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

The band finally kicks in...

Last month (April 9) when I went to have the band tightened (the new way I am going to refer to the process of filling the band with saline since most people don't get what I mean by saying that "I am going in for a fill") I had just recovered from the flu (not the H1N1 variety). As a result, I must have been quite dehydrated and my weight measurement was low. So, this time, when I weighted in I had actually gained weight. No problem: I also realized that the gastric band still was tight enough after the first tightening on February 26 to have any impact on my hunger. And, the same goes for the second fill on April 9.

So, last Thursday, I went in for a third tightening and that seems to have had an impact on the rate at which food can travel from the top part of my stomach to the bottom part -- and this indeed makes me feel full much sooner than before. I am quite hopeful that I will finally experience the intended results of having the band implanted in my body.

All of this focus on the band ignores that to arrive at a healthy weight, I do indeed need to change a number of things. The band alone won't do it -- and in fact, the tightened band requires some noticeable behavior changes. By this I mean some really deeply established eating patterns -- patterns such as the speed by which I eat my meals, the way I chew my food, and most importantly the amount of food I think I need to eat.

Hunger and satiety turn out to be complex sensations and the tightened band has driven that fact home. I find that visually, when I serve myself food, I still am thinking about portion sizes that would satisfy me pre-band installation. Those decisions are pretty basic, and having to intentionally think about how much I want to eat doesn't come naturally. Prior to having the surgery people said that a good technique for dealing with this is to serve yourself food on a dessert plate and eat with small utensils. Intellictually I understood what this meant, but behaviorally I didn't get it. It turns out that small plates and utensils are indeed useful, but I am working on intentionally changing my behavior, and that is difficult. I can see how I am going to do this, but it is going to take a little time to get used to my new stomach size.

I feel confident that I will master this new set of sensations.

Next I write about some issues that are a bit of an over-"over sharing" (i.e., this entire diary is over sharing), so click only if you want all of the details.

The consequences of failing to make this adjustment are not immediate, but they are quite apparent. By not immediate, I mean that I can still eat more than I need to feel satisfied, but for some reason, the message of satiety does not register immediately. The consequences of doing this are not pleasant. By not registering that my upper stomach is full, I overeat (even with reduced food intake) and start feeling as if things are getting caught in my throat. The remedy for this is to NOT drink water because that only makes the upper stomach fuller. The remedy ranges from walking around to help things readjust, to the equivalent of spitting up small amounts of excess food -- not as bad as throwing up because throwing up involves stomach acid and there does not seem to be any stomach acid coming from the upper part of my stomach.

Clearly this is not a pleasant situation and as a result, now when I approach eating I do so with these recent experiences in mind. It certainly forces me to think about how much I am eating no matter how good it looks or smells. But that is the purpose of the band -- to reduce the amount that I am eating -- and no one said it would be easy. I am certain that I will get beyond this situation and the result (weight loss) will be very satisfying. Worth a little pain.