Born in Missouri

I love you to pieces, @GreenTealael. Your comments, attitude, and your wry sense of humor are always inspiring. As long as you are a part of this forum, I'm not going anywhere. The same goes for you as well, @Matt Z.

I understand about the weight loss decision, just not the decision regarding the sleeve vs a gastric bypass.

Your body is doing a cleanse. It's not enjoyable, but it's not harmful. Hope you don't have to remain far from the throne. Just keep with the program while your bowels continue to shake and bake. We'll be here for the good, the bad, and the not so pretty sounding. Starting weight: 400lb (understandable) Current weight: 400lb (understandable) Goal weight: 400lb (Are you sure about this one?) I see that your surgery is Dec. 19. How did you decide on the sleeve, if I may ask? And are you really 141 years old? (Check your profile page)

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Listen to Matt. Here's wonderfully knowledgeable when it comes to this topic.

I had my bypass a little over five months ago and I couldn't be happier. My 3-month labs came back great, and my visit to my endocrinologist yesterday showed an A1C of 5.1 (I stopped taking my metformin after my bypass). My blood pressure was 112/68 with no lisinopril. I can't remember being this healthy. And the weight is dropping off steadily with very little effort on my part. You'll have a rocky start at first, perhaps, but hang in there and let your body heal and adjust. Taking supplements is no big deal once you know which ones to take (For example: calcium citrate, b12, iron, a good multivitamin with micronutrients such as copper, zinc, and selenium. I also take magnesium for leg cramps.) I still use my C-Pap even though I'm not sure if I still have sleep apnea.

No problem! That's about all I can eat anyway now.

Unfortunately, people (even health professionals) are inclined to believe what they want to believe... even when faced with evidence to the contrary. So many people suffer from pain, the worst pain being pain that no one believes. The reason why being believed is so critical, is because we are expected to "prove our pain" if we want treatment. I don't have fibromyalgia, but I empathesize with those who do. The topic of chronic pain, whatever the source, drains a little of my life force every time I think about all the people who lead dark and desperate lives.

Why do you feel cold when you lose weight? https://www.livestrong.com/article/305720-how-come-when-you-lose-weight-you-feel-cold/ ----------- Skinnier and chillier https://www.nytimes.com/2015/12/08/science/weight-loss-always-feel-cold.html ----------- Q. I used to be heavy and was always warm. Now, after losing weight, I am always cold. Why? A. The general answer probably involves the loss of part of the body’s insulation in the form of unwanted body fat, but the answer in any specific case could be far more complicated. Cold intolerance is a frequent complaint among those who have lost a considerable amount of weight. The body’s core has lost a significant part of its protection against heat loss. The problem is usually worse for those who become very thin, especially small women. While someone is losing weight through severe calorie restriction, the metabolism may slow down to protect the body’s heat-producing store of calories, leading to a cold feeling. And anyone who suffers inordinately from the cold, whether thin or not, should be checked for medical problems that can interfere with thermoregulation or slow the metabolism. Such problems include blood vessel disorders, which can impede warming circulation from reaching the extremities; an underactive thyroid gland, which interferes with heat production by slowing the metabolism; anemia, which involves a shortage of oxygen-carrying red blood cells; and problems with the hypothalamus, the part of the brain that normally acts as the body’s thermostat. ----------- Negative side effects of weight loss that no one talks about. https://www.thisisinsider.com/negative-side-effects-of-weight-loss-2018-1

Enjoy your weirdness with all its weird specificity. I can think of a thousand things worse than pickled green beans with a hint of ginger and olive oil. I was overdosing on pan-fried (unbreaded) okra for a while. I still crave it. I've since added thin strips of rib-eye steak and udon noodles to the mix. It's not how much of it I eat (which is three bites tops before I'm stuffed), but the fact that I've actually found something for which I have an appetite. Food, in general, has still taken a backseat in my life. I'm embarrassed to admit that I've turned into one of those annoying people who sometimes says, "I think I forgot to eat today." You'll move on to the next big thing in the weird foods department soon enough. Take weird pleasure in discovering your latest craving. Shrimp with peanut butter? Arugula pancakes? Dried crickets? As long as you're taking your supplements and following the other recommendations the best you can, I'd say you're on the right track. Hey, you've almost lost 100 pounds!

People with fibromyalgia have widespread inflammation in their brains, new research reveals. "Finding an objective neurochemical change in the brains of people who are used to being told that their problems are imaginary is pretty important," explained senior study author Marco Loggia. He is associate director of the Center for Integrative Pain Neuroimaging at Harvard Medical School. https://consumer.healthday.com/diseases-and-conditions-information-37/fibromyalgia-news-310/brain-scans-suggest-pain-of-fibromyalgia-isn-t-imaginary-738325.html Even though this topic is not weight-loss surgery related, I've known people (mostly women who were also obese) chided about their pain being "all in their head". If being shamed about one's weight isn't enough, many sufferers have had to contend with being mocked about their pain as well. Tragic. It really makes my blood boil. “Few things a doctor does are more important than relieving pain. . . pain is soul destroying. No patient should have to endure intense pain unnecessarily. The quality of mercy is essential to the practice of medicine; here, of all places, it should not be strained.” ― Marcia Angell “The erosion of an effective patient-physician relationship has no place when dealing with chronic pain. Worst of all, dismissing the patient's pain is as devastating as crushing a patient's hope.” ― Melissa Cady “The stigma of chronic pain is one of the most difficult aspects of living with chronic pain. If you have chronic pain, people can sometimes judge you for it. Specifically, they can sometimes disapprovingly judge you for how you are coping with it. If you rest or nap because of the pain, they think you rest or nap too much. If they catch you crying, they become impatient and think you cry too much. If you don’t work because of the pain, you face scrutiny over why you don’t. If you go to your healthcare provider, they ask, “Are you going to the doctor again?” Maybe, they think that you take too many medications. In any of these ways, they disapprove of how you are coping with pain. These disapproving judgments are the stigma of living with chronic pain.” ― Murray J. McAlister “I will be living with chronic pain for the rest of my life. I don’t have the mobility, energy or life options I used to have. I work hard to manage the pain, and I want the medical system to be a respectful and effective partner, not a jailer. The opioid crisis is not my doing.” ― Sonya Huber “The addiction crisis is terrifying, and many people don’t comprehend appropriate opioid use. When I first started taking pain medication, I remember a family member saying, “Dianne, you’re going to become an addict!” We need to help people understand that taking pain medicine to maximize one’s ability to be productive and to sustain enriching relationships is very different than the disease of addiction, which limits one’s ability to contribute to society and maintain healthy habits.” ― Dianne Bourque “We have a genuine and devastating epidemic of opiate abuse in this country, and it is of critical importance that this problem be addressed. But we must do so in a way that doesn’t cut off an effective (and often the only) treatment for the chronically ill, many of whom are able to function in this world at all only because of the small respite that responsible opiate use provides.” ― Michael Bihovsky “Since my symptoms began 13 years ago, I’ve tried every form of pain management I could access — NSAIDS, nonopioid analgesics, neurologic medications, acupuncture, laser therapy, physical therapy, prolotherapy, massage, and trigger-point injections. Most of these have been unhelpful; others provide temporary relief, often at great expense. At the end of the day, when my body is fully depleted of its resources and in the most pain, a single dose of Percocet is the only tool that silences the pain enough for me to fall asleep. I honestly don’t know what I’d do if Percocet became unavailable to me, and the very thought scares me. I’ve been taking it for five years. To avoid any chance of addiction, I only take it at night and have stayed on a consistently low dose.” ― Michael Bihovsky “My doctors, who are not cavalier with prescriptions, give me this medication because I have earned their trust. And yet, with mounting government and public pressure, my doctors’ hands are becoming increasingly tied. They apologetically explain to me why they are required to make the medication even harder for me to get, against their own medical judgment. If the day ever comes when they aren’t allowed to prescribe Percocet to me at all, it may well be the end of the minimal quality of life I fight so hard to achieve.” ― Michael Bihovsky “In the debate over opioid addiction, there’s one group we aren’t hearing from: chronic pain patients, many of whom need to use the drugs on a long-term basis.” ― S. E. Smith “Despite what appears to be a low risk of addiction in naïve, chronic pain patients, it is reasonable to ask how much harm is actually done to patients with chronic pain by withholding opiate analgesics.” ― Howard L. Fields “Anyone who takes opioids on a regular basis will become dependent upon them, meaning they will have to taper off gradually to avoid withdrawal symptoms. But very few chronic pain patients exhibit the compulsive drug-seeking behaviors of someone who is addicted.” ― Karen Lee Richards “Chronic pain patients like me are not the cause of the opioid crisis; only 22% of those who misuse opioids are prescribed them by a doctor, and only 13% of ER visits for opiate overdoses were chronic pain patients. Most chronic pain patients are rule-followers who just want to function.” ― Sonya Huber “Personalized medicine is an art that advocates for the patient, not the pocket or convenience of the medical system.” ― Melissa Cady “Government agencies are trying to get doctors to cut back on prescribing opioids. I understand that they need to do something about the epidemic of overdoses. However, labeling everyone as addicts, including those who responsibly take opioids for chronic pain, is not the answer. If the proposed changes take effect, they would force physicians to neglect their patients. Moreover, legitimate pain patients, like myself, would be left in agony on a daily basis.” ― Alison Moore “There are a lot of victims when it comes to addiction. I know there's an overdose epidemic. We see those faces. But then I see these other faces - the ones who commit suicide because they can't handle the pain. Those faces mean just as much to me.” ― Donna Marsh “The stigma of chronic pain is one of the most difficult aspects of living with chronic pain. If you have chronic pain, people can sometimes judge you for it.” ― Murray J. McAlister

Initially, which is common postoperatively, you'll ask, "What in the heck have I done to myself?" After a few weeks, however, and after shedding several pounds, you'll be wondering why you didn't do this sooner. Make sure you let us know how you're doing after your surgery. We care!

Wow, Matt. You look dangerously handsome. And I like your long hair, too. Do men lose their hair the same way some women do after a bypass? (Not a question that pertains to your appearance, btw.)

Other than needing to talk supplements, what other side effects are you concerned about with a bypass? Once you know which supplements to take (ex. calcium citrate, B12, a good multivitamin with micronutrients, iron), all you have to do is take them. I'm actually healthier now and my bypass (my vitamin D is no longer in the single digits). I have NO regrets regarding my bypass. And GERD scares me more than anything. Having a sleeve, to me, is like Russian roulette. Will I develop GERD or won't I? I also hated the thought that a part of my anatomy would be permanently removed.

I tried EVERYTHING before finally settling on opioids. My daughter is a PharmD and two of my three sons are medical doctors. Anyone who tries to treat me as an attention-seeking, drug-seeking hypochondriac... WATCH OUT! My pain is my pain. 360mg morphine daily with oxycodone 10mg for breakthru. The CDC has made it hell for many chronic pain patients because of the opioid-crisis hysteria. https://twitter.com/ThomasKlineMD http://dontpunishpainrally.com

The most important thing that will help you before and after surgery is this site. Read and read often. And ask questions... you're doing a good job of that already. Oh, and chapstick... post-operatively. I like coconut and also watermelon.

I never had to take a test, a pop quiz or ANYTHING with my psychologist. What the holy heck? We talked about random nothingness, then she wrote out a four-paragraph recommendation in old-fashioned cursive on her letterhead. That was it. What are some of your 344 questions? I hope you get a gold star and a happy face sticker on your test.

I've made a new friend on this forum. He currently has a BMI of 63. Apparently, there isn't even a term to classify his size. I found somewhere that Super Morbidly Obese is for a BMI of 50 or so. Anyway, this new friend has a great sense of humor so I know he can appreciate his dilemma of being medically nameless. But I digress... After meeting with his nutritionist and surgeon recently (since he was still trying to decide sleeve vs bypass) his size pretty much decided for him. I found out why below: "A BMI of 60 or above is categorized as super morbid obesity. A laparoscopic Roux-en-Y gastric bypass in these patients is technically very difficult due to the size of the abdominal wall, the size of the intra-abdominal fat and the size of the liver. Due to these technical aspects of the procedure, the risk of leak and other complications are increased. I think that a laparoscopic sleeve gastrectomy is a much better procedure in higher risk super morbidly obese patients. It is a technically easier operation than a Roux-en-Y gastric bypass and has a much lower complication rate for this patient population. The sleeve gastrectomy can also be the first stage in a two-stage procedure. Once the patient has lost a significant amount of weight, and if he/she is still morbidly obese, it is safer to then convert the laparoscopic sleeve gastrectomy into a gastric bypass or a duodenal switch. The sleeve gastrectomy started as a procedure for high-risk patients but is now used as a primary procedure for lower BMI patients as well."

It's been my experience that it's generally male doctors who tend to behave this way. Do you live in a small community with few primaries? My life turned around 180 degrees when I found myself a good, compassionate female primary. I'm not suggesting that all male primaries are jerks, but they tend to have more acorns up their butt than necessary.

It's just a routine, insurance-required obstacle to weed out the not-so-serious and those who, for whatever reason, would not be able to emotionally handle the challenges ahead. I generally mock the visit saying that they just want to make sure that you aren't nuts. I say this because, to me, the visit is contrived and "forced" upon people. Seriously?!? Do heart/lung transplant patients have to go through this shaming requirement?! What other surgical procedures require psychological intervention? There is an extremely small likelihood of being declined at this stage. The psychologist is actually on your side and wants to recommend you. S/he knows that weight-loss surgery is a positive step for most people and that it will have major life-changing advantages. Unless you come in with doubt written all over your face, you will get your sign-off and be sent on your merry way. Being forced to read the psychologist's thumbed-through, out-of-date waiting room magazines is the only real burden ahead of you.

Outstanding response. You got this, too, Kimmie K!

As always, outstanding and succinct words of wisdom, Matt.

What an inspiring post. In just a few sentences you managed to convey humor, hope, and sweet fatherly love. You have an amazing attitude that will serve you well in the months ahead. It's important to maintain a good sense of humor and to know when not to take life too seriously. My crystal ball tells me that you have a bright future ahead of you. And a bright future for you pretty much guarantees an even brighter future for your darling little son. Just think of all the other things (besides sharing good eating habits) that you'll be able to do together. Let's all hope that your son will be able to keep up with you! You know those stunt chairs that break easily in the movies? Those will be to only chairs you'll be able to break in the future because the others will be too sturdy for a slender young guy like you. Don't disappear on us, okay? We want to hear from you regularly. It's also time for you to start paying forward by helping others who are struggling. Not everyone has your courage. Yet. This forum needs more male participation. Someone could be lurking on this forum right now... hoping for the kind of encouragement you have to offer.

As disheartening as your first stall can be, get ready to experience the opposite. On more than one occasion I've lost close to 3 or 4 pounds overnight. What a feeling! It makes me want to dance on the ceiling!! Also, I like to weigh myself after a big Number Two. Who knew that going to the bathroom could be so exhilarating?

They stuck me 14 times in pre-op trying to get an IV in. Both arms - both hands and both feet had multiple sticks. My surgeon was ready for me and I still didn’t have an IV in. At one point I had 4 people at once trying to get one in!! They finally got one but it wasn’t in very good. I woke up with a different one in my left wrist! (And for a week after surgery I looked like a junky! Lol) All the nurses, including their "big guns" failed to get an IV started before my surgery. I finally had two anesthesiologists working in tandem with a hand-held doppler looking for a vein. (They succeeded, by the way.)