This has been a week to remember...

A lot has happened since I chatted last. I have worked a ton and only been home to sleep, until today. I would be remiss if I didn't account this past weeks events.

Wednesday, June 30th was a bad day. While working during the afternoon, Park Nicollet called me that my surgery, the focal point of my last year, was being postponed indefinitely because of the impending nurse's strike set to commence on 7/6, my surgery date. You have to understand; but, seriously, why did I have to be at work when all I wanted to do was run, hide and cry. I wasn't the only one affected by this potential strike. To think of the hundreds or thousands that would be affected by this strike, it was hard not to feel selfish, but feel sympathy. None the less, it was a tough day.

Thursday started so early and was a struggle all day. I had to come in to work at 4am to begin and finish and post inventory for the restaurant AND work a double. I worked a total of 20 hours that day; but, in the middle, at about 1:30 pm, the hospital called me an informed me that the strike was resolved and a stoppage was averted. I was elated and called my loving wife as fast as I could. We did a little dance on each end of the phone. I slept very hard that night.

Friday and Saturday were very tough, as I was at my second home, Target Field, and I was unable to have anything at the stadium. It had a joyless effect on me. Saturday, I forgot to take my protein drink before going to the park. We eventually had to leave in the 8th inning because I was feeling dizzy from lack of food and the heat. My wife was so awesome and strong. Instead of taking me to a hospital for fluids, she turned on the air and headed for home, trusting that when I said I was fine, I would make it home. We enjoyed my first relaxing night at home since early in the week. We watch a movie on TV and I headed for bed early and slept in late.

Now, it's the 4th of July today and it doesn't seem that special as the day goes. It's my sister's 15th Birthday today and I am looking at 7-9 hours of work for my last day before my surgery. My focus is the surgery and doing what I need to do to get through this last day of my liquid diet. As of this past Friday, I had lost 19.7lbs. In one week, almost 20lbs. That seems a bit unhealthy but it was necessary to get me to this point. I am not looking forward to tomorrow; but, again, it is getting me towards my goal. I won't go into the absolute hate I have for a bowel prep tomorrow and I will spare you the details. I look for one more entry before hospital on Tuesday. Thanks to all who have given me encouragement and sent their good thoughts and prayers. They are all heartfelt and appreciated.

For the greater good...

Day 4 and 5

I did miss posting yesterday; but, instead, spent a wonderful evening with my wife shopping at Best Buy for some new headphones for the hospital and I finally found the U2 360 on Blu-Ray. Getting prepared for this time away from work has become more work than anything at work. My beautiful wife, Lisa, has remarked how proud she is of me and how hard it is doing what I am doing. She has been great to talk to about this process. I know she wants to be there for me and make me as comfortable with this decision as possible. There are times when I don't feel like I need help and others when I feel there is no way to do this without the love and support of my friends and family.

This road I am embarking on is going to be hard. These first 5 days of my liquid diet have been testament to that fact. I finally lost it in my office at work yesterday. I was trying to complete some tasks to get out for the day. The phone kept ringing, my phone kept ringing, people kept coming in and asking question (which is normal for any day). I finally shouted for everything to "Leave me the fuck alone!". Not knowing anyone was around me, a peer poked her head in and asked if I was OK. I felt instant embarrassment because at work, I am complete composure. Sure I may looked stressed at times when we are really busy and I may be short with people at other times when we are REALLY busy; but, normally I hopefully bring an air of calm to an otherwise chaotic existence sometimes.

I find my self tired most of the time since this past Saturday, when I started my liquid diet. I also started taking a full pill of the Atenolol on Saturday. This is the description of what Atenolol is:

Atenolol (Tenormin) is a selective β₁ receptor antagonist, a drug belonging to the group of beta blockers (sometimes written β-blockers), a class of drugs used primarily in cardiovascular diseases. Introduced in 1976, atenolol was developed as a replacement for propranolol in the treatment of hypertension. The chemical works by slowing down the heart and reducing its workload. Unlike propranolol, atenolol does not pass through the blood-brain barrier thus avoiding various central nervous system side effects.^[1]

Atenolol is one of the most widely used β-blockers in the United Kingdom and was once the first-line treatment for hypertension. The role for β-blockers in hypertension was downgraded in June 2006 in the United Kingdom to fourth-line, as they perform less well than newer drugs, particularly in the elderly. Some evidence suggests that even in normal doses the most frequently used β-blockers carry an unacceptable risk of provoking type 2 diabetes.^[2]

Indications

Atenolol can be used to treat cardiovascular diseases and conditions such as hypertension, coronary heart disease, arrhythmias, angina (chest pain) and to treat and reduce the risk of heart complications following myocardial infarction (heart attack). It is also used to treat the symptoms of Graves Disease, until antithyroid medication can take effect.

Due to its hydrophilic properties, the drug is less suitable in migraine prophylaxis compared to propranolol, because, for this indication, atenolol would have to reach the brain in high concentrations, which is not the case (see below).

Cardioselectivity and asthma

Atenolol is classified as a β₁-selective (or 'cardioselective') drug, one that exerts greater blocking activity on myocardial β₁-receptors than on β₂ receptors in the lung. The β₂ receptors are responsible for keeping the bronchial system open. If these receptors are blocked, bronchospasm with serious lack of oxygen in the body can result. However, due to its cardioselective properties, the risk of bronchospastic reactions if using atenolol is reduced compared to nonselective drugs as propranolol. Nonetheless, this reaction may also be encountered with atenolol at high doses. Although traditionally B-blockers have been contraindicated when a person carries a diagnosis of asthma, recent studies have revealed that at moderate doses selective B blockers such as Atenolol are well tolerated.

Provisional data suggests that antihypertensive therapy with atenolol provides weaker protective action against cardiovascular complications (e.g. myocardial infarction and stroke) compared to other antihypertensive drugs. In some cases, diuretics are superior. However, controlled studies are lacking.^[3]

Unlike most other commonly-used β-blockers, atenolol is excreted almost exclusively by the kidneys. This makes it attractive for use in individuals with end-stage liver disease.

Contraindications

• bradycardia (pulse less than 50 bpm)
• cardiogenic shock
• asthma (may cause broncho-constriction), although unlikely as atenolol is cardioselective
• symptomatic hypotension (blood pressure of less than 100/60 mm Hg with dizziness, vertigo etc.)
• angina of the Prinzmetal type (vasospastic angina)
• metabolic acidosis (a severe condition with a more acid blood than normal)
• severe disorders in peripheral arterial circulation
• AV-Blockage of second and third degree (a particular form of arrhythmia)
• acutely decompensated congestive heart failure (symptoms may be fluid retention with peripheral edema and/or abdominal fluid retention (ascites), and/or lung edema)
• sick sinus syndrome (a particular form of arrhythmia)
• hypersensitivity and/or allergy to atenolol
• phaeochromocytoma (a rare type of tumor of the adrenal glands)

Caution: patients with preexisting bronchial asthma

Caution: only if clearly needed during pregnancy, as atenolol may retard fetal growth and possibly cause other abnormalities.

Side effects

Atenolol causes significantly fewer central nervous system side effects (depressions, nightmares) and fewer bronchospastic reactions, both due to its particular pharmacologic profile.

It was the main β-blocker identified as carrying a higher risk of provoking type 2 diabetes, leading to its downgrading in the United Kingdom in June 2006 to fourth-line agent in the management of hypertension.^[2]

In addition, β-blockers blunt the usual sympathetic nervous system response to hypoglycemia (i.e. sweating, agitation, tachycardia). These drugs therefore have an ability to mask a dangerously low blood sugar, which further decreases their safety and utility in diabetic patients.

Side effects include:

• indigestion, constipation
• dry mouth
• dizziness or faintness (especially cases of orthostatic hypotension)
• cold extremities
• hair loss
• problems with sexual function
• runny/blocked nose
• depression
• confusion
• difficulty sleeping, nightmares
• fatigue, weakness or lack of energy

The last four side effects seem to be what I am experiencing while on the medication. It's amazing to think that a pill 1/3 the size of a normal aspirin can have this effect. Work days are made longer. Today is end of the month inventory. I have a double tomorrow and I have to count, input and gather end of the month numbers and hopefully make everything correct before I'm done on Sunday. YEAH!

2 and 3 still don't make 5.

Howdy everyone!

Just wanted to see how that sounded when there are only 2 people following this blog. I missed writing on Day 2 of the liquid diet. I have plenty of time to write on Day 3 because...I have no freaking energy to do anything. It's hard to work and concentrate and be nice and not burst into tears, which is exactly what I did when talking to my wife realizing that I could, under my current circumstances, go to tonight's Twins game. Do you know how flipping hard that is?!? I live for baseball, the Twins, Target Field and here I am, sitting at home, too tired to even write this blog.

I was mentally unprepared for this liquid diet. Physically unprepared for most things. I thought, "No problem, you've crash dieted before...no problem". This is beyond anything I have ever done before, as will most things on this adventure. I always would cheat a little, breaking down after 2 or 3 days. I can't now. This is permanent. It has been so hard at work. All I do all day is focus on food, talk about food and type about food, smell food and develop food. It's an insane situation to be in. It is like working in a brewery as a recovering alcoholic, or cutting the cocaine as a drug addict. How many times have I fantasized about food at work in the last 3 days? I feel like I need to recite the Reinhold Neibuhr prayer:

God grant me the serenity

to accept the things I cannot change;

courage to change the things I can;

and wisdom to know the difference.

Living one day at a time;

Enjoying one moment at a time;

Accepting hardships as the pathway to peace;

Taking, as He did, this sinful world

as it is, not as I would have it;

Trusting that He will make all things right

if I surrender to His Will;

That I may be reasonably happy in this life

and supremely happy with Him

Forever in the next.

Amen.

I know this may sound funny; but, this may help me get through this next stage of life. I am not overtly religious. I am, however, able to recognize it's place in my life rather than run from it. So, on Day 3, I have not eaten solid food, chewed off my arm or leg or anyone else's and I most certainly have not ripped anyone a new one yet...pleasant thoughts, big puffy clouds, the love of a good woman and kids and my little doggy, Kirby.

Day two feels like the longest day ever!

Help! How do you make it through this hunger? The best part of the equation is that I am working the entire time I'm on this liquid diet. I have been faithful to the Boost and Ensure routine for over 24 hours. Holy crap! Everything looks so freakin' good! I do and I don't understand this preparation for surgery. Couldn't it be to have several meals replaced by the nutrition drinks and get to have one meal a day? I feel lethargic at times and other times, I literally am not hungry...me, not hungry. I've been hungry since I got out of my mom's womb!

Everyone keeps pulling for me and the days are moving quickly; so, before I know it, I'll be back home recovering from surgery and learning to eat right, learning to taste again. I went to Target yesterday and purchased almost everything I need to move forward. That was a big step. It was solidifying what was happening. Today, I filled out a new dry erase calender for myself and nobody else. It will help me remember when my appointments are or when I need to stop taking medications or at what stage I am at in the recovery process depending on what stage of eating I am on.

Thank you goes out to my wife Lisa who is a constant supporter of me and my crazy ideas. I could not do this with out you baby. I will always love you all ways!

And now for something completely different...

So, today is the official start on my weight loss adventure.

Yesterday, at 8am, I met with an RD named Morgan. Went spent an hour together going over the appropriate lengths of time I would be spending on each phase of my progressive eating the days and months following my surgery. I was starting to be a realization that this was finally happening. I was a bit emotional on the car ride home. While listening to WCCO talk radio, which I do with passion, I heard a news story that Minnesota nurses are voted to strike again. This time, on July 6th, the date of my surgery. I don't plan on having any changes; but, fuck off and let's do this surgery!

As I mentioned at the beginning, today is the first "Official" date of my adventure. I started this morning with a delicious cocktail of vitamins, meds and Ensure. While I am awake, for the next 10 days, Boost or Ensure will be my every 3 hour meal, up to 5-6 times a day. I will be ingesting approximately 1100 calories for 10 days. Astonishing numbers if I think there have been days when I consume 10 days worth in 1 day. I have not felt sluggish or hungry, except when it's about 3 hours since my last one. In between meals, I can have broth or non-calorie, non-carbonated beverages, all day long. I was sitting at Zane's baseball game and was talking to Erica about all of this and she asked if I wanted one of her potato chips...she is not grasping the idea and HELL YES I WANT TO SMASH THE WHOLE CAN OF BBQ PRINGLES IN MY MOUTH! Then she said, oh right, sorry. I don't want people to think they have to apologize to me for me being fat. They didn't make me eat until I got this way. It's been all me baby! It's all me.

Day one on a liquid diet at work should be fun...

Happy Summer Equinox!

I always loved the summer solstice. As a younger man, I had many great opportunities to celebrate this day. My two most memorable ones were: When I was 17, I was on my first trip to Europe with an art expression group of college students from the University of Pittsburgh. We were so full of ourselves back then. We were in the highlands of Scotland and staying at a bed and breakfast in the village of Glenfinnan. This village sits on Loch Long. It was June 21, 1988, the longest day of the year. Somehow, a group of us found cloaks and candles and set off in true druid style. The bridge you see in the picture was adorned with candles and we took turns interpreting Yeats and Shelly and shouting barbaric yelps to bring forth summer. It was truly the first time I connected with nature.

My second best Summer Solstice came June 21, 1989 in Shoreline Amphitheater, Mountainview, CA. I was on my way to college back in Portland, OR. I had seen the Grateful Dead a few times up to this point; enough to consider myself a dead head. Little did I know what was in store for me. Mountainview is just north or Palo Alto and south of San Francisco. This amphitheater was nothing like I had experienced before. The place just seemed free and welcoming to my skewed view of the universe and I never felt alone, even though I was traveling by myself. I was off on an adventure that I climbed out of in 1993. After serious touring across this country, graduating and moving back to Minnesota a changed man. Forever.

Until now, my change was inside. Now I am about embark on a change inside that will greatly affect my perception by others and by myself. There has always been a view I have held of myself. A vision of how life could be without this prison I'm in now. I am on my last week of real food and real portions for the remainder of my life. Food has been my prison and I've served my sentence out in the body long enough. Don't get me wrong. I am going to miss the hell out of food. Cheeseburgers and popcorn and anything my Wife, Lisa bakes. I'm eating this week like it's my last rights. Don't get too close or you'll pull back a stump. Like Bob Dylan sings so eloquently, "Any day now, any day now, I shall be released."

Commitment to Long-Term Lifestyle Changes

Howdy brave followers. Today was a most excellent day. I was able to sit down with my boss, Dermot, to hash out the details of my time away. Never in my almost 25 years of service industry experience have I had the good fortune to work for a man as connected to my needs as a professional as Mr. Cowley. We have a great working relationship. I am a Maverick who bucks the system that is set before me; but I have dedicated staff, serious retention rates and the ability to steer my ship towards profit-town. Without this key element of support, there is no way I could even conceive to accomplish what I am about to set forth.

I wanted to share with anyone who reads my blog, the commitment to Long-Term Lifestyle Changes that I signed with my Surgeon, Dr. Thomas Jones (Yes, my surgeon's name is Tom Jones and it is for that reason alone that I choose him).

I agree to make the following long-term lifestyle changes after my bariatric procedure:

Dietary Guidelines

• I will follow the dietary guidelines as indicated in my patient handbook.
• I will choose foods low in sugar and fat and high in protein.
• I commit to eating three meals a day, with protein first at each meal.
• I will eat each meal for at least 20-30 minutes and no more than 30 minutes.
• I will not drink for 30 minutes before meals, with my meals or for 30 minutes after meals.
• I will avoid snacking or grazing between meals.I will take vitamin and mineral supplements as outlined in my patient handbook or as instructed by my bariatric team.

Fluid Intake

• I commit to consuming 48-64 ounces of calorie-free liquids (except milk) every day.
• I will not drink alcohol for the first year after surgery.

Exercise Plan

• My goal will be to exercise an average of 30 minutes a day, five days a week.
• I can break up the exercise into two 15-minute or three 10-minute sessions daily.

Follow-up

• I commit to returning to the Bariatric Surgery Department for follow-up appointments at the scheduled times indicated in my patient handbook. I understand that I am at risk for nutritional deficiency and that lab tests to evaluate my nutritional status should be performed regularly.
• I will follow recommended referrals made by the bariatric team. These referrals may be to a dietician, psychologist or other clinician.
• I understand the benefits of attending a support group and will make an attempt one regularly.

I commit to the follow all of the guidelines outlined by my surgeon and his staff. This includes all instructions and teaching provided to me before and after surgery, as well as in my patient handbook.

This was signed by myself and my surgeon, Dr. Thomas Jones on 14th day of June in the year 2010 (Yes, I do want Dr. Jones to play "It's Not Unusual" when I'm wheeled into the operating room!).