Levels

This morning was my first visit to the coumadin clinic.  When you go on coumadin, your blood levels have to reach a certain range.  This is especially important at the beginning when you are about to run out of the inject-able you take along with it.  I have 3 more days of Arixtra left for injections.  The goal is to get my levels to 2-3 before I run out.  This morning, my level was 1.8, which, I am told is quite good after only 4 days.  So, for the next day, they are adding an extra half dose of coumadin and I will go back again on Thursday.  After that, they follow up once a week until the levels stay within the range and the goal is to only see them once a month.

Today they confirmed that the trip to Boston should not be a problem.  The reminded me to be good about hydrating and getting out every hour to move around while we are driving.  We are taking 2 days to make the drive, which made them much happier as well.  I just hope my stamina is up to the trip.  I know I will be the thinnest I have been in 10 years (since I already am), but with the blood clot, my leg gets tired pretty quick.  They assured me that will change faster than I think and that one day I will realize that it isn't bugging me at all.  But I still worry!  I do want to show John some of the things that I remember from visiting there as a kid.  The best part will be being on soft foods by that time.  I'm thinking Boston is going to be a good place to be during that phase.  If nothing else, there will always be seafood!

A Long Day

I'm not so sure why it is taking me so long to write this blog, but I need to write it. First, I owe my surgeon a big thank you. If he hadn't required me to have the IVC filter, this week could have gone completely different.

 On Monday, I woke to my left leg hurting. On Sunday, I had unwisely done my own grocery shopping. By the time we got home, I was exhausted. I thought I was being good and getting up every hour to move around. So, I assured that the pain was from overuse.

 By Wednesday, the pain had not gotten any better and I was to go back to work on Thursday. Plus, there was a fullness behind my knee that wasn't normal. However, I had no other signs of a blood clot. I called my surgeon and was advised to see my PCP that day. My PCP wasn't in but another physician saw me. He examined my leg and said he didn't think it was a clot, but took blood for a D-dimer test and to check my electrolytes. If the D-dimer was up, he would send me for an ultrasound.

 Overnight, the results were posted and they didn't draw enough blood for the test. I had an appointment that morning with my PCP anyway. She took a look, said the same, drew more blood, but told me to go ahead and set up an ultrasound; she'd let me know if I didn't need to go. I then went back to work.

 Friday morning came and I heard nothing. I will admit there was a part of me that wanted to chance the ultrasound until I heard the result. The smarter part won out and I got it done. I had a "new" clot in my calf. At the emergency room, they asked me to describe the symptoms. When I mentioned the fullness behind my knee, they told me that was the most apt description of a DVT they had ever heard (remember that, it might save your life someday). Because I had the filter and my CBC was "normal", they didn't admit me. I was shown a training video on how to inject myself with anti coagulant and given coumadin, which I will now take for 6 months.

There were 2 good things about the clot. First, a clot in the calf is the safest. It is the least likely to dislodge and go to your lung. Second, it was "new". This means it will dissolve quickly and there is no scar tissue left behind. This means less chance of recurrence. But the biggest lesson I learned from this is to stop trying to be so self-sufficient. It's so hard when you live alone, but I have great friends who are willing to help. I need to be more grateful!

Chicken and Vegetables

After a rough week, I am finally feeling like I have energy again. Unfortunately, my meats have gone bad. I am thankful that I have friends willing to help me out. My friend, Leland, is headed to the grocery store to get me a rotisserie chicken. I hope they have some available. I decided to just make a melange of sorts and add chicken for protein. It smells really good cooking on the stove.

 Chicken Vegetable Soup

• 1/2 large onion, finely diced
•  1 small butternut squash, diced
•  3 stalks celery, with leaves, diced
•  2 carrots, diced
•  1 red pepper, diced
•  2 Tbsp extra virgin olive oil
•  1 28oz can diced tomatoes
• 4 cups low-sodium chicken stock
•  1 small rotisserie chicken, shredded

 Prepare vegetables. Heat olive oil in a large Dutch oven. Add vegetables and cook until fork tender, about 20 minutes, stirring frequently over medium heat. Add diced tomatoes and chicken stock. Reduce to a simmer and cook 20 minutes. Add shredded chicken, cover and cook another 20 minutes. Blend a 1-cup serving.

Note: I have purposely overcooked this soup to make it blendable. Cooking times can be adjusted and chicken added with the tomatoes and stock if you prefer firmer vegetables.

Making Sure

Today has been an adventure in and of itself. I have been dealing with a painful leg since Monday. I assume at first that it was from overuse on Sunday. But it wasn't getting better. The pain in down the back of my left leg and there was a fullness behind my left knee when I stood. There were no other signs of thrombosis, but I felt it important to get checked out. I got an appointment set, but noticed a twinge in my right calf when I stood up and decided to drink a V8. For anyone who doesn't know, a can of V8 (low-sodium, of course) has 1150 mg of very accessible potassium. As soon as I finished 1/2 cup, the pain and fullness lessened. I hadn't thought of it before, but it totally makes sense this would be the case. I take HCT for my blood pressure. It is a diuretic and thus is known to leach potassium from your system. I also have been on a stilt liquid diet for 2 weeks so I am sure my nutrients are all screwed up.

 When I got to the doctors office, I forgot to let him know that I am an immunologist and he seemed a little annoyed with my suggestions.However, when he checked my leg out and then found out what I do for a living his attitude completely changed (for the better). He told me he agreed that it didn't look like DVT, but wanted to test my electrolytes and for blood clothing factor to figure out why it hurt. He said if they came up with a positive on the blood clotting factor, they would bring me back for an ultrasound to locate the clot. I am now just waiting on results.

Soon to today's recipe.I have been craving Italian. So, I set out to figure out a deconstructed lasagna. Surprisingly, it was quite easy. I had ricotta in the fridge. And I just went from there.

Blended Deconstructed Lasagna

• 1 cup part-skim ricotta
• 1/2 cup low-sodium V8
• 2 Tbsp grated Romano cheese
• 1 tsp dried basil

Mix all ingredients. Blend if necessary. Heat 1 minute on HIGH in microwave.

I cannot tell you how satisfying this dish was! I would guess that you could add any ground meat if you prefer meat lasagna. However, at this stage in the game, it is quite hearty enough.

Milestones

I have a couple milestones to report today. First, as I mentioned on Facebook, I consider being healed enough to lay on my side a milestone. As of last night, I was able to do that. Second, I have been taken off one of my blood pressure meds. Third, I have reached phase 3 in the food plan. What that means is I can now have blended foods.

I decided about midweek last week that I was not going to take the easy way out and rely on yogurt and baby food. I want real food. It won't be pretty, but I sure hope it will taste good. Here's what I've done today.

 Tropical Cheesecake Smoothie

•  1/2 cup Fage 0% fat Greek yogurt
•  1/2 cup part-skim ricotta
•  1/2 cup coconut milk
•  1/2 cup frozen mangoes

 Place all ingredients in blender. Puree until completely smooth.

 
 Blended Egg Salad 

•  2 hard boiled eggs
•  2 Tbsp Fage 0% fat Greek yogurt
• 2 tsp brown mustard
•  2 tsp Brussels sprouts relish

 Place all ingredients into blender. Puree until smooth.

 Both of these items filled me up with half a serving. I split them between a meal and a snack. I should have one more meal tonight, but I'm full right now, so I'm having a hard time thinking of that. I'm going to have some tea now and see how I feel in an hour.

I have to admit that I am struggling tonight. I made a protein shake to get the rest of my protein in. I had had some peanut butter for dinner and I guess that might be a little heavy for my stomach because I am feeling up way too fast with the protein shake. It's too bad because the peanut buttes is a good source of protein and it seemed to go down well. Tomorrow I have to cook. Hopefully, what I make will work, making the rest of the week easier for me.

Renee's Ramp Recipe

I am being tortured every day by people cooking with ramps. If you don't know what they are, you are missing out. Ramps are wild onions and they have this beautiful sweet onion/garlic flavor. They became a favorite of mine last year. The downside is that because they are wild, there is a very short window every year.

Because of the early warm weather this year, their arrival corresponded to my surgery. But never fear, my dietician, Renee, who took over my winter shares, has provided me with the recipe she used them in.

Ramp and Bacon Frittata

4 slices bacon

1/4 cup onion,  diced

1 cup ramps, chopped

3 thick slices bread, cubed

7 eggs

3/4 cup skim milk

2 tsp Dijon mustard

Salt and pepper, to taste

3 Tbsp Parmesan cheese

Crisp bacon in a large frying pan over medium-high heat for 4 minutes. Mix in onions and ramps; cook 3-5 minutes. Remove pan from heat and add bread cubes.

Whisk together eggs, milk, mustard, salt and pepper. Pour egg mixture over bread and heat over medium-high heat 5-8 minutes or until almost cooked through.

Sprinkle with cheese and cook under a preheated broiler for 1-2 minutes or until cooked and golden brown.

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Easter Sunday

I will admit that when my surgery was scheduled, I didn't realize that Easter would fall at the end of phase 2. It's been a strange Easter Sunday. My parents are still in FL and I just had surgery, so no family get together this year. John took me to Whole Foods to stock up for the blended phase. I was really surprised they were open today.

 It has been a good year to year-and-a-half since I have made a real trip to a grocery store. I have been subscribing to the community supportive agriculture program for that long. I have to say, I can't wait to get back to it! It makes me sad to go back to "normal" living! I made it through the shopping, with my legs very tired at the end. Of course, by the time we got home, all I wanted to do was take a nap. It's going to take some time to get back to my busy active life. But I've got to tell you I I can't wait!

 The other thing I find interesting is that my initial aversion to blending meats is quickly waning. For my first blended meal, I decided to make salmon florentine. Salmon is soft enough that I think I should be able to get it smooth. I'll sure to post the recipe and a picture of the completed dish before blending. I'm thinking nobody will want to see it after it's blended. I am hoping the flavor will override the look.

Feeling great!

I have been up and down getting my liquids and playing with the "kids" a bit and just noticed that I suddenly feel really good.  Clearly, the incisions are healing because even the itchiness is gone now.  The only remaining reminder is a bruise they gave me during surgery, but even that is half the size it was. 

Now I can pay attention to some of the other things I haven't really paid attention to.  Those who know me know that I have been perimenopausal for almost 10 years now.  Lately, the indications have been that I might finally be winding down.  Now, I'm not so sure.  Of course, losing weight will do things like that.  But I have noticed a couple things: first, my emotions aren't running away from me this month.  Usually, the last week of my cycle, I get very irritable.  Well, this month, it hasn't hit yet.  Second, the edema related to my cycle has NOT gone away.  This is a disappointment.  But since I don't already have edema in my legs, the cycle-related edema isn't bothering me as much as it has the past few months.  I hope all of this isn't TMI for anyone.  It will be interesting to see how this all evolves as I lose weight.

My knees do seem to be affected by the cycle-related edema.  They don't exactly hurt, right now, but they get stiff easier.  I am guessing that is the reason that they hurt so bad at the end of my cycle the last few months. On the plus side, when I know that they are going to get stiff, I move around more.  The stiffness comes from sitting in one place too long.  So, I have probably been up and down more today than any other day since the surgery.

Stir-Crazy?

I am now 10 days post surgery.  On Wednesday, I spoke with the bariatric nurse who called to check up on me.  At the time, I was still sorting through what I can or can't tolerate.  My husband had accidentally gotten reduced fat milk when he went to the grocery store.  It was Lactaid milk so that if I was having a hard time with lactose, that wouldn't bug me.  Well, we learned 2 things.  1) I cannot tolerate 2% milkfat, even after the surgery.  2) Lactaid milk has a lot of sugar!  A whopping 12g of sugars, regardless of fat level! It was a little shocking.  John returned to the grocery store to get me bananas (a suggestion for bulking up calories in my protein drinks) and checked all the different types of milk available.  The sad thing that he discovered is that all non dairy milks have added sugars!  Even the "original" unflavored versions.  Thankfully, the added sugar amounts to far less than the Lactaid milk, but it was an interesting lesson.  We settled on coconut milk, which is good, but has an inherent sweetness to it which is a little weird when you use it to make cream soups. But it's okay, I am only a few days away from the blended food phase.  Given how much better I feel when I have the banana in my protein drink, I think I am going to be getting quite busy making blended foods from REAL food during the next 2 weeks.  I already have Carrot Miso soup and Brussels Sprouts Split Pea soup in my freezer, but after these two weeks, I think I am going to be a lot more creative than I thought in this next phase.  I am even getting over the aversion to blended meats. I promise I will post recipes for anyone who is considering this procedure because there are really only about 10 recipes that I have been able to find online for this phase.

In the rest of life, my dietician, Renee, has taken over my winter CSA shares.  And wouldn't you know, the week that I have surgery, she received ramps in her share.  I'm so sad because these are such a treat!  I did, however, ask her if she would like to contribute her recipe to my blog.  I hope she does, because even though I can't eat them now, that doesn't mean I can't have them eventually!

Tomorrow, we head back to Cleveland. We will be stopping by my mother-in-laws to watch the hockey game with her (she's the biggest Red Wing fan I have ever seen and it's so much fun to watch games with her!).  They will probably order a pizza, so I will have to make up one of my savory shakes to enjoy while we watch the game.  Then we will head back to my place.  I have to admit, I am truly looking forward to having my recliner back!  We will have to do some shopping when we get back there because my refrigerator is basically empty.  But I have already started making a list.  And then Monday is my follow-up appointment.  Returning to work, however, will not be allowed until I am into Phase 3 (blended foods), so I won't go back until the end of the week.  I am looking forward to returning to life.  I am not good at this sit back and relax stuff.

A Good Day

Today I had a visitor. My husband's cousin drove over from the Ann Arbor area. We chatted, walked and she gently reminded me to drink whatever it was I needed to be drinking. I also had a really great phone conversation with my sister-in-law. Now, I call this a good day because yesterday wasn't so good.

 On Sunday, I realized that having 3 protein shakes made with water was not giving me enough calories. So, I tried to start adding other caloric liquids to the routine. I have never been able to drink milk with milkfat over 1%. We grew up drinking nonfat dry milk and my system has never learned to deal with milkfat. I sent my husband to get Lactaid milk when we got here and neither of us noticed it was 2%. Actually, I'm a little disappointed Lactaid put the 2% milk in a blue carton That's a color usually reserved for skim. I had also had him pick up some cream soups because it was mentioned that if I skimmed them, I could have them. So for dinner last night, I made cream of broccoli, skimmed out a serving, mixed some protein powder (unflavored) and tried to have that for dinner. I managed to eat it, but it was a truly uncomfortable experience. That's when I discovered the milk was 2%. Clearly, this is one thing that has not changed.

 Before I put the soup away, I diluted it with an equal amount of water. It made a really nice dinner tonight. But I will not be taking a chance with that again. It's just too much fat!

Today's lesson

I discovered today that three days on three protein shakes a day made with water is definitely NOT enough calories to sustain me! The hardest part of this surgery is figuring out what you can tolerate to get all of your liquids and proteins in. (In case you are wondering, the three shakes came to a whopping 312 calories a day). I know that sugar bothers me right now, but haven't tried anything with a little bit of sugar (12 g or less) since my reaction to the Boost on the first day (18g sugar, 26g carbs). So, I just checked at the rest area to see what I might be able to try for "lunch". I came out with a muscle milk (12g carbs, 3g sugars, 230 cals) and a coconut water (11g carbs and sugars). I am starting with the muscle milk for the protein and so far no reaction. The coconut water is an experiment in hydration for later. I figure if I can't tolerate it, my hubby will finish it, but if I can tolerate it, it will become a source of potassium for the future.

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Eventful Weekend

I am trying hard not to be a drama queen through this experience. However, when you have major surgery and you are told by every doctor and nurse that it was handled a certain way, down to care instructions after going home that back that up, I don't think it's unreasonable to be upset when you find that is completely wrong. There are 2 methods for closing incisions following bariatric surgery: staples or glue. Because I planned to go home this week, I was told they would use glue instead of staples. At every point leading up to the surgery, this change was mentioned by all involved to remind the doctor. After the surgery, I was told by every member of the surgical and care staff that glue had been used. Nobody looked beneath the bandages because there was no seepage, and thus, no reason to look. When they discharged me, they gave me care instructions for incisions closed with glue.

The main difference is showering. Incisions closer by glue have plastic over them. So, when you shower, you do not need to cover them. They also told me not to worry about the bandages unless I saw seepage.When closed with staples, however, you are supposed to cover the incisions with plastic wrap. Needless to say, I had followed through with care as I was instructed.Yesterday, the incisions starting itching (a normal effect of healing). I decided to take a look to make sure there was no signs of infection. Imagine my surprise when I removed the first bandage and found staples! The next few hours were spent trying to reach the bariatric nurse. Since such a big deal had been made before surgery, I had a feeling this was important. 

This morning, I finally reached my surgeon. I had to remind him the reason for using glue was because I was to go home for this second week of recovery. His response was to ask how quickly I could get to the hospital. He had me come in to have the staples removed. Now that that has been done, I am to switch my care to the staple protocol. Which means we now have to get supplies.

In the end, I am sure everything will be okay. It does, however, bother me that 2 mistakes have occurred already. Let's hope the rest is fine.