Reflection on the Surgery

I started this blog for a couple reasons. One of the primary reasons was to document the bariatric surgery from the perspective of a patient and have a record to look back on, and to make those public enough for other people to look at if they were researching the surgery. All they had to do was just come here and click the tag "bariatric surgery" and voila'...a list of thoughts and hurdles encountered by me in the course of having and recovering from the surgery.

The whole ordeal has been quite a personal trip. What started as a strong recommendation from my internal medicine doctors to get weight loss surgery transformed into a month-long physical healing process, a diagnosis of depression and Asperger's, and a long series of therapy sessions to deal with my own demons and quirks as well as issues influenced by the surgery that lead me to fighting off an increase in stress from my day job.

I figured now would be a near appropriate time to reflect a little...over six months later...on my view of the surgery.

It happened long enough ago that I barely recall the recovery process. I have some vague recollections of how difficult it was to even sit up in bed. You have no idea how much you rely on muscles in your abdomen until you're unable to use them! Rereading old entries brings those memories flooding back.

I'm glad I had the open Roux-en-Y surgery. I couldn't stand the thought of having a little band strangling my stomach with the accompanying lifelong risk of erosion, or having a little "port" just under the skin where the band is adjusted in how much or how little it strangles your stomach. And while the open surgery had a much longer (and more...gruesome...) recovery, I understood that it benefited me in that the surgeon had far more flexibility in determining what he was doing and getting it done right. Laparascopic surgery is to benefit the patient; smaller scars, faster healing, etc...but it means your surgeon had to be at the top of his or her game and may have to cut corners while maneuvering around in your fat-laden abdominal cavity. Open surgery means that if he needs to lift part of your intestine to get that cut just right, he reaches in and does it.

Eating...well, here's what I can tell you. I am pretty sure that I could eat VERY SMALL quantities of something like pie or a brownie. I generally don't, though, because I'd rather not risk the dumping syndrome. Plus it runs against what the surgery was meant to help promote avoiding in the first place; eating foods that are unhealthy and against a healthy diet.

As a matter of fact I strongly believe that once the intestine and stomach heal there's very little that is "abnormal" about the dietary needs and tolerances. The change means you do run the dumping syndrome risk so you need to avoid sugars. Avoid them altogether? No. Look at food labels. You can't realistically avoid sugars altogether. And there aren't any evil foods; your body needs sugars and fats to function properly.

I could eat just about anything in moderation, in theory. I don't because I'm obsessive about routine. Because of my own habits my body doesn't like dietary changes that are abrupt anymore.

In addition to cutting down the sugar content there is one other thing that changed; I can't eat large quantities without pain. If I ever wonder if my "pouch" is still smaller than it was I could just try pushing my food intake a little more and I'll feel a big "blah" feeling, if not outright pain if I gulp too much food at once.

The smaller stomach gets full sooner. It's a good thing.

Those are the two big differences. Less sugar. Less food.

It's not a magic bullet because it can be actively sabotaged. I could keep eating until my stomach is bloated; gradually, it'll stretch. As it gets bigger I can eat bigger meals until eventually the surgery was essentially all for naught.

Or I could keep eating calorie-rich foods during the day, spreading out what was a large sit-down meal into an all day affair. That brownie I could have in small small quantity? Instead of popping it in my cakehole all at once, I could finish it off over the course of the day and avoid the sugar spill into my digestive system. All the calories and none of the immediate "oh dear oh dear oh dear" side effects.

So in my case the surgery has simply helped shape a new lifestyle of eating less. This means eating more like I should have been eating; smaller portions.

I also exercise more. I don't like it, but it helps with weight loss and supposedly makes me healthier. As weight reduces from my body the effort of moving isn't quite as high.

The last big benefit I know I've seen from the surgery and weight loss is the reduction in my other illnesses; sleep apnea, high blood sugar, cholesterol, blood pressure,...all those things are either reducing in severity or disappearing.

There are drawbacks though. I have had to deal with other issues that before I comforted through eating. Various stresses get to me even more. My Asperger traits seem to be getting stronger and asserting themselves more; little pet peeves are becoming really strong issues for me to deal with to the point where I can't stand being in the same room as people who are chewing with their mouths open.

I have folds of flesh that I can't stand looking at. I avoid mirrors whenever possible because I wince at the horrific sight of me melting. And I get a flare of anger at people who suggest I go to the gym and build a little muscle to fill the skin (are you @#% daft?! How much muscle do you think you'd have to develop to fill all this??)

I have to deal with my depression issues. They tend to run more deeply than I normally admit to others; I do wonder at times why I bother getting out of bed in the morning. Sometimes I think if it weren't for the huge bills I have to pay off then there wouldn't be a reason to get up some days. The hole used to be somewhat filled by looking forward to a tasty fudge brownie. Now...well, broccoli isn't quite as satisfying.

And there's the head hunger. The surgery cut back on physical hunger and for the first month or two there was a definite drop in the desire to eat. It was definitely freeing. Gradually, though, another hunger asserted itself. Head hunger. The emotional need to eat. Stress, boredom, anxiety, all the things that before were quelled to some degree with food now roar through me at the most inopportune moments. I fill the head hunger pangs with things that are generally more healthy...mixed nuts, activities, and broccoli (sometimes with some mustard or salsa on it). Generally low calorie items (okay, the nuts aren't low calorie; they were an energy pickup I used when I started going to the gym). No cookies. No slices of cheese or makeshift sandwiches or leftovers from the fridge.

There is also a bit of resentment. I miss some aspects of my old lifestyle, despite knowing that I gave them up for something that is supposed to be better for me. I don't have soda anymore. The doctor forbade it; the carbon dioxide fills the stomach pouch and I was told can stretch it or make it more difficult to eat the things I'm supposed to have. I am supposed to be more careful about when I drink, although I haven't noticed any side effects from when and how much I drink. I go to restaurants and wonder what it would be like to be like the old days; "mozzarella sticks look great! I'll have those!" This has morphed into, "mozzarella sticks! They're probably 300 calories apiece, plus they're fried so I'll get the craps, and I wouldn't be able to have any entree even if I did try them..."

A trip to a fast food restaurant has turned "cheeseburger" into "300 calories" when I see them on the menu.

There's the change in perception of other people and their habits. I see someone eating fries with their double cheeseburger and I think, "Do they know how much sodium they're eating?" "Why do you need all those fries with your burger?"

I have french fries once in awhile. Literally. I eat two or three sticks for a taste of the fry. That's the upper limit. I also eat the pickle off my son's burger-cheese because he doesn't like them. Otherwise, I start to obsess over whether or not it's going to get me rolling down the slippery slope of weight gain.

But I can't see other people out there with their eating habits and wonder how many of them bitch about not being able to lose weight but not see how much they're eating. Low fat foods don't equal losing weight (of course not...they're filled with other things to make up for the lost flavorings). Do you look at the calorie counts of the food you're eating? I think the majority of dieting issues would be taken care of if people were looking at their calorie expenditure and intake.

Of course, that won't help with the secondary effects of obesity, like emotional issues...but in the cut and dry, wanna-lose-weight-how-can-I-do-it approach, you cut down on calories and you should lose weight.

That is the heart of the whole weight loss surgery. It kicks you in the rear towards starting a healthier lifestyle.

There is another side to the surgery to consider. If you have an addictive personality (and let's face it, if you fill a need with food, you probably have some kind of addiction issue) then you might learn to transfer that addiction to another behavior. Some surgery patients move to alcoholism. Due to the physiological changes in your digestive system it supposedly takes a lot less alcohol to make you drunk. I haven't tested it yet, but I guess a glass of wine is supposed to be a real hoot post-surgery.

Or you become more obsessive about losing weight. I've always been like this; it wasn't the surgery that triggered it, but I live in perpetual fear that the surgery will "fail". Or as it was put to me, the surgery doesn't fail, I fail the surgery. I watch my weight. If it levels out I get worried. If it goes up, I stress. If it climbs for a week, I...don't know. It hasn't happened yet. But it very well might. I lost over 200 lbs before, about six years ago, and thought I wouldn't go back to the Fat Life. After a plastic surgeon more or less laid out to me that the skin folds were permanent (no amount of exercise was going to fill that, the connective tissue is far too damaged...by the way it's considered cosmetic surgery so you'd have to pay for it yourself) I was more depressed and saw less reason to maintain my restricted calorie lifestyle. Life moved on, I went back to old habits, I got fatter again.

These memories of my first time in "Skinnierville" leave me with the fear that this weight loss is temporary and that no matter what, the fatman is still inside these folds of flesh. And the head hunger reminds me that he wants out. My response to this is to monitor my weight periodically during the week. I keep to a routine to limit my portions growing out of control or hopefully limit the amount by which my stomach stretches. I obsess over getting a certain amount of exercise in each week.

I keep my old belt with me as a reminder. The belt was with me at my fattest and I wear it every day. I am still saddened that it doesn't reach around me twice yet. I sometimes add another notch to the band as I notice that the pants aren't holding up properly, but it's slow progress.

The surgery has been a mixed blessing. It was an aide, and it may be something to help my case if the insurance company is every to try paying for skin removal. Essentially that was another big reason for the surgery; the insurance company would never okay skin cutting if I lost the weight on my own like I did the first time around. So I had to have a really expensive surgery to do it first. Who says there's waste in healthcare?

The surgery has helped by giving me a fear of going off the lifestyle...I can't have cake and cookies, for example, and I'm in a habit now that while I could have a slice of cheese as a snack I won't for fear of what it could do to derail me. It has given me permission to be different in some ways.

The surgery has hurt in that now I have to face my other issues that promoted the weight gain. I have the sense that my Asperger's habits are asserting themselves more. My depression symptoms sometimes seem worse. And I miss the ability to go out to eat or try other things without hearing all the fears and worries and food-related anxieties swirl around in my head.

Can't say I regret having the surgery. For me, six and a half months out, it's been worth it. Everyone's mileage varies, though.