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Pre-Op Diet The pre-op diet has a few purposes. The critical one is to shrink your liver so it’s not blocking your surgeon’s view of your insides during surgery. That makes your operation easier and safer. The pre-op diet also helps you lose weight. That may be surprising since you’re expecting to start your weight loss after surgery, but it’s actually a good idea to start losing weight beforehand. In fact, the more you lose before surgery, the safer surgery will be, and the better you’ll feel afterwards. Different surgeons suggest different pre-op diets. The diet has about 1,000 calories. It could depend on lean proteins and other nutrient-rich foods, or it could be a liquid diet with protein shakes. Or, it could be a combination of the two, with each day including two protein shakes as meal replacements plus one meal with vegetables and protein. The pre-op diet can last from a few days to several weeks or even months. In general, the longer you’re on it, the better. You’ll lose more weight, shrink your liver more, and gain confidence that you’ll be able to continue a strict eating program long-term after surgery. Get in Shape Why exercise before surgery? One reason is that, like with a good diet, it can make surgery safer. In this case, it’s because exercising can strengthen your heart, lungs, and blood vessels. Of course, exercise also burns calories and can help you lose a little extra weight before surgery. Another reason to get in shape before surgery is because it will make recovery easier. Many weight loss surgery patients find that walking around the house and then the neighborhood is their best tool for fighting post-op pain. If you’re used to being active before surgery, you’ll have an easier time walking after surgery. You don’t need to go crazy on your pre-op exercise regimen. If you’re not used to exercising, start small. As long as your doctor approves you to be active, just find a few minutes each day to walk at a comfortable pace. Clean and Stock the Kitchen Fact: you can’t eat food that’s not there. So, clean out your kitchen. Get rid of sugary desserts, starchy snacks, and fatty meats and cheeses. Anything you know you shouldn’t be eating shouldn’t be in your kitchen. Get rid of it before surgery because for weeks after surgery, you won’t be physically able to carry out heavy trash bags filled with forbidden foods. Once your kitchen is cleaned out, stock it up! At least get the protein shakes and powders you’ll need for weeks or more after surgery. Consider getting some flavored water in case you’re unable to tolerate water post-op. You can also stock up on non-perishable staples, such as canned chicken and tuna, frozen fruit and vegetables, and instant oatmeal packets. Take Your Nutritional Supplements You know you’ll be taking nutritional supplements post-op. If you have the sleeve or bypass, you’ll be taking them for life. With the band, you’ll need supplements for months, years, or life. Did you know you shouldn’t wait until after surgery to start taking your supplements? At a minimum, take a multivitamin beginning when you start your pre-op diet. Even if you’re eating a balanced diet, the supplement helps make sure your body has the nutrients it needs to heal your surgery wound. Also, it’s an insurance policy so that if you have trouble eating and swallowing supplements for a few weeks after surgery, your body will still have a good store of nutrients in reserve. Practice Your Healthy Eating Habits Consider the pre-op period practice for the post-op diet. That includes eating slowly, measuring portions, and choosing nutrient-dense instead of processed, high-calorie foods. Also consider making exercise a habit now, so it’s easier to get back to it after surgery. You cannot guarantee an easy surgery, but you can certainly do a few things to improve your chances. Use these tips to take control of your pre-op prep as soon as you’re ready to lose weight and get healthy!

Over the 8 years I have met with weight loss surgery patients, the one concept I find myself going over and over is this idea of becoming full from within. The idea that if we don't fill ourselves up intrinsically- we will always need some thing to fill the void, whether it be food, gambling, sex, drugs, or alcohol. The problem is- we always end up on empty, psychologically. The next question often becomes, "ok so how do I fill myself up psychologically? I don't think I will ever be fulfilled because I have never been truly happy. I was not born a naturally happy person? I've spent most of my life feeling empty- how do I turn it all around now? I grew up with unhappy parents, how am I to unlearn all of that early programming?' "Wondering if you're happy is a great shortcut to being depressed." - Annette Bening, 20th Century Women I think, unfortunately happiness gets a bad rap. There is a wide misconception that for us to be fulfilled, or full from within- we need to be blissfully happy all the time, and that's just not the case. Not only is it untrue, but it is an unrealistic standard and one that sets people up for disappointment. Rather than always questioning how we SHOULD be feeling, we should just practice acceptance of whatever temporary state we happen to be in at the moment with non-judgement and non-attachment. Like busses, moods come around every five minutes. Even therapist's aren't immune to life's ups and downs. Believe it or not, as a psychologist who literally wrote a book on Happiness, I have to remind myself certain mantras that help me keep my own life in balance and my happiness and fulfillment sustained. I actually have a list on my phone that says "things to remember," and page through it daily, when I'm feeling off track. So if you're feeling off track yourself- first understand that you're human and give yourself a break + then thumb through my personal list of happiness tips, little pearls I've gained in my 37 years on this planet, and see if any of them might help to increase your happiness quotient today: 1) In silence, the heart begins to finish its unfinished business. I think I picked this up from a book I read about Sufism. In any case, I liked it and it stuck. Oftentimes, we think that we must actively and aggressively pray, yet Sufis believe that it is in the stillness that God comes to us. Whenever my life gets a bit too chaotic with all the "should-ing" all over myself- I remind myself that it is often when I take pause, let go, and let God- that what is truly important, rises to the surface and I begin to reclaim my life instead of it claiming me. 2) Do more want-to's vs. have-to's every day. Someone once told me that the "have-to's" will never be done. I repeat- they will never be done. So we might as well splice in some time for the things that we thought we were going to do once they were done. Take the scenic route to work, take a long walk and listen to that book on audible that you have been wanting to read for the last few months,go shopping with a friend, get a massage, take an extra long lunch and sit out in the sun, or just curl up with your loved one or pet. A wise man once said "time you enjoy wasting, is not wasted time," and I couldn't agree more. 3) Happiness is not the absence of problems, but the ability to deal with them. I remember when I was in grad school, thinking "if I can just finish school- then I'll be the relaxed, happy go lucky person I want to be," then it morphed into, "once I get licensed," then "once I get married," then "once I have kids..." You get the idea. It is not the situations or circumstances in our lives that determine if we are a happier person or not. It truly is the way in which we approach them as they come, that determines what type of person we are and how happy we will be. In the "car of life," that we all have to drive, will you wear stilettos or uggs? 4) Connection with others is key to fulfillment. I am an introvert by nature. I enjoy my downtime, and require coming back to my home base in silence, to relax and unwind. However, there is something inherent in our very nature about the need to feel connected to the world around us- introverts included. My best girlfriend from childhood came out for a week a while back, and so I was unable to get caught up in the hamster wheel of daily activity. I was forced to be fully present and engaged with her for four days in a row. As a result, I was actually more grounded, more at peace, less anxious, and more optimistic about the future. Whenever we notice our egoic drives propelling us towards isolation, judgement, rumination, or comparison- we should remind ourselves to get out and connect with our fellow man, and fakebook doesn't count. 5) Like attracts like. Happy attracts happy. When we find ourselves feeling left out, isolated, or out of touch with those around us- it is important to look at our recent focus. Are we always dwelling on the negative, gossiping about someone? You know the saying "what sally says about susie, says more about sally than susie." Although, many of us sub-consciously believe that if we can just "get it out" about whatever is chipping away at us- it will somehow allay our negative feelings- it really doesn't. In fact, research supports that when we ruminate on negative feelings, it actually increases our negative feelings. This doesn't mean we should all be superficial and "surface-y" towards everyone, but that we should work a bit harder to find the happy. 6) To receive abundantly, ironically we must give abundantly. It is engrained in our DNA to wake up each morning with a needs list: "when will I get that bonus?" "when will I hear back about that promotion," "when will she call me back?" Yet, spiritually I truly believe that when we make the shift from "what can I get," to "what can I give?" It is a complete gamechanger. It's almost as if the universe aligns with us and says "yep you finally figured it out." 7) Choose your thoughts like you choose your clothes. Our minds are quick and fast like ferraris. They are an intricate and complex machine designed for ultimate performance, but just like we must use the right fuel for a Ferrari, we must also carefully select and filter which thoughts we allow to permeate our consciousness. When you notice yourself feeling down, take a cognitive step back and look at what thoughts you were having. Most are unproductive. Choose to let them go. The same tool that created the problem (our mind) is not likely going to solve the problem. 8) Legitimately and truly don't care about what others think or do. I can honestly say that this is still a work in progress for me. I was born a people-pleaser, but as I get older, I realize the more I try to make others happier with me, the less happy I am with myself. 9) Go out into the world with your heart, not your brain. Yes, our brain is required for some part of our days. Otherwise, our bills wouldn't be paid, our tasks wouldn't get done, and our goals wouldn't be met. But, other than that- when we greet people, meet people, share with others, observe, smile, walk- it is quite a different experience to live in our heart space, in that emotional space that is more visceral than verbal. 10) Relish in the remarkable ride. I watched a movie a while back called "about time," and it was all about a man who had time travel figured out. He lived his day once all hurried and bothered about the little stressors of life, but then went back to live it again. He said he would just rest in the moment, relax, and relish in the remarkable ride that was his life. I love this. After all the late notices have come, all our debt has fallen or risen, our weight has gone up and down, our kids get a failing grade in school, our lover breaks our heart, our cars break down... it always ends the same: none of us get out alive. So why not just sit back and enjoy the ride?

I have worked as a psychologist, providing psychological evaluations prior to bariatric weight loss surgery for the past eight years. For the most part, people need a power tool to help them lose and keep off the weight they have lost over and over again in their lives. The gastric sleeve, bypass, and now balloon are those tools. However, every once in a while, I will encounter someone who believes these procedures are the magic bullet. I can pick this up in five seconds when I learn that: this person has no exercise plan to maintain their weight loss a barrage of excuses as to why they can't exercise anymore zero insight into why they are overweight ("I don't know why I am overweight, I just eat steamed vegetables and grilled chicken mostly.") a lack of motivation or understanding for why they also have to engage in behavioral modification in addition to the surgery "Why would you reveal all of this?" you ask. Aren't I giving away the keys to the kingdom to anyone who reads this and wants to pass a psychological evaluation? Perhaps- but who are you really cheating if you don't go within and face the real demons that got you here in the first place? When I ask people about their eating styles, I tend to group them into four categories: 1) emotional eater- someone who uses food when they are bored, stressed, tired, lonely, sad, or even happy in addition to eating when they are hungry 2) skip and binger- someone who fails to think about food until it is too late, and when they are ravenous end up going for whatever is available which is usually some type of carb and calorie laden fast food 3) miscellaneous- someone who just recognizes that they eat too large of portion sizes and/or the wrong types of food 4) food addict- usually someone with a history of other addictions, trauma, and a significant amount of weight to lose. They usually have comorbid psychological diagnoses that have been unaddressed or ill-addressed. Out of the four categories, the 4th is the most troubling for a psychologist. This particular person is most correlated with the patient who fails to address their core issues, eats "around the sleeve," or bypass, experiences dumping syndrome, comes back a year later and asks for the bypass, or a different procedure. This is the person who, ironically, is usually the most resistant to my recommendation that they seek therapeutic support prior to the surgery. They want it done YESTERDAY. They want it NOW. It is this type of thinking that got them into trouble in the first place. The impulsivity and lack of emotional regulation. I've witnessed people fail to address their maladaptive eating patterns and never quite get to their goal weight. I had a male that would buy a bag of pepperonis at the grocery store and snack on them all day and couldn't understand why he wasn't losing weight. This daily "snack," which was a mental security blanket, served as a veritable IV drip of fat and calories throughout the day. I've had a woman who figured out how to ground up her favorite foods into a liquid form because she never quite let go of her attachment to "comfort foods." One of her most notable liquid concoctions consisted of chicken and Cheetos. I'll just leave that for you to chew...er swallow. They say with drug and alcohol recovery- you "slay the dragon," but with food addiction recovery, you have to take it for a walk three times a day. If you don't fundamentally shift your relationship with this dragon, you're going to get burnt when you are walking it. My number one tip for transforming your relationship with food is to start looking at eating the same way you do as brushing and flossing: You don't necessarily salivate at the idea of what type of toothpaste you will use, where you will do it, who you will do it with, right? You just do it twice a day because you don't want to lose your teeth and you want to maintain healthy gums. Food has to be thought of in the same way. You fuel up. You don't use food as a place to define your quality of life. You don't use food to celebrate. You don't use food to demarcate the end of a long day. You don't use food to help you feel less alone. You figure out healthier coping alternatives to meet these needs. Loneliness-call a friend for support Celebrate- get a massage Demarcate the end of a long day- start a tea ritual and use essential oils Another reason you must say goodbye to comfort food is that it triggers the pleasure center of the brain, which ignites our dopamine, which perpetuates the addiction. Many people think we are just telling them to get rid of the comfort food because of the carbs or calories, but there are unique and harmful chemical consequences to ingesting these types of food we know are bad for us. If you are ready to take a modern approach to weight loss and stop dieting for good- check out my wls/vsg psychological support course here for free.

With the New Year comes the New Year Resolutions. For many people, one of the largest resolutions is a change in lifestyle - that includes losing weight! I remember my resolution in 2012 was to lose weight and get healthy. And I was able to do that with the help of the vertical sleeve. 2015 is going to hold that for many people and thousands of people undergo weight loss surgery to help them achieve their healthy goals for the new year. For those of you that are just thinking about surgery, I want to encourage you to know that you are not alone! You have a wealth of resources at your fingertips. I wanted to take a moment to share with you some amazing resources that you may find helpful on your journey! Websites BariatricPal.com Of course, BariatricPal is one of the very best websites to find information and support. Here there are “rooms” geared for each surgery as well as pages for recipes, articles, and much more. You will find information on everything you might want to know from before surgery to years after. I suggest checking out the Before/After pages for a good dose of motivation and inspiration! 7BitesShow.com 7 Bites is the first cooking series on YouTube geared specifically toward the bariatric community. The website has videos, recipes and blog posts. weightlosssurgerychannel.com Weight Loss Surgery Channel has a collection of videos on everything WLS related weather it be health, food and recipes, and more. BariatricFoodie The Bariatric Foodie has some great recipes for those that still love food, but want to stay on track TheWorldAccordingToEggface Eggface is one of the most popular of the bariatric cooking blogs. You will find great recipes, blog posts and giveaways on her blog. BariatricCookery.com This is a great resource page for everything from recipes to products. Books The “Big Book” series by Alex Breacher and Natalie Stein. There are four books in the series and all are great reads. They have a wealth of information on everything you need to know before, during and after surgery. The very best thing about these books is that they include personal stories from people that have been there. Breaking The Chains: A Guide To Bariatric Surgery by Jennifer DeMoss and Suzette Munson. The ladies of 7Bites pull from their and others’ experiences with weight loss surgery to provide a simplified, but comprehensive guide. Information on everything from how to pick your surgery and doctor to how to survive the first two weeks after surgery are included. The Sleeved Life by Pennie Nicola. This book tells about Pennie’s experience with the Vertical Sleeve procedure and discusses the ins and outs of the surgery from start to finish. Weight Loss Surgery For Dummies. The everything you ever wanted to know and then some guide to all things weight loss surgery. Many, MANY doctors and nurses recommend this book to their patients. Another great resource not listed here is your local bariatric support group! If you haven’t found one yet, contact your Surgery Center of Excellence or your nutritionist, they should be able to give you a good idea of one or two in your area. Or you can check out the list here on Bariatric Pal - it’s a very comprehensive list of support groups around the world!

I often times get asked what is the biggest piece of advice I could give someone for surviving their hospital stay. For me the answer is a hands down no brainer. CONTROL YOUR PAIN MEDS! Nurses and hospital staff will be in and out to see you, but you need to realize that each nurse probably has four to six other patients all vying for attention. It is your responsibility to take your pain management into your own hands. You do not want to mess around when it comes to managing your pain! If you are in pain you will be unable to get up and walk. The longer you take to begin walking the greater your risk of complication and the longer your hospital stay. In this case DO NOT BE A TOUGH GUY! Wuss out and take the meds. You will be constantly asked during you hospital stay what your pain level is. It will be on a scale of 1 to 10 with 1 being no pain at all and 10 being the worst pain you have ever felt in your life. Be sure to answer honestly. DO NOT TRY TO BE MACHO! 3 to 5 on this scale is considered pain, but tolerable. If you drop below a 3 many doctors will begin reducing pain medication. Above 5 and they may begin increasing. The doctors and nurses want you in the blissful middle zone of 4 to 5. It should feel as though you have a bad muscle pull in your stomach, but no sharp or stabbing pain on a continual basis. Your pain post-surgery will most likely be controlled in one of a two ways. The first is with a gloriously blissful device known as a PCA pump. This is a machine in which a syringe of Morphine or Fentanyl (depending on what your doctor and a hospital pharmacist deem to be appropriate) is placed to be administered to you at the push of a button. The best part is that you have control of the button! The machine can be set to allow you to administer the dose yourself every so many minutes; usually half an hour. The other way your pain will be managed is with an injection of morphine or fentanyl? This is pretty straight forward and don’t worry if you are scared of needles. This pain candy is injected into your IV. Once you get past the injections or PCA pumps, usually once they take out your IV, you will most likely be weaned onto an oral pain medication of some kind. Many surgeons prefer Percocet for this application, but you may also be given an oral morphine. There is really no major difference between these in terms of effectiveness though there are other consideration that your doctor and a hospital pharmacist will use in consideration of which to give you. It will be your job in the hospital to stay on top of when you get your pain medications. Here is what you need to know from an insider. I work as a pharmacy technician in a hospital so I am familiar with the workarounds. Here is the rule of thumb. The PCA pump will be available to you at your discretion and will most likely be hooked up before you wake up from surgery or shortly after, but injectables last about two hours and the oral liquid lasts about four. That is a very short window and you need to be sure to talk with your nurses and find out how long each medication is good for. I made it a point to let my nurse know half an hour before each medication was due. This will allow them plenty of time to get your medication to you before time runs out. If the medication is not stocked on the floor then it will be delivered from the pharmacy and will take time. You want to give your nurse plenty of time to make this happen. Your nurse will not always remember when your pain meds are due so it will be your job to remind them. Remember, they have five other six people all needed medicines and all needing extra special attention so it is possible that you could be forgotten if you do not speak up. I am positive some nurses found me annoying, but other said they really appreciated the fact I was trying to stay so consistent with things and remind them. They key here is to be very nice and just let them know you are trying to stay on top of things since you know how the pharmacy works. Nurse’s love blaming the pharmacy for delays and they will love you for not blaming them. Far too many people do. Running out of pain medication is a lot like falling off a cliff. You go down fast and it takes a while to climb back on top of it. So do yourself a favor and make sure you understand how long your pain medication will last and what types you are on. Make it a point with one of your final doctors’ visits prior to surgery to discuss what their plan for pain management will be and specifically which drugs he likes to use and why. With this in particular and your weight loss journey in general, KNOWLEDGE IS POWER! The power to finally begin taking control of your life. That is what this amazing journey is all about. This will be a great way to practice in the hospital before you get home and the real work begins!