I'm feeling really good today. Like I've said, every day is better than the one before. I had my follow-up visit with the doctor this morning, and he's happy with how I'm progressing and how my incisions are looking. I'm down 15 lbs according to their scale, 20 according to mine. 15, 20, whatever it is, I'm on my way. I just got back from taking my daughter Chloe for a walk to the library. Felt good to get out for a walk. I walked around the block a couple times yesterday, but it was chilly and raining so not too pleasant. Much nicer out today.
Well, I bit the bullet and posted a note on Facebook about the surgery. I woke up at 5 am and couldn't sleep, and all I could think about was getting it off my chest. I spent the next 2 and a half hours working out what I would say. I created the note, then shared it to my wall with the following statement - "Dear friends, please read the attached note in its ENTIRETY before passing judgment. I hope for your support. Thank you, Joe"
Here is what the note said:
On Friday March 8, 2013, I had a surgery called 'vertical sleeve gastrectomy'. This is a bariatric weight loss procedure. This was not a decision that was made lightly, or hastily. I will try my best to outline my reasons for doing it, what it is, and reasons for not telling anyone.
Reasons for not telling people
First, I want to say that I was originally planning on only telling a very select few people about this. But I realize that this is probably not very realistic, as the changes will probably be pretty significant, and pretty quick. I've even outright lied to some people, including some of my coworkers and bandmates, which I am very uneasy about. I hope they will forgive me. Please don't be offended if you were not one of the people I chose to tell beforehand. My main reason for choosing not to tell people beforehand was that I didn't wish to invite any negativity, or have anyone trying to put doubts in my head as I had already made the very difficult decision and none of that would have been helpful to me. Every person I did choose to tell had the exact same comment - "you're not THAT big." I appreciate the 'compliment', and suppose I got pretty good at hiding it. Before surgery, I weighed 274 lbs. I'm sure this number will probably shock most of you, as that seems to be the universal reaction. Another comment I heard was "you could do that yourself". There have been times I've been able to shed decent amounts of weight, only to put it all back on, and then some. And each time I would do this, would make the next time even harder. I also REALLY didn't want to hear anyone say to me that I was 'taking the easy way out', as no doubt some of you reading this might be thinking right now. This would have done nothing but anger me, and would have jeopardized our friendship. Believe me, there is nothing easy about having surgery. I'm still recovering, and wouldn't ever want to relive the first 24 hours. It is still going to take hard work and exercise to get to my goal and maintain it. This is only a tool to help me achieve that goal.
What it is
There are basically three main types of weight loss surgery. There is the gastric bypass. This was never a consideration in my mind, as I view it as being a last resort for extremely overweight people, and there can be a lot of malnutrition involved. I was actually scheduled for the lap band procedure, as I know a few people who have had it done, with varying degrees of success. After hours and hours of further research, I decided against this. Basically, the lap band is a device that is implanted and placed around the entrance to the stomach. The band gets filled with saline so that it inflates and restricts how much you can eat. The 'temporary' aspect of the band (the fact that it can be removed if any issues arose), was the biggest plus to me initially. The more I read online, the more I saw people not happy with the lap band, and having it removed and getting the procedure I had, the vertical sleeve. Some issues with the band include slippage, erosion, and the long-term maintenance (you have to go periodically for 'fills' to adjust how much the band is filled). Some people just could never find what they call their 'green zone', the perfect level of restriction where they are restricting enough to lose weight but not so much that they are vomiting after 2 bites. Also, insurance concerns crossed my mind - would insurance cover the fills forever? What if I moved or had to change doctors? All of these things pointed me in the direction of the vertical sleeve. The vertical sleeve is the newest of the three types, and is basically a laparoscopic procedure where up to 85% of your stomach is removed, leaving you with a sleeve about the size of a banana. Basically, you are then restricted to eating between 3 and 5 ounces at any meal. You can eat pretty much what you did before, only MUCH less. Some people find that they don't tolerate certain foods after surgery, or don't like the tastes of some foods they liked before. It is a permanent solution. The weight loss results are comparable to the bypass, typically very good. Another benefit of this surgery is that the part of the stomach that is removed is the part that produces the hormone grehlin, the hunger hormone, so feelings of overwhelming hunger go away. People say that they go from eating extreme amounts of food and never feeling full before surgery, to having to remind themselves to eat so they can get in enough calories after. The fact that the lap band was 'temporary' and could be removed at any time, was what made it more attractive to me initially, and seemed less 'drastic'. But the more I thought about it, the more I realized that I needed a permanent solution that would help me make the lifelong changes I needed to make. Wanting something because it was reversible, enabling me to go back to the way I was, no longer made sense to me.
Reasons for getting surgery
First and foremost, I did this for my wife and kids. I don't want to leave them without a husband and father. Sure, I'm not happy with how I look, but looks were at the bottom of my list of reasons. I would have been perfectly happy to continue to eat 5-6 slices of pizza and being upset that there wasn't any more because I still didn't feel full, and watching my weight continue to rise every year. I 'know' what the right things and right amounts to eat are. But 'knowing' and being able to stick to it because you never feel satisfied are two very different things. I never smoked or drank or did any drugs. Food was my drug, and it was negatively affecting my health. Besides weighing 274 and growing, I had a BMI of 36, which is considered obese. I have high blood pressure, high cholesterol, erosive GERD (acid reflux), shortness of breath, a leaky heart valve, and what my doctor says is the second worst case of sleep apnea he's seen in his office. If you don't know, sleep apnea means you stop breathing for significant periods of time, which lowers your blood oxygen level, and the 'jarring' that occurs when your breath comes back could cause your heart to go into a deadly rhythm. So basically, I was a ticking time bomb that could die in my sleep at any time. I have a machine called a CPAP machine that helps me breathe at night, but I've tried it and find it impossible to sleep with it. I'm actually getting a new one today that my doctor says is easier because the air pressure level automatically adjusts based on what you need at any given moment, instead of being set at a fixed level that sometimes seems like too much and would wake me up.. I plan on giving it a try, and hopefully once I lose a significant amount of weight the sleep apnea will disappear. I also hope to be off my medications. Most people who get the sleeve are able to get off their medications and are cured of their sleep apnea. I've seen stories of people being cured of type-2 diabetes (which I thankfully did not have, yet) the day of surgery. Amazing. The apnea and medication for blood pressure, while being the result of being overweight, also become self perpetuating problems. They limit my energy level, which in turn limits my activity level, further adding to the obstacles to weight loss on my own.
How I'm doing
The surgery went well on Friday. The surgeon found a fairly large hiatal hernia, which he repaired while he was in there. The first day was basically Hell. I was in pain, discomfort, had a hard time taking deep breaths, and was extremely tired. All I wanted to do was sleep, not only because I was tired but because I wanted to avoid the discomfort. They pump your belly full of air during the procedure to maximize the space they have to work, and this air leads to gas pain which radiates to your left shoulder. This gas pain is no joke. Every day gets easier than the one before it. I am on a clear liquid diet for 1 week, basically limited to water or crystal light, broth, sugar free jello, and sugar free ice pops. I also need to drink protein shakes until I can start eating foods with protein. They want you to get between 60 and 80 grams of protein in every day, and if I can't get all of that in from food I will have to continue with the shakes. At first, it was very hard to get in the fluids, due to swelling. Very small sips. That is getting easier by the day. After 1 week, I progress to a few weeks of a puréed diet, eating mushy foods. A blender will be my friend for this phase. After that, I can start introducing some 'real' foods, slowly to see what I can tolerate. They still want you to concentrate on getting most of your calories from lean proteins and vegetables, limiting sugars and starches. I welcome my new relationship with food. It will no longer be something that I do for pleasure, consuming unlimited quantities. Instead it will be something that I will have to be conscious of, sometimes reminding myself to eat so that I can get in enough calories to sustain good nutrition and fuel my body. It will be a big change, for sure. I continue to feel better every day. The pain is basically gone, limited to what I would describe as a 'tightness' feeling at the incision sites. I had 7 small incisions, which should leave minimal scarring. The first step out of bed or off the couch is the hardest, because of this tightness, and my fear of twisting or stretching anything the wrong way. I'm walking well, just a bit slow at the moment. The tightness also makes it impossible to sleep on my side or stomach right now, limiting me to my back, which is the worst position for my sleep apnea. To counter this, I've found that sleeping upright on the couch with my feet up on an ottoman is the best for me. I tried piling pillows on the bed to elevate my head, but found that it was pushing my head forward, further restricting my airway. I will get my new CPAP machine today, and look forward to sleeping in bed with my wife again tonight. As of this morning, I've lost a total of 20 lbs, including 9 lbs lost during a strict one week pre-op diet.
I am a very private person, who doesn't like divulging personal (potentially embarrassing) information, as I've done at length here. I only just decided to write this after waking up at 5 am and not being able to fall back asleep. I hope for all of your understanding and support, and 'friendship'. I welcome any questions or comments, either under this post, or in a private message, or in person. I do not welcome any criticism or cruel comments or jokes (even lighthearted ones, as I might not view them this way). If that is your inclination, please refrain from commenting, or go ahead and remove me from your friends list. I apologize for ending this on such a down note like that, I just want to make it clear how serious I am about this. Thank you.'
So far, I've gotten all positive comments from people, except for one person. He used to be a close friend, but we grew apart in recent years, but are still friends on Facebook. It's been years since we've talked, even on Facebook. He said he was hurt that I didn't contact him, because he had weight loss surgery also and could have helped me in my decision. I had no idea he had surgery, and told him that and asked him how I would have known. We sent messages back and forth, and he still was upset, saying stuff about how he's sick of putting himself out for other people only to get nothing back (paraphrasing). I told him that I was disappointed that he chose now, a time when I'm reaching out for support and understanding, to make it about him and his hurt feelings that our friendship isn't what it used to be. Whatever, I can't worry about that now. I need to take care of myself at this point in time.
I believe anyone that has 85% of their stomach removed will lose weight. You can't help but lose, if you are limited to 4oz of food every few hours.
Now the big question is, where is your hunger coming from? Only you can figure that part out. Is it from emotional eating, boredome, stress, or is it because you have hunger pangs caused by the hormone ghrelin?
From my own experience, I knew that my hunger was real (even though I had eaten 2 hours earlier, I'd be hungry again). It wasn't until I talked to my surgeon that he told me that I had an excess of the hormone ghrelin (produced by the stomach). The bigger the stomach, the more of the hormone produced.
The surgery stopped my hunger pangs. I have not had that nagging sense of hunger (other than my stomach growling) since surgery 7 weeks ago. And 4 or 5 oz of food keeps me satisfied, whereas before, I could eat 1 lb of steak and know I'd be raiding the fridge in 2 hours.
And I don't have any cravings anymore for certain flavors. Whereas before, I'd think about something that would taste good and I couldn't get the thought out of my head until I ate it - and a lot of it, not just a small portion.
Don't get me wrong, you can sabotage yourself after surgery. There are foods, called slider foods, that are calorie dense (ice cream, peanut butter) that pass through the stomach quickly, so it's possible to eat more. And it is possible to just graze all day on snacks that are high in calories.
The sleeve gave me the control over my eating that I needed. When I eat, I have full control of what I eat. I can pass on the donuts or just have 1 and be satisfied. With the exception of pasta - it triggers my sugar cravings. So I have to be real careful about eating it.
But I don't know if I'd the same success if my hunger was tied to my emotions instead of hormones.
I really believe food was an addiction - one you can't quit and never touch again.
Other addictions can be quit and never touched again. But what if a heroine addict, smoker or alcoholic knew they had to take some every day or their body would die?
What if they had 75 TV channels that ran commericals for cigarrets every 10 minutes during their favorite programs? Or had reality programs (like the best places to pig out or the food challenges) devoted to the best places to get their fix and showed people taking drugs and loving it? Could the addicts just reduce the amount they took every day and never over do it or would they give in to the nagging voice in their head telling them how good it was going to feel?