Rick Genter's blog

My chronicle of my experiences, starting with my upcoming plastic surgery.

Monday, September 19, 2005


(with more apologies to Eric Clapton)

This morning I had my other drain removed. Finally! My mobility greatly improved when I had the first one removed on Thursday, and having this one removed makes me feel free. And the best part is: I can go back to wearing regular clothes! :-)

Yesterday I went for a one mile walk. It felt so good. The sun was out and the temperature was in the mid-70s. I mentioned this to Dr. Gee and he said that that was good, and I verified with him that I can keep walking like this, so I will. I'll continue to do a mile per walk for now, but I want to start increasing it as soon as possible.

Next Thursday (the 29th) I get to remove the plastic tape that's covering the incision. When he looked at it today he said that it looks like its healing extremely well; there was one spot where some fluid had accumulated, which he drained, but other than that he said it looks great. He also said that it looks like my shape is coming out the way it should, and I have to agree. No more rolls of skin on my butt, and no more roll around my waist that I can grab on to. I actually feel like a "normal" thin person. It's amazing, and what I was hoping for when I decided to have this surgery.

My next appointment is two weeks from today, and that's the day when I can resume driving. I may cheat and drive a day earlier; my car is at my friend Gail's house and she has my parking pass so that she can come and go to my apartment building while I convalesce. She's been a godsend, shopping for me and even making dinner for me a few times, especially the first few days after the surgery. She walked with me when I took my walk yesterday - she insisted, and it was a good idea to have someone with me on my first "big" walk outside - so I made her a low-calorie pumpkin custard. The custard is basically a crustless pumpkin pie, using fat free condensed milk and sweetener instead of sugar. The calorie content is about four-fifths less than regular pumpkin pie (72 per slice vs. ~350-400 per slice) and just as tasty.

I talked with Nancy, my health educator at the weight management program. She said that I shouldn't change my calorie budget, even though I've dropped eight pounds, since skin really doesn't affect my metabolism. I argued that my calorie budget was probably wrong before, in that case, since I had budgeted for my pre-surgery weight. She pointed out that my pre-surgery budget was working, so there's no reason to change it. We compromised, though; I've altered my calorie budget to maintain a weight five pounds lower than before, and I'm being particularly careful until I can resume my normal high levels of physical activity. With my metabolism, five pounds is only 41 calories, so it's not a huge difference in any case.

Metabolism is interesting. There is a rule-of-thumb that says that an adult male requires 12 calories of food intake per pound of weight to maintain that weight. This reflects the energy used by the body's organs during the day; it takes energy for your heart to beat 24 hours a day, for your liver to process fats, and for your brain to operate. In fact, unless you do a lot of exercise, keeping your body's organs going burns more calories than anything else you do. Exercise is critical to maintaining health, but it's misguided to think that an hour at the gym will make up for eating pizza and a hot fudge sundae. An hour at the gym just doesn't burn as many calories as you'd think.

Anyway, about a year ago I took a test to measure my metabolism. The device used is called a MedGem; it measures your body's at-rest oxygen consumption to determine your resting metabolic rate. Just from the detailed record keeping I do on calorie intake and physical activity I knew that my number had to be lower than 12; at 12 calories per pound, to maintain a weight of 185 pounds I should be able to eat a little over 2,200 calories a day. There was no way I could eat that much without exercising and maintain my weight. So I took the test.

My number is 8.26.

I didn't want to believe it, so I took the test twice. The results came out almost exactly the same both times. While it made sense, I also found it depressing. It means that, to mantain a weight of 185, instead of eating a little over 2,200 calories per day, I get to eat a little over 1,500 calories per day. And the calorie equation is grossly unfair; if I eat nothing, the largest deficit I can have in a day is 1,500 calories, but there's effectively no limit to how much above my budget I can go in a day. I mean, there is a limit as to how much you can eat in a day, but it's so easy to eat 3,000 or even 4,000 calories in a single sitting! A large hot fudge sundae at a gourmet ice cream shop like J.P. Licks is 1,600 to 1,800 calories.

I had been operating on a budget for maintaining 185 pounds (and I've been consistently weighing in at about 190 to 192, which, considering that my clothes weigh about 6 pounds, worked out about right). I've resumed weighing myself daily and I'm consistently running about 8 to 9 pounds lower than I was before the surgery, so I figure that retargeting for 180 is probably about right; yes, the 8 pounds that was removed was skin, but it must take something to maintain skin, right?


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