Dances with DS

http://news.bbc.co.uk/1/hi/world/africa/7120263.stm

Well there we have it. Insanity in a nutshell. The war of the teddy. And there I was yesterday blogging about my excess skin. Mmmmmm!:roll:

Just as well, tbh I’d rather live in my small drop of the greater pond. I don’t hold out much global hope for the people of this world conditioned by religion and political ideology. I’m tired and bleary eyed with the constant injustice and down right stupidity that spans our beautiful planet. There is too much hatred, too much fuel for it and hidden agendas everywhere.

In my family the boys have solutions to governments. Some of what they say makes sense to me. I’m glad they still have vision. I’m proud that they can think beyond the box and that they don’t buy mainstream propaganda.

Me, I just throw my hands up in despair. My life is miniscule but I am pleased for that. I am pleased for the small life that consists of kindly words exchanged with strangers of all ethnic backgrounds. I am pleased for my garden full of bare branched trees, my family, my dogs and little mouse. As trivial as it all is at least there  is some sanity and peace in such a little life.
Sometimes in my many forays into personal moments of thanksgiving & gratitude, I do think of the rape of babies throughout Africa. Of the people who have lost beloved sons to bitter wars. Of the scars of racism in my own country. Of the woman raped by many men in an Islamic country then flogged and taken to court for the audacity to speak out about it. I think on the aids orphans left at tender ages to survive starvation in mud huts. Of the beatings women recently took in Zimbabwe for trying to voice basic human rights issues.

On the grand scale, it’s a pretty appalling world out there.

Today so early in the morning a phone call from my daughter! She is in Israel for a week with friends. How the memories flood back of good times I spent there. I am a bit of a Jewish mama sometimes, without the Jewish…I tell her…visit Neve Tzedek when you are in Tel Aviv and Yafo is a great place too, take care, if you walk on the promenade feed ‘my’ feral cats will you! Buy meat at Carmel market for them. Also at Carmel market buy a giant custard apple for a taste that will blow you away! When you leave blow a kiss to my ‘white city’. Poor child! She is having a great time and I know that actually she will find her own way. Both in Israel and in Life.

My house is empty all day long. Just me and the doggles. And Smiler my mouse. Little Mimi mouse got ill again and died last week. I cried. I was sad for two days. Pete was bemused but tried to be understanding. Bless his heart.

At night my son comes home and it’s better then. Not as lonely. I don’t like to just cook for two though. I look forward to having the bulk of my family home next week. I ponder how old age will be when my children all have lives of their own. I suppose one gets used to it eventually.

I’m having a ‘bad skin’ day. This is an ongoing saga in my post DS life. When my kids were small we used to play a game with them. They had pulley woolley ears and wibbly wobbly tummies. I stood in front of my mirror this morning while getting dressed and gazed apon my bagginess and wibbly wobblies. Wibbly wobbly everything actually! I pulled all the excess skin out to my side and imagined a smooth sleek tum. My skin looks dead it’s a strange thing. It’s inanimate. Beneath it my muscles are toned but it lies en masse over them. It’s squidgy almost.

I should not do this but I always do. Why I don’t know. Extra torture? I always lean forwards. Bad mistake. The skin hangs like a bag then and I feel repulsed by it. That’s the moment I entertain reconstructive surgery. When I straighten up it’s bearable again. I reckon I have 2 kilo’s of wrinkly skin there. I thought it would be cool if surgeons could operate on the contoured edge of the body, at the side rather than on the front.

It’s not a taboo subject. WLS patients write about it a lot on the forums. But the reality of it is way different from how I thought originally. I kind of glossed over this aspect in my desperate need just to function and to evict my obesity from my life. I never thought of the residual reminder of obesity that would be with me long after my surgery was effective…or should I say - because my surgery was effective.

Some days I forget about it - I have the luxury of being able too. Not everyone will be this lucky. But somedays it takes the gloss and shine off WLS. This morning was one of those.

I weighed myself. Not gained a jot. It’s okay though - I feel good for the extra protein and think it will help. It’s just that patience is not my virtue.

I very much enjoyed a post by a fellow DSer the other day on the forum. Trinny and Suzannah worked out a whole lot of body shapes beyond the old apple & pear type. There was much dissing of their new idea in the article which amused me. For heavens sakes…it’s just a guide! Not set in stone. I thought it was rather creative even if I am clearly an oddball hybrid of 3 shapes with a bit of brick thrown in.
http://www.dailymail.co.uk/pages/live/femail/article.html?in_article_id=488236&in_page_id=1879&in_page_id=1879&expand=true

What happened to fun? Some people took this very seriously indeed. Me - I won’t lose sleep over it. The world is full of way more important things…but it doesn’t hurt to play around with ones body shape (or lack of it :roll:).

It did make me think though on how my own body has changed shape as I lost weight. At first it was my face that showed the loss and then the rest of my body. My tum was an area that seemed to take an age to go down, but the last area to lose finally were my thighs. I began as an apple, then a brickified apple was my name. For a while I was a pear but then my bum fat went. Now I am a lollipopy columny thingimebob. I don’t mind! I dress how I please anyway. Sometimes to the horror of my family!

The other day I was sorting out the old wardrobe. Tucked in the back a pair of punk trousers size 8 - black tight numbers along the side of each leg are around 12 huge buckles. I thought maybe they’d fit me now. Pulled them on and they did! I wore them all morning, my family rolling their eyes around me - lol. I don’t care. I really like them.
They’d give Trinny & Suzannah an apopelectic fit I am sure! I’m just never going to be a twinset and pearls kind of girl though. Half the outfits Trinny & Suz dress their long suffering proteges in scare the pattootie off me. So flipping girlie. Mind you I do like how Trinny wears her jools. I am also a fan of the big chunky jool. I cannot abide mass produced ‘delicate’ insignificant rings or slim gold chains. Give me lapis, give me chunks of red coral and chrysanthemum stone, give me smoky topaz and burmese sapphire any day.

I still work on & off with old recycled parts and pieces of broken jewellery. Sometimes I sit at my work bench lost in an ancient piece of enamelled filigree work. Or admiring endlessly natures beauty in stone. It gives me joy to take a broken old locket, finely etched by an old time silversmith and to bring it to life in another context.

As I speak infront of me is a bowl of pieces. To most people not worthy of a second glance. Wait - I will take you into my next necklace! Here is a very old bead. Peking glass from a time when China was imperial. It is green and cool to hold.  Very smooth and the green colour almost holds the light internally.  On it are several yellow butterflies, also glass. They remind me of cameo’s because they are raised. It’s so feminine, maybe the sort of bead an empress would have worn.  This is my centerpiece bead. It will tell me just how this necklace will come together. I spent a morning shifting through my boxes of pieces. I found two antique silver buttons that are in the form of chinese bats. Beautiful high grade silver they are dismissed here as ‘white metal’ just because they don’t bear a hallmark, for goodness sakes:roll:. Anyway my gain. They cost me next to nothing because of this. I found old jade carved into flower buds and a silver tassel that I rescued off a broken fob chain. There are victorian coral branches - again these came from a necklace that was falling apart. They have faded to a soft red brown colour, but I can still feel the sea in them. They are textural and rich with memory and well worn by time spent around some victorian ladies neck. They hold one hundred or more years in each delicate branch. Magic! And so I go. I won’t bore you more but this is how my necklaces are born.

Now I am hungry. Staaaarving!  Petal is nosing me - she needs her chunks.  Breakfast is calling. I think it will be eggs on toast and bacon. Maybe cherry yogurt to follow.

Pete has arrived safely in Canada and peace has descended here once more. A computer failure also descended which was not great! I’m not technical, Pete does this side of things. No cyberspace for a couple of days was a strange lost kind of feeling.

I have pottered around really, thinking about all I should do & not achieving much. My neighbour accross the road goes in for a cancer surgery today. He is frail from several surgeries this year. He is in his 80’s. Please send a prayer for Jack’s safety through the surgery.

The dogs and I went for a long walk yesterday after Petal had a bad bout of highly frisky cabin fever! I ran across the field with them, light as a feather. Oh, the ease of it! I still have days of wonder that I have a body that can actually do such things!

I’ve been staying with the big eat. I never felt much like lunch yesterday but I ate anyway. Just an omellette stuffed with mushrooms and cheese. Still, it was quite an effort.

I cleaned out my spice cupboard. Feels better to be organised now :-).

Here’s the condimenty list I promised the other day:

I can’t think of condiments without remembering my friend Les who was with me on the ward after my bowel obstruction. Everyone else had flowers and books and cards on their bedside tables. Not my Les! She had neatly arranged bottles of condiments shining like jewels on hers. Reminding me that one day I too would live to eat again - lol!

Anyhoo here is my standby list:

Dried thyme, origanum for any tomato based dishes, rosemary for lamb mostly, dill for fish, basil, spring onion,sage for pork and stuffings. Dried garlic, dried ginger. Chilli powder. Dried mint for lamb.
Paprika for colour. Smoked paprika for pork and taste! Turmeric for yellow rice.

Saffron - for chicken dishes. I love the beautiful glowing yellow gold colour in a cream based sauce.

Vanilla pods, cinnamon sticks, cloves, nutmeg, quality cocoa for hot winter milk drinks.

Jamaican Jerk powder.

Chinese 5 spice.

A bottle of ‘barbecue’ spices.
I always keep sundried tomato paste on hand.

Mr Atif stocks a range of curry powders and I buy his brands, one for chicken, one for meat. If you have an Indian deli nearby it is worth buying their curry mixes. Tesco’s cannot compete!

The best chutney in the world is ‘Mrs Balls’ it’s a sweet Malaysian chutney made in South Africa. Tesco stocks it thank goodness, saves my mom posting it to me! I whip up a quick Malay curry for chicken with it.
Here’s the recipe: Half cup of cream (or yogurt if cream is too rich or taboo for you). If I want a little extra protein power I use carnation milk instead of cream. Sounds strange but tastes delicious! 1 teaspoon of curry powder (for a mild soft curry - more if you like it punchier and if hot is your thing add chilli powder too. Half cup of Mrs Balls. Mix together - it thickens up. Simply smear over chicken pieces and bake at 180 for the usual 40-45 mins. Utterly delicious. It can be left on chicken overnight as a marinade, but is just as good if done last minute! I always try to save a little chicken to eat cold the next day but my family usually does not allow that! If you can save a few pieces, by adding a little mayo & maybe a little more curry powder, it makes a supreme chicken coronation dish. Great on burgens bread with lettuce for a fast tasty lunch.

Sesame seeds, ground almonds. I keep peanut butter & hazel nut butter in the old cupboard too, but once open find they last best in my fridge.

I don’t know what I would do without Knorr Stock. It’s pukka stuff. I keep a veggie stock, chicken stock and beef one to hand. It flavours almost everything I make. Sometimes I dry the chicken one out and use it as a powder neat for roasting chicken.

I have a bottle of Sweet chilli sauce and a good dark Soy sauce on standby too. I use these to make cheats satay sauce. Just add them to taste with peanut butter - viola!

I always keep white madiera wine and a small bottle of red port. I seldom drink but if I am cooking for many people I have a little in a glass while I am at it! Mostly though I use it for beef pots or cream & wine chicken dishes. I am attached to cream as you can see! It sits well with me.

If you can’t eat cream, wine can be added to Bisto gravy granules for a really tasty alternative. Add a little sundried tomato paste and some garlic too and you are away!

Bisto onion gravy granules.

A box of coconut cream which I use in place of oil for stir fries mostly.

Mustard - good old Colmans of course!

Japanese barley Miso. I use in place of stock sometimes.

Balsamic vinegar which I use for salad dressings in summer mostly although it’s good as a dressing with olive oil on hot steamed green beans too.

These are my basics. I need them to keep my protein interesting and diverse. I’m only ever limited by lack of imagination.

I also keep a few oils on standby. Sesame oil is great for stir fries and on chicken. I always keep a deep green fragrant olive oil on hand, Spanish preferably for dunking warmed burgens bread in. And a mild one which I use for general purposes. And Mels lovely virgin coconut oil which I use in stir frys and for plenty of other purposes too.

To the right of this blog, if you click on the words Calcium, vits etc you get to Mels site where you can buy it if you wish.

It’s an excellent oil to use in almost all cooking. Very good for the tum too as it has antibacterial/anti viral properties. I know of an endocrinologist that includes it in his malnourished DSers diet to good effect.

I used to keep dried parsely for the winter, but tbh it never looks as good as the fresh stuff on food. I use it a lot because it is rich in chlorophyll which is a natural gut sweetner and odor remover. So nowadays I just buy the Flat leaved variety from Tesco’s who sell it by the bunch. Plonked in a vase of water near my cooking area it lasts me for 10 days before it goes yellow. Sometimes I add a bunch of fresh coriander to it as well, especially if I feel some chinese or indian cooking coming on!

Next to my vase of greenery I keep a bowl of sweet baby tomato’s, shallots and garlic, both the regular and the smoked one. Sometimes fresh ginger and lemon grass and a few mild chilli’s or jalopena peppers go in my condimenty bowl as well. I whip bay leaves off my neighbours tree with her permission as and when I need them. That’s a point actually , I must remember to plant my own bay tree this winter!

I know without these diverse flavours my food would be boring as anything. I’d have difficulty enjoying all the protein I need to consume. My cupboard has grown in ‘must haves’ over the years but a good basic store of a few well chosen spices and herbs and some stock cube, can make a world of difference to those of us that must eat protein.

Well enough for today. I must rush as I’m having a good friend over for lunch today. I’m cooking my butchers delish chicken thigh parcels, asparagus and cauliflour cheese and looking foward to a good old catch up natter!

It’s a frenetic weekend. Pete is going to Canada and I am relegated to ironing & packing. Deep joy.

Nothing wonderfully exciting to write about then. I just can’t wax lyrical about housework! I’m hoping to cheer myself up with a spot of antique restoration work tomorrow once he has left and peace settles on me.

The Ancient Japanese silk screen still weeps in the corner for my attention. Be nice to make more headway on it. It kind of scares me though. So delicate and easy to make a pig’s ear of it!

I’m still iced but not frosty. Yet. It’s getting colder by the day and true to form my radiators (yup plural ) have sprung rusty leaks. The gas fires in the house are doing overtime. I’m a michelin girl - thermal vest, light jumper, quilted jacket and thick woolen socks just hold the cold at bay. Thinking if I wear all my tog I will weigh decidedly more at Mr P’s weigh in - lol

Makes me smile because I remember when I went for my weight watchers weigh ins…no knickers :o, stocking socks, lightest clothes I possessed, removal of earrings! Anything not to face the dreaded gain I inevitably showed. I was probably the only Weight watchers member who consistently gained weight.

On a different tack, I discovered our recently opened Butchers Shop and it is so good! The meat is superb. I was a little embarressed because I’m in there everyday oogling all the products and speaking trite! I tried to explain that as I had a malabsorptive surgery I needed almost double the protein, hence my frequent visits. The butcher looked very chuffed indeed - lol!

Anyway his prices are great and the meat is top quality. Recently I have eaten my way through juicy lamb chops, mince that tastes like heaven and has no water content and very little fat, yesterday I nearly levitated with excitement when I tasted the mans sage stuffed chicken thighs. I never thought one could stuff thighs, only breasts. But there sat these perfect thigh parcels covered in bacon and I was salivating! Thighs I love the best of all…the meat goes down much easier than white chicken meat and it’s softer and tastier. I struggled with chicken breast meat in my first year, then by year two when I could handle them just fine, thighs had become my mainstay.

I love protein! I used to get so bored with it in my first year but I think what helped me was to keep on ringing the changes. Someone once said ‘variety is the spice of life’ - I’d agree. There are endless ways to prepare meat and serve it…it just takes time which is precious for most of us - so if you are up to your neck with protein my advice is find a good butcher who is passionate about his subject to do most of the job for you!
Tonight I am having strips of pork fillet fried in a little sesame oil with ginger, sesame seeds, garlic, dark soy sauce, and fresh lemon grass. I’ll have around a small cup of rice noodles and top up with beansprouts, carrots and bok choy. I’m happy just thinking about it, how sad am I!

For a Dser - no, for any WLS patient condiments & herbs rock!!! I’m stocking up later today on smoked garlic, fresh ginger and mild chilli. I’ll be unpacking and chucking out old sticky bottles and long overdue bottles of musty herb matter. If I have time perhaps tomorrow I will let you in on my store cupboard condimenty stuff… I can’t live without 90% of it! It’s what makes me feel good about being a complete protein whore.

Usually in summer I have a small but extensive herb garden packed with basil, parsely, bok choy, fresh garlic,lemon thyme, basil, thyme, sage, rosemary,savoury,coriander, green chilli, baby toms and dill but it’s all gone now - only the thyme and rosemary remain. I should really learn to oven dry the last growth, but I never do, I am just too disorganised. So will be buying bottles of these to tide me over the winter. In the centre of my herbal paradise I plant old fashioned sweet peas up a pyramid trellis - not edible but I love them. They evoke childhood memories of nans garden. In summer with the garden roses in bloom I cut huge bunches of them to make wonderfully fragrant flower arrangements.

My herb garden is just outside the kitchen door. It’s not fancy, it’s just 4 railway sleepers placed simply into a rectangle, filled with reasonable soil. Sometimes I keep a few pots nearby to take overflow. I’m thinking if I can bear the cold I will buy more rosemary and thyme plants and try to lay a kind of ‘knot’ garden in preperation for planting summer herbs between them.

I am dreaming of summertime and the real winter is not even here yet!

Anyhoo - let me ponder springtime, roses, fragrant herbs, homemade lemonade, green tree’s and all things warm & beautiful, while I get on with the dreaded ironing.

Have a good weekend my friends!

I quite often get asked what a sleeve gastrectomy is. It’s based on the first part of a DS. Often called ‘the Sleeve, SleeveG or Part one DS or VSG (vertical sleeve gastrectomy.)’ The stomach is transected, with much of it being removed so that what remains is a slim banana shaped tum.The pylorus is left in tact and the stomach functions pretty much as a normal one does.

Measurements of stomach capacity will be done as the surgeons preference anywhere between 30cc & 150cc, so always confirm with your surgeon what yours is likely to be.

If it is only explained as ‘A stand alone sleeve surgery or VSG’ and not as a ‘Part one DS’, the implication is that patients won’t be needing the more complicated invasive aspect of intestinal bypass, which is Part 2 of a DS surgery. If this is what you want then the stomach measurement should be made as tight as is feasible in your case.

Can be complicated and confusing sometimes to get a grip on the terminology if one is just at the outset of research!

CLICK HERE FOR VSG DIAGRAM!

SOME THINGS TO THINK ABOUT:

What concerns me is people thinking the VSG is going to be a permanent solution across the BMI spectrum.
Consider whether you might end up requiring part 2 particularly if you are have a higher BMI. Worries me when I hear patients who are very happy that they don’t need to worry about malabsorption (usually they are in the first 6mnths or so post surgery). Some express this as though it was never mentioned to them in the first place that later on they might actually need part two. Part 2 is a big step. I’ve been a sounding board for some patients as we bounce part 2 possibilities around, and it is by no means an easy decision to make. Financially it costs too.

There are a couple of positive medical papers that look good. One compares the VSG with the lapband and VSG patients had a superior excess weight loss of 57% compared to 41% for the Lap-Band. However other medical abstracts I have read end with caution and state that despite promising outlooks, more experience longerterm needs to be gained, before the surgery is properly assessed as having good long term success rates.

It’s also sometimes weighed up against the band (as mentioned above) and thought to be an alternative option for lower weight BMI’s. Can these surgeries really be compared on every level? The band relies on fills for restriction and restriction will therefore be adjustable longer term. With the VSG there is no adjustability later on, except by another surgery to either tighten the tum or to develop the malabsorption aspect.

CONSIDER THE HISTORY OF RESTRICTIVE SURGERIES & THE DS:

The VSG is not ‘a new surgery’ as is sometimes stated. I think that is quite a misleading statement tbh. In 2001 Gagner began to do the 2-part DS mainly to help reduce risks for high BMI patients who were getting the DS…so there is a history of the surgery. Also, all DS patients embody the surgery in part.

What might have changed is the degree of restriction, although this also might not always be the case…as above - this depends on surgeons preferences.

The DS VSG was designed to provide tight restriction with accelerated weightloss for iro 6 months. Thereafter it was meant to stretch out and continue to do so until patients could eat near normal portions of food. The idea was a bigger capacity for eating meant more ability to take in enough nutrients to carefully offset the malabsorption aspect of the DS. It was one of the things that I liked about the biology of the DS most…I felt that although the tum could not be reversed it would stretch enough to never require a reversal anyway - a rather neat hat trick imo!

My own tum was made smaller than the usual DS tum due to polyp removal, though not as small as a VSG could allow. However five years on you can see how much I can eat. That said, my tum still does not allow me to eat as I could pre-op… there is still a point of acute discomfort if I breach the warnings. However as I’ve often said I can eat a near normal plate of food comfortably. That might be too much food to stave off the complex issue that obesity is in many cases, without a counterbalancing malabsorption factor or an extremely tight initial VSG.

Purely restrictive surgeries in the past have not had the greatest outcomes - stomach stapling never worked longerterm. I think almost all those original surgeries have been revised now, due to regains. However obviously the method used for VSG is much more up to date. Still - I write this here because the stomach is comprised of stretchy tissue and it may try to compensate. There is evidence of this even in surgeries where retaining materials such as bands have been used or in surgeries such as the RNY that have a very tiny stomach pouch.

I think it’s important for higher BMI pre op patients considering VSG - to think about if they could live with a DS ultimately. If not, the VSG might not be the best option for them. If they are fine with a later DS…no problemo.
Of course it’s not black and white - the DS part 2 might be replaced with a RNY or a band which might be more suitable for lower BMI patients that still need to reach good later weightloss or maintain it. But as yet there is no guarentee these will be effective longerterm either. In the event that VSG patients would not want a DS or qualify for it - these are possible options. However it should be made clear then that such surgeries are also currently investigational and that there is very little longerterm outcome data available currently.

ADVANTAGES OF A VSG:

Relatively simple safe procedure with fast recovery times.

A solid advantage for higher risk patients. As a part one DS with intention to do part 2 later for high risk patients it is a very valid option.

Can be done laprascopically for patients over 500lbs, making it an ideal first stage surgery for the DS.

No dumping as pylorus is intact.

Removal of Ghrehlin Tissue may mean reduced appetite.

Might be a very viable option for overweight or obese patients. (Lowerweight BMI’s).

Worth considering for people with Chrohns, IBS etc.

No malabsorption syndrome, however patients who are very restricted should consider a calcium supplement & a multivitamin. Both can be normal RDA intake.

Protein should still be the first food of choice. Enough needs to be eaten to make up the RDA of 45gms or the weight based method of working out individual requirements should be applied. This can mean a lot of effort on the patients part.
A flexible surgery that could be converted to other surgeries later on if required.

May be worth considering for teenagers or young adults that urgently require WLS.

DISADVANTAGES:

Diet needs to be watched carefully as soft foods such as sweet drinks, ice cream etc will sabotage this surgery.

Amount that can be eaten initially is very small.

Leaks are still possible as a complication as the stomach is transected and then stapled or sewn closed.

Higher BMI patients may need Part Two of the DS.

Potential for regain is there. This goes for any surgery but purely restrictive procedures are at higher risk of this.

A two part DS may be more expensive than a full DS. Same goes for any other type of additional surgery to be added to the VSG later on.

Some consider it investigational. There is not a lot of longer term assessment of it’s outcome in terms of weight loss and later regains.

FINALLY:

This might be an option worthy of considering if one needs a revision due to regains with other surgeries. I feel it could be an interim measure - something to help kickstart the both the weight loss and revisional process for revision patients, and to help boost morale into the deal. This may be a viable idea that might also reduce conventional risks associated with revisions. However I am not a surgeon and I am not sure how surgeons would feel about this , but they might not mind revision patients broaching the subject.

As always, those considering WLS should be aware that WLS patient recommendations, experiences and enthusings are inspirational and great to read and will provide some valuable insights. However they are not scientific and not intended to be either.Research into any WLS must be done pragmatically in conjunction with your surgeon and as many longerterm patients contacted as is possible to try to get an idea of overall outcomes. Read the medical abstracts out there too.

Longerterm outcomes in terms of what will be required to maximise surgical success and how many surgeries do achieve good excess weight loss, need evaluating in as much as possible before anyone commits to a surgical choice. This includes the VSG. While initially it looks like a promising relatively simple safe solution - there may be longerterm issues that might mean enhancing the surgery along with the risks, time and financial considerations that go with that.

…and the goose is getting thin !

…the ‘to do’ list is getting long too. Panic is nipping at my heels. It’ll be a full house this season and suddenly I realise that if I don’t knuckle down it’ll be a chaotic house too.

Our Petal has been a ‘problem kid’ of late. She developed a habit of tail chasing as a pup which escalated a couple of weeks ago leading me to think this was not normal. Dogs do tail chase sometimes but Petal did it almost hourly. I researched and found that some bullies will do this until eventually the start to progress to what is called ’spinning’. Spinning is an OCD (obssesive compulsive disorder) and it is sorrowful. Some dogs spin themselves to death. It’s horrendous.
Armed with this awful possibility I decided we had to put a stop to it. I worried the tail chasing might lead to neural pathways in the brain becoming patterned. But how to help her? I’m no dog trainer. We tried what the puppy trainer suggested to just ignore it and if that did not work to give her ‘time out’ in the bathroom.

Bad mistake. She had a ‘time out’ and when I opened the bathroom door she was standing nose to the wall a cowed wreck of abandonment. It took an age to coax her out. I said to Pete - that’s it! I am done with this lilly liberal way of handling my girl! Later in the day she wet her bed. Bearing in mind it had been a stressful day for her I was about to just gently point this out when she went to the bathroom and put herself against the wall again. Self punishment. It was heartbreaking.

We decided our girlie needed firm but definite bootcamp. For several days she was never out of our sight as we put her through the paces of getting nothing unless she obeyed us by performing simple commands. We removed her toys. She wanted them, she had to wait and then obey what was asked of her. I’m against ever beating a dog but occassionally when she pushed the envelop she got a short clip. Much better imo than the pyschological banishment we had been following before. It occured to me that in a wild dog pack there is no bathroom to go to. Also if a dog is ignored and pushed out the pack that is the ultimate punishment. Most times if a dog misbehaves there will be a comeback that puts it in it’s place swift and fast.

She has responded very well. Her tail chasing is hugely reduced. She is more relaxed and secure in her pack because she knows where she stands. We are not 100% there but we are doing very well. I have hope that eventually the tail chasing can be totally resolved and that it has been behavioural/environmental in origin not chemical/biological.

I must say (though everyone thinks I am biased as hell!) that she is an extremely smart dog. She loves to learn and is incredibly quick to learn. She can sit, ‘leave’ (on command will ignore a tasty tidbit), lie. She knows what ‘off means’ knows if I say ‘gently’ she must take a treat with gentleness, knows if I get my coat or boots on it’s time for a walk because she makes for the door!

She knows when we are picking up Kate from work as on the way as soon as we get to the bridge before the station she gets excited that her sister is almost with her! If I ask her for a ‘kissie’ she lightly nibbles my neck. If I say ‘lets get you a treat’ she heads for her packet of gravy bone biccies in the kitchen pronto and sits immeadiately in anticipation! She does crack me up!

The latest is that she ‘gives paw’ if she wants a treat. She has figured that if a treat is in the offing she must do this before being given the command. So that little stiff bully leg shoots into the air anytime she is saying please! Petal is driven by her tummy just like her mum! She’s only 6 months old. She’s hard graft my girlie, but I think because she is so bright this is par for the course. We adore her so it’s hard sometimes to act all top doggish when all I want to do is spoil her rotten and cuddle her! She’s very affectionate and a real little charmer.

I have started the countdown to xmas, started buying small bits and bobs for everyone. Mainly items for my snazzy handbag emergency kits! But I also found a fantastic book for the girls…called The Goddess Guide. Tesco’s sells it for £7.00. It is full of girlie info stuff and I think it is a neat gift although alas I myself will never be a goddess, I know some ladies in my life who decidely are.

The boys are much more difficult. I’m still in sock mode. I really have to get more creative. I’m thinking maybe a relaxation entertainment Book & DVD box. A good movie to interest them, a book for if they are not in telly mood, mug with marshmallows and pukka satchet of posh hot chocolate drink popcorn, some great chocs, crisps, a throw to snuggle up in (Ikea sells some nice ones at a good price, hot water bottle for ultra comfort and some cosy socks. See! The darned socks always snuck in!

They probably all want gadgetry but I am crap at gadgets. So back to old fashioned home comforts for my boys.

Today is just too cold for a smoothie so I’m going for rice tea instead. As usual I include few quantities because it’s best made to your own taste.

DECADENTLY CREAMY RICE CHAI:

• Fragrant basmati rice - around a quarter cup or mug. (Pre cooked)
• Cardomom - for one large latte mug I use 2 pods, crack them open!
• Cinnamon stick or two
• A clove or two or more (if you are making this for other lucky bunnies too)
• Good tea bags - I like darjeeling
• Milk
• Honey to sweeten to your taste or brown sugar
• Final touch - Whippy junk cream with cinnamon powder on top

For DSERS : carnation milk or add marvel for extra protein

For RNYers & Bandsters: use your regular sweetner, omit cream and don’t add carnation milk.

Heat the milk until it simmers and then add all the above ingredients except the whippy cream & the tea. Let it simmer to extract the flavours of the spices until you are happy with them. Then add tea bags. Let it simmer until you have the strength of tea you like…I like mine strong! Stir & fish out the spices and tea bags. Pour into a latte mug. Squirt whippy cream on top, cinnamon powder drizzle with honey and enjoy!

LITTLE TIPS: pouring cold water in the base of the pot and then tipping out and not drying so that the base is just coated, before adding milk, will help prevent milk from scalding. It sounds illogical but seems to work for me. Better still watch your pot! Keep the heat low and the simmer gently because burnt milk is yuck!

This is very best with basmati rice but I have been known to corrupt this elegant recipe this recipe and use rice crispies thrown in at the last minute instead of the rice. Not too bad either.

Most days I twirl my way through life with my DS but sometimes I stop at thin lines and jagged little edges.
Most days I forget I am readjusted, a little experiment in the grand scheme of WLS. I just get on with things.

But sometimes I am reminded very lucidly that the DS I have, is possibly forever. I say possibly because if they do develop some amazing wonderdrug with no side effects for obesity I might go that route. I also say possibly because I have seen how the JIB surgery came and went, the VBG is well on it’s way out and some other surgeries are seeing quite a high revision rate. Forever is one big loaded word as is never. I quite often see newbies in WLS sign off with words such as ‘thinforever’, ‘nevertogain’ etc. Mmmmmm.

I’m not judging. I’m understand the hope, god knows we need the hope, but it is loaded hope. It is high expectation hope. If the card house blows down it is just too painful. Other solutions may yet come our way that we choose to go for ultimately. Things can & do change.

Anyway, I am reminded of ‘possibly forever’ when I am dancing the rumba with this DS. When things change from slow easy waltz to me tripping over my own DS feet. And big effort is the order of my day. Big effort always reminds me that there will be these times way down the line from now when I will need to make effort. No if’s or but’s. No sabotaging. Focus. Stay with it effort even if I’m frustrated. Even if it’s been a crap day. Even if we have not had one hour of sunshine in the day.

The smoothies are sitting well. Yesterday I knocked up this one:

Frozen blueberries, apple and yogurt. I had to add a little apple juice to thin it though and I added some honey to make it less tart. It tasted good. The night was peaceful. The bowels seem to be behaving although currently I do visit the throne one more time in the day than usual, but that’s fine if it isn’t in the middle of the night.
So it will be an additional smoothie a day for me. It’s not killing. But it will mean being organised and making sure fresh fruit is on hand daily. It will be one more thing to remember on top of my wildy multiplying ‘things to do’ list. Also I will eat extra protein if and where I can. I will add either a small liquer glass of condensed milk to my daily life or a chunk of Rocky road. (Gawd I hope that is not an inauspicious description of things to come ) See what I mean by Rocky Road below. (They are not exactly healthy, but both these do have more protein than say a bag of crisps).

I will also snack more frequently as goes against every WLS book on regains. Plan B is set for action. I’m chucking out the bulk of the crap carbs now and going back to threshold quantities, because the ratty bowels are no fun.

My feet are freezing already and it’s not even winter yet. I winge about our poor central heating endlessly. I threaten to leave cold Britain for good and relocate to sunnier climes. I’m the proverbial muttering pain in the derriere right now. I might have SAD. Am I the only one in search of warmth so early in the autumn day?

In desperado I bought some microwavable sole slippers from Lakeland for under a tenner. Randomly, infused with festive spending spirit, I also bought a something called a ‘Rocky Road’. Not cheap but it is large, big enough to provide me several helpings (justifying the expense wildly now). It has to be Australia’s best kept secret. Did I say I would only eat a little choc some days ago. Heh! I don’t think so - this has to be the best thing my sweet tooth has ever tasted!

Please I beseech you do not open this link if you have weight to lose. It is dangerous. Ignorance is bliss. Eating a rocky road might lead to a rocky road indeed.
Final friendly disclaimer: Dances with DS blog is not responsible for your credit card going bust nor your late weight regains.

http://www.lakeland.co.uk/product.aspx/!11124_11123

But back to the slippies. Thinking this might be a really good plan for xmas prezzies too. I’m not wildly keen on the slippers (they are alright) but the insole pads can be inserted into other shoes and slippers. They are heavenly. Sadly though the heat does not last as long as I would want it too. I got about 15 mins of heat out of mine. But it’s enough to give one a good boost of toastie toes. I also need a microwaveable body suit and Petal & Zen Zen cordially request microwaveable dog coats for our long walks in dampened fields. Any entrepenuers out there?!

Frankly I think when the surgeons do the DS they should insert minute remote control heated pads into the body at locations such as hands, feet, bum, lower back and tum. This would not only help us out but it would help in the fight against global warming too.
While I am at it could they insert a wee carbon pad right at the very bottom of the large bowel system too, for avoidance of gaseous odours - I won’t go into more detail than that but it would create a near perfect surgery then.

Here’s the slippers link:

http://www.lakeland.co.uk/product.aspx/!7956_7966_7953

Have a happy day.

My apols - I rethought some  of this post and have subsequently edited. So if you read it yesterday you might wish to spare another perusal of it’s contents.
I am reading of a bad turn of events for the malabsorptive surgeries in Australia. A DS & BPD surgeon is in the line of fire from the press because he has lost 6 patients. Seems some to malnutrition, others to other causes. It’s unclear whether these are BPD or DS patients, but from what I could gather it seems both types of surgeries are involved. It’s on the telly and in the papers.

http://www.abc.net.au/news/stories/2007/10/22/2066798.htm

I’m not defending nor judging this surgeon. I don’t know him as a surgeon, so anything I say in regard to him would be mere speculation. Besides, it’s a fact that not all surgeons are equal, some are better than others, as in any profession. Not all patients are equal either. A few don’t comply, most do. Some are very high risk patients due to pre existing co-morbs. There are many other factors too on both psychological and physical levels that add up to a very complex picture.

On the other hand if a surgeon has a morbidity or a complication rate that is beyond the acceptable limits - patients do need to know. Things must be investigated. The full picture should be sought.

It’s how it’s done that bothers me. Things like this can be fuel for fire. It’s easy for people driven by fear and the need to protect citizens, to throw a blanket over everything and do the black and white scenario - especially when they have no clue as to what they are actually talking about.

I think our surgeons go out on a fine line and a long limb (excuse the weak pun;-) ) to do this surgery for us.

In the past I have heard of good surgeons getting a bad deal because of one difficult case. Some surgeons might work with very high risk patients others would not dare to touch & perhaps because of this they see more morbidity. (But they also save lives that would have had no hope otherwise.) It can’t be easy. And I am pretty sure when this sort of thing comes to light unfortunately they might get a spattering of tar from afar. Unfairly. Also the media adores finding a witch. And if it is flavoured with WLS or obesity which can be senationalized, so much more brutal the trial. The hanging tree is always waiting. Events may be far from the truth, or twisted to not present the full picture.

In the fervour of press reports it’s easy to conveniently forget about the many thousands of lives saved by the DS surgeons performing this surgery worldwide. Not to mention the incredible quality of life we get more often than not, the excellent initial EWL and longerterm statistics that show it as a WLS leader amongst it’s peer surgeries.

Sometimes - rarely, there are Jack-the-hammer surgeons too. They turn out a fair proportion of badly done DSes and if you walk the forums as I do, it can become pretty apparent that technical proficiency is not their strong point. Over a few years, patterns become apparent as patients often suffer very similar problems. The DS is a very carefully balanced surgery. Correct calculations are essential.

But I digress. It’s not the case that all this surgeons patients died of malnutrition. It was one factor in a tragic and sad case that had other factors as well .

However, on a forum one of his patients stated that he gave instructions to his post op’s for a low protein diet… oh mannnnnnnn! * sigh *

There are still a few surgeons advising we take a couple of vitamins and we’ll be fine. But some things are self evident on the ground floor of patient interaction and research. You don’t need to read a peer reviewed paper to find that doing just this has not been the wisest choice for many longerterm WLS patients. This patient was savvy and internet literate enough to do her own research and found out out the requirements of DS surgery nutrition for herself. Her surgeon supported her choice although he did not unfortunately endorse it (or variations on a high protein theme) for all of his patients.
Every DS patient should leave hospital properly informed about supplementation and vitamin routines. If this is not done, it’s not right. If it is done, but the patient leaves with a RNY fact sheet (yup it has happened here), or patently wrong advice that will have an adverse effect on the patients health, that is also clearly wrong.
On the other hand it is not all cut and dried. Let’s face it, there is only so much even the most accomplished surgeon can do. Even when we are correctly advised about compliancy and our supplement needs - it’s up to us to follow through. There are responsible Dsers worldwide who work daily to help newbie patients or struggling patients on the road to good health. I have also tried hard on my website to always stress compliancy and that DS patients empower themselves right from the getgo.  Precisely because it’s not only about the individual patient when tragedy happens (though that is wayyyyy bad enough! ). It affects surgeons (even the very best ones), it affects the concept of the DS globally, it affects other patients too.
All the above said, perhaps the thing that stays with me most right now are his patients. I wonder how they are coping with the many thoughts and feelings that they must be dealing with in the light of all of this? I think it must be a very difficult and trying time for them indeed. They have been in my thoughts a great deal this week.

This balancing act between the good stuff (my health, my protein intake!) and the crappola (the carbs and sugars I must eat to try to gain some weight) is not easy peasy.

I’m living proof today of the balance gone to the dogs! Yesterday I ate just that little too many carbs and the night has seen me out with plenty of very gastric, mildly crampy, watery diahorrea. Deep joy & forgive me for being graphic.

In my case the line is fine. I get the liberty with my DS of eating carbs with no ill effects until the magic figure of my threshhold. It usually means I can eat iro several slices of bread and maybe a sliver of cake, but I only need to add 2 biccies to that and the loo becomes my second home. I thought perhaps if I slowly and very sneakily built up carb intake over several days my DS would be okay with it. But you can’t outfox something as smart and powerful as this! And yesterday in addition to all my protein, I ate 3 caramel and nut chocolate covered biscuits and around 3 slices of white bread, half an iced cinnamon bun and oh lord I nearly forgot to add a packet of salt & vinegar crisps too. In Africa we have such a lovely expression ‘Oh WENAAAAAAA, wennnnnaaaa’. It’s half mournful and embodies regret, deep regret. Which is how I felt at 3am bedraggled in my pj’s sitting on the icy seat of my throne groaning ever so slightly as my DS did it’s job full tilt.

It did cross my mind that the bathroom needs a magazine rack. I wished for a mag to bury my crampy little self in. When I was a bebe Dser I used to have a moth eaten pile of readers digests in the bathroom which helped me while away the time much better. But life moved on and my DS poopy habits were faster and easy and I forgot the merits of having a good pile of reading matter on hand.

Never never my dear friends think the DS will not modify your behaviours! Big fallacy this. It will. I know the RNY is sold for it’s dumping effect to many who feel they want behaviour modification. I also know the idea of dumping filled me personally with terror. I’d still rather be paying the price of bad eating according to my DS this way. And therein my dilemma. Bad eating is something I stopped long ago so it is ironic that now I must persevere with it. It is all relative though…eating carbs right now is actually good eating for me. Aaaaargh! So confusing!

I also have my doubts that I will gain weight if I am consistently diahorreac. Scopinaro once wrote about a kind of metabolic threshhold that the BPD has and I think I am experiencing that now. Past a certain threshhold of calories the BPD kicks in bigtime to hold the metabolism at a certain level preventing gains.

I don’t resent my DS at all at times like this. It’s not easy, in fact it can be hair pullingly frustrating, but I don’t hate it for doing it’s job. I had it for this in the first place. I’m actually dead impressed with my DS that is a true trouper and still works very well (if very graphically) at 5 years out.

I had fears I might become carb dependent again. It can set up an addictive pattern for me. I think it was last christmas that the carb devils seized me badly and I had to come off them much like a drug. So I don’t want to revisit old lessons. But in all honesty even the choccy nut shortbreads I ate were no longer that wonderful to my taste buds. I just like a bowl of scallops with herb butter so much better. I have turned weird!

So now what? I need the weight but I don’t fancy the diahorrea becoming my second cousin.

I don’t know what. I really don’t. I did toy with the idea yesterday, of a fruit smoothie daily to try to boost the sugars in a more healthful way. I think it’s something I will try today and see how it sits.

I’m wondering too if I ate protein over my usual 80-100gms if the excess would not be converted to fat. That might be worth a try too. Just going to mean a heck of a lot of eating though.
Creon remains my last resort. This drug helps patients absorb both calories and nutrients better, but I still feel it should be reserved for those who are underweight. I’m not underweight - yet. I’m on the fine line though.

Well, onward and hopefully upward (on the scales anyway!).

I’m off to buy ingredients for a smoothie right now. (And a readers digest * sigh *). I think I fancy something tropical…mango, banana, kiwi fruit and a little coconut milk. How does that sound?

I’ve had a good day on the food front today. I’m pushing forward with a concerted effort to eat a little more. I’ve deliberated eating more carb & sugar before, but tbh I don’t like to push that envelope too much - just a little more. It is easy for me to slip into the old addictive patterns and such foods could trigger that for me. So instead I will try for more good food. With the odd dessert and piece of cake in the day and see if in a weeks time it makes any difference.

I kicked off with a good start. Coco pops for brekkie. Then I had a bacon, beans and cheese melange which was delish & tasted a thousand times better than the coco pops.

For snacks I bought a mixed variety of mini cereals and ate a packet of honey loops dry. Not bad as a snack!
Lunch was fish in sauce with plenty of mixed veggies.

I had a small choc for the afternoon snack and enjoyed a huge fortified latte.

Supper will be lamb chops, fresh potato chips baked in the oven , sweet potato & green beans.

I’ll round that off with a banana later in the evening and another milk drink.

Food stuff aside I am updating my old website big time. I’m enjoying bringing it into alignment with modern times. It will be a lot more user friendly. I don’t know when it will go live yet but hopefully not too long now.

Had a great afternoon catching up with my youngest Matt. Don’t see the lad often now he is at Uni. He needs a coat so we trawled the shops but found nothing he liked. But we had good fun anyways. He is one of the few lads I know who can tolerate his mam going into the charity shops for a ferret about. I tried on a top over my shirt and asked his opinion. ‘Mmmmm it does nothing for your chest mum.’ Bless the child…what chest? I have no chest left alas!

Mmmm..I think it really is time to go for the padded bra’s now!