18 Month Check Up

I recently went for my 18th month check up. Here's a rather long recap.

Preparation

One way to help you get the most out of your follow up appointments is to prepare. This time around I only met with the doctor and the exercise expert (last time I met with the dietitian and the behaviorist too). In preparation for this visit I had a gazillion vials of blood drawn. It sure seemed like a gazillion! It was really twelve. I also wrote down my current exercise activities and any fitness/activity goals I would like to shoot for and any questions I wanted to ask. These "mile marker" appointments are a great time for me to review my goals -- to see how I'm progressing and if I'm still doing what I purposed to do when I set the goal. To ask my self if I need to tweak things or make a radical change.

The Office

Every time I go to my surgeon's office, I am absolutely impressed with how well run it is. They have enough staffing for the patient load, and the entire staff is very well trained. I've been in there close to 2 dozen times and everyone appears to be doing what they are supposed to be doing -- everything and everyone involved with my appointment is in order and there are no long wait times. I also like the fact that my surgeon is huge about follow up and support groups -- the extra support and accountability really does make a difference.

The Medical Evaluation

First I met with the nurse. She weighed me, took my vitals and did a body composition scan. Then the doctor came in to examine me and ask a million questions. I am a participant in 2 medical studies so I answered a laundry list of questions about how my health and life is going since surgery. One of the potential side effects/complications of gastric banding in general (and having your band adjusted too tight) is acid reflux so he asked me several times in several different ways if I'm having any problems with acid reflux, which made me a little nervous. Is he expecting I will have a problem? But over all, I'm glad he was so thorough.

My doctor said I'm doing very well and he is pleased with my progress. I've lost 14lbs since my 1 year check up and gained more muscle mass, which means the weight I am losing is fat -- not muscle. That's a very good thing. If you don't ingest enough protein and take efforts to build your muscle mass, you stand to loose it and that's not what we hope to achieve with weight loss surgery.

The Exercise Visit

We started off great; I always like meeting with Andy. He is so very helpful and inspiring! At 18 months out, a visit to Andy to discuss fitness is optional and you have to pay out of pocket (previously the cost for this visit was in the program fee). I think he was delighted that I found fitness important enough to continue to include visits with him in my follow up care.

Just hopping onto my soapbox here.... Exercise and physical fitness are vital to long term success with any weight loss surgery and feeling good. At my one year check up and at this one, I heard from every professional I met with that many patients start experiencing struggles with weight regain at the 1 year mark. Exercise goes a long way towards helping reduce the chances of regain and can help with continued weight loss. Knowing this, why would we purposely exclude one of the "success keys" to our weight loss journey?

Review of Fitness Goals

Andy and I went over my fitness goals that I shared with him at my 1 year check up. (here they are reprinted for you)

8-3-10 Fitness Goals: I would like to be able to weed whack for 1.5 hours without needing to rest. (We have a nearly 2 acre yard with close to 1 million obstacles that need weekly weed eating. Because my husband has been working such long hours lately I've been helping him out by doing this chore and it is killing me! I feel like I need to rest every 15 or 20 minutes. It would be a real victory in my book if I could do this without needing to rest. I mean, come on. How strenuous is it to weed whack?!

As of last October, I could weed eat for an hour without feeling like I needed to rest. This is partly because my husband got me my own smaller -- almost kid sized weed whacker it only weighs about 15 pounds compared to his manly John Deere weed eater that weighs twice as much. I'm sure this season it will take me a little time to get back into the swing of things but by my 2 year appointment I fully expect to be able to do our enormous yard all at once without needing to rest!

8-3-10 My other fitness goal is to be able to comfortably lift 60lb cement and 70lb sand bags. I can do this now, but not comfortably -- esp the 70lb bags of sand. In the line of work my husband is in, there are always bags of cement and sand right in the way of something I need and my husband isn't always available to move them for me. This probably seems like a weird goal, but at our home between my husband's work supplies, the landscaping supplies, the bird seed and the water softener salt there is always something heavy that needs lifting. It would be a great convenience to me to be able to do all of this comfortably. Plus, there is another thing at work here; when I was nearly 10 years old, I was allowed to start stacking straw in the hay mow of our barn. Those bales weighed in the 50 -60lb range and I did it with ease -- at 10 years old. Nothing makes you feel so soft and old as not being able to lift something a little kid can.

I can do this now! My husband hurt his back this winter, so I've been doing a lot of the heavy lifting (with him hovering over me like a Nervous Nellie so afraid I was going to kill my self). A couple of months ago I moved a stack of 70lb sand bags into the shed and then later lifted them up into George's truck.)  40lb bags of salt don't even require batting an eye lash. It is so fabulously awesome to feel strong. Now I would like to not be so clumsy. lol

New Fitness Goals

One new fitness challenge I want to take on is yoga. This will hopefully help me develop better coordination and improve my flexibility. It will be done at home to a dvd, where I can look like a freak in private. I have issues about exercising in front of others : )

One other thing I would like to do is learn how to swim and try water aerobics. Probably water aerobics first -- is looks like so much fun! Plus I'm scared to death of learning how to swim drowning. Our town has a very nice aquatic center and they have many lessons, activities and open swim periods. Since the cost of the facility is subsidized by property taxes the out of pocket cost to use the facility is pretty inexpensive. I'm pretty nervous about doing the whole water aerobics thing for a couple of reasons, the bathing suit and doing it in front of other people. But learning how to swim and doing some time of water exercise (besides swimming) is something I've always wanted to do and swimming is something my husband loves. He said he would like to come with me -- so there's a fun thing we could do together!

Andy was very encouraging and supportive --- he seemed to know this pool thing was a big mental barrier for me to overcome. He suggested that I go in there some day with no plans to get into a swimming suit and just check the place out -- get the full tour and watch a class in action. Baby steps. I think I can do it.

The Importance of Follow Up

Undergoing weight loss surgery doesn't "fix" you. I know... big news flash if you've never undergone weight loss surgery or think it is an easy way out. Even if we progress far enough to loose every last pound of excess weight we still benefit from regular medical follow ups, exercise, proper nutrition and emotional/mental support. I liken it to someone that has coronary bypass surgery. Sure -- those blockages are cleared out for the time being, but if you want the best shot at long term success, you have a lot of follow up to do!

Weight Watchers Ice Cream Treats

Weight Watchers has put out a $1.00 off coupon out for their ice cream treats. Go here to get yours. Here's a list of all the frozen treat offerings and their point levels.

I Bought the Red Purse

I bought the red purse. To most people that's probably not a big deal.  But to me it is. As a matter of fact it's HUGE! You see, I've always been so practical, choosing neutral colours and plain jane stuff and not really spending much attention or money on clothing or accessories.

I had been looking for a plain black handbag for months and couldn't find anything that wasn't adorned with numerous buckles, I wanted a classic, rather plain black handbag with handles just big enough to fit over my shoulder so it could easily be worn over my shoulder or carried. Obviously I have very specific handbag needs.

Earlier this winter I found the perfect black handbag -- because you know black goes with everything and that's just what I do. I found it at the grocery store no less! And it was only $11-- it's the exact same purse as the one pictured above, only black. My first inclination was to get just the black purse. After all, who needs two purses?!  Shhh don't tell my fashionista sister I said that. She would faint dead away at the thought of only one purse.

The whole time I was looking at the black purse I was longing to buy the red one.  I've always wanted a bright red purse, they are so beautiful and add a little sparkle. If I went with the black, I figured I would be wishing I would've got the red one too. So, since it was only $11 more, I splurge on the red one too.

I'm Just Not Hungry

Uh, that's my husband -- not me.   My husband has been laid up for a month with a back problem and is on doctor's orders to take off 3-4 more months. George is one of those people that never seems to struggle with their weight -- EVER.  (yeah, I know, but I still love him : )  He has a very physically demanding job and normally eats 4000+ calories a day to be replenish his energry supplies.

I've always suspected that I am one injury away from gaining a massive amount of weight. You see; I count on my activity level -- even now with the surgery to keep my portions in check. If I was in any way not able to exercise or had to reduce my daily activities for any length of time, I'm pretty sure I would balloon up overnight. Even though I eat 1400 calories a day, I still have to count on at least 30 minutes of pretty heavy exercise to make that 1400 work for me.  Couple that with inactivity in general and Houston we've got a problem. For example, the first week I changed from an active job to a desk job I gained 5lbs --in one week! And the next week I gained more and the next week more, well you know the rest of the drill. I kept eating the same even though my calorie needs dropped dramatically.

An Experiment

It's not that George is my science experiment or anything, but I was curious, so I've been watching him. I wanted to know if his body told him to eat less (because obviously mine goofed up on that point -- or maybe it told me and I didn't get the message?) Anyway, it's been a month now that he's been taking it easy. The first couple of weeks he was on some pretty strong medication that took his appetite away (maybe the medical community should be hawking this stuff instead of Dexatrim and the like) so I thought, okay; it's probably just the medicine.  The last two weeks he's only eaten about 1/2 to 1/3 of what he normally eats. I wondered if he was doing this on purpose to not gain weight. Because if I was laid up, you had better believe I would have to have some sort of serious plan of action to not gain a bazillion pounds.

So, I asked him. To be real honest, he looked at me like I was nuts. Don't worry; it's not like I haven't seen that look before: ) Apparently he hadn't even CONSIDERED food. It's not something that ever crossed his mind.  He just looked at me and said with a puzzled look."I guess I'm just not hungry so I don't eat much. Probably because I'm not working hard".

And, that my friends is one of the reasons why the experts tell you that if you are obese, you will always be "obese" in your brain -- even though you lose all your excess weight and look like a skinny minnie on the outside. We just don't view food the same as those that have never had a weight issue.

Tips to Fight Discouragement

Okay, so I had weight loss surgery. Doesn't that mean I've essentially bought myself a ticket to "the easy way out"? Where the weight just drops off and in the blink of an eye and I'm Skinny Minnie?  Um.... yes and no. Mostly no, at least for me. 

As of this Monday I am down 58 pounds. Fifty-eight pounds in seventy-seven weeks -- that's how long it's been since my surgery. Now, don't get me wrong, I am absolutely thrilled about losing every single one of those pounds. If you average it all out over the 77 weeks I've lost an average of .75lbs each week which is 100% on track with the 3 year weight loss plan my surgeon's team and I developed. The problem is I'm feeling all discouraged and just blah in general about it. Actually in my mind, I had myself thinking I was way off track and was really behind on the plan and was doing horrible.  When I ran the numbers tonight I was really surprised to find that I'm a fraction ahead of my goal.

So, why am I feeling so down and discouraged?

Reason # 1. I am comparing myself to others.

I've been doing this a lot lately, even though I know it's wrong and caution others to not do it. I know several people (some in real life, some on support boards) that have had surgery after I did and they have lost twice as much or even more weight than I have.  Now, there are some surgeries where you can lose all your excess weight in 6 months -- for people that had those types of surgeries that is a reasonable expectation. Even folks that have my surgery type (adjustable gastric band) can loose everything in a year or so if they follow a very strict low calorie plan and exercise a bunch. The problem is I am comparing apples to oranges; I have a unique plan designed just for my needs and I should only be comparing my progress to the expectations laid out in MY plan  - not someone else's plan. It just seems like those other plans are so much more exciting than my own right now.

Reason #2 I am in another stall.

I had a big stall 12 pounds ago and wasn't really expecting another one so soon.  According to the doctor there's not much you can do to fight these stalls. Just keep on keeping on until the scale moves -- the body has to catch up with what's going on.

Reason #3 I'm getting a little bored with this weight loss thing. 

Did I just say that?!  Hello? This is the rest of my life. One of the chief reasons my surgeon's team and I made a 3 year weight loss plan was so I could very slowly transition into a new "normal" pattern of eating. The key for me was this transition phase had to be gradual enough so I could smooth right on into maintenance phase without the dropping off a cliff feeling of "oh, GREAT, I am at goal, I can eat like before". The way I eat in the active weight loss stage needs to be very similar to how I will eat at goal. The problem is this isn't all new and exciting anymore (at least most of the time).  The logical mind would come to the conclusion of "Hello, anybody home? THAT's what you were aiming for!" Alas, my mind isn't always logical.

Now that I have a good grasp of why I'm discouraged, here's my plan to get free from discouragement. Hopefully this will be of some encouragement to you if you are struggling like I have been.

Step #1

Stop comparing myself to others -- especially to the people that had surgeries where it is common to lose 10, 15 or 20lbs in a week. I didn't choose that route on purpose and I need to tell myself that's okay. I also plan to remind myself regularly that I chose this route and method to give myself the best possible chance at maintaining my weight loss.

Step 2

Accept the fact that stalls of several weeks, perhaps even a month or two are a part of this process. But that does not mean I get to unwrap a candy bar because I feel sorry for myself. Count myself very fortunate that I did not gain any weight over Christmas - what an awesome bonus, considering I had several days of higher calorie eating. Continue to focus on eating good, high quality, lean protein and drinking lots of water. Even if I don't lose a pound from doing those things, they are still good for me.

Step 3

Recognize that I have some "head work" to do on this weight loss surgery thing not being new and exciting anymore.  I didn't have surgery because it was going to be exciting -- obviously definitions of exciting vary : ) I did it to help me reach a healthier weight. Eating right probably shouldn't be thrilling or exciting. It should probably just be eating. Sure we can enjoy and appreciate tasty foods and meals, but excitement? That's unrealistic. Is this one of the things I need to be on guard against? Feeling as if my new way of eating isn't exciting, so why bother -- just go for the 400 calorie coffee?

Healthy Printable Coupons

There are quite a few printable coupons for healthy products out on the net. Here are just a few. You can also go here to get a great assortment of personal care, paper, Valentine's candy and animal products coupons.

$1.00 Lank O Lakes Cheese
$1.00 Welches Juice
$1.00 Eucerin Lotion
$1.00 Oscar Meyer Carving Board Meats
$1.00 Truvia Zero Cal Sweetener
$1.00/2 Athenos Greek Yogurt (has anyone tried this?)
$1.00 Udi's Gluten Free Foods
$1.00 Good Earth Tea

Free Winter Samples

Quality Health is giving out their free winter samples. Go here to sign up for yours.

Using Nutrition Facts to Build a Better Meal

One of the most helpful things I’ve learned since having this surgery is to have an awareness of what I am eating. This is especially helpful to me when dining out a “healthy” fast food place. I put the word healthy in quotes because a lot of quick serve restaurant places brand themselves as so much better for you than the typical drive thru burger joint. And in many cases that can be true, but if you are looking to limit calories you have to choose very carefully at these places.

Case In Point: Weighing My Choices

Today I planed to get a bite to eat at Panera, one of my favorite healthy quick serve places. Since I had a free espresso drink credited to mypanera card and the remnants of a gift card to use, you better believe I wasn't going to turn down a free fancy coffee and a cheap meal.

Knowing fancy coffee drinks have a lot of calories – but not wanting to pass up a treat I did a little checking of the menu to see what my options were.

I love the companies that have the interactive nutrition facts menu where you can add or delete menu items and a whole host of condiments to arrive at a meal that fits my needs.

Obviously, the cappuccino and the plain latte offer the lowest calorie choices, but I wanted something a little fancier -- but not 400 calories fancy. So I weighed my choices and picked what I was willing to splurge on calories for -- sugar or fat.  I opted for the caramel latte -- only no caramel, just sf vanilla syrup. I could've saved an additional 100 calories by foregoing the whipped cream, but didn't because I wanted the extra treat of the whipped cream and made the conscious choice to include it.

Being aware of what I am eating helps so me so much!  The nutrition facts are not for me to identify the lowest calorie/fat food and choose that no matter what. It's more of tool for me to develop a good idea of what I'm going to be eating and to plan better choices. If I'm at a place that doesn't have the info available, no big deal.

Try New Things

Once I decided what free coffee to get, I checked out some other menu options and decided to do a U Pick 2 deal to try 2 new items out. Usually I get the same old same old when I go out and don't try new things very often but lately I've been having the urge to try new things.

For lunch I ate a 1/2 Cuban Chicken Sandwich and am planning to take the 1/2 Thai chicken salad home for supper. Plus, I forgot they give you a side item too. So now I have a bag of chips for some other day. Planning out a meal like this is such a lesson in contrast for me. I'm always reminded of how much I used to eat before surgery.  I would've gotten the full everything coffee drink, possibly a pop, the chips, a whole salad or sandwich and eaten it all in 15 minutes or so.  A meal like that is more calories than I would eat all day now.  Again, it's not that a meal like this in and of it's self is "bad" (of course it's probably not something you would want to do daily)  it's just that I could never use all those calories up before they ganged up on me as a fat roll.

Today's Lunch

Coffee: 220 calories, 8 grams protein

1/2 sandwich leaving 1/2 of the bread behind: 255 calories, 19.5 grams protein

Dinner

1/2 of a Thai Chicken Salad: 260 calories, 18 grams protein

Using Cauliflower to Make Mock Mashed Potatoes

 

This week I decided to try something new in the cooking arena. I have long been curious about about the low carb trick of substituting mashed cauliflower for mashed potatoes. My first thought was "yuck". But after all I do really like cauliflower so there was no way I would end up with something inedible.


Last night I made Shepherd's Pie and instead of the mashed potato topping, I used mashed cauliflower. 

Here's how I did it: Take one whole cauliflower and rinse well. Separate into large chucks from the bottom up. Note: when cutting cauliflower or broccoli, try not to cut into the top part of the head, you will have more "crumbs" than you know what to do. Cook in boiling water until tender.

Mash well. My masher is one of the more open types (not the little squares) so I had a hard time getting the cauliflower to mash up super fine. This masher works well for potatoes but not something as grainy as cauliflower.  When making mashed potatoes I usually use 1/2 cup of warmed milk and 2 tbsp butter. The cauliflower didn't seem nearly as dry as mashed potatoes so I only used 1/4 cup of milk and the 2 tbsp of butter and a sprinkle of salt and pepper.

As I was mashing up the cauliflower it was very clear that I wouldn't be tricking anyone into thinking these were anything like real mashed potatoes, no matter how much butter,salt and pepper I added. 

Here's the final product: the shepherd's pie with mock mashed potato topping. I added 1/4 cup of shredded cheddar cheese and a sprinkle of paprika and parsley.

My personal feelings on the matter:

It was okay. I really like cauliflower, so keep that in mind. If you don't like cauliflower this might not be the dish for you.  They were not similar in any way to mashed potatoes in texture, taste or appearance. A shepherd's pie really should be topped with mashed potatoes. The only reason I would do this again is if I were out of potatoes, but had cauliflower on hand, or if my husband or I were on a very strict low carb diet. 

Here's the nutrition info for 1/2 cup of mashed cauliflower (absent the milk and butter).  By using cauliflower in place of mashed white potatoes you save yourself 12.8 carbs and 34 calories for each 1/2 cup serving.  Personally, I would choose the mashed potatoes.

A Good Closet Cleaning is Good for the Soul

This year (well, so far this year :) I'm on a big cleaning and organizing kick.  I'm trying to do one project a week. Last week's project was cleaning out our bedroom closet.  Boy did it feel great to get a good way into cleaning it up!

(This is the after -- NOT the before. I'm not done yet)

A lot of what I cleaned out of there were clothes that were too big for me. As I went through each item, I was appalled at just how big some of these things were. Most things were especially loose in the legs and arms. Which means my stomach is not shrinking in proportion to the rest of my body. Rats. Another interesting/appalling thing was how worn some of those clothes were.

I've always been a big fan of wearing clothing until it's actually used up or on it's way to being too good to wear in public but I didn't realize how worn things had gotten. Most of what I tossed out hadn't been worn in months and as I was carefully looking each article over to see if it should be taken to the consignment shop, donated or torn into rags, I noticed that most things fit into the "rags" category. 

While it felt terrific to eliminate the old clothes -- freeing in a way, it was also a little disturbing how old and raggy some of that stuff looked. Had I always done that -- worn clothes into absolute rags? Or, had I started to do it because I didn't feel comfortable even trying on new clothes because hardly anything fit. Or, was it because on some level I didn't think I deserved to look nice if I was so overweight?  Probably a little of all three.

Another thing about discarding old too big clothes. I have this nagging little fear in the back of my head of "waaaiiiit!!!! save those because you might grow back into them". The one other time in my life where I lost a lot of weight (early 20's oh dear, that seems like eons ago) getting rid of old clothes didn't bother me one bit. I yanked those clothes out of my closet and threw them into trash bags and dropped them at a charity or gave them to friends faster than you could bat an eyelash. After all, my weight loss was going to stick. I was never going to be overweight again. On the other side of regaining every single one of those pounds back and then some I'm not so cocky.