I am just getting home from the my regular doctor. We discussed her writing a letter for me and her feelings about WLS. She supports me but also cautions me to view this is a serious lifestyle modification. She has had 6 patients in her practice that have ate themselves through a gastric bypass. She frankly put it, mashed potatoes and cheeseburgers won't cut it.
I explained to her that I have done extensive research over the last year and that this is probably the most informed decision I have ever made in my life.
She seemed comfortable with everything and will have my letter ready on Monday.
Next step, consultation with the surgeon on 5 May.
Tuesday, April 28, 2009
Thursday, April 16, 2009
Questions
Here is my list of questions for my consultation. I will add to this list when I think of additional topics that I feel need to be addressed.
1. What are the various recovery times from surgery? (Hospital discharge, return to school, return to work...)
In general this takes three to six weeks but on average one month.
2. I have already given up soda in preparation for life after surgery, do I need to give up coffee as well?
No, just no coffee for the first two weeks after surgery since the caffeine will slow healing.
3. What about spicy foods such as Indian and Thai?
No problems at all but not until I am on regular food.
4. Is there a support system for adjusting to life after surgery?
They have a support group that meets once a month at the hospital as well as the nutritionist, psychologist, and staff at the center.
5. How soon after surgery can I start exercising?
Walking up to one mile a day is greatly encouraged and after six weeks all routines and activities may be started.
6. If I have surgical related complications that would require a trip to the ED, can I go to my hospital or do I have to go to St. Mary's Hospital?
I can go to my hospital but if it is a serious complication, it would be best if I went to their ER.
7. Due to the often strenuous nature of my profession, should their be additional recover time to prevent possible injury?
I shouldn't need more than six weeks off work.
1. What are the various recovery times from surgery? (Hospital discharge, return to school, return to work...)
In general this takes three to six weeks but on average one month.
2. I have already given up soda in preparation for life after surgery, do I need to give up coffee as well?
No, just no coffee for the first two weeks after surgery since the caffeine will slow healing.
3. What about spicy foods such as Indian and Thai?
No problems at all but not until I am on regular food.
4. Is there a support system for adjusting to life after surgery?
They have a support group that meets once a month at the hospital as well as the nutritionist, psychologist, and staff at the center.
5. How soon after surgery can I start exercising?
Walking up to one mile a day is greatly encouraged and after six weeks all routines and activities may be started.
6. If I have surgical related complications that would require a trip to the ED, can I go to my hospital or do I have to go to St. Mary's Hospital?
I can go to my hospital but if it is a serious complication, it would be best if I went to their ER.
7. Due to the often strenuous nature of my profession, should their be additional recover time to prevent possible injury?
I shouldn't need more than six weeks off work.
Tuesday, April 7, 2009
The stigma
I know I have always viewed people who had weight loss surgery with a certain amount of stigma. I think most people look at people who have had weight loss surgery as weak. Weak physically, mentally, and psychologically.
If they weren't weak they would be able to lose their excessive weight!
Well, I am a hypocrite.
Here I am, three weeks away from my consultation with a bariatric surgeon. I really think there is a cycle that prevents people who diet and exercise from maintaining their efforts and weight loss results.
For me, I have never been able to get past the wall. Anyone who has, they are better than I am.
So this leads me back to the stigma of weight loss surgery. Do I tell my family, friends and coworkers? Or do I just state, "Diet and exercise" when asked. Everyone always wants to know what someone did to lose weight. I also know that when people talk about someone who has had weight loss surgery it usually isn't very positive.
I think I will eventually tell some people in my life but I think I will leave a majority believing it was diet and exercise.
If they weren't weak they would be able to lose their excessive weight!
Well, I am a hypocrite.
Here I am, three weeks away from my consultation with a bariatric surgeon. I really think there is a cycle that prevents people who diet and exercise from maintaining their efforts and weight loss results.
For me, I have never been able to get past the wall. Anyone who has, they are better than I am.
So this leads me back to the stigma of weight loss surgery. Do I tell my family, friends and coworkers? Or do I just state, "Diet and exercise" when asked. Everyone always wants to know what someone did to lose weight. I also know that when people talk about someone who has had weight loss surgery it usually isn't very positive.
I think I will eventually tell some people in my life but I think I will leave a majority believing it was diet and exercise.
Choosing a surgery
I decided to start investigating weight loss surgery months ago. I never allow anyone to make decisions for me and I truly believe in (self) informed consent. When I attend my consultation appointment with the surgeon I want to already have an idea about which surgery I feel is the best fit for my life and what questions I want to ask.
According to my extensive research there are generally three surgical options offered: gastric bypass, sleeve gastrectomy, and adjustable gastric banding. I have reviewed each option, their advantages, disadvantages, complications and results.
By far the most common surgery is gastric bypass specifically roux-en-Y stomach bypass. This option has demonstrated to be the most successful tool used to reduce weight. Basically, the stomach is reduced to the size of one ounce or two tablespoons and the new small pouch is connected to the small intestine bypassing several inches of small intestine limiting caloric absorption. It is the latter half of the surgery that concerns me. Along with limiting caloric absorption, vitamin and mineral absorption is also limited. I feel this will be a problem for me. Plus the other side effects I find less than desirable. Some of the side effects that concern me the most are bowel obstructions, ulcers, and dumping syndrome. The nutritional deficiencies are also concerning. Deficiencies in calcium, iron, vitamin B12, thiamine, and vitamin A are all things that lead to serious problems. However, it seems all of these problems can be managed with supplements.
The next most common form of surgery is adjustable gastric banding. I heavily considered this option after learning about all the potential complications of gastric bypass. This option allows for slower weight loss and no malabsorption issues. However this form of weight loss surgery allows for the least amount of excess weight loss. I find the side effect profile for this surgery bothersome as well. First, what is called the lap band may become dislodged, it may cause gastric erosion, and certain foods have a high propensity to become stuck in the opening. This surgery is by far the safest but considering I weight 365 lbs I do not think it is the right choice for me.
The least common form of surgery is sleeve gastrectomy. This surgery preserves the pyloric valve and does not cause malabsorption issues since there is no small intestine bypassed. However, the suffix –ectomy means removal and 85% of the stomach is removed which makes this surgical procedure irreversible. The new stomach size is about two ounces or four tablespoons. Because a majority of the stomach is removed the production of a hormone called ghrelin is significantly reduced. This hormone is responsible the feeling of hunger. The side effects of this surgery are ulcers and gastric leakage. This surgery also may lead to inadequate weight loss or weight gain from overeating, which causes the new stomach to stretch. The weight loss results and ultimately success is heavily dependant on the size of the stomach after surgery. This depends on which size bougie the surgeon uses during the surgery. Most recommendations state the use of a 32-french bougie results in superior weight loss but some surgeons may use a bougie as large as 40-french. This surgery has the potential of achieving the weight loss results of gastric bypass.
Because of everything I have learned, I am heavily considering the sleeve gastrectomy procedure. I will only consider this surgery if the surgeon uses a 32-french bougie. I do not want a stomach that is bigger than two or three ounces. If for some reason this surgery cannot be performed to these specifications then I will choose gastric bypass.
According to my extensive research there are generally three surgical options offered: gastric bypass, sleeve gastrectomy, and adjustable gastric banding. I have reviewed each option, their advantages, disadvantages, complications and results.
By far the most common surgery is gastric bypass specifically roux-en-Y stomach bypass. This option has demonstrated to be the most successful tool used to reduce weight. Basically, the stomach is reduced to the size of one ounce or two tablespoons and the new small pouch is connected to the small intestine bypassing several inches of small intestine limiting caloric absorption. It is the latter half of the surgery that concerns me. Along with limiting caloric absorption, vitamin and mineral absorption is also limited. I feel this will be a problem for me. Plus the other side effects I find less than desirable. Some of the side effects that concern me the most are bowel obstructions, ulcers, and dumping syndrome. The nutritional deficiencies are also concerning. Deficiencies in calcium, iron, vitamin B12, thiamine, and vitamin A are all things that lead to serious problems. However, it seems all of these problems can be managed with supplements.
The next most common form of surgery is adjustable gastric banding. I heavily considered this option after learning about all the potential complications of gastric bypass. This option allows for slower weight loss and no malabsorption issues. However this form of weight loss surgery allows for the least amount of excess weight loss. I find the side effect profile for this surgery bothersome as well. First, what is called the lap band may become dislodged, it may cause gastric erosion, and certain foods have a high propensity to become stuck in the opening. This surgery is by far the safest but considering I weight 365 lbs I do not think it is the right choice for me.
The least common form of surgery is sleeve gastrectomy. This surgery preserves the pyloric valve and does not cause malabsorption issues since there is no small intestine bypassed. However, the suffix –ectomy means removal and 85% of the stomach is removed which makes this surgical procedure irreversible. The new stomach size is about two ounces or four tablespoons. Because a majority of the stomach is removed the production of a hormone called ghrelin is significantly reduced. This hormone is responsible the feeling of hunger. The side effects of this surgery are ulcers and gastric leakage. This surgery also may lead to inadequate weight loss or weight gain from overeating, which causes the new stomach to stretch. The weight loss results and ultimately success is heavily dependant on the size of the stomach after surgery. This depends on which size bougie the surgeon uses during the surgery. Most recommendations state the use of a 32-french bougie results in superior weight loss but some surgeons may use a bougie as large as 40-french. This surgery has the potential of achieving the weight loss results of gastric bypass.
Because of everything I have learned, I am heavily considering the sleeve gastrectomy procedure. I will only consider this surgery if the surgeon uses a 32-french bougie. I do not want a stomach that is bigger than two or three ounces. If for some reason this surgery cannot be performed to these specifications then I will choose gastric bypass.
What has lead me to this point?
My story is much like the others I have read. All of my attempts to lose weight have been refractory. I’ll discuss my dieting attempts first.
I have tried the conventional methods of caloric restriction and exercise. I did lose weight but when I would stop exercising or dieting I would regain weight with little effort. I found this extremely disheartening because I wasn’t over eating, gorging on sweets, or eating excessively large meals. However, the failure of caloric restriction was always due to hunger and guilt. It’s easy to understand where the hunger came from but the guilt? Anytime I would engage in eating that I perceived as failure, i.e. restaurants, family gatherings, or any environment where I couldn’t control what I was eating I would feel guilty about what I considered to be a failure.
I found the low carb diet to be very interesting, especially the cravings. I am not the type of person who eats high carbohydrate foods such as breads and pasta often and I never crave them. However after about two weeks into the diet all I would think about would be bread or pasta. It would consume my idle thoughts. I can vividly remember fantasizing about eating plain spaghetti. I would rapidly lose weight with little effort but I found the diarrhea and carbohydrate cravings discouraging.
My most recent attempts at dieting were more of a food revolution. I stopped eating processed foods especially processed meats and started eating whole foods, real meat, and vitamin, mineral, and antioxidant rich fruits and vegetables. This diet had profound effects on my health. I no longer have to take blood pressure medication and my cholesterol levels have normalized. I figured my weight would reduce as well but it has only maintained. However, I continue to eat this way today.
This brings me to talking about my exercise. I have never been a lazy person and I have never allowed my weight to affect my activity level. With that said, my weight has limited my choice of activities. I have received compliments concerning my endurance level. My weight has never slowed me down. As the saying goes, I can keep up with the best of them.
Over the years, I have noticed increasing amounts of back and joint pain that I can only attribute to my weight. Which presumably will only get worse with age.
I have a dream of being the type of person who can run. I definitely have the endurance but my weight has always been a stopping factor. My weight also stops me from doing other things that I love such as roller coasters, shopping for clothes, skiing, and any other thing that causes me to think, “Am I too big to do this?”
I have a gym membership. I have tried to regularly workout however my weight has made me feel very self-conscious at the gym. Also this is where the feelings of guilt play an important role. If I would not match or exceed my previous workout or if I skipped a workout then I would feel guilty and this was a major source of failure. I also find my weight embarrassing when I am at the gym.
The psychological impact of being overweight is profound. I find my weight, weight gain, limitations and almost every weight related issue depressing. I would not say my weight has lead to major depression but it does lead to negative feelings and anxiety.
And the amazing part about what I just wrote, it is only a small amount of the actual thoughts and feelings that have lead me to where I am at today.
Everyone has their own experiences and reasons why they decide to lose weight and maybe from everything I have just written may help anyone reading this understand my struggles and why I have made the profound decision to alter my anatomy as a tool for achieving permanent weight loss.
I have tried the conventional methods of caloric restriction and exercise. I did lose weight but when I would stop exercising or dieting I would regain weight with little effort. I found this extremely disheartening because I wasn’t over eating, gorging on sweets, or eating excessively large meals. However, the failure of caloric restriction was always due to hunger and guilt. It’s easy to understand where the hunger came from but the guilt? Anytime I would engage in eating that I perceived as failure, i.e. restaurants, family gatherings, or any environment where I couldn’t control what I was eating I would feel guilty about what I considered to be a failure.
I found the low carb diet to be very interesting, especially the cravings. I am not the type of person who eats high carbohydrate foods such as breads and pasta often and I never crave them. However after about two weeks into the diet all I would think about would be bread or pasta. It would consume my idle thoughts. I can vividly remember fantasizing about eating plain spaghetti. I would rapidly lose weight with little effort but I found the diarrhea and carbohydrate cravings discouraging.
My most recent attempts at dieting were more of a food revolution. I stopped eating processed foods especially processed meats and started eating whole foods, real meat, and vitamin, mineral, and antioxidant rich fruits and vegetables. This diet had profound effects on my health. I no longer have to take blood pressure medication and my cholesterol levels have normalized. I figured my weight would reduce as well but it has only maintained. However, I continue to eat this way today.
This brings me to talking about my exercise. I have never been a lazy person and I have never allowed my weight to affect my activity level. With that said, my weight has limited my choice of activities. I have received compliments concerning my endurance level. My weight has never slowed me down. As the saying goes, I can keep up with the best of them.
Over the years, I have noticed increasing amounts of back and joint pain that I can only attribute to my weight. Which presumably will only get worse with age.
I have a dream of being the type of person who can run. I definitely have the endurance but my weight has always been a stopping factor. My weight also stops me from doing other things that I love such as roller coasters, shopping for clothes, skiing, and any other thing that causes me to think, “Am I too big to do this?”
I have a gym membership. I have tried to regularly workout however my weight has made me feel very self-conscious at the gym. Also this is where the feelings of guilt play an important role. If I would not match or exceed my previous workout or if I skipped a workout then I would feel guilty and this was a major source of failure. I also find my weight embarrassing when I am at the gym.
The psychological impact of being overweight is profound. I find my weight, weight gain, limitations and almost every weight related issue depressing. I would not say my weight has lead to major depression but it does lead to negative feelings and anxiety.
And the amazing part about what I just wrote, it is only a small amount of the actual thoughts and feelings that have lead me to where I am at today.
Everyone has their own experiences and reasons why they decide to lose weight and maybe from everything I have just written may help anyone reading this understand my struggles and why I have made the profound decision to alter my anatomy as a tool for achieving permanent weight loss.
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