A Final VSG Follow-Up

(Me at 280#)

I say "final" because I feel as though I've basically reached a stasis point and there will be little further to report on, at least as relates to bariatric surgery. (Of course, I will surely pipe up again if this proves wrong.)

(The posts about my deliberations leading to the surgery and the surgery itself can be found by following the link to the tag flabbergastery.)

As of today I'm just past seven months post-surgery. Everything has played out in my case exactly as I was told, without exception really. My experience with the surgery was just what I was told to expect. The recuperation and weeks immediately post-op were precisely as I was briefed. My return to normal life was right on schedule, and my medications were spot-on for the results I was trying to achieve. I had a couple slightly unpleasant experiences--exactly the experiences I was told to expect--as I learned to cope with my new limitations. Everything has played out right on schedule. I'm down now just shy of 100 lbs (my highest pre-surgery weight was 283, and my weight last Friday was 184). I have gone from a BMI of 41 ("morbidly obese") to a current figure of 27.2 (just slightly into the "overweight" category--normal BMI extends up to 25). I lost most of my weight in the first three months, and a bit more during the next two months. My weight for the last six weeks or so has been steady between 187 and 184. I expect to lose a few more pounds leading up to my 1-year anniversary, but am quite happy to stay here at 185. And given that I go up and down a bit from here, it's quite possible that my weight loss may be done. And that's just fine; 185 is a great weight for me, and one I never expected I would see in my life (I used to dream of some "miracle cure" that would let me get down to 200 lbs).

My scars from surgery are now almost invisible, and I feel at this point entirely normal on dietary matters. My brain seems to have adjusted to a new normal for meal size and food quantity--about 1/3 of what I used to eat--and I have no sense now of things being different than they were, even though everything has changed. This is just how I eat now--simple. As I expected, my food brain itself is not fundamentally altered; I still would eat Double Stuff Oreos or Peanut M&Ms 24/7 if I let myself, though the sleeve prevents me from indulging in very much of that stuff--or anything. I concentrate on protein (though not very hard), and the space left over for dessert is pretty small. That's the way it works. I have had a slight return of physical hunger, though--as before--most of my desire to eat is purely psychological. The sensation of being full has changed, and I now have new triggers for that feeling. Overeating is easier to achieve now, since it takes relatively little food to get there, and what used to be uncomfortable is now a slightly different, and *slightly* more unpleasant kind of uncomfortable. These sensations are all much more of a slight shift in "normal" than any kind of major change. In sum, this change has been easy and painless--and effective.

My buddy Tom had the same surgery as I about three weeks before mine. His results have mirrored and bettered my own. He's down a whopping 130 lbs now! These radical changes have inspired him to embark on a pretty vigorous exercise regimen, which of course further assists his weight loss. The paths opened up to, literally, the "new you" are varied and exciting. I think it's really fascinating that both he and I made it to our early 50s before realizing what it feels like to be a normal-sized person. (And how inspiring for the doctor and clinic workers to see so many of these new-life stories.)

I have purged every single scrap of clothing in my closet (except for socks) a couple times now. I went through a bunch of transitional sizes and have now been wearing the same stuff for a couple months. I've gone from a 44-46" waist to 34"s (and a couple of 33"s)--that's an entire foot off my waistline!--and shirts have gone from XXLs to M or L. I kept a couple favorite clothing items from my heaviest weight as a reminder, and these seem really shockingly large now. How quickly we adjust to a new reality. The idea of weighing myself down now with, say, 100 lbs of flour bags and going about my day is a really mortifying idea. Literally.

I get a lot of compliments now on how much better I look, but I'm very much aware that this is no great accomplishment of willpower or philosophy on my part--which is what people traditionally think about someone who has lost weight (that or illness). My great results are the result of a surgical procedure, not an act of will. But I think this desire to "conquer" our weight issues hearkens back to an older way of thinking about these problems--a way that doesn't get us anywhere. I spent a couple decades trying to "fix" myself, feeling wretched not only about how I looked and felt, but about what it is in my psychology that makes me look and feel this way. And all the while, like much of the rest of American society, I just got heavier and heavier, and looked and felt worse and worse. Enough of that.

For me, the VSG is simply about results. It's not a way to fix my fouled food brain (a subject we could explore in quite some detail); it's a tool employed to circumvent this maladjustment and bring a normal life within reach. And from where I stand it has worked brilliantly. The specter of morbid obesity affects every aspect of life--how I fit in cars and airplanes and theater seats, what I spend on food, how I fit in my clothes, how my joints feel, my love life, my self-image, every single thing. To anyone contemplating this step, I can only give encouragement. The people I know who have undergone this procedure have gotten, nearly to a person, the same results as I have. Bad experiences are pretty rare, and, near as I can tell, almost always accompany some other complicating factor (additional health problems going in, say). I join my fellow surgery mates in saying that I wish only that I had done this ten years ago. As it is, I feel 10 years younger (even if I have a wattle under my chin now; it's worth it).

(Me at 185#)

All Quiet on the Home Front / Further Progress Report

Not much going on here at Ye Olde Journal lately.

Several mundane reasons for this, I suppose, but it's mostly because I'm still rather absorbed in the whole post-surgery weight loss thing (and there's not much to write about in that case). On my work days, weather willing, I try to devote an hour in the morning and an hour in the late afternoon to walking. Some of this is simply a desire to move more, now that I have many fewer aches and pains and movement is a good deal easier than before. And some of it is a probably-misguided effort to keep my metabolism from shutting down.

There must inevitably be trauma for one's metabolism to go literally overnight from a life of substantial overeating to one of not getting enough to hold station. The body goes into a kind of starvation mode, and there's not much to be done about it. This is the new normal. I used to think I might exercise more, but the more I read the more I'm convinced that exercise just burns more calories without changing the metabolism per se. So long as we consume too-few calories, the body is unhappy to give up its fat stores and it will stay that way. And that's one of the chief take-aways from this process--something I've suspected from past diets: a fat person losing weight will have a permanently slowed metabolism relative to a person who is naturally thinner. I knew from the start that I would never again be able to eat as I have been accustomed, but this is still a daily learning process.

In concrete terms, probably the core change I'm having to undergo after surgery is to re-calibrate what constitutes a meal in my brain. I have decades of experience of eating 500 or 750 or 1000 calories at every sitting, and now I'm having to accept that maybe 200 calories is all I get. It's not what my food brain wants--it never had a problem with the thousand-calorie meals--but it's what the body will now tolerate. And my success in establishing this as my new normal will determine my success in keeping weight off in the long haul.

So, the progress report:

Starting weight: 280
Current weight: 206

I've established an easy routine with food for my days at home, having 4-6 little meals and a snack or two during the day, and I've learned to improvise on my topsy-turvy workdays. From decades of never failing to clean my plate, I'm now unable to eat at a restaurant without taking 1/2 or 2/3 of what I ordered home with me. So leftovers have become my friend, and I try to choose foods that will taste OK the second time around. I travel with a few protein shakes and protein bars in my bag, and I have an upcoming 11-day trip thru Asia that will really challenge my meal planning.

Clothing-wise, I've purged myself of every stitch of clothing I owned except socks and shoes (even some of my HATS have become loose! How fat do you have to be to make your SKULL fat?!) and have replaced everything with a series of Goodwill purchases (thrifty clothes shopping is a whole new kind of addiction). And some of those acquisitions are already back on the Goodwill pile as the weight continues to drop. I began wearing a tight 44" waist pants (and Carhartts at that, which are notorious for being roomy) and am now down to 35-36". Shirts have gone from XXLs to L. Add in the changing seasons, and I've gone through several sizes of shorts and shirts and pants and I'm now looking for sweatshirts and sweaters in ever-diminishing sizes.

I've even begun to run again for the first time in a dozen years. After deliberating, I decided that calories burned in running are no different from calories burned in walking, but it just takes considerably less time. The idea that running hurts the joints just doesn't find much support in my online investigations.

It's hard for me to know where my weight should ultimately end up. If my weight loss should suddenly stop where I'm at now, I would consider the surgery to have been a complete success. My blood chemistry is much happier, and physically I feel 10-15 years younger. But if my weight loss has slowed since my surgery it's not by much. I've begun experiencing the occasional mini-stall, with my weight holding steady for a week or so before dropping 3-4 lbs. in a couple days. My average weekly loss since my surgery (minus the first week) has been 4.2 lbs., and these little stalls seem not to have affected that overall pace, at least not for now. And while I think I look much less rotund than I did, I still have plenty of obvious fat stores that could disappear without hurting my feelings. So I'm still aiming at 170 as a target weight, and it's not hard to see where that weight might come from. That's 36 lbs. to go.

Some photos (with my best serial killer scowl):

Progress Report

Hmmm. How quickly I move from "No diet talk" to "All diet talk, all the time."  Guess there's not much more going on at the moment.

I'm spending these days lately re-learning how to eat. Not really that, exactly; I'm not starting from scratch, but rather I'm having to learn a fundamentally new way of eating. This is kind of like remodeling one's house while living in it and ending up in a house that really doesn't resemble the old one at all. I've got 50 years' experience stuffing food in my mouth, and I'm having to radically change ALL of these deeply-ingrained behaviors.  

This happens in stages. We progress after surgery in 10-day increments from clear liquids to opaque liquids ("full" liquids, they call them) to pureed / mushy foods. A month after surgery we are back to regular foods, but we are introducing them back into a changed landscape. The long and short of it, as I've said a few times here, is that we can eat very little in a sitting now, and that changes everything, really.

We are told to emphasize protein, which is hard in the early stages when one can't eat meat. We rely on protein shakes and drinks and powders, and there is such a dizzying variety that there must be some trial and error. I bought some "unflavored" whey protein, which I thought I might just mix with any flavored drink, but it doesn't really work out that way.  "Unflavored," it turns out, doesn't mean "no flavor;" it means "flavored so as to be incompatible with most other flavors." After a couple servings that stuff hasn't gotten much exercise.  Following the recommendations of others, I bought some pre-mixed shakes that are really quite good (the chocolate tastes like liquid pudding), and there are a couple flavored powders I've tried that are quite passable. One wants to make friends here, as some form of protein supplement seems to be the lifelong companion of most bariatric patients.

These early liquid-only phases did not bring me firmly up against my new small-meal limitations. This is because the liquids don't sit in the stomach; they pass quickly through and into the intestine, which leaves room for more very quickly. So I'm able to consume more liquid in a sitting--albeit at a reduced pace--than my new stomach will hold, which in turn cheats my brain into thinking my capacity is greater than it is. I know it intellectually, of course--meals of 1.5-2 oz. in the beginning. But I'm only starting to grasp that this is what a MEAL will be. For the last 50 years 2 oz. wouldn't even begin to rise to the level of a snack.

Even so, I had a couple incidents in the liquid phases that have helped show me the light in a fairly visceral (sorry!) way: I mentioned my jello epiphany of a week ago, when I blithely ate a sugar free jello cup and realized that it was sitting in my esophagus because *surprise!* there's not ROOM for 3.25 oz. in there just now! Because jello qualifies as a "liquid," my digestive system was rather tolerant of this excess; but I understand that the same quantity of solid food would have brought a stronger (and less pleasant) reaction--a serious nausea or a return of the goods, as it were.  I got another sense of this when drinking a protein shake a couple days ago.  The pre-mixed ones I'm drinking (by Premier, in chocolate flavor) are quite thin, almost like chocolate milk, and they go down quite like a liquid (despite being 11 oz., I'm able to drink a whole one in 15 minutes or so). But when I used some Matrix Cookies and Cream powder mixed with milk, I find the texture considerably thicker, and I very quickly feel full with just a couple sips of this. I initially drank, say, 8 oz. in a short-ish time (kind of sipping unconsciously) and found my whole system vaguely unhappy--vaguely achey and slightly nauseous, none of it very strong but present just the same.  It struck me that this powdered stuff may not be passing through like the Premier, and I may have to drink this stuff veeeery slowly.

As I say, this is a valuable lesson, because the pureed / mushy foods I started today will bring me up against these limits straight away: nothing that qualifies as actual food gets the free pass treatment. The pyloric valve at the bottom of the stomach, as I understand it, makes a determination of what needs digesting and what can pass without processing. Solid food gets held up for digestion, and we will come to rely on this feeling of "fullness" to be our new trigger to eat or stop eating.

I officially started the mushy / pureed food phase today (a day early), initiating the milestone event with a piece of quiche and a bite or two of macaroni and cheese. The quiche was not pureed enough, I'm sure, but it went down without too much trauma. But the interesting thing is how little I ate and how convincing was my sensation that it was still too much. I wasn't sick, but I was uncomfortable and had a vague feeling of overfullness. It passed in about 15 minutes, but I feel pretty sure that my five bites were two too many.

There's definitely a learning curve.

I'm grateful that my learning curve so far has involved very little discomfort and no sickness or difficulty apart from flagging energy--which is to be expected when one is eating little or nothing. And actually even this low energy state is pretty handily offset by my needing markedly less energy to DO things; the lighter I get the easier everything becomes. Add in that my body will adjust over time and I'm beginning to consume small quantities of real food, and I expect my world to change in really substantial ways. I've lost about 30 lbs. so far, not quite a third of what I hope to lose, and the changes are pretty noticeable already. I've been in this current weight range a number of times in the last decade with diet after diet, so this is not really new territory for me, however welcome.  I started at about 280 and am now down to 250 or so (no scale in KY, so I'm not exactly sure of my progress until I get home Wednesday).  When I get below 240 I'm in pretty rare territory for me, and below 200 is a place I've not been since seventh grade. When I met Susan 14 years ago I was running a lot and down to about 210, and I remember an aviation physical at the time showing 203. This is the skinniest I've ever been in my adult life, and it lasted about 25 seconds. And even then I qualified as obese, even if I looked fantastic to the friends who were used to seeing a 250 lb. me. So the prospect of being a normal, healthy body weight is like a dream to me.

I'll post some progress pictures in a week or so on my one month surgery anniversary (often called the "surgiversary."

Day 4

At some point I'll have to call a halt to these daily progress reports. After all, bariatric surgery is interesting and beneficial and all, but there are limits. Especially if one isn't directly involved.

Still, for the benefit of my family and a few close friends, I'll give a quick update of this, my first full day at home after surgery, and Day 4 since the event.

I feel very clearly on the mend now--in fact I feel just about perfectly normal. I have few pains related to the procedure, and my incisions seem to be healing very nicely. My abdomen is almost back to normal, soreness-wise, and my ability to take and hold a deep breath--perhaps the most painful thing to do after surgery--is almost unimpeded now, say, 90%. I feel markedly nearer my normal state today than yesterday. Amazing how quickly this happens; I suspect it's a function of the minimally-invasive surgery techniques.

What remains, and what will occupy me for some months to come, is learning how to eat and drink in new fashion. These first 10 days after surgery are the hardest, as we are restricted to a diet of only clear liquids: water, tea, broth, Crystal Light. No caffeine (no coffee), no soda (of course). And we need to get 1.5-2 quarts, which is not so much in my normal life but is quite a bit now.  Additionally, we need to be ingesting 70g of protein (via powder), which means that our drinking cannot be just whatever strikes our fancy.  The stuff I bought initially--an unflavored whey protein--adds a bready taste to the Crystal Light which, while not disgusting, makes it less palatable. I'm looking into other options. (One thing I've learned about bariatric patients: they've all tried a zillion protein products and have a database of their favorites and rejects.)

While I have almost no pain, as I say, there is still a bit of discomfort to drinking pretty much anything. Every little sip / small gulp of fluid makes what feels like slow progress on its way down, typically releasing some air bubbles as it goes. I think it's those very small changes in pressure that I sense in my new stomach. I expect these sensations to diminish quite a bit over the next few days as the staple line heals, and I also expect the stomach is still swollen from the procedure; the reduction of that swelling will make consuming anything easier.

But this is all part of the new landscape that I'm exploring with fascination. One of the allowed food items in this first phase--really the only thing remotely "food"--is sugar-free jello. And I was amazed at the very clear sensation after eating a 3.25 Oz. cup of cherry-pomegranate that there just wasn't quite room for all of it.  No pain or discomfort, no feeling sick or anything like that, just a sense that stuff was backed up in the esophagus because there wasn't room for it in the stomach pouch. Figure-wise, this is exactly what I'd expect--2-3 oz. is supposed to make a meal initially--but this is my first real experience of it. (Liquids just kind of move right through; so while you're restricted in how quickly you can drink something, the rate is still much higher that the rate you can eat something.) In retrospect, I should have held myself to less than the full 3.25 Oz. serving, but as I say I'm not really thinking about this yet. This is my wakeup call. Everything in steps.

That's all the news that's fit to print. Pretty much a normal day doing normal stuff around the house.  I don't expect I'll chime in here but occasionally when there's something of significance to report.

Day 3

Wednesday.

I was surprised at how little pain there was... until there was pain.

Monday, surgery day, was taken care of by that miraculous spinal morphine.  I felt like I could have skipped about town.  And Tuesday morning felt pretty good too as liquids were started.  But the chest cavity pain gradually increased during the day until by 3 in the afternoon it was pretty uncomfortable. We're drinking a lot of liquid (in little sips) and the air from that does not escape easily, so there's an overfull sensation that could be fixed easily with a burp--but burps don't come (presumably because of the swelling). Add to that the hiccups and spasms that occur, each of which kind of pressurizes the painful area causing a twang of discomfort, and it's hard to relax.  We try to keep our breathing exercises going--which are more painful--plus adequate walking, when you really just want to lay down and snooze.

Eventually, about 8:PM, I got a sublingual pain pill and a crushed sleeping pill and I was quite comfortable all night. This morning I'm a bit less sore--though still pretty tender--and have been up making my walking rounds and sipping at my liquids. It's the staple line, of course, that's the sorest thing. I assume that's what makes it painful to breathe very deeply. And this pain gets in the way of sneezing of coughing, since you naturally try to intake a big breath for those actions. But I can see that all this is on the mend and we'll soon be left with our regular selves and a pain-free, restrictive stomach.

This morning: our final leak check and a visualization of our new digestive tract courtesy of barium and an x-ray machine. The barium is a thin, white chalky liquid faintly flavored of strawberry. We sip this on command while standing in front of an x-ray plate with a transmitter in front of you.  So a little motion x-ray picture is made of your chest cavity--and displayed on a screen in front of you--while you drink the liquid and watch its progress down the esophagus and through the new stomach and on into the upper intestine.  Took about 90 seconds. Fascinating.  The doc stands there next to you in a lead apron watching the monitor with you and telling you what you see (and checking his work). The first thing that strikes me is that so much on the screen is in motion: With the the spinal column basically stationary in the center of the picture, everything else (mostly shadowed on the screen) is wiggling around to your breathing and heartbeat. And then comes this dark streak of fluid which winds down and around, kind of snaking along as the new stomach moves a bit. Doesn't really look like three separate components: esophagus, stomach, intestine; it all just looks like a single tube that spirals a bit.

And you only see that tube while the barium is passing through. You see little flat spots and shallow pockets where fluid has a tendency to pool, and the little burps and spasms we've felt all our lives play out now in this tubular world with a visual component. Odd but very cool.  The doctor liked what he saw--as of course did I--so I've now graduated to...

Chicken broth!  Good. I find that apple juice and water both go down without too many issues, though trapped air bubbles make things a bit uncomfortable. Those other two options--a kind of flavored tea and a mild, warm green tea--just don't do much for me. More Gatorade, please! [Oh, and the chicken broth? Awesome. My new favorite food!]

I sense that I have turned a corner and I'm now in recuperation mode. Last night I just felt sore and stiff, like things were not all happy. I'm still stiff and sore this morning, but it feels like I'm on the mend.

***

I'm curious how they manage the timing of everything. One naturally arrives thinking about one's own schedule, thinking that everyone is oriented around the things being done to you during your odyssey here.  But this is a 7-day-a-week operation (there are no actual bariatric procedures on Sunday, but the second- and third-day stuff continues) and you come to realize that the various meetings you have with the staff are wedged in--for them--between the other meetings with the previous days' patients, meetings that will occur in your own schedule over the next three days. Everybody gets a dye test, everybody gets a barium test, everybody gets various juices and broths, everybody's blood pressure and temp are taken five times a day, everybody gets their drain removed, everybody gets a series of followup checks. It's like a clockwork where everything hums along, each thing linked to the adjacent thing.

The doctors in particular seem to work very long hours. Aceves, the surgeon, shows up at all times day or night, and he's never in his scrubs; so much of his job--performing the surgeries--is invisible to us. Campos, the nutritionist, is here sunup to sundown. It all makes for some very full days for the key players. The nursing staff is young and quite casual. Little English spoken among these folks, but enough to get the job done. Everyone is helpful and cheerful, very professional.

***


Next up, the drain removal. Somehow I thought this would be the worst thing of all--pulling a long piece of rubber from among my innards. And while it certainly felt... odd and not entirely pleasant, it might almost have passed unnoticed.  The worst part, with the drain and several other little tack-on probes on my abdomen, was that it was all stuck over copious amounts of hair. THAT part of hurt like the dickens.

But that's it. Drain gone; IV port removed. Only four little pieces of tape over the four smaller holes remain, and they're to stay until they fall off on their own. The big hole is just covered with gauze and left alone. Wash gently with good soap once a day and re-bandage; it'll close up when it's ready.

Tomorrow morning we drive away and re-enter normal life. This little chapter will close, and a new landscape awaits.

Laytex glove on L. hand covers IV port for my shower,
and then got removed right after the shower.  Go figure.

There's the damage. Hard to imagine that big one doesn't need a stitch.
But I guess they know what they're doing!

Day 2

An uneventful night last night with one exception: I could not pee for about 18 hours after my surgery. This is expected, a function of the spinal narcotic getting in the way of normal bladder contractions, but it was weird. Of course, I haven't been drinking for all this time, but they have us on a hydrating IV for these first couple days until we are able to resume drinking. So you're still producing urine even without drinking.  I never reached the point of discomfort, but it's odd NEEDING to pee and being unable to do so.  And I was *almost* able to, it seemed, several times. I finally got up about 3:30 AM and sat there until something happened, damnit! And eventually a tiny, pathetic trickle came, barely measurable. I had been told that it got easier and easier as we went, and that has proven true.  I'm peeing like a champ now ;-)

This was my first time getting this spinal pain killer, and it's kind of miraculous! Just a tiny bit beneath the skin somewhere there along the spine and *poof!* no pain! None! Kind of amazing. (The anesthesiologist says a dose of morphine is normally measured in milligrams, but this spinal was just a few micrograms. Amazing.) Now it's worn off this morning--which is why I can pee, of course--and there are a few aches and pains but hardly worth mentioning.  Filling my lungs fully is a bit uncomfortable, and my drain on the left side hurts a little.  Actually, not the drain, but just the stomach in that area, like I had been doing too many (that is, ANY) sit-ups.

Tough to see in the picture, but there are four small holes covered in tape, and a bigger hole at the drain.  The icky-looking stuff in the drain is the leftover from surgery. There's a little bleeding during the surgery, and then the chest cavity is rinsed out; most of this is the leftover from the rinsing.

This morning we get our second test of the staple line to be sure it's not leaking (though very rare, this is this particular surgery's chief risk, a leaking staple line; these typically show themselves right away). The staple line is pressure-tested the first time during the procedure, the doctor inflating the stomach with air like a tire when the chest cavity is being flushed. Any leaks are seen as bubbles. Anyway, for test two, we get a sip of water followed by four little cups of grape-flavored intense blue dye (our first drink of anything). They watch to be sure nothing blue comes out our drain. It's not the end of the world if there is a leak, of course, but it'll mean they have to go back in and fix it, which restarts the clock here. Another day or two. So great pains are taken with the initial procedure to make it secure.  Once we've passed the leak test, we're off and running with a variety of clear liquids--variant of which will constitute our sole diet for the next 10 days. Haven't seen them yet, but I expect some chicken broth, water, Crystal Light. No bourbon.

***

OK, leak check passed! Whew!  Now onto clear liquids. Surprisingly, the water and dye / juice went down exactly as it has for 50 years. Small sips, admittedly, but there was absolutely nothing different in sensation. The grape tasted a bit funny, which could either be the grape or my taste buds courtesy of the antibiotic I'm on (the name of which I do not know).

We got some Gatorade, some warm tea and some apple juice.  So far the two cold drinks have gone down totally normally.  Cool.

I've asked Dr. Aceves to give me a look at the surgical staple they use. I'm curious what it is? Is it a series of individual staples (yes) put in like a sewing machine? Or are they mounted in a strip? He said he'll bring me one.  I'll try to get a picture. This is now a permanent part of me, like a dental bridge or artificial joint.

Some pictures from the drive over:

We drive over in CA and cross into Mexico at Calexico / Mexicali. There ain't much in extreme Southern California.

Mexicali. When we cross the border, there are a couple miles continuous of medical places--more dental than anything, but bariatrics, plastic surgery, optometrists, etc.

Residential Mexicali from our hotel.

The Hospital Almater. Not a clinic, but a full-service private hospital with ER and ICU.

My room, #25. Cozy. Everything is clean and being continually cleaned.

My occupation for three days (a day and a half with my scarecrow). Note the exquisite Omar-the-Tent-Maker couture! I'm thinking of petitioning UPS to adopt this as the new crew uniform. Compression wraps on legs come off today.

Our little ward. 13 rooms.

There's the damage. The two little electrode-thingies at the top are for the EKG during surgery, I think. The bag comes off on Day 3, when it's done doing its job.

More hijinx tomorrow.

Day 1

Sitting in Room 25 of the Almater Hospital in Mexicali. It's about seven hours after my surgery.

We were picked up by our regular driver at 7:AM from the lobby of the hotel (white, late-model Honda Odyssey with about 80,000 miles on it. With these trips made seven days a week with possible duplicates on Saturday, this van will last only a couple years). Whatever the reason, I was the first chosen to go. The one woman in my group looked in good general health and of about my size, so why I was chosen over her I do not know. The third woman was substantially overweight--perhaps "super obese"--and I can imagine them keeping her for last in case there are difficulties or complications.

We got to the hospital about 7:20 and waited a few minutes until we were assigned rooms, then we sat in those while a few people came in and talked to us individually. The Internal Medicine doctor came in for a quick hello, and I had one more quick bit of paperwork for Yolanda (the patient coordinator). Then I just played solitaire for half an hour on my phone until there was a knock on the door and there was Yolanda and a dude with a gurney. "Guess who's first?!" she asked. Great, that was my preference. (I forgot to look. I'm guessing it was before 9:AM)

She told me to strip myself of all clothing under my gown--watch, rings, socks, everything. I did this and got on the gurney and was wheeled a short distance to the surgery area. I sat there for 10-15 minutes before being rolled into the suite proper. My legs, knee-down, were wrapped in compression wrap, and I was given an IV and chatted with in friendly fashion. What little I saw of the room was clean and orderly and well-equipped. A place of modern medical business.

My next thought was hearing stuff in the recovery area. My eyes were very heavy, and it took quite a while to open them, and after my happy realization that I was in recovery and the deed was done I really just felt like sleeping more. I do remember the odd sensation that I didn't have enough strength to move my legs. I could feel them well and good, and I could move my feet and toes, but it seemed as though to raise the leg proper would require more energy than I could really muster at that moment. I dozed off and on like this for another half hour to an hour (no watch, remember) before Yolanda was there announcing it was time to return to my room.

Back in my room, the gurney was raised to the same height as the bed and I was encouraged to help move across. This I did with no problems, though I still felt pretty weak. I continued my dozing in here for another couple hours--after having the nurse get my phone and my calling Susan--with people coming and going as I drifted in and out. A breathing device--an inhaler that raises three balls sequentially with the strength of the inhale--was brought in, to be used once an hour for 10 breaths. Wards off pneumonia, they say, and I believe them: my first inhalation always gets a phelgmy cough and the others are clear.

About 5:PM I finally got up, quite shaky, from bed for a bit of a walk around the small ward, the nursing staff extricating my IV pole from the rest of the stuff in my room. I did this, very slowly, for half an hour. Still feel pretty weak and skaky, and I haven't yet peed. This is as much a function of the spinal morphine as not having much in my bladder, I'd say. They just gave me a syringe full of something to help with that. I can feel it already.

In all, absolutely no discomfort whatsoever. I'm told the main entry holes will be sore tomorrow when the few micrograms of morphine injected in the spine wear off. But so far, no pain at all. Just weakness / feebleness. I have an IV in my left hand, four very small holes surrounding my belly covered each with a piece of clear-ish tape, and a half-pint-sized clear bag on the left size of my abdomen into which has drained a couple tablespoons of relatively thin, bloody liquid. This is the leftover of the post-surgery cavity-rinse they perform, and is normal. This liquid should change to a clear / yellowish color in the next day or so before the drain comes out. The yellowish liquid will continue to seep for several days, which is why a gauze pad is needed. No stitches are used, as the hole needs to heal from the inside-out.

That's all I'm good for today. It's all I remember! Tomorrow: a morning leak check of the staple line and the beginning of my clear liquid regimen, with an emphasis on learning how my stomach has taken to the surgery. More then (and maybe some pictures!)

 ***

 A few stats:
 Age: 50 years, 18 days
Height: 5'9"
Weight: 271.2
BMI: 40.1
Highest Weight: 283,
2009 Goal Weight: ? We'll have to chat about that.

Thoughts On The Eve

Tomorrow I'm off for my bariatric procedure. Tomorrow is just a few tests and a travel day, and the procedure itself--all 45 minutes of it--occurs Monday morning. I'm quite excited for it, and, truth be told, I'm a bit sick of waiting. As luck would have it, I spent the last eight days here in Louisville waiting for a phone call that never came. This is normally not such a terrible thing--to be paid to NOT work--but in this case my mind naturally kept busy with the impending event and I'm sick of living inside my own head on this topic. I'm eager get past the thing and for life to resume.

All this chewing is not for naught, however. I begin to see more clearly why this procedure--the Vertical Sleeve Gastrectomy--works and why it's a good fit for someone with my psychological makeup. It works, of course, because it restricts a person's intake of food--that's simple enough. But HOW it does that, and the logistics and timing of things seem felicitous. The period of greatest restriction from the procedure is immediately after having the procedure done. Not only is the new stomach pouch the smallest at this time (due to swelling from the procedure itself) but it's also less pliable--that is, stretchable--than it will become over time. But our diet is most restricted at this point as well, a function of the new stomach needing to heal. So for a month afterward we are confined to a liquid diet with very few calories. (This is tolerable because the portion of the stomach which secretes the hunger hormone Ghrelin is removed in the procedure, so most people experience little or no hunger. Sensations of hunger do return with time, but they are typically much less insistent.) After a month we are back to normal foods, but in greatly reduced quantities.

This whole time we are losing weight like a swimming pool with a wall removed, so the incentive to honor the program to the letter is very high; for an obese person, to be freed from this ever-present, all-encompassing cage of fat is the stuff dreams are made of, as Bogie would say. Most of our weight is lost in the first three months, though most people will continue to lose for up to a year before their weight finds its new set point.

It's what happens afterward that I've been chewing on. I have little uncertainty and no anxiety about what will happen in this first phase; everybody loses a boatload of weight in the months following the procedure. But what happens down the road is kind of the whole banana, since weight lost that is not kept off is as bad--no, it's worse--than weight never lost in the first place. There is no diet or bariatric procedure that cannot be beaten or overwhelmed, and my overriding concern is that I not fail to take all the appropriate steps to make good on the changes I'm about to undergo.

There's a fair amount of information about this. My doctor has a number of handouts, plus they spend some time before and after the procedure itself talking about dietary matters. Other specialists in bariatric procedures have their own protocols, and of course there's a wealth of information from those having already gone thru the procedure and who are living with the aftermath.

So many questions: Do we track our food intake scrupulously? Do we develop certain key rules which we abide by and leave the details to circumstance? Should one measure and weigh things? And for how long? Forever? And if so, how much of the long-term success of the procedure depends on that?

One universal I've seen is the focus on protein. Initially, getting enough protein is vital to keep the body from consuming its own muscle during the early months. But down the road it seems like the emphasis on protein continues. Near as I can tell, this is for a couple of reasons: 1) protein is the most innocuous of food sources (compared to carbohydrates and fats), and 2) the protein signals the pyloric valve in the stomach to close, thus enabling the quickest sensation of satiety at mealtime. This is one of the reasons that we do not eat and drink at the same time after getting the sleeve. Liquids tend to move quickly through the system, and will flush the small quantity of food out of the stomach before it can register "full" to our brains (another reason is because the small stomach needs the food that will supply nutrients to the body, and the room taken by liquid can be better used by solids). My own doctor's instructions say that failure to get enough protein will slow weight loss and can cause hair loss and cracked nails, etc.

So protein's the thing. But after getting a small amount of protein at each meal, the trail becomes harder to track. Some plans say to get veggies, others just emphasize percentages of protein vs. carbs vs. fats. Most recommend exercise, and all suggest avoiding sugary foods, both because they may not sit well with the new stomach and because they will slow or sabotage weight loss.

I've made a point to ask the people I know who have had the procedure how they are eating now. Their response is universal: "I eat whatever I want; I just don't eat very much of it." Other "sleevers" have echoed a similar theme: start with your protein, and then finish up with whatever you want--with the understanding that after a couple ounces of protein there's little room left for "whatever you want." My work contacts say, "I still eat dessert, but it's generally a bite or two. And that is quite satisfying."

One key thing my doctor talks about is not relying on feeling FULL as an indicator of when you've had enough to eat. The nerves of satiety, he says, are "slow" nerves, and it takes several minutes to register that we've had enough to eat. The better thing, he says, is to gain a visual and mental sense of what constitutes a proper amount of food--based on careful observation of what works and doesn't work early on post-procedure as we're learning a new way of eating--and go strictly by THAT sense rather than relying on a feeling of fullness. Over time, as the stomach becomes more pliable and we are able to tolerate more food, our reliance on this new sense of what constitutes a meal--rather than a feeling of fullness--ensures that we retain the sleeve's restrictive properties (this restriction is the keystone of the procedure's effectiveness).

I'm also concerned with my historic penchant for chocolate and such. It seems unrealistic to think I'm going to live the rest of my life without eating another M&M (though I'll do my best if this seems necessary). And during the weight loss phase of 6-12 months I expect to avoid desserts with great care. But I also don't want to turn the occasional pleasure carbs into an unattainable fetish. It would seem wise to introduce the occasional bite of chocolate cake or apple pie into my diet in a controlled fashion so that the tendency to fall off the wagon in a meltdown of slobbering weakness does not loom so large. (One of my contacts says that one of his favorite food groups--starches; breads and pastries and potatoes, etc.--just lost their allure after getting the sleeve. "They fill me up immediately and I feel like I've been cheated out of the (admittedly small) meal I was looking forward to." I'm interested to see what becomes of my own cravings over time.)

The sleeve will not solve my problems magically by itself. It is a tool to be used to help make better choices and avoid some of the more destructive paths. My regular practice of eating two huge triple-chocolate donuts every morning or of eating a whole pack of of Double Stuff Oreos in a single day (and then enduring several days of self-loathing because of it) are options that are precluded by the sleeve. And good riddance to them. It remains to be seen whether Oreos and I can be friends at vastly lower dosages or whether we need to part company permanently. Stay tuned for this.

Many obese people--myself certainly--are obsessed with food (more or less). It's not uncommon for me to be planning a meal as I'm eating the previous one, or even before. I think about food a lot, and I strategize my beverages so that I'm never without one. For a mentality like mine, the sleeve's requirement to minutely strategize the day's eating is not an unwelcome thing; it meshes nicely with my already-existing food interface. And since each meal is relatively small, the consequences of not eating what you like or not liking what you eat are diminished, because another meal is just up around the next bend.

We'll see if I'm singing the same tune a year or two from now.

To Run Or Not To Run

As I prepare for surgery, I find myself wringing my hands about exercise.

I used to be a runner. I stopped running about 12 years ago, but prior to that I ran pretty regularly. I was never fast--I raced only once, and found it was not my thing--but I logged some fair mileage, averaging between five and nine miles a day four-five days a week. I did this, off and on, for the better part of a decade.

But here's the thing. Ultimately, I only became a runner to try and keep my weight under control: that was my whole reason for wanting to exercise. And while running certainly made my cardiovascular fitness a good deal better, I very quickly figured out how to eat to compensate for all the calories I burned. And so my weight held steady and even increased slowly even as I was approaching half-marathon distances. Knowing my pathological food interface, this now seems not shocking in the least.

But this reality poses a challenge as I try to map out my recovery from bariatric surgery and my new life as a thinner person. Exercise is strongly encouraged as part of one's new routine, and I can imagine that for many obese folks very strenuous exercise has long been off the radar. As we lose weight, it becomes easier and more alluring to live a more active lifestyle--and indeed, I find myself dreaming about doing more bike riding, having an easier time walking and hiking, even strapping on my running shoes again. I'm more fortunate than some: though I stopped running a dozen years ago, I still walk two-three miles most days, and when I'm traveling it's not uncommon to walk five miles or more. So exercising at that level will be no problem whatsoever for me.

But what of more strenuous exercise? As my weight drops and I begin to exercise more, I'm also trying to learn anew how to eat; I must adjust my new eating routine to the lifestyle I'm living. And if my new eating regimen must accommodate the calories burned by running, I will settle on a richer diet than if I were not exercising. If I ever stop running I'll find myself used to eating more calories than are needed for the non-runner. 

And this seems a perfect recipe for putting weight back on.

So I have to decide whether running and accounting the calories is a smart strategy for me. It's almost as though if I start running I'll have to keep at it. My track record of cutting back my consumption for changing conditions is a bit spotty, though I'm definitely eating less now than I was during my running days.

More Bariatric Fun: The Ballad of Diet Coke

For those who don't know me, I have had a longstanding--almost comical!--fetish for Diet Coke. In my early airline days I was known (one of many nicknames) as the "Diet Coke Cardinal," and I've basically drunk a 12-pack a day, at a minimum, for 25 years or more. For most of my adult life I was NEVER without a DC. Ever. I carried one up to bed with me at night and it was the first thing I did in the morning. My drives, long and short, would be planned around who had a good mix of DC and it was not uncommon for me to buy a fresh one long before my current one was gone. In all my travels, job one was to scope out where I could get DC and who had the best mix (which typically meant who filtered their water).

This obsession arose kind of by plan: I realized several decades ago that I have a compulsive personality--which surely plays a role in my being overweight in the first place--and I made the decision to grant myself this item as an outlet for my compulsion rather than, say, Peanut M&Ms or some other thing. This was, I thought, a relatively innocuous thing that would satisfy the compulsive part of my personality without doing me much harm otherwise (I suspect if I were not a teetotaler I would likely have a problem with alcohol).

Despite the warnings of well-meaning friends, I have suffered very little for my fetish. Well, apart from spending a couple grand a year on it. I had a doctor tell me some years ago that in the interests of moderation "I wish your 12-pack were a 6-pack, but if you had to pick a habit you chose a pretty harmless one." Every now and again a study pops up saying that Aspartame is demon spawn, but these seem to come and go quietly. And indeed there are few substances in recent history with a deeper and wider track record than Aspartame; with billions upon billions of doses consumed, if it caused bad stuff we'd surely know it by now. (True, at the amount I consume there may be consequences that other folks will never see, but to date I've had no issues.)  I also used to have people tell me that diet soda would not hydrate properly, and yet I used to regularly run 7-9 miles at a crack and I NEVER drank anything else. Can't be much clearer than that, at least for the short term.

And it became more than a fetish, I think: I really do love the stuff. It's very common for me to get a fresh one from a McDonald's drive-thru (they filter their water, so their soda is always perfecto!) and feel positively giddy at how fabulous it is: bubbly and icy and perfectamundo. (Makes me wonder if they put something in it to make it addictive.) Even so, I'd decide every five years or so that it can't POSSIBLY be good to drink this much diet soda, and I'd take a month or two on the wagon. Apart from a caffeine-withdrawal headache for the first three days, I found that I felt no different whatsoever after a month off the stuff than I felt while drinking it; which led me to wonder why I should bother making the sacrifice.  Interestingly, though, after a month away I was surprised that the stuff didn't really taste all that great. But I was soon enough back off the wagon and life moved on.

Fast-forward up to a couple months ago. I read in the VSG literature from my surgeon that carbonated beverages were verboten after the surgery, pretty much permanently. I think the reasons for this are twofold: 1) acid reflux is an issue after this surgery, and carbonated beverages make it worse, and 2) the carbonation in the newly-shrunk stomach works to inflate and stretch it out, which works against its therapeutic power (Generally, the success of the sleeve is related to how small a pouch the surgeon can make; the smaller the pouch / stomach, the more likely a person will achieve their long-term weight goals). So this was my wakeup call: if this were going to work, I'd need to drink something else.

Naturally, for those who know me, this is a HUGE question mark. But I was unworried, which surprised even myself a little. I think I knew that my behavior was as much habit pattern and pacifier as it was a reflection of my love of the product itself. In the past five years I found I was buying and drinking more and more diet Snapple instead of DC, something quite new in my history. So after reading the surgery literature I immediately swore off the stuff to take a trial run, as it were. I've been focusing on iced tea and (since caffeine is off limits for the first month after surgery) on drink mixes like Propel and Crystal Light, etc. And I find I haven't missed the DC in the least, though I have long-standing behavior patterns that still try to assert themselves--like thinking about what drive-thru to hit for a beverage on my long drives. Interestingly, I find that a good glass of ice water becomes much more attractive when I'm weaned off the DC, and I also find that I'm drinking about 1/3 less overall than I used to (so much of my DC drinking had nothing to do with hydration). I've had a sip here and there of Susan's DC in the interim, but I've had little reaction to it.

One good thing is a great reduction in acid reflux. I haven't had bad heartburn like some folks, but all that carbonation surely doesn't help, and I find I eat a lot fewer Tums now than I used to. My esophagus surely thanks me.

Another Precedent Falls

This post marks the official lifting of my long-standing ban on this blog about discussing weight-related matters. It hasn't been an absolute ban; I wrote a year ago about insulin resistance. But I've always tried to steer clear of the topic exactly because it seems so self-absorbed, and because so many people can write the exact same posts. Plus, it seems hopeless and intractable to expect others to live in the head of someone whose interface with food is fundamentally out of whack; it's like, I suspect, the non-addict reading a day-to-day account of the addict's mindset: alien and depressing and rather hopeless, for the addict himself, certainly, but also for the reader who would have no reason to opt into a situation they could otherwise avoid. And to what end? I could see myself doing the Oprah: writing about my struggles, vowing to follow a new path, losing weight in triumph, basking in the glow. And then slowly (or rapidly) putting it all back on again. I could see this because I *have* seen it, several times.

I'm lifting my ban now because I have decided to undergo bariatric surgery to get my weight under control. This therapeutic approach--medicalizing my weight problem--perhaps takes a garden-variety topic into less-familiar waters; and so if there are fewer people who might relate to the whole business, it might also be interesting for its comparative rarity. The blog is slow these days, and I've come to rely on writing things out as a means of making sense of them.  So here we are.

***

I'm scheduled on 7/16 for a procedure called the VSG for Vertical Sleeve Gastrectomy (sometimes called a Vertical Sleeve or  Gastric Sleeve). This decision took me the better part of a year to make, and this post is an attempt to put my deliberations down on paper. It will help everything that follows make more sense (assuming there's anything to talk about after the fact). 

My introduction to bariatric surgery, and the VSG specifically, came a year ago when I flew a couple long international legs with a pilot who, a year prior, had undergone the procedure. We talked about the procedure and its aftermath in exhaustive detail for several hours. He had been encouraged in his procedure by another pilot at our company--we'll call him "the Godfather," since he has advised a bunch of people at my company who have gone on to have the procedure. The Godfather had undergone the same procedure several years before, and I realized as we discussed it that I had heard of him. Anyway, this lengthy discussion started me chewing on the idea of bariatrics, and I spent the next several months thinking about it, off and on. My wife was mortified at the very idea, and so I did most of my deliberation internally.

By way of background (most of which is on that previous post): I've been overweight my whole life. I remember seeing with horror 202# on the scale when I was in eighth grade, and by high school I was in the 220# range. By college I had moved up to 240# or so, and have gradually edged up from there to my current 275-280#. Along the way I have lost substantial amounts of weight on half a dozen occasions, each weight loss followed with sunrise certainty by a regain of the lost weight and another 10# in penalties. In between these half dozen short-term successes, I have undertaken literally a thousand diets. I have gone to bed feeling disgusted at the day's eating an uncountable number of times and awakened with a vow to do better in the new day only to scuttle my plans by the first hour or two of the day. This has been going on for decades. The person who struggles with their weight--particularly the obese person--will no doubt find a painful resonance here; for those with a more normal interface with food, this will be foreign territory.

Like all fat people, I have spent countless hours contemplating issues of will power and psychology and craving and addiction, all of which have gained me exactly nothing. I'm not 600#; I do not order 4 porterhouse steaks at a sitting. I do have a mechanism that tells me when to eat and when to stop like any other person. But that mechanism seems to shut off about 20% later than it should, and the result sits at the keyboard now.

***

The Vertical Sleeve Gastrectomy (VSG) was developed about 15 years ago as the first part of a two-part procedure (the second part is called a Duodenal Switch). The idea was for the VSG to help super-obese patients lose weight preparatory to having the more extensive part of the procedure. But it was discovered that many people--especially those not super-obese--had good enough results from the VSG alone that the second part was not required. While most bariatric procedures--including the Duodenal Switch--involve some kind of re-plumbing of the intestinal tract, the VSG avoids this. With the VSG, about 80% of the stomach is carefully removed while leaving everything else exactly intact. The radically smaller stomach restricts the amount of food that a person can eat in a sitting. That's it. The stomach and the pyloric valve remain, their functions unchanged. The rest of the digestive tract is untouched. Where other bariatric procedures may impose post-operative nutritional requirements because of physical changes in one's digestive tract, with the VSG one can eat pretty much anything, though in greatly reduced quantities. (There are a few nutritional requirements: one is encouraged to concentrate on protein, both to help prevent muscle loss during the initial, rapid weight loss after the procedure and as a means of filling the small stomach with innocuous foodstuffs, leaving little space for the bad stuff; and one is encouraged to take several supplements because there is simply less food coming in to satisfy the body's nutritional requirements. Also, carbonated beverages are generally off limits, as the gas contributes to acid reflux and can stretch out the newly-shrunk stomach.)

As I said, after flying the trip with my new bariatric surgery contact I chewed on his procedure and his results for a number of months. He had lost about 120 lbs. without exercise, and (a refrain I was to hear again and again) he said it was the single best thing he had ever done for himself--he was sorry he hadn't done it a decade ago. His life now seemed entirely normal to him; he had merely switched his expectation about how much food constituted a meal, and everything else was unchanged. He said he still eats out most of his meals, ordering from the appetizer menu and bringing half of that home. While exercise is strongly encouraged, he lost his weight without exercising. My later discussions with the Godfather only amplified all of these impressions. He had gone from about 375# (as I recall) to about 170# now and has taken to running triathlons. He said it was like being given a new life (another refrain I've heard numerous times).

As I said, my beloved wife was frankly horrified at the whole idea. Removing a majority of a perfectly functioning major organ--which was not in itself defective nor responsible for my problems--just didn't make sense to her. I was contemplating something drastic and *permanent.*  And at first I tended to agree with her, though I admit to being secretly intrigued: whatever I thought about the matter, it was hard to argue with the results, especially when none of my contacts had had their lives turned upside down in any way by the procedure. On the contrary. I remained in this contemplative state for several months until, a couple months back, I ran across an article online (at NPR, I think) with the headline that bariatric surgery worked better than diet and exercise. The article said that stats showed that bariatric surgery was simply much more effective at helping obese people take their weight off and keep it off than were diet and exercise, which basically had a dismal track record. And whatever else I did or did not know, I could attest firsthand that diet and exercise were not working for me. It's not that dieting did not take the weight off: if I dieted, I lost weight; it's that I could not succeed in starting a diet in most cases, and in staying on that diet in every case. My gradually-rising weight over the years was a testament to my inability to control the situation, whatever tools and resources one may think were available to me.

And so I began a more earnest investigation of bariatric surgery.

One of the first things that jumped out at me was the realization that I had been living under a kind of reverse-anorexia. My weight has been an issue for all of my adult life, and I don't think I've ever been in denial about it. Or not exactly. But I also don't think I live my daily life with an awareness that I am over 100 pounds overweight. This places me firmly in the category of morbid obesity, the highest category of overweight available (Category 3 Obesity, technically). I have long been concerned in a general way with my risk of heart attack and stroke, but there's a denial in living every day pretending there's not a noose around my neck. So Step One was to face this: as a general category, I'm as overweight as they come, and I must face that I'm in the highest possible risk category for a bunch of bad shit that I need to take seriously. And further enforcing that I'm not an exception to the rule, my weight is responsible for my taking medicine for blood pressure and cholesterol, and my blood sugar has slowly been rising over time. I will eventually be facing Type 2 diabetes, and at age 50 probably sooner than later. The denial comes from not acknowledging the huge risks these factors represent.

Researching bariatric surgery, I find I'm exactly the person for whom the procedures are intended. With a BMI of 41, my issues are exactly those for which these procedures have been developed.

So I got in touch again with the people I knew who had undergone the procedure and began to amass some data. I also, at my wife's very sensible insistence, went to my local doctor and discussed the subject with him. My wife, still repelled by the idea of bariatric surgery, was sure he would send me home with a scolding and tell me it was a terrible idea and what I really needed was to go on a diet. But he did not; indeed, he was quite supportive. Even before talking to him, I chatted with his nurse, who had undergone bariatric surgery some 25 years before (and had then needed to have it altered after there were complications); and she was still 100% happy she had done it and was THRILLED to learn that there were newer, laparascopic procedures available. The doctor insisted that bariatrics were not extreme or fringe procedures; this was sensible, mainstream medicine, he said, and he was confident these are relatively low-risk procedures which are almost certain to lower the very real risks I'm laboring under now.

And of the four guys from work I talked to who had undergone the procedure, three had spouses or other family members who joined them in the procedure, including two medical professionals who were at first very skeptical. I could not find a single discouraging word from firsthand sources, and even those rare cases I read about on the internet where difficulties had been encountered, the difficulties were relatively minor and no one regretted their decision or would not undergo it again. And the rest--the rule--were strong advocates of the procedure.

So this is all very encouraging.

But I wanted not to make such a far-reaching decision on a wave of euphoria, and my wife was still very much a hard-sell. So I tried to focus on her objections, both to honor her anxiety and to see if I were overlooking something. Her chief complaint is that the procedure doesn't fix what ails me, which is true enough so far as it goes. If I'm food-obsessed and in love with all the stuff I'm not supposed to eat; if for whatever reason I fail to eat as I should, this procedure doesn't fix that--it doesn't change what's wrong with my brain and my interface with food. But that leads inexorably to the question of whether ANYTHING can fix what is wrong with me? Ideally that would be the goal--"fixing" me--but that's maybe setting the bar to a height that no one could get over it. My experience suggests this in my case, and regardless we must deal with what can be made to happen. Bariatric surgery doesn't work by revising our mis-wired brains, but by circumventing the negative effects of that mis-wiring. Given the odds of anything else on the table, I think we have to be OK with this. If we are unable to re-wire the brain--and I have zero confidence that anything will make my interface with food a healthy one--then I think we need to focus on what will alleviate the negative symptoms of that mis-wiring.

The field of bariatric medicine has arisen exactly because people like me are becoming an epidemic problem. I agree that the long-term solution to society's problem cannot be surgery for everyone. But fixing the world's food supply and fixing my food brain are quite separate challenges, I think. I suspect that my mis-wiring is the outcome of decades lived in a bad food environment and my tastes and preferences cannot be re-decided. Maybe not forever, but for now; maybe medicine will eventually get a handle on this. Anyway, I've come to believe that alleviating the symptoms is probably the best possible outcome for me.

And so that leads me up to the present day. I'm on the clinic's schedule for mid-July, a couple weeks after another (non-pilot) friend is undergoing the same procedure at the same clinic. We've become "sleeve buddies," and have been exchanging information.

More to come.

***

PS: In the long term, I suspect we're going to have to get the vast amount of processed carbs--sugar and HFCS and white flour--greatly reduced in our diet. It's probably my particular paranoia, but I think we're in this epidemic because crappy food is more profitable: highly processed foods are cheaper to make, and more and more of our food comes from corporate sources. Their low nutritional content means that people eat more, and the resulting insulin-resistance makes for an addicted society--which means huge profits for big corporate food companies.