Almost 6 month update – Everything is awesome!

Last week, I started a list of things to write about for my weekly update (last Friday), but then became so busy I didn’t have a chance to get around to it.  So today, I’ll do a special two week update in one post.  Some old news, some new!

Meeting Colin last week was a reminder about how far I have really come over the past five months.  I had forgotten about all of the little things about recovery and visiting him reminded me about everything I have accomplished since surgery.  I am not back to where I would like to be, but I am getting closer to that goal each day.

The biggest change over the past two weeks has been my eating.  Big win!  After having the dilation a few weeks ago, I have noticed a large difference in my ability to swallow.  Since I am able to swallow more in one sitting, my small intestine has to adjust to the increased food intake.  This means I have to be careful about how fast I eat because if I eat too fast, I pay for it 15-20 minutes later.  Paying for it means anything from intense intestinal cramps to bloating to dumping syndrome and I must not forget – gas.    Before, the stricture was acting like a sphincter – limiting food passage into my intestine.  Now it’s mostly smooth sailing.  Which leads me to my food update!

The past two weeks I have been able to eat a variety of foods and it has been fantastic.  I got a lot of good food ideas from the gastrectomy book I bought off of amazon last month.  Most of the recipes in the book have been a success which has been exciting.  Things I am most excited about re-introducing into my diet are:

- whole wheat tortillas – filled with tuna, cheese slices, and hummus.  Oh and sometimes for extra calories – spreading Philadelphia cream  cheese between the layers when I roll it up.
Apples – I used to eat one every day before surgery and I am so excited that I am able to eat them again.  Especially because they are in season right now
Whole wheat pancakes – with almond butter on top (I just eat 1-2 small ones at a time)
A small slice of blueberry pie – this pie was home made with minimal sugar and it was fantastic!
Also, last Saturday, my friends threw me a surprise birthday party and one of them baked a special cake for me that was sugar free and made with Japanese sweet potato instead.  I’m sure she spent hours researching the perfect cake and a lot of time to bake it.  It was super thoughtful and I was able to eat it without any issues.  Thanks Kiriko!
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Last update, I wrote about trying a Mass Gainer.  The idea was exciting but the outcome wasn’t that wonderful.  After drinking it, I would feel like my head was in the clouds and feel extremely tired.  The feeling took close to an hour to pass.   I decided that the extra calories was not worth it and ended up returning it.  I have a feeling the crash was due to the large quantity of carbohydrates added into it to bulk it up.  Also, there are a lot of other ingredients in it which must be difficult to digest.

However, my mother in law gave me “Raw Meal” for my birthday.  It is a very clean vegan organic protein that provides many nutrients and vitamins.  I was excited to take it because I have issues drinking Ensure or Boost (other meal replacement beverages).  But, I was a little weary of trying it because it’s third ingredient was “organic brown rice syrup” and the sugar content was 26 grams for 27 grams of protein.  Until this point, I have tried to limit my sugar intake to 9 grams or less.  I ended up mixing half a serving into a glass of lactose free milk and much to my surprise, had no issues.

Raw Meal - I have only tried the natural flavour so far

Raw Meal – I have only tried the natural flavour so far

I don’t know if this is placebo effect or anything, but I have noticed a large difference in my energy level since I started taking it.  If you can get past the chalky and gritty texture, it isn’t all that bad and to be honest, I’ll do it for more energy!  I am guessing it is so easy to digest because the ingredients are simple and pure.

In terms of my physical fitness, I am in rotten shape.  I may look lean and small but I can assure you that I am far from being in shape.  I feel the fatigue in my quads after climbing one flight of stairs.  I get short of breath after power walking for ten minutes.  I think about returning to the gym every day.  A while back I had mentioned that my family doc told me not to run yet.  Well, I have booked a ski trip to Calgary (Banff, Lake Louise) with my family for the end of February.  I missed my baseball season, I’m not missing my snowboarding season.  I’ll be physically ready by then…no if, and’s or butts.   My gym membership re-activates Dec 12th.  I will be back by then.

Me at Whistler - March 2013

Me at Whistler – March 2013

Tomorrow, my family and I will be participating in No Stomach for Cancer’s awareness walk.  November is Stomach Cancer awareness month and this walk kicks it off.  We will be doing a walk followed by a nice breakfast.  I plan to do some fundraising over the month of November for No Stomach for Cancer.  Their goal is to reach $75, 000 for research.  Currently they are close to $30,000.  If we could find a way to better screen or even cure stomach cancer, then future generations will not need to have the surgery that I have had.  If you would like to donate – click here.

I am following up with my surgeon next Wednesday and believe it or not, I have actually been booked for my next dilation for Nov 12th.  Unfortunately, both fall on Wednesdays and I am missing two more days of work.  I am hoping that Nov 12th will be my last dilation.  Fourth time’s a charm, right?

In closing, I want to wish everyone a safe and Happy Halloween!  Everything is Awesome!

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The Full Circle

Remember back in my early early blog posts, I spoke of the Gastrenterologist who did my original upper endoscopy with biopsy in late 2013?  Well I saw her again but this time, while visiting a family member I had never met before.

Until 2009, my mom had never met many people from her father’s side of the family.  Mainly because he passed away from stomach cancer hours before she was born.  After my mom found out she was positive for the CDH1 gene mutation she learned that her cousin was going to have a total gastrectomy at a local hospital.  A cousin she had never met before.  Mom was able to get in touch with her and was able to meet her for the first time while she was recovering.  It was during this time, my mom made the decision to have her prophylactic (arguably curable) total gastretcomy.

Fast forward to now.  Mom and I found out from her cousin that her son was going to be having his total gastrectomy at a local hospital.  It would be performed by the same gastroenterologist I saw early last year.  At the time, I was her first CDH1 case.

He had his surgery on Monday and mom and I were fortunate enough to be able to visit him on Tuesday as well as Friday.  Just before visiting him on Friday, we ran into my original Gastroenterologist while she was doing rounds.  I was super happy and excited to see her again.  We were able to talk a little bit and she still offered to do more follow-ups with me locally as well as my screening for colorectal cancer.  I mentioned to her that I had a post op complication and was getting dilations and she said she has only had 1 patient who had a stricture post op but that I was in very good hands with the physician I am seeing in Toronto.  We were both  puzzled about why one physician has patients who develop strictures while another does not.  All and all, it was really great to touch base with her again and I’m super happy we crossed paths once again.  Even though it was the first time, I have a feeling it won’t be the last.

Okay back to my visit with my 2nd cousin once removed (it took my mom, his wife and I a few minutes to figure out our relationship).  Even though we had never met before, I didn’t feel like we were strangers, it just felt like I was visiting a family member I had known for a while.  We shared stories and talked stomach-less shop.  I had forgotten a lot about of a lot of the smaller things about being in the hospital (i.e. going for daily walks around the ward, the infamous wet sponge to keep your mouth moist, feeling afraid to eat your first stomach-less meal).  His hospital recovery was amazing (even better than mine and I thought I was doing well!) and if he’s reading this now, I hope it’s from his home.

While we were visiting, his wife had mentioned that my blog was very helpful to them and I was really happy to hear it.  I can see that people are reading my blog but it all became really real when his wife came up to me almost in tears telling you that the blog has been so helpful to them.  It was really an eye opening moment.

On Friday evening, I was also able to meet his younger brother and his girlfriend who were also visiting.  He is still deciding whether to be tested or not.  I had forgotten about that time before being tested and remembered how stressful that time was for me.  Since it was Friday evening, we all decided to go out for dinner before parting ways.

His brother said it best while we were in the elevator going to the main lobby, “It’s funny we are all brought together because of a gene that tries to kill us all”.  Well said!

Dinner after the hospital visit

Dinner after the hospital visit

One year older. One year wiser

30 funny

Yesterday was my 30th birthday and what did I do? I went for dinner surrounded by my family.  Perfect.

Last year when I turned 29, I had envisioned going really big for my 30th birthday.  Go big or go home sort of deal.   Yesterday, when people asked me what I was doing for my birthday this year, I said that I would be going to work for the evening and then going out for dinner with my family to a local restaurant.  A completely different vision than what I had planned a year ago.  Probably a different vision for the majority of people who turn 30.

When you have a major surgery and learn afterwards that you really were a ticking time bomb that could have exploded any minute, your perspective changes in a lot of ways.  You realize a lot of things like how important your health is, how wonderful your support network is, and how we take a lot of things for granted.

Yesterday among all the sadness that struck our nations capital, I was thankful to be alive, enjoying a slice of home made chocolate (sugar free!) cake and home made ice cream (sugar free too, thanks mom!) with all members of my immediate family.

A month and half after my 29th birthday I found out about CDH1.  I’m happy to kiss 29 goodbye and see what adventures 30 has in store for me!

 

 

 

Who loses weight over Thanksgiving? Five month post op update

I have had an eventful past week and lots of updates.  Prepare yourself, this is going to be a longer post with ups and downs.

Last Thursday Oct 9th

I met with a dietitian who is part of my family doctor’s family health team.   I had no idea they even had one but after speaking to my doctor a few weeks ago, she recommended that I see her.  I wasn’t sure how much information I was going to learn during this meeting because I had already seen the dietitian at the hospital  (June 19th blog post).  But, I figured even if I took one piece of new information with me, it would be worth the visit.  I’m always game to learn more.  Sometimes at these meetings, I’m teaching them more than what they are teaching me.  So there really was nothing to lose and lots to gain.

A few times during the visit she referred to gastric bypass documents.   Rachel brought up a good point that the goals of a total gastrectomy for CDH1 mutation is to gain weight and not lose.  So the dietary restrictions are similar but also a lot different.  We want to gain weight not lose.  However, I did learn at the end of the meeting that a small amount of B12 is absorbed into the body by osmosis.  She also identified that I do not drink enough water during the day and should attempt to drink more fluid in between meals.  So the meeting was a win-win.

Thursday evening, I ate a handful of food and something gave me the WORST gas pains I have had since the 2nd day after surgery.  I was telling people that I couldn’t remember the pain that I experienced that day but that I could only remember that it was really painful.  I now remember what that pain felt like because I suffered for two hours after eating dinner.  I am not sure if I ate too fast or too much but it was awful and spent two hours curled up on the couch in the fetal position.  It was brutal!

Friday Oct 10th

I had my much anticipated third dilation.  My mom, her friend and I all made the trip back to the big city.  My appointment was for 11am and was promptly brought in and gowned up by 11:15am.  The nurses had a hard time inserting the IV but after two pokes, they were successful!  Inserting the IV is probably the worst part of the procedure closely followed by the throat numbing spray.  By 11:30am I was all ready to go!  But, there was a delay and I was taken into the procedure room and knocked out at 2:30pm.  Thankfully, I came prepared this time and was allowed to play my Nintendo 3DS!  Cell phones aren’t allowed but hand held consoles are (big win!).    After my procedure was completed, I was told that they were able to stretch the stricture to 15mm.  So now I only have 5mm more to go!

I was feeling good in the recovery room and for most of the way home…but I took a drastic turn for the worst just before I arrived home.  I started to feel really nauseous and almost threw up a handful of times.  I hadn’t eaten since midnight the night before so my system was empty.  I knew that I needed to eat though, so I forced myself to eat some chicken noodle soup that evening that my mom prepared.  Anytime I was upright, I felt sick, so I spent all of Friday night lying on the couch.  I had to cancel going to our friend’s post wedding celebration which was also big bummer.

Thanksgiving weekend

My parents, Brandon and I had planned a big shopping trip to the large shopping outlet in Grove City, PA. Saturday – Monday.  The deals are so good there we usually head down annually.  I woke up Saturday still feeling unwell but I wasn’t going to back out of a trip that has been planned for months, plus, I needed to replace my fall wardrobe!  I slept the majority of the car ride down and was able to muster up a bit of energy to shop a little bit Saturday evening.  By Sunday, I was starting to feel like my normal self again.  Maybe it was the shopping therapy?  I figured all of the sickness was a side effect from the sedative used for my dilation.

After arriving home Monday evening, Brandon and I went straight to Thanksgiving dinner with his family.  I was able to eat a small dinner plate of food as well as…wait for it…a sliver of blueberry pie!  Big win!!

After all the activity over the weekend, I was wiped and still recovering today.

 

Even though I really needed the dilation, the unfortunate side effect resulted in 1.3 lbs of weight loss between Friday-Saturday morning.  As of yesterday morning, I still weighed 104.3lbs.  I know earlier I mentioned about not going on the scale, but this time I felt it was validated given I needed to monitor weight loss following the dilation.  I actually lost weight over Thanksgiving weekend! That’s a first. Haha.

I think this is the first time I have actually felt the fear about losing the weight so quickly.  After calculating my BMI, I am so close to being considered underweight and need to start picking up my A game even harder then before.  I’m not afraid about my current weight, but it is concerning that I don’t have any extra weight to lose at this point.  If I get the flu this winter or maybe even my next dilation, I could be putting myself at much greater health risks.  Plus, I have at least one more dilation to go.

After a serious chat with Brandon, we decided that it was best for me to scale back my hours at work.  It kills me to cut back because it feels like I am going backwards.  However, I know that this is only temporary and gives me an even bigger reason to work on weight gain.  I also was unable to hit any of the goals I had set out for myself for the month of September which was another downer.  Brandon reminded me that it is a year recovery period and my year is a little longer because of my post-op complication.   I am still working on my mental state about feeling positive about this change because cutting back at work has been a really tough thing to swallow (pun intended!).  Sometimes I feel tired from the recovery game and just want to get back to my normal activities.  However, I know that once stricture has been fully dilated, I am optimistic that I will jump onto the fast track of recovery and catch up!

I recently learned about mass gainers and am going to start mixing it in with my smoothies.  I am hoping that it will give me the extra calories I need to gain the weight with minimal GI upset.  If it works, it will be gold because 1.5 scoops is about 350kcal!  That combined with my regular smoothie ingredients, I could boost my smoothie caloric intake to over 1000kcal.  A lot of mass gainers use maltodextrin as a sweetener and I’m not sure how I’m going to react to it but I am hoping for the best.  Fingers crossed!  I have also been using coconut milk to add to my oatmeal instead of lactose free milk because it has 100kcal per 1/4 cup.  It is pretty heavy but I seem to be doing okay with it.  Fingers and toes crossed!

The book that I mentioned on my last blog arrived yesterday and I have taken a look through the first few pages of it.  It seems promising and half of the book has simple recipes for breakfast, lunch, dinner, beverages and snacks.  I feel like it is a great reference for dietitians as well as people who have just had their total gastrectomy and not sure what to use for a reference.  It’s also a quick and easy read.

So a lot has happened over the past week and I’ve had some ups and downs physically and mentally.   I found this quote while reading my book from Dr. Peter Thatcher this morning and found it very fitting for this blog post.

“By remaining as positive as possible, and by focusing on getting healthier, it becomes possible to start to feel much better about your situation.  When you genuinely feel better in your mind, your body can feel better as well”. (Dr Peter Thatcher – The Art of Eating Without a Stomach: How to Thrive after Gastrectomy for Stomach Cancer).

Good timing!

 

 

 

When there’s a will, there’s a way

Well good news everybody, I have finally been booked for my dilation and it’s happening this Friday.   It couldn’t have come with any better timing.  This weekend is Canadian Thanksgiving and I am happy that I won’t be restricted with my swallowing.  It has been a long road of waiting and it’s finally coming up.  I am counting down the days like a little kid counts down until Christmas.  Only 2 more sleeps!

To avoid a long long story, I will give you guys the long version.  Just to recap, I was supposed to have my dilation end of August.  I’ve had two so far.  The first one was done in July and the second one about two weeks later.  I was told to return in four weeks to have another dilation.  This is where it gets messy.

My 2nd stretch was performed by a different specialist in the same centre because my original specialist had gone away on vacation for the month of August and I would be due for my 2nd stretch during that time.  At the end of this appointment, I was told to call the office in 3-4 weeks to discuss a follow-up and repeat dilation.  No problem.

When I called my original specialist at the end of August (just as I was instructed), I was told that I was supposed to book this appointment 3-4 weeks ago.  News to me!  The administrator told me I would NOT be getting in that week and questioned me on who told me that information originally.  Remaining cool as a cucumber,  I replied that it was fine with me, I was just doing what I was told to do.  I had hoped that I would be getting in at least a week later at the latest (first week of Sept).

After waiting a week, I hadn’t heard from the centre yet, I decided to contact my surgeon’s office to see if they could advocate for me.  Frankly, I was afraid to call the centre back because I feared getting scolded again.  Thankfully, my surgeon’s administrator, who I’ve now become BFF’s with, said she would gladly help out.

Two weeks ago, I had my follow-up with my surgeon.  Still no dilation.   The patient navigator at the office took over from here.  This is where I left off last blog post.  It took two weeks of telephone tag between him, myself and the hospital to finally be booked.

Since I’m a visual person, I created a calendar to show the timeline of events.

Calendar of Events Dilation

During the weeks of August 25th to Sept 22nd, I had a difficult time swallowing.  Lots of excusing myself from the table again.  I started to choose foods that were soft and easy to digest.  It felt like I had never even received the 2nd dilation.  It gets frustrating when you know the stricture is closing again and there isn’t anything you can do about it but wait for you appointment to be dilated.  Your mind can really wreck havoc again.  I decided to stop stressing out about it and just let things fall into place.  I had followed all the correct steps and all I could do is wait.

Somehow, over the past two weeks, my swallowing feels like it has actually improved a little.  I have less of a gurgle when I swallow and have had less times where I had to excuse myself from the table.  It seems like I can eat a little faster.  I definitely still have the stricture, but I think it may have actually stretched itself out a little.  That or I’ve become REALLY good at chewing thing down to a paste.

My only good explanation is that by removing some mental stress regarding swallowing has actually caused my system to relax a little and heal.  I used to joke about it but I actually am starting to believe I have used will power to open back up a little.

All and all, it doesn’t matter how it’s opening back up or if it actually is opening back up, I am feeling better with swallowing and that’s all that matters!

Happy Canadian Thanksgiving to everyone.  I will be sure to post food updates after this holiday focused on gluttony.

P.S. I stumbled upon this book that was recently published.  It’s called the “The Art Of Eating Without A Stomach: How To Thrive After Gastrectomy For Stomach Cancer” and it is written by Dr. Peter Thatcher who is a  Physician and Gastroenterologist at the Royal Cornwall Hospital.   I have ordered it from Amazon and I am hoping it will have some good tips!

 

 

Seven more reasons to be thankful

I’ve had a busy week this week and lots of updates for everyone.

Wednesday I had a follow up with my surgeon. I was hopeful that this may be my last appointment but I will be returning in November. But that’s okay! It was a great appointment.

The intern who I met with gave me some great advice and I felt pretty happy at the end of the appointment. Not only did he ask me about how I was doing with my physical symptoms, he also made sure I was doing well mentally. He reminded me that it’s important to have a good work-life balance and not to rush getting back to work, especially because my job is physical.  I really appreciated his advice because I am a do-er and I sometimes feel like I should be farther ahead than I am.  I had hoped at this point in time I would be back working regular hours.  I know recovery takes a year but I am just too impatient!

He also tried to call the hospital that performs my stricture dilations.  I was supposed to be dilated beginning of September.  Unfortunately, he was unable to speak with anyone and ended up leaving a voice message.  He joked that he always has to leave voice messages because they never pick up the phone.  As a physiotherapist who often calls adjustors advocating for patients, I fully understood and appreciated the humour.  He said, “next time, do not leave the hospital without booking your next appointment”.  Great advice and duly noted.  It’s never fun having the dilation, being able to eat so well, then slowly having that taken away as the space shrinks back down and there’s nothing you can do about it. He said he was going to continue calling and hoped to have me booked soon.  Me too!

I also received an update on my pathology report and the pathologist discovered seven more foci of cancer in my stomach.  The largest one was 2.5mm which is fairly small but still scary!  Just one foci was enough to scare me back in January but now the total has increased to 18.  Wild.  Seven more reasons why I’m glad not to have my stomach.

On Thursday, Brandon and I went for a small jog down to the local hardware store.  I managed to run for about 10 minutes without stopping.  I was super happy and impressed my cardiovascular system could handle it.  Okay, maybe it was all downhill…but I still made it!  I mentioned on last week’s update that there is a 5km Santa Claus run that Brandon and I participate in annually and this year it is November 30th.  I wanted to see what I was up against.

On Friday, I made an appointment with my family physician for my routine check-in.  For the past three months, I have been visiting her monthly and having blood work performed to ensure my levels are all normal.  After each blood test, I usually receive a call from a nurse giving me instructions to add another vitamin or mineral supplement.  First time it was iron, last time, vitamin D.  I haven’t required a B12 shot yet because my levels are in the upper range of normal.  Yay!

My family physician told me to stop doing strenous activity (running) and to avoid returning to the gym because my levels are still off, I haven’t had a period in a while (don’t worry folks, I’m not pregnant), and I am still losing weight.  This was sad news for me but I think I’ll still do a little run/walks here and there to build my cardio back up.  I continue to do my 15 minute strengthening program.  I didn’t need more blood work this time because she figured it would be the same since I haven’t had the dilation yet.  I will follow up with her 1 month after dilation.  She also referred me to her dietitian.  I’m not sure how much this dietitian can tell me on top of what I already know, but I will always take more information if it’s offered to me.

Speaking of food,  I often struggle with finding something to eat for breakfast.  Before surgery, I would eat cereal for breakfast.  Now, it just isn’t the same because it takes me too long to eat it and sometimes I get dumping from the carbohydrates.  So I switched to oatmeal.  Oatmeal is great but when you eat it every day, it can get a little mundane.  I was flipping through my “Oh She Glows” cookbook and found a great oatmeal recipe.  Instead of adding milk to my oatmeal, I could add vegetable broth.  Instead of just having oatmeal in the bowl, I could add some lentils for additional protein.  It was a great discovery and I have really enjoyed the change up.  I also top it with hummus or salsa.

So I think that’s about all for my weekly update.  I cross my fingers that I will be called next week for my dilation.
Oh and I also have updated my “Fellow CDH1 Bloggers” page on my blog.  I have come across a few other helpful resources that may help you too!

keepcalmeaton

 

 

Too skinny? No problem

Two days ago, I had a great chat with my RMT (registered massage therapist) and he pointed out that when I was speaking about my weight loss it usually was negatively.  I often say things like, “Oh I’m so thin now” or “all my muscles are gone”.  When I think about my past blogs, a lot of it has been focused around weight.

So that got me thinking….

When I wake up in the morning, I feel pretty awesome.  Refreshed.  Awake.  Ready to take on the day!  Then I start my morning routine and that usually involves stepping on the scale.  If the numbers have increased, I continue to feel great, but if the numbers have decreased, it can be discouraging.  How can I have lost weight when I ate all day?   But what if I didn’t step on the scale and just kept on with my day?  No discouragement.  Still feel refreshed.  Still ready to take on the day.

I tell my patients that age is just a number, it’s all about how you feel.  There are 90 year olds who feel fantastic and there are 5 year olds who are very sick.  Although monitoring my weight loss is important, I should focus more on how I’m feeling and not the number itself.   I often hear, “Oh wow you look great!”.  I reply, “I feel really great as well”.  Then I look in the mirror and I can see and feel more of my skeleton than before.  When I am lying in bed, I can no longer sleep with my knees touching because I can feel the bones butting against each other.  I can’t help but compare my new body to my old body.  I don’t “look” great in my mind.

But comparing really gets me no where!  My stomach is gone.  I am a different person than I was four months ago.  I won’t have my stomach back so I should really stop comparing.  I should focus on the positive things about the weight loss.   If people are saying I look great, I obviously look great and should start believing them.

I have decided that I will continue to eat as many calories in a day and if I lose a pound.  Don’t get discouraged.  I am still recovering.  As long as I am feeling great and I am continuing to eat as I should, things will all work themselves out in the long run.  Even though I may not feel like I look great some days, I will keep saying it to myself and I will come around and believe it 100%.

Not dwelling on my weight so much over the past day has already made me feel a lot better about myself and my body image.  When I stepped on the scale today and it read 105.6lbs, I didn’t tell myself, “Oh you must stay above 105lbs”. I told myself, “that’s okay, still lookin’ good, today is another great day”.

if-skinny1_lrg

Four month update – Becoming a better physio

I’m now four months and one week post op and I have made some significant gains over the past two weeks.

In terms of work, I am now up to an 18 hour work week.  I work three afternoon/evening shifts a week.  While I am at work, it feels like nothing much has changed in terms of my physical capabilities.  I am able to do everything that I was able to do before surgery (although, I do have a lighter caseload).  However, when I come home, the adrenaline fades away and as the week goes on, I become progressively more fatigued.  This happened a little bit at the end of last week and more so at the end of this week.  It’s an odd fatigue though.  It doesn’t feel like I need to go to bed and sleep.  It’s more like you feel slow and sluggish although you look just fine.  I have a feeling that this is a combination of building endurance for work and being nutritionally deficient.  Since I am a do-er, I can’t help myself but just keep pushing through it.

More frequently over the last two weeks, I have been feeling mild upper/mid thoracic pain. As a physio, you can’t help but try self diagnose yourself.  There could be many reasons but I have come up with a couple of explanations:

1)   To avoid a large anatomy/physiology lecture, I will stick with the Coles notes version.  Basically, the nerve supply to the stomach originates between your 6th and 9-10th thoracic vertebrae.  If there are issues with your stomach you may have referred pain.  See diagram below:

2) It may also stem from a combination of weak musculature through my thoracic spine (secondary to sitting on the couch and poor posture during the first couple of months of recovery) and a weak core.

My mom had the same thing after surgery and I am wondering how many other people post total gastrectomy also experience the same thing.  I think it would be a great research paper to write…maybe I should start a study? Haha.   Anyways, I have made a point to do a series of upper back exercises and core exercises every day to see if this will solve the problem.  I have also started seeing a registered massage therapist to help complement my home exercises.

Speaking of exercises, I am now  able to complete a full thirty second plank AND I challenge myself by lifting my feet off the ground one at a time. I am also able to complete three full push-ups.  Woo Hoo, three is better than none!  There are a series of other exercises that I am doing at home to help  me build up strength and they are getting easier each day.  I am more motivated to complete my home exercises now that I am back at work telling people to do their home exercises.  Lead by example, right?

Before surgery, I would hear my patients say, “I am going crazy not working” or “I just want to be able to walk 5 minutes”.  I would watch them try to roll over on the bed and have difficulty.  I would see the pain in their faces as they flex their knee after having a total knee replacement.  I thought I was a understanding physio before I had my surgery, I now know, I had a lot more to learn because I have and I still am living it.  I now know what it is like to be off of work for a prolonged period of time.  I know how hard it is to just get out of bed when you are in pain.  I know that sometimes exercises will hurt but they are necessary for recovery.   Although I may not be as strong as before, I know that I am returning to work a better physiotherapist than I was four months ago.  Yet another unexpected perk.

Eating update

In terms of eating, I am doing well with what I’ve got.  The stricture is still present and I know that it is still closing.  Unfortunately, I am back to spitting up food 1-2x a day. Often, it’s due to me swallowing too much at a time because there is less space for the bolus to pass through.  I was used to swallowing more at a time so now I have to go back to what I was doing before the last stretch.  I also have started to experience the infamous esophageal spasm.  I describe it as a pain on the left side of my abdomen that feels like a deep constriction which then radiates into my left shoulder and sometimes up my neck.  It lasts about two to three seconds.  I still haven’t been called for an appointment for the stricture dilation but I am following up with my surgeon on Wed so we will see what happens.  Despite this little set back, I am able to eat a larger quantity of food in one sitting.   It takes me about half of an hour to forty five minutes but I am now able to polish off a side plate worth of food.   This has been very exciting and I hope that it keeps going! Once there is no more stricture, I should be able to finish it a lot faster.

I am more bold in my food choices and purchased a box of Oreo’s at the grocery store.  I ate one last night before bed and that way if anything bad happened, I would be sleeping…haha.  I also tried to eat a quarter cup of chocolate chip mint ice cream.  After three spoonfuls I started to feel uncomfortable so I stopped.

Bread still continues to be an issue.  Anything that is white and processed (like Wonderbread), it makes me feel awful afterwards.  However, anything that has been freshly baked or gluten free has been a lot better.   I believe that it has something to do with the sugar content in the white breads.   I make sure I load something with protein on top as well (like cheese).   I continue to experiment.  I am not ready to say goodbye to bread yet, so I keep trying.  What doesn’t work one week, may work the week after.

I feel thirsty a lot but I have trouble staying hydrated.  Before surgery I was able to drink up to two litres of water in a day!  Now I am lucky to drink one glass.  I have started to put a slice of lemon in my water to help break the surface tension in the water and make it easier to swallow.  Lemon also aids digestion so it’s a win/win.

Weight update

I am at my lowest weight yet, 105.6lbs.  But I am still above 105! Yahoo!

Since I have returned to work I am now  building more muscle.  I am also building muscle from my strengthening program. This is a great thing.  But it comes with a steep cost.  More muscle = more calories burned at rest.  Clearly, I am not keeping up with my caloric intake.

I would love to return to the gym for some yoga or zumba classes but I am worried that this will cause me to lose even more weight.  I know that my cardiovascular endurance is horrendous right now and needs some serious help.  There is a 5km Santa run at the end of November that Brandon and I participate in annually and I am hoping that I will be able to participate in it once again this year.  I don’t know if I will be able to run 5km but I have my fingers crossed that I can at least run/walk it!

So that about sums up my four month update!  I will keep you all posted on what happens after my surgical follow-up on Wednesday.

 

 

 

 

 

 

 

 

 

 

 

 

15 Weeks post up – Still got it!

So maybe it was like 15 weeks but whose counting?

So maybe it was like 15 weeks but whose counting?

As promised, here is my Friday back to work update!

I have worked a total of 8 hours this week.  Most people work this in one day.  I was happy to completed it over the course of two.  Wednesday was my official first day back to work and at the end of my 4 hour shift, I felt good.  There is never a dull moment at work and as predicted it was a busy day.  I arrived an hour and a half early to do some chart review and catch up with co-workers.

Before surgery and after, my biggest concern for work was finding time to eat throughout my day to minimize weight loss.  After working two four hour shifts, this is still my biggest challenge.  Both days, I had packed a lunch pail with snacks and both days, I ended up bringing it all back home with me. Since the stricture issue is still not fully resolved (more on this later), I have to watch how much I swallow at one time.  Right after I have the procedure, I am normally pretty good and can take a large bolus down; however, I am now four weeks post stretch and I can feel the dysphagia (problems swallowing) returning.  This results in slower eating which becomes an efficiency issue while working.  So far my greatest success has been sipping a calorie loaded smoothie throughout my shift.  I have a feeling my patients may start to question how I can eat so much but remain so thin.

My core is not as strong as it should be which is understandable.  Last week I tried to do a full push-up and failed miserably.  Not being a person who accepts failure lightly, I then tried to do a full plank.  Again, Plank 1: Rachel 0.  I finally settled with push-ups on my knees as well as tricep push-ups on my knees.  I was able to complete three.  Brandon and I had a good laugh.  It was a huge wake up call.  Prior to surgery, I was able to complete two sets of twenty full push ups.  Part of it is weakness and the other part of it is fear.  With every hard contraction I have an odd feeling that I am going to be torn apart which is then followed am I giving myself a hernia?  It’s hard to explain for those who have never had abdominal surgery before but it’s not a nice feeling but must happen to break all the adhesions formed over the past three months along my abdominal wall.  I know that I will get back to where I was, it will just take time.  I am impatient.

Other great news is that last week for the first time at a restaurant, I was able to finish my meal in one sitting!  It was half of a grilled cheese sandwich with a tomato puree soup.
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I didn’t experience any dumping after the meal as well which was another added bonus.  I figured with the bread it was risky but I survived.  However,  I avoided the crust because it was tough to swallow.  I was super full after the meal but I had a good twenty minute walk afterwards which helped with digestion.  Although I cannot eat fast, the size of my new ‘stomach’ is growing and over the past week, I have been amazed about the quantity of food I am able to eat in one sitting these days.  Yesterday, I was able to eat a small plate dinner plate of spaghetti (gluten free noddles) in thirty minutes.  Amazing!  Let the food keep coming!

Back on the stricture front, I have been having issues getting booked for my 4 week stretch.  Long story short, one email and two phone calls with no word of an appointment being booked.  I have called in back up and the medical assistant for my surgeon is now on it.  She has been pivotal throughout my recovery process and I am so happy she is advocating on my behalf.

So in summary, week 15 has been one of my best weeks yet.  I even did so well at work over the past week… I asked for more work.