Another week of Protein shakes... and a taste of dumping syndrome

So now I'm into the third week; two weeks since the op.  I had thought to be going back to work this week but I realise now this is not sensible - it's still difficult to get through the endless regime of dispersible medication, and the very thought of the skimmed milk protein shake for breakfast (so important for some protein) is beginning to make my tummy churn...  Oh for some solid food!

Now this is the choice I REALLY want for breakfast... but I have a while to wait yet.

The nutritionist phoned near the end of the week and we made an appointment for a check-up at the end of June at the clinic.  I asked her about the exhausted hungry feeling in the morning and she quizzed me on how much protein I was getting.  Like how much protein is in the protein shake?  Well 19 grams - which is pretty good, but not good enough.

Apparently the target is 45 grams a day.  Interesting, as everything else (including the soups) has MINIMAL protein content; you just don't get it in fruit juice and sugar-free drinks...  She suggested a Slimfast drink would be a good supplement, so I tried one mid afternoon.  Disaster.  Well, not disaster, that would be putting it much too strongly, but a mild taste of dumpling syndrome - sweating, feeling faint, heart pounding - generally unwell.  What is dumping syndrome, you may ask?  It's specific to having a bypass operation and relates to the body going in to a sort of shock at having too much sugar or fat 'dumped' into the lower intestine.  Because the operation bypasses the ileum and duodenum, where fats and sugars are absorbed by the body, these enter the system lower down and the intestine is not able to process these 'nutrients'.  So I guess I have been rerouted, in case I was in any doubt!  I used to get a sugar-rush from drinking Slimfast shakes before the op (they have quite a bit of readily available sugar, and as it's liquid it just runs straight through) - more so that I would get from eating a chocolate or two - so my two packs of 6 bottles are now redundant...


Sat on the OCADO app looking at the protein content of soups.  Hopeless.  Even chicken soup which should be made from, er, chicken, has a woefully low amount of protein.  This is one of the problems with the diet Lilly warned me about - getting enough protein for healing and muscle retention.  However, I am working at the protein and hunger aspect from another direction, by adding more bulk to my soups (thicker too, my stomach seems happy with thicker) in the form of DIRECT PROTEIN.  I remembered a had frozen the last few little slices of chicken breast from my pre-op diet - defrosted them and added to mushroom soup - all blended with the whizzer, some seasoning and a little milk.  What a difference. It was heavenly - tasted like canned chicken in white sauce.  With a nice bowl of soup with added protein twice a day the starving feelings are waning.  Returned yesterday as an almost tender stomach after going for a long walk (for me) and obviously needed nutrition. A small glass of vegetable juice and the discomfort went away.  So there is a need to learn new signals from my body whilst everything is healing up.

On Saturday Jon took me to Sainsburys and we bought lots of fruits and vegetables to add to his diet and more cans of soup for me, along with steamed salmon, chicken breast, fresh ham (no water added) and corned beef - all to add to the soups.  So far I've had pea and salmon (hmm, bit windy there though) and parsnip and ham - today will be chicken and chicken for lunch and oxtail with corned beef for dinner.  Preparing the salmon yesterday there was a huge urge just to pop it in my mouth - so soft and tender; had to make do with licking my fingers instead. I reckon I've got a bit nearer my protein quota today.

So what has been taking my attention during the long days lounging around thinking about what I should be drinking, or sticking in myself (the clexane) or drinking?  The cats of course.  There is a whole world out there, largely outside of our awareness, the tumultuous and complex world of cat relationships.  When we first started letting our girlies outside a few weeks ago we thought the worst we would have to deal with was Lara's intermittent antics prompted by irrepressible curiosity and naivety.  Then came Mr Socks.  We have a local stray that we've been feeding (a tuxedo male we guess) coined Mr Socks because of his long white socks on his back legs.  The outdoor excursions of our three are now daily peppered with altercations with this boy, who is putting on weight slowly due to our feeding and now wants to come inside - camping out on our exterior mat when he's not off bullying other local cats.  Our two little girls he actively attacks - and would do Sophie as well if he wasn't scared of her.  Every time the back door is open to allow them out I'm up and down after one noise or another, making sure the marauder isn't at the gates.  Just hoping he's an intact male as we aim to trap him and take him to the vet for investigation.  If he's not been done he's at the mercy of his hormones - and will be an altogether better boy if fixed.  If he has been done we have an anti-social bully on our hands who we can't allow to starve.  Sigh.

Okay, nearly finished a bowl of chicken soup with added chicken.  Lara has licked out the tin for me (so helpful). Amazing gurgling of digestion going on so I think I'll take a leaf out of the feline book and have a little snooze - me and Jessie on the sofa, Lara and Sophie on the window ledge and Mr Socks on his mat outside the patio doors.  Peace.

Black Tongue - things they don't tell you...

Well here I am starting into the second week since surgery.  Actually that started on Saturday, but Saturday was far too nice a day to be blogging - sunny and warm and I spent a good while sipping fruit juice in the garden admiring the bees buzzing round our flowers and watching Jon pottering in his kingdom.

Today it is cold, damp, I have the heating on and I'm drinking hot stock... Ah the coquettish nature of the British summer.

Coming back from hospital was a milestone and felt good until the next morning when the affects of the last 'happy pill' (a so called opiate cocktail designed to give you that bright, positive world's-a-better-place feeling) had worn off.  Horrible dry mouth, painfully bloated with gas, tenderness and general debility if you try to do anything.  I was a bit of a wreck for visitors.

So the first week - not the best, and must advise anyone approaching a similar procedure that you will feel generally exhausted, swollen, sore and traumatised by having to drink so many supplements when everything is accompanied by belching, gurgling and sometimes hiccupping.  However, it passes.

There are dispersible tablets for everything. Actually that's something to be grateful for as Lilly had to open up capsules and EAT the foul contents; now they've made a soluable version which is pleasantly fruity.  So here we go: First, an anti-acid, on the tongue, 30-60 minutes before food.  Next, make up a protein shake with liquidiser.  This takes about 30 minutes to drink, slowly.  Then, dissolve vitamin tablet in water.  Dissolve Zinc tablet in water (tip - both together in squash kills two birds with one stone).  Then, clexane injection around navel (not as bad as it sounds) and iron syrup (disgusting to others I actually LIKE this, it's made with maltitol, yum).

Keep drinking.  Then, small bowl of sieved soup for lunch, thin and runny.  Then another dissolved zinc (tip - it will dissolve in a very small glass but don't overfill or it will go everywhere).  Mid afternoon it's the calcium.  Keep drinking.  Dinner = second half of the can of soup.  Another dissolved zinc.  More iron syrup. Keep drinking, keep some water beside the bed to see you through the night.

The other thing to remember is that you only have 7 small holes on the outside, which are generally healing well, but inside a lot has changed.  As the nurse has put it, someone has taken a knife to your insides and it will take the body time to readjust and repair, so expect to feel tired.  No-one tells you about the alarming evacuations from the other end though, in all the post-operative literature.  Lots of information about feeding and drinking, but nothing about the ultimate result...  Not attractive, we shall leave it there.  Then there's the tongue.  Stuck my tongue out yesterday - as you do - in front of the mirror and got a shock.  It is black.  As you can see (I could have gone closer but have spared you this delight) there is a black coating on my once pink tongue.

Twenty minutes of scrubbing later and we have a more acceptable offering. Apparently you can pay a lot of money to get a special device to do this but a soft toothbrush and some Colgate seem to do the trick :-)

There's also a rather unpleasant film taste inside my mouth.  Normally a sign of poor dental hygiene this appears to be caused by the vitamins and iron liquid.  It is not a pretty sight but should sort out once I start taking pills instead of liquid, which will be a while yet.  But if anyone else gets black tongue, don't worry, it's not a problem.

Drinking is getting quicker though.  As it's all clear liquids it runs down quite fast and I can now get through a cup of tea before it gets stone cold.  Had to give up on the skimmed milk there, and now using coffee-mate light instead - the thin milk made me feel queasy.  Okay in the protein shake though, as it's cold and I put some extra Splenda in for added sweetness.  Okay, okay I've got a sweet tooth.

So the good stuff - fancy the look of food I like, but don't have any 'need' to eat it.  Part of it is mental = you know you can't eat it because your stomach wouldn't cope with it; part of it is physical in that you just don't feel you need to eat.  I can tell when I need something substantial (like a soup) when I start feeling tired.  Put some of my favourite sugar snap peas in the fridge for Jon and boy did they look nice, but there's no temptation to actually eat them - not when you've had all the painful distended belly and the incredible gurgling just with soup.  I look at food on adverts (there was a warm grilled courgette, asparagus and feta salad and a quorn sausage the other day) that I could eat later down the line and make a mental note that it would be jolly nice, but you seem to have an awareness that all is not quite as it should be and these things are the stuff of the future at the moment.  It will all happen one step at a time.

Now I think I'll make a nice cup of tea and have a read - what a luxury!

On the way

Well, here I am on the next step to my new existence.  If 50 is the new 40 I'm catching up a bit late but it doesn't matter at all -getting to the point where you say that enough is enough and having the WHEREWITHALL to take a drastic decision isn't within everyone's remit, so for that and the support of my family I will be forever grateful - hopefully for the next 30 years, if I can follow in my parent's footsteps.

Freshly washed and wearing a new fetching accessory - these little tubes (all with blue plugs on the end - are actually descending through the carotid artery and at least one of them going directly into the heart.  Amazing - you don't feel a thing.  The most uncomfortable one is one the left forearm, which catches on things, and then the one in the inside elbow.  There's another high on the chest on the left (discretely hidden).

I'm in the Chelsfield Park hospital on Day 3 after a Gastric Bypass operation.  Basically I've had 7 small incisions in the stomach, been blow full of gas, had my stomach dissected into two with a little pouch remaining and the edges sealed with titanium staples.  Then the bottom of the new pouch has bypassed the ileum and duodenum and enters the intestine lower down.  This means that not only do you have a greatly restricted capacity, but some of the constituent parts of your food can no longer be absorbed - in particular a large part of the fats and sugar, which are normally absorbed in the upper intestine.  This operation can practically cure type 2 diabetes over night.  Whilst not diabetic, I recognise that the sugar rush I've had in recent years from pure orange juice, for an example, is a precursor.  Now if I eat too much fat or sugar at once I will experience something very unpleasantly called 'dumping syndrome'.  Today I'm having the first soup of my new life - one spoon at a time - tomato and chorizo thin and slightly spicy into my tiny stomach.  Thing is, I've eaten whatever I liked (and most of it good, admittedly) for certainly 40 years of conscious memory - it's no real hardship to do it differently now, if it will give me better health.  I've seen it, done it and got the t-shirt, you could say.  I can move on.

This really is delicious.  One sip at a time, let it trickle down.  No need to hurry; the first few weeks will all be like this, then I can start trying tiny helpings of pureed food.  I will work my way back up to savouring low-fat houmous (chick peas are on the good-for-you list from our surgeon).  I have a role model too, my gorgeous daughter who can tutor me through the whole process, having been through it all before.

So it took me an hour to eat the soup.  At home I can warm it when it cools of course - but for this first week I'm not rushing anything.  Managed to swallow my pills though - impressed there - and the gurgling in my stomach is a wonder to behold.  This will continue, I'm told - a result of the interesting plumbing.

Yesterday lunchtime I had my catheter out.  I'd been wanting it out for a day, but they won't do it until you actually start drinking.  Paul, the EXCELLENT day nurse (couldn't be smarter or nicer) told me he'd give me 12 hours to pass water or it would have to go back in.  People are scared to go when they've had an op.  I've had a knife cone biopsy (cutting away half your cervix) and gone within a few hours.  A stomach realignment is no problem.  Proving I could sip water (they have to watch the first sips) he brought me a pot of tea.  30 minutes later I have the first specimen for him.  On an empty stomach I'm like a sieve with water - in and out in no time.  Oh the bliss of the first little bit of milk in tea for two weeks.  I got through 4 small pots of tea and 2 pots of peppermint tea throughout the day.  Wonderful.

Interestingly when you've had your surgery, before you go to recovery, they put you under an X-ray and send some dye down through the whole system to make sure the new valve and stoma aren't too tight to pass fluid.  Now that's impressive.

Last night Paul gave me a happy pill.  A mixture of opiate derivatives I had wonderful morphing imagines on the back of my eyelids whilst I tried to sleep, galloping horses, wild creatures, mysterious forests and trees - I could watch them fascinated. Such a nice happy feeling too and no pain (glorious) from the trapped air, but I hardly slept more than a couple of hours.  But it was not only the pill I think - it's the realisation that I'm on the way.  I will, come some way down the line, be able to wear the clothes I like, get rid of my old big things (really for good this time) and embrace being me.  Yes, I'm on the way.

Jessie's Choice

Jon was putting in a cat flap last week - a major job as it had to go through a solid outer wall, but he's  finished it, and now they just have to learn to use it - Jessie, Lara and Sophie.

Jessie was a calico feral kitten we took in at the beginning of July 2012. Jessie was born to a feral mum in the roof space of a garage behind our house, and when her mum deserted her we caught her and took her in. Afraid and skittish, yet gentle and sweet natured, the vet recommended not to let her outside again for a long time - if ever, or we might lose her.  Well since Jessie we acquired two other gorgeous girls who have been together now for 7 months.  Jessie has come a long way since those early days and last weekend we finally let her back out into the world, after 10 months as a house cat.  

Jessie is now over a year old and recently she's got a lot less skittish, and very affectionate, so we took the plunge and left the back patio door open... At first she was curious but scared and barely got past the patio onto the lawn for the first two days. On the third she explored every inch of the garden. On the fourth day out she went to the back of the garden, hopped up the tree and went straight into the roofspace of the garage behind like an old pro - this is where she was born. 

She stayed up there all day - sometimes sunning herself on the roof of the adjoining garage outside. As it got later the other girls came in, but Jessie stayed in her old home. We shook treats, banged the dinner bowl, but although she'd poke her head out she stayed in there. 

As it was getting dark and not so warm we shut the patio door and Jon had his dinner in a chair opposite the door to see if she came back. At dusk she came down, played a little with the moths in the shadows (as she'd done as a tiny kitten) - then as darkness fell she came to the back door. I let her in. 

She was a bit skitty as she came into the light then rushed upstairs - I think to check out her new nest, under our bed, with all her soft toys and stolen socks. Then she came down as if nothing had happened and gave us loving headbutts. 

She's been in the garden every day since (apart from Friday when it poured all day) and not been back up to the old nest again. 

Now I know people say cats don't have great memories and don't do a lot of thinking, but I reckon there was a residual emotional attachment memory to her birthplace and old home. Most rescue cats never have a chance to go back to their old homes, so we have no idea how they would react. I think she was enjoying being there and just taking her time. Then she came and checked out her new home, and made her own decision. 

Jessie is our girl now, and this is her home, and it's her choice.