A change in thought...

I've had a reversal in thinking when it comes to the type of surgery I want to have. I was pretty set on having roux-en-y gastric bypass surgery but the thing that I kept in the back of my mind was the potential complications after surgery. I am well aware that an excellent surgeon makes all the difference in the world but you never know what adverse events might occur.

Recent studies have suggested that the weight loss from roux-en-y gastric bypass and vertical sleeve gastrectomy are almost identical and the rate of weight loss occurs at about the same pace. The caveat to this suggests that the patient's BMI be ~50 or less. My BMI is currently around 51 so I am confident that I will achieve the same success.

I have identified several distinct advantages of vertical sleeve gastrectomy (VSG) over roux-en-y gastric bypass (RNY.)

1. Patients feel the "full" feeling with VSG as opposed to a "pressure" type feeling with RNY. Patients must learn the "pressure" feeling and when to stop eating. Until this is achieved vomiting or pain may occur.
2. The portion of the stomach that produces the hormone ghrelin is removed. This is beneficial for reducing the desire to eat.
   
3. The incidents of gastric dumping is basically eliminated due to the fact the pylorus is preserved.
   
4. The overall complication list is drastically reduced due to the fact no anastomotic openings are created and the intestines remain unchanged and intact.
   

I also figured that on average VSG patients enjoy the same amount of weight loss as RNY patients. As with any surgery it is all about how the patient uses the tool (weight loss surgery) and how successful they are afterward. It is quite possible to lose 100% of excess weight after VSG but on average most patients lose 70% of excess weight. For me this translates to a final weight of 220 lbs. Granted this is still considered overweight but it is not morbidly obese at 360 lbs.

Here's the concept I needed to understand. WLS will not cure me from being fat, it will only give me a tool to lose the weight myself. My weight loss is directly proportional to my commitment to changing my lifestyle and eating habits. If I fail to do this the surgery will fail. This is true for any type of weight loss surgery today. Dedication and commitment are all it takes to be successful.

"If you eat fast food after surgery, you have already failed." -me

Also, there is the question of quality of life. Which surgery will afford me the best quality of life? I figure that after my surgery and I have lost the weight I will have a better quality of life with VSG over RNY due to the simple fact I won't have to worry about malabsorption and the other complications that might arise at any time after gastric bypass.

However, what I perceive as good for me may not be good for someone else. There are several different factors that my surgeon considered before recommending VSG:

• My reactive hypoglycemia has a strong potential to worsen after RNY
• My ability to consume Motrin is eliminated. Motrin is superior to Tylenol for treating musculoskeletal and considering my employment Motrin is a necessity.
• My pre-op drive to lose weight. I had already given up bad foods and made several changes to my lifestyle before setting foot in his office.
• My age, health conditions and medical history are all suggestive of achieving great success with VSG.
  

However, if for some reason the need arises to be converted from a VSG to a RNY I will embrace it and continue to live my life.

Supplement Research

Today I drove over to the health food market and picked up a few things for post-op.

In my WLS class they recommended trying a few things before surgery to avoid buy things that aren't good.

They mentioned the "protein bullet" as a good source of protein in a very compact form.

The IDS New Whey Liquid Protein comes in a 3.4 fl. oz. screw top container. It comes in fruit punch, orange, blue raspberry and grape flavors. It contains 42g of protein, 0g of sugar, and 0g of fat.

I mentioned previously that the body can only utilize at maximum 35g of protein in one meal. The nutritionist recommended 60g to 80g of protein a day. So that means 3 or 4 meals containing 20g of protein.

These protein drinks are the perfect two "meal" size. Theoretically I could drink half and then drink another half at a later time for two very quick protein meals.

Now, let's talk about the taste. It is sweetened it with sucralose and acesulfame. I generally find anything sweetened with sucralose too sweet and this product is no exception. I quite frankly would describe the taste, smell and texture as drinking sugar-free gelatin before it sets. It's quite thick and very sweet. I have found that cutting it with 3 parts cold water helped it become more palatable.

The next product I purchased was No Shot® Sub-lingual B-12. The bottle contains 100 very small red tablets. When I was at my local pharmacy earlier the sub-lingual b-12 they sold were large tablets that took several minutes to dissolve. The No Shot® brand promised a quick dissolve. And they are correct. I placed the small tablet under my tongue and within 30 seconds it was dissolved. It was nicely priced at 11.99 per bottle and the product works as described.

And the last product I purchased today was Designer Whey Natural French Vanilla flavor protein powder. I absolutely love their natural flavor powder but sometimes I don't have time to haul out the blender, frozen fruit, yogurt, bananas and milk to make my own flavored protein drink. Don't get me wrong this is my preferred method but seeing as how protein will be a major dietary concern after surgery I need quick options.

One scoop delivers 2g Sugar, 2g Fat and 18g of protein. The manufacturer recommends mixing 3 oz. of water or milk (I tried both) with one scoop of protein powder. Much like the natural flavor it dissolves very well with no grit or aftertaste. It has a hint of vanilla flavor and is not sweet. I liked it very much. I did not discern any taste difference between milk and water. Those that prefer sweet protein drinks will not favor this product or may need to add their favorite artificial sweetener. This product is sweetened with olgiofructose or inulin.

So this rounds up my current product research. I think I will continue to purchase all three after surgery.

My next plan is to attempt to make naturally flavored gelatin. I purchased some organic blueberry juice and will try my hand at that later on tonight.

The EGD (Endoscopy)

I had the EGD on Friday morning. It was a piece of cake. All they did was start an IV, give me three drugs, perform the procedure and then I went home. I think I was there for a total of 2.5 hours.

Here are the drugs they used:

1. Robinul - to dry up my mouth and pharynx
2. Versed - for relaxation and sedation
3. Diprivan - to put me to sleep

The procedure lasted about 5 minutes and then I was awake, getting dressed, and going to the waiting area to speak with the doctor.

He said everything looked normal but decided to give me a prescription for Prilosec. It helps strengthen the esophageal sphincter. This is good for gastric bypass patients because it will help to reduce vomiting.

My PCP should get the results in a few days and at that time I will also pick up my surgical clearance and take them to the surgeon.

WLS Class 2 and beyond...

On Wednesday I attended the second half of the mandatory WLS class. The room wasn't quite so full this time.

We reviewed the post-op diet again and then we covered the topics of supplements, the day of surgery, the hospital stay and subsequent discharge, and post-op exercise.

On average WLS patients spend two nights in the hospital. I was very surprised at how busy I will be after surgery. There will be frequent five minute walks, a leak test, and another type of test that I am not remembering at this time... Hey! It's 4:30am and I'm tired... and hungry but more about that in a few.

Regarding post-op supplements I learned quite a bit.

1. The body can only utilize about 500 IU of Vitamin D at a time.
2. WLS patients regardless of gender need 1500 IU of Vitamin D daily.
3. Regarding protein, I have read that people recommend adding it to hot coffee, hot soup, and other types of hot meals. I specifically questioned this practice. In theory, it sounds like a great idea and an easy way to get 20g of protein in a meal. Well... it really doesn't work that way. As we all know, heat breaks down protein. This happens when we fry an egg and the originally clear egg whites turn white or when we cook meat and it goes from red to brown. Heat will do the same thing to whey protein. The dietician recommended allowing the heated liquid to cool to below 120 degrees. My coffee maker will heat coffee to above 150 degrees so that is out of question. And I love HOT soup... so again, out of the question... However, I do plan to come up with some creative protein ideas (which I will post here.)

In regards to post-op exerciese they recommend walking one mile per day about two or three weeks out of surgery. However, walking my large dog who likes to pull is out of the question for the first month.

They offer an eight week exercise course with an exercise physiologist for $128.00. I am not sure if I will participate in the program. It definately is not the cost because that is exceedingly cheap. I made sure the participants in the class were well aware of that. My employer offers an exercise program through their exercise facility for employees. I think I'll check into this program first before participating in the program offered by my surgeon's team.

So why am I so hungry??? I have my pre-op endoscopy this morning. I'm not quite sure what to expect. Everyone says it's not terrible and they don't usually remember it due to the drugs. I believe they will use versed and fentanyl to sedate me but if they don't I'll update it here. These are the most common drugs used.

So what's left to do before surgery?

• Chest x-ray
• Psychological evaluation
• Pre-op shopping
• 8 day 1,000 calorie pre-op diet
• Submit short-term disability paperwork to human resources
• Receive my surgical clearance from my PCP
• Visit the kennel for the dog

Wow... I still have a lot to do and only 3.5 weeks left!

Weight Loss Surgery Class 1 of 2

Today from 4 until 6 I was required to attend a class covering the weight loss surgery.

The room was completely filled by the time I got there and extra tables and chairs had to be brought in to accommodate everyone. It was slightly obnoxious. I can understand bringing your support person but your entire family? Not necessary. I was expecting maybe 20 people tops, not fifty.

It was mostly middle-aged women and younger men. I was very surprised at the amount of VSG type surgeries scheduled. It was about 50/50. Which kind of leads me to believe that the surgeon is pushing VSG when RNY is just as acceptable. I have basically been beating myself up over why the surgeon would recommend VSG over RNY for me but from what I'm seeing that is his preference.

Here are some interesting statistics I learned today concerning VSG:

• If the patients BMI is 45-49 weight loss results are the same for RNY and weight loss occurs at the same rate.
• The size of the sleeve after the surgery is about two times the size of a drinking straw.

My concern about pushing the VSG at this point in time is the fact most insurance companies will not cover the surgery unless the patients BMI is greater than 50. I certainly qualify for coverage but the statistics seem slightly disadvantageous to me.

The class covered the general differences between surgery and what the patient needs to do to be successful with minimal complications. Strict adhearance to the post-op diet plan seemed to be the number one way to reduce surgical complications.

Here are the new things that I learned today:

• The body can only utilize/absorb 30-35g of protein per meal.
  
• RNY/Gastric Bypass basically eliminates diabetes for 85% of patients following surgery.
• There will be no more chugging water.
  
• NSAID's are not allowed after surgery because of their ulcer causing potential.

I basically knew NSAID's were not allowed after surgery but I have read conflicting information. I have not used acetaminophen based products for several years and I guess the next time I have a headache I will try it and see if it helps. Otherwise, I will go back on Midrin or try Fioricet which I have heard works very well for tension headaches.

The next class is supposed to cover vitamins, exercise, and post-operative recovery.

Here are some questions I would like answered during the next class:

1. In their experience how long does it take someone to modify their eating habits (e.g. portion size, bite size, and frequency?)
2. Do they recommend using a scale to measure food portions?

First consultation complete

had an appointment today at 4pm to meet with the team at the center. I walked away accomplishing everything I needed to.

I have a date for surgery: 16 June. That's seven weeks from today... I was very surprised I could get it scheduled so soon.

I have a few steps to accomplish before the surgery.

1. Chest x-ray, blood work, and an endoscopy I will schedule tomorrow.
2. I have an appointment with the psychologist on 1 June.
3. I have two mandatory classes that I need to attend.

The mandatory classes I need to attend is the only snag in the entire process due to my summer college course conflicting with the class. I will have to see how the course is when I begin it next week and determine if special arrangements need to be made.

The surgeon recommended gastric sleeve but I'm not entirely sure I'm sold on the idea. I am more sold on the bypass. I'm pretty sure the surgeon recommended the sleeve due to my health insurance but it could have been because of clinical indicators i am not aware of.

I will have a recovery time / vacation from work for four to six weeks. That will get me through the post op dieting at home, which is most beneficial.

I will also have an 8 day pre-op diet which will consist of eating less than 1000 calories a day.

I'm frankly very satisfied with the experience I had with the program director, the surgeon, and the nurse. Everyone was very friendly and very informative. I definitely did not feel like I was being run through an assembly line type process or hurried along.

The nice thing about the staff at the office is three of them are RNY patients.

The next major thing is the Endoscopy. I'm seriously hoping it's not horrible. :)