Monday, March 1, 2010
THIS IS NOT BRAIN SURGERY
I borrowed that catchy little title from an out-of-print book about gastric bypass. I never got to read it but I don't need to. I already know it's true. I have mentioned before that my biggest beef with the "gastric bypass industry" is that one-on-one personal therapy isn't absolutely required after surgery. Overweight people generally ate for an emotional reason. So, they need to deal with their issues. Otherwise, gastric bypass will not work for them in the long run.
There is a myth out there that you cannot gain your weight back after surgery. This is completely untrue. You have to work at it, but it's very possible and it seems to be happening more and more.
There are no simple steps to deal with weight gain after gastric bypass. Losing weight after gastric bypass is hard (I mean, losing weight after weight gain after gastric bypass...you get the point). Part of what keeps me successful (er, mostly successful) is sticking close to my roots and not forgetting that I am a gastric bypass patient. I try to keep going to my support group meetings. I also try to eat better more often than not. Of course, people will see me put things in my mouth that I shouldn't. That's a choice I make, though, to keep myself sane. Everything in moderation! Maybe every time you see me, I'm eating cake. But do you only see me every six months? I don't eat cake every day, so don't judge me. Also, as I stated before, exercise is key and the number one way for me to keep my weight off or lose weight. I know I cannot do it very easily with diet alone.
It is very easy for people to sit back and judge. Of course, I've heard that gastric bypass is the "easy way out." Easy, huh? Really. Of course it is. There's nothing easy like having your guts sliced open and rearranged, being able to barely eat jello and 1/4 cup of soup for months, throwing up if you eat even a drop too much, feeling dizzy and light headed or blacking out, losing your hair, enjoying dumping syndrome if you eat too much sugar, possibly getting ulcers from lack of stomach acid... Yeah, that sounds easy (and FUN). Sign me up!
When I was going through the process to get approved for gastric bypass, I went to support groups and had to talk to a dietitian and psychologist. I remember hearing a statistic that only 1 in 20 people can successfully lose 100 plus pounds and keep it off. Who knows why. Maybe it's easy to fall back into old habits. Maybe your body physically won't let you and you don't have the will power to stick through the plateaus. But that was the selling point of gastric bypass: THIS will be the tool that helps you keep the weight off this time!! (Hello, I've tried all the other tools, including phen fen when it was on the market.)
Gastric bypass surgery has actually been around for awhile. There are many types of weight loss surgeries, but I had (and focus on) the roux-en-y gastric bypass surgery (See: Link about the surgery, issues that can arise and death statistics). Although it has become popular in the last 6-8 years for weight loss, I understand the surgery itself has been around for many years -- primarily to remove parts of the stomach due to cancer. I also understand that, when this surgery was first suggested as a weight loss tool, it was meant for those in the 500-600 pound range (a catch-22 since, at that weight, their hearts could not always survive the anesthesia). Some form of bariatric/weight loss surgery has been around for many, many years though. In the last 10 years, though, it has become more popular for the "regular" fat person in the 300-400 pound range. I remember when I had the surgery, you most definitely had to be 100 plus pounds overweight. But lately, when I see people coming into support groups, I'm thinking they are new patients, a month or two post-op, and it turns out they're waiting for their surgery date. It looks like insurance companies are loosening the standards to allow more patients to get surgery.
I'm sure the insurance companies are thinking they're going to save money in the long run by not having to pay for sleep apnea machines, blood pressure medication and insulin shots (etc.) for all the fatties they're making skinny. But they're just handing this surgery out like candy and then releasing people on the street with almost no supervision. They are refusing to pay for plastic surgeries even though I had a friend who was actually throwing out her shoulder from her "bat wings" flying around. The domino effect. The insurance companies are thinking they are taking care of one problem, but they're only creating another one. And they all cost money to fix. If people are gaining their weight back on top of it all...what a waste.
Clearly, there are many ways to judge your good health. Getting on the scale isn't the only one. You should take measurements of your body to see if you might be losing inches even if pounds aren't coming off on the scale. What's your BMI? How's your blood pressure and cholesterol? You should have a good idea of your overall health rather than relying on one "good" reading. When I was still overweight, I thought I had good health because I had somewhat low blood sugar. However, I found out later that sometimes low blood sugar in overweight people is just the lead up to having full blown diabetes later. However, your weight DOES count at least a little bit. I knew someone who weighed almost 400 pounds. He too felt that since he didn't have any health problems, he was healthy. But bodies just aren't made to weigh that much and, eventually, the health problems will catch you.
After years of battling my weight, I clearly did decide that gastric bypass surgery was for me. Some people like to do that "last supper" before gastric bypass. Go out and shove your face full of as much food as you can tolerate. I didn't do that. Some programs will try to dissuade such behavior by telling you that if you show up on the date of surgery with even an ounce of weight gain from your pre-op appointment, they'll send you home. My program didn't threaten that, but I still didn't want to do that to myself. In fact, at my pre-op appointment (which was like three weeks before surgery), I hadn't actually hit the goal set by my doctor. My doctor kind of guilted me and said, well I'll suggest that we still go through with surgery even though you didn't hit your goal. Ouch. I worked my butt off to lose that last little bit of weight and actually weighed less than I "needed to" on surgery day. I was a little disappointed that they never weighed me on surgery day, so they didn't even know!
My journey was an eventful one, for sure. My surgeon attempted to do the surgery laparoscopically. Fail. The intestine they had chosen to connect to my new pouch was too short, so they had to open me. My surgery took hours longer than it should have (leaving my poor friend in the waiting room with no idea of what was going on). Apparently one of my nurses cut herself with a scalpel and they had to call my mom for permission to do an HIV test.
I still remember waking up after surgery. I was SO groggy (they probably over-medicated me since they had to keep me asleep longer than they expected). I was bent over a table and the nurses were attempting to put an epidural in my back for pain. It was the most intense pain I had ever felt in my life. The neck of my hospital gown had opened and I could see my stomach. I was totally out of it but I KNEW I should not be looking down my gut at the train track of staples. I kept asking what had happened (hello, it's HOURS past when you said I'd wake up and I look like I have been stabbed to death by Michael Myers!!!). The nurse just kept saying, you had surgery, honey. OH I KNOW!! WHY DO I HAVE THESE STAPLES?! I didn't find out about the complication until the next day. It's funny how the brain functions when you've been under with anesthesia. It's like I can comprehend things but I can't get my mouth to work right. Then, on top of the regular pain, I assume from being sliced open, I'd get these very intense body spasms. That first night was not a good one.
Normally after gastric bypass, they want you up and walking within a few hours of waking up. Not me. I couldn't even keep my eyes open long enough to sit up, much less stand. I was assigned a one-on-one nurse who literally sat on the edge of my bed for the entire night. One thing I've learned about myself when I've had surgery is that I obsessively ask what time it is. I'm sure that nurse wanted to punch me when I asked him every 30 minutes what time it was, but he sure didn't show it.
I lost weight pretty quickly. By the time I went back to work in two months, I was already down 55 pounds. And I continued to lose quickly. Then I started having issues. Blacking out mostly. So they thought maybe I had orthostatic hypotension. Basically, your blood pressure changes drastically when you stand up, which causes you to black out. Or maybe vasovagal syndrome. The doctor explained that one like this: It's like your heart is a half-empty water bottle and if you squeeze it, you just get a fine mist instead of a steady stream of water (maybe because I'm tall and my heart has to work harder to pump blood to all parts??). Anyway, all I know is that if I stand still too long, I pass out -- doesn't matter if my knees are locked or not. I can feel it coming on, so I told my doctors I didn't want any medication. If I started to feel tight in the chest, I knew it was coming and I'd sit down, no matter where I am. That was a fun one. I was waiting in line at a concert in San Francisco and -- *POW* -- I hit the ground. Hard. Three times. No bueno. Now that I recognize the signs, I just sit, no matter how nice my clothes are or how dirty the ground is.
I also have a funny side effect. It's not well known although I've heard other people complain of it. I get a runny nose if I eat too much. Who really knows why it happens but I take it as a hint to stop friggin' eating.
Another side effect is how alcohol affects you. I remember the first time I had a drink after surgery. It was like a sonic boom to my system. Your stomach has very little acid after surgery, so drinking is dangerous (possible ulcers -- same reason we shouldn't drink coffee/caffeine). After surgery, you get drunk SO fast (although it goes away fast too). I understand that it happens because your stomach is smaller and it gets to your intestines still in it's pure form. But at least now I'm a cheap date and, even though I wasn't much of a drinker before surgery, I can nurse one drink all night and be fine.
Anyway, the point of that meandering story was that gastric bypass is not the easy way out. And it's definitely not brain surgery. It's just another tool in my belt to help me. Even though I do deal with some side effects, I also appreciate the opportunity I've been given to be thinner and healthier. I plan to continue down the right path by losing my excess weight (again). I am writing my own story and the ending fully depends on me. This story WILL have a happy ending.