Beating the Odds - Never EZ!

A sleeve gastrectomy removes about 80% of the stomach, reducing the capacity for food in one sitting to about four ounces. Intended benefits of a gastrectomy include weight loss and remittance of diabetes. Short-term complications can include bleeding, pain, and blood clots while long-term complications may include failure to lose weight, the eventual regaining of weight initially lost, intolerance to certain foods, dyspepsia, addictions (believed to be transfer reaction from overeating), GERD, abscesses or ulcers, gallstones, diarrhea, and, believe it or not, divorce. Some studies have shown that over 80% of marriages end in divorce after gastrectomy surgery.

Nearly 68% of gastrectomy patients have regained all or nearly all weight lost by five years post-surgery.

My wife had laparoscopic sleeve gastrectomy surgery performed in the summer of 2014 by Dr. Lisa D. Brostrom, Chief, Plastic and Reconstructive Surgery, Brooke Army Medical Center in San Antonio, Texas.

Pre-surgery, her weight was 234 pounds and she was a diagnosed type 2 diabetic. Her body mass index (BMI) was over 36. Six-months post-surgery, she weighed 145 pounds. Her fasting blood sugar levels and A1C (average blood sugar levels over three months) were normal. By the middle of May 2020, six years post-surgery, her weight remains 145 pounds with a BMI of less than 23 and there is no sign of the return of diabetes. She has had no gastric distress or problems of any kind, with the possible exception of a small but noticeable increase in stomach gas, which has not caused her any distress. To this non-medic, the operation seems to have been successful and well worth the cost and healing required.

During the pre-discharge briefing, Dr. Brostrom stressed that with her decreased stomach size, it was essential that we modify her diet to ensure that she got sufficient protein. After discharge, she was to be restricted to a liquid diet for a few weeks. After that she was to eat six to eight very small meals per day, and also ensure adequate water for hydration.

Considering her need for protein and her newly-limited stomach size, we determined that a protein supplement may be helpful. As she was on a liquid diet, at least short-term, we decided that making her a morning protein shake would be a wise thing to do. After some thought and research, I decided that just dumping a package or scoop of protein powder into some water or plant-based-milk would not provide the optimum solution (no pun intended). Accordingly, I developed the following recipe.

1 package* Carnation Instant Breakfast Light Start™ (Sugar-Free)

¼ cup raw rolled oatmeal

1 20-gram scoop of no sugar added whey protein powder*

1 medium not over-ripe banana

3-4 ounces unsweetened plain yogurt

3-4 ounces in-season fresh berries

6 ounces of unflavored, unsweetened soy or almond milk

I place the dry ingredients into a blender, add fruit, yogurt, and plant-based milk then blend until smooth and creamy. This makes about 22 ounces of creamy shake which she enjoys through a straw for breakfast, mid-morning snack, and (most days) lunch. She generally snacks on fruit and/or whole-wheat toast in the afternoon and we enjoy a normal dinner with a protein entrée (which may be fish, poultry, meat, or vegetable protein such as lentils or beans), a vegetable side or salad. An evening snack often consists of about 2 ounces of ice cream or some buttered popcorn. I have observed that she normally drinks about 48 ounces of water per day. She does not drink coffee, beer, liquor, or caffeinated tea. A sugared soda is a rare treat – her preference is ice-cold root beer.

Here is something that is probably key to her success: she has stayed active. She normally gets about 40 or more minutes per day of light exercise, either in the community pool or walking. Her balance and vision no longer allow bicycling, but we have added some 1- and 3-pound weights and some stretchy bands to her routine for arm and wrist resistance work and a large body ball for balance.

Making the shake is quick and simple, but it does require some time and effort and some planning for shopping to ensure ingredients are always on hand. To me, it would be inconvenient to try to carry the ingredients and a blender for travel, so we rely on products like Boost™ or Ensure™ for times of travel or if I were to be unable to prepare her concoction.

The table below presents the estimated representative nutritional values for the morning shake. In compiling this table, I noted that the amount of total sugars is higher than I expected, and exceeds the recommended daily allowance for sugars. We are using no-sugar-added and unsweetened products where possible; the largest contributor to the sugars is the banana. In defense, those sugars are ‘natural’ and mostly in the form of fructose. Less-ripe bananas have lower sugar content.

Values are approximations
(a) 0.8g per Kg body weight

Oh, and did I mention: We are still married. We will celebrate our 52^nd wedding anniversary on August 16, 2020.

For more information on sleeve gastrectomy surgery, see the World Journal of Gastrointestinal Surgery, April 27, 2017, National Institutes of Health, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5406732/ .

DISCLAIMER: I am not a physician and this article is not providing medical advice. I am simply relating our success story with my wife’s gastrectomy. Always seek competent medical advice from a licensed professional before selecting any course of action regarding your health.

*She prefers chocolate

Stay-at-Home makes it EZ to rant!

In the United States, our current politics stink. There is much rotten in Washington. The politicians there have forgotten who sent them there and what we sent them there for.

Photo credit - Rats! by ricardo on Flickr. Used per Creative Commons License.

They are supposed to be our representatives. They work for us and are to serve our ‘common welfare’ yet they call themselves our ‘leaders’ and expect us to kowtow to them while they ensure their nests are feathered with pay, benefits, travel, a fat retirement, and health care while we the people slave for them. Many of them have never worked in the private sector or even served in the military. The United States has become a feudal society supporting a few oligarchs. Some of the oligarchs are powerful businessmen or women. More are in our Congress. Many of them have become wealthy while serving in Congress while complaining that they can't live on their Federal pay and benefits.

We badly need to fix our system.

1. Term limits for Congress. I recommend six years for Representatives and eight for Senators. No exceptions. Members of Congress need to know they will have to live with the laws they create.

2. Establish fair, transparent, enforceable standards for obtaining ballot access. You want to start a party and back a candidate? Sure. Here are the rules for getting your candidate certified and listed on the ballot. The same rules apply to all. This may be the weakest link in my reform proposal – It will be especially essential that money must be prevented from ruling supreme here – I’m not sure how to accomplish that. Party primaries will have to be considered and solutions found.

3. Limit public campaigning for any federal position to 120 days prior to the election date (180 days within states where a primary is required). Incumbents are NOT allowed to hold rallies or partisan events of any kind prior. No campaign funds may be expended prior to 240 days before the election date (this allows for travel, communications for planning, and to meet requirements to get a candidate on the ballot). Money spent in the party selection process during the period between 240 and 180 days before election day must be accounted for and meet federal rules for campaign funds and donations. All other political donations are made to the Federal fund to be spent equally by the candidates. There will be NO private-source money spent to support any candidate or any party after the campaign process begins in any way for any purpose, including in-kind contributions with the exception of labor donated by campaign volunteers. Money remaining after a candidate is certified and the campaign process begins must be returned pro-rata to the donors or donated to the Federal fund for elections.

4. Repeal Citizens United – it will be mostly moot anyway, if items 2 and 3, above, are enacted.

5. Eliminate lifetime stipends and benefits for representatives. Provide a 2 – 4-year post-service period where pay and benefits continue at a reduced rate to aid in transition back to civilian life, but end payments and benefits completely after that period. All elected officials participate fully in the Social Security (and any socialized medicine program) exactly the same as civilians.

6. Once campaigning starts, fund all campaigns for all certified candidates for all federal offices with public funds. All certified candidates get the same amount (which amount may vary based on position—House vs Senate vs Executive). No other money may be spent from any source at any time for any reason. Political donations are made to the federal fund to be spent equally by the candidates.

7. Re-enact some form of the “Fairness Doctrine.” This is an area that needs thoughtful action. Media can be too unbalanced with no checks in place.

8. Enact legislation limiting each action of either house of Congress to ONE ITEM per bill and per vote. Disaster Relief Bill? Take out those non-related items tacked on or added as riders. One bill, one topic. No funding of the arts in a transportation bill, etc. Limit the page count for bills. No 800-page bill will ever by thoughtfully considered by our representatives anyway.

9. Enact legislation to make it a felony for any representative to vote on any legislation that they have not personally read. In its entirety. No more of this, “We have to pass it to learn what’s in it.”

10. Voting fairness. One person, one vote. Make registration and voting easy, safe, and secure for every person 18 and over. Require some form of personal identification but ensure that all who are eligible to vote can quickly and easily obtain such. If they can do it in Afghanistan and in Ghana, we can do it in the U.S.

11. Reform the electoral college – eliminate the possibility of “faithless” electors (Note: done by the Supreme Court in July, 2020). Also eliminate 'first past the gate' elections.

12. Mandatory retirement from the Supreme Court bench after 20 years of service.

13. Enact sunset legislation for all federal rules and regulations (note: Not laws – just the rules and regulations that are implemented and enforced by non-elective agencies – laws remain in effect until revoked or replaced). Perhaps 12 years would be a reasonable sunset limitation? Rules and regulations die at their sunset date unless renewed – there must be a reasonable public comment period prior to the renewal effective date.

14. Make the Post Office profitable. Home delivery reduced to three days a week – geographic routes get Monday, Wednesday, Friday OR Tuesday, Thursday, Saturday pickup and delivery. Allow PO personnel strength to diminish to right-sized counts as people retire or die. Raise rates as necessary – make the service competitive and worth any increased cost.

15. Improve medical care in the U.S. by fixing Obamacare, one step at a time. Consider allowing states to implement their own rules so long as they provide at least the minimum benefit as the federal plan. Remove federal restrictions, but not standards, so health insurance can work across state lines.

16. Remove the ‘cap’ on Social Security contributions. Keep long-term capital gains taxes low, but include all income, to include ‘non-earned’ income in the Social Security program taxation (dividends, rents, stock profits, etc.) Every dollar of net income or salary is subject to the SS tax. Remove gender-based discrimination from SS. If a man dies, his widow can choose the greater of his (before death) or her benefits. If a woman dies, her widower has no such option.

17. Make the heads of all Federal agencies subject to Civil Service rules.

18. Public Service unions, by definition, are a huge conflict of interest. Find some transparent way to ensure fairness and representation for Federal employees without the COI of a union. Ensure that employment rules do not unwisely protect marginal or worse employees but do provide fairness for all.

19. Repel or fix the Patriot Act and FISA. Ensure the Bill of Rights is respected and enabled.

20.  Outlaw (or severely restrict) paid lobbying.

"If a law is unjust, a man [or a woman] is not only right to disobey it, he [or she] is obligated to do so." Thomas Jefferson: Papers of Thomas Jefferson as presented by the Jefferson Monticello project at monitcello.org.

“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain inalienable rights, that among these are Life, Liberty, and the pursuit of Happiness.—That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed. — That whenever any Form of Government becomes destructive of these ends, it is the right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles, and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness… it is their right, it is their duty, to throw off such Government, and to provide new Guards for their future security.” The Declaration of Independence, 1776. From the works of Thomas Jefferson, vol. 2, as presented by the Online Library of Liberty at oll.liberty.org

The golden years may not be EZ.

I really, really want to rant. I know this has to be near the acme, the epitome of a privileged, first-world problem. I know I should sit down and shut up. I know how blessed we are, still, this hurts.

Photo credit - Heather Cowper, Flickr. Used under Creative Commons license.

The number one item on my bucket list of earthly delights has been, for some time, a Danube River Cruise with my sweetheart. Deluxe top-of-the-line service on a world-class ship, an upgraded stateroom with a balcony, evening drinks watching the sunset over the river from the shaded upper deck, guided excursions in Southern Europe's historic capitals and art musea, dining with the locals, symphony concert in  Vienna's  Musikverein Orchestra Hall, first-class air travel round trip, two nights in a luxury hotel in Budapest before the cruise.

Photo credit - Alex Talmaciu, Flickr. Used under Creative Commons license.

Importantly, to be most enjoyable, this trip needs (or needed) to happen while Glenda and I still enjoy good enough health for the travel, the walking tours, and such.

I have saved my pennies for years for this trip. YEARS.

Finally, in 2020, we can do it, we thought. Over a year before the trip, in July of 2019, we sought out a travel agent to help plan and arrange the travel. I have normally done all of our own travel arrangements, but this trip is complicated, with many international requirements and connections not to be missed. With the agent's help, we selected and booked a cruise with Avalon Waterways. We would leave Phoenix on August 3, 2020, and fly by Delta's best class of service to Budapest, Hungary. There we would spend two nights at the JW Marriot hotel, giving us time to overcome jet lag and to enjoy the relative luxury of the surroundings. After two nights of rest, we booked an escorted private tour of Budapest, concluding with a formal catered candlelight dinner for two on a balcony overlooking the 17th Century Chain Bridge crossing the Danube between the sister-cities of Buda and Pest. The next morning would begin our 8-day cruise with Avalon, visiting a new European treasure of a city each day with appropriate tours and such. Nights aboard the boat as we sail to a new city.

Then came Covid-19.

Today, May 12, 2020, Avalon notified us that all operations are canceled through August of 2020, including, of course, our August Danube Cruise. They really have no choice, as the government of Hungary is not allowing any international travel into the country right now, anyway, and it's unknown how long that will go on. They are allowing us to use our paid fares, along with an additional $400 credit, through 2022. Delta has also said that our airfare can be used as a credit for rescheduled travel through, I believe, September of 2022. So while the money is tied up with Avalon and Delta, it is not lost.

Photo credit - Krisijan Brkic, Flickr. Used under Creative Commons license.

So nothing is lost but time, right? Yes. But time...time becomes so precious when most of your time is certainly behind you. Or, as Bonnie Raitt puts it, "Life gets mighty precious when there's less of it to waste." Nick of Time (1989)

It is EZ to be afraid!

Some people just have to stir up fear. China has been investing internationally for at least four decades. We DO need international law that provides a level field so that U.S. businesses can fairly invest in China, too. If our "leaders" could get off their asses and stop fighting each other so they could work laws and treaties, that would be a good thing. Fear doesn't fix anything. Last year the *add-to-your-fear meme* was: we will all soon be forced to live under Sharia Law. In the '90s, it was that the Russians will own all of the beach-front properties by the turn of the century. In the 1970s it was the Mexicans will take all our jobs. In the 1960s it was those hippies and their damn marijuana and free love. In the 1950s it was Hollywood is all Communist. In the 1940s it was the Japanese are all traitors and must be locked up. In the 1930s it was the Jews will own everything! In the 1920s it was that devil liquor. In the 1880s, it was the Irish will take all of our jobs. In the 1870s it was the Italians will take all our women. Just stop spreading fear. It doesn't help.