HeatherS.

What's a TMI post you (might) be asking.  It's a post about those things I'm finding a part of VSG life that people don't talk about in polite company or usually admit to in any company, but that I really wanted to know about before getting myself into this! (Don't worry, still no regrets). So if you are polite company or do not want to hear about blood, bodily functions, and the vagaries of animal existence, you might want to skip this one. 
To those of you who are still with me, this edition will cover Underwear woes, scabs, itches, surgical leftovers, bowel movements, vomiting, periods, and a special surprise guest appearance by Yeast.
 
Underwear woes:
Your surgeon will tell you not to bother buying new clothes, because you'll only wear them a couple of times before they no longer fit.  
Your surgeon will not warn you that your boobs will soon be falling out of the bottom of your bra, and your oversized underwear will twist in new and exciting ways on your body. 
As a woman, I can honestly say I have never needed to "adjust myself" so many times in a day as I have since surgery.  I started out wearing size 10/Torrid size 1/2 underwear that were all either snug (the 10s) or fit perfectly (Torrid, of course).  Now, they're all a nightmare of chafing, twisting, falling down, and creeping up my butt. 
I would seriously recommend considering the purchase of an inexpensive package of underwear every few weeks or so.  
 
Scabs, itches, and surgical leftovers: 
Let's put all of the skin stuff together.  
We'll start with itching, since it has been a constant since surgery. There are two types of itching, though.  There's a deep, crazy, going-insane itch that happens inside with the healing tissues.  I hate that one.  That seems to have faded around week 3.  The other itch has been ongoing and is stopped only by Eucerin for eczema lotion. It's a combination of healing and difficulty fully hydrating. 
When I came home from the hospital, all of my incisions were covered in purple surgical glue with the instruction to shower carefully and avoid getting "much" water on them for "long."  I followed this to the letter, and when I saw Dr. Zane again for the 10 day follow up, he was surprised the glue was all there, and he said go ahead and peel it off.  
This is where the blood comes in.  The incision above my belly button had glue that had lifted by a good centimeter, so I figured I'd go with his advice.  I got half way across when, blood! I stopped there, and was seeping blood for the next 12-16 hours, and now, two and a half weeks later, that incision is a bit deeper and more tender than the others. That also happens to be the incision with a stitch in it.  The stitch is still there almost a month later, and it is black with blood I can't get out of the knot.  I may just be slow to dissolve the last part, though a week ago, a 1" piece of filament poked out of my skin next to it and slid out when I scratched at it.  No pain for that one, just "weird." 
As tempting as it is to peel after approval, go slow, and if there's any tenderness,  maybe wait.  The others that I peeled the last of the glue off of were no longer tender and looked sealed underneath, and that's what I found.  The only raised scar I seem to be developing is the bigger scar where my stomach was pulled out to the left of the belly button.  That one is raised on the edges where it was (I assume) stretched during removal. 
Other surgical leftovers not to stress over: 
I came home with iodine on my sides, no big deal, but a bit itchy.  It looks like they washed the area where surgery actually happened (good to know!). 
I found serious gunk in my belly button once everything was un-swollen and de-tenderized enough for a thorough wash in there. I can only describe it as goo. I do not know what it was, but it didn't do me any harm, and I assume it was from the surgery, since I've never seen anything like that in there before. There was a lot of it, though!  
I also had a big bruise on my tailbone along with a painful abraded area about 2" long and 1" wide.  Silly me, I put an antibiotic ointment on the rash.  DO NOT DO THIS.  I woke up the next morning to pustules all along the abraded area.  The doctor I saw for that diagnosed it as a reaction to the ointment, and said to just use petroleum jelly or a steroid cream because (something something - sorry) antibiotic ointments can cause reactions after all those IV antibiotics of another type. 
 Following those instructions, the area cleared up within a week after shedding the entire top layer of skin. 
I found out from my surgeon's office that the bruising is because they sit you up during surgery.  Mystery solved. 
 
Bowel movements: 
I had to gird myself for this one, since I'm not really the type who usually talks about bathroom habits in public, but if this helps one person not feel so weird or at least feel better knowing what to potentially expect, it's worth it. 
Bowel movements since surgery have been consistently weird.  The first was about three days after surgery (which they say is good), and very very little actually came out of me in a thin, strangely orange, stream.  In spite of how little there was, I still felt the same cue from my body as I did pre-surgery that it's time to find solitude and a toilet. 
Since then, BMs have been increasing slowly in bulk, but they remain orange, soft-to-runny, and low-velocity enough that as soon as I feel that cue, I'm also planning a shower.  Aside from week 3, in which velocity was so slow, I spent all day close to the house, it hasn't been awful. 
It's not fun, but it's also not often.  Once a week or so at a month out from surgery. 
I should also mention that it's one of the things that can cause that "my heart is racing" feeling, because there's an enormous blood vessel that runs right next to your sphincter. I may only notice it so much because BMs are no longer a daily occurrence.  As far as I understand it, the phenomenon is harmless; drink more water. 
I'll also add that urinating is fairly normal, though for the first week after surgery (or longer if you're slow to clear anaesthesia) prepare for some stop/start and give yourself a little more time. 
 
Vomiting: 
There has been more vomiting than I'm accustomed to after surgery, and I've pinpointed a few things that tend to cause it and others that don't. 
Triggers: 
Vitamins, unless buffered with a lot of food, are coming right back up.  Even the ones I don't need in chewable form.  I'm looking into the vitamin patches for this reason.  Even before surgery, my stomach has been iffy with multis and B vitamins.  Juice without water.  Even a tiny sip.  Too cold water on an empty stomach  Water without additive (I had a serious case of water nausea which is starting to resolve just this week)  Stress (I had to ask my family to please not talk about anything remotely stressful around meal times)  Not a trigger: 
Fat  Protein Carbohydrates  Fruit  Dairy  Physical activity  I do find that sometimes I need to lie down after a meal or taking medicine until the nausea goes away.  Lying on my side seems to help. 
 
Periods: 
Depending on your rate of recovery and when it falls, prepare to be more exhausted than ever on your period.  That hit me hard.  Otherwise, totally normal.
 
Yeast:
I found out at my 10 day checkup that I had a mighty yeast overgrowth on my tongue from the IV antibiotics. I was first prescribed the slimiest mouthwash in the world (which belongs on my vomiting triggers list, probably), then 5x/day tablets to suck on which left my tongue raw and painful but tasted like nothing at all, and finally a single pill, take it once and you're done oral treatment. (Why not that one first? I don't get it!) 
It's almost gone now at 4 weeks out, but while it was active, the entire back 2/3 of my tongue were slimy and thick, and a lot of foods tasted very strange.  
So, keep an eye out for that. 
 
This concludes the first month TMI post. I expect any future posts to be shorter.  My top recommendations really are to watch out for yeast and make sure you always carry Eucerin (or similar thick lotion for SUPER dry skin that works for you). 

The first month diet of soft foods has been smooth.  Make sure you're following your doctor's plan, not my doctor's plan, because each plan is unique to our situations, including anything your doctor found or did during or before your surgery.   It's also important to note that I am not diabetic and I do not have any signs of insulin resistance, before or after surgery, so my body has a healthy relationship with all of the food groups.
Here's last night's family dinner, all made from scratch with my meal front and center and my wife's delectable tostada on the far right. I eat vicariously through others and cannot wait to be allowed something crunchy again.  I miss crunch, but I know I'll be allowed to crunch again soon. Oh, how I pine for a sturdy lettuce leaf!   

Homemade refritos, a little bit of spiced ground beef, requeson, crema con sal (a type of sour cream), and two tomato salsas, one very mild and fresh and the other hot and cooked. 
SW: 275
CW: 244 
So, a month out, I'm on "soft foods" which my doctor defines as foods that are soft BEFORE you put them in your mouth and that anything hard to digest like solid meats and veg needs to be taken down to more of an apple sauce/fine mince consistency.  I've been on this regimen since my 10 day follow up and will continue until my 6 week follow up in two weeks. There was no intermittent "mushy" stage for me.  
I try to eat before I take my pills with very small sips of water.  Pills taken on an empty stomach may come up. 
I'm eating 3-4 T at meals that go well for me (that is, no stress, which makes eating any more impossible and leaves me sick for an hour or two). I tend around 30-40g protein a day from a variety of sources: lactaid milk, yogurts, cheeses, finely ground beef, beans, meatballs cooked in soup, soft tofu, and egg. I do not avoid carbohydrates, as I feel better when I eat a balanced diet. I eat 5-6 very small meals a day (some as small as a tablespoon of yogurt or a small skim string cheese).  I often add nutritional yeast to savory foods to increase protein and B-12. 
My carbohydrate intake tends to be slow-burning low glycemic index (oatmeal, berry, beans combined with high protein rice, fresh apple sauce with no additives, a bit of high protein pancake...)   The exception is that I do occasionally eat some white rice, always combined with a protein, and I have had no crash and burn. I have also had ice cream and sorbet in very reasonable amounts that fit within my plan with no ill effects or delay in weight loss.  
With the restriction I've felt from my sleeve, I average 350 calories a day with my highest day just under 500 and my lowest day 0.  I registered my greatest weight loss after the 500 calorie day and felt my best, so I'm working up to that as a second month goal.
Here's what I won't be eating again for a while due to nausea and/or vomiting: Full fat dairy, lentils, ginger (go figure!), oral B vitamin, whey protein 
Here's what I won't be consuming again for a while ever due to migraine strong enough to punch through the botox*: Aspartame, sucralose  
Here's what I won't be eating again for a while due to changes in taste: Ginger, cheddar cheese, V8, melon (with the exception of watermelon) 
I haven't felt the kind of "hey, I'm kinda hungry" hunger I felt before surgery since then, but If I skip a meal or two, my stomach will gurgle, and if I've missed 3 or more meals, I tend to feel a bit dizzy, headachey, exhausted, and/or fuzzy-headed.  Fair enough.  If I don't eat a balanced diet (for me: too much protein or fat), I feel generally unwell, but I can power through.  
No dumping syndrome or anything related.  Just lots and lots of water nausea that leaves me out of action for an hour or two when it hits.  I've also had a couple of bouts of stress tummy which results in worse nausea, a fever, and, strangely, intolerance to light, so maybe migraine, too.  It lasts about an hour.  I've always had a stomach sensitive to stress, but the surgery has made that worse.  
Oh, and the best reason not to cheat?  That's down to my doctor.  who cheerfully told me all about some of his patients who had advanced too soon or cheated (fits through a straw on full liquid does NOT mean fits through a boba straw) and did rupture the staple line. It's fragile while it's healing the first month or so, especially.  Will it happen to everyone? No.  But it COULD happen to you.  And then you spend a miserable (up to a) year in the hospital being operated on, in pain, possibly dying, and guaranteed not eating those tasty things you thought were ok just a little early and felt fine at the time.
Was it tall tale hyperbole to keep me on the straight and narrow.  Mmmmmmnnnnnnnpossibly.  But I know he wasn't joking, and I'd rather not risk it.  Would you?  
And last, but not least, here's a random picture of my dog discovering Bones Are A Thing That Exists In The World and elevating, on the spot, to a higher level of doggy existence: 
 

 
 
*I have incapacitating migraines that have been unsuccessfully controlled with medications.  Botox was the next step, and it's working great as long as I avoid my worst triggers. (Bright sun, aspartame, sucralose, non-natural cleaning products)  10/10 would recommend. 

While shuffling down a longevity rabbit hole on PubMed, I found a fascinating recent study in the area of calorie restriction and longevity.  What I wasn't expecting was its findings on low protein, high carbohydrate diets. 
The study found, amongst other things, that low protein, high carbohydrate (20% fat) was associated with the greatest longevity and best overall metabolic health in spite of a tendency to weight gain as fat. The improvement was equal to caloric restriction alone, and combining the two had no additional metabolic benefits (LPHC also tended to expend the most energy)
The version of the experiment where LPHC was combined with CR had the same longevity, but also avoided the increase in body mass from the high carbohydrate Intake. They also had the best immune systems
The low carbohydrate, high protein group were found to have reduced longevity and poorer cardiovascular and metabolic health, though again, LCHP group with CR fared better than those allowed to eat freely.
The area where LCHP created an advantage was in reproduction. Not in fertility, but in the actual process of reproduction, which makes complete sense.
You can read the whole report here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4472496/
It should be mentioned this study is still one part of decades of research on Calorie Restriction and dietary composition.
From the strong evidence in favor of dietary restriction, we should all be seeing increased life spans (depending on age of intervention, some will be more modest than others).
But I wonder how the evidence building up for HCLP can be applied to us.
HCLP emphasizes low glycemic index carb sources and 5-15% protein intake, but at our level of consumption 600-1000 calories a day in maintenance depending on your needs), that would only be 12.5-37.5g protein which seems like it would result in a deficiency. The famous Okinawan Ratio is on the low end of that, though people studied consumed about twice the calories (if I remember right, and I might not) which is still only 25g protein/day.
And yet, I'm not seeing any of these deficiencies in the literature. No deficiencies in the Okinawans either. 
Curiouser and curiouser.
What do you think? What did this study make you wonder? 

Things seem to be progressing and moving along, yet the surgery date feels so far away. Since my last entry I've completed my psychiatric evaluation, home sleep apnea link, had my monthly appointments, and attended a support group at my surgery center. 
I'm really disappointed with my psychiatric evaluation, as the doctor recommended I return for therapy prior to surgery to address potential binge eating behaviors. I was honest on all of the material of course, but I did not see myself as someone who has an issue with binge eating. Hopefully, one visit will cut it and I'll be cleared. 
My home sleep apnea link study went just as I had expected and I've been recommended for a full sleep study. This is something I look forward to doing, as I have long suffered through sleep issues and look forward to being helped in that department.
My monthly visits have gone as expected and I've lost weight sticking to my goals each month. I have a lot of pride that I do not indulge in Starbucks Mocha Lattes every single morning and only reserve them for a once a month treat.
The support group was also helpful and I was able to glean some useful information. The topic of the group was inspirational stories and a panel of 6 people who had surgery gave their stories on their surgeries. It truly was inspiring and reaffirmed that I made the right choice to have the sleeve rather than the gastric bypass.
I have also scheduled my appointment with my PCP to get my weight history and a letter of medical necessity. I am content with where I am on my journey in all areas aside from the minor hiccup of the psychiatric evaluation and further therapy.  

I have jumped through all of the hoops that were laid out by my insurance company.  My surgeon's office submitted my information for insurance approval yesterday.  Now, it's time to sit and wait.  Except, I am not the "sit and wait" type.  I shall prepare to divide and conquer.  
List making has begun:
Items to pack for the hospital Books to read after surgery Movies/TV shows added to my Netflix queue Additional questions for my surgeon at my final pre-op appointment Food ideas for the full-liquid stage (which lasts for 5 weeks post-op!) I have also decided to implement life-long lifestyle changes now, rather than later.  Per my nutritionist, adults can only handle 2-3 major changes at once, so I figure I by starting now, I am setting myself up for success.  Some of these changes I will be working on over the next several weeks are:
Eliminate caffeine Eliminate refined sugars Have several smaller meals throughout the day Chew food more thoroughly Eat slowly No liquids with meals No straws No gum Find replacement activities for when head hunger or the urge to boredom eat kicks in Start walking more Additionally, I have started the process of cleaning out my pantry and freezer, getting rid of any food items that are not in line with my new lifestyle.  If it is something I shouldn't consume after surgery, I certainly do not need it now.  I am not one to waste food, however, I do not want to "waste" my health any further and these items will be removed from my home.  Anything that can go to the food pantry, will.
Lastly, I have begun taste testing various protein shakes and "clear liquids" for those stages after surgery.  I plan to use my blog as a place to post my reviews for me to revisit when the time comes.  
Here goes nothing.  Or everything.

While shuffling down a longevity rabbit hole on PubMed, I found a fascinating recent study in the area of calorie restriction and longevity.  What I wasn't expecting was its findings on low protein, high carbohydrate diets. 
The study found, amongst other things, that low protein, high carbohydrate (20% fat) was associated with the greatest longevity and best overall metabolic health in spite of a tendency to weight gain as fat. The improvement was equal to caloric restriction alone, and combining the two had no additional metabolic benefits (LPHC also tended to expend the most energy)
The version of the experiment where LPHC was combined with CR had the same longevity, but also avoided the increase in body mass from the high carbohydrate Intake. They also had the best immune systems
The low carbohydrate, high protein group were found to have reduced longevity and poorer cardiovascular and metabolic health, though again, LCHP group with CR fared better than those allowed to eat freely.
The area where LCHP created an advantage was in reproduction. Not in fertility, but in the actual process of reproduction, which makes complete sense.
You can read the whole report here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4472496/
It should be mentioned this study is still one part of decades of research on Calorie Restriction and dietary composition.
From the strong evidence in favor of dietary restriction, we should all be seeing increased life spans (depending on age of intervention, some will be more modest than others).
But I wonder how the evidence building up for HCLP can be applied to us.
HCLP emphasizes low glycemic index carb sources and 5-15% protein intake, but at our level of consumption 600-1000 calories a day in maintenance depending on your needs), that would only be 12.5-37.5g protein which seems like it would result in a deficiency. The famous Okinawan Ratio is on the low end of that, though people studied consumed about twice the calories (if I remember right, and I might not) which is still only 25g protein/day.
And yet, I'm not seeing any of these deficiencies in the literature. No deficiencies in the Okinawans either. 
Curiouser and curiouser.
What do you think? What did this study make you wonder? 

have my second pre-op appointment with my surgeon.  I have read, researched, and spoken to many people that have had this surgery.   I am working hard on staying positive and having realistic expectations.  I have not been worried about complications at all, until today.  I know these negative thoughts are normal.  My strategy is to push them aside and focus on all the benefits this surgery will bring.  In the past few days, arthritis in my hips has been acting up due to the weather changes.  I know that carrying all this extra weight does not help.  
My son is graduating from High School 9 days after my surgery.  My first goal is to be there for him.  It did suck that the dress that I bought for the graduation would not fit. My hope is that it fits by the time of the graduation. This is exactly why I am having this surgery, to be there for my family.  I am not so focused on a weight goal,  more on being healthy. 

I can't believe it's the day before surgery! Six months has flown by. As of this morning (according to my scale) I am at 262. Today is clear liquid only and if I thought the past week of two protein shakes and one meal was hard and I was hungry all day...I woke up hungry and can't eat anything for the next two weeks or more depending on when my followup appointment is. Ugh. At least after tomorrow morning it shouldn't be too bad from what I've heard since my tummy will be so much smaller. I hope everyone's right. LOL! I'm just looking forward to more energy. That is the biggest thing because for the last week I have had zero energy. Anyway, short entry for now. Talk to you laters!