Introduction

[Note: The entries in this diary appear last in first out, after this Introduction.]

This is my diary of my experiences with weight loss surgery. I use this general term, because there are two (actually more) types of weight loss operations: gastric bypass or lap-band. But, I am getting ahead of myself. Click to see more...

[Note: in the rest of this blog, you will see the "Click to see more..." message at the end of each posting. Many times,there is actually nothing more. So, at the end of those posts, I have proceeded the "more" link with "End of post, so don't ...".]

Friday, September 26, 2008 I had my first set of appointments in the preliminary examinations for Weight Loss Surgery. Here are the facts:

• Weight: 343lbs (350lbs with clothes on, but I will use 343 as it seems to be my body weight set point)
  
• Height: 5' 11"
• Body Mass Index: 47.8 (non-overweight BMI: 18.5-24.9)

(go to BMI Calculator to figure out yours)

The standard qualifications for WLS patients are a BMI > 40 and an age between 18 and 65. I qualify.

I had an electrocardiogram which was judged OK, but there was one little dip where there should have been a rise and so, since I am 61 I am scheduled for a stress test to make sure everything is OK.

The subject of the appointments I will have, ending with a meeting with my chosen surgeon, are:

• Two seminars on Weight Loss Surgery
  
• Blood work
• Introductory meeting with Bariatric nurse
• Introductory with director of WLS program at BIDMC
• Ultrasound to determine if I have gallstones
• Stress test
• Nutritionist
• Psychologist
  
• Exercise physiologist
  
• Surgeon

i.e., extensive.

On my application to the Bariatric Surgery Program at Beth Israel Deaconess Medical Center, my answer to the final question of "Tell us about yourself..." was:

My primary reason for wanting to get control of my eating and consequently my weight is because I am fearful of all of the adverse health conditions that have accumulated in my body due to being significantly overweight in the last 15 years. Yes, there are many activities that I no longer can do because of my excessive weight. Things like walking, hiking, enjoying the adventurous aspects of traveling. Then there is the self-loathing that results from my lack of discipline to "just eat less" and my appearance.

I'm pretty smart and that has worked against me. Although I was very successful in loosing weight in Overeaters Anonymous, after a while I started to fail because I started to ignore the advice that "Thinking is not on of the tools of OA". And indeed it has taken me several years to fill out this form, because after I investigated everything there was to know about weight loss surgery, I thought "Why go through that? I can always exercise the discipline that you will need after the surgery and loose weight without going through the surgery." The only problem is that I never got around to exercising the discipline, and so the weight stay on. I have finally realized that all of this intellectualization has resulted in me weighing 350 pounds and on the verge of diabetes, the third or fourth medical condition due to my obesity. My biggest fear is how to deal with the stress I currently relieve by medicating myself with overeating. Then, of course, there are the unknowns about what it will feel like after the surgery, and the well publicized surgery complications.

Having said all of this, I want you to know I am both enthusiastic as well was watchful about what I am going to do. Please wish me luck.

Harry

P.S. Why did I choose the name "Reboot" for this blog? Well, in computers when the machine starts to perform badly because of the accrual of lots of junk, mismanaged memory, rogue processes, etc., the best thing is to reboot the machine and start from scratch. I find this a metaphor for what I am about to do regarding my eating: lots of bad habits, reasons for eating, out of control behaviors. The best thing is to start again with learning how to eat and WLS surgery is the only 100% foolproof way to do this. -- HF

3 Week Checkup 1/29/2009

Last Thursday I had my 3 week checkup, and all went well. Everything seems to be healing and working as intended.

First, I met with Dr. Henry Lin -- a surgical fellow at Beth Israel Deaconess. Dr. Lin came by when I was in the hospital and is very thorough young doctor who came in my room with a small team of, I am going to guess, residents/interns.

After making sure I was progressing as needed, he started to ask me questions about what I had done in the past. There is no better way for a doctor to flatter a patient than for them to change the topic of conversation to something special to the patient, different from the medical reason being addressed. I remember my father being flattered when his doctor asked him for investment advice.

Apparently Dr. Schneider told Dr.Lin about our conversation about my early involvement in the Internet and Dr. Lin introduced me to his team as someone who was involved in the early days of the Internet and proceeded to ask me a lot of questions about those experiences. Nice bedside manner.

In any case, in the 3-week checkup appointment, Dr. Lin asked me a lot of questions about how I was doing. One interesting piece of advice he gave me was to leave the dining area after 20 minutes. The issue is that at about 20 minutes of slow eating I will sense fullness -- but this too will pass and if I am still around food, there will be a desire to satisfy hunger. He warned me to avoid grazing because this can defeat the purpose of the band. Obvious once you hear it, but very good advice.

No one was surprised by my lack of sense of change in either my hunger or any sense that anything was different: in fact, this was the desired effect and I had indeed healed properly from the operation. Initially, I did feel some increased sense of being full after eating small amounts of food, but this was because there was swelling around the site of the placement of the band. Gradually as this healed, the swelling went down, and my food passages returned essentially to their pre-surgery dimensions. The prednisone that I was taking for my attach of gout also contributed to the cessation of swelling.

This effect can be seen in my weight loss graph to the right. For the 3 months prior to the operation (actually more accurately one month prior) I lost weight the old fashion way: by will power alone. Then I had the operation and my esophagus and upper stomach where the band was placed was swollen, constricting the flow of food to my main stomach. So, I lost weight at an increased rate. Then, when the swelling went down, my food passages were as they were before the operation, I am hungrier than immedately after the operation, and consequently I ate more and the weight loss slowed down -- it hasn't stopped, but is more gradual. So, I would expect to see this small rate of weight loss due to choice of diet, not hunger attenuation, increase at the end of February when I get my first "fill" -- when the surgeon injects the first amount of saline solution into the band. It will take a couple of visits before we get the exact right amount so that I do not feel hungry while still eating a reduced amount.

The bottom line is that now I have an "implant" -- the band -- that is ready to be activated at my next appointment at the end of February.

I next went up to radiology where I had a test to make sure that everything was working properly. I drank a liquid containing Barium which provided a high contract liquid that a continuous xray could follow the flow down into my stomach. This all proved that there were no leaks and that the band was in the right position. I was even able to see the band -- although it was much fainter than the liquid.

Finally, I met with Kelly Moore, the bariatric nutritionist who went over the Stage 4 eating plan, which introduces a number of new choices and textures.

This was all over in about an hour and 15 minutes, which was fine with me: with the positive review of my surgery, I was eager to move on to our next adventure, leaving for Florida the next day. End of post, so don't ...