My body has been many things over the last 39 years. It's been a trap, a prison, a bastion of pain and misery. But never has it been fascinating. Until now.
When beginning this journey I was made to answer questions, talk to various people, take classes. None of it fully prepares you for the reality of post surgery life. I was not expecting such drastic physiological changes. Nor was I expecting it to have such an affect on my psychological health.
The change in flavors and odors is odd enough. Getting use to how much I can eat, how fast I get full, and then hungry again is proving difficult. But the hardest thing for me is my head. To look at all the things I loved to eat and know that I can't. Just trying to sit though dinner with my family is enough to trigger my depression and cause me to leave the house.
It's much harder than I thought it would be. I miss not so much the food its self, but the flavors. To bite into a burger and taste the juice mixed with the toppings and bun. I know this gets better as time goes on. But right now, it sucks. I have no regrets with the surgery. The benefits to my health and longevity, not to mention the ability to actually do things far outweighs any temporary discomfort or aggravation. And remembering that is what's going to get me through this.
Saturday, September 7, 2013
Thursday, September 5, 2013
Am I hungry or am I full???
As you grow up you learn your body. What certain sensations mean. You know when you're tired, when you want to wake up, or drink water, or use the bathroom. And most people know when they're hungry and when they're full. Now, some of us fat folks have a slight issue with the full side, but when we finally get there, we know. Usually.
Now, imagine you suddenly didn't. Your stomach pouch is the size of an egg, give or take. Everything inside has been moved, poked, filled with air. And it all feels completely different. You can't tell if the pain you're feeling is from the surgery or because you ate or drank too much. And you worry that you're going to do something to injure yourself. The last thing I feel like doing is going back for more surgery. So, you have to completely relearn your body signals. It's quite difficult to recognize something completely foreign.
Hunger is a collection of physical symptoms that begin with mild, periodic contractions of the stomach called hunger pangs that progress to a continuous pang, a ‘growling’ noise and perhaps even to lightheadedness. These signals prompt a person to seek food. Sensations of hunger typically begin several hours after the last meal a person ate. Researchers have suggested that hunger occurs when blood sugar and/or liver glycogen fall below an optimal level.
Appetite is the emotional desire to eat. Appetite may be general such as simply wanting to eat whatever food is readily available, or it can be very specific, such as a craving for a particular food item like chocolate or mashed potatoes.
Satiety is the disappearance of hunger after a meal.
Satiation is the feeling of being full to or beyond the point of satisfaction.
Satiety is what we're after these days. And this can be problematic, especially at first. There should be a sensation of pressure or fullness in the center of your abdomen just below your rib cage. Some people feel a sense of pressure up under their shoulder blade. Stop eating as soon as you feel these sensations. One small bite can be the difference between full and "oh my god, kill me now".
Overeating after surgery can bring very uncomfortable side effects including nausea, heartburn, and even vomiting.
Eating inappropriately is the most common source of vomiting following bariatric surgery. Common causes of vomiting after surgery are:
Your stomach can't handle the amount you used to eat before the gastric bypass, so you might experience indigestion if you eat too much. Also, indigestion can result from poorly chewed food. The opening between your stomach and small intestine is smaller than it used to be, so large pieces of food can block the opening and inhibit digestion. Symptoms might include nausea, vomiting or abdominal pain. Tell your doctor about all digestive symptoms in case they are due to a complication. Chew your food to a pureed consistency to decrease the chances of obstruction.
http://www.livestrong.com/article/488087-what-if-i-eat-too-much-if-ive-had-gastric-bypass/
http://www.localbariatricsurgeon.com/surgical-weight-loss/recognizing-signs-of-fullness-after-bariatric-surgery
http://www.bluepointgroup.com/weight-loss-surgery/problems-after-surgery/
Now, imagine you suddenly didn't. Your stomach pouch is the size of an egg, give or take. Everything inside has been moved, poked, filled with air. And it all feels completely different. You can't tell if the pain you're feeling is from the surgery or because you ate or drank too much. And you worry that you're going to do something to injure yourself. The last thing I feel like doing is going back for more surgery. So, you have to completely relearn your body signals. It's quite difficult to recognize something completely foreign.
Hunger is a collection of physical symptoms that begin with mild, periodic contractions of the stomach called hunger pangs that progress to a continuous pang, a ‘growling’ noise and perhaps even to lightheadedness. These signals prompt a person to seek food. Sensations of hunger typically begin several hours after the last meal a person ate. Researchers have suggested that hunger occurs when blood sugar and/or liver glycogen fall below an optimal level.
Appetite is the emotional desire to eat. Appetite may be general such as simply wanting to eat whatever food is readily available, or it can be very specific, such as a craving for a particular food item like chocolate or mashed potatoes.
Satiety is the disappearance of hunger after a meal.
Satiation is the feeling of being full to or beyond the point of satisfaction.
Satiety is what we're after these days. And this can be problematic, especially at first. There should be a sensation of pressure or fullness in the center of your abdomen just below your rib cage. Some people feel a sense of pressure up under their shoulder blade. Stop eating as soon as you feel these sensations. One small bite can be the difference between full and "oh my god, kill me now".
Overeating after surgery can bring very uncomfortable side effects including nausea, heartburn, and even vomiting.
Eating inappropriately is the most common source of vomiting following bariatric surgery. Common causes of vomiting after surgery are:
- eating too fast
- not chewing food properly
- eating too much food at once
- eating solid foods too soon after surgery
- drinking liquids either with meals or immediately before or after meals
- lying down shortly after eating a meal
- eating foods that do not agree with you
Your stomach can't handle the amount you used to eat before the gastric bypass, so you might experience indigestion if you eat too much. Also, indigestion can result from poorly chewed food. The opening between your stomach and small intestine is smaller than it used to be, so large pieces of food can block the opening and inhibit digestion. Symptoms might include nausea, vomiting or abdominal pain. Tell your doctor about all digestive symptoms in case they are due to a complication. Chew your food to a pureed consistency to decrease the chances of obstruction.
http://www.livestrong.com/article/488087-what-if-i-eat-too-much-if-ive-had-gastric-bypass/
http://www.localbariatricsurgeon.com/surgical-weight-loss/recognizing-signs-of-fullness-after-bariatric-surgery
http://www.bluepointgroup.com/weight-loss-surgery/problems-after-surgery/
Taste and Smell, they changed drastically
And I wondered why. So, off to Google I went to do some reading. It seems the leading suspect is a substance called ghrelin. Ghrelin is responsible for enhancing exploratory sniffing and olfactory
sensitivity in order to locate, identify, and select foods. In a 2011
study, Tong et al concluded that lower ghrelin production equaled
increased satiety and pleasantness ratings for food odors were reduced
dramatically in humans.
Ghrelin is a hormone produced mainly by P/D1 cells lining the fundus of the human stomach and epsilon cells of the pancreas that stimulates hunger. Ghrelin levels increase before meals and decrease after meals. It is considered the counterpart of the hormone leptin, produced by adipose tissue, which induces satiation when present at higher levels. In some bariatric procedures, the level of ghrelin is reduced in patients, thus causing satiation before it would normally occur.
So, with the removal of most of the stomach, the production level of ghrelin is greatly reduced. This causes changes in the need or desire for food and thus the olfactory stimulus normally associated with many foods.
Ghrelin has emerged as the first identified circulating hunger hormone. Ghrelin is also the only known circulating orexigen, or appetite enhancing hormone. It is produced mainly in the small and large intestines, but can also be secreted by the lungs, pancreatic islets, gonads, adrenal cortex, placenta, kidney and brain (Ariyasu, 2001). Again the diversity in areas of ghrelin production indicates that this hormone has widespread and numerous biological function. Ghrelin and synthetic ghrelin mimetics (the growth hormone secretagogues) increase food intake and increase fat mass[16][17] by an action exerted at the level of the hypothalamus. They activate cells in the arcuate nucleus[18][19] that include the orexigenic neuropeptide Y (NPY) neurons.[20] Ghrelin-responsiveness of these neurons is both leptin- and insulin-sensitive.[21] Ghrelin also activates the mesolimbic cholinergic-dopaminergic reward link, a circuit that communicates the hedonic and reinforcing aspects of natural rewards, such as food, as well as of addictive drugs, such as ethanol.[21][22][23] Indeed, central ghrelin signalling is required for reward from alcohol.[24] and palatable/rewarding foods.[25][26] There is also strong evidence that ghrelin has a peripheral appetite modulatory effect on satiety by affecting the mechanosensitivity of gastric vagal afferents, making them less sensitive to distension resulting in over eating.[5]
I had many issues with the last sentence above. I would eat, eat some more and be hungry. So I would eat some more. And feel hungry. And then, after stuffing myself with entirely too much food I would suddenly feel full.
Body weight is regulated through energy balance, the amount of energy taken in versus the amount of energy expended over an extended period of time. Studies have shown that ghrelin levels are negatively correlated with weight. This data suggests that ghrelin functions as an adiposity signal, a messenger between the body’s energy stores and the brain (Schwartz, 2000). When a person loses weight their ghrelin levels increase, which causes increased food consumption and weight gain. Conversely, when a person gains weight, their ghrelin levels drops, leading to a decrease in food consumption and weight loss (Tung, 2005). This suggests that ghrelin acts as a body weight regulator, continually keeping one’s body weight and energy stores in check.
This, of course, is assuming that your body functions properly.
The change in taste and smell actually have a much researched name. It can present in people who have not had surgery for various reasons.
Disorders of taste and smell may be overlooked in aspects of medical practice because these senses are not considered critical to life. However, it is important to diagnose and treat dysguesia and dysosmia because these disorders could possibly lead to nutritional deficiencies (which in turn could cause other more severe problems), if they prevent a patient from consuming adequate food and/or supplements.
The disorders of smell are classified as "-osmias" and those of taste as "-geusias."
So I'm fascinated and anxious to discover what else smells different and what else tastes different. I know that chocolate milk is off the edible list. That was a most disgusting experiment.
Ghrelin is a hormone produced mainly by P/D1 cells lining the fundus of the human stomach and epsilon cells of the pancreas that stimulates hunger. Ghrelin levels increase before meals and decrease after meals. It is considered the counterpart of the hormone leptin, produced by adipose tissue, which induces satiation when present at higher levels. In some bariatric procedures, the level of ghrelin is reduced in patients, thus causing satiation before it would normally occur.
So, with the removal of most of the stomach, the production level of ghrelin is greatly reduced. This causes changes in the need or desire for food and thus the olfactory stimulus normally associated with many foods.
Ghrelin has emerged as the first identified circulating hunger hormone. Ghrelin is also the only known circulating orexigen, or appetite enhancing hormone. It is produced mainly in the small and large intestines, but can also be secreted by the lungs, pancreatic islets, gonads, adrenal cortex, placenta, kidney and brain (Ariyasu, 2001). Again the diversity in areas of ghrelin production indicates that this hormone has widespread and numerous biological function. Ghrelin and synthetic ghrelin mimetics (the growth hormone secretagogues) increase food intake and increase fat mass[16][17] by an action exerted at the level of the hypothalamus. They activate cells in the arcuate nucleus[18][19] that include the orexigenic neuropeptide Y (NPY) neurons.[20] Ghrelin-responsiveness of these neurons is both leptin- and insulin-sensitive.[21] Ghrelin also activates the mesolimbic cholinergic-dopaminergic reward link, a circuit that communicates the hedonic and reinforcing aspects of natural rewards, such as food, as well as of addictive drugs, such as ethanol.[21][22][23] Indeed, central ghrelin signalling is required for reward from alcohol.[24] and palatable/rewarding foods.[25][26] There is also strong evidence that ghrelin has a peripheral appetite modulatory effect on satiety by affecting the mechanosensitivity of gastric vagal afferents, making them less sensitive to distension resulting in over eating.[5]
I had many issues with the last sentence above. I would eat, eat some more and be hungry. So I would eat some more. And feel hungry. And then, after stuffing myself with entirely too much food I would suddenly feel full.
Body weight is regulated through energy balance, the amount of energy taken in versus the amount of energy expended over an extended period of time. Studies have shown that ghrelin levels are negatively correlated with weight. This data suggests that ghrelin functions as an adiposity signal, a messenger between the body’s energy stores and the brain (Schwartz, 2000). When a person loses weight their ghrelin levels increase, which causes increased food consumption and weight gain. Conversely, when a person gains weight, their ghrelin levels drops, leading to a decrease in food consumption and weight loss (Tung, 2005). This suggests that ghrelin acts as a body weight regulator, continually keeping one’s body weight and energy stores in check.
This, of course, is assuming that your body functions properly.
The change in taste and smell actually have a much researched name. It can present in people who have not had surgery for various reasons.
Disorders of taste and smell may be overlooked in aspects of medical practice because these senses are not considered critical to life. However, it is important to diagnose and treat dysguesia and dysosmia because these disorders could possibly lead to nutritional deficiencies (which in turn could cause other more severe problems), if they prevent a patient from consuming adequate food and/or supplements.
The disorders of smell are classified as "-osmias" and those of taste as "-geusias."
- Anosmia - Inability to detect odors
- Hyposmia - Decreased ability to detect odors
- Dysosmia - Distorted identification of smell
- Parosmia - Altered perception of smell in the presence of an odor, usually unpleasant
- Phantosmia – Perception of smell without an odor present
- Agnosia - Inability to classify or contrast odors, although able to detect odors
- Ageusia - Inability to taste
- Hypogeusia - Decreased ability to taste
- Dysgeusia – Distorted ability to taste
So I'm fascinated and anxious to discover what else smells different and what else tastes different. I know that chocolate milk is off the edible list. That was a most disgusting experiment.
Day Six Post Op
And over 10 pounds gone forever. Todays weight is 486.4 When I went in for surgery on the 30th I was a touch over 500. So, at this point I have lost a bit over 100 pounds.
The pain is significantly lessened today. I had an interesting experience in bed last night. It felt like everything in my belly suddenly fell back into place. As if the swelling had subsided enough for things to return home. And a second after that feeling, the pain level diminished noticeably.
Also, my emotions seem to have regulated for the most part. Still have episodes every once in while, but nothing like it was the first couple days. That may have to do with getting my meds back in me more than anything else.
So now it's about healing, eating and drinking what I need to and figuring out and focusing on, the future.
The pain is significantly lessened today. I had an interesting experience in bed last night. It felt like everything in my belly suddenly fell back into place. As if the swelling had subsided enough for things to return home. And a second after that feeling, the pain level diminished noticeably.
Also, my emotions seem to have regulated for the most part. Still have episodes every once in while, but nothing like it was the first couple days. That may have to do with getting my meds back in me more than anything else.
So now it's about healing, eating and drinking what I need to and figuring out and focusing on, the future.
Wednesday, September 4, 2013
Post surgery
The last six days have been intense. I went in for surgery on the 29th of August at 10:30 am and finished up surgery around 3 that afternoon. I remember very very little of that day.
The pain is the first thing I remember. It was substantially more than I had imagined. A very intense, burning pain that just didn't stop. It doesn't help that I have unpredictable reactions to medications and what they had been giving me for pain just wasn't working. So they gave me more. And then some more. And then some more. And then I woke up in my room after apparently overdosing on pain medication.
So, once I'm awake and functioning it's standard hospital stay procedure, with the exception of food. And the fluids. And the fluids. And the fluids. 15ml every 15 minutes for the first day and then 30ml every 15 minutes after. Let me tell you, that's a pain in the butt.
And you get really tired of jello really fast.
They get very concerned about blood clots after such an invasive surgery.
So they make you walk as much as possible. For me, not an easy achievement. The pain was pretty extreme in my case. But with the help of my little cheer leader I managed to do my rounds.
The walking did get easier after the first day. I could do it without worrying about falling over in the hallway.
So, I spent a day longer in recovery at the hospital than many people do. My body just wasn't adjusting to such a drastic change. It took some time to get the pain under control and then my blood work came back with low potassium. If you're ever in the hospital and someone mentions an IV drip of potassium, run. Run fast. It was like having lava pored into my arm. And no, that is not an exaggeration. It was so extreme that the nurse stopped it and made the doctor figure out something different. So, I got to drink the liquid version. How utterly disgusting. But in comparison, a joy.
Potassium is a mineral that helps maintain the water and acid balance in blood and tissue cells, assists in muscle building, and transmits electrical signals between cells and nerves. Symptoms of hypokalemia, or potassium deficiency, include dry skin, muscle weakness, fatigue, and slow reflexes. If the deficiency develops rapidly or is left unchecked, heart problems and paralysis may result. Hypokalemia is a very serious condition which requires immediate medical attention.
So, after getting the potassium under control, checking my blood sugars every couple hours, sucking my blood like a hungry vampired and filling me full of fluids and antibiotics, all was well in the world. Well, mostly.
Home again Home again Jigity Jig
So, after three long days in a hospital room it was finally time to go home. I was ready. Eager even. And then I got home. The level of exhaustion my body was hit with, mind boggling. All I wanted to do was sleep. So I did. For hours and hours and hours. And then weird, unpleasant things started to happen. All in my head, or mostly. The emotional roller coaster I experienced, and still am to a small extent, was intense.
I went down, down and down. Panic attacks rolled through me while I laid in bed. Feelings of remorse, of extreme regret. Feeling like I made the biggest mistake since the first atomic bomb got built. I laid in bed, contemplating the pains I was feeling and wondering if I had made the right decision. Wondering if I was going to really be able to do what I need to do to be successful. For some time I was nearly in tears.
Now, when you sign up for this surgery they warn you about all of this. But really who takes it all that seriously until it's happening to you? Knowing what to expect and then actually experiencing it, very different. It seems that depression, even extreme depression, is quite common after such a life altering surgery. But, for someone who has fought against it for so many years, it felt like a slide backwards, toward the abyss. An altogether unpleasant experience. But that, happily, is becoming less and less of an issue as the hours pass.
Now it is all about adjusting. Learning my body again. Eating what I should, how much I should. Making sure to get plenty of fluids. And the hardest of all, relearning my body signals. Figuring out the difference between surgery pain, hungry pain and too full pain. It's much harder than you would think.
And the very strange changes in your body. Things taste different, smell different. I had a touch of chocolate milk and almost vomited from the flavor, it was horribly horrible. Hamburgers don't smell the same, nor do pickles. I'm not sure what else will be different because I'm limited in what I can eat for now, but it will be interesting to out.
The pain is the first thing I remember. It was substantially more than I had imagined. A very intense, burning pain that just didn't stop. It doesn't help that I have unpredictable reactions to medications and what they had been giving me for pain just wasn't working. So they gave me more. And then some more. And then some more. And then I woke up in my room after apparently overdosing on pain medication.
 | |
| Dinner is served |
 |
| walking with the boss |
 |
| My best friend in the whole world |
So they make you walk as much as possible. For me, not an easy achievement. The pain was pretty extreme in my case. But with the help of my little cheer leader I managed to do my rounds.
The walking did get easier after the first day. I could do it without worrying about falling over in the hallway.
So, I spent a day longer in recovery at the hospital than many people do. My body just wasn't adjusting to such a drastic change. It took some time to get the pain under control and then my blood work came back with low potassium. If you're ever in the hospital and someone mentions an IV drip of potassium, run. Run fast. It was like having lava pored into my arm. And no, that is not an exaggeration. It was so extreme that the nurse stopped it and made the doctor figure out something different. So, I got to drink the liquid version. How utterly disgusting. But in comparison, a joy.
Potassium is a mineral that helps maintain the water and acid balance in blood and tissue cells, assists in muscle building, and transmits electrical signals between cells and nerves. Symptoms of hypokalemia, or potassium deficiency, include dry skin, muscle weakness, fatigue, and slow reflexes. If the deficiency develops rapidly or is left unchecked, heart problems and paralysis may result. Hypokalemia is a very serious condition which requires immediate medical attention.
So, after getting the potassium under control, checking my blood sugars every couple hours, sucking my blood like a hungry vampired and filling me full of fluids and antibiotics, all was well in the world. Well, mostly.
Home again Home again Jigity Jig
So, after three long days in a hospital room it was finally time to go home. I was ready. Eager even. And then I got home. The level of exhaustion my body was hit with, mind boggling. All I wanted to do was sleep. So I did. For hours and hours and hours. And then weird, unpleasant things started to happen. All in my head, or mostly. The emotional roller coaster I experienced, and still am to a small extent, was intense.
I went down, down and down. Panic attacks rolled through me while I laid in bed. Feelings of remorse, of extreme regret. Feeling like I made the biggest mistake since the first atomic bomb got built. I laid in bed, contemplating the pains I was feeling and wondering if I had made the right decision. Wondering if I was going to really be able to do what I need to do to be successful. For some time I was nearly in tears.
Now, when you sign up for this surgery they warn you about all of this. But really who takes it all that seriously until it's happening to you? Knowing what to expect and then actually experiencing it, very different. It seems that depression, even extreme depression, is quite common after such a life altering surgery. But, for someone who has fought against it for so many years, it felt like a slide backwards, toward the abyss. An altogether unpleasant experience. But that, happily, is becoming less and less of an issue as the hours pass.
Now it is all about adjusting. Learning my body again. Eating what I should, how much I should. Making sure to get plenty of fluids. And the hardest of all, relearning my body signals. Figuring out the difference between surgery pain, hungry pain and too full pain. It's much harder than you would think.
And the very strange changes in your body. Things taste different, smell different. I had a touch of chocolate milk and almost vomited from the flavor, it was horribly horrible. Hamburgers don't smell the same, nor do pickles. I'm not sure what else will be different because I'm limited in what I can eat for now, but it will be interesting to out.
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