October 23, 2016

My Gastric Bypass Experience

My gastric bypass surgery was on October, 19th 2015 and I received the Roux-en-Y gastric bypass (RYGB) procedure. The Roux-en-Y gastric bypass was chosen because of its abundance of evidence-based research. After two weeks of research, I found tons of evidence-based medical journal articles (over 25 years worth) related the results and complications of the Roux-en-Y procedure. While the sleeve gastrectomy (SG) procedure, only had around 10-15 years of research. There are many weight loss surgery options out there, such as the adjustable gastric band, duodenal switch, and single-anastomosis duodenal switch, also called stomach intestinal pylorus-sparing surgery (SIPS). Each of these procedures offer different levels of malabsorption and/or restrictiveness.

After attending a gastric bypass information session, I called my insurance company and inquired about gastric bypass surgery coverage. My insurance company explained to me that a mandatory three-month (90-day) physician-monitored diet was needed before weight loss surgery could even be considered. The insurance company would also require progress notes from the physician each month, for a total of three progress notes. I guess this method solidifies to an insurance company that you have exhausted all other options, and that the surgery is your final chance at weight loss. The insurance company also wanted a letter of recommendation from my primary care provider. Oh, I also had to obtain cardiac clearance for surgery. Cardiac clearance included: a 12-lead electrocardiogram (ECG), echocardiography (ECHO), cardiac stress test, repeat stress test, and many many co-pays and deductibles.

Remember that whole research speech from before? Well, I later spoke to my surgeon about these findings and he revealed that many insurance companies often only approve Roux-en-Y procedures based on its comprehensive research versus the sleeve technique. My decision was based on these research variances and my personal preference weight loss goals. I was looking for a surgery that would make my stomach as small as possible. Clearly, willpower was something I was lacking and had been lacking for many years. I was looking for maximum malabsorption and maximum restriction. This procedure was my choice. I accepted the lifelong vitamin (and mineral) commitment, along with obvious eating restrictions.

Vitamins are my life and will be yours too if you choose this same path. Due to the procedure (and it's malabsorptive nature), post-operatively you will need supplements. Supplements, plural and plentiful. Daily, I take seven pills (and one thyroid pill). I take a multivitamin twice a day; calcium twice a day; iron, B12 complex and Co-Q-10 once a day. The GI tract can interfere with the absorption, or some supplements neutralize each other (hindering absorption entirely). Consequently, you can't consume your pills all at once. Timing is critical and will determine if you truly absorb what you need to. If you do not take your vitamins, you could have nutritional and neurological dysfunction(s) that could be permanent. I take a B12 complex pill daily, but a monthly B12 injection is required. Pills and injections are a part of the deal.

Oh, and I hope you didn't think you would be consuming pills whole right after surgery? Because, umm no. After the surgery (for a month), I had to consume powdered vitamins and minerals. They were chalky, gross and made everything I mixed them in taste like runny glue. That was the worst part for me, being post-surgery and feeling completely helpless. I thought I had made the wrong choice. I was laying there in pain, drinking gritty vitamins, eating popsicles, sipping chicken broth from medicine cup thimbles and throwing up if I drank too quickly. Everything was painful and a struggle. Did I do the right thing? What had I gotten myself into?

Fast forward two days later and I knew I had made the right decision. I was walking the halls of the bariatric floor, and I was a new version of myself. It noticed my body was responding and changing. I was breathing better; I wasn't sluggish, and I had a new found energy about life. I would NEVER "just walk" before the surgery. It was too difficult. But now, I wanted to move and had the capacity to do so. Surgery is a big deal, and you must consider the positive and negative aspects. You must factor in your pre-existing conditions and whether or not surgery is worth it. Only you (with the guide of your physician, of course) can determine if it is worth it.

Yes, I wanted to lose weight, but that wasn't the full representation. I wanted to be healthy. I wanted to see my son's children and grow old with my husband. It wasn't about vanity. It was about being healthy. Without this surgery, I wouldn't be off most of my medications or have the ability to play with my son at a park. You take for granted being able to walk up a flight of stairs without taking a break or gasping for air. When you're 260 pounds, you know exactly how difficult tasks such as these can be. They are exhausting and painful. Your bones hurt, your skin burns, you feel everything. Yes, this surgery was an extreme decision. It's not for everyone and has its own set of complications. But I chose to live and be better for my family.

Now let's talk about what's happening today. I'm a year out (so I can finally enjoy a drink), and this is where things get tough. After the year mark, your body chemistry normalizes (metabolism wise), and the weight loss starts to slow down. From what I was told, the malabsorptive properties tend to decline after the first year. The body has a new "standard" and has now reset the bar. The junk food binges will have consequences now. And by binges, I mean five spoons of ice cream. Don't get it twisted, my stomach is tiny-tiny. But I still have cravings for unhealthy food choices. Early in the post-bypass journey, I could have a little junk food and still lose a ton of weight. Not anymore, fun time is over folks. If I'm over on carbs that day, no weight loss for me. That phase of eating whatever and dropping 10 pounds a week is over. The positive habits you form in the first year must become routines. They must become a part of your life. Gastric bypass surgery is a tool, not a key. You CAN gain weight. You CAN gain all your weight back. Surgery isn't magic dust, and this isn't a movie. You work hard, and you will see results. But if you continue eating unhealthy items and/or grazing (eating tiny portions over longer periods), you will gain weight.

So that's the story. I'm 80 pounds lighter (October 2016), I workout at least five times a week and I monitor what I eat ALWAYS. I've stopped using food to express my emotions and sought treatment. Sometimes, it's not even about the food. It's about the feelings we carry and process from within. Don't knock therapy. It's pretty awesome to understand why you are the way you are and how your childhood has affected your life. I now have a healthy relationship with food and consider each meal fuel instead of an event. Don't get me wrong, I love good food, but it doesn't run my life. I no longer fixate on eating. Gastric bypass got me here, and I'm grateful I did my research and found a procedure that worked for my family and me. If you're considering surgery, I recommend you do the same.

Surgery Rundown
Keith C. Kim, MD - Awesome Dude!
Florida Hospital Celebration Health
Obesity Medicine & Surgery Institute
410 Celebration Place, Suite 401
Celebration. Florida 34747

My Starting Weight: 261 lbs.
My Current Weight: 178 lbs.

Surprise Surgery Finding
Hiatal Hernia - Repaired

POD #2 - Severe Chest Pain, Dyspnea
- MI & PE/DVT Workups Negative
- Symptoms Resolved Spontaneously
- Probably R/T Gas From Procedure

POD #15 - Trouble Swallowing, Food Stuck
- EGD Declined, R/O Esophageal Stricture
- Symptoms Resolved Spontaneously
- Probably R/T Not Chewing Thoroughly

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