9 Months!

In this photo, we're both nine months. I'm nine months out from my surgery. My sister is nine months pregnant.

Giving Thanks

On April 2, 2009 I was given the gift of gastric bypass. On November 25, 2009 (the day before Thanksgiving) I reached my goal: 137 pounds.

I am thankful:
*For my husband's support throughout the highs and lows of this journey.

*For Sarah and Alissa's wardrobes--I'd be broke without them.

*For running--who knew?

*For a healthy future!

I wore my way-too-cute new sweater dress and boots to my sister's baby shower this weekend. Can't tell you how much fun I had shopping. I never even made it to the mall but I tried on dozens of outfits which--believe it or not--is a really new expereinces. In the past, if I needed a dress for something, I had two options: Lane Bryant and CJ Banks. If I was lucky, each store would have one dress and a couple of skirts. If I didn't like them, I was out of luck.

After the shower, my sister and I went shopping for a bit after and then I met some friends for a glass of wine. What a great way to spend a Sunday.

Pam's Chai Recipe

At a bariatric group meeting last week, a couple of people asked about protein drink otptions. My first thought was Pam's protein chai recipe. It is a staple in my diet. I have it (or Click, a espresso protein shake) every morning. The recipe is found on Pam's blog (http://pamtremble.blogspot.com/2009/02/protein-hot-chai-mix.html). Pam has great recipes and wonderful nutrician information, so check out her site! But, for convenience, I'll paste the recipe here, too.

Pam T's Protein Hot Chai Mix

6 scoops vanilla protein powder
1.5 cups non-fat powdered milk
3/4 cup instant unsweet tea mix
3/4 cup Splenda
1T. chai spice mix (or use half cinnamon and half ground ginger)
1t. ground cloves
1t. cardamon (original recipe calls for this, but I don't have any, so skipped it)

Mix all dry ingredients in bowl until well blended. Add 1/2 cup of mixture to mug and add either splash of cold milk or water -- stir to create smooth paste (so you don't get lumpy protein powder). Add 8oz hot water and mix well. You can top with Light Redi Whip and a sprinkle of chai spice or drink it naked. (The drink is naked, not you.)

Recipe makes 7 half-cup servings. Calculation below is without the "splash of milk" when you're mixing the tea. If you use RediWhip -- it adds about 20 calories.


Calories: 146
Fat: 1g
Carbs: 9g
Protein: 27g

Calorie Increase

For the past couple of weeks, I've been eating a bit more each day. For the most part, I've been making good choices, just more of them. In fact, I've had several 1200-1400 calorie days despite my plan to eat around 850 calories. The weight has continued to come off but I've felt guilty about not sticking to my guidelines. Then, I realized, I can change my guidelines. So, as of today, I am upping my calories to 1000/day and readjusting my balance of carbs, proteins, and fats to 40%/40%/20%.

Here is what I'm eating today:

Breakfast: Click (a double espresso protein shake--Yummy!)
Snack: mini Luna bar (granola bar)
Lunch: Greek yogurt with granola
Snack: minestrone Soup
Dinner: pork chop, wild rice, asparagus, cranberries
Snack: reduced fat Wheat Thins

My Morning Weigh-In

I weigh myself nearly every morning. After weighing in, I enter my weight into my Fitday account before entering my food plan for the day. After entering my new weight this morning, I received the following message:

Your BMI is: 24.9
A BMI between 18.5 and 25 is considered healthy.
The healthy weight range for your height is 107.8 - 145.6.
Your weight is within the healthy range.

I have no words...

Card-Carrying Memeber

This week marked two great moments:

I have lost over 100 pounds since surgery and for the first time in my adult life, I only need the 100 pound slider weight on the standard medical scale.

The Big Race

It was a lovely day for a run! I had a great time (thanks to my good friend and running partner, Alissa)! My actual time was 56:37 (about 11.5 minute miles) but since I had to stop to use one of the oh-so-lovely port-o-potties conveniently placed along the route, I'm guessing I ran about 11 minute miles overall. At the end, I was doing well and looking back, I certainly could have pushed myself. In fact, this morning I hopped on the tread mill and did a 5k in 32 minutes (under 10-minute miles). So, in the end, the race was a success if for no other reason it motivated me to step things up a notch. Oh, and the fact that I wasn't the last to cross the line after all.

Road Race Results

Results for:Amy Ramsay CenturyTel 5 Mile Run



Bib # 565
Age 35
Gender F
Age Group F 35-39


Finish Results
Finish Time 00:56:37.4
Pace 0:11:19 min/mi
Overall Place 649 out of 729 CenturyTel 5 Mile Run finishers
Division Place 357 out of 420 Womens 5 Mile Run finishers
Age Group Place 57 out of 67 F 35-39 finishers
Gender Rank 357 out of 420 F finishers

Weather Report

I just checked the weather and it looks like it will be cool (55o) and cloudy, but shouldn’t be raining for the run! I'm getting excited but honestly, as I type this, I am starting to get a sickly nervous feeling in the pit of my stomach. Part of me can’t believe I’m really gonna do this and is starting to wonder what I’ll do if I am the dead last person finishing. Ugh!

Six Months Out

I had my six-month follow-up appointment this morning. There have been some pretty obvious changes to my appearance, but I thought I'd let you know the less obvious changes as well:

• My blood pressure was in the at-risk range but in is now in the optimal range at 118/70.
• My cholesterol was in the at-risk range. It is now 131 which is well below the normal/optimal of 200.
• I was insulin resistant/pre-diabetic. My fasting blood sugar is now 77 -- perfectly normal.
• I had sleep apnea, snored, stopped breathing, and was supposed to use a machine while sleeping. All of the issues related to apnea have been resolved!
• At my heaviest, I weighed 273 pounds. I am now 160.
• My BMI at the time of surgery was 43.4. I was morbidly obese. My BMI now is 27.5. I am overweight and am within 15 pounds of being in the "healthy weight" range. I used to get annoyed with people who "only" had 15 pounds to lose.
• My body fat percentage at the time of surgery was 53%. My body fat percentage is now 34%.
• I had quite a bit of joint pain especially in my ankles. I now run a 5k at least twice a week and am running in my first 5-mile race this weekend.

Milestones--Five of Them

Okay, so there aren't really mile markers on the treadmill, but I ran 5 miles this morning. When I went to the Y this morning, I really didn't have a plan for my workout today. Then I noticed on the September calendar posted in the locker room that there are only ten days until the Maple Leaf run. Yikes! In ten days I need to be able to run a 5 mile race and even though I have no illusions of having a great time, I do intend to finish the thing. I have been running a few times a week for just over a month and had been working up to longer runs but most weeks I did a 5k (3.12 miles) once or twice and then one 3.5 to 4 mile run. So, instead of a 30 minute elliptical session, I decided I would run. And I did. All five miles. I broke no records--except it was the first time in my life that I ran five miles.

Another 10% Gone!

I've set mini-goals for myself based on the premise that every time a person loses just 10% of her body weight, she sees significant improvement in her health. In fact, many physicians have stopped preaching ideal body weight and instead ask patients to simply lose 10%. The request feels more reasonable and attainable and physicians see greater results when asking for this smaller step.

Questions about Post-op Pregnancy

Many people have asked me about pregnancy after surgery with questions about everything om fertility to nutrition.

Will this make it easier for you to get pregnant?
In general, losing the weight should make it easier for me to become pregnant. As many of you know, I have poly-cystic ovarian syndrome (PCOS) which effects the regularity with which I ovulate. PCOS symptoms include obesity, hair growth, infertility, irregular cycles, painful ovulation, and more. Insulin resistance and inappropriate hormone levels are highly connected to PCOS and the severity of the symptoms. Since fat stores hormones, losing the weight can help achieve an appropriate hormone balance, eliminate insulin resistance, and thus decrease the severity of PCOS, making it more likely to achieve pregnancy.

Since you can't eat that much, is it safe for you to get pregnant?

The key is to have stabilized my weight. Once I am maintaining a consistent weight (usually 12 months post-op), I will find a calorie/activity level that works for me and allows me to maintain a consistent weight. Then, once pregnant, I will add 200-300 calories a day (a couple small nutrient-dense snacks). This calorie increase is the same for all mothers--not just RNY mothers. My surgeon may recommend increasing the dose of my prenatal vitamins and may suggest testing your levels to make sure there are not deficiencies. In general, though, my body gives the baby what he/she needs first and I get the "left-overs", so if there are deficiencies in anything, it would effect me not the baby.

Are there other issues with surgery and pregnancy?

According to Booster Shots, an LA Times health blog, a woman who has weight-loss surgery before becoming pregnant may help break the cycle of obesity in her family, researchers say. A study published today in the Journal of Clinical Endocrinology & Metabolism found that children of obese mothers who had weight-loss surgery before pregnancy have a lower risk of obesity and improved heart health compared with their siblings who were born before the mother had surgery."Full article here: latimesblogs.latimes.com/booster_shots/2009/09/obesity-surgery-pregnancy.html

I'm Overweight!

I weighed in at 173.8 this morning which means I now have a BMI of 29.83. For the first time in remembered history, I am simply overweight--not obese (BMI 30-40) or morbidly obese (BMI 40+). It is great timing too. I have a regular check-up with my PCP this morning. I haven't seen her since she put in the request for the surgery to my insurance company. I'm going to ask for about a million labs to be done and am hopeful she'll just sign off on it all. I really want to keep track of what is going on with my nutrient levels.

Training Schedule

I have eight weeks until the Mapleleaf Race. This morning I spent time online researching training and here is the schedule I've come up with. Basically, I have three runs a week, two cross-training days a week (probably eliptical, maybe swimming), and two rest/stretch/strenght days a week.

Fitness Challenge

On one of the boards I follow, someone posted a fitness challenge. We were to each set goals for the remainder of the summer. I decided to challenge myself to do a 5k three times a week. I'm not particular on how I complete it (walk, run, eliptical) but I plan to run it at least once each week. I managed to get all three in last week and ran it yesterday so I'm off to a pretty good start. Once I've got the habit down, I'll add a challenge of having a more respectable time; yesterday's run came in just over 36 minutes (about 12 minute miles).

Before & Now: 3 Months Out

My photographer friend just sent me a peek at my progress. Thanks, Megan!

Fourth of July!

Great Grains!

My nutritionist has me adding one serving whole grain each day and so far so good. About a 2T of long grain brown rice, 1/2 slice Ezekiel (high fiber whole grain) bread, or 1/4 cup whole grain pasta (I'm big fan of spelt and just discovered kamut--looking forward to trying it) is as much as I can handle.

Here is my plan for the day:

B: Scrambled egg with colby and 1/2 slice Ezekiel toast
L: Cherry Cheesecake protein shake
S: 1 oz jerky
D: 2.25 oz tuna salad made with light mayo on 1/2 slice Ezekiel toast
S: fresh blackcaps with 1/4 cup milk

704 cals
22.4 fat (28%)
46.6 carbs (26%)
79.1 protein (46%)

Half-Way There

My goal is to lose 115 pounds. Last week sometime, I hit the mid-point of 57.5 pounds lost.

Another WOW moment

I was in Waukon so I thought I'd check out the clearance racks at Pamida. Sparked by my first wow moment, I dared to try on a dress in a size large and...it fit! Okay, so I'm reminded of someone's recent cute post that said, just because you can zip it doesn't mean it fits, so I'll qualify my statement by adding I need a good week and spanx but since I haven't worn a large since junior high and the dress was $7.49, I'm still counting it as a WOW moment!

First WOW moment

A week or so before surgery, I lost my driver's license. I had no idea where it could be but between surgery, the end of the semester, and lots of traveling around the Midwest, I just didn't get around to taking a trip to the county seat to get a new one. Finally today I went in. the woman asked for some basic information and then asked if my height and weight were the same as the last one. I said I really had no idea what was on the last one but she could just keep it the same. She had me fill out a form and she took it to her desk. A few minutes later she came back to the desk and asked, "how much do you weigh?" I said, 195 or so. She responded, "I knew there was no way you weighed that much!" I still don't know how much was on my last license, but it really doesn't matter, does it!

I'm in ONEderland!

I've been enjoying summer and not been home much so I haven't been able to weigh in daily, so you can imagine my surprise and joy when this morning the scale said 199!

Weekend Weigh-down

A graduation party and a cookout and I'm still down another couple of pounds. We've been traveling every weekend. I don't know if it is the travel or the fact that it is the weekend, or a combination of both (most likely) but I seem to get off track. I think part of it is I don't log my food day ahead of time on the weekends. I just log when I get home and see the "damage." I still get my protein in--but way too much fat. In fact, yesterday I had 50% fat 12% carb and 33% protein. So, I had an orange to up the carb percentage and knock the fat down a bit but that didn't change the grams of fat I consumed. Those percentages are really pretty helpful for keeping me honest. Since I'm only eating 7oo-900 calories a day, if I only looked at grams, I could get by with more--48 grams of fat in a day would have been a victory on a 2000/day calorie diet.

I have now lost 35% of my excess body weight.

What Are You Doing/Eating Today?

I haven't posted to the blog in a while but I post nearly everyday to a weight loss surgery (WLS) board forum called "What are you doing/eating today?" It helps me stay on task and track what I'm eating and what activities I'm doing. I'm sure nobody wants to read this mundane info on a daily basis, but I'll post it occasionally for a sense of the types of things I'm doing/eating at each stage of my WLS journey.

What Are You Doing/Eating Today?
I left the hotel (Scott is training in Marshfield, WI for his new job and we've been staying with him) this morning hoping to make it back for Gianna's swim lesson. We missed it, but I still took her to Y-watch and got a pretty good 45 minute elliptical workout. I don't like the brand of elliptical at that Y though--much more jarring than the Precor or Life Fitness. Oh well. Then I took her swimming so she wouldn't be too disappointed. I can't wait until she can actually swim on her own and I can use pool time for workouts.

Pre-B S: Special K protein tea
B/pre-workout: 1/2 apple and 20 almonds
L: 2 oz. deli beef and a string cheese
D: 1 cup venison and two-bean chili (oh do I wish I had some Greek yogurt in the house!)
S: Protein Shake of some sort --see what I'm in the mood for

804 cals
32.3 fat (34%) a little higher than I'd like but with the workout, almonds were a decent choice
60.0 carbs (28%)
77.2 protein (37%)

Watch My Surgery

A bariatric surgrgeon posted an edited-for-time version of an RNY gastric bypass (the same surgery I had) on You Tube. I found it fascinating!

http://www.youtube.com/watch?v=KAKhpKBEMKI

Happy Mother's Day

I had a wonderful weekend with family and a beautiful day with Scott and Gianna. We have a tradition of going to the Shrine of Our Lady of Guadalupe for Mother's Day and now that the church is built and our little Gianna is a permanent part of the shrine, it made Mother's Day even more special. I realized, too, that today I weigh 23 pounds less than I did when I got pregnant with Gianna. Yippee!

25%

My goal is to weigh 137 pounds. In order to do so, I need to lose a total of 115 pounds. I have lost just over 29 pounds which means I have officially lost 25% of my excess body weight!

Month in Review Chart

I know the ticker tells the bottom line, but seeing the data plotted on a chart was pretty exciting.

Protein Shake Sale

GNC is having a BOGO half sale this week. Plus, it is the first week of the month so I get another 20% off. Yippee! Got vanilla and cookies & cream. I had the latter for a snack last night. Yummy! I added an individual packet of instant coffee granules to my chocolate shake this a.m. Yummy (and saves the pocketbook since my nonfat/skinny lattes with protein powder at Starbucks are $4.21 each--yikes--but oh so worth it for an occasional treat.) I bought a jar of decaf instant granules this evening. Might try a vanilla/coffee shake for breakfast tomorrow.

German Chocolate...

No, not cake. But almost as good. One of the women on a WLS web forum I check occasionally has recipes for dozens of protein shakes. Tonight, I am enjoying a chocolate protein shake with
SF caramel syrup and a few drops of coconut extract.

German Chocolate Protein Shake German Chocolate Cake
146 calories versus 583 calories
1 g fat versus 17 g fat
10 g carbs versus 103 g carbs
24 g protein versus 7 g protein

Yippee! I'm Obese!

Obesity levels are monitored not by weight but by Body Mass Index (BMI) which is a calculation based on weight and height. A BMI over 40 indicates morbid obesity. In fact, a BMI over 40 is required for being accpeted as a candidate for bypass sugery. Yesterday, my BMI fell to 39.82 moving me out of morbidly obese, to just obese. Here is the breakdown of the levels for my height:

BMI 40+ = 232+ pounds = morbidly obese
BMI 30+ = 174-231 pounds = obese
BMI 25+ = 145-173 pounds = overweight
BMI 19+ = 110-144 pounds = healthy

What Can You Eat Now?

I've heard this question so many times in the past two weeks that I thought it time to post the basics. For now, my nutricianist wants me to focus on getting as much protein as possible and since I'm eating small amounts, you'll notice protein is the focus of each meal/snack. Here is my plan for today:

7:30 Breakfast -6 oz skim milk with a scoop chocolate protein shake

11:00 Lunch -1 cup Healthy Choice beef pot roast soup

2:30 Snack - 2.25 oz garlic herb tuna salad with three wheat crackers

6:00 Dinner - 2 oz. baked chicken breast strip

9:00 Snack - 6 oz plain yogurt with sugar-free raspberry jelly and light readi whip

(70+ ounces Crystal Light throughout the day.)


Cals 617
Fat 10.2 (15%)
Carbs 59.2 (37%)
Protein 72.6 (48%)

The Scale Does Work

I haven't posted in awhile mostly because I was frustrated with the scale. I lost so much that first week and was so excited and then nothing--the scale refused to budge. Actually, there were two days that my weight actually increased. I knew that my weight was reflecting a whole host of things not related to what I was eating: hydration level, recovery from surgery, constipation from lack of fiber, etc. I also knew that it was physically impossible to eat 500-700 calories a day and gain weight. But, all the justification in the world didn't change the fact that I wasn't losing and was frustrated. I even removed the battery to reset the scale just in case. Alas, it was just the dreaded stall!

Luckily--yippee--my body is starting to adjust to the new plan and I've seen 1.5 pound loss twice this week. Even with the stall, I've averaged almost 1 pound per day. (18.5 pounds in 19 days).

In the end, I guess stalls are good motivation to keep me vigilant about my water and protein, but boy, am I glad it is over...for now.

Water Victory

I am 11 days post-op and have really struggled with getting my water in...until today! I just managed to finish my 64th ounce of the day! Scott is out of town for the evening so I thought I'd post my little victory, but a victory no less!

My First Stall

Yesterday I felt great though and was able to get a bit more liquid in. I did make the mistake of drinking about 8 ounces of a protein drink in 10 minutes which would actually be slow to normal people, but it was too fast and I had dumping (catch-all euphemism for nausea, chills, or diarrhea) almost immediately afterward. Just need to remember to slow down! It took me 45 minutes to eat a scrambled egg this morning! Cold food is gross but eggs might be the worst! :)

I also had my first stall this morning -- no weight loss. I bit of a bummer, but since I was able to get a bit more water in yesterday, I'm probably just starting to rehydrate myself. Once I'm no longer dehydrated, I will be able to get a realistic sense of weight loss to date. In any event--I'm down 14 pounds in 7 days.

Meal Plans

I'm slowly getting used to eating soft foods. Gianna is trying to help, too. Yesterday she had crackers with peanut butter and raisins as a snack and smeared some of the peanut butter on her little finger and offered to to me saying, "Look Mom, it's smooshy. It will make your tummy feel better." It's amazing how fast kids pick up on things! Yesterday I planned to try egg salad for lunch. An egg slipped when putting it in the pan and got a slight crack, so I had scrambled egg for breakfast. The scrambled egg went pretty well. I didn't need to puree it, just chewed each pea-sized bite many many times. For lunch I did indeed have egg salad which didn't go so well. It was chopped pretty fine, so I don't know if I ate too quickly, I ate too soon after drinking, or if I just am not ready for the 1.5 tsp. of low-fat mayo I mixed in. In the end, I managed to have about half an egg for lunch and just couldn't manage another bite. Luckily, protein supplements made it possible to still get closer to my protein goal of the day. I had 48.8 grams yesterday.

The First Weigh-In

It is hard to believe, but I have lost 6.5 pounds in 4 days. Of course, at this point, it has nothing to do with my efforts, but it is still pretty exciting to know that those pounds are never coming back. Even if long term, I regain a little of my weight back, I will never see 250 again!

The weirdest part is that automatically, the desire for food just went away. It is kind like when your sick and just don't even think about eating. This morning I made a 4-oz protein shake and completely forgot about it after drinking 2 ounces! How's that for weird. The thing I really need to work on is getting in all my water. I am supposed to have at least 64 oz a day--not an easy task when I am only supposed to take a sip at a time and can't drink 30 minutes before or after "meals" or "snacks".

I finally felt like I slept last night. My pain medication make me a little nauseous so I've tried to only take it when needed and right before bed.

4/2 The Hospital

The morning of surgery was an early one. We got to the hospital by 5:30 a.m. on Thursday and started almost immediately with gowns, IVs, and the like. By 7:00 I was unconscious. I have very vague recollections of saying bye to Scott in the hallway. I don't remember coming to, being in the recovery area, or seeing Scott again. I don't even remember what I remember first. But, all went well! The only surprise of the surgery was when my surgeon discovered that I have significant gallstones which might mean a later gallbladder surgery.

Recovery was steady. I was walking by Thursday afternoon. I had a swallow test on Friday morning to check for leaks in the new pouch that is my tiny (golf-ball size) stomach. I started on liquids (1 ounces cups of grape juice). Lots of family and friends stopped by. I was still bit drugged and worn-down but it was great to have every one's support.

I graduated to thick liquids by Saturday. I was a bit stir-crazy and spent a good bit of time every hour walking the halls. I was able to shower by myself (something I was warned I might not be able to do). After a purred lunch (not a fan of purred meats!) I was discharged.

We spent the afternoon visiting with neighbors and watching basketball. (Who am I kidding? Scott watched the game, I tuned it out.)

Pre-op

On April 2, 2009 I had gastric bypass surgery. While I had been planning the surgery for well over a year, the initial date I was given was late summer (July/August). Then, the week Scott was scheduled to return from Iraq, the surgeon's office called and said they had a cancellation and could get me in in just 10 days. Even though we knew it would make the homecoming transition even more chaotic, we decided to take the early date. One benefit to doing it early was that since Scott was still technically on active duty (he earned about three weeks of leave that was tacked on to the end of the deployment), our secondary insurace through the military covered deductables. Another benefit was that Daddy was home to care for, lift, hold, and cuddle Gianna while mommy recovered.

Pre-op weight 252.5