Back to PLANET FITNESS!!!

I finally dragged my butt back to the gym.  I did my same circuit that a good fitness friend set up for me last year.    I had to modify the lower body weights because my left knee is still a little tender.  Lower weight and more reps are better for the circulation.  But it felt good to be doing this again.  I plan to go three times per week.  My workout takes about 20-30 minutes.  On the days I don't go to the gym I'll do my walking. 

I'm still having trouble with my pills.  The NP at Dr. Choi's office told me not to take any of the big pills for now.  Fine by me.  I had about 3 hours of vomiting today but I was able to clear the problem without a trip to the ER!! YAY!!! 
Best wishes,
Marlena of Mohegan

There seems to be a pattern here.

Last Monday I was in the ER.  I did ok for the next three days and then on Friday I was at the ER again.  The weekend and yesterday were fine.  Today I was in a hurry to get out of the house and rushed my pills.  I threw up all day and finally drove myself to the ER and got another IV.  I did not, however, get another CT scan.  Two in a weeks time was enough. 

Eventually I felt better, after some Reglan in my IV, and I went home.  Tomorrow though, I will be making an appointment for an upper endoscopy to see if there is something amiss down there that doesn't show up on CT.  I definitely had some pill fragments today.  I think I will be crushing all my pills from now on.  I plan to soak them a little before I take them.  Maybe a little milk or applesauce will soften them up if I let it sit for a while.  Its hard enough to get all my protein and fluids ingested without these setbacks. 

 My left knee has been a little sore so I saw my orthopedist today and got an injection of Supartz (synthetic joint fluid).  I've used similar products before with great success.  I get a second injection in a week and another the week after that.  Usually the knee feels great for six months to a year afterward.  I know my increased walking aggravated the knee but I want to keep up with my exercise. 

I plan to go to the gym tomorrow.  Dr. Choi said I could do weight training after four weeks.  In spite of the setbacks with the vomiting and the knee I still feel pretty good.  I am trying to be proactive with any problems that arise rather than let myself get debilitated.  I'm still happy I had the surgery and grateful for all the encouragement I've gotten from my doctors, family and friends. 

Best wishes,
Marlena of Mohegan

Back to the ER

Well, I ended up back in the ER last night.  I couldn't keep anything down.  When they gave me the oral contrast this time I couldn't keep that down either.  I kept vomiting over the next hour or so.  I even had to throw up while I was in the scanner and they had to get me out quick.   Finally after the episode in CT I felt better.  I had a negative result of the scan so I was given some juice to drink and it stayed down.  I don't know what keeps going wrong.  Today I'm taking everything in slowly and hopefully I'll get to keep it.

Best wishes,
Marlena of Mohegan

Who'd thunk?

Never in my wildest dreams would I have thought I'd have trouble eating enough.  I'm still having some difficult episodes.  I've been trying really hard to keep hydrated but I still have difficulty tolerating both food and drink sometimes. 

I used to eat pretty fast.  I could eat something so quickly that I forgot I'd eaten it.  That's right.  I'd bring some cookies over to the computer and ate so absent-mindedly that I'd go looking for them and be surprised that there were no more left.  Not anymore. 

Now I have a spoonful of something and have to wait a few minutes to make sure it stays down.  Sometimes I feel some gurgling and belch a few times after a tiny bit of food.  Some days I have had trouble getting in all my protein and all my fluid. 

Today I crushed my big pills and mixed them with some pudding.  An hour later I drank some Crystal Lite and it didn't stay down.  A little later the same thing happened with water.  Now I'm struggling with applesauce.  I really don't want another trip to the ER.

Best wishes,
Marlena of Mohegan. 

Up, down and all around

The past few days have been rather interesting.  I'll start with Sunday.

I attended a friend's barbecue, my first since the surgery.  I brought a couple of bottles of Glucerna shakes and a bottle of water.  My hostess had thoughtfully bought some sugar free Jell-O cups for me.  I felt like I could handle anything.  There was a lot of food and it all looked wonderful.  I had my Jell-O as I chatted with old friends and made new friends.  I did get a cup of ice from the sno-cone machine (no flavoring).  I found that I really enjoyed the company and could be satisfied with what I had and did not feel like I was missing out on anything.  I had a wonderful time.

And then there was Monday.  In the morning, I had another episode of the pill getting stuck.  I had used my pill splitter to make smaller pieces but it didn't work for me.  After a couple of bouts with chuck, (you know, UP-chuck)  I tried laying down as I had done on Saturday.   When I got up a couple of hours later I took one sip of V8 juice and knew I was in trouble.  I had pain in my stomach and that one sip did not go anywhere.  A few more rounds with chuck and I did not feel any better.  I called Dr. Choi and she told me to go to the ER.

I managed to get to the ER without any episodes of you-know-what in the car.  I felt a little better when I got there but still had some pain.  Well, the ER, the one I work at, was really hopping.  Just before we arrived there was a Trauma Alert.  There were two head-on crashes with a total of seven victims.  To the untrained eye it probably appeared out of control.  To me, it looked like a typical, crazy summer evening.

Anyway, I ended up with an IV, blood tests and a CT scan.  I was given some medication for the vomiting.  When you get a CT scan of the abdomen oral contrast is given and then there is a wait time for the fluid to percolate through your body.  It was near midnight when I had my scan.  On my way back to my curtained cubicle I heard some yelling about a bat.  Sure enough, a poor misguided bat was circling around the nurses station.  Naturally this did not add any serenity to the already chaotic atmosphere.  Somehow the bat was herded away while I waited for my results.  As it turned out my scan was fine, I felt better and went home.  I'd had a liter of fluid in the IV.  I had been feeling pretty dry.  My friends at the ER took good care of me and it was good to see everyone.

Tuesday was the day of my long-anticipated follow-up visit with Dr. Choi and consult with the dietitian.  I was weighed and found to have lost a total of 29 pounds.  (the scale in the ER had a better reading.  According to that one I've lost 34 pounds but Dr. Choi says that only her scale counts, darn)  Anyway, she told me that the problem with the pills was not because of their size or jagged edges but dehydration.  It has been very hot here and she says if you are not getting enough fluid your esophagus becomes less flexible.   So I have to be a good girl and drink, drink, drink.  She says I'm doing fine otherwise.  I can start going to the gym in another week. 

She also told me that when I felt so bloated after the surgery I was experiencing a normal condition called third-spacing.   The fluid I was given in my IV was not going  in one end and out the other as usual but was soaked up by my tissues thus making me look and feel like the Michelin Man.  After doing a gazillion of these surgeries she has seen this effect over and over. 

After Dr. Choi, I met with the dietitian.  This was exciting because I get to have pureed food now!  I'm so excited.  Tonight I had some garlic hummus!  Later I had some low-fat cheese and some sugar free pudding.  I'm in heaven.

I'm also starting a medication which will, hopefully, prevent me from getting gallstones during the next few months.  (Rapid weight loss causes a greater risk for gall-bladder problems).  The medication comes in a big, huge horse pill.  I know Dr. Choi told me I shouldn't worry about pills getting stuck if I keep hydrated but just in case I bought a pill CRUSHER!  Its merely a little insurance.

Love to all my friends,

Marlena of Mohegan

The first one was TOO big........

This morning I had a little trouble with my pills. You may remember that I am not supposed to swallow anything larger than an M&M candy.  One of my medications, Diovan, is an ovoid shape that is slightly bigger than what I should be swallowing.  Since my discharge from the hospital I have been breaking it in half (rather unevenly I'm afraid) and it has been going down OK.  Some tablets are nicely scored in the center and break in half easily.  Not this one.  One day last week I felt like something got kind of stuck but I could still swallow liquids and I felt better after a while.

Today after I swallowed the big half of the pill I immediately felt discomfort in my stomach.  It was fairly sharp.  I drank some more fluid and waited.  It didn't feel any better after the fluid.  This potentially was a serious problem.  If I could not get the pill to move I would have to go to the hospital and have it removed with endoscopy.  Ultimately it came back up along with everything I'd had to drink.  I still felt discomfort all day and finally took some Mylanta liquid which helped.

Now I have a pill splitter and I plan on making smaller pieces from now on.  I don't want to do that again.

On a good note, yesterday I went to the town track for my walking.  I wanted to know the actual distance I could do.  I went twice around the track for a total of half a mile.  When I first got home from the hospital I could barely walk half a block without becoming exhausted.  I try to do my walking in the evening when it is a little cooler.  Sometimes I have to stop and rest halfway through my walk but I feel a lot better than I did three weeks ago.

Best wishes,
Marlena of Mohegan

Check up

I saw Dr. Landman, my endocrinologist today.  I am still not using any insulin at all.  YAY!  She is very happy with me.  I have lost 26 lbs so far.  Not bad for 18 days.  It feels good. 

I found Glucerna shakes in butter pecan flavor.  YUM! 

Another heat wave is headed our way so I have to keep up with my fluids.  I feel like crap if I don't. 

Best wishes,
Marlena of Mohegan. 

FOOD IS FUEL.....my new mantra

The family was sitting round the TV last night enjoying some chips and other non-nutritive food.  I was a little jealous.  Even my new protein supplements, which aren't too bad (more about them later), are not FUN to eat.  How sad is that?  Food as entertainment.

As human beings we do not only eat with our mouths.  We eat with our eyes, nose and ears.  Japanese cuisine is usually presented artistically to stimulate the eyes as well as the palate.  Indeed, the sound and smell of popping corn,  the homey tableau of the Thanksgiving table and even the snap, crackle and pop of a certain breakfast cereal are essential parts of enjoying the experience of eating.

During this period of liquids only I have had to forgo the sensory pleasures of eating.  I have only hot or cold, salty or artificially sweetened liquids.  Some have been frozen or jelled.  That's it.  If I swallow too much at a time there is some pressure in my stomach.  If I get behind on my volume of fluids, I feel a little woozy.  I try to keep on a simple schedule and write down what I eat each day.  I keep track of carbs, ounces of liquid, protein grams and calories.  I eat from 60-80 grams of protein per day and roughly 500 calories.  I drink 64 ounces per day and more when the temperature is very hot.  If I keep up everything then I have energy for walking.  If I get behind then I don't feel up to it.    

I discovered on line Mybariatricpantry.com.  I ordered sample packs of several different protein supplements.  The milky bottled ,drinks called OH YEAH came in five flavors, one of which is banana cream.  Usually supplements are only  chocolate, vanilla or strawberry.  The banana wasn't bad and I appreciated the change.  I also got three different flavors of Isopure, a juicy supplement which does not have any carbs at all.  So far I have tasted two of them.  They need a little more sweetness, in my opinion, so I added Splenda to mine.  The third kind, called Nectar, comes in packets of powder.  I haven't tasted all the flavors yet.  Like the Isopure, it needs more sweetness.  They work best if you have a shaker.  The package says it mixes with a spoon but I had a few lumps. All the products I tried had way more protein than other supplements I have tried.  I appreciate being able to purchase sample packs to try things without having to order a whole case.                                                                                                                                                                          

So it is my task to keep the idea in my head not to be entertained or comforted by food but to remember that the engine of my body needs fuel.  Also I must learn to replace the emotional cues from tasty but unhealthy foods with other pleasures.  I learned this concept many years ago at Weight Watchers.  I just haven't been able to put it into practice yet.   If anyone has ideas I'd be glad to hear them. 

Best wishes,
Marlena of Mohegan. 

and so it goes...

Here I am 10 days after surgery and 16 pounds lighter.  Not bad.  It has been extremely warm for the past few days 100+.  We have no AC so the temperature inside the house was not too great either.  I've been drinking lots of extra water.  My blood glucose has been steady.  127 yesterday, 132 today.  Still no insulin.  Dr. Landman does not want to give me any insulin because if the glucose level bottoms out then bringing it back up will be difficult since I'm not able to take in any sugar.

My family has been great.  My daughter has been doing the cooking for the family which has been a big help.  They all feel a bit guilty when they eat and I don't but I think guilt is a good thing once in a while don't you?

I have a couple of questions.

1.  Why do all the TV ads with food look extremely delicious?  Is there a plot?
2.  Will the staples in my stomach set off airport scanners?
3.  Why doesn't the abandoned part of my stomach growl? 

Good news, UPS just delivered my package of protein supplements I ordered.  The drinks I have been buying are getting boring.  Thank heavens I can have V8 juice because that's the only thing I've been getting that has actual flavor.  I'll let you know how the new stuff is. 

Best wishes,
Marlena of Mohegan

Happy Birthday Baby

When I told my husband the date of my surgery he asked me why I didn't wait till after my birthday so I could still celebrate.  Well the reason I wanted to go before July 1st is because, as any nurse who's worked in a teaching hospital knows, July 1 is when all the new interns show up.

While they are supervised, they do have a lot of opportunities to impact patient care, not always positively.  As it turned out, the house staff arrived early this year and two very nice first year residents (that's what they call interns now) were writing all my orders.  My discharge instructions included returning to the same insulin regimen as before the surgery.  There was no way that was going to work.  I'd be in insulin shock before it got dark my first night home. 

When I got home I checked my blood sugar which was 144 and called my endocrinologist.  She advised me not to take any insulin at all and call her in the morning with my fasting blood sugar.  In the morning my glucose level was 140.  So I am continuing not to take any insulin at all with instructions to call the doctor if my glucose goes up to 200.  So far, so good.  The glucose level has been steady every day.

The orders also instructed me to resume all my pre-op oral medications which included metformin, for the diabetes.  Since I knew I was not to swallow any pills larger than an M & M, I knew that this inch-long football-shaped tablet would be a problem.  My endocrinologist agreed that I should not take that either.


Heaven help the non-medical people who do not know when orders are wrong and should be questioned!

Anyway, back to my birthday.  True, I did not have a birthday cake (and I love cake with LOTS of butter-cream frosting) I did inform my family that they did still have to sing "Happy Birthday" and I would blow out a candle.  I still wanted my wish!  They were fine with that. 

I refuse to feel deprived.  Instead I feel like I have given myself an amazing present.  Rev up the DeLorean because I'm going back in time!  I am going back to the time when I could wear jeans comfortably (I'll tell you right now Mom Jeans are fine with me).  I am going back to the time when I could sit in an airline seat with the tray properly down.  I will be back to having seatbelts fit without an extender.  I will be able to "walk and not be weary or run and not faint"  Time travel is an amazing gift and I am not at all worried about messing up the "space-time continuum"!

Love,
Marlena of Mohegan

Disclaimer: This is not a subject for polite company. You have been warned.

Gas is not my friend.  As I mentioned in my previous blog the surgeon inflates the abdomen with air in order to have room to work.  I've been working on getting rid of this air for the last five days.  It has not been pretty. 

I felt so huge after the surgery.  On Wednesday evening after I had been home a while I went to sit in my car to check out the fantastic detailing job my kids arranged while I was in the hospital.  I could not fit behind the wheel of the car.  Now this was two days after surgery and I had been struggling to expel the excess. 

My family has been impressed with the deep sonorous sounds of my flatulence.  Imagine the trumpeting of a mastodon looking for a mate.  You get the idea. 

The belching has not been nearly so entertaining.  That has been rather more uncomfortable.  I seem to be able to get rid of it better when I go for a walk.  I have been taking Gas-X which gives some relief. 

Today I feel a lot better.  I'm about to go for a walk and I think I'll check to see if I can fit into my car yet. 

Best wishes,
Marlena of Mohegan