Thursday, January 23, 2014
It has been a year now since I had the hernia diagnosed, and started paying attention to the calorie part of the nutrition tracker. In that time, I’ve started learning to cook, discovered a lot of fabulous new foods and flavours, and dropped about 80 lbs – a third of my body weight – going from “obese” to “healthy” on the BMI scale.
I saw the surgeon yesterday, and he tells me that he’s happy with where my weight is now, and feels sure that it doesn’t pose any risk of another hernia in future. THAT was my one and only “goal” when I started losing weight.
So – I’m declaring myself in “maintenance” on the nutrition side. My calorie ranges are set for maintaining (1350-1700), and I will be quite happy to stay the size that I am (size 8 jeans - down from size 16).
I still need to regain all of the lean muscle mass that I’ve lost over the past couple of years, but the doc wants me to take that really, really slowly --- starting with yoga and stretches, gradually adding body-weight circuits, and eventually getting back to the weights. I may end up doing some tweaking on the calories so that I don’t lose or gain too much while doing that, but for now I’m going to rely on the nutritional habits that I’ve built and put my focus on the fitness side.
When I told the Man last night that I was changing to “maintenance”, he asked me “What is going to change?”
Good question. The answer: “Really, ummm, nothing.”
I’ll still be tracking my food every day, and weighing and measuring everything, although I may let myself get a bit more lax on that with the low-calorie veggies.
I’ll still be making sure that I get in all of my tracked nutrients every day, and trying to avoid “portion creep”.
I’ll still be trying new recipes and new foods and having a lot of fun in the kitchen.
I’ll still be enjoying dinners at restaurants, and desserts from our favourite bakery, and doing my own baking --- all with moderation, and focusing on truly savouring the very best.
I’ll still eat when I’m hungry, stop when I’m satisfied, and not get my knickers in a twist if I’m having an occasional day when there’s not enough food on the planet (those seem to get balanced out by the occasional day when food isn’t interesting in the least).
Hmmm – apparently I’ve been “in maintenance” right from when I started on here! Now it’s time to have some fun with the next stage in the journey… hope all my Sparkpals will be having fun with me!
Thursday, December 19, 2013
One year ago yesterday, I came home from the doc with the knowledge that I was seriously deficient in vitamin D, iron and folate, and a lot lower than they liked in B12. I already knew that my body doesn't handle supplements (besides D3) well, so I would need to get these back in to line using food. I figured that my best bet would be to start tracking everything I ate, and learn which foods were highest in the nutrients I needed.
I got on line and started researching the various trackers available. I spent the day trying different ones to see which would be the easiest to use, and give me the most accurate information. The one which stood out for me was here at Spark, so one year ago today I started tracking my foods to make sure that I was getting at least the minimum on the nutrients of concern.
When I signed up, I entered my current weight according to my ancient analogue scale (which turned out to be 5lbs more "kind" than the new digital scale I got a few months later), and let the system choose a "goal" for me of losing 50lbs over the course of a year. I blithely ignored the calories of the foods I entered, since I wasn't actually concerned about my weight, and concentrated on changing the foods I ate to get those nutrients. This set me on the road of learning to cook, with the aim of making sure that my nutritious foods were delicious enough that I would continue to eat them forever because I *wanted* to, not because I *had* to.
A month later, that changed. I had been gradually getting back in to working out (trying to get some strength back after a couple of years of inactivity due to the cancer), and I managed to create a massive hernia along the incision from the 2 surgeries. I went to see my surgeon about getting it fixed, discussed the fact that mesh was not an option for me, and was quite bluntly told that the main cause of the hernia was my obesity (the abdominal fat on the inside pushing out on the incision, and the subcutaneous fat pulling outwards as well), and that he wouldn't consider doing the repair unless I got down to a healthy BMI. Fair enough - I was in absolute agreement that the risks of the surgery wouldn't be worthwhile if my body fat put me in the position of most likely having the hernia re-appear very shortly. Besides - that hernia hurt every day, and I definitely didn't want to go through the pain and risks of surgery only to get it back again! We agreed that we weren't going to put a time limit on it (I don't do well with deadlines), but that we'd meet in the autumn and see where I was at and whether a surgery could be scheduled.
So - I started paying attention to the calories on the tracker. In my mind, there was and is no option of ever gaining the weight back again, so I knew that I had to look at changes that would be permanent. This, to me, meant that the changes had to be ones that made me happy, since I'm not big on self-discipline and have no use at all for deprivation or guilt.
I never consciously made a big drop in calories consumed - just let them naturally fall as I learned more about proper portion sizes, nutrition, and how to make really, really good food. I always made room in my ranges to allow for the occasions when we wanted to go to a restaurant, or eat with friends, or have apple pie and ice cream for dinner (home-made and ohhhh so good). These are things that make me happy, and a world where I couldn't make them work is not a world that I would willingly live in, even temporarily for the sake of a "diet".
When I met with the surgeon in early autumn, he was happy enough with my loss to set a date for the surgery, with the understanding that I would be around 70 lbs down (not quite in the healthy range, but close enough that he was comfortable with it). Then, a couple of weeks before the surgery, we met again and he suggested a panniculectomy at the same time so that the weight of my left over "apron" (you can't spend the majority of your life obese without a price) wouldn't be a continued risk for a future hernia. His only stipulation was that I continue to do my part of the job, and get down to the healthy BMI range and stay there.
The surgery was a few weeks ago. I went in to it at 73 lbs down, but "gained" 10 that day from the swelling. I no longer have a time-line, and need some extra protein for healing, so I set my ranges for what would be maintenance at 150 lbs. That's what I'm seeing as my "goal" for now, and am finding it easy and comfortable to stay in the range that I'll have to be in for life. The swelling has been gradually going down (will take 2 to 6 months for it all to go away), and I hit a pound below surgery weight this morning. I'm figuring that I should end up hitting "goal" some time in the next year or so - without ever feeling deprived, or disciplined, or like I've been "on a diet".
The Man was and is totally on board with everything (even though it makes it a bit hard for him to not accidentally lose weight that he shouldn't), and has made it a lot of fun by challenging me with new foods to try, new cooking methods, and new ways of spicing things. We both automatically weigh everything as we are preparing it, and weigh my portions as we're serving them. He's better than I am about eye-balling a portion (I've got lousy vision), but this is such a habit by now that we don't even think about it.
We've spent the year joking about my "dieting" and how "deprived" we are (usually as we're noshing on something particularly yummy). The best example was a couple of days ago as we were at the hospital to get my staples removed. As we left the elevator from the parkade, we walked by a sale-table set up by our favourite German bakery (one which we either drive 2 hours to visit, or hit their stall in a busy local farmer's market). After we were done with the doc, the Man suggested that we take a different set of elevators to the parkade so that I wouldn't have to "suffer from temptation"...
When we were done laughing, we stopped at that table, picked up their plum cake and apple strudel, and proceeded home to have plum cake and whipping cream for brunch (we had the strudel for dessert that evening) --- which fit nicely in my ranges, left enough room for me to eat the nutritious foods that I need, and made us both very happy. THIS --- THIS is a way that I can easily live forever.
Over this past year I have lost just under 74 lbs, "met" some incredible people, learned a ton about nutrition, learned a ton about myself (my likes and dislikes, what satiates me, and what doesn't), and have had a lot of fun in the process. I've got another 16 lbs or so to go, but am perfectly content for that to take however long it takes.
I *LIKE* how I'm living, what I'm eating, and how I'm feeling now that I no longer have any nutritional deficiencies. Every change has been one that has *added* to my happiness, which has made this a ridiculously easy journey for me. I know that I'm totally un-trustworthy when it comes to eye-balling portion sizes, remembering what I've eaten, and keeping on top of nutrient values, so I'll be on here for a good, long time --- weighing and tracking every single bite. It may seem like a lot of work to some, but for me it is a pretty small price to pay in order to get rid of the hernia pain, and feel better every day.
My deep thanks to all of my Spark Friends for your knowledge and support, and most especially for sharing from your hearts --- you have been a huge part of the joy for me. I wish you all the very best of the season, with hopes that you find the same fun and happiness in your journeys that I have found in mine.
Thanks, all, and strong thoughts that 2014 brings you all of the love, laughter, and happiness that you deserve!
Wednesday, December 04, 2013
The hernia is fixed!!!
I was really worried about how bad this surgery was going to be, which turned out to be a waste of my time: it was by far the easiest of the abdominal surgeries so far. I think I hit the right combination of having a great surgeon, going in to the surgery in relatively good shape, and knowing my body and how it reacts to anaesthesia and painkillers.
The surgery started at 7:30, and I was in the recovery room by 11:00, and in to the ward around noon. I did my first few laps of the ward before 1:00 --- really slowly, but at least I was moving. They put in a local across my whole abdomen that lasted for about 6 hours, and had me on a morphine pump that I could use for 1 mg of morphine every 6 minutes as required --- I only used 12 shots of that total, with the last being around 3 in the morning. Other than that, the only painkillers I have needed are extra-strength Tylenol and ibuprofen, spaced every 6 hours.
There definitely was a fair amount of nausea to deal with, but eating small amounts every couple of hours and taking Gravol made that totally tolerable.
The docs made sure that I had stronger pain relief available if I needed it (there were orders written up for morphine, percocets, and oxycontin), but I know that those cause me major constipation, which is just NOT a thing I was willing to risk after this surgery! Same situation with the anti-nausea drugs: they had stematil and Ondansetron both on order if I wanted them, but I stuck with plain old Gravol since it doesn’t bung me up. I much prefer dealing with a low level of pain and nausea to having to deal with all of the additional pain and nausea caused by constipation (not to mention the risk to the incision if I were to be so foolish as to strain trying to empty).
The incision for the hernia repair is vertical, from pubis to the base of the sternum, while the panniculectomy incision is horizontal from hip to hip. I’ve got 99 staples in there that I know of (although there may be another one or two tucked in to the belly-button that I can’t see yet). There is some bruising, but not too bad. The worst looking spots are where the 3 drains came out of the belly – they were pulled out after a week, and are going to heal a bit more slowly since I was back on the blood-thinners by then.
I will be wearing an abdominal binder for support for at least a month, will be attempting to sleep on my back for about the same amount of time, have lifting restrictions (10lbs) for at least 8 weeks, and was strongly encouraged to walk as much as I can (but to listen to my body when it wants me to stop). I wasn’t able to sit properly when I had the drains in (it hurt too much when they kinked as I bent), but can move pretty freely now that they’re out.
One of my nurses had worked for a plastic surgeon who specialized in bariatric surgery and reconstruction, and was really shocked that I had chosen my colo-rectal surgeon to do this for me. She happened to be on duty when he came in to rip off the dressings for the first time, and had a look of total shock on her face when she first saw the incisions --- she came back after the surgeon had left to rave about how good it looked: the plastic surgeon she worked for apparently always had some skin puckering at the ends of the incisions and at the navel, and I have none of that.
Even with the drains, there is a massive amount of fluid and swelling that will be around for a while. I literally put on 10lbs from the morning of the surgery to the morning of the day after. I still have 5lbs of that on, and it’ll be anywhere from 2 to 6 months before the swelling goes away entirely. It’s also kind of funny to have areas where all feeling is gone --- I can see it being touched and not feel a thing. The nerves get cut during the surgery, and may or may not grow back over the course of a few years. Pretty small price to pay to get back my ability to move without fear of the hernia, in my opinion…
The Man and I both have had to laugh at ourselves, and how much our lifestyle really has changed over this year. He was trying to deal with fast food and cafeteria food while I was in the hospital, while I was doing my best with the hospital food, and both of us just could not wait to get me home so that we could eat REAL food again! We both headed straight for the veggies when I got home, and, even though I had declared it a non-tracking week, he automatically weighed and measured out all of my portions (yup – he’s a keeper – he took over the cooking and serving for the first few days). Who knew that asparagus and brussels sprouts could be “comfort foods”?!?
We’re settled back down in to our routine, I’m back to tracking (although staying in maintenance ranges and not looking at losing for a while), and the staples should start coming out next week. There is still a fair bit of pain, but not too much worse than I had from the hernia itself, and that’s fading day by day. All told, I’m thrilled to be at this point, and am looking forward to getting the all-clear to start working out again.
Thank you so much to my Spark buddies who sent me so many strong thoughts and support – you brought me many, many smiles. I hope that none of you ever have to go through this, but if you do, please remember that it really is not too bad at all!
Hope you all have a great week!
Thursday, November 14, 2013
Well, I do have some things to update from my long whine of a while ago…
The eyeball thing is still up in the air. The “top of the line” retinal surgeon I was referred to turned out to be one of those “I am a surgeon-god --- don’t ask me questions” types, who wasted a ridiculous amount of my time either not telling me anything or lying to me. He did, apparently, refer me to an ocular oncologist to get the thing checked out, but left with a “don’t you worry about it – leave the worrying to us – enjoy your Christmas”… and a follow-up appointment in January. The Man was with me, and neither of us have a clue what that appointment is for --- it could be for a biopsy, it could be for surgery, or it could be so that the twit could just waste more of my time. This dude may be awesome dealing with unconscious patients on the operating table, but he is obviously incapable of communicating with someone conscious.
Ummm. No. That’s not how things work in my world. In my world, I get copies of test reports, discuss them with the doctor, and make the decisions about my own care.
So – I am in the process of going around him, and have my oncologist from the colon cancer arranging to get me in to his preferred ocular oncologist. It will likely be a few weeks before I can get in, which will work out well with my schedule.
The other update is that my hernia repair surgery is confirmed for November 25. I had my final pre-surgery meeting with the surgeon on Tuesday, and the surgery itself has now changed: instead of a simple hernia repair, it is now a complete abdominal reconstruction combined with a panniculectomy (removal of the pannus, or “apron” of skin and fat below the navel).
Both my surgeon and I are dedicated to doing whatever we can to make this a permanent fix, with the lowest chances of complications and of future re-herniation. This was the reason behind me losing weight, and he was thrilled that I had done so well.
I am extremely grateful for some folks who have blogged here about their thoughts and discussions with their surgeons about hernia repairs combined with either panniculectomy or abdominoplasty. Those blogs spurred me in to doing the research, so that I was prepared when my surgeon wanted to discuss the same thing. The studies that I found showed that there were fewer complications with repairing a hernia by stitching the muscle together instead of using mesh. I also found studies showing that there were less complications and less chance of a new hernia if a panniculectomy were done at the same time.
Since I am so obviously dedicated to doing whatever I can to make this work, my surgeon wants to do the same. If I hadn’t done what I had, then the repair would not have happened. Due to allergies, I can’t have the “standard” “stitch in some mesh and hope that it holds”. Instead, it will be a much longer surgery, with the skin and fat separated from the muscle, the muscle pulled together and stitched, and the excess skin and fat removed. There will be a full horizontal incision from hip to hip, and a full vertical one from pubis to sternum.
He’s not a plastic surgeon, but I have incredible trust in him (since he did a great job with me on the original cancer surgery), so the new incisions will be stapled shut and I’ll have some new “railroad tracks” to go with my old ones. We’re definitely not talking about “bikini ready” here!
What I’ve found really interesting about this is that I have discovered that I apparently have a lot more vanity than I had realized. I’ve always been comfortable with myself nude (even at 290ish pounds), am quite fond of my current sets of railroad tracks, and even have a somewhat bittersweet fondness for the “flap of flab” that I had thought would be my permanent reminder of what size I used to be.
Yet still, when I found out that there were definite health benefits to the removal of that “flap”, I discovered that I was quite happy about losing it. I went searching on Dr. Google for pics of similar surgeries, and discovered that I am actually quite adamant that the results turn out to look at least remotely human, and not like the end of a 3-year-old’s day playing Dr. Frankenstein with the office supplies on their teddy bear. I’m quite fine with scars, but had my surgeon laughing when I firmly reminded him that straight lines and even curves are wonderful things, and that I would be more than happy to supply a straight-edge and a compass if they were required…
He, in turn, reminded me that I’m not allowed to start back with even the simplest strength training until he tells me it’s ok (he figures at least 3 months with the extent of this surgery), so I guess I’ll focus on being a bit excited to see what my “new” body will look like for a while, before I’m allowed to focus on what it can do! I’ve had the Man shaking his head and laughing at (with) me as I pose in front of the mirror and try to push/pull the old belly in to what I think it might end up like…(ok – I’m a goof – I’m good with that!). I have absolutely no mental image for myself post-surgery, so I’m hoping for a pleasant surprise!
Many, many thanks to those of you reading this, and to my Spark-buddies for their amazing support. I’ve had a few bumps in the road lately, and you all have done so much to keep me focused on finding the good stuff in each and every day.
Now, the question is: do I record the weight of the removed pannus as weight “lost” on my ticker?!? Or is that cheating?!?
Saturday, October 26, 2013
Best grab a fresh cup of coffee first if you choose to read on...
This is for me --- to get my thoughts out of the swirl in my head and clearly in front of me. They can get too big to deal with when they’re building up in there, so need to be cut down to facts…
So – I’ve never been totally what you could call “healthy”. I’ve dealt with an auto-immune disorder and IBS for my entire life. Those gave me some limits, but I learned to work around them and enjoy life.
I spent most of my life obese, but fit and active. I loved heavy lifting, and used my strength daily at work.
A few years ago, when my Dad was dying, I had an extreme sciatica attack (due to degenerative disc disease) that necessitated basically re-learning how to walk (I was a shoe-in as the winner of the Ministry of Silly Walks), quit lifting and working out (since activity just made everything worse), but still enjoyed life. The Man and I just made some adaptations to our activities, and it was ok.
Then, I got sick. I was increasingly dizzy, and disoriented, and confused. I was always nauseated, had extreme pain at the base of my sternum, and couldn’t follow a simple “how was your day” conversation. I was unable to work – heck, I was unable to sit upright without being supported by the arm of the couch and some cushions. Multiple scans didn’t show anything, but some great docs stayed with it and found that I had colon cancer. I had surgery to remove half my colon, and then 8 months of chemo.
During the chemo, I ended up with a pulmonary embolism. I was put on injections of blood-thinners, but still ended up with two more as chemo went on. The final post-chemo scan showed some trouble spots in my lungs and the PET scan to see if they were dangerous or scarring showed up some scary activity around my uterus and ovaries. So, I had a full hysterectomy.
I seemed to be recovering, but 3 weeks after the second surgery, I started to randomly faint. It started as once every few days, and progressed over the months until I was dropping 3 to 5 times per day, every day. We still managed to enjoy life, just made some more adaptations to accommodate my “strategic naps”.
I started the rounds of every medical specialty to try to figure out what was going on. I started tracking every bite in case it was caused by nutritional deficiencies. We got a treadmill so that I could safely start to get my strength back, and I hesitantly started working out again. Yay for me – this caused a massive hernia on my incisions. The doc informed me that my excess weight was one of the major causes of the hernia, and that he couldn’t attempt a fix unless I was almost at “normal” weight, and that he couldn’t see it being a permanent fix unless I maintained “normal” for the rest of my life.
Fine. So – I started restricting my calories while still maintaining the nutrition. I started learning to cook, so that there would still be as much pleasure as possible in eating. We made still more adaptations so that we could still have fun.
It actually was a relief to me that there was something that I could control that would have a positive impact. I kept seeing docs and trying meds to get the fainting under control (it’s improved, but not gone), but could at least work with the surgeon about getting the hernia fixed. A date for surgery was set, I’m almost where the doc wants me weight-wise, we really enjoy how we eat now, and – even with all of the adaptations – life was good.
Two weeks ago was the first time in a couple of years that I felt safe and comfortable enough with my level of health that I said to the Man that I actually believed that it was possible that he might have to put up with more for a few more years.
Then I had this bright idea that it was time to get some new glasses and contacts. My vision seemed to have settled down after being all over the place during chemo, so it was time for a new prescription. Saw the eye doc, and got a “hmmmm – I’m sending you to a specialist”.
There is a spot on the back of my right eye that has been there for years – according to the last specialists it is simply that the opening in the back of my cornea where the blood vessels come through is slightly smaller on that side, making the vessels squeeze together and look like a lump. Nothing to worry about, but this time the eye doc said that it looked more “raised” and wasn’t happy about it.
Off to the retinal surgeon, who was quite inordinately happy while shining bright lights in to my dilated pupil: “Oh – this is cool. You are an interesting patient.”
Damn – I HATE being interesting!
Apparently, there’s something there besides the clumped-together blood vessels. It could be a cyst, it could be scarring from a bleed (I’ve been on blood thinners for a long time), it could be a benign granuloma from my auto-immune disease, or it could be a metastasis from the colon cancer.
My brain hates me, and has been focusing on that last one. I’m not having an easy time keeping myself from spiralling down in to fear. Logic tells me that the odds of it being cancer are miniscule, but it comes down to this:
REALLY?!? FREAKIN’ REALLY?!? AFTER EVERYTHING ELSE, I CAN’T EVEN GET FREAKIN’ GLASSES WITHOUT THERE BEING SOMETHING TERRIFYING?!?
So, right now I’m scared. And whiny. Really, really whiny. And starting to get more than a bit PO’d.
The Man is working crazy OT right now, so he’s not around to logic and laugh me out of it, so I need to do that myself…
So – here I am. Writing this all out, so that I can SEE that it’s not as big and scary and threatening as it seems when it’s swirling around in the dark recesses of my mind. And really, it ISN’T so bad…
Week after next, I will have a quick hospital visit for them to scan the cornea and retina, and I’ll KNOW what I have to deal with. Knowledge is power – the power to deal with whatever it is. There’s nothing I can do about it until then, and, regardless of what it is – LIFE IS GOOD.
The Man and I will make more adaptations if we have to, but we’ll find a way to keep having fun. We always have, and we always will.
The hernia will get fixed. Hopefully, we’ll get the fainting fixed, but we’ll be fine even if it stays how it is now (we’re awfully good at dealing with it, and it’s a great source of dark comedy when we’re out), and the eyeball will … well, it will be whatever. None of that is ultimately important. What IS important is that we’ll deal with it, and have a lot of love and laughter along the way…
Hmmmm – there might be something to this writing thing. There definitely is power in the “spin”…
So, those who were silly enough to read this --- thank you for your time, thank you for being here, and please: take a few minutes to clarify what is important in your life, and “spin” your perspective to focus on that…
Right here, right now, life is good.
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