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Two years post-op: the good and bad about life with a gastric sleeve

Two years ago this month, I had most of my stomach surgically removed. In hindsight, that was the easiest part of the last three years’ journey of weight loss and maintenance.

The surgery was, if not the best, then one of the best, decisions of my life, not only for my physical health but my mental well-being, too.

By that, I don’t mean it’s been a huge success or a carefree, easy path. It’s actually been a kind of personal hell. I think about my weight more than I ever have, but now largely through the lens of fear: fear of gaining weight back and watching some come back on seemingly by itself. More on that in a bit.

It’s not a lens I’d wholesale recommend for everyone. Fear is no way to live your life. But I don’t regret–in the least–the decision to have the surgery. I’d highly recommend others consider it.

I have gained a perspective of diet, food and exercise I never could have had before, and it’s both interesting and instructional. It’s been a great experience overall.

I exercise a lot more than I ever have. I run when I can. Ok, trot. I do elliptical. Between those things, I hit a goal of 365 miles in 2014, more than I could have ever imagined at my peak of 362 lbs. I try to lift weights a little. I still can’t do a pullup, but I’m getting there. I can hike faster, further, carrying more gear on my back, than ever.

I did my first mud obstacle run this spring, and it was great. As I was at the top of one particular obstacle, a rope ladder-like structure, I realized that I literally couldn’t have done it pre-surgery. And if I had tried, well, it would have been even more unattractive than it already was.

I’ve determined that exercise, while wonderful, therapeutic and amazing for your health, is not enough. In general, you typically can’t exercise your way out of obesity.

I eat less than I used to. While the physical restrictions imposed on me by my surgery have lessened over time, I simply am not able to eat like I once could. I get full fairly easily, more from dense protein than crappy carbs, which, unfortunately, I can seemingly eat a lot of. I get in about 1,700-2,000 calories in a day, tracked as best I can. I try to live a small-portion, high-protein diet and stay in that calorie range. Some days are better than others. Some days are bad.

I’ve determined that calorie-counting is huge, but not enough, to escape obesity. I’ve determined that I seem to be increasingly susceptible to gaining weight after eating crappy carbs. I seem to be able to eat protein, even fatty protein, without the same gain. Despite what I read and am told sometimes, it seems like a calorie is not really a calorie to my body. My doctor, if not confirmed this, hinted at it during my two-year checkup.

I’ve determined that tracking what you eat is a major factor in battling obesity. We eat so much, so often, so mindlessly, in so many places, that it still shocks me. Servings at restaurants shock me. I am a judge on what other people eat, although I have no right to be.

I’m almost never physically hungry. My surgery removed the part of my stomach that controls a lot of the hormones that regulate hunger and satiation. Or so they say. Could be a placebo effect, but I think there’s something to it. I’m rarely physically hungry. Not when I wake up, not when I skip a meal, not on low calorie days. It’s kind of weird.

My stomach itself, cause of so much discomfort and GI unpleasantness before the surgery, is fairly stable today. I’m not saying I’m normal or regular or whatever the right word is, but the old me never quite knew what to expect from the ol’ plumbing on any given day. Things are fine now. That may be the biggest side benefit to the surgery for me aside from the weight loss itself. If anything, I remain constipated.

I’ve determined that hormones and gut biology must play a massive role in weight gain, loss and maintenance.

I’m emotionally hungry a lot. Forty+ years of conditioning to turn to food for comfort, companionship and balm doesn’t go away overnight, if ever.

The emotional feelings are easier to squash, because I can reconcile them with the notion that I’m probably not really hungry. But they’re always there. Every day. Throughout the day. The monkey is always on my back. The only easy day was yesterday.

I’m still getting used to my new body. My legs now seem crazily muscled to me; I think they look like ham shanks. My upper body…not so much. I have excess skin and a lot of it. I have my man boobs still. I get cold easily. But I can do stuff faster, stronger and longer than ever before. I’m probably in the best shape of my life.

I’m both down a lot of pounds and up a lot of pounds, depending on how you look at it. Down 110 from my all-time high and 49 from the day I was cut. Up 43 from my post-surgery low and up 20 from where I want to be. I’m 17 lbs above what my goal was for pre-surgery life, and that’s frustrating. Trends on the scale haven’t been in my favor for a year; on average, I gained weight 11 of the 12 months in 2014 and 15 of the 17 months since my low. I was up to 258 at one point, but am at 252 today.

Oddly enough, the pants, jeans and shirts I bought at my post-surgery low of 209 still fit at 252. I have gone from a size 56 jean in 1999 to a tight 36 today (gotta wear your jeans a little tight, right?). I wear a 38 dress pant still, which was a pre-surgery goal. Neck size went from an 18 1/2 to a 16 1/2 today. I’m still able to easily wear clothes I wore in college. My weight gain must be distributed oddly somehow.  I can feel my legs tighter in my pants legs, but if I can still button a 38 dress pant, by God, I’m a 38.

People don’t comment on my weight loss anymore. That is, on balance, a good thing. A few close friends have commented on the weight gain. That’s good, actually…keeps me aware. I’m surrounded at work by all-new people who didn’t know me pre-surgery and I believe all they think is that I run and eat small lunches. Fine by me. In the first year post-surgery, I got a lot of comments and a lot of attention. It’s nice but it’s unsettling, to a degree. People would pay attention to me who wouldn’t before. It’s actually more routine now. Occasionally, I’ll come across an old friend or a business contact who goes on and on, but it’s limited.

I no longer get the inquiries about what I can eat, or get the side comments about others’ thoughts on how I lost the weight. I start to wonder if the lack of comments means people see the gain and think I’m a failure. It’s a perpetual mind game.

So, two years out, with 50 or so more years to go for me, life is normal…and anything but. The decision to remove most of my stomach was one made after a decade of off-again, on-again weight yo-yoing, and if there was any perception that surgery was an “easy” path to keep it off, it’s long gone. But the health and mental benefits so far have justified the decision, and while it’s difficult, each and every single day, it’s also been a journey worth taking.

Mistakes, Recovery and the Big Picture

One of my favorite e-cards is this one:

everything-happens-for-a-reason1

It’s been on my mind a lot lately, as money, health, friends’ health, family, life, work, home, etc. has hit a kind of suckiness factor of something close to ten-out-of-ten. Too much going on to even list, but it’s a combination of things, some of which are completely out of my control; most of which I have some ability to shape or cause; and several of which I brought on myself. My choices on health are a prime category of the latter, and, of course, “Everything happens for a reason.”

Also, of course, like everything else, the health situation isn’t floating out there in isolation. It’s all connected; work’s been stressful lately, with a lot of long hours and days and tough deadlines. I was also informed two weeks ago that my request to interview for a promotion at work was not being advanced, which leads to additional stress about the future, which leads to turning to coping strategies for stress that I’d developed over four decades, which leads to slacking off on the exercise, which leads to weight gain, which leads to stress, which leads to making dumb mistakes on projects and well, you get the idea. Sort of an endless vicious feedback loop. Now mix in the other factors at the same time and it leaves you wondering which way is up, which is down, and which is the way forward.

And that road typically has some brand-new boxes of cookies along the path.

Or if cookies aren’t your thing, the road gives you plenty of other things to drag you off and out.

Everything happens for a reason, right?

So, I was stupid and made bad health decisions, and I paid the price at today’s weigh-in. I would say it was shocking, but it couldn’t have been. While I’ve made great progress in my 365-miles-in-365-days workout challenge, the past week has seen precisely zero work on the elliptical (and it’s still too stupidly cold and snowy to run outside, and god, I want to). Went for a nice walk in the woods last week, but that only gets you so far on the cardio scale.

I love getting e-mails from this blog or my videos. So many people write (too many to respond to, increasingly, it seems!), I love hearing from all of them, but I wish they’d stop saying, “You’re such an inspiration.” Because, you know what? The bottom line is I’m weak. We all are.

Today was the first day in weeks I’d been in my daily calorie range, and as soon as this is published I’m heading downstairs to work out. And that’s basically the point here. You are human. You make mistakes. The surgery, or the lifestyle, are there for you to use, but there’s nothing forcing you to use them. If you’re stupid and make bad decisions, things will happen. For a reason. The best you can do is pick yourself up, pick up those who went down with you (see: “cookies, buying a lot of”) and move on. You can’t erase the past; you can only learn from it. And it’s not a given that you’ll be stronger and better in the future. Nothing is free.

And, guess what? You’ll fuck up something in the future too. You. Are. Human. Doesn’t defend your bad or unhealthy decisions, but this sure would be easier if you were a robot. You’re not. You’ve got feelings, emotions, and a ball of grey matter that seemingly exists to mess with you. You can’t apologize for any of that, by itself. You can only apologize to yourself and others for what you do with it. We all got to this spot in life–RIGHT HERE, RIGHT NOW–because of emotions, because of family, because of the society around us, because of the issues we struggle with. They define us, they define the fight and, in a perverse way, they define the way out. You just hope you find that way out in a way that’s healthy for you and those around you.

The only easy day was yesterday. The only day that can be better is tomorrow. Put down the cookie and give yourself (and everyone struggling, which is everyone) the respect you all deserve. This too shall pass.

Are You Not Entertained?

I don’t know Rachel Frederickson. I don’t watch The Biggest Loser. I barely know the concept of the show. But I’m struck by the media coverage at Frederickson’s big reveal of her journey, which took her from  260 lbs. to 105 lbs. The dramatic loss generally seems to have prompted the common question, “Has she lost too much weight?”

My only possible answer to this question can be, “And who the fuck are you to ask?”

One of my favorite movie lines is from Gladiator, when Russell Crowe’s character slews an arena of gladiators and then hurls his bloody sword into the stands at the still-cheering crowds.

“ARE YOU NOT ENTERTAINED?,” he bellows. And then again, “ARE YOU NOT ENTERTAINED?”

I don’t understand Rachel’s desire to go on national television in a quest to lose weight. But in some ways, it’s really just an extension of what I did by sharing my story on Facebook (or here!). It’s just the stakes are higher for her, the comments more widespread, and the exposure so much greater. I am simultaneously disgusted and impressed with her openness on this journey. As someone who has lost that kind of number on my own frame, I get both the desire to be the public center of attention and the deep psychological issues at play with why we got that heavy, why we undergo such radical steps to lose it, and what it takes to lose and keep it off.

I keep coming back to good old Maximus in the arena, though.

Weight is a rich societal blood sport. Too heavy, and you’re judged incapable of self-control. Too light, and you’re judged obsessive. If you’re a man, a little hefty is judged OK. If you’re a woman, a little underweight is judged the sign of a mental disease. It’s torture, and we do it to ourselves. And, frankly, this is a sport only of the affluent, modern culture. Only since food became ubiquitous, and calorie-dense, and marketed as a balm for the soul. If you teleported to the 1800’s, for example, the idea of an entertainment vehicle based on a person’s weight would have seemed unreal…kind of like men fighting other gladiators in an arena, to throw out one connected example.

I’ve seen several photos of Rachel today. In one, her arms are positioned in an extremely unflattering pose, making them look skeletal. The gladiators wore scary helmets and gear to change their appearance. We rely on the media and Photoshop to do it for us. I think I’d prefer the helmets. I’m reminded of the quote from an American soldier in Vietnam, when he said that he feared the news media more than the Vietcong. The Vietcong, after all, could only kill you.

I wish Frederickson a lifetime of health, both physical and mental. I don’t know if she’s too light, too heavy or just right. There’s one person whose opinion matters on that subject, and that’s her. It’s her fight. And trust me, it’s a fight. Every waking minute of every day. Every piece of food she sees, and every time she exercises. There’s always another fight ahead. Another opponent to kill.

The rest of us should stop rewarding the culture that makes shows like this and turns this life-altering journey into a kind of competition. Rachel’s got enough of a fight in her head right now. The crowd deserves to have a bloody sword thrown into its lunch plates for making that fight harder.

One Year Out, and What I Eat

A delayed post, but life’s been busy. So, I’m one year out. Crazy. And now experiencing my first bout with a slight weight gain. I’m up about five from the 215 lbs that I’d been at from July through October, and while I’m telling myself not to freak out, it freaks me out a little bit. I can’t go back, I won’t go back.

Here’s my latest video, and after that, a written response to a common question I get on message boards, e-mails, etc.

So, video first.

Now, one question I get a lot is “So, what can / do you eat?” And the simple answer is pretty much anything, just not a lot.

Some basic stats, because everyone’s diet is different. I’m a very tall (6 foot 6) 43-year-old male. Sedentary during the day, but work out 3-4 times a week, which had been running but now is elliptical for the winter. I should do more free weights, planks, push ups, etc., but I don’t. So, it’s like 90% cardio.

I have been using a baseline of 1,800-2,000 calories net a day, per my nutritionist, who actually tells me I can go up to 2,200 calories a day if I’d like, especially when exercising. It’s not as hard as it sounds (“That’s what she said.”)

Some people have written in amazement that I can eat so much…I’m not sure what to say. I can definitely eat MORE than I could in the first six months or so, but I also do get full fairly easily, which is wonderful, since pre-op, I literally never did.  And believe me, you CAN gain weight eating 2,000 calories a day. I’ve long been a believer that it’s not just calories-in, calories-out that creates weight issues; it’s what you fill that bucket of calories with. At the holidays, with all the shit food, family stress, etc., I did have some things I normally wouldn’t, and paid as a result. Cheap carbs suck.

Anyway, here’s a more-or-less typical day for me. On a typical, “normal” day, I eat what I describe as a small-portion, low-carb diet.

BREAKFAST

I MUST eat breakfast. It’s probably my favorite meal of the day, and I could eat breakfast foods anytime. I love a good, high-protein breakfast. On days when I have some time, I’ll have a single scrambled egg, with a few turkey (or other) sausage links or meat of about 2 oz in size total. I’ll add an ounce or two of cheese on time. I eat so little that I tend not to use low-fat cheese, and I also think it tastes like crap, so I’d rather use 1 or 2 oz of a good sharp cheddar or something.

If I don’t have time to cook, I’ll make a protein shake (rarely), or more likely work on a Greek yogurt with some Fiber One mixed in, and then have a cheese stick.

If there’s fruit, I may have a handful of berries or an orange. I don’t eat as much fruit as I used to. I miss it.

I also drink 2-3 cups of coffee in the AM, typically, and sometimes get a small black Dunkin’ iced, maybe even one of the syrupy flavors.

MORNING SNACK

I don’t always have one, but if I do, it’s typically a Greek yogurt or a cheese stick.

LUNCH

Typically, a chicken sausage, or some turkey wrapped around a cheese stick, with maybe a piece of fruit or with a Greek yogurt. If I’m on the road, I can do a fast-food-ish burger and just have half the bun. That’s pretty unusual.

If I’m eating out, I typically go for a salad with protein on it, or something heavy protein (for example, Indian buffet, just get some chicken tikka without the rice, etc.).

AFTERNOON SNACK

Depending on how I’m doing, I may or may not have an afternoon snack, but it’s usually the same as the morning snack options.

DINNER

I usually come how with 400-700 calories to spare, and here’s where it gets tricky. I try to eat what the rest of my family eats, which can get tricky. We meal-plan out the week on Sunday, and I do the grocery shopping. My ideal dinner is 4 oz of a steak with some vegetables, but the rest of my family eats rolls, pasta, etc. I eat most of my day’s carbs at dinner, typically, but I try not to. Even if they do something like baked ziti, we’ll make a meat sauce and I’ll eat mostly the meat with a little of the pasta.

Anyway, dinner is hard with the family’s various likes and dislikes. I do what I can and try to end the dinner with about 100-200 calories left for a little snack at night.

LATE NIGHT

The witching hour. I’m a night owl, and the 7pm – midnight time slot has always been my weakness. Head hunger, bored hunger, emotional hunger. I try to keep sugar-free popsicles on hand, but that only gets a guy so far. Lately, a guilty craving has been Triscuits with some olive oil drizzled over them, which can get tricky quickly on the calorie count. In my ideal world, I work out and stick to high-protein snacks like fat-free ricotta with some Stevia and almond extract (or cocoa powder and instant coffee…yum). But life’s not ideal. I have had binge-eating issues in the past at night, and surprise-surprise, they haven’t gone away with the surgery. But I think I can control them better. It’s all a head game, people. The monkey is never off our backs.

WATER

Religiously, at least 8 glasses of 8 oz water a day, between meals. If I’m drinking tap at home, I usually add some lime or lemon juice and maybe some Stevia. If it’s work and the Poland Springs bottle, I stick to plain water. But I’m always drinking.

So, that’s a day’s worth of food. It varies a bit, but you get the idea. I have no trouble filling up 1,800-2,200 calories a day!

Nine months out, my first 5K

Not my normal, every-other-month video, but a big day…my first 5K race. A short little update.

Down 150 lbs. from peak, and exercising

Holy crap, I’m a runner. Also, I need to do something about the lighting in my basement.  And maybe trim the eyebrows a bit.

 

Down 150 lbs. from my all-time high in 1999. Down about 90 since the surgery.

 

Video

Six-Month Update

At my low (so far) of 216, and looking at both some mental issues and the struggle to maintain for the rest of my life. But all is well!

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