Surgery tomorrow!

I’ve been scheduled for surgery tomorrow. That means I’m super excited and somewhat nervous. We met with the surgeon last week, and he seemed very smart and good at his job by all accounts, which is to say online searches and word of mouth.

In order to prepare for surgery, I’ve been on a liquid diet except for some very low-carb raw veggies since the moment I heard I was cleared, July 13th. The drinks I’m allowed to have are all “meal replacement” high protein, low carb and low fat drinks. They’re very disgusting, being chalky and sickeningly sweet, but I’ve been extremely diligent, learning to drink them quickly and try not to gag.

Since my overall calorie intake has been less than 800 calories per day, I’ve been in ketosis since around the 15th, which means I have been burning body fat (it also means I’m not exactly starving – appetite is subdued in ketosis). This is exactly why I’m on the pre-op diet: to get rid of the extra fat hanging around on my liver and around my stomach. This will make it easier for the surgeon to get to my stomach laparoscopically tomorrow.

One thing that upset me a couple of days ago is that I was feeling very weak, confused and disoriented. I could barely walk around after waking up. I guessed that simply being on such a low calorie diet might explain such symptoms, but I also started desperately craving salt, to the point where I cheated: I ate two small pieces of grilled skinless boneless well-salted chicken. I simply couldn’t resist the saltiness. Then I looked into the salt content of the “meal replacement” drinks: they don’t have enough salt, even though they’re supposed to provide all the vitamins and minerals my body needs. What?!

When you add to that the fact that it’s extremely hot outside, so I sweat profusely every time I take a walk, I realized I was sodium deprived. This could actually be very unhealthy and possibly dangerous. It’s upsetting that I was making myself sick by following directions carefully. I modified my diet to include chicken broth and now I feel perfectly fine, but it made me wonder how the directions could be so badly off. Wouldn’t other people have noticed this defect?

Well, that brought me to a google search, with the result that I found an online bariatric pre-op diet forum which explained to me the following:

  1. there are lots of different pre-op diets
  2. some of them tell you to have chicken broth or even lean meats or even crackers
  3. nobody, or at least very few people, seem to actually follow these diets
  4. some people are hilariously bad at following their diet
  5. or maybe it’s really sad, but I chose to find it hilarious
  6. except for the crazy people who are eating sandwiches right before surgery and planning not to tell their surgeon
  7. that could actually kill you
  8. yes, I realize that the people on a forum like that are self-selected, but even so

Long story short, I think I’ve been more than sufficiently compliant on my diet, and I will tell the nutritionist at Columbia Presbyterian to add “broth” to the daily schedule.

Today it’s all liquid, I’m not even allowed to have raw veggies. Tomorrow I don’t get to eat or drink at all in preparation for the surgery.

Wish me luck, friends!

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Criminal Algorithms

A piece I wrote for the Observer over in the UK just dropped, as part of my book’s softcover launch over there. Here it is:

How can we stop algorithms telling lies?

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Cleared for Surgery!

Happy birthday to me, folks! I’m 45 today and my present was that I got the call I’ve been working towards for 6 months, since January: my insurance company has cleared me for the bariatric gastric sleeve surgery I’ve been talking about.

In fact, I’m likely to get the surgery in about two weeks, before the end of the month, or soon after that. In preparation I need to start a strict “pre-op” diet consisting of protein shakes and nothing else except possibly celery. That means no coffee until a couple of weeks after surgery, and no carbonated beverages for pretty much the rest of time.

Wish me luck, friends! I’m super psyched.

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Going to London!

I’ll be in London next week for my WMD softcover launch with Penguin UK. They’re having me do a bunch of stuff, and they even gave me this promotion card to show you:

weapons_math_destruction

Please come by if you’re in London next week!

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Why am I getting bariatric surgery?

I want to explain my reasoning, because it’s probably slightly deeper and more complex than most people imagine, unless they know me pretty well, in which case it might be simply baffling. A run-down:

  1. I love my round body. I am dreading losing a lot of weight in terms of what it will do to my body, especially because I will not be left with a perfect skinny person body, but rather a bunch of skin. I have spent months trying to come to terms with that but I haven’t yet.
  2. However, the dread I have about losing my round body is more than balanced by my long-term health considerations.
  3. I’m pre-diabetic and at extremely high risk for diabetes. My dad is diabetic and I’ve seen what it does to people long-term. People know about problems with feet, which he has, but people sometimes lose sight of the long-term effects it has on the brain. And I like my brain even more than I like my round body.
  4. Also, I like staying in shape. Biking is my favorite way to do that.
  5. Last summer, I realized that I simply couldn’t go biking in the summer heat. I felt like a prisoner all summer, cooped up inside the house and getting less and less fit. Thank goodness for swimming, but I’d really prefer to bike.
  6. Post-bariatric surgery patients complain about being cold, not hot. I’d rather be cold, because then I can wear one of my hand-knit sweaters outside while biking.
  7. Even when bariatric surgery patients don’t end up losing very much weight, which is rare, they’re almost always cured of diabetes.
  8. I also have arthritis and bad hips and bad knees in my family. Chances are that I’d need more surgeries, sooner, if I stay at my current weight than if I lose 100 pounds. Also, doctors don’t treat overweight people well.
  9. Indeed, if I didn’t have bariatric surgery now, I might find myself doing it in 20 years when I’ve had two knee replacements. Why wait?
  10. The surgery is laparoscopic, very safe, and I think the lifestyle changes are major but achievable.

Long story short, it’s a quality of life issue for me. I want to be one of those active grandmas that takes their grandchildren (or anyone’s grandchildren who will have me) to the zoo, and then bikes home. I don’t want to be defeated by global warming, nor do I want to be forced to move to Maine.

Now that I’ve explained myself, I’ll quickly mention what I find fascinating about the whole experience. Namely, all the reasons I’ve been given, and all the pushback in general, that this is a bad idea. They come down to three categories, which I plan to tackle in turn:

  1. Shaming tactics
  2. Financial incentives
  3. Bad medical information
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Bariatric Surgery Update

I’m back from Ireland. It was as magical as I’d hoped. We had such a blast and I’ll always remember the trip, and also how much more mature Wolfie is than me in the context of long lines at airports, even though he’s only 8 (his words: “Of course I do get impatient, mom, but I just hold it inside and I think about positive things like that we’ll eventually be home and that we’ll be able to see our family”).

Also, after coming home yesterday, I went to a nutrition seminar for bariatric surgery with my husband. I have officially completed all the paperwork (tons of it) so right now I’m in the waiting phase, hoping that my insurance clears the surgery soon so I can get on with it. As usual, I’m impatient. I should probably try to channel Wolfie here.

I’m guessing it will be another 6 weeks before I get the surgery, so around August 9th. That’s four weeks for the insurance to clear, and then once that happens, I need to be on a very strict diet for two weeks heading into the surgery. Theoretically I could get cleared in two weeks, and I could even just start the diet early, but since it’s so intense I’m probably not going to start until I have a date.

The strict diet is essentially a protein-drink only, starvation diet meant to reduce the size of my liver in order for it to be not in the way for the actual laparoscopic surgery. It turns out that many people of my weight have “non-alcoholic fatty liver,” which just means a liver that’s bigger and contains more fat than a normal liver. It can get in the way of the surgeon’s tool, which can be a problem. The good news is that livers respond quickly to dieting, so the two week extreme diet goes pretty far in decreasing the size of the liver to a manageable obstacle.

I’ve been practicing making protein shakes lately, mostly with fruit and milk, in order to get used to them, because generally speaking they’re horrible tasting and sickly artificially sweet. I have found a pretty good one though, by which I mean it’s not too sweet, and I just tried it alone with water, and it was actually fine. The trick is: lots of ice and a really good blender. I got a “Ninja Professional Blender with single serve” and it’s perfect.

Also in last night’s seminar we went over the diet for the various stages of recovery. Here’s a cheat sheet:

  1. For the week after the surgery, you’re never hungry and you only drink, but the weird thing is you have to drink tiny 1 ounce cup of water or broth every 20 minutes while you’re awake.
  2. For a few weeks after that you eat every three hours, even though you’re probably not hungry, but it has to be the pureed like baby food or applesauce. The reason is that your stomach is still healing and is swollen, and might not be larger than the size of a straw in places, so larger chunks of food could get stuck. You also drink tiny amounts very often but you can’t drink and eat at the same time.
  3. After that you start introducing slightly less pureed food into your diet. You eventually eat pretty normal food but your stomach is much smaller than before, so way less of it. They suggest you eat mainly protein, and you eat that first, followed by vegetables and fruit.
  4. They also give you the following long-term rules: never eat and drink at the same time. Never drink carbonated beverages. Try to eat on 25% of your diet in fat, and avoid refined carbohydrates forever. Also, take vitamins every day for the rest of your life.

If that all sounds like a major behavior change, you’re right. It’s intimidating. On the other hand, the people I’ve interviewed have all told me the one thing that I think makes it possible: namely, that you’re not hungry all the time, even though you’re eating way less. That small amounts of food fill you up for hours. This sounds like a miracle to me, as a person whose hunger rages at me like someone screaming in my ears on a daily basis. So I’m taking a leap of faith, knowing that I’m pretty good at following plans I’ve set for myself, and also knowing that once you’ve developed a habit, it’s not that hard to follow it.

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Random thoughts on hotels

First of all, forgive me if I’m blathering on, I’ve been hanging out with an 8-year-old for a week so I’m kind of starved for adult conversation. And even if you can’t actually answer me in real time, your comments are very welcome.

Second of all, I would like to comment on traveling in general.

  1. What’s with all the mirrors in hotel rooms? They’re everywhere, and, may I say, completely unnecessary. Now, I get that they make the rooms look somewhat bigger, but what’s the deal with sitting down at the toilet and seeing yourself in a mirror, sitting down at the toilet? It’s not a good look for anyone, I’d wager, and I’m not being ultra self-conscious when I say that. For that matter, I’m pretty at ease with my body, but nobody looks good at the toilet. Or rather, people who do look good at the toilet would look good in any position whatsoever. So even for them, I’d suggest fewer mirrors near toilets, are you with me? [the way I deal with the mirror problem is I walk around the room without my glasses on so I can’t see anything. It solves the problem of the mirrors but also produces its own problems]
  2. Also, coffee. I’m not complaining, since free coffee is always welcome (although in Las Vegas the coffee pods cost like $20 each, and I couldn’t even find them because I was on my hands and knees looking for free coffee pods without my glasses), but why oh why so little? I’m in a hotel now where they have one of those tiny pod machines, and they give me all of 2 tiny pods for an entire day’s worth of coffee. Is there any serious coffee drinker who could make do on such a small amount of caffeine? I mean, a small Starbucks black coffee would be equivalent to about 8 pods alone, and who buys small coffee anymore? I don’t get it. [the way I deal with the lack of coffee problem is I steal coffee pods off of the maid carts in the hallways whenever I get the chance. This solves the problem of too little coffee but leads to the problem of feeling somewhat guilty all the time]
  3. Having made those whiny complaints, let me say how much I love hotel rooms, and especially how utterly anonymous they are. They’re so comfortingly bland! And everything is designed with disgusting behavior in mind, so you don’t have to worry too hard about messing something up. It’s much better than staying in someone’s house where you might break something. In a hotel room there’s basically nothing to break because it’s all bolted onto the wall and/or stain resistant. It’s heaven.

Also, before I leave, I should mention that I did get a wonderful fiddle lesson from Leisha. I don’t have pictures but here’s a recording of her doing a tune called Cooley’s Reel:

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