Day 0 - Day 2

So, with my lack of changes, I thought I would put into the blog what my binder guidelines are telling me about gastric bypass.

Day 0 - Surgery Day - Take a shower, arrive at the hospital at the appointed time, have surgery.  Pretty easy in short words, but mentally, wow.  It was a lot.  I kept thinking, is this really happening.  I can stop this.  I can leave.  But I didn't let myself vocalize my anxiety.  I didn't let myself do anything I shouldn't, just listened to the hospital staff as they weighed me, IV'd me, injected me, moved me to the OR, put a mask on my face... left me in recovery, rolled me to my room, told me to transfer myself the 5 steps to the hospital bed.  Then I slept a lot.  No food on surgery day, just a glucose drip.

Day 1 - Grape Popsicle, so early in the morning!!  I have no idea what time it was.  If I could eat it and keep it down, time to move onto clear liquids.  Success.  Food for the day consisted of sugar free gelatin, broth, 50% diluted apple juice.  Two meals in the hospital, one at home.  I could barely drink anything all day, but since I had the IV in for over half the day, not a big deal.

Day 2 -  The day was supposed to consist of four 8 ounce protein shakes plus four cups of water or crystal light.  That didn't happen.  Day two was lousy.  For details, read Day 2 Post-Op - A really bad day.

At this point, the binder goes into detail on specific discharge and recovery instructions.

Recovery - I may be weak and tired, but try to be as active as possible.  Avoid sitting and standing without moving for long periods, i.e. we don't want you to get blood clots.  Perform 10 ankles pumps per hour to help prevent clots, and use spirometer every hour to help prevent pneumonia.  Avoid lift more than 20 pounds and do not vacuum or mow the lawn for two weeks.  You may travel in the car when you feel up to it, but no driving until you are completely off pain medication.

I did pretty good at this.  I was much more faithful with the spirometer than the ankle pumps.  But that darn lingering cough had me worried.  Thankfully, it is gone now.  I did not vacuum for two weeks, it drove me crazy!  Dog hair everywhere.  Yesterday, I swept the whole house and was happy to do so.

Pain Medications - Stay on top of the pain.  Pain medications work better at warding off pain than they do at stopping it once it has begun.  Cut the pills in half, wait 30 minutes and then take the other half.

No problems here.

Time Off Work - Plan on 2-4 weeks.  Less for sedentary jobs, more for active jobs.  Some extremely active jobs may need up to 6 weeks.  You are cautioned not to return to work too early.  You need time to recover, acclimate to your new digestive system, exercise, and get support.

No problems here either.

Personal Hygiene - You may need someone at home to assist you the first few days.  Flushable baby wipes are gentler as well as a peri-bottle.  You could also use a small sports-top water bottle.  A long handled sponge can be useful.

Thank God I had no problems here.  Able to do what I needed by myself without special equipment.

Incision Care - The incisions will need minimal care.  If you had sutures, they will dissolve.  If you had tape, leave it on until it falls off.  Wear loose clothing so the incisions are open to the air.  Keep them dry and clean.  You may shower with soap and water, but do not scrub them.  Pat the area dry.  No tub soaking for 3 weeks.

Signs of infection: incision is reddened, swollen, leaks pus, has red streaks, has yellow/green puss-like and/or odorous drainage, feels increasingly sore, or if you have a fever above 101.5 F.  Check your fever twice a day for ten days.
Signs of something wrong other than incision infection:  fever above 101.5 F, increased belly pain, persistent vomiting or diarrhea, shortness of breath, new leg swelling or new leg pain.  If any of these occur, call your surgeon right away, we have an after hours and weekend on-call doctor.  So call immediately!  Do not use any antibiotic ointment or other ointments on your incision.

I had a very successful surgery and outcomes with regards to recovery.  I did check my fever.  Especially with the green stuff I was coughing up.  But all was well.

Drainage Tube (if present) -   You will need to drain the small bulb at least three times a day, or when it gets half full.  Write down the amount of drainage.  Call the doctor if the drainage changes from pink to green or brown.  Do not soak in the tub as long as the drain tube is present.  normal drainage will change from bloody to pink to a clear yellow.

My doctor does not do the drainage tube unless circumstances warrant it.  His partner does for every surgery... phew close call!

Tomorrow will be Day 3 - 9, unless something more interesting happens to write about.

Also, my Mom came through surgery just fine.  :)

Keep On Keeping On

Things are going well.  I haven't had too much to say, simple because not too much has changed.  I have been consistently walking 1.5 miles a day since this past Sunday.  The last two mornings I even took our dog with me.  I have been better at doing my daily stretches and band exercises, but I did miss Monday.  My bathroom habits have remained regular without any over the counter assistance.  My food intake is the same although I have increased my protein as I am supposed to do.  I haven't noticed any changes in my body with regards to being small or losing hair.  I am losing at a steady pace of 0.5 - 1.0 lbs a day.

Mentally, I am in a better place than I was last week.  I am not being so hard on myself.  I still want foods I can't have.  But it is all in my mind.  I don't have any physical cravings as I have now been without any high carb/high fat/sugary food for four weeks now.  I am actually tired of all the sweet food.  Protein shakes, pudding, gelatin, popsicles, etc... almost everything I can eat at this point is sweet.  I look forward to the day that I can have meat again.

It is going to be busy here for the next week or so.  Tomorrow, my Mom is having surgery to have a hernia repaired.  I have an order to make a graduation cake for this Saturday.  First cake, since surgery, eek!  Monday, my husband is having his gastric bypass and gall bladder removal done.  So, I will have a lot on my mind and a lot to do.

One thing, that I have noticed, is I am having less back pain.  That is a major plus for me.  There is still some pain, maybe there always will be.  But a month ago, I wouldn't have been having a morning walk.  It would have been a late afternoon walk, maybe.  It took that much of the day for me to loosen up enough to walk more than 10-20 steps before having to sit down.  Look at me now!  A mile and a half at 7:30 in the morning!  Five days ago, I was doing my walking mid-day.  Ten days ago, it was in the afternoon.  Prior to surgery, as I said, late afternoon.  I am quite please with this.  I don't attribute it to the little weight I have lost so far though.  It is only 15 pounds difference since 05/10/15 and now.  I think it is mainly due to the stretching, band exercises, and walking.    So I've got to keep it up!

My knee and hip pain is almost gone.  I am still having ankle pain and Achilles tendon pain.  I ice for 20 minutes per ankle after I walk everyday.  It helps.  If I forget, I find myself hobbling around the house.  I am really looking forward to getting back in the water.  I'm just going to keep on keeping on at this point.

Attitude adjustment

Between this week's church service and something I read online, I've decided to adjust my attitude and stop being so negative however fast or slow my weight loss may be.

Yesterday's sermon was on using your compass to stay on the straight path, taking one step at a time, and fixing your eyes on the end goal.  Obviously they were not talking about weight loss, but rather on having a close relationship with God.  Still, I think it applies to me in weight loss too.  It was just what I needed to hear.

I have my compass, my binder, that will guide my exercise, food choices, vitamins, follow-up appts, etc for the whole next year.  It is up to me to stay faithful to the rules and stay on the path.  I am on the section labeled Day 10-Day 16.  One week, that is all I need to focus on.  What comes next week, well, when I get there I'll deal with it.  My end goal is to be healthier and more active with less pain.  Each day that I stick to the plan, that goal of being healthier and more active is realized bit by bit.

What I read online, was from someone else who had had a gastric bypass and was now a year down the road.  She said she didn't lose anything at all for the first three weeks.  Then it seemed like a struggled to lose every pound for four months.  Finally in month four, she was able to eat enough that her body no longer thought she was starving, and the weight began to fall off.  Maybe that is happening to me?  I don't know.  But I didn't go into this process with the sole purpose of losing weight.

I've already had accomplishments besides weight loss.  Everyday since day 4 post-op, I've been walking a mile just for exercise.  Today, I upped it to 1.5 miles.  In addition to that, I am using my Vivofit to track my total daily steps.  So including the exercising, I am making sure I get no less than 5,000 steps in a day.  Day 4, I put in 5,508 steps.  The Vivofit's step goal keeps creeping up, so I am aiming for 7,000 steps a day now.  That is amazing compared to what my activity level was even 2 months ago.

I've resisted a myriad of foods that I shouldn't or literally cannot eat.  Do they look great?  Of course!  Do I want them?  Yes!  Could I still eat some of them?  Sure I could, but I won't!  I didn't go through an expensive and painful procedure to sabotage myself now.

As of today, I've lost 5 pounds.  I want it to be more.  But it will come with time.  You cannot eat low amounts of healthy food and exercise daily, and still not lose weight.  So, I will get there.

So the Nutritionist said...

I am doing normal.  That is pretty much the results of my follow-up appointment yesterday.  Everyone is pleased with my results (except me).

We went over my food intake.  I had taken my tablet in with me so I could access myfitnesspal.com and show her exactly what I had been eating.  I log food into that website religiously.  She said it looked like I was doing great.  This is good news.

We discussed any issues that might occur such as dizziness, burping, heartburn, constipation, diarrhea, vomiting.  Which led me to telling her about my Day 2.  She said it sounds like my intestines had not woken back up after they were paralyzed for surgery.  There was enough room for my clear liquids to go down from Day 1, but once I moved onto thicker liquids, they just couldn't handle it.  So when I got over full, it came back up.  Then later in the day when they finally woke up, that is why I had so much cramping and pain in my abdomen as the intestines were moving what was in them down all at once.  She said if I had a build up of scar tissue, or any other surgery complication, I would still be having pain.  I am not.  More good news.

We discussed my weight loss.  She said they expect patients to lose between 3-7% of their excess weight by the one week appointment.  I am at 3%.  I went on to say I didn't understand how I would get to losing 44 lbs by one month when I was losing so slowly.  She did the calculation herself and saw that yes, a 25% loss for me would be 44 lbs.  Then she said that they expect patients to be a 25% loss by their 6 week follow-up appointment.  (Clearly in contradiction to what was given me by the doctor.)  So I just let it go, realizing that she had no answers for me.

After that I was taken to an examine room to see the doctor's Physician's Assistant.  The nurse took my vitals, reviewed what medications I was on.  I asked if if I took the leftover cough syrup with codeine in it to sleep at night if it would be okay.  She said she could not recommend it, but it would not interact badly with my surgery or any of the medications I was currently taking.  She said I could not take it if I was still on pain medication, but I am not.  She went on to recommend taking Claritin daily and Benedryl nightly until the Claritin took effect.  She said it was much more effective at clearing up post nasal drip than what I had been taking.  I asked her when I could expect to be healed enough to go back and see the chiropractor.  She told me to skip one visit and then continue on as before.  So that is good news.

They the PA came in.  He asked me some of the same things.  He told me that I could resume swimming after week three.  He examined my incision sites commenting on the huge bruise on my lower belly.  It is as big as a baseball.  I told him it was where I got one of the Lovenox injections, that's the blood thinner.  He said all the incisions looked great and to not pick at the tape covering them.  He said as I produce new skin the tape will come off naturally.  If edges start popping up, I could have someone I trust take a small, sharp pair of scissors and trim them.  He said the reason I should not pick at the tape is because if the tape comes away before it is ready, it may take the scab from the incision with it.  So all in all that was good news too.

I was given my lab work order to be completed a week before my six week appointment and sent on my way.

Weight Loss Expectations After Surgery

As I've posted before, I feel like I am losing weight very slowly.  I realize not everyone loses at the same rate.  But when I hear other people's success stories, both from Support Group and the Facebook support group I joined, it makes me feel like my progress so far is not the norm.  I know what you are thinking, it's only been eight days.  I should ease up on myself.  I know, right?

I have a chart from my doctor showing what my expected weight loss should be at certain times based on percentage of excess weight lost.  This is based on the averages of his past patients.  I also have a picture from the FB support group showing what you may expect to lose by a certain point based solely upon your beginning weight.  Let me share them.

From my doctor:

At one month, I can expect to have lost 25% of my excess weight.  For me this would be 44 lbs.

At three months, I can expect to have lost 43%.  For me this would be 75 lbs.

At six months, I can expect to have lost 69%.  For me this would be 121 lbs.

At nine months, I can expect to have lost 75%.  For me this would be 132 lbs.

At one year, I can expect to have lost 81%.  For me this would be 142 lbs.


From the FB support group:

As you can see, the FB expectations are much more moderate.  And I would be okay with them.  I fall in the 300-400 lbs category.  So in the first ten days, I could lose 10-30 lbs.  Well, seeing as I'm at day eight today, and I have not even lost 5 lbs, I just don't see that happening.

This is why I am not happy with my progress.  Chart showing my expectant loss, patient's telling of their success.  It makes me think, "Well, don't I just suck."

I can't eat any less at this point.  It would be difficult to eat more, although I could try.  So the only thing I can do is up my exercise.

My one week follow-up appt with the doctor is in an hour.  I will have to ask him about it.

Week One Post RNY in review

It's been a week!  I'm still moving along, not that I have a choice in it at this point.  But I am feeling a little better.  Here is my week in review.

1 - Made it through surgery with flying colors.

2 - Had my first food? blockage.

3 - Threw up for the first time.

4 - Cried for the first time.

5 - Had first BM and it was unaided by medications.

6 - Have begun doing my stretches and band exercises.

7 - Have started walking daily, though not far.

8 - Have taken all my pills each day.

9 - Am consistently drinking 5-6 cups a day, but need to get it up to 8 cups.

10 - Have gotten up to eating 40 grams of protein daily.

11 - Have not been tempted to eat anything off the plan.

12 - Still have a cold, spend most nights coughing.

13 - Getting very little sleep.

14 - Lost my first 2 lbs.

That about does it and there are more positives than negatives.  So yay!

Where is my ray of sunshine?

Well, it's Monday again, good ole weigh-in day.  I'm disappointed.  I weigh 333.1 lbs.  I haven't lost anything.  I expected something, a pound, maybe two, but nothing major and certainly more than zero.  Support Group is tonight.  At last month's Support Group meeting, there was a man who was five days out, just like me now, who had already lost ten pounds.  Granted, he is a man and they lose faster, but that was why I was going to be happy with a 1-2 lb loss.  Now, I fear I will fail at weight loss even with surgery.

Last night was my first night sleeping all the way through the night and actually in my bed.  It was great to get some good sleep.  I even woke up on my stomach at one point, which I didn't think I'd be able to do for a while yet.  Of course, now my lower back hurts like it always does when I spend more than 3-4 hours in the bed.  It was kind of nice going six days without back pain.

Most, but not all, of my six incisions have been stinging the past couple of days.  None look infected, so not sure what that is about.  I thought you were supposed to itch as you healed, not sting.  A couple of them have some pretty good bruising around them.  But there are the 3 bruises from where I had the blood thinner shots.  Those were to prevent blood clots while I was in the hospital.  Here is a picture.

Incisions and bruises

I feel like this was a very negative post.  I wish I had some good news or something nice to say besides that I slept all night.  I think I might be a little depressed, but I have to keep on a happy face for my husband who has surgery in two weeks.  I don't want to scare him off.  I know he'll do great, that's what guys do.