Monthly Archives: October 2013

WLS 20 – RNY 20 Weeks out

Been an interesting last couple of weeks.

First, my weight loss has slowed or stalled out. I’m not sure if this is normal or not, but, frankly, it sucks.

I’m getting back into the swing of things in my work. I’m involved more, have more energy, I’m doing more things that are mentally stressful, and I’m traveling, speaking and keeping my schedule off-balance enough that it’s difficult to stay in a routine. Usually when I’m busy and stressed, I just go through a drive-thru, pick up a 2,000 calorie meal, and absentmindedly eat it while watching Oprah or something. That don’t work any more even if I wanted it to. Of course, I’m sure I could always still try to make it work. With enough practice, I could probably end back up where I started.

I have increased my intake. While I don’t get the overpowering physical hunger like I used to, I do feel a kind of emptiness in my pouch that’s like hunger. Enough that it calls me to eat. I believe this is a result of my blood sugar dropping.

The bad news is, without a valve at the bottom of my stomach, I’m basically eating directly into my small intestine. This means, I think, that my blood sugar should be even more sensitive to spikes than it used to be. Kinda seems like a step backwards, eh? So my guess is that watching sugar intake for a RNY patient is very important.

So what I ended up doing last week is eating a protein bar sometime within the 2 hours after I’ve had a meal. I’m not sure whether to count this as another meal or not. Should I use the 30-30 rule? Or is it just a solid version of a protein shake. So I haven’t been paying attention one way or the other. Sometimes I do the 30-30 thing. Sometimes not.

So that adds 600 calories to my daily diet right there. It probably puts me around 1400-1600 calories a day — 600 from protein bars, 360 from protein shakes, and 600-700 from three meals.

I’m just not going to worry about this. If I’m hungry, I need to consume something. Protein or water really are the two choices here. Perhaps I should be drinking more water. Don’t know.

The other piece of bad news is that I have decided I hate my exercise program, which basically consists of getting on the elliptical machine several times a week.

In my life there have been several things that I find I have a hard time hating. These are usually things that people tell me are good for me, that I know I’m supposed to like, that I really want to like, but that I just can’t stand. So I end up doing this thing where I keep telling myself that I “want” to do something, then I half-assed do it, or I put it off, or I quit too easily.

Last week I found myself just not caring about my workout anymore. The week before I had moved my target pulse up a bit, and increased my workout time to 65 minutes. It was enough to get me a bit winded, but it didn’t seem too bad. Then, after a few workouts, I just lost interest. I’d get on, go for 10-15 minutes, then just not feel like doing it anymore. Usually the toughest part is the first 20 minutes, where your body is first adjusting to the intensity, but heck, even after 30 or 40 minutes I’d be ready to get off. I wasn’t feeling like I was getting anything accomplished. Just standing there sweating. It was like being on an endless treadmill that stretched out as far as the eye could see. A lifetime of standing in one place and sweating while I played cards on my iPad.

Not so much.

So I gotta mix it up some. Take a class. Start jogging. I really, really, really need to shift gears. But for now, I’ll probably just go back to the elliptical. Bah.

On the good side, my energy levels are coming back close to normal, and I’m getting to an understanding with my lower bowels. We have had our problems in the past few months, but plenty of liquids and more solid foods seems to make things fine there. Enough said.

So with all of that negative energy, I was pretty down about the whole thing the past couple of days. Five weeks ago I was 220 pounds. The next week? 219. Then I was 217. Then last week 217 again. Then the exercise problems began. My eating increased. It was not looking too good. I was really tempted to start drinking caffeine and alcohol again. Tea in the morning and a few drinks on Friday nights. These things helped me maintain an equilibrium. But they also were highly influential in making me eat too dang much.

Did I mention one of my clients is one of these new high tech companies? They have an open kitchen with all the food you could want to eat provided — free. There’s beer in the fridge. There’s a popcorn machine. I was looking for salt the other day and found an entire cabinet dedicated to fine teas. Yikes!

Not. Helping!


So I resisted the urge to go back to bad habits. At least for now. I made it home, hit the sack, then got up this morning and weighed.

I was down 4 pounds, to 213. That’s a total of 7 pounds over the past four weeks. Not terrific, but about 2 pounds per week. A few months of that and I’ll be at my target weight, plus 2 pounds a week is actually an optimum rate to lose. Perhaps I really should be easier on myself.

I think it’s easier for you, the reader, to consume this. You’re probably reading from the distant future. You already know how it’s all going to work out. “Oh, this is chapter 20 in the book where the guy loses 150 pounds” you might think. Gee, don’t know what the big deal was. He simply had a plateau for a while. Or you could be thinking “This is the blog entry for that guy at work. You know, the one that lost all that weight then gained it all back? Looks like at one point he was almost 210 pounds. Wonder what the heck happened to him? Guess some people just aren’t ever going to get straightened out, huh?”

From the future, this is all fairly simplistic, even trivial. What was this schmuck obsessing over so much, anyway? Doesn’t he know that he gets hit by a bus the following month? All that worrying and fussing isn’t going to change anything.

Living it, however, is a different can of worms. I didn’t know until this morning that I had lost 4 pounds over the past week. Before I got on the scale, looking at all the eating I had been doing, and the lack of exercise, my best guess was that I had gained between 1 and 2 pounds. When I saw the loss, I was as surprised as I could be. Now, of course, I can say “Sure was great losing those four pounds. Sometimes you just have to take a break from exercising and let your body catch up” But 1 hour ago it was a different story.

Things always look different in hindsight, and there are many things we do not understand about weight loss, no matter what the books and TV shows will tell you. So I think it’s always going to be a struggle. I’m just not sure I want to spend my life struggling so much.

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WLS 19 – 18 weeks out from RNY

Daniel Markham

18 Weeks out. Daughter Katrina enjoys grabbing all the skin around my face and making funny faces with it

The last three weeks or so have been pretty much a slog on the weight loss front. I’m losing about 2 pounds per week instead of 3, and I’m eating more sliders. Still sticking to the 30-30 rule, though, and I manage to eat less when I pre-measure everything. Still, I’m not doing as well as I used to.

The temptation is to blame exercise, which I missed quite a bit last week. If only I exercised more! I’ll think, and then plan out some brutal week of hard workouts to make up for things.

But if there’s anything at fault, it’s my eating more, which, I have to say, I like.

It’s great to have more physical food in my digestive system. I don’t think the nutrition value of the food matters much at all. It’s just nice to have volume. So I’m eating about a cup of food three times a day, usually a half-cup of some kind of vegetable/protein, like beans, and then a half cup of fruit or berries. I’ve also upped my protein supplements up to close to 100 grams daily. And I’m shooting for 4 liters of water, although I don’t always get this much.

As disappointed as I might feel at times, I have to remind myself that yes, I am still losing weight. And 2 pounds a week is probably a much more sustainable and healthy loss than that crazy 5 or more pounds a week I was doing there at the start. The trick is keeping things going at this rate.

Weight loss is a crazy thing. You are fighting your natural inclination, which is bad, and you are dealing with a system which you don’t understand, which is also bad. This kind of obsession could make you crazy. If nothing else it will twist your thinking.

I’ve also had to come to some kind of conclusion regarding my opinion on dieting. While I’ve tried a bunch of diets, I came into this thing not wanting just to diet all over again. On the other hand, I definitely don’t want to be one of those guys that gains it all back. So how to reconcile these two feelings?

My decision is twofold: 1) I will get into the habit of putting my food in containers ahead of time and eating only what’s in the container (mostly, aside from the weird social situation like a reception or party), and 2) I will discipline myself to the 30-30 rule. No snacking, and no liquids 30 minutes before or after eating.

Other than that I’m going to follow doctor’s orders, but I’m not going to get too wrapped up around the axle. In other words, I am not going to obsess over small details. Odds are I will stop losing at some point. Hopefully I can go another 30-40 pounds, but who knows? The important thing is to find a new system that can last ten years, not reach some arbitrary goal. I figure learning to package my food ahead of time and eating in a certain way doesn’t constrain me too much. After all, there are plenty of other habits and disciplines I’ve gotten into, like packing for a long trip or shaving every morning. This is just something else like that; something to be learned and practiced.

People might wonder what it’s like to have a stomach the size of an egg. How can I eat a cup of food? Well, it’s a funny thing. If I were eating a dry, chunky food like chicken, I could probably eat just enough to fill my pouch. Then I’d be full. But by eating “sliders”, the food just slides right out of my pouch and into my small intestine, so really there’s not much of a limit. I could sip on chocolate milkshakes all day long, drink gallons of the stuff. Sure, I’d weight 300 pounds again, but it’s possible.

Do I feel hungry and want to eat more? Not really. That’s also a funny thing. No matter how much I eat, it seems to fill me up. Yes, it’s easy to get into the habit of eating the sliders and such, but I know that if I went back to liquids for a few days, I could start right back over at a quarter cup a meal again. I’m not eating due to insatiable hunger. I’m eating more out of comfort and habit.

I had some unplanned eating events in the last few weeks that underscore this. One of the places I’m working with routinely feeds its folks on Fridays. They bring in some kind of buffet. Because I want to be a polite guest, I figure I should eat with the people I’m trying to help. So a couple of weeks ago I line up for a great lunch. There was chicken casserole, beans, and so on. Then I went and sat down outside to mingle.

Now with dry food like that, even a half a cup is pushing it, but I knew to chew my food carefully and listen to my body for signals it was time to stop. What happened, though, was that some really interesting people joined the conversation around lunch. We started talking about all sorts of fascinating stuff like hobbies, political views, and so on. I was engrossed in trying to learn more about their world.

And I found that I could not stop eating.

Somehow I have learned to associate nervousness with eating. So when the conversation lulled, or I had nothing to do with my hands, I wanted to find something, anything, to put into my mouth and chew. Even after I ate as much as I needed (of course my plate was full, one scoop of three items will fill a plate). So I’d pick at my food, pull off a little bit, and chew it. It gave me something to do while listening. It was calming.

And I ate too much. My pouch filled up and started to spasm. Yikes!

But hell, even then I kept going and ate 2-3 more tiny bites over the next 5-10 minutes. I just wanted to be doing something while engaged in conversation.

By the time lunch was over, I was in terrible pain. I spent the rest of the afternoon feeling like I wanted to throw up. If I didn’t consume anything, the pain was manageable, but the minute I swallowed anything the nausea would come over me in a terrible way. The pain kind of subsided for a bit, so I started chewing gum and went to a meeting. Ooops! Not so much. About ten minutes into the meeting I felt like barfing, so I ran to the bathroom. But no luck. Just a lot of spitting.

I waited for an hour. The pain subsided. So I tried sipping water. After a couple of sips, back with the nausea again. My body was not happy! Hello Daniel! We have some serious complaints down here! Are you listening?

Went out to the car, found a whole plastic bag of Papaya Enzyme, and ate all of them — about 30. Still no luck. I drove home feeling like I was going to throw up. It was not a pleasant experience.

Once I got home, I made some hot tea and sat down, prepared to drink all of the tea no matter what. If I threw up, then so be it. Something had to give somewhere. It’s impossible to live if you can’t drink or eat! While I knew in my heart the problem was going to work itself out one way or another, I still had to recognize that if it went on for more than a day I’d need to go to the hospital. That kind of gets your attention.

I sipped about half of the tea and the nausea hit again. I ran to the bathroom and my stomach convulsed, but I didn’t throw up.

That one convulsion must have shaken something loose because that was it. The pain was gone. I was fine after that.

So a week later I’m in the same exact situation. I’m at a dinner party before a conference I’m speaking at. It was a great dinner. All kinds of foofy food. I made a plate again, and again I sat down and started having a great conversation with some folks.

This time, however, I remembered the pain from last time. Once I started feeling full, I covered my plate up with my napkin and physically pushed it away. Even then, that would not be enough. I know myself well enough to know that I’d soon start picking at the food again as the conversation progressed. Fortunately Melissa was there, realized what I was doing, and took my plate to the trash while I continued talking. That’s what having a good wife will help you with!

Yesterday it happened again. Another catered meal at my client site. Another great conversation with one of the folks there. This time it was fried chicken, mashed potatoes, and green beans. (I skipped out on the rolls, pies, macaroni and cheese, and other stuff!) I really enjoyed the flavor! And the conversation was going well also. But sure enough, not five or ten minutes into the chat, I was full. There I was with a plate 90% uneaten, and my pouch was telling me it was time to stop. So I smiled, said “You know, this is extremely good food, but I’m completely stuffed. It was great talking to you!” and excused myself. Crisis averted. I dumped a full plate of food in the trash can. Felt like I was committing a terrible crime doing it.

Interesting thing about that is that 20 minutes later I still felt a little hunger. So I ate a protein bar. Much better to complete my lunch with protein than do a repeat of the eating too much experience.

Writing all of this, it occurs to me that maybe I haven’t been doing so badly after all. I am learning quite a bit — my pouch is helping me out, whether I like it or not. I’m learning why I eat, I’m learning some ways to control things. I’m also learning how easy it is to screw up, even with a modified digestive system. It’s not all stuff I want to know, but it’s stuff I need to know.

But I still feel uneasy about all of it, as if I’m resting on a house of cards that’s bound to crash sooner or later. From reading other folks who have had this surgery, this is a very common feeling.

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