The question I get asked most: “what do you eat?”…which is understandable. I mean, I’m kind of missing a major part of the whole digestion process.
If you’re a fellow seahorse reading this, I hope this entry helps you on your journey. If you still have your stomach, I hope this encourages you to appreciate how magnificent the human body is and provides some educational fun.
There are so many different aspects, rules, and parts of my new eating routine. I am going to try to organize this as best as possible. But, if it seems confusing, it’s because it is. I’m still learning and still making mistakes.
Let me take this opportunity to reiterate that I am not a nutritionist nor should anything I write be perceived as medical or nutrition advice. Phew. Ok, got that out of the way.
Nutrition
The stomach is a key player in how your body absorbs all the yummy vitamins and nutrients that are in the foods you choose to eat; without a stomach, that absorption changes. What does that mean for me? In order to avoid osteoporosis and deficiency, I take a number of vitamins throughout the day. While I wish I could take some yummy vitamins like Olly or Flinstone’s…I take vitamins made specifically for gastrectomy or bariatric surgery patients.
They are chewable…and…chalky.
Every day I am supposed to take three calcium tablets (total of 1500mg) spread throughout the day. Why so much calcium? Well, now one of the main concerns I will have moving forward will be bone density. In addition to the calcium, I will also (eventually) start doing exercises that will concentrate on building bone density.
The multivitamin I take, which has 45mg of iron, cannot be absorbed with any type of calcium so it has to be taken separately and without any kind of dairy. The multivitamin also has a medley of B6 & B12, which can no longer be absorbed via food.
The last pill I take is 5,000 mcg of biotin. It’s a small little pill that is mostly for my vanity. My hair has started to fall out. They say it is normal and a reaction to both surgery and the sudden decrease in nutrition. But, the biotin helps. I’ve also added a product called Vegamour into my routine to help regenerate the hair I’ve lost.
So…those are my daily vitamins. Jealous?
Protein
While we are talking about nutrients, let me dedicate a whole section to protein.
I have never thought about the grams of protein in each meal more than I do now.
Not only is a protein critical to healing, but it also slows down the digestion process. Before I eat any type of carb, first I make sure I get a few strong bites of protein.
Braver seahorses will try sweet treats after a few bites of protein. I’m not quite there yet. But, I have tried 3-4 dark chocolate “dusted” almonds. After weeks of no sugar, they are life-changing.
Liquids
As you may have previously read…I love water. A lot of seahorses struggle with plain water because of the density level H2O naturally has. The best way to describe how it feels going down: it gets stuck. It’s like the water won’t push down the esophagus so it just sits. It is extremely uncomfortable. Sorry if that is graphic but…no sense in lying. To combat this, I squeeze a lemon into my water to help “cut” the density. I’ve also tried Hint, Vitamin Water (zero sugar), and ice. Ice is a harsh no-go for me. Vitamin Water (zero sugar) is much easier to get down, but I don’t like to consume a lot of artificial sweeteners. Most days I try to just suffer through regular water and hope for the best. On a good day, I get around 60 ounces of water. It’s not a lot but I’m trying every day to add more.
Why is it such a challenge to get a high volume of liquid in? Well, a couple reasons. First, the whole getting stuck thing. Second, there’s no gulping (and no straws); everything has to be sipped. Finally, I can’t mix liquids and solids. Before I eat a solid, I have to wait 30 minutes after drinking and then another 30 minutes after I finish eating to start drinking again.
This is to prevent a flushing situation. Additionally, I only have so much space to work with…here’s a visual reminder.
So, with that in mind, there’s a limited amount of space to fill with either solids or liquids and it is a competition to get as many calories in at each feeding time. If I filled my available space with water during a “meal”, I couldn’t get as many calories in.
However, there are a lot of days when the thought of chewing food seems like too much. On those days, I turn to smoothies and protein drinks. If I am going from liquid to liquid I don’t have to wait in between smoothie/ water/ broth and just continuously sip.
Solids
It’s honestly amazing how far I have come in 11 weeks.
The first few days after I got home from the hospital it was a relief to just eat non-hospital foods. I was still only taking 2-6 ounces of food at a time. I was sticking solely to safe foods, with little flavor, and timed every meal.
For example, here is one day from my food journal.
- 7am – 9am: 16oz water (sip, sip, sip)
- 9:00am: 4oz of a smoothie (blueberry, banana, benecalorie, peanut butter, Greek yogurt, Fairlife milk) + calcium tablet #1
- 10:00am: 1 cup warm lemon tea, 4 oz chicken broth
- 12:00pm: 3oz tuna, mayo, 3 saltine crackers + calcium tablet #2
- 1:00pm: 6oz water
- 3:00pm: 4 bites chicken pot pie (made only with peas & carrots) + calcium tablet #3
- 3:30pm: 6oz water
- 5:00pm: 6oz Fairlife milk
- 6:30pm: 2oz turkey, 2oz baked potato with cheese, butter, and sour cream, a dab of sugar-free BBQ sauce + multivitamin
- 7:20pm: 6oz water
- 8:15pm: 2oz tuna & 2 saltine crackers
- 8:50pm: 6oz water
On this particular day, I remember I overate at dinner and had to take a 20-minute nap to let the pain pass. Pain from eating? Oh yes. Let me introduce you to a fun new phrase: dumping syndrome.
Mayo Clinic defines the cause of dumping syndrome as:
In dumping syndrome, food and gastric juices from your stomach move to your small intestine in an uncontrolled, abnormally fast manner.
https://www.mayoclinic.org/diseases-conditions/dumping-syndrome/symptoms-causes/syc-20371915
Symptoms of the syndrome are:
- Feeling bloated or too full after eating
- Nausea
- Vomiting
- Abdominal cramps
- Diarrhea
- Flushing
- Dizziness, lightheadedness
- Rapid heart rate
Aren’t you so glad you read this? It’s so attractive.
My personal experience with the condition has been flushing and rapid heart rate. I have experienced the abdominal cramps and boy, was that fun! The best way for me to get through it is to get very still and close my eyes for about twenty minutes until it passes.
With that in mind, my selection of solids mostly revolves around what is not going to send me into an episode of dumping syndrome. This means avoiding foods with more than 3 grams of added sugar, always eating a protein first, eating *very* slowly, chewing until I can’t chew anymore, and then chewing one more time, and learning when enough is enough.
In addition to sugar, other foods that are currently off limits include, but are not limited to: carbonated drinks, red meat, pork, wheat, lentils, raw veggies, raw fruit, honey, potato skins, maple syrup, agave nectar, cereal, sweetened sauces, sugar alcohols (sorbitol, etc), meat with casings (sausage, hot dogs), high fiber foods, fried foods…you kind of get the picture?
My “safe” foods are creamy peanut butter, cheese and crackers (Ritz are a current favorite), cashews, pistachios, plain Greek yogurt, salmon, mashed potatoes, no sugar-added oatmeal.
Foods that I can do occasionally, but don’t like: eggs & chicken. I only eat them when I am desperate for protein. They are super challenging for me to swallow.
I should enter “phase 2” at the end of the year and be able to add more variety. I very much look forward to that milestone.
This is hard. I don’t want to complain because there are people who have it so much worse than me but, this is hard. I was recently reminded that it’s ok to not be ok. So, I’ll tell you the bad.
I never feel hungry. I never feel satisfied. I constantly battle fatigue. My new hunger “signal” is getting lightheaded. I dream of food. I am always thirsty. I don’t have any cheat days. There are good days, but the bad days are beyond frustrating.
I hear people say “it will get better” and that’s so easy to say. This is mentally the hardest thing I’ve had to overcome. It is a daily battle. Some nights I think back on the day and shake my head knowing I didn’t get enough calories, protein, or liquids. There’s nothing I can do but make an effort to do better the next day.
I am physically weak. I have to ask for help more than I’ve ever had to in the past. I can’t lift more than a gallon of milk. My prayers come in short, quick, urgent pleas – “Jesus, help me”.
But, I am grateful to have the rest of my life and I will appreciate my body and the amazing way it has adapted. It’s getting better and it will continue to get better. I have so much to be grateful for and one day I’ll get to have the bite of ice cream I dream of and it will be wonderful.
Yes, there are a lot of rules. I am finally getting the hang of it, but they say it takes about six-twelve months to really click with the new system. That seems like a long time, but in the grand scheme of things, a year is nothing in comparison to the gift of living cancer free.
There is a story in Ezekiel where the prophet is led to a valley filled with dry bones (chapter 37). The quick version: God asks Ezekiel “Son of man, can these bones live?” Ezekiel replies, “Sovereign Lord, you alone know” (v3). Then, through God’s power, the dry bones are restored and life is breathed back into what was lost. Whether you’re a Bible believer or not, this is a confusing passage. However, I mention it because I have never related more to the heap of dry bones than I do now.
But just like the heap of bones in the valley, there is nothing beyond God’s restoration. There is no situation beyond His power. What a gift I have been given to reach the end of myself and my own ability. One of my favorite teachers and authors is Dr. Tony Evans. He has this description of faith:
Faith is acting like something is so even when it is not so in order that it might be so simply because God said so.
Psalm 27 says, “I remain confident of this: I will see the goodness of the Lord in the land of the living. Wait for the Lord; be strong and take heart and wait for the Lord” (v13-14).
I have faith that I will see the goodness of the Lord in the land of the living. And on the days that I choke on water and cramp from eating peanut butter, I’ll remember that I could have lost my life to the cancer that was growing inside me.
I was saved. It’s humbling. God still has a plan. And it will all work for good…God said so (Rom. 8:28), even though it doesn’t always seem so.
If you feel like you’re a heap of dry bones, know that you aren’t alone. It’s ok to not be ok. It’s ok to ask for help. And if you need a friend, I’m here.
Can these bones live? The Lord alone knows.
Sorry, these always get so deep, I’m sure you just wanted to know how much yogurt I eat. But, this is a physical, mental, and spiritual journey. Buckle up, buttercup (which makes me want a Reese’s cup…).
Also, just a note of thanks to Rachael at NIH. She works so hard and cares about her patients so much. She answers every desperate question of “can I eat this” and “should I try this”. If you’re looking at programs for total gastrectomy, NIH is amazing in general but Rachael is truly life-changing.
Hard To Digest 