Introduction
Well, it’s done. As I write, it’s Saturday, day five
post-op, and I have some time to reflect and compile. I had bariatric surgery
done. It was a big step, and it will mean a lifetime of changes, hopefully the
gross majority of which will be for the better. So, how did I get here? What
happened? Well, I will start almost 30 years ago.
The Issue
I’ve been big almost my entire life. I’m currently 32 years
old. As a small child, I was a healthy size and active. Then, at age 4, I broke
my right tibia and fibula. This was in the era before boots-for-breaks, so I
was stuck in a cast for quite a while. I couldn’t go out and play, work off the
natural energy. I was forced to learn to be content being still, doing
activities like reading or watching television. Also, I was in a lot of pain,
and I lived in a society where “comfort food” is a byword. The two combined, I
learned a lot of bad habits which I was never quite able to break (not for lack
of effort) and set me on a path to obesity.
Fast forward through an obese childhood, adolescence, and
adulthood filled with various diets, cures, methods, tricks, books, exercises,
groups, plans, supplements, drugs, machines, deprivations, and suggestions from
well-meaning supporters, all which failed, to my current state. At the
beginning of this part of the journey, late August this year, I was about 530
pounds. I’ve been measured as high as 550, though I may have gotten higher at points.
I wear t-shirts in a 6XL. Dress jackets necessitate a 72/74 inch chest size,
and shirts require a 24 inch neck. Pants require a size 62, though the actual
size is larger due to vanity sizing. I have a 23 inch inseam, and I’m severely
knock-kneed, my legs having adapted to support my immense weight. At 5’11”, my
BMI was 73.9, well into the NIH’s “morbidly obese” range. One might even say it
was a “DAYUM!” on the Iglesias Scale. Something had to be done.
Why Surgery?
In short, it was the last option. As I said before, I tried
a very wide variety of methods to try and lose the weight. However, there was
at the center of all those techniques two inextricable components: my willpower
and my physiology. One worked for my goal, and the other worked against.
I had willpower and desire to lose the weight. Anyone who
knows me knows that I can be more stubborn than a tree stump. Push me too hard,
and I will push back simply out of spite. If willpower alone was the only independent
variable in the equation, I would have licked this years ago. Unfortunately, they
body has a say in the matter, too.
The human body, through evolutionary design, wants to be
fat. I know this sounds strange, but consider: human beings evolved as
hunter-gatherers for millions of years before the agricultural revolution.
Prior to that, we ate what we got when it was there to be gotten. The body
stored any excess for when food wasn’t as available as body fat. As such, the
ancestors who responded more readily to this desire to stock up and store had a
greater likelihood of surviving periods of famine to pass on their genes. They
responded in this manner because the body adapted incentives to encourage the
behavior: namely, sugar and fat, those concentrated sources of calories, TASTE
GOOD. They trigger all kinds of feel-good chemicals in the brain when consumed
to the point of fullness and satiety. These incentives and responses occur
completely independent of rational human thought. Therefore, humans have a
natural tendency to consume fat and sugar whenever it’s readily available and
stomach space exists.
Fast forward to modern times. We no longer live in the
feast/famine world that our bodies evolved to survive. You can get a quarter-pound
cheeseburger at 3am on any Sunday in the middle of winter, and that cheaply. You
can get bread and cakes and confections just as easily. Science has made leaps
and bounds over the last hundred years or so with regards to preservation and
transportation, making “out-of-season” almost a thing of the past. Yet, fat and
sugar still taste good. For many, our bodies have not yet adapted to dampen the
evolutionary impulses to stock up. This may be one explanation for the obesity
epidemic: everything’s too available.
This is a lot of exposition, but I wanted to be clear in my
reasoning as to why the body worked against the goal of weight loss. As to my
current situation, my willpower, while strong, was unable to override millions
of years of genetic programming. I needed something to counteract the body that
didn’t depend on my willpower.
Notice earlier I said that the desire to consume was
dependent on stomach space being existent. It turns out, doctors know what
causes the feeling of fullness/satiety. There is a nerve at the top of the
stomach, where it joins the esophagus, that, when contacted, imparts a “full”
signal to the brain. For a feeling of long-term (about 6 hours) satiety, this
nerve needs to be continuously triggered for 25 minutes. This makes sense: when
you have eaten enough, the food bounces around as the stomach churns and
digests it, constantly hitting the nerve. The solution to overriding the body’s
desire to overconsume, therefore, lies in triggering that fullness feeling
sooner. Enter gastric bypass.
The Operation
Bariatric surgery comes in a couple different flavors, with
varying degrees of risk and effectiveness. Each one has the same goal: to
reduce the amount of food necessary to contact the fullness nerve by reducing the
amount of available space in the stomach. One of the more popular ones is the
lap-band. Simply put, an inflatable band is attached around the stomach near
the base of the esophagus. This is fairly low risk, reversible, and adjustable
post-op, but also relatively low results. Next is the sleeve, where a section
of the stomach is simply cut out and removed. Better results, but it’s riskier
and irreversible. Third is the most effective and the first developed: the Roux-en-Y
gastric bypass. For this, the bulk of the stomach and upper small intestine is
cut away and sealed shut. The small remaining part of the stomach, which is
still attached to the esophagus, is connected directly to the small intestine,
bypassing the duodenum. See http://www.webmd.com/diet/weight-loss-surgery/gastric-bypass-surgery-for-obesity for a picture.
Because I was already so far overweight, my doctor
immediately set aside any notion of a sleeve or lap-band: the results would be
insufficient, and the risks of the bypass have been mitigated through
experience. So, we set about for a full bypass.
The Process
This was not a short thing. I didn’t show up to the doctor’s
office on Friday and have an appointment for the following Monday. As I said
before, this portion of it started back in late August. I say “portion” because
I’ve had this decided in my mind for several years: I’ve just never had the
wherewithal to see it done until now. (Thank you, federal benefits!!) I’ve done
copious research on the whats, whys, and hows, of this whole thing. Indeed, I
started on it during the second year of my dissertation at Missouri. I attended
seminars, read journal articles, and generally did my homework. I decided then
that it was the right course of action for me. Unfortunately, grad-student
insurance sure as hell wasn’t going to cover it, and the cost of doing this procedure
sans-insurance is prohibitive: about $15,000. I attempted a crowd-sourcing
thing through Facebook (Indiegogo wasn’t a thing, yet), but failed to raise a
single dollar. So, I decided to carry on and bide my time. In the meantime, I
graduated from Missouri, moved back home, got a job in D.C., moved again, and
here I am.
Once I took a little time and got settled in, I decided that
I had waited long enough. I first checked out the doctors in my area. There
were a few close to home, so I dug deeper and checked credentials. The guy I
chose, Matt Fitzer, was a bit of a drive away in Reston. But, he had the creds:
thousands of operations performed, numerous awards, and a fellowship at
Missouri with the doctors I originally scoped to do mine while there. I found
out later that he was derby-girl approved, having worked with Dethblok of the
CoMo Derby Dames. After I decided who would do it, I sat down with him and laid
things out. He had me watch a couple webinars detailing the process and
answering questions. Then the other shoe dropped: I had to lose 25 pounds to
get this done.
Dafuq?
I thought the whole point was to have this done so I didn’t have to diet, to pit mind versus body in
yet another failing battle. Turns out, he needed the room to work. The
procedure is done laparoscopically, with instruments inserted through small
incisions doing the work. This drastically cuts down recuperation time. To
enable him to get the tools in and have them move around, I needed to shed some
layers, make a little working room. So, he put me on caffeine pills.
In the meantime, I met with his nutritionist to go over the
post-op diet. More on that later. I also had to get a cardiac clearance,
bloodwork clearance, and general primary-care-physician clearance. Fortunately,
my ticker’s fine, my blood is clean, and the doc was happy. Dr. Fitzer also
generally includes a psych eval as part of the process, but, I think he decided
it wasn’t necessary given my own credentials and through discussions with me.
In addition to all this, I still had to get clearance
through my insurance. Fortunately, I had inadvertently fulfilled all their
requirements already. They wanted a six-month nutritionist/registered
dietician/doctor supervised dieting period to have occurred in the last two
years. Also, they wanted three months of dieting overseen by the surgeon
himself immediately before. I saw a nutritionist while I was at Mizzou. I got a
letter from MU Student Health detailing the dates, and sent it off to Aetna.
Dr. Fitzer’s office handled the rest, and I was go for launch, almost.
Things on the weight loss side were a little sketchy at the
end. See, I knew I would have to be on a clear-liquids diet for three days
pre-op. So, the fourth day, I said my goodbyes to big meals by having one last
go: a nice filet mignon done medium rare, fried shrimp, steak fries, baked
potato soup, and a slice of chocolate cake to top it all off. I figured the
pre-loading would help me stick to the clear liquid diet better. It also pushed
me a bit further away from goal. Fortunately, I was close enough on the day of
surgery to proceed.
Surgery Day
The day itself went like most surgeries under general
anesthetic, insofar as I don’t remember most of it. But, there were standard
things like getting to the hospital way too early, meeting with the anesthesiologist
and the doctor, getting hooked up to an IV, and putting on the gown that leaves
your ass hanging out the back.
After surgery itself, they kept feeding me narcotics for
pain relief, since anti-inflammatories would cause stomach upset, which we
really didn’t want. I finally got them to stop that nonsense and just give me
straight Tylenol, so my head could de-fog. I met with the doc’s assistant a few
more times while there, and they held me for two nights for observation, making
sure I could drink enough to be sent home without getting dehydrated. Now I’m
home, and working on getting back to living normal life.
The New Norm
Now that the surgery is done, I have a new way to approach
eating. I’ve got a very strict diet to follow for the first two months after
surgery, to ensure I heal properly. More clear liquids for the first week,
followed by toothless-person food (grits, oatmeal, applesauce, cottage cheese)
the second. Tuna, scrambled eggs, and toast are added in the third. Starting
week four, I begin to really start getting back into real food: eggs, fish,
cooked veggies, soft fruits, beans, and oh-thank-God-finally pasta. At week
seven, the leash comes off and I can start adding things in, experimenting.
Everything will be in very small portions, and there are four basic rules to
follow.
1) Spread meals out over 25 minutes, and eat three meals a
day. No skipping.
2) No drinking anything 15 minutes prior and 45 minutes
after a meal.
3) Make the majority of the meal a protein source.
4) Avoid sugary liquids.
There are other things, and countless minutiae, but I will
save you from those.
I want to thank everyone who has offered prayers, well
wishes, or even just kind words on my journey to this point. I think this will
change me for the better once it all pans out. As it stands, I am hopeful for
the future.
