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

Questions for my first checkup

My report is that things are going well, but I understand that what I really have done is recovered from the installation of a surgical implant and now that device needs to be activated and used in conjunction with diet and exercise to start significant weight loss.

Nothing worse than listening to an enthusiastic patient talk about his/her operation. If you really want to read my punch list of things to ask my medical team (surgeon, nurse, nutritionist) on Thursday 1/29/2009 when I have my "3 week" check up, click below.

Topics to discuss:

1. Lack of Significant Feelings of Fullness
   
   1. Some fullness, but still get hungry
   2. Is this to be expected?
   3. What is the progression on filling the band?
      
2. Gout
   
   1. Is there a cure? Diet? Medication?
      
   2. What should I do when I detect an attack? How to relieve pain when it happens?
   3. Suggestion: In the future, mention this to patients before the operation.
      
3. Medical Contacts in Southwest Florida
   
   1. What do I do about Gout attacks?
   2. Who do I contact, where do I go if I feel I am having problems with gastric band?
      
4. Next stage eating
   
   1. Nutrition: Protein vs Gout -- sources of protein to reduce gout?
      
   2. Specific Foods:
      
      • Fruit: Types? Citrus?
      • Bread: no? Pasta: no? Pizza: no? Rice: no? Sushi: no?
        
      • Salad?
      • Carrots?
      • Decaffeinated vs caffeinated? Tea, Coffee?
      • Trailmix: Raisins, Seeds, Nuts?
      • Hamburger, Ground turkey, Chili w/ground meat?
5. Upper part of stomach
   
   • What actions to I need to avoid so as not to stretch the upper stomach and possibly dislodge the band?

End of post, so don't ...

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Response to a Nice Message

Anne,

Thanks for your kind words. In my Reboot blog, I am trying to share all that I experience -- a hopeful story but a real story where I talk about the inevitable ups and downs of a long term behavior change aided by a surgical implant. I can assure you that the emotional lift of feeling that I have finally taken some believable action, coupled with the knowledge that there is still a lot of hard work to do, is a great motivator to succeed. By going public I have committed to my friends my resolve to succeed. That is turning out to be very helpful to the entire process.

[...]

Go Sox,
Harry

End of post, so don't ...

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Weight Loss So Far

So, how am I doing? Well at my first appointment in late September, I weighed 343 --a weight I have held for sometime.

By the time I had the operation on Jan 5, I weighed 330.

Today two weeks post-surgery, I weigh 319.

I don't think the weight loss in the last two weeks is very realistic or real. Rather, it is the result of the impact of the surgery, a very restricted diet of mostly liquids, and possibly some dehydration. So far, I don't really think the band is much of a restriction. My reduced eating is a combination of the shock of the surgery, my initial will to control my eating, and perhaps a slightly lower desire for food. I'm trying to keep my view of this to not be euphoric because this kind of reaction has not put me in a realistic place for long-term weight management.

The following chart is dynamic in that as I loose weight and enter it into an online spreadsheet, this chart will be updated. Pretty cool. Day 0 is September 25, 2008. The first infection [editor Alex McKenzie: make that inflection] point in the blue line is the date of the surgery, January 5, 2009. Day 116, is today's date, January 19, 2009. The red line is my goal.

End of post, so don't ...

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First Support Group Session

The Beth Israel Deaconess Medical Center Bariatrics department holds bimonthly meetings to support their patients who have gone through Weight Loss Surgery. I have been to many support groups in the past relating to weight. Probably 2-3 years of Overeaters Anonymous, and a little bit of Weight Watchers. Of all of the tools I've used before to loose weight, support groups have been the most effective -- but my conclusion has been that they are not enough. Thus my conclusion to have weight loss surgery.

Well, back to my first session after my lap-band operation. I arrived at just about 6pm and found the group in one of the large conference rooms on the first floor of the Shapiro building. To my great surprise and pleasure, there were 6 women and, get this, 6 men in the group. Plus June Skoropowski, one of the BIDMC nutritionists.

Here are some observations:

• Nice group of people. Completely different tone than OA meetings in that there was considerable hope expressed in the group. It wasn't as weird as OA meetings used to be. These were ordinary people, with ordinary strengths and weaknesses. I don'[t mean to pull down OA -- it is a wonderful organization. It's just that in this support group, there was no need to have the group think that goes on in OA.
  
  
• WLS patients have exactly the same issues regarding food as other dieters: it is still hard to control ones eating habits. Much of the meeting was spent talking about various psychological forces at play in people who are overweight.

I liked the tone of the meeting and I will go back when we return from Florida -- the next one is not until we will have departed for Naples. End of post, so don't ...

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Pretty Much Recovered...

Sorry, I have taken so long to make a post here. It turns out that it has taken me about a week to really get back to normal.

Status report: I am feeling much better and all of the little (at least they seem little now...) issues I first had seem to have resolved themselves. I can see a clear path ahead of me.

A couple of days ago I started exercising on my new exercise bike and it was great. Am taking it gradually so as not to hurt anything after not exercising for a week or so. This morning got up at 6am and rode while watching morning news. Worked pretty well, and I got my exercise over with early.

Last night I went to a meeting of the Board of Directors at LexMedia and this morning I went back to my morning coffee group at Peets. So, I'm back.

What's next? Well until January 29th when I have my 3 week checkup, more of the same: keeping hydrated, drinking high protein drinks, blended cottage cheese (it's the lumps that make cottage cheese palatable :-), plain, fat free yogurt -- I actually like plain fat free yogurt -- it has a tartness that is different. I tried decaf coffee this morning and the results were not good... But after talking with the nutritionist this afternoon at BIDMC, I discovered that my tolerance to this will return.

Thursday night is my first (and only opportunity for several months) to go to a post-op support group, which I will do. Not sure whether this is going to be good or not, but I'll give it a try. I have several other options for group support, including OA.

Finally, I know that I am feeling better because I am starting to do the things I really like to do -- including surfing the web and finding all of the wonderful things you find there. Today, I found two really interesting things:

1. MUTO - An Ambiguous Animation, an animated drawing on a wall which blew my mind because it was a series of still photos put back to back to form a 6 minute evolving picture. It isn't just a time lapse movie, but rather a movie essentially painted frame by frame as graffiti on urban walls. Amazing:
   
   
2. The details about how graphic artist Scott Hansen created a poster for Obama, from initial conception to final proofing at the printers. Very interesting -- or at least to me. I have always wanted to expand my abilities in graphics arts and plan to do some with this while in Florida. This website shows how a real graphic artist goes about this business.

In any case, trusting that things go OK, I'll probably not make many entries until the end of the month. End of post, so don't ...

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Back Home, Returned to Reality

I felt really good in the hospital. The biggest pain was the awkwardness of the IV. Getting out of bed wasn't a big deal. Everything was new and I thrive on change.

I came home from the hospital yesterday afternoon and back to my normal surroundings While moving around the hospital was pretty smooth, riding home in a car on normal roads with their inevitable bumps and pot holes was a different story. And switching from the on-demand morphine to the liguid Oxycontin/Tylenol was a step down in the pain relief department.

Bottom line is that I have to work a little harder to manage the pain of the incisions -- but this is only day 3. I am expecting this to improve with time. Patience...

Sipping 96 oz of water a day is going to be a challenge. Let's see, 96 oz times 8 sips per oz makes 768 sips per day. No more chugging down a cool one for me. In fact, no more cool ones for me: carbonated is a no-no and although alcohol is not prohibited, it seems to be highly discouraged.

OK. Those are all of the negative thoughts for this morning...

I am currently sitting in our wonderful explorer's room -- Ben's room reclaimed when he got an apartment in Brighton. Modeled after various explorer's clubs, adventure club, Yale L&B library, Yale Club (NYC) library rooms we have come across over the years. No stuffed animal heads, but rather various souvenirs we have bought over the years of traveling, plus a lot of guide books. We have several pieces of mission-style furniture and I am sitting on a big old mission arm chair. Quite comfortable because it allows you to sit with your back at a slight angle back. Good for tummies that have a lot of small incisions in them.

The Operation

Marsha, Will and I set off at 6:40am on Monday morning for Beth Israel Deaconess Medical Center in Boston. We got there exactly at 7:30 when we were supposed to be there. The receptionist handed us one of those hockey puck pagers they hand you at a restaurant. "They" would page us when they were ready for us. An hour and 10 minutes later, our hocky puck went off. We went up to the 5th floor and after calling in on the telephone, I was lead into the operation preparation area by a nurse. Marsha and Will had to stay in the waiting room for now. Various nurses and doctors came by and asked me a lot of questions. Then Marsha and Will came in and we waited another hour. During that time, my surgeon, Dr. Schneider, came in explaining that the first surgery of the day took a little longer than expected.



Manny (pre-dreadlocks), Dr. Schneider, and Red Sox Scholar Gerard Widzaire
aDr. Schneider looks quite young, although he isn't as young as he appears. Most importantly, he has a lot of great experience in doing Wieght Loss Surgery and General Surgery. I told him that taking his time when performing surgeries was fine, I hope he hadn't rushed on his last operation -- the implication being that he wouldn't rush on mine... So, my operation that was supposed to happen at 9:30 actually started at 11:30am.

While I was waiting, the nurse gave me some sort of relaxant, but I was already pretty relaxed. The anesthesialogist said was he about to give me the anes...

The next thing I remember was waking up in the recovery room, a little groggy at first, but then quite comfortable and cheery. The operation lasted about two hours. At that point Dr. Schneider came into the family waiting room and talked to Marsha and WIll, saying that everything had gone fine. Meanwhile down in the recover room, I guess I was still out of it because I don't remember much of the next three hours. I think some of the assistant Drs came by, in particular one very nice Dr (I think Dr Li) that I had seen in the preparation bay.

The next thing that happened was that I was brought up one floor to my room -- which was a single room -- very nice! Will and Marsha arrived shortly after and it was great to see them. I wasn't feeling any pain... W&M left at around 6:15pm. I watched the 6:30pm news.

At around 8pm Ben came by and after going for my first walk, he and I watched a reply of the BC - UNC Basketball game where BC beat the #1 ranked, previously undefeated UNC. Vert sweat. When that was over, I walked Ben out to the elevator.

The nurse installed a self-administering morphene dispensor into my IV. This worked very well. It regulared things so that I could give myself a small dose that lasted six minutes. The dispensor was regulated so that it would only respond once every six minutes.

I went to sleep at about 10 pm and although I woke up several times during the night for vital signs readings, I slept quite well.

Tuesday morning I went onto "Stage 2" food -- instead of water only, I could expand to flavored water. Wow!

Dr. Schneider came it at around 9am and said that everything had gone fine -- that the 13 pounds that I had lost had helped a lot when navigating the band between the stomach and the liver. We talked about the followup appointment and he was gone.

Marsha came in at about 11am, and to make a long story short, we left the hospital at about 1:30pm with instructions and perscriptions.


I think most of the excitement is over now and we are entering the long hall part of the process. I spent a lot of time getting to my current state. I am assuming it will take some significant time to get to a better place.

-- Harry

End of post, so don't ...

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The Night Before ...

People have been calling me all day with good wishes for tomorrow. This feels really good and I am so glad that I went public with what I am doing.

My brother-in-law, Larry Baker, made the astute observation that I was clearly being so public because I wanted to make a commitment to my friends to succeed in this effort to loose weight. And he is right: Having going on many weight loss efforts in the past and assured myself that I was committed to loosing weight, this time I wanted to up the stakes and state this commitment out loud to the people who matter to me.

I went to church this morning (as in "there are no atheists in foxholes", although I am far from an atheist) and sang at the last minute with the choir.

This afternoon Will and I put together our new Schwinn Recumbent Exercise Bicycle which I can use for exercise on those days when the weather is not good for riding outside. So, here is are two pictures of my exercise stock:


For Nice Days


For Not So Nice Days
I'll be going into the Hospital at 7:30am, with the operation at 9:30am.

So, I feel have all of my ducks in line and eagerly await tomorrow.

A while back, I expressed my desire to add a little humor to all of my verbiage. My friend Richard Homonoff came through with a reminder about where my head has been for the past 30 years:


End of post, so don't ...

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Call from Surgeon

Yesterday my phone run and it was my surgeon, Dr. Schneider, calling -- not his secretary, but he himself. He asked if I was all set for the operation on Monday. We talked about the examination of my throat which I had had because I was concerned with a swallowing problem I sometimes have. (I had already concluded, and it was verified by the examination, that this was mostly likely a spasm that happened when I was nervous and ate small things too quickly). He was very careful to make sure that I was still convinced that the lap-band was the right operation -- which I was.

We chit-chatted a bit more about how I felt about things, etc. The bottom line was that I came away from that conversation feeling good about my choice of surgeons.

Two days from now, I will be in the hospital, recuperating from the operation. Right now, I can't wait. I've been anxious about getting on with all of this. Although I had some sleeplessness earlier in the week, last night I slept very well -- better than usual.

So, all in all, I'm ready. End of post, so don't ...

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