Talkdoc55

What follows is a narrative of my personal experience with the vertical sleeve gastrectomy (VSG) and my subsequent weight loss. It is specifically written for both preoperative and recent postoperative patients. This is my way of thanking Bariatric Pal for the wealth of valuable information I gleaned before undergoing the surgery. I need to underscore that my story is not intended to provide weight loss advice or suggest that the way I did it is the only or even best way to lose and maintain weight loss. I have broken and continue to break most of the postoperative rules I was given by my surgeon and, yet, I’ve been able to maintain a weight loss of 88 pounds over four years (my weight fluctuates within a five-pound range). There are too many self-proclaimed experts on this forum: I am not seeking feedback or a critique about the particular path my journey has taken. There are a few things I would do differently in retrospect. Perhaps others will benefit from my story. Back Story Obesity runs in my family. My parents were chronically 30 to 60 pounds overweight throughout my entire life. My father died at 62 from arteriosclerosis (years of cholesterol plaques broke free and clogged his valves: he suffocated to death). My mother died at age 61 from a massive stroke. Three of my four grandparents died in their late 50’s and early 60’s. I am 63-years-old and thank God every morning for giving me another day. I was a skinny kid but my mother forced me to finish a large glass of eggnog every day even though I would spend over an hour trying to get it down. Her plan worked: At age twelve, I weighed around 30lbs more than I should have. The year was 1967 and Weight Watchers had just opened a branch in my hometown. My mother joined and I decided to follow her program (there were no teen programs at that time. Back in those days, one weekly serving of liver and three daily doses of that foul-tasting Malba powered fat-free milk were mandatory). I lost the excess weight in a relatively short period of time because I was consuming far fewer calories than a growing boy needed and I was active with sports throughout high school. I kept the weight off until after I was married. Throughout my young and middle adulthood, I would continuously lose 30 pounds over a period of a few months and then slowly but surely regain the weight over a two-year period. However, the total amount of each weight gain increased with age and losing the weight became increasingly difficult. At 57 years of age, at a height of just under 5’7”, I weighed in at 244lbs reaching a BMI of 38.8. Bariatric Consultations My initial plan was to obtain a gastric balloon (I wasn’t quite ready to accept that I needed a permanent solution). I consulted with three bariatric surgeons who each told me that a gastric balloon was not the answer as, first, I had too much weight to lose and, second, each physician anticipated that I would regain the weight as soon as the balloon was removed (in six months’ time). Two surgeons recommended the vertical sleeve; one was in favor of the gastric bypass. I eventually decided on the VSG as I didn’t want to have to worry about nutrient absorption (although, as it turned out, I still have to take daily supplements as I just can’t hold enough food in my stomach to receive the minimum daily requirements of vitamins and minerals). My decision to undergo the surgery was not based on vanity. I would have continued to let my pants out if that had been an option as I loved to eat. The surgery was a medical necessity: I had developed obesity-related diabetes (type II) and was taking 1500mg of Glucophage daily and it was only marginally successful. I was functionally crippled: I could not walk more than 100 yards without feeling as if the soles of my feet were on fire. I would need to stop and sit down to give my feet a chance to recover. I was miserable. I could do nothing but lie in bed, watch TV, and eat. In addition, as my weight increased, my blood pressure continued to spike. I was taking five different antihypertensive medications daily and my pressure was still in the high-normal range (155/90). My wife lost her partner in that I was physically unable to do the things with her that we used to do together. She often referred to herself (with me only) as a widow. I hit rock bottom emotionally during the summer of 2012 while visiting Disney World because I needed to rent a scooter (I could not keep up with the others and would hold them up while I rested for a few minutes). I was deeply humiliated although my companions were thrilled that we were able to skip the long lines and enter the rides through the handicap entrance. I scheduled the surgery well in advance for the winter break of 2012 as soon as we returned home (I’m an academician and a university student counselor). My eventual choice in a surgeon was based on a recommendation from my stepson, an emergency room physician, who heavily researched various doctors for me. This particular surgeon was the first to ever perform bariatric surgery in our state and, most impressively, has a “leak rate” of zero percent (even to this day after five years). The Good, The Bad, and The Ugly The operation went smoothly although I awakened to four incisions instead of the expected three because the surgeon could not see his way around my fatty liver without that additional entry point. My mild to moderate pain was sufficiently managed with a pushed IV dose of morphine and tramadol followed by regular intervals of more tramadol. I was very comfortable during my two-night hospital stay. I was sent home with only liquid Panadol and it worked. What pain I had was negligible by the fourth day, when I was able to get out of bed without help. I attribute this outcome to my surgeon’s skill. What I did not anticipate, from having read these forums, was just how damn thirsty I would be before I was cleared for liquid intake. My mouth and throat were so dry that the Barium liquid they gave me to drink for the leak test was literally a welcomed respite from my thirst. I was one of the unfortunates to suffer chronic diarrhea for three-and-a-half-months. This condition is not uncommon after vertical sleeve gastrectomy. I went to work every morning wearing a diaper. I also did not anticipate how weak and dehydrated I would be. I was readmitted to the hospital after two days of dehydration and syncope, a condition that persisted for weeks. I lost my balance a couple of times while at work, which led to speculation among my colleagues that I had either contracted alcoholism or cancer (the latter guess was reinforced by my rapid weight loss). I chose not to broadcast my surgery to anyone other than a few close relatives. My healthcare issues are no one’s business but my own. I also don’t discuss my hypertension, benign prostatic hyperplasia, and reoccurring planters wart with relative strangers such as waitresses and coworkers. (There is a great deal of debate on this forum about the merits of telling the world about one’s bariatric surgery. I do not necessarily believe that one approach is better than another. I only know what was and is best for me). I lost weight too quickly because I didn’t prepare sufficiently for the postoperative 14-day liquid diet. I couldn’t stand the taste of the liquid protein drink I purchased and there is only so much clear broth one can tolerate without feeling as if you’re drowning. By the ninth day, I broke my first postoperative rule and had my wife make me a simple poached egg without seasoning. To this day, that single poached egg was the most delicious meal of my life. I was starving. I believe I lost 30 pounds within the first five to six weeks, followed less dramatically by another 40 over the course of the next six months. Unfortunately, a significant percentage of that weight loss was muscle. Consequently, by the time I reached my initial target goal, I was disheartened by the fact that I looked nothing like I did the last time I had weighed 170lbs. My pants size never changed as my weight decreased from 185lbs down to goal weight, owing to this apron of loose skin in my lower abdomen: I have had to wear 36-inch waist pants regardless of weight. That has been an enormous disappointment. The last time I weighed 170lbs (back in 1997), I wore a 33-inch waist. Over the course of the five years that followed, I gradually lost another 15lbs while not particularly trying to. I have a hunch that my surgeon removed more stomach than he let on, although a gastroenterologist told me that I had about 50 percent of a normal stomach after she performed an endoscopy to rule out stomach cancer. I developed a terrible case of acid reflex and must take antacids every day. During the summer of 2012, my wife and I went on a five-week culinary retreat, including a 10-day cruise. I returned home to discover that my weight had climbed to 180lbs from the 168lbs I had started my vacation with. It was a harsh wake-up call that I could not eat with total impunity. The fear of regaining my weight gripped the pit of my stomach like a heavy duty Craftsman’s vise. I made a decision and commitment to myself that exact moment to never allow myself to gain this kind of weight again. I made a concerted effort to reduce my daily intake of food until my weight fell back down to goal weight. My weight has remained fairly constant from the beginning of 2013 to present day, fluctuating from 155 to 160 pounds. When my weight hits 160, I make a decision to become acutely mindful of what I eat until I see 150-something on the scale. As for the apron, I will go in for liposuction this summer. I gave serious thought to an abdominoplasty but the surgeon talked me out of it, claiming that I would require a four to five week recovery period. In addition, he felt that the loose skin would eventually retract after the underlying fat was removed. In fact, my apron has slightly decreased in size over the past year, an effect of regular activity I think. The Aftermath I am convinced that my metabolism has increased as a result of having been able to maintain my lower body weight over several years. It seems to me that I can eat more now than I could one year after the surgery without gaining weight (my wife, on the other hand, thinks that this isn’t necessarily true, i.e., that I am not really eating more than I had). I am amazed by all the energy I have today: my wonderful and beautiful wife is no longer a widow of obesity and diabetes. Today, I seize every opportunity I can to accompany her to the malls and stores. Today I can walk for hours without pain or fatigue: my diabetes went into permanent remission after a weight loss of 30 to 35 pounds. My BMI varies from 24.6 (normal) to 25.4 (slightly overweight) depending on where I am in my five-pound weight range. My blood pressure is currently maintained in the low-normal range (i.e., 120/70) on just one-fourth the medication I used to take when I was fat. I am on the scale every single morning. I do not like surprises. I want to know immediately when my weight starts to creep upward so I can nip it in the bud. I know myself: I would not be able to rationalize that personal failure away. I am a big fan of the reality TV show “My 600lb Life” on TLC. According to bariatric surgeon Dr. Nowzaradan, less than five percent of his patients enjoy long-term success. Based on the scientific literature I have read, patients with a starting BMI of less than 40 have the highest long-term success rates. Those who were morbidly and super obese (BMIs of 40 to over 50) at the start of surgery have a tough nut to crack. In most cases, they will need to consult with a psychotherapist who specializes in the treatment of obesity to change their emotional relationship with food. Aside from eating solid food after just nine days, I started drinking carbonated beverages at six months after the surgery, e.g., diet cokes and vodka tonics. I am not aware of any change in my stomach’s capacity and I’ve been drinking carbonated beverages every day for almost five years. (Please note: In no way am I encouraging anyone to do the same. Follow your surgeon’s guidelines. I do not want to read any criticisms or dire admonishments from this forum’s formidable food police about how I am inadvertently sabotaging other people's weight loss program). I am simply sharing what has worked for me for the last five years. Many forum members claim that their taste for certain foods changed after the surgery (and, quite fortuitously and even miraculously, it’s always foods high in carbs and fat that members seem to lose their taste for). I cannot claim such good fortune. All foods taste the same to me as my surgeon refused to remove even one of my 10,000+ taste buds: What has changed, however, is my appetite for certain foods. Prior to the surgery, I used to put away four to five 16oz Angus ribeye steaks every week. Today, I don’t find red meat as appetizing as I used to because of its density. I prefer fish because I can digest it easily and without suffering from an agonizing attack of acid reflux. Chicken is also good. Sometimes I do feel frustrated that I can’t eat more than three to four ounces (including fluids) at a time. The good news is that my surgery paid for itself in about 18 months owing to dramatically reduced grocery bills (my insurance did not cover the surgery). I was thrilled when—by fasting all morning long from food and liquids—I was able to finish an entire half of a Second Avenue Deli pastrami sandwich while visiting New York City (and a few sips of their beef barley mushroom soup as well). I have not restricted or eliminated any foods from my life. As a behavioral therapist with over 37 years of clinical experience, I don’t believe in abstinence from food or alcohol as a lifelong strategy. Abstinence is not an effective alternative for moderation. My diet is predominantly the same now as it had been before the surgery. I still eat candy, cake, and pizza, for example… just a lot less than I used to. The only genuine difference in my diet, as stated before, is a decrease in the amount of red meat I consume because it’s harder for me to keep down than fish and chicken. My stomach is very sensitive to overeating: the difference between digesting my food in peace and having to run to the bathroom to cough up a silky combination of excess mucous and gastric acid is literally one bite or a single sip of beverage. Would I have the surgery again given what I know now? Absolutely and in a New York minute. The only regret I have is that I didn’t commit to the surgery sooner. What I learned from my experience I urge anyone planning on having a sleeve gastrectomy to invest the time and money to experiment with different brands and flavors of protein drinks before the surgery. You need to have a reliable source of protein and sufficient calories or you will lose muscle along with fat as I did. The only regret I have is that I lost the weight too quickly, leaving me with an annoying apron and lots of loose skin on my arms, stomach, and hips. There is an implied assumption on this forum that all bariatric surgeons and results are the same, i.e., if one patient supposedly sprung a leak by eating solid food on day 13 (instead of day 15) or allegedly gained back half the weight by allowing him or herself to eat M&M’s again, then everyone should expect the same results. This is simply not true. No two surgeons are the same and no two patients of the same surgeon will have identical results. One size does not fit all when it comes to bariatric surgery. I suggest to friends contemplating the surgery that they find the best surgeon they can regardless of cost even if it means traveling. You don’t shop for bargain basement prices when you’re about to have more than half your stomach removed. The risk is too great. My stepson, the emergency room physician, after looking into the first surgeon I had selected advised, “I wouldn’t let him operate on our dog.” The “less than one percent leak rate” is not an immutable or predetermined statistic: There are bariatric surgeons who boast a zero percent leak rate. Find one of those. I hope my story has been informative and helpful.

Thank you Kathy. Yes, I wanted folks here to know that the surgery does work. I attribute 98% of my success to the surgery and the remaining 2% to mindfulness.

Thank you Kathy. Yes, I wanted folks here to know that the surgery does work. I attribute 98% of my success to the surgery and the remaining 2% to mindfulness.

Thank you Sleeve1st. It's just "one day at a time," putting one foot in front of the other and refusing to give up. You will get there. I haven't tried to regain the muscle back yet. I imagine it might be harder at 63-years than when I was in my forties. Below, you'll find a photo of what I'm talking about. There used to be well-developed triceps where the loose baggy skin is hanging. This is probably just as much a function of age as it is dieting-related muscle loss. Yes, we had a treadmill in the house at the time and I did use it often. Thank you FluffyChix and others for your good wishes.