Wow, this is supposed to be the tropics and it is darned COLD! Of course, here; the fifties is cold to us...forties is fleece lined Uggs, gloves, a down jacket that makes you look like the Michelin Man and HOT CHOCOLATE! I have probably served up 100 cups of the stuff at work the last couple of days.
At home, I have a special recipe for hot chocolate that is better suited to a bariatric patient and yet still satisfies that need for a rich, chocolaty cup of goodness. Once I get the opportunity to create the pages for the different phases of bariatric eating, this one will go into the "liquids" category...obviously. NOT the clear liquids however.
There isn't much to this really. It's mostly just an idea that can be much more cost effective than buying those boxes of special bariatric protein drinks because you get so many more servings out of a big tub of protein. In this case, I have used Designer Whey in chocolate. Let me just say right here that I detest most protein powders and I do NOT do well with whey, whey isolates or casein BUT...as whey products go Designer Whey is not bad. I have the added headache of finding protein products that do not contain egg protein or potassium iodide which is a common ingredient in many protein supplements. I won't attempt to explain the science...just click on the link. What it means for people like me; who are deathly allergic to shellfish is...DON'T USE PRODUCTS CONTAINING POTASSIUM IODIDE! Good luck with that when it comes to the "diet product" industry! It essentially works as a diuretic so it's in MOST of the commercial protein drinks and bars.
So...here is MY version of hot chocolate which I call Chocolate Protein Mocha Latte
Combine one envelope of sugar-free hot chocolate mix with 1 scoop Designer Whey Chocolate protein powder and one individual packet decaffinated instant coffee. It's best to do this in a small bowl for stirring room OR in your blender. Add 1 cup of hot water, unsweetened almond milk or 1% cow's milk (if you can tolerate it). You may also use soy milk if you choose. Blend until no lumps remain. Pour into a mug and enjoy! BTW...you can vary the flavor by adding a cinnamon stick or a pinch of ground cinnamon, sugar free flavored coffee syrups, vanilla extract...whatever suits your fancy!
Depending on the brand, your sugar-free hot chocolate mix will run you about 50 calories, 0g fat, 170mg sodium, 9g carbohydrates, 6-8g sugar (all or partially in the form of sugar alcohol) and 3g protein.
The decaf instant coffee costs you nothing. The scoop of Designer Whey breaks down to 100 calories, 1g fat, 85mg sodium, 3 carbohydrates, .5g fiber and 18g protein.
If you use a cup of unsweetened almond milk you can add another 35 calories, 2.5g fat, 75mg sodium, 1g fiber and 1g protein. Making your grand total:
185 calories
3.5 g fat
305 mg sodium (which is too high if you ask me BUT...your diet is likely to
be really low in sodium so this splurge won't kill ya!)
12g carbohydrate
1.5 g fiber (jack this up with a tablespoon of natural acacia fiber if you need
to)
22g protein
Based on the calorie and protein content; I would consider this a "meal replacement" meaning...if I were going to eat a small meal in the evening and I wanted a Chocolate Protein Mocha Latte...I would skip the food and have the latte. Remember; the gastric bypass patient's stomach is about the size of a walnut or a golf ball. You will not need...nor will you be able to hold both food AND a protein drink at the same time. Don't force it...or else you'll be worshiping at the feet of the great white porcelain god!
Let me share a great online resource with you guys. DPS Nutrition They have got just about any kind of protein (and other things) supplement you could possibly want at absolutely unbeatable prices! No healthfood/nutrition store can touch their prices. I also plan to compile a resource page eventually because I have LOTS of them to share.
Ahhhh...almost finished and it was good!
In spite of all I have learned and now know about my "new" stomach and all it's quirks some days I do something that makes me wish I could kick my own butt!
Understand that one person's experiences with this life will NOT exactly mirror any other person's experiences. That being said...this is MY experience. I cannot under any circumstances and in even the smallest quantities tolerate BREAD of any sort! I know this. I've pay for every indiscretion, no matter how small where bread is concerned. No to be indelicate, and this is certainly not going to be the first or last time that I am; there are just some foods that you will learn to expect to either throw up, "dump" (and yeah it means just exactly what it sounds like) or experience pain when you eat them. I have a LOT of foods that don't go down well but I can manage them in miniscule quantities but bread is not one of them. I can take a bite small enough for a toothless infant, wallow it around in my mouth until it's basically a liquid before swallowing it and somehow it still feels like I have a baseball just beneath my skin right in the middle of my sternum.
When and IF it finally goes into my stomach, I'm in pain. It's hard to describe really. It isn't nausea...though that follows once the bread is metabolized because my body turns it into sugar at an astoundingly rapid rate it seems. Initially it's more like pressure; stress on the walls of my walnut sized stomach and it really does hurt. But what does my dumb-ass do? Everynow and again, I think...oh I'm going to be able to handle it this time. I REALLY want just the tiniest slice of that yummy fruit/nut breakfast bread that my mother brought home yesterday.
Two hours later when I'm still trying to expell that COW from my chest and am now GREEN from nausea...I think to myself...was it really worth all THIS? No, no and NO. No bread tastes good enough to put up with the consequences for me. YOU (other bariatric patients) my not experience this and I hope you don't but if you do; don't say I didn't warn you!
The pain issue aside; I realize that my food bypasses a portion of my intestines and I know this has a lot to do with why most gastric bypass patients cannot tolerate sugar. Keep in mind that when I say SUGAR, I don't necessarily mean sweets. I mean ANYTHING that converts to sugar...slowly or rapidly. THough fast carbs are much worse! Yes, this means even fruit can make you nauseated or cause you to throw up. I eat fruit...but I eat it very judiciously. I try to stick to berries because they have the lowest glycemic index. Now and again I will put a fresh orange in my vanilla protein shake (tastes similar to an Orange Julius and makes the otherwise crappy protein palatable). THat usually works out ok since I'm using the entire piece of fruit, not just the juice. The fiber in the fruit helps lower the glycemic load. Drinking fruit juice is about like mainlining simple syrup!
Long story short; I was unable to eat or drink anything for several hours until that damned bread was finally digested. Plus...I got to feel like CRAP for most of the morning; cold sweats, nausea, rapid pulse.
When I finally felt like the worst of it was over which was around noon; I poured a blue raspberry Isopure over a big cup full of crushed ice and nursed that for most of the afternoon. That left me with a protein shortage for the day since I didn't get any in the morning.
Around 4pm I made myself a small green salad and topped it with about an ounce of rotisserie chicken ( I buy a fresh rotisserie chicken every couple of days). I ate the chicken first and then finished with only as much of the salad as I could comfortably hold...which was about half of what had originally been in the bowl. I buy Walden Farm's salad dressings because they are sugar free...or I make my own. Most commercial salad dressings have quite a bit of sugar (not to mention sodium). I particularly like their Honey Dijon dressing on a raw spinach salad!
Tomorrow I plan to behave myself! I'm making a hot cereal of quinoa flakes, flax, unsweetened almond milk, a spoonful of Stevia in the Raw and topped with a few fresh blueberries. Recipe and pictures will be forthcoming! I will take an Isopure to work with me, have half a Power Crunch Bar on the drive home from work. Though these bars only have 5g. of sugar, my system cannot tolerate a whole bar without repercussions! They have 12-14 grams of protein depending upon the flavor though. So even if I can only eat half; that's at least 6g of protein in just one or two bites. I'm going to do an entire article of protein bars and all the GARBAGE that's out there...blechhhhh! Power Crunch is a decent bar though. We bariatrics have our "faves" when it comes to stuff and we are a pretty loyal crowd...out of necessity!
I will also continue with the "story" of my surgery and recovery. My plan is to eventually add a page for each of the "phases" of the bariatric diet which will make finding appropriate recipes much easier. There are SO many aspects of the bariatric life to cover...food addiction and the pitfall some face of transferring that addiction to other harmful things, psychological changes, physical changes and so on. I hope to just take one day at a time and find out where it leads!
There are a lot of decision to be made when considering bariatric surgery! I will tell anyone who is thinking about it and has not yet decided that this is NOT for everyone! It isn't a "quick fix". It isn't easy. It IS often unpleasant; or better said, some of the side effects of surgery are unpleasant. If you are not committed to changing your habits then you shouldn't go any further.
However, if you have given thoughtful and serious consideration to your decision and know it is for you then you will be learning a lot about what choices you have.
If you are one of the lucky ones, like I was; your insurance company will pay for the proceedure provided you meet certain health/weight criteria. Years ago; the rule of thumb for any bariatric procedure was that you had to be at least 100lbs overweight! Baby...lets face it...once you are "at least" a hundred pounds overweight it's probably closer to 150 and you are living a nightmare existence trapped inside a body that is literally dying under all that pressure. For some strange reason, that was the magic number doctors and insurance companies used to decide FOR you whether or not you needed surgical intervention.
Then we started hearing buzz words like "co-morbidity factors" or just "co-morbidity". Yes, it means exactly what is sounds like! We all understand the word morbidity. It's a factor or issue that COULD have a morbid outcome. In terms of your health; simply said, that means it could kill you! In relation to obesity which is in itself a morbidity factor, we have all these other health problems that arise as a result of being overweight. Cheif among them are diabetes, hypertention, congestive heart failure, asthma/respiratory distress, sleep apnea, osteoarthritis, gerd, hiatal hernia, non-alcoholic fatty liver disease, arteriosclerosis (hardening of the arteries) and many other conditions both minor and severe. Limited mobility makes exercise an unatainable ideal for many morbidly obese people.
FINALLY...after 20 years, doctors and insurance companies have begun to realize that you don't have to be 100 lbs overweight to be at risk for obesity related illness. This is where the co-morbidity factors come in. The guideline was just recently changed. NOW, if you are 35% (instead of 40) bmi with at least three or four co-morbidity factors...you ARE a candidate for bariatric surgery. This is where I found myself; 38% BMI with hypertention, sleep apnea, hialatal hernia, chronic heartburn, osteoarthritis and fatty liver.
Since my insurance is Humana Military (Tricare), they follow the same standards and guidelines as Medicare, medicaid or any other government sponsored insurance. I knew they recognized the 35% rule. But, just to cover the bases and because I didn't want to get my hopes all up only to be told that they would not pay for it; I called Tricare FIRST and spoke with a representative. She explained to me that they would need a letter of medical necessity from my primary physician, several pre-op tests, a psych eval, the surgeon must be willing to accept Tricare of course and be willing to jump through all the hoops to aquire pre-authorization and then of course, the final authorization! PHEW!!!! It is a LOT. This does NOT happen overnight. Generally you can expect to be dotting i's and crossing t's for 5-6 months from the time you find a surgeon till the date of your surgery.
Which leads me into the next critical decision...your surgeon. Please, please, PLEASE...DO YOUR HOMEWORK! There are just as many quacks performing bariatric surgeries as there are in any other medical/surgical field. If you get one...YOU COULD DIE!
I scoured the internet for surgeons from Pensacola to Miami and much to my delight discovered Dr. Thomas Bass and the wonderful support staff at Gulfcoast Bariatrics with offices in Fort Myers and Naples. They are a bariatric center of excellence and Dr. Bass himself is a caring, concerned and thoughtful physician. He sat down with me on my consultation visit and we just talked about how my weight was affecting my life and my health. He listened carefully. I was an emotional wreck; crying and distraught because I felts SO hopeless and out of control. I just felt like, if they turn me down; there's nothing else...nowhere else to go, no more diets to try. I'm going to DIE from being fat!
Dr. Bass reviewed everything I had told him and then he said the words that changed my life. "I do think you would benefit from weight loss surgery. You are definately a candidate." I wanted to jump up and down with joy! For me it was validation. I know this sounds weird but if you are a fat person you are going to understand this. Your family and friends may say you need to lose weight for your health or they may elude to the fact that you need to lose weight but they DON'T understand how it feels to be the carrying that weight around like an albatross around your neck. When you have that once piece of birthday cake at your cousin's party (no bigger than anyone else's piece)...I'm willing to bet that you are looking around the room at all your skinny relatives and feeling guilty for eating your piece of birthday cake. They may even say things like, "well yeah honey, you are a little plump but we love you just the way you are." You've got a mirror....50 lbs of BUTT ain't just a little plump! So well meaning as they may be, sometimes in an effort not to hurt our feelings, friends and relations downplay our weight.
My family was loving but not at all supportive of my decision to have surgery. My mother and my husband were especially apprehensive. My adult daughters were scared of the procedure but were more understanding of my desire to do it. My best friend was afraid for me but she said, "you have to do what you think is right for you."
I began the pre-surgical screening process immediately; attending a support group and a mandatory orientation meeting where we watched a film that thoroughly explained each type of procedure that was available and how to know which one to chose. I went to my primary and told her that I was going to have bariatric surgery and that my insurance company required her to document that I was on a medically supervised weight loss regimen for the next three months. At the end of which; if I had not lost any significant amount of weight she could write her recommendation that I go ahead with surgery. Which is exactly what happened.
I had an upper GI to check for any blockages in the pipes! They went down my throat with a scope and yep...I had a big ole hernia sitting right at the base of my esophygus. But there was something unexpected; some strange allergy condition in the esophygus that made it very narrow and the "walls" somewhat thick. No wonder I always got food stuck in the pipe! They stretched it (since the opening was about the size of a number 2 pencil). But the most important discovery that came from this procedure was that it changed the type of bariatric surgery I thought I was going to have. I had originally planned to do a lap band but was now NOT a candidate for this particular surgery.
I went back to Dr. Bass who then said, well okay...so we do a sleeve gastrectomy. That is a procedure in which a part of the stomach is removed, leaving you with a stomach roughly the size of a banana but not redirecting or any cutting of the small intestine. Again, we went through all the hoops and then I get a call from the lady who handles all Dr. Bass's insurance approvals. Tricare says NOPE...we don't pay for the sleeve gastrectomy because it is "experimental". It isn't. But because it is the "new and improved" version of the gastric bypass they still consider it such. Dr. Bass even spoke with them explaining that he thought I would benefit from the less invasive sleeve gastrectomy (due to some pre existing gastrointestinal issues) but they would not budge.
I was so upset. I cried for days. I'd been prepared to go through with first one, then another and now...my only option was a full on gastric by-pass. The granddaddy of them all; the Roux-en-Y Anastomosis which is of course a very invasive procedure. It not only affects consumption of food, it also affects the absorption of the nutrients from that food. You will need vitamins for the rest of your life. I took a few weeks off to think it over. Then my aunt Marianne (Auntie M as she is affectionately known between the cousins) came down for a visit. She has been in the medical field for 30 years and she said..."girl, you need to do this... you are going to feel SO much better."
At this point I was three months into the screening process and during this time; my husband of 7 years found his high school girlfriend on classmates and two weeks later...he was GONE! We'd never had a serious argument in all our time together. It was so abrupt and cruel and really had thrown me into a tail spin. I knew that I had to get past that if I was going to get through the psych eval for my surgery. My heart was shredded but I met with the psychiatrist and she was able to see that I was basically a stable person (no comment from the peanut gallery) and that I was capable of compartmentalizing my surgery and the issue of my cheating, lying spouse! Not an easy thing to do when your heart is broken!
Finally, nearing the end of the physcal year for my insurance company and capped out on my copay...if they could just pull this off before Oct 1, 2011...it would not cost me ONE RED CENT! We got the last two pieces of the puzzle in place the last week of September...the sign off from my primary and the results of the psych eval. Carol at Dr. Bass's office rode Tricare like a mechanical bull to get that final authorization in time. It was faxed to her that same day and she called me to give me the news. I cried with relief. I was on the surgical schedule for September 26th...just FOUR DAYS short of the cut off for the current year on my insurance!
This is where I will stop for tonight. I want to explain each of the bariatric procedures in depth in the next few posts but I needed to lead up to that. Plus, I want everyone to get a real picture of what is involved in this decision so it might help someone else.
I don't have much time for a post this morning because I have to get to work. I travel light when it comes to food for work; a bottle of Isopure with 40 grams of protein, no sugar or carbs and only 160 calories. This is what we call an RTD or Ready to Drink product. It isn't always practical to carry around powders and mixing cups.
I have tolerance issues with whey products anyway. Isopure drinks are NOT thick and shake like. They basically taste like kool-aid...pumped up! I think they come in about 12 flavors. IMHO...blue raspberry and grape taste the best.
I won't kid you, they are not cheap. A single bottle will set you back about 4.00 in most health food or vitamin stores. There is a slight advantage to buying them by the case but then you are stuck with only one flavor. More on these later!
Heads up, the cheapest place I have found to get them is actually Amazon.com
I had Morning star veggies sausage weighing in at 10 grams of protein and
about 3 0z of Greek Yogurt for breakfast with roughly 12g of protein. The goal should be at least 20g per meal. I will definately get into this in greater detail later!
With an Isopure drink to take along giving me an additonal 40g of protein, I should be good till after work. I carry a protein bar in my purse just in case though.
I wanted to add a few words about dinner. Sometimes I make more of an effort but I was just really tired after work tonight. When I'm tired or don't know what I want, don't have a taste for anything in particular I go to my standby meal.
It is vitally important for the bariatric patient to pack as much nutrition as possible into an incredibly small amount of food. For the Roux-en-y gastric bypass, like mine; the stomach is initially the size of a walnut and eventually stretches a bit to about the size of an egg. That is NOT MUCH ROOM! I know, I'm throwing out some terms that you may or may not know much about and I promise a thorough explanation of them in futures posts.
Back to dinner though. The MOST important nutrient the bariatric patient is looking for is protein. You will hear about protein ad nauseum. You will eat/drink protein till you want to gag at the mention of the word. You will consume protein BEFORE any other food group and only IF you have enough room in your stomach will you worry about other types of food..initially at least. The lenght of time you will need to eat this way will vary from patient to patient but no matter how well you tolerate carbohydrates (and many including myself do not tolerate them well) you will always eat proteing FIRST.
When I don't have time or the energy to cook my stanby dinner is a dish of Fage greek yogurt which has a whopping 23g of protein per cup. Now of course, I cannot eat an 8oz serving but I can manage about 4oz. at this point (four months out from surgery) since yogurt is technically not a solid food. There are greek yogurts flooding the market right now because they are the new "in" thing in yogurt. Let me just caution you though; not all greek yogurts are created equal! They can be LOADED with fat, sugar and crap of all sorts so READ YOUR LABELS.
I eat Fage almost exclusively because I think the texture is amazing...extremely thick and creamy, the protein content is the highest of all the brands I've seen so far, the taste is sharp but not acrid, the sugar content (yes, even plain yogurt has sugar from milk or lactose as it is known) is low AND..it is a clean product. By clean I mean not loaded with a bunch of junk I can't pronounce.
In case you have never seen it; this is how the carton looks.
In most stores these six ounce cartons sell for 3 for $5. and occasionally go on sale for 3 for $4. They are also available in a 16oz tub which I generally see for about $3.50 -$3.99 THis is the 0 fat variety but you can also get it in 2%. Strictly speaking, the bariatric diet is often low in fat (even good fats) just because of the limited amount of food you can eat so if you want to use the 2% I don't see that hurting anyone. I just got used to eating this one and it's so creamy that you never miss what is not in there.
So here is what I do. Place about 3-4 oz of fage in a bowl and stir in Stevia to taste. I add 1/2 a teaspoon of good quality cinnamon which is an excellent metabolisim booster by the way and a splash of real vanilla extract. Stir this to mix well. Then I toss in about 2 tablespoons of chopped walnuts; a rich source of healthy medium chain unsaturated fatty acids (good fats), a tablespoon of ground flax seed for fiber but also for it's store of Omega 3 and if I have any on hand, a couple tablespoons of some type of organic low sugar granola. However, I have to watch that later because even a little bit can make you sick if the sugar is too high. Plus, since it is a grain (carbohydrate) it has a tendency to over-sugar me anyway because my post surgical body VERY RAPIDLY converts grain to...you guessed it...SUGAR! Sugar is the enemy...take my word for that for now because we'll speak to this in depth as we go along.
This is more than sufficient for a meal. You may not even be able to finish the entire amount but I know I'm eating someting my body can use...protein! Yogurt for dinner? Yea, well sometimes I eat a 2oz ground sirloin patty for breakfast! You may find that foods you liked before surgery (and I'm not talking about the junky stuff...in my case it is chicken) don't taste so hot to you afterward. Vice versa...things that you could not stand before may be appealing to you afterwards. It's a coin toss. A good rule of thumb for me is...I eat what I think I can tolerate at any given time. If that is steak or hamburger at 8 am and yogurt for dinner...so be it!
