Reboot

When food is difficult to get, I loose weight...

2009-10-28T10:00:00.006-04:00

Marsha and I have just returned from a 25 day trip to Denmark and Sweden. I lost about 10 pounds. This is partially due to more exercise, but mostly due to me not having access to food as easily as I do when home. This is a pattern. When we travel, I loose weight. I guess the conclusion is that I need to travel more :-) And exercise more :-( End of post, so don't ...

Almost 6 Months

2009-07-03T12:26:00.005-04:00

It is two days shy of 6 months since I had my operation. Recently my goal has been to have lost 50 pounds by then and I am happy to report that I weighed 293 yesterday morning. Of course my weight varies a lot over the course of even a single day and so I was lucky to catch the scale at the right moment, but I'll take what I saw.

During that 6 months I have to say that I wasn't convinced that this was all going to work as I had imagined until about 3 weeks ago. That is when I truly felt that the amount of food that I was able to take in was restricted. And still I have these thoughts of "Why am I so weak that I can't loose weight unless someone/thing puts a strangle hold around my esophagus preventing me from swallowing food?" But, success in loosing weight eliminates those feelings of defeat. I don't care to be negative when the positive results of getting control of my eating feel so good.

The actual success I have had in the last three week gives me positive feedback that improves my thoughts around food, and that is what I need. A classic feedback loop in a linear system -- although the body/mind is far from a linear system. But, I digress into my Electrical Engineering / Mathematical background.

When I graphed my weight loss today, I see that I have entered the weight loss zone of 1 to 2 pounds per week, which is where I want to be. From what the surgeon said in my pre-operation sessions, there is no reason why the Gastric Band can't continue to be used to loose weight for a long time, and so slow but steady is the right way to go. The thing that will trip me up is if I loose trust and don't see results and stop being engaged with the weight loss doctors. I am not going to let that happen.

I am lucky that I am a person who thrives on the approval of others: this engagement and the reinforcement I receive from interactions with the medical staff at BIDMC is key to my success. End of post, so don't ...

Response to a Message from a Friend

2009-06-23T09:00:00.005-04:00

Dear Harry,

I just read the latest Reboot post. Congratulations on the continued progress.

It sounds as if weight loss doesn't HAVE to be continually on your mind with WLS as opposed to OA. I think that is better for your psyche; is that how you feel about it?

Not exactly It is continually on my mind, but I feel that I have more than my willpower helping me control my eating. The band makes it quite uncomfortable to overeat. And, it is taking me some time to remember this discomfort -- but it does work. So the negative enforcement works -- as does the positive encouragement of loosing weight and noticing that I look trimmer.

[You sound a little ambivalent about how much support is most helpful.]

I don't think as much support is needed if you have something other than willpower working in your favor. And, I believe that the OA style of peer support is far preferable to a support group lead by a "professional".

You are making progress toward your goal without the constant intrusion. I would guess that makes your dieting feel more like normal living rather than your feeling that you must constantly make a yeoman effort.

I only wish this were the case -- and it may come to be. But right now, it still feels like a yeoperson effort. I believe that this will be a continual effort that I will live with forever -- and that is OK with me, as long as I can loose weight so that I feel better.

The most debilitating, defeating situation for me is where I loose weight and then regain it. With the gastric band, I can see how this effect can be lessened.

Thank you so much for your questions and concern.

-- Harry

End of post, so don't ...

Not entirely understandable

2009-06-21T07:20:00.003-04:00

The reason there have been no updates is that things are indeed changing and indeed I am feeling fuller -- but it has not been an entirely understandable (to me) process. I had the fill 9 days ago. The first two days I was on a liquid diet and so I couldn't notice a change. Days 3-6 indeed I felt a predictable increase of fullness. Day 7-8 something must have gotten caught, because I felt full all of the time and couldn't eat much. I was concerned. Day 9 (yesterday) I started feeling as if food indeed was going down, and in fact was going down easier then days 3-6. I'm not entirely sure what that means.

Bottom line is that right now, I feel that the band is doing it's job and I indeed feel as if I want to eat less than I have in the past. In addition, my weight is indeed decreasing -- not as fast as days 7&8, but actually at the right rate -- somewhere between 1&2 pounds a week.

There is an interesting contrast in the Weight Loss Surgery (WLS) approach to weight loss and the Overeaters Anonymous (OA) approach.

With WLS, there are three components: the gastric band, sensible eating plan, and exercise. In some sense these are pretty easy in that there is not a lot of ambiguous territory: you are what you eat and how much you exercise. The band is an almost passive partner used to reduce your appetite.
With the OA approach there are also several components: a detailed food plan, daily contact with your sponsor, reading literature, multiple times per week meetings, readings about weightloss that go into the psychic and spiritual aspects of eating and the impact of over eating on yourself. There is no advocacy for exercise -- something which I find curious. With WLS there are support groups, but no where near as effective as the OA support group -- which is one of the most significant parts of the program.

I am clear in understanding how much I value and prefer the WLS approach. However, there are some aspects of OA that I still find useful: the reading about the impact of being overweight on both my physical health as well as how I feel about myself. I wish there were a stronger -- but perhaps not quite as strong -- patient support group. The Beth Israel Deaconess Medical Center (BIDMC) WLS support groups suffer because they are lead by BIDMC staff rather than by the patients themselves. I am also resisting organizing one myself because I am already doing too many things -- but I may decide to do this in the fall. End of post, so don't ...

The band finally kicks in...

2009-05-04T06:33:00.012-04:00

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.

A little confused

2009-04-06T18:15:00.005-04:00

We got home Friday from our 9 weeks away in Florida. While I was in Florida, I didn't have a scale which measured above 275 pounds and so I was in the dark about my actual weight.

I went back to Boston from Florida at the end of February and had my first "fill". Initially, I felt that my appetite was somewhat reduced -- but this was a temporary effect lasting about a week. Then, I felt nothing. Not much difference I could notice.

We got back from Florida Friday and when I step back onto the scale, I weighed 304 -- down 15 or so pounds. Amazing, but I must say, I don't understand how this could have happened because I wasn't eating a lot less than I normally eat.

In the leadup to the operation, people described how I would use a small plate and have really small portions and feel satisfied. The image of eating portions the size of an egg was presented. Well, that is not at all how I felt or saw.

In any case, I am very happy to have lost weight and will try to gain an understanding of why at my next meeting. End of post, so don't ...

A little discouraged

2009-03-11T11:10:00.008-04:00

I know that it takes a while to get the size of the adjustable band opening correct, but currently, after one fill, I have very little sense of appetite suppression from the band. I know this will be corrected in the future, but still, I am growing impatient to experience the effects of the band as it was described to me.

Although intellectually I know this all to be true, emotionally, I am getting impatient and discouraged. I don't believe I have lost much weight since the end of February and find myself thinking more as a "dieter" than as someone who has had some help from the band in changing their eating behavior. By "dieter" I am referring to the emotional feeling that I am going to eat a certain way for a while so that I can loose weight, using a combination of an eating plan combined with will power to stay on the diet. And then ...

What I am trying to accomplish is to change the way I eat food with the assistance of the lapband to lessen my appetite. I realize (now) that there will always be a planning component, and a will power component, and an exercise component, but each of these will be aided by the lapband component. And, that is the part that isn't working for me at the moment.

The image of people with lapbands eating off desert sized plates with tiny portions using tiny spoons and being satisfied just isn't my current experience... End of post, so don't ...

My 8 Week Checkup & First Fill

2009-03-01T15:26:00.010-05:00

Diver: "Will you fill up the tank?"
Gas Station Attendant: "Sure, and would you like me to check under the hood?"

That's what the language sounds like, but the experience is a little bit more important to me.

On Thursday, I flew back to Boston from Florida for my 8 week checkup since the gastric band operation on Jan 5. It was all pretty simple -- much less drama than the title sounds.

The first part of the appointment was a meeting with 2 other patients with June Skoropowski, one of the two nutritionists on the team. This was mostly an information session where we went over a new information package about Stage 5 of the eating plan -- that one that I will be on for the rest of my life -- such a harsh phrase...

After that, I met with Ben Schneider, the surgeon who installed the band. He asked questions about how things were going, how I felt, what my hunger was, etc. Then we agreed that he should do the first fill (and I had to sign some papers saying that if my insurance company refused to pay for the fill, I would pay for it).

The fill itself was painless, and over before it started. He inserted a needle into the port that is anchored just below the surface of the skin in the middle of my stomach. All I felt was a slight pinch and then a short pause while he injected the 3cc of saline into the port. And then it was over and he was putting a bandaid over the injection area. Easy.

[Note: This is not my X-Ray, but one that I found on the Internet]

Three days after the fill, I am now understanding, for the first time, the impact of the band on my feeling of fullness.

It is one thing to feel full, it is another thing to anticipate fullness before you stop eating. A new thing for me. Recognizing fullness coming on is still something I need to learn. This is why there is emphasis on eating sloooowly -- to allow your stomach's messages of fullness to register with your brain.

I am much more encouraged about all of this than I was before because the band is actually doing what has been described to me for the last 5 months. For a while there, I was feeling just as hungry as I have always felt. I was beginning to wonder, but I had been reassured that this was common prior to the first fill. Now, I know the feeling of fullness after eating a reasonable amount of food.

I still need to resign from the clean plate club. Seeing food on the plate does not mean that I have to eat it.

I am sure this was said to me during the build up to the operation, but I need to remind myself always: The gastric band is a tool which when combined with diet and exercise, can results in weight loss. This needs to be my mantra that I keep reminding myself of until I feel that I am "with" the program. It isn't something that I come to naturally. But I want to learn...

So, How are things going?

2009-02-20T02:22:00.009-05:00

Just an update on how things are going. There have been some big changes -- but not necessarily in the weight department. Rather, in the exercise department. Marsha and I have been in Florida since Feb 1 and we both are getting a lot of regular exercise -- bicycle riding, kayaking and swimming. This time of year in Naples is wonderful for exercising -- temperate days (75°-80°) cool nights and mornings (60°-65°).

The net effect is that we have both been getting a lot of exercise and it feels good.

Next week I return to Boston for 2 days and an appointment with my weight loss team where my surgeon will inject saline into the port for the first "fill" of the gastric band. Right now, I feel no change in my appetite, but expect that after the fill, I will experience a sense of being full faster at meal time. This is the effect we are after, and I know that it may take several attempts to get the right amount of saline so that I am feeling full after eating the right amount. So, patience is the word here -- and I appreciate that the slow, deliberate approach is being taken here. I don't want any mistakes...

Latest developments in Weight Loss

2009-02-02T16:46:00.010-05:00

Thanks to my relative Jeff Blaustein, here is a video summarizing an article that reports on two new techniques for controlling the amount of food metabolized by a severely obese person. The article appears after the "Click to read more..." break.

I imagine surgeons who have carefully built up a practice in one form of weight loss surgery have to constantly look over their shoulders to see which new techniques are being developed. If not, the entire fast moving world of weight loss intervention might blow on by them.

http://www.newscientist.com/article/mg20126936.300-gastric-condoms-could-help-obese-avoid-surgery.html

Gastric 'condoms' could help obese avoid surgery
by Peter Aldhous

GASTRIC surgery is a last resort for people who are dangerously obese. But there may soon be a gentler option in the shape of a removable device inserted into the gut though the mouth.

The EndoBarrier, developed by GI Dynamics of Lexington, Massachusetts, is an impermeable sleeve that lines the first 60 centimetres of the small intestine. In animal experiments and preliminary human trials, it reduces weight and rapidly brings type II diabetes under control.

Given the rising tide of obesity across the developed world, new treatments are a matter of priority. In the US alone, more than 15 million adults meet the criteria for gastric surgery because they have a body mass index of more than 40, or a BMI of 35 plus a complication such as diabetes.

While the operations do cause dramatic and sustained weight loss, their high cost and concerns about the risk of dying on the operating table mean only a fraction of those who might benefit go on to have the surgery. According to the American Society for Metabolic and Bariatric Surgery, around 220,000 people in the US had gastric surgery for weight loss in 2008.

GI Dynamics is not the only company working on alternatives (see "Wired for weight loss"), but its approach is appealing for its simplicity and low cost. The device, enclosed in a capsule, is inserted via the mouth using an endoscope. Once in place below the base of the stomach, the capsule releases a small ball that with the help of a catheter pulls a flexible sleeve made of the slippery polymer PTFE through the intestine. The ball is jettisoned and the sleeve fixed in place by releasing a spiked attachment made from the shape-memory metal alloy nitinol (see diagram).

The entire process takes less than half an hour, and the EndoBarrier can also be removed in less than 10 minutes by tugging on a drawstring to collapse the attachment device and pull out the spikes. The EndoBarrier is then pulled back out though the mouth.

At the Massachusetts General Hospital in Boston, a team led by gastroenterologist Lee Kaplan has shown that a miniature version of the sleeve causes weight loss in rats equivalent to a popular form of gastric surgery in humans, where food intake is restricted by an adjustable band placed around the top of the stomach (Obesity, vol 12, p 2585).

"We aren't doing anything to the stomach, so the patient can still eat normally," says Stuart Randle, president of GI Dynamics, who adds that some patients given gastric bands find ways to fulfil their cravings for more calories. "They can do a lot of creative things - basically putting food into blenders," he says.
We aren't doing anything to the stomach so the patient is still able to eat normally

Kaplan's team also found that the device caused a rapid reversal of type II diabetes, even before the weight loss kicked in, thought to be the result of changes in neural and hormonal signals sent from the gut. This also happens in patients given a gastric bypass, in which the gut is replumbed to miss out a large part of the stomach and part of the small intestine.

The weight loss triggered by the device is larger than can be explained simply through reduced absorption of nutrients, Kaplan adds. So that, too, seems to be driven mainly by changes to gut physiology.

Around 150 people have tested the device, with similar effects to those seen in rats. Randle says the total cost of the EndoBarrier, including installation and removal, will be around $7500. This compares to $15,000 or more for inserting a gastric band, or at least $20,000 for a gastric bypass.

More extensive trials will be needed to ensure the device is effective and can safely be left in the gut for long periods, says David Flum, who studies the outcomes of gastric surgery at the University of Washington in Seattle. "We don't really know what the implications will be."

But if the studies prove successful, many more obese people could have access to potentially life-enhancing weight loss treatment.

Wired for weight loss

BEFORE doctors knew peptic ulcers were caused by a bacterial infection that can be treated with antibiotics, one approach was to cut the vagus nerves to reduce the release of stomach acid. This had an interesting side effect: many patients lost weight.

Now EnteroMedics of St Paul, Minnesota, aims to treat obesity using an electronic device that blocks vagus nerve signals to the gut. This seems to suppress appetite, inhibit the expansion and emptying of the stomach, and reduce the secretion of digestive enzymes. "It allows patients not to feel as hungry and to feel fuller much sooner," says EnteroMedics president Mark Knudson.

The vagus nerves descend from the brainstem, branching out to organs including the heart and the larynx, as well as the gut. The EnteroMedic device blocks signals to the gut by electrically stimulating the nerves just below the diaphragm at a frequency of 5 kilohertz. The electrodes are connected to a controller implanted beneath the skin above the ribs. Radio signals both program the device and recharge its battery.

When the vagus nerves are cut the body tends to adapt so in time shed weight can pile back on. To prevent this, EnteroMedics' device blocks signals for 5 minutes, shuts down for the next 5 minutes, and repeats this cycle throughout the day. It is also switched off at night.

The cost of device, now being tested in some 300 obese patients, will fall somewhere between a gastric-band operation and the costlier, more radical gastric bypass.

© Copyright Reed Business Information Ltd.

3 Week Checkup 1/29/2009

2009-02-02T07:25:00.009-05:00

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 ...

Questions for my first checkup

2009-01-24T06:56:00.026-05:00

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:

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?
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.
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?
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?
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 ...

Response to a Nice Message

2009-01-23T06:56:00.005-05:00

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 ...

Weight Loss So Far

2009-01-19T22:25:00.009-05:00

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 ...

First Support Group Session

2009-01-16T17:48:00.002-05:00

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 ...

Pretty Much Recovered...

2009-01-13T15:14:00.008-05:00

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:

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:
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 ...

Back Home, Returned to Reality

2009-01-07T08:30:00.007-05:00

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 ...

The Night Before ...

2009-01-04T20:22:00.007-05:00

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 ...

Call from Surgeon

2009-01-03T14:20:00.004-05:00

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 ...

One week to go...

2008-12-29T06:22:00.003-05:00

Coming down to the wire. I am feeling pretty good about all of this. Not that I am 100% sure -- but that is the result of an active, questioning mind.

I am very happy that I shared what I am doing with my friends. The responses I received back were great! All of them very supportive and very helpful.

I need to figure out a way to add some humor to all of this: it wouldn't be like me not to find a funny side of all of this. I think there might have been a comic yesterday that might apply.

Food-wise, I have made it through one week of the two week pre operative diet, which wasn't that bad: three high protein meal substitutes and one "real" meal per day. Nice discovery: there are high protein bars that taste good and the frozen fruit/whey/yoghurt smoothy that Ben recommended is quite tasty. I could even recommend these for people not having surgery.

I also have been having a great time on my new crank forward bike: exercise that I can do without feeling as if my knees are going to come apart. This is going to be great in Florida. My knees and feet are feeling much better today -- perhaps due to bike exercise? Let's see if this continues...

This week I will gather together all of the literature I have been reading as well as all of the stuff recommended for the hospital and days after to make sure it is all in order. End of post, so don't ...

Message to my friends

2008-12-26T09:37:00.002-05:00

Yesterday and today, I sent out the following letter to my closest friends. Initially, when I started this, and not too sure about what I was doing, I kept most of this information to myself. Now that I have been through all of the screening and read a lot more about this operation, I am ready to go public with my closest friends.

Folks,

After having struggled with being overweight for many years, I have finally decided to do something about this. I have decided to undergo weight loss surgery -- the so-call "lap-band" operation. I have not come to this decision without considerable thought and research. As a result, I am very comfortable with my decision as well as the changes this will mean to my life and the lives of the people around me (you included).

Being comfortable with this decision doesn't mean that I am not anxious -- the grownup word for scared. Scared or anxious, I am still convinced that this is what I need to do to have a chance at living a better life.

I have already told some of you about this when we were able to have private conversations. You already know about this. Unfortunately because I have not been able to talk with others of you alone, I haven't been able to tell you this face to face.

Since September, I have been undergoing evaluation and tests at the Beth Israel Deaconess Medical Center in Boston for "bariatric" surgery -- the formal name for a set of surgical procedures intended to help morbidly obese (nice term, eh?) patients loose weight.

My evaluation has gone well and I have passed all of the tests -- it is really somewhat surprising to me that there haven't been more irreversible side effects of my being so overweight, but there apparently haven't. Don't get me wrong, I'm not in love with the sleep apnea, onset diabetes, knee pain, foot pain, low energy, etc, but these are at least mostly reversible with weight loss.

I have decided to have a gastric band installed laproscopicly -- or the so called "lap-band" operation.

I have been keeping a diary, recording my experiences with weight loss surgery. If you desire, you can find out more about this operation and my thoughts about all of this at:

http://www.forsdick.com/reboot/

I will keep this diary updated as I go through this process. In addition, I am happy to answer any questions you may have about this process.

At this point, I am not keeping this a secret so you are free to mention this to others. Sometimes I wonder if I am too open -- but that is who I am. I like to share what I am doing -- to talk about and discuss what is going on in my life. I think people understand this about me.

I will be in the hospital one night and then will come home. I am expecting the first couple of months to be a challenge -- and that is OK. Important to this entire process is exercising every day. To improve my chances of doing this in the Winter months, Marsha and I have decided to go to Florida for February and March so that I can be in a warm climate to build up my exercise habit. Ben and Will likened this to a Florida "rehab" session much like injured Red Sox players do before coming back to Boston to play. When you are a Red Sox fan, everything looks like a baseball...

Please keep me and my caregivers in your thoughts on January 5th when I will have this operation -- as well as for the rest of my life, as I am making a lifelong commitment to change.

Thanks,

Harry

End of post, so don't ...

Loosing confidence, limitless support and some small victories

2008-12-25T02:36:00.002-05:00

Last night as I was sitting in Church at the Christmas Eve service, I started thinking about some things that I had been reading -- not all of which were supportive of the decisions I have made about WLS. In particular, I started thinking about an article I saw on a website of a bariatric surgeon where a table indicated that Lap Band surgery was both more disruptive and restrictive in what you can eat, as well as less effective than Gastric Bypass surgery.

Then I read the whining of someone who was 3 months post Lap Band surgery and discouraged about her progress.

Together this put me into a funk about whether I was doing the right thing.

I decided to talk about this on the drive home with my family. I told them what I was thinking about. My older son shot back immediately that he was so relieved that I was going through with this operation.

His gut reaction reminded me that although this operation and the significant effort I will spend for the rest of my life is not going to be easy, my need to do this is not a vanity, but rather a requirement, if I am going to get my life back from the destructive results of overeating.

I thank my family for being straight and direct with me. It is so easy to get off track when thinking about this emotional topic and their unswerving support is going to help get me through the confidence dips.

On a brighter note, I am now on the 2-week pre operative diet which is really not too bad -- although as my wife points out, I have had a long time to get used to all of this and you, the reader, may think that some of the things I think are "normal" take some getting used to.

From now until the day of my operation I am eating 4 meals a day: 3 "meal substitutes" and 1 "normal" meal. The substitute meals are some form of high protean meal (a bar or a shake). I've found one brand of bar, Balance Bar Gold, that is pretty good. Still trying to find a shake that tastes OK -- with most of them the taste of whey is a bit strong for me.

I've actually lost about 13 pounds since I started the screening process back in September (343 down to 330) -- that is encouraging, although I am no fool on this weight loss stuff to think that if I can loose 13 pounds myself, maybe I can continue without the surgery. I've lost 13 pounds many times before -- in fact I've lost 70 pounds before, only to gain it all back. I am expecting the Lap Band surgery to help counter the "gain it all back" component of most diets.

I am also realizing that there are many elements of this that are just like the diets I have been on before -- that the principles of weight loss (control food intake & exercise regularly) are the same. The only difference is that my appetite will be decreased and controllable by the adjustments to the band.

When people say that this is taking the easy way out, they are quite wrong. This is no easier than going on a regular diet: it will be hard work. But the difference is that part of my limitless appetite will be decreased. The emotional appetite won't be impacted and I will need to concentrate a lot of effort to defeat that component of my overeating. End of post, so don't ...

Ups and Downs

2008-12-10T20:22:00.002-05:00

Monday I was down because I seem to be in this never ending cycle of injuring my legs (because of my excess weight), hurting, healing, feeling better for a while and then repeating the cycle. Today, I am on the mend -- but this isn't the first time I have gone through this cycle, and until I actually loose some weight, probably not the last.

Throughout the lead up to this operation, I haven't actually lost weight even though I have been doing this for three months. Not that I would be expected to do so. (I actually have lost a bit because if I loose a little before the operation, that will make things go easier).

But, I am ready for the loosing to begin, so that the other forms of recovery can kick in. It is difficult to think about exercising when most forms of exercise result in stress on joints. The two month trip to Florida will allow me to be in the pool a lot and this is a good place to start. Our new crankforward bikes will also be good devices for getting less stressful exercise.

I do find that writing about this forces me to sort things out from the random set of thoughts that go through my mind. Writing lets me make sense out of many disorganized observations and feelings. End of post, so don't ...

Exercise

2008-12-08T10:34:00.002-05:00

Exercise is an important part of weight loss with a lap-band. I hate to exercise on machines or in a gym. Better for me is exercise obtained by doing something else. My favorites are walking and bike riding

Recently, those have gotten difficult because of the pain in my legs (walking) and difficulty riding a bike due to my weight. It's a dilemma and I need to figure out some way to move off this difficult place.

Today, I am nursing a swollen foot that is due to some sort of stepping on it in the wrong way. This makes me a little depressed about my chances of increasing my exercise so that I get 30 minutes of walking for 30 days before my operation. End of post, so don't ...

One month to go

2008-12-07T19:15:00.002-05:00

I have started on a pre-surgery diet. For the next two weeks, I am on a pretty normal but somewhat restricted (for me) diet. It isn't a big deal to be on it, even though the surgeon when describing it understood the irony of asking people who clearly have problems dieting to go on one. But, it is relatively easy to go on any diet and loose weight -- it's keeping the weight off for a long period of time that is difficult.

On December 15th I will have my pre-operation examination where they will go over anesthetics to be used and some other stuff. After that appointment I will be on a significantly different diet: it consists of two meals of protein drinks and one normal meal per day.

Then several days before the operation (and for about 3 weeks after the operation) I will be on strictly liquid protein meals.

I know to someone not involved in this, what I am describing sounds wierd and extreme. But, I have been preping for this for 3 months so far and I am accoustomed to how my eating will change -- and change for the better. I know that this surgical procedure is only a tool to help me loose weight -- but it is the one tool that I have proven time and time again that I need: something to help me reduce my sense of hunger. I will still be changing the things I eat, and changing the amount of exercise I get. The major benefit of the lap-band is that I won't have that dreaded time when I overeat and then give up. I won't be able to overeat in the first place. End of post, so don't ...