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VSG and Reflux

Well, aside from not losing much weight, the truly sucky part of my sleeve recovery has begun. As I wrote about the other day, I decided to discontinue taking Prilosec because I didn’t like the long list of issues that can arise with long term use. I was expecting some acid rebound, so I had Pepcid, Tums and Zantac on hand.

I had a couple of days with no acid after I discoed the Prilosec. Then it hit me hard. I beat it back with Zantac and it was mostly OK (pain level 3-4) for a few days. THEN, day before yesterday, the acid started really hurting, like 7-8 with spikes to 9. I took Zantac and Pepcid, but didn’t get much sleep that night. Then yesterday the acid was terrible all day, despite the Zantac. I even took a Prilosec before dinner, to no effect. The pain kept me up most of the night last night. I took a Zantac around midnight when I got up and went to the couch to sit up for a while. I dunno about YOU, but I cannot sleep sitting up. So all together, yesterday I took Zantac, many tums, Prilosec and another Zantac. FINALLY at around 4-5am, the pain eased off and I slept a little. I moved to the bed around 7am and slept until 11am. No pain today, but my stomach feels weird. And I feel like little bitty RAT TURDS.

I took a Zantac this morning and I’ll take another before bed. Hopefully I’ll be able to sleep tonite.

I talked to Amy and she is still having reflux at 7 months. She takes Zantac twice a day and still wakes up with reflux every morning. Which tells me that I’ll probably have reflux for the rest of my life. Great. I never had any issues before VSG.

YES, I have buyers remorse. I have horrible reflux, I can’t eat anything, I can’t drink anything alcoholic (reflux and I can’t get drunk at all) and I’m very depressed that I’ve only lost 17# in TWO MONTHS. Overall, VSG has been mostly negatives for me.

I know intellectually that this is all just the Period Of Suck that everyone goes through, but it just doesn’t matter, I still feel crappy and depressed. Ugh.

I have a theory that the reflux (that is VERY common) with this surgery is partially due to the design of the sleeve itself. Let’s think about this. They make a narrow tube from the esophagus down to a pouch at the bottom. What do tubes do well? THEY SIPHON. I think sleeve patients get reflux because the tube siphons the stomach acid right up to the esophagus and VOILÀ! REFLUX. I hope someone who designs these bariatric surgeries reads this and will rethink the shape of the sleeve. Why not mimic the original shape of the stomach, just smaller?

Anyway, those are my thoughts on the HORRIBLE reflux that I and many other sleeve patients suffer with. Maybe in the future, they can do something about it by changing the shape of the sleeve. All I can say is that Prilosec forever is NOT the answer. Zantac is not much better, but it appears that I’ll have to take something for the foreseeable future. Which makes me SAD.

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Week 6.5 Daily Foods Snapshot

So, I hope to do a video for you tomorrow, but I wanted to give you an idea of the kinds of things I’m eating on a daily basis for an idea of what it’s like after you’ve healed. Also: the videos will now be ONCE A MONTH, starting with July. The next video (besides tomorrow) will be at the END of July/beginning of August. This is to retain my sanity about the weight loss numbers.

Ok, so, daily eating. There is a learning curve, I won’t lie. My serving size is that of a toddler for the most part. I eat protein first, which means that is about all I eat. I ate shrimp ragout the other night which was full of veg and tonite I’m making gyro sausage w/ sauteed greens, but mostly I’m eating just the protein. We typically have baked fish and I can get in about 4oz of that. I find that different foods fill me up in different ways, which has been interesting. I’m also eating salad again, which makes me VERY happy. I’ll have a wee salad for a snack in the afternoon sometimes. Vitamins are SO important, folks. Get a good multivitamin, take tons of B12, take calcium + D and take iron if you run anemic. (I’ve written about vitamins in depth here.)

Alright, here is a typical day for me. I’ll include the protein count and variations just FYI.

8:30-9am
1 cup of coffee w/ creamer and cream (may or may not finish; about 10oz)
2 eggs, either whole scrambled or beaters w/ salsa (10-12 gm) OR 1/2 cup cottage cheese 12 gm
take vitamins and supplements (SEE Prilosec info below.)
1 20 oz Vitamin water that I sip all day (yes, there’s sugar, but there’s also a TON of vitamins)
noonish
4-5 slices of deli meat (usu ham or turkey) 8gm
4 crackers either triscuit (sriracha!!) or Ritz
1 cheese stick, string or cheddar 6gm
afternoon snack 3-4pm
small salad OR
more meat + cheese 14gm
fizzy water zero cals 12 oz
dinner 7ish
Baked fish filet (cod, tilapia, salmon, about 4 oz) 17gm
OR protein with sauteed veg, various protein, I aim for 15gm+
8ish
protein shake 30 gm (sometimes I have this in the afternoon instead; trying to move it to the afternoon)
another fizzy water if I can manage it 12 oz
For a grand total of around 85 grams IF I have the meaty snack; without the afternoon meat, it’s 71gms, which is within spec. Liquid intake is 65oz IF I get in the second fizzy water, 53oz if not (I count ALL liquid, including coffee and shake). These are under spec, but for me, this is better than I was before VSG. I’ll take it.

I am happy with these numbers. However, every day can’t be a winner, so sometimes it’s barely 60gms. Eh, what can you do?

Now I know you’re looking at the water intake and gasping in disbelief. Well, I’ve never been much for drinking allll day, so 44oz of drink is good for me (one vit water and 2 fizzy waters). I’m doing well at getting in the second fizzy water.

Another thing I’m messing with is Prilosec. When you leave the hospital, you are told to take a double dose of TWO per day, in order to assist your stomach in healing and to prevent the reflux/heartburn you’ll get from your stomach acid going crazy. I switched from the Mexican omeprazole caps to US Prilosec tablets when the first ran out. According to the US package, it is supposed to be ONCE a day. I’ve been trying once a day with varied success. If I don’t take it at night, I’m DEFINITELY refluxy. Today I did not take the morning dose to see how that goes – so far, so good. I’m VERY concerned about acid rebound, which is the effect that Prilosec has when you take it for months, then stop taking it. The whole point is to get your stomach to STOP making too much acid on its own; I fear that taking too much Prilosec for too long will cause me more pain in the long run. Here is a compelling study about the dangers of Prilosec. Here is another. Interesting to note that the long term effects is another area that the Drs don’t seem to have much info about. Long term effects COUNT, people!

I will keep you posted on the stepping down from Prilosec. I’m going to ONE per day before bed and getting some Zantac to use if I feel refluxy during the day. I really don’t want to deal with a stomach that makes too much or too little acid. The body is a marvel of self regulation if you allow it to do its job. I feel that too much Prilosec is interfering with my body’s attempt to self regulate. I feel that my stomach will regulate the acid production if given the chance. I’m giving it that chance. (This is why Drs can’t STAND me and call me “noncompliant”. Whatever. I know what’s best for MY BODY. Deal with it.)

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More About Eating After VSG and Vitamins

**Vitamin list for the healing stage of VSG at bottom!

So, after doing some more reading and youtubing, I now have proof that my “quick” move to regular foods is NOT unusual. I found a couple that both had the sleeve at the same time and their Dr cut them loose at 5 wks to eat “regular” foods. They did 2 weeks liquid, one week pureed, one week soft then onto regular food. JUST LIKE I DID. It’s all about what the Dr hands you on the little care sheet. The timelines are just suggestions, everyone is different. While I’m fine with the 5 wk timeline, someone else might be struggling and end up on the 8 wk timeline. You won’t know until you are doing it. I followed my body’s lead and when I wanted to try different foods, I did. Listen to your body!!

I’ve also been doing research on the no drinking while eating “rule” and that also depends on the person. The logic behind it is that the pouch fills up fast and you don’t want to have a liquid hogging space – which is sensible and has been my experience. Another theory is that too much fluid will “wash out” the foods too soon and you’ll not get the nutrition. That one I think is suspect, but perhaps?

What I DO NOT like is when the medical people – be it Dr, dietician, nurse or other caregiver – have hissy fits if you don’t follow *their* rules and threaten you with statements like “OH, if you drink water with meals, you’ll have trouble down the line!” Which is a total LIE (NOT told to me, but to the couple on youtube). Drinking with a meal will NOT harm the pouch, but it may not feel great to you, either. Once that puppy is healed, IT IS HEALED. It’s not going to pop open or anything! ALSO, drinking carbonated drinks will NOT stretch out the pouch. That is a myth. I drink carbonated water all the time before and now. I also drink beer, sake and wine without issue. I didn’t do these things during healing, but I do now and it’s fine – but not with meals.

So, again, when dealing with bariatric surgery (VSG in particular), do your research, but don’t be afraid to experiment and see what works best for YOU. The 5 wk timeline has worked fine for me (I’m almost at wk 6). Drinking with meals does NOT work for me (yet), but I don’t usually drink a lot while eating anyway. Drinking carbonated water is fine for me. As I always say: your mileage may vary.

For me, doing this procedure was precisely to NOT have to be on a diet ever again. I don’t intend to live my life counting calories, protein, carbs or anything else. I think 40 years of dieting is ENOUGH. I am very mindful of what I eat right now because I’m still adjusting and creating new habits, but I don’t intend to be keeping food logs at 6 months. I intend to live my life and still lose the weight, which is what I’m confident will happen. Here’s to NO DIETS.

To quote a guy on a forum: “I may be a renegade, but to me a normal person has some water with dinner…and my goal was to look, feel, and act like a normal person for the first time in my adult life. I am obviously not advocating that anyone follow in my footsteps; I just wanted to give a different perspective.” Yep, I feel ya, buddy, I feel ya. :)

**Addendum: I seem to have removed the list of vitamins I took at the beginning of my VSG journey! Here is the list that I took when I was healing:
Adult Gummies multivitamins (Kirkland from Costco): 4/day (double dose because gummies are low quality)
Pioneer Calcium/Magnesium, dark chocolate, 4 quarter sized tablets per serving
Quickdots Vit D3 and K2 chewables 1 tiny melt per serving
Quickdots Vit B12 (and folic acid) chewables, 1 small melt per svg

Once I was eating normally and taking capsules w/out issues, I added in some of the other things I take and you can see that list here.

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Doing Better…

Not shiny and happy, but better. That big dip has been thankfully short lived.

Part of it is some good luck at getting an iPhone 5c for $76 and then finding a tokidoki case. Another part is Nick is feeling better, which naturally makes me feel better.

Some of it can be attributed to resolving to simply take care of myself and saying BUGGER OFF to the various medical people who have let me down. Between my research skills, knowing my body and some input from Amy, I think I can handle the dehisced incision myself.

To cover the backstory:

My dermatologist did not get the messages I was leaving her all last week due to idiots in the two offices she works in, so she never called me back until Friday night after 9pm. ?? When she did, she basically told me that she had no idea what to do about the incision and I should call the Wound Care Clinic for an appointment. Nice! Thanks medical person I’ve seen FOR YEARS. >:( So, Monday morning, I called this clinic and the nurse informed me that if I don’t have insurance, I’d have to pay $700 just to walk through the door. I laughed at her and said, what? She reiterated the $700 fee. I asked why it was so much and of course she had no idea but said, “well, you have to pay the hospital and the doctors”. Um. Yeah. I told her that was pure-T bullshit and hung up. Then I called another clinic – with the SAME motherfucking doctor – and their initial fee was $225. Much better, but still.

Due to these fees and bullshit, I’m very hesitant to pay for a “wound specialist” to look at a NON-infected wound, tell me I’m doing fine and sending me on my way. Which is what I feel will happen.

SO. I take care of myself, as usual.

The coordinator in Mexico called me yesterday to see how I was doing. Which is great, I appreciate it, but it devolved into her subtly implying that my slow weight loss is due to my not following the whacked out meal plan set forth by their useless dietician. Grrrrr. I’ve put the diet rant into its own post (below).

Again, it’s that deeply rooted belief that the reason Americans are fat is solely due to eating fast food and too much sugar. I resent it and it REALLY pisses me off. I was pretty pissed when I finally got off the phone. Just goes to show: NEVER believe any person whose job it is to keep you happy. NEVER. They will lie to do their job (keep you happy while you are in their care) and you will eventually see their true feelings shine through the bullshit. It’s a sad but true fact. (Anyone in Mexico reading this: I am not mad at any person, I’m mad at the overall belief that being fat and/or weight loss is strictly a factor of diet. IT IS NOT. There are REAMS of facts to back this up. NOR is this a slam at the ladies who coordinate things. They are VERY good at their jobs and very caring. I am just a very perceptive person and see through bullshit more than the average person.)

But oddly, getting pissed off about that attitude has helped pull me out of the doldrums, so hey, thanks for that, I guess.

I also had some good info from a scientist friend who did some digging and confirmed that actually, I’m on target for this procedure. She found anecdotal evidence that 15-30# was typical for the first month and 5-20# was average for the following months after VSG. The people in Mexico were just blowing hot air up my skirt with the claims of 40# in the first month – again, NEVER believe people who are paid to keep you happy. They’ll say anything. It’s not malicious, it’s their job.

In typical ME fashion, information soothes me and gets me off my ass. I feel capable of taking care of this wound and managing my weight in this new normal. I’m still not happy that I’ve lost most of my enjoyments of life (good food, good wine, cooking), but I know they’ll come back in a few months. I will continue to bitch, but overall, I’m holding on to the hope that my life WILL get back to normal and I’ll get back the few things that make me happy.

In the meantime, I’ve got a truly great partner to help me get through it and to support me when I need it. Nick has been AMAZING during all this and I have not said enough how much I could NOT have gotten through this without him. He is my rock. I love you, baby! XOXOXO

I’ll have a video for you guys by the end of the week. :)

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A Little Diet Rant

This turned into its own post, a spin off of the Doing Better post. I am opinionated, yes, but I think common sense would tell anyone that the wacky diet proposed by this dietician is not really logical or even doable. I tossed it out long before I went to Mexico for the surgery and I suggest YOU toss it out, too. The coordinator calls me noncompliant, I call me SMART for being concerned about overall nutrition. I am not sorry for dissing their suggested diet and I am not sorry for sticking to my guns and doing things the way I feel is best for me. I know me better than any of YOU, so I will take care of myself as I see fit. I do respect professionals, however, I do NOT simply do as I’m told without research and deciding if it is the right path FOR ME.

People who live in this country with its poor one-size-fits-all healthcare would do well to follow my example. You must take the reins, be your own advocate and do what YOU feel is best for YOU.

I’ve pointed out to the Mexican team SEVERAL TIMES that I will NOT follow a meal plan that revolves around fruit, yogurt, smoothies and potted meat. It’s crazy and I’m not doing it. I’ve said that from DAY ONE. The coordinator implied that my slow-ish weigh loss was due to my not following their wacky diet, and went so far as to recommend that I contact that dietician and ask for help! LOL Right, let’s call the person who makes a diet for VSG patients that has meals consisting of 3+ cups volume and are laden with fruit (sugar, no nutrients) and rely on yogurt every meal. NEIN. I don’t know what planet that dietician lives on, but NO VSG patient can eat that much, like, EVER. 5 oz pouch can’t hold 2-3 cups. DUH.

Here are a coupla screen shots of the offending “diet”. This one is from the pureed section with the infamous 1 cup potted meat (deviled ham, which is 90% FAT, this is like FOUR cans):
Potted meat! YUM!
Here is a daily plan for the last few weeks called “Soft Foods” which is mostly fruit and yogurt and identical to the pureed foods diet:
Daily diet plan. Crazy.

For the record, you should NOT continue to eat pureed or soft foods indefinitely. THIS is how you’ll gain weight, since you never reach satiety. This diet is POOR. I’m not eating anything pureed at this point. I am still eating soft foods, but since pretty much all I can hold is protein, it’s mostly baked fish, canned chicken, ground chicken and veg where I can fit them in. Oh, and scrambled eggs for breakfast. I’ve found that egg beaters are awesome for this, so I have beaters with salsa. I really don’t like sweets for breakfast. I have my 30gm protein shake (Premier Protein, not cheap, but palatable) at 8pm every night. No other proteins yet and certainly few carbs – although I have had mac and cheese twice with NO REGRETS. I am averaging between 60-70 grams protein a day. My diet is FINE. Read this book for more about “mushy food syndrome”.

I have had a very smooth surgery (other than the dehisced incision) and I’ve moved through the recovery weeks well. I am not typical, but I feel that my diet has been moving along at its own pace and it’s FAR from done. I think I probably am typical, and if patients would eat a better diet and not be married to the diet given by this dietician, they’d move faster, too. I have no proof of this, but it’s my feeling.

I am on track for the average weight loss of VSG patients: 1st month is 15-30#, following months are 5-20#. I am confident that my diet has nothing whatsoever to do with my perceived slow weight loss, because it is not slow, it’s typical. I am just impatient and I want the weight GONE, like, yesterday, so it feels slow to me.

As always, I only write about MY experience and your mileage may vary (YMMV). Any advice given here is geared towards reminding you that YOU know your body better than anyone else and therefore YOU have a say in how things progress. I will not apologize for doing things my way, because it’s my body.