If you don’t know what NPO means and you are interested in SWL, you are about to learn all about it. Nihil per os, nothing per oral, nil per os… It all basically means that you may put nothing down your throat no matter how hungry you get. This is for a variety of reasons. Sometimes it’s because what you eat or drink may alter the accuracy of the test required and sometimes it’s to prevent you from breathing food or vomit into your lungs, regardless it is medically necessary.

Today I was up at 500 AM to have blood drawn. A few of the tests ordered required that I remain NPO, I was starving and cranky. I got to the lab at 600, took a number, and was told to take a seat in the empty lobby until it was my turn. I waited and watched another human wander in, take a number, and sit. Repeat. After fifteen-ish minutes, I was called up and then told to sit back in the lobby again. The second time I was called it was to discuss whether or not I was sure I wanted these tests and if I was sure that I wanted my results to go to my surgeon and not my PCP. Why not both? No. It had to be one. Fine, then send them to my surgeon since his name is on the requisition.


The third time I was called a very nice phlebotomist asked if I was excited while she drew nine tubes of blood from my antecubital fossa with a butterfly needle.

I eyeballed her. “Not particularly, why do you ask?”

“I only see people after their surgery and you don’t look like you’ve had surgery.”

I laughed lamely. “I am not particularly excited, I have a long way to go until I can have surgery. Right now, I am just hangry.”

Afterward, I stopped by a diner for eggs, hash browns, and toast and was mistaken for a homeless person. It could have been my thick beanie, paint stained sweats, and hoodie… but I was followed to the bathroom, given sympathy, and continuous price quotes to ensure I had enough change. It wasn’t necessary to disabuse the waiter.

By 1200, I was NPO again for an afternoon that would end in biometric testing in another zip code. The wife and I drove an hour and a half down the interstate to my surgeon’s primary clinic (the satellite clinic in my area is only open Wednesdays) to start my “approved pre-surgical program.” This activity was not entirely covered by my insurance and I paid a one-time program fee of $350. This fee will be applied to my surgery once the program is completed. Here I had my nutrition consultation with a registered dietician (RD). She was kind, professional, and easy to speak to. She took two full pages of notes and asked questions regarding my eating habits and relationship with food. She asked about social eating, who prepared food, and where the food came from. She was incredibly thorough and direct. It was a two-hour appointment that ended with a calorie-reduction program (to be logged on MyFitnessPal), an exercise regimen, and a behavior modification program. I was given four weeks of paperwork to document my goals and daily efforts. These would be started during my visits with the RD, completed throughout the month, and evaluated at my next monthly visit.

Writing my goals with the RD.


I will document my food every day with MyFitnessPal.
I will attempt to limit my calories to 1800 calories per day.

I will perform 30 minutes of intentional activity three times a week.

I will attempt to find new coping mechanisms to handle stress in the place of food.
I will attempt to find new coping mechanisms to handle strong emotions in the place of food.

Finally, it was 4’O clock, almost time to eat! I met with my new exercise physiologist. He was very tall and incredibly athletic, equal parts intimidating and inspiring. “Do you want me to get naked?” I asked. I was informed that I should wear tight-fitting underwear and bra or swimsuit for biometric screening, I was ready. “No! Not yet.” We discussed fitness goals and he explained to us that we would be testing my body composition using a BOD POD® and resting metabolic rate with a MedGem.

According to Eviva’s website…

 “BOD POD testing accurately measures your body composition to indicate the percentage of body fat vs. lean body mass. This test is quick and simple with printed results in about 5 minutes. The BOD POD is the gold standard to measure body composition using air displacement technology to provide the most accurate measurement available. Your test results can be used to assess body composition, track the efficacy of your nutrition and exercise program, and more…”

“The MedGem indirect calorimeter is a clinically validated medical device for measuring resting metabolic rate (RMR). RMR indicates how many calories your body burns while at rest. The results can be used to help create individualized nutrition plans and assist in diagnosis of metabolic disorders. The MedGem determines your resting metabolic rate by measuring oxygen consumption (V02). Knowing and understanding RMR can benefit those wanting to lose weight, maintain weight or enhance athletic performance…”

Both of these pieces of equipment could be a claustrophobic human’s nightmare. Let’s start with the MedGem, because I was not required to remove clothing for this test. In some ways, it feels like a nebulizer treatment, but with a very tight nose clamp to ensure you are only breathing through your oral cavity. I sealed my lips around the mouthpiece and breathed in and out, against resistance, and never breaking the seal of my lips against the plastic. I was sweaty, rubbing my palms on my jeans, and failing at trying to visualize the calm body of water. It took 10 minutes but it felt like 10 years. Results were immediately available My resting metabolic rate was 2766.

Next, it was time to get naked, well.. mostly naked. I declined a gown, undressed, and

Me inside the BOD POD…

handed my clothing to the wife for safe keeping. I would not be the first or last fat person in that room and I was there for bariatric services. They already knew I was fat. Fat was free, soft, and very white against my black sports bra and panties. It was oddly liberating. I was weighed, measured, and then told to climb inside this large, white sci-fi egg. “Take pictures!” I yelled as the lid closed around me and the world went thickly silent. After a moment, I heard a click followed by the sensation and sound of pulsating air pressure around me. I felt like I was about to be launched into space, looking at my wife across the room through thick glass that obscured the details of her face. This puff puff puff process was repeated three times. It was easier that the MedGem! “I wish all appointments where this interesting!”



I am more than half fat…  I was blown away by this cool test.