DAY 365 the one year anniversary/update

You remember that picture, it was the first one I uploaded to the blog last December.

So exactly one year ago, Cheryl, Mom, Dad, and I woke up really early on a Monday and loaded into my car for the drive to Mass General. I was wearing my airplane outfit which consisted of sweatpants and a t-shirt. It was really cold and I remember it being a bit of a quiet car ride. I don't think there was a lot of fear, but I think it was 6:00 a.m. and we were still tired.

When I get into unknown situations, I become very focused on logistics. I worry about things like finding a parking spot, where is the right building, what floor are we on, which desk do I check in with, when do I need to say goodbye to my family, etc... Sometimes I think I become a bit of a grouch in these situations because I am not at all relaxed. But I remember on this day, being that it was so early, it all fell into place very easily. We were there way before we had to be, but after waiting in the waiting room for only 5 mins they called me back. From there it was pretty much non-stop medical stuff...vitals check, questions like "Have you eaten? did you take your pills?" etc.

They let Cheryl and the parents come back to say bye and wish me well, then I was rolled around on a bed. I still don't remember being nervous, but I am sure I was at least a bit anxious. I remember several hospital staff asking me what surgery I was getting...this alarmed me at first because I thought "You should know." But then I realized that it was probably some sort of safety check to make sure everyone was on the same page and that there was no miscommunication or something.

I do remember feeling a bit "awestruck" when being wheeled into the operating room - it was SO FLIPPIN' BRIGHT, I remember thinking "this must be what the light at the end of the tunnel feels like" but I quickly dismissed that thought as being ill-timed. That passing thought was probably the only moment where nerves hit me. The staff was really professional and comforting and the only other moment that gave me any stress was when they were going to move me from the rolly bed to the operating table. I remember thinking that this could be disastrous if they try to lift me. I quickly dismissed that thought after realizing that they have dealt with patients much bigger than I. Dr. Hutter showed up like a rockstar, last that is. He was awesome and I immediately felt at ease when he arrived.

I have been put under general anesthesia twice now. Both times it amazed me that you seem to blink to find yourself in a different room with different people...it startles me. But unlike my wisdom teeth extraction, this time I woke up with a catheter. I was not thrilled about that and quickly asked for it to be removed. I don't know how I went through all this preparation and did not know that that stupid thing was gonna be a part of me for 2 more days. I think they leave that information out of the pamphlet on purpose.

Anyway, the journey began from there. The next few days were uncomfortable but not unbearable. The worst part was probably the swallow test and trying to drink enough crystal light on the final day to prove that I could keep myself hydrated w/out an IV. But I did, and I got home and got better really fast. It's been an amazing year since.

From 298 lbs (on a good day) to 186 I'm now down approximately 112 lbs.
I've gone from a size 48 pant to a size 34.
I've gone from stretching out XXL shirts down to L.
I've gone from a daily regiment of 24 mg of atenolol (beta blocker), 320 mg of Diovan (another blood pressure med), 20 mg of Omeprazole (for acid reflux) to 12 mg of atenolol only
I no longer where a CPAP to bed for sleep apnea, and I usually don't snore anymore.
I've dropped 3 ring sizes and so I have had my wedding ring resized
My hats and shoes are now to big
My cholesterol levels are normal
I've gone from pre-diabetic to completely normal levels of insulin resistance
My fatty liver is now showing normal function
My lab work shows good vitamin and nutrient absorption
KNOCK WOOD- no gall bladder issues or ulcers.

What's changed? I have not had a sip of carbonated beverages in over a year. I can't seem to eat more than a couple french fries. I also can't have more than a few bites of ice cream...although I have not tried in a long while. I try to completely avoid snacks w/out some sort of nutritional value. I opt for whole grain products, or high fiber/protein type ideas. I don't do potato chips or doritos much. Why don't we have whole grain doritos? seems like a slam dunk to me.

What needs to change? EXERCISE. I just haven't been doing it since it got cold here. I've noticed that I get cold now...I guess 100 lbs makes for a good amount of insulation. I need to get exercising, I can't have come all this way to get tripped up by something that is completely within my control.

I hope you guys enjoyed the one year update...I hope very much that I have another one for you in a year (along with some smaller ones before then) that shows sustained health and weight management.

HAPPY HOLIDAYS!!! Thanks for all your support this year...

PS. Please excuse the formal "suit" picture...it was a Cheryl request and the only recent picture I have that I don't hate ;)

Joe had a roux-en-y gastric bypass on 12/15/2008 at Mass General Hospital in Boston. This blog follows his experience.

Day 253 (194 lbs. minus approx 104 lbs)

A look at the progression of Jeans since this all began...The bottom pair is the size I wore pre-surgery, the middle pair were bought in February, and the top pair were bought on vacation a couple weeks ago.

Day 230 (196 lbs mins approx 102)

Cracked 100 lbs!!! Not much to say, so I thought I'd share with you a photo from last year's anniversary with Cheryl, and one from this year. Thanks to everyone for their support since the surgery, I'm still working hard and hoping to continue to get healthy.
Love joe.

Day 203 (203 lbs, down approx 95 lbs)

Hi everyone! Sorry for the long delay, but I guess my posts are gonna come less frequently because there is not a lot to report - thank God. Things are goin' very well, I had my 6 month follow up at MGH last week and they are very pleased. My lab results are looking good, my blood pressure is 120/80, and I am almost down 100 lbs. I can not hope for more from this.

I still have room to improve my exercise routine, but things have been very busy at work and I have been fairly active.

I hope to break the 200 lb mark soon and I will let everyone know then!

best...joe

Day 148 (213 lbs, minus approx 85)

Hi everyone,

Things are going very well. I continue my workouts under MGH supervision. I still have not joined a gym because I can't seem to make up my mind. I've been putting in long hours at work but still get my walks in.

Cheryl graduates a week from today...so that is exciting.

My diet is going ok. I am trying to find new ways to eat more veggies and such. Last week I improvised a garbanzo bean burger...i posted the recipe here on my epicurious page. http://www.epicurious.com/recipes/member/views/GARBANZO-BURGER-50033068. I kinda just made it up on the fly, so I will probably refine it after a few more attempts.
I made cheryl's like a patty melt and put it on rye bread...i ate mine w/out bread since I can't do too much bread yet.

I had a friend come to town this past weekend and it was great to trek around Boston and not get immediately tired. We did a fair amount of walking and I kept up and did not need to huff and puff. As a matter of fact, I enjoyed it. In the past, I would have been happy to find a restaurant table and pray that we stayed there for several hours, I was actually anxious to get back into the city and explore. So that's nice.

Day 118 (221 lbs, minus approx 77)

Ok, I know it's been a rediculous amount of time since my last entry. But that is mostly due to things getting back to normal. The weight loss has slowed down as expected, I've had almost no issues (knock wood) and we have been cruising along here towards Cheryl's graduation - which is only about a month away. I've been exercising at cardiac rehab and I have started at the YMCA in Quincy.

Just had a nice weekend in ME for Easter...went to "Our Lady Queen of Peace" for Easter Mass. It's right on the water in Boothbay Harbor. It's also the most photographed place in Maine. Above is a watercolor I painted from memory on the way back to Quincy today.

Day 92 (228 lbs minus approx 70)

So as you will see above, there is an inequity that I have to live with for now. On the left you will see a grilled chicken, bell pepper and cheese wrap with a Balsamic Vinagrette sauce and pan handled potatoes that I prepared for Cheryl last night. Towards the bottom right you will see a bowl of Fiber One that I prepared for me. Yum.

Things have been going well for the most part. I had that setback the other night but I have felt fine since. I'm still contemplating which GYM to join. The YMCA is conveniently located and has all the facilities I would want, but it is also pretty expensive. The GYM at MIT is kinda conveniently located (although, I prefer to get out of the city ASAP after work) and has all the stuff I need also...but it's also not cheap.
There are lesser priced options that aren't easy to get to (I am car-less for awhile) and have less stuff...not sure what to do there.

Later...

Day 88 oops

Uh oh.

I ate too fast at dinner. It didn't stay with me long. I took this picture to show the broken blood vessels around my eyes from the incident.

Oh well, I was just starting to relax and forgot myself. Need to eat slower and take smaller bites.

later

Day 86 (231 Lbs minus approx 67)

A blast from my childhood, I have been on a TOTAL cereal kick. I ordered a bunch of the single serving boxes off of Amazon. I take them to work.

So yesterday I had my first exercise session at the MGH Cardiac Rehab unit. For those of you joining this blog already in process, I am going to these sessions because of a heart condition called Hypertrophic Cardiomyopathy. This disease has become a bit of a regular character on TV in the past few years. Some of the shows that have used it for their characters are "Without a trace", "Eli Stone", and "One Tree Hill". I think the reason it has appeal to writers is that the victims of HCM can look, feel and act completely normal but still have an above average chance at sudden death.

Depending on whether the distortion of normal heart anatomy causes an obstruction of the outflow of blood from the left ventricle of the heart, HCM can be defined as obstructive or non-obstructive. Luckily for me, my HCM is monitored regularly and my condition is considered "non-obstructive" for now. Also, most cardiac incidents with this disease seem to happen to people under 30, so that's one advantage to my getting older. It's unclear to me at this point if the age anomaly is due to athletes being more active in their high school-college years, or if there is another reason for most sudden deaths occur to people under 30.

Another piece of good news is that there are medical interventions that can work if my cardiologists start to see advancement of this disease. There is surgery and alcohol sublimation and of course transplant. But as of last monday, the cardiologist at the Cardiac Rehab unit could not even detect the disease via stethescope.

So my cardiologist wanted me to begin my exercise journey while being monitored. So while hooked up to a bunch of electrodes and such, I jumped on the tread mill. They kept it pretty tame to begin with...I did about 40 minutes at a level incline and fairly slow speed (around 3mph). The good news is my blood pressure stayed about the same the entire time. A drop in blood pressure would have been a bad sign. So the cardiac people will monitor me for a few more sessions to see how it goes, and if need be schedule me for a stress test.

I will be allowed to lift light weights. I will learn techniques for keeping safe (no above the chest or head lifting) while still having a varied and effective workout. While you workout, one of the cardiac nurses gives lectures on various heart-related topics.

Most of the guys in rehab are coming off some sort of coronary disease / infarction. So some of them are curious as to why I'm there. But that's ok, they will grow to love me soon. It's awkward having the nurse instruct the guys about their sexual stuff...I might bring my mp3 player next time.

Day 79 (234 lbs, minus approx 64)

So yesterday I had my intake session with Cardiac Rehabilitation. It went pretty smoothly and I will be attending sessions twice a week starting Monday. They will monitor my blood pressure and such during the first week or so and they plan on getting me on an aerobic and light weight routine.

I'm also contemplating some new additions to the wardrobe. Right now I look a bit like MC Hammer with my parachute sized pant legs. Any suggestions? I was thinking Gap or LL Bean...

Food is still a work in progress...

I made a very nice dinner last night: Ziti Marinara, with Seared Chicken Breasts, Green Beans and Homeade cracker/chips made out of Tortillas. I cut the tortillas into wedges and brushed them with garlic butter, crisped them in a skillet, seasoned them and then melted mozzarella and parmesan on them in the oven.

Cheryl enjoyed everything as I got a few bites down before having to stop. I think I got 3 bites of chicken, 4 zitis, 1/2 a tortilla wedge, and a few bites of green beans. Dang. I'll take pictures next time. I now use our little plates to avoid wasting food on a big plate for me.

Talk soon...joe

Day 68 238 lbs (minus approx 60)

So things are going well. I saw the MGH Weight Center MD today and he was pleased as well...my labs showed deficiency in Calcium and Vitamin D. I informed him that the nutritionist told me the same thing 2 weeks ago and I have since become religious with my supplements. He accepted that w/out making me take a prescription supplement. But he told me to go counter to traditional advice and take my Calcium citrate with meals so that the Oxolates in my food bind with the Calcium and filter through my system. I only have to avoid taking my calcium with my multi-vitamin because of the Iron in the MV.
He told me the rest of my labs looked better...my insulin, while still on the high side, is much improved. So I have avoided diabetes for now. My liver levels are also normalized. So things are looking good.
My BP was 120/80 with just the atenolol. The MGH WC Dr. doesn't understand why I am not on more BP meds. He would just assume that they keep my BP at 100/60 with the heart condition and all...but he is bowing to the opinion of the Cardiologist.

One of the challenges I am facing is compiling opinions from 6 different doctors and taking the best advice from each. My PCP is supposed to be the "Quarterback" of the team, but realistically I see him a few times a year (once if I don't get ill). So I kinda have to be my own quarterback.

On top of all that, I sliced off a chunk of my thumb this week. So it's never dull here.

Day 63 - (240 lbs, minus approx 58)

I eat like a toddler.

So Valentines has come and gone. It was a nice night out for Cheryl and me, but it was also one of those nights where you miss eating.

We went to a decent restaurant we've wanted to try in Quincy. And like most restaurants they had plenty of delicious special appetizers, entrees and desserts to try. I knew I should skip the meal and just get some soup but I think I felt like the restaurant would frown on that so I ordered the duck. My hope was that since the duck is a bit fattier, it would go down easy.

It sort of worked, however I'd say $24 worth of the $25 duck was still there when I finished...it now resides safely in our refrigerator. Please feel free to send me any "leftover duck" recipes. I stopped eating after a few bites and just accepted the dilemma w/out forcing myself to eat more. I also wanted to save room for dessert since there would surely be something mushy on the menu. You can see my dessert in the picture...I forget what they called it but it was basically an Italian version of Flan.

Overall it was a nice night. Cheryl had Filet Mignon with Gorgonzola Mashed Potatoes. I waited till she had eaten most of it and decided she liked them before I let her know that Gorgonzola is a type of blue cheese (bleu?). Cheryl is not normally a fan of the Bleu.

While I do have a love/hate relationship with my itty bitty stomach...I do hope I can at least eat a bit more next year.

So now I eat like a toddler. Cheryl and I went to breakfast this morning and I ordered one scrambled egg and sausage. I got through half the egg and one sausage link...do you think they'd let me order off the children's menu?

I got hungry later and had a sippy cup of milk and dry cheerios...It's like I'm 2 years old sitting in a pew at Church...but I have to admit I'm starting to embrace my toddler stomach-pouch.

later.

Day 59 Need to push fluids

Well it's almost been two months since my surgery and things are still going fairly well. I have been back at MIT for almost two weeks, I haven't been "sick" in a few weeks (knock wood) and I am down at least 52 lbs or so.

My problem now is that I really need to do better with my fluid intake. Since I don't feel thirsty (or hungry for that matter), it's hard for me to remember to sip all day. At the MGH weight center, one of their mantras is to remember to listen to your body...that this surgery has now opened up a line of communication from your body to your brain to let you know when you are full, hungry, etc... However, in the first year or so, this is not entirely true. They encourage us to eat in a normal pattern, whether it's Breakfast, Lunch, Dinner, or 5 small meals or so, whatever...they want us to ingest something in the pattern (even if it's just a few bites), regardless of our hunger level. So the same applies to fluid.

I need to achieve 64 ozs of fluid a day. Let's see where I am at on a typical day.

Morning - Instant Breakfast, Milk 10-12 ozs
Lunch - applesauce 4 ozs
Dinner - no drink
In between meals, usually a fruit 2'0 16 ozs.

So that puts me in the 32 ozs area. So I am only taking in about 1/2 my fluid. This probably contributed to my kidney stone incident.

I need to double my fluids. Yuck .

wish me luck.

Day 52 (246 lbs, minus approx 51 lbs)

Cleared to exercise...sorta.

So I had a followup with Dr. Hutter today and he was very pleased with the progress. He has given me permission to exercise without limitation.

However, I also had a followup with my cardiologist, Dr. McFarland. Dr. McFarland is also very in favor of an exercise regiment, but he wants it supervised by the Cardiac Rehab unit at MGH. This is due to the Hypertrophic Cardio Myopathy that I was diagnosed with way back in 1991. I am a little concerned about this since cardiac people seem to love things such as treadmills, exercise bikes, and stairclimbers...boring, boring, and boring. I don't need to hulk out like a professional wrestler but I would like to be able to lift some lighter weights, play some basketball or whatever...

Anyway, Cardiac Rehab is normally covered for those people who have had some sort of incident. Dr. M is trying to get me in on the grounds that I have the HCM and I am post-bariatric surgery. So before I pick a gym, I now have to wait for the "consult committee" at MIT Medical to approve this and then get an appointment at MGH.

Day 51 - New Jeans

So it's been awhile since I posted anything. Sorry for the delay.

Last Monday, I made my triumphant return to work. I worked a full day and then woke up to a passing Kidney Stone the next morning. My colleagues at work wanted me to wait till I had an official clearance from my Dr. before returning, so I wound up being out the rest of the week.

I don't know if the Kidney Stone passing was related to my return to work...I blame it on my lack of liquid intake. Although I do try to make sure I drink enough, it doesn't always happen. So I paid the price last week. It was painful and I made a terrible scene in the lobby of urgent care. But really, when someone is in agony you should help them quickly instead of answering the phone.

I made another triumphant return to MIT yesterday and have decided to ease back in slowly. I am only going to work 4-5 hours a day this week, and then see about getting back up to 8 hours next week.

I visited Peter in NYC over the weekend. He made me buy new jeans because he felt my old jeans looked like "Clown Pants" and that they were making a mockery of things. I actually bought jeans from "The Gap". I don't remember the last time I bought clothes at the mall.

I have a followup with Dr. Hutter on Wednesday and then I'll be cleared to start exercising. I haven't decided if I should join the gym at MIT or the YMCA in Quincy. The Y is kinda expensive but you do get a lot of facilities...MIT has a better deal but then I am staying in the city an extra hour or so.

I'll repost after my Dr. H visit.

Day 37, Yes I Can

Today is inauguration day and they are just wrapping up the ceremonies in Washington. As the leadership changes in our country, I am reflecting on the regime change in my digestive system. I am still adjusting to the reality that my food intake is now governed by President Tiny Stomach.

Some of the challenges that this has created include:

Thirst. Have you ever been really thirsty but only able to take a tiny sip of water at a time? Try it...it's a little tortuous.

Hunger. It's kinda the same as thirst...you are really hungry, you know you need to take small bites, and you know you need to space them out...but you look down and realize you have just eaten half of your food and once the first bite reaches President Tiny Stomach, you are in for some discomfort at best.

Fatigue. It's not the same as sleepiness but you realize your stamina is not where it should be...you are losing weight and you don't have enough calories to fuel a full day.

Cold. Don't ask me why, but with all these metabolic changes comes chilliness. In my marriage, i was the one who always felt hot, but now I'm the one sneaking the thermostat up.

Bad Breath. It's not fun to talk about, but when your body has burnt up all it's glucose it starts burning fat. This process is called Ketosis. This burned fat turns to Ketones and leaves the body via the mouth. Something like that anyway. Gross? I know.

Anyway, there is a new doorway pic for you guys to look at. I'm including the ones from before the surgery and two weeks after surgery for comparison.

Day 32 (253 lbs minus approx 45 lbs) A plateau?

Hi all, sorry for the delay between posts. I've been in a bit of a holding pattern this past week. I am still not back to work and there hasn't been too many developments of which to speak.

I seem to have hit a plateau...although the MGH weight center will tell me that there are no real plateaus and the reason the scale has stopped showing weight loss has more to do with fluid fluctuation than a cessation of fat loss. I'll take their word for it.

According to my own googling, it is common for people to lose most of their excess weight in the first 65 days. So if this is true, I am about 1/2 way through this period. Of course, everyone is different and having lost almost 1/2 the weight I expect to lose already, I won't be surprised if I am truly through the rapid part of the weight loss.

On the other hand, I have had very little activity since the surgery. Even though, I feel I haven't had that much to eat, it's possible that I am just not burning enough calories. I am researching exercise options now, so I am ready when I am cleared for more activity.

Some people were concerned with my mood. I want to let you all know that I feel ok. I think too much time in my house leads me to the life of a hermit...It's amazing how fast the days go by with nothing to do. I don't really miss work, but I miss a routine a bit. Well I am going to get out on the town this morning and run some errands.

I have a picture for this entry...but since Cheryl and I have a disagreement over who last had the camera cord (it was she), it will have to wait till tonight. Best...

Day 25 preparing to transition

Well it's been more learning the past few days. I have to admit that I have been a bit down too. I'm not sure why.
Part of me wants to get back to work, but part of me is not sure I'm ready. It's hard to judge my energy level at this point. When I am home watching TV, I feel like my old self. But if I have to function for 8 hours at work, I am pretty sure I'd be exhausted fairly quickly. I don't think my eating is stable yet.
I'm toying with the idea of going back to work in a flexible manner. I may go in mid-morning and leave mid-afternoon, just to get back into the groove. However, that would end my sick-leave and leave me in a bind financially. I'm thinking of calling HR at MIT to see if there are any options.
Although I am fortunate enough not to have any pain or severe problems after this surgery, I have to remember that the surgery I had was major and that it's ok to take some time to recover.

Regarding the feeling down...it's strange. I am not sure if it's boredom or loneliness, or what. I just kinda feel restless all day. Well I'll have more to say in a couple days. Feel free to let me know if there are issues or questions that you'd like to hear about.

Day 22 (256 lbs. minus approx 42 lbs)

So I had another bad morning, but luckily I had another followup at the MGH Weight Center. The nutritionist gave me some good adivice; I have to remember that it has only been 3 weeks since my surgery and it's going to take time to learn to eat again. I have always been a fast eater and that does not work post surgery. So now that I've had two bad experiences, hopefully I can be a more mindful eater. She also informed me that this is certainly a behavior related problem, for if it was stricture caused by surgery, I'd have trouble getting water down.

Another issue I have been having is nose bleeds. It's very possible that my sleep apnea pressure setting is too high right now (since I have lost some weight). This could be causing my nasal passages to become overly dry. I need to followup with the Sleep Dr. about that.

It was interesting to go to my nutritional group today and hear some of the problems other folks are having...some very similar to mine, some do not line up with mine at all. But for me, I have to learn to tell the difference between fake hungry in my head, and real hunger from my body. I now realize that I had no idea when I was truly hungry or full before this surgery.

Day 20 Bad Night

So last night I had the pleasure of going out on the town with a few old friends. We had a very nice time. The only problem was dinner. Even though I understand that my stomach isn't ready for all things yummy again, I still forget because I feel so normal. I ordered some things I should not have, and, to keep the graphic level to a minimum, it did not stay with me long.

It was the first time that I had such a severe problem since my little incident with the swallow test back in the hospital. After Gastric Bypass Surgery (Laporascopically that is), you have to do a swallow test in front of an x-ray machine. That involves drinking a cup of iodine, followed by a cup of barium. I had only been out of surgery about 24 hours and I just couldn't handle the gross-ness of these two liquids. The radiology people tell me that happens all the time.

But last night was just me getting ahead of myself. I need to be patient and just give myself time. Perhaps this bad experience will help me remember that.

The other issue I'm facing is fatigue. Even though I feel good, I am certainly not getting enough calories. While we were out and about around 10:00 pm, it felt to me like 3:00 a.m. This will certainly improve over time, but I need to remember that when making plans.

Day 18

So Happy New Year everyone. It's interesting to start a new year where I actually believe that I'll be lighter and healthier this year. This has been a fairly smooth couple of days. There is no huge weight loss to report, but I was weighing close to 260 yesterday. I think I weighted a bit more this morning, but that is why the MGH Weight Center people tell us to stay off the scale. There is a lot of fluid fluctuations going on so there will be some ups and downs on the scale.

Last night we hosted a small NYE party at our house with Cheryl's brother, Jeremy and his wife Meredith. Although there were lots of snacks I felt like digging in on, I pretty much settled for some Decaf Diet Tea and a few small Buffalo Tenders. Everything went down smooth. However, I think I have pulled an abdominal muscle. We don't really have an ideal spot in our living room for games; and I think I hurt myself reaching for an Apples to Apples card. At first, the pain was alarming because I feared I gave myself a hernia. I soon realized that the pain wasn't that severe and I only felt it if I turned a certain way. Hernias are not as common with a laparoscopic procedure as with an open one, but they can still happen.

Today I had a CIB to start the day and actually had a few bites of chicken, broccoli and sweet potato fries for lunch. I stopped after a toddler serving, but it is still progress. I am posting some updated "doorway" shots...Cheryl and I are not experts at the time lapse photos and the perspective is all wrong. I don't see much of a difference in size....do you?
Joe had a roux-en-y gastric bypass on 12/15/2008 at Mass General Hospital in Boston. This blog follows his experience.