Okay for those of you who have been asking me what's going on with everything, here's a big update:
1. No, I still haven't heard back from Ray Wilde, the office manager over at Rocky Mountain Associated Physicians. I haven't lost hope yet but at this point we are a couple days past when I was supposed to hear from him.
2. My plastic surgery is coming up in about 5 weeks. I'm a little nervous about it only because I keep thinking... what if I made a mistake with the surgeon I chose? I don't think I did ... I'm thinking it's just normal jitters.
3. I had my back molar worked on back on Tuesday and I'm wearing a temporary crown for the next 3 weeks. This means I can't eat anything hard to chew (i.e., beef jerky, nuts) or anything sticky (i.e., gum, chewy candy). So far this has proven to be a bonus. Who knows, in 3 weeks, I could lose another 5 or so pounds. *lol*
4. I bought a mountain bike from REI. As a REI member, I was able to use my 20% off dividend (only for the Navarro bikes) and get one for a really good price. I've been out biking with my daughter a few times already and I'm hoping the weather will hurry up and warm up so we can go more often. It's amazing how much I like going out in public now. I don't feel all self-conscious biking along the edge of the road now whereas before I hated even walking on the side of the road because I could have sworn everyone looked at me because of my size.
Other than that, all is well. Life continues to progress and get better with every day. Thank you everyone for keeping in touch and being such a great support system for me. I appreciate every one of you.
Sean
Weight Loss
My Playlist
Thursday, March 12, 2009
Wednesday, March 11, 2009
RMAP: Ray Wilde
I meant to post this earlier but I haven't had time yet. Last week I talked to Ray Wilde, the office manager for Rocky Mountain Associated Physicians about the issue that occurred between Carly and myself. I'm pretty sure I already posted about it. At the end part of the week, I followed that up with an email to him (per his request) outlining my perspective on the entire situation. He was supposed to get back to me by yesterday and I haven't heard from him yet but I am still hopeful. I would like to continue working with RMAP and I remain in disbelief that by relating what I thought was a small negative experience snowballed into me being banned from the message boards and into something that now involves Meredith and Ray. I never thought telling a story could have such an impact.
Anyway, two days ago a friend of mine (RMAP patient) started experiencing strong pain in her rib area. Yesterday she called RMAP and talked to Carly. Carly contacted Dr. Smith and Dr. Smith talked to her and she ended up going to the hospital where they operated and fixed the problem (I won't get too detailed because that's her story to tell). Anyway, as she related this story to me, I thought about what I would do if in the same position. Due to this situation, I don't know whereas I would be comfortable calling RMAP which irritates me. It irritates me because I had no malicious intent at relating my negative experience. I didn't even think it was that much of a negative experience. It was just relevant to the conversation going on in the forum at the time and fit the topic of the post which was saying that the one area RMAP could improve in was customer service. I stated in that post, however, how great I think RMAP is.
Oh well. Hopefully I'll hear from Ray and this issue can become a thing of the past. It would be nice to feel again like if something were to go wrong I could feel comfortable in calling RMAP.
Sean
Anyway, two days ago a friend of mine (RMAP patient) started experiencing strong pain in her rib area. Yesterday she called RMAP and talked to Carly. Carly contacted Dr. Smith and Dr. Smith talked to her and she ended up going to the hospital where they operated and fixed the problem (I won't get too detailed because that's her story to tell). Anyway, as she related this story to me, I thought about what I would do if in the same position. Due to this situation, I don't know whereas I would be comfortable calling RMAP which irritates me. It irritates me because I had no malicious intent at relating my negative experience. I didn't even think it was that much of a negative experience. It was just relevant to the conversation going on in the forum at the time and fit the topic of the post which was saying that the one area RMAP could improve in was customer service. I stated in that post, however, how great I think RMAP is.
Oh well. Hopefully I'll hear from Ray and this issue can become a thing of the past. It would be nice to feel again like if something were to go wrong I could feel comfortable in calling RMAP.
Sean
Plastic Surgery
I'm getting excited about my upcoming plastic surgery with Dr. Scott Haupt. I'm going to have to stage this into two separate operations but the first is going to be the most extensive and do, in a way, the more exciting of the two. This first one will remove the excess skin from my upper arms, thighs and abdomen. Yay!!!!
I'm so excited that I can't even explain it. I can't wait until I can come back and leave a post tell you all about it and how I feel about having a flat stomach (without excess skin) for the first time ever).
Stay tuned!
I'm so excited that I can't even explain it. I can't wait until I can come back and leave a post tell you all about it and how I feel about having a flat stomach (without excess skin) for the first time ever).
Stay tuned!
Tuesday, March 3, 2009
Food Labels
So here's something new I recently learned:
Because I have made a conscious decision to learn how many carbs, proteins, sugars, fats, calories and dietary fiber is in everything I eat, looking at labels now helps me get past cravings. For example, the other day I was at the store. Before check out, I noticed I was hungry. In fact, I was starving. At the check stand I almost bought potato chips or some candy. It was obvious to me that my blood sugar level was low. I almost bought several different things. Why didn't I? I'd like to say it's because my will power is so strong but that's not it.
I didn't buy them because after each one I picked up, I read the label. When I realized the serving size and how many calories, carbs, sugars, fat were in them, I found myself thinking that if I ate that one thing, it would throw my entire day off. That thought process had me putting the items back and instead thinking of what I could eat -- and it ended up being a lot better for me.
So don't buy into it when you hear people tell you that they don't want or need to pay that close attention to those things. It does help. Perhaps not today but you never know when down the road it will help. A mental food journal or a written one. If you don't do it already, start today.
Sean
Because I have made a conscious decision to learn how many carbs, proteins, sugars, fats, calories and dietary fiber is in everything I eat, looking at labels now helps me get past cravings. For example, the other day I was at the store. Before check out, I noticed I was hungry. In fact, I was starving. At the check stand I almost bought potato chips or some candy. It was obvious to me that my blood sugar level was low. I almost bought several different things. Why didn't I? I'd like to say it's because my will power is so strong but that's not it.
I didn't buy them because after each one I picked up, I read the label. When I realized the serving size and how many calories, carbs, sugars, fat were in them, I found myself thinking that if I ate that one thing, it would throw my entire day off. That thought process had me putting the items back and instead thinking of what I could eat -- and it ended up being a lot better for me.
So don't buy into it when you hear people tell you that they don't want or need to pay that close attention to those things. It does help. Perhaps not today but you never know when down the road it will help. A mental food journal or a written one. If you don't do it already, start today.
Sean
Meredith's Phone Call
Meredith called me this afternoon. We had an interesting phone conversation. Meredith is nice but nothing has changed in her stance or the stance of Rocky Mountain Associated Physician. A quick review:
RMAP believes that I slandered Carly. They state that it is okay to have freedom of expression on their board but apparently when you have that freedom of expression and actually name one of their employees, that's not okay. Nevermind that the post was not a personal attack, but rather me just relating an example where I was frustrated with the customer service of RMAP (like those who had been talking in the forum). I specifically stated in that post (at the end) that I thought highly of RMAP but hoped they would get better at customer service. There was no slander about it. As stated before, here's the definition of slander:
"a malicious, false, and defamatory statement or report: a slander against his good name."
The key here is "false." To be slander, it has to be false. I posted a true story and related my feelings to what happened. Meredith believes that could have been handled behind the scenes. Could it have been? I don't know. Who would I have talked to about it. I can't talk about it now as everyone at RMAP believes Carly's version of the story and certainly don't appear to give any weight to my version. To this date I have never heard one person say "I understand that you just wanted to know if Dr. Smith needed to see you based on his statement 'check back with me in six months.' I understand that you didn't need or really want an appointment unless Dr. Smith determined he really wanted to see you. I apologize that Dr. Smith wasn't consulted as to whether he needed to see you." No. All I continue to get is "Carly was just trying to tell you that you needed to make an appointment to see Dr. Smith." I know. That wasn't what I was asking her then and it's still not what I'm asking (nor is it the story I continue to tell). *sigh*
Anyway, Meredith believes in the above. That's fine. I believe things should be taken in proper context and this totally wasn't. Anyway, Meredith states that an email was sent to me saying that to be reinstated to the board, I would have to write a letter of apology to the surgeons. You have got to be kidding me!! An apology for what? For relating a true happening and openly hoping that it wouldn't happen again?
Okay. So I told Meredith that if she wanted a letter of apology that I would be willing to write one BUT Carly needed to provide me with one as well. Well, let's just say that's not going to happen. Meredith wants RMAP's apology for the incident to be her phone call to me. Okay, well then my apology should be able to be had over the phone as well. You want it in writing, I want one in writing. After all, I didn't create this situation myself -- in fact, I was trying to help when I wrote my post. I certainly didn't expect someone to decide it was a personal attack.
It became obvious on the phone call that Meredith and I weren't going to cover any ground that we hadn't already covered in email. Meredith and RMAP are unwilling to admit that they did anything wrong in regards to this incident. Meredith said that she did not call me evil. This is true. She didn't. But she and Carly make me feel like a criminal and she is trying to mete out some type of punishment in order to make it all better.
So what it comes down to is this: I basically admit that the entire incident is my fault and write a letter of apology to the RMAP surgeons and I can be reinstated to the message boards. Ummm... am I the only one who sees a problem here? By the way, I still find the whole issue of "resolution" to be interesting. So in our email exchanges before, I was told that Meredith's offer to resolve the situation was that I stop posting negative things about Carly. I have NOTHING against Carly. I never did. I actually think Carly is nice though I wish she had taken the time to listen to what I was saying. But how is it a resolution, as Meredith stated on the phone, that if I stop saying negative things about Carly that RMAP will move on and forget the incident? Hmmm. I don't know about you but to me resolution means that when I carry out my side, then the ban is removed. At least that was the assumption I made.
And I thought I was clear but apparently I wasn't. My entire reason for contacting Meredith was to rectify this situation and get things back to where they were. Why? Because of all the wonderful RMAP patients who reached out to me via email and my blog. Those who reached out to me on obesityhelp.com, those who have my cell phone and call me for advice. And those who have formed a help group on Facebook. I love being able to help all of them with personal experiences, things I've learned, etc. RMAP's message board was an easy way to do that. Why else would I reach out?
Anyway, like I said, I believe Meredith's goal was admirable but if RMAP isn't willing to admit to any kind of wrong doing here, then I'm not interested. If Carly wants to deliver a personal apology to me, I am more than willing to deliver a personal apology to everyone within RMAP. If they want me to stop writing about the incident and let bygones be bygones and put things back how they were before the incident, I'm good with that too. But to ask me to say I was the only person who did anything wrong is ridiculous and it isn't going to happen. Because it's not true. My intent with the offending post was not malicious, it was not slanderous, and it was not even detrimental to RMAP. What has been done to me, however...
Anyway, Meredith stated that Ray, the office manager will call me since her and I can't seem to find middle ground. I hope he does but somehow I think he won't. We'll see. Stay tuned. I would like to work this out but I'm not willing to sell my soul for it.
Sean
RMAP believes that I slandered Carly. They state that it is okay to have freedom of expression on their board but apparently when you have that freedom of expression and actually name one of their employees, that's not okay. Nevermind that the post was not a personal attack, but rather me just relating an example where I was frustrated with the customer service of RMAP (like those who had been talking in the forum). I specifically stated in that post (at the end) that I thought highly of RMAP but hoped they would get better at customer service. There was no slander about it. As stated before, here's the definition of slander:
"a malicious, false, and defamatory statement or report: a slander against his good name."
The key here is "false." To be slander, it has to be false. I posted a true story and related my feelings to what happened. Meredith believes that could have been handled behind the scenes. Could it have been? I don't know. Who would I have talked to about it. I can't talk about it now as everyone at RMAP believes Carly's version of the story and certainly don't appear to give any weight to my version. To this date I have never heard one person say "I understand that you just wanted to know if Dr. Smith needed to see you based on his statement 'check back with me in six months.' I understand that you didn't need or really want an appointment unless Dr. Smith determined he really wanted to see you. I apologize that Dr. Smith wasn't consulted as to whether he needed to see you." No. All I continue to get is "Carly was just trying to tell you that you needed to make an appointment to see Dr. Smith." I know. That wasn't what I was asking her then and it's still not what I'm asking (nor is it the story I continue to tell). *sigh*
Anyway, Meredith believes in the above. That's fine. I believe things should be taken in proper context and this totally wasn't. Anyway, Meredith states that an email was sent to me saying that to be reinstated to the board, I would have to write a letter of apology to the surgeons. You have got to be kidding me!! An apology for what? For relating a true happening and openly hoping that it wouldn't happen again?
Okay. So I told Meredith that if she wanted a letter of apology that I would be willing to write one BUT Carly needed to provide me with one as well. Well, let's just say that's not going to happen. Meredith wants RMAP's apology for the incident to be her phone call to me. Okay, well then my apology should be able to be had over the phone as well. You want it in writing, I want one in writing. After all, I didn't create this situation myself -- in fact, I was trying to help when I wrote my post. I certainly didn't expect someone to decide it was a personal attack.
It became obvious on the phone call that Meredith and I weren't going to cover any ground that we hadn't already covered in email. Meredith and RMAP are unwilling to admit that they did anything wrong in regards to this incident. Meredith said that she did not call me evil. This is true. She didn't. But she and Carly make me feel like a criminal and she is trying to mete out some type of punishment in order to make it all better.
So what it comes down to is this: I basically admit that the entire incident is my fault and write a letter of apology to the RMAP surgeons and I can be reinstated to the message boards. Ummm... am I the only one who sees a problem here? By the way, I still find the whole issue of "resolution" to be interesting. So in our email exchanges before, I was told that Meredith's offer to resolve the situation was that I stop posting negative things about Carly. I have NOTHING against Carly. I never did. I actually think Carly is nice though I wish she had taken the time to listen to what I was saying. But how is it a resolution, as Meredith stated on the phone, that if I stop saying negative things about Carly that RMAP will move on and forget the incident? Hmmm. I don't know about you but to me resolution means that when I carry out my side, then the ban is removed. At least that was the assumption I made.
And I thought I was clear but apparently I wasn't. My entire reason for contacting Meredith was to rectify this situation and get things back to where they were. Why? Because of all the wonderful RMAP patients who reached out to me via email and my blog. Those who reached out to me on obesityhelp.com, those who have my cell phone and call me for advice. And those who have formed a help group on Facebook. I love being able to help all of them with personal experiences, things I've learned, etc. RMAP's message board was an easy way to do that. Why else would I reach out?
Anyway, like I said, I believe Meredith's goal was admirable but if RMAP isn't willing to admit to any kind of wrong doing here, then I'm not interested. If Carly wants to deliver a personal apology to me, I am more than willing to deliver a personal apology to everyone within RMAP. If they want me to stop writing about the incident and let bygones be bygones and put things back how they were before the incident, I'm good with that too. But to ask me to say I was the only person who did anything wrong is ridiculous and it isn't going to happen. Because it's not true. My intent with the offending post was not malicious, it was not slanderous, and it was not even detrimental to RMAP. What has been done to me, however...
Anyway, Meredith stated that Ray, the office manager will call me since her and I can't seem to find middle ground. I hope he does but somehow I think he won't. We'll see. Stay tuned. I would like to work this out but I'm not willing to sell my soul for it.
Sean
Monday, March 2, 2009
My Response to Meredith
Meredith.
I was unable to respond to your call/voicemail today because I am out of the state on business. In fact, I just got back to the hotel room. But from the sounds of your email it doesn't sound like I need to call you tomorrow. Like your other emails, it appears you're being very biased on this subject and though you're being relatively nice in your emails, I fail to see where you're offering any type of resolution.
What I would like to point out is that this isn't about me, it isn't about Carly. It's about RMAP. My post that I got banned for wasn't about me, it wasn't about Carly. It was a request for RMAP to get better in a certain area. This is a complaint brought up by many patients and has been sooooo evident. The post was left out of a desire for RMAP to get better and to be the best. Carly took it personal and there was no reason to. But that's not how you choose to see it though many many patients read that and agree with that.
However, I'm glad you have a flood of anger and are upset by my words. Perhaps that finally gives you insight into my situation. Here for over 18 months I spent my free time to give back to RMAP, to be there for their patients, to give back because of this gift I was given. I defended the RMAP surgeons when they were attacked by patients on the message boards, I soothed things over when former patients complained about how horrible gastric bypass surgery was to them or when they complained about the educational program, how they felt the $500 educational fee was a waste or how unresponsive they felt the office was. I have carried the RMAP flag higher than was ever expected of me and drove as many patients to RMAP as possible.
Then I had a negative experience with Carly. I didn't say anything for a long time then it became relevant in a post. The whole point of the post was not to degrade Carly. You never read the post. If you had, you would have seen that I merely suggested that RMAP could improve on the customer service side. Yes if I was Carly that would have been hard to take but I would never have banned anyone for relaying a negative experience and their perception. I wouldn't try to call it slander when it doesn't come close to the definition of the word. I would have taken a hard look at the experience, perhaps talked to the person if necessary, maybe even addressed it. I wouldn't have run from it. But that's just me.
You never, in any of your emails to me stated that RMAP wanted a letter of apology. And honestly Meredith, the situation between Carly and I was the banning from the boards. You offered a resolution to that. Offering a resolution means that if one side follows through on their side of things, the other side does as well. So please... don't say that you followed through on yours. I made it clear in my initial email that I was addressing the ban from the message boards. You offered a resolution that I accepted. You reneged. It's as simple as that. If you want to talk about slander, how about the slander that RMAP has thrown my way? You accepting Carly's version of what happened without reading the emails other patients have left about it stating quite the opposite or even reading the post in and of itself. And did you expect that by telling me that Carly is the victim and I'm some hate mongering individual who is into slander was not going to offend me? Much like you, I've tried to keep the anger out of it.
I reached out to you in hopes that this situation could be resolved. Your proposed resolution was fine. I wanted to just let bygones be bygones and go back to flying the RMAP colors. But I guess that isnt' good enough. Now you want to exact a piece of flesh. I'm sorry but I've given up the days of when I was willing to let people walk over me. I am owed a written apology from Carly that specifically lets me know she understands what she is apologizing for. If I get that, I would be more than willing to provide a written apology to the surgeons and Carly herself and spend my days praising everyone at RMAP. But since that isn't going to happen, I don't have to worry about that, do I? Right. Because neither you nor Carly believe there is any wrongdoing on your part.
You are always welcome to call me. If I am able to answer, I'm always willing to talk. But if this is just going to spin wheels, then I'm not interested. I am active in the legislature and the medical community with gastric bypass and trying to get more insurances to pay for it (through passed bills, etc). I actively offer support of past patients and love it. If it's not going to be through the RMAP board, it will be somewhere.
I do not feel it is appropriate to ask a patient to apologize for relaying a true story and voicing his/her frustrations. It also isn't appropriate to label that patient as a slanderer. It's obvious how RMAP has positioned themselves. If I felt that it would do any good to talk to you about this on the phone, I would. But at this point I don't see how the two sides are able reconcile. Your resolution was for me not to say anything negative about Carly anymore. I agreed. The fact that you offered a "resolution" to the situation implies that any punishment would be rescinded. It was not. It is obvious that you feel that I owe an apology. I personally believe that I have been unjustly vilified and that I am owed an apology for having been put in this position and being slandered myself (and in this case the word fits).
I am sad to see RMAP take this position. I was certainly willing to work with RMAP and try to make some good will out of this. I am a big believer in the gastric bypass surgery and I am a huge advocate in the legislative sessions as we try to pass bills that will cause the insurance companies to pay for this surgery whenever medically necessary and I also, through my mother's past connections as well as my own, work within the medical community. I am reaching out to more and more obese people and past patients every day and I do give recommends. I would have always preferred those recommends be to RMAP but I cannot in good conscience continue to recommend anyone to a practice that condones this type of action. A practice should not fear its shortcomings but rather should realize that all practices have flaws and that bringing those flaws into light allow that practice to grow and become greater and stronger than before. If RMAP is not willing to do that, if they seek to always hide anything negative, no matter how true it might be, then it is not the practice that I thought it was.
Take care Meredith. Contrary to what you might believe, I harbor no ill will. It was my hope that you would come into this situation unbiased and allow a peaceful compromise take place between myself and Carly that would allow me to continue to help RMAP patients as I have tried to do for well over a year. I am somewhat dismayed that my efforts will need to take a different direction now. Please let your surgeons know that I will always speak very highly of them but that this situation makes it impossible for me to recommend their practice.
Thanks.
Sean
I was unable to respond to your call/voicemail today because I am out of the state on business. In fact, I just got back to the hotel room. But from the sounds of your email it doesn't sound like I need to call you tomorrow. Like your other emails, it appears you're being very biased on this subject and though you're being relatively nice in your emails, I fail to see where you're offering any type of resolution.
What I would like to point out is that this isn't about me, it isn't about Carly. It's about RMAP. My post that I got banned for wasn't about me, it wasn't about Carly. It was a request for RMAP to get better in a certain area. This is a complaint brought up by many patients and has been sooooo evident. The post was left out of a desire for RMAP to get better and to be the best. Carly took it personal and there was no reason to. But that's not how you choose to see it though many many patients read that and agree with that.
However, I'm glad you have a flood of anger and are upset by my words. Perhaps that finally gives you insight into my situation. Here for over 18 months I spent my free time to give back to RMAP, to be there for their patients, to give back because of this gift I was given. I defended the RMAP surgeons when they were attacked by patients on the message boards, I soothed things over when former patients complained about how horrible gastric bypass surgery was to them or when they complained about the educational program, how they felt the $500 educational fee was a waste or how unresponsive they felt the office was. I have carried the RMAP flag higher than was ever expected of me and drove as many patients to RMAP as possible.
Then I had a negative experience with Carly. I didn't say anything for a long time then it became relevant in a post. The whole point of the post was not to degrade Carly. You never read the post. If you had, you would have seen that I merely suggested that RMAP could improve on the customer service side. Yes if I was Carly that would have been hard to take but I would never have banned anyone for relaying a negative experience and their perception. I wouldn't try to call it slander when it doesn't come close to the definition of the word. I would have taken a hard look at the experience, perhaps talked to the person if necessary, maybe even addressed it. I wouldn't have run from it. But that's just me.
You never, in any of your emails to me stated that RMAP wanted a letter of apology. And honestly Meredith, the situation between Carly and I was the banning from the boards. You offered a resolution to that. Offering a resolution means that if one side follows through on their side of things, the other side does as well. So please... don't say that you followed through on yours. I made it clear in my initial email that I was addressing the ban from the message boards. You offered a resolution that I accepted. You reneged. It's as simple as that. If you want to talk about slander, how about the slander that RMAP has thrown my way? You accepting Carly's version of what happened without reading the emails other patients have left about it stating quite the opposite or even reading the post in and of itself. And did you expect that by telling me that Carly is the victim and I'm some hate mongering individual who is into slander was not going to offend me? Much like you, I've tried to keep the anger out of it.
I reached out to you in hopes that this situation could be resolved. Your proposed resolution was fine. I wanted to just let bygones be bygones and go back to flying the RMAP colors. But I guess that isnt' good enough. Now you want to exact a piece of flesh. I'm sorry but I've given up the days of when I was willing to let people walk over me. I am owed a written apology from Carly that specifically lets me know she understands what she is apologizing for. If I get that, I would be more than willing to provide a written apology to the surgeons and Carly herself and spend my days praising everyone at RMAP. But since that isn't going to happen, I don't have to worry about that, do I? Right. Because neither you nor Carly believe there is any wrongdoing on your part.
You are always welcome to call me. If I am able to answer, I'm always willing to talk. But if this is just going to spin wheels, then I'm not interested. I am active in the legislature and the medical community with gastric bypass and trying to get more insurances to pay for it (through passed bills, etc). I actively offer support of past patients and love it. If it's not going to be through the RMAP board, it will be somewhere.
I do not feel it is appropriate to ask a patient to apologize for relaying a true story and voicing his/her frustrations. It also isn't appropriate to label that patient as a slanderer. It's obvious how RMAP has positioned themselves. If I felt that it would do any good to talk to you about this on the phone, I would. But at this point I don't see how the two sides are able reconcile. Your resolution was for me not to say anything negative about Carly anymore. I agreed. The fact that you offered a "resolution" to the situation implies that any punishment would be rescinded. It was not. It is obvious that you feel that I owe an apology. I personally believe that I have been unjustly vilified and that I am owed an apology for having been put in this position and being slandered myself (and in this case the word fits).
I am sad to see RMAP take this position. I was certainly willing to work with RMAP and try to make some good will out of this. I am a big believer in the gastric bypass surgery and I am a huge advocate in the legislative sessions as we try to pass bills that will cause the insurance companies to pay for this surgery whenever medically necessary and I also, through my mother's past connections as well as my own, work within the medical community. I am reaching out to more and more obese people and past patients every day and I do give recommends. I would have always preferred those recommends be to RMAP but I cannot in good conscience continue to recommend anyone to a practice that condones this type of action. A practice should not fear its shortcomings but rather should realize that all practices have flaws and that bringing those flaws into light allow that practice to grow and become greater and stronger than before. If RMAP is not willing to do that, if they seek to always hide anything negative, no matter how true it might be, then it is not the practice that I thought it was.
Take care Meredith. Contrary to what you might believe, I harbor no ill will. It was my hope that you would come into this situation unbiased and allow a peaceful compromise take place between myself and Carly that would allow me to continue to help RMAP patients as I have tried to do for well over a year. I am somewhat dismayed that my efforts will need to take a different direction now. Please let your surgeons know that I will always speak very highly of them but that this situation makes it impossible for me to recommend their practice.
Thanks.
Sean
New Email from Meredith
Meredith called and left me a voicemail today. I was unable to take the call or return her call today because of work but after her email (see below), I don't see any reason for making that call. I'll post my reply after this but it's obvious that this is going nowhere. It's sad. It would have been nice to have resolved this and let bygones be bygones but oh well. (btw, let me ask you, when the "banning" is the issue and someone offers a resolution, wouldn't you think that implies a reversal of the banning? As you read Meredith's email, ask yourself that question).
Sean,
I called you and left a voicemail today wanting to speak with you regarding our current miscommunications. I would prefer to speak over the phone or in our office; however, it appears e-mail is your correspondence medium of choice.
First of all, I really appreciate the second follow-up e-mail to your previous one this morning. I feel I must speak honestly and I need to let you know I was quite offended by your words. I feel I have been trying my absolute hardest to appease the situation and keep anger at bay. I hope you can recognize that.
Second of all, it appears some mind-reading has been occurring on both of our parts. In my resolution with Carley, nowhere did I state part of the deal was to reinstate you to the boards. I apologize if you ever felt differently. When you offered your help to current and future RMAP patients, I assumed you meant in a different educational capacity, i.e. support group. It appears when you offered your services to us, you meant to be reinstated to the boards. This is a miscommunication that I do hope we can resolve.
In your previous contact with RMAP, we made it clear to you that in order for forum reinstatement to occur, a letter of apology addressed to the surgeons would be necessary. Because that has not happened, we must still stand by our decision to not allow you to post on our forums. I know this is difficult for you, and is not the resolution you were hoping for; please know I understand that.
I feel I have very much so stood by my word, as RMAP has moved on from the situation. I do not see where we have fallen short of that promise. I also do not see how I have pushed you away, as I gladly accepted your offer to help RMAP patients in the future in my very first e-mail to you. Again, I apologize for that miscommunication.
We have support group every month and I do not see a better place to start helping RMAP patients than our support group. Your $500 fee for education goes to support group; it is up to you whether or not you utilize the resource.
Due to our history of misunderstanding one another through e-mail, I recommend that we either speak over the phone or in person to further resolve the issue, if you would like.
Thank you,
Meredith, RN
Education Director
Sean,
I called you and left a voicemail today wanting to speak with you regarding our current miscommunications. I would prefer to speak over the phone or in our office; however, it appears e-mail is your correspondence medium of choice.
First of all, I really appreciate the second follow-up e-mail to your previous one this morning. I feel I must speak honestly and I need to let you know I was quite offended by your words. I feel I have been trying my absolute hardest to appease the situation and keep anger at bay. I hope you can recognize that.
Second of all, it appears some mind-reading has been occurring on both of our parts. In my resolution with Carley, nowhere did I state part of the deal was to reinstate you to the boards. I apologize if you ever felt differently. When you offered your help to current and future RMAP patients, I assumed you meant in a different educational capacity, i.e. support group. It appears when you offered your services to us, you meant to be reinstated to the boards. This is a miscommunication that I do hope we can resolve.
In your previous contact with RMAP, we made it clear to you that in order for forum reinstatement to occur, a letter of apology addressed to the surgeons would be necessary. Because that has not happened, we must still stand by our decision to not allow you to post on our forums. I know this is difficult for you, and is not the resolution you were hoping for; please know I understand that.
I feel I have very much so stood by my word, as RMAP has moved on from the situation. I do not see where we have fallen short of that promise. I also do not see how I have pushed you away, as I gladly accepted your offer to help RMAP patients in the future in my very first e-mail to you. Again, I apologize for that miscommunication.
We have support group every month and I do not see a better place to start helping RMAP patients than our support group. Your $500 fee for education goes to support group; it is up to you whether or not you utilize the resource.
Due to our history of misunderstanding one another through e-mail, I recommend that we either speak over the phone or in person to further resolve the issue, if you would like.
Thank you,
Meredith, RN
Education Director
Email (Meredith from RMAP)
Aha! So I was able to retrieve the email Meredith at Rocky Mountain Associated Physicians sent me. It is a rather nice email but I would like to point out for those of you who have read all the emails, the resolution was aimed at getting me back on the RMAP message board. RMAP did move on but they did not hold up their end of the resolution. I am still effectively banned from their message board. I'm not a big fan of those who do not hold up to their word.
Sean,
Thank you for your e-mail. It appears some miscommunication has occurred between our correspondences. First of all, I appreciate your willingness to accept my proposed resolution offer; furthermore, I have appreciated your efforts in following through with the aforementioned resolution with Carley and RMAP. However, I felt your e-mails in response to my initial e-mail carried a feeling of aggression and argument. I did not feel a response from me would prove productive, as one or the other, would find fault and/or offense would be taken. Hence, RMAP has done our part in accepting and following through on our end of the deal. We have, in fact, moved on.
I apologize if you felt we did not appreciate your offer to help current and future RMAP patients; I currently did not have immediate need to implement you into our educational system. I currently have several patients who are involved with support for our patients; however, that certainly did not mean I would never have need of you. I lament your decision to hastily offer your services to Dr. Cottam, as I had been brainstorming how to best utilize your experiences and I was looking forward to using you this summer in our support groups. Nonetheless, I wish you best of luck with sharing your experiences to the rest of the world. Whether it is through RMAP, Salt Lake Regional, or any other weight loss medium, you, along with many other successful weight loss surgery patients, possess a unique perspective and I am happy you are so willing to share it.
I do hope your efforts in reaching out to Dr. Cottam will not inhibit your follow-up care with us here at RMAP. We want to ensure your optimum health through yearly visits and annual blood work. Please do not hesitate to contact us with any further questions.
Wishing you all the best,
Meredith, RN
Education Director
Sean,
Thank you for your e-mail. It appears some miscommunication has occurred between our correspondences. First of all, I appreciate your willingness to accept my proposed resolution offer; furthermore, I have appreciated your efforts in following through with the aforementioned resolution with Carley and RMAP. However, I felt your e-mails in response to my initial e-mail carried a feeling of aggression and argument. I did not feel a response from me would prove productive, as one or the other, would find fault and/or offense would be taken. Hence, RMAP has done our part in accepting and following through on our end of the deal. We have, in fact, moved on.
I apologize if you felt we did not appreciate your offer to help current and future RMAP patients; I currently did not have immediate need to implement you into our educational system. I currently have several patients who are involved with support for our patients; however, that certainly did not mean I would never have need of you. I lament your decision to hastily offer your services to Dr. Cottam, as I had been brainstorming how to best utilize your experiences and I was looking forward to using you this summer in our support groups. Nonetheless, I wish you best of luck with sharing your experiences to the rest of the world. Whether it is through RMAP, Salt Lake Regional, or any other weight loss medium, you, along with many other successful weight loss surgery patients, possess a unique perspective and I am happy you are so willing to share it.
I do hope your efforts in reaching out to Dr. Cottam will not inhibit your follow-up care with us here at RMAP. We want to ensure your optimum health through yearly visits and annual blood work. Please do not hesitate to contact us with any further questions.
Wishing you all the best,
Meredith, RN
Education Director
Review: Rocky Mountain Associated Physicians and Surgical Weight Loss Center of Utah
Okay, so as stated before, I wrote Meredith to ask what the deal was with Rocky Mountain Associated Physicians (RMAP). I was going to post her response on here but it went to my spam folder and for some reason yahoo deleted it. I can't find it any longer. However, it basically stated that my response to her was aggressive and confrontational and so RMAP decided not to respond to me and to move on.
I posted the entire email exchange here in my blog. As you have read, all I did was to express my disappointment in her bias and to express my perspective since I was basically being told that I was this horrid person. I stated in that same email, over and over again, that I held no negative feelings towards RMAP or Carly and expressed my desire to resolve the situation.
Apparently, Meredith didn't like me giving my perspective. So it's okay for them to tell me how evil and inappropriate I am but I'm not allowed to have my own views. I'm supposed to let them tell me every little thing they don't like about me but I'm not afforded the same freedom -- lest I be banned. Hmmmmm. Well, I'm sorry. I made the effort to make nice with RMAP but this is indicitive of what they do. This is why their surgeons are great but the rest of their practice sucks.
So I'll say it here. I won't recommend RMAP to anyone. The surgeons are top notch but the $500 educational fee is a joke, the education part of their practice is a joke and the fact that they ban patients rather than deal with someone like Carly (I've heard from 12 of you to date -- thank you for relaying your negative experiences with her) they turn a blind eye.
I don't ever regret the surgery. I never will. But if I had to do it again, even knowing Dr. Smith the way I do, I would be hard pressed wanting to have the surgery with RMAP. Especially knowing that Dr. Cottam and his group is a Center of Excellence that is actually thought of in a better light than RMAP.
So if you're thinking of bariatric surgery, my recommendation is to go to the Surgical Weight Loss Center of Utah. Dr. Cottam and his group will treat you much better than RMAP and the surgeons there are also top notch. The number to the Surgical Weight Loss Center of Utah is 801.746.2885. Trust me, the surgeons there are the equal of those at Rocky Mountain Associated Physicians but the overall customer care experience is much greater at Surgical Weight Loss Center of Utah and you'll want that. I promise.
Email me if you have any questions.
Sean
I posted the entire email exchange here in my blog. As you have read, all I did was to express my disappointment in her bias and to express my perspective since I was basically being told that I was this horrid person. I stated in that same email, over and over again, that I held no negative feelings towards RMAP or Carly and expressed my desire to resolve the situation.
Apparently, Meredith didn't like me giving my perspective. So it's okay for them to tell me how evil and inappropriate I am but I'm not allowed to have my own views. I'm supposed to let them tell me every little thing they don't like about me but I'm not afforded the same freedom -- lest I be banned. Hmmmmm. Well, I'm sorry. I made the effort to make nice with RMAP but this is indicitive of what they do. This is why their surgeons are great but the rest of their practice sucks.
So I'll say it here. I won't recommend RMAP to anyone. The surgeons are top notch but the $500 educational fee is a joke, the education part of their practice is a joke and the fact that they ban patients rather than deal with someone like Carly (I've heard from 12 of you to date -- thank you for relaying your negative experiences with her) they turn a blind eye.
I don't ever regret the surgery. I never will. But if I had to do it again, even knowing Dr. Smith the way I do, I would be hard pressed wanting to have the surgery with RMAP. Especially knowing that Dr. Cottam and his group is a Center of Excellence that is actually thought of in a better light than RMAP.
So if you're thinking of bariatric surgery, my recommendation is to go to the Surgical Weight Loss Center of Utah. Dr. Cottam and his group will treat you much better than RMAP and the surgeons there are also top notch. The number to the Surgical Weight Loss Center of Utah is 801.746.2885. Trust me, the surgeons there are the equal of those at Rocky Mountain Associated Physicians but the overall customer care experience is much greater at Surgical Weight Loss Center of Utah and you'll want that. I promise.
Email me if you have any questions.
Sean
Sunday, March 1, 2009
Music
BTW, (off the WLS subject for a second), samples of my music are here on my blog. I'm always looking for new music so if you like the music you hear here, please let me know what other types of songs in this vein that you are listening to. You can find my email address by accessing my profile.
And, just so you know, I never, ever get tired of hearing "Supermassive Black Hole" by Muse.
Sean
And, just so you know, I never, ever get tired of hearing "Supermassive Black Hole" by Muse.
Sean
Email to Meredith at RMAP
Just wanted to share the email I sent to Meredith this morning:
Meredith.
I appreciate the time you took to respond initially to me on February 6, 2009. I also appreciate the offer of resolving the minor issue that existed between myself and Carly. As stated, I have nothing against Carly or RMAP. However, though I accepted your offer and have done my part (not saying anything that could be considered even slightly negative regarding Carly or RMAP), it appears the issue has not been resolved (or let go) from the RMAP side.
I have a big need to give back and share my 250 lbs loss with others who are contemplating or just beginning the journey. My blog, the RMAP facebook group and obesityhelp.com has allowed me to reach out to many former RMAP patients who were negatively affected by my ban from the RMAP board and a few others but my intention at reaching out to you initially (as I stated) was to increase my ability to give back, to share with others everything I have learned and help them be as successful as I have been. Since RMAP has made it obvious they have no need/desire to make use of me and my experiences to help their current and future patients, I have reached out to Dr. Cottam and his weight loss group.
As the other center of excellence here in Utah, I will be able to give back to their large patient group. This was a hard decision for me as my mother has a huge connection to RMAP surgeons (Dr. Smith, Dr. Halverson) as well as with Paula. I will always hold a soft spot for RMAP but life's too short to push for something RMAP obviously doesn't want.
Thanks for your time. And I do wish you and RMAP all the best.
Sean
Meredith.
I appreciate the time you took to respond initially to me on February 6, 2009. I also appreciate the offer of resolving the minor issue that existed between myself and Carly. As stated, I have nothing against Carly or RMAP. However, though I accepted your offer and have done my part (not saying anything that could be considered even slightly negative regarding Carly or RMAP), it appears the issue has not been resolved (or let go) from the RMAP side.
I have a big need to give back and share my 250 lbs loss with others who are contemplating or just beginning the journey. My blog, the RMAP facebook group and obesityhelp.com has allowed me to reach out to many former RMAP patients who were negatively affected by my ban from the RMAP board and a few others but my intention at reaching out to you initially (as I stated) was to increase my ability to give back, to share with others everything I have learned and help them be as successful as I have been. Since RMAP has made it obvious they have no need/desire to make use of me and my experiences to help their current and future patients, I have reached out to Dr. Cottam and his weight loss group.
As the other center of excellence here in Utah, I will be able to give back to their large patient group. This was a hard decision for me as my mother has a huge connection to RMAP surgeons (Dr. Smith, Dr. Halverson) as well as with Paula. I will always hold a soft spot for RMAP but life's too short to push for something RMAP obviously doesn't want.
Thanks for your time. And I do wish you and RMAP all the best.
Sean
The Effects of Weight Loss
I was just about to log off my blog when something popped into my head that I wanted to share. What are the biggest changes in my life due to my weight loss? I mean surely weight loss alone can't make my life different, can it? I wanted to take a moment to explore that in my mind and as I do so, I want to capture my thoughts on it for you. Yes, I'm just going to ramble. So consider yourself forewarned *smiles*
1. Movement. I always knew that I'd be able to move better if I lost weight. It wouldn't be as hard to get up off the couch and I wouldn't have to fight to maintain my balance or to push up each stair as I go up them. But I NEVER anticipated the change here. I exalt in the feeling of my muscles now as I move. I want to get out and move. I run up stairs now not for exercise but because I can and it feels GOOD to do so. I park way out in the parking lot at stores because I LOVE to feel my thigh muscles as I stretch them out and walk. This summer will see me at the local high school stadium a lot stretching out and yes, even running. HUGE difference.
2. Reactions. As much as I always wanted to believe there were people out there who treated me as a person despite my weight, I now know for sure what I always suspected... that's not true. Even my best friends treat me different now than they used to -- though they do argue that's not the case. It's even a bigger change with those who are somewhat biased against large people (whether they know it or not). I was almost invisible to them and treated much like you would treat garbage (if you treated garbage in a certain way). Suddenly I am the focus of attention just by walking down the hall at work or the grocery store and flirtations come my way almost every day from all ages. It's fun but it has really surprised me.
3. Past Relationships. I'll be the first one to admit that running across my ex-mother-in-law for Halloween 2007 (six months after surgery), when I was walking to my daughter's Halloween parade at her school was one of my best post-surgery moments. She stopped to cross the street, looked back at me and when she noticed how much weight I'd lost, her jaw literally dropped open. That image is burned on my brain. And now this last weekend when my daughter asked me if coffee causes you to gain weight -- I had to chuckle when she told me my ex-wife is really affected by the 50 lbs she has gained (she used to be super thin). I'm sure it doesn't help whenever she has to see me and the 250 lbs I've now lost. While it ultimately doesn't matter to me these days, it is a bit of a delicious delight.
4. Behavioral Control. There isn't a lot we control in this life other than our behaviors and reactions. Not having control over what I ate, or rather having my body win the battle over my mind in regards to eating and not being able to change that no matter how hard I fought, was one of the most frustrating aspects of my life. That has all changed now. Recently I gained 9 lbs (from 223 lbs to 232 lbs). 230 is my scary weight -- when I start getting concerned. No problem!! I just focused on my water and everything I was eating. I wasn't perfect but I improved a lot and now I'm back to 224 lbs. Yay! Pre-surgery, no way that happens. Post-surgery? Easy!
5. Size does Matter. Oh yes it does. Now I can go to Ballet West, the Capitol Theater, Lagoon, Disneyland, Kingsbury Hall, Energy Solutions Arena, the Venue, etc. because I FIT IN THE SEATS!!!!!!! This also holds true for airplanes (my new job allows me to travel -- I wouldn't have been able to take it before as I couldn't have flown). I've been able to share a lot of things with my daughter, make plans with my daughter, and travel like I've always wanted to -- all because my size is now normal and not 2-3 times bigger.
Oh. And one last thing. Ask yourself this. What was your reason for taking control of your life, having the surgery, and losing the weight? Keep that reason in your head at all times!!!! It's important. It's easy to say you did it for yourself. That's the politically correct thing to say. But let's be honest, that's not the only reason you did it. Here are my reasons:
(1) Because I wanted to improve my health, be happier, and have the life I always dreamed about;
(2) Because I wanted to be the kind of dad for my daughter that I couldn't be with an extra 250 lbs packed onto my body;
(3) Because my failed marriage taught me that I was never going to have the type of relationship I wanted unless I did something.
And now that I've done it. Now that I've lost 250 lbs, you might ask how has that changed how I view those three things.
(1) My blood pressure is better than anyone else at my work. Well within the normal range. My cholesterol is a beautiful thing. I'm healthy, healthy, healthy. And I can feel it. My life is quickly becoming everything I always wanted it to be. I just wish I had done this a long time before I did. At least 8 years before I did. Actually I think if I would have had the surgery 19 years before I did, my life would most certainly have spun off in a different direction. Who knows though if that would have been better or not. I can't know so I just enjoy where I am now. But that would have been interesting, for sure.
(2) I love being able to take my daughter to plays, to amusement parks, hiking/camping, and planning trips with her. I can now be the type of dad I have always wanted to be. It does suck a bit that I only get her 40-45% of the time. I miss her sounds and presence when she's not around. I love hearing her singing and dancing in her room, the "thumps" from upstairs, or the "daddy?!" when she has questions. But that's always the downside to divorce. At least my time with her now is of a high quality. We're always out doing something. This summer I'm going to get her into exercise and that will be yet another thing we can share.
(3) Ah, this is a big one. My ex-wife has a lot of qualities that I still admire to this day but how she was when we met... I never would have had a relationship with her if I'd been healthy. I didn't feel I was going to meet anyone better where I was weight-wise and so I ignored a lot of red flags. Now that I'm dating, I'm finding that I have the ability to make wise choices that aren't based around "what if I never find someone else?" This area is one of the more exciting to me. My self-esteem and self-confidence levels are at an all time high and continuing to increase with every day.
I'm absolutely giddy about where things are headed. I love my job, I'm highly thought of by the C level management at my company, the dating pool is amazingly large, I'm able to enjoy every minute of time with my daughter... things are good. So assuming I don't get hit by a bus tomorrow, I'm looking forward to every minute of every day for the next few decades. So all in all, the weight loss has exceeded every dream that I had of how it would be like if I lost the weight.
1. Movement. I always knew that I'd be able to move better if I lost weight. It wouldn't be as hard to get up off the couch and I wouldn't have to fight to maintain my balance or to push up each stair as I go up them. But I NEVER anticipated the change here. I exalt in the feeling of my muscles now as I move. I want to get out and move. I run up stairs now not for exercise but because I can and it feels GOOD to do so. I park way out in the parking lot at stores because I LOVE to feel my thigh muscles as I stretch them out and walk. This summer will see me at the local high school stadium a lot stretching out and yes, even running. HUGE difference.
2. Reactions. As much as I always wanted to believe there were people out there who treated me as a person despite my weight, I now know for sure what I always suspected... that's not true. Even my best friends treat me different now than they used to -- though they do argue that's not the case. It's even a bigger change with those who are somewhat biased against large people (whether they know it or not). I was almost invisible to them and treated much like you would treat garbage (if you treated garbage in a certain way). Suddenly I am the focus of attention just by walking down the hall at work or the grocery store and flirtations come my way almost every day from all ages. It's fun but it has really surprised me.
3. Past Relationships. I'll be the first one to admit that running across my ex-mother-in-law for Halloween 2007 (six months after surgery), when I was walking to my daughter's Halloween parade at her school was one of my best post-surgery moments. She stopped to cross the street, looked back at me and when she noticed how much weight I'd lost, her jaw literally dropped open. That image is burned on my brain. And now this last weekend when my daughter asked me if coffee causes you to gain weight -- I had to chuckle when she told me my ex-wife is really affected by the 50 lbs she has gained (she used to be super thin). I'm sure it doesn't help whenever she has to see me and the 250 lbs I've now lost. While it ultimately doesn't matter to me these days, it is a bit of a delicious delight.
4. Behavioral Control. There isn't a lot we control in this life other than our behaviors and reactions. Not having control over what I ate, or rather having my body win the battle over my mind in regards to eating and not being able to change that no matter how hard I fought, was one of the most frustrating aspects of my life. That has all changed now. Recently I gained 9 lbs (from 223 lbs to 232 lbs). 230 is my scary weight -- when I start getting concerned. No problem!! I just focused on my water and everything I was eating. I wasn't perfect but I improved a lot and now I'm back to 224 lbs. Yay! Pre-surgery, no way that happens. Post-surgery? Easy!
5. Size does Matter. Oh yes it does. Now I can go to Ballet West, the Capitol Theater, Lagoon, Disneyland, Kingsbury Hall, Energy Solutions Arena, the Venue, etc. because I FIT IN THE SEATS!!!!!!! This also holds true for airplanes (my new job allows me to travel -- I wouldn't have been able to take it before as I couldn't have flown). I've been able to share a lot of things with my daughter, make plans with my daughter, and travel like I've always wanted to -- all because my size is now normal and not 2-3 times bigger.
Oh. And one last thing. Ask yourself this. What was your reason for taking control of your life, having the surgery, and losing the weight? Keep that reason in your head at all times!!!! It's important. It's easy to say you did it for yourself. That's the politically correct thing to say. But let's be honest, that's not the only reason you did it. Here are my reasons:
(1) Because I wanted to improve my health, be happier, and have the life I always dreamed about;
(2) Because I wanted to be the kind of dad for my daughter that I couldn't be with an extra 250 lbs packed onto my body;
(3) Because my failed marriage taught me that I was never going to have the type of relationship I wanted unless I did something.
And now that I've done it. Now that I've lost 250 lbs, you might ask how has that changed how I view those three things.
(1) My blood pressure is better than anyone else at my work. Well within the normal range. My cholesterol is a beautiful thing. I'm healthy, healthy, healthy. And I can feel it. My life is quickly becoming everything I always wanted it to be. I just wish I had done this a long time before I did. At least 8 years before I did. Actually I think if I would have had the surgery 19 years before I did, my life would most certainly have spun off in a different direction. Who knows though if that would have been better or not. I can't know so I just enjoy where I am now. But that would have been interesting, for sure.
(2) I love being able to take my daughter to plays, to amusement parks, hiking/camping, and planning trips with her. I can now be the type of dad I have always wanted to be. It does suck a bit that I only get her 40-45% of the time. I miss her sounds and presence when she's not around. I love hearing her singing and dancing in her room, the "thumps" from upstairs, or the "daddy?!" when she has questions. But that's always the downside to divorce. At least my time with her now is of a high quality. We're always out doing something. This summer I'm going to get her into exercise and that will be yet another thing we can share.
(3) Ah, this is a big one. My ex-wife has a lot of qualities that I still admire to this day but how she was when we met... I never would have had a relationship with her if I'd been healthy. I didn't feel I was going to meet anyone better where I was weight-wise and so I ignored a lot of red flags. Now that I'm dating, I'm finding that I have the ability to make wise choices that aren't based around "what if I never find someone else?" This area is one of the more exciting to me. My self-esteem and self-confidence levels are at an all time high and continuing to increase with every day.
I'm absolutely giddy about where things are headed. I love my job, I'm highly thought of by the C level management at my company, the dating pool is amazingly large, I'm able to enjoy every minute of time with my daughter... things are good. So assuming I don't get hit by a bus tomorrow, I'm looking forward to every minute of every day for the next few decades. So all in all, the weight loss has exceeded every dream that I had of how it would be like if I lost the weight.
Plastic Surgery
Again I have to apologize for taking time away from updates. I've been under the weather. Before surgery I never used to get sick. I have to think that was due to one (or all) of three things: (1) My body had a lot more food to use to keep my body healthy; (2) the extra food and the lack of malabsorption helped my body be able to fend off illness; (3) I was too heavy to do much so I didn't get out and around people who were sick much.
I know it wasn't JUST (3) because I caught my daughter's illness this time and I've always been around her when she was sick (before and after surgery). But the first two times I EVER got a bad case of the flu have been post-surgery. All I can say is "ick!" I feel icky.
Anyway, today I wanted to talk about where I am on this journey. I currently weight 224 lbs. I still can't believe that I'm 250 lbs lighter than I was on April 11, 2007. I still double take whenever I see myself in the mirror. I went in to see the plastic surgeon this past week to discuss removal of my excess skin from my thighs, abdomen, upper arms, back and chest. I've scheduled (within the next couple of months) the first surgery for this. It will include the upper arms, the thighs, and the abdomen. I'm both excited and a bit anxious about this surgery. With any luck by June I'll be loving life.
But here's what I wanted to talk about in regards to that surgery. The timeline for this type of plastic surgery is much the same as it was for gastric bypass. You have to walk a lot after the surgery to avoid blood clots, 5-6 weeks and your surgeon's clearance before you start heavy exercise, and overall it takes about 18 months for 100% recovery -- scars looking their best, skin reattached perfectly, nerves regenerated, etc. So I'm going into it looking at it like 2009 is my plastic surgery year and 2011 is the year when my entire journey will be completely, 100% behind me. I'll be living my life long before 2011 (I already am) but I'm looking forward to the little improvements this is going to make for me with my exercise, etc.
By the way, if you want a plastic surgeon reference, try Dr. Scott Haupt. You can google him. I think he's amazing -- he spends an inordinate amount of time (both he and his patient coordinator Sheri) answering your questions and making sure that you have all your questions answered. If you elect to see him for a free consultation, please let him know you were referred by me.
Anyway, wish me luck.
Sean
I know it wasn't JUST (3) because I caught my daughter's illness this time and I've always been around her when she was sick (before and after surgery). But the first two times I EVER got a bad case of the flu have been post-surgery. All I can say is "ick!" I feel icky.
Anyway, today I wanted to talk about where I am on this journey. I currently weight 224 lbs. I still can't believe that I'm 250 lbs lighter than I was on April 11, 2007. I still double take whenever I see myself in the mirror. I went in to see the plastic surgeon this past week to discuss removal of my excess skin from my thighs, abdomen, upper arms, back and chest. I've scheduled (within the next couple of months) the first surgery for this. It will include the upper arms, the thighs, and the abdomen. I'm both excited and a bit anxious about this surgery. With any luck by June I'll be loving life.
But here's what I wanted to talk about in regards to that surgery. The timeline for this type of plastic surgery is much the same as it was for gastric bypass. You have to walk a lot after the surgery to avoid blood clots, 5-6 weeks and your surgeon's clearance before you start heavy exercise, and overall it takes about 18 months for 100% recovery -- scars looking their best, skin reattached perfectly, nerves regenerated, etc. So I'm going into it looking at it like 2009 is my plastic surgery year and 2011 is the year when my entire journey will be completely, 100% behind me. I'll be living my life long before 2011 (I already am) but I'm looking forward to the little improvements this is going to make for me with my exercise, etc.
By the way, if you want a plastic surgeon reference, try Dr. Scott Haupt. You can google him. I think he's amazing -- he spends an inordinate amount of time (both he and his patient coordinator Sheri) answering your questions and making sure that you have all your questions answered. If you elect to see him for a free consultation, please let him know you were referred by me.
Anyway, wish me luck.
Sean
Sunday, February 22, 2009
Weight Loss / Inches
For those of you who have followed my blog and are familiar with my journey, you know that I got down as low as 223 lbs but have fluctuated in the months since between 225 lbs and 232 lbs. It's been a little frustrating but I owe it to my diet and lack of water on a daily basis.
I really haven't had much weight change since December 2008. However, I did my measurements (waist, thighs, upper arms, neck, chest) in December and measured again just today. I've lost 2 inches in my waist alone. So while the weight hasn't gone down, the inches are still down. And inches are where it's at.
So keep this in mind anytime you hit a plateau. Sometimes the weight stabilizes but the inches continue to drop. Inches are better than weight.
I really haven't had much weight change since December 2008. However, I did my measurements (waist, thighs, upper arms, neck, chest) in December and measured again just today. I've lost 2 inches in my waist alone. So while the weight hasn't gone down, the inches are still down. And inches are where it's at.
So keep this in mind anytime you hit a plateau. Sometimes the weight stabilizes but the inches continue to drop. Inches are better than weight.
How Others See Us / How We See Ourselves
How We See Ourselves
How many of you have lost a ton of weight but your mental image of yourself is still as an overweight person? I know it's still hard for me to wrap my mind around. I find myself still acting (in some ways) lke I did when I was overweight and sometimes thinking others view me as that overweight person.
How Others See Us
Isn't it amazing how others now see/treat us? Now that the weight is gone, suddenly we are more human, we aren't considered the invisibles. Opportunities in all areas of life are not available to us -- opportunities that were not available before. In all the years leading up to this moment, not once did anyone tell me that they thought I was good-looking. Not even when I was married. But since I dropped below the 250 lbs barrier I have had several comments. Wow. How much of a difference that makes. It's much like never being touched by another human being for 10-15 years and then all of a sudden getting a big hug.
Time and new experiences are what will ultimately change our perceptions of ourselves. I've noticed my perception of myself slowly changing over time. It's almost as wonderful as the weight loss journey itself.
Yay!
How many of you have lost a ton of weight but your mental image of yourself is still as an overweight person? I know it's still hard for me to wrap my mind around. I find myself still acting (in some ways) lke I did when I was overweight and sometimes thinking others view me as that overweight person.
How Others See Us
Isn't it amazing how others now see/treat us? Now that the weight is gone, suddenly we are more human, we aren't considered the invisibles. Opportunities in all areas of life are not available to us -- opportunities that were not available before. In all the years leading up to this moment, not once did anyone tell me that they thought I was good-looking. Not even when I was married. But since I dropped below the 250 lbs barrier I have had several comments. Wow. How much of a difference that makes. It's much like never being touched by another human being for 10-15 years and then all of a sudden getting a big hug.
Time and new experiences are what will ultimately change our perceptions of ourselves. I've noticed my perception of myself slowly changing over time. It's almost as wonderful as the weight loss journey itself.
Yay!
Update: Weight
For those of you who have been reading my blog on a regular basis, I altered my diet slightly over the past few days. I got away from eating so much beef jerky and I was really good with my water intake. The result has been shedding the water (finally) that I've been retaining. On the bad side was I was having to visit the restroom every hour for a day but the good news is that I lose 2.2 lbs just yesterday. Yes that means I weighed in at 227 lbs this morning. Yay! Below my scary weight. The funny thing was how all this affected the fitting of my pinkie ring that my daughter gave to me. Whereas it was perfectly snug before, now it's a little big.
I love the control that I have now. I eat like a normal person, can eat pretty much what I want... but now I eat the same portions as everyone else. I now can have conversations with others about how I'm eating and because I no longer have the large amounts of weight, I don't feel self-conscious about having the conversation. Yes, it's all good!
I love the control that I have now. I eat like a normal person, can eat pretty much what I want... but now I eat the same portions as everyone else. I now can have conversations with others about how I'm eating and because I no longer have the large amounts of weight, I don't feel self-conscious about having the conversation. Yes, it's all good!
Saturday, February 21, 2009
New Update
Sorry for the absence but life gets hectic sometimes. I haven't been doing very good on my pledge to stay true to the diet plan. I actually went up to 232 lbs. Started freaking out. 230 is my scary weight so it's been nerve racking to say the least. However, I had two really perfect days (today wasn't but the two days before that) and I weighed yesterday morning at 229 so at least I'm headed in the right direction.
NEW FOODS
Protein Bar. I have a new protein bar. It's a bar put out by Premier Nutrition called "Protein: High Protein Bar" I found it first at Costco for about $1.62 a bar (12 pack). But recently I discovered it at Sam's Club for about $0.94 a bar (15 pack). The bar is bigger (which is good for me because I can eat a lot more now than in the past) but the bar packs 30grams of protein. So I bought four boxes (should keep me for like a month), along with a block of cheese, a lot of beef jerky (peppered) and a bunch of my new yogurt (see below). That plus some veggies should pretty much keep me for a long time. I know, I know. I'm not very creative when it comes to food but the regimen is what works for me.
Yogurt. At first I was in to the Yoplait Light (Thick & Creamy because it has Sucralose instead of Aspartame) but then I discovered Weight Watchers (better tasting, uses Sucralose, and has a bit more protein). However, recently I've moved to Kroger's (only available at Smith's). It's called Carb Master. Stupid name but amazing yogurt. Only 4 grams of carbohydrates and more protein than any other yogurt I've found (and only 1 gram of sugar). It's not as sweet or yummy tasting as those other ones but now I don't cringe when I eat yogurt.
Okay.. there you have it. My update. More later. Thanks to everyone who has written me to let me know how they are doing. I appreciate it. Also I haven't heard from Meredith at RMAP since I accepted her resolution to my situation with Carly. I have nothing against anyone at RMAP, I really wish they could say the same.
NEW FOODS
Protein Bar. I have a new protein bar. It's a bar put out by Premier Nutrition called "Protein: High Protein Bar" I found it first at Costco for about $1.62 a bar (12 pack). But recently I discovered it at Sam's Club for about $0.94 a bar (15 pack). The bar is bigger (which is good for me because I can eat a lot more now than in the past) but the bar packs 30grams of protein. So I bought four boxes (should keep me for like a month), along with a block of cheese, a lot of beef jerky (peppered) and a bunch of my new yogurt (see below). That plus some veggies should pretty much keep me for a long time. I know, I know. I'm not very creative when it comes to food but the regimen is what works for me.
Yogurt. At first I was in to the Yoplait Light (Thick & Creamy because it has Sucralose instead of Aspartame) but then I discovered Weight Watchers (better tasting, uses Sucralose, and has a bit more protein). However, recently I've moved to Kroger's (only available at Smith's). It's called Carb Master. Stupid name but amazing yogurt. Only 4 grams of carbohydrates and more protein than any other yogurt I've found (and only 1 gram of sugar). It's not as sweet or yummy tasting as those other ones but now I don't cringe when I eat yogurt.
Okay.. there you have it. My update. More later. Thanks to everyone who has written me to let me know how they are doing. I appreciate it. Also I haven't heard from Meredith at RMAP since I accepted her resolution to my situation with Carly. I have nothing against anyone at RMAP, I really wish they could say the same.
Sunday, February 15, 2009
When Weight Loss Ends
I've recently found that my weight loss has stalled. I got down to 223 lbs (which was 2 lbs under my goal weight) but more recently I'm up to 230 where I have settled. I'm perfectly happy at this weight. Other than my excess skin which I'm hoping to have removed as soon as I can afford it, I'm very happy and feel great. But I've wondered why the stall. I've only lost 85-90% of my excess weight. (keep in mind I'm not quibbling about it, just wondering)
So I started taking a micro look at the calories I ingest every day. I am prone to eat simple carbs here and there throughout the day. Especially at work. Not a ton, mind you, but a few little cheats here and there. As I analyzed it, I realized how many calories I am letting into my diet without even really knowing it. One piece of bread is like 100 calories. All in all, I think that's how anyone eventually gains some of the weight back. It gets to where you can eat normally and so you do. You can't eat as much but you get into this false sense of security because of how easy it was to lose the weight. Now you have to pay attention.
This is why I've advocated a food journal though most people (myself included) don't do this. But with the success I had using a food journal and turning it in daily to a friend (having a competition with her for best journal really helped too), I think I'm going to go back to that, see if I can get back to 223 again.Wish me luck.
So I started taking a micro look at the calories I ingest every day. I am prone to eat simple carbs here and there throughout the day. Especially at work. Not a ton, mind you, but a few little cheats here and there. As I analyzed it, I realized how many calories I am letting into my diet without even really knowing it. One piece of bread is like 100 calories. All in all, I think that's how anyone eventually gains some of the weight back. It gets to where you can eat normally and so you do. You can't eat as much but you get into this false sense of security because of how easy it was to lose the weight. Now you have to pay attention.
This is why I've advocated a food journal though most people (myself included) don't do this. But with the success I had using a food journal and turning it in daily to a friend (having a competition with her for best journal really helped too), I think I'm going to go back to that, see if I can get back to 223 again.Wish me luck.
Saturday, February 14, 2009
Changes in Libido
One other thing that they don't tell you is that your libido will be affected. I've heard a few say that their libido decreased. I'm not sure if that's because of everything you suddenly have in your life that wasn't there before or what but for most of us our libido will increase.
Yes, INCREASE! It's kind of scary in a way. But it can also be a wonderful thing.
I haven't had a libido like this since I was 18. It has to be because my body is truly healthy. Healthier than it's been in a really, really long time.Anyway, the reason I bring this up is because you really need to keep this in mind and be ready to deal with it otherwise you might end up making decisions that aren't good for you.
Yes, INCREASE! It's kind of scary in a way. But it can also be a wonderful thing.
I haven't had a libido like this since I was 18. It has to be because my body is truly healthy. Healthier than it's been in a really, really long time.Anyway, the reason I bring this up is because you really need to keep this in mind and be ready to deal with it otherwise you might end up making decisions that aren't good for you.
Friday, February 13, 2009
My Tailbone
Sorry I've been so neglectful with my blog lately. Life has been hectic. My work sent me out to Boston. I flew out to Baltimore and then took a connecting flight to Boston. On the way back, I flew from Boston to Atlanta and then to Salt Lake City.
One thing they don't tell you going into this surgery is that when you lose your weight, you feel your tailbone a lot more. I'm always finding I'm sore there. And the flight from Atlanta to Salt Lake City was no different. I thought I was going to die it hurt so bad.
But there is always a bright side. In this case it's that I fit in the seat without a problem. Even on the Baltimore to Atlanta flight when I was in the middle. It's so awesome sitting in a seat without overflowing. Yay!
I hope you all are finding little things like this on your journey. Revel in each and every little wonderful thing that happens to you. It's a great ride.
Sean
One thing they don't tell you going into this surgery is that when you lose your weight, you feel your tailbone a lot more. I'm always finding I'm sore there. And the flight from Atlanta to Salt Lake City was no different. I thought I was going to die it hurt so bad.
But there is always a bright side. In this case it's that I fit in the seat without a problem. Even on the Baltimore to Atlanta flight when I was in the middle. It's so awesome sitting in a seat without overflowing. Yay!
I hope you all are finding little things like this on your journey. Revel in each and every little wonderful thing that happens to you. It's a great ride.
Sean
Tuesday, February 10, 2009
Beef Jerky/Sodium
If you eat a lot of beef jerky, you might notice your weight loss slowing down. If you're eating the appropriate amounts, at the appropriate times, and not deviating much for your diet, then the problem most likely is the high sodium content in the beef jerky.
I LOVE beef jerky and eat a ton of it every week. It's and easy food (already prepared), tasty, and it has a ton of protein. However, it does have a tendency to cause water retention. So you can still be losing fat (your body still has to eat) but the scale might not reflect as much because of the water retention.
There are two ways I've found to fight this. (1) Up your water content. As long as you flush your body with a ton of water, it has a hard time retaining water. I usually find if I'm retaining water (even with the beef jerky) it's because I'm not drinking enough. (2) Every so often I go off beef jerky and focus on other things (and stay super close to the eating plan including my water level). This really gives your body a flush and if you've been retaining water you usually notice a huge drop in weight (though I'll warn you if you're retaining water you'll be visiting the little boys/girls room a lot over the course of the next couple of days).
I hope that helps.
Sean
I LOVE beef jerky and eat a ton of it every week. It's and easy food (already prepared), tasty, and it has a ton of protein. However, it does have a tendency to cause water retention. So you can still be losing fat (your body still has to eat) but the scale might not reflect as much because of the water retention.
There are two ways I've found to fight this. (1) Up your water content. As long as you flush your body with a ton of water, it has a hard time retaining water. I usually find if I'm retaining water (even with the beef jerky) it's because I'm not drinking enough. (2) Every so often I go off beef jerky and focus on other things (and stay super close to the eating plan including my water level). This really gives your body a flush and if you've been retaining water you usually notice a huge drop in weight (though I'll warn you if you're retaining water you'll be visiting the little boys/girls room a lot over the course of the next couple of days).
I hope that helps.
Sean
Sunday, February 8, 2009
Yogurt
Over the past year or so, I've had numerous conversations with WLS patients about yogurt. Some like it, some don't. Some believe you should eat it, some don't. It's been referred to as a "slider" food (a food that doesn't have enough consistency to stay in your pouch for long).
For what it's worth, here's my take on yogurt.
UP UNTIL NOW:
My body seems to crave yogurt. For a long time I believed it was because of the calcium. While that might be the case, I'm not of the belief that's because of its sweetness. Most yogurts are insanely sweet. Case in point, Kroger's regular yogurt has 43 grams of sugar.
I personally prefer yogurts without Aspartame in them (the light thick & creamy by yoplait or the Weight Watchers). Each of these yogurts (6 ounces) are 100 calories and are sweetened by sucralose (splenda). While both taste great (I think the Weight Watchers is better), both of them are also sweet tasting. I believe that makes it easier to eat more and have it curb your appetite for less time. Weight Watchers has 6 grams of protein, 3 grams dietary fiber, 17 grams of carbohydrates (12 grams of sugar) -- and it's the better of these two (by a slight margin).
CURRENTLY
Recently, a dear friend of mine put me onto a new type of yogurt. Kroger's (available at Smith's only) has a yogurt called "Carb Master." Yes, it actually says Carb Master on the label. It only has 4 grams of carbohydrates (3 grams sugar) and 1 gram of dietary fiber but get this, it has 10-12 grams of protein. The result is a yogurt that isn't as good tasting (since it's not as sweet) but I've found that it's way more filling and curbs your hunger for longer than those other brands. And it only has 80 calories (6 ounces). I highly recommend it.
As I've always maintained, the more simple carbs you eat (and sugars count here), the more you trigger your hunger. Your body burns off simple carbs FAST and it raises your blood sugar level quickly. Once they've been burned off you have a crash and your blood sugar level drops and your body suddenly wants more. It's like a drug. That's why things like nuts, beef jerky and other meats stay with you longer.
For what it's worth, here's my take on yogurt.
UP UNTIL NOW:
My body seems to crave yogurt. For a long time I believed it was because of the calcium. While that might be the case, I'm not of the belief that's because of its sweetness. Most yogurts are insanely sweet. Case in point, Kroger's regular yogurt has 43 grams of sugar.
I personally prefer yogurts without Aspartame in them (the light thick & creamy by yoplait or the Weight Watchers). Each of these yogurts (6 ounces) are 100 calories and are sweetened by sucralose (splenda). While both taste great (I think the Weight Watchers is better), both of them are also sweet tasting. I believe that makes it easier to eat more and have it curb your appetite for less time. Weight Watchers has 6 grams of protein, 3 grams dietary fiber, 17 grams of carbohydrates (12 grams of sugar) -- and it's the better of these two (by a slight margin).
CURRENTLY
Recently, a dear friend of mine put me onto a new type of yogurt. Kroger's (available at Smith's only) has a yogurt called "Carb Master." Yes, it actually says Carb Master on the label. It only has 4 grams of carbohydrates (3 grams sugar) and 1 gram of dietary fiber but get this, it has 10-12 grams of protein. The result is a yogurt that isn't as good tasting (since it's not as sweet) but I've found that it's way more filling and curbs your hunger for longer than those other brands. And it only has 80 calories (6 ounces). I highly recommend it.
As I've always maintained, the more simple carbs you eat (and sugars count here), the more you trigger your hunger. Your body burns off simple carbs FAST and it raises your blood sugar level quickly. Once they've been burned off you have a crash and your blood sugar level drops and your body suddenly wants more. It's like a drug. That's why things like nuts, beef jerky and other meats stay with you longer.
Friday, February 6, 2009
Conversation with Meredith (part 4)
There you have it. What happens from here on out is up to Meredith and RMAP. Thanks to everyone who urged me to write a letter to RMAP about what was going on between me and Carly. If not for the 20 plus emails that I received regarding that, I don't think I would have reached out to Meredith. I'm glad I did, regardless of what she decides to do.
---------------------------------------
Meredith.
Sorry about the long reply email before. Look. This has been a very intriguing but unbelievable issue between Carly and myself. She was certainly welcome to reach out to me and let me know that she felt I was personally attacking her as that was never my intent. Your offer for resolution is fine as I have never thought negatively about Carly. My only desire through it all has been to give back to RMAP and I have done a lot of work in that area towards supporting the patients and giving glowing recommendations of RMAP as well as Doctors Smith, McKinley and Simper (especially Dr. Smith). Those recommendations have come from my mother's conversations with various nurses at St. Mark's and LDS hospital (she worked as an anesthesiologist for many many years and keeps in touch with many within the medical community) and her personal knowledge of working with Dr. Smith at the SL Surgical Center as well as the former RMAP I know and those in the medical community I work with since I'm in the field of healthcare.
As stated, I contacted you in order to try and continue to give back to RMAP. That offer still stands. I believe in RMAP and have always felt that to give back is the least I can do for what I was able to accomplish with their help.
Sean
---------------------------------------
Meredith.
Sorry about the long reply email before. Look. This has been a very intriguing but unbelievable issue between Carly and myself. She was certainly welcome to reach out to me and let me know that she felt I was personally attacking her as that was never my intent. Your offer for resolution is fine as I have never thought negatively about Carly. My only desire through it all has been to give back to RMAP and I have done a lot of work in that area towards supporting the patients and giving glowing recommendations of RMAP as well as Doctors Smith, McKinley and Simper (especially Dr. Smith). Those recommendations have come from my mother's conversations with various nurses at St. Mark's and LDS hospital (she worked as an anesthesiologist for many many years and keeps in touch with many within the medical community) and her personal knowledge of working with Dr. Smith at the SL Surgical Center as well as the former RMAP I know and those in the medical community I work with since I'm in the field of healthcare.
As stated, I contacted you in order to try and continue to give back to RMAP. That offer still stands. I believe in RMAP and have always felt that to give back is the least I can do for what I was able to accomplish with their help.
Sean
Conversation with Meredith (part 3)
This is my reply to Meredith. I was astounded by the information that she sent in her email which confirmed my suspicious that she would get and take Carly's side. I'll admit that in reading the first part of her email my defenses went up and that's where this response came from. While this response is true in everything, it was merely me getting defensive. I completely missed the part of her email wherein she offered a resolution. Once I read her email a second time and caught that part, I sent a second follow up email (see part 4)
--------------------------------------------
Meredith.
My email in no way was an attempt to have anything done to Carly. I have never harbored ill will of Carly. Period. However, I will point out that despite the fact that you and Carly both have the best interests of RMAP in mind, not thinking there is room for improvement is not the best place to start. No one on this planet (myself included) is infallible or error free. There have been many complaints about customer service with RMAP -- including complaints against Carly. NO ONE (especially myself) has ever slandered Carly or anyone at RMAP for these failings but merely have brought them to light in hopes that RMAP will continue to improve (as they improved in order to become a center of excellence). The complaints seen on the board include not being responsive to calls, unnecessary delays in paperwork, perceived rudeness (at times - no one is saying all the time) from nurses or even perceived poor bedside manner by certain surgeons. Case in point, there are multiple posts on the message board talking about Dr. Smith's perceived lack of caring and poor bedside manner (an opinion not shared by me -- in fact I vehemently countered these claims by my own personal knowledge of Dr. Smith) but yet no one was ever banned for their perceptions.
However, I do take issue with your definition of slander. The dictionary (and the legal world) define slander as a malicious, false, and defamatory statement or report (i.e., a slander against his/her good name). If a comment is true, if it is not malicious, and if it is not defamatory, it cannot be slander. I have never written a post that could be classified as slander (as I have never posted anything that wasn't (a) true; (b) defamatory; or (c) malicious).
I can guarantee that you never read the post in question. I actually have a copy of it. If you had, you would have read my accounting of my phone call with Carly that day. It did not say she was unable to do her job, it did not say anything bad about her at all. It stated that I hoped that RMAP had room for improvement in the customer service area and I hoped that they would continue to improve there. It was not a personal attack on Carly a fact that everyone on the board (other than Carly) who read it shares. As for the phone call between Carly and myself, there was no courtesy involved. I did not ask for Dr. Smith's time. I told Carly that I did not "need" an appointment with Dr. Smith as everything was fine but since he had "asked" me to check in with him after 6 months about where my weight was, I wanted to know if he really needed to see me. Though I rephrased this question three separate times, Carly completely ignored the request and merely repeated that if I came in I would have to pay for the visit. There was no attempt to set up a block of time. My post reflected that and also made the jump in logic that it would have been nice if she would have just asked Dr. Smith if he wanted to see me due to this or if we were good. Now, since I know you are obviously going to lean towards the side of your colleague (why wouldn't you, you don't know me but you work with her) I know you'll dismiss my statements. That's fine. However, since the incident, I have had several (unsolicited) people contact me and leave me comments about Carly. Every single one of them have brought up her need to improve on her courtesy and customer service skills. None of them (mine included) have said she is a bad person. There has been no slander. And to ban people who point out flaws in the hope for improvement is merely to turn a blind eye to an area that can make RMAP (as a whole) better.
Anyway... the only reason I related that to you was to let you know why I am no longer providing support for RMAP patients via the message board. It wasn't to argue my side or to convince you that I should be reinstated. I was on the board as a way to give back to RMAP. It certainly took a great deal of my time but it was something I felt I owed. After all, my mother worked directly with Paula, Dr. Halverson and Dr. Smith which is why I went with RMAP in the first place. I have posted in several forums my direct knowledge of Dr. Smith's excellence as a surgeon (based not just on my experience but from my knowledge captured from may places).
My reason for contacting you was to offer my help (if ever needed). It was yet another attempt on my part to give back to RMAP. However, if it's not wanted or needed, that's fine. One day I hope Carly will recognize that I never harbored any ill will towards her and that the only malicious thing that happened on the message board was her banning me for leaving a post that she took personal but was actually not personal.
Anyway, enjoy your weekend.
Sean
--------------------------------------------
Meredith.
My email in no way was an attempt to have anything done to Carly. I have never harbored ill will of Carly. Period. However, I will point out that despite the fact that you and Carly both have the best interests of RMAP in mind, not thinking there is room for improvement is not the best place to start. No one on this planet (myself included) is infallible or error free. There have been many complaints about customer service with RMAP -- including complaints against Carly. NO ONE (especially myself) has ever slandered Carly or anyone at RMAP for these failings but merely have brought them to light in hopes that RMAP will continue to improve (as they improved in order to become a center of excellence). The complaints seen on the board include not being responsive to calls, unnecessary delays in paperwork, perceived rudeness (at times - no one is saying all the time) from nurses or even perceived poor bedside manner by certain surgeons. Case in point, there are multiple posts on the message board talking about Dr. Smith's perceived lack of caring and poor bedside manner (an opinion not shared by me -- in fact I vehemently countered these claims by my own personal knowledge of Dr. Smith) but yet no one was ever banned for their perceptions.
However, I do take issue with your definition of slander. The dictionary (and the legal world) define slander as a malicious, false, and defamatory statement or report (i.e., a slander against his/her good name). If a comment is true, if it is not malicious, and if it is not defamatory, it cannot be slander. I have never written a post that could be classified as slander (as I have never posted anything that wasn't (a) true; (b) defamatory; or (c) malicious).
I can guarantee that you never read the post in question. I actually have a copy of it. If you had, you would have read my accounting of my phone call with Carly that day. It did not say she was unable to do her job, it did not say anything bad about her at all. It stated that I hoped that RMAP had room for improvement in the customer service area and I hoped that they would continue to improve there. It was not a personal attack on Carly a fact that everyone on the board (other than Carly) who read it shares. As for the phone call between Carly and myself, there was no courtesy involved. I did not ask for Dr. Smith's time. I told Carly that I did not "need" an appointment with Dr. Smith as everything was fine but since he had "asked" me to check in with him after 6 months about where my weight was, I wanted to know if he really needed to see me. Though I rephrased this question three separate times, Carly completely ignored the request and merely repeated that if I came in I would have to pay for the visit. There was no attempt to set up a block of time. My post reflected that and also made the jump in logic that it would have been nice if she would have just asked Dr. Smith if he wanted to see me due to this or if we were good. Now, since I know you are obviously going to lean towards the side of your colleague (why wouldn't you, you don't know me but you work with her) I know you'll dismiss my statements. That's fine. However, since the incident, I have had several (unsolicited) people contact me and leave me comments about Carly. Every single one of them have brought up her need to improve on her courtesy and customer service skills. None of them (mine included) have said she is a bad person. There has been no slander. And to ban people who point out flaws in the hope for improvement is merely to turn a blind eye to an area that can make RMAP (as a whole) better.
Anyway... the only reason I related that to you was to let you know why I am no longer providing support for RMAP patients via the message board. It wasn't to argue my side or to convince you that I should be reinstated. I was on the board as a way to give back to RMAP. It certainly took a great deal of my time but it was something I felt I owed. After all, my mother worked directly with Paula, Dr. Halverson and Dr. Smith which is why I went with RMAP in the first place. I have posted in several forums my direct knowledge of Dr. Smith's excellence as a surgeon (based not just on my experience but from my knowledge captured from may places).
My reason for contacting you was to offer my help (if ever needed). It was yet another attempt on my part to give back to RMAP. However, if it's not wanted or needed, that's fine. One day I hope Carly will recognize that I never harbored any ill will towards her and that the only malicious thing that happened on the message board was her banning me for leaving a post that she took personal but was actually not personal.
Anyway, enjoy your weekend.
Sean
Conversation with Meredith (part 2)
Apparently Meredith spoke with Carly after reading my email and she then sent this reply. It's about what I expected. I find it interesting that she thought I was trying to get Carly fired. Was there ANYTHING in my first email that would give ANYONE that thought? Can you say paranoia? By the way, the definition of "slander" (keep this in mind as you read it) is making a false, malicious, defamatory statement against someone's good name.
_________________________________
Sean,
I appreciate the time you spent to contact me. First things first: Congratulations on such an INCREDIBLE journey to find the new you- inside and out! The task you undertook (and will continue to undertake) was certainly far from easy and I am sure it was bathed with bumps along the way. Dr. Smith, the blessed man that he is, did provide the means to change your life, but ultimately, it was you who changed your own life. And in that you should take great pride.
I am aware of the recent forum situation and would like to shed some light on it for you, if I may. Not only is Freedom of Speech permissible on our RMAP forums, but it is a right provided to us in this country. But just like the God-given right to speak freely, there are respectful limitations. None of us are perfect, and that definitely includes us at RMAP and our interactions with our patients. I fully recognize that you felt you were not given appropriate customer service during a conversation with Carley, and that always feels frustrating, no matter the situation. However, I would hope you can put yourself in her shoes and try to understand the demands of a medical practice. Unfortunately, for all involved, our doctors live hectic lives and lead very busy schedules, which puts a damper on the amount of time they can spend with patients. From what I understand, Carley simply wanted to set a block of time, just for you, to meet with Dr. Smith. It appears this courtesy may not have been received properly, and for that we do apologize.
I do feel it necessary to share with you that in the short time I have been with RMAP (4 months in the summer, and now since middle of January upon graduation), RMAP needs Carley. She has bright ideas for improvement and has the fortitude and determination to promote and execute change. She and I have very similar goals for RMAP, as we look to the future as a big picture, and we are constantly looking for improvement. I am not sure if you are trying to have us let her go, or not; but I must tell you, she will be the last person to be let go. Again, RMAP needs her. The difficulty found in voicing your opinion about one of OUR employees in a negative light on OUR forum, is the setting. Just like you have seen, people feed off of one another on the message boards and will only add fuel to the fire (good and bad). Hence, when stating your disappointment in one interaction with Carley on a public forum, is slanderous. Put yourself in Carley’s shoes, would you want to be a moderator of a forum to only find hate messages posted about you? From patients you care about deeply? It comes across as backstabbing. Of course, all of us can improve our customer service skills, but if presented in a constructive critique. Your approach did not appear to be a constructive critique.
And I do know, that it only makes it more difficult for us to feel that your criticism was constructive when you currently still permit other patients to degrade Carley on your blog. Do not get me wrong, blogs are personal and they are for your own particular use. I have a blog- and what I choose to write about it is my own business. However, frequently adding more anti-Carley posts is degrading, hurtful and malicious in nature. I do hope you can appreciate that and, again, see it from her perspective.
In terms of your thoughts regarding the $500 education fee, that truly did not play a role in the removal of your membership from the forums. We were already aware of the problem in the education department; hence, I was brought on. Just as much as I hope you take great pride in your weight loss journey, I take great pride in improving our education program. My priority is to provide various useful resources for our patients, and to be utilized as a resource for knowledge, a listening ear, and to offer advice when needed. Support group has become my “baby,” and do hope you can find a way to attend. I am excited with the direction it is going and am always looking for ways to improve it. Please do not hesitate to flood me with ideas, questions and concerns to help better RMAP. I so value patient input, as their satisfaction means my satisfaction. But I do hope that such input will be directed toward a single entity, like myself, and can be addressed in a constructive way.
I want to acknowledge and extend my gratitude for the many good works you have done for RMAP and our patients. It sounds like you are a great asset for those patients who know you and look up to you. And my hope for a resolution in this matter is as follows: No more negative posts about Carley, as we clearly have witnessed both negative and positive testimonials pertaining to her; all of us are striving to be better. And I hope to maintain your trust in RMAP. We are on your side, we are your allies and we want to help you succeed in any useful manner possible. We choose to do what we do, here at RMAP, because we find joy in serving you. Your experiences will be of great use to me- I hope you didn’t bite off more than you could chew when you offered your services!
Meredith, RN
Education Director
1160 East 3900 South STE 4100
Salt Lake City, UT 84124
Phone: (801) 268-3800 Fax: (801) 268-3997
_________________________________
Sean,
I appreciate the time you spent to contact me. First things first: Congratulations on such an INCREDIBLE journey to find the new you- inside and out! The task you undertook (and will continue to undertake) was certainly far from easy and I am sure it was bathed with bumps along the way. Dr. Smith, the blessed man that he is, did provide the means to change your life, but ultimately, it was you who changed your own life. And in that you should take great pride.
I am aware of the recent forum situation and would like to shed some light on it for you, if I may. Not only is Freedom of Speech permissible on our RMAP forums, but it is a right provided to us in this country. But just like the God-given right to speak freely, there are respectful limitations. None of us are perfect, and that definitely includes us at RMAP and our interactions with our patients. I fully recognize that you felt you were not given appropriate customer service during a conversation with Carley, and that always feels frustrating, no matter the situation. However, I would hope you can put yourself in her shoes and try to understand the demands of a medical practice. Unfortunately, for all involved, our doctors live hectic lives and lead very busy schedules, which puts a damper on the amount of time they can spend with patients. From what I understand, Carley simply wanted to set a block of time, just for you, to meet with Dr. Smith. It appears this courtesy may not have been received properly, and for that we do apologize.
I do feel it necessary to share with you that in the short time I have been with RMAP (4 months in the summer, and now since middle of January upon graduation), RMAP needs Carley. She has bright ideas for improvement and has the fortitude and determination to promote and execute change. She and I have very similar goals for RMAP, as we look to the future as a big picture, and we are constantly looking for improvement. I am not sure if you are trying to have us let her go, or not; but I must tell you, she will be the last person to be let go. Again, RMAP needs her. The difficulty found in voicing your opinion about one of OUR employees in a negative light on OUR forum, is the setting. Just like you have seen, people feed off of one another on the message boards and will only add fuel to the fire (good and bad). Hence, when stating your disappointment in one interaction with Carley on a public forum, is slanderous. Put yourself in Carley’s shoes, would you want to be a moderator of a forum to only find hate messages posted about you? From patients you care about deeply? It comes across as backstabbing. Of course, all of us can improve our customer service skills, but if presented in a constructive critique. Your approach did not appear to be a constructive critique.
And I do know, that it only makes it more difficult for us to feel that your criticism was constructive when you currently still permit other patients to degrade Carley on your blog. Do not get me wrong, blogs are personal and they are for your own particular use. I have a blog- and what I choose to write about it is my own business. However, frequently adding more anti-Carley posts is degrading, hurtful and malicious in nature. I do hope you can appreciate that and, again, see it from her perspective.
In terms of your thoughts regarding the $500 education fee, that truly did not play a role in the removal of your membership from the forums. We were already aware of the problem in the education department; hence, I was brought on. Just as much as I hope you take great pride in your weight loss journey, I take great pride in improving our education program. My priority is to provide various useful resources for our patients, and to be utilized as a resource for knowledge, a listening ear, and to offer advice when needed. Support group has become my “baby,” and do hope you can find a way to attend. I am excited with the direction it is going and am always looking for ways to improve it. Please do not hesitate to flood me with ideas, questions and concerns to help better RMAP. I so value patient input, as their satisfaction means my satisfaction. But I do hope that such input will be directed toward a single entity, like myself, and can be addressed in a constructive way.
I want to acknowledge and extend my gratitude for the many good works you have done for RMAP and our patients. It sounds like you are a great asset for those patients who know you and look up to you. And my hope for a resolution in this matter is as follows: No more negative posts about Carley, as we clearly have witnessed both negative and positive testimonials pertaining to her; all of us are striving to be better. And I hope to maintain your trust in RMAP. We are on your side, we are your allies and we want to help you succeed in any useful manner possible. We choose to do what we do, here at RMAP, because we find joy in serving you. Your experiences will be of great use to me- I hope you didn’t bite off more than you could chew when you offered your services!
Meredith, RN
Education Director
1160 East 3900 South STE 4100
Salt Lake City, UT 84124
Phone: (801) 268-3800 Fax: (801) 268-3997
Conversation with Meredith (part I)
I reached out to Meredith (the new Director of Education) today. My reason for reaching out to her was to offer her my help if it was ever deemed that it would be beneficial to RMAP. In whatever capacity. I don't have the ability (time) to go to support groups so in the past I have tried giving back by being active on the support board. Obviously since the ban by Carly, I haven't been able to do that. I gave Meredith a little background on the ban. Here's the email I sent:
________________________
Meredith.
I apologize for not being able to speak with you yesterday. Work has been crazy as of late. I just wanted to introduce myself. I had gastric bypass with Dr. Smith on April 11, 2007. My weight at the time was 474.1 lbs. As of today, my weight is at 223.2 lbs (which is 2 lbs below the goal I set for myself). The journey has been amazing and I have learned a lot about myself and how to keep myself situated on this end of the spectrum for the rest of my life.
Anyway, after surgery I spent a great deal of time on the RMAP message support board and several of the old timers helped me out a great deal. As I got further along in the journey, I found myself giving back the support I had received. There came a point where I stopped frequenting the message board and only responded when I received private messages from other patients. Over the next couple of months I had so many RMAP patients emailing me asking for me to come back to the message board that I did. However, I apparently offended Carly when I relayed a frustrating experience at my 18 month mark. The experience I related spoke about how at my year mark Dr. Smith told me to check back with him in six months just to see where I was with my weight. That conversation happened only because I told Dr. Smith I wanted to go beyond the 250 lbs mark that he had set for me. I didn't need an appointment with him but called RMAP only because he told me to check with him in 6 months regarding my weight. Anyway, Carly informed me that I'd have to pay for an appointment if I wanted to see Dr. Smith. I asked her to just ask him what he wanted because I didn't necessarily need an appointment but he had told me to check with him about my weight. If he wanted me to just stop by so he could see where I was at, great. If not, fine. Anyway, long story short... it just wasn't the most ideal customer service moment. The other portion of that email was stripping down the $500 educational fee that some of the members were complaining about. In my message, I broke down what the fee was really for -- which is the pre- and post- surgery educational component and stated that if you take advantage of that component, it's worthwhile otherwise it's not. I also stated that RMAP believes that the educational component is necessary for long-term success and require it for their patients. The result of this email was a ban from the message forum.
It doesn't really bother me that I am banned from the message board. I've completed my journey. However, after the ban many RMAP patients continue to email me to ask me questions about my journey and to get my support during theirs. I offer them my (as needed) support through a personal blog and email. One RMAP patient created a Facebook group for everyone.
Sorry for the really long email. Where I'm going with this is that I have had an amazing journey. I believe in giving back in life which is why I was on the message board to begin with. Patients do need their doctors and nurses to provide them with medical help and advice but they also need the support and help of those who have gone before. If you read through the messages left by Michelle Christensen from the start of her journey to today you will clearly see what I'm talking about. Anyway... for what it's worth, I have been and am still willing to be there for RMAP patients. I do not usually have the time to go to the support meeting each month which is why I was on the message board. But if you ever need assistance from someone who has lost 250 lbs and understands the journey (from a personal level -- not a medical level), let me know.
Also, would you please let Dr. Smith know how much he has changed my life? I owe him a lot. Losing this weight has been everything I ever dreamed and more. I've attached a few pictures so you can see the transformation.
Thanks.
Sean Joyce
________________________
Meredith.
I apologize for not being able to speak with you yesterday. Work has been crazy as of late. I just wanted to introduce myself. I had gastric bypass with Dr. Smith on April 11, 2007. My weight at the time was 474.1 lbs. As of today, my weight is at 223.2 lbs (which is 2 lbs below the goal I set for myself). The journey has been amazing and I have learned a lot about myself and how to keep myself situated on this end of the spectrum for the rest of my life.
Anyway, after surgery I spent a great deal of time on the RMAP message support board and several of the old timers helped me out a great deal. As I got further along in the journey, I found myself giving back the support I had received. There came a point where I stopped frequenting the message board and only responded when I received private messages from other patients. Over the next couple of months I had so many RMAP patients emailing me asking for me to come back to the message board that I did. However, I apparently offended Carly when I relayed a frustrating experience at my 18 month mark. The experience I related spoke about how at my year mark Dr. Smith told me to check back with him in six months just to see where I was with my weight. That conversation happened only because I told Dr. Smith I wanted to go beyond the 250 lbs mark that he had set for me. I didn't need an appointment with him but called RMAP only because he told me to check with him in 6 months regarding my weight. Anyway, Carly informed me that I'd have to pay for an appointment if I wanted to see Dr. Smith. I asked her to just ask him what he wanted because I didn't necessarily need an appointment but he had told me to check with him about my weight. If he wanted me to just stop by so he could see where I was at, great. If not, fine. Anyway, long story short... it just wasn't the most ideal customer service moment. The other portion of that email was stripping down the $500 educational fee that some of the members were complaining about. In my message, I broke down what the fee was really for -- which is the pre- and post- surgery educational component and stated that if you take advantage of that component, it's worthwhile otherwise it's not. I also stated that RMAP believes that the educational component is necessary for long-term success and require it for their patients. The result of this email was a ban from the message forum.
It doesn't really bother me that I am banned from the message board. I've completed my journey. However, after the ban many RMAP patients continue to email me to ask me questions about my journey and to get my support during theirs. I offer them my (as needed) support through a personal blog and email. One RMAP patient created a Facebook group for everyone.
Sorry for the really long email. Where I'm going with this is that I have had an amazing journey. I believe in giving back in life which is why I was on the message board to begin with. Patients do need their doctors and nurses to provide them with medical help and advice but they also need the support and help of those who have gone before. If you read through the messages left by Michelle Christensen from the start of her journey to today you will clearly see what I'm talking about. Anyway... for what it's worth, I have been and am still willing to be there for RMAP patients. I do not usually have the time to go to the support meeting each month which is why I was on the message board. But if you ever need assistance from someone who has lost 250 lbs and understands the journey (from a personal level -- not a medical level), let me know.
Also, would you please let Dr. Smith know how much he has changed my life? I owe him a lot. Losing this weight has been everything I ever dreamed and more. I've attached a few pictures so you can see the transformation.
Thanks.
Sean Joyce
Basic Gastric Bypass Information
Nutritional effects
After surgery, patients feel fullness after ingesting only a small volume of food, followed soon thereafter by a sense of satiety and loss of appetite. Total food intake is markedly reduced. Due to the reduced size of the newly created stomach pouch, and reduced food intake, adequate nutrition demands that the patient follow the surgeon's instructions for food consumption, including the number of meals to be taken daily, adequate protein intake, and the use of vitamin and mineral supplements.
Protein nutrition
Proteins are essential food substances, contained in foods such as meat, fish and poultry, dairy products, soy, nuts, and eggs. With reduced ability to eat a large volume of food, gastric bypass patients must focus on eating their protein requirements first, and with each meal. Proximal GBP rarely leads to protein deficiency if this simple precaution is followed. Distal GBP is more likely to lead to protein deficiency, particularly if fat intake is excessive, and the position of the Y-connection is farther downstream. In some cases, surgeons may recommend use of a liquid protein supplement.
Calorie nutrition
The profound weight loss which occurs after bariatric surgery is due to taking in much less energy (calories) than the body needs to use every day. Fat tissue must be burned, to offset the deficit, and weight loss results. Eventually, as the body becomes smaller, its energy requirements are decreased, while the patient simultaneously finds it possible to eat somewhat more food. When the energy consumed is equal to the calories eaten, weight loss will stop. Proximal GBP typically results in loss of 60 to 80% of excess body weight, and very rarely leads to excessive weight loss. The risk of excessive weight loss is slightly greater with Distal GBP.
Vitamins
Vitamins are normally contained in the foods we eat, as well as any supplements we may choose to take. The amount of food which will be eaten after GBP is severely reduced, and vitamin content is correspondingly reduced. Supplements should therefore be taken, to completely cover minimum daily requirements of all vitamins and minerals. Absorption of most vitamins is not seriously affected after proximal GBP, although vitamin B12 may not be well-absorbed in some persons. Sublingual preparations of B12 will usually provide adequate absorption. After the distal GBP, fat-soluble vitamins A, D and E may not be well-absorbed, particularly if fat intake is large. Water-dispersed forms of these vitamins may be indicated, on specific physician recommendation.
Minerals
All versions of the GBP bypass the duodenum, which is the primary site of absorption of both iron and calcium. Iron replacement is essential in menstruating females, and supplementation of iron and calcium is preferable in all patients. Ferrous sulfate is poorly tolerated. Alternative forms of iron (fumarate, gluconate, chelates) are less irritating and probably better absorbed. Calcium carbonate preparations should also be avoided; calcium as citrate or gluconate, 1200 mg as calcium, has greater bioavailability independent of acid in the stomach, and will likely be better absorbed.
After surgery, patients feel fullness after ingesting only a small volume of food, followed soon thereafter by a sense of satiety and loss of appetite. Total food intake is markedly reduced. Due to the reduced size of the newly created stomach pouch, and reduced food intake, adequate nutrition demands that the patient follow the surgeon's instructions for food consumption, including the number of meals to be taken daily, adequate protein intake, and the use of vitamin and mineral supplements.
Protein nutrition
Proteins are essential food substances, contained in foods such as meat, fish and poultry, dairy products, soy, nuts, and eggs. With reduced ability to eat a large volume of food, gastric bypass patients must focus on eating their protein requirements first, and with each meal. Proximal GBP rarely leads to protein deficiency if this simple precaution is followed. Distal GBP is more likely to lead to protein deficiency, particularly if fat intake is excessive, and the position of the Y-connection is farther downstream. In some cases, surgeons may recommend use of a liquid protein supplement.
Calorie nutrition
The profound weight loss which occurs after bariatric surgery is due to taking in much less energy (calories) than the body needs to use every day. Fat tissue must be burned, to offset the deficit, and weight loss results. Eventually, as the body becomes smaller, its energy requirements are decreased, while the patient simultaneously finds it possible to eat somewhat more food. When the energy consumed is equal to the calories eaten, weight loss will stop. Proximal GBP typically results in loss of 60 to 80% of excess body weight, and very rarely leads to excessive weight loss. The risk of excessive weight loss is slightly greater with Distal GBP.
Vitamins
Vitamins are normally contained in the foods we eat, as well as any supplements we may choose to take. The amount of food which will be eaten after GBP is severely reduced, and vitamin content is correspondingly reduced. Supplements should therefore be taken, to completely cover minimum daily requirements of all vitamins and minerals. Absorption of most vitamins is not seriously affected after proximal GBP, although vitamin B12 may not be well-absorbed in some persons. Sublingual preparations of B12 will usually provide adequate absorption. After the distal GBP, fat-soluble vitamins A, D and E may not be well-absorbed, particularly if fat intake is large. Water-dispersed forms of these vitamins may be indicated, on specific physician recommendation.
Minerals
All versions of the GBP bypass the duodenum, which is the primary site of absorption of both iron and calcium. Iron replacement is essential in menstruating females, and supplementation of iron and calcium is preferable in all patients. Ferrous sulfate is poorly tolerated. Alternative forms of iron (fumarate, gluconate, chelates) are less irritating and probably better absorbed. Calcium carbonate preparations should also be avoided; calcium as citrate or gluconate, 1200 mg as calcium, has greater bioavailability independent of acid in the stomach, and will likely be better absorbed.
Nutritional Deficiencies
Nutritional deficiencies:
* Hyperparathyroidism, due to inadequate absorption of calcium, may occur in over 30% of GBP patients. Calcium is primarily absorbed in the duodenum, which is bypassed by the surgery. Most patients can achieve adequate calcium absorption by supplementation with Vitamin D and Calcium Citrate (carbonate may not be absorbed - it requires an acidic stomach, which is bypassed).
* Iron frequently is seriously deficient, particularly in menstruating females, and must be supplemented. Again, it is normally absorbed in the duodenum. Ferrous sulfate can cause considerable GI distress in normal doses; alternatives include ferrous fumarate, or a chelated form of iron. Occasionally, a female patient develops severe anemia, even with supplements, and must be treated with parenteral iron.
* Vitamin B12 requires intrinsic factor from the gastric mucosa to be absorbed. In patients with a small gastric pouch, it may not be absorbed, even if supplemented orally, and deficiencies can result in pernicious anemia and neuropathies. Sublingual B12 appears to be adequately absorbed.
* Thiamine deficiency (also known as beriberi) will, rarely, occur as the result of its absorption site in the jejunum being bypassed. This deficiency can also result from inadequate nutritional supplements being taken post operatively.
* Protein malnutrition is a real risk. Some patients suffer troublesome vomiting after surgery, until their GI tract adjusts to the changes, and cannot eat adequate amounts even with 6 meals a day. Many patients require protein supplementation during the early phases of rapid weight loss, to prevent excessive loss of muscle mass.
* Vitamin A deficiencies generally occur as a result of the deficiencies that involve the fat-soluble vitamins. This often comes after intestinal bypass procedures such as jejunoileal bypass (no longer performed) or biliopancreatic diversion/duodenal switch procedures. In these procedures, fat absorption is markedly impaired. There is also the possibility of a vitamin A deficiency with use of Xenical or Alli weight loss medications.
* Hyperparathyroidism, due to inadequate absorption of calcium, may occur in over 30% of GBP patients. Calcium is primarily absorbed in the duodenum, which is bypassed by the surgery. Most patients can achieve adequate calcium absorption by supplementation with Vitamin D and Calcium Citrate (carbonate may not be absorbed - it requires an acidic stomach, which is bypassed).
* Iron frequently is seriously deficient, particularly in menstruating females, and must be supplemented. Again, it is normally absorbed in the duodenum. Ferrous sulfate can cause considerable GI distress in normal doses; alternatives include ferrous fumarate, or a chelated form of iron. Occasionally, a female patient develops severe anemia, even with supplements, and must be treated with parenteral iron.
* Vitamin B12 requires intrinsic factor from the gastric mucosa to be absorbed. In patients with a small gastric pouch, it may not be absorbed, even if supplemented orally, and deficiencies can result in pernicious anemia and neuropathies. Sublingual B12 appears to be adequately absorbed.
* Thiamine deficiency (also known as beriberi) will, rarely, occur as the result of its absorption site in the jejunum being bypassed. This deficiency can also result from inadequate nutritional supplements being taken post operatively.
* Protein malnutrition is a real risk. Some patients suffer troublesome vomiting after surgery, until their GI tract adjusts to the changes, and cannot eat adequate amounts even with 6 meals a day. Many patients require protein supplementation during the early phases of rapid weight loss, to prevent excessive loss of muscle mass.
* Vitamin A deficiencies generally occur as a result of the deficiencies that involve the fat-soluble vitamins. This often comes after intestinal bypass procedures such as jejunoileal bypass (no longer performed) or biliopancreatic diversion/duodenal switch procedures. In these procedures, fat absorption is markedly impaired. There is also the possibility of a vitamin A deficiency with use of Xenical or Alli weight loss medications.
Living with Gastric Bypass
Gastric bypass surgery has an emotional, as well as a physiological, impact on the individual. Many who have undergone the surgery suffer from depression in the following months. This is a result of a change in the role food plays in their emotional well-being. Strict limitations on the diet can place great emotional strain on the patient. Energy levels in the period following the surgery will be low. This is due again to the restriction of food intake, but the negative change in emotional state will also have an impact here.
It may take as long as three months for emotional levels to rebound. Muscular weakness in the months following surgery is common. This is caused by a number of factors, including a restriction on protein intake, a resulting loss in muscle mass and decline in energy levels. The weakness may result in balance problems, difficulty climbing stairs or lifting heavy objects, and increased fatigue following simple physical tasks. Many of these issues will pass over time as food intake gradually increases.
However, the first months following the surgery can be very difficult, an issue not often mentioned by physicians suggesting the surgery. The benefits and risks of this surgery are well established; however, the psychological effects are not well understood, and potential patients should ensure a strong support system before agreeing to the procedure.
It may take as long as three months for emotional levels to rebound. Muscular weakness in the months following surgery is common. This is caused by a number of factors, including a restriction on protein intake, a resulting loss in muscle mass and decline in energy levels. The weakness may result in balance problems, difficulty climbing stairs or lifting heavy objects, and increased fatigue following simple physical tasks. Many of these issues will pass over time as food intake gradually increases.
However, the first months following the surgery can be very difficult, an issue not often mentioned by physicians suggesting the surgery. The benefits and risks of this surgery are well established; however, the psychological effects are not well understood, and potential patients should ensure a strong support system before agreeing to the procedure.
Sugar Alcohol
In commercial foodstuffs sugar alcohols are commonly used in place of table sugar (sucrose), often in combination with high intensity artificial sweeteners to counter the low sweetness. Sugar alcohols do not contribute to tooth decay.
As a group, sugar alcohols are not as sweet as sucrose, and they contain fewer calories than sucrose. Their flavor is like sucrose, and they can be used to mask the unpleasant aftertastes of some high intensity sweeteners. Sugar alcohols are not metabolized by oral bacteria, and so they do not contribute to tooth decay. They do not brown or caramelize when heated. In addition to their sweetness, some sugar alcohols can produce a noticeable cooling sensation in the mouth when highly concentrated, for instance in sugar-free hard candy or chewing gum.
Sugar alcohols are usually incompletely absorbed into the blood stream from the small intestines which generally results in a smaller change in blood glucose than "regular" sugar (sucrose). This property makes them popular sweeteners among diabetics and people on low-carbohydrate diets. However, as for many other incompletely digestible substances (such as dietary fiber), overconsumption of sugar alcohols can lead to bloating, diarrhea and flatulence because they are not absorbed in the small intestine. Some individuals experience such symptoms even in a single-serving quantity. With continued use, most people develop a degree of tolerance to sugar alcohols and no longer experience these symptoms. As an exception, erythritol is actually absorbed in the small intestine and excreted unchanged through urine, so it has no side effects at typical levels of consumption.
People who have undergone gastric bypass surgery, specifically Roux-en-Y (RGB), should be careful not to eat too many sugar alcohols as doing so can lead to "dumping".
As a group, sugar alcohols are not as sweet as sucrose, and they contain fewer calories than sucrose. Their flavor is like sucrose, and they can be used to mask the unpleasant aftertastes of some high intensity sweeteners. Sugar alcohols are not metabolized by oral bacteria, and so they do not contribute to tooth decay. They do not brown or caramelize when heated. In addition to their sweetness, some sugar alcohols can produce a noticeable cooling sensation in the mouth when highly concentrated, for instance in sugar-free hard candy or chewing gum.
Sugar alcohols are usually incompletely absorbed into the blood stream from the small intestines which generally results in a smaller change in blood glucose than "regular" sugar (sucrose). This property makes them popular sweeteners among diabetics and people on low-carbohydrate diets. However, as for many other incompletely digestible substances (such as dietary fiber), overconsumption of sugar alcohols can lead to bloating, diarrhea and flatulence because they are not absorbed in the small intestine. Some individuals experience such symptoms even in a single-serving quantity. With continued use, most people develop a degree of tolerance to sugar alcohols and no longer experience these symptoms. As an exception, erythritol is actually absorbed in the small intestine and excreted unchanged through urine, so it has no side effects at typical levels of consumption.
People who have undergone gastric bypass surgery, specifically Roux-en-Y (RGB), should be careful not to eat too many sugar alcohols as doing so can lead to "dumping".
Thursday, February 5, 2009
ALL THINGS SUPPORT GROUP
Utah County Support Group Established
Finally, the moment many of us have all been waiting for...
Beginning in March, we are pleased to offer a Utah County Support Group!
When: 1st Wednesday/Month @ 7pm
Where: Timpanogos Regional Hospital, Women's Center Classroom
The program will mirror Salt Lake City's support group, so you will receive the same benefits and not miss out on unique opportunities.
Leaders: Lesa Hazen, (801) 423-2580, mom2hazen@comcast.net
Tess McCormick, (801)-766-9876, tessr5871@yahoo.com
Jeannine Whittaker, (801) 373-6759, jfrogmusic@msn.com
Special Announcement: You can now find a 12-month Support Group Program on our website UtahBariatrics.com, under Home and RMAP Announcements.
February Support Group
Salt Lake City: February 11, 2009 @ St. Mark's, Room G04C, 6pm
Speaker: Leslie Miller, LCSW (WLS patient)
Leader: Meredith Mangum, RN (801) 268-3800,
meredith@rmapinc.com
Kim Cundick (801) 268-3800, kim@rmapinc.com
Ogden: February 10, 2009 @ Ogden Regional, Oak Room, 7pm
Speaker: Chuck Nuttall, MD (Psychiatrist and WLS patient)
Leader: Gloria Merritt, (801) 737-0351, mokimom@sisna.com
Finally, the moment many of us have all been waiting for...
Beginning in March, we are pleased to offer a Utah County Support Group!
When: 1st Wednesday/Month @ 7pm
Where: Timpanogos Regional Hospital, Women's Center Classroom
The program will mirror Salt Lake City's support group, so you will receive the same benefits and not miss out on unique opportunities.
Leaders: Lesa Hazen, (801) 423-2580, mom2hazen@comcast.net
Tess McCormick, (801)-766-9876, tessr5871@yahoo.com
Jeannine Whittaker, (801) 373-6759, jfrogmusic@msn.com
Special Announcement: You can now find a 12-month Support Group Program on our website UtahBariatrics.com, under Home and RMAP Announcements.
February Support Group
Salt Lake City: February 11, 2009 @ St. Mark's, Room G04C, 6pm
Speaker: Leslie Miller, LCSW (WLS patient)
Leader: Meredith Mangum, RN (801) 268-3800,
meredith@rmapinc.com
Kim Cundick (801) 268-3800, kim@rmapinc.com
Ogden: February 10, 2009 @ Ogden Regional, Oak Room, 7pm
Speaker: Chuck Nuttall, MD (Psychiatrist and WLS patient)
Leader: Gloria Merritt, (801) 737-0351, mokimom@sisna.com
RMAP EDUCATIONAL DIRECTOR
Introducing Meredith Mangum, RN
Due to changing needs and Centers of Excellence requirements, we are pleased to announce the new Rocky Mountain Associated Physicians' Education Director, Meredith Mangum.
During the Summer of 2008, she worked as Dr. Steven Simper's medical assistant. Upon graduation from Boise State University's Nursing Program, she joins us again as a Registered Nurse. We are very excited for the direction and passion she brings to our Education Department and to help better serve you!
Feel free to contact her with any questions or concerns: meredith@rmapinc.com
(801) 268-3800
Due to changing needs and Centers of Excellence requirements, we are pleased to announce the new Rocky Mountain Associated Physicians' Education Director, Meredith Mangum.
During the Summer of 2008, she worked as Dr. Steven Simper's medical assistant. Upon graduation from Boise State University's Nursing Program, she joins us again as a Registered Nurse. We are very excited for the direction and passion she brings to our Education Department and to help better serve you!
Feel free to contact her with any questions or concerns: meredith@rmapinc.com
(801) 268-3800
Wednesday, February 4, 2009
Another Viewpoint
I thought about not posting this but ultimately figured that I don't want anyone else to have the experience I did -- and by making others aware of it perhaps somewhere down the line RMAP will realize it needs to address it. With that said, I did ask the author if I could post this but promised to keep his/her name private.
---------------------------------
Hi,
So that is funny that I'm reading your post and I had a bad experience with Carly too at RMAP. She is young, rude and doesn't have any kind of sympathy for FAT people. They should not have her as a nurse there. They need people who will be compassionate toward heavy people. She just is not.
I can't believe they hired her.
Uh!!!!!!!!!!!!!!
---------------------------------
Hi,
So that is funny that I'm reading your post and I had a bad experience with Carly too at RMAP. She is young, rude and doesn't have any kind of sympathy for FAT people. They should not have her as a nurse there. They need people who will be compassionate toward heavy people. She just is not.
I can't believe they hired her.
Uh!!!!!!!!!!!!!!
Frustrations
So two days after reaching 225 lbs again, I find myself back up to 229. What happened?!? It's frustrating because I've been so good. I haven't had much carbs at all, the calories have been within the desired range and my water has been good. I'm almost positive it's water retention but why? I'm not going to beat myself up too much about it, I know I'm on the right path. If I was eating a bunch of stuff that was boosting my daily caloric intake to unknown heights, I'd be worried. It's just frustrating.
Valentine's Day
Valentine's Day is coming up next week. How many of you are NOT looking forward to it (by show of hands)? Wow, that many. Interesting. Same here. I haven't ever been in a relationship where Valentine's Day was amazing so it's never been my favorite holiday. When I was married, my wife was the worst at making any day special. I've been dating but I'm not deep into any relationship at the moment so it's kind of a ho-hum deal this year as well. But keep your eyes on the future, you never know when this day might elevate itself to a much better day.
Improvements
One thing I would really like to hear about from everyone is a list of things that have gotten better in your life since the surgery. Whether that is being able to go to Lagoon, running up a flight of stairs, being able to walk, having the opposite gender pay you more attention, or just plain sex (have you noticed PALIN [as in Sarah] uses the same letters as PLAIN? I just noticed that). Anyway, please email me your lists. It will be fun to compile them and find out how many of us have these things in common. You can find my email address by clicking on my profile under my picture.
Valentine's Day
Valentine's Day is coming up next week. How many of you are NOT looking forward to it (by show of hands)? Wow, that many. Interesting. Same here. I haven't ever been in a relationship where Valentine's Day was amazing so it's never been my favorite holiday. When I was married, my wife was the worst at making any day special. I've been dating but I'm not deep into any relationship at the moment so it's kind of a ho-hum deal this year as well. But keep your eyes on the future, you never know when this day might elevate itself to a much better day.
Improvements
One thing I would really like to hear about from everyone is a list of things that have gotten better in your life since the surgery. Whether that is being able to go to Lagoon, running up a flight of stairs, being able to walk, having the opposite gender pay you more attention, or just plain sex (have you noticed PALIN [as in Sarah] uses the same letters as PLAIN? I just noticed that). Anyway, please email me your lists. It will be fun to compile them and find out how many of us have these things in common. You can find my email address by clicking on my profile under my picture.
Monday, February 2, 2009
Continuation of my Journey
Okay, so quick update. As of today (2/2/09), I'm back at 225 lbs. Yay! I'll tell you, it is amazingly easy to put the weight back on even now than it is to take it off. But at least I know that I can do it whenever I want.
Now... for today's thoughts:
When I went into surgery I told myself that I wasn't going to date for 24 months. I figured with the amount of weight I wanted to lose, I was in it for 24 months. I think that was a wise choice. I'm starting to date a bit now and I've actually met someone really nice who I've started to date a bit. I hope that will work out. My self-esteem and confidence about myself is at an all new level and I've lost all the weight that I started out to lose. Now I just need to figure out to pay for and schedule the surgery to at least remove a good portion of my excess skin.
It's funny to me that people tell you that you shouldn't let your weight keep you from things but those people have never been 474 lbs. The difference in how you are perceived and treated is amazing. Even by those who it doesn't really matter much to. Since losing the weight, I feel like I've been phased into the same reality as all those who I watched live life for so many years. Finally I can experience and be a part of the same world I saw for so many years. It's exciting.
The future has taken on a million new colors and now it's up to me to make sure I make the right choices in who I elect to date, etc. And most of all it remains a MUST to be forever vigilante as to my weight, what I'm eating, how much I'm drinking. It truly is a lifelong commitment. It sounds like a daunting task but carrying around an extra 250 lbs is a daunting task. This is nothing.
Take care.
Sean
Now... for today's thoughts:
When I went into surgery I told myself that I wasn't going to date for 24 months. I figured with the amount of weight I wanted to lose, I was in it for 24 months. I think that was a wise choice. I'm starting to date a bit now and I've actually met someone really nice who I've started to date a bit. I hope that will work out. My self-esteem and confidence about myself is at an all new level and I've lost all the weight that I started out to lose. Now I just need to figure out to pay for and schedule the surgery to at least remove a good portion of my excess skin.
It's funny to me that people tell you that you shouldn't let your weight keep you from things but those people have never been 474 lbs. The difference in how you are perceived and treated is amazing. Even by those who it doesn't really matter much to. Since losing the weight, I feel like I've been phased into the same reality as all those who I watched live life for so many years. Finally I can experience and be a part of the same world I saw for so many years. It's exciting.
The future has taken on a million new colors and now it's up to me to make sure I make the right choices in who I elect to date, etc. And most of all it remains a MUST to be forever vigilante as to my weight, what I'm eating, how much I'm drinking. It truly is a lifelong commitment. It sounds like a daunting task but carrying around an extra 250 lbs is a daunting task. This is nothing.
Take care.
Sean
Saturday, January 31, 2009
Fighting the Good Fight
Okay, for those of you following my journey, let me tell you about my struggle to get back on track after gaining 7 lbs in 5 days. Yes I went from 223 lbs (2 lbs under my pre-surgery goal weight) to 230 in 5 days. Since then I recommitted to drinking all my water and staying close to the diet. I've done really well. 3 days back on track and I've lost 4 of those lbs already. With any luck it was all water retention and I'll be back to my good old 223 lbs mark early next week. Or maybe a little longer. You never know.
It's nice to know I can fight the cravings and the occasional stress or boredom and come out on top. Yay!
WLS has been such a godsend for me. It's amazing that I can go on a date and hold hands through a movie and know that it's just as exciting for her to hold my hand as it is for me to hold hers. Very unlike before when all I'd do is wonder whether she would accept me as I was and wonder if I should even try to hold her hand. Such a change. Again, yay!
Sean
It's nice to know I can fight the cravings and the occasional stress or boredom and come out on top. Yay!
WLS has been such a godsend for me. It's amazing that I can go on a date and hold hands through a movie and know that it's just as exciting for her to hold my hand as it is for me to hold hers. Very unlike before when all I'd do is wonder whether she would accept me as I was and wonder if I should even try to hold her hand. Such a change. Again, yay!
Sean
Friday, January 30, 2009
Ability to Control Weight
I work with a woman who had gastric bypass 8 years ago. She initially lost a lot of weight (I saw her pictures) but then gained back a chunk. She took charge and lost the weight again and then had a big emotional event happen in her life. She gained a lot back. Now she's again starting to take charge and get back down.
I relate this story in this forum because that's probably the BIGGEST change I see in myself after having WLS. The fact that I finally have control. Yes, I'm not always perfect. But when I think back on how I was pre-surgery, I wasn't even close. Now I have days when I am perfect (diet-wise) and plenty of days when I am close. I never got and buy a bag of oreos and eat the entire bag or feel like I have to sneak food when people are looking so they won't wonder why I would eat so much or so crappy. I can't eat most of a large pizza before and... when I want I can survive on 1500 or less calories in a day without my body screaming at me or really even feeling deprived.
It's amazing.
But the other reason (in conjunction with the one above) for relating that story is to let everyone know that if you lose your weight and then gain some of it back, you haven't failed. You still have the tool to get back on track and lose again. You are in control. And that might be (if you're anything like me) the sweetest thing you've ever heard.
Sean
I relate this story in this forum because that's probably the BIGGEST change I see in myself after having WLS. The fact that I finally have control. Yes, I'm not always perfect. But when I think back on how I was pre-surgery, I wasn't even close. Now I have days when I am perfect (diet-wise) and plenty of days when I am close. I never got and buy a bag of oreos and eat the entire bag or feel like I have to sneak food when people are looking so they won't wonder why I would eat so much or so crappy. I can't eat most of a large pizza before and... when I want I can survive on 1500 or less calories in a day without my body screaming at me or really even feeling deprived.
It's amazing.
But the other reason (in conjunction with the one above) for relating that story is to let everyone know that if you lose your weight and then gain some of it back, you haven't failed. You still have the tool to get back on track and lose again. You are in control. And that might be (if you're anything like me) the sweetest thing you've ever heard.
Sean
Thursday, January 29, 2009
Re-Committed
On Friday, January 23, 2009, I weighed myself in the morning and came in at a stellar 223.2 lbs. Over the next four days I gained 7 lbs. Yes, that's right, 7 lbs!!! I weighed on Tuesday, January 27, 2009 at 230.2 lbs. How can I gain 7 lbs in 4 days? That's a good question. It freaks me out everytime I see a fluctuation like that but I always know what causes it.
1. Poor diet. I wrote about this in an earlier blog (titled: Snacking). I was horrible for about a week or so. It ALWAYS takes time to show up.
2. Low Water. Yes, for the same week where my diet was poor, I wasn't drinking even close to the 64 ounce mark.
I know some of the weight gain is from water retention. Here are my steps to reversing what has happened (I always do this when this type of fluctuation happens):
The first step was to commit to myself that I wouldn't snack on sweets anymore. Today was day 1. Did it!! Woo-hoo! I had a really good day diet-wise. No sweets and pretty near perfect.
The second step is to increase my water intake. I did really well. I drank 80+ ounces today (32 ounces by 10am in the morning). I've already started shedding some of the retained water. By keeping up on my water, I help control my appetite as well.
I expect that it will take about a week to 10 days to get back down to where I was but I know I can do it. I'll keep you updated.
Sean
1. Poor diet. I wrote about this in an earlier blog (titled: Snacking). I was horrible for about a week or so. It ALWAYS takes time to show up.
2. Low Water. Yes, for the same week where my diet was poor, I wasn't drinking even close to the 64 ounce mark.
I know some of the weight gain is from water retention. Here are my steps to reversing what has happened (I always do this when this type of fluctuation happens):
The first step was to commit to myself that I wouldn't snack on sweets anymore. Today was day 1. Did it!! Woo-hoo! I had a really good day diet-wise. No sweets and pretty near perfect.
The second step is to increase my water intake. I did really well. I drank 80+ ounces today (32 ounces by 10am in the morning). I've already started shedding some of the retained water. By keeping up on my water, I help control my appetite as well.
I expect that it will take about a week to 10 days to get back down to where I was but I know I can do it. I'll keep you updated.
Sean
Wednesday, January 28, 2009
Thiamine Deficiency (Memory Loss/Dry BeriBeri)
Some of my fellow gastric bypass patients once had a discussion related to a burning type sensation they were having in their feet and lower legs. As we discussed and researched this, it was theorized that perhaps this might be a symptom of dry beriberi which is caused by a deficiency of the vitamin B1 (or Thiamine). One such patient had her blood tested prior to this discussion and had informed her surgeon's office that her B1 levels were low. She was told that she didn't need to be overly concerned. Being the go-getter that she is, after our discussion she brought the issue up with her primary care physician. He confirmed the dry beriberi and worked with her to normalize her B1 levels and the problem went away. Dry BeriBeri is rarely fatal but it can cause partial paralysis due to damage of the peripheral nerves.
Recently I have heard discussions regarding memory loss. The person who brought this issue up has been concerned. His surgeon's office responded to his inquiry by telling him that this was most likely caused by a B12 deficiency. He remarked that his B12 levels were fine. While without having his blood tested, there's no way to know for sure, I suggest that this is another case where a Thiamine deficiency can be the culprit.
In fact, according to US researchers, gastric bypass can lead to a B1 vitamin deficiency that can cause memory loss and confusion and an inability to coordinate movement. Known as thiamine, vitamin B1 is essential for carbohydrate metabolism and normal functioning of the nervous system. People who are most at risk for B1 deficiency are those who frequently vomit after having gastric bypass surgery as vomiting prevents the vitamins from being absorbed into the system. If untreated vitamin B1 deficiency can lead to Wernicke encephalopathy, a severe neurological condition.
I am not sure why surgeons who perform gastric bypass operations do not track B1 vitamin levels. Perhaps because B1 deficiencies are not as common as B12, vitamin D or Calcium deficiencies. However, a B1 deficiency can be more devestating due to its neurological impact especially if it develops into Wernicke encephalopathy which if left unchecked it can potentially lead to coma and death.
So PLEASE, Please, please have your blood work checked regularly and always insist on making sure your B1 (Thiamine) level is checked. If it is deficient your primary care physician can help you. Vitamin deficiency of any kind is a danger.
Sean
Recently I have heard discussions regarding memory loss. The person who brought this issue up has been concerned. His surgeon's office responded to his inquiry by telling him that this was most likely caused by a B12 deficiency. He remarked that his B12 levels were fine. While without having his blood tested, there's no way to know for sure, I suggest that this is another case where a Thiamine deficiency can be the culprit.
In fact, according to US researchers, gastric bypass can lead to a B1 vitamin deficiency that can cause memory loss and confusion and an inability to coordinate movement. Known as thiamine, vitamin B1 is essential for carbohydrate metabolism and normal functioning of the nervous system. People who are most at risk for B1 deficiency are those who frequently vomit after having gastric bypass surgery as vomiting prevents the vitamins from being absorbed into the system. If untreated vitamin B1 deficiency can lead to Wernicke encephalopathy, a severe neurological condition.
I am not sure why surgeons who perform gastric bypass operations do not track B1 vitamin levels. Perhaps because B1 deficiencies are not as common as B12, vitamin D or Calcium deficiencies. However, a B1 deficiency can be more devestating due to its neurological impact especially if it develops into Wernicke encephalopathy which if left unchecked it can potentially lead to coma and death.
So PLEASE, Please, please have your blood work checked regularly and always insist on making sure your B1 (Thiamine) level is checked. If it is deficient your primary care physician can help you. Vitamin deficiency of any kind is a danger.
Sean
Tuesday, January 27, 2009
Exercise
Ah! I didn't want to tell anyone this in case it set a bad example for someone but I don't exercise a lot. Yes, I've lost 250 lbs without much exercise. Yes, I do move a ton more. In essence I really do get a lot more exercise than when I was at my highest weight but still...
I do eat a lot of protein which helps so I don't lose a lot of muscle mass but now that I'm down to my initial goal weight, now I need to exercise to tone up my muscles and help augment my soon to be plastic surgery.
Plus... if you see my post about snacking below, you'll know why it's important to exercise. It has to be a life change as well as with the eating. The reason? Sure I've lost a ton of weight (1/8 of a ton actually) in just 21 months but I want to keep the weight off for as long as I live (which hopefully will be another 40 or so years).
Anyway, that's my two cents worth!
I do eat a lot of protein which helps so I don't lose a lot of muscle mass but now that I'm down to my initial goal weight, now I need to exercise to tone up my muscles and help augment my soon to be plastic surgery.
Plus... if you see my post about snacking below, you'll know why it's important to exercise. It has to be a life change as well as with the eating. The reason? Sure I've lost a ton of weight (1/8 of a ton actually) in just 21 months but I want to keep the weight off for as long as I live (which hopefully will be another 40 or so years).
Anyway, that's my two cents worth!
Snacking
I'm driving myself crazy. My work (which is in the field of healthcare [this is the ironic part]) has all kinds of sweets and carbonated drinks around (for free!). I don't have an issue with the soda but my job is stress filled on most days and so try as I might I always end up grazing a little. So far it hasn't hurt me but I keep thinking ... if I don't get this under control, it will doom me in the end.
I know, a little negative thinking but....
In talking to another RMAP patient about this, she related a story told by her surgeon, Dr. McKinley. He told her about the only person he had ever seen who gained all her weight back. Apparently it happened because she was eating about 5 lbs of peanut M&Ms every day. If I remember the story correct, that's about all she ate. A little at a time but all day long. As I think about that my inner voice tells me that I desperately need to get a handle on this because it's just a little now but it has the potential to grow into a bigger problem as time goes on. If it's hard to handle now, how much more difficult will it be down the road?
Wish me luck!
I know, a little negative thinking but....
In talking to another RMAP patient about this, she related a story told by her surgeon, Dr. McKinley. He told her about the only person he had ever seen who gained all her weight back. Apparently it happened because she was eating about 5 lbs of peanut M&Ms every day. If I remember the story correct, that's about all she ate. A little at a time but all day long. As I think about that my inner voice tells me that I desperately need to get a handle on this because it's just a little now but it has the potential to grow into a bigger problem as time goes on. If it's hard to handle now, how much more difficult will it be down the road?
Wish me luck!
Sunday, January 25, 2009
10 Top Tips
With WLS, the ability to lose weight finally becomes a battle that we not only can win but that is easier to win than I ever imagined. Here is my breakdown on how losing 250 lbs (for me) happened so easily (21 months).
1) Get into a routine. I stopped trying to think of food as exciting and taught myself to think of it as fuel for my body. I quickly learned that if food was boring and just something I had to eat in order to fuel my body, I didn't have the cravings.
2) Water. Pushing water between meals helps curb your appetite and keep you from eating too soon after each meal. Setting times for when you have to drink a certain amount of water helps, as does carrying water with you everywhere you go.
3) Types of Food. After about 3-4 months, start looking for foods that curb your appetite longer. For me, beef jerky and nuts were great for this. This gets more and more important as you get further and further out from your surgery.
4) Preparation/Grocery Shopping. We all have those times when we're super hungry and during those times it's much more difficult to stay away from eating the wrong thing. It's great if you can prepare your food, especially if you can freeze it for quick use later. However, don't find yourself unprepared. Have quick things like beef jerky, nuts, protein bars on hand for those times when preparation isn't possible. If you use them, be wise in your choice of protein bars. Atkins Advantage (Double Chocolate Crunch - yum!) are my favorite but High Protein Slim Fast are also good (the Peanut Granola, not the Chocolate -- trust me). And don't go grocery shopping hungry. Ever.
5) Exercise. Some people love to exercise, some don't. It's just the way it is. Like some people love purple but others hate it. But even if you don't like to formally exercise, do yourself a favor and move as much as possible during the day. Make it a point to park far away from the store or mall when you go shopping or far away when you go to work. Whenever you find yourself saying "oh I'll do that later" because you don't want to get up to do something (like perhaps get the laundry out of the dryer), make yourself just get up and do it. Move, move, move. As much as possible all day long.
6) Bad Days. Even after WLS, you'll have bad days. Especially as you get farther out from surgery. DON'T worry about it. It happens to everyone. Just chalk it up to a bad day, focus on how successful you've been so far, and recommit to doing better the next day.
7) Carb Addictions. There will also be periods where you will eat the wrong types of carbs (pasta, bread, sweets). Perhaps for a few days in a row. Those slips should be few and far between but you need to be realistic. They will happen. The important thing is to realize that when you have those slip ups, it's HARD to get back on track because your body is addicted to simple carbs. And when you start trying to get back on track, your body goes through withdrawals. For me, getting back on track after that is a process. I try to be perfect from day one but realistically it's usually day 3 before I get back to where I should be. I do better on day one than during the slip up and better on day two than on day three. Just keep that in mind and don't get discouraged as you try to get back on track. Discouragement just leads to failure. Think about what you've done so far, be proud of yourself, and know that you are now the one in control.
(8) Malabsorption. Okay, we all know this one. We've talked about it a lot. Don't mess around with it. Get your multi vitamin in. Push water every day so you can take your calcium (preferrably with Vitamin D). Take your daily B12 supplement. Don't take your calcium and multi-vitamin (or iron) at the same time. And never justify eating the wrong thing by saying "that's okay, my body won't absorb it all."
9) Revel in your Weight Loss. I've read a lot of posts about how hard it is when eating with your family or friends and not being able to enjoy the meal or feeling a little out of place. Stop thinking of it like that. How many of us know that skinny person who is the one in the crowd who doesn't eat sweets while everyone else is? Or perhaps the vegetarian who doesn't join in when everyone else is eating because there's nothing for them to eat? This is you now. It doesn't matter what you tell them, you don't really even need to explain. Personally, I like being seen as the skinny person who doesn't indulge and who is in control of what I eat and when. It doesn't offend anyone when I don't eat. They sometimes try to talk me into it but they respect me so much when I stand by what I know is best for me.
10) Your new body. Spend time each day noticing the changes in your body. Can you see your collar bone? How about your hands and feet? Are you noticing veins and bones there that you never saw before? Are you kneecaps more visible? How about your jawline? Can you feel your lymphnodes? Did you think they were tumors? How much easier is it for you to move? Does it excite you to be able to jog (or even walk) up a flight of stairs and notice that you no longer feel like you're about to have a coronary? When you lay down, is your stomach flat now whereas before it wasn't? Even if you noticed things the day before, spend time every day marveling in the changes.
Enjoy every day of the journey.
Sean
1) Get into a routine. I stopped trying to think of food as exciting and taught myself to think of it as fuel for my body. I quickly learned that if food was boring and just something I had to eat in order to fuel my body, I didn't have the cravings.
2) Water. Pushing water between meals helps curb your appetite and keep you from eating too soon after each meal. Setting times for when you have to drink a certain amount of water helps, as does carrying water with you everywhere you go.
3) Types of Food. After about 3-4 months, start looking for foods that curb your appetite longer. For me, beef jerky and nuts were great for this. This gets more and more important as you get further and further out from your surgery.
4) Preparation/Grocery Shopping. We all have those times when we're super hungry and during those times it's much more difficult to stay away from eating the wrong thing. It's great if you can prepare your food, especially if you can freeze it for quick use later. However, don't find yourself unprepared. Have quick things like beef jerky, nuts, protein bars on hand for those times when preparation isn't possible. If you use them, be wise in your choice of protein bars. Atkins Advantage (Double Chocolate Crunch - yum!) are my favorite but High Protein Slim Fast are also good (the Peanut Granola, not the Chocolate -- trust me). And don't go grocery shopping hungry. Ever.
5) Exercise. Some people love to exercise, some don't. It's just the way it is. Like some people love purple but others hate it. But even if you don't like to formally exercise, do yourself a favor and move as much as possible during the day. Make it a point to park far away from the store or mall when you go shopping or far away when you go to work. Whenever you find yourself saying "oh I'll do that later" because you don't want to get up to do something (like perhaps get the laundry out of the dryer), make yourself just get up and do it. Move, move, move. As much as possible all day long.
6) Bad Days. Even after WLS, you'll have bad days. Especially as you get farther out from surgery. DON'T worry about it. It happens to everyone. Just chalk it up to a bad day, focus on how successful you've been so far, and recommit to doing better the next day.
7) Carb Addictions. There will also be periods where you will eat the wrong types of carbs (pasta, bread, sweets). Perhaps for a few days in a row. Those slips should be few and far between but you need to be realistic. They will happen. The important thing is to realize that when you have those slip ups, it's HARD to get back on track because your body is addicted to simple carbs. And when you start trying to get back on track, your body goes through withdrawals. For me, getting back on track after that is a process. I try to be perfect from day one but realistically it's usually day 3 before I get back to where I should be. I do better on day one than during the slip up and better on day two than on day three. Just keep that in mind and don't get discouraged as you try to get back on track. Discouragement just leads to failure. Think about what you've done so far, be proud of yourself, and know that you are now the one in control.
(8) Malabsorption. Okay, we all know this one. We've talked about it a lot. Don't mess around with it. Get your multi vitamin in. Push water every day so you can take your calcium (preferrably with Vitamin D). Take your daily B12 supplement. Don't take your calcium and multi-vitamin (or iron) at the same time. And never justify eating the wrong thing by saying "that's okay, my body won't absorb it all."
9) Revel in your Weight Loss. I've read a lot of posts about how hard it is when eating with your family or friends and not being able to enjoy the meal or feeling a little out of place. Stop thinking of it like that. How many of us know that skinny person who is the one in the crowd who doesn't eat sweets while everyone else is? Or perhaps the vegetarian who doesn't join in when everyone else is eating because there's nothing for them to eat? This is you now. It doesn't matter what you tell them, you don't really even need to explain. Personally, I like being seen as the skinny person who doesn't indulge and who is in control of what I eat and when. It doesn't offend anyone when I don't eat. They sometimes try to talk me into it but they respect me so much when I stand by what I know is best for me.
10) Your new body. Spend time each day noticing the changes in your body. Can you see your collar bone? How about your hands and feet? Are you noticing veins and bones there that you never saw before? Are you kneecaps more visible? How about your jawline? Can you feel your lymphnodes? Did you think they were tumors? How much easier is it for you to move? Does it excite you to be able to jog (or even walk) up a flight of stairs and notice that you no longer feel like you're about to have a coronary? When you lay down, is your stomach flat now whereas before it wasn't? Even if you noticed things the day before, spend time every day marveling in the changes.
Enjoy every day of the journey.
Sean
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