Kaiser Point West Says Goodbye to Gity

I will be in Sacramento tomorrow at Kaiser’s Point West facility to bid farewell to Gity Tabriztchi Baxter, who is retiring from Kaiser. Those of you who are Kaiser members may know Gity from the bariatric programs in South San Francisco and Richmond.

Gity has been special to me from the moment I met her at my bariatric orientation in October 2004, when she asked the assembled group why there was so much guilt among the obese.

“Does anyone ever blame the cancer patient for their disease? Or the bypass patient for their heart problems? No. Why? Because we all understand that diseases are out of our control.”

Gity is the first person I recall seeing when I awoke from surgery. She wished me a happy birthday, since Feb. 24, 2005 was the first day of the rest of my life. And she was right, it was a happy birthday – and my life has never been the same.

I will miss her, though I know we’ll keep in touch. I just wonder if Kaiser has any idea at what they are losing.

Tales From the Dark Side, Part II

In following up to yesterday’s post, I want to address my answer to the question, “Given the chance, would you have RNY again?”

WLS blogger Melting Mama, has a nine-minute YouTube video that explains why she wouldn’t. If you haven’t already, please watch the video (at the top of yesterday’s entry) before reading this. It’s not that MM wouldn’t have WLS, it’s just that given the choice, she would have picked an alternate procedure.

MM’s WLS journey is similar to mine in that we both went under the knife when we were in our 20s, both were over 300 pounds at the time, both had RNY and both now suffer from anemia and hypoglycemia as a direct result of that surgical procedure.

Yet now, more than three years later – four for her – we have very different views on what path we’d take if we could go back in time.

Why?

Because of one very key difference: MM was a very healthy 20-something who just happened to tip the scales at more than 300 pounds. I, on the other hand, was slowly dying in a 27-year-old fortress of fat. That’s the difference that makes our post-op experiences worlds apart.

Here’s my laundry list of pre-op concerns:

1. Chronic joint and back pain (I popped Darvocet and ibuprofen like candy);
2. High blood pressure (filled my first prescription for the condition at 21);
3. Debilitating migraines;
4. Infertility;
5. Chronic swelling;
6. Difficulty breathing;
7. Lack of mobility;

At 27, I felt like I was 80. I worked so hard to pretend the above conditions weren’t a problem and that I was “healthy” despite my weight, that I was exhausted by the end of the day. I had been morbidly obese since childhood, and my body was ready to collapse under its own weight.

After a long talk with a compassionate, yet direct, medical provider, I realized that I was on the cusp; my obesity was just beginning to catch up with me. I could continue down the path I was on and face increasingly severe co-morbidities or I could do something drastic to lose weight in an attempt to drastically reverse my course.

I chose the latter, and I haven’t had a single regret since.

Even when writhing in pain from a life-threatening bowel obstruction, I said with confidence that I would do it all over again because one day of life in a normal-size body is sweeter to me than any number in my pre-operative form.

But let’s get two things clear:

1. I DO NOT feel that way, because I’m “thin.” Go back and read my early posts – from before I had surgery – and you will see that I was terrified of being thin. It was a foreign concept to me at the time, something I could not wrap my brain around.
2. Surgery wasn't a cure-all for me. I still suffer from some of my pre-operative health concerns; they are just easier to manage at this size.
   

At the end of the day, my life is truly better now than it was in 2004 when I started my journey.

In my opinion, MM is not a whiner. Every word she says is true. We just have a different perspective on our situations. MM is right on the money when she calls WLS a trade-off. You give up obesity in exchange for other concerns or issues. In her case, the juice isn't worth the squeeze. In mine, it is.

She may not have had a bowel obstruction, but her hypoglycemia and nutritional deficiencies are much more severe than mine; I don’t suffer seizures nor do I need round-the-clock glucose monitoring. I also think that I’ve gotten more diligent after-care than she has – even when that bowel obstruction went misdiagnosed for six freaking months.

And I will say one thing very plainly: Reactive hypoglycemia is a nightmare.

MM says it best with the succinct comment, “Yeah, I look good. But what does that matter if I’m dead?”

If I ever came close to regretting bariatric surgery, it was when I became hypoglycemic. It’s difficult to articulate what it’s like other than to say it feels like your body is your enemy. Between that and the anemia presenting themselves at the same time, I felt like I was at the brink of insanity. The emotional and physical toll of hypoglycemic episodes were debilitating for me until brought them under control with the help of a caring, knowledgeable doctor a few months ago.

This last year has really been tough. I won’t lie. But in my situation, morbid obesity was still tougher.

Tales From the Dark Side, Part I

This video, courtesy of WLS blogger Melting Mama, is a must-see for anyone considering bariatric surgery. The picture she paints is grim reality that more pre-ops need to be exposed to. It’s a nine-minute video but it’s worth the time.

It’s been almost 3½ years since I had gastric-bypass – roughly about six months after Melting Mama. Our stories are similar in many ways: we were both over 300 pounds before WLS, we both were under 30, we both had roux-en-Y procedures, and we both suffer from anemia and hypoglycemia as a result of our surgical procedures.

Despite those similarities, though, we have different perspectives on our surgeries. Melting Mama would not have RNY all over again; I would.

I don’t want to steal the video’s thunder but it addresses the biggest issue I have with the popularity of surgical weight loss: LACK OF EDUCATION.

I remember my WLS orientation like it was yesterday. After six months of waiting, I was finally at Kaiser SSF to get more information on bariatric surgery. Like Melting Mama, I wanted the LapBand; it was less-invasive than gastric bypass, had no malabsorption and led to more gradual weight loss. I was also talked out of it when the surgeon at orientation informed me it was not covered by Kaiser and then gave me his laundry list of reasons why it was a bad idea anyway.

Beside that, there was one thing that struck me as odd about orientation – my fellow pre-ops didn’t seem to have a clue about bariatric surgery or what they were getting themselves into.

At this point, I had spent months poring over articles and research about WLS. I had interviewed people who had various procedures at various times. I talked to people with life-threatening complications and ones whose post-op journey was smooth sailing. I was armed and dangerous with more knowledge than my own physician when I marched into his office and asked to be considered for Kaiser’s program.

My cohorts at orientation, however, seemed to know little more than RNY made Al Roker and Carnie Wilson lose lots of weight and that they looked thin and beautiful. I remember one man who was downright outraged when he was told he’d have to limit his intake of sugar.

“But Al Roker says he can eat whatever he wants; he just eats less.”

It was hard not to roll my eyes.

I sat through three similar group classes before making a big decision: I would document my journey in writing and share it with the world.

Up to that point, I had intended to keep my surgery private. Like many of my friends, I was merely going to have “abdominal surgery” and let people think I was having my gall bladder removed or whatever. I didn’t want to make myself a spectacle. I didn’t want to open myself up to negative comments. I wasn’t even going to tell my family.

But the reactions and comments of the pre-ops I encountered in my journey showed me there was a dearth of reliable information on the subject of WLS that was easy to access. It also showed me that when it comes to losing weight, few people read the fine print. They are so intoxicated by the idea of being thin, they don’t pay any attention to the price they may have to pay. In short, they hear what they want.

So, my mission was simple: I would write a column dedicated to the subject with the goal of educating those who wanted or needed bariatric surgery and the general public. I wanted people to understand the seriousness of the decision, the dangers of the surgery and the fact that it requires a complete change in attitude and habits. I figured that since I had already done all the research, I could make it easier on others who followed in my footsteps to be as educated as I was when it came time to go under the knife.

Sadly, I overestimated my peers. Since I started this journey in 2004, I have only come across a handful of pre-ops truly willing to weigh the pros and cons of surgery. Even more sad are the number of post-ops who actually go on to make the changes necessary for success.

The Human Pin Cushion Speaks Again

My latest set of lab results just came in, and the news is mostly good.

After three rounds of iron therapy with Repliva, my hemoglobin has risen to 10.2 -- a small increase, but we're taking it as a good sign and continuing my current dosage of 150mg.

My B-12 levels are on the low side of normal at 232 with normal being considered any amount over 200. Doc isn't worried yet.

Parathyroid hormone (PTH) is elevated to 87 instead of being below 65, which -- combined with normal calcium levels -- indicates hyperparathyroidism. Don't you just love big words? Long story short, I'm not absorbing the calcium I'm taking in. I'm switching to UpCal D, which is a powdered form of calcium that mixes easily in liquid. I have a few friends who credit it with rapidly decreasing their PTH levels. I found it online for about $20 for a 16-oz canister. If you know of a cheaper source, e-mail me.

With my body having a difficult time still recovering from last year's bowel obstruction, my doctor has recommended keeping close tabs on my labs this year. We'll retest iron, B-12 and PTH in two months to see if my modifications have improved matters at all.

Maybe We're Doomed Before Birth

An LA Times article suggests we may be predisposed to obesity in utero, depending on our mothers' eating habits and health concerns during pregnancy.

What do you think?

Time Flies

Hard to believe it's been so long since I've posted. I was thinking about it the other day. I'm always thinking of posting on here or reminding myself to remember to post something I think is profound or would be worthwhile to others with interest in obesity or weight loss. But then I get side-tracked and it slips my mind.

I think that's what happens to most of us.

I remember a couple of years ago -- shortly after my first post-op anniversary -- that a similar subject came up with a WLS friend of mine. I had recently returned from a conference and was relaying to her how many surgeons and bariatric coordinators complained that attendance at support groups and bariatric events drastically dwindled after the first post-op year. Docs were looking for answers as to how to retain their patients' interests.

The consensus at the time was that as pre-ops, patients will jump through any hoop necessary to get doctor and insurance approval. But once they go under the knife, they become less compliant. After all, it's not like anyone can take your surgery away after the fact, right?

My friend, however, posed another explanation. She had missed her support group's last three monthly meetings at the time. Her reason? "I'm too busy living life," she said.

Hmmm...

She went on to explain: "I worked too hard in having surgery and losing weight to live my entire life according to support group schedules. I am making the most out of my new life, and if that means I can't sit through two hours at a support meeting because I'm in Shasta or Disneyland or on a cruise with my husband, then so be it. I refuse to apologize for that."

Interesting...

At the time, I thought, "good for her." She was out living life. I didn't feel like I was sitting on the sidelines, but I did make a concerted effort to organize my playtime around support group meetings and events whenever possible. Then again, I was leading a WLS support group, writing on the subject of WLS regularly in print and online and dipping my toes into the waters of private consulting. I was eating, sleeping and breathing the world of surgical weight loss.

Then another year passed and I got knocked on my backside with a bowel obstruction. The months between my second and third WLS anniversaries trickled by at an unbearably slow pace as I struggled to regain my health and vitality. It wasn't until March of this year that I started to feel some resemblance to the upbeat ball of energy I had been in my first post-op year.

Since then, life has been too good to stand. And like my friend, I'm so busy living it that there doesn't seem to be much time left over to sit down and document it. All I can say is that it's an amazing adventure -- and given the choice, I'd do it all over again.