In need of advice or maybe tough love?

Sorry I have been lax at posting, I do lurk alot.  Part of the issue is I don't feel like alot of the "guidelines" apply as much to me because I have had a few major complications which make my :food plan" different then many.
I currently have a stricture that I am going to have dialated on 6/24.  I had some severe complications with a lacerated spleen, and gerd to the point of being on tpn (iv feeding) for 4 months.  Now the tpn was stopped 3 weeks ago, I am able to get in liquids, soft mushies or "crunchy" things that dissolve.  My Sleeve was done 7 months ago and I am down around 130 lbs.  The thing is I haven't lost a lb in the past 5 weeks.  I know some of the issue is my carbs are too high and my metabolism has crashed after 7 months of VERY low calories, protein malnourishment and muscle wasting (was in the hospital for over 2 months and on activity restriction for most of the past 7 months)

My dilemma now is my baritric doc and dietician say work on getting the density of my diet up and limiting myself to 3 meals a day (NO possible way to get protein to over 70 g that way with a stricture -- I vomit with beef, chicken, turkey or pork) My gastroenterologist says my goal now is to maintain my wt and not lose anymore now to get my protein high and get in calories anyway I can (Im sure you all can imagine the anxiety that causes me!!!
I am worried about the increase in my calories (honestly a bit of that is increased carbs because I can digest them) --  I don't want to blow this, I want to get to goal so badly...  but if I live on greek yogurt, protein shakes and cottage cheese I dont feel any satisfaction OR any sense of being satiated, but I can get my protein in...   If I eat my graving and keep the carbs up then I feel more satiated and I feel like my head hunger is gone as well but my nutrituin sucks, my blood protein drops and my wt loss stalls...  plus it is the way many here gain wt back.

Any thoughts?  I really am looking for any ideas I may not see from those of you who know about the post op requirements but also the mind set issues after years of overeating...  Not like I haven't had a ton of therapy over the issues...  just really struggling over what is "effective" for me to do after none of my doctors seem to agree,   Thanks alot for reading this!    Amy

 Amy, you are often in my thoughts. Good to hear you are getting better, however slowly. I am six months out and still get my protein from shakes, cottage cheese, cheese, nuts, and protein wafer bars (OhYeah). I have trouble getting down even one ounce of meat, chicken, or fish.

My weight loss is slowing down and it scares me, too. I want to get to a normal BMI after all this work.

Can you do any walking or light weight work or bands? I know you have so many responsibilities with your family, but I hope you can focus on yourself, too. I am going to a gym and taking Pilates and yoga classes. You may not be up to it yet, but 3 pound weights while you sit can help build up some muscles. My Pilates teacher recommends that I stretch with rubber bands to help loosen my hips and develop core strength between classes. We are also at a disadvantage because our abdominal area is usually weak after surgery.

I guess I have no real advice except to say that I think the protein and getting to move is more important than ever now that you are recovering. Protein is supposed to help with healing, too. You have been so brave and an inspiration to me. When I start to whine I think of all you have been through with such a good spirit.

Hi Wendy,
    Thank you soooo much for the encouraging message.  It was exactly what I needed to hear.  I think if I put my nurse hat on I could see tha what I need to do is to keep my protein up by whatever works and can "stay down"...  and while my protein is up work on incrfeasing my lean muscle so my metabolism, strength and stamina improves.  I was playing with the idea of 3 very small (need to be if it is dense!!) meals and 1-2 protein snacks like maybe a shake for 1 and greek yogurt for second...  that way my carbs would be down and I might feel more satiated because of the fullness that would cause?  Maybe that would help some of the grazing????   I still have my PICC (central line) in my upper arm and will until after my procedure in late June so I can't do alot of weight lifting, but with my right arm I could, my legs I could and my core I could strengthen.  Sometimes I get perfectionistic and think I need to do what is optimal but not necessarily what is optimal given my current health status?   Life is more grey then that!!!

Thanks again!    Amy

Ditto on the ditching perfection and going for whatever works, my friend.

Because what you need to work is a combination of satisfaction for your mouth and soul, but protein so you do not get/stay any sicker!

Me?  I *have* to still consume at least 70 g of protein via shake per day to keep my labs up.  I *can* eat dense all the proteins I need, but my body shuffles through/will not retain *choose whatever phrase you like best* that protein, and honestly, for me the yogurts and cottage cheeses are not satifying *plus* the texture is a binge trigger for me, so - for optimum nutrition I must have the shakes.

We have a lady on the vsg board who was eating a diet that was way low in protein and she suffered such sickness!  :{  Its so important that by hook or by crook we meet minimums so our body can function, and as a nurse you know its so our body can heal too!

Take care of you, and working on making your meals more dense is groovy and a must do, but cover your *needs* bases! 

DItto on building muscle however you can, but not to the deteriment of weak incision lines!

Sorry for your whole ordeal!  BOoo!

Feel better and be sweet to you!

I will echo what's already been said...protein shakes!  Until that stricture is fixed, I wouldn't worry about anything dense. If you mentally need a little bit of crunchy carbs, perhaps rice cakes or or soy nuts or roasted edamame. I know folks that drink 6 - 30g protein shakes a day to maintain their protein markers, so perhaps just sip on those all day and make a little time 3 times a day for a "meal". I have a feeling if you're full of protein shake, you won't want much more. Please keep us posted on how you're doing.

--gina
 

First, I'm so glad you get getting better and so sorry you have had to go through all this.

Next, every dr is different and it sounds like your are not like each other which complicates stuff.  But my plan, even at 8 months out is for 4-5 meals a day, 2 protein drinks.  Meals are 2 oz protein, 2 oz of veggies or fruit if you can fit it in.  I know that isn't what is being recommended but it works for me and may help you get in liquid and solid protein. Can you do puree?  Something like a chicken soup, pureed, may sit better than a piece of chicken.  Some real flavored foods, like refried beans or the soup, may help the head hunger issues.  I don't know much about strictures but it seems like they usually fix them pretty quickly so it surprises me that you have to wait so long for that.  Maybe because of your other complications.
I'm swinging that you do better each day. 

Amy-
Wow---sorry to hear that you have gone through so much.  Why in the world are they waiting so long to fix the stricture.  My WL group fixes them immediately (within week)y, especially if the person is having problems like not eating or vomiting.  Some people are able to eat past them.  It seems cruel to me to wait so long.  Of course I think we all need food that satisfies your whole self.  I had a revision, with not a lot of great results in weight loss---but I can tell you...I find yogurt, cottage cheese taste good but dense protein makes me full not much else.  I have real struggles with shakes- do not like any of them that I have had to date-- but my WL group discourages them as on going intake.  Good luck and sending positive vibes you will be better soon. 

My surgeons plan is also 3 meals a day.  Im almost 15 months out and I STILL cant get all of my protein in in just 3 meals.   Protein shakes are my livesavers.  Good luck on your journey Amy.  Cindy

you've been through so much and im so glad to hear you're getting better and healthier. i agree with what everyone else said about protein shakes and other soft proteins (cottage cheese, greek yogurt, eggs). its important to just focus on healing first right now. 

maybe to satisfy your crunchy carb craving you could try  pork rinds or "popped cheese". they're high in fat, but at least give you some protein and crunch which you crave.

i think what's effective is what works for each individual. its takes some trial and error to get there but you'll find it.

Hi Amy, I am so sorry that you are having problems. You have had more than your fair share of difficulties.

Now, I am not in favor of protein shakes, but I do mix beneprotein with my yogurt and/or cottage cheese, which adds another 6 grams of protein on top of the 18 that the chobanini or fage yogurt contain. I also put 1/4 cup of fruit in it. Protein shakes never satisfied me, but you could add protein powder to your food, which would boost up the protein.

Can you tolerate soft boiled or any type of egg? Egg whites have a lot of protein and you can use some cheese to bump up the protein.

Rice cakes have NO nutrition, but roasted soybeans or edamame are fairly high in protein and can satisfy that crunchiness.

Complex carbs like beans may be helpful. You are down 130 lbs and need some calories and protein, which the beans can provide. Plus, they are filling and stay with you longer. Wendy's chili comes to mind, but you can probably find chilis with less sodium and fat.

Can you grind up the protein a bit, so that it is easier to go down? Someone mentioned pureed food, which is a good idea.

You need to start with some light resistance training to build up some muscle. You have probably lost most of your lean muscle mass, which is why your metabolism is shot and your weight loss has stalled. I hope you are walking, which can also help tone some muscle. I would focus on maintaining your weight and getting in your protein.

It is difficult to go against past patterns and behavior, but you have different needs and requirements right now. I think that you need a meal in between the 3 meals/day, but that is just me and I found that I needed that early on.
 
Remember, if you eat carbs, then have some protein with it. Cheese goes down easily, but you do need to eat more dense protein, even if you have to grind it up.

JMHO,

Gail

If you would like a ride to the Fremont support group this Friday, let me know.