I've never blogged before but I'm going to give it a try. This is basically me trying to work out whether to have another weight loss surgery (got a band in 2008) and, if yes, which one. It will probably be extra long and all over the place.
To be honest, I've pretty much decided to have another surgery. I hate it and it terrifies me but after 40 plus years of fighting and losing, its becoming pretty obvious that diet and exercise aren't going to work. And I'm just so tired of fighting every day and never winning. And I'm not just mentally tired. I'm physically tired, also. I can barely get myself up for work in the mornings. I'm sucking air like a fish out of water just walking from the car to the office. My knees and hips hurt. Somehow, I've managed to aggravate/pinch my sciatic nerve while sleeping (yes - sleeping!) twice just this year. I know I've been very lucky up until now with being this heavy and not having too many medical problems. But I think that is changing. Forty four years is just too long to put this much weight on my poor joints and bones and heart. I can only hope I haven't done so much damage that I can't come back from it.
As I said, its felt inevitable for some time but I just got back from vacation with family I hardly ever get to see. There are so many things this weight keeps me from being able to do. I'm constantly stressed over where I can sit/fit and can I walk that far and that fast. I hated slowing everyone down. I even had to take a rest while walking to a restaurant. Granted, it was hilly and three blocks but no one else had issues. Just me. Everything I do is impacted by my weight. In fact, everything about me has been shaped by my weight.
I haven't told too many people yet but once I get the insurance approval and the appointments start, I will tell everyone close to me. When I got the band, I kept it a secret from my co-workers and cringed whenever family would try to discuss it. In fact, I still don't really tell anyone. I'm really very ashamed at my failure with the band. I think I don't tell people about the band because I don't want people to know I'm fat. As if they can't see me trying to bust out of my size 26/28 clothes. Also, I think it was sort of a fail safe for me - if I don't tell people, they won't see if/when I fail. This time, I'm going to be open about it and take away my ability to deny everything after the fact.
I'm also going to start seeing a therapist to help with my food issues and binging. I am hopeful that the surgeons office will have someone to refer me to. I think this will be very important for me. If I could do this alone I'd have done so by now. I'm also thinking maybe some medication to help with mood swings and cravings.
When I first decided to consider another WLS, I was not really aware of what the sleeve was. I thought it was just another new type of gastric bypass. So now I'm trying to decide which WLS would be best for me. The gastric bypass truly scares me. Re-routing intestines just seems like playing with fire. If we didn't need them just like they were we wouldn't have them in the first place. I like the idea of the sleeve. Cut out most of the stomach and hunger hormone. No hunger and a tiny stomach. My cousin got the sleeve and has lost 200 lbs in 3 years. She says she often forgets to eat cause she's just not hungry. Wow - what is that like? Just the idea of not being hungry makes me hungry (yeah, I'm broken). But the sleeve is restriction only and I already have a restriction only device inside me. I was hungry immediately following my band surgery and it never made me feel full, just sick but still hungry.
For my own decision making purposes, below are some questions I think I need to address in order to make a decision:
1. Do I want to be normal sized or just not so fat? Weird question, I know, but a friend of mine had the gastric bypass a few years back and lost so much weight the docs wanted her to gain 20 lbs, She is a couple of years younger than me but she looked so old. Nearly twice her age. BUT, she had a lot of bad complications and is/was very malnourished. Maybe a sleeve would allow me to lose enough weight to get healthier but not too much. Yes, I'm very vain. I'm not sure, though, that going through surgery to maybe lose a little weight is a good idea. If I'm going to have surgery, why not go big and try to lose the majority of my excess weight?
2. Can I give up food? This should be number 1. A tiny little voice in my head is telling me this is the real source of my fear. Food is my ultimate frenemy. Seriously, I only just gave food the title of frenemy yesterday. I smoked for over 20 years and quit 10 years ago. To date, that is the hardest thing I've ever had to do. But to give up food - the thought terrifies me and nearly brings me to tears. When I think of it, I think of an episode of My 600 lbs Life about Lupe. She is 39 years old and immobile. She's nearly died a few times. She hides food and binges. Food is her comfort. Because of her heart issues, she gets a sleeve instead of gastric bypass. At one point, she asks out loud if she can give up food because its been her comfort for so long. I think about her asking that a lot. For her, it wasn't just maybe food was killing her. It had already tried a couple of times. Food has such a hold on her that despite the knowledge, she was still asking if she could give it up. I realized watching that episode that I would have to give up food if I have surgery. I don't believe I can have both because food (my frenemy) wants me to be sick and tired and die young. I will definitely need the therapist for this one.
3. What will I do without food? Breakfast. lunch and dinner are currently the highlights of my day. What will I do without them? I'll need something to look forward to and concentrate on. This is probably where the therapist will come in handy.
4. Can I handle the post surgery diet? I'm going low carb on Monday to sort of get ready for eating high protein after surgery. Not the same, I know, but close. Sort of. I diet well for a limited amount of time and then I start to slip, eventually binging on all the forbidden foods. I've never been able to maintain the momentum of a diet, though. I lose interest. Get tired of it. Confuse myself by reading about a different kind of diet and then fall off and into a binge.
5. If I choose gastric bypass, will the fear of dumping be enough to keep me away from my fave foods - cake and cookies? This probably goes with #2.
I'm scheduled to attend a WLS seminar on 16 April. I can't wait. The surgeons office said its about two weeks after the seminar before you get an appointment with the surgeon. I feel like he would recommend the gastric bypass due to my BMI of 59 and because it would be a revision from the lap band.
My health insurance currently offers a free weight loss coaching program that I am participating in (not successfully). It uses the DASH diet. I'm wondering if they would consider that to be medically supervised. Also, my primary care docs office has a weight loss program I'm doing. Maybe that would also count. Not that either have really helped me much. They've actually been kind of non-starters for me. The one through my insurance allowed me to get weight loss drugs at a lower cost but they didn't really do what they were supposed to do so I didn't continue. Definitely my insurance has records of my weight issues, though.
So my seminar is this Saturday and I went ahead and filled out my patient profile packet yesterday. It was pretty long and asked me why I thought I was unsuccessful in the past and why I think I'll be successful this time. Not really hard questions but they got me thinking.
Why was I unsuccessful in the past? My friends and I (all professional dieters) have a saying about weight loss -- when I'm on I'm on and when I'm not I'm not. Maybe we aren't all that creative but we're basically saying that when I'm motivated, I can pass anything up and am a model of control. But when that motivation fades or I'm not "feeling it", I pass nothing up. In fact, I grab extra for later and just in case. I've been like this since I first started dieting in my teens. I lose interest/motivation, get tired of not having what I want, decide "I've got this" when I really never do have it. The sad thing is I can rarely get that motivation back for that particular diet once I've fallen off. I think my body treats diets like a virus and develops antibodies against it. Underneath all that, of course, is my food addiction. Yep, I'm an addict. And like all good addicts, I can quit for a while but I always go back for my fix.
A few years back I started going to Overeaters Anonymous (OA). I am currently 44 years old. Prior to my 40's, I would have said I was not a food addict. I didn't really eat all that much, I just have a slow metabolism and bad genes. Then I went to my first meeting and realized these were my people. They weren't all heavy like me (some were quite slim) but they were just like me and I was just like them. That was such an emotional shock. My whole life I thought I was alone and then I discovered I wasn't. I did really well in OA but then I quit going and quit following my eating plan. I have yet to successfully get back to that eating plan. It was such a great eating plan, too. I created it myself. I lost maybe 30 plus lbs but in OA, losing weight is secondary to controlling the overeating so I didn't sweat the weight loss, I was working on not overeating.
I learned a lot in OA --- that I wasn't alone, that I didn't need to eat until I was full - just until I wasn't hungry anymore, that food addiction is a progressive disease, and that even when we are most in control of our eating, our addiction is in the corner lifting weights and getting stronger. I also learned that just about all OA'rs fall off the wagon. Repeatedly. I tend to forget the good things I learned but I never forget that nearly all of them fall off the wagon. So disheartening. It makes me mad that I have to have an addiction that I can't just kick for once and for all. Nope, I have to have a food addiction. The one addiction most people don't care about and don't really consider much of an addiction. In fact, most people joke about it. Don't get me wrong, though, OA is a wonderful program. I wish I had never quit going. It was such a stupid and childish reason.
I don't live in a large city but I live very close to one. I went to my first few OA meetings in that city but couldn't continue making that drive so often so I started going to a local meeting on Saturdays. This meeting consisted of 3 people. Four people once I started going but I think we only had all 4 show up just once. It wasn't a very good meeting and one of the members would stare at me the whole time. It made me so nervous and anxious. I should have said something but I didn't want to embarrass anyone. Usually I would just stare at the reading so I didn't have to see this person staring but one meeting, I had plans immediately after and texted my friend to say when I'd be there. The member who continuously stared at me interrupted the reading to ask that I not use my phone during the meeting because it was distracting. Of course, I was embarrassed at first but then I got really angry. This persons habit of staring distracted me terribly and yet I said nothing and here he had the nerve to say I distracted him with my phone. Of course, I never said anything. I just didn't go back. Showed him! Not very mature, I know.
My history worries me that I won't be able to do this no matter what surgery I choose. So often I give in to my food addiction in all its sneaky and not so sneaky ways. I hate to admit it but sometimes I don't even fight, I just give in. Yes, I plan to start seeing a therapist to help with my food issues but that is not an overnight fix. I'm playing with the idea of going back to OA (not the same local meeting, though!). Maybe they have a better online presence than before. I'm afraid that whichever surgery I choose will not curb my hunger. I can't stand to be hungry. It makes me feel sick and consumes my mind.
I think if I were to ask my friends and family if they thought I could do this, most would answer no. Oh, they would support my efforts but they've all seen me start and stop so many diets and lifestyle changes. After all, I already have a lap band and that didn't work. Granted, only one person aside from myself really understands what happened with the lap band. She got hers right after me and had so many problems it was removed a few years ago. She's going to the seminar with me for support and because she's the most level headed person I know. I trust her to not get overwhelmed or confused with stats or data (I'm easily confused). Okay, one of my other friends might not be so supportive but I don't expect support from her. She generally takes every opportunity to remind me that she lost (and regained and lost and regained) her weight the old fashioned way - hard work and exercise! That's okay, I've lost and regained more than her over the last 30 years using the same methods. I'm just more tired of it than her.
One of the other questions was why I thought I would be successful this time with the drastic diet and lifestyle changes. I answered that I would be seeing a therapist and spending a lot of time with the nutritionist. Which is true. I kind of feel like I know myself and WLS better this time. When I got the band, my reason was that I didn't want to be40 and still be fat. A good reason. I did a lot of reading on the lap band and felt that I would be successful because the band would get rid of my hunger and that would allow me to focus on working on my food issues. I knew I would have to work out still and watch what I ate but I would get full faster and not be hungry. Win! Of course, for various reasons it didn't work out like that and here I am, heavier than ever, trying to decide if yet another WLS is right for me and whether or not I'll just fail the same as I did with the lap band. Can I be stronger than my food addiction? Not just for a few months but really successful?
Went to the WLS seminary on Saturday. It was scheduled for one hour but was closer to two hours. It started with a sleeve patient a year or so out who had lost all of his weight. He told us about his journey and it was quite inspiring. He started by saying nothing works until you get your mind right. Which I thought was an awesome way to start out. After all, the surgery is not on your head it is on your stomach. He was followed by the surgeon, who was interesting and answered lots of questions. He started with a video with information on obesity that is fairly new to me (and here I thought I'd heard all the theories), basically stating that obesity is caused by hormones, especially ghrelin. The bariatric coordinator spoke last and I didn't get a very good impression of her. Probably because she acted kind of annoyed when I asked a question.
So, the seminar was good. It was a very good day overall. My friend came with me and we had a very nice day discussing surgery and everything else while shopping.
Overall, the seminar didn't really scream a decision at me. The surgeon does all types of WLS so he mainly presented facts about each. I have, however, begun to think that maybe WLS isn't my answer. I've struggled with why this would be different than the last one and how not to fail again. I had decided to see a shrink, a nutritionist, maybe get some drugs and, most recently, go back to OA to help me with my food issues on top of WLS. On Saturday, my plan was definitely go back to OA and see a shrink and nutritionist (I really don't like drugs) on top of WLS. Now, though, I'm thinking OA, a nutritionist and maybe no WLS. I did go ahead and submit my packet, though. The bariatric coordinator said they'd contact me in maybe two weeks to set up a day for marathon testing. Among other fun stuff, she mentioned an EGD. While I don't like the idea of having something shoved down my throat, after 8 years with a band, its probably a good idea to have it done.
So, no rush for me on WLS. I'll go through with the certifications but for now, I'm back in OA and already feel a little of the calmness and a lot of the hope returning.