, and I reject the idea that it needs to be. I reject the idea that obesity defines me. I reject the idea that it’s too late for me to learn how to do hair and makeup–please! And I reject the idea that I can or should do anything to my body to make myself more or less appealing to a lowlife rapist.

I’ll press on, one foot in front of the other. I’ll keep writing when I need to. I’ll identify these mental demons when they rise up, and then I’ll knock them the hell down.

Greek yogurt

A number of duodenal switch patients discover after surgery that they are lactose intolerant. In order to avoid the more unpleasant DS side effects, the ones that are often mentioned as cons to having this particular procedure versus another form of weight loss surgery, these patients must avoid dairy products for the rest of their lives.

Fortunately, this was not true in my case. Lactose intolerance would have severely crippled my efforts to get enough protein, as milk products such as cottage cheese, cheese, and milk itself have been essential joys in a world where suddenly I am very picky about food.

One of the greatest sources of protein (and deliciousness) I’ve found is Chobani’s plain Greek yogurt. I buy it in huge tubs. Recommended to me by my aunt, one measuring cup of the stuff packs 26 whopping grams of protein. Being plain, there are no additives to mess me up. Most flavored yogurts have lots of added sugar, and I have to avoid (or at least minimize) all sugars, even natural ones. The only sweetener I can really use is sucralose, and I can’t find any yogurts that are sweetened that way.

So I do it myself, at home.

At first all I did was throw a cup or a half cup of Chobani into a bowl and mix in some Splenda. However, lately I’ve tried a few variations, and it’s been rather nice.

The first thing I tried was putting in some Hershey’s cocoa. Worked like a charm. You have to be careful not to put in too much cocoa, but otherwise, it makes for a nice creamy chocolate dessert.

The next experiment was raspberries. I know, I know, natural sugar…but I only put a few berries into the cup of yogurt, then mashed them up and mixed them in. The swirls of tartness made me suck in my cheeks with delight. I obviously can’t eat a lot of fruit all the time, but a little here and there shouldn’t destroy me.

My latest flavoring is cinnamon, and I think it might be my favorite. I’ve always loved cinnamon, but I never really thought about it. When people would ask what my favorite treat was, I’d probably say “chocolate”…but to be honest, chocolate is getting a little old these days. I like a tiny bit here and there, but it’s not how it used to be. I don’t want to eat a whole box of Oreos (not like I even could).

In any case, cinnamon and Greek yogurt go together really well. I haven’t really been measuring anything but the yogurt as I’ve been making my concoctions, but I think it turns out to something like 1 cup Greek yogurt, 2 T Splenda, 1 T cinnamon. Experiment with it…I think you’ll like it!

Beauty

They tell you when you decide to have weight loss surgery that the physical changes you undergo will touch off emotional reactions. Here’s how my handbook puts it: “Although you have intentionally undergone the surgery to resolve your obesity, weight loss changes the life style you knew so well. Even with its problems and tensions, obesity was comfortable, it was known. Now that life is gone.”

This is not something you really understand until it happens. I read these words. I read about the stages of grief, which many patients go through after weight loss surgery. I thought I knew what it meant. I thought it meant that I was comfortable with my old eating and (lack of) exercise habits, and that I’d have to be strong to adjust to the changes.

So I prepared myself to change my eating and exercise, and I’ve worked really hard at both. And while I do find it depressing that it’s difficult for me to get enough protein each day, I’ve felt strong, and I’ve persevered. Every day is a victory.

But that wasn’t what the handbook was talking about at all.

Today, I am just barely (by .1 pound) into the 170s. My body has changed so much. Sometimes I don’t recognize myself. My face is slimmer, but to me it looks like Play-Doh, like a field of enormous dimples. In the apartment complex fitness center the other day I looked in the mirror and saw an ugly old woman, thin hair pulled back from a big pasty face. It was me.

When I look at my naked body in the mirror, I can see that I’m starting to have a more pleasing shape. But I can also see how being fat has destroyed my skin. I’ve got the surgery scars, of course, but worse than that, I’ve got stretch marks. Everywhere. Stomach, arms, legs, breasts, everywhere.

I have always held in my head this perfect image of how I’d be if I wasn’t fat. I’d look great in a bikini. I’d have a cute face with big eyes and smooth skin. I’d look young.

I’ve never really worried about age before. I’ve never worried about whether or not I could look like my perfect image, because I never thought it was possible to not be fat.

I didn’t really know this until today.

Now I’m looking at myself in the mirror and I’m disappointed. I’m not approaching that perfect image. When I reach whatever final weight I reach, I’m not going to look 22. I’m not going to be able to wear a bikini.

I had never thought of myself as vain before. I always thought I was “above” that somehow.

Now I know that I was just using my obesity as a shield.

I’m sick. :(

I have had a cold for over a week. Last Wednesday, January 25, I felt it coming on–a few sniffles, a sore throat, some coughing. It’s been nonstop since then. The cough’s gotten worse, then a little better. The sniffles turned to sneezing and lots of nose-blowing. My throat is no longer sore, but I have sinus pressure and a headache, and for the past few nights I’ve had trouble getting to sleep and then staying asleep. I’ll be in bed for 12 or 13 hours but I’m not sure how much of that time actually involves rest.

My mucus is clear and I don’t have a fever. There’s been no throwing up or anything like that. It’s just a head cold. But it won’t go away.

At this point I am considering trying to use my CPAP to get some restful sleep. I haven’t needed it in weeks thanks to weight loss. I’m not sure if it would even work, but I feel so terrible, it’s worth a shot.

Since I’ve been sick, I haven’t been able to work out properly. I’ve tried a couple times, only to feel exhausted and lightheaded way too soon.

I’m wondering if the rapid weight loss period after weight loss surgery makes one more susceptible to illness. Is my immune system weakened by the ordeal my body’s going through? If so, is there anything I can do to break free of this cold? I do have some generic cold medicine, but that of course treats symptoms, not the cause.