Weight Loss

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Thursday, March 13, 2008


Happy bandiversary to me!

I'm in a very different place than I was on this day last year. Literally: I'm in Spokane, WA, in anesthesia school. But obviously it's much more than that.

I've always been a person who identified problems that I could solve and made plans and solved them. Sometimes the solutions might not have been the best ones, or might have caused their own problems. But inaction has always been my greatest fear, and usually I do pretty well with the plans I make. Deciding to have WLS wasn't much different. I identified that my weight was an ongoing problem that wasn't getting better, that losing weight seemed to be a problem I wasn't able to crack on my own, and that repeated cycles of losing and gaining were going to be harder and harder on my body in the long term. At the same time, I had images of my own father fresh in my mind: probably 200 lbs overweight, and barely able to walk on joints that are giving out, partly from trauma but mostly from supporting his frame for most of his life. He has lost and gained weight repeatedly, which I'm sure hasn't helped his body with his history of chronic hypothyroidism. I did not want to be his age, which this year will be 64, barely able to walk, and double my ideal body weight.

So WLS became another project for me. I was approved for surgery and scheduled it as soon as I could after that point. I had just interviewed at OHSU and Gonzaga for anesthesia school and decided to go to Gonzaga; my life was changing dramatically. I think I chronicled the details pretty well last year in this blog.

I don't think I really knew what to expect for my one year post op results. I hoped I would have lost ALL of my excess weight by now, but I knew that I probably wouldn't. I think I would have been surprised to learn that I would get as far as I have by now.

A lot happened in the course of this process that I didn't expect, but which I have all but forgotten about by now. I lost about 22 lbs initially but gained 10 back within the first month, as my post op diet progressed. Then I started getting fills but didn't have any noticable change in my hunger until July, which was my 3rd or 4th fill. So that time in between, I did lose weight, but very slowly. And I was hungry for a lot of it. I experimented with ignoring my post op diet, progressing to soft foods early, but learned soon the reasons that it's a bad idea, and slapped my hand. I sort of sweated the time ticking by, when I was losing in spurts. I've lost in spurts and then stalled during the entire process, which I think is pretty normal. The body isn't as simple as we like to think it is when it comes to weight loss.

Now my focus is more on exercise and general health. I'm continuing to advance my fitness level, trying to keep it interesting and challenging. I am still losing weight--I lost 3 pounds in a few weeks, then have hung at the same weight for the last week. I am an advocate for daily weighing, at the same time in the same conditions each day. I think this is the ICU nurse in me, wanting to track trends more than absolute values (although when it's your weight, and you're trying to lose weight, you are definitely interested in the absolute value too.) I weigh every morning, after I pee and before I drink or eat, as soon as I wake up. Naked, on the same scale. Doing this every day has kept me on top of things, knowing when I've been stalled for a while, and most importantly, knowing my pattern of weight loss intimately. I don't get discouraged by seeing the exact same weight for 5 mornings in a row, because I know that happens before I lose weight. I also know that after 5 days of that, it might go up a pound or more before it drops 2 or 3. That's how my body loses weight. I wouldn't know that if I weighed once a week or once a month. It doesn't work if the scale has the power to ruin your day, but it doesn't for me. Research shows that people who weigh every day keep their weight under better control, so I like establishing this habit so when I am in maintenance I can continue.

My health is a gift I partially gave to myself, but I have to thank my genes too--and of course, my lap band. I'm an advocate of treating it well so it will stay with me for the long term. That means not challenging it, by overeating, and not keeping any more fill than I absolutely need in it. I've never needed an unfill, never vomited or had any food get stuck, never "slimed". I'd like to keep that record intact, to keep my stomach under the band as happy as possible. I'm also curious about the effects of intraabdominal and intrathoracic pressure on the band--I have been noticing, when I do the leg press, that if I follow the recommendations and exhale when I press up, it creates a lot of intrathoracic pressure, and I think that might cause a very slight risk of prolapsing my stomach through my band under the right circumstances. So I let my breath out passively when I press, and try to minimize intrathoracic pressure to keep from that happening. (I thought of this after one woman lost her band when she lifted very heavy furniture and immediately had symptoms of a slip--when she finally had emergency surgery her stomach was ischemic, although they were able to save it--but not the band.)

On an unrelated note, I finished my third "orientation" day of IV starts in the surgical admit unit this morning. I'm so glad we will only be doing IVs once a week. Getting up at 4:30 am kills the rest of my day. I took a nap after class today and I feel a lot better now. I have a lot of studying to do this weekend. There's no class tomorrow, so I can start yet another fun weekend of nothing but studying. Of course, hubby is supposed to be coming here this weekend, which will be nice. But I have a lot of work to do, too. Anyway, the IVs, I missed 1 patient entirely this morning, and another one I got on my second attempt. I got 3 more on the first poke after that. But I hate sticking people more than once. Yesterday I had 5, all on the first poke, which was fantastic. One was even particularly difficult--very tiny, fragile veins, on a dialysis patient who said she'd kick me if it hurt! (She was sort of kidding.) But we are required to use lidocaine for IV starts in SAU, which is technically more difficult because it obscures the vein underneath it--and because of the lidocaine, she didn't even know I was done as I got ready to leave. IV in place, fluid dripping in just fine. So that was a nice success. I enjoy starting IVs, actually--I'm pretty good at it, after 11 years of nursing, and it's always a good challenge and very gratifying to get a difficult line. But I don't really enjoy getting up at 4:30, or the sleep disruption that goes with it. I've slept really poorly this whole week. Anyway. Next week: we start intubating! I'm excited for that.

Okay, I'm outta here...gotta go run, and study after that.

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