2nd month pre-op nutritionist follow up

So in this waiting journey that my insurance company requires me to do before having the surgery, I am now in the second slow month. This month the insurance company requires me to have a follow up conversation with the dietitian and the exercise guy. This can be either done through email, phone or an office visit.

My follow up with the dietitian was via email. In the email she asked some basic questions and wanted me to either email or call in a response. I answered them honestly and I'm sure that she didn't like some of the answers I provided.

Here were the questions she asked in red and my answers in blue:

1. Please list any food and beverage consumed in the past 24 hours.
Sunday
2 BBQ chicken sandwiches on Poppy Seed Kaiser Roll
2 all beef fat free hot dogs on white buns
1 grab & go cup of Kraft Mac & Cheese
1 serving meat Lasagna
3 pieces garlic Texas toast
4 20 oz bottles of water
6 mini powdered donuts

Monday
4 tootsie rolls
2 miniature Hershey bars
2 tootsie pops
4 slices of turkey with gravy
2 scoops mashed potatoes with gravy
8 oz of fountain Pepsi
8 oz of water so far

2. How many times per day do you eat? (Including snacks and meals)
2 big meals - usually lunch and dinner I normally snack on stuff through out my work day

3. What kind of beverages do you drink throughout a typical day?
Water and for the moment usually less than 12 oz of Pepsi

4. When considering your daily intake, would you say you eat “normal portions,” “more than normal,” or “less than normal?”
more than normal I found this question difficult to answer. It really depends on when and what I am eating.

5. How many times per week do you eat away from home? (Includes restaurant dining, fast food, convenience food, etc., but not a lunch you may pack yourself and take to work)
lunch is usually 5 days a week, dinner is usually 1 sometimes 2 times a week I guess I should have clarified my answer on this one. I don't normally pack a lunch, so I either eat in the company cafeteria or go out for lunch. Usually if I go out for lunch, it is usually to Subway or Panera Bread.

6. What obstacles do you face in preparing foods at home?
time Isn't that the obstacles that everyone faces? Not just fat people?

7. Stress is a part of everyone’s life. When under stress would you say you eat more or less than usual?
More Doesn't everyone? I'd really like to meet the people who don't eat more when they are stressed!

8. If more, what foods are you eating when stressed?
sweets, salty items Can you say Chocolate? Hello?!?!?!

9. What would you say is your biggest obstacle to weight loss success, and how do you plan to overcome this obstacle?
I snack at my desk while at work. I think the biggest problem for me will be breaking that habit. I have been trying to prepare myself, but have not had much success.

Needless to say the dietitian did not like my answers. Here was the response that I got back after supplying my answers:

Based on your nutrition evaluation, I would like for you to work on the following things before your next follow up visit. These goals will be important expectations after your surgery, so let’s see if we can start forming some new, healthy habits now.

* Eliminate your intake of carbonated beverages
* Decrease your intake of fast food and the number of times you are eating away from home (except lunches that are pre-packed and taken with you)
* Drink at least 64 ounces of water daily.
* Decrease your portion sizes. You can do this by using a smaller plate, smaller utensils, or eliminating second helpings.
* Start reading nutrition facts labels. You are going to be focused on consuming a high protein, low carbohydrate diet after surgery.
* Try to consume three meals per day, with only one snack between meals. You mentioned that the snacking between meals was your biggest obstacle, and the best way to get over that is to make sure you are getting in adequate protein at your meals so that you do not get hungry for snacks in between. Try to have something high in protein at each meal, and do not keep snacks at your desk at work.

Be prepared to explain how you have made these changes in your life at our next visit, and also to give a recall of the foods you consume in a typical day.


Sure that's easy for her to say! Some of the things she has talked about in her response, I have already started doing. I didn't mention that I used to drink 3 or 4 or more 12 oz cans of Pepsi a day and I cut back to less than a 12 oz glass of fountain Pepsi 5 days a week.

Or how I started paying more attention to labels from when I was active in Weight Watchers.

Anyway, just waiting on the follow up with the exercise guy. I get to tell him that I walked in 2 Society walks the past 3 weeks and walked a total of 7 miles in those walks. I really want to get a pedometer so I can see how many steps I make in a 1 job day and on those days were I work 2 jobs. Maybe as an early Christmas present to myself.

I also need to follow up with my PCP. I told his nurse that I needed the 5 year history by the 16th. Letting her conclude that I meant the 16th of November rather than the 16th of December. Hopefully he has gotten that information to the doctor already. I want to hurry up and get this surgery over with so I can start my new life as a new me!

First Doctor Visit

So today was the first visit with the Dr. This doctor seems to have the most patients and seems to have a very good success rate. One of the things I found interesting was it seems as several nurses and office staff seem to have had one form of weight loss surgery, with some pretty amazing results.

So after filling out paperwork, I got called back to fill out more paperwork and talk with the nurse before actually talking with the doctor. Of course there was the dreaded scale check. I have decided I like the scales in this doctor's office better than the scale in my PCP. According to the special scales, today I weighed 396. I knew I liked this scale! Of course I have been sick with a sinus infection so that may have something to do with it. That and the fact that I have not drank a full can of Pepsi since I got sick last week. All I have had is a few sips from the fountain soda machine at work. Not even a full glass!

So before the nurse left I told her that I was hoping to have the surgery by the end of the year due to a change in insurance. When the doctor came in he didn't give me a definite yes, we can get it done by the end of the year, but he did say that I should tell the lady who handles the insurance to save a space for me in December, which I of course forgot to do. I need to remember to email her.

It was interesting meeting the doctor. I guess I was a little different than most of his patients because I really didn't have any questions for him. I told him that most of the questions I had got answered at the support group meeting. There was something about his manner that I just couldn't quite put my finger on. It was almost as if he really didn't like being around fat people. He just seemed a little distant. Maybe it was me.

After about 15 minutes with the doctor it was time to move on. Next I met with the office dietitian. She gave me some information about the surgery to read and answered a couple of questions that I had concerning the pre-op/post-op diet. She did let me know that it would be about 6 months after surgery before I would be able to eat beef. Okay, I guess I can deal with that.

After talking with her for about 10 minutes, it was time to meet with the next consultation.

Time to talk with the exercise physiologist. Talk over what type of exercise I've done previously, what I like to do for exercise, what limitations I may have, etc...

After 10 minutes talking with him, it was time to leave. Before leaving I talked briefly with the insurance lady and got the questionnaire for the psychiatric evaluation. 340 questions that repeated themselves, just asking it a different way. One of the questions that was hard to answer was Do people annoy you? Well, let's see...are you talking about people in general, or the people that ask the stupid questions over the phone, or the co-workers who wait to the last minute to bring you something that they want you to drop everything you may be doing to work on their stuff? If the answer is yes, then hell yes they annoy me! How does an normal person answer that question? I answered some of the time.

So I answered the 340 questions to the best of my ability and turned it in. Now it's a waiting game to hear from the Psychiatrist to go over the questions.

The next step for me is to attend the 2nd support group meeting, follow up emails with the dietitian and exercise physiologist and push and prod my PCP to send in the proper paperwork so that I can meet with the doctor a final time to schedule the surgery in December.

So until then, it's reading over everything that I have gotten, take the online class and mentally prepare myself for this journey.

Mandatory Support Group Meeting

So in order to have the bypass surgery, I must attend 2 procedure specific support group meetings. The hospital that I will be having my procedure only offers 1 a month.

This past Tuesday I attended my first meeting. There was probably 15, maybe 20 people at the meeting. About half of them were pre-op visitors.

Of the post-op patients, the biggest amount lost in the group was 226 pounds. The longest length since surgery I believe was 4 years. It was a woman who had lost the most of the group and had you not know that she was a gastric patient, you would have never know she was a fat girl. She looked absolutely AMAZING!

So after talking about how to stay motivated during the weight loss process and learning to set goals for yourself that don't involve a number of pounds to lose or a set weight you want to be at. Things like not having to ask for a seat belt extender on an airplane, or being able to fit comfortably in a restaurant booth, fitting into a dream piece of clothing, etc...

After the meeting, there was mingle time with the post-op patients talking to the pre-op patients. During this mingle time I was able to ask a couple of different post-op patients to get some of the questions that I posted in my previous blog answered based on other's experiences.

One other thing I also learned is that a couple of them even lost weight in their feet, shrinking their shoe size. For me this is a giant YIPPEE! I wear a size 12 shoe which means it's damn near impossible and damned expensive to buy shoes!

I have one more meeting to attend in order to meet the surgery requirements. I must admit that I did enjoy going to the support group and enjoyed hearing and seeing the success stories of others.

Trying to imagine

So I've been trying to imagine what my life will be like post surgery. I've also been trying to pay attention to everyday "food" things that I do/eat in order to make myself aware and prepare for the skinnier me. Here are some of the things I've been thinking of/noticed lately.

* Caffeine. I am not a coffee person. I love the smell of fresh coffee brewing, but no matter how many creams and sugars, I can't get past the bitterness. My caffeine drink of choice is Pepsi. I've tried Diet Pepsi before and just can't get past the nasty taste. I recently tried a Pepsi Max which is supposed to be the same as a Coke Zero. It tasted like a Diet Pepsi to me. I guess I need to start weening myself off of the Pepsi, but I just can't imagine never having another one ever again.

* Chocolate. I love chocolate. This probably explains part of my size. Again, like Pepsi, I can't imagine never having a piece of chocolate ever again.

* Snacking. I work a desk job. 8 1/2 hours a day sitting in front of a computer screen at a desk. I knew before, but it's becoming more apparent. I sit at my desk and snack all day. Since I don't get up much, that would probably explains why I'm the biggest I've ever been.

* Protein. I know that I will need to get a lot of protein in throughout the day. I am not a fan of fish so that pretty much leaves chicken. I'm not sure how much protein I could get out of steak, but from my understanding it will be a while before I would be able to eat steak.

* Picky Eater. I am a very picky eater. I know it. I don't like seafood, Mexican, Chinese, salads just to name a few foods. I guess you could call me a good ole fashioned meat and taters type of girl. I do eat a lot of chicken and I like turkey as well. I wonder if my food tastes will change after having the surgery? I can't seem to find a definite answer to this question.

* Chewing. Everything I have read/heard says that you will start to have to take smaller bits and make sure that you chew your food up completely before swallowing.

* Vitamins. I know that I will have to take vitamins the rest of my life. Unfortunately the only way I have ever been able to swallow pills, is to chew something first and then put the pill in the chewed up bits then swallow them.

* Flabby Arms and Fat Calves. Since my weight is all over my body and not specific to just my middle section, I'm wondering how long it will take for me to lose the weight in my legs and arms. Will I need to get plastic surgery to get rid of the excess skin in those 2 places? Surprisingly I'm not really worried about excess skin on my belly/butt area. At least not right now anyway.

* Liquid diet. I'm wondering if I'll be able to do the liquid diet before and after my surgery. I guess if other's can do it then I can too.

These are just a few things that have been running through my mind since deciding to go ahead and start the process. Granted all I have done so far is attend a seminar and start the paperwork process. Today I tried to imagine what I would look like by the time the family reunion would roll around next July. How much weight will I have lost by then? Hmmm....