Monday, December 7, 2009

There's Gonna Be Less of Me to Love

Okay, kids, it goes like this. I'm a great big fat guy. I've been a great big fat guy most of my adult life. You know how it goes. You get a driver's license, out goes the bike riding. You get a job, there goes time for a lot of extracurricular activities. You get a sedentary job in the computer industry, fueled by junk food, soda, and long periods of moving nothing but your mouse, and then it happens. You wake up one morning to find the active kid that you used to be--the one that would bike to Balboa for fun--is now a fast-approaching-middle-age Jabba the Hutt lookalike who can barely waddle to the fridge. I stared in the mirror for several years, my visage growing more and more like Peter Griffin, and my outlook on life becoming more and more gloomy. I also began to suffer from other problems as a result of my weight, like joint pain, back problems, and obstructive sleep apnea (which can lead to heart attack, among other nasty things). I finally got tired of looking in that mirror, and getting no rest no matter how much I slept. Last December, I decided to do something about it.

I am one of the fortunate individuals enjoying non-government-excreted health care coverage with Kaiser Permanente, via my employer. A few years ago, Kaiser bestowed their blessing to begin performing gastric bypass surgery for weight loss. I read pamphlets, went to seminars, and learned all I could. In 2007, my then 59-year-old mother had the procedure performed through Kaiser. Two years and an astounding 150 pounds later, she is thinnest--and happiest--she has ever been. She considers her surgery date to be her "re-birth day." I needed no more convincing.

In December of 2008, I went to Kaiser's sign-up and orientation event for the gastric bypass surgery program. The program requires you to attend--without absence--a 24-week education course called "Options." This course (once per week for 24 weeks (6 months)), led by a registered dietitian and a psychologist, explores the physical and psychological reasons that cause people to overeat and gain weight. During this 24 weeks, you are asked to try to lose 10% of your body weight, as this loosens the abdomen and makes the surgery easier to perform. The course teaches about label reading, ingredient awareness, general nutrition, and healthy eating strategies and habits. Perhaps most importantly, it provides invaluable information and preparation for the surgery itself--the positives, the negatives, and realistic expectations, chiefly: This surgery is NOT a magic bullet. It is NOT a cure-all. It is a TOOL--no more, no less. Like any tool, it will only be as effective as *I* make it. I still have a lot of work to do, and I have to be aware of a lot of things concerning my diet. The days of mindlessly stuffing my face are over.

At first, I grumbled about these requirements, feeling that I was being made to jump through a bunch of bullshit hoops. As the class progressed, however, I began to see its value--not only for the information imparted, but for the support and accountability that the group setting provided. I met people there who are still good friends. And yes, I did manage to lose most of the 10%. It wasn't easy, but it wasn't impossible, as I had thought at the outset. I began the Options program in January, and finished in June. It took a bit longer to lose the rest of the weight, but in September, I was approved to go forward. In October, I had a consultation with my chosen surgeon, and then I had a date: my "re-birth day" will be December 11, 2009.

So what is gastric bypass surgery?

Well, there's lots of information about it generally here on Wikipedia. That page has a lot of (again) very general info, some of which is not applicable, but it's a good overview. It also talks about the benefits, restrictions, and risks. More specifically, there are three types of weight loss surgery offered by Kaiser. They are:

The Lap Band
You've probably seen commercials and billboards about this all over the place. A small, inflatable band--adjustable from the outside via a port--is placed around the top of the stomach, essentially pinching it in order to slow the intake of food and create a rapid feeling of fullness. While again, a tool can only be as effective as you make it, my doctor is not a fan of this, and neither am I. Speaking solely for myself, it seems like a really half-ass, non-permanent solution, and it has a host of problems associated with it--everything from acid reflux, to "slippage," where the ring slips out of position and causes havoc, to stomach damage from the ring growing into the stomach lining or causing severe inflammation. Do your own Googling. I expect the next rash of medical injury lawsuits (a la "Phen Fen" and "Yaz") to be about this stupid gadget.

"Roux-en-y" Gastric Bypass
The "Roux-en-y" procedure, so called because of the "y" configuration the stomach/intestine is left in, is the "gold standard" of surgical weight loss procedures. All but a tiny portion of the stomach is cut away just below the esophagus, leaving only a tiny "pouch" for food. The intestine is cut away from below the stomach and hooked directly to this pouch. The stomach, which still produces acid, is reconnected to the intestine to allow digestive juices to continue on their way.

The arrangement is severely calorie restrictive. The pouch that now serves as the stomach starts out at about 3 ounces in size. Ever see those little bottles of "5-Hour Energy," or the little containers of hand sanitizer people carry in their pocket or purse? Those are 2 ounces. So yeah, not much food in a sitting. It is also what is called "malabsorptive." This means, as the name suggests, that certain things do not absorb or digest very readily, like sugar and sweets (good) and vitamins (bad). A person who has this surgery is consigned to liquid or chewable vitamin supplements for the rest of their life. This is a permanent change, and it is the most restrictive option of the three.

The Gastric "Sleeve"
The gastric "sleeve" procedure involved cutting away approximately 80% of the stomach, leaving only a banana-shaped "sleeve" for intake of food. This is a much simpler surgery than the full "Roux-en-y" bypass, and it is less restrictive. It is calorie restrictive, but it is not malabsorptive. Everything is absorbed in the stomach lining as normal, avoiding the issues with vitamin absorption and intolerance to certain foods--including sweets. This process was initially developed as an intermediate surgery on very large patients (500+ pounds) to get them to a size where the full bypass could be successfully performed. However, it is gaining momentum as a stand-alone solution, and many people lose weight with much the same success as the full "roux-en-y" surgery.

My Choice
For my surgical weight loss option, I chose... (drumroll)...

option "B," the "roux-en-y" gastric bypass.

I never seriously considered the lap band, but I very seriously considered the sleeve. It seemed the most straightforward with the least problems, and still had a high success rate--with one caveat: you can't have a sweet tooth. If you like snacking on sweets, it is very easy to fill up--very quickly--on sweets alone. Clearly, that could seriously sabotage your weight loss goals. Most people who have the "roux-en-y" surgery develop a serious intolerance for sweets. I am not a HUGE sweet-eater, but I do like them, and have experienced periods of several days where I craved them heavily. The surgery choice came down to knowing and being honest with myself, and this point tipped the scales (pun intended) for me in favor of the more restrictive surgery. I know my habits and cravings, and having the more restrictive enforcement with regard to junk food gives me more confidence that this change will be successful and permanent.

So, there it is. With a lot of work and a little luck, by this time next year, I'll be half the man I am today... and a hell of a lot happier and healthier for it. Wish me luck!


P.S. -- Please feel free to comment. I will try to answer any questions you have. I ask only that you spare me any tales of terror about how your cousin's sisters boyfriend's mom had this done and this somehow caused wild piranha to spawn in her digestive tract and devour her uterus. It's not that I'm not open to skepticism, it's just that I've been at this for a year, and trust me--I've heard them all.

P.P.S. -- Oh yeah, I should probably include this:

Weight Before Options Class: 366 pounds
Weight After Options Class: 334 pounds
Lifetime Highest Weight: 385 pounds
Weight Before Surgery: 353 pounds