The Importance of Communication and Follow Up with your doctor

I knew I had an appointment today with my surgeon, and I was completely ready to get a fill in my otherwise empty band. I woke up this morning, after having coughed all night long, with a fever, sore throat and a pain in my stomach.  I knew I needed to go though, for the sake of follow up, though I am 3 years and 3 months out, I think it's still necessary to spend the time communicating with your doctor.  It may only be 5 minutes, but your doctor needs to know what's going on.  The reason I coughed all night?  I took my vitamins too late.  They sat in my pouch for hours. I knew better, but it just slipped my mind that it was already 11:30pm, way to late to be taking my vitamins. For the most part, vitamins should be taken with food. Cardinal rule broken there. Sometimes, even those of us who are years out, need to be refreshed in the simple order of things. Mistakes are made, it's best to just recover from them quickly and get back on track.

So, what happens when you're so off track, you've gained 5, 10, 15, or even 30+ back after surgery?  It's important to go back to your doctor.  Your doctor should have a list of trained psychologists, dietitians/nutritionists, counselors/social workers, and/or personal trainers who can get you back on the loser's bench.  Sometimes, we need the help of a trained professional to understand our disordered eating behaviors and lost motivation we had went we eagerly started our journey. Each of us has our individual disordered behaviors, both in our nourishment practices, lack of motivation with exercise, life stressors, food addictions, and/or transfer addictions that may need serious attention. Reach out. If you need help, email me.  I will be happy to find someone, wherever you are, to help you! 

Saturday Group

REPOST FROM ObesityHelp.com:


Hi, my name is Nanette Wilson and I am a Counselor Intern (#5099) with the Licensed Professional Counselor Board of Examiners.  I have a Master's degree in Counselor Education from the University of New Orleans (2006) and I am seeking to gain experience in conducting weight loss surgery group therapy sessions. Becoming a Licensed Professional Counselor takes 2 years and 1500 direct contact hours, and is conducted under the supervision of a Licensed Professional Counselor Supervisor. I am currently 6 months into the process and seeking to specialize my skills in bariatric counseling, pre and post op counseling. Individual counseling will not be required but encouraged if issues that should not be worked on in the group are recurring for some members. I've decided to take on pro-bono clients in Louisiana who have undergone bariatric surgery and would like to participate in group therapy. The group will be available,free of charge to anyone who is interested and emails me to sign up. The group will be limited to 6-8 people. If anyone is interested and lives in the New Orleans area, please let me know.

This group will take place on Saturdays at a local library where we could meet in a conference room. If you or anyone you know is interested, please message me.  Also, if anyone participating in the group is interested in individual therapy outside of the group, I will see clients on a sliding scale fee ($25-$50/per session) as I can not currently take insurance because I am not yet licensed as a Professional Counselor.  If interested, please contact me by email at nanette@bariatriccounselor.com.  I will require a brief intake questionaire over the phone to get some information from you regarding your experience with counseling and your currently weight loss surgery status/progress. 

Evaluating Your Impulse Control

The essential key to success after weight loss surgery is impulse control.  Sure, you were able to follow so many diets and exercise programs for weeks and months, even years on in, but when it came to the slip ups, were you able to own it and take new actions?  Let's look at the bigger picture.

In order to be successful as a post-bariatric surgery patient, you must learn new health habits that are sustainable.  If you commit to the lifestyle for the first 6 months and then revert back to old habits, you will inevitably gain weight back.  This is a learning experience when it happens, and hopefully, if it has happened to you, you've found resiliency and jumped back on the wagon.  However, if you continue to struggle with impulse control issues and you don't keep accurate records of your food and calorie input and output, you may see yourself on the failure end of WLS.

The key is owning your behaviors and actively making efforts to change those behaviors.  I recently ran had a visit with my great aunt and she said to me, "I'm so happy to see you're maintaining your weight loss after surgery because "so-in-so" seems bigger than before."  I refrained from calling her out on this third person judgment of "so-in-so" because I don't know "so-in-so"'s circumstances, but I can make a solid assumption that she isn't practicing impulse control or following the rules her doctor gave her.

Why?  Why not?  What is it that keeps us from truly changing our habits?  There are usually deeper seated control issues going on underneath the weight gain and food addiction.  It's the way they've learned to cope with stress, anxiety, and depression by using food.  Those behaviors have not been unlearned when the doctor when in to perform surgery.  This is why the movement should be to work with a Professional Counselor to process the client's motivation to change and their ability to control the impulse to reach for food to soothe themselves.

Ask yourself a few questions:

Am I ready and willing to spend time preparing my foods at home for my work day and in the evenings?

Do I understand what good post-bariatric surgery food choices are?

Do I comprehend the size of my pouch?

Generally, post-surgery, your pouch will be the size of a walnut.  It will inevitably stretch some, but the idea is not to have it stretch to the size of a baseball but rather possibly a golf ball. You must commit yourself to planning ahead or having a plan when you're out of the house.  If you fail to plan, you plan to fail.  I keep a list of good choice WLS friendly meal options out, I look for high protein options when it comes to soups and order that as my entree or find an high protein entree and order it sans rice with extra soft steamed veggies.

Another big issue is alcohol. Anytime you consume alcohol your ability to make good judgments is compromised.  This can be a big problem when you're post-surgery and your consumption levels can cause severe problems, such as low inhibitions or blackouts.  You must become increasingly aware of the effect drugs and alcohol have on your ability to make good decisions.  Seek professional help if you find yourself risking your safety due to a transfer addiction.

So where is your impulse control?  Are you able to make good choices all the time?  Are you still struggling with making good choices and grab those cookies when you've had a stressful or emotional day?  What's behind the emotions of those bad habits?  It's wise to seek out a Professional Counselor that specializes in Dialectical Behavior therapy for binge eating disorder or food addictions.  If you need help finding one in your area, please feel free to email me and I would be glad to locate someone to help you!

nanette@bariatriccounselor.com

Essentially Recovered...

This week, the topic for the new group I am attending for my personal recovery was to answer this question.

"I will know I am essential recovered when..."

It is a difficult question to answer. My answer was simple, "Every day I am in recovery. Every day I must eat, every day I must make choices.  Some days I make poor choices, which means I have relapsed."

Now, I'm not talking about the tiny taste of a piece of fudge that I've wanted for the past few weeks due to all the holiday sweet treats that until today I had successfully passed by with ease.  I have had peanut butter fudge on the brain for a while now though.  I've wanted to make it, but I knew I'd eat the whole pan.  Unfortunately, today at work there was a tray of chocolate fudge, peanut butter fudge, and toffee on the table.  I passed by it several times, and then decided to take a sliver of toffee no more than 1/2" inch by an inch, took a bite and spit it out.  It was quite possibly the worse toffee I've had, nothing like what I could make.  Later, I decided I would taste the peanut butter fudge.  Again, I took the smallest of pieces, tasted a quarter of it enough to know it was not as good as I could make, and spit it out.  Neither experience produced the perceived outcome of sugary pleasure I sought, but I did not deny myself the experience. The experience turned out to be unsatisfying. I don't regret it, I just won't let temptation get the best of me again anytime soon.

I will always be a recovering food addict though.  I've learned to stop myself insomuch that I will not indulge in something that does not speak to the foodie in me, but I still struggle with my food addictions.  I obsess over recipes on the internet, I admit to my love of food.  I have broken my addiction to the Food Network, in fact, the channel is blocked on my TV.  Parental controls are not just for parents.  Sometimes, we have to put measures in place to save us from ourselves.  I have established certain boundaries to avoid situations where I will be tempted.  I try never to go to Sam's Club on Saturdays, as I prefer not to be tempted by the sampling stations.  Luckily, I have a business membership and go between 7am and 10am before these people have set up their enabling little booths of temptation.

So, I will know I am essentially recovered when I am not obsessed with food?  Doubt that will ever happen.  I have found I am obsessed with these questions, "Have I gotten all my protein today?  What did I eat that caused this acid reflux tonight?  Did I get enough water today?"  While these are healthy questions to be asking myself, I still have to think about the addiction daily.  I still have to eat and account for everything I put into my body.  I still am an addict, the difference is that my addiction is to something that I must have to sustain life.  The only viable answer I have heard has been that the addiction is to sugar, fat and carbohydrates.  Those are the types of foods I craved.

If I had to really narrow it down, maybe the true answer is, "I know I am essentially recovered when I don't want ice cream."  Then, I'll really know the paradigm shift has occurred in my brain and I am no longer an addict. However, I doubt that will happen... Greek yogurt has been a great replacement, but my addiction for gelato will never truly be cured.  I have vowed to treat myself to a small gelato when I have been compliant with my healthy eating behaviors and exercise routine, once a month (on the 3rd.)  It's a small, measurable trade-off to indulge in while still keeping with my commitment to better health.

Letting Go

Tonight, I attended a support group held weekly that I had never been to before.  The topic of tonight's discussion was "Letting Go."  A topic I've often discussed with clients and worked through myself, but tonight, I admitted to myself that I had let go of many toxic relationships.  Of course, the one relationship in particular was my relationship with the person who supported and encouraged me to have surgery.  It was difficult for me to do this, but I let go of this relationship not that long ago.  Within the last year, I finally made the decision that I had held onto the friendship too long.  It was time, way past time, actually.

This person had supported toxic behaviors, despite being supportive of my decision, it was just not a good situation.  I wanted to hold on because we went through Katrina together, we cared about (and once loved each other,) we could remain friends... in the end, I saw we are better off not communicating it was truly me that had held on when this person had left the friendship long before I made the decision to end it.

This question made me think about what else I hold on to that isn't healthy.  Coincidentally, around the same time I let go of this relationship, I also let go of a very toxic job.  A job that had me regaining the weight I'd lost in the first two years post-op.  Now that I'm back in the mental health field working on my LPC license and certification in bariatric counseling, I recognized that stress in my life came in the form of pounds.  There is so much I have let go, but also, so much that I have found I am more assertive about that is TRULY IMPORTANT.

Before surgery, I was overly concerned with many things that did not matter.  Now, I am truly finding what matters to me and what I am worth.  I am worth the time and energy it takes to keep in touch.  I keep in touch with my true friends now, I make the time to see them, I don't make excuses because I am embarrassed about the size of my waistline.  I don't worry about what people think of me with regard to my fatness, but rather I worry about whether I am acting in a way that is befitting to my profession.  I am living my personal life in a way that I am proud of my behavior at all times?

I ask myself this often.  I am making the good choices I want my clients to make?  Am I eating the way a post-op should eat?  If the answer is not yes, then I am not doing what I need to do to be mentally well and capable of counseling post-ops.  This is a major reason for my personal decision to not drink alcohol any longer.  I have removed it from my social interactions as a way to truly, genuinely act as myself and not be under the influence of anything other than my own mind.  I have let go of toxicity in my social life, and I am making meaningful relationships and connections without allowing social anxieties to creep in.  I am comfortable with myself and with others.

I won't judge those who do drink responsibly.  I won't judge those who are not able to drink responsibly.  I understand the nature of addictions, and I realize we are all in our own place, at our own time, and must get to where we need to be in order to find what we consider healthy.  However, if I see someone endangering themselves, I will address this as gently as I can.  I am concerned, but I do not want to offend anyone.  My decisions are for me, and your decisions are for you.  We are all our own people.

Weight loss surgery does not change who you are, but it will change how you view yourself.  You will find yourself in ways you never imagined.  I remember feeling my hipbone for the first time.  Yes, the very first time, I'd been overweight all of my life, that hipbone had last been that close to my epidermis when I was 5.  I have also found that I am assertive in my behaviors where it counts.  Once upon a time, I was extroverted and confident because I didn't care what people thought about me as an obese woman. Now, I am extroverted and confident because I care about others and want to help anyone who needs it.

I have let go of shame.  I have let go of judgment.  I have let go of my arrogance about obesity.  It is a health problem, it is not an aesthetic problem. Some of us are simply just genetically pre-disposed to obesity, the disease.  Fight the disease, not the person.  Find yourself, let go of the rest.  Find peace and love for you and all of those around you.  Love yourself the way you are but work toward a better you.

You are in control

I don't care how you cut it, you are always in control.

Mind over matter, we can each choose how we respond to stimuli every single day.  As a counselor, I see it every day, people living up to the labels which are placed on them.  People giving in and not thinking about their actions, people using a stigma to justify their behaviors rather than thinking through the decisions and not acting on impulse.

I admit, I do it myself too.  Sometimes, I just don't want to think about what I put in my body.  Sometimes, I just want to go out and order something I know I shouldn't or even can't eat.  I've gotten better though, I might not be 100% well at doing it right all the time, but I'm working at 99%.  I mean that with diet and exercise, I am working on giving it 99%. If we always work on giving in 99%, that means we're only messing it up 3.56 days per year.  If 3.56 days per year, you're doing it right, you've got nothing to worry about.

A friend of mine has a very simple saying that comes to mind every time I am presented with potentially making a bad choice. I hear it in my head in his voice, so this makes it particularly meaningful, "Girl, we all know right from wrong, chose right!" Chose right means to me that while I'm in the grocery store, I don't let my eyes spend more than 2 seconds on a potential pantry hazard. Pantry hazards are the things I throw away when I do my pantry purge. These items include, but are not limited to: potato chips, cookies, snack cakes*, and pretty much anything that has empty calories I never should have bought in the first place.

I must admit, over the last 3 years of my life I have been able to minimize the amount of hazardous waste products I bring in from the grocery store, but there's always room to improve. That's a monetary savings right there. $3.50 for a bag of chips over $2.50 for a bag of apples is a savings. It's the effort it takes to peel, core and eat the apple that often gets in the way. I hate to see anything go to waste, the pantry hazards just appear to linger longer. A few things sneak into the house here and there, and I'm always glad when I purge the pantry to see that I'm not throwing away an empty bag. Most often, it wasn't something I purchase for myself anyway.

I do my best to exhibit self control in my grocery shopping trips by always having a list. Last week, I successful went down the chip aisle, analyzed all my salty snack cravings, and passed the opportunity on each to make a bad decision. It was pretty rewarding to see myself make it down the aisle, assess my primary trigger foods (Golden Flake Cheese Puffs & Zapp's Spicy Tomato Chips, I'm looking at you) and gleefully walking away from those and others without looking back, until now. The moment that I did it though, I felt no desire to ruin all I'd worked hard for. I realized I was in control and I could not be tempted.

It's a constant battle though. It's a battle that we can always win when we're in control of our thoughts to assess our impulses and emotional triggers. Just keep fighting the urge to "do bad" and you'll always win.

Digging Deeper, Finding Wellness/Balance

The journey to have weight loss surgery is often a long one.  A number of failed diets over many years, regained pounds multiplied by stress and life, feelings of hopelessness, years of depression, and hopefully, an acceptance that therapy may play a role in helping you understand where the urge to overeat comes from- what is it within you that has caused weight gain?

For each of us, it's different yet often similar experiences that brought us to armor ourselves with adipose tissue.  The gain did not occur overnight, it was gradual and the emotions behind it were deeply rooted.  Often, when the pressures of life were out of hand, be it harshly judging parents, poor parenting, trust issues, lack of self esteem, uncertainty, or traumatic events, we turned to food.  It was reliable, it made us feel good.  I can't depend on you, but I can depend on this Snickers to soothe me.

What do you do when food can no longer soothe?  It's not uncommon to have transfer addictions post weight loss surgery.  We may well "commit to our physician's requirements for the first year" but it seems like after that they just become mere suggestions for some.  Bad habits creep back in, new bad habits develop, or some become overly obsessed with calorie counting, exercise and watching the scale like a hawk.  Introducing the dangers of alcohol and drugs to the weight loss surgery after life bring up a host of issues.  Often the stomach, be it banded, pouched, or sleeved, your weight and body is no longer what it used to be.  If you've also developed the habit of drinking fast and go out on an empty stomach, there's possibility that it won't be too long that you've blacked out and done something you'll regret.

You may drink to feel better, to socialize, to meet new people.  You're receiving attention you may or may not be comfortable with, you may find a new side to yourself.  Realize, exploring your new self sober is the best way to gain knowledge of your true self.  If you are suddenly getting a lot of attention from the opposite sex, be cautious about your involvement.  Develop an understanding of what you will and will not put up with and have respect for yourself.  The repercussions of only one one night stand can have an impact on the rest of your life.  Take responsibility for your actions before they happen.

TAKE RESPONSIBILITY FOR YOUR ACTIONS BEFORE THEY HAPPEN.

I'm repeating that because it's applicable to every aspect of this journey.  It's as simple as having a plan when you dine out, to having a plan when you go to a bar, to knowing what your expectations are from the opposite sex, down to engaging in healthy, positive behaviors at all times.

Now, let's talk about the extremes of post-op behavior - that seem healthy, but are actually extreme, obsessive-compulsive actions that could be counter productive to your overall wellness.  What is reasonable when it comes to dieting and exercise?  1-2 hours?  You be your own gauge, but if you've developed a leniency toward exercise bulimia, or you find yourself obsessing over calorie counting for months at a time, then you binge on something ridiculous, you're going to extremes.  BALANCE IS KEY.

Again, BALANCE IS KEY.   Daily exercise for 30 minutes is a reasonable, bare minimum.  Excessive exercise for weeks on in without giving the body a break is extreme.  Consider resting yourself 1-2 days a week.  I use the rule of exercise 4 days a week for 1 hour or 5 days a week for 1/2 hour. This is my balance.  Prior to surgery, I went through extreme periods of exercise bulimia where I worked out every single day at 5:45am, came home from work and repeated this process, but still I did not have the balance in my eating habits.  I was working out so much that I built up more *head* hunger, that I felt it was okay to binge in the evenings.  That went on for a period of two years before I realized my self defeating behavior.

Then I found balance.  I used my formula of 4/1 or 5/.5 and I ate reasonably.  My body plateaued for 4 years at or around 265.  It resisted change.  I fought for change, and my body had a mind of its own.  I looked at whether or not I was having "food amnesia," I went to therapy to deal with my issues, and still, I fought the scale and the scale won.  It took me 10 years to make the decision that I had tried everything, I had done all I could, I needed something more to help me through to healthiness.

Now, I live an alcohol and drug free life.  All drugs, I no longer take any medication for anything.  Nothing for anxiety, depression, mood.  I have developed positive self talk, improved self esteem, and appreciation for the gift of weight loss surgery.  I have accepted my body for what it wants to be, where it wants to be, and though I would like to be down to this or that weight, I realize that scale doesn't matter.  What matters is how I feel every single day about my successes.  The journey includes the successes and the mistakes.  We all will make mistakes in this journey.  What mistakes are we willing to change, or how have our behaviors contributed to the problem, and where are we unwilling to compromise?  This is about that.  What are you willing to give up?  Where can you find a balance between what you want and what you need?

You don't have to spend thousands of dollars on therapy. (However, if it's covered by your insurance, do it.  Some of us aren't so lucky!) You just have to reflect on the mistakes you've made and understand how you can apply yourself to do better. Each and every day, make conscious, mindful decisions about what you put into your body, what you get out of each day, and how you live your new life.  Are you counting your blessings?  Are you thankful for what you've received?  I am.

I am thankful for sobriety. The other day a good friend and personal trainer I know asked me, "So, you've given up everything?  No vices?  You won't even have a drink with us?"  I simply responded, "Yes."  I have given up everything.  No, I won't have a drink with you tonight.  But yes, I will have a drink with you in the future.  My balance is simply to understand where and when indulging in something is appropriate, meaningful and deserved, not just because it's Friday night.  I don't need alcohol to relax and have a good time.  I enjoy the company of friends without it.  If they are uncomfortable with my sobriety, that's their problem, not mine.

Several years ago, these words would not have come from me.  I've grown and prospered so much, and for that, I am thankful.