Fat Man on a Diet

It’s been a while since I posted in the blog. Not because I’m bored… but because there’s been so little to write about.

My weight has somehow stabilised at 134.0 kilos and is in no hurry to move south! This probably because I’m now eating ‘normally’ and maintaining the wight my body thinks it wants to be… and because I’m still doing no exercise.

Still – I feel so much better having had the surgery and having lost the weight I have I’m not complaining.

More later.

Went back to the clinic today to have the initial fill returned, and boy do I think I needed it!

According to their ‘records’ I only lost 200 grams this week… however I was wearing heavier clothes and had just had soup and coffee for lunch so was actually ‘lighter’ than the scales indicated, or would have been had I not had lunch before I went.

Even so… the positive spin is that my weight has clearly ’stabilised’ and so the reduction in the capacity of the ‘pouch’ almost certainly means I’ll be *forced* to lose weight by the simple mechanical process of not being able to eat anything in quantity.

Actually for the past week life has been ‘interesting’. I’ve not been hungry, though *have* been eating more than I suppose I should have been. Once or twice I managed to eat the wrong foods… or the wrong quantity of food and ended up writhing around in pain. Once was at the bowling alley with the kids when I ate a couple of chicken nuggets without thinking. Boy that hurt!!

Basically it looks as though I need an attitude readjustment again and hopefully this ‘fill’ will help me on the way.

Having said that, when I came home I still had my ‘afternoon snack’ (an hour or so ago) which was a cup of soup… and now I feel totally bloated. I suppose I’m *still* eating too fast.

I’ve paperwork to read through which is supposed to help me along the way, but sadly right now little of it seems to apply to me specifically. Whether this is because I had my ‘initial fill’ removed I don’t know but I *do* know I’ll be cutting back this evening regardless. The kids have made fish cakes for dinner and nice as the mix was (I tried a spoonful) I think a whole one, even with salad on the side, will just be too much for the smaller puch to cope with.

We’ll see… and I’ll learn, however long it takes.

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!

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

Here we have what I consider to be a problem and where perhaps the surgeon is taking a somewhat cavalier approach to a potentially serious issue.

To begin with let me say that I *was* and still *am* morbidly obese… this is what the Gastric Band is meant to help ‘cure’. When I went to see the surgeon a little over a month ago I was weight at 150.9 kilos. This morning on my home scales I weighed 138 kilos… i.e. I’ve lost at least 12 kilos. This might not sound so bad, except for obvious reasons this first week I’ve done very little exercise so the weight loss is entirely down to fat/muscle… or water… loss. Looking at the charts from the last time I really gave weight loss a fighting chance, I dropped over 15 kilos in the first month, but then I was exercising hard *and* eating a real meal every night simply replacing two meals with Optifast or similar. Basically, there were no serious issues relating to the diet.

This time is different. To begin with, before the operation I’d already had three weeks replacing *all* meals with Optifast (and a cup or so of steamed vegetables in the evenings). I gave up tea and coffee etc and stuck to it religiously. Yes I was hungry and even cheated a little occasionally but stuck to it and felt pretty goo overall. Then I had the operation.

Since the operation I’ve effectively been almost starved. I’m unable to ingest safely even the three Optifast meals because of the problems I’ve been getting with referred pain from my stomach to my neck and have had to dilute the ‘meals’ by three times in order to get any nourishment in at all. In other words, instead of dissolving the powder in 200 ml of water… I use the 600 ml to make it thin enough to reduce the effect on what’s left of my stomach. The result is I simply haven’t been able to take the three meals and often just have the one to last me all day! When you consider that even at their best these packets are listed as containing a max of 209 calories my calorific intake is currently not even reaching the already meagre 650 calories a day indicated by the instructions handed out to me to cover my immediate nutritional needs during the first two weeks following the operation. The wife bought ‘drinking yoghurt’ and has been diluting that with milk to help fill the gap but I’m still not sure I’m getting a balanced diet!

To me this is a bit of a concern – yet the surgeon wasn’t at all concerned!

Can I do anything about it?? Well not easily. Yes I could attempt to drink more of the packets… but that would either cause more of the intense pain in my neck, or worse dislodge the band before the stomach walls have fused sufficiently to stop it moving.

Basically, despite looking dreadful (to my eyes at least) and feeling far less well than I’d expected, I’m just going to have to live with it until I see the dietitian on the 25th June and see what she can suggest. What I’m *not* considering is liquidising mars bars in ice-cream as some people have been reduced to. Well… not consdering quite yet anyway!

One other small consideration is that I’m also not able to get sufficient liquid into my system to stave of dehydration! Luckily this is winter so outside temperatures have been fairly low (relatively) recently, but had this been summer and I’d been outside I think I might have been in trouble!! Something else to discuss when the time comes.

So here we are at the end of the first week. I was originally going to write up a day by diary but figured the idea was boring me so lord knows what readers would have thought!

Still, it *has* been seven days since I ‘went under the knife’ and it’s been a bit of a mixed experience. The overall impression is that it still feels worthwhile tho there have of course been a few ‘issues’ regarding after-care, pain, nutrition and exercise that are yet to be fully resolved! Since this is an overview I’ll stick to general comments and leave discussion on individual aspects to their own posts.

In general then, it hurt a little more than I expected, so I went back to the clinic and discussed my problems with the surgeon. For the most part they were resolved. Nutrition was linked to the pain and despite occasionally getting hunger pangs as the swelling associated with the operation reduces overall I’m satisfied with what I’m taking in even tho it’s still entirely liquid!!

To date I’d say coping with this new regime is tolerable… tho sitting at a table watching the family tuck into the sort of meals I love is still a bit daunting and I’ve started to avoid drinking my ‘meal’ with them, something that will have to stop! Mealtimes are a social occasion. I’d tell myself to just sit there and bite the bullet… except of course, I’m not allowed solid food yet!!

The blog is beginning anew. Times have changed as I shall explain and I attack the problem of my weight with new determination and resolve.

It’s been a *long* time since I last wrote in the old blog and a lot has happened. For a start my weight increased above the level when I first went to see the diet specialist (Dr. Stephen Parsons) years ago. Despite several attempts to kick start my weight loss, nothing was happening. Six months ago I finally told Stephen I’d had enough and was giving up. My only option I felt then weas to go for Gastric Band surgery and told him so. Having seen all other options closed to me because I seem unable to stop myself ‘grazing’ no matter how resolved I am at the outset I figured this was the last chance. So Stephen gave me a referral and off I went.

Circle of Care:

The best of the local clinics is called “Circle of Care” and one of its practicioners is Dr. Roy Brancatisano. I made the appointment and fronted up at the clinic with the wife in tow really gung ho to get it done post haste. I was examined by a nurse prior to the appointment and she went through some of the issues surrounding the procedure/ The frightened me that much that far from going in feeling totally confident… I was all for cutting and running.

Nevertheless, I went to discuss with the doctor… agreed I’d go for blood tests etc… went home and thought about it… and decided the changes to my lifestyle would be so extreme I’d not bother thanks and cancelled the second appointment.

Time moves on:

We move on several months. Xmas has come, and gone and my weight didn’t decrease at all, in fact it rose to 155 kilos and I was feeling more and more uncomfortable. The pains in my back, my neck and hips were increasing, and I’d even been given a DIsability Pass by my doctor to make it easier for me to get parking close to shops etc. It wasn’t looking good for the future.

Nevertheless I felt positive and yet again started on the low carb weight loss regime. I *do* have faith in it because I know it works. The problems I have are stopping myself cheating and eventually I had to come to the only conclusion left to me that if I wanted to live a little longer – maybe to see my youngest kids grow to adulthood then my lifestyle simply *had* to change or it would be changed for me… adversely!!

The upshot is that just over three weeks ago I went back to the Circle of Care, saw the doctor again, went for the blood tests, had a barium swallow to check for hiatus hernias and reflux problems… and booked in for the operation.

I went in to The Hills Private Hospital on Monday morning, had the operation, came out Tuesday and am now here tapping away in what will I hope be an object lesson for anyone having similar problems to myself and finding that at the end of the road all their options are gone… bar one.

So this is a background to the current state of play. From here on in I’ll describe the procedures, the problems, the issues and… god willing… the successes!