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Saturday, December 25, 2004

The procedure explained

Originally published Dec. 25, 2004, in the Tracy Press.

Weight-loss surgery is a big decision.When I was talking myself into the idea of sharing my story with readers, I told myself that if it prevented one person with unrealistic expectations from having the surgery, it would be a good thing. Now, I realize that I also want to help people who may truly need the surgery but are unaware of how to obtain it.For me, deciding whether to have surgery was difficult, but picking the procedure from the handful available was easy — my insurer only covered one.

Touted as the “gold standard” procedure, Roux en Y — often called RNY for short — is considered by my insurer as the only surgical weight-loss method that has proven success. Two celebrities — former talk show host and singer Carnie Wilson and NBC weatherman Al Roker — both used this procedure to lose weight.This procedure will drastically alter the size and capacity of my stomach and reroute my digestive tract.

My new stomach will be a thumb-sized pouch that connects to about 18 inches of lower intestine. The pouch will stretch to the size of a chicken egg to accommodate food. The procedure is called gastric bypass because much of the gastric system is bypassed.The digestive tract becomes like a sink. Food goes down the drain of the esophagus into the stomach and then empties through another drain into the intestines before it exits the body. The drains are about the size of a dime.

Aside from preventing me from eating much in one sitting and significantly limiting my feelings of hunger, this procedure also will cause unpleasant side effects if I don’t follow the rules. If I don’t chew my food well enough, it will either block the opening between my esophagus and pouch or plug the outlet from my pouch to intestine. Usually, there are two solutions to this problem: vomiting or having a doctor use an endoscope to remove the blockage. Neither sounds like fun to me.

If I eat foods with too much sugar or fat, I may experience dumping syndrome. A phenomenon experienced by about 15 percent of all RNY patients, dumping is described by doctors and former patients as “behavior modification with a vengeance.” The syndrome occurs when a high concentration of sugar or fat is dumped into the intestine. It manifests itself in different ways, but often causes reactions similar to hypoglycemia, such as sweating, feeling faint, heart palpitations and an overwhelming need to lie down. The idea is that after patients experience dumping syndrome once or twice, they stay away from foods loaded with sugar or fat permanently.After surgery, my main dietary focus will be protein.
For the first few weeks with my new digestive system, I will only be able to eat one to two ounces three times a day. That’s not a lot of food. So I will have to work very hard to get in as much protein as possible.

If I don’t get enough protein, I will suffer brittle nails, scaly skin and baldness. I don’t plan to go through this ordeal to end up looking like the Crypt Keeper. Protein also helps maintain muscle mass and the feeling of being satisfied after a meal. I’ll supplement my limited food consumption with a host of vitamins. I’ll take a high-potency multivitamin, calcium and iron every day for the rest of my life. I will also take vitamin B12 under my tongue twice a week because my body will no longer be able to absorb the vitamin through my digestive tract.Vitamin deficiency is linked to permanent hair loss, anemia, hearing loss and other neurological disorders. I’ve already warned my husband that if I start looking AND acting like the Crypt Keeper, crushing up some chewable vitamins in a protein shake should do the trick.

In all seriousness, a lot of work is involved on the part of the patient to ensure the success of gastric bypass.This is not a passive cure-all.As you can see, I will suffer some serious consequences if I don’t follow the post-operative program to the letter.The end-all nature of this is a scary thought for me. I’m the one who has gained and lost the equivalent of two average-sized people in my short time on this planet.What makes me think this time is different? The short answer is: because it has to be. The long answer is fodder for another column, maybe one I’ll write next week.

Saturday, December 18, 2004

A difficult decision made

Originally published Dec. 18, 2004, in the Tracy Press.

I’m officially under the gun to lose weight. I have obesity-related infertility, and if my husband and I hope to conceive the old fashioned way, I need to drop at least 100 pounds. And my doctor suggests I do it sooner rather than later. That’s no easy undertaking.After all, only 5 percent of Americans who diet are successful at maintaining weight loss. I’ve never been among that 5 percent — not even for a minute.

I’ve given up on the commercial weight-loss circuit. It’s not that I don’t believe Weight Watchers, Jenny Craig and similar programs are beneficial. I’ve spent seven years as a WW member, but I’ve never had any long-term success with those types of programs.

I’ve worked with three dieticians in the past two years. They succeeded in helping me improve my food choices and figure out meal planning. One has even helped me make a healthier transition to a pseudo-vegetarian lifestyle (I now abstain from red meat and poultry).But we never succeeded in the realm of weight loss.

I have worked with a couple of therapists on my issues with emotional/binge eating and had great success. It’s been at least six months since I’ve binged, and I no longer use food to quell uncomfortable emotions. But I still haven’t lost much more than five or 10 pounds from changing those behaviors.

That’s where gastric-bypass surgery comes in. It’s a drastic solution, but I have a drastic problem.I thought about it for four months before talking with my primary physician. I had discussions with my husband — who was against it for some time — my mom — who remains opposed — and a handful of close friends and relatives — all of whom are cautiously supportive.

I’ve had to discuss my decision with loved ones because they have a right to know, my employer because I will need a significant amount of time off and my health-care providers because their opinions determine whether my insurance company will cover the procedure.

I spent four months poring over research and patient accounts of the different types of surgery available. I devoted at least two months investigating my insurer’s policy on weight-loss surgery.

It’s a good thing I did that, too. Though there are a handful of different styles of weight-loss surgery performed in the United States, my health-maintenance organization only covers one — the Roux-en-Y gastric bypass, which I’ll discuss further in next week’s column.Gathering information on the procedure was daunting.

Actually, that’s a lie. Gathering information was easy; gathering information that can be understood by the average person was a different story.

When I first discussed gastric bypass with my doctor, he sent me home with a 60-page booklet published by my insurer that made my college biology textbook seem engaging. It took me a week of hard concentrating to plow through it, and I’m typically a fast reader.

I found my most useful information on the Internet.

Sure, not everything on the Web is credible, but there is a plethora of sites created by weight-loss surgery patients. One thing I’ve discovered is that WLS patients are part of a warm, welcoming community. For the most part, they have worked very hard to be successful and they want to help others do the same. There are also numerous Internet message boards that freely disseminate information and advice. Message boards are great because they are interactive; you can post questions and have them answered quickly. Finding out everything I could about surgical weight loss was important to me.

I’m almost embarrassed to admit it now, but I’ve been a vocal opponent of weight-loss surgery for a long time.Like many people, I thought surgery was a lazy way out. I knew it would be hard for me to explain to my loved ones why my tune suddenly changed. And it was important to me that I could justify it to myself.

Research helped me change my mind rather quickly. The first thing I discovered is that gastric bypass is far from a passive method of weight loss. Most bypass patients report spending more time planning their meals and exercising than ever before.

What I think makes surgical weight loss so much more effective than other methods is the rapid weight loss. Surgery patients are able to drop weight fast enough that exercise becomes easier on their bodies — which motivates and enables them to stick with it.That quick weight loss also serves as an emotionally motivating factor. It’s easier to feel successful when you can see your body changing before your own eyes.

I only finally decided that surgery was the option for me about a month ago. I spent about eight months weighing my options (no pun intended) and telling myself that I should try traditional methods one last time.

I’ve come to accept that traditional methods haven’t worked for me, and it’s time to try something else. It’s not going to be easy, but I’m willing to go through this in the hopes of one day becoming a mother — and a healthy one at that.

Saturday, December 11, 2004

Drastic measures for drastic times

Originally published Dec. 11, 2004, in the Tracy Press.

Few souls would embark on a weight-loss plan in the middle of the holiday season.

Fewer still would do so publicly, as I’m about to do. My journey is different from many in that I’m opting for a drastic solution to my weight problem — gastric-bypass surgery. Contrary to the belief of some, including myself at first, deciding to go under the knife is not an easy choice to make. In fact, it’s the hardest decision I’ve ever made. But I’ve come to realize it’s the only choice I have.

For me, this isn’t about fitting into a certain size or looking good in a bikini. Two decades of obesity has ensured that I will never look good in a bathing suit. This is about my health. I have been overweight for as long as I can remember. My size was encouraged. I remember being praised by the school lunchroom attendant for always eating all of my food. The idea of “bigger is better” was ingrained in my family. I was praised when I gained weight or outgrew a size. I was a happy kid with a bulging belly and chunky thighs.

By the third grade, I weighed 111 pounds. It didn’t occur to me that anything was wrong with that until a teacher asked if I wanted her to remove my weight from the classroom biographical chart. I had no idea until I saw that chart that most of my classmates weighed 60 to 70 pounds. Of course, that’s about the time that playing tag and hide-and-seek stopped appealing to me. I preferred instead to read books during recess or trade Garbage Pail Kids cards with my friends. I was teased a lot, but those memories are vague. As an only child, I didn’t have any siblings to motivate me to be active, either. It was just me and my mom — who was overweight herself — keeping each other company. By the fifth grade, I was about 5 feet tall and weighed 199 pounds. That weight on a 21-year-old woman equates to a body mass index of 38 — or severely obese.

If my life has been a war with obesity, the fifth grade is when I first engaged in battle.

By this time, I understood that I looked different than other kids. I couldn’t buy the same clothes in the same stores as the cool kids, and keeping my ever-expanding body in clothes was an expensive endeavor at best. I made up my mind that I would not gain any more weight. I almost succeeded. I did fairly well maintaining my weight from fifth grade through high school, graduating at about 205 pounds.

I wish I could say the same about my college years. By the time I graduated from college, I had packed on another 100 pounds doing nothing in particular — though I’m sure my stints working in fast food and my own casual dining didn’t help. Five years later, I’ve added even more to my 5-foot, 4- inch frame. My body mass index, or BMI, is now 56, well above being morbidly obese.

According to the BMI chart on ObesityHelp, I’m “super obese.” Maybe I should buy a cape and some queen-size tights.

Any way you look at it, I’ve been severely obese for 20 years. The problem is that the consequences have finally begun to catch up with me. I have high blood pressure, bad knees, a bad hip and problems with fluid retention — and I’m only 27.

I’ve tried just about every diet and exercise program on the market, with minimal success.Even after trying — and failing — each program, I still didn’t feel like I had tried everything. I figured my failures were symptoms of a greater character flaw. I would tell myself that once I was truly fed up with the weight, I would find a method, stick to it and be able to be fit and healthy, once and for all.

That day of being fed up finally came earlier this year, though not in the way I expected. I imagined it would come after I had children and was frustrated with lugging around babies and “baby weight.” But instead it came in an OB/GYN’s office when I was diagnosed with obesity-r-elated infertility.That’s when my weight stopped being about me, and I realized how my battle with obesity affected those around me, particularly my husband and our future family.

Obesity-related infertility isn’t uncommon. Stored fat also holds stored estrogen, and when you have lots of stored fat, all that estrogen confuses your reproductive system.

Doctors can prescribe drugs to trick the body into ignoring the excess estrogen or force the body to ovulate. Or they can perform artificial insemination and fertilization procedures.

But to me, it just doesn’t make sense to combat this obesity-related hormone imbalance with more hormones. All of those prescriptions and procedures seem more like a Band-Aid than anything else.

After all, if getting my fertility back — if I ever had it to begin with — is as simple as losing weight, why not just solve the basic problem of obesity?