GOOOOAAALLLLLLL!!!!

Dr. Marchesini's goal, that is! Yeah, baby, yeah! 250 is the number Dr. M. told me I'd lose to and that I'd be a success. I have officially met and exceeded that goal! This morning, I hit an all-time low, 249.6 lbs! Yea! That's a loss of 2.4 lbs since yesterday, 20.4 lbs in 12 days (mostly water) and a grand total of 267 lbs loss. Woo-hoo! I feel like I've broken through a barrier. It seems like I've been on the brink since early April when I got down to 251.2 lbs, but then I went home on vacation, came back and was sick for like 2+ weeks, then my dad had his accident & surgery and I wasn't eating like I should, etc, etc. and I gained like 20+ lbs of freakin' water. Once I got my mind right and back on track -- getting my protein in -- the water weight really started to drop. I mean, 20.4 lbs in 12 days is craziness and to think I had been lugging that around. It's a little scary too to think that my body is that sensitive to protein deficiencies and it wasn't like I was getting no protein in, I was probably in the 70-100g range, which isn't great, but not horrible, but it wasn't enough. I think for me, I maybe absorb more like 35-40% of the protein I eat versus the 50% or so that is often mentioned in Duodenal Switch circles. I have a short common channel (65 cm) and I think a good bit of my small bowel bypassed (over 45%) so I most likely tend toward needing much more protein than the average DSer. I easily get in over 100g before noon. That will be my life, I just have to accept it and let me tell you, it's a heckuva lot easier to accept choking down protein shakes everyday for the rest of my life than living a much shorter life being 500 lbs.

I sort of indirectly mentioned it yesterday, but I am officially changing my goal weight to 216.6 lb as far as pre-plastics are concerned. I want to lose as much fat as I can PLUS I want to add some muscle so I figure I can do that much more safely in the 210's than sub 200. I'm just worried that losing down to 199, I would be losing fat AND muscle which would not be good since my muscle tone sucks right now anyway. I'd rather be fit, strong and healthy at 216 than weak, skinny and sickly at 199.

Happy Father's Day to all the dad's out there. I will be calling mine today. He is doing so much better, he's back to driving and getting out on his own and he's back to cracking jokes about mom so I know he's almost back to normal. I'm hoping to get down there sometime in late Summer, but I do have a trip to my alma mater in early September so we'll see. The trip back to my alma mater is important because I have to go thank my mentor and tell her what a positive influence she's been to me, the football game, etc. is secondary to that.

No tennis clinic today, that starts next week so I am going to go practice my serve and backhands, then it's off to BP's house to setup for a couple of new employees we have starting on Monday.

Setting the Tone

I've been doing a lot more reading on OH lately, trying to find to confirm a few things I have come to fully accept on my own in the past month. First, this morning I weighed in at 253.0 lbs, down 2.8 lbs from yesterday, 11.4 lbs for the month and down 263.6 lbs total. Assuming I end the month, month 19, exactly where I am right now, that's the most weight I've lost since September. What was so special about this month? I think I found a good sense of what my nutritional balance. I really feel like I have found a way to manage my nutritional goals with my desire to eat a wider variety of foods, some that I would normally not consider "good" during a weight loss phase. For example, in the past I was convinced that cheese was a big no-no, and frankly I do have to watch my cheese intake, but it's not that I can't have cheese, I can't have large quantities of it, I shouldn't eat it without eating another protein with it, and "real" cheese is 10 times better than processed cheese food. Where I would put cheese on everything, probably easily eating 8-10 oz of it in a day if I let myself, I now spread out 2-3 oz of real cheese (Muenster, swiss, provolone, Monterrey Jack, Cheddar, etc.) over the course of the day. It satisfies my need and desire for cheese, but doesn't clog me up too bad. I've also been able to manage low carb bread and tortillas really well. Instead of 5-6 servings in a day, I now maybe have 2, usually a slice of toast with my breakfast and a slice mid-day for an open-faced sandwich.

What's happening is that I'm consistently, day in and day out, eating meals that I can see myself eating once I'm done losing weight. A big goal here is to find a way to eat that'll last a lifetime. I don't feel like I'm dieting, I don't feel like I'm missing out on anything anymore. I don't really see my "diet" changing all that much when I reach goal. There are really delicious, more nutritionally sound lower carb versions of anything I think I'd might want post-goal. Looking at my food logs, I am averaging somewhere between 50-80 carbs a day which is surprisingly fine. For awhile there, I was pretty convinced I'd have to consistently stay sub-40 in order to lose weight, but that hasn't been the case, in fact, I discovered something else surprising. If I am within 90% or greater of my protein goal for the day by the time I am at my last meal, as long as I have protein at that last meal of the day, I can have a high carb side like potatoes or rice OR even a small dessert and it have no effect on my weight loss and it will NOT derail me. Now, I do not do this two days in a row, but I've done it 6 or 7 times this month. The amazing thing is it doesn't trigger the carb-crazies where I feel like I need to eat every sugar-laden food within a 10 mile radius. It's funny because I used to read about DS-ers on OH who would do something similar and would continue to lose regularly. I didn't buy it at the time, but now I think I understand it. I don't look to have a higher carb serving at the end of the day, but if I am out to dinner or at a celebration, I know I can eat a little bit of rice or potatoes and not stress about it. It's kind of cool because a lot of stress of maintaining a good level of nutrition has dissipated. I feel much more comfortable about it and feel like when I hit goal, it won't be like hitting a brick wall. Yes, I'm impatient and yes, I want to be at goal already, but I don't know how well I would handle a situation where I would need to drastically change my eating when a weight loss number is reached. There are a few folks on OH who brag about eating all manner of candy, cookies, pastas, rice, etc. in order to slow or stop their weight loss. Sounds awesome at first. The fat girl in me is saying "hell yeah!" -- eat 1/2 a dozen Krispy Kremes in order to MAINTAIN my weight! Woo-hoo! But long term that has got to suck. Sure there are enzymes and such to be taken, but I personally don't think that situation would be good for me, I don't think I could handle that very well. I know me and I just don't think that would be a position I want to be in.

In my mind, the day after I reach goal won't be too much different than the day before, as I hope for it to be 5 years afterwards. Remember, my goal is 199. That still puts me at like a 27.9 BMI, smack dab in the overweight category. I'd still need to lose 25 more lbs to get a "normal" BMI. Plastic surgery should address most of that. I just want a sustainable healthy way of eating, and everyday I learn a little more and more about what that means for me. I'm so over "dieting", I don't ever want to have to do that crap again. The DS has done and will do the bulk of the work for me, but I still have to do my part.

Anywho, I only have 36.4 more lbs to lose til I reach the 300-lb loss mark. Craziness. I'm 3 lbs away from Dr. M's goal for me, plastic surgery time, according to him...uh...no. My flab has quite a bit of fat within it so, when that changes, I'm guessing in another 60 lbs, I should be okay with looking into it, honestly, probably not for another year.

This fall, I am going to my alma mater for a football game. I haven't been back since 2005 and hadn't seen many of my college friends since then. I'm really looking forward to it, although I'm pretty sure a particular person is going to be there that I am not sure I want to see, yes, we're talking about Guy. I would really, REALLY, like some closure with him. I ain't gon lie, I wanna see him, rather, I want him to see me. For all I know, he could be married by now, actually that would be perfect because then the door would certainly be closed!

Oh well, I'm hungry, time for food!

Good Things

I've decided to indulge in some of the things I really enjoy tomorrow for my birthday. This whole pituitary tumor thing is bumming me out therefore, I am going to make an effort to bring a little joy to my day, maybe it'll snap me out of this funk. So far I have the following:

1. Play tennis.
2. Go clothes shopping at a store other than Wal-mart/Target and pick up something nice.
3. Get my hair done.
4. Take some photographs of myself with my cute hair and cute clothes.
5. Watch Lost with some good friends.
6. Buy myself something I really want...at the moment it's 6 wooden poster-sized frames for the artwork I just purchased recently.

I think that's good. Odds are 50/50 that my mom will actually remember my birthday and call. Nothing to get upset about as I'm the youngest of 12 kids and when you tack on 25+ grandkids and 10 great grands, I'm just happy she remembers my name! LOL! I'm only half kidding, I can't tell you how many times she's called me one of my sister's names. My dad will call though, that's not even a question.

I'm writing Dr. Marchesini an update letter to let him know how I am doing and mostly just to ask him what he thinks my goal weight should be at this point in time. Initially, he said 250-ish and I am just about there. I would, however, like to lose at least another 50-70 more lbs. I'll see what he says.

I'm working on my testimonial for support group meeting tomorrow. I am bringing in three items of clothes, one, a pair of shorts I wore in Brazil (size 64 waist) and my favorite gray shirt (size 5/6X). I haven't worn either in over a year I don't think. The last item of clothing is a pair of size 10 pants that Beth gave me. They are my goal pants. One way or another, I am getting in them! When I look at my old clothes I am just flat out amazed, I can't believe I wore them, especially the shorts because I clearly remember them being tight enough that I didn't need a belt, in fact, the belt was too tight! It's just incredibly wild. I'm going to put them on tomorrow and take a few pics and send to Dr. M. I'm sure he'll get a kick out of it.

I actually had a few phone calls from the doctor's office concerning my upcoming MRI. They asked me a bunch of questions like am I claustrophobic (no) and do I have any metal clips in my body (uhm...no), that kind of thing. My last phone call, they gave me my appointment date, February 29th at 8:30 AM. They are submitting my info for approval but didn't want to wait til they got it before scheduling me. Tomorrow, I just have to pick up the orders and wait til the 29th. Easy as pie. Mmmmm, pie.

Goal = confusion

Weight: 290.6 lbs. Total Loss: 226 lbs.

According to Dr. Marchesini's goal for me of 250 lbs, I have reached 85% EWL (226 lbs out of 266.6lbs). Technically that makes me a DS success story. That would also mean I'd need only to lose around 40 more lbs to consider myself at goal. I've said in the past, that I'd like to see 199.8 lbs. As time goes on, and I seem to get smaller and smaller much faster, I'm not so sure of that goal. I look at myself and wonder where exactly this 90 lbs is supposed to come from. I am still disproportionate, pear-shaped and have the bulk of the excess weight in my hips and thighs, I just don't know if I have 90 lbs worth. I don't know, it's a tad stressful because I'd like to know where the end is, I'd like to know when I'm done. I may just stick to Dr. M's goal for me, which I truly feel like I can meet by the end of the year or at least by the birthday in February.

There is a thread at DuodenalSwitch.com about whether or not we ever get over our food issues. I don't think I had an eating disorder per se, I do think I treated food like a source of comfort, but I also come from a culture where food is a pretty big part of it. My father is a typical southern guy from a typical southern food/soul food background. My mother is Creole and so Creole food was fairly prominent in our household. Add to that the fact that I grew up in a border town and Mexican food was also big in our diet. I ate a lot of good, delicious, totally bad for you food, but it was freakin' delicious and there was plenty of it. Now, I worry about the relationship to food that I have now. Now, it's all about the nunbers, protein and carbs, but once I reach goal, what then? Yes, it'll be about protein as an overall goal, but the other rules relax a great deal. I worry about that sometimes. The idea, I guess, is to find something, a plan/approach that is a no-brainer for the future, where I can indulge in the "bad" stuff every now and again, but not make those things a staple of my day to day life. That is going to be a challenge if there ever was one.

I had a weird bout of explosive poop late this morning. I've been off my acidophilus for a couple of days, I'm experimenting to see how much it is contributing to my constipation -- apparently a lot. Great afternoon reading, yes? Anyway, I may have to get back on it. I'm going out of town Thursday and I'd rather deal with constipation than diarrhea whilst I'm away from the safety of my house. The last trip I took I came home with some major stomach issues, this time around I'd like much better results.

Dr. Marchesini

August 25th will always be a special day for me. It was the day, a year ago, that I met the wonderful Dr. Joao Marchesini. I remember it well, I had arrived in Curitiba absolutely exhausted and was in little mood to do else besides sleep and maybe get some food. Durval told me that Dr. M wanted to see me that day instead of the following Monday and I was immediately anxious and nervous. Walking into his office all doubt and fear was almost instantly gone. He was everything that I had heard he was, warm, courteous, comforting and he answered all my questions and then some. I felt all the confidence in the world in him.

I love Dr. M. He salvaged my life and I owe him big. I don't know who may read this, possibly someone who is in desperate need for the Duodenal Switch but who is confronted with the reality that they must go out of country to get it done, well, I am someone who went out on a limb and trusted this man with my life and I'd do it again without hesitation. No question.

Thank you Dr. Marchesini for all you've done for me! Thank you God for leading me to him.

Goal Weight

I guess it's one of those days when I feel like blogging (rambling) a lot.

I've been thinking about goal weight. According to Dr. Marchesini, it's 250 lbs and with plastics, I'd probably end up in the 200-225 range. I think I have a lot of excess skin. That would mean, I am also about 60 lbs away from that goal which would also mean I've lost 77% of my excess weight so far. Right now I am about an 18 on top and a 26 on bottom. 60lbs from now, I'm not sure where I'd end up. At one point, I had said my goal was 175 lbs, but I have pretty much tossed that out. That is probably way too low for me I think, especially considering my height and bone structure. It would give me a normal weight BMI, but I'm not sure that is healthy. Right now I think I've settled on 199.8 lbs, which puts me at I think around 65% EWL. I am cool with that plus it puts me solidly in the overweight BMI category, at 250 lbs, I'd still be considered obese. I do believe those 25 lbs make a big difference and most importantly, I have to see onderland. I've heard so many tales of how wonderful it is there, I'd like to see for myself. An acceptable compromise would be around 225 lbs pre-plastics. I know I'd have 20+ lbs of skin, at least, and after all is said and done, I'd be stable in the 200 lbs range anyway.

When I think about it, there are a few more milestones for me before I hit goal, special weights that when I hit will mean something. The most immediate one is 299. I was probably 18 years old the last time I weighed 299. Then there's 257, the weight I weighed when I left for college when I was at the doctor's office trying every trick I could think of to manipulate his scale. Then there's 216 lbs so that I might say I've lost an even 300 and the last one is 199.8 itself.

I know I will need plastic surgery. Looking at my arms and thighs, I know by the time I hit goal, it'll be necessary, but honestly, I'm in no rush to have surgery again AND from what I hear it's like 10 times more painful. Truth be told, the only thing that sucked about the DS surgery was getting up and out of bed, but then that was a non issue after awhile. I never had any serious pain.

Size-wise, a dream would be to wear a size 10 jeans, but I'm not sure with my structure (specifically my hips!) that's going to happen. I'd be content in 12/14s. The next several months will tell the tale as far as sizes go. My bottom half has some catching up to do.

Right now I am wearing one of the many company shirts I have kept that I've acquired through the years that I never got to wear. It's an XL and I half can't believe I have it on. It's been almost 11 months and it still boggles the mind. I find myself trying on clothes that have long since become way to big and I try to comprehend that I was that big. What really trips me out is that it's hard to believe that I am as different as the difference really is, if that makes any sense. I look at my favorite shirt that I mentioned a few days ago and it looks like a tarp you'd cover a boat with. It's just absolutely insane...

Yeah well, hump-day is nearly over so only a couple more days of massive boredom and it's the weekend. Maybe if I am lucky the doctor's office will call and schedule my endoscopy for Friday so I won't have to go to work!

Holy Mary, Mother of GOD!!!

Yesterday, I fried me up a center-cut ham steak. Yum. It was delicious, very tender but a little salty. I thought for sure it would clog me up or make me retain water and I had zero expectations about losing weight today, so much to my surprise after my rapid-fire poops this morning, I weighed in at 316.4 lbs. What does that mean? Well boys and girls, it means I am down 3.2lbs since yesterday and have lost a total of 200.2 lbs from my highest ... holy crap. I don't want to get too excited ... but pardon me while I dance a little jig in the privacy of my own home ...

Ok then ...

In over a year of keeping this blog, I don't think I ever talked much about the entire experience in Brazil. A few of you may have gotten my semi-daily updates while I was there, but I don't think I have ever really described the whole experience. I am going to make a point of doing that fairly soon. In the meantime, J, asked about my costs for going to Brazil to have surgery with Dr. Marchesini, so here they are:

Passports & Visas: I think we paid a total of about $1100 for 2 passports and 3 Brazilian Visas and we expedited it all so that was extra. We did it all in about 4 weeks. If you apply for your passport and visa early enough, you can probably get it all taken care of for like $200-$250 or less, I think.

Plane Ticket(s): $2100. I had to buy two tickets as there was no way I could manage fitting in one seat. It still wasn't all that comfortable, but it was better than trying to squeeze into one seat going from Atlanta to Miami, then Miami to San Paolo and finally San Paolo to Curitiba and THEN doing the reverse on the way home. My two friends traveled on buddy passes so they paid like $350 each for their own flights.

Hospital Fees: $5500 - At the time I had my surgery, this covered the typical 3-4 day stay in the hospital and up to two weeks if there were complications. I know Dr. M is operating out of a different hospital now, but I am sure this fee covers the normal hospital stay. You may have to contact him about fees associated with complications.

Medical fees: $4,500 which includes Dr. M and any other staff related to the surgery.

Private Nurse: $300 This pays for Durval who is like Dr. M's right hand man. Some people need him more than others, but he takes care of you as needed pre- and post-surgery from pickup and dropoff from the airport, taking you to any pre-op tests, picking up your prescriptions, tightening your binder, picking up and dropping of laundry, etc.

Pre-Op Testing: $250-300. I did most of my testing in Brazil. I had a chest X-Ray, an abdominal ultrasound, EKG, an endoscopy and a psych eval. It was just easier and crazy cheap. My two sets of pre-op X-Rays cost me a whopping $32 US, for example.

Hotel, Meals, Taxis, Souvenirs: $1700-2000. Typically this won't cost the average person this much. During my 3 week stay in Brazil, there were three people in my room for a week which cost me more than if there were 1-2 people in the room. I think the rate went from 150R (Brazilian Reals) for one person per night to 200R for three. Between the Brazilian BBQ place we went to twice to room service and a couple trips to the store for protein drinks, etc it added up. Plus we went out shopping a couple of times for gifts to take home and you really can't go anywhere without taking a cab. A single person can probably get away with $1200-1300 or so.

In total that's around $14,500 I paid which again, is more than the average person. I think if a patient were to travel with a companion, they could probably do it for probably $13,000 or so depending.

Now, I am not sure what the going rate is but I think Dr. M's, the hospital's and the private nurse's and pre-op testing fees are the same. Everything else might vary because it depends on the conversion rate between the US dollar and the Brazilian Real. When I was there it was like 1 US dollar to 2.10 Brazilian Real. As a comparison, it would have cost me over $40,000 to have the surgery here in Atlanta with NO cap. A friend of mine's surgery came out to over $70K because he had some complications.

Anyway, I am a happy camper right now, but cautiously so. Needless to say, I have no plans to deviate in the slightest from my current nutritional plan.