1 Year Update.  Down 184.8 lbs

On January 21st, 2016 I had my first appointment at UW Weight Loss Management Center. My official weight was 473.4 lbs. One year later, after a whole lot of hard work, a whole lot of sweat, a few tears and finally surgery, I am down to 288.6 lbs. I'm not done yet. My ultimate goal is 225 lbs so I still have some work yet to do. This is how I did it.

For me this actually began back in July of 2014. I had a stomach ache. A really bad stomach ache and after 5 days of the worst kind of burning pain imaginable, I took my happy ass to the ER. Turns out my little stomach ache was pancreatitis. Fortunately for me it was just a mild case (a bad one ends up in the morgue) and after four fun filled days in the hospital I started the epic trip through the medical system to discover the cause. Many months and many tests later it turns out I have gallstones and my gallbladder needs to come out. The first surgeon I met with suggested that I could also do weight loss surgery at the same time.

For me this actually began back in July of 2014. I had a stomach ache. A really bad stomach ache and after 5 days of the worst kind of burning pain imaginable, I took my happy ass to the ER. Turns out my little stomach ache was pancreatitis. Fortunately for me it was just a mild case (a bad one ends up in the morgue) and after four fun filled days in the hospital I started the epic trip through the medical system to discover the cause. Many months and many tests later it turns out I have gallstones and my gallbladder needs to come out. The first surgeon I met with suggested that I could also do weight loss surgery at the same time.

This was me back in August of 2015. I'm not sure what my weight was here but it is one of the few pictures I have from this time. Shockingly I didn't feel very photogenic, and still don't. The suggestion that I have weight loss surgery was back in May of 2015 but unfortunately the surgery was not available through my current provider. Or to be more precise, it was available but my insurance would only cover it at another hospital. Getting my referral to the University of Washington turned out to be a massive cluster fuck. This was partly my fault. Back when I had the initial bout of pancreatitis, I was newly on the ACA (Thank you Mr Obama) and didn't have a primary care physician yet. On discharge from the hospital they said to follow up with my PCP so I went out and got one. What I didn't know was the hospital had assigned me a PCP without telling me. As long as I was within the Swedish system (the PCP I went out and found was part of Swedish) all my referrals went through just fine but when we tried to do a referral to another system, they looked to my insurance company and since the PCP on file didn't match the one on the referral, they rejected the referral, twice. Once I found out why they were rejecting the referral it took all of five minutes to fix, and three of those were spent stuck on hold. My third referral was also rejected, this time by United Healthcare. I appealed and was finally approved. This process took the better part of 8 months. I started the weight loss program at UW at the end of January 2016. My official starting weight was 473.4 lbs.

Now because they don't want to throw away a bunch of money on people who aren't serious about the weight loss, you have to earn the surgery. Getting into the program is just a start. Before you qualify for surgery you first have to go through 6 months of monitored weight loss. This means monthly visits to your PCP and twice a month with a dietitian. My new UW surgeon and United Healthcare wanted me to lose 40 lbs prior to surgery. I went a little overboard.

June 2016 398.6 lbs.

This was a pretty big deal. 74.8 lbs down but more importantly, I crossed into the 300's, a place I had not been for at least 6 years. Unfortunately while my logical brain looks at those numbers and knows it is a very big deal, the fat bastard looking back from the mirror still sees a long way to go.

So just how is this miraculous transformation from "Fat bastard" to "slightly less fat bastard" possible? Lots of hard work. Sorry folks, there is no short cut. Also, and here is my nickle's worth of free advice, the younger you start this work, the better. I have been big my whole life. When I was younger, I didn't care. I could eat what and when I wanted and that was all I needed. So what if I had to buy bigger clothes? Then I turned 40 and my warranty expired. Shit started to hurt. I have a lifetime of old injuries and arthritis in my knees and shoulders. Losing the weight is always going to be a lot of work but if you wait until you are my age or older, it is going to be a lot of work and pain. Welcome to the freak show.

So just what is this "work"? No real mystery here. It is diet and exercise.

Diet

First and foremost, get a food diary and track every last thing you eat. There are lots of apps and web based programs out there. I used http://www.myfitnesspal.com/ but it is one of many. These are a lot of work at the beginning since you have to enter all the recipes you use but once you do that it becomes quite easy to use. The kicker is, you need to be honest. If you eat it, track it. If it is good for you, track it. If you cheat, and it will happen, track it. The diary can't make you do anything but if you use it, you can see patterns and make the necessary adjustments to reach your weight loss goal. Also, and this might just be me, but when you have to write everything down in black and white, it helps keep you honest. It guilt's you into sticking to the diet because you feel a little bad when you look at those cheat meals. One thing, the myfitnesspal database is user generated. Some people are very anal about getting the nutritional information correct for an entry, some are not. If it looks too good to be true, it probably is. Do your own research and make sure the numbers add up correctly. Bad numbers in a recipe can really kill you down the line.

My diet was very simple. I could eat whatever I wanted but I was on a calorie and sodium count. Sodium is the killer. It is in absolutely everything and processed food has way too much. My sodium count wasn't even what is considered "low sodium" but merely the healthy amount "everyone should eat". That amount is 2300 mg per day. 2300 mg a day is very hard to do. Initially I cut my calorie intake in half and was averaging 1400-1700 calories per day but after my initial weight loss slowed way down (the first 30 lbs fell off, the next 30 not so much), my dietitian decided I wasn't eating enough and it had slowed my metabolism so she bumped me up to 2000-2400 calories. I aimed for 2000. This allowed some wiggle room in case my math was bad or there was a bad data entry. Error low for safety.

I'm a fairly lazy person so I like to do my meal prep as little as possible. This means I make large batches of food, and then eat from them for a week or so. It is a lot of work in the beginning to get the recipes entered correctly but once that is done, you just adjust the weights every time you make a batch.

My meals looked something like this.

My typical Breakfast

1 piece thick cut bacon , 1 egg, 2 tbsp egg whites, 1 oz low fat American cheese on a whole grain english muffin. 1 medium banana, 5.3 oz greek yougut. Yes the bacon really made it tough to work with my sodium count but I love bacon so I made sacrifices elsewhere and made it work.

526 calories, 803 mg Sodium

Lunch Time

Chicken, Rice (long grain brown rice thank you very much), and vegetable casserole , Whole grain toast with 1 tbsp of strawberry preserves.

475 Calories, 845 mg Sodium

Dinner

Grilled Chicken breast 6-10 oz, 5 oz steamed green beans, whole grain toast with 1 tbsp strawberry preserves and 1 cup of either a tofu hash or summer squash with tofu (needed to keep my protein up).

775 Calories and 845 mg of sodium.

You'll notice everything has black pepper sprinkled on it. My numbers were so close to the line on sodium, I couldn't afford to sprinkle any table salt on my food so I went nuts with the pepper instead.

I also got 2 snacks, one between breakfast and lunch and one between lunch and dinner. These snacks consisted of a piece of fruit each. Orange, apple or banana. Yum. Grand total for this day was 1968 Calories, 2259 mg Sodium and 134 g protein. I did this with very few cheat meals until the end of August when I started the 1300 calorie pre surgery diet.

Weight everything

Get a kitchen scale. They are cheap (I think mine cost $11 on Amazon) and weigh everything you eat. Weigh every ingredient in your recipes. The more accurate you are, the easier it is to properly track calories.

Diet alone is not enough.

One of the first people I met with once I started the weight loss program at UW was their physical therapist. She started me on an exercise plan. That plan called for 30 minutes of cardio 5 days a week. That doesn't sound like much and at this point, it is laughable but in the beginning just getting up to 30 minutes was tough and it took about two weeks before I was able to meet the goal of 30 minutes a day, 5 days a week. I am poor so when I started, joining a gym was out of the question but guess what, walking is free. I also bought this stationary bike about 10 years ago and it was a fantastic clothes rack for many years. Now it is getting its proper use. For the first few months I did just the 30 minutes. If the weather was good, I went for a walk. If it was crappy, I used the bike. Soon 30 became 45. Then 45 became 60+. Once summer came around I broke down and finally joined the Y. Right up until surgery I swam for 60+ minutes, 3 days a week and on the days I was not in the pool, I walked for 30+ and rode for 30+. I did this at least 6 days a week, sometimes 7. I was planning on starting weight training when joined the Y but that got back burnered when I separated my shoulder in a fall. Oops.

This Fucking Thing (no those are not my feet, it is a stock photo)

It is a necessary evil. Do not weigh yourself every day. Two maybe three times a week is more than enough. My weight could fluctuate as much a 5 lbs on any given day depending on what I ate or how recently I used the bathroom. Try to weigh yourself at the same time every time to avoid these fluctuations. Most of all, don't get discouraged. I hit many plateaus during this journey. They will happen. The scale is just a tool, don't let it rule your life.

On August 27th I got the call I'd been waiting for. My surgery was approved and scheduled for October 3rd 2016. I had a brief moment of panic but it rapidly morphed into relief. Unfortunately this call signaled the beginning of my 1300 max calorie pre surgery diet. The idea is to shrink my liver so they can see what they are doing. Lose enough weight and they can do the surgery laprascopic. Don't lose enough and I get unzipped. I really didn't want to get unzipped.

1300 calories looks something like this.

Goodbye Bread.

Yes I kept the bacon but the english muffin is toast. This is a veggie omelet. 1 egg, 2 tbsp egg whites, 3 oz veggies (onion, mushroom and green pepper) and 1/2 oz of low fat cheddar and a tbsp of low sodium ketchup. Medium Banana and that glorious greek yogurt.

398 Calories and 593 mg sodium.

Look familiar?

Initially I dropped lunch altogether and replaced it with 2 protein shakes, a banana and orange eaten as several snacks between breakfast and dinner. Unfortunately according to the UW dietitian, this was too much protein so I had to drop the shakes and go back to this but without the bread. Dammit.

301 Calories and 466 mg sodium.

Very similar do my previous dinner but now my chicken is only 5.5 oz and I had to make the summer squash without the tofu (although I think this batch still had some).

394 Calories and 584 mg sodium.

I still got my 2 pieces of fruit for snacks. It took about a week to get used to it. The first several days I was very hungry but that fortunately didn't last.

This was me the night before surgery. 342.0 lbs . Still a fat bastard but I was down 131.4 lbs. I have friends who weigh less than I've lost. My blood pressure which was once high enough that it freaked out my doctors (195/120) is now under control. My knees still suck but perhaps not as much as before. My clothing was no longer tight and was in fact getting quite loose (They actually got ridiculously loose before I considered replacement). It has been a long road but that fat bastard in the mirror says we aint done yet.

The surgery itself went very smoothly. In addition to having the gastric bypass, they also removed my gallbladder. Thanks to my extreme weight loss prior to surgery they were able to do laparoscopic surgery instead of unzipping me. This meant I only had to spend three days in the hospital and made my recovery much easier. The early part of my recovery was very easy. I was fairly heavily medicated, but I got more than my required exercise and breezed through the liquid only part of my recovery diet.

Surgery scars. Six small incisions, the biggest of which is on my left side and about 1.5 inches long. This is infinitely preferable to a large cut right up the middle and in my case it would have been both since the plan was always to start laparoscopic and only unzip if they couldn't see everything they needed to. The extreme weight loss prior to surgery made visibility better and I didn't get unzipped.

Also worth mentioning, when they do this surgery they pump you full of gas (nitrogen I believe) to help with the visibility. This gas stays in you when they are done and has to be "naturally" removed. What followed was the most flatulent week of my entire life. Additionally, since I was on some fairly hefty pain killers which "can cause constipation" , I was given a stool softener to take. By the way, a liquid post op diet, post surgery gas and a stool softener are a truly horrible combination. I only took that damn pill once. Somehow I managed to avoid complete disaster but there were several very quick trips to the bathroom.

Let it be known far and wide that I am a fucking idiot. After two weeks of a liquid only diet (and still on post-op pain killers) I was cleared to start on soft foods. I had eaten nothing but jello, applesauce, yogurt, pureed soup and protein shakes for two weeks and I had a serious craving for something with a little substance. I went with scrambled eggs. Yes, I am a party animal. For the longest time, I have enjoyed my eggs with a healthy squirt of sriracha in them. That was pre-diet me. In deference to my sodium count more than anything else, I only put 1 very small squirt into two raw eggs before scrambling them. I got about two bites into my eggs before I had to stop (I only got that far because I was shoveling the second bite in while I was swallowing the first one). The most ungodly burning pain had lit my insides on fire. I curled up into a fetal ball for about an hour and then threw out my eggs. I thought I was done, I wasn't. For the next 4 hours, I couldn't even drink water without reigniting the volcano that was living in my gut. Apparently adding sriracha to a newly healed gastric bypass (not to mention the now absent gallbladder) is an incredibly bad idea. On the bright side, I no longer had a unstoppable craving for scrambled eggs.

I walked into this with my eyes open and I did my research, but I also had a few misconceptions. My biggest misconception was just how long recovery was going to take. I expected to be back on normal food after a month and on to a problem free life where I just had to watch my diet, do the work and the weight would just fall off (stop laughing). Predictably, it didn't quite work out that way. I was on the liquid diet for just over two weeks. Then I moved on to soft food (plus liquid) for just over four weeks and soft food kicked my ass. My scrambled egg disaster was just a taste of things to come. My liquid diet had gone so smoothly that I thought everything was going to be easy. Soft foods quickly disabused me of that notion. After surgery everything changes. Not only am I eating less (1/2 a cup at a time for the first month a a half) but I have to be very careful to take my time while eating. If I eat too quickly, it causes pain, nausea, dumping (just what it sounds like) and sometimes vomiting. If I don't chew enough (don't swallow anything above the consistency of applesauce), pain, nausea and sometimes vomiting. Same goes for eating something my stomach will no longer accept. Noticing a trend? This is the fun part. Because I also had my gallbladder taken out, what my stomach will and will not deal with has changed. Finding out what those things are requires a lot of experimentation and when the answer falls on the not side, I get pain, nausea and vomiting. I did this for a month on soft food before they cleared me to resume solid food and the experiments continue. I thought the recovery was only going to be a month but according to my doctors, it can be a year or more before I figure everything out and even then, things might still change. Nothing to do but do it.

Other big things to worry about, dehydration and constipation. These are the most common issues that land gastric bypass patients back in the hospital. Fortunately I have not yet had an issue with constipation but getting enough water is sometimes rough. Drinking anything with your meals is strictly forbidden. The new stomach is very small so if you drink with your meal, it can flush out the pouch and lead to dumping (no fun). I am supposed to wait 20 minutes before and after a meal to drink anything, and I am eating 5-6 times a day (very small meals) to get enough calories to function. I am supposed to eat 1300-1500 calories a day, something I only achieved for the first time about a month ago (before that I was way under and on sick days I'd be lucky to hit 800 calories). For proper hydration I need to drink at least 8 cups (64 oz) of water per day but I can't gulp. Drink too much at once and it can cause dumping so it must be done in small sips over the course of a day. So I can't drink with meals. There are 5-6 meals a day and I need to wait 20 minutes on each side before drinking anything. Getting enough to drink is hard.

Also when I say drink anything, I mean water. Carbonated beverages like soda or beer and really any alcohol are still on the forbidden list. Fruit juices are okay but they are also calories . Drinking your calories is a great way to get fat.

Here I am one month ago when I busted the 300 barrier for the first time since the mid 90's. This is the part they don't really tell you about. Skin. I was knocking on the door of 500 lbs when I started this process and while skin will shrink with weight loss, there is only so much that can be reabsorbed. I've lost me in high school and that is just a bit too much skin to shrink away. The worst that I'm willing to show you is under my arms but as you can see above, I'm sagging all over. I call this my flying squirrel look. I work out at least 5 days a week right now (the Y has stupid weekend hours), for 70+ minutes of cardio per day (swimming, treadmill and stationary bike) and I've started lifting weights to try to put a little of the right kind of bulk back in but the long and the short of it is, I will probably need additional surgeries down the road to remove the excess skin. It is a good problem to have. My choices were to remain fat, with all the associated health problems, or lose the weight and fix some of the existing problems, even if I found a new one. Easy choice. Of course the easiest thing is to not get fat in the first place but that ship sailed a long time ago. The best time to plant a tree is 30 years ago. The second best time is now.

This is me at my one year mark. 288.6 lbs. I'm down 184.8 lbs and 225 was actually starting to look possible.

Cat tax.