ebert

Hi Everyone, I just got my stomach sleeved a week ago. I'm in phase one of my post-op diet, having crazy "head hunger" issues, and I thought I should do something productive instead of thinking about food I can't eat. So I'm going to explain how I got the sleeve in Osaka, Japan. This might be of interest in case you are (like me) a foreigner living in Japan, or if you are interested in how the Japanese pre-op procedures differ from those in other countries. Finding a Bariatric Surgeon (Nov, 2013) This was a hard part. If you've ever been to Japan, you've probably noticed that most Japanese people don't have significant weight issues. Obese Japanese people are very rare, as are foreigners in general. Because of this, I always assumed that if I were to get the sleeve surgery, I'd have to go to another country to get it done, which seemed really cost-prohibitive. Although I've wanted the sleeve for years, I labored under this impression (been in Japan almost a decade), but it turns out that's not the case. There are surgeons here who do the sleeve procedure. My employer mandates an annual physical, and every year the doctor told me useless things like, "did you know you are overweight?" and "have you tried taking 20-30 minute walks each night?" I don't blame the doctor--average checkup doctors simply don't encounter fat people very often, and they probably haven't studied up on options to help obese people. But because I knew that I'd be told these things again at the annual checkup, I googled "gastric sleeve Japan" and found an obscure article about a team of bariatric surgeons doing the procedure in Kyushu. I printed out the article, and before the doctor told me to try exercise, I gave him the printout. "I want this," I said. He looked at the article, told me he'd research it and get back to me. Less than a week later, he told me that, right here in Osaka, there is a bariatric team that does the sleeve. He gave me a referral, and a week later I had my first appointment. If you live in Japan and would like to find a surgeon, that's the way to do it. It would seem that living in Tokyo, Osaka, or Kyushu would be easiest, but if you live elsewhere you might still find a bariatric surgeon near you. Meeting the Bariatric Team (Dec, 2013) I went to Osaka University Hospital in December to meet the doctors. I had no idea what to expect, and I tried to lower my expectations by expecting disappointment. The surgery will be too cost-prohibitive because everything in Japan is expensive, or, They won't be willing to work with me because my Japanese ability will interfere with vital communication. Turns out I was wrong about both of those things. The head of the bariatric team told me it'd be possible, but only after a long wait--Osaka University Hospital mostly uses its Operating Rooms for severe cancer patients, and would-be sleevers often get their surgery dates abruptly postponed. As for the costs, I was told that my insurance would cover the medicine and hospital stay, but wouldn't cover the surgery. This was disappointing to hear, but when I asked him what the surgery would cost, he told me they generally charge about 500,000¥ (~$5000). That's not too bad, I thought. I also learned that the surgery cost could be split up into monthly payments, making it even more manageable. This was really encouraging news. Next I had to do an exercise test (to see how quickly my breathing rate would rise), a spirograph lung capacity test, a pee test, a CT scan, and countless blood tests and x-rays. They also weighed me at 168 kg (370 pounds). This was an issue--their medical machines are only safe for people weighing a maximum of 150 kg (330 pounds). This was a depressing irony--I was too fat to qualify for a surgery for people who are too fat. Instead of giving up on me, they gave me an appointment with a local nutritionist and told me to get my weight down. Working with the Nutrition Doctor (Dec 2013-March 2014) The NUT did an ultrasound on my heart, revealing that the veins and arteries of my heart were more swollen and large because of my size. He gave me a dieting book (to add to my collection of diet books) that he did primary research for when he studied nutrition in America. Although I was happy the book was in English, I wasn't terribly impressed by its insights--nothing revelatory. But the NUT also prescribed me Sanorex, an amphetamine designed to suppress my appetite and stimulate my metabolism. This pill was very effective--instead of getting hungry, I'd just get agitated and jumpy, but small salads left me full and my carb-cravings went way down. Unfortunately, the laws in Japan prohibit doctors from prescribing Sanorex for a period longer than three months in order to prevent people from getting addicted (three months on, three months off, three months on = OK). I didn't want my weight yo-yoing with some diet pill while I danced my way closer to 150 kg, so I worked hard and, by the beginning of March, got my weight down to 154 kg. The bariatric surgeon thought this was close enough, and on March 19, phoned me and told me my surgery had been scheduled for March 26. Surgery Preparation (March 24-26) My brother who lives in America also got the sleeve two years prior, with very good results. But from conversations with him, I knew that the typical procedure in America is to fast for two weeks prior to surgery. I thought this two week fast would be used in Japan, but nope. Perhaps this is the way all over Japan, or perhaps it's a policy of Osaka University Hospital due to their occasional postponement of sleeve surgeries in favor of more serious cancer surgeries other patients have. What I did have to do was admit myself to the hospital two days prior to the surgery. The American way of doing this procedure with just a night or two in the hospital is something that Japanese hospitals don't. They prefer much longer hospital stays--this could be an effort to get more money, or it could be due to extreme risk-aversion that is a characteristic of Japanese culture. They wanted me there two days before the surgery, and seven days after. I was willing to do two days before (especially in lieu of a two-week fast), but seven days after seemed a bit excessive to me. They agreed to shorten the post-op time to four days. I checked in Monday morning on March 24, and they hooked me up to an IV which "fed" me for the next two days. During that time, I did more X-rays, more blood tests, and an attempted gastroscopy which the doctor aborted because I couldn't stop gagging on the camera, even with heavy anesthetic. (I asked if they were going to try the gastroscopy again with heavier anesthesia or possibly even sedation, and the doctor said "nah," leading me to wonder why they even tried in the first place.) They also took me to the OR, where they tested me on the table. Turns out they weren't kidding about a 150 kg weight-limit. The table was designed for smaller Japanese bodies, and they had to do lots of adjustments so that it would accommodate my frame. Finally, the night before the surgery, there was a big "informed consent" meeting, with the head surgeon, anesthesiologist, head nurse, several other doctors, and a NUT. They even brought in a translator who worked in a different hospital two hours south. During the meeting, the surgeon explained the risks of the surgery and the NUT went over my post-op diet instructions. He also gave me a choice of bougie--36 or 40. I picked 36, asked a lot of questions, signed a bunch of forms, and that concluded the meeting. Afterward, back in my bed, the nurse shaved my stomach, gave me a potent laxative and, after my eventful bowel movement, a sleeping pill. I woke up the next morning around six. The nurse gave me an enema (first time for that--hopefully the last time). After that, I was escorted to the OR, where they strapped me onto their modified table and sedated me. The End (of the beginning…) And that concludes my epic account of the events leading up to my gastric sleeve surgery in Japan. Tomorrow, when I feel similar "head hunger issues," I'll probably write a similar recap of the week following the surgery, only I'll put it in the "post-op" section. I realize this post was likely too long and too detailed for most people, but hopefully some people found it interesting and informative. Perhaps others were able to use it to help fall asleep. I confess to being self-indulgent: writing all this down helped me stop obsessing about the food I won't be able to eat for a long time.

Nope, the NUT cautioned me against it … I thought it was strange too. I went in his office and told him about all the long walks I'd been taking thinking he'd give me a pat on the head, but instead he grimaced and told me to focus on putting on muscle. He told me a scary story about a lady sleever he'd recently worked with who lost a lot of weight in the year after her surgery. So she got the skin-removal surgery to remove her flappy skin. But then she starting putting on weight again and, because her stomach flab was gone, her abdomen fat started pushing out in strange ways, making her appear as if she had three sets of breasts. Yikes! After that experience as well as other research he's been doing, he's started advising his patients to focus more on muscle gain than fat-burning exercise. It might be a "ebert-specific thing" though. In the first week after my discharge from the hospital, I lost 9 kg (about 20lbs). While I was stoked, he thought this was slightly worrisome, hence his advice not to try to lose too much weight too fast. The following week I only lost 1 kg (2.2 lbs) which was depressing for me, but more in line with his expectations. In subsequent weeks, I've been losing about 3 kg a week (6-7 lbs). The bad news is that a lot of that weight loss has been in muscle mass, which I feel every time I go to the gym. Lifting exercises I used to do at moderate levels are now too heavy for me, and I've had to go a few steps back. Anyway, while I sometimes wonder if my NUT is a nut, he's really got me thinking that perhaps my journey isn't a sprint to lose as much weight as I can, but rather a more gradual process to lose weight at a healthy rate while toning my body at the same time. That seems fairly prudent to me. But everyone's body is different, so listen to your NUT, kids. (I guess…)

Hi Sleevie! I also just returned to the gym for the first time since my surgery, but my NUT recommended I exercise in a different way. He told me to avoid aerobic exercises (treadmill, elliptical, etc.) and instead focus on anaerobic exercise, specifically weight-lifting. He said the best way to avoid flappy skin is to pack as much muscle on as possible. But, I'm a guy with previous weight-lifting experience, and I live in Japan and there's not many sleevers around for the doc to compare me too.

I'm feeling good now. I lost 20 lbs originally, but now my body is in the dreaded 3-week stall. The Japanese docs insist on a slightly longer post-op diet--two weeks of thin liquids followed by two of thicker. Currently, I'm drinking fruit/yogurt smoothies for Breakfast and lunch, and blender-processed Soup or curry for dinner. The smoothies can be bought at local convenience stores, and I supplement them with whey Protein. I'll be really happy when I'm allowed to eat soft solids again in 10 days. As for exercise, my NUT is really insisting on anaerobic exercise, not walking or biking. He's prescribed me a testosterone infused lipid blocker (called Lipokine), and in a couple weeks, he wants to start testosterone steroid injections. He really wants me to pick up as much muscle as I can while I shed weight .The idea is that he doesn't want me looking like a normal guy wearing a big suit of flappy skin (and I don't want that either). So, long story short, yes, I'm able to do weightlifting, but only as long as I focus on back/biceps, chest/triceps, and legs/shoulders. No abdominal exercises yet, and if anything is remotely painful for my stomach, I'm supposed to stop doing that right away. I used to live in Stuttgart when I was younger, so I know what you're talking about. It's been strange living in Japan for the past 8 years, always being (as you say) the fattest person in the room. The nice thing about being a foreigner in Japan, however, is that no matter what, you're always going to be the strangest person in the room simply because you're not Japanese. Being fat in Japan is like having a slightly more ridiculous clown nose to go with the rest of the clown outfit that all foreigners are imagined to wear. Japanese people aren't too shy to point out the fact that I weigh too much--they commonly ask my weight and openly wonder if American food did this too me--but they don't do it judgmentally at all. They seem to like the distinctiveness that I bring into their ordinary world. I had an attractive Japanese gf for a year who loved my body shape. Most of my friends here are fellow foreigners, from the US, Aus, GB or Canada. However, I have few Japanese friends too. I'd have more J-friends, but I'm not all that social and am rarely interested in the things they're typically interested in, e.g. Japanese pop-music, television, baseball or soccer.

Hi! I also teach at a uni, albeit in Japan. I got sleeved on the 26th of Mar, spent the next week in my office prepping for lessons, and last week was my first week teaching of the semester (the Japanese academic calendar is weird, I know). Anyway, I had zero problems teaching. No pain or lack of energy or anything like that. In fact, by working (prepping, teaching, grading) I was able to distract myself from head hunger, which has been the toughest part of recovering for me. As for other people noticing, that's up to you. Originally I told only a few close friends, but their reaction was so positive, I'll now tell anyone who privately mentions something to me. I don't want to make a dramatic announcement or anything, but I feel weird fibbing to people who I like, and I generally like my coworkers.

I'm glad to hear that I'm not the only one shedding serious weight at this point. I'm 12 days out and this morning I went to the NUT for a weigh-in and consultation. The weigh-in revealed that I've lost 20 pounds since leaving the hospital, and 28 since the surgery. The NUT was considerably surprised and slightly concerned. He green-lit me for more sugar in the form of 100% fruit juice drinks each day (200 ml). I'm going back next week--if I lose another 20, he'll be officially worried, and me as well. Even though I might be shedding too fast, it's kind of hard not to feel excited.

Wow! I'm so happy to hear I'm not the only one having food dreams. I call them "pleasant nightmares." Pleasant in the sense that, in the dream, I'm sooooo enjoying the delicious junk food I'm eating. Nightmare in the sense that, at this stage in my post-operation recovery (12 days out), eating any solid food might create a leak which would be a huge horrible disaster. So in my pleasant nightmares I'm thinking "this is so delicious--nooooooooo!" And then I wake up.

Hi! I got sleeved on the 26th, about five days ago. My story is different from most of yours because I'm an American living in Japan--a country where people rarely have issues with obesity. I'm only the 18th sleeve patient that my hospital has done. One big difference between Japan and Western countries w/r/t the sleeve procedure is that Japan is fairly insistent on a lengthy hospital stay. I checked in two days before the surgery (where they fed me intravenously only), and they wouldn't let me check out until earlier this morning. According to the doctors, the surgery was a big success--no evidence of leaks or any other issues. But I still confess to having had two little freak-outs. The first was two nights after the surgery, when my stomach wouldn't stop rumbling. Oh no, I thought, I'm not supposed to feel hunger anymore, but I'm dying to eat something! I've made a huge mistake--I'll always be ravenous for the rest of my life! The nurse gave me a nausea pill and a sleep pill (both melted in my mouth), and I went to sleep in about 15 minutes. That was the worst of the rumbles--it was likely the gastric juices settling, from what I've read. The second little freak-out happened just now, my first evening home. I've consistently sipped about 2 liters of water today (which should be enough) but I'm still quite thirsty. Does that mean the water isn't staying in my stomach but is instead dripping out in a dreaded LEAK? So, I got out of bed, poured another tall glass of water, and checked for sleeve info on the net which brought me here. While checking the net, and creating a new id for this forum, and writing this post, I continually sipped water once every two or three minutes. And now, guess what: I'm not so thirsty anymore. I'm thinking I put too much miso paste in the miso soup I made for lunch and dinner, and that dehydrated me a little. Anxiety is down and I'm feeling foolish for freaking out, but really happy I found this site and community. If anyone has any questions about getting sleeved in Japan, please let me know. And any advice about my dehydration, I'd love to hear it (but I doubt it's much of an issue as long as I keep sipping). Thanks!