Monday, February 22, 2010

Some questions and some answers (at least my answers)

Did you have a gastric bypass?
No. There are currently several surgical options. I had what is called a vertical gastrectomy or a VG. That surgery is done using a laparoscope through a small incision in the abdomen and physically removes between 85% and 90% of your stomach. The surgery results in a mechanical restriction and has little effect on the physiology of the digestive processes. Its effect is to restrict the total amount of food you can eat at one time. The surgery took about 1.5 hours and I then stayed in the hospital overnight. I went home the next day.

What are the differences between the surgeries?
I discussed the surgeries in an earlier blog entry (September 2009, Bariatric Surgery) and will summarize them here. There are two surgical techniques that I call physiological surgeries (the Roux Y and the duodenal shunt). These techniques physically bypass the stomach and insert the esophagus directly into the intestinal tract. These would be defined as Gastric Bypasses, since they bypass and/or also remove the stomach. The third surgery is the Gastric Band. This is an inelastic band that is placed around a portion of the stomach to restrict food intake. It is generally considered reversible and often people have it so they can have it reversed at some point in the future. The other surgeries are not generally reversible.

Was there any pain or post-surgical problems?
In my surgery, I went to the hospital at 10AM, and walked into the surgical suite at 1:30PM. The surgery took about 1.5 hours and I woke up in my room about 4PM. I had no major discomfort or pain that evening and after a liquid breakfast and lunch the next day I left the hospital about 1PM. Over the next few days I had a little bit of an infection in one of the laparoscopic incision sites, but it was treated with some topical antibiotics and a band aid and resolved itself quickly. In general I had no significant post surgical problems. I stayed on a liquid protein diet for three weeks and followed the “manual” carefully. I did not push the process and began to lose weight immediately.

What was the time frame to eating normal food?
I began eating a soft diet at about 3 weeks and at about six weeks I could eat almost anything I wished. For those first months I kept the portions very small and generally soft. I had a few incidences of pain, but they went away quickly. Normal eating began about 3-4 months after surgery, with a somewhat careful selection of foods.

How much weight did you lose and how fast did you lose it?
I lost about 35 pounds in the first month, and 20 more in the second month. Surgery was on June 4, 2008 and by September 2008 I was down 70 pounds. I was down 80 in October and 91 in November. I had lost 100 pounds by Christmas. The rate of loss slowed after the first of the year and by June 2009 I had lost a total of 135 pounds and the weight loss had stopped. Since that time, I have been at a stable weight of 165 pounds with no variability. I believe that I have reached my ultimate goal weight.

How do you feel?
I feel great. I had the surgery to see if it would resolve my outstanding health issue including diabetes (four insulin shots per day), high blood pressure (160/90), and significant sleep apnea. I have a reasonable exercise regimen using a stationary bike and a significant amount walking. When I saw my surgeon for the first time, my biggest health concern was the long term health implications from the diabetes. He gave me about a 93% chance of getting off insulin. I have not had to use insulin since July 2008, one month after surgery. My blood sugar in the morning is between 75 and 90 which is great. Blood pressure is significantly lower and I no longer snore or have sleep apnea (much to my wife’s approval).

What about exercise?
I exercise probably less than I should but try to get in some stationary bike time at least three times per week. I ride for about a half hour each time. I walk a lot and when visiting the hill towns in Italy often have to walk for extended periods in fairly steep locales.

What about all that extra skin?
Depending upon the type of weight loss and how you carried the weight and where, there is a signiciant potential to have extra skin sort of drooping down from the abdomen and often the neck. I was pretty lucky and my mother had very elastic skin so mine is not too bad. It is often necessary to have some plastic surgery, particularly if you have a lot of excess skin. That is something each person who has the surgery must consider.

You seem to have to drink a lot of water?
The post surgical period is one of rapid weight loss and it is necessary to drink a lot of water to help the body flush away the various metabolites that require excretion. The surgeons recommend 60-70 ounces of water per day and generally not to be taken with meals. It is not that difficult to be sure that you drink a sufficient amount of fluid.

Did it change your life?
Absolutely! I had been heavy for almost 50 years, ever since high school. I was unhealthy and in 2006 had a minor heart attack and double by-pass heart surgery. With the surgery I lost over 165 pounds. I can do a lot more physically than I used to do, and have no significant physical problems. So yes, the surgery changed my life for the better. I will be around longer for my grandchildren and for my new wife.

Did it change your lifestyle?
It didn’t change who I was inside my head, but it did change how I looked and the things I was able to do. Physically I went from a size 54 jacket to a 42, a 46 inch waist to a 32 inch waist, and from a 3X shirt (size 19-20) to a 16. I am able to wear clothes that I have never been able to wear before. I could exercise for a half hour when before I pooped out at 5-10 minutes. I have a pretty well-developed social life with my new wife and my friends seem to appreciate the fact that I am healthier and can do more.

How can you work as a chef and have this surgery?
For the past year I have been working rather steadily as a cook for my wife’s catering business. I serve as a ook to groups from 4 to 40 people. I make antipasti, pasta, sauces of all kinds, grilled meats, and a variety of desserts. I have found that I can eat one or two bites of things I make and appreciate the flavors, textures, and tastes. I have also found I don’t need to eat a lot of anything to feel satisfied. I love to make nutritious as well as beautiful foods for my guests and to see their appreciation and enjoyment of the meal. I don’t feel the need to eat excessively while I am doing so.

What can you eat (and can’t eat)?
Early on after the surgery I carefully assessed any new foods I ingested. I ate only one new food at a time as I learned what worked for me. I found that ground beef was problematical early, as well as tomato sauces and red wine. So I restricted those items. Highly seasoned and spicy foods did not seem to create problems. Pasta still causes me some problem, especially here in Italy where it is not cooked to the softness I need. Al dente here is simply not cooked enough and pasta tends to just sit in my stomach for long periods of time. I cook my pasta a bit longer and have fewer problems. In general when I go out to restaurants, I look at the appetizer menu first to see if I can see if there are interesting things there. I am restricted to 8-10 bites per meal so a full dinner is out of the question. I either share my meal with my wife or I will order an antipasti (which often I can’t finish). I love a bite of dessert and often get to share one either with the table or my wife.

What overall effects has it had on you?
As I stated before, it has totally changed my life. I am healthier, and working on getting stronger. I no longer inject myself with insulin. I look a lot better and enjoy wearing nice-looking clothes. I have been extending my skills in the kitchen. So I have a new life, and hopefully an extended one. I enjoy what I do, who I am and how I look now.

What about your family and friends, what are their perceptions?
The role of family and friends are critical in dealing with the issues of the post surgical time and your subsequent weight loss. They can sabotage you by trying to get you to eat more than you should. They can affect your self-esteem by saying “You are too thin”, “You need to gain some weight” or “You don’t look healthy.” Or conversely, if they are supportive of your weight loss they can be inordinately helpful. You need to be sure how you feel about the comments from family and what they say about them as well as you. Friends who have known you at your larger size will have some issues with your weight loss. But if they are true friends they will understand why you did what you did. This is an ongoing process of discovery and change. Try to minimize contact with those who are not supportive and increase the contact that is supportive.

Conclusion and processes
This is a life-changing process. If you did it for the right reasons, the results will be wonderful and healthy. If you did it for the wrong reasons, the end result can be problematical, like regaining the weight so dearly lost. It is important for each person contemplating this radical process, to fully understand the whys of their weight as well as the reasons for changing it. Myself, I will never allow myself to go back to being heavy again. I hope these answers have helped. Please remember they are based upon my experiences and the people I have met who are either contemplating the surgery or examining the after effects.

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