Post Surgery Diet

[ElizabethB]

George is having Bariatric Surgery (gastric sleeve) August 7th.

He will be on a very restricted diet 2 weeks prior to surgery and 2 months post surgery. The Clinic provides a diet regime for 2 weeks pre op. Protein, veggies and limited fruit.

Post Op:

2 days clear liquids
Day 3 to week 2 - full liquids
Week 3 to 4 - Purée'
Week 5 - 8 - soft

I am roasting marrow bones and browning cubed chuck for a base of a beef/veggie soup. The veggie are onions, garlic, celery, carrots, leeks, turnips, bell & jalapeno peppers, fresh tomatoes - blanched, peeled and seeds removed and green beans.

I will strain and filter the broth and reserve the meat and veggies (packed separately) all frozen in serving size packages. He will have the clear broth to start with then I can gradually add pureed veggies and beef to the broth.

I am also making a chicken, celery soup. We usually add a little rice. I will add cauliflower instead. Process and store like the other soup.

The chicken will be great for chicken salad - alone, stuffed in avocados or tomatoes or in a lettuce wrap.

I have 20 heirloom tomato plants. The plants ravaged by the horn worms are showing some recovery. I do not expect full production from those plants but they are not a total loss. I will have LOTS of tomatoes to stew and freeze for lovey tomato basil soup.

George is out of town today so I can make this big mess in my kitchen and get everything packaged and stored before he gets home.

George had an aortic heart valve replacement in '08. He is on Coumadin and a greater surgery risk than most. He is also Diabetic.

This surgery is drastic. We have consulted with his Family Practitioner and his Cardiologist. Both say that the surgery is less risky than his obesity. There is also a high probability that he will no onger be Diabetic after surgery.

This is not an overnight process. He has to have 6 months of monthly evaluations with his Family Practitioner, a Psychiatric Assessment, clearance from his Cardiologist including procedures for getting off of the Coumadin, a meeting with the Clinic Dietitian, a 2 week clinic proscribed diet prior to surgery and a 3 hour training session prior to surgery.

We are both excited and anxious. My primary job is to keep George up beat and positive. I get really when his family and friends tell him horror stories instead of offering their support.

I can not get my mind around their problem. One look at my love is enough to tell anyone that drastic measures are needed.

Sorry for the rant. We have enough to deal with without negativity.

If you have any belief in any higher power please include both of us in your prayers.

[rainbowgardener]

Sorry if this is too personal, but can I ask how old George is? I'm curious about the upper age limit for doing this surgery...

Wishing you both the very best as you go through what sounds like a long and arduous journey. My understanding is that he will never be able to eat what we consider "normally" again. Not necessarily in what he can eat, but just in terms of extremely limited portions, which have to focus on protein, since there is not much room in such a small amount of food to waste any calories.

[imafan26]

To qualify for bariatric surgery you
1. must have a condition in which obesity is a prime factor and if you don't lose weight your risk of dying or complications from things like diabetes are so severe that the benefits outweigh the risks of the surgery

2. Most people have usually been put on a traditional weight loss program and have really tried and failed for at least a year

3. Bariatric surgery reduces the stomach to the size of your thumb so you fee satiated and hopefully stop eating sooner. But, it is still a stop gap measure. It is a way for people to try to learn new eating habits without feeling hungry. However, I have seen people who seem to be able to stretch their stomachs back within a short time and not lose very much weight. For the people who can change their habits and grow healthier ones, it does work miracles and can have long term results

4. People have to be committed and really want to be healthier. The surgery is not going to cure their cravings or bad habits. They really have to learn how to live differently.
One doctor in a bariatric clinic will not even consider doing surgery on someone unless they can prove that they will be dedicated to a weight reduction program. He gives them a couple of months to lose so many lbs and if they can do that, and pass the home study he will consider the surgery. For most obese people, there are enablers, and triggers (some of them emotional) that sabotages most people trying to lose weight. They usually should have counseling along with the program to identify the enablers and triggers and try to get the enablers to be partners and to find ways to avoid the triggers.

5. Exercise is part of the program. When you are really heavy it is hard to move around, carrying all that weight is tiring, but as the weight is lost, moving should get easier and with increased activity some of the other problems start to fix itself. Diabetics can lose enough weight to get off insulin and their feet aren't as swollen, taking off weight , takes a lot of the burden off the heart to have to struggle to move so much blood volume against a high resistance.

6. If the surgery works they go home in a day. Right after surgery or within 24 hours they have to do a barium swallow to make sure that the pouch is working. If it is blocked then they will need to go in for surgery again. It is always a risk to put anyone who is in poor health and especially someone who is morbidly obese under anesthesia. All the risks of surgery will apply. Luckily, most people do not have complications

7. The post op diet usually consists of clear liquids then they progress until they get solid food. The difference with gastric surgery is the portion size and frequency. Portion sizes will be about the size of a medicine cup every 10-15 ,minutes. Some people watch the clock until their next dose, but it is better if they occupy themselves and wait until they are hungry. Most people who succeed on the diet are satisfied with a couple of bites and feel full. They eat a couple of bites at a time eat more frequently like every couple of hours. They need to remember to stop when they are full and wait until they feel slight, not ravenous hunger to take the next couple of bites. That is kind of what they have to learn, new eating habits and mostly learning when the body not the mind has said it has had enough. Usually, I don't see people eating healthier food, they just eat less of the desserts they usually would eat. In the long run it would be better to not only learn portion control but to learn to eat things that are good for you too.

People who have been able to lose weight and keep it off for a year have a much better chance of making it. They just have to stick to their new habits and not go back to the old ones.

Good luck to George and hope he has a great result and healthier and longer life to look forward to.

[ElizabethB]

RBG - George celebrated his 70'th birthday n May 10'th.

Imafan - your comments are spot on.

We met in January of '82. I was 29 and George was 35. This blonde, blue eyed hunky man stole my heart.

At the time he was a little over weight but nothing that would causes concern. Unfortunately he continued to gain weight.

Over the years he has tried exercise programs, prescription diet drugs, Weight Watchers, Ideal Protein and assorted "Miracle Diets".

When he had heart surgery in 2008 he was weighing 360 lbs. In 2011 he started Ideal Protein. In 10 months he got down to 225 lbs. Still borderline obese but a HUGE improvement. I was SO proud of him.

Today he will hedge on telling me his weight. Based on hugs I estimate 330+ lbs.

His obesity, on top of having an artificial aortic valve and diabetes is a critical issue. High blood pressure, high cholesterol, fluid retention and sleep apnea are additional issues. That is why it is called Morbid Obesity.

I spoke to the clinic Dietitian. She suggested tips to help modify eating habits. This is pre op.

- weighing food
- using smaller utensils - a small salad fork instead of a dinner fork
- at least 20 minutes spent on each meal
- chew, chew, chew and chew again
- no liquids 30 minutes prior to each meal and 60 minutes after each meal

Portion control is another issue.

30 minutes exercise every day.

OMG - there is a learning curve for both of us.

This surgery is not a "Fix It". Life changes are necessary. George has a friend who had the surgery but made no commitment to change his life habits. He lost 150 lbs. and has gained back 90 lbs. I have seen him eat and understand why he has gained the weight back. I honestly think part of his problem is that he is a divorcee with no one living with him to provide an in home support system.

Sorry. There I go again just spouting off. I do appreciate your patience with me. This is an arduous process that preys on my mind.

[imafan26]

It is hard for anyone to lose weight. Skinny people can't see how someone can just let themself go. Fat people don't really enjoy or want to be fat, at the same time they often feel ashamed and have low self esteem because of the insesitivities of others. Food is comfort and a lot of the time eating is as much a psychological need as a physical one.

The surgery will make it easier to lose the weight in the short term, but over time that pouch will stretch, that is why learning new habits is so important.

What helped me on my many diets was keeping a food journal because so much of what we eat, we don't count. It adds up. Some foods have more calories than we realize
It is hard to give up a lifetime of bad habits.
You have to throw everything out of the house that will tempt you. And load up on healthy snacks. Fresh crudite, grapes and other low calorie fruits, not the fruit juices or as many fleshy fruits. Fruits have daily limits because of the natural sugars they contain. Rice husks are a good snack, it has few calories and it makes you thirsty so drink a lot of water.
Buy packages with individual portions. It costs more but it is harder to eat more than one portion accidentally.
Zero point cabbage soup was actually filling and tomato soup dressing was relatively low in calories and tasted good to me.
Flavoring the water helps with lemon or lime.
It takes a while to get used to some healthy foods, at first it may not taste all that good until you get used to it
Some healthy foods really aren't all that healthy, like yogurt with fruit and brown bread.
I got smaller plates and used a smaller spoon. I was told to make things more appealing was to actually buy a nice plate and table setting and make it special. Including placing the food on the plate so it looked appealing. And then their was the 30 bites rule. Everything has to be chewed 30 times unless it was water. The brain does metering so food has to be eaten slow enough for the brain to register it. Lots of fiber, takes longer to chew.
I learned to eat salads without dressing. I figured out that I used so much dressing on the salads to make it palatable that it was equal to a small hamburger. I may as well have had the hamburger instead. Actually, I ended up putting the salad in the burger and skipping the dressing.
I tried making a menu plan, but it did not work out. I could stay within the calories but I had a hard time getting all of the required exchanges in like the milk. I often gave up starches so I could save the calories for things I wanted more of. I was told the starches would keep me fuller longer, but I could not get used to the whole grain starches and it was easier for me to eliminate them all together. Something I don't miss to this day.
I did manage to lose 40 lbs and get down to a size 10 but it only lasted 3 months. I had to keep up with the diary and ended up eating the same thing pretty much every day. A boiled egg for breakfast, salad with no dressing for lunch, protein and cooked vegetable for dinner and diet colas to keep me full the rest of the time. I did feel deprived since my maintenance was 1000-1100 calories a day. Once I started going back to eating the things I liked, it was hard to go back and start over. I ended up gaining more weight than when I started. I know they say the diet colas don't really help since they increase the cravings, but I tried other drinks and I was never satisfied even when I filled up on them. I did learn that as long as I thought of the changes as a diet and not as permanent thing, it is hard to stick to it. It is doomed to fail unless you can live with and accept the diet as a permanent change.
Stay occupied. If all you think about is eating, it only makes it worse. You have to find activities to make the time fly.

[rainbowgardener]

I struggle with this too, despite being vegetarian and eating from my garden a lot.

I have twice lost 40#s on diet plans (which takes me most of a year of working very hard at it) and then gained it all back. I'm now heavier than ever and trying to decide what to do about it now (as I turn 70). The first time I lost the weight was on the Dr. Joel Fuhrman plan (https://www.drfuhrman.com/ ). It is basically a pound of raw vegetables and a pound of cooked vegetables every day with a little bit of whole grains and very little else. ("The salad IS the meal.") You don't have to count calories and all those (non-starchy) veggies do keep you pretty full, so you don't feel like you are starving. But as soon as I quit eating like a rabbit, I gained it all back, faster than I lost it.

The second time was just a calorie-counting, food-journaling plan, write down and track every single bite you put in your mouth. There are websites (mine was sparkpeople.com) that help with that. At sparkpeople, I could put in what I ate and it would tell me the calories, fat grams, nutrients, etc that were in it and it would track exercise, give me all kinds of graphs of progress, etc. I kept the calories to between 900 and 1100 a day, aiming for 1000. That's very little food and I mostly was hungry all the time.

Back in WWII, they used a group of conscientious objectors as subjects in a study of the effects of starvation. They were housed in a barracks where their food intake was controlled. They were kept on a diet of 1500 calories. These were young men, so clearly different metabolisms than me, but still - I could gain weight on 1500 calories! The men suffered very severe effects of the starvation, lost 25% of their body weight in six months. Here's what wiki says about the effects on them:

"Among the conclusions from the study was the confirmation that prolonged semi-starvation produces significant increases in depression, hysteria and hypochondriasis as measured using the Minnesota Multiphasic Personality Inventory. Indeed, most of the subjects experienced periods of severe emotional distress and depression. There were extreme reactions to the psychological effects during the experiment including self-mutilation (one subject amputated three fingers of his hand with an axe, in order to get out of the study). Participants exhibited a preoccupation with food, both during the starvation period and the rehabilitation phase. Sexual interest was drastically reduced, and the volunteers showed signs of social withdrawal and isolation. The participants reported a decline in concentration, comprehension and judgment capabilities... " https://en.wikipedia.org/wiki/Minnesota ... Experiment

It is clearly not good for me to be carrying the extra weight around, but I really believe that what it takes for me to lose weight at this point is also very hard on my body. (I always get sick when I start a diet, even though I am almost never sick otherwise.) It's a dilemma that is much on my mind right now.

Incidentally there was a recent study of people who lost significant weight and successfully kept it off for at least five years. They had two things in common: they maintained very strict portion control and they exercised one hour every day.

[ElizabethB]

Imafan and RBG you have both raised serious issues.

Imafan all of your comments are accurate, well spoken and ell taken.

RBG - I am obviously very ignorant when it comes to vegetarian eating. I can not imagine that a vegetarian would suffer with obesity. Where are the excess calories coming from? From your post you are obviously active. You are not consuming near as many fats as us omnivores do. (excuse the poor word usage). Are Carbs the issue? Where are they coming from? I am missing something.

Age is less of an issue than health issues. Our DIL is 42. She had Gastric Sleeve Surgery done 2 years ago. She is thrilled with the results. I must say that she went from an obese, frumpy old lady to a Hot Mama.

That was off track.

Back to issues.

George is 70. He has high blood pressure, high cholesterol, an artificial aortic valve, on Coumadin, has fluid retention, sleep apnea and is diabetic. He is a walking time bomb.

George is an intelligent, educated man. Intellectually he understands that this surgery is a tool. There is another part of him that thinks that this will be a cure all.

RBG - if you do not mind I would like to be able to PM with you when he makes me crazy. Your professional expertise may help me help him.

Obviously you have serious concerns about your weight. If you were to consider Bariatric Surgery protein would be a major issue. IDK if you could consume enough protein on a vegetarian diet. Again my ignorance. Post Op is a lifetime of high protein eating.

Bottom line - I m both anxious and excited. I love this man and want him to be around for a long time. I want him to see his Grand Children graduate from high school and college. I want him to see them get married. I want him to hold his Great Grand Children in his arms. I want him to live longer than I do because I do not want to live without him.

[rainbowgardener]

check your private messages, Elizabeth!