Head Space and Eating Right

Although we both had our appointments scheduled on the same day, in May we each saw different people, Ally saw her nurse Darla, and I had two appointments, one with the clinic Psychologist Patti, and the other with a Dietitian names Colleen. Most people who enter into the program are supposed to see a Dietitian as soon as possible to help them with the one cup diet and ensure that you are getting enough vitamins and nutrients to lose the weight the “right way.” By now we have almost accomplished our entire pre-surgery required ten percent weight loss and are just now getting our appointments with the Dietitians. I have mine this month and Ally`s was canceled and rescheduled for next month.

Ally saw her nurse Darla who was very happy with her progress and her weight loss of 3 lbs. this month bringing her to 269 lbs. She told Ally that there was no point to making an appointment with the surgeon until the offsite psych evaluation and scope are done. They talked about Ally’s hernia, which is why she had a scope done in the past, and she is going to ensure that the surgeon is made aware of it before surgery. Other than that they mostly just went over her Food Journal and any food related struggles (temptations) that she was having. Have I mentioned we like ice cream?

First I saw Patti, who is my Psychologist within the clinic. Unlike Ally’s experience there was no large booklet of questions we just sat there and talked while she made the occasional note. We covered family history, child hood, and my support system to name a few topics. It was very natural and just flowed from one topic to the next. Although it did last about an hour and a half and was quite a bit of talking for me as I don’t normally talk all that much.

After my Psychologist appointments I had my Dietitian appointment with Colleen. We went over a lot, she looked over my food journal and I explained everything I was eating, she wanted to know about water intake and eating habits. While we were talking she takes notes and was writing down the advice that she was giving me on things like recommended protein per day, and calories per meal. She suggested that I try a Boost: High Protein drink in the morning since I don’t like eating breakfast, saying that I could even try getting a prescription for it and seeing if it is covered by medical. Colleen would like me to start a prenatal vitamin as it is the best one to get all your levels up before surgery. An increase in fruits and vegetables was also recommended, she wants me to eat an extra cup a day of just fruits and vegetables, when I asked about the effect on the one cup diet because I was concerned about what the surgeon would say and how it would impact my surgery she said that it’s what I need and the surgeon doesn’t even look at our Food Journals.

My suggested Calorie intake:

   Aim for 1400 – 1900 per day

   300 – 400 per meal

   150 – 200 per snack

My suggested Protein intake:

   60 – 65g per day

   20g per meal

When I came out of my Dietitian appointment to book our next month’s appointments I was excited to learn that we had received our scope dates. We are both booked in for February 4, 2014 and are on the next day cancellation list. The receptionist told me that there was a woman last month that received her date for next year as well and then was called to have her scope the week after she had gotten the date, so fingers crossed. We are both so excited. It seems that everything is falling in to place; we have either seen everyone we need to or else have appointments to do so.

XOXO, Evie & Ally

On Baited Breath: The Surgeon

The Appointment we had been anxiously waiting for was finally here. Our appointments with the surgeon were for the end of April. Ally spent a lot of time doing research on the surgeons at the clinic and when we looked everything we both decided to go with Dr. Farris. He has the most experience with the surgeries and with comorbidities combined with high BMI’s. The consensus of our research was that he is one of the best surgeons if a little abrupt and not known for his time management. Ally needs someone who is used to people with other complications other than weight as she had a list of conditions including kidney disease and Rheumatoid Arthritis, while I need someone who can handle my high BMI.

When you arrive at the clinic check in and take a seat. There will be other people with the same appointment time as you will all be watching a video on weight loss surgery (about an hour long) as a group before you see the surgeon individually. There were three others watching the video with us, including a gentleman who brought along his wife. We were brought back to an alcove outside the room we saw the surgeon in, where we sat (not the most comfortable seats) to watch the video. The video itself is a little dated, but it was done by Dr. Farries himself.

After the video we waited our turn to see the surgeon. There were two people before us and then when we went in there was Dr. Farries and a nurse. Ally and I went in and saw him together as it was faster that way. The nurse took our weight Ally had lost 5 lbs. putting her at 272 lbs., and I lost 12 lbs. making me 391 lbs..

Then he asked questions about family and medical history (we both had our medical conditions written down so we don’t forget anything). He wanted to know which surgery we were aiming for and agreed that the RNY was the most appropriate for us and the one that would be the most helpful. After all the questions he examined our stomach, said that we were good candidates for the surgery and asked if we had any questions.

He doesn’t even ask to look at your Food Journal, but he does ask if you are on the one cup. Honestly you are in and out really quickly and the longest part of the appointment is the video in the beginning.

The day we saw the surgeon Ally had an appointment with one of the clinic Psychologists as well; her name is Chelsea and she is in training to be a psychologist. Originally I had an appointment with her as well but since we are sisters they wanted us each to talk to a different person. Ally said that she had to talk a lot; Chelsea had a large booklet full of questions to ask. They talked about her history, support system, potential life stressors and things that could get in the way of successful weight loss.

Chelsea told Ally that she seemed to be on the right track, to watch out for stressors and that while she was there to talk to anytime she doesn’t need to see her again unless Ally wants to speak with her.

Note: While these aren’t the psychologists that say whether you are mentally ready for the surgery (that is someone else) they do make a report of everything you talk about and talk to everyone else in the clinic (“The Team”) about what they think and any potential problems.

XOXO, Evie & Ally

Sleep Apnea Test

The time came for my Sleep Apnea test. They called one day and made an appointment for the next. I arrived and they show me to a room where they ask you a few questions, medical history and lifestyle then comes the moment I was dreading. She pulls out this little pouch with the machine in it. What? What happened to the rather large machine my mother and sister had to use, the one with the wires and the nodes that stick all over and make it impossible to move let alone sleep. I let out a sigh of relief and she proceeds to show me how to set it up before I go to bed. There is a band that goes around your chest, a wire with a finger heart beat monitor attached, and a breathing tube that goes up your nose. Three little wires attached to a wallet sized machine. This is what I had been worrying about? HA piece of cake. Or at least that’s what I thought.

They told me they need at least four hours of sleep to get an accurate read, so I give myself an hour of leeway and aim for five. I get into bed a one and proceed to try and hook myself up. Finger monitor….check, tube up my nose….check, band around my chest....not so much. I place the band around my chest (one size fits all…my double wide butt it does!), and finally getting it secured I press the on button and try to turn it around to my side like she showed me, only every time I get it there it has turned itself off. By this time it is 1:30 in the morning and everyone in the house is asleep. Deciding that it doesn’t fit anyway, I just wear the nose and finger monitors and leave the band alone.

Two days later I get a call saying I have to do the test again because one of the monitors failed. That chest band might have been more important than I originally thought. Picking up the machine again that next day I enlist Ally to help set me up, only to open the pouch and find that they have not included all the pieces of the machine.

Sleep test take three. I have the machine, all its working parts, and Ally. It takes us 20 minutes and some swearing but I am finally hooked up. I did not sleep well that night, I kept waking up afraid that the machine had turned itself off or a pug had come undone. A few days later I get a call saying that I have severe sleep apnea and stopped breathing an average of 37 times per hour.

 

I asked the nurse if it makes a difference for surgery if you have it or not, and if you are able to use the machine of not. She said no, that it is just a different tube they use if you have it. Even with the not great results I am happy to have this out of the way and be one step closer to surgery.

Sleep Apnea Test Advice

1.      Have someone on hand to help you strap in.

2.      Try and aim for at least 5 hours of sleep.

3.      Make sure that you have all the pieces before you leave the clinic.

4.   All pieces are important, if you don't use one you will just have to do it again.

FYI: When she was giving me the referral for the sleep test my nurse told me that I was going to have to pay for the test out of pocked. When I got to the clinic they told me they were billing the program directly. I am not sure which way it was supposed to be but I haven’t had to pay anything for it.

 

XOXO, Evie & Ally

Day and Night - Our Second Appointments: Nurses

Our second appointments were supposed to be with the surgeon and that is what we had booked earlier in the month, but we got a call a few days before the appointment that there was an emergency and he had to reschedule. Since he didn’t have anything available this month we made appointments to see him next month and nurse appointments this month, because remember you have to see someone at least once a month.

Both Ally and I were excited for this appointment. We had been working hard and knew that we had lost a significant amount of weight. The night before we both printed out our Food Journals and looked over it to see where our weaknesses were. I found late night snacking to be an issue while Ally finds getting up in time for breakfast hard. We both have an ice cream problem. It’s been helpful having it written down and going over it periodically, where we both thought we were doing well with the ice cream looking back you get to see exactly how much you had and that it really does add up.

Ally had a different nurse this time as her last one is now working in a different part of the program. Her new nurse is named Darla and Ally likes her very much. Her weight was taken and she is now 277lbs. She has lost 18lbs and her nurse was shocked at how much she had lost, and has no doubt that she can lose the rest of the 10% by the next appointment. She only has 11.5 lbs. to go. They talked about her food journal, any question Ally had,  then went over her blood results and while most of her levels were good her Vitamin D was very low. They want to make sure that all your vitamin levels are on track before surgery because afterwards you are going to have even more trouble keeping them up due to malabsorption. Darla thinks Ally is doing so well that she wants her to get the surgeon and scope appointments as soon as possible.

Nikki was my nurse again and she took my blood pressure first thing, it was still a little high but I have been to my doctor and just started some medication. Then she gets me to step onto the scale and this has got to be the first time I have ever looked forward to getting on one. I am at 403 lbs. down from 422 lbs., I have lost 19 lbs.. I ask her is that’s a good amount and she just nods her head and says “yeah, not bad,” and moves on to my test results which are fine. Not much left to the appointment after that, she just tells me to keep on track, then goes to make sure my scope referral has been sent.

When we compared notes after, our experiences were like night and day. While Ally left excited and raring to keep going, I left disappointed and hankering for a cheeseburger. Eventually I came to see that I was doing a good job and should be just as excited as Ally, whatever the nurse’s problem was just that her problem. We are excited to continue with the weight loss and the program.

XOXO, Evie & Ally

Needles, Blood and Vampires. Oh my!

We went for our blood work on a Saturday and if you have ever had to have blood work done then you know the process can be outrageous. You leave at six in the morning just to try and be one of the first in line, and it never works. Stand in line for an hour until they open at seven, only to take a number and find a seat unless you are one of the really unlucky ones to have gotten there so late that it is standing room only. Wait until your number is called and then wait again until your name is called to get the actual blood drawn and all of this in a stuffy room where the man next to you is coughing without covering his mouth and woman on your other side is talking on her phone about things you really don’t want or need to know. If you’re lucky you walk out only three hours later a little light headed and missing enough blood to keep a vampire going for a few days.

Ally, who has needed quite a few blood tests in the past, recently found out that you can make appointments and skip this charming routine. I always thought this was the way you had to do it, I mean who would go through all of that if you could just make an appointment and be out of there in half an hour. This is how I remember it being done since I was little and we went with our mother to get her blood taken. So I am not sure if it is a recent development or not but you can now book appointments online. For those in Calgary you go to the “Calgary Laboratory Services Online Patient Appointment Booking” page and with a few clicks of your mouse make an appointment that is convenient for you.

Arriving ten minutes before our appointment we signed in, checked in when our names were called and then followed the nice “blood sucker” to a room in the back. We always take a little longer because they have trouble finding our veins. A butterfly needle is the only one they can use on both of us, Ally has to have her line in the back of her hand and I have to be poked at least twice before they get anything. It’s faster since we both go in at the same time, but there were problems getting both our lines this time so we were in a little over an hour.

Remember if you have problems with getting blood drawn that if you get the surgery you are going to have regular tests done to check your vitamin levels as malabsorption is practically guaranteed.

XOXO, Evie & Ally

The One Cup Diet: Part 2

Stir-Fry and Omelets are something that we enjoyed coming up with and putting together. They are versatile and you can pack them full of protein and vegetables.

Stir-Fry

We made a huge batch of this each; I think we got somewhere close to 25 to 30 cups each. Both of us made out own because we like different things in it. It started with the same base of bell peppers (red, green, orange, and yellow), onions, and chicken and then we each added what we liked from there.

Ally added cans of baby corn, bean sprouts and a jar of salsa to her batch. While I added mushrooms and salsa to mine. I would have added more but I wanted to also be able to use mine for a fajita. For the Fajitas I just take ½ of the frozen 1 cup and put it on a small tortilla, and save the rest for another meal the next day.

If you don’t like just eating the stir-fry plain try freezing it in ½ cup bags and then serving it over ½ a cup of rice or noodles. And instead of salsa try adding a low sodium teriyaki or sweet and sour sauce. You can even make your own sauce from scratch so you'll know exactly what is in it.

Omelets

We both liked these and made them the same way. They are also known as "Omelets in a Bag" or "Camping Omelets." Taking our measuring cup (1 cup/250ml) we cracked in three small eggs and whisked them with a fork, then filled the rest of the measure with shredded cheeses (cheddar), green onions, and ham. Pour your uncooked omelet directly into the baggie and freeze (uncooked).

When it comes time to eat, you take it out of the freezer and unthaw, then place in a pot of boiling water for 12 to 13 minutes. For this recipe you are going to want to use a good quality Zipper bag so that when it is cooking in the water it doesn’t split open.  

Hint: if you forget to take your meal out of the freezer with enough time to unthaw then just place it in a bowl of cold water. The omelets should only take about twenty minutes or less.

XOXO, Evie & Ally

The One Cup Diet

For those who enjoy quantity over quality this is going to be very hard to get used to. Basically you are supposed to eat one cup of food three times a day. That’s one cup for breakfast one cup for lunch and one cup for dinner. In the beginning you can have a snack in between meals but ultimately they want you to only be having the three, one cup meals.

There is not much too it and once you get used to portioning out what you eat it’s pretty easy to follow as long as you don’t mind being hungry. In the beginning you are going to become intimately involved with the hungry gnawing feeling in your stomach. But they say it takes three weeks to form a habit, so don’t give up. After the three weeks we have noticed that it does become easier.

As to what you are supposed to eat, just because in the beginning you are going to lose weight simply because you are limiting your portion size doesn’t mean you should still eat unhealthy foods. They want most of your one cup to be protein, which will keep you fuller for longer and supposedly keep you going. Then the rest is supposed to be made up of mostly fruits and vegetables.

Knowing that we were going to have to begin this diet soon, Ally and I decided to prepare big batched of meals and then portion them out into the one cups and freeze. We made a stir-fry, a chicken marinara, omelets and a cauliflower potato cheese soup (which was disgusting and was trashed).

Chicken Marinara

For this we just took chicken, we used the precooked/cut stir-fry strips, but you can cut up a chicken breast or thigh, anything really. Measured ¼ cup into a Ziploc bag, then measured out ¼ cup of marinara sauce into the same bag, we just got a jar from the grocery store comparing what was available to make sure we got the healthiest (looking at things like sodium, protein, sugars, and carbs). We also threw 1 Tbs. of shredded cheese (cheddar) into the bag. Do this into separate Ziploc bags until you run out and throw into the freezer.

Then whenever you are in the mood take it out and heat it up in the microwave. Since this is only ½ a cup we served it with broccoli, just throwing ½ a cup of frozen broccoli into a pot while the chicken is warming up. I like having the sauce over my broccoli too, but since Ally likes it separate so she just puts more chicken and less sauce into each of her bags.

More to come on the stir-fry and omelets later.

XOXO, Evie & Ally

First Appointments - Nurses

Nurse appointments are the first actual appointments you will get. Ours were on February 7, 2013, both of us with a different Registered Nurse or RN. Ally had a woman named Colleen and I one named Nikki. In our separate appointments we both had out height, weight, blood pressure and pictures taken. Ally came in at 295lbs (133.8kg) and I was 422lbs (191.5kg). Although those are the numbers that we were more or less expecting it is still horrifying to see them staring at you from the scale. We discussed which surgery you are interested in, both Ally and I have decided on the Roux-En-Y Gastric Bypass (RNY). They then asked us all kinds of questions about medical, family and diet history.

And they both went over with us some of what is expected of you during the program, including but not limited to…

1. Monthly appointments at the clinic
2. Daily Food Journal (if you don’t bring it you don’t see them)
3. 10% weight loss before surgery (from weight on first appointment)
             - For Ally that will be 29.5lbs
             - For Evie that will be 42.2lbs
4. You have to meet with all the different branches of the staff (team)
             - Nurse, Surgeon, Dietitian, Psychologist
             - You will have to see the on staff Psychologist who is there for you to talk to and to
               evaluate how you are doing and the off-site psychologist who will evaluate if you are
               even right to have surgery (mental capacity included)
5. You have to get a gastroscopy done by the surgeon

After taking my blood pressure and seeing that it was really quite high, Nikki recommended that I make an appointment with my family doctor to discuss blood pressure medications. She also sent in a referral to a clinic in Calgary for me to get tested for Sleep Apnea. It’s been recommended to me in the past to be tested for Sleep Apnea, as a lot of my family members including Ally have it. And although I have a suspicion that I do have it, I never went and did the test because I didn’t want to be pressured into having to get the machine that I know I cannot sleep with it. Not to mention I dread the test itself, I have visions of wires, large machines and not being able to move.

They went over our food journals with us, and they were very impressed with how organized we were, (all credit goes to Ally for her exceptional template). We both have a binder dedicated to this, with tabs and everything. We put our food journal, questions, and any relevant information/papers in it. Each of us has a printed list of our medications and conditions so when they ask you just read from the list which cuts down on the chance of forgetting something. With my OCD I have even put my Food Journal in sheet covers, but there is no need to go that far. Ally often rolls her eyes at me whenever she sees I’m obsessing over my binder.

Nikki recommends slowly cutting back on the amount I am eating and making healthier choices. She wants me to gradually change and become more aware of what you are eating, so I can make healthier choices. Colleen recommends that Ally begin the 1 cup diet (more to come about that later) first thing Monday.

Before the end of our appointments both of us asked our individual nurses what the soonest we could get the surgery would be? They both gave us the same answer, that although a few have done it as soon as four months it would probably be closer to six.

Both Ally and I are given forms for blood tests. They are just routine tests, checking to make sure all your levels are ok and if there is anything that they should be worried about. Referrals are sent in for both the gastroscopy and the psychologist. Our RN’s recommended we see the surgeon right away, so after we were finished we both booked our next appointments.

When we left and compared notes we were both excited about getting started.

XOXO Evie and Ally

The Food Journal

Food Journals are another obligation of the programme. If you show up to your appointment without your food journal you will not be seen. And don’t forget that you have to see them once a month, so if you have missed the appointment because of a forgotten Food Journal you are going to have to make another for the same month.

A Food Journal is where you are going to write down everything you eat and drink. You have to record what, when and how much you eat. There are many ways of doing this, buy an agenda or note book and record your intake in that, use a little note book, or like Ally and I create a page on the computer. I am on the computer many times throughout the day and just update as I go along, while Ally, who logs on less often, carries a pocket size note book with her and then updates her log whenever she gets the chance. We then print them out at the end of the month or before each appointment. If you are someone who often eats out or on the go you might want to make a note on your cell phone (voice recording apps are good for this), and then just write/type it out when you get a chance. They are not particular about which format you use as long as you can see and read it.

Some people find it helpful to record other things about their eating in the Journal as well. Such as how they were feeling, what they were doing, and how hungry they were on a scale of one to 10. Things like these help identify patterns that occur outside  of what you are eating. Some might eat more when they are depressed or make unhealthy choices when they are sad or celebrating something.

The point of your food journal is to identify patterns in your eating that might be holding you back from your goals. Are you eating more than you think because you snack or graze throughout the day and then only eat small meals? Maybe you are making great choices during the day but have to have that midnight snack. People often eat their meals and then move throughout the day to the next, forgetting what they had the previous day. They take each meal as they come and then move on. Your Food Journal will give you a chance to look back and figure out what needs to change.

It’s not something they expect but I started my Journal back in August when our referral went in and Ally started hers a few months before orientation. You don’t have to and since some don’t even know what a Food Journal is until orientation it is perfectly alright to wait and start after orientation.  

The most important part of your Food Journal is to be honest, because if you aren’t then there really is not point to doing it at all.

I am going to attach the link to an example of some Food Journal entries as well as the Food Journal Template that Ally created and we both use. Feel free to use it or if it’s not exactly what you are looking for there are plenty downloadable off the internet. Jut type “Food Journal” or “Food Journal Template” into Google or your favorite search engine.

Entry Examples
Food Journal Template

XOXO, Evie and Ally