NSV - An Emptier Closet

Two weeks ago, I got rid of all my size 20s, 18s, XXLs and many XLs.  

That empty closet must contain a methaphor for other parts of life that now have more space.  For what.. ?

I've got one and half more weeks to lose one and half more pounds to leave the obese BMI category.

Onwards...

Feeding Fat vs Feeding Muscle

While listening to an interview with Lou Ferrigno today on the Adam Carolla podcast, Lou mentioned training intensely now as he did during his body-building days, both with the amount of weight he lifts and how he watches what he eats.

He said something very simple that made a lot of sense:  "Do you want to feed fat or do you want to feed muscle"?

When I make decisions about what to eat, I know I can stay within my energy limits by making nutritionally dense and and muscle-feeding choices, or I can feed fat by eating sliders.  

So, this week, I'll practice Lou's simple, mindful check-in before I eat and ask "Do I want to feed fat or do I want to feed muscle?"

9 months banded.  57 pounds lost.

New Challenge

9/13/11: Lose 11 lbs in 14 weeks (by December 23rd) to achieve a BMI of 29.9 and no longer be obese.  A Christmas present to myself.

Happy Birthday to Me!

It's Monday; it's my birthday!

As of this morning, I weigh 42 lbs less than my birthday last year.

Also, I nailed my mini challenge of losing 11 lbs in 11 weeks.  Accomplished three weeks early.  Booyah.

Happier and healthier.  It's a good thing on your birthday.

Lose It! I Love This Tool!

I've been using a fantastic program to log calories and exercise called Lose It! http://www.loseit.com/  Thank you Sharon for turning me on to this fantastic website! 

I noticed I often eat 2/3 - 3/4 of my daily calories after 4pm.

I sometimes eat 1/3 - 1/2 my daily calories in snacky foods. 

So, going forward this week, I'm trying to:

1) Make sure 2/3 of my calories are consumed before 5pm.  That means less night snacking and figuring out what I need to do during the day to decompress instead of waiting until night to flop out with a bag of sunflower seeds and popcorn to unwind.

2) Replace some of my typical snacky foods with other choices.  Like what you ask?  Aforementioned sunflower seeds and, get ready for it... chocolate-covered gummy bears.  Or really, gummy anything.  My kryptonite.

And an update:  I've lost 49 pounds since December 20, 2010 and am now under 200 pounds.

Vacationing With The Band

http://www.intuitiveeating.org/

I'm vacationing in the beautiful San Juan Islands (Washington State) and flying completely blind with no scale in sight.  Vacation strategies:

• Focus on intuitive eating.
• Watch for the soft signals, those advance warnings of impending fullness.  Lately, my soft signals have been nasal congestion and runny nose.  Nice signal, huh?  When you can't breathe, stop eating!
• Have fun and relax.  I have no pressing or immediately impending work activities and no projects that need immediate attention.  I left my house in immaculate shape before leaving and all is well.
• Read for pleasure.

A Fill Appointment In Pictures!



The ferry ride to Bremerton, WA.



Surgeon's office

Fluroscope for precision guidance.



The RN who performs the fill procedure.  A medical
technician is also present to run the fluoroscope.



Locating the port.

  



 

Inserting the fill needle. 



First, the fluid is removed..



 


Swallowing barium to check flow-though rate
 between upper pouch and lower stomach.

 

The view on the way back to Seattle

A Fifth Fill?

The view arriving in Bremerton, WA via state ferry.

I'm on route to Bremerton now for a fifth fill appointment.  My satiety seems to have decreased in the last 2-3 weeks and I'm far hungrier about 1.5 hours after meals.  I have absolutely enjoyed the ability to enjoy any type of food, breads, pastas and rice in the last month with no untoward affects.  However, I'm willing to give that up to remain satisfied 3-4 hours after meals.  So, off to Bremerton I go.

My bariatric surgeon has two offices, one in Olympia, WA  and one in Bremerton,WA. 

First Challenge Goal Down!

I made my first challenge goal today that I set six weeks ago:  Lose 1 pound per week for six weeks.  Done. http://myquatto.blogspot.com/p/challenges.html

Since my last post in late May, that's about 12 lbs down. 

August is a big vacation month.  I'm planning to continue a 1 pound per week loss throughout the next six weeks, but without the assist of a regular schedule with regular, planned gym workouts and regular, planned meals.  Onwards.. 

Gaines Burgers AKA Brown Rice Power Patties

Remember Gaines Burgers?  That's the name I'm giving to  Brown Rice Power Patties, a fantastic recipe my mother sent me to combat the afternoon sugar cravings.  They are delicious.  Heres' the recipe so you can make your own Gaines Burgers Brown Rice Power Patties:

Brown Rice Power Patties

231 Kcals, 10 grams protein each.

2 cups cooked brown rice

4 ounces sharp Cheddar cheese -----grated

1 1/2 cups finely-grated carrots

1/2 cup raw sunflower seed

1/2 cup raw or toasted sesame seeds

3 eggs

1 teaspoon dried basil

1 teaspoon salt

1/2 teaspoon freshly ground pepper

1 1/2 cups toasted slivered almonds or dry roasted peanuts

Preheat oven to 350 degrees. Mist a baking sheet with non-stick spray.  In a mixing bowl, combine cooked rice, grated cheese, carrots and seeds.  Combine the eggs and seasonings in the food processor and blend for about 5 seconds. Add nuts and process another 5 seconds. if using dry roasted peanuts you may need to process them an extra 5 seconds. Don't over-process the nuts; their texture is important. Add to rice mixture and mix thoroughly.

Use a 1/4 cup measuring cup to scoop mixture onto baking sheet, and form into plump patties about 3/4 inch thick. I pack the measuring cup firmly and rinse it between scoops so that the mixture drops out more or less cleanly formed, ready to be patted our a bit more and shaped the rest of the way. Bake at 350 degrees for 15 minutes, then turn patties over and bake 10 minutes more. Transfer patties to rack, flipping them so their toastier side show.

If you're not eating them the same day, keep in the refrigerator. They will easily last at least a week if kept cold and stored in an airtight container.

Monitor Measure Manage

Today:  I will

*  Monitor my hunger signals

*  Measure my Kcals & protein

*  Manage my stress.

Off for a walk around Greenlake (2.8 miles) ...

4th Fill, NSVs and Compulsive Eating

I'm riding the ferry back from my 4th fill appointment and have some time to reflect on what's been going on this last two weeks. 

First, a couple of NSVs (non-scale victories). 

• I'm getting the hang of smaller bites, slower eating and stopping eating without needing that "full feeling".  I found it I don't wait until I'm ravenously hungry, I can manage these new eating techniques, which, with continued practice will become my usual eating habits.

• I have a couple of tops and dresses that are getting big.  Or, am I getting smaller? 
• Significantly less knee pain and stiffness. 

Second, the 4th fill:  The fill technician predicted I'm likely getting close to the "sweet spot" that might hold me for the next 6-8 months.  I'll still need to check in monthly, but I may not need as many fills in the next several months as these first three months.  In the last two weeks, I certainly did feel hungrier sooner (1.5-2 hours instead of 3-4 hours) after eating.  I found myself ruminating and over-planning meals last week as well..a near-certain precursor to compulsive eating.  And, a little sugar craving has popped up between meals, especially towards the end of the day.  Game plan:  After these next two days of liquids (always mandatory after a fill to allow the stomach to heal and settle), I'm going to increase protein in the afternoons with some really great fiber (almonds, apples) to see if I can kick the sugar cravings in the evenings.

Third, and speaking of compulsive eating, I was trading stories with the fill technician about our greatest feats of compulsive eating.  We both agreed that sometimes, for whatever reason, one's brain is wired to just EAT.  Whatever and whenever, with no signals or guidance from other parts of the body.  Silly brain.  So competent in some areas and so defective in others.  It will likely always be this way.  Just like managing a disease or a birth defect.  There are work-arounds and scripts and practices that can help make up for the deficit.  It reminds me of advice adult Aspergian John Robison gives to parents of young children diagnosed with Asperger Syndrome:  "Give them the social scripts they need to be successful in the world.  It doesn't matter if you don't understand why you need to look someone in the eye and say hello when you enter a room.  You just do it and it makes life easier for you."  So I suppose the script for us compulsive eaters is:  "Slow down, taste your food, stop when you feel just barely full but in no way stuffed.  Take little bites.  Eat small meals and make sure they are nutritionally dense so you'll stay satisfied for 3-4 hours.  Deal with stress and feel emotions instead of smothering them with anesthetizing food.  It doesn't matter if you don't understand why.  Just do it.  Your life will be easier".

"You Cannot Manage What You Do Not Measure"

This is a quote from Dr. Simpson's Book "Lose the Last 30 lbs" .  This is the same bariatric surgeon who wrote the excellent article on appetite suppression vs restriction. 

The most successful gastric band patients learn how to be satisfied with a cup of food.  They learn to walk away, regardless of being able to "eat more".  The let their bands "fool their brains" into thinking they had more food and thus, get appetite suppressant for several hours on just a cup of food.

"The band goes around your stomach, not your lips and not your brain".

Dr. Simpson's recommendation is to track volume and measure what you want to manage.  I've been measuring calories and protein, but not necessarily volume.  I'll make that my next 4-day win beginning tomorrow and track when my hunger returns after eating a cup of volume.

(I wonder:  If one is used to large volumes of food, likes large volumes of food and thoroughly enjoys that "stuffed feeling", I wonder what the process was like getting used to 1 cup of food at meal times?  Is there grieving at that big lifestyle change?  I've heard some WLS patients will take up other addictions (drinking, gambling, shopping, etc..) to fill up what is now missing.)

Excellent Article on Using the Band Successfully

It's not about fullness and restriction, it's about appetite supression. 

http://drsimpson.net/fills/Lap-band-eating/lap-band-not-restriction/lap-band-and-restriction.html

Thank you, Heather for posting this link!!  Visit Heather here:  http://heatherslapband.blogspot.com/

Open Door

Something has changed in the last two days.  The tightness of my band from the fill last week seems to have loosened significantly.  The first thing I noticed was a return of hunger about an 60 - 90 minutes earlier than I'd expect and the ability to eat a greater quantity at once.  Secondarily, food seems to "slide through" more easily instead of remaining in the upper stomach, creating stretch, fullness and satiety.

So.  What to do?  When the door is open, should you step through?  When the band is feeling quite restrictive, it's impossible.  The door is locked.  Now that the door is open (about 1/4 way), it obvious that it's time to engage the brain.  Those that have gone before me talk about the band being a tool but not the solution.  The solution is me.  I get to choose what, when and how much to eat.  The band gets to be the band.  The bumpers in the bowling lane gutter.  It can't throw the ball for me. 

Strategies for the next 4 days:
(Why 4 days?  Check out the 4 day win )

1.  Watch and hunger and fullness cues carefully.  Be careful of getting too hungry and then over-nourishing as a result.

2.  Focus on primary rather than secondary foods (this is based on integrative, holistic nutrition.  Check out http://www.integrativenutrition.com/primaryfood  or http://primarynourishment.com/my-approach

The Bus

You ticket to incidental exercise!  Getting an extra 2 mile walk in today since I'm bussing from Phinney to Capital Hill.  That's good.  Ever notice how can smell what the person sitting next to you last ate?  That's bad.  What is that smell?  KFC?

Analogies & Experiences

Having too loose of a band, or, how I know I need a fill right away:

• This feels much like driving with a very loose parking break on:  You feel something kinda dragging on you, but you can pretty much drive as fast as you want.
• You over-plan eating and ruminate about the next meal.  Thoughts of food dominate your consciousness.
• You feel like you need to satisfy your hunger as soon as you feel it.
• Letting your hunger build also makes your anxiety build.
• Easy to eat over 2000 Kcals a day.

The green zone, sweet spot, or perfect fill level

• Weirdly satisfied with about 1/4 or 1/2 of what you'd normally eat.  (This is still novel and on occasion, I still over-fill my plate.
• Little rumination about food between meal times.
• No physical need and less emotional need to graze and snack.
• 1200 - 1500 Kcals feel about right.  It might be difficult to eat too much over 2000 Kcals.
• Feel like bowling with bumpers:  You still have to throw the ball straight to get a strike, but the bumpers will prevent you from rolling a gutter ball (or totally blowing it by over-eating).

Band too-tight

• Hurts to drink water.
• Takes an hour or more to finish 20 ounces of protein drink
• Hard to get 900 - 1000 Kcals
• Feel like there's a parking boot on your car.  You're not going anywhere and if you try to drive, you're going to damage your car.

Awesome Shoes and Excellent Clothes

How cute is this dress?  Have you tried bamboo clothes?  So light and soft, it's like wearing nothing.  If your skin felt like super-soft, stretchy bamboo viscose.  But it doesn't .  Go, now and get yourself a cute dress from Organic Bamboo Clothing.  Great for morphing shapes. 

Gah!  Look at these shoes!  So comfortable; so light.  If you're a fan of flexible shoes, you need to know about Merrell's Barefoot collection.  And, you need to go get a pair right now.  Very little cushion between you and the ground but with surprisingly ample arch support.  Odddly, my feet aren't nearly as fatigued as when I wear my 5 Fingers.  Unlike the 5 Fingers, you can wear socks with these.  Unlike the 5 Fingers, you don't look like a dork.  Love these shoes!

Got My Corset Tightened

Goodness.  I got my 3rd fill on Tuesday.  Big difference.  Immediately after the procedure, I had a 20 ounce protein shake that took 20 minutes to drink. 

 

Today, that same drink took over an hour.  I might be a bit swollen and need to take it easy (liquid diet) for a couple of days to see if this more extreme restriction eases up.  Most solids (and some liquids) resulted in productive burping after 2 tablespooons of food.

Fingers crossed that things get more comfortable (but not too comfortable) in the next couple of days.

I'll use this experience to practice the golden rules of successfully banded:

• Small bites, no bigger than a dime.  Put fork down.  Chew.
• Stop eating when you sense the first whisper of fullness.  No need to continue eating past the point of discomfort.

Such foreign concepts, right?  The guzzling and gobbling habits I perfected over the last 43 years will take time to unlearn.  I remain amazed at this tool that's helping me unlearn those habits.

Monday Cycling

Coach says we're taking a tour of the heart rate zones.

Goals

Have You Seen My Body Gallery?

Cool site.  I've been trying to find out what the ideal BMI (24.9 - 18.5) looks like on a 5'6" woman and found this site:  My Body Gallery. 

Fascinating!  140 pounds can look amazingly varied depending on body shape and muscle mass.  Enjoy.

Morning Power Drink - The Pre-Breakfast of Champions

Switching from normal vitamins to liquid vitamins was one of the hardest things about about the band.  Liquid vitamins are caloric, too, adding about and extra 110 calories a day.  Here's how I start each day:

In one 12-ounce glass of water, add:

1 ounce Nature's Source of Life for Women (50 Kcal)
2 heaping teaspoons (1 powdered, 1 not) psyllium husk (25 Kcal)
2 tablespoons Floradix Cal/Mag (60 Kcal)
1 teaspoon Nordic Naturals Omega 3D fish oil (45 Kcal)
Juice of one small lemon (improves the flavor of all the above)

Swirl it all together with a fork and gulp it down before the psyllium husk coagullates into a gel.  Mmm good.

2nd Fill...Wearing Off!

Isn't that an icky picture?  It's what it feel like when the fill-induced satiety and meal satisfaction wears off.  Like slipping down into a hunger hole.

Glad I though ahead to make an appointment for my 3rd fill next Monday.  I'm noticing a rapid change from just two days ago: 

1. My morning hunger has returned in a big way,
2. The sausage link and tofo scramble, which was about 1 & 1/2 cups didn't leave me feeling full or satisfied.  I definitley could have kept eating.
3. The sausage link had no problems going down.  This type of meat would have been a problem last week.

So..strategy time.  I may be white-knuckling it a bit until next Monday.  I'll try to up my protein, make sure I'm keeping liquids and solids seperate at meal time, and track, track, track to those blindly eaten snacky bites don't start adding up.

Neat Book: BandWagon by Jean McMillan

Just read a Jean McMillian's great book on strategies for success with the adjustable gastric band.  Her thorough, friendly style of writing was comforting and informative.  Jean's ability to add perspective of the early part of the banding process (surgery through the first couple of fills) and keeping the big picture in mind is particuly helpful. I plan on reading the rest of the book in the bathtub tonigt.



Dinner

Asian veggie burger bowl.  All but 4 bites came home with me.

Today's Strategy: Eat Breakfast Like a King and Dinner Like a Pauper

Yesterday I ate lightly at the beginning and finished the day by eating, in 3 hours, more calories than I had in the first 8 hours.  I woke this morning with NO hunger and am still feeling too stuffed to try my usual fiber and vitamin waker-upper. 

Reverse strategy today:  More protein and calories in the AM vs the PM.

5am:  Coffee
7:30: Lightly hungry.  Steak and pasta:  350 Kcal, 18 protein
8:30:  8 oz water
9:30:  8 oz water
10:45:  Hungry.  Fiber and vitamin drink:  140 Kcal
11:30 8 oz water
1:30:  Hungry.  Steak, artichoke and cottage cheese:  375 Kcal, 25 protein
3:30:  Snacky.  Almond Roca 140 Kcal.
5:30:  Dinner out. Not hungry.  French fries, red wine, salad:  300 Kcal, 3 protein

Kcal:  1305; protein:  46

Tracking Hunger and Fullness Cues Today

7:30:  Not hungry.  Vitamins and fiber drink.  140 Kcal, 0 protein.  8 oz water.  Full.
8:30:  Coffee;  8 oz water.
9:30:  Hungry.  1/2 Artichoke w/lemon & olive oil; Cottage cheese:  295 Kcal, 25 protein.  Full.  Artichoke  feels a little "twisty and turny", but not stuck. 
10:30:  16 oz water
11:45:  Hunting for something sweet.  Not hungry.  Two Sees Truffles:  180 Kcal, 2 protein.
1:30:  Very hungry. Pasta with chicken:  175 Kcals, 10 protein.
1:30:  Small piece of soft pretzel:  50 Kcals.  0 protein.  (Bad idea.  I probably irritated things a bit by challenging my pouch with such a soft, bready bite.  By the second bite, I knew  I shouldn't have had it and greived the loss of not being able to eat any more pretzel.)
2:30:  8 oz water
3:30  Feeling snacky, but not hungry.  Coffee and pumpkin seesds.  285 Kcal, 12 protein
5:30  Almond roca:  70 Kcal
7:00  Steak salad & pasta:  580 Kcal, 32 protein
8:00  Cake:  104

Totals:  Kcal:  1879 and 81 protein

Feeling at the end of the day:  Overfed and overfull.

Full!

Yesterday I felt the lap band advantage with great, satisfying fullness after my 4 small meals and that satiety lasted about 3-4 hours after each meal.  Fantastic!  It's working!  So, I'd going to keep an eye on this fullness/volume/satiety equation over the next couple of weeks and try to pinpoint when it the satiety goes away and the need for volume increased.  I hate elaborate tracking systems so I'll try a post it note and post it here at the end of the day. 

Tuesday Body Pump

60 minutes of circuit weight training.  Done.

The View

Coming back from Bremerton. 

2nd Fill

After white-knuckling the last two and half weeks with hunger (and losing no weight, either..double bonus!) I found out at the bariatric surgeon's office that I didn't have to wait for a whole month for a second fill.  I could have just come in when my hunger told me it was time to get the band refilled.  Ooohhh...  Got it.

I also found out that it'll take 3-5 fills before I really feel the full effects of how this band works.  Apparently, it takes multiple fills to fill up all the nooks and crannies of the band before it's full enough to begin constricting between the stomach and the upper pouch.  Ooohhhh... Got it.  Good to know.  I was having visions of being the first band patient that always felt hungry with their band. 

So, two down, and let's figure two more to go before we get some really serious satiety out of a cup or two of food.

Now, I must have read about needing multiple fills before maximum satiety hits and that you can go in more often than once a month for fills if you need, but boy, I sure don't remember it.  I'm also likely one of those people who has to live it to understand it.  Damn dominant kinesthetic learning style.  It's all words and theory until I live it.

Onward with living...

Interesting Study on Food Addiction

Context  Research has implicated an addictive process in the development and maintenance of obesity. Although parallels in neural functioning between obesity and substance dependence have been found, to our knowledge, no studies have examined the neural correlates of addictive-like eating behavior.


Objective  To test the hypothesis that elevated "food addiction" scores are associated with similar patterns of neural activation as substance dependence.


Conclusions  Similar patterns of neural activation are implicated in addictive-like eating behavior and substance dependence: elevated activation in reward circuitry in response to food cues and reduced activation of inhibitory regions in response to food intake.

http://archpsyc.ama-assn.org/cgi/content/short/archgenpsychiatry.2011.32

I have activation in the dorsolateral prefrontal cortex and the caudate in response to anticipated receipt of these gummy Japanese candies:

Two 20 Minute Walks

I had a tight schedule today but managed to get in two brisk 20 minute walks in two of the most beautiful neighborhoods of Seattle:  Queen Anne and Capitol Hill.    Here are the cherry blossoms on Capitol Hill.

Best breakfast ever!

Artichoke with lemon and olive oil.

Cinnamon Roll Post

Having a lap band that need filling is much like driving a car with a very loose parking brake:  you can drive almost normally with just a little bit of annoying drag.

I tested the theory that white, doughy bread is problematic for a banded pouch.  Not this one.  The medium-sized, house-made roll from Kens Market went down smoothly.  Problem was it was a GD cinnamon roll!

That was at 3:30.  It's. 6:30 now and I'm still not hungry. If that changes later tonight, I'll have a bit of cottage cheese.

Enough experimenting for today.  And enough driving with the parking brake on.

What's Going On.. 7 Weeks Post Surgery/ 2.5 Weeks Post 1st Fill

I've had two cold, back-to-back since the beginning of the month.  This is after a couple of years without a substantial cold and I'm certain it's due to the surgery, subsequent healing and lack of regular supplementation and a decrease in physical activity.  Looking forward to getting firmly back in the wellness saddle very soon.

I'm surprised at how little time I got out of that first fill.  At this point, just 18 days after the first band fill, I'm ravenously hungry between meals and really not feeling very full after a medium-sized meal.  I understand that's to be expected and it'll take 3-4 fills to find the "green zone" (see below)

When there is no restriction between the banded part of  the stomach and the bottom, ALL the habits and urges to overeat during meals, to eat between meals when you're not hungry, and eating at night just to relax come roaring back.  I'm trying to keep a tight lid on it until April 11th when I go back for my second fill.

Returning to Greenlake Nutrition's Women's Emotional Eating group has been helpful.  A new 10-week worshop began this week with this session's theme being:  "Setting Loving Limits".   What a perfect concept to practice while I spend the next two weeks waiting for my next band fill. 

First Band Fill Last Wednesday + Results

I had my first band fill last Wednesday in Olympia.  I've decided to make the best use of the hour-long drives by listening to Byron Katie's audiobooks.  I was able to finish "A Thousand Names For Joy:  Living in Harmony with the Way Things Are" .  What a mind-bender this book is.  She goes straight to the big scary things in life (cancer, death of a child) and using "The Work" challenges the reader/listener to see the Tao in all of it.  The beauty in all of it, just exactly the way it is.  Never the way you think it should be.  Promise me, if you get interested in Byron Katie's work, please start with her earlier books like "Loving What Is:  Four Questions That Can Change Your Life" so you have a foundation in her concepts. 

Onwards to The Fill:  My band, model AP Standard LAP Band has the capacity to hold 10 ccs of saline.  I received a 4.4 cc fill on Wednesday.  The procedures was done under the guidance of a seated flouroscopy machine (a streaming xray machine), similar to this picture.  There was a nurse and a technician with the nurse administrering the barium and band fill.  The procedure was simple: 
1. drink barium,
2. watch the flow through rate between the upper pouch and the lower stomach
3. add saline until the flow through rate looks right and the contents of the upper pouch empty very slowly into the lower stomach.

The nurse and technician were amiable and were happy to answer technical questions and followed sterile technique.  I was grateful this practice uses a flouroscope to help the nurse know specifically how much to fill the band by direct visualization and not guessing or sensing the pressure by hand.  All around a pleasing experience.

How was the pain?  Bigger than a bee sting for sure but not as bad as some dental novacaine experiences I've had.  No involuntary tears leaking out the corners of my eyes.  That's a large gauge needle and I certainly felt it pierce my skin and connect with the lap band port.  I didn't flinch and the nurse asked if had a high tolerance for pain.  Ma'am, flattery will get you a compliant patient.  The sensation of the actual fill was startling; a strange, electrical shock-y feeling as the saline is put in and drawn back and put back again.  Not horrible, but not nothing, either.

The reccomendation is to eat a full liquid diet for the next 48 hours after every band fill.  I continue to struggle with this reccommendation as I did the first two weeks after the surgery.  Shhhhh.

The experience of eating, getting full with a small quantity of food, and staying satisfied longer with that small quantity has been interesting.  More to tell later.

A Recent E-Conversation... (Three Weeks Post Surgery)

Kim, Let's put all your research and experience to work! I need a favor. I have a lot of patients that need the kind of help that you yourself have sought out for conscious eating. Do you have references, groups, etc that you'd suggest?  Thanks!!  - K

Thanks for asking, K, I’m doing great!  Started working out at the gym again this week after an almost six week hiatus (blah!!!!) and the only thing that’s a little trouble is lying down on a mat and holding position on a training bike for more than 20 minutes.  The little port that is sewn into my upper abs is still a little sore and likely has another 2-3 weeks before it’s completely healed. 

My first fill is on the 16^th  and I’m quite looking forward to it since I can (and want) to eat everything and I’ve had lots of night-time and emotional eating urges return.  I can’t say they are at the forefront of my brain, but as I get tired and especially at the end of the day, I want that “release” that food so faithfully provides.  So, onwards towards lifestyle and mental changes that prevent some of the needs for those “big releases” at the end of the day.  How about a bunch of little releases accomplished via means other than food?  Onwards, I say. 

And tying in the above to your question, here are my greatest resources for lifestyles and mental health changes:

Greenlake Nutrition:  http://www.greenlakenutrition.com/  Specifically their women’s emotional eating support group.   The counselors are excellent and the prices are right.  New group starting in two weeks!

Intuitive Eating:  http://www.amazon.com/Intuitive-Eating-Revolutionary-Program-Works/dp/0312321236?&camp=212361&linkCode=wey&tag=myqua04-20&creative=391825  The book that started it all for me.

Nourishing Wisdom:  http://www.amazon.com/Nourishing-Wisdom-Mind-Body-Nutrition-Well-Being/dp/0517881292?&camp=212361&linkCode=wey&tag=myqua04-20&creative=391825   When I started studying how the mind and body interact and how emotions come into play while eating, this book was helpful in sorting everything out.

The Work of Byron Katie:  http://www.thework.com/index.php  This is the real mental work I do to find out what’s going on inside my head and to release suffering.  Super good.  Hard to get at first, but it works really well for folks who respond well to the cognitive behavioral therapy approach, which I do.

Anything by Karen Koenig:  She’s a great CB therapist who writes crisp, enlightening books and articles on eating normally.  Love her.  Love her books.  Anything she writes is excellent.  http://www.eatingnormal.com/

Good Information on Gastric Banding

http://en.wikipedia.org/wiki/Adjustable_gastric_band

Day 15...Sort of Back To Normal

I've delayed posting since I've been busy teaching all-day workshops (at days 12 & 13 post surgery) and getting ready to begin a new childbirth education series tonight.  Here's what's been going on...

I still supposed to be on "mushy", pudding-like consistency foods to allow the stitches holding the band in place to heal.  There is no saline in the band at this time, hence little restriction to how much food goes into the pouch.  The food that lands in the upper pouch can pretty much flow through the open stoma into the rest of my stomach.  Now, combine low restriction with eating food the consistency of baby food that's designed to have no resistance as it travels through the new stomach pouch and you've got a recipe for...HUNGER. 

My food volume at meals is about 1 cup.  I am trying eat that cup of food slowly to feel the first inklings of satiety.  If I'm very hungry when I sit down, though, every fiber, every cell of my being is screaming "Throw away that baby spoon, get a ladle and fire it down NOW!".  I try to imagine that I have a small, very expensive sports car wrapped around my stomach that requires a driver that is attentive and knows how to drive it, how it like to be handled in the turns, for optimal performance.  It requires special fuel, a knowledge of when to release the clutch and when to downshift.  Pop the clutch too early, and it's going to stall.  Don't flood the engine.  And God forbid, don't run off the road by eating a 2-3 cups quickly and popping out all those stitches!

The medical advice for this phase of the process is to increase protein intake (via cottage cheese and a high-protein/low-carb drinks).  Two more weeks.  Two more weeks.

It's been helpful to be told and to remember that "you just have to get through this hard part".  Once I get my first band fill (March 16th), the restriction begins and presumably (and as promised), the hunger ends.

So far, I'm down about 14 pounds, with the majority of that occurring the first week.  This last week, I consumed a higher percentage of carbohydrates than the first week and added back about 300 - 400 calories a day so that I'm at 1,100 - 1,200 calories per day now and consuming about 60-80 grams of protein a day.  I also exercised for the first time since surgery yesterday.

I have a couple ideas for posts coming up:

Restricted eating and consequent emotions
How I chose my bariatric surgeon
Eating in social situations with a band.

Let me know you're out there!

Cute, New Dishes

Thank you, Katherine, for the wonderful little dishes.  A 1/2 cup fits perfectly.  (That's my baby spoon that reads "Kimberly").

If you're going to go small, better go with something that nourishes the eyes as well.  So much nicer than eating out of a Pyrex measuring cup.  Again, thank you, Katherine!  Love my new dishes.

Less Swelling = More Hunger

I thought I was getting cheated out what other band users feel the first week after surgery:  No Hunger!  Turns out if you have little post surgical swelling, you will experience more hunger.  Ah, an explanation for what I've been feeling.  So I didn't receive the placebo Lap Band, I just am an excellent surgery-recoverer.  That's the good word from my flattery-proficient bariatric surgeon whom I saw in Bremerton for my first check up.

I have no restrictions at the moment (other than the band itself) and have had no fills.  Those saline fills will start 4 weeks from now when we can be reasonably assured that all that fine stitchery holding the band in place on my stomach is healed. 

Oh, I shouldn't have had the little piece of octopus that was in my Sun Du Bu soft tofu soup yesterday?  Surgeon not impressed.  Even after describing how I HAD chewed that tiny piece into a pudding-like paste (I chose to follow the intent of the pudding-like consistency law rather than the letter of said law), he was insistent on NO SOLID foods for the next two weeks.  Something about not blowing his stats...  Okay, my bad.  You win.  I get pudding-like consistency.  Time to break out that baby food mill.

Am reading "If The Buddha Came To Dinner:  How To Nourish Your Body To Awaken Your Spirit" on the ferry ride back to Seattle.  Trying to take care of the head while addressing the body.

Less IS More

I knew forced mindfulness would happen.  I was looking forward to it.  Today begins my change to mushy, well-chewed, pudding-texture foods.  I started experimenting a little early at Rosita's Family Mexican restaurant last night.  I ordered a side of refried beans and guacamole and had about 1/4 - 1/3 cup total volume for my meal that lasted as long as my family members who ordered enchiladas and burrito plates.  What a joy to have a taste other than a sweet protein drink.  The beans where silky with just a bit of texture.  My job was to eliminate that texture before I swallowed so as not to dislodge or irritate Quatto in anyway.  Voila..suddenly very mindful of what was in my mouth, where it was inside my mouth, judging if I should swallow, noticing flavors, and being, well, what they say we should all be when we eat:  mindful.  Delightful!

Today featured about a 1/2 cup of soft tofu in a kimchi broth at Olympus spa.  Again, complete mindfulness. There was so much more nuance to the soup than I ever would have noticed before.  When you're analyzing when it's properly time to swallow, you get to taste every bit of your food on every bit of your tongue.  Now, how often does that happen in real life?  Again, delightful!

I think the bits and tastes of solid foods in the past 24 hours, have been more satisfying and certainly more enjoyable than the last two weeks of of pre-surgery celebratory, "good bye to food" eating.  Maybe it is all about quality and not about quantity.

Quatto-Fueled Fury

At seven days post-op, I'm past (and quite finished) with the all-liquid diet phase of recovery.  To tell the truth, I was tired, hungry and irritable at all of life the past three days.  The high-point of irritation occurred at the Ballard Pool prior to my six-year-old's swimming lessons.  The class just ahead of us is a parents-and-tots sing-and-swim class.  It's great.  I did it with both my kids.  What I DID NOT do was pile my back packs, towels and shoes on the treaded bleacher stairs so no one else could use them.  This wildly ignited my anger.  Wildly!  With my Quatto-enhanced fury, I cleared the treaded stairs of others' stuff, moving everything three feet to the left and marched to the top bleacher where I dared and glared the next navel-gazing, Ballard hipster parent to stack their kids' Uggs where everyone else needs to walk.  Totally Dirty Hairy move, right?  Thanks, Quatto for giving me the quick furry to get the nasty business done.  Looking forward to working on more civil vigilantism projects with you.

Day Four..Get Back to Work? I Don't Think so..

The lady in the Lap Band brochure said she felt like going back to work by day 4.  Whoa!  Me, not so much.  I still have a little inferred pain in my left shoulder and sitting for more than an hour is quite painful on the incisions.  We'll see what an afernoon of napping and light work can accomplish. 

I've discovered I will never be a narcotic addict.  I can do nothing but sleep when I use my pain medication.  There is to functionality there for me.  No "light computer work".  I can manage a little stoner-vaccuming before I have to lay down and nap.

I do have an interview later on tonight.  I scheduled that thinking, like the lady in the damn brochure "I'd feel like going to work on Day 4".  I suspect I'll be able to pull it together for an hour this evening.  Vicodin-free, even.

Thank you all for the kind words in your emails and phone calls. They help enormously.  Today feels like it's going to be a pretty emotional day. I knew making drastic physical changes would bring into sharp relief equivalent emotional changes.  At least I'll have some interesting "material" to bring to my next group session at Greenlake Nutrition.

What's Happening Now..Recovery

Here's a handy link for understanding recovery in the first days and weeks after placement of the Lap Band.

http://www.lapband.com/en/live_healthy_lapband/the_first_weeks/

Good Morning..Day 3

Morning.. Easier deep breathing this morning.  Woke to do dishes and laundry.  Hoping to have a BM at some point today.  I entertained the kids at dinner last night with the longest, lowest, rumbliest gass-fest.  So, we know the GI system is working.  Fingers crossed for some "productivity" later on today.

Today my goal is 64 -84 oz of fluid + 30 grams of protein. 

I'm thirsty, thirsty, thirsty.  I've noticed I'm pretty swollen in the fingers, wrists and ankles.  I'm going to see if the extra fluid consumption and maybe a long bath with epsom salts will do the trick in pushing this fluid back into the circulatory system.

Afternoon... I think I let the pain get ahead of me this morning.  I ended up soaking in the tub with a couple of bags of epsom salts to reduce swelling and get things moving.  I napped from 9am - 1pm..in the tub and woke up feeling great.  The water allowed me to take deeper breaths and stretch out my torso.  Since the brusing on the incisions is looking uglier today, I thought I'd try some Arnica to hasten healing.

For Those Who Like Stats..I'll update the Ticker Every Week.

Day After Surgery..How'd I Get Here?

I began studying natural and intuitive eating about three years ago.  I can't remember exactly where I heard of the method (a blog, I believe) but it's principles seemed sound and grounded in logic and best nutritional practices.  Intuitive Eating, as defined by Tribole and Resch (2003) is simply following these ten principles:

1.  Reject the Diet Mentality
2.  Honor Your Hunger
3.  Make Peace with Food
4.  Challenge the Food Police
5.  Feel Your Fullness
6.  Discover the Satisfaction Factor
7.  Cope with Your Emotions Without Using Food
8.  Respect Your Body
9.  Exercise-Feel the Difference
10. Honor Your Health-Gentle Nutrition

After two years of trying to practice intuitive eating, most principles clicked for me except for #5, Feeling Your Fullness (I didn't) and #7, Coping With Your Emotions Without Using Food ( I couldn't).  I knew I needed more serious support for both.  The best support group for me continues to be Greenlake Nutrition's "Women's Emotional Eating Workshop".  Here's a testimonial I wrote for them last year:

"...I just finished a 5-week group counseling workshop with Ying and Julie at Green Lake Nutrition. One of the best self-care efforts I've ever undertaken. If you're looking for clarity and help transforming your relationship with food that empowers you to make healthy living a daily practice, I cannot imagine a better resource.  The $$ to value ratio was fair and both Ying and Julie are fantastic counselors:  Compassionate, inspiring and real masters at getting our group of six women to open our hearts and let our hair down. If you’re someone who reacts intensely to feelings and emotions (your own, others’, etc..) and uses food to mask, anesthetize or otherwise cope with said feelings to the point where it affects your life negatively, you might find this type of group counseling a life-saver."  - KJ

And, I have found it a life-saver.  I am more at peace with feeling feelings and have quite an arsenal of new coping skills when dealing with life's unpleasantness.  I'm quite certain this quest for equanimity and mindfulness requires lifelong practice and that the increase in day-to-day happiness makes the practice well worth it. 

However, the more research I did on over-eating the more I discovered the disconnect some folks have between feelings of fullness, satiation and the hormones ghrelin and leptin.  For a variety of reasons, many overweight and obese people have out-of-whack hunger and metabolic hormones.  And, mindfulness or not, if you're getting a chemical signal to GO EAT NOW or don't have the chemical signal that readily says STOP EATING NOW, you're just hanging on by sheer will.  And that is exhausting and not sustainable.

The relationship between emotions, hormones and the brain and body's chemical signals is complex and opinions will vary about how to approach.  I'm curious about combining a surgical approach to help control the hunger and hormonal aspects of over-eating with continued emotional eating counseling to build mindfulness and coping skills.