Sunday, December 9, 2007
Saturday, December 8, 2007
Monday, November 19, 2007
So, I guess I know part of why I lose weight slowly. But some folks are lucky enough to cut the quantity of their eating with the lap band and just lose so much weight so quickly. It seems like they are the norm, but I think they are not. And it's so unproductive for me to even think about those people. I'm not one of them!
My last visit to the doc in October, I had lost about 6 lbs in a month and was right on track, and we decided not to do a fill. I thought I should just be more careful about my eating and working out and see how it goes. That was fine until the past week when I started noticing I was getting more hungry and sooner after I ate than before. I found myself foraging for food more, grazing more, and thinking about food more. So I went back today, had lost 3 lbs in the last 4 weeks, and got a fill of 0.2cc to get me to 3.2cc. Hopefully this is right. I am doing liquids and mushies today and things go down fine so it's so far, so good. I can't get too tight a fill now since I'll soon be in Spokane full time and won't be able to come back quickly for an unfill.
I might be losing more quickly if we weren't camping in our old place now with nearly no furniture or belongings...it's all in Spokane now...and eating out all the time. We're pretty good about splitting our meals and making good choices, usually, but it's still a lot of eating out, even if the quantity of food is smaller. It's kind of an uphill battle. I hate this in between time, not moved out, not moved in, nowhere to really relax and feel at home. Ugh. But we're carrying on, and in a couple weeks we'll be moved altogether.
Wednesday, October 17, 2007
So, the roundup so far:
Monday: Spinning class (Cycle Express, 50 minutes) and swimming
Tuesday: Yoga (apparently it was Advanced, but I did fine)
Weds: Flow Yoga and swimming
More movement seen on the scale...very nice...great success. (Right Borat?) But better than that, I feel like I'm working muscles that aren't used to working. I feel good, at peace. My mind is "right".
Monday, October 15, 2007
Here's an NSV for me: I got my first pair of knee high zip-up boots today! I ordered them from Aerosoles and they took 2 weeks to get here, and I wasn't sure they would zip up, but they do and they are awesome! I'm so excited. My calves have always been too big for zip up boots. I had one pair of long boots a few years ago, but they were stretch and pull-up. They always fell down, since they didn't go all the way to my knees and they were pretty tight. Finally the seams just wore out and I had to throw them away. These are also stretch, but they fit nicely and are great quality. I have an Aerosoles obsession. Their shoes are so comfortable, and they make lots of lovely high heels that I can wear AND walk in comfortably. Not every pair is perfectly comfortable, but most are, and I can wear them all day without complaint. I'd rather spend a little more on shoes that I feel like walking in than half the price on shoes I don't want to walk more than 5 feet in. I usually get them on sale, so they tend to actually cost me $30-40 per pair. I'm totally obsessed with their shoes! Really, it is a problem. At least my husband thinks so. But in another month, I won't be able to buy shoes anymore for quite a while. I'm "living it up" a little now.
Another NSV: I wanted to get a pair of size 12 jeans today because my 14s are getting a bit big and soon it will be time to go to 12s. I tried them on, and they zipped up--they are definitely snug, and I need to lose 5-10 lbs to be comfortable in them, but I was a little surprised that they zipped up all the way. I also got a fall dress (on sale) and a sweater (on sale), both mediums, and they fit perfectly. Super cool!
I realize this is all pretty banal. Weight loss sort of has that effect. It's such an artificial thing to focus on, and yet it really is so important. The perks of improved appearance and buying fun clothes are nice, but the real goal is being a healthy old woman who can still walk and be active and care for myself. I have a lot of confidence in my constitution; I come from pretty healthy people, and I don't have a lot of concern for heart disease or diabetes based on my family history. But I want to keep my joints in good shape, and...well, hell, we all know the reasons for maintaining a healthy weight. The best thing right now is my physical fitness is improving, and I enjoy exercise. I have a lot more energy than I used to, I don't take my antidepressant anymore, and my mood is great. So while it's nice to get clothes in smaller sizes and have people compliment me on my appearance, how I feel is the best reward. My next scale victory: 40 lbs weight loss. I hope to get there in a couple of weeks.
Thursday, October 11, 2007
In 10 lbs, I will be the weight I was when I met my hubby. That is my next goal. After that I am in a weight zone that I haven't seen since I was 19. It's exciting!
I'm thinking of starting a more global blog. I'm not sure, but maybe a student CRNA/health care professional/chronic cynic sort of vibe. The whole package, including the weight loss stuff, moving to Spokane, being married (remarried), anything I can think of. We went to Spokane last weekend to attend the picnic for new students, meet the staff and current students, and scope out a place to live. Finding rentals in Spokane is sort of disappointing, but we definitely didn't want to buy a place and have to sell in 2 years, not with the trend in the housing market currently. We did find one absolutely perfect place, but the owner had just taken a deposit on it (asshole) and showed it to us anyway, and then drove us over a few blocks to his new manufactured-home type duplexes which were sparkly new and utterly depressing. View out the windows? More duplexes! Ugh. Then he was sort of disparaging about my desire to live in one of the numerous lovely old houses in Spokane that you see everywhere, kinda like the one he showed us first that we couldn't have. He really pissed me off with that little bait and switch. We decided on the first floor apartment of a beautiful historic home very close to the hospital where I will spend most of my time. Just waiting on the approval process so we can work out everything else. I would have preferred to rent a house with no upstairs neighbors, but we just didn't find one in a good location that was worth renting. There are some downsides to the place we are going with, but I think overall it will be a good fit.
Sunday, September 30, 2007
Everything is winding down for us here in Stumptown. I find myself looking around a lot and trying to remember the things I love about Portland. I'm sure we'll end up back here eventually, but I don't know when. Starting school is getting more real, and more scary, every day. My program is going to be incredibly challenging in many ways, not just academically but also for our personal life as a couple, for me no longer being a financially contributing partner in our marriage, and in a time management sense, trying to manage having enough time for classes, studying, fitness and quality time with hubby. That's not even taking into account any attempts to continue with my glass art! I don't know if THAT will happen at all or not. But I'm trying not to worry about it. It's exciting to go back to school and start something challenging and stimulating. And I love the prospect of being able to earn more money in a career that I think I will enjoy, and getting closer to fulfilling my dream of having a family of my own and a real home. My life has been interesting so far, and while it's tough that I'll be trying to have a family when I'm getting close to the end of my reproductive years, I wouldn't change the experiences I've had for anything. I couldn't have done all the things I've done in life if I had had children in my 20s (even if I had that option...I didn't have a partner to have children with back then).
This past year has been a personally challenging one for my hubby and me, but I think we've done well with the difficulties we've had to face together, and we're stronger for it. I'm especially proud of my hubby in the way that he's dealt with so much stress this year. He's such a strong person, and so supportive and kind. I just love him to pieces! Thanks sweetie. :)
Tuesday, September 11, 2007
Other things fill my days than weight loss. I will be resigning my position at work in November, which is just around the corner. We will move to Spokane and I will start preparing to embark on my next professional goal, becoming a CRNA. My good friends Jon and Shannon both got in to anesthesia school in Florida, and they start a month after I do. I feel like we will all be going to school together, even though we will be on opposite coasts. I continue to make glass beads. I have made a lot of progress in my work this summer. I hope to get around to photographing the beads and selling them one of these times, but there are a lot of glass artists selling beads these days. I'd like to just be able to support my hobby; it's quite expensive. Hubby and I continue along, spending most days just with each other when we are not working. We have our bumps along the way, but we are fortunate to have a very loving and playful relationship.
This summer has been brief, but good. As far as the band goes, I have only had 2 fills this summer--in June and about 2 weeks ago. I had lost a great amount of weight at my June appointment, so Dr Jan had me come back in 2 months, but I came back sooner when my weight loss stalled again. When I saw the PA, Patrick, for the first time, he took out the fluid before filling me, saw I only had 2.1 cc rather than the 2.7 that should have been there, filled me to 2.6, and here I am. I think I could use a little more of a tweak--some days my restriction is pretty good, others I feel hungry a lot. It's never "tight"--I've never felt like I might get something stuck or had a hard time getting any kind of food down. I've never had reflux or vomited for any reason. I've never had a single difficulty with my band, actually, just difficulty finding the "sweet spot" of restriction. Yet, still I am losing weight, and I don't feel like I am dieting, so I call it success. I have to resist comparing my weight loss to anyone else's because I know I am a slow loser, and I know I'm doing the best I can. I work out at least 6 hours a week, and I eat 1000-1100 kcal per day. I have a healthy diet, I eat enough protein, and I'm not dehydrated. I'm doing the things I'm supposed to do and I am losing weight; almost 6 lbs per month, which is perfect. So I would say that things are going very well with me and the Band.
Maybe another 13 lbs by Thanksgiving? Who knows?
Tuesday, July 24, 2007
Monday, July 23, 2007
I met the new surgical fellow, a nice Indian man whom I liked much better than Dr Stinky, who was Dr Hong's fellow when I had my surgery. He was very thorough in his history and assessment, but unfortunately could not access my port to do my tiny 0.2cc fill. Dr Jan was there too, and he had no problem--this was actually the first time anyone has had trouble getting into my port, but the only people to try before were Drs. Hong and Jan, and they are experienced. I just hope and pray that the jabs (which were north of my port, or closer to my head, therefore closer to the tubing) did not puncture the tubing and start a leak. Water went down fine, and I went home.
I did get wiser this time, and schedule my fill late in the day rather than early. Why spend the whole day hungry? :) Dr Jan was pleased with my 9 lb loss since my last appointment 5 weeks ago. My next appointment is in 7 weeks, which is early September. Nice! I get the rest of the summer "off", so to speak. Hopefully I post another nice weight loss by then and can cruise like this for a while. 7 weeks, I should be able to manage at least 10 lbs more by then.
Saturday, July 21, 2007
I have an appointment Monday with Dr Jan, my 'replacement' surgeon (since my surgeon Dr Hong left the practice and moved back to Canada). It's about 5 weeks since my last fill. I have lost about 5 lbs in the last 3 weeks. I get hungry about 4 hours after a meal. I have never vomited one time since having my band placed, or gotten food stuck in my stoma. I am not sure if he will want to fill my band some more or not. If he does, it would be a very small fill, I would think. I think things are going very well for me right now, and I don't want to screw it up. I work out about 4 days a week, get plenty of protein and veggies, and am losing weight.
I am lucky that I am not terribly picky about what I eat, and I like a lot of things, especially healthy foods. My mom did a great job in giving us kids a lot of variety in our diet and a lot of healthy foods growing up. We all like to eat nutritious food (we like junk food too, but still) and we don't turn up our noses at much of anything. I think that has made the band journey a lot easier for me than for some people. I actually have changed very little about the way I eat since being banded. Now I am more careful about eating protein, and I obviously eat smaller portions. I also try my best not to eat when I am not physically hungry. That's a daily struggle, as is drinking enough water. I try not to eat as many sweets, but I don't avoid them entirely. I am more conscious of the fact that eating sugar reinforces the sugar addiction and causes a crash that makes me crave more sugar later; it's a vicious cycle that I try my best to avoid. I don't always make the best choices, but I do get back on the horse after I fall off, and I can get back on track more easily than I could before having the band.
Monday, July 9, 2007
I continue to lose weight, to my constant amazement and delight. I have lost 23 lbs now. I am happy with this so far. I get hungry about 4 hours after eating a meal, but I never get extremely hungry. The hardest thing for me continues to be not grazing on treats at work. At work the best thing for me seems to be spreading out my lunch over the whole shift so I have something to snack on instead of treats. If there is a potluck, I make the best choices I can and don't go back. Some days it works better than others.
Friday, July 6, 2007
What have I done differently? I'm trying to drink more water, but that is still difficult for me. I took a class at the gym 2 times this week, called the NIA technique, to change up my usual routine. And I've been tracking what I eat more closely on fitday.com. That seems to help. And I've been tapering off of my antidepressant, so hopefully that will help me stop holding on to a little of that weight. If I find I still need one, even though it's summer and sunny outside (my primary problem is S.A.D.) my doc gave me a script for Effexor to try that might work without as much weight problem. So. I'm getting through my first plateau! Yay me.
Monday, June 25, 2007
1. Drink all my water--this will always be a challenge for me
2. Change my workouts--I do an hour of cardio 5 days a week, but I'll do different things
3. Eat out less. This is a real challenge, as hubby and I both enjoy eating out.
4. Worry less.
I got my third fill, and I do have some decent restriction, and stay full for 4-5 hours. I still eat about 1200 cal a day, try to keep it closer to 1000 but that is hard to do still. I don't chart this daily, more like once or twice a week, just to "check in". Tonight we did go out--it was a beautiful, 70 degree June night in Portland, and we went to a favorite Cuban restaurant, Pambiche, to eat outside on their sidewalk. I had part of a sangria and he had a mojito, and we split an appetizer platter of 1 leek and cheese empanada and some yam fritters, and split a pan pescado, Cuban style fish sandwich with snapper and avocado. I ate mine open-face and left the top part of the bread on the plate (ok, I nibbled the edge a bit). And I experienced my "soft stop", a cross between a sigh and almost a burp. But we did split a dessert too. It was probably more calories than I needed, but it was lovely.
While I'm not experiencing a lot of scale victories currently, I do have oodles more energy than I did before surgery. I'm eating healthfully, getting lots of exercise, and looking trimmer. My mood is better overall as is my ability to withstand stress. I'd have to say I am on the right track. Hopefully the scale complies soon!
Val's website (above link) sells some of her furnace glass frit and is home to her lovely, photo-heavy blog (she has a beautiful country home and is a talented photographer). Her sister's website sells the majority of her glass frit: http://www.valcoxfrit.com/ . But, in addition to Val's blog, where you really should turn your attention (unless you have an interest in COE 96 glass frit, which you might) is her sister's blog. Her sister Sabrina is also a great photographer and offers an equally lovely vision of rural American life. Check 'em out, and don't ever say I didn't do anything nice for y'all.
(Val Cox beads, photos by Val Cox, and fiddlehead ferns, photo by Sabrina)
Friday, June 22, 2007
Actually, according to the current science, we all are hardwired to obsess about food, as is nicely summed up in this Time magazine article from last week. Some of us do it more than others. I guess it was only a matter of time in the course of human civilization that the combination of food obsession and industrialization eventually produced an environment where we can pour high calorie, low nutrient foods down our throats all day while sitting on our ever-widening backsides.
Speaking of wide backsides, I went to a support group meeting last week for lap band people, and I doubt I'll ever go back. I brought hubby this time so he could see what it was about. While this one was worse than most, they all are pretty banal, actually, and not very useful. When you have a support group with pre op and post op people of widely varying experience, you end up with a lot of time that is not useful to most people in the room. There were two women there who pretty much dominated the conversation--one with her helpful tips on what protein shake is best, along with other gems of dubious usefulness, and the other who is pre op but repeatedly reminds everyone that "I have a food and nutrition degree" and talks about her time in "nurse's training" which almost always means either, a.) she is a nursing assistant or b.) she got kicked out of nursing school and had to settle for the nutrition degree. I'm guessing (b) in this case. About the time that the back part of the table got completely derailed from the main conversation and kibbitzed about the best protein shakes for 15 minutes, we decided to walk out, and had sushi down the street instead. I think I get much more support and useful info from OH.com than I do from those "support group" meetings.
Saturday, May 26, 2007
Saturday, May 19, 2007
The band works!
It gives me a little extra confidence knowing that I can be human occasionally and not undo all the hard work I've put into this with one night of less than perfect choices. (The sangria was ok...I made it, not my best...those little bits of pasta salad and dessert were really good...and my garden burger was great!) I'm so glad this hasn't been a waste of time and money. I'll never be as fast a loser as most, but as long as I don't gain it back, I enjoy not being hungry and still losing weight.
Thursday, May 17, 2007
I had my 2nd fill on Monday. I got 0.7 cc which fills me to a total of 2.2 cc's. I believe I have some restriction from this, but I still get hungry after about 3 hours. I think I eat a little bit less, though. And I've finally dropped another pound. Yay! I've been working out a lot, and biked to work for the first time on Tuesday, which was fun. (I didn't bike up Marquam Hill though; I took the Tram instead. I'm motivated, not crazy.) I never thought I'd say this, but I love exercising. It clears my mind, and it feels good to move. My personal best is 54 minutes of cardio at the gym. My gold standard goal is 60 minutes a day, every day. If I get 5 days a week, that's pretty good, though. Currently I'm working out 3-4 days a week.
On a tip from Kim Miles, beadist, I checked out a free tarot card (single card selection) today at www.osho.com and this is what my card for the day says:
23. The Creator
There are two types of creators in the world. One type of creator works with objects - a poet, a painter, they work with objects, they create things. The other type of creator, the mystic, creates himself. He doesn't work with objects, he works with the subject; he works on himself, his own being. And he is the real creator, the real poet, because he makes himself into a masterpiece.
You are carrying a masterpiece hidden within you, but you are standing in the way. Just move aside, then the masterpiece will be revealed. Everyone is a masterpiece, because God never gives birth to anything less than that. Everyone carries that masterpiece hidden for many lives, no knowing who they are and just trying on the surface to become someone.
Drop the idea of becoming someone, because you are already a masterpiece. You cannot be improved. You have only to come to it, to know it, to realize it. God himself has created you; you cannot be improved.
Whether you believe tarot or not, it's an inspirational thought for the day. And now I must go get propane and make beads.
Thursday, May 10, 2007
I feel like I do the right things 85% of the time, maybe even more. How much less can I eat when I am properly restricted? I'm having a bit of buyer's remorse right now...which I understand is common during this phase of the band life. There is so much time to sit and ruminate on why I'm not losing as fast as this person or that person. And of course, people ask if I've lost weight yet after my surgery...which adds a bit of pressure. Grr.
But, the weather is beautiful, and I am going to start bike commuting while the weather is nice. I rode the route today and it only takes 20 minutes. I can shower at the gym and take the tram up to work! It's really the perfect biking scenario for someone who doesn't want to face the giant Marquam hill climb on a bike just before working 12 hours. It sounds like a great way to start the day, and I only have to get up 15 minutes early.
Tuesday, May 1, 2007
Saturday, April 28, 2007
I'm hanging on the 13 lb loss. I'm restless. I work out regularly and make good choices about 85% of the time. I've been in charge at work for the last couple of days and do well except when people leave food at the desk, which happens A LOT. The desk in the middle of the nurses station is Grand Central for sharing food, and the food sits right by my computer. Today I had to ask people to put it in another room so I'm not sitting by it all the time. I mean, come on!! How's a girl going to avoid french fries and cookies when they are sitting six inches from her?!? geez.
I have nothing to add. Lap band time is different and slow. I can't wait for that magic moment when I have restriction and things can get started.
Saturday, April 21, 2007
In the past 5 1/2 weeks I have strived to follow all the rules I have been given at various stages of this process. Here is how I think I am doing at this point:
- eating enough protein
- eating small portions
- making quality food choices
- taking my vitamins
- chewing thoroughly
- drinking enough water
- eating 3 meals and a snack
- paying attention to eating only
- not eating in front of the computer
- eating very slowly
It could be worse, definitely. But the issue with sitting at the table to eat meals is going to be a struggle. I usually eat alone, and I just get so bored eating a meal by myself. I can't stand it. I can't be content to "chew" and "enjoy" my food and pay attention to the eating and getting full. That will be a problem when I have real restriction and I need to be careful with small, well chewed bites eaten slowly to prevent getting stuck or barfing. I need to read or something. Lately I've been trying to compromise by reading and paying attention simultanously to what I am eating and how I'm feeling. That seems to be fine, but I don't know if it is good enough and if I will lapse into distracted eating again over time.
All of this will be put to the test with my next fill, I'm sure.
Thursday, April 19, 2007
I called to make my next appointment for 1 month from now, and the receptionist told me Dr Hong is moving! WTF? He is moving back to Canada at the end of the month. I am sad about that, and a little surprised that he didn't tell me yesterday, especially since we talked about me moving to Spokane in January. So I have seen Dr Hong for the last time, unless something comes up in the next few weeks.
I am finally down a couple more pounds, but I don't count on that staying that way until I have at least another fill. I'm doing well at the gym, though. I guess I can start weights and abs again since it's been 5 weeks since surgery---I forgot to ask at my appointment.
Wednesday, April 11, 2007
I thought about cancelling with the nutritionist, but decided to see her anyway. It was an additional hour's wait, but I was already there. We both agreed that I would need fewer than the generally recommended 1200 cal per day to lose, based on my record keeping, and that I probably won't be able to achieve that without some restriction. She thinks he might give me a fill before 6 weeks. I rescheduled my appointment for next Weds, which will be just over 5 weeks post op. HOPEFULLY he will fill my band and I can get this thing rolling.
Then tonight I went to my first support group meeting at the hospital. It was an interesting experience...a lot of the information I got was the same stuff we talk about online on OH.com. It was the little tidbits of info that will probably have me coming back again. The group leader, Dale, spoke a lot about "releasing the ghrelins" (hormones that stimulate hunger feelings), enough that it made me think of releasing The Hounds, which made me laugh a little. It's catchy, it sticks with you. I was struck by how much the people who have been banded for any significant length of time wanted to talk about what they knew, and how much of that differed from what the group leader said. In other words, people are doing the wrong things and spouting it to other people, and they were reluctant to listen to any suggestion that it might be better to do things a different way. Bandsters are a chatty, moderately informed group who often forget that they too are still learning--not just these Bandsters, but most I have had contact with, in my observations. One guy brought up the idea of having to "avoid certain foods forever" because they are just triggers. Dale disputed this idea, talking about what he called the "abstinance violation" phenomenon, which is just the basic idea that if you make certain foods forbidden and then you eat them, you set yourself up to give up and binge. I agree with this idea, and the thought that "dieting" is not sustainable in the long term. Rather than avoiding these "trigger" foods, we should be trying to learn how to deal with them and eat them in a moderate way, occasionally. It seems to me that many people who seek weight loss surgery resign themselves to the idea that they will just have to diet for the rest of their lives. They've given up on the idea that they can eat moderate amounts of anything, and as long as they usually choose healthy foods, can indulge in the occasional "treat" as long as it is a controlled portion and they just do it occasionally.
I was also struck by people talking about how when they had proper restriction, their cravings for certain foods--any foods, in some cases--disappeared. One woman talked about being too tight for a long time, and vomiting for months, but not saying anything because she was losing lots of weight. She ultimately had to have her band unfilled for a few months because of all the inflammation all that vomiting had caused, and she ended up regaining 35 lbs. She had also exacerbated a hernia and had to have a new band placed. She said that once she was unfilled, all those food cravings came back just like before. It is unclear whether this phenomenon is entirely psychological or if it is a hormonally mediated thing; probably a combination of both, but restricting the stomach results in restricting foods, and when you choose the right foods, those ghrelins go down and you supposedly lose those cravings. How cool is that? (As long as you aren't barfing, that is.)
One woman reported having been stuck 47 times for one fill (how is that possible?) and ending up with punctured tubing proximal to the port, which had to be replaced surgically. Again, no restriction for months while waiting for that to be diagnosed, fixed, and healed. That would suck. I'll keep that in mind when my surgeon wants to let his fellow do my fills.
So, is this dieting? It seems the answer is No. I do not plan on going back on diets, although that may change when I hit a plateau in my weight loss. The point here is to stop doing all the damage that yoyo dieting has done over the years, and start learning to eat smaller portions of a variety of foods, and maintain weight with the help of the band. So my post-support group scoop of gelato at Mio Gelato on NW 23rd? I have no guilt about that.
Monday, April 9, 2007
I am supposed to keep food records for the 3 days prior to my nutritionist appointment. Aside from Easter dinner, I've eaten pretty much the same things every day:
- Protein shake (this keeps me full for about 3 hours so I have continued to use them, although I didn't this morning)
- 4oz. pureed tuna salad
- 4oz. chopped broccoli topped with 1/2 tbsp asiago cheese
- 1/3 c. pureed refried beans, with 1tbsp. shredded cheese and salsa
- or 1 c. yogurt
- maybe 1/2 c. applesauce or pureed canned pears (in juice)
- more tuna salad
- maybe a V8
- more broccoli
- 1 SF pudding cup with 1 tbsp cool whip lite
I think I'm missing a few things here. It ends up being around 1200 calories, which is supposed to be the right amount for me to lose weight, but I'm just holding. I was very depressed for a few days, thinking that I was supposed to eat this much when my band is filled and I wouldn't lose any weight. But I think I actually need closer to 1000 cal to lose weight consistently. I don't normally eat a lot anyway and I gain weight with that, so I think my body is just very efficient with the calories I give it. If this is true, the band is perfect for me, because I can't eat that little without feeling like I am starving all the time.
I read in my book from the surgeon's office that they usually do a first fill at 6 weeks, which is the generally agreed-upon time to start filling. Earlier seems to interrupt the healing of the stomach and can lead to future slips. (A slip means the band slips lower onto the stomach, which is usually something that has to be surgically fixed and sometimes results in having to remove the band entirely.) So, that is only 2 weeks away! I hope it doesn't take too long to get this thing rolling. I'm ready.
Monday, April 2, 2007
Without restriction I feel...like before. The only way I can tell I had surgery is by my healing incisions. I DID have one experience this weekend eating breakfast where I experienced a "soft stop" signal (it might have actually been the "hard stop") and had to stop eating. Usually I get sort of semi-full, which is fine. But trying to make the full mental switch to a new way of life without any physical signals is just dieting.
I can't decide...is this dieting, or a new way of life? How do you approach eating after WLS? It seems the lap band community online is divided on this. Some people even go on diets after their band is "up and running" so to speak...on Atkins or WW or some such. WTF? Personally, I think the point is to eat like a normal healthy person, and not be on a diet. I get that it's frustrating when your weight loss slows down, and I'm sure there will be a bit of a mental challenge when I get there myself. But I guess I'm hoping that the restriction will fill in where my relatively healthy eating habits aren't able to. That, and not keeping ice cream in the house. :)
Saturday, March 31, 2007
I will weigh myself on Monday, but I probably shouldn't. I have eaten my pureed foods, but today wasn't exactly a Good Food Choices day. I did get my protein, at least. And a lot of sugar. Oh well, start over tomorrow.
Reading the other blogs, especially the non-bandster blogs, and seeing people's success photos...somehow I just have a hard time envisioning myself like that sometimes. Or I find myself wondering if I should have had a more drastic but effective surgery instead. But then I try to remind myself of all the reasons I chose the Band over the others. And I realize that I have to accept more responsibility for my success because there is no malabsorption to assist me in my weight loss. It's all choices and upkeep. I CAN overeat and eat the wrong foods and drink my calories and sabotage my weight loss. Can I keep from doing that? I hope so.
Friday, March 30, 2007
I've done 3 partial days of light duty, and was planning on going back in today, but I am so tired and just feel blah. I had an eye appointment at 1045 which I didn't get out of until noon (he's always at least 30 min late to see me), then I had to deposit a check and then I read a bit and took a nap. It's a lazy day and I just couldn't bring myself to do this boring desk work today when I am not sure when I'll even get the energy to go work out. Ugh.
There is nothing new band-wise to report so I'll just add a few features to the blog: a list of links and other goodies at the side.
Wednesday, March 28, 2007
Things are moving along in Band World. I'm eating my purees and abstaining from weighing myself. Nothing much to report.
Hubby helped me get my oxygen tank exchanged yesterday, so I'll be able to make more beads tonight. :)
Saturday, March 24, 2007
I am PMSing, I have cabin fever, and I have a lot of food guilt and food grief. It's a gray mucky spring day in Portland. Bleh.
Friday, March 23, 2007
What I hear in practice from fellow band folks and what I hear from the nutritionists at the O.I. are pretty different. The nutritionists painted a bleak picture of an extremely austere diet in this stage (and forever, actually). The truth seems to be that early on, people do what it takes to get through this "Bandster Hell" phase, whether that means sugars and starches or not, and even later in the more active weight-loss phase, focus on making good choices at least 80% of the time and have an occasional treat and still lose weight just fine. That seems smart. I do want to limit the refined sugars, but for now will just do that modestly. As long as everything is the right consistency to slip through the stomach and not make it churn, so the sutures heal well, I'm not going to sweat the rest of it too much, except getting protein and about 20% fat, as I was instructed by the nutritionist for post op. I still struggle with getting enough water.
I am reading a good book, "You: On A Diet". It's written in a kind of gimmicky, cutesy way, but has really good information and great cartoonish illustrations. It's pretty no-nonsense and sensible, and cites a lot of research, although it's hard to say if it's interpreted correctly without doing a lit review. So far it's been engaging and informative, especially the focus on obesity as an inflammatory process and the way our diets contribute to inflammation and cause other problems for us. Thumbs up.
Thursday, March 22, 2007
Why can't people just say that yes, without restriction, you are hungry? Really hungry, sometimes?
I do have emotional eating issues, as I think many, many people do. No doubt there. But that is something I have been dealing with for a long time before I ever considered WLS. And honestly, I don't really find myself wanting to eat so much out of boredom, loneliness, anger, frustration, whatever as I do out of actual physical hunger.
The full liquids and purees regimens that my surgeon's nutritionists outline are sensible, pragmatic, and nutritionally complete, as much as one can be on so few calories. It's hard to stick to for a long time. Maybe I just need more calories, and then I will feel more satisfied? I get plenty of protein, less than 100g of carbs, about 20% of my calories are coming from fat. But I'm consistently eating less than 800 cal, and for the first several days that was totally fine. No problem. The last 3 days I've been okay too, on the purees, which technically I should still not be taking until next Tuesday. But my band is so loose, the purees go right through too, and my stomach doesn't have to do any work.
I'm hearing that advancing the diet too early might seem fine at the time, but later can lead to slips (band slips) because the stomach didn't heal properly around the band. I'm looking for some documentation on that; so much of what the WLS community says doesn't seem to be necessarily backed by reliable research, so I take some of these claims under advisement for the time being. But proper healing is the point of the liquid and puree phases, and that's a point well taken.
So...I'm going to back it off to true purees. And I'm going to eat more calories, and add some treats. I'll continue tracking everything on www.fitday.com and continue getting all the nutrition that I am now. But I'm still going to eat tuna, I'll just whirl it in the blender a little first. The more real protein I can get, and the less reliance on powders, the better.
Wednesday, March 21, 2007
I'm lucky to have a good life in a great part of the world, lucky to have a husband I adore and who adores me, lucky to have plenty of income and opportunities to advance myself. Lucky to have great family around me, good friends, plenty to eat, drink, and do to entertain myself. Lucky to have been able to do just about everything I have wanted to do before having kids, lucky to be healthy and able to have them later. Lucky to be well respected and well educated. Lucky not to have a face only a mother could love. :) Lucky not to live in a war zone or an undeveloped country without resources or means for survival. And I'm lucky to have had this surgery that is improving my quality of life as we speak, and to have lost 12.6 lbs in 8 days for the first time in my life, without having part of me cut off or putting my health at risk. :)
OK, barf-fest over. I just feel lucky, is all.
On a sad note, I discovered today that a woman who used to work at my hospital finally died of the leukemia she was diagnosed with in December 2005. Jet was the nicest cashier in our cafeteria. She worked the night shift, had neat tattoos and remembered everyone who ever came through our line. Her many friends rallied behind her as she refused (wisely, in my opinion) to have a bone marrow transplant, a treatment that is often worse than the disease. She was a sweet girl and will be missed by all.
Tuesday, March 20, 2007
I'm only down another 0.8 lb today, but I think that is PMS water retention. It's still 10.8 lbs in 1 week, which has never happened in my life before. I felt almost normal today. I had a lot of energy in the morning, did some errands with hubby in the morning, then did a Costco run and went to Bed Bath & Beyond for a digital kitchen scale. I got home and unloaded everything, ate a bit and...ran out of gas. I'm not 100%, I guess, but I do feel pretty good. I thought I'd go to the gym but the weather is ok so I think I'll go for a walk with hubby instead. And we're going to see a movie tonight! How exciting.
On another nice note, Grandpa had his follow up gallstone removal done, and went home from the hospital today. He looked as weak and shaky on Saturday as I've ever seen him. I guess he has a right to be, at 91 years old, but he's a strong, sturdy farmer, always on the move, even at his age. We'll see him in a few days, and hopefully he'll be doing better by then.
Even if you're on the right track, you'll get run over if you just sit there. ~Will Rogers
Monday, March 19, 2007
I am down 10 lbs! While the scale at my doctor's office might be the most "official", I consider my own weight tracking to be more accurate because I check my weight at the same time on the same scale when I get up and before I get dressed. I know I can't blame variances on my clothes or shoes because I'm not wearing them. And as any good critical care nurse will tell you, the accuracy of the measurement is not as important as the trend you record. So, 10 lbs down in 6 days. I'll take it!
Sunday, March 18, 2007
I'll probably start the purees a little bit early. I'm not ready yet, but I probably will be before 2 weeks is fully up. I am so anxious to have some sashimi! OMG.
Last night I woke up from a nap shaky and nauseous. I actually thought I would have my first vomiting episode, then I realized I was dehydrated. It doesn't feel good with all the water sloshing around in my belly, so I don't drink as much as I should. I did push the fluids after that and felt better.
Post op day 5 recap: belly less painful, less sore. Still need to push the water intake. Not feeling too hungry or nauseated today. Walking every day. Beautiful weather here today, nice evening walk around the neighborhood with hubby. And 8 lb weight loss. I'll take it!
Saturday, March 17, 2007
We went to see them today, and saw my Dad there as well. My uncle Ron even came by, whom I haven't seen in years. It was kind of a fun reunion, although Grandpa still isn't feeling very good yet. Grandma seems a little embarrassed that she had to be admitted at all, but it sounds like she's having these TIAs pretty frequently. She says she is having it checked out. I'll have to trust her.
Today has not been a good day at all, comfort wise. I woke up with a splitting headache from my tense shoulders that I've been sleeping on for the last 4 nights. This morning it felt like a bear had clamped his jaw right down on my left shoulder. Hubby rubbed it for me and it did get quite a bit better for a while, but it's hurting and stiff again now. My abdomen has been very uncomfortable and I can't figure out exactly why--I don't think it's surgical pain, it could be gas from the laproscope, or my GI tract waking up again, or hunger even. I just can't tell. It's incredibly uncomfortable though. I've finally taken some lortab to see if that will help. It's not severe pain, but definitely uncomfortable.
Didn't really feel up to working out today, and most of the day was taken up with going to visit my family. But this morning I was down a total of 4.6 (1.2 from yesterday). Not bad!
Friday, March 16, 2007
Got out for a walk today...gorgeous 65 degree sunny Portland day! I was a little slow, partly to take lots of pictures and partly obeying my bloated belly. I was out there from 11am to 1:30, walking most of that time. Wow! I'm tired.
Here's my Picasa album with some photos I took.
I did work out last night at the gym. By "work out" I mean nothing more serious than walking on the treadmill, at a slower pace than I usually do. I did 37 minutes; my goal was 30 but I was watching Animal Planet and wanted to finish the show. :) This morning I think I might go for a walk on the Eastbank Esplanade. I'll bring a camera in case anything fascinating points itself out to me.
Today I have 2 main tasks, besides drinking water: write thank you cards to the nurses at Good Sam, and write letters to Gonzaga and OHSU regarding my intent to enroll at Gonzaga. I also plan on making some more beads. I really need to learn how to photograph them so I can share them here.
Down 4 lbs from my preop weight...
Thursday, March 15, 2007
Besides trying to get enough water down my gullet without feeling too full, I'm feeling pretty good today. I have to force myself to convalesce and take it slow. I will go for a walk later today, but other than that I guess I'll make some beads and relax. And drink water, my friend.
Wednesday, March 14, 2007
Anyway, I stayed in preop holding for 2 hours. 3 people were brought back there after me, and 1 was left when I went to surgery. I met Dr Hong again, who basically just assured me that everything would be fine and looked to make sure that I was getting my antibiotic and my lovenox that was ordered preop. I didn't see my anesthesiologist until about 5:15. He was very friendly, and probably only 5 years or so older than me. Shortly before I was wheeled back, I jokingly told him that I would tell him a "secret": that I was going to Gonzaga for CRNA school. He took it well. :) Not long after that, I was wheeled to the OR by the surgical techs. Stopping in the hall where Dr Ford was talking to a colleague, he gave me some Versed (sedative) in my IV, and I was asleep before I got to the OR.
I'm not sure if I remember PACU or not--I don't think so. I do remember waking up in my room around 8pm. I felt okay. They set up my PCA, and I asked them to call my husband into my room. I was groggy, but not too painful, and very happy to see hubby. I could tell he was fighting the urge to get into my bed with me. :) He was so sweet. Thanks honey! My nurse showed me my incisions when she checked them. They were higher up on my abdomen than I expected. The port incision is just to the right of midline, and it looks to be just over 1" long. I have 2 just left of midline, one over the other, and I have one all the way right and one all the way left. The steristrips are a bit bloody, but covered with clear dressings, so I can shower before they come off.
I got incredibly itchy around 1am, and requested some benadryl (IV). It worked a bit, but I kept getting itchy. I don't know if it was all the stuff that was put on my skin, the sheets, or the dilaudid, but I stopped using the dilaudid around 3am and it seemed to get better. At that point I was only using it to help me sleep anyway. I really had surprisingly little pain, just a bit when I moved or tried laying on my sides. They had ordered Toradol for me as well, which is a strong anti-inflammatory drug, so that was helping a lot with the pain.
I stopped trying to sleep around 4am and just read my book for a while until I got sleepy and dozed off. I slept a little off & on the rest of the morning, but mostly have been awake since then. My hubby came back around 10am. I spent the morning waiting for my swallow study in radiology to make sure that the band was in place and was patent. It didn't happen until 1pm, most likely due to all the surgeries the day before. The band was fine and I started drinking water when I got back. They had me write down my 1 oz. of water (or fluid, including the lortab elixir, which was NASTY!) that I was supposed to drink every 15 minutes. Then I just had to wait for the dietician, who was also held up due to the large number of surgeries on Tuesday. I saw my surgeon around 2:30, who told me everything had gone smoothly and he had used the smaller band (the 4cc band) and even that was pretty loose on me. He said there wasn't a lot of fat around my stomach which had a lot to do with that. I guess when you are on the low end of high BMI, that happens.
I finally saw the nutritionist at 4pm, and she had my personalized Stage 1 diet, which said I should be taking 45-52gm of protein per day. She had some more specific requirements for the first 2 weeks: to use protein shakes, and to use 2% milk instead of my nonfat I have been drinking for years, since I won't really be getting much fat otherwise; and to use full strength fruit juice when I do drink it because I'll need the carbohydrates. She said to use milk based soups and blend them rather than using broth based soups, since those are mostly salt water when you remove the solids. She went over the stage 2 diet (purees) and made sure I knew to use some fat and some sugar so I'd get the needed fats and carbs while my caloric intake is so low. She went over vitamins a bit. Then I was free to go.
It was just great to get outside where it was sunny (although a bit nippy at 54 degrees). Being off the drugs and out of bed, I had loads of energy this evening. The only issue I'm having is after several hours of drinking my required water, and 2 oz. of protein drink which was OK'd for today, I feel FULL. I still am supposed to drink more but I'm just full and uncomfortable and don't want to test my vomiting limit just yet, 24 hours post op. Not sure what to do about that...? My instinct says to trust the fullness and hope it's gone soon.
There it is, post op day 1. Tomorrow I walk!
Live in such a way that you would not be ashamed to sell your parrot to the town gossip. --Will Rogers
Monday, March 12, 2007
My dear hubby came with me to the class. We were a little late, and the class was waiting for me and a couple of other stragglers who did not end up coming. (What happened there?) The class was pretty general, nothing really new based on my research but specific to my surgeon's preferences: how long on liquids, which liquids, details about purees (or "mushies" as the bandsters online call it), etc. I can't say it was really interesting, but it was good to go to. Because I was later than I had planned, I got my blood drawn afterward rather than before.
We were late because we went to a favorite local restaurant for a late breakfast: The Cup & Saucer on Hawthorne. I had 2 eggs, one large blueberry pancake, and some vegetarian sausage. I LOVE blueberry pancakes! I hope I can still eat them postop eventually, even if I can only manage a few bites. :)
Much to my surprise, at the class we went around the table introducing ourselves, saying how much activity/exercise we get, and when our surgery date is. Most were soon, but I was the only one there having surgery tomorrow. The NP who led the class asked, "Oh, so you're on liquids now, huh?" I said, uh, YEAH. No one told me to be on liquids the day before surgery! I mean, lots of surgeons put their patients on liquid diets for up to 2 weeks prior, but the only instruction my surgeon ever gave was NPO 12 hours before surgery. WTF?! Anyway, I'm not gonna stress too much about it. My last solid food was almost 24 hours before my surgery, which is at 1:30 pm tomorrow. I'm on liquids now!
Weight loss surgery is not the only thing going on in our household, just the only thing this blog is really going to address. We have some other things going on right now that are sort of beyond our reach at this point, but it's kind of calming to just focus on the surgery and recovery today. All of the things I will need for the hospital will fit into the nice little bag that my CPAP travels in. I'm not bringing much--most people bring too much stuff to the hospital. I'll go home in the clothes I arrive in. I'm just bringing clean undies, a real toothbrush, a book, a magazine, my earplugs, my CPAP and my iPod. I'll bring my pills just in case I need to or can take them, but I'm hoping I stay sleepy on a PCA and don't have to worry about sleeping medicine! (I had a breast reduction in 2001 and slept FINE on the dilaudid PCA, did not need my nortriptylline at all!) If I did take them, they would have to be crushed anyway, and I probably won't have my swallow study before 5pm anyway since my surgery is so late in the day, which will mean I stay NPO all night. On second thought, maybe I should leave them at home after all...
I made sure to have my advance directive signed by my good friend Lori before surgery too. I've gone over my wishes pretty extensively with my husband, family and friends, but having something in writing is reassuring for people when they have to make decisions for you. I don't think anything bad is going to happen in this surgery, but I am an ICU nurse and we've all seen people have simple procedures (simpler than laparascopic gastric banding) and not do well for one reason or another. I needed an advance directive anyway, so this was a good excuse to get it done.
I also went through my photos over the last 5 years that show my weight fluctuations. Hubby took some pictures of me the night before last, and as always they are incredibly revealing. I don't see myself as obese as my photos show. I need to do some final measurements tonight so I have some point of comparison for later when the new me is revealed.
What else can I say? Time to get cut! Wish me luck.
Saturday, March 10, 2007
Friday, March 9, 2007
I continue to prepare for surgery, which is next Tuesday, just 3 days away. I have ordered more protein powder, organized the kitchen, and have just 1 more shift to work before my leave starts. I'm reading lots of band blogs. Some are full of gems and some are irritatingly whiney. Some people seem to "get it" and some don't, which shouldn't come as a surprise to anyone. The worst are the ones who go on and on about how they aren't losing as much weight as they want, but they are eating whatever they want, and still ARE losing weight. Grr. I just doubt that would be me.
I'm getting more used to Pappy (the CPAP). I don't find myself waking up during the night now. I do sometimes take it off in the morning and sleep without it for another hour or so. That's ok, according to the sleep lab people. I still get sleepy midday but it seems a little better. I also had another appointment for my eye, which my doctor says is 99% improved. Yay! No drops for now, but also no contacts for another week. And my vision in my left eye is still much worse. He'll recheck the refraction in 3 weeks. I've been wearing my glasses only for the last 5 weeks, which is frustrating since my left eye doesn't see as well as it did when I had them made just a few months ago.
I'm making lots of beads and still having fun with it. I don't particularly enjoy getting my oxygen tank refilled every 3 weeks, but it's okay. I may look into an oxygen concentrator that can handle my big torch at some point. One with the right capacity will cost me around $1000-1500. First I want a new kiln with a digital controller. The one I want is also about $1000. I think I will get one after my debt is all paid, which should be this summer. Right now I am sticking to one bead that I particularly like. I want to make an entire necklace of these beads, and the repetition should help me build my skills. I'm already much better at encasing from making the same bead 12 times. I bought lots of new Italian Moretti glass but I can't break myself away from the Bullseye, I love it so much! And their store is blocks from my house, I just cannot get over that. :)
Today I brought my violin to the violin shop down the street from me. I haven't played it in years but want to get it back in shape and start playing. So, I'm having the bridge slightly reshaped, getting new strings, having the bow rehaired, and then I'll take the case to a luggage shop to have it repaired. A few hundred dollars that will have my most prized possession ready to use again. I might buy a new carbon fiber bow to play with also, but that would be down the road a bit.
Things are changing, and it's a good thing.
"When you blame others, you give up your power to change."~Douglas Noel Adams
"The meaning I picked, the one that changed my life: Overcome fear, behold wonder." ~Ã†schylus
Tuesday, March 6, 2007
- Tiny utensils at Crate and Barrel
- Ginko leaf plates. I love all the stuff in this line, but we have enough dishes already and I love my Fiestaware, so I'll just get these 2 plates for daily use.
- Stainless steel shakers for protein powders (see below)
I'll need to get (at some point) a digital kitchen scale.
It seems, as I read all these wls blogs out there, that everyone has a clever name for their blog and a cutsie nickname for their band. Should I have one? I can't stomach another weird "band" pun. But maybe a name for my band...dunno. I'll keep thinking. Suggestions are welcome!
Kate's blog is really great, a good read and useful info. I loved her suggestion of putting the powders into those shakers you can buy with the handles. You can shake the unflavored on veggies, into soup, anything that you can think of. The vanilla or chocolate can go on top of sugar free jello, coffee, drinks, desserts, yogurt, whatever. Extra protein! I love it. I went out and bought shakers for that purpose. (While I was at it, getting the shakers at BB&B, I got some small utensils for taking small bites, and I went to Crate & Barrel and found these really adorable small plates shaped like ginko leaves. Should make the small meals more fun--especially when made bento style. Check out www.cookingcute.com for suggestions!)
Getting too much protein can be a problem for lots of people eating the standard American diet, but as a vegetarian I don't get too much. I get enough for now, especially since I started eating fish again, but the powders can put too much stress on your kidneys if you take too much. You can only absorb about 30 gm at a time, so I'll be careful to stick to that (no more) with each meal.
It takes me a little while to get to sleep with it too; despite the fact that it is pretty quiet and I wear earplugs, the fact that it is on my face and vibrating my facial bones means that I "hear" it in my head anyway. I can't sleep with ANY noise or light, so it makes it a little challenging, but once I get to sleep I sleep pretty soundly. In fact, I can't remember waking up during the night like I do without wearing it. So maybe that IS why I wake up so much during the night.
So, it's a love/hate relationship with the CPAP. I don't know how this little story will end, except that after I lose about 50 lbs I hopefully won't need the darn thing anymore.
Surgery is one week away!
Monday, March 5, 2007
- December 2006: Attended an informational seminar by the Legacy Obesity Institute (Portland OR) which is a Center of Excellence for bariatric surgery. My insurance specifies that it will only cover surgery from a Center of Excellence. At the end of the seminar, which was about 45 minutes, you may receive a binder which includes an application to have surgery. You cannot get an application without going to (and listening to) a seminar.
- Completed and submitted an application to have surgery, which included some basic information about myself and my nutrition and exercise history. In addition, I submitted a typed history highlighting my particular reasons for wanting surgery.
- Early January 2007: Appointment with sleep medicine doctor, Poh Leng MD. He got my sleep history and recommended a sleep study, as he felt it was likely I had some sleep apnea.
- Mid-Janurary 2007: Scheduled and attended two consultation appointments at the Legacy Obesity Institute (LOI). These two visits entailed taking a psychological assessment (the Minnesota Multiphasic Personality Inventory, 264 questions) and a nutrition assessment, meeting with the nurse practitioner, dietician, psychiatrist and physical therapist, having a 12 lead EKG and a body composition analysis, and having a lot of blood drawn. The MMPI assesses whether or not you have some hidden psychiatric issues that might interfere with long term complience with instructions or ability to make decisions. The psychiatrist reviewed the MMPI with me and told me I was not psychotic. (yay!) The nurse practitioner did a physical assessment to get a sense of my general health and extent of comorbidities and obesity related health problelms that I might have. The nutritionist talked at length with me about what to expect nutrition-wise after surgery and what to do to prepare for surgery. The physical therapist discussed exercise post op and assessed my flexibility and ability to perform basic physical tasks. She declared me one of her fittest and most flexible patients. (Not that there is much competition for that title, I'm sure.)
- Early February: My paperwork was forwarded to the surgeon's office (Oregon Weight Loss Surgery, or OWLS). About 2 weeks later they called me to make an appointment to view an informational video about the band and see the surgeon. Although I wasn't sure yet if my insurance would cover the band, we tentatively planned for it pending insurance approval. I thought they would only cover gastric bypass, so up until this point was planning on having that surgery.
- I also had my first sleep study around this time. Although I barely slept and kept waking up every hour all night, it did show some mild sleep apnea according to Dr Leng. There is lots of info available online about how sleep studies go, so I won't go into much detail there.
- It took a little over 2 weeks to have my surgeon's dictation sent off to my insurance to get official approval. I was approved just last week and was able to schedule surgery almost immediately.
I'm lucky that this has all happened on a quick timeline. I thought about doing this for a long time, but once I decided I didn't want to wait around too much. I do think that the entire process is important to know where you stand from a complete physical standpoint, and to be sure that nothing is missed.
I also think the Centers of Excellence program is the key to the recent dramatic improvement in patient outcomes with bariatric surgery. After the horror stories from the late 90s and early 2000 until about 2005, something was needed to stop surgeons who made easy money off of desperate obese people willing to do anything. The requirements to become a Center of Excellence are strict and are almost entirely outcome based, that is, a surgeon or program has to be able to document and prove a long track record of short and long term positive outcomes to become a Center of Excellence. Usually these are hospital based practices that can do this, but some are free standing surgery centers.
Interestingly, everyone I met at the LOI and OWLS asked why I wasn't having surgery at OHSU, my employer, which is the other Center of Excellence in Portland. Well, I work in one of the ICUs there (the Trauma ICU). Every night the surgery schedule is printed and gone over so each ICU knows what cases to expect the next day post op. I would be on that schedule...so even if I managed to get through the OR and PACU and short stay unit without meeting anyone I knew, the chances are that everyone would still know what I was up to, and it's just not everyone's business. I had a hard time telling my FAMILY...I'm not going to announce my surgery to all of my coworkers and friends. The OHSU obesity clinic assured me that they would give me an alias and protect my privacy, but word spreads in hospitals, and I just felt better knowing my privacy was a little more secure in a hospital where I knew no one. Plus, OHSU doesn't do many Lap Bands, so it's better to be at a practice where half of their cases are bands.