Am I being to greedy??

ü      6-9 months postop: Frightening CHANGES takes place. The stomach pouch softens and expands slightly so that a patient regains a regular appetite and can "suddenly" tolerate a significantly larger amount of food.  Patients frequently worry that something has pulled apart or broken on the inside, though this is rarely the case. This increased interest in food and increased capacity for food is a very natural and appropriate part of the recovery process after gastric bypass surgery. The reason it frightens patients so much is that they had previously felt they had control of their weight for the first time in their lives, and the renewed appetite threatens that they are losing control once again. You must realize that for the first 6 months or so after gastric bypass you did NOT have control of your weight.

NOW THE WORK BEGINS TO LIVE THE REST OF YOUR LIFE! WHAT DO YOU WANT IT IS WORTH THE WORK! The pounds were going to come off almost no matter what you did The pouch can’t handle enough calories to maintain weight for the first few months. The return of appetite and the increase in food capacity signal an end to the honeymoon period and a transition to the rest of life. Your surgeon has created a stomach pouch that will be your tool to use to control your weight for life.  In the beginning it worked 90% now you have to work 90%!

ü      ASK YOURSELF (although you hinted to needing more exercise or finding how to fit this in your life it is so important!)WHAT DO I NEED TO CHANGE?  The first postoperative year is a critical time that must be dedicated to changing old behavior and forming new, lifelong habits.  THIS IS OUR TASK AT HAND A LARGE ONE BUT NOT IMPOSSIBLE!

After that it is typical and expected to eat a greater variety and quantity of food, lessening of sheer will power coupled with return of appetite for many is the point fear kicks in. Those who can embrace it feel it and move through it have a much easier time than those who deny it, struggle against it. DUMPING sadly is only expected in less than 50% RNYers and usually only early on, and sometimes it is a quantity thing (one Oreo won’t make you dump 3 might etc) and after time the body adapts to sugar especially the more one exposes their system to it! The intestines have a large capacity to adapt (elongate, grow more folds and little villi for absorption) I am not making this up it is in the literature.  We can mourn non dumping or move forward with a tad bit of more knowledge!

We can keep feeling ashamed about ‘’cheating’ or accept we are human and make different choices on sweets/carbs if we wish next time, shaming ourself keeps us down, and not successful or able to change we feel bad so we emotionally eat, noticing w/o judgment is a opportunity to learn and grow and change if we wish!

Fluid, well I get plenty that was not my issue but it is for many, taking a 64 oz bottle and filling it with water each fluid you take by midday it should be ½ full? Works for some. Also drink 8 oz water before you eat or snack this may help, as Amy said drink with exercise I get 32 oz water in with my am workouots! TIP: Journaling has helped me tremendously be aware, accountable and successful, it may be a new adventure and one we sometimes avoid (connecting to our inner thoughts and feelings) but one very worthwhile and free! As others have commented on the things we were challenged by preop if not addressed seem to only get more challenging and difficult to ignore. The fear is justified of not losing as much as one could and regain, not just 10, 20 or 50# but possibly all of it in some! WLS as a tool must be incorporated into a lifestyle adjustment. The tummy may be smaller with the gastric bypass but they never bypassed our emotions/brain! The food addictions/demons are still there waiting to be addressed. I waited until my 3^rd year, wish I hadn’t it wasn’t any easier! I envy those who started preop the emotional work!

ü      Exercise addresses not only out metabolism, rate of wt loss and maintenance but it assists in things such as improved mood, stress management, positive body image & self-esteem. Finding something fun (Carmen Electra’s strip tease! or belly dancing, can entice our spirit and mind!) using an ipod, getting a friend involved, videos for home in inclimate weather so there are no excuses. Joining Curves for some or a gym helps others. Water aerobics, my favorite motto is if you cannot fit exercise into your life then your life needs to change! Although many start preop many say “I will start when the wt slows” you may have been one of these folks but can change that motto and start at any time! It doesn’t get easier with time or wt loss actually. The hardest things is not the exercise itself for many but the act of getting ones sneakers on! LOL

ü      Hair loss occurs frequently with any form of dieting/weight loss. After WLS MANY (I have seen 30-50% as the stats) patients experience hair thinning or hair, which is easily removed during washing/combing. Once you have the surgery, your caloric intake is drastically reduced to a mere 300-600 calories a day.  This puts the body in an “emergency/starvation” mode as it thinks something is terribly wrong, (it used to get up to 10X that amount!) and it begins to focus ONLY on supporting the vital organs that will sustain life.  Hair has never been under the category of a “life-sustaining” organ; therefore, the body puts the hair on the back burner until it is sure that the body is going to be okay enough to again send nutrients to the hair. Protein and iron deficiencies are a common cause, and increasing both can help *BUT that can take 3 months of so!*. It starts generally around 3-6 months and stop around 6-9 months postop (*but can occur anytime there is a deficiency). This is because immediately following WLS adequate protein intake is difficult and it takes about 3 months for the effects to become evident, therefore taking in additional protein via shakes/supplements this minute will not yield results for a few months!. There are also many other things including medications that can cause hair loss. In reality treating the underlying cause is necessary (so if from trauma of surgery/rapid wt loss/protein malnutrition then ONLY time will help and upping protein as early as possible for today’s hair loss is from malnutrition/trauma 3 months ago, over time if your focused on the protein and vits it will stop and regrow! (no extra expensive vits or minerals/shampoos needed!), people say this vit or that shampoo did it when in essence most likely TIME was the biggest factor! Taking those things r using them may of lessened our worry and helped pass the time better :-)

ü      Most people (myself included) who have WLS look forward to all the ‘wonderful’ things they want to happen to them when they reach their goal weight…Clothes, comfort with self, increased social activity, no more isolation/loneliness, improved health, enriched relationships…and much more.

WHAT PEOPLE FAIL TO CONSIDER IS THE LONG JOURNEY FROM WHERE THEY ARE PREOP TO WHERE THEY WANT TO BE…NO MATTER HOW INFORMED/EDUCATED YOU ARE NO ONE CAN PREPARE FOR THE DIFFICULT ADJUSTMENTS..MANY FEEL THERE IS SORT OF A ‘MAGIC’ TO WLS. MEANING ‘MAGICALLY’ THEY WILL SURVIVE SURGERY, RECOVER, MAKE ALL THE LIFESTYLE ADJUSTMENTS NECESSARY TO LIVE A NEW LIFE.IT IS A RUDE AWAKENING WHEN YOU (I) RUN INTO OBSTACLES ON THIS PATH….

ü      COMMON BUMPS IN THE ROAD ON OUR JOURNEY:

EMOTIONAL ISSUES….Losing weight does not solve all your issues and you soon realize it may make them WORSE!

 #1 LOST FREEDOM OF CHOICE WITH FOOD EARLY POSTOP

THIS CAN BE EMOTIONALLY PAINFUL IN DIRECT CONTRAST TO PREOP WHEN ONE COULD EAT WHATEVER, WHENEVER IN WHATEVER AMOUNTS THEY WISHED…

NECESSITATES GRIEVING PROCESS…..

REFUSING TO GRIEVE LEADS TO ‘CHEATING’ WITH FOOD INTAKE (WRONG FOOD, TIMES, AMOUNTS)

#2 DEALING WITH TRIGGERS

PLACES, TIME, EMOTIONS

#3 CONTROLLING CRAVINGS

EATING IN RESPONSE TO A CRAVING SETS YOU UP FOR SELF SABOTAGE

#4 WEIGHT PLATEAUS

1ST FEW MONTHS RAPID WT LOSS..BEGINS TO SLOW..CAN STOP COMPLETELY FOR A FEW WEEKS…FRUSTRATING basically you can only do what you can do, if you are following the eating and exercise guidelines remembering to accept, and turn over control to the body (because we don’t have control at that point we can only influence things to a certain extent!)

NEED TO CONTINUE ROUTINE AND NOT GET DISCOURAGED/DEPRESSED

#5 EXCESS SKIN!

I believe (we)YOU WILL NEED TO CHANGE YOUR(our) LIFE & MIND to be successful long-term, otherwise this too can be a 1 year failed diet attempt! Do not see this as overwhelming see it as a great opportunity you never had before! Think of yourself as successful and you will be!

ü      5 Behaviors of Successful Maintainers post it on a wall and read daily for mindfulness

1.Give UP  Dieting FOREVER, instead practice a healthy way of eating based on bodies nutritional needs.

2.Stop being a couch potato:

EXERCISE: Regular/intentional

3.Find SUPPORT:

Friends/Family

Group

In person

Online

Therapist

4.HONESTY: Look at self-sabotaging behaviors/attitudes & develop positive ones to support their wt loss.

5.STOP reacting to STRESS

Realize they turn to food to cope with stress

Practice proactive stress  management

Problem solving

________________________________________________ 

As you progress on your WLS journey toward your ultimate goals of health and weight maintenance you will encounter both internal and external challenges. How you deal with these challenges depends mostly on your attitude. Your attitude depends mostly on your choices, because attitude itself is a choice! Yu must learn to effectively cope, self-soothe, problem solve & process feelings without food.

Some highlights to consider on the journey! It is about PROGRESS not PERFECTION! Look to live life well 90% and not so well 10%! There are so many rules that we teach concerning the use of the "pouch/tool" it is important to emphasize that it is not necessary to follow every rule all of the time.

ü      Now is the time to define a new relationship between you and food.

ü      Dispel old beliefs. REFRAME!

ü      Live in balance.

ü      Changing old unhealthy habits into healthier ones.

ü      Finding happiness in your mind and life.

ü      Find non-food rewards.

ü      Loving your life makes you successful at any goal.

ü      Life happens stop making excuses  Holidays, celebrations, stress will always come how will you cope?

ü      Break out of your isolation.

IT CERTAINLY HAS BEEN THE MOST CHALLENGING THING I HAVE EVER DONE! BUT: Change is inevitable, struggle is optional! Other quotes that help me reframe positively:

"I, not events, have the power to make me happy or unhappy today. I can choose which it shall be." – Groucho Marx

"We either make ourselves miserable, or we make ourselves strong. The amount of work is the same." – Carlos Castaneda

"The art of living lies less in eliminating our troubles than in growing with them." – Bernard Baruch

 My journey entailed losing most of my wt at 7 mo oout I had 15# left then to make it to ideal (I knew WLS wasn't meant to do that but I was sure I was different!) HS HA It took the rest of those 4-5 months to lose that 15# PAINFULLY Slow but with food and exercise choices it happened. My hunger returned and I was able to eat much more at 7 mo, it was scary. I embraced the fear and kicked up my healthy choices. Wt regain over 5 yrs has been up down 10-20#. BUT I am a success no matter what because I maintain 140# of my 160# wt loss at 5 yrs something I never did before ever when I lost 100# 3x before!  Working on the body image, the self esteem may assist you in dropping more wt w/o changing anything in your routine because you are accepting life and living it happily each moment while you work to grow and learn from each moment!

 PS I did a powerpoint presentation for my support group on Trimming the Psychological fat after WLS, I will post seperately if I can! Repeat after me I am a success and perfect just the way I am at this moment! Keep using positive affirmations (fake it until you make it!) :-) Whatever you think you are you are (a success or a failure!)

  Take Care, Jamie 100cm proximal Lap RNY 10/9/02 Dr. Singh Albany, NY 320(preop)/163  5'9'' (lost 45# before surgery) Plastics 6/9/04 & 11/11/2005  Dr. King www.albanyplasticsurgeons.com http://www.obesityhelp.com/member/jamiecatlady5/ "Being happy doesn't mean everything's perfect, it just means you've decided to see beyond the imperfections!"