This past month has been an incredible adventure. I've been on the road, traveling with my wife for her job, and have explored so much of the United States! Much of our sightseeing has included trying each region's cuisine, and while it makes me incredibly happy to eat delicious food, it has not been great for my weight loss.
When I left the hospital, I had lost nearly 15 pounds after only three days. Since then, I have lost 3 pounds--three pounds in six weeks! I kept justifying this stall in progress on the stress of not having any routine/permanent residence at the moment (valid), the fact that many people plateau when they begin eating soft foods (true), and that I was doing the best I could without the ability to prepare my own foods (questionable). The truth is, I am not doing the best I can right now, I'm enjoying as much food as my pouch allows! This isn't necessarily a bad thing, but I am only in post-op Week 7, and am already eating normal foods...in smaller amounts, of course, but certainly not the soft-foods-only diet I should be following. See, I thought that since my tummy was so sensitive immediately following surgery, I would automatically reject foods that I shouldn't be eating yet. So far, I have only had a problem once: a bite of soft noodles a few days ago--I know, I know, definitely not bariatric-friendly--sent my pouch over the edge, and around twenty minutes after eating it, I vomited in my scarf as we were cruising down the highway. With this reaction in mind, I erroneously assumed that if I can tolerate what I'm eating, I'm not eating anything I shouldn't be. That is absolutely not true. Our bodies have an incredible ability to adapt, and our stomachs in particular are made up of rugae, tiny folds on the inside lining which stretch and contract with the coming and going of food. Even though my pouch is much smaller, it still has plenty of these stretchy folds, and every time I push my limits, the rugae expand farther to accommodate my meal. At this point post-op, I shouldn't be putting this kind of stress on my pouch, because it completely negates the point of the surgery! Realizing that I'm doing this, and knowing that I won't be settled in my new home for another two months, has been pretty hard on my psyche. I feel like if I had a stable routine, 24/7 access to my kitchen, and significantly less stress, I would be much more successful at following my diet and losing weight. This is just not the hand I was dealt, so I need to buck up and make the best of it. I'm begrudgingly realizing that I actually do have control of what I eat, but that it's going to take a lot more mindfulness and self control to reset my eating habits. I need to start facing this hard truth. Many doctors recommend the reset diet when their patients begin to revert back to weight gain (typically months to years after the surgery). I'm hoping to modify this diet and reduce its duration to a few days, since I've caught my bad habits fairly early on in journey. The most important thing to keep in mind right now is that I am not a failure, that I have simply wandered off course, but can easily right myself. Letting go of the shame from overeating and making bad food choices is extremely hard (because I've grown up with that my whole life!), but is so important to my success. I have to acknowledge my own humanity, and affirm my strength and my goodness within myself in order to remain positive and stay the course. I promise I'll keep working on it.
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Well, I've read that this is bound to happen at some point, but it finally happened to me: I've gained weight! It was initially pretty shocking, since I've been maintaining my progress slowly, but surely, so when I stepped on the scale yesterday morning and found "169" (+2 pounds since last week) staring back at me, I was a little dismayed.
I have to keep in mind that I am beginning to eat normal foods again, albeit small amounts at a time, and that although I'm excited to be traveling nonstop for two months, it does come with its fair amount of stress. This, combined with a plethora of new, rich foods, has made conditions ripe for weight gain, so my thrice-weekly, hour-long workouts in the hotel gym are becoming all-important. Before leaving for Jacksonville, I had a few days at my in-laws' home by myself, and made a fantastic gsleeve-compatible recipe. I hope you like it as much as I did! Puree Stage-Friendly Lasagna Bake Ingredients:
Directions:
Note: Because I was only on Day 2 of pureed foods when I made this recipe, I was not able to eat much in one sitting, and had leftovers for the next day. In the spirit of self love, I'd like to talk about a topic we might not normally broach: sex after bariatric surgery. While not an obvious side effect of this procedure, changes to your sex life are likely to happen--and trust me, they are not bad! Let's break down some of the biggest ones.
Your new diet and vitamin and supplement regimen is nourishing your nervous system and adrenal glands. If you're like me, your nutrition team has ensured that you're taking high quality multivitamins, vitamin D, vitamin B12, calcium/magnesium, and possibly some iron. You can probably guess these benefits are long-reaching (especially since you can no longer synthesize these yourself, and have a difficult time absorbing them from food), but what is specifically happening? Well, your multi is giving you important minerals like zinc, which nourish your skin and support normal immune function. Vitamin D is a powerhouse, helping with calcium absorption (helping bone mineralization), regulating immune function, and supporting healthy hormone levels. Vitamin B12 is an insulator, and nourishes the length of your nerves, resensitizing your nerve endings. Calcium is essential for bone strength and heart health, and magnesium, which balances/counteracts the effects of calcium, is important for muscle relaxation and calming nervous tension. If you have anemia, you were probably recommended iron supplementation, which dramatically increases energy and strength. These effects translate to your body feeling less stressed out and more sensitive to touch and stimulation, with a higher sexual drive and an improved stamina. Bottom line: don't neglect your vitameatavegamins! Your hormonal system is coming back to balance. I briefly touched on this with vitamin D, but even more significantly, excess weight (fat) stimulates excess estrogen production, throwing your entire endocrine system out of whack. Excess estrogen manifests as decreased libido, mood swings, and fatigue, among other undesirables, so you can imagine how rebalancing this hormone could affect sexuality. Your new exercise routine brings increased flexibility and stamina. Since the surgery, I've finally found the courage to step foot onto a treadmill again, after a five-year hiatus. This newfound determination, combined with the reduced stress on my joints, helped me run for three minutes straight during yesterday's workout--a tremendous feat for me! My experience is not unique, as most patients report increases in energy, flexibility, and stamina several weeks after their surgeries. Libido and sexual health benefits greatly from this too, meaning more sexual adventure, more often, and for longer. You are beginning to feel much more confident in your own skin. There is something so beautiful and rare about reveling in your body, and it is truly unfortunate that more people, especially those with more corpulent body types, don't experience this more often or more fully. Still, it's highly likely that as your body begins to morph, you'll be amazed, intrigued, and hopefully, enamored with your evolving frame. As this self love, self appreciation grows, so too does confidence. So, give in to the urge! Try on that risque lingerie, choose that bold hairstyle, and experiment in the bedroom. Get to know yourself in an entirely different way; I promise you'll like what you find. So a ton of things have been happening to my body and my psyche since the surgery, not the least of which is a complete remodeling of my size and shape. At first, this rapid change was disconcerting. Within days of returning home from the hospital, I could no longer fit my bras, my underwear, and my most prized possessions: my collection of gorgeous dresses.
I remember standing in front of a three-way mirror in a dressing room at Target, after clasping closed a bra measuring 36C, around two weeks post-op. I had previously only been able to squeeze my barrel chest into 41D brassieres, so having to continuously leave the fitting room to hunt for smaller size until I landed on this one was shocking enough, but when I looked at my body under the harsh fluorescent lighting--abdomen flattened to soft curves, scars beet red with purple blooms underneath, skinny neck holding up a seemingly alien gaunt face--I began to cry. For thirty-three years, I have known myself as the sweet, funny, charismatic, and witty chubby girl, and although I had never had trouble garnering dates or attracting sexual partners, the Western ideal of beauty I was not. Morphing into something I had secretly envied for so long threw me, and I had to mourn the loss of...what, exactly? I'm not sure, but it was something, and I was sad. Being skinny felt like a betrayal to my former self, the self that fought for so long to make peace with her uniqueness, that held onto her extra pounds like a shield. I felt guilty for not only looking great in a totally average-bodied 36C, but even more for liking it. It took a some time, a few appointments with my therapist, some heartfelt and supportive chats with my wife, and some literal hand-holding in more changing rooms before I could finally find excitement in discovering my body again. While I'm absolutely shocked that this formerly 14P frame is finding 12P pants too baggy, that size M dresses hug my new, smoother curves beautifully, and that even my shoes feel much roomier now, I'm becoming more comfortable with these thoughts, and dare I say it, even excited by them. In my mind, this has so little to do with being thinner, and so much more to do with feeling better. I'll freely admit it: I love my "new" body! I loved myself as a heavier person, and I love myself now: smaller in size, and more vibrant and excited for life than ever. I no longer have to take medications that left me without energy or motivation, or to mentally note all restrooms within walking distance before I eat something, or to avoid physical intimacy with my wife because I feel so physically ill. I'm at the point now where I can begin to enjoy the physical, emotional, and spiritual benefits of this life-changing healthcare decision, where I can learn to appreciate my slimmer self without reservation. I know this journey will be full of many more moments of doubt and soul searching, but for now, I'm feeling the skinny love. As a post-op patient myself, I have recently revisited the naturopathic surgery protocols I learned in school, and am excited to update them with pearls from my own experience. In general, naturopathic doctors are qualified to perform minor surgery in several states and territories, but higher force interventions like pharmaceuticals and surgery are usually reserved for more advanced stages of disease. Still, there is a very unique place for naturopaths in the care of pre- and post-op patients, as I hope my experience demonstrates.
Naturopathic doctors approach surgery with several goals in mind: to bolster nutrition stores in order to build resilience, to minimize unnecessary inflammation and pain, and to support the natural healing process inherent in all of us. Sometimes these lofty goals are easier said than done, but for straightforward surgical procedures, here's a general outline of naturopathic tips and tricks.
Of course, this list is a just a general outline of naturopathic interventions to consider when planning for surgery. While it is by no means exhaustive, incorporating even a few of these basic concepts can make a big difference in healing times following an operation. As with any changes to your healthcare plan, consult with a licensed healthcare professional and with your surgeon to devise the best course of action for your particular situation. I hope these are helpful, and from one post-op patient to another, happy and speedy healing! References (1) Danielski, et al. "Preoperative vitamin C supplementation improves colorectal anastomotic healing and biochemical parameters in malnourished rats." International Journal of Colorectal Disease. 2016 Nov;31(11):1759-1766. (2) de Andrade Calaca, et al. "Probiotics as a preventive strategy for surgical infection in colorectal cancer patients: a systematic review and meta-analysis of randomized trials." Translational Gastroenterolgy and Hepatology. 2017 Aug 23;2:67. This week has been an intense one. While I was thrilled when I received confirmation that I could have my surgery before we relocated out of state, the timing couldn't have been worse! We close escrow on our current home tomorrow, and then head westward for a family reunion before traveling for work for nearly three months straight. The incredible amount of work necessary to pack and move a two-bedroom condo had me feeling motivated to push through my sagging energy and to get us ready, but as I soon found out, that is an incredibly foolish thing to do.
Here's the thing about bariatric surgery that I suppose I understood cerebrally, but definitely did not internalize until recently: your entire body changes! There following are just a few examples of unexpected body developments so far.
For anyone who knows me personally, it may have come as a bit of shock to learn that I have been preparing for vertical sleeve gastrectomy for quite some time. I don't fit the picture of a typical VSG patient, as my Body Mass Index barely met the obesity requirements for surgery, I live a very active and healthy lifestyle, and eat high quality, organic food (I'm a naturopath, for Pete's sake!). Still, my labwork told a different story. With every blood panel run, every tightening of the pressure cuff, and every injection of glucose-lowering medicine, my body lost its vitality, and eventually, I became too sick to be employed. In the year away from work that I've taken to reclaim my health, I've faced some hard truths: I cannot correct my imbalances with natural and lifestyle interventions alone; I cannot correct my imbalances with medication therapy, either; I cannot pursue motherhood via pregnancy safely in my condition; if I don't do something to dramatically change my life, I may not ever be healthy (and happy) again. So, last fall, I picked up the phone, and registered for a Weight Loss Surgery Orientation Night hosted by my local bariatric surgeon.
Two days later, my wife and I sat in a small auditorium at our local hospital, and listened to Dr. Craig Floch explain the differences between the various types of bariatric surgeries, the success rates of each, and the lifestyle modifications necessary after such interventions. I was riveted, and to my surprise, Allie was, too. On the drive home, we discussed what we had learned, and hashed out our feelings about the prospect of moving forward with this super-scary-but-really-exciting thing. From day one, she has supported this decision, shuttling me to and from specialists' offices, taking FMLA leave to care for me after the operation, and even adjusting her own eating habits to complement my new dining schedule. The process has made our family healthier and stronger, and that has made all the difference in my success. So, why VSG? Here's a little personal background. My mother had Roux-en-Y (gastric bypass) surgery fourteen years ago, when the technique was still relatively new.This procedure reroutes the gastrointestinal tract, connecting the stomach (which has surgically been reduced in size) directly to the large intestine. By eliminating the food pathway through the small intestine, a significant decrease in calorie and nutrient absorption occurs, and significant weight loss is inevitable. Unfortunately, this procedure has long-term complications, as several important nutrients are absorbed in the small intestine (including B12, essential for nerve and blood cell health), so diligent supplementation and evaluation is necessary. As a person with a smaller weight loss goal than most, and as a naturopath, I did not want to alter my anatomy and physiology this drastically, so I gave it a hard pass. I'll be honest, I was intrigued by the "less invasive" options of the Orbera balloon and lap band procedures, but was ultimately dissuaded from these as well. For those just beginning to explore bariatrics, Orbera balloons are inserted into the stomach through the nose, and are filled with saline. When food enters into your stomach, there's less room available, and less surface area to absorb nutrients, so it can be an effective way to restrict food intake without permanently altering your anatomy. This solution seemed very practical for my situation, but because it is a pretty new technique, insurance companies often do not cover it, and for as much as we pay in insurance premiums, you can bet I'm going with what CIGNA gives a green light! The lap band procedure also seemed like it might be a good fit for me because it is not as drastic of a procedure as VSG or Roux-en-Y, and does not produce as much weight loss as these. By inserting a band around the top of the stomach (that is then tightened or loosened by your surgeon via saline injection at regular intervals), this procedure also restricts the amount of food you can consume at one time, encouraging weight loss. The upside is that no permanent changes to your anatomy are made, and recovery time is really minimal. The downside to this technique is that follow-ups with your surgeon are frequent (so that your band can be adjusted according to your needs), and with my family's travel schedule and cross-country moves every other year, long term maintenance just wasn't possible. So, I was left with the sleeve, and honestly, it was absolutely the best choice for me. Vertical sleeve gastrectomy essentially reduces the size of your stomach by stapling off the J-shaped pouch, and creating a slim tube. This reduces the amount of food you can consume (and therefore the amount of nutrients you can absorb), but does not alter the food pathway at all. Recovery time is typically a 2-3 day hospital stay, and you can technically begin consuming clear fluids on the same day of surgery. With modern technology improving the accuracy of the surgeon's cuts and the quality of the staples, this procedure is fairly low risk and reliable. Knowing that VSG would be permanent but not drastic, that choosing high quality foods in smaller amounts would go far in meeting my body's nutritive needs, and that I would be able to live my very active and mobile lifestyle after a brief recuperation period sold me on the #gsleevejourney. There are so many factors that play into a decision as life-altering as weight loss surgery, and I share my own thoughts here to illuminate only one example. If you're curious about the possibility of surgical intervention, or want to work through your thoughts in a nonjudgmental and affirming space, don't hesitate to reach out! I'd love to help you along this journey in any way I can. In #healthandhumanity, Sarah |
AuthorSarah Ouano is a naturopathic doctor and writer. Currently on a #gsleevejourney, she frequently writes about the intersection of naturopathic medicine and metabolic maintenance, throwing in personal anecdotes and tasty, practical recipes along the way. ArchivesCategories |