Post RNY day 4

I am on Day 4 post-op with my laparoscopic RNY Gastric Bypass.  Today is starting off well.  I've gotten all but one of my morning pills in.  I'm waiting a half hour after each one before taking another.  I have had 16 oz of water so far.  I had my first BM after surgery.  It was diarrhea, so not pleasant, but better than being constipated.

I have not had any more issues so far with blockages.  Sometimes my intestines still cramp when my pouch empties into them.  I think it is probably because they are healing more than anything else.  Yesterday, one of my protein shakes was entirely too foamy when I drank it.  I had gas pain all evening.  not fun, but it passed.

I am still not able to eat as much as the binder says I should.  Yesterday, according to the binder I was able to move on to "Full Liquids."  This includes: Sugar-free pudding, thin Oatmeal made with skim milk, Cream of wheat made with skim milk, Cream of rice made with skim milk, Grits made with skim milk, Malt-O-meal made with skim milk, Low-Fat creamed soups made with skim milk and then strained so there are no chunks, and Protein Shakes.  From the previous days, I can still have broth, sugar-free Popsicle and sugar-free Jell-o, but these count towards my liquid intake, not my food intake.

I had so much trouble the day before I decided to stick with Protein Shakes.  I managed 1.5 protein shakes, which was a far cry better then the day before, but obviously not ideal.  I am supposed to now be getting 40 grams of protein a day and 64 oz of liquid.  The protein shakes now count as part of that 64 oz, whereas before surgery they did not.  If I do well on my first two meals today which will be protein shakes, I will be adventurous and attempt one of my other Full Liquid options.

One of my sister's friends, Carrie, had bypass 5 weeks before me.  She has moved onto soft foods and is no longer utilizing her protein shakes.  She gave me a bag of samples containing various shakes, puddings, and soups for a total of 13 samples.  She has also offered to sell me 6 canisters, two of Unjury and four of Nectar, for $75.00  That is a fabulous deal considering the Nectar alone can retail for 44.00 a canister.  So, I think I am going to buy them.  I haven't talked to her yet, but I have her phone number.  This info and the samples was passed to me by my sister.  Carrie has also offer to be my bypass buddy.  She said she didn't have anyone to talk to who went through it before her and she missed it, so if I had any problems or questions I should feel free to ask her.

Today my weight is hovering just above my surgery day weight of 333.5.  I was told my the nurse who ran my IV that my veins were very full (well-hydrated) and usually when people came in for surgery the veins were thin from dehydration.  The day I was discharged, I had gained ten pounds of water weight from all the IV fluid I was given.  It's been three days and I've just about lost it all.

One more thing to mention, since yesterday I am having horrible post nasal drip and am coughing constantly.  Cough medicine doesn't seem to be helping.  I took an allergy antihistamine this morning and it seems a little better.  But still I cough.  At least it is no longer as painful as the first few days after surgery.

I've got to go eat now.

Day 2 Post-Op - A really bad day

Today was really, really rough.  Like really.

According to my binder, I was supposed to be drinking 4 protein shakes, albeit very slowly over an hour or more if needed.  Plus 4 cups of water/liquid.

So optimistically, I started the day off with half a pain pill because I still hurt.  I waited the requisite half hour and began sipping my first protein shake of the day.  I sipped half of it (4 oz) over 45 minutes.  Then, I stopped because I felt full.

I waited another half hour and took my first blood pressure medication, a small pill so I did not need to cut it.  I took it with water.  I still felt really full.  Then, I started to feel painfully full.

I had stomach pain and back pain.  Thinking my pipes were still swollen (and they probably are, I just had surgery!) I put ice on my stomach.  Not on my incisions which are near my waist, but high right under my rib cage.  This seems to help.

From 9:30 to 1:15, I was in pain.  I tried to walk to see if it would help move things along.  I called the surgeon's office, but had to leave a message.  It just felt like nothing was leaving my pouch.  I was having little burps every few minutes.

At 1:20, I threw up the first time, a little clear liquid, and mostly curdled milk.  Five minutes later, the surgeon's office called me back.  I explained what had been going on and that I had just thrown up.  The nurse told me it sounded like I might not be tolerating the protein shake very well.  I should concentrate on getting my liquid in and maybe just try a quarter of protein shake.

In the next twenty minutes, I threw up two more times.  Almost all clear liquid at this point.  But after the third time, I finally felt better.  Stomach and back pain were gone.  I waited an hour so my stomach could settle and began sipping water.

In three hours, I sipped close to 8 ounces of water.  That is less than an ounce per 15 minutes, which should be doable with just water.  Something that should be able to go right through my pouch and keep me hydrated.

But no, that full feeling was back.  Not as bad though.  So, I just stopped drinking, waiting for my pouch to empty.  It was getting a little painful again and I was burping again.

Then, something inside released, painfully so.  It was like a plug had been pulled.  I literally felt the water rushing out of my stomach into my small intestine.  It was almost like a burning feeling.  When it reached my large intestine, it became more of a painful cramping feeling.  I had to take a nap at this point, I was so tired and couldn't take the pain anymore.  When I woke from my nap, I passed gas for the first time since surgery.

So, I had some sort of blockage.  I don't know what it was.  I ate fine yesterday.  I kept everything to small sips and all liquid.  All larger pills (just the pain pill) were cut in half.  Hopefully, it will not be a reoccurring issue.

I just started sipping some chicken broth.  So here's hoping.  On the bright side, now that that is over almost all my pain is gone.  So I am hopeful that I won't be taking any more pain pills, unless it gets bad again tomorrow.

Home

I am home.  I was told the surgery went excellently with no complications.  I'm tired and in pain, but happy it is done.  The incisions hurt, and my abdomen above and below the incisions hurt.  I am also having back pain just below my shoulder blades.  I was told this is due to the air they pumped in me to make the surgery safer.  It definitely hurts more when I cough, but I am doing that less and less.

I am doing well with clear liquids.  There is no nausea when I drink and I am able to drink about 3 ounces at a meal.  Tomorrow, I am supposed to have 4 protein shakes.

My mouth was horribly dry the day of surgery and I had to use mouth swabs to moisten my mouth since I was not allowed to drink at all.  But I was sooo out of it, I pretty much slept through the entire time people visited.  Then I was up all night.  The bed was comfortable for about an hour and then whatever I was laying on (tailbone or hips) would start hurting something awful and I had to switch positions.  So sleeping a full night was out of the question.  I spent a lot of the night peeing which I finally managed to do at midnight.  The catheter was removed about 4 PM but I just had no urge to go until midnight.  Then it was every two hours, much to the night nurse's annoyance I am sure, since I was using a urine hat she had to keep emptying.  I also walked the halls a lot, a very slow shuffle walk.  I caught a marathon of American Pickers.

Before Surgery

After Surgery

Video of the morning the day after surgery.

Pre-Surgery Photos

I had no intention of posting more before surgery.  But as my luck would have it, I got three hours of sleep and that was it.  So, since I am up extra early, I thought I would finally throw together a picture post.

I had no idea how few photos I had of myself.  Had serious difficulty locating any that I had not purposely taken for weight loss.

12/2013 - Exact weight unknown - Between 350 lbs - 360 lbs

10/2014  About 355 lbs

3/15/15 - 345 lbs

3/15/15 - 345 lbs

3/15/15 - 345 lbs

5/27/2015 - 333.5 lbs Surgery Day - Still in my P.J.'s before getting ready

5/27/2015 - 333.5 lbs I sure hope my butt shrinks

Surgery is a GO!

I talked with my surgeon's office this morning.  I was told it should be fine to still have surgery as long as I am not taking any medications.  So I am going to do it.

I watched a Youtube video of someone who had a cold when she had surgery.  She said that she had pain when she coughed.  I think I can deal with that.

I figured out my goals, and I decided to take my measurements after all.  The Goals will have their own page, and I will stick the measurements on the progress page.

No doubt I will not be posting tomorrow morning as I have to be at the hospital by 5:30.  Next time I'm here, I'll be on the way to a new me.

Sickness - Will surgery be rescheduled?

It is two days until surgery, I hope.  I have a cold.  Today is the first day my left lymph node is no longer tender to the touch.  The right node never got tender.  I am hoping for a miraculous recovery, but I know I will have to call the surgeon's office tomorrow morning and let them know I've been sick.  I fear they will reschedule the surgery.

Day Eight of Pre-Op Liquid Diet

I am not hungry all the time any more.  I still get hungry of course, it is just not a constant.  I don't have any cravings per se... I just want to eat.  If I get busy enough, I forget about wanting to eat.  But it creeps back in, and really I just want to eat.  I have a feeling that is a mental thing that is going to take a while to get over.

Two days ago, I began getting vertigo right before I get out of bed.  Once I'm up, I am fine.  I can move around, bend over, and what not without consequence.  Also, I am so tired.  I am having a hard time getting up.  I want an mid-morning or afternoon nap.  I can't stay up late.

Lastly, I am tired of drinking.  I'd like to sink my teeth into something.  Although, I am not tired of just vanilla and chocolate protein shakes.  I thought I might be, but no, I like what I like.

This morning was my pre-op class.  The nurse, Kelly, reviewed the surgery and what to expect during our hospital stay.  She discussed what medications we should be taking up until the surgery and what we would be given in the hospital as well as what we would be discharged with.  She went over bladder catheters, drains, leg pumps, and incentive spirometers.  She reviewed the medications we need to avoid taking if possible, ones we could never take again (NSAIDS), and the reasons why we are told to not drink alcohol for a year and to never ever ever smoke.  Some gross stories accompanied the reason to not smoke to emphasize the point.

Then she took each person aside one at a time.  She reviewed my pre-op testing results with me.  I was told I need to take Vitamin D because I am low.  She called in a prescription for D2 to the pharmacy, I already have some D3 at home that I will take until I pick up the prescription.  D3 is better, but I guess you can only get prescriptions for D2.

And that is where I am at.  Six days to go until surgery day.

Goals

I updated my progress page, go me!

With less than 2 weeks until surgery, I have been thinking a lot about goals lately.  I don't know for sure how my body is going to do with surgery, although weight loss seems a guarantee.  We were given a chart showing the average percentage amount of excess weight lost at 1 month, 3 months, 6 months, 9 months, and a year.  The averages are based off of all the patients that had surgery with my physician over a two year period.  I could use it as a guide...

So how do I set a goal?  Do I set goals strictly as an amount to weight with no time limit?  Or do I use a deadline and say I want to weigh this by that day?

I am leaning toward setting a deadline for each weight I want to achieve.  I could base the number on the chart I was given.  But what if I don't make a deadline?  What if I am a below average patient?  Will this motivate me to exercise more, or just depress me?

And then there is the personal satisfaction of reaching a goal vs. a reward.  Should I have rewards?  What will they be?  I like rewards, who doesn't?  But honestly, the only thing I can think of as a reward is clothing.  And I would need to buy that anyways...

Oh, I know... I was planning on buying most of my down sizing clothing at a Goodwill type store, because I will be changing sizes to fast to buy all new clothes.  I have a feeling I will be wearing clothes that are baggy for the next year or so.  I can't afford a whole new wardrobe every three months.  So, maybe when I reach a goal, I can buy myself something new and not used.  This sounds like a good idea.

Maybe I won't make deadlines, just weights.  I could have exercise goals too, maybe... I keep forgetting I can't walk very well right now.

But let's stay optimistic here.  I will be able to exercise, and the less I weigh, hopefully the easier it will be.  So now I have to work on my goals.

Food in the Future

Day 5 of protein shake liquid phase and I am still going strong despite my struggles.  I am hungry and I am craving everything, but I am losing weight every day.  It is not a lot each day, but I am pleased.  I realized I had not updated my progress log in over a month now.  Tomorrow is Monday, my official weigh-in day, so I will update it, because at this point I am definitely not forgetting to weigh myself.  It is just a matter to remember to post.

I would like to say my weight will be drastically less than the 341.7 I weighed on 4/06/15... but I plateaued for quite a while due to eating of things I ought not to have eaten.  I had this mind set of "I need to eat this thing one more time."  Said things included Five Guys burger, pizza, Taco Bell, cake, McD's mocha frappe, and chocolate chip cookies.  Especially the mocha frappe and cookies... I may have had more than one "one last time" for those.  Sweets, mostly chocolate ones, have always been my downfall.

I do know I will be able to have these things in a severely limited capacity someday in the far off future.  Gosh, even 6 months seems like far off when you can't eat your favorite foods for that long.  But seriously, the odds are in favor of my having dumping syndrome, so I don't expect much in the way of eating sweets ever again.  I am hoping that what I heard was true, and that you no longer have the same tastes and desires for food.

There was a small discussion in the last support group about what your eating would look like 2-3 years on down the line.  We were told that you should be able to eat normally.  This was explained further by a 3 year post-op patient who said, when they said you would eat normal again that meant types of food not quantity.  Never again should we be able to eat more than a cup of food at a meal.  Which suits me just fine really, nobody should have to eat 4 pieces of a large pizza to be full... but I do.

So here's to the future... may it be filled with small meals of meat and vegetables.

Hunger

Today is the first day I've really felt a lot hunger rather than a mixture nausea/upset stomach/hunger.  So, I guess I am glad my stomach is adjusting to the protein shakes.  But, I am not thrilled that the hunger beast has reared it's ugly head.

If I eat all four protein shakes, with the addition of a beverage with calories (chicken broth, sugar free jell-o) or two, I am still under 1000 calories a day.  Depending on the brand and flavor I drink, I'm looking at 875-915 calories per day.

That's crazy!  How am I supposed to sustain that for two weeks?

Just in a funk

Day two closes on the liquid diet with little improvement.  Do I really have to do this for 12 more days?  Can I?  I browsed weight loss surgery websites and found many people of the opinion that they cheated on the liquid phase so probably everyone does.  One woman said her doctor outright told her that no one sticks to it and that is why he doesn't have his patients do it.  But if it makes surgery easier and the outcomes better, shouldn't I?  I re-read my binder to try and motivate me and it worked to a degree mentally, but I am still having physical problems.

I woke with a headache, and spent most of the day with a headache.  I woke with a backache, and spent the whole morning with a backache.  Pain relievers have not lived up to their name.

If pain was not enough, I was able to enjoy some diarrhea today too.  Protein shakes still nauseate me, but to a lesser extent then yesterday.  I was able to eat three of them today.  So yay me.  I would say I am getting plenty of liquids, except if I continue having diarrhea, am I?

I don't know.  I was so looking forward to getting this process started.  I even tried a wide variety of protein shakes to find ones I like.  I've been gearing up the exercise.  To the point that I injured myself on Monday.  Achilles Tendinitis... good luck getting in my walking now.  I spent Tuesday completely off my feet icing the back of my ankles.  At least that doesn't hurt as much now.  I managed a very slow, short-stepped walk to get the mail and back with minimal pain.  So all in all... I feel a little defeated.

I wasn't perfect on the pre-surgery diet.  And I admit three days ago, I had one last mocha frappe because I love those stupid things.  So am I battling sugar withdrawal?  Caffeine withdrawal?  Am I ill?  Is it the weather?  Whatever it is... it is kicking my butt.

Liquid Diet

Day one is closing on the start of my liquid diet.  I have not had a good day with this.

I am supposed to be drinking 4 protein shakes made with skim milk or water.  Additionally, I must consume 64 ounces of beverages including: water, chicken broth, sugar free jell-o, any non-carbonated and non-caffeinated zero calorie drink.

I have not gone outside of those guidelines, but I haven't been able to drink that many protein shakes either.  The day started late for me, but I began with a vanilla protein shake made with skim milk.  I felt a little nauseated after drinking, but attributed to air bubbles in the froth.

A while later, I had a glass of orange kool-aid, that liquid squirter stuff that has zero calories.  Then I felt that feeling you get when you eat too much grease... not out right nausea, but upset.  So I decided no more of that today.

When it was meal time again, I tried a chocolate shake this time.  I felt like I was going to vomit this time, and considered running to the nearest sink.  I settled for putting my head down and letting it pass.

Of course, this whole time I have been waffling back and forth between actual hunger and the incessant nudging my my brain telling me I should go get something to eat when I am not hungry.  I've also developed a headache, I am sure from not getting enough to eat today.  I haven't been able to drink another shake, in fact, the thought of it makes my stomach roll.

I've had water, chicken broth, herbal tea, jell-o, and that's it.  I am at 56 oz of non-shake liquid.  Only two protein shakes for a total of 530 calories.  I'm sure I will get another 8 ounces of water or something.  Not sure what to do about the shakes though.  Maybe I will wave the white flag for today and try to at least drink three of them tomorrow.

Pre-op testing

Today was my morning of pre-op testing.    I was up at 5:30 AM, so that I could make it to the hospital by 7:15 AM.  Nothing to drink and no medications.  That part was kind of hard, I was thirsty.  But brushing my teeth helped.  I got turned around and drove the wrong way once I reached downtown.  But I made it with about 5 minutes to spare.

A friendly woman checked me in.  She also gave me a financial estimate regarding the hospital portion of my upcoming medical bills.  I must say it was less than I expected, but I am sure it is only an estimate of the use of the OR and a one night stay I was told to plan for.  Should I need to stay longer, well, more money then.  Before I left the room, another large woman showed up with the tell-tale white binder in tow.  I continued to see her following me until I left the hospital.

I was called into the back room.  I had to give a urine specimen, followed by changing (from the waist up) into a gown.  The nurse, Michelle, was very friendly.  She then asked me all sorts of questions regarding my health and family history.  Pretty much all stuff I have already written down on multiple forms, but I guess you can never be too careful.

After that a female technician came in the room and conducted the EKG.  That was followed by a man (nurse? phlebotomist? other?) who came in to draw blood.  I must say he was very efficient.  My left arm wasn't cooperating, so rather than force it and bruise me up, he moved to my right arm.  It was easy, hardly any pain.  One tube right after another, and only a small red dot to show where he did it.

Once they were both gone, Michelle moved on to taking my vitals.  My blood pressure was high at 140/88... but considering what I was doing and I had not taken my medication since 5 PM the day before, I think not too bad.  All other vitals were good.  She took down my email address to email me an informational video on what to expect on the day of surgery.

Next up, the Nurse Practicioner came in the room.  An physical examine is required within 30 days of the surgery, so she did her little exam.  It pretty much consisted of looking at my throat, and listening to my heart and lungs.  She too asked a few medical questions and that was that.

I changed back into my street clothes, as Michelle called them, and followed Michelle across the hospital to radiology.  I had about a 5 minute wait until a woman came to show me where to change back into a gown.  Once changed, all most at once I was taken back to have a chest x-ray done, from the front and from the side.

I spent another 10 minutes in the waiting room and watched a little GMA.  It seems to be what all medical offices have on the TV at this time of day.  Then I as taken back to have an upper GI done.  The radiology technician explained what would happen and she had everything ready to go.   Google says:

1. Upper gastrointestinal tract radiography, also called an upper GI, is an x-ray examination of the esophagus, stomach and first part of the small intestine (also known as the duodenum). Images are produced using a special form of x-ray called fluoroscopy and an orally ingested contrast material such as barium.

What it doesn't say, is that first you have to thrown back as far as you can into your mouth some medical grade pop rocks followed by a small amount of water to wash them down.  They instantly start fizzing and it is difficult to swallow.  They fill your stomach with air, which helps the images.  You want to burp... don't burp.  I do anticipate having gas later, delightful!

Then you go ahead and stand in the x-ray fluoroscopy machine and drink the barium when the radiologist says go.  The barium is thick and chalky.  For an instant my stomach rebelled, but I got it all down.   The doctor watches it go down your esophagus, which I think probably is pretty cool, but I did not get to see it.  Then the back portion of the unit was tilted down to form a table.  I laid on my back for a moment, then I laid on my right side for a moment.  Then the radiologist left and had the radiology technician finish up with a standard x-ray of my stomach.  Which she had to repeat because she cut off the bottom half inch of my stomach the first time.

From there I went to the information desk and asked how to get back to the entrance I had parked at.  He told me to go outside and walk around the building.  I kid you not!  He said it in a nice manner with directions on which way to turn once I was outside.  He said it was the quickest way since it was a nice day outside.  So I did.

I had 45 minutes to get a have a snack and take my pills.  I brought a protein drink with me so I decided to drive to the next location to make sure I could find it.  I got turned around again and drove by a CVS.  So I stopped and bought a water and a bottle of Hibiclens Soap.  Michelle told me that I need to use it to shower the night before and the morning of surgery from the neck down but avoid the genital area.  It is an antimicrobial soap found in the first aid section.  She said if I couldn't find it a antibacterial soup would be okay, but to try to find it.

So I got myself re-orientated and drove back the way I came to the rehab place for my PT appointment.  I met with Todd who went over twenty different exercises I should start performing.  Some of the require a band, some a wall, and some the floor.  All exercises were doable, in fact I am already doing some of them for my back.  We discussed aerobic exercise too.  I told him I was already walking about 4 days a week, usually for a half hour.  Sometimes in the pool, sometimes not.  He said I should target getting my heart rate up to the range of 17-22 beats per 10 seconds.

And I was done.  All in all I was in appointments from 7:15-11:15ish.  19 more days until surgery.  Next Wednesday, the 13th, I start my all liquid diet to shrink my liver a bit before surgery.