On Eating, 5 things to know 3 years post-op.

After more than three years of experience eating "normally" with the sleeve I have these observations.

1.  Slow down.  Chew your food.  Sounds simple enough, and I'm sure you've heard it from your surgeon's office, but if you're like me, you've gotten used to tuning-out the things that medical professionals say about obesity.  Well, it turns out this is really useful advice after you've had a sleeve, and if you'll think about it with me for a moment you'll see why.

Your stomach went from being a stretchy muscular storage baggie to a muscular toothpaste tube with a big scar down one side.  Think about putting a salad, let's say, into each of these containers.  You can pretty much stuff the salad into the baggie as is, if you want to get it in the toothpaste tube you'll need to throw it into a blender first.

If you will keep in your mind that food needs to be in a state that will slip down into that toothpaste tube before you swallow it you will get much better results.  When I do this I am less nauseous, I burp less, and I enjoy eating more.

2.  Get used to throwing away food.  Rehearse your lines for the servers.  It is possible, I know, to get most restaurants to serve half-portions of entrees or use an appetizer as an entree.  I've done this.  It disrupts the meal, it disrupts your companions, it disrupts the kitchen, it disrupts the process of getting a check and getting out of the restaurant.  You'll give it up, just like I have.

You will very quickly tire of take-home containers.  It would be awesome if that Dover Sole that was so exquisite on the plate at last night's meal was something other than a soggy piece of fish today.  That's not the world we live in.  You will quickly tire of eating left-overs, there is no reason to chill your garbage before ultimately throwing it away.

Decline the take-home containers, here are my favorite lines for servers:

"I don't eat very much."  Usually that's enough.  I get lots of raised eyebrows because I am still a physically large man, but I don't have to have my server's approval, I just need them to clear the table.  If they want to believe I have some covert agenda for leaving food I have purchased unconsumed, that's fine with me.

"I'm having some trouble with my stomach."  This is always the truth.  I have GERD, frequent belching, regular mild nausea.  Rare is the occasion that I am not having some kind of trouble with my stomach.

These things no longer distress me, don't get me wrong, the GERD is treated well by omeprazole, I have learned to belch quietly (when I think of it), and even though I never would have believed it before it happened, it is possible to get used to being nauseous.

It's just a sensation, and once you mentally de-associate the sensation with becoming physically sick (nausea is the sensation, vomiting is the sickness), it just fades to the background, and the most problem it ever presents is just making me disinterested in my food, which I don't really mind.

"I can't be carrying anything with me where I am going next."  This is the last resort, the white lie, but it works every time.

3.  Eat your protein first.  Keep track of what you're eating.  I know, I deserve a brick to the head for saying the same kind of nonsense that comes from the mouths of clueless medical professionals, but it does help.  What I mean is this:  When you are eating small portions in a large portion world it is very easy to get full before you have had a well-balanced meal, even if it is on the plate in front of you.

I haven't found it necessary to eat perfectly at every meal, but I do think about it during the day.  Here's the typical non-optimal day that will illustrate my point.  I have to go to a conference or something, there's a continental breakfast.  Half a bagel with cream cheese, a cup of coffee, I'm done.  I've had loads of simple carbs and some dairy fat, probably from grain-fed feed-lot cows.  Not a good start.

Then, I get a break at ten and grab a banana.  More simple carbs, a few complex carbs, now I'm going to go halfway through the day without protein (other than a trivial amount of dairy protein).

Lunch-time is a box sandwich, a bag of chips and the "choice" of HFCS/artificially sweetened soda.  I grab the sandwich, get rid of the bread, and eat the sandwich meat (or salad) first.  Nothing else goes in the mouth until all of the protein has been consumed.  I never, ever, ever eat artificial sweeteners except when they are in prescription drug formulations, so I will grab a ginger ale if it is available, a cola if not.  I will drink about a quarter of a regular can, excuse myself to the restroom, pour the rest of the syrupy mess where it belongs and refill with water.

After the middle of the sandwich is gone I will turn to the chips.  I love chips, since the surgery they are like crack to me.  They are calorically-dense, full of salt, and trigger the reward centers in my brain as reliably as cocaine probably would.  Chips make me motivated to go out and get more chips!

So, I eat them last.  Anything I really, really like is eaten at the end of the meal.   I enjoy them sensually, slowly, and in small measure.  I often take the last one as I drop the 2/3rds full bag into the trash.

That evening, when I get home and can choose my own food, I will have an all veggie meal, raw if possible.  Raw food is the one thing that does travel and keep well overnight, and salad for breakfast is a little known pleasure.  I favor spinach salads in this regard.  I ate all that protein at lunch (even though it was crappy protein) if I want to feel well, I need to pack in the veggies.

So, there are different versions of all this for different days, just notice that even between and across meals I keep in mind what I have been eating, making choices in subsequent meals according to the choices I made in earlier ones.  It's good to develop this habit.

4.  Soup is your friend.  It's cheap, it's ready for your sleeve *before* it goes in your mouth, and it can be a really good balance of macronutrients.  All restaurants have it, and the crappier the restaurant, the better choice the soup usually is (compared to what else is on the menu).  Learn to love soup.

5.  Five meals, just accept it.  Here's how I conceive of mine:  early breakfast, late breakfast, lunch, early dinner, late dinner.  You will eat alone at least 40% of the time.  This is more socially disruptive than you think.  Here's an example;

I go to a big BBQ feast with friends.  I have a small piece of meat and some cole slaw.  They eat half a cow each.  Three hours later, it's time for me to eat again, they really just finished eating a couple of hours before, they still feel tight as a tick, but it is time for me to get something to eat.  I get the weirdest looks and snide comments about being a glutton.

I shrug that off, but the problem is that I need to put a meal together at a time when everyone else is completely disinterested in eating.  If we are doing something else, from shopping, to some physical activity, or a movie, or dancing, or whatever, I need to divert to grab a bite.  I will be the only one in the group with this issue.  It's a hassle.

Regarding the Tummy Tuck (the Panniculectomy).

Scheduling problems interfered with my schedule to have the panniculectomy, the plastic surgery to remove the excess skin around my abdomen, in March.  There was a confusion between me, my surgeon, his office, and the day surgery center about which Tuesday I was on the schedule.  At the same time, there were developments at work that made it advantageous for me not to take the days off I had planned to take off to recover.

So, my surgeon and I resolved to reschedule in May, and I have not contacted him to do so since.  I want to wait.  I'm not sure why, really.

The skin needs to go.  The procedure has been approved by my insurance carrier as a therapeutic procedure.  There's no fudging that fact.  The justification for doing this isn't cosmetic.

Clothes minimize visual attention to this irregularity in my body contours.  My body contours are still changing.  The part of the skin that needs to be removed becomes clearer with each passing month.  That is, this excess skin is looking more and more like it is *not me* as time passes.  Everyone with an informed opinion (i.e., those who see me naked) has expressed a notion that it seems like the surgery would turn out better if I let my body contours continue to evolve a bit longer.

The skin under my panniculus (beer gut) gets a simple, common skin condition that results from an excess of moisture and a dearth of open air to the skin surface.  My dermatologist tells me that I have nothing that a couple of weeks on a nude beach in the tropics wouldn't completely cure.  He says he sees exactly the same condition on the undersides of breasts in many otherwise healthy women.  I can't eliminate it with topical agents, but I can keep it under control.  In one sense, clothes cause this.

I don't want to live with this forever, but getting rid of it isn't as urgent as it could be.   Also, I do not like general anesthesia.  I am happy to postpone any encounter with it.  So, that's where I am at the moment, but like my body contours, I expect this will continue to evolve and change.

What this is about

I have a collection of essays online concerning my bariatric surgery.  I originally conceived of those as being completed someday.  That is, I had in the back of my mind that one day I would write "the last one" and that would be it for that document.  Signed, sealed, delivered.  Well, it didn't work out that way....

I realize now I thought my bariatric procedure would also turn out that way.  I had a vertical sleeve gastrectomy three and a half years ago and I am still changing.  Today.  I am still making adjustments. I am still discovering new things.

So, do I continue to write these pages by hand in HTML and CSS (direct instructions to the web browser you are using the read this), or do I do something easier and just start a blogger account?

I'm lazy.  The surgery didn't change that.  Welcome to the blogger account.

If you came here from the rdewald.com/surgery web-site, click the title at the top of this page to go to the home page for the blog.  Thanks for showing up.