It has been 2 1/2 months since I had gastric sleeve surgery and it has been 10 weeks of learning how to eat. Seriously, eating has been a full-time job that has gotten progressively more difficult to manage. For the first two weeks I continued on a liquid diet that consisted mostly  of Kaizen chocolate meal replacement drinks. I continue to use this product when I need a quick breakfast. If I am going running I may add a frozen banana or powdered peanut butter to amp up the caloric value. Foods like this are very easy to include in my daily diet but they are also highly processed, expensive, and not always easy to access.

​The second phase of post-op food included pureed foods about 1/4 cup at a time. A favourite dish was skyr yogurt blended with lox - high in protein, flavour, and the texture of salmon mousse. I also consumed a lot of Happy Planet soup, blended with Kaizen unflavoured protein powder (add protein powder after heating to avoid texture change). Fruit and yogurt protein smoothies were also a great way to get food and calories into my system. 

The third phase of post-op eating were soft solids, which felt like the first time in 10 weeks that I was able to food that I had to chew!! This stage of the post-op diet lasted three weeks and included things like canned tuna, cottage cheese with salsa, ground chicken or beef, and Indian curries. Poached eggs with avocado became a favourite breakfast - I can still only eat 1 poached egg and 1/4 an avocado at a time.

I am now in the regular gastric sleeve diet, which means that I prioritize protein, limit sugar and processed foods, and try to maintain a diet of 1100 calories/day consisting of: 75+ g of protein, <65 g of carbs, and >15 g of fibre. I am also to take (I'm still struggling with this) Vitamin D, B12, Calcium, a prenatal vitamin, iron, and if necessary a stool softener daily. I'm doing much better at remembering to eat properly than I am at remembering to take all the pills. This is my short-term goal...remember to take all the freaking pills (12/day). This also means that I don't eat big salads as they have little nutrient/protein/calories to add to the mix!

The other major change that I made pre-op and post-op is a new focus on physical fitness. A friend in South Africa (Gareth Evans) convinced me to train for the Two-Oceans 1/2 Marathon and I joined the Steve Nash gym in Nanaimo. I waited as long as I possibly could before returning to physical activity (4 weeks) and started off slow - walking around Westwood Lake. At the 5 week mark I returned to the gym and paid close attention to how my body felt when lifting weights - I also started off lighter than I would normally go and worked with a trainer (Josh). A close friend and skilled runner, Dr. Audrey Giles at the University of Ottawa, has signed on as my running and accountability coach. Most weeks I get 2-3 runs (needs to be 3-4) and 2-3 workouts at the gym.

All in all - it has been a crazy few months of adjustment that isn't close to be over. I've learned that eating out is a challenge (wasted food and lots of menu changes) but family style dining is awesome. It allows me to sample a number of dishes and not over eat. I've learned the pitfalls of not planning ahead - I don't feel hungry so it isn't until my energy crashes that I really get the message. I also discovered the real need to ensure that my calorie intake is good prior to exercise...lightheaded trail running isn't a good thing! Most of all I have learned just how many supporters I have and how interested people really are in this journey. I will attempt to do better at more regular posts - I will also post about some of the less positive lessons in the next one! 

The numbers: 

• Weight loss since mid-September 2019 - 50 pounds (17%)
• Weight loss since highest weight (2013) - 86 pounds (26%)
• Inches lost since Sept 22 - 36 (13.51%)

Today is my last day of the three-week pre-op liquid diet and I can't believe how fast that time has gone by! One of the things that helped was the discovery of powdered peanut butter! Low in fat, high in protein, low in sugar, high in flavour....a perfect addition to a protein drink for an added boost of flavour! I started with PB2 (Amazon and Costco) but am switching to PB & Me as it has no added sugar or salt! I'm not really done with the liquid diet though - tomorrow is my surgery and then I will be on more liquids (a larger variety thankfully) for another two weeks as my staple line heals. Then I get to have pureed foods for another two weeks. I'm dreaming of pureed avocado and a soft poached egg! 

I've been fielding a lot of questions about the surgery that I'm going to be having. FYI: As an educator I love to answer questions so don't be shy about asking them but please try to phrase them in a non-judgemental way! There are a ton of misconceptions about the surgery (the first being that it is an easy way out) and what the different surgeries are (each with its own issues), and why people do it. I'm fortunate enough to have not only two friends who have had the surgery but also a few medical doctors (versus all us PhDs) who can provide some insight and blunt answers. For those wishing a little info here goes (remember: I'm a PhD not an MD!)

I have chosen to have the vertical gastric sleeve which is essentially the removal of the majority of my stomach (see image from Mayo Clinic below). This really restricts the amount of calories that I will be able to consume at any one time, so combined with behaviour modifications about WHAT I'm eating, it should result in weight loss and weight loss maintenance. It's not fool proof - I can screw it up by continuing to overeat (which will be painful) and by eating the wrong foods (e.g., carbonated beverages which can cause my 'new' stomach to stretch). There are very few limitations on what I can eat once healed; however, I will be taking a vitamin regime for the rest of my life as I won't be able to eat enough food to get it all in naturally. For those who know me well...the prenatal vitamins are due to the surgery and not on my stance towards having kids! The main advantage of this surgery versus the Roux-en-Y Bypass, that requires 'replumbing', is that I should not have malabsorption issues.

Yesterday was a major milestone in my journey to wellness – a successful pre-op check-in and compliments on my one very high blood pressure. Today was generally good; a great workout, participating in a public protest (we really do need to deal with the climate crisis), positive results on the scale, and I read a great book by Pennie Nicola called The Sleeved Life: A Patient-to-Patient Guide on Vertical Sleeve Gastrectomy Weight-Loss Surgery. It was also a day of incredible struggle with the desire to eat anything other than another chocolate shake – a struggle that I lost.
 
I have done so many diets over the last 25 years – Weightwatchers (too many times to count), Jenny Craig, elimination, low carb, low fat, pills and supplements, and a few others not worth mentioning! What I didn’t know – and what none of the commercial weight-loss companies tell you – is that “once a person becomes morbidly obese, the body changes on a hormonal and chemical level” (Nicola, 2018, p. 41). This confirmed something my own doctor told me when I experienced weight gain after I stopped using the appetite suppressant Saxenda  – my body liked my maximum weight and it wants to get back to it!! Nicola also referenced a study by Wing and Phelan that was published in the American Journal of Clinical Nutrition in 2005 – the researchers found that as low as 2% of morbidly obese people manage to maintain weight loss through exercise and diet alone. The key here is how overweight someone is because they also note that on average, 20% of people do maintain weight loss of at least 10% of the weight initially lost.
 
So some of you are likely wondering how far I went off the rails today – it could have been worse but it still wasn’t good! I walked past my favourite gelato spot (twice), I walked past four different fast food (fake food is what my Bariatric Dr. calls it) joints, and thought I had made it safely home. But I had made a big mistake – I let myself get too hungry. I walked over 10 km, did some strength training, and expended over 1100 calories through movement (or so my apple watch tells me) but I had only consumed 450 calories and I didn’t ensure that I was drinking enough water (helps you feel full). I got home and had a shake but it was too late – I was ravenous and worse…I was fixated on food. So after fighting it for a while (3 hours) I gave in and made myself popcorn – complete with melted butter.
 
Here’s the difference between tonight and even a few months ago – let alone a few years ago – I’m letting it go. I’m not hiding that eating in shame (I may not brag about it to my surgeon though) nor am I going to spend the next 11 days beating myself up about it. I need to figure out the reasons why (I listed a few above but there are always psychological reasons too) and get back on track. So today, I leave you with this thought…
 
I have always been fairly active but I have struggled with my weight since I stopped playing high school sport but still ate like a high school athlete. I become obese in my late teens/early twenties as I became depressed over the loss of my athlete identity. I have dieted constantly – something that has ultimately damaged my ability to achieve weight loss through ‘just burning more calories than I consume’. More important, I have learned that a journey to health is like any good logging road on Van Isle – full of potholes, washboards, and detours – and if you have a good map you’ll eventually arrive at your destination. It may not be the originally planned destination but you’ll arrive where you were meant to be!
 

I both love and hate this photo! I love it because it is one of the final ‘good’ pictures of my grandmother, mom, and I. I hate it because I can’t stand to look at myself and see how large I was. For those of anyone who is about to say… “you look beautiful” or “I don’t see size when I look at you” or “focus on the wonderful memories” – don’t, it’s not helpful! Making statements like that to people who feeling poor about their size (regardless of how big or small they are) can actually add to the problem! At least that’s my experience, and besides, it’s not about you! It’s about me and how I feel and it’s taken a long time to get to the point where I fully understand that.
 
I love this picture for another reason though – this photo is the reason that I finally started on my journey of better health and a greater focus on myself. It started me asking questions about what realistic and long-term options for weight loss exist – not an easy out, but a way out of the constant diets that don’t work, a way out of the cycle of shame and depression that comes with failed diets, a way out from being the ‘big one’ in the picture.
 
One year after this photo was taken I started the journey of exploring bariatric surgery. I knew about it from friends who had the surgery (and who are rocking their own journeys) and with their encouragement I asked my doctor what his thoughts were. He responded with science – something he know that I would like – and said that the literature was clear. Bariatric surgery was one of the only (if not the only) medical approaches to obesity that had long term success; quite simply the cycle of yo-yo dieting that I have been on for 25 years wasn’t going to work! 
 
I didn’t know it at the time (fortunately) but one of the quick paths to surgery is to simply save the cash (approx. $6000 CAD) and head to Mexico. I looked into this option at the 2 ½ year mark – frustrated with what appeared (at the time) to be moving goal posts for approval. I had gone so far as to ask my doctor if he remain my primary care physician if I did it (he said yes). Fortunately, I was approved for surgery by the head of the bariatric program at Royal Jubilee Hospital just a few days later!
 
I took the a longer path to my surgery (scheduled for Oct 1) – 2 years and 10 months where the staff of the Island Health Bariatric Program had me working on my relationship with food; how I eat, what I eat, and what I do when I’m eating. I had to come to terms with the fact that many of my ideas about food and how I relate to food in the future had to change. I have come to realize that I am not defined by being obese and that I am not more of a failure because I have advanced education and the ability to afford ‘good food’ – having a PhD in Recreation and Leisure (therefore having read much of the literature that experts refer to) actually added to my feelings of failure and shame! I am glad that I had that time because now I am prepared for the (I think) for what comes next.
 
I don’t know if anyone (even my mom) will ever read this but I’ve decided to share my journey for a few reasons:

1. We keep too many health issue in the dark in our society and that adds to the shame and stigma surrounding them.
2. Writing actually helps me process and right now, it’s all about me!
3. It allows my caring and supportive family and friends a window into who I am and who I am becoming (without me having to talk about it constantly which is boring for them and me).
4. Maybe, just maybe, it will help someone else who is struggling with similar issues.

 
This is my first blog about this journey and there will be more to follow. If you are reading this, please feel free to ask questions and to check out the rest of my website – so you can see who I am beyond being a 45-year-old woman who has struggled with weight and depression for 25+ years!
 
Aggie