The Makings of a Nurse

• The Nurse Becomes the Patient

by Nurse Teeny

Sorry the blog has been so quiet lately. The rest of the summer was a flurry of teaching, clinical and classes (not to mention continued recovery). I’ll have more news on all fronts very soon, I promise.

But the big news of the week is that I was in a very serious car accident last Wednesday. I was waiting at an intersection to turn onto a highway when someone decided it would be a good idea to turn left right in the path of oncoming traffic. They collided with said oncoming car so hard that they slid across the road, right into me, causing my car to spin and roll into a roadside ditch. It wasn’t pretty. I’ve been rear ended a couple times in my life, but nothing like this. It was terrifying and there was definitely a moment when I thought “This is it. This is how I’m going to die”.

Considering the damage that was done, I’m amazed everyone involved was not more seriously injured. I honestly believe that my side air bags saved me from a head injury. But the impact was pretty stunning. I was transported to the ER (in a C-collar … as soon as I said “My neck hurts”, the paramedics had that thing on me faster than you can snap your fingers), scanned and released the same night. I was told the next few days I’d feel like I was recovering from a really hard workout…they weren’t kidding. Ice and heat have become my best friends (not to mention pain meds and muscle relaxants). Fun fact: NSAIDs are often the medication of choice to take for musculoskeletal pain (no duh, right?), but guess what? As a bariatric post-op patient, I’m not allowed to take NSAIDs! Boo. Since the stronger stuff knocks me out and I can only take it at night, I’ve had to grin and bear it for the most part.

Unfortunately since I was hit on the driver’s side, the impact did some damage to my back and flank and the pain hasn’t dissipated with the the rest of my generalized aches and soreness. So tomorrow I meet with my PCP to talk about what’s next.

In the meantime, I wait for the insurance adjuster to tell me whether my poor car is totaled or not. I am praying it is fixable but I am not holding out hope…

The fallout

Airbags may have saved my life…

The worst part of this whole thing is feeling like it’s a giant step backward. I was just starting to feel like I had a handle on things. At almost four months postop, my energy levels were better, I was able to eat more, and I had just signed up back at my gym to create a long-term workout plan. I felt like I was moving forward. Then some yahoo decides to turn into oncoming traffic and it all changes in the blink of an eye. Not to sound whiny because I know it could be MUCH worse (and I could have been much more seriously injured), but the past few months have been such a roller coaster that I was really looking forward to the idea of progress.

For now I guess it’s back to one day at a time.

Tags: car accident

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• The Nurse Becomes the Patient

by Nurse Teeny

Last week I celebrated my eight week postop-aversary. This is usually the point at which we are cleared to eat regular foods and swallow pills whole. For many bariatric patients this is quite a milestone when you are supposed to start feeling “normal” again. I have to say I feel anything but.

My postop life continues to be a roller coaster. I continue to struggle getting my protein in, have no appetite and with the heat and humidity raging in NC, it’s even harder to eat. This has resulted in some days where I have just dragged. I definitely notice that when I do reach my protein goal (80 g/day), or even get really close, I feel MUCH better. But my boss pulled me aside a couple weeks ago and said she was really worried that I might be anemic since I was so pale. Of course I panicked, called my doctor’s office and begged for my labs to be checked. The results? Everything was beautiful. Everything. I’m not anemic or vitamin-deficient or hypothyroid. My labs literally couldn’t be better.

It really is all about the protein, folks.

I had my two month post op last week with the PA, who was wonderful and helpful. I think my surgeon is great at what he does, but he’s not super warm and fuzzy and I needed some affirmation and support (especially after my practice’s triage nurse verbally berated me over the phone a few days prior…I was feeling pretty vulnerable).  My PA reassured me that with SIPS patients, the “magic number” seems to be more like 3 months instead of 2 and that as long as I took care of myself, I should start to feel normal again soon.

The good news? I was cleared for regular food, with the caveat of always getting my protein first. The bad? Advancing my diet has done nothing for my appetite. I’ll try something new, think it tastes decent, and then loathe it with the next portion. Poor Steve is getting stuck with tons of leftovers. The only flavors that seem to really resonate with me are Asian foods and fish…I still love miso soup and now that I can have (some) vegetables, have become enamored with lettuce wraps. Scallops are my new best friend and I could eat white fish all day.

I’m still discovering what foods sit well with my new stomach. Granted, a lot of the foods that felt like lead (i.e. shrimp) haven’t been attempted for a few weeks – when my stomach was still in the healing phase – so I’m trying to convince myself that it’s worth another try. But beef just does not agree with me at all. The “head hungry” side of me is mourning the idea that even if I wanted to, I could no longer eat a cheeseburger because it would make me sick as a dog. But I know that’s actually a good thing.

The two hardest adjustments have been fear and mental exhaustion. I fear trying new foods outside of my home because I don’t know how they will affect me and I don’t like to get sick in public (nor do I have time…more on that later). I may just have to get over this but my anxiety makes it even harder to eat because I’m not very willing to experiment.

The mental exhaustion is in knowing that for the rest of my life, every morsel that I put in my mouth will require focus and mindfulness. Not that mindless binge eating was any healthier, but bariatric surgery does not fix the delicate and tenuous relationship that many of us have had with food for most of our lives. I could see how the constant attention to what we eat could go to the opposite extreme and become pathologic in itself. It will be a delicate balance and I think it will be a different kind of struggle. I have had moments of sincere regret about having this surgery and its consequences for my lifestyle.

Then again, I have lost over 50 pounds from my highest weight and almost 40 pounds since surgery. I can walk without my legs chafing and climb the stairs without having to catch my breath. I look forward to vacations because I can start keeping up with the rest of my family (and even fit in airplane seats)! I enjoy shopping again and rediscovering old clothes in the closet that now fit…or are too big! I feel like I am starting to get my life back.

I may be exhausted and beat up but I did undergo major abdominal surgery and my body is still healing. During my harder moments, I need only to remember how far I have already come.

Tags: two months after bariatric surgery

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• The Nurse Becomes the Patient

by Nurse Teeny

Last Thursday, I hit the 4-week mark and Saturday was my official one-month postop-aversary. I can honestly say there have been moments when I doubted if I would ever make it this far. (Especially during Week 2 of liquids…cream-based soups still make me want to gag.)

Overall I am doing well. My energy levels are just not where I want them to be, but I haven’t reached my protein goals yet. I also aim to get 600-800 calories (no more than 1000) daily and it is an effort to reach 500 most days. Says the girl who used to down an entire plate of loaded nachos in one sitting (by herself).

My how times have changed. 😉

I know it can take up to eight weeks to really start “feeling normal” so I am doing my best in the meantime. I’ve been walking as much as I can (and as much as this blasted Southern humidity will let me).

I’m a week into my “soft diet” phase, which will last until week eight. So far it’s not bad … it’s a relief to actually eat things with texture. I’m just beginning to figure out what works and what doesn’t work for my body. So far I can handle meat if it is sliced thin or in a soup. I adore fish of all kinds but shrimp makes me feel like I’ve got a rock in my stomach. As does ground beef or ground chicken. It’s kind of amazing how individualized our food tolerances become after bariatric surgery. I’m still not craving sweets or junk food. I’ll walk down the grocery store and see a shelf full of Cheez-It’s (my #1 preop vice) and think “Huh, I remember really liking those.” And it stops there. Thank goodness.

My sense of smell, however, is very much intact, if not sharper than before. This is really annoying. Over Memorial Day weekend when Steve and I would take walks around the neighborhood, I could smell our neighbors grilling all kinds of goodies and it actually made me hungry. But when I actually had food in front of me, the hunger went away. Occasionally I’ll “crave” a particular type of food – ironically it’s usually soup. The other day I desperately wanted to try a Panera Quinoa Broth Bowl (my favorite) but when we got there, they were fresh out. Wop wop. Tonight I’m curiously interested in trying egg drop soup with wontons.

I continue to be amazed at how much my taste buds have changed. Foods that are traditionally salty (but tolerable to my palate before) are overpowering for me now…I tried prosciutto rolled up with some Laughing Cow cheese the other day and could barely finish a slice. Sweets of all kinds make me nauseous (particularly artificial sweeteners). And cheese is my new favorite condiment. I put it on everything. Small amounts of part-skim cheese, mind you, but I eat such small volumes and struggle to get my calories anyway, so I figure if it makes food more palatable then I am willing to go there. Especially for the added protein.

Some other curious changes… My stomach is starting to act more “normal”. It is much less talkative, except when it is empty…just like old times. My incisions are healing really nicely. I weirdly hate hot showers now – I used to be able to stand in the steam until the water ran cold. Now I get dizzy if I’m in there too long. Not sure how I will do with jacuzzis or baths once I’m allowed to use them.

Probably the most satisfying outcome so far has been the utter lack of migraines. They were pretty well-controlled before surgery, especially once I started sleeping with a CPAP, but I had heard that bariatric surgery often improves headaches, sometimes to the point of eliminating them completely. I saw my neurologist today for a post-op followup and he couldn’t have been more pleased. He didn’t see a need to put me back on a prophylactic medication (my surgeon discontinued my propranolol because my BP was running low). We slightly tweaked my rescue meds to remove any trace of NSAIDS or caffeine from my regimen. He said as long as I feel this good I don’t have to come back for six months! If I can get rid of these damn headaches for good, that alone would make this experience well worth it.

Tags: bariatric surgery and migraines, bariatric surgery and taste changes, one month after bariatric surgery

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• The Nurse Becomes the Patient

by Nurse Teeny

If I could describe my first month of recovery, it would be akin to walking a tightrope on a roller coaster. How’s that for an image? 😉

In all seriousness, I am actually thankful that recovery has been fairly smooth. I’m keeping food down, have minimal reflux problems, and although my stomach is still quite vocal (seriously, stomach, shut the eff up), have been pain free for weeks and am generally doing okay.

The main challenge has been staying hydrated and getting my protein. Which is harder than it sounds. In fact, the only (slightly) major hiccup in this whole experience so far has been doing what I swore I wouldn’t do: I got majorly dehydrated over the weekend.

The challenge is that now that I’m actually eating (huzzah!), I can’t drink fluids for 30 minutes before or after a meal or snack. And I’m supposed to eat 4-6 times a day. And get in 80 grams of protein and 64 oz of water. You do the math. It’s not easy. Oh, and add on the fact that I’m supposed to be getting about 600-800 calories a day … y’know, to sustain life and all. I’m barely getting 400, if I’m lucky. Sigh.

So this weekend after I advanced my diet to semisolids/pureed, I had trouble balancing the fluid versus food equation and got behind on my sips. So behind that when I woke up Monday morning I felt like pure hell. I knew I wasn’t going to catch up on my own and I knew that if I didn’t catch up I was in trouble. So poor Steve got woken up at 6:30 am by a pitiful little voice begging him to take me to the ER. Two boluses of normal saline later and although I was still tired, I at least no longer felt like I was going to die.

The other difficulty has been protein. Ah, protein, you are an elusive bugger. I know 80 grams daily is a goal and I’m not expected to be there yet, but I also know how important it is to my healing and energy levels (and continued weight loss, so my body eats fat and not muscle). I was WAY behind on the liquids because I was just so sick of …. liquids. The PA at my postop appointment gave me some helpful pointers that I will share with you in a future post, and that has helped, as has advancing my diet.

Speaking of which, I advanced to soft foods yesterday! Woohoo! It’s been a fun adventure re-experiencing new (old) foods and new combinations. It’s funny because whenever I reintroduce something into my diet, Steve gets a text from me proclaiming that what I just ate was the “best thing ever”. But seriously…to put actual, real food into my mouth, and taste it (and then chew the hell out of it). It’s just a divine experience. I have 4-5 weeks of soft foods and then I can slowly add “normal” food back into my diet. As I’m able to eat more volume, I’ll also be able to add back in more cooked veggies and complex carbs (gasp). Once I’m further into this soft diet phase, I’ll share with you some of my favorite combinations.

So onward we go… I go back to work next week, start my final (!) semester of NP clinicals, and generally resume a “normal” life again. Whatever that means.