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.

WLS not right for everyone

Melting Mama has a thought-provoking post on her blog about surgical weight loss. Instead of trying to restate what she says -- truly, she articulates the point way better than I ever could -- I suggest you click over to her site and read her words for yourself.

The highs and lows of blood sugar

Melting Mama posted an article to her blog this week about the relationship between gastric bypass and low blood sugar. The article was of particular interest to me, because I was diagnosed with hypoglycemia a few weeks ago. Since then, life has been a constant balancing act as I figure out the best way to keep my blood sugar level throughout the day.

Before the diagnosis, I thought I was losing my mind. I was lethargic, spacey, dizzy, easily confused and could not focus on the simplest tasks. It would take every bit of willpower I had to stay awake at work and on the drive home. As soon as I'd walk in the door, I head straight to bed and crash. Often, I'd sleep for the entire night only to spend an hour the next morning willing myself out of bed.

After a month of dealing with this, just about any diagnosis would have been welcome. But once I heard the news, then reality set in. Not only is this most likely a permanent condition that will require constant diligence, I had trouble wrapping my brain around my body's new dietary needs.

Here I had spent two years following the gospel of three meals a day (no snacks), few to no carbs, protein drinks vs. protein bars (drinks are lower in calories), and absolutely no sugar. I had finally gotten the rules down pat and didn't have to think about them anymore.

But hypoglycemia carrries its own set of rules: Eating every three to four hours keeps blood sugar most level; protein elevates blood sugar but fiber helps level and maintain it so complex cars are a good thing; protein bars are better than protein drinks because they don't cause a rapid change in blood sugar; and in low moments, sugar can be the difference between maintaining consciousness and passing out.

I had a brief moment of bitterness upon hearing my surgeon's bariatric coordinator rattle off this advice to me. I felt like the rug had been pulled from beneath me. Eating four to five times a day worried me. What if I gained all my weight back? Carbs a good thing? What if eating them led me to feel hungrier or caused me to binge? Eat sugar? Seriously? What planet was this and what did the pod people do to my doctor?

After getting off the phone, I did a little Web research and talked to other post-ops who also had hypoglycemia. I made myself a shopping list and other notes based on their advice. Though my doctor wanted me to eat three full meals a day and two protein-rich snacks, most post-ops I talked to said their blood sugar levels were best maintained by eating four or five equal-sized mini-meals each day. All the post-ops I spoke to said cheese and peanut butter were their best friends. Some kept glucose pills handy; others didn't. All recommended I keep a stash of yucky-tasting crackers that I could grab when at a low point but that wouldn't be tempting to me otherwise.

Next, experimentation came into play. Cheese was definitely my best friend, but peanut butter wasn't as helpful. I keep a jar of it at the office just in case I get desperate, but I'm more apt to select a protein bar instead. My body feels best if I eat at least three whole-food meals each day.

For me, bars are definitely better than drinks. My favorite bars are Think Thin cruncy peanut butter (available at Trader Joe's) and Oh Yeah! chocolate-mint wafers (available online and at the Vitamin Shoppe). A half-serving is all I need to keep my blood sugar level. Both Think Thin and Oh Yeah! chew down very well so as not to overfill my pouch, but the Oh Yeah! bars are more convenient because they come with two wafers in each pack -- instant portion control.

Liquid protein is a toss-up for me. AchievOne sends my blood sugar soaring through the roof and then crashing down, but I can mitigate that if I eat an ounce of cheese after finishing my drink. Nectar-brand drinks don't cause any wackiness at all.

Carbs are a necessity for me, but I'm still learning how to effectively use them. My typical breakfast is high-fiber cereal mixed with flax seeds and Fage 0% Greek-style yogurt. Cheese and crackers is not as helpful and ends up being more of a trigger food. Salads are a good way to incorporate complex carbohydrates with my protein. I eat salad almost every day now.

As I said before, it's a balancing act. It's a challenge but it's not impossible. and if anything, at least it prevents me from getting bored.

Melting Mama

I've become hooked this week on reading other blogs related to surgical weight loss. There's an abundance of them out there, and each has its own merits. Take Melting Mama, for example.

The site's owner, Beth, is a Bostonian about my age who once topped the scales at more than 300 pounds. What I love most about her blog is its snarky tone. She's had a slew of complications since WLS, and she doesn't shy away from them. I appreciate that about her, because as I've said, this journey isn't all peaches and roses -- and I think more people need to be aware of the risks associated with it.

So, take a sec and check out Melting Mama, and then click back here and tell me what you think.