Today I had my meeting with the Dietitian.  I had met her before in her private practice and knew that she was really lovely and supportive, and she didn’t disappoint today.  We talked about my health and my current eating habits.  The things that act as triggers and how I plan to handle the changes that the sleeve will bring.

I knew prior to the appointment that I would be doing a two week detox on Optifast so that my liver is in a manageable position for the operation.  So that didn’t come as such a surprise or shock.  The four to eight weeks after the surgery however look like they could be hard work, but I’m positive the fear of having to have surgery again will keep me motivated.

It’s hard at the moment to be focused on all the information I’ve been receiving.  I’m tired and really cranky today.  My frustration levels at the whole process are elevated.  I’ve had to deal with my gynecologists office and they never seem to put me in a good mood.  It’s so hard to find good service.  Canberra Bariatric have been brilliant.  The surgeon sat with us and spoke at length about what was happening.  He patiently answered all of our questions.  I didn’t feel rushed or like I was being steamrolled.  The dietitian was exactly the same. Really helpful, listened and gave advice.  Didn’t try and push any agendas.  It was brilliant.  Then I go to the gynecologists office and it’s the complete opposite.

They don’t have any of my hospital paperwork.  I can’t see the gynecologist prior to the surgery.  He’s not spent any time with me going through the possible complications or any further side affects of the surgery.  Just made me fill in the day surgery admittance forms and give them money.  It’s so frustrating, it’s not like I’m putting my car in for a service.  This is my health and my life we’re dealing with.

I very rarely get upset with people, but today I told the receptionist that the level of service I was experiencing from this practice was “giving me the shits”.  She didn’t do anything, no apology, nothing; just went on to tell me how her husbands been in a work accident and is going to have to have major surgery.  If she was trying to guilt me in to shutting up it worked.  I’m such a pussy.  I see other people rant and rave and get rewarded with the things they want just so they’ll shut up.  But I go in there nice as pie trying to be respectful of everyone and not cause any ripples and I seem to get screwed over.

I don’t think it’s acceptable to have not had a follow up appointment with the gynecologist after he removed a massive cyst.  In fact, if I am being perfectly frank about it, I think it’s bullshit.  Surely, there’s some rules about having follow up with a patient after surgery.   You don’t just smack them on the bum and send them on their way in the world never knowing exactly what happened.  I want to sit down with him and have him walk me through the operation, step by bloody step.  It didn’t go the way he said it would prior to the surgery, so I’d like to know how it did go.  I’d also like confirmation, formally, of exactly what the hell he did remove.  Did he take both fallopian tubes, or just one tube.  Did he see anything else?  Will there be issues with scar tissue on any of the remaining organs?  I don’t think that’s too much to ask for.  Or maybe it is?  I’ve never had surgery before, so maybe this is the done thing and I’m just being a little drama queen.  I don’t know…

It makes me really mad when I think about it.  In fact, I’m getting a little teary thinking about it now.  It’s my body dammit.  I’m not going to let the same thing happen again.  I’m going to make an appointment with the gynecologists office and demand that I get face time with him and he goes through exactly what he did in both procedures.  That he informs me of exactly what the impacts and ramifications will be.  And then, when it’s all said and done I’m changing specialists.  I don’t care if they say he’s the best in Canberra, he might be technically very good but his follow up sucks and it’s not helping me to heal and move on.  And if it’s one thing I’ve learnt, life is too damn short to put up with unhappiness.

But, back to the eating plan. The dietitian provided a high level overview of what the eating will be like with the Gastric Sleeve.  Here’s what it looks like:

Food & Eating Time Line with Gastric Sleeve

Before Surgery

A Very Low Calorie Diet regimen is strongly recommended to make the surgery easier by reducing the size of your liver.

• For at least 2 to 4 weeks before surgery
• Eg. Optifast® regimen
• A specially formulated Very Low Calorie Diet (VLCD), which includes meal replacement drinks

In Hospital

The following eating stages are important to ensure safety and healing after gastric surgery:

• You will not be allowed to eat or drink on the morning of your surgery.
• You may be asked to stay on a clear fluid diet for a few days while in hospital.  Clear fluids are drinks that you can technically ‘see through’.  Examples include water, black tea and coffee, apple juice, consomme and cordials.
• You should move on to Nutritious fluids before discharge from hospital.

At Home

Fluids

• For 2+ weeks after surgery
• Nutritious fluids
• Keep fluids thin during the first few days – a consistency that you can take through a straw.

Blend/Puree

• For approximately 2 weeks after fluid stage
• Blended or pureed food at the consistency of baby food
• Food with lumps or highly fibrous must no be eaten during this phase.

Soft to Regular

• 4 to 6 weeks after surgery
• Progression to food of normal consistency usually happens at 6 to 8 weeks after surgery.

Please note that the above texture-modified stages are a guide.  Progression through the phases varies from one person to the next.  Keep textures smooth and thin if you experience tightness on ingestion.  You may upgrade the thickness gradually if you get a sense of hunger and thin textures are ‘going down’ comfortably.

Into the Future

Once you have progressed to eating food of normal consistency, it is important to find a healthy eating plan that works with your surgery to help achieve your weight loss goals.

Your dietitian can guide you in the most suitable eating plan for you.

Source: Canberra Bariatric; Mari Eronen; Dietitian; July 2007

I start the Optifast on the 30 November 2009, the before surgery part of the time line.  Here’s the information from Canberra Bariatric on what I need to do:

Optifast® Regimen for Weight Loss before Surgery

The Optifast® regimen is important for the purposes of making surgery easier.  It is a Very Low Calorie Diet (VLCD) that includes:

• 3 Optifast® meal replacements daily:
  • You can choose any product: Optifast® shake, soup, food bar, mousse – or a ‘mix and match’ of these
  • To vary the flavor and taste, try adding instant coffee powder, low joule toppings or food essences (with no sugar) to the shakes; and non-starchy vegetables/herbs/spices to the soups.
• At least 2 liters of fluids each day
  • Water
  • Black tea, herbal tea
  • Mineral water (plain, or low joule flavored)
  • Low joule cordial
  • Diet soft drink (in limited amounts)

Avoid: alcohol and limit high caffeine drinks

Sometimes you may wish to have some low calorie jelly with or between meals.

• Non-starchy vegetables (limit to 2 cups per day)
  • Asparagus
  • Beans (string)
  • Bok choy
  • Broccoli
  • Brussel Sprouts
  • Celery
  • Cabbage
  • Capsicum
  • Cauliflower
  • Cucumber
  • Eggplant
  • Lettuce
  • Mushrooms (fresh)
  • Onion
  • Spinach
  • Squash
  • Tomato
  • Watercress
  • Zucchini

Avoid: carrots, corn, potato, pumpkin, lima beans and green peas.

To maintain variety, rotate the types of non-starchy vegetables you include.  Try different ways of preparing them.  Have them raw, as salad or eat them steamed or cooked in the microwave.  You may add ingredients such as herbs, spices, vinegar or lemon juice for flavour.  Try not to use any condiments or sauces that contain calories.

Fibre

The Optifast® regimen may affect your usual bowel patterns.  If you experience constipation, make sure you drink enough fluid and include a variety of vegetables as listed above.  You may wish to consider a fibre supplement:

• Benefiber® can be mixed into your Optifast® drink
• Metamucil® or Fybogel® in a glass of water
• Psyllium husks blended into Optifast® with additional 100ml water

Fresh Breath

It is natural to experience ‘bad breath’ on Optifast® or on any VLCD.  Ways to freshen breath include chewing on parsley, a low calorie mint or sugar free gum.  Note that artificially sweetened confectionery still contain calories, so try not to have too many.

Source: Canberra Bariatric; Mari Eronen – Adapted from Novartis Product Leaflet – October 2009

So, are you jealous yet? I know I would be if I was you!  It’s going to be an interesting time.  HUBBY is talking about doing the plan with me as well so there’s no additional temptation in the house.  I admire him, and love him for the thought, but I think he should stick to the real food.  Two cranky fatties in one house might be one too many.

The dietitian and I spoke about the lack of information on the internet about eating with a gastric sleeve.  A lot of the information comes from the US.  Our surgical procedure and after surgery care varies then the US, so while the information is still valuable it’s not really reflective of what Australian patients can expect.  I told her I was blogging about my experience and that I’d be happy to journal the foods I’m eating and my body’s reactions to things.  I think it fits with part of the reason I decided to blog about whats going on.  There’s little information out there for Australian patients and if some of what I’m going through can help someone else, than I’d like to do what I can.  It’s hard to not feel isolated when you make such a big decision like this, and really in this day and age we shouldn’t feel like that.  Information and support is only a click away.

HUBBY and I have floated the idea of having a feast on the 28 November 2009 to farewell my old lifestyle and welcome in the new one.  I’m trying to imagine what would be on the menu for such a feast.  I’m also trying to think whether there’s any restaurants that I’d like to binge at one last time and my mind is coming up blank.  I’m sure in the throes of hunger pains I’ll be able to rattle of a massive list of all the foods I wish I’d eaten before embarking on this adventure, but right now I just feel like a nap.  In fact, I think I might just go and take one.  I had a horrible nights sleep last night.  I dreamt of Penny Wong for some reason… go figure.  I imagine that in my future there will be dreams the likes of Willy Wonka’s Chocolate Factory, can’t wait for those!  Just call me Augustus Gloop!