Weight Loss

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Monday, March 24, 2008

Nutrition recommendations, and a new doctor...

Carbs are bad.

Now, I'm just being provocative. I don't believe carbs are bad. They are necessary for life as are other macronutrients. Simple carbs--sugar, the tasty stuff--aren't so good, especially in excess. I love sugar and sugary things, and getting away from them has been a necessary part of my weight loss. Most of us swear off "carbs" at the beginning of weight loss, especially via WLS. Eventually they creep back into our diets and we have to get rid of them all over again. But ridding our diets of the evil carbs is not really the point. The point is more that we need to eat a fair amount of protein, and our caloric intake is (supposed to be) restricted enough that you just don't have space in your diet for "carbs". Also, the carbs most of us eat just don't have any nutritional value. But, there's always room for carbs....and that's the thing about the band, sugary things just slip down so easily. Few of us can avoid them without really trying hard.

I've been eating more sugar, and I need to cut it out. Sugar makes you want more sugar.

I saw "the new surgeon" last week, Dr. John Pennings of Post Falls ID. He's a nice guy, reminded me a lot of Philip Seymour Hoffman actually, with longish scraggly balding hair and a goatee, looks like a graying redhead. I almost didn't see him, actually; just as I was leaving for my appointment, his office called me and told me that they had a new policy for patients of other surgeons, that I had to have a letter of referral from my other surgeon and all my records before he would see me. This policy has been put in place in the past few weeks, long after I made this appointment. I strenuously objected to this, since it's hard for me to make appointments in the first place with my schedule and I was on my way to the appt. The surgeon who took over my care from Dr Hong when he moved to Canada, Emma Patterson, is a colleague of Dr Pennings and she told me that he would definitely see me if I told him she sent me. I think they trained together at Emanuel Hospital in Portland. Anyway, I told the office coordinator this and she checked with Dr Pennings and he agreed to see me without all the extra documentation. Sheesh.

So anyway, I see Dr Pennings, at last. He didn't seem super impressed with my weight loss at 1 year, but he saw I was within 20 lbs of goal. He liked how much I am exercising. They did a Tanita body composition thingie and determined that I had 120 lbs of lean mass, and he used that number with his personal number of 1.5 gm protein per kg lean body mass to determine that I need 90 gm of protein per day now. Um, what? How am I going to do that, without protein shakes? I think 75 gm might be more doable. My "people" at the Portland office told me 45-52gm, which I have been going by for the past year. Pennings believes that my weight loss will pick up again if I get 90 gm protein in per day. I believe he might be full of crap. But anyway, I'm trying to increase it some.

One useful tidbit he did give me was the calories-per-protein-gram rule. He told me to check labels on foods, and "gravitate" towards foods that have a ratio of 15 calories or less per 1 gm of protein. This seems reasonable and simple to do.

It kind of sucks having to see a different surgeon. This guy is nice, and seems to know his stuff. He does a lot of bypass; I didn't ask how many of his patients are banded. But I'm not sure if his 1.5 gm rule might be more bypass-oriented. A lot of bariatric surgeons take their RNY guidelines and just give them to band patients, which doesn't really work because the surgeries are so different and the requirements are really different, too. If a RNY patient takes in 90 gm of protein, s/he won't actually absorb all of that, because of the bypassed intestine. Honestly, I've never heard of a banded patient being told to eat more than 60 gm of protein per day. But, he was quite interested when I told him I am in anesthesia school. He told me he only uses CRNAs for his surgeries, he likes working with them better, and told me to come work at their hospital when I graduate--which I won't do for a few reasons, one being that we don't want to live in Idaho, another being that I need a much busier practice when I am first starting out. But it was nice to hear anyway.

He gave me a fill before I left, and here is another bit of discrepancy between what the office staff told me and what he did. They told me he always does the first fill on a patient that he didn't perform the surgery on under fluoroscopy. Well, he did a blind fill, just like everyone else has always done. Honestly, my port is quite easy to find, and he had no problem hitting it on the first try. I don't believe I was charged for fluoro, based on what they told me the charges are. But it was kind of interesting. Another interesting thing: he withdrew the fluid from my band and I had about 1.5cc LESS than I should have had in there. I really have only been noticing a reduced restriction lately. But he just gave me a 0.5cc fill and said to come back in 6 weeks if I need another, which I think I might. I notice the reduced restriction much more now that I know my band was a lot less full than previously believed. Interesting how the mind works. I didn't get the 1 year followup upper GI that I need. I have to make a separate appointment for that. It's going to be expensive, and cash, and I don't really feel like doing it right now.

So that's the lowdown with the band. I need to keep working on reducing sugars and increasing protein, and keeping the amount of food down. I ran today, was more tired than yesterday when I was able to run 20 minutes straight. Today I did 12/6/6 (24 minutes total) while listening to This American Life on podcast. The topic was "The Ghost of Bobby Dunbar." It is a fascinating tale of a family's response to learning the truth about their ancestor's kidnapping 80 years ago. The podcast itself isn't available for free any longer (the website for This American Life only allows free download for about a week, after that it's 99 cents, and iTunes only keeps 1 episode at a time) so if you don't want to pay to download the podcast I recommend reading this article about it. Great story.

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