So nine weeks ago I had a Roux-en-Y Gastric
Bypass. Thought it might
be worth writing a bit about the experience and a few of the things I would
have done in preparation knowing what I know now.
Disclaimer: I am not a medical professional. This article is opinion from a
lay person. Advice here may or may not work for you.
The story so far: A bit over four years ago I
had a Lapband
installed. It had the attraction of being reversible whereas the bypass is
permanent. While it was effective and I lost about thirty kilograms, after
four years weight loss had completely stalled and I started having other issues
with it – mainly reflux and heartburn. It turns out in the four years
since I got my lapband the prevailing wisdom on the subject has decided
lapbands generally last about four years then start having problems, and help
the recipient loses about thirty kilograms, but no more. Nice to be inside the
curve I guess.
So, still wanting to be alive in twenty years or so, I needed to do something
else. The bypass seemed like the logical option to pursue. It’s been around for
a fair while and seems to have a pretty good track record (you always hear the
horror stories, but they are the exceptions).
So, here’s the rough order of events leading up to and the weeks after the
surgery:
Two weeks before, you’ll start a very low carbohydrate diet, consisting
mainly of protein shakes and soups like
Optifast plus a cup or two of veggies per
day. The purpose of this is not to enlighten you to the virtues of a
Ketogenic diet, but to
shrink the size of your liver so it is not in surgeon’s way while they
meddle with your other internal organs.
Surgery. Don’t be a hero, take the pain medication.
All things going well, you’ll spend four or five days in hospital.
For the first week after surgery you will be on fluids only. This is
basically anything that you could suck through a straw. So soups, shakes…
more soups. Expect that you will have a very low tolerance for anything
with sugar in it (more on that below).
Weeks two and three you upgrade to mush! Anything that can be run through a
blender to become puree. This can include casseroles, pasta, risotto and
thicker soups. If you can run it through a blender without burning it out,
than it is probably fair game.
Week four you actually get to use your teeth, kinda. Soft foods. Mostly
what you’ve been eating for the last two weeks but without having to blend
it first. More casseroles and pasta, but also poached eggs, mince dishes
and chunky soups.
Week five, all things being well, you’re onto your quote long-term eating
plan unquote. Eat sensibly and all that.
Post surgery you want to be pretty kind with yourself. Not only has some of the
internal plumbing been rearranged, but the surgery itself is pretty big. Your
body will spend a few weeks going, “What the hell just happened?” I found even
five weeks later I would be going fine for four or five days then completely
conk out and want to sleep for a day, then be fine again. It’s a big
adjustment.
Another thing I found post-surgery was a high sensitivity to sugar, called
Dumping
syndrome.
Basically the stomach valve is no longer there to regulate the release of food
into the bowel, so the sugar gets dumped into your intestines all at once.
Among other things, your body responds by producing an excess of insulin.
Symptoms can include a rapid heart beat, sweats, nausea and can even trigger an
anxiety attack. Basically you feel like the sky is falling on your head for
twenty to sixty minutes.
Initially, even the lactose in milk was enough to make me feel unwell. Even the
protein shakes from the pre-surgery low-carb diet had enough sugar in them to
trigger episodes, which nixed my plan to use the left over shakes during the
first week as part of my fluids.
Fortunately around week four or five, when I started eating substantial food
again, the sensitivity started to lessen. While if I were to eat half a family
block of chocolate it would make me feel like I was dying, I can enjoy a couple
of pieces with only a mild flutter. More importantly, although lactose free
milk was okay, I can use regular milk in my coffee again, so life goes on.
For me, this negative buzz if I eat too much sugar was one of the more
distressing changes. Not so much because I want to eat more chocolate, but
because of how ill I feel if do eat something that disagrees with me.
Discovering that peanut butter really does not agree with me any more was a
rude surprise that wiped me out for a good hour. On the other hand, as a
incentive to eat a bit healthier it is certainly effective. I’ve convinced a
bypass is two parts changing the way your body processes food and one part
aversion therapy.
With the rearranged internals, you have to get use to different sensations
around eating and hunger. Feeling hungry is usually a mild thing that only pops
up if I haven’t eaten or drunk anything for half a day. When sitting down to a
meal it is also quite easy to eat too much and be over-full. You don’t get the
feeling of a full stomach in quite the same way. Also, you’ll be surprised how
little food you end up eating at a meal. Having lived with the lapband
previously was probably good preparation so I adjusted pretty fast. Looking at
the last couple of bites of food on your plate and thinking, “I’ll just polish
that off,” can be the difference between thinking, “That was a satisfying
meal,” and, “Oh, why did I eat so much?” You adjust in time. When eating out at
a restaurant I now take a plastic container in my bag to bring the leftovers
home for lunch the next day. Unless you spend the rest of your life ordering
entrées you’ll never finish a restaurant meal.
So, things to do in preparation for having a bypass? Figure out as much of the
foods you can eat for the first few weeks after surgery in advance. Especially
if, like me, you hate soup. Figure out and test the options well beforehand.
Assume anything sugary is going to make you feel sick. Even the lactose in
milk. Prior preparation will help you resist the temptation to rush the
schedule and move onto the next phase sooner. Don’t do that, you might bust a
seam.
After the surgery, your body wants lots of protein to help it heal. So
beforehand, find a sugar-free, lactose free, maybe even gluten free protein
powder that you think you’ll be able to put up with drinking daily for a while.
You’ll probably want to avoid anything that tastes sickly sweet. (Pro tip: A
drop or two of peppermint essence can really help.) First week home I went down
to the local body building supplements
store and explained what I needed and why. I wasn’t their first customer in
this situation and they were very helpful.
You’ll also have been pumped full of antibiotics for a couple of days, so
taking some sort of probiotic is probably a good idea too. Think yoghurt,
kombucha, kefir, kvass or other fermented foods. (Flavoured yoghurt usually has
too much sugar. A couple of big spoonfuls of plain yoghurt blended up with some
almond milk and half a banana or some frozen berries can work well.)
Be prepared to supply your own food while in hospital, in case their idea of a
good post-surgery bariatric fluid menu is milk shakes, fruit juice,
sustagen and a thin soup that tastes like a
doormat. Having not figured out the dumping syndrome thing, and being
completely out of it for a couple of days after three hours of surgery, I
thought feeling absolutely crap after eating anything was normal. It wasn’t.
Check with your surgeon what medications you may need to be on and for how long
after the surgery. In my case I need to be on
pariet
for about six months to minimise stomach acid production while things heal and
the body adjusts. You may need to go back to your GP to get a prescription with
repeats.
It is good to find a surgeon that is part of a larger team that does follow-up
and looks after you both before and after the surgery. You get to talk to a
dietician that will tell you some of what to expect, and make sure you’re set
with the proper vitamin supplements and such. Go over the types of food to eat
and what can be problematic. You can ring the nurse when the larger
laparoscopic incision on your left side starts really hurting after four weeks
and they can tell you that is normal and what to do about it. They’ll field
weird questions like, “My lips have been really, really dry since the surgery,
is that normal?” (It isn’t, but it cleared up after about four weeks, and you
can steal the moisturising stick out of your partners handbag to deal with it
in the meantime.) They’ll assure you that you’re not being a bother and they
would far rather you ring and ask instead of worry.
If all this sounds painful and a hard and a big thing, well it is. But remember
the end goal is still being alive in twenty years. I’ll be around too.
Listening to Kate Taylor tell stories this morning about how she founded The 2H Project reminded me of something George Bernard Shaw wrote:
The reasonable person adapts themself to the world; the unreasonable one persists in trying to adapt the world to themself. Therefore all progress depends on the unreasonable person.*
I am glad there are unreasonable people like Kate in this world.
So 2015 was very similar to 2014 in terms of book reading, which clocked in at 72 books and a total of 20,909 pages for the year. Or 57 pages per day, or a book every a book every 5 days on average.
There was only one book I gave up on (it was an early novel from an author I usually enjoy, so that was unusual). My average rating was 2.94, against a Goodreads average of 3.89 for the same set of books. Last year my average was 2.79 so perhaps I am getting a bit kinder in my ratings.
I also read a whopping 789 articles and blog entries (most done via my ereader’s integration with Pocket). A word count of about 1.15 million. (Looking at the month by month, there’s a big spike in May when I was doing a lot of bus travel.)
Two books rated with five starts, 18 with four stars, and 28 with three. That’s 60% of books with a three star rating or better (which is a 5% drop from last year). This year all 72 books were read as ebook format on my Aura HD.
In 2014 I read 72 books, a total of 20,572 pages for the year. That works out to about 56 pages a day, or a book every 5 days on average. That’s a 14% increase over the previous year, so I’m definitely becoming more of a shut-in, if there was ever any doubt.
This does not include four books that I didn’t finish as I found them not to my taste, or two audio books I listened to this year.
This also does not include 882 various articles and blog entries that I also read via my ereader. This naturally includes a lot of computer programming related articles, as well as the occasional movie review, something about coffee, diversity in tech, stoicism, or anything else that captures my interest.
I’ve been tracking my book reading via Goodreads. My average rating is 2.79, which is about on par with last year. The average community rating of the same books is 3.87, which is also about the same as last year. Interesting to see the consistency there.
All in all my year old reading glasses got a very good workout.
My favourite book for the year would have to be The First Fifteen Lives of Harry August by Catherine Webb under one of her several pen names, Claire North. It’s on my list of books to read again sometime. Special mention would also have to go to Rubbernecker as the second runner. All in all, I rated sixteen books with four stars and the bulk, thirty-one, with three stars. That’s 65% of the books I read with a three star rating or better. Of these books, I read six on paper (pbooks), the rest were ebooks.
I also plowed through a few series, including the four books in Gregg Hurwitz’s Tim Rackley series, and fifteen books in Craig Johnson’s Longmire series.
Special mention also has to go to the audiobook version of Dune that I listened to. It was a very good production. I’ve read Dune at least three or four times previously, but probably hadn’t picked it up in over a decade. Listening to this reminded me how much I enjoyed this book (and loathed the rest of the series).
I started the year with an Icarus Pocket six inch ereader. It was okay, and the firmware had some nice features, but it never really played well with plugging it into my Linux desktop computer and loading stuff with Calibre. Hard restarts were required regularly. Then some of the buttons stopped working, so it was time for an update.
I ended up going with Kobo’s Aura HD and am really happy with it. I always found the six inch e-ink screens a little cramped, so the 6.8 inch gave me the bit extra room I needed. I was also surprised to find the higher resolution screen a big difference to me, and was just that much more comfortable to read with.
With regard to using my ereader to read articles and blog entries, for the last few years I’ve been using a program I wrote called Erudite that downloads articles saved via Instapaper or Pocket, convert them to an appropriate format such as EPUB or MOBI, and add them to my Calibre ebook library.
However, one feature of the Aura HD ereader I purchased this year turned out very handy. It has the ability to synchronise with Pocket. So if I saved all the articles I want to read with Pocket, then they are wirelessly synchronised onto my ereader, saving me having to plug it via USB into by desktop and run through my Erudite → Calibre → ereader pipeline all the time. (I still use this for articles Pocket doesn’t deal with, or that I want to keep a copy of.)
However, I still wanted to track my article reading habits, plus follow up on articles in related forums such as Hacker News after I’d read them and such, so I wrote a litte PHP browser based application that interfaces with the Pocket API to help me manage all that.
I’ve been interested in having a sit/stand desk in my home office for quite some time. There have been lots of articles in the last few years about the health risks of sitting at a desk all day, and it is something I’ve wanted to put in place for quite some time.
I had a modified desk with a three tonne hydraulic automotive jack under it for a while which made one thing clear. You have to be able to adjust the height very easily, with little fuss, or you wont adjust as often as you would like. To that end, a motorised desk was clearly the order of the day.
After playing around with some electric car jacks as a lift mechanism, and a rocky frame that didn’t travel smoothly, I finally said, “screw it,” to the DIY project and ordered a QDOS desk frame.
Here’s the end result, my new desk, currently set at standing height. (Click on any image to see a larger version.)
I reused the desktop from my old desk, although it was quite wide so I cut it down a bit so it could sit closer to the wall. I also wanted some nicer monitor stands as I was tired of plastic boxes and phone books, and wanted all the monitors at the same height.
I like my monitors sitting quite high above the desk, and pretty much vertical, not tilted back, which became a problem as I found most suitable monitor stands were not tall enough unless I was going to buy one that would mount two monitors vertically. So instead I bought some wall mount brackets and then wandered down to the local hardware store to figure out how I was going to use them. This is what I came up with in the end:
A bolt is run though the desk from underneath, screwing into the bottom of the shaft. An angle bracket provides additional stability. Placement was a very fiddly process as you don’t want to go drilling holes in your desk in the wrong spot, but it turned out alright in the end.
Pulling the old desk out also provided an opportunity for a good clean-up, and I think you could agree the final result is a lot neater than before.
So I’ve been tracking the books I’ve been reading (via GoodReads) for the last year (started mid-January). In 2013 I read 52 books, or a total of 17,213 pages in around 341 days. That works out to about 50 pages a day, or a book every 6.5 days on average. (Mind you, those numbers are a little high as there are two books in that list I know I wasn’t enjoying enough to finish.)
My average rating is 2.81, compared to the community average of 3.84 for the same set of books, so that perhaps makes me a hard critic.
All 52 books are fiction — I’ve started but not finished a few non-fiction books this year, and none of this includes the copious amounts of technical and other articles I read from the Internet. (I even wrote a program to make it easy to download and convert web-site articles to a format suitable for my ereader for that very purpose.)
Yesterday’s check-up at the optometrist verified something I had long suspected: I now require reading glasses.
In the past our cats have had free access to roam the outdoors. It seems they
abused this privilege though, to the distress of a couple of our neighbours who
were either allergic or whose garden became a bird hunting ground. So as
responsible pet owners we decided we needed to keep the cats contained to our
property while still giving them an area outdoors to bounce around in.
After a bit of consideration we decided to cordon off the narrow part of the
yard off the laundry door and up the side of the house as “the cat run.”
Here are the views of the run from each end (click on any image to see a
larger version.)
As you can see, containing the cats largely involved building a fence and a
gate at the end of the area, and erecting some loose netting along the top of
the fence to dissuade the cats from trying to climb over.
Dissuasive as it may have been, the scheming little fur balls tested their new
pen and staged several successful breakouts. The first was from the top of the
water heater that provided a high enough ledge for them to jump clear over the
netting.
I first tried putting a spiky platform over the heater, and while the cat was
nonplussed, he would still gingerly make the jump, so I ended up extending the
netting all the way to the brick.
Next they decided if they can’t go over, they’d go under, so some netting along
the bottom of the fence to discourage digging, and the run was escape proof.
Before I installed the cat doors, we were leaving the laundry window open
during the day so they could come and go, so I made a ramp so they didn’t have
to jump so much, but only one of them ever used it. And for entertainment, I
made a climbing post up to a window ledge where they can look out upon the
world, and wrapped some carpet around some support posts for scratching.
Fitting the pet
doors to the timber
and security doors turned out to be surprisingly straightforward thanks to an
angle grinder, a jig saw, careful measurement, and judicious use of a mallet to
make sure everything aligned properly.
So the cats are corralled, and it seems my cat herding days are over for now. A
surprise benefit has been the cats hanging around the house a lot more during
the day which is nice.
And as I work away in my office I get to watch the cats play and fight and
skitter around outside my window. My own personal cat terrarium.
My Aunt and Uncle recently moved from Papua New Guinea to Vanuatu, and are
learning Bislama, the local pidgin.
Pidgins can sometimes be a bit awkward, requiring entire phrases to get across
an idea.
In Bislama, to mention a cave you would say, “hol long ston.” The literal
translation more or less being, “Hole in stone.”
It can lead to some eccentric and terribly charming expressions though. A
violin is a, “wan smol box blong white man, oli scratchem beli I singout
gudfala,” and my personal favourite, a helicopter is a, “mixmaster blong
Jesus Christ.”
According to Pacific Island
Travel
the phrase for “Piano” is, “black fala box we i gat black teeth, hemi gat
white teeth you faetem hard i singaot.”
According to my Aunt, everybody just says, “keyboard.”
The Awesome Foundation has about twenty
chapters around the world, each of
which provide monthly $1,000 grants to a someone in order to do something
awesome.
There is a Melbourne chapter. Previous
grant recipients include:
A project to
completely cover a car in macarons (because 
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