February 27, 2010

Um, Duh!

Went to choke down some vanilla protein powder this afternoon. Mixed a scoop of Isoflex Vanilla (which I usually like, but lately I don't like ANY of them!) with ice water as usual, plus a bit of Cinnamon. Yucko. Had a brainstorm and added a couple ounces of milk. Voila! Much tastier - even, actually, tasty.

I think I am going to go with almond milk rather than dairy, but if this will help me get that protein in, (and perhaps even enjoy it) I am ALL for it!

Post-Op week 1 - February 25, 2010

Post-Op diet: I have to say the first 10 days of clear liquids kind of sucks! I was very, very bored, though not hungry. I was lucky and it was fairly easy for me to get in the recommended 70g of protein / 48-64 oz of water. Some find this difficult in the immediate post op period. Today I start full liquids and this should make tolerating it all a lot easier. Mushies will be heaven! I have NOT been able to get in the recommended 600-800 calories at this stage - but think it will get easier now that I can have a wider variety of foods. For clears I found the following the most tolerable: Isopure ready mixed with some crystal light powder added, Unjury chicken. Also ate SF jello and my homemade beef and chicken stocks.  At day six I added Nectar Crystal Sky and New Whey Cran-Raspberry cooler. I also sometimes mix Vanilla protein with a tablespoon of sugar free chocolate pudding mix and a pinch of cinammon and blend it all with water and a handful of ice - pretty tasty actually....though at the moment I am sick of all of it.

I'll see how it goes with full liquids starting today and mushies next week.

Supplements: I am back on all of my chewable and sublingual supplements since a week post-op- will add the capsules back at the end of the first 30 days. I did start to supplement in advance of surgery - with vitamins and protein - tried to get levels up and be in as good health as possible when I went into surgery.

Progress: No complaints here! I lost about 7 pounds week one and when I compared my measurements to my November measurements, I lost lots of inches, from all over too!

The Hospital Experience

Arriving in San Diego/Mexicali: This was a smooth process. I was met at the airport by the driver with my name on a sign, we waited for everyone to get gathered up, then took the van to Mexicali, directly to the hospital. It was the weekend so we had the relief driver, Frederico, who was lovely.

Make sure not to eat after 6am that morning so that they can do your pre-op testing. The pre-op tests were overseen by Yolanda, who is kind of a sergeant at arms there - very efficient and organized, and fluent in English, if you have any questions. (Most folks were English-fluent, other than some of the nurses - even then it was not difficult to communicate.) I do speak a little Spanish, which helped, but the translation guide provided pre-op will give you most of the info you need for a hospital stay. After the tests, Dr Aceves met with us to discuss the surgery and the lifestyle changes we would need to make to be successful. Yolanda gave us an antibiotic and a sleeping pill to take that evening and we paid our surgery fee. Ask for a reciept so you can claim the expense as a medical deduction on your taxes (Airfare and hotel also, I think). We were given a packet of paperwork to fill out at the hotel that night and to bring back in the morning. Then we were taken to the hotel, where check in was arranged by our driver. A bellhop brought us to our rooms and we were free until our 7am pick up at the hotel the next morning. The rooms were very nice. Although the chair in the hospital room unfolds into a bed, I arranged for my dad to stay all through our visit at the hotel. It cost about $60 / night and my patient coordinator made the reservations for us. We just stopped at the desk on our way back from dinner and provided credit card info and that was it. We ate at the restaurant just off the lobby serving Mexican and continental gourmet style food and I thought it was very good - and with the exchange very reasonable also - we spent maybe $70 and I had an appetizer, main and a beer and my dad had a 3-course prix fix which was very good. (Also, you've been fasting all day - so when you get to the hotel you are HUNGRY!) There are a couple other places at the hotel too - an upscale Italian and a cafe style with casual Mexican (Which I might actually have preferred, in retrospect).

Day of surgery: When we got to the hotel, we were moved fairly quickly into our rooms - they are very comfortable with a sofa, a big soft chair, a private bath with shower and the hospital bed. Some English language channels on the TV - they gave me a list of which were English. I think the order of surgery that Dr Aceves uses is Lap Bands first, then sleeves in order of distance of home from the hospital. I live in Vancouver and was the first sleeve that day and went in about 11:00. Before the surgery, Dr Aceves will be in to check in, the anesthesiologist will come in to explain the  anaesthesia procedure, and the hospital internist will pop in also. You'll have an IV placed and be given a mild sedative a bit before the surgery. My surgery lasted almost an hour and a half. I was done at 12:25 and remember waking up in recovery room about 12:30 - I kind of faded in and out a lot - not in any pain, just sleepy, and was returned to my room about 2:30.

I felt pretty good the first day - the morphine from the epidural that they give in addition to the general anesthesia sticks around in your system for about 24 hours. So,  I was up and walking, dragging the IV with me as soon as the epidural wore off. One person who came with me had a lot of nausea and some vomiting that day, but I was fine. Nothing by mouth day one, but I felt hydrated with the IV and didn't have any dry mouth or other problems. I slept pretty well the first night. Dr Aceves and Dr Campos were in a few times to check on me - and this was true every day of my stay - lots of Dr visits - very different from my experiences in the states.

Day 2: Again, a fair bit of walking around - by the afternoon I was feeling pretty lousy - achy and sore and a little nauseated - the morphine had worn off; however, as soon as I asked for pain medication and medication for some nausea I got it and was able to sleep and rest fairly comfortably. Got a sleeping pill that night and appreciated it! This was also the day they do the methylene blue dye test. They'll bring you 4 tiny cups of apple juice with dye in it - you drink it and they'll watch your drain bag to see if any dye leaks out - if you are clear, they'll start you on some liquids: apple juice, tang, chamomile tea. I haven't really had any trouble drinking more or less normally, but for many, tiny sips are necessary. I did urp a bit with one of my first overly generous sips of tea - but that's been it so far. I found that the team in Mexicali is fairly aggressive about pain management, and while I never felt particularly "doped up" all I had to do was ask and appropriate medication was provided. Another sleeping pill that night - also IV was disconnected, although a port was left in my hand for injectable pain/nausea meds.

Day 3: I  took a  shower this morning once the IV was out and it felt great - just ask the nurse for some towels. This is the day they do the x-ray of your stomach. Dr Campos will bring you to radiology and you'll be asked to drink three sips of contrast fluid. A lot of people can't stand this, I just found it mildly bitter - unpleasant, but not horrifying, and it's over pretty quick! You'll see it all on the screen and its pretty interesting. Kind of a boring day really - you'll be feeling more ready to go home. Later you'll receive an envelope with your chest x-ray and the shots of your stomach, a copy of your pre-op labs, and a surgical report to bring home. Also a two week supply of Nexium and 8 of the sublingual pain tablets. I already have Nexium prescribed by my PCP at home and paid for by insurance, so I didn't go to the pharmacy for more. I do wish I had gone to get some of the Supradol (pain med) as it works well and is not as easily available in Canada and the US. This is a good day to go to the pharmacy or have the person accompanying you, if any, do so. It's right across the street from the hospital, so you'll have a short walk - but will need to get dressed in something other than pajamas! They take credit cards - just make sure your bank knows you'll be using the cards in Mexico ahead of time. Once you've had your leak test you'll get chicken broth along with your other drinks - and it tastes really good!

Day 4: Time to go home - you'll need to be up and packed and ready about 7am. Then a longish wait at the border and then the drive to San Diego. We had come from Los Angeles area, so had parked in long-term parking and Ernesto dropped us off right at our car - no need to wait for the airport shuttle.

What to bring "just in case": I brought some Gas-X which I used a couple times and seemed to help. I also brought some chewable Imodium - some folks experience some diarrhea - not a problem for me though (keeping in mind that liquids in = liquids out, so be careful!).

Nurses: All very nice, very competent, with varying degrees of English fluency. There is usually somebody on the ward who is fluent - Lucy was he charge nurse during my stay and was fantastic.

Post-op education
: You'll get some printed info on incision care and post-op diet prior to discharge. Also, Dr Aceves wants you to check in every 10 days for three months and monthly for a year. You can also contact your patient coordinator with questions. I have found OH to be a good resource and also have trolled around the web for as much info as I can find. A lot of WLS info is RNY specific - but there is a lot of overlap in post op diet etc - so much of the info is useful anyway. I'm a believer in supplements, so did a lot of research whilst coming up with my list of vitamins etc.

It's ideal to arrange for follow-up care with your own doctor prior to leaving for surgery. Mine will be checking incisions and then running labs / doing an Upper GI at three months. I'll see him this week and discuss a prescription for Actigall also - one study showed that it reduced the chance of Gall Bladder disease in post WLS patients from 30% to 3%. I'll probably have labs run again at 9 months post-op and then annually - to be sure that none of my levels are trending downward and to catch deficiencies in time to fix them. Dr Aceves welcomes inquiries from your doctor if any questions arise.

My Experience in Mexicali with Dr Aceves:- Pre-op Prep

Pre-op prep:  I had a BMI >40, so I was on a one-week, protein only, low-carb, low-fat diet to shrink my liver. I did mostly protein drinks, broiled chicken (just bought a roasted bird at the market and picked at it), salmon, sole, cottage cheese and non-fat plain yogurt- mainly just to keep it simple. Fish and other meat is ok too, as long as it is low fat. Boring but very doable after the first day or two - because I wasn't really hungry. I lost about 7 pounds during the week of the pre-op diet.

I also spent some time pre-op pulling together my vitamins and post surgery supplies. I made and froze a batch each of very rich and concentrated low-sodium and de-fatted beef and chicken stocks and bought some sugar free jello, pudding etc. I already had protein drinks which I have been using for a while, so didn't really need to stock up. I collated a bunch of WLS-friendly recipes for when I am able to eat again and made lists of options for full liquid and mushy stages of the post-op diet.

I was actually not feeling nervous or anxious about the surgery, but did make sure my will / living will were updated and accessible just in case. Also made sure my family had the contact info for the hospital and hotel. Your room at the hospital will have a phone, so family and friends can call you there through the hospital's direct line.

I live in Canada but visit the US frequently and have a pay-as-you go US cell phone (Virgin Mobile) so I charged that up and brought it with me. It worked fine from the hospital (with an American provider, so no roaming charges) but not from the hotel.

Finally, I took my weight / measurements and a set of front back and profile pre-op photos so that I can track changes over time.

January 7 - Surgery Scheduled

Confirmed surgery date of Feb 15th - I'm sure it will be here before I know it. School is likely to be very busy between now and then, so my challenge will be to work on healthy eating habits. Speaking of which, I REALLY overindulged during the holidays and have 5 extra pounds to show for it (added back onto the 11 that I lost). Blech. Anyway, this morning had a protein breakfast and have green salad with roasted chicken breast already planned for dinner, so lunch is the big challenge in terms of staying on track for today... really hoping that this tool helps me get a handle on the hunger and cravings...

August 14 - Weight Loss Goals

I have been keeping a list as I approach surgery - eyes on the prize!

Have been writing down some of the things I anticipate as I shed pounds and inches:


Normal blood pressure
Normal cholesterol
Controlled blood sugar
Reduce/eliminate joint pain (have ALREADY had a knee replacement following an injury)
Size 14 or below
180 pounds or less
Able to polish toenails without straining
No more huffing and puffing up the hill
Can reach behind my back to fasten my bra
Exercise is more fun than it is torture
Increased energy
Can buy clothing at regular shops
No more worrying before sitting on fragile looking furniture
No more worrying about whether the seat belt on the airline will fit
More space in my airline seat!
Easy to fit in all of the amusement park rides - and the energy to do a day at Disneyland!
Able to schedule a dude ranch vacation without worrying that I am too heavy to ride the poor horses
Learn to kayak
Learn to scuba dive
High heels don’t hurt (as much, let's be realistic!)
Cute undies!
Able to fit my behind in the bath - and able to hoist myself out of it!
Bike riding is fun and not a form of torture
A hike is no longer the equivalent of a forced march
Attend a reunion in July 2010 looking FINE!

August 2009 - Deciding on VSG

 So, have just begun my journey by making the decision to have WLS, doing the research, and choosing VSG as the best option for me. I am headed back to school in a couple of weeks (Ph.D. social work program) and the next block of time that I have free is Christmas and then two weeks in February when school is closed whilst the Olympics are held here in Vancouver. I am thinking February will be best as travel can be complicated during the holidays (and, honestly, I don't really wanting to be on clear liquids and feeling rubbish during the Christmas season - I figure by next year I will have adjusted and be able to enjoy myself whilst still eating sanely).

So the worst for me now is waiting for 6 months!

The plan is to travel to my Dad's in LA and he will accompany me to Mexicali for surgery with Dr Aceves. I feel very positive about my choice of surgeon and my family is being pretty supportive, although a bit concerned by my decision to travel to Mexico.

My sweet daughter (age 8) burst into tears when I talked to her and my husband about the surgery. She says she likes me just the way I am with a nice soft tummy to snuggle on! She's coming around though when we talk about all the things we will be able to do together (biking, horseback rides, kayaking etc) when I am smaller and healthier.

So that's what is up for now - will post more as more happens!