A Conversation With My Nutritionist

Next month marks the sixth month anniversary of my having a sleeve gastrectomy and with that anniversary comes a couple of very important follow up visits for me.  One of them is my follow up with my surgeon, in which blood work will be done, along with certain measurements taken.  The other follow up happened today.  That follow up was with the nutritionist who works with the surgeons at the hospital I was sleeved at, Forrest Park Medical Center in Dallas, TX.

I had several questions for her that I needed answered.  Questions such as:

1. Do I need to count net carbohydrates or gross?
2. Am I eating too much?
3. What should my ideal weight be; what should I be aiming for?
4. How should I nutritionally balance my meals?
5. How should I nutritionally prepare for race days?
6. Is it okay to use fuel gels during an endurance race?
7. How should I eat to recover after a race is finished?

After going over my weight loss so far and my exercise habits, Sarah (the nutritionist) was very complimentary over what I had accomplished so far.  She told me that it normally took most sleeved patients a year or more to lose 130 pounds and that I was doing quite well for the time I had been sleeved.  She was also complementary on my running and circuit training that I do.

But onto the questions and her answers.

Q:  Do I count net calories or gross calories?  (For those who may not know the difference, Net calories are calories burned during exercise (not BMR/Sedentary burn), minus calories eaten)
A:  I need to count net calories, especially when I am on my exercise or run days.  My net calories need to be between 950 and 1200, which could put my gross calories for those days at anywhere from 1800 to 2500.

Q:  Am I eating too much?  (Please understand that my current caloric intake right now averages about 1000 to 1100 calories, and there are times when the calorie count can reach upwards of 1800 or more, even though my daily goal is 950.)
A:  No I am not.  Right now my caloric intake should be between 950 to 1200 calories on the days in which I don't run or exercise, and up to double that on the days I do run and/or exercise.

Q:  What should my ideal weight be; what weight should I actually be aiming for?
A:  According to the nutritionist, the ideal body weight for my height and body structure should be 178.  However, because I am old and decrepit, well, old enough that my skin really no longer has the elasticity it used to have, the body weight I need to shoot for would be 210.  That would also be with approximately 20 pounds of excess skin hanging on my body.
(It will be nice when I am able to have plastic surgery to have that excess skin removed, but that surgery will not happen for at least another year.)

Q:  How should I nutritionally balance my meals?
A:  Right now my nutritional balance for my meals should be be as follows:
      On days that I do not exercise:

• 80 to 100 grams of protein

• 80 to 100 grams of carbohydrates

• 30% of calories dedicated to be fat grams

      On days that I do exercise:

• 160 to 200 grams of protein

• 160 to 200 grams of protein

• 30% of calories dedicated to fat grams

Q:  How should I nutritionally prepare for race days?
A:  To nutritionally prepare for the days in which I race, whether it is a 5K, 10K, 8M, Half Marathon or Marathon, the nutritionist informed me that I need to start fueling up about three days before the race.  To fuel up properly I will need to start eating as if I had run or completed my circuit training that day, doubling up on both carbohydrates and protein and increasing my caloric intake as well, to 1800 to 2000 calories for those three days.  She also told me that it didn't matter what foods I ate for the carbohydrate count as long as it had carbohydrates.  (So I don't just have to eat pasta.)

Q:  Is it okay to use to use fuel gels during an endurance race?
A:  Absolutely.  If I am going to do endurance races longer than 10K I was encouraged by the nutritionist to make sure I use them to ensure I have the fuel to complete the race.

Q:  How should I eat to recover after a race is finished?
A:  The nutritionist told me that I needed to eat a balanced carbohydrate/protein "meal" as soon after the race as possible.  This could be anything from a peanut butter and jelly sandwich to a commercially prepared protein shake.  Usually the meal needs to be eaten within 30 minutes after the finish of the race.

So after my talk with the nutritionist, I feel confident that I have been doing and eating the right things and the right way.  I was concerned that I might have stretched out my sleeved stomach, but that is not the case.  As I continue on this journey of weight loss and healthy living, I can honestly say, so far, so good.

Thanks for reading.  Have a great rest of the day!

Listening to Your Body After Being Sleeved

I have several things I "love" to do in life and fishing is one of those, so when I had the chance to go fishing July 4th and then again yesterday, I jumped at the chance.  Having my daughters and Father-in-Law going made the days even better.

Now normally I can fish all day long, in the heat or cold, in rain or sun, but that was when I had a complete stomach and not a sleeve.  I am learning that this is making a huge difference now and is a difference I need to pay attention to and quickly!

July 4th this year in Texas was hot, humid and for those not in the shade, downright miserable.  But for the four of us walking the mile from the truck to the creek bank, climbing down the rocky bank, wading an additional miles up and down the creek bank, it was heaven.  The water is crystal clear and you can see down to the bottom, and the fish are always eager to respond to a well placed lure or worm.  

My Daughters trying to catch a monster white Koi

My Father-in-Law readying a hook

We were all having a great time and then my body decided it was time to start speaking to me.

Speaking to me came in the form of occasionally becoming light headed, becoming very fatigued, and to be very honest I wasn't sure if I would make it back to the truck or not.

After we all got to our respective homes, I decided to weigh myself before I showered and found out I lost over two pounds since my weigh in that morning!

Now, fast forward to yesterday, which was Sunday, July 8th.  Once again, we were out in the heat and humidity, this time with very limited shade, but with a nice breeze and occasional cloudiness.  The other Godsend I had with me was my wife, who does recognize the signals coming from my body better than I do.

We fished out at Lake Texoma for a little over five hours yesterday and at several times I felt worse than drained.  I was to the point that several times I had to sit down as I was light headed, I was fatigued and simply drained.  My wife was the one who bought me the apple juice and Gatorade to help replace the sugars and electrolytes I was losing and then made me sit and eat.  It took a long while after we got home for me to recover.

Once again I weighed when I got home and once again, I had dropped weight.  This time I had dropped almost three pounds!  All of it, I believe, to be water weight.

So right now the moral of the story, and the lesson learned is that I cannot take in what my body is loosing during these times and I am going to have to plan more accordingly. 

My advice to you is to do the same.

Have a great rest of the day!

Eric

Officially on the Loser's Bench Part 2

This is my third day after surgery and my second day at home.  So far it hasn't been too bad for me as I compare my situation with what I know others have gone through.  Mostly I'm going stir crazy to be quite honest.   

I have my own little corner of my bedroom where I sit and sleep in our leather recliner.  The TV is within sight and I have my remote, so mindless entertainment is taken care of.  I have my laptops near me and easily accessible so I can, and have started working from home: answering emails, starting to work on projects that need my attention and the like.

My fill up station with the flowers sent to me by the company I work for.

But it does get tedious.  And boring.  I do not like to be kept in a corner for very long, so I have been walking every hour or so which is nice.

Physically I am doing really well.  I am still at a higher weight than when I went into surgery, but that is not bothering me too much as I know once the gas and fluids they pumped into me go away, the pounds will start to shed.  Trust me when I say I am really looking forward to when I can ride my bike again, or even do my four to five mile walks!  Now that I had just started to become active, I really miss the exercising!

I seem to be more bloated today than I was yesterday.  I was told that is normal and has happened to others after surgery, so I am not worried about that.  I am taking in fluids quite well, perhaps too well.  I have been told that I need to slow down even more and sip more.  To me I am sipping (coming from a gulping perspective) but I am doing my best to follow orders and slow down.  I really think the chewing aspect is going to be harder for me.  This whole slowing down will be a challenge, but one that I have chosen to embrace as a lover for the new physical life I want to share with my God, family and friends.

I do feel that I have been  productive today as I went out to our garden and watered with miracle grow.  No, I did not, nor could I bend down to turn on the water.  That is what my youngest daughter was there for,  to help me turn on and off the water.  I love my Morgan.  She was very concerned that I was overdoing it and wanted to make sure that I wasn't hurting myself or anything.  She's a very compassionate nine year old.  So she made sure the water was on and made sure the hose didn't kink and I had lots of slack.

The one thing that is bugging me is the gas I am experiencing.  That is the one thing I wish would go away more quickly than it currently is.  Somehow the Gas-X strips just don't seem to be doing the job very well.

So there you have it.  I am home, with very manageable pain, to the point that my hydrocodone sits by its lonesome like some forgotten relic of my past in the corner of my little world right now.  The liquid Tylenol has taken a hiatus and is nowhere to be found and although I am not looking for it my wife has left for the store to make sure I have some.  Just in case.

Overall I am in really good shape, as my limited knowledge of recovering from this surgery and my body can tell me.

I'll keep posting my results on this journey.  I hope you enjoy the ride with me.

Have a great rest of the day!

Eric

Officially on the Loser's Bench Part 1.

Tuesday was my surgery date and I'll be honest, I wasn't really nervous at all. I think what I was, was simply ready to get it over with.

Waiting for the IV to be put in.

I checked into the hospital at 6:00 AM and the waiting game began.  About 45 minutes later I was called into the admission area and my hospital bands were placed on my wrist.  Very soon after I was weighed, and placed in my holding area where I was told to get into the hospital gown and yes, wait some more.

My throat was sore and I was very thirsty at this point.  Part of my prep for this surgery is that I could not have anything to eat or drink after 10 PM the prior night.  It would turn out that I would not, could not have anything at all until the following day (Wednesday the 20th of June).  That was not fun, believe me.

Eventually the RN came in and put my IV in my left arm.  After that it was only a matter of minutes.

The IV is in!

Within a few minutes the anesthesiologist arrived and had me start inhaling a gas.  After that I didn't wake up again until I was in my room.

I was operated on at Forrest Park Medical Center in Dallas, TX which has to be one of the nicest facilities I have ever seen.  Every patient has a private room with WiFi, flat screen TV,  and room.  Lots of room actually.  When you called for the nurses for whatever reason, they responded very quickly with whatever you had asked for.

After the surgery, which lasted about an hour, the surgeon, Dr. Nick Nicholson, came out to talk to my wife and one of my fears was relieved quickly.  I was very concerned that my liver would not be up to par for the surgery.  You see, you need as small and healthy a liver you can get to have a good shot at a successful surgery.  I know of some patients who have been in the operating room and had the surgeon call off the surgery because the liver wasn't ready.  So that was a very nice bright spot for me.

Except for the numerous times I was awakened for the various normal functions the nurses had to take care of, I slept.  And slept.  And slept a lot more.  There were times when I thought the nurses were growing concerned over my sleeping all the time.  Oh, and those normal functions I needed to do?  That consisted of having my vitals checked, breathing through an airlife spirometer and walking.  Not to mention having my blood sugar checked due to the steroid shot I received before surgery.

In My room after surgery.  Sleep was my best friend!

The dreaded spirometer!

It took me a while to start drinking liquids again, but when I did I felt like I was in heaven!  Finally cool liquid goodness running down my parched throat!  I just had to do it in sips.  SIPS!  One of the items a newly sleeved patient absolutely has to learn how to do.  If I didn't sip, I had the hiccups.  Trust me in that I learned that lesson very quickly!

A couple of things about my stay and then I'll save the rest for my next post.

The first is that apparently there was a new doctor making rounds at the hospital who had never worked with bariatric patients.  All I can say is thank God I was asleep when he came in.  My wife informed me that he lifted my gown, and started pressing in and poking my stomach!  He actually thought I had just gone through a hernia surgery and my wife had to explain to this young doctor what I had surgery for,  why I had a drain installed, and why I had a pain pump installed.  My wife told me the young doctor was lucky I was asleep and I believe she was right.  I don't think I would have hit him, but I would have told him a few things he would not have wanted to hear!

The other item before I sign off this post was when the nurse took the drain tube out of my body.  My wife said it was an uncomfortable feeling when I asked her about her's being taken out.

She lied.

I have never had such an excruciating pain in my life!  I actually was crying and hyper-ventilating from the pain it was so intense!  I actually asked her, begged her to stop for a couple of minutes just so I could start breathing normally.  It finally came out, but holy cow!  That was actually worse than anything I had ever gone through before.

A little while after that I walked out of the hospital, got into our minivan and watched the world go by as my wife drove us home.

In part two, I will go over how things are going at home for me.

I hope you have a great rest of the day!

Eric