all great changes are preceded by chaos, or how I decided to quit fighting and go under the knife.

The last post I made to this blog was in June of 2012.  This was the last time that I really invested time into taking care of myself.

Since then, I’ve backslid in the biggest of ways–not really paying attention to what I ate, how much I ate, or how much I moved.  As a result I’ve gained back over half the weight I lost when I set out upon the latest of weight loss journeys that my adult life has been consumed with.

In January, I had a 6-month checkup with my primary care physician.  Because I am diabetic, I must go in every 6 months and have my a1c, cholesterol, triglycerides and other things checked.  I knew before I went in to do the lab work that the results would be dismal; I was just waiting for her to say them to my face.

I remember sitting in her office that morning and saying, “Ok, I feel like this is Confession, so I’m going to say it, ‘Forgive me, Doctor, for I have sinned.’  How bad is it?”

She gave me a copy of my labs, as she always does.  They weren’t fabulous.  My a1c had climbed up a few notches, just short of 7.0 (not good), and my triglycerides were out of whack.

I shook my head–why, I don’t know, because I knew full well what had led to the lab results.  I looked up and said, “Okay, you know I’ve resisted this for the longest time, but I’m tired of fighting.  I’m tired of trying and failing Every. Single. Time.  I need your help.  I want to go ahead and pursue weight loss surgery.”  I proceeded to describe the types of surgery available, and which ones I did not want to have, and she nodded and agreed that neither the lap-band nor gastric bypass would be best for me.

My doctor nodded and said, “You are the perfect candidate for sleeve gastrectomy surgery.”  She then explained a bit about the surgery, and gave me the card of a surgeon that she knew.  She explained that my diabetes would resolve itself after surgery–mind you, not right away, but fairly soon, so much so that I would no longer require medication.  She also told me that post-surgery, my high blood pressure would no longer be an issue and that I would be able to come off of that medication as well.  The sleeve was starting to sound more and more awesome the more she talked about it.

After we talked a bit more and finished up my visit, I set about doing my research on the surgeon she had recommended.  Not finding much, I started looking for other surgeons in the area who could help me get to where I want to be:  healthy.  I also researched the procedure, as going in, I did not know a whole lot about it.  I knew enough about the others that I knew early on I did not want them, but the sleeve was intriguing to me.

So in a sleeve gastrectomy, the surgeon goes in through several small incisions in the abdomen and removes roughly 80% of the stomach, like so:

sleeve

from bariatric.templehealth.org

This leaves the patient with a stomach that is roughly the shape of a banana, and that can only hold about 3-4 ounces at a time.  In removing the part of the stomach that is discarded, the hunger hormone ghrelin is no longer produced.  It is this ghrelin that is part and parcel of the complex physiology of hunger, and what stimulates us to eat.  This, coupled with the restriction that comes from having a stomach that will only hold a small quantity of food or liquid is what makes this a successful strategy for surgical weight loss.

This is the route I have decided to take.  I know that it will not be easy, despite what some people think about those who pursue surgical solutions to weight loss.  Here’s what I think about that line of thinking.

roadtoglory

photo credit: author

There is nothing easy about beginning the path to surgery.  There are a great many hurdles:  mental, medical, physical, financial.  It is the first hurdle–mental–that is the toughest to overcome.  Then you worry about all the pre-surgical testing, and wonder what sorts of tests you will need to have per your surgeon’s orders.  Then you worry about whether or not the insurance will cover the costs of all that you are about to undergo.  Finally, you worry about the drain this will place on your savings account but then recognize that this surgery is the most important of investments.

There is nothing easy about acknowledging the need for surgical intervention to help you lose weight.  Getting into your own head, heart and soul requires a certain kind of introspection and honesty that not everyone is willing to engage in with themselves.  For some of us, it’s that lack of introspection and self-evaluation that led us to be the size we are.

There is nothing easy about how you handle the flood of emotions and thoughts surrounding what you’re about to do to yourself.  You begin to think about what life will be like post-surgery.  You attempt to find friends and colleagues who have undergone similar experiences so that you can have a taste of what life is like afterwards, knowing that your post-surgical experience will be different.  You attempt to learn as much as possible by frequenting online communities for those who have had your surgery and asking as many questions as you can generate.  You begin to wonder how your life will change and realize that it will not do so overnight.

There is nothing easy about re-examining your relationship with food.  You have to sit and think about how food fits into your every day life.  While talking with your psychologist, you start thinking about foods that trigger you to overeat and realize that these things are some of your favorite things that won’t be sleeve friendly post-surgically.  You have to think about how you will restructure activities that once revolved around food (Sunday brunches, parties, celebrations) so that food is not the focus of those events.  You have food funerals knowing that they are probably a bad idea, but the thought of parting with some of your favorite foods even for a short period of time distresses you.  Even though your surgeon says you will be able to eat them again eventually, you know in your heart of hearts that you really shouldn’t, lest you go down that slippery slope of addiction because that’s what it really is, and you know it.

There is nothing easy about telling your family and friends that you will be making a drastic change to your health.  This may influence how they include you in social activities, especially the ones that revolve around food.  Some of these people will be supportive.  Some of them won’t be, and some of them will outright try to sabotage your efforts.  You hope that the people in your life will not begin to treat you any differently other than to notice your weight loss in a complimentary way.

There is nothing easy about major surgery For Chrissakes, a surgeon is going to remove a goodly chunk of your stomach.  For good.  That chunk will end up being incinerated in some medical waste facility, never to be seen or used again.  There will be a long recovery period during which all that goes into your mouth is liquid.  There will be pain, and gas, and possible complications.  You will stay in the hospital overnight because your insurance requires it, thank goodness.  You will (for the first time in your life) have major surgery and are terrified of the prospect of not knowing what will be happening while you are under anesthesia.  You are afraid of the pain that will accompany the incisions.  You are afraid you could die.

There is nothing easy about all the prep work that has to be done in order to be approved to have this surgery.  So far, I have had two sleep studies, a surgical consult, a psychological evaluation and have been fitted for and now own and use a CPAP machine.  Left to do?  Meet with a nutritionist, have a second surgical consult and set a date with the man and his knives.

There is nothing easy about this decision.  Not at all.  But I’ve made it, I own it, and I’m excited about it.  I’m ready to know what life is like as a healthy person.  I’m ready to know what life is like as a smaller person.  Most of all, I’m ready to know what life is like as a person who is fully and completely happy with herself.

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4 responses to “all great changes are preceded by chaos, or how I decided to quit fighting and go under the knife.

  1. Wow, Lee. Thank you for sharing with those who love you about this deeply emotional subject. I’m just glad to have this post, so that I can understand a little bit about what is up for you. You’re right: it’s drastic surgery. You have all my prayers and hopes for the outcome you’re looking for!

  2. I’m excited for you as you start this journey.

    How did you decide which of the many different kinds of surgery was best for you?

    • Thanks, Joy. I am excited, nervous and scared, but I am told by vets of any of the varieties of bariatric surgery that exist that this is normal so I am glad that I’m not experiencing anything unusual!

      I’ve been looking into surgery for over 5 years now, and knew from looking at others which procedures I knew would not work for me and the way I choose to live my life. I also had to look at how I view food and its role in my life, and how I treat it on a day to day basis. When it came right down to it, I narrowed my choice to the gastrectomy because what I need most of all is restriction. I need the extreme portion control that VSG forces upon you, because let’s face it: I know how to eat healthy. I know how to exercise. What I don’t know how to do is properly control portions. And even though I’ve been taught multiple times, multiple ways, this is something I still struggle with mightily. The sleeve gastrectomy (VSG) will allow me to use the weight loss tools I already know how to use (that sorely need dusted off) in combination with forced restriction and altered physiology to lose weight. Since the portion of my GI tract that produces ghrelin (hunger hormone) will be gone, for the first year I will not feel physical hunger, like I do now. After a period of time, however, the other hormones involved in hunger regulation (leptin, et al) will upregulate and the sensation of hunger will return, but not as full-force as I feel it now. The sleeve was the best choice for me because I did not want something I could cheat that was high maintenance (lap-band) and I did not want malabsorption or rerouting of my GI tract (bypass). After this surgery, I will be left with a largely intact GI tract, minus a good chunk of my stomach, which I can deal with. If it keeps me from overfeeding myself as I am prone to do now, then I’m good with it.

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