I've never blogged before but I'm going to give it a try. This is basically me trying to work out whether to have another weight loss surgery (got a band in 2008) and, if yes, which one. It will probably be extra long and all over the place.

To be honest, I've pretty much decided to have another surgery. I hate it and it terrifies me but after 40 plus years of fighting and losing, its becoming pretty obvious that diet and exercise aren't going to work. And I'm just so tired of fighting every day and never winning. And I'm not just mentally tired. I'm physically tired, also. I can barely get myself up for work in the mornings. I'm sucking air like a fish out of water just walking from the car to the office. My knees and hips hurt. Somehow, I've managed to aggravate/pinch my sciatic nerve while sleeping (yes - sleeping!) twice just this year. I know I've been very lucky up until now with being this heavy and not having too many medical problems. But I think that is changing. Forty four years is just too long to put this much weight on my poor joints and bones and heart. I can only hope I haven't done so much damage that I can't come back from it.

As I said, its felt inevitable for some time but I just got back from vacation with family I hardly ever get to see. There are so many things this weight keeps me from being able to do. I'm constantly stressed over where I can sit/fit and can I walk that far and that fast. I hated slowing everyone down. I even had to take a rest while walking to a restaurant. Granted, it was hilly and three blocks but no one else had issues. Just me. Everything I do is impacted by my weight. In fact, everything about me has been shaped by my weight.

I haven't told too many people yet but once I get the insurance approval and the appointments start, I will tell everyone close to me. When I got the band, I kept it a secret from my co-workers and cringed whenever family would try to discuss it. In fact, I still don't really tell anyone. I'm really very ashamed at my failure with the band. I think I don't tell people about the band because I don't want people to know I'm fat. As if they can't see me trying to bust out of my size 26/28 clothes. Also, I think it was sort of a fail safe for me - if I don't tell people, they won't see if/when I fail. This time, I'm going to be open about it and take away my ability to deny everything after the fact.

I'm also going to start seeing a therapist to help with my food issues and binging. I am hopeful that the surgeons office will have someone to refer me to. I think this will be very important for me. If I could do this alone I'd have done so by now. I'm also thinking maybe some medication to help with mood swings and cravings.

When I first decided to consider another WLS, I was not really aware of what the sleeve was. I thought it was just another new type of gastric bypass. So now I'm trying to decide which WLS would be best for me. The gastric bypass truly scares me. Re-routing intestines just seems like playing with fire. If we didn't need them just like they were we wouldn't have them in the first place. I like the idea of the sleeve. Cut out most of the stomach and hunger hormone. No hunger and a tiny stomach. My cousin got the sleeve and has lost 200 lbs in 3 years. She says she often forgets to eat cause she's just not hungry. Wow - what is that like? Just the idea of not being hungry makes me hungry (yeah, I'm broken). But the sleeve is restriction only and I already have a restriction only device inside me. I was hungry immediately following my band surgery and it never made me feel full, just sick but still hungry.

For my own decision making purposes, below are some questions I think I need to address in order to make a decision:

1. Do I want to be normal sized or just not so fat? Weird question, I know, but a friend of mine had the gastric bypass a few years back and lost so much weight the docs wanted her to gain 20 lbs, She is a couple of years younger than me but she looked so old. Nearly twice her age. BUT, she had a lot of bad complications and is/was very malnourished. Maybe a sleeve would allow me to lose enough weight to get healthier but not too much. Yes, I'm very vain. I'm not sure, though, that going through surgery to maybe lose a little weight is a good idea. If I'm going to have surgery, why not go big and try to lose the majority of my excess weight?

2. Can I give up food? This should be number 1. A tiny little voice in my head is telling me this is the real source of my fear. Food is my ultimate frenemy. Seriously, I only just gave food the title of frenemy yesterday. I smoked for over 20 years and quit 10 years ago. To date, that is the hardest thing I've ever had to do. But to give up food - the thought terrifies me and nearly brings me to tears. When I think of it, I think of an episode of My 600 lbs Life about Lupe. She is 39 years old and immobile. She's nearly died a few times. She hides food and binges. Food is her comfort. Because of her heart issues, she gets a sleeve instead of gastric bypass. At one point, she asks out loud if she can give up food because its been her comfort for so long. I think about her asking that a lot. For her, it wasn't just maybe food was killing her. It had already tried a couple of times. Food has such a hold on her that despite the knowledge, she was still asking if she could give it up. I realized watching that episode that I would have to give up food if I have surgery. I don't believe I can have both because food (my frenemy) wants me to be sick and tired and die young. I will definitely need the therapist for this one.

3. What will I do without food? Breakfast. lunch and dinner are currently the highlights of my day. What will I do without them? I'll need something to look forward to and concentrate on. This is probably where the therapist will come in handy.

4. Can I handle the post surgery diet? I'm going low carb on Monday to sort of get ready for eating high protein after surgery. Not the same, I know, but close. Sort of. I diet well for a limited amount of time and then I start to slip, eventually binging on all the forbidden foods. I've never been able to maintain the momentum of a diet, though. I lose interest. Get tired of it. Confuse myself by reading about a different kind of diet and then fall off and into a binge.

5. If I choose gastric bypass, will the fear of dumping be enough to keep me away from my fave foods - cake and cookies? This probably goes with #2.

I'm scheduled to attend a WLS seminar on 16 April. I can't wait. The surgeons office said its about two weeks after the seminar before you get an appointment with the surgeon. I feel like he would recommend the gastric bypass due to my BMI of 59 and because it would be a revision from the lap band.

My health insurance currently offers a free weight loss coaching program that I am participating in (not successfully). It uses the DASH diet. I'm wondering if they would consider that to be medically supervised. Also, my primary care docs office has a weight loss program I'm doing. Maybe that would also count. Not that either have really helped me much. They've actually been kind of non-starters for me. The one through my insurance allowed me to get weight loss drugs at a lower cost but they didn't really do what they were supposed to do so I didn't continue. Definitely my insurance has records of my weight issues, though.