Big Fat Queer

August 31, 2011

Two Weeks Post Op – Two and a Quarter Miles

Last night I got a pretty solid six hours of sleep and after being up for a while I had another hour “recliner nap” so today my energy was pretty good. I felt better than I have since the surgery and took advantage of it with a nice long walk. I took some pictures along the way.

I went east to York Avenue and walked down towards the hospital where I had my surgery. It was my home away from home for a week and I haven’t been in that area since I got out. Along the way I passed by Sotheby’s auction house, which is one of the larger buildings on that path (it’s at 72nd Street and York Avenue).

Sotheby's Auction House.

Once you get further south on York you enter the hospital zone. The largest is New York Presbyterian where I had my surgery and lived for a week. It is the teaching hospital of Cornell Medical School and also affiliated with Columbia Medical School. It is a huge complex of buildings and divisions. According to US News and World Report’s hospital issue this year, NYP is rated No. 1 in New York and No. 6 nationally. They are in the top two or three in several categories. From my experience, they deserve the ranking.

New York Presbyterian Hospital Main Building

This is the main building. I have tried to find out who the architect is without much luck. If anyone knows please educate me.

Across York Avenue from NYP is Memorial Sloan Kettering Hospital which is ranked as the second best cancer hospital in the United States. I hope I never need their services, but it is good to know that such good quality care is walking distance from home.

Memorial Sloan Kettering Hospital

Across from Sloan Kettering and next door to NYPH is The Rockefeller University, which is a small research institution. There is no undergraduate school there. The only students are doctoral candidates and post doctoral fellows.

Entrance to The Rockefeller University

Close up of Rockefeller U Entrance

For a small university The Rockefeller University has large accomplishments.

Past The Rockefeller University there is a footbridge to a promenade along the East River. I walked over than and took a rest on a bench by the river.

The 59th Street Bridge over the East River and Roosevelt Island.

East River Tug and Barge

On the 71st Street foot bridge back from the river you can see the Hospital for Special Surgery which is ranked as the No. 1 hospital nationally for orthopedics and No. 2 for Rheumatology.

The Hospital for Special Surgery

With these top ranked hospitals and Rockefeller University in just a few blocks the amount of brainpower and healing concentrated in such a small area is almost palpable. I have walked this walk many times over the years and I am still impressed by the amount of groundbreaking science that goes on here.

My ankles are skinnier than they have been in a decade.

August 30, 2011

A Walk in the Park

I walked from my apartment to Central Park this afternoon. It is about six tenths of a mile (or one kilometer). I sat for a while and enjoyed the view, then walked some more in the Park. When I was ready to go home I took a bus and got out a few blocks from home and walked the rest of the way. Altogether it was about 1.2 miles.

Despite that I didn’t feel as energetic today. I didn’t sleep so well last night. Since my surgery I have had a problem with my cpap machine. My mouth comes open a lot when I sleep. This reduces the effectiveness of the cpap since some of the air pressure escapes, and it also dries out my mouth and sinuses. The dried sinuses produced a sneezing jag that woke me up in the middle of the night and lasted for quite a long time. I even began to worry that I might injure something internal (like my incision) with the endless sneezing. I eventually got control of things and went back to sleep. I have had several short naps today, but I never really caught up. I don’t know why the open mouth problem has started. I have used the cpap for a few years now without the problem. In a few months I won’t even need it any more. Here’s hoping tonight I get better sleep so tomorrow will be more pleasant.

At least my lower energy today was not due to a lack of progress in recovery, but something explainable.

For lunch I had leftovers from dinner last night, cucumber soup, sweet potato mousse and some vegetable puree. For dinner I ordered a steamed platter from my favorite Chinese restaurant with vegetables and steamed shrimp. I blended five shrimp with a little egg drop soup to moisten them and it was tasty. I also blended some vegetables but they did not taste so good so I didn’t eat much. In place of the vegetables I had some apple-apricot sauce. I always seem to be able to get fruit down. I’m getting really tired of purees. In a week I can start real food. For breakfast I had a protein shake, which I will continue doing after I start real food for the protein supplementation.

P.S. When I was just about home I passed a restaurant around the corner from my building. There is an al fresco dining area. I saw my surgeon with four residents sitting outside having dinner. I started to say hello, but I decided not to bother them outside a professional situation. He was holding court with the young acolytes hanging on every word. I did find it a strange coincidence to see them there.

August 29, 2011

New Phase of Recovery – Healing the Mind

This is my last week off before I return to work. My physical recovery from sleeve gastrectomy surgery is going well and I think I will be ready to get back to some routine. While I do need this week to continue to get strength back, I am looking at this week as a time to begin working on my mental health. Not that my mental health is seriously compromised, but I have been through a lot, have repressed a lot in order to do what had to be done and I think I would be unwise not to consciously unpack the last couple of months and decompress. Also I need to prepare psychologically for the coming months.

The health care system doesn’t really talk about this much. I have nothing but praise for the care I have received from the surgeon’s team and the hospital staff. They were fantastic, competent and compassionate. But our culture still has some problem with openly discussing mental health. I did require a psych clearance for the surgery, but it was somewhat perfunctory. The psychologist offered to see me again if I need him, but I don’t have specific problems to work through, at least not yet. I may uncover some this week.

I approached the lead-up to the surgery as a project management case. Some of what I do for a living involves project management, and I think I’m pretty good at it. Also, having specific tasks and milestones helps me focus on the practical matters at hand and allows me to fend off emotions. When my father died I got the news at around five in the morning and made reservations to travel south about six hours later. During the intervening time until I had to leave for the airport, I cleaned house. Vigorously. It gave me something to to. I would have time to think and feel on the plane. Of course being in a somewhat public place would inhibit any display of emotion, but I could at least reflect. Having a task is useful.

I did have some fears about surgery in general. Most specifically I was worried about how my severe obstructive sleep apnea would affect anesthesia. Those fears were somewhat allayed by talking to a couple of anesthesiologists, but still the fear was there even when I came out of anesthesia. I don’t remember drifing off; it was very quick. I came too with several people shouting at me to “breathe!” I couldn’t breath at first, partly because my torso was traumatized from the surgery, there was a tube in my throat and I was heavily drugged. I felt a moment of panic that I couldn’t breathe. After a few efforts I was able to suck in some breath and they extubated me. Immediately in the recovery room, or as they call it now the PACU (Post Anesthesia Care Unit), they hooked me up to a cpap machine to help me breathe if I fell asleep. The anesthesiologist had even suggested I bring my own mask, which added a certain comfort factor. Most importantly, I was alive.

Another fear was blood clots, which is a major contributing factor to death from surgery, apparently particularly this type of surgery. My cardiologist gave me a doppler test to check the circulation in my legs which was fine. In the hospital they put inflatable leggings on me which periodically inflated and deflated to keep the circulation up. I was given regular shots of heparin (a blood thinner). And I was encouraged to walk, which I did as much as I could. The night of surgery they got me up and walked me about twenty feet before I insisted they get a chair so I could sit. I was getting quite nauseated. Also it was extremely painful. One thing I am glad of is that I did not throw up during the whole ordeal. I am extremely averse to throwing up. At some times, especially on that first walk, I had to really focus my mind to keep things together. In the succeeding days I was doing multiple laps up and down the hallway every couple of hours. By this point I think I am beyond the danger zone for clots.

There is also the fear of blockages or leakages. Leakage is potentially dangerous because if food leaks out of the stomach incision it can lead to peritonitis which can lead to death. They did a “swallow test” the day after surgery. I drank a barium beverage and a doctor viewed my upper GI on a scope. I could see the scope through the window of the room he sat in. The liquid flowed into the stomach and kept going. No blockages or leakages. Scar tissue can develop post op, but so far everything is going through. Overeating while the incision heals can pop the staples and cause leakage, but I am very careful not to do that.

These risks were all managed well and I did my part to help manage them, but the fears were real, though they stayed subliminal. I got a really good night’s sleep the night before surgery and I was not nervous when I was wheeled up to the Operating Room. I was surprised by that. Fear is useful. It is a great motivator. Without the fear I might not have been as disciplined and organized. But it is still stressful.

There is also the fear of the surgery not being successful, but so far it seems to be. Quite. And there is some anxiety as to whether or not I will be able to adjust my life to support the success of the surgery and not to sabotage it. My history with dieting is not encouraging. I lost a lot, then gained back more. Rinse and repeat. It’s called yo-yo dieting and it’s pretty common, especially among the Super Obese (which is what I was). It really is a term used in bariatric medicine. It is a step more severe than mere Morbid Obesity. Nothing but the best for me.

In addition to the fears, there are the matters of cabin fever and lack of independence. In the hospital I had very little independence and for a couple of days required complete round-the-clock care. The way I felt I didn’t mind, but by the seventh day I was ready to get out of there.

But even when I got home, I needed help. I had everything delivered because getting out on my own was not feasible. I did take daily walks, but only when friends came to walk with me. Not wanting to waste their time, I went about my walks in a workman-like way, getting it over with and not dawdling too much. After a while, all of this makes one feel a bit like an invalid.

My eyes started to become like mole eyes, accustomed to dark rooms and viewing things up close. I looked out the window, but it wasn’t the same as being out in the world. At the end of the week I did venture out on my own for a short walk to the market to stock up for the stormy weekend. While Irene didn’t impact me much, the constant alarmism on the news did build up some stress. It also kept me indoors for two days (along with half of the East Coast).

So today it was time to break out. I went out this afternoon and walked almost a mile. I stopped and shopped at the drug store and supermarket along the way. I stopped at Starbucks and got a cup of tea and sat for the better part of an hour at a little outdoor “pocket park” across from Starbucks and watched people go by, some of them quite nice to look at. I looked off into the distance and took my Ray-Bans off (Wayfarers, of course) and let my eyes adjust to daylight. I looked at the sky. I took my time. I was beginning to feel human again.

As I gain independence I need to build up my confidence that I can stretch a bit and go a little further each day. Not just distance in my walking, but pace and willingness to go places. Tomorrow I may go to Central Park. I had thought about it today, but the ground is really soggy from the hurricane and every year we do have news stories about people getting killed from trees falling over or tree limbs falling on them. I figured I would give the Parks Department a day to assess everything and give the ground a chance to firm up a little before I go sit in the park.

I also need to build confidence that I can continue to manage my relationship with food. At first after surgery, there was swelling in the stomach so the area that could contain food was very small. That seems to have subsided. Also I wasn’t hungry at all at first and because of gas cramps and a compromised sense of smell, I didn’t want food. I had to make myself ingest something for nutrition alone.

When I came home for the first several days I had purees I had prepared and frozen, which were ok. But by the end of the week I starting preparing fresh foods. At first just fruit. I bought some fresh pears and white peaches and mashed them up for snacks. Fresh food is so much better. I started actually enjoying food. I want to enjoy food, I just want to be able to stop at the appropriate time. So far I am doing that. I don’t want food to be drudgery, but I also don’t want it to be compulsive.

I don’t think I was much of an emotional eater. Sometimes I would seek comfort in food, but most of my overeating was due to constant physical hunger. I don’t have data to support this, it is just an educated guess, but I think my overeating was due to an imbalance in hormones, particularly too little leptin and/or too much ghrelin. Ghrelin stimulates appetite and leptin suppresses it. A normal healthy body will use these in a balanced way. You need food to survive so ghrelin tells your body it’s time to eat. When you have had enough, leptin tells your brain to shut the mouth and stop eating. That’s an oversimplification. Insulin is also part of this mix and I was injecting a lot of insulin, which throws the hormones into further imbalance. The part of my stomach which was removed produces the lion’s share of ghrelin, so that should help me regulate appetite. My blood sugar is already in much better control with far less than half the insulin I was injecting before.

Today after my walk I did have some appetite. At the supermarket I saw some nice cucumbers and decided to make a chilled cucumber soup. I peeled and seeded the cukes, cut them up into a blender, added plain non-fat Greek Yogurt, a bunch of dill and a pinch of salt and blended. It was delicious, and I have leftovers for tomorrow. I also baked a sweet potato and pureed it with yogurt and cinnamon to make a mousse. I bought frozen peas and made a nutty tasting pea puree. Between the cucumber soup and sweet potato mousse I used a full cup of yogurt so I got adequate protein for this meal. All of this was enjoyable food, but I was full after about a total of a half-cup of food and was no longer hungry. I am still not hungry. This is how it should be going forward. Food is enjoyable, but I eat small amounts and then stop. Tonight’s meal is my model going forward. I have some very tasty cantaloupe for later. I will not puree it, but I have cut it into small bites and I will chew it thoroughly. This also slows down eating and allows me to register fullness quicker.

I have lost 26 pounds since I got home from the hospital. That is an extremely fast rate of loss, but they did pump me full of intravenous fluids which I got rid of. I weighed 407 when I first saw the nutritionist on July 1. This morning I weighed 362. I have lost 45 pounds in less than two months. I have to prepare psychologically for the rate of loss to slow down and for plateaus to occur. One day at a time; focus on being healthy and not on the scales.

In sum, today was a good start to mental health week. One of the nurses asked me before surgery if I was ready. I told her that in my mind I had already gone past the surgery and was in the recovery phase. I was just waiting for the doctors to catch up. Well, life has caught up. This is real time recovery and I am beginning to feel like I have a future.

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