Categories
Diary Health

My weight loss surgery experience

On September 26, 2011, I had weight loss surgery.

Here I am right before the procedure. That day I weighed in at 257 pounds. I wore a size 26W (4X).

And here I am being released from the hospital a few days later, at 253 pounds.

After three months, I was already below 200 pounds. Here I am in November:

Over the next 15 months, my weight dropped precipitously, bottoming out at 127 in December of 2012. I was able to fit a size 6 at that time.

Around two years out from surgery, my weight stabilized in the 140 to 145 range. It’s stayed there ever since, and I now wear around a size 10.

I had struggled with obesity since I was a teenager. The most I’d ever been able to lose on my own was 50 pounds. I started investigating weight loss surgery in 2009 after recovering from congestive heart failure, but it took another health crisis to convince me to finally do it. In August of 2011 I was told, point-blank, that if I didn’t lose weight, I would go blind in my left eye. A buildup of fluid was pressing on my optic nerve and would soon block out my sight. I posted on Facebook:

Even though I knew it already, the doctor felt the need to repeat “IF YOU DON’T LOSE WEIGHT, YOU’LL GO BLIND” until I started crying.

Things were bad at that time. We had moved to Atlanta for Sean’s new job just months before, but he’d been shifted into contractor status, so he wasn’t guaranteed regular pay or health insurance. Meanwhile, I hadn’t yet found employment. I posted in a comment on the above status,

I am looking for a job and trying to eat healthier and work out more, but if being terrified into losing weight worked permanently, it would have happened back when I had congestive heart failure.

The health insurance we’d had through Sean’s job would expire in a month, and that insurance flatly refused to cover any form of bariatric surgery for any reason. I could prove it was a medical necessity, but they didn’t care. I felt so, so stupid for letting pride keep me from pursuing weight loss surgery back when I had insurance that would have covered it.

In this time of despair and desperation, extraordinarily generous family members came to my rescue. I’m not sure I can ever repay them.

I had the duodenal switch procedure done at Pacific Laparoscopy (PacLap) in San Francisco. Due to my circumstances, I was able to go through the approval process fairly quickly. I had to fill out a lengthy health and weight history questionnaire; undergo new tests (blood tests, chest X-ray, EKG, echocardiogram); have my GP, my neurologist, and my cardiologist sign off on the surgery; and have a psychological evaluation. We started the process on August 31 and managed to get everything done by September 14. Mom and I flew in on September 21, the pre-op appointment was September 23, and the surgery happened on September 26.

My relationship with food

Immediately post-op, I could only take in three sips or bites of clear liquid at a time. That first day I had broth, jello, a popsicle, decaffeinated tea, and juice. The next day, soft foods like cream of wheat, applesauce, mashed potatoes and yogurt were added to my tiny meals. After that, I was able to eat more solid food. But it was very difficult for me to eat. I could barely take in two or three bites, and I didn’t enjoy eating. I had to force myself to eat, and I had to be careful not to have even one bite too many, as that would have caused me to throw up.

Those first few months, eating right wasn’t very difficult for me. I couldn’t eat much at a time, and I hated eating and never felt particularly hungry, so it didn’t really matter to me what I ate. I’d grill a chicken breast and just eat that. A few hours later I’d eat a bowl of plain Greek yogurt. Later, I’d have a bowl of peas. Small frozen dinners were a mainstay. I have many pictures from restaurants demonstrating how very little I was able to eat. In this picture from September 2011 I’m taking home a piece of quiche and three links of sausage from J. Christopher’s; I had managed a couple bites of quiche and one bite of sausage:

The next time I went to J. Christopher’s, in October, I simply ordered the three sausage links and nothing else. I made other allowances when eating out as well, such as eating the fish and leaving most of the rice when I ordered nigiri, turning down side salads, and skipping dinner bread. Food choices were relatively easy; I had to focus on getting protein. My next priority, if I had any room left, was vegetables, then whole grains. Simple carbs were something to be avoided, and in the beginning, it was fairly easy to do so.

Over time, though, I gradually became able to eat more and more. Most of my stomach is gone, so I will never be able to eat as much as I used to, but I can eat a decent meal in one sitting these days–the size meal health and diet experts usually say you should be eating. I have also regained my enjoyment of food. I remember in the beginning wondering why other weight loss surgery patients were eating food that was bad for them, when it was so easy not to. Around the two-year mark, I understood. Food was delicious again. It was no longer a simple matter to avoid bad foods. This is something I’m still struggling with. While it is likely impossible for me to ever be obese again, I can still make unhealthy food choices that have an impact on my health.

Along with only accepting decreased portion sizes, my body reacts a little differently to food now. I can’t usually handle having sugar in the morning. If I have it, I end up feeling awful for about two hours. If I have a dessert in the evening, I generally choose something far less rich than what the old me would have gone for, for similar reasons. Eating really rich desserts doesn’t give me the pleasure it used to. Sometimes even a simple ice cream cone is too much.

I also don’t enjoy eggs the way I used to. There was a time when I absolutely loved eggs over-easy. They are still delicious, but I feel strange while and after eating them. The effect is short-lived, but it’s odd enough to make me seriously consider whether or not I want eggs. This is kind of a shame, since eggs are such a good source of protein.

Of course, the most notorious food effect of the duodenal switch is gas due to malabsorption. This has been a struggle for me. According to PacLap, foods that cause gas include white flour, white rice, sugar, beans, vegetables, some fruits, milk and milk products, and processed foods. I can avoid white flour with minimal effort. White rice is more difficult for me, but I haven’t found it to be particularly gas-inducing. Sugar, of course, is a challenge. I should be avoiding it anyway, as my surgery doesn’t affect the absorption of sugar. It’s hard to know what vegetables and fruits to avoid; I haven’t really figured that out. As for milk, I love having a bowl of cereal every now and again, but it may not be so great to do so. The big one, processed foods, is difficult to avoid in our packaged-food culture. Now that I’m working full time, I rarely feel like cooking, so I’m sure I’m eating a lot of things I shouldn’t be.

Thanks to the surgery, I am realizing more clearly that I have a strange relationship with food. When I am at a restaurant I love, I feel bad that I can’t eat everything. I want to enjoy the different dishes all at once. It’s as though I believe each particular visit is my last chance. I’ve found it frustrating to have to choose, and also to have to eschew foods I used to really enjoy because they will have ill effects on my stomach.

At the other end of the spectrum, there was a time when I would eat and eat and eat out of boredom. I can now pretty easily tell when I’m doing this, because I’ll be full and still trying to eat. During these times, it used to not matter to me so much what I was eating. Now, if the food doesn’t have enough protein, or if it’s too carby, I’ll get irritated by it, which I consider a good thing–it’s like a knock upside the head telling me to make better choices.

Exercise

Immediately following the surgery, I was encouraged to walk as much as I could without over-fatiguing myself. I was also encouraged to walk up and down stairs. I did pretty well in both regards. While I do spend a lot of time at a desk or on a couch, I tend to get antsy if I’m in one place too long. I like to be up and moving.

At first it was very frustrating how quickly I would get tired. I also wasn’t allowed to reach over my head or lift heavy objects, which was quite annoying for someone as independent as me. Sean was a huge help during this time.

Recovery took about three months. At that point I was able to pretty much go back to normal. I remember the first time I did an exercise video after having surgery; I was shocked at how easy it was without all the extra pounds weighing me down.

During the rapid weight loss period, I kept walking, did workout videos at home, and joined a gym. Unfortunately, after awhile these efforts dropped off, especially after I started working full time again. Now, at nearly three years out from surgery, I’m not particularly active. I do try to take the stairs at work, at least in the parking garage, and I go on photo hikes on the weekends…but I really need to do more, for the sake of my cardiovascular system. I’m considering taking up running again, or trying to ride my bicycle to work.

I can say that thanks to the surgery, I have plenty of energy, and if I feel like spending an entire day walking around, I can do it with no problem. This is not something I could say before this dramatic weight loss.

Next steps

Weight loss surgery helped me with the hardest part: losing over 100 pounds. It’s up to me to take advantage of this opportunity, to make good choices for my health. It’s something I have to work on every day. My fight to eat better and be physically active will never end.

There is one other thing I might do to make my transformation complete, and that’s reconstructive surgery. After losing this much weight, there’s a lot of skin left over. While I’m not unhappy with the way I look, the skin can be irritating to deal with. I don’t feel comfortable wearing sleeveless shirts, for example, and certain articles of clothing don’t seem to fit right. Health insurance generally only covers this in cases of medical necessity, so I would have to pay for it out of pocket, which I’m not sure is going to happen. Still, it’s something I keep in the back of my mind.

Final thoughts

Simple pride kept me from seriously pursuing weight loss surgery until it was almost too late. I felt that I should be able to lose weight on my own, and that if I couldn’t, it just meant I was weak. In other words, I was too proud to accept help. Eventually it got to the point that I had to choose between being proud and blind, or humbling myself and keeping my sight. It seems like such an obvious choice in hindsight, but when I was going through it, it was a struggle.

The lesson I’ve learned from this is that accepting help does not make you less of a person. It doesn’t mean there’s something wrong with you. It just means you’re making smart choices.

Every day I look in the mirror and like what I see. Every day I pull on clothes I never thought I’d fit into. Every day I feel healthy and strong.

I am so happy that I had weight loss surgery.

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Categories
Diary Health

Weight loss surgery

I’ve been a candidate for weight loss surgery for years, but due to various circumstances and my own reticence, I haven’t pursued it seriously until now. You’d think I might have done something about it in 2007, when I was diagnosed with congestive heart failure and sleep apnea; but I lost just enough weight on my own to help my heart recover, and I sleep with a CPAP machine, and I got used to that state of being and didn’t worry about anything else. Even when, last year, I was told I could go blind if I didn’t lose weight, I didn’t immediately begin preparations for surgery. I talked about it a lot more, sure, but I didn’t actually do anything.

Now I’ve been to another neurologist, and he was very insistent that I lose weight, that I do whatever I have to do to lose it now, because I will go blind, and I don’t want to have shunts surgically installed in my head as a stop-gap measure that probably won’t work anyway.

So I’m doing it now. I’ll be heading out of state for the procedure. I was looking into a doctor near me, but many circumstances have changed and I’ll go to a place where I’ll be surrounded by family. It could happen very soon; I should know exactly when here in the next few days.

Right now I’m working on the ten-page questionnaire the bariatric surgeon’s office sent over. It’s slow going. I’ve partially filled out paperwork like this before, so I have some of the material I need already, but I’m stumped on questions like “When did you first become obese?” and “What did you weigh 10 years ago?”

I’ve kept track of my weight in various ways since the mid 2000’s–I didn’t have a scale until 2004–but the time before that is virtually a blank. I didn’t really start my blog until 2002, and I didn’t talk about my weight in the beginning. Back then, there were no smartphones with apps to track personal data; I didn’t even have a cell phone. Any paper records I might have had were destroyed in the apartment fire in 2005. I do know about how much I weighed in my teens thanks to some diary entries I transcribed to this blog before the fire. But that doesn’t help me with 2001, alas.

I know I was 150 by my junior year, and after I quit kung fu I ballooned. I think I may have passed the 200 mark my first year of college, but I’m not sure. The next year, I lost a lot of weight due to chemotherapy, and I managed to stay around 150 through 1999 thanks to the Atkins diet. When I stopped doing that due to misguided concerns about my kidney function, though, I ballooned again. Looking at pictures from 2000 on, I can see that I gained weight steadily thereafter. I suppose I’ll just have to find my earliest recorded weight and guesstimate, assuming a steady rate of weight gain. (I wonder if I went to any doctors in 2001? Maybe my weight for that year is recorded in my medical records somewhere…)

As for the question of when I first became obese, that would be whenever I hit about 170 lbs the first time. I’m sure that was before the leukemia, but again, I have no information from the 90s other than that I was 150 in 1992. I suppose if I had my weight at time of admission for cancer, I could guesstimate that answer as well.

Maybe I’ll try to call about my medical records in the morning. For now, I’ll check out more of the forms…then head to bed.

Categories
Health Writing

Obese people are people too

Canada has ruled that people who require two airline seats can have them without paying extra.

The high court declined to hear an appeal by Canadian airlines of a decision by the Canadian Transportation Agency that people who are “functionally disabled by obesity” deserve to have two seats for one fare.

My friend posted to Twitter, “This is kind of ridiculous. If you’re wide enough for a second seat, you ought to pay for it.”

He doesn’t believe he’s being unfair, because he’s one of the people who might be affected by this sort of ruling. However, there is a fundamental fallacy in his argument, and that is

Obese people don’t have the same rights as people at lower weights.

If you think of each airline seat as a commodity, it seems unfair for one person to get two while others only get one for the same price. But that’s not really what’s going on here. The obese person isn’t enjoying a luxurious extra seat, with room to lounge or lie down or spread out. The obese person is simply getting enough room to actually sit down. To say that a person must pay extra for a seat because they require more room is nothing more than prejudice. Should a person in a wheelchair pay extra for the room her chair takes up?

This brings me to another fundamental fallacy. This fallacy is what breathes life into the first.

Obese people choose to be obese.

How many obese people do you know who say, “I love being obese! I wouldn’t change a thing about myself!” I doubt you know anyone who says that. No, what an obese person is more likely to say is, “I’m obese because I’m lazy and don’t eat right.”

That argument may or may not be true. I’m not trying to diminish the importance of personal responsibility for one’s health. But the fact of the matter is, our society makes it ridiculously difficult to escape obesity.

We are less active

We hardly have to walk anywhere. We drive our cars straight up to the buildings we want to enter, even if they’re right next door. There’s a negative connotation associated with walking. When you see a person walking down the street, do you think, “Oh, how healthy!” or do you think, “What a vagrant! Get a job!” Yes, there is laziness involved here. But our country’s transportation fundamentals–the way we organize how we get from place to place–are heavily skewed against healthy options.

We have evolved into car-addicts. We zone our towns so that it’s often impossible to commute by any way other than car. While large cities may have subways or buses, these seem to have a negative connotation. Smaller cities may or may not have public transportation, and certainly not enough to make switching a viable choice for most people. The “ideal” is to have your own car and drive it everywhere.

We also have an obsession with “convenience” and “efficiency”. Americans have always been about innovating in order to save time and money. It somehow seems more efficient to us to drive everywhere than use other methods of transportation. It’s certainly more convenient. We can carry more things in a car, and we can stay cool in the summer and warm in the winter. We can drive right up to wherever we’re going and be inside in a flash.

Our transportation issue has evolved into a self-feeding cycle. We drive everywhere because city planners zone commercial and residential far away from each other, because we like the convenience of driving and the “safety” of neighborhoods secluded from commerce. We can’t stop driving everywhere easily, even if we want to. It takes too long to get to places by foot or bike. It’s less safe. And we don’t have any other options, except perhaps a bus that doesn’t quite go where we need it to.

We don’t eat right

This point hardly needs to be made. Everyone knows by now that human beings are not supposed to eat as much as we eat here in America, and certainly not the types of food we eat. The majority of us are built to store fat to keep us from starving when times are rough. As many have noted, though, our cheapest food items nowadays are the ones that are the worst for us. It’s harder to eat fresh vegetables because we often don’t have time to cook, so we pick up something quick (and loaded with fat and salt) and the veggies go bad in the fridge.

Why don’t we have time to cook, if everything is supposedly so convenient? Because we don’t actually save any time doing things the way we do them. We sit in the car driving to work on the other side of town. We sit around for 8 to 12 hours trying to make more money. Instead of setting convenience as a means to an end–a healthy, joyful life–we’ve made convenience our goal.

Our relationships, just like our health, suffer because it’s inefficient to spend time working on them.

“I deserve it”

The sheer amount of time, energy, and money it would take for an obese person to work themselves down to a healthy size are the reasons more of them (us) aren’t doing it. We basically have to fight basic precepts of our society. We have to teach ourselves that convenience is not good. We have to teach ourselves that it’s okay to spend more money. We have to teach ourselves to spend less time on things we enjoy so we have more time to exercise. And all of these things run completely counter to the “pursuit of happiness” we are indoctrinated into growing up.

We’re told we can do whatever we want, whenever we want. That this is our privilege as Americans. We believe that we have a right to convenience. We have a culture of entitlement, and if things don’t go our way we feel it’s perfectly acceptable to pitch a fit. These underlying assumptions feed our quest for more, more, more, now, now, now, whether that be a faster route to school than walking or the bus, or as much food as we can scarf for the least amount of money.

We are, essentially, training ourselves to be lazy in all things–making it appealing to be selfish and miserable.

The inverse

Many of us recognize this sense of entitlement in ourselves and others and find it repulsive. We don’t want a handout, we’ll say. We don’t want special treatment. We want to be treated like everyone else.

The problem is, sometimes we go too far. We’ll state that it’s only fair that obese people pay for as many seats as they need, for example, because they shouldn’t get more of anything than anyone else. We’ll buy into a logical fallacy because we don’t want to be identified with our gluttonous society.

Obesity is not something we can turn off like a light switch. It is a fundamental problem in our society that everyone–individuals, businesses, and government–needs to work together to eliminate. But while we’re working on it, the fact of the matter is, people are going to be obese.

Obese people are people too

Giving a person a chair that is the right size is not special treatment. It is not saying, “You are entitled to be obese.” It is saying, “I want you to be just as comfortable as everyone else.”

Marginalizing people due to their size ignores the fact that obesity, for many people, is not a choice. Poor education, societal pressures, convenience and “efficiency”, genes, the slow death of the community, and factors we may not even be aware of yet have all combined to thrust Americans into an unhappy, unhealthy world. We can no longer simply blame the fat guy for being fat. We have to take a hard look at everything we do as a society.

We need to educate. We need to reform our transportation system. We need to offer more healthy options. We need to put an emphasis back on communities, on taking care of each other. We need to do all of these things and more to get ourselves back on track.

And in the meantime, we need to treat the ones who are affected most with the same dignity and respect we give everyone else. No more…and no less.

Categories
Health Ponderings

More on obesity

I have been thinking more about the “obesity isn’t unhealthy” argument that I linked to in a previous post, and I don’t know…it just seems like bullshit. Maybe the idea that obesity is bad is too far ingrained for me to have an objective opinion…but I don’t know. I tend to think that things that have historical precedent have stronger arguments. We come from a line of hunter-gatherers who ate natural foods. They weren’t necessarily rail-thin or bodybuilders, but they weren’t fat, either, in general.

That was one of the things I wondered about from that article–it said that an overweight person who worked out could be more healthy than a thin person who didn’t. That’s certainly true…but how many overweight people do you know who work out regularly? The ones I know who do have lost and are currently losing weight, so I hardly think they count.

The argument seemed to be that being fat is natural for many people, and therefore there shouldn’t be a stigma. I can agree that overweight people shouldn’t be stigmatized, but I’m not sure that the proliferation of obesity these days is “natural”. Something is causing it; and just because something is caused to happen doesn’t mean that that is the natural order of things. It is one of humanity’s responsibilities as thinking beings to evaluate how we affect the world and how the world affects us, and to try to correct damaging behavior.

Today I got an interesting motivational mailing about fitness and obesity from Leanne Ely, an associate of FlyLady. I think the FlyLady policy is that I can quote the emails in order to spread the word about the system, I just can’t archive emails for people to get elsewhere…so I hope it’s okay that I’m quoting this part:

We do ourselves no favors when we eat stuff that merely puts volume into a space that requires nutrition. I believe one of the reasons obesity levels have hit such highs with children is because they can’t get the nutrition they need–they keep eating because their bodies are screaming for real food! When your body wants and craves nutrition, until it gets it, you’ll want to keep eating. Have you ever noticed how junk food just doesn’t satisfy? That’s why–it’s not real and you need real food to fuel your “engine”–all stuff you can pronounce, not the chemicals, colorings and additives that are so prevalent in junk food.

Ms. Ely is a nutritional therapist, so it’s not like she’s some housewife who just came up with an idea…but it does ring of common sense, doesn’t it?

(I know that sometimes my body screams out for chocolate, but I don’t think that invalidates the theory.)

Right now I’m home for lunch, eating some leftovers. I suppose that’s mildly healthier than going for fast food…although part of this is meatloaf :> After work today I’m going biking with Mari and Kelly (and maybe Brooke; haven’t seen her to ask if she’s coming). I’m really looking forward to it. I haven’t been on a bike since 1997! Time to see if the phrase “it’s just like riding a bicycle” is a viable simile.

Hmm, hope I don’t fall on my face.