Month: December 2015

Ain’t Nobody Got Time for That!

Emotions, Weight Loss Surgery (WLS) Bariatric Surgery Gastric Bypass, What to eat

The-Time-Traveler-Surreal-art-by-Xetobyte

Foggy, unattached, surreal, this is how I feel about the surgery.  In the midst of all the Christmas preparations, there was a 4th nutrition appointment with Lori and a consultation with Dr. Troy Lamar.  When Dr. Lamar asked which surgery I’d like, gastric bypass or gastric sleeve, I said I’d like gastric bypass.  He said I am a good candidate & proceeded to tell me how the insurance companies calculate my ideal weight.  At 5 feet, 5 inches, my ideal weight is 125 pounds.  Then he said I’d realistically be between 140 and 160 pounds when I plateau at my weight loss goal.  This is where surreal comes in.  When I was in high school, I was starving myself to be thin, and before there were Fitbits, I walked circles in my National City  block obsessively, dozens of times a day to burn off all the calories I had consumed that day.  Yes, this same frame, once held a meager 109 pounds.  

Let’s be clear, I wasn’t healthy, in my head. I was miserable and desperately trying to compete with an imagined and completely unrealistic ideal. Now, 25 years, yes over 25  years later, I can’t believe I’m STILL revisiting this topic of weight loss.  I despise it, like cooked spinach as a side dish, or mildewed laundry, or whining children, this topic of weight loss is my nemesis.

Now I’m much healthier, in my head. Years of therapy and deep relationships have helped me get here. The time has come to help my body become healthier.   Feelings of ‘cheating the system’, come to mind.  I can’t help but feel like I’m taking the easy way out.  The ‘if I only’ song plays in my head, if I only had more will power, if I only ate more vegetables, if I only exercised more, if I only resisted the See’s Candy box.  Then I remind myself that I HAVE gained and lost pounds at different times over the past 25 years, and with none of these attempts, have I maintained significant long-term success.  So, I go full circle back to the research, “Back in 1991, the National Institute of Health, made a consensus statement, they said that basically anybody who as a body mass index that’s greater than 40 or greater than 35 with associated co-morbidities, the only long term solution to their weight problem is surgical intervention” Asok Dorasiwamy, MD, FACS.  (See video below.)  My BMI is below 40 but I have the co-morbidities of sleep apnea and diabetes which make me an ideal candidate for gastric bypass.  Moving forward, I know that for me, there’s more of a likelihood of weight loss success long-term, with gastric bypass, than continuing to simply ‘eat healthier and exercise.’  Continuing to berate myself for lack of willpower in the weight loss department will likely turn out to be another 25 years of unsuccessful weight loss attempts.  I’m too healthy and smart to continue down that road.  This has become one of my fav phrases to keep it real, when there just ain’t no more time for nonsense.  “Ain’t nobody got time for that!” 😉

This picture is exactly how Dr. Lamar looked in the consultation.  Here are more details about the differences in weight loss surgeries.

 

Meeting with the Psychologist

What to eat

1_Messy-Desk-More-Creative-750x400This is about to get real, my weight loss surgery.  We make up all sorts of scenarios in our minds about how it’s going to be.  Here was some of the inner dialogue that raced through my mind before my meeting with Dr. Klein.  “What will I have to say for him to disqualify me for surgery?” “Oh boy, I hope I don’t say something stupid.”  I made it to my appointment a few minutes early, rode the elevator to the 7th floor and as I looked inquisitively out of the elevator toward Dr. Klein’s office, a man was standing just outside and because I must have looked disoriented and lost, said, “Where are you headed?” He guided me to Dr. Klein’s office.  As I arrived there was a clipboard of paperwork to fill out. Oh, yay! Then a questionnaire on a scale of 1-5, which related to my quality of life ranging from activities to relationships.  As I was taking it, I was worried that I was psyching myself out about how I should answer the questions on the scale, but finally decided to go with my gut instinct.   As it turned out, as I walked into his office, the man at the elevator who guided me to Dr. Klein’s office, was Dr. Klein himself.

He put me at ease right away, with his less-than-tidy paperwork habits.  It seemed like he’s the kind of guy to keeps everything, because someday he might use it. Or, maybe he’s just so busy focusing on patients he doesn’t have time to sort through the paper on his desk, or in the water damaged box on the floor with heaping papers spilling out.  Regardless, as I sat in the 1992 Lazy Boy rocking chair, ready to be barraged with questions about my history, I suddenly felt like a little girl again.  My feet weren’t touching the floor and somehow this made me feel small.  Maybe this was another element in his office to make me feel at ease?  Ironically, in the midst of feeling small, I felt comfortable at the same time.

First question, “So, what diets have you tried in the past?”  (Again, I have to go through this?)  Weight Watchers, Atkins, Curves diet, personal trainer & diet, that’s all I could think of in the moment.  There’s more.  I ended that question with, “I haven’t done any diets, of late.”  I’m so over it.  This was followed with questions about my medical history and family history.  “Does anyone in your family have mental illness?” Well since you asked, “Yes, my youngest sister has schizophrenia, which is why I have her daughter.”  This resulted in dialogue about recent events with the San Bernardino shooting and mental health and gun violence.  He listened intently and seemed genuinely surprised that my sister has been at a locked psychological facility for almost a year.  He said, “That’s virtually unheard of nowadays.”  I agreed that we’re so grateful that she was able to receive treatment in this way.  Needless to say, my belly has taken a back burner to the pressing events of raising a third child unexpectedly and dealing with the challenges we faced as a family.

As we moved along to the reason for the visit, the main reason he thought I’d benefit in addition to the weight loss, was that I have Type 2 diabetes and the likelihood that it would be cured post surgery.  (There’s a 78% chance, I read later, Link here.)  He said that the reason the FDA hasn’t approved gastric bypass as a remedy for Type 2 diabetes is that there hasn’t been enough research in the U.S. to satisfy the FDA’s guidelines.  Interesting.  In some countries, gastric bypass is used as a way of treating Type 2 diabetes, not to mention the fact that living longer is an added bonus.

There is now enough evidence to state that bariatric surgery may reduce mortality in patients with diabetes. In the analysis by Adams et al., deaths attributed to diabetes were reduced by 92%. Thus, there can be little doubt that in very obese patients with type 2 diabetes, bariatric surgery in general is a highly effective means of treating type 2 diabetes.

Consequently, conventional bariatric procedures are being used worldwide to treat type 2 diabetes in association with obesity, and increasingly among less obese or merely overweight patients.Link here.

Contrary to the idea that gastric bypass will cure diabetes, some studies indicate that diabetes goes into a dormant state.

Patients should be counseled that bariatric surgery alone does not reliably “cure” diabetes. Obesity and diabetes are chronic diseases that may be placed in remission. Article here

Whether it’s in remission or cured, it’s better than the consequences of being on medication for diabetes. So far, I’m not taking medication, but that is in my foreseeable future if I don’t have the surgery.

As the visit came to an end, he said he’d forward his report to Dr. Lamar, my surgeon.  As I was about to leave he said, “Have you considered…(he paused, like he’d lost his train of thought)”  I finished his sentence “…going to the support groups?”  “Yes, I’m planning to go to the next one.”  Then, “Great, I’ll see you there. I run those meetings.”

Anytime you’re going to go through something intense and life-changing, it’s a good idea to have support.  If you can have the support of others who’ve gone through the experience, well, that kind of insight is worthwhile.