Thursday, February 10, 2011

A new resolve

The other day I wrote about how I have taken responsibility to make myself healthier through the WLS weight loss and other life modifications that I have made. I talked about the heart catheterization I was going to have last Monday and what that meant to me both physically and mentally. I went into that procedure two days ago with a positive attitude and little apprehension. Some cardiac emergencies came in while I waited and my schedule got pushed backwards an hour and a half. But finally it was my turn. A few needle sticks and I was asleep, sort of. When I awoke an hour later it was over and they slid me over on to my bed again and said they were taking me over to the hospital so I could stay overnight, That meant they had put in a stent. The nurses and the doctor were all quite positive about the procedure so I was too. No pain or discomfort and I got a private room, because there were no more rooms available.

I was starving since I had not eaten in almost 24 hours, so they brought me a turkey sandwich (actually very good). I got a phone call from a friend checking to see how I was doing and then a second call asking if I was going home that night and needed a ride. The nurses kept a check on me all night so there was actually little sleep, but I was not in any discomfort, and felt pretty well. The doctor had told me that if everything was okay he would discharge me in the morning so I just dozed off until he came in. He told me about my stent and how it had gone well. Then he told me about the other problems that they had found. Apparently the blood vessels downstream from my bypasses done in 2006 showed signs of heart disease. They were in locations that apparently could not be stented or bypassed. This meant that the only recourse I had was medical therapy. So we discussed the long term issues and options and while they were not determined to be of immediate concern I would have to deal with at some point in the future.

Needless to say that was not the news I wanted to hear. I was a bit down the rest of the day and when I got home to the empty house, it was awfully quiet. But then I started to consider all of the things that have happened in my life and I realized that while I had done everything I could do to change the health status of my life there were still things created many years before that were hanging over my head like Damocles’ sword. Thirty to forty years of poor diets, lack of exercise, diabetes, and the weight gain were superimposed on top of that my family genetics. It was an equation that did not balance well. And frankly I should have realized that a long time ago. But I thought that all I had to do to become healthy is lose the weight and get rid of the diabetes.

So as I sit here this morning thinking about the message I received from my doctor and drinking a cup of coffee I realized that I had gotten up this morning just so that I could start all over again, again. I try to think that way every day. Each day is a new beginning. The problematical stuff with my heart will likely become an issue in a few years. But also will be managed medically. There are apparently no surgical options available at this time. I stress the "at this time" as this may change with our changing technology. I am not expecting medical technology to make my life perfect, but I do expect that technology may very well change how they treat this problem. But until they do, I am pushing forward doing what I have to do.

These back side health problems almost always started many years earlier and to me that meant that your healthy life’s choices need to be made better and earlier than we think now. I guess any special insight I may have is based upon accepting who I was and why I was where I was; and doing what was necessary to change as many risk factors as I could. After that, I then have to deal effectively with those factors that are either genetic (and to some degree out of our control, though not totally) and/or self-driven. There is a lot to be said about looking critically at yourself and your life and evaluating these things.

Accepting some responsibility for changing the front side is very important. I have only watched the Biggest Loser a few times and didn’t particularly like the way the heavy people were treated by the trainers and to a more significant degree by the public. We applauded their successes and seemed to almost gloat in their failures, almost like we expected them to. And as a heavy person, we sometimes start to look at ourselves as a failure. That perception causes us to spiral downwards. Weight does not affect your intelligence and yet many people perceive heavy people as not that smart. “If you were smart, you can change.” To me the biggest perceptual problem with people who are getting heavier is their general unwillingness to critically look at their life simply from the point of health maintenance. It can be said as an excuse, “Since everyone is heavier, what is so wrong with me?”

Now as I look down the path I am on I realize that issues created many years ago under conditions where I was not particularly responsible for my health are going to cause me problems in the future. The weight loss was a positive step; and the elimination of diabetes was also a positive step. But they were probably insufficient to make up for all those years prior. In reality, what other choice did I have? If I had not done what I did to improve my health, I probably would not be writing this or anything, ever again. I probably would not have made it to this point. But I have, and now I know I have some more work to do to ensure that I live as long as possible.

So in ending this entry, I would ask you that if you are considering weight loss surgery or have had it and are moving along, do not be surprised if more health problems are encountered. The WLS is not a total health “fix”. It is really just a reduction or elimination of one risk factor for heart disease. The additional elimination of diabetes also reduces the risks. But other risks are not going to go away. A family history and genetics is an important element and will never go away. Be sure you stay active and exercise as much as you can. Eat as well as you can, given the limitations the Eight Bites life will allow you. And do not fear the future, for it is the only one you will ever have. Your future will last as long as you do. You can do some things to influence it though. You have taken or may be preparing to take your health into your own hands. Handle it with courage, care, and gentleness, but look back at where you were and then do the things you need to do to reduce as many health risks as possible. You also must look forward to dealing with more health issues in the future. Just don’t let them freeze you in place or make you hesitant to act now to reduce your risks.

People do respond to a rational discourse in this increasingly irrational world and I guess that is what I am trying to do. If I manage to get people to think differently about their own health, that is an admirable goal. Maybe I can get some to realize that detection and action, when there is a problem, may simply not early enough. You almost always have to think a long ways back and then a long ways forward, don’t you?

Sunday, February 6, 2011

A test of character

As we confront ourselves each day in the mirror we begin the daily testing of the character that we are, and what we hope to be. It is not a simple matter of doing something. It is the matter of doing the right thing. The reasons we give ourselves tests our honesty and personal integrity; and above all else we have to be honest with ourselves. Every day we pick the path we will walk that day. Sometimes it is the same path we were on yesterday and the day before; sometimes it is a new path with unknown pitfalls, hazards and potential rewards. Do the satisfactions from walking the same path you have been on still make your life a good one? Or is truly time for a change?

When I decided to have my weight loss surgery in 2006, I had been involved with the process for 24 years with my first wife, and truly understood the limits that would be placed upon me after my surgery. There were many elements that had to be considered. The most important was my overall health and its attendant risk factors. At 300 pounds on a 5’9” frame I was entirely too heavy. I was on daily insulin support (four injections daily), and I was hypertensive and could not effectively bring my blood pressure down. I had a family history of high blood pressure, diabetes, and heart disease. My father died of a heart attack, significantly influenced by his diabetes. My mother died from a sudden heart attack at the age of 83, when she developed congestive heart failure. Many of my siblings were overweight, and were experiencing many of the same medical issues faced by our parents.

So the primary reason I had the weight loss surgery was to gain some semblance of control over my health, my life and to some degree in my own longevity. It retrospect it was a good decision. I have lost the weight I needed. I have eliminated the diabetes that scared me so with its long term prognoses of neuropathy, blindness, circulation problems, and cardiac risks. But my blood pressure was still higher than I wanted it to be. I was still taking medications for control, and while they were at lower dosages, they were apparently still needed. In 2006 I had a heart attack and double bypass surgery and in general, my heart was in pretty good shape. There is always a bit of paranoia about the artificially altered circulation in your heart after bypass surgery. You want the bypasses to last forever and most of the time they do. But the paranoia still is there.

Last summer I started having some tightness in my chest when I carried heavy loads to and from the houses where we catered meals in Italy. The tightness went away quickly but it did cause me some concern. It was not constant and didn’t always occur when I worked; but it did occur often enough to raise the hair on the back of my neck and start that paranoia again. After leaving Italy, and returning to California (and being eligible for Medicare) I decided to have a stress test to see if the bypasses were still okay and functioning. So on my 65th birthday I went in for that test. They injected, probed, prodded, and I walked faster and faster. Then I felt that twinge of pain and tightness again. But it was apparently not the bypasses, it was something new.

Tomorrow I will go into the hospital for a cardiac catheterization with three possible outcomes. First they may find nothing of significance and I will go home with new medications. Or they will find some minor blockages and put in a balloon stent to open up the artery. Or they might find that I need another bypass. The doctor felt that the need for a bypass was a 1% probability, while the stent was about 99%. At first I was angry after all the work I had done to lose the weight, but that quickly went away as I realized that a lifetime lived heavy was the likely cause of this issue. I reconciled my actions taken to improve my health with the retained potential for problems into the future. So this has been the test of my character for today. As I looked in the mirror this morning I saw a changed man, who has taken charge of his life and yet still suffered the consequences of what he was before.

How does this fit into Eight Bites today?  The combined effects of our past health issues, what we do about them, and where we go has to be considered in our decisions. Weight is the most easily changed of the risk factors that we have had. Doing something about that brought me a great deal of personal satisfaction and eliminated my diabetes. Two factors have been reduced to relative insignificance.  But the heart is another factor. The weight loss has helped but it has not solved the long term problems. Now I must deal with those issues and move on. The path beckons. It is still into an unknown future, it still may be difficult and include new problems, but I have done something to change it. Do not expect the weight loss surgery to solve everything in your life. Take responsibility for changing the things you can, deal with the things you can’t change intelligently and calmly, and continue to live. Eight Bites at a time. Live on!

Friday, February 4, 2011

My 65th Birthday

This picture is me when I was 5 years old, in Antioch, California.  Last Tuesday was my 65th birthday and I decided to have a party. So Friday night, I had a group of old friends over for a buffet of lots of different foods, some good laughs, some quiet conversations and a peaceful beginning to my 65th year. This has been a year of substantial changes and I look forward to the new year with confidence and anticipation.
As to Eight Bites and my thinking and status, this is where I am. I have retained my weight loss at about 140 pounds and weight 160-165 right now. I have been able to stay at this weight for a year and a half now and feel that it is unlikely that I will allow myself to put weight back on. At times I do want something more than I should eat, but I have found that with the gastrectomy, I feel uncomfortable when I eat a couple of bites too much. It is an auto-regulating mechanism. It hurts if I overeat and since I am not a big fan of pain, I have learned to stop eating before I reach that point. Calories are automatically restricted and I don’t have to do anything austere or drastic to prevent my weight from going up. It is why I feel so confident that I will not regain that weight so dearly lost. Besides what would I do with all the clothes I have purchased that fit me so nicely now?

Party food or how to have a good time at a party and not over eat. The menu for the party was pretty extensive but was focused on small individual bites of things. The Eight Bites component of the food for the birthday party was:
• Crostini with turkey spread, crisp bacon, and chipotle cranberry sauce
• Deviled eggs
• Barbecued chicken crepe stack
• Stuffed peppers with sausage
• Crostini with mushroom pate
• Crostini with black beans, chipotle orange sauce
• Cheese plate with Gouda, Havarti and provolone
• Brie with spiced walnuts
• Salami and smoked Gouda
• Vegetable plate with grape tomatoes, celery and bocconcini
• Rigatoni with vegetable sauce
• Squash ravioli with a white herb sauce
• Tortellini gorgonzola
• Flourless chocolate cake with ganache
• Lemon tart
• Chocolate truffles

The following description of four of these dishes shows how you can have a number of different tastes, and enjoy the party without eating too much. As the cook, I tasted everything to be sure that the food items were what I wanted them to be, but these four items are what I had as my dinner. The balance of the dinner was designed for guests who had not had weight loss surgery. The dishes included pastas and desserts.

Crostini with turkey spread, crisp bacon, and chipotle cranberry sauce
For all the crostini, I sliced French bread baguettes into ½ slices, brushed them with olive oil and a light sprinkle of salt and toasted them in the oven at 350 degrees until they were barely crisp.

I used a ½ pound of a good quality of smoked turkey breast from the deli, put it in the food processor with a couple of tablespoons of sweet, hot mustard, a tablespoon of the chipotle sauce, and a couple of tablespoons of softened butter and processed it into a smooth puree. I cooked the thick sliced bacon in the oven with a small amount of brown sugar on each slice and a few drops of the chipotle cranberry sauce then cut each slice into 1” long pieces. To make the crostini, put a little of the chipotle sauce on the bread, spread a layer of the turkey spread and top with a piece of crisp bacon and a few drops of the chipotle sauce. These antipasti provide a fair amount of protein from the turkey and bacon, and a single piece can be a nice addition to your Eight Bites plate. Nutritionally, a 1 ounce serving of the smoked turkey breast is approximately 8 grams of protein.

Deviled eggs
Just make your favorite deviled egg recipe. One or two halves provide a nice amount of protein and pleasant change from the bread crostini. One egg consists of 6 grams of protein content and at least 9 amino acids. Proteins constitute nearly 13% of the weight of an egg. Eating an egg as part of the Eight Bites meal will give you almost 10 percent of the protein required for post-bariatric surgery patients and is also a very high quality protein source.

Barbecued chicken crepe stack
These antipasti are easily made using simple crepes and chopped barbequed chicken and some cheddar cheese. Make crepes from your favorite recipe and add couple of teaspoons of dried chives to the batter before cooking. To create the stack, place a crepe on a baking sheet, top with ¼ cup of chopped chicken mixed with barbecue sauce, then top with cou[ple of tablespoons of grated cheddar cheese. Put another crepe on top of the first, and repeat until you have about 7 or eight crepes in the stack. Finish with a layer of chicken and cheese. Bake in the oven until the cheese is melted and serve hot in wedges. A serving wedge should have about an ounce of chicken and 7 grams of protein.

Stuffed peppers with sausage
This dish is simply made using mild sweet peppers, available fresh in most grocery stores. Slit the peppers in half lengthwise and remove the seeds, rinse and allow to drain and ry. Make the stuffing from 12 ounces of sausage (use your favorite type of hot, or sage, or Italian), a medium chopped onion and a cup of grated Parmigiano=Reggiano cheese. Cook the sausage with the onions until the meat is no longer pink. Put the meat in a food processor and add the cheese. Process using pulses to obtain a coarse mix. Stuff the mixture into the pepper halves and place on a baking sheet. Heat under the broiler until the top is bubbly and golden. Serve warm or hot. The amount of sausage in each pepper is approximately ½ ounce and provides about 6-8 grams of protein per serving.

From the perspective of Eight Bites, having a single piece of the smoked turkey crostini, two deviled egg halves, a wedge of barbecue chicken crepe stack and two stuffed peppers was enough to give me approximately 35 grams of protein or about 50% of the protein required for the day and I didn’t have to eat a lot. And happily, I also have the opportunity to taste a lot of different dishes.

Think Eight Bites, think interesting flavors, think positively about your weight loss and think positively about your new life. Enjoy the day. So, Happy Birthday to me. May there be many more in my healthy new life. There is no good alternative to another birthday.