This is likely to be long... and more accurately a vent or a rant than anything else, probably.

I had my (about 3 month) followup with my surgeon today and I am spitting mad! About 5 weeks in I had some nausea, which resulted in me averaging less than 700 cal/day (don't have my charts on hand to give an exact #) for about 3 weeks. For me, that was too low and resulted in an extreme lack of energy, nearly passing out, I thought I was extremely dehydrated, and long story long... I ended up in the ER trying to figure out if something was really wrong. Turned out to be no big deal, and all I needed was stronger anti-nausea meds, fortunately. Unfortunately, as soon as I was able to eat at my prescribed calorie level, I gained 10 pounds within just a few days, and now, 4 1/2 weeks later, my net loss is only about 1/2 a pound.

I've done some reading on what happens when a person is subject to starvation or semi-starvation and then is able to re-feed. In the simplest terms, the body pretty much thinks it better hang onto every bit of energy it can in case there is another "famine" around the corner. One thing I read stated that in a fairly short period of some level of starvation, one can expect the body to take up to 3 weeks to stabilize. Now that I'm at about 4.5 weeks from beginning to eat more appropriately and feel like my body is still not normalizing, I'm looking for more information on exactly what's happening, so I can figure out what to expect and how best to support myself and my system while it adjusts. This is the same kind of thing I always do when I encounter a problem... A big part of my identity (and career, in fact) is in problem solving. Nearly everyone within my sphere of influence comes to me for answers and advice. I encounter a problem, work to understand it, decide what I think is the best course of action, and then implement it and see if or what adjustments need to be made. Not really any different from anyone else, but I work really hard to figure things out and come up with good solutions and I'm pretty well recognized and trusted among my friends (all well-educated professionals) as having a talent for it. So that's the background...

When my surgeon walked in and asked how I was doing, I admitted to being frustrated since getting the nausea worked out a month ago. I explained what had happened with my weight. I told her that I documented over the last 2 weeks (just the duration of the report I ran) that I had been running about a 1200 cal/day deficit and didn't really understand why my body wasn't responding. She stopped me and asked me what that meant (I think now because she didn't think I knew what that meant). I told her that I use a bodybugg (sophisticated body monitor that measures caloric output)... before I even had a chance to finish my first sentence, she cut me off and told me that I couldn't go by the information that a bodybugg gives me, and I can't use it to decide how many calories I should be eating. I tried to explain to her that was not how I use it. That I've been eating an average of 1100 cal/day over the last week (again, just the length of report I ran), which is still 200 cal below what the nutritionist in her office directed me to eat. I told her that I simply compare what I eat to what I burn to get an idea of what I should expect from my body. I explained that I have used this method to great success (115 pounds) within even the last 4 years and my experience with it has been that it was exceptionally accurate and reliable for me in the past (measurements proved to be accurate right up until surgery). So, sometime between right before surgery and now, I went from being able to eat about 2400 calories/day (without any significant exercise) without gaining weight to not being able to lose at less than 1/2 that. That tells me that there has been some significant change very recently and warrants some consideration and perhaps investigation, but did not trigger any reconsideration of her stance, no thought or discussion toward figuring out why my body isn't responding as expected. She got defensive and said "Well it's not working for you now, is it?" That was pretty much where I determined that I would be unlikely to take any further advice from her on this particular topic...(talented surgeon, but this is complete b.s.) She asked me if I was measuring my food. I replied I was. She then tested me, and asked me if I owned a food scale (So, what? I'm lying to her now? I told her I was measuring my food, of course I own a scale! 2, in fact! And GASP! I use them.). She then said that maybe 1100 calories was too much for me. (I'll note here that I'm about 5'9" and have a very large build for a female. I have had a weight loss doctor tell me that I had the largest bone structure any woman he had ever treated. I'm also naturally muscular and athletic. I have never had any trouble burning calories. I have always been successful in losing weight when I was able to maintain an intake lower than my expenditure. My issue seemed to be in the amount of effort it took to do that when I felt like I constantly needed to eat. At some point, I would get tired of it and give up.) She stated that I could drop down to 800 cal/day and still preserve my muscle mass, but I would have to exercise rigorously at the same time, and make sure that I "resisted the temptation to increase my calories with the increase in activity". (I'll note here that an average of under 700 calories with no exercise put me into a state of such low energy that I needed to go to the emergency room. I don't think a hundred or even 200 or 300 more than what put me in the ER would be healthy for me considering it would be combined with an extra burn of approximately 400-600 cal.) Thank you, I will pass. She then went on to say that I can't expect my body to fall in line with "normal people" because I'm a morbidly obese patient and "they" have different metabolisms than "normal people". I bet you're pissed now, too... That's all fine and good. She's right in that there is a lot of research and studies on the metabolic hormone differences in morbidly obese people in comparison to normal weight people. However, she's doing the exact same thing as lots of doctors do that is completely unfair... she's responding to me based on her stereotype of an "obese patient". There are many hormones that have been discovered that play critical roles in metabolic function. They interact with each other and their respective receptors to give the brain the "right" signals. There are about a million places where this system can have a glitch, a breakdown, or simply function sub-optimally so to imply that all obese patients are the same is just as much garbage as saying that all people are the same. That was the "easy" answer, and completely unhelpful.

At this point, I'm furious. I really couldn't go any further with her and just pretended I was accepting what she was telling me. I redirected her and told her that I really just wanted to understand exactly what was happening with my body right now, and asked her if she could recommend some resources and references for me to read. She suggested "Wheatbelly", and "Fat, Sugar, Salt". Seriously?!?! I ask for some educational information on the function of metabolism and my doctor suggests that I read a couple books on the evils of specific foods and additives in our diets? Sorry, doc. Not. Good. Enough. Pissed really doesn't even begin to explain how I was feeling. My concerns had been dismissed as something I must be at fault for, or lying about, because I must be a non-compliant patient, and when I asked for more information I was directed to dramatized crap, not educational sources. Angry. Hurt. Frustrated. Feeling like I'm still fighting the "Fat person" stereotype in a place where I should feel safe from that.

So... my next steps: Discuss this with my PCP on Monday during my appointment. I think I'm going to look into some metabolic testing to figure out what exactly is going on right now. I may discuss a referral to an endocrinologist to see if some information can be gained by digging a little deeper into my metabolic hormones. And, of course, keep reading articles and looking for books that can give me some understanding (I've got some stuff lined up I found with Google Scholar that I haven't worked my way through yet, and I have a couple college textbooks on metabolism and nutrition that I need to work my way through still). Ultimately, I may have to do what I've always done: figure it out for myself.

Full disclosure: I do recognize that it may be too early to worry. I very well may just still need to wait a little longer for stabilization. This doctor appointment just whipped up every instinct of determination to "solve" this that I have. Nothing like pissing me off to get me to throw everything I have at a problem... While I'm angry, I'm not panicking, nor am I feeling any despair. I know that I will get it figured out and all will be well once I do. I'm really not feeling overly emotional or depressed or anything over this, so fear not, caring VST circle of friends, I'm totally fine.

Thanks all for reading! I think if you made it all the way to the end, you deserve a medal!!! :-) Since I'm fresh out of medals, how about pictures of baby otters instead!

All together now... "AWWWWW..."

http://www.huffingtonpost.com/2012/03/08/painfully-adorable-baby-o_n_1332519.html

Hope you all are having a good night and I wish you all good luck and success!

Aaand I probably should have read the other pages before I posted because I read you weren't asking for help or advice but rather sharing your frustration with the surgeon.oops. I can delete my post if you'd like?im kinda half man so I always look for solutions even when people are just venting.

I will say the reason I didn't automatically delete my post is because I do think for people like us, letting go IS part of the issue. It's also part of your issue with your surgeon thinking she knew better what was good for you and ignoring your input. I would respectfully like to suggest that while her bedside manner may have sucked, maybe she does know better. Maybe.

No, definitely don't delete your post. I've always valued your opinion.