Fat Man on a Diet

I had quite a good day yesterday overall. Apart from the early morning hiccough with the Optifast all went well. I managed to walk comfortable to the local town centre (some 20 mins) did a few chores and returned in good order… albeit very tired. One point of note was that I felt ’sick’ on almost every 10 20 steps forcing me to sort of ’swallow’ the discomfort. No idea what that was but it wasn’t pleasant

When I got back, I was both hungry and thisty so knocked back 200 ml of drinking yoghurt, 250 ml water and a cup of coffee… again a bit fast but there weren’t the extreme side effects I’ve *been* having.

In the evening over the space of an hour I downed around 200 ml of some ‘Dutch Curry’ soup… followed by 250 ml of water and a cup of coffee. This tells me I’m well over the worst effects of the operation and *well* on the mend. Despite the predictions earlier I might yet be going in for my first fill ‘on time’!

From tomorrow on… or maybe the weekend anyway… I’m going to be starting back on puree’d food and that’s when the real crunch time will begin. I have a couple of weeks of that before I restart real food and am a little concerned but, again, I feel so much better that there should be little to be concerned about.

I was feeling quite positive this morning. I’d drunk 250 ml of water and had no problems so decided to try a nearly ‘full strength’ Optifast mix on the basis if I don;t try I won’t know if I can. Mixed it into an extra 50 ml to thin it slightly and off I went.

What I’d not taken into account was just how thirsty and hungry I still was (am) so drank most of it far too quickly. The first 250 ml went down in 15 – 20 mins and boy do I feel like I shouldn’t have downed it so quickly!

Apart from the ‘full’ feeling and the slight urge to throw it back up, the amount of liquid stimulated that ‘twinge’ again and started off the referred pain. I’m *really* going to have to make a bigger effort to retrain and restrain myself so that I actually do ’sip and swallow’ slowly.

I still feel ok overall compared to last week but lordy this shoulder ache is an uncomfortable sort of pain!!

Back to plain water for me for another hour or two!

Decided to make up the site after all. Nowhere near ‘complete’ of course as I need to add a decent theme and a few ‘extras’ before it’s fit to be advertised but it is on its way.

Will it be used? Who knows. Sites come, sites go… few ’succeed’ overall.

I was considering setting up a forum for those of us ‘horizontally challenged’ individuals to be able to discuss our experiences. I figured on actually *calling* it ‘gastricbandits.com’ – whaddya think??

There is possibly some confusion out in the wider community about why this site is a part of the ‘Low Carb Webring’ since it would appear to be wholly dedicated to a physically moderated regime not one specifically aimed at reducing intake of particular foodstuffs. The reason is quite straightforward. Simply the two *are* intimately linked.

For people like myself who are in all honestly just unable resist eating foods highly laden with carbohydrates the Gastric Band is an avenue of last hope. I’ve no idea whether my (very real) addiction to these foods is generated by psychological or physical needs but the result is the same… morbid obesity!

Having found myself unable to resist these foods *even during the run up to the operation itself* I see no contradiction in advocating the low carb diet as the best way to control diet for those capable of following it!

And we have to remember than after my current physical issues have subsided (unusual as they are for Gastric Bandits) I will still have to maintain a healthy dietary lifestyle if I want to maintain not only the weight loss but just to maintain health!

Once I’m back eating ‘normal’ food… albeit in reduced quantity… I will have to ensure that my diet is not only balanced, but consists of good quality ingredients that provide all the nutrients my body needs to function. Foods with a high carbohydrate content simply won’t do this. We’ll no doubt discuss this more as the weeks go by and I begin to eat ‘real’ food again.

Having visited the clinic and having the initial fill more or less removed I *do* feel far better than previously and am capable of eating and drinking a little more. However, ‘more’ is still not in line with the amounts indicated by the nutrition plan! In theory my current minimum diet should consist of the following:

08:00 a.m. 250 ml water
09:00 a.m. 250 ml ‘nutrition supplement’ (i.e. Optifast etc)
10:00 a.m. 125ml fruit juice
11:00 a.m. 250 ml tea/coffee/herbal tea
12;00 noon 250 ml thinned lumpless tomato soup
01:00 p.m. 250 ml nutrition supplement
02:00 p.m. 250 ml diet cordial
03:00 p.m. 250 ml tea/coffee/herbal tea
04:00 p.m. 250 ml water
05:00 p.m. 125 ml drinking yoghurt
06:00 p.m. 250 ml nutrition supplement
07:00 p.m. water or ‘diet’ hot chocolate drink

(Adding Benefibre to as many as these as possible will help reduce constipation… !)

As you can see this is already a very restricted diet. Bearing in mind each Optifast sachet only contains 150 calories even with the addition of the ‘yoghurt’ and ‘fruit juice’ this diet provides *at most* 750 – 800 calories a day, which to my way of thinking is already far below the nutritional needs of most adult males… let alone one who is, let us say, a little ‘chunky’??

So where am I in all this? Well I’ll pass on what today’s ‘menu’ has consisted of so far.

08:30 a.m. 200 ml water
09:30 a.m. 100 ml drinking yoghurt
10:00 a.m. 250 ml coffee
11:00 a.m. 200 ml ‘double diluted’ Optifast milkshake

As you can see I’m still not quite keeping up with the schedule. I’m constantly ’sipping’ at the water and (currently) Optifast coffee milkshake, but I doubt I’ll get them emptied before the next ‘meal’ (e.g. thin soup) should be ready at mid-day. Remember that the Optifast meal replacements are being ‘double diluted’ so I’m not even getting the full 750 calories per day. Each ‘meal’ is actually no more than 75 calories so my *maximum* daily total is currently in the region of 500 – 600 calories per day and I just can’t force more in!

Part of the problem is obviously that with a stomach reduced to 20 – 25 ml in size *anything* that goes into it needs time to pass through the reduced opening into the remainder of the ‘old’ stomach for processing. I simply *can’t* swallow a sufficiently large quantity. Why not? Basically because if I *do* attempt to increase the rate at which I drink, my stomach feel ‘overloaded and bloated and reacts by producing these shooting pains into my neck!! Of course the pains don’t arrive immediately to ‘warn’ me I’m drinking too quickly, no… the body waits for two or three minutes first so I’m past the point of no return and *then* reacts with the spasms and pains (as it did again a few seconds ago)!! Simple behavioural psychology will explain what happens with stimulus/reaction… the pain makes me hesitant to try!!

Whilst I understand the purpose of being on liquids only is to try to reduce any premature ‘pressure’ on the stiches and thus hopefully reduce the chances of the band slipping, I’m still questioning if in my particular case the liquid is sufficient. Time will tell I suppose.

Because the food intake is restricted I’ve finally started supplementing my diet with ‘additives. Each day at breakfast I take 50 ml of hot water and add to it a tablespoon full of Manuka honey, the contents of 4 fish oil capsules, and one ground up Centrum multivitamin capsule. The flavour combination of fish oil and honey is quite unique but actually not as bad as you may think!

Just for the record, I was told by both the dietitian *and* the doctor to expect to regain around 4 kilos over this week and next as my body rehydrates. When they told me this I was 135.5 kilos (from the original 150.9 kilos). This morning I weighed in at 134 kilos. Is a weight loss of a kilo a week aceptable??? Can’t say I’m convinced it is, but I’m not complaining… yet!

So did the removal of the fill solve the problems?? Not exacly no. As began to type this I experienced yet *another* ‘twinge’… which is similar to an attempt to ‘burp’ I suppose which still results in nothing more than a pain shooting up my neck and further pulling of that already inflamed muscle in my shoulder.

Apart from these twinges that cause intermittant (if severe) discomfort, I still also experience a constant feeling that there is ’something’ about to explode from my stomach… a la John Hurt in alien!

Can I do anything about them? Currently I think not. On the assumption that Dr Brown took out as much fill as possibly, the only ‘cure’ would be to take the band out entirely which would not only be expensive (not to mention painful!) but would reurn me to my previous predicament of being unable to control my appetite for certain foods.

If this option is barred to me then all I can is grin and bear it. It *will* get better, of that I’m sure. Once the swelling has gone down fully and the fat layer has vanished from around my stomach everything else should simply fall into place and I can just ignore it as does everyone else I’ve spoken.

The time period is of course an issue. If I thought this was going to continue indefinitely then I might be less accepting than I am. However, for most people the first band fill is carried out around 4 weeks post surgery. After 4 weeks I think I should be in the position most were in a week or so after surgery… i.e. I’ll be following along with a lag of 2 – 4 weeks. At most I expect the situation to be fully resolved in 12 weeks so I’m content to simply ler it all ride for that period.

After all, I didn’t just have the band fitted, I also had a hernia repaired so for me, at my age, the experience is probably not as bad as it could have been. I’m still good.

Well another week has gone by and an interesting one it was!

The wife took a day off work and accompanied me to my first appointment with the dietitian. I was there along with another guy who’d recently had the operation so naturally I asked him how he was finding the after-effects. He said he hardly knew it was there and was quite seriously wondering if in fact it *had* been insterted. He was a little less hungy than before and got the occasional twinge in his neck (and of course had the scars) but otherwise… nothing.

So I started explaining to the dietition how painful my experience was and how hard I was finding it to swallow the amount of liquid indicated on the instructions… and that I was totally unable to get sufficient nutrition.

To be fair she was quite concerned and went off to make an appointment for me to see the doctor immediately after the session. Her concern was that my total weight loss (some 15 kilos) was in large part made up of water loss. She figured from her instruments I was at least 10% dehydrated, possibly more, and that I was in danger of going into acute renal failure.

After the session, which really was pretty basic and which I’ll cover in the next post, I went off to se the doctor.

This time I saw a Dr Brown, who assisted in the operation. It took me a few seconds to recognise him because I’d only seen him once before when he was dressed in his greens! We discussed the issues I’d been experiencing and his conclusions, after showing me some gory pictures on my intestines during the operation, were that I was indeed very dehydrated, and that I needed to have the ‘initial fill’ removed from the band. He explained that I’d also had a hiatus hernia repaired and that might be contributiong to the referred pain in my neck and shoulders and that emptying the band would probably relieve the worst of what I was experiencing.

It appears that when the band is clipped and stitched to the stomach wall, it is given an ‘initial fill’ of 4 ml in order to help fix it in place and facilitate the healing process. In some cases, 1 in a 100 or less, the stomach is coated in sufficient fat to make this initial fill not only superfluous but a positive problem. Anyone who knows me of old will understand that I was naturally going to be that ‘1 in a 100′ who got problems.

The solution was fairly simple. I was given a local anesthetic and the fill tube was aspirated. The procedure was almost totally painless other than the slight prick of the needle holding the local anesthetic so I’ve no concerns about subsequent fills! He said he could only remove 2.5 ml because some was sticking naturally to the sides of the tube, but I should find some relief immediately. I decided against reminding him that I’d been in severe discomfort since the operation and that the previous week the surgeon had decided *against* removing the fill… just in case he decided to replace it!

The initial relief from the aspiration was instant. The muscle was still damaged from the constant tearing, but I *did* at least feel more at ease and far less ’sick’ than I had been. Turns out this is good because I learned that *any* attempt to vomit at *any* time in the future could cause the band to slip. In fact this is such a potential issue that they advised ‘bandits’ to front up to the local clinic and tell them to open a file on them to make it faster to be treated, rather than have to try to explain when the emergency occurs that a gastric band has been fitted! Currently this is a task yet to be done… !

Why is it a potential emergency? Basically because the band slipping could well entirely block the stomach making it impossible to swallow *anything*… even saliva. Nice thought.

That was pretty much it as far as any physical intervention was concerned. He suggested that I stay on the liquid diet for a further week to not put any additional stress on the stomach walls, and informed me that unlike others who have their bands ‘filled’ soon after the installation, I might have to wait three months or more before I need to have any fill reinserted. Basically, the ‘fills’ are carried out whenever a person gets hungry between their usual mealtimes and since I’m already at a point where the band is tight enough to stop me eating already, further tightening might be pointless!

After the consultation, I went out to the waiting room and consumed a couple of small glasses of water to be sure I *could* swallow… normal procedure… and went off home.

So… did it actually ‘work’? See next post

Without putting too fine a point to it, I am simply not eating ‘real food’. Not only am I not eating ‘real food’ but what food I *am* taking in is almost totally devoid of fibre! The results are quite obvious… or not in this case. What’s worse is that the slow dehydration caused by not being able to drink sufficient quantities of water is exacerbating the problems!!

I’ve started adding a tablespoon on ‘Benefibre’ to the milk drinks to at least give me some sort of ‘bulk’ internally but this hasn’t yet had the desired effect so after a week all I seem to produce is copious volumes of gas which apart from being uncomfortable also contribute to the spasms in my stomach… and therefore to the pains in my neck!

Again I’m going to just have to live with this for a couple of weeks and see what the dietitian suggests. Maybe by the things will have settled down… but on current form I doubt it.

I knew I wasn’t going to be able to go straight back to the gym and follow some sort of strenuous exercise program, but I’d figured on being able to at least get some serious walking in during this first week – wrong! For me at least it’s just not been that easy. Even leaving aside the rain that’s dampened down my ambitions, my stomach has actually been hurting so I didn’t want to do anything that might make things worse.

What’s made it even more difficult is feeling so ‘flat’ and wondering if it’s because because I’m not eating an adequate diet? Hard to say.

For most of this week I might still forgo the walking (which is all the exercise that is advised at this stage) to make sure there are no after effects waiting to make themselves felt before I make a start. From then on, and for the next month or so, I think walking the dogs to the local park and back will be sufficient to make a start on fitness and then I’ll get advice from the surgeon when I see him.

If he gives me the go-ahead I’ll rejoin the old Focus gym and sort out some exercises that will both bring back my mobility and strengthen my core muscles to hopefully avoid and of the recurrent problems I have with my back!

First things first though… and walking will do for now.