Getting There

Neeven · July 22, 2011

16 December 2010

Suddenly, I'm one week away from undergoing a vertical sleeve gastrectomy. It is almost too much to digest that this truly is the beginning of the end of my 15-year battle of the bulge?

The long-and-short of my story is that I was a chubby kid, athletic high-schooler, super-athletic collegiate (squash team) and, league player in my twenties and early thirties. A back injury (herniated disc) whilst training for a tournament spelt the end of competitive squash and any form of athletic activity. A job for a bachelor that involves numerous lunch meetings and after-hours cocktail functions is a recipe for disastrously rapid weight-gain. The trouble with athletes who suddenly quit working out is that they retain their appetites and eat with the same care-free abandon as they did when they were burning it up in the gym. Thus began my long addiction to food. A 10-year marriage-to-date to a wonderful wife and excellent cook fuelled the addiction. Despite sporadic forays into the gym and some tennis, I went from 85 kg (187 lbs) in my playing heyday to my current 160 kg (351 lbs). I've gained the equivalent in weight of another entire adult human being.

Interspersed in this 15-year saga were numerous efforts to lose the weight, the likes of which are all too familiar: cabbage Soup, Exchange, Atkins, X-Diet, etc. There was one time that I managed to stick to a so-called 'detox' eating programme that caused me to lose weight possibly at the same rate as many bariatric post-ops. I actually fought through the back pain and starting playing squash again. It was tremendously gratifying to fit into my college clothing once more. The diet itself, though, was tantamount to starvation and led to my becoming incredibly sad. Although not diagnosed as such, I came about as close as I can imagine to being chemically depressed. It makes sense, I suppose, that if you deprive yourself of fat and not take supplements, plus cut out salt and sugar without electrolyte replacement, you're not going to absorb fat-soluble Vitamins which has to affect one's sense of well-being.

Short-lived was my renewed thinness because at the end of the two-month crash diet, my resolve came crashing down too. So pleased was I with reaching my goal that I celebrated with a hearty double cheeseburger from the world's greatest supplier of lard disguised as food and have been supersizing ever since.

Five years ago when my doctor noticed the increase in my blood sugar levels and expressed alarm at my increasing size, I took notice but was sure I had the strength of mind to return to my athletic ways. I didn't count on the severity of my backache nor the added damage that must have been caused to my back lugging all this weight around over the years. When he asked his assistant to find out who did bariatric surgery in Canada, I really froze in my tracks. A failed business contract, the commencement of accounting studies towards a different career and a home relocation found me in the offices of a new personal care provider. I discussed my weight with my new doctor and told him what the previous one had suggested. This time, I assured him, I wanted it too.

That was two years ago. The wheels of the Canadian public healthcare system grind slowly. It took about a year to first see one of only three bariatric surgeons serving our entire province. At the time, the wait-list to have surgery here for free was around 3 years. I had two visits with the surgeon spaced six months apart. In that time, the only hospital where bariatric surgery is performed in our province announced a 60% cut in the budget for the procedure. This further clogged the bottleneck and increased the wait-time for surgery to 5 years.

I couldn't afford to self-pay abroad so explored a not-so-well-published option of out-of-country-funding by our provincial health insurance for elective surgery. When I was approved, it felt like I had won the lottery (indeed I may have in terms of longevity). In fact, the first time I knew the outcome of my application was when I checked my voice-mail one evening early in November. There was a cheerful message from Virginia Mason Medical Center in Seattle regarding a referral. There was no mistaking then that funding had been approved.

Until a few weeks ago, I was working nights as a security guard whilst studying accounting through night classes. I kept playing phone tag with the administrator of the bariatric office until we eventually connected and set the ball in motion. Since her first voice-mail on Nov 5, I have been scheduled for surgery on Dec 23 and am seeing my new, American surgeon for the first time this coming Monday. The pace of things South of the 49th parallel is at lightning speed by comparison.

I had two final exams to distract me these past weeks but can now fully concentrate on preparing for surgery. I'm an irreligious, sceptical 46-year-old so there's some irony in getting a gift of sorts (we actually pay a sizable premium for health insurance so it's a right rather than privilege) when the rest of the Western world is exchanging trinkets and electronic gadgets in State-mandated spending sprees. I'm deliberately trivializing the arbitrary commercialization of the Winter solstice against what in my case will amount to better health and possibly, longer life.

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19 December 2010

With not a little trepidation, I pointed the car South and put pedal to the metal. It must have been the fatigue after a late night at Mark and Stacey's party rather than a hangover--I was careful not to overdo the Jägermeister and spiked punch--that made me want to get this journey over with. Testing a new pair of progressive lens glasses from behind the wheel for the first time, I made a beeline to Dave's house in Tacoma where I would be spending the night. Everything seemed a little clearer on the drive down.

I have known Dave since I first started playing squash at the YMCA in the centre of Tacoma, WA. In 1990, I was wrapping up the penultimate year of my economics degree and Dave was a high-risk options broker. A substitute for one of two older brothers that I never had, Dave was a mentor and friend. In fact, it was on a trip that Dave sponsored to a squash tournament in Vancouver that sparked my love for the city that my wife and I now make our home.

Cut back to a year earlier when I met fellow ex-South African, Claude where we played squash at the same club in Los Angeles. Claude had had his full of LA and when he heard that I was heading to the Pacific Northwest to complete my studies, he and his wife, Lynelle contemplated selling up and following suite. After a few visits to me in Tacoma, both were sold on the idea and moved. From being an only son with two sisters, I was privileged to now have two brothers in the same town.

Needless to say, over the years, both these guys have watched anxiously as my weight practically doubled after my return to South Africa and subsequent emigration to Canada. They were always classy enough not to chide me but often asked how my squash was, as if to prod and propel me back onto the courts.

Dave's wife, Rasha had prepared a magnificent prawn dinner with Pasta which we washed down with red wine followed by sliced kiwi fruit and pumpkin pie. Over several rounds of backgammon, we dissected and analysed the American economy. It was indeed a last supper of sorts. Having solved the problems of the world, we all turned in for the night. The next morning would be quite eventful for me. Dave had pancakes on the stove and heaps of bacon sizzling in a pan. The last Breakfast, he said. With a mouthful of pork, I told him this felt like taking a drink before meeting one's parole officer.

When Dr. Jeffrey Hunter walked into the room with a beaming smile and firm handshake, I knew immediately that my surgery next Thursday would be in safe hands. During the 20-minute drive from Dave's house to the hospital, I didn't once doubt my decision to pursue the surgical path to wellness. This surgeon and his staff reinforced it. Everything at my first visit to the man who will next week be removing the greater curvature of my stomach, representing 85% of it's current size, went swimmingly. My visit included a lengthy stint with the nutritionist who walked me through the diet plan that will be the mantra that I chant over the next several weeks.

With my sights set firmly on Protein shakes and lean cuts of meat with heaps of spinach leaves, I made tracks to Claude's in the hamlet of Woodinville a few kilometers Northeast of Seattle. Claude owns a house with a veritable park for a backyard complete with flowing stream all nestled amongst giant douglas firs. I love going there. With the clock ticking to get back to Canada to fetch Shamin at work, Claude and I barely had time to do a deep analysis of what Obama and the Democrats are doing to fix the problems of America before we spirited ourselves off to a Mexican restaurant. The last lunch, Claude called it. Faced with a two-hour drive, I declined any liquid nourishment and stuck to a black bean Soup plus a quarter of Claude's chicken enchilada.

Not only had my brothers treated me to some pretty amazing meals, but Shamin had ideas of her own when I fetched her. We made tracks to our favourite sushi spot in our hometown of White Rock and indulged as only convicts facing the gallows can, with the maki 18-piece combo, miso soup, agadashi tofu and mugs of green tea. Shamin said that this was our last supper.

Since Saturday, I have had three last suppers, one last Breakfast and one last lunch. And thanks to Mark and Stacey, one last party.

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6 January 2011

It's 11h30 and two weeks to the hour that I was being wheeled into surgery. What Shamin expected to be a 45-minute routine procedure like a visit to the dentist, an impression I had created, turned out to be a 2-hr major operation that resulted in yanking out 80% of my stomach. Mostly the upper curvature, the stretchy part of the stomach, was removed leaving me with a pouch about 4-6 oz in volume, the size of a small banana or 2/3 of a cup. This new pouch does not stretch.

I chose this particular version of bariatric surgery to avoid some of the malabsorptive issues related to Roux n Y (a.k.a. RnY or gastric bypass), the current gold standard of WLS, and to be able to take anti-inflammatories as and when I become lighter on my feet and engage in more sport.

The sleeve gastrectomy went quite well and there were no complications. My first night post-surgery though, was rough. I was in a lot of pain from the surgery and kept burping which caused quite a bit of discomfort. The staff at Virginia Mason Medical Center in Seattle is absolutely top-drawer and took excellent care of me.

The next day, the barium drink during the x-ray in order to check for leaks and make sure that Fluid was passing through the stomach via. the pyloric valve into the small intestine, ranks amongst the most vile stuff I've ever drunk. It was all I could do to keep from throwing up. Isn't it remarkable how attuned you become to everyone's expressions when you're a patient? Why is the nurse frowning at my chart and how come the doctor is gesturing so animatedly? When the surgeon and the radiation team relaxed as the barium made it's way successfully through my tract, I also breathed a sigh of relief. Later, one of the nurses explained to me that they medicate the stomach to near-lifelessness in order to operate on it, then it becomes of paramount importance to revive it as soon as possible the next day. So they're constantly listening through the stethoscope for signs of activity. You'll never see from polite company or one's wife quite the kind of elation when you tell them that you've farted than erupts from the nursing staff when you inform them after bariatric surgery that you've passed gas. In fact, after your first bowel movement if indeed you have one, they're ready to hand you a trophy and send you home. Two days after surgery on the 2010th birthday of our lord Jesus, I was desperate for a shower. After I accidentally yanked out my glucose supply line, they deemed me fit to be discharged.

Shamin helped me get my things back to the hotel room. No sooner did we set them down than we were in the car heading to Kirkland for lunch. Shamin drove. On the menu was medium rare sirloin, baked potato, crumbed shrimp and salad, with cheescake and chocolate for dessert. I pigged out on soup broth and sugar-free jelly. Wine flowed liberally so two days after surgery, high on oxycodon, it fell to me to drive back to the hotel. In fact, the next day, I took the wheel to blaze a trail out of Seattle and made it half-way back to Canada before succumbing to fatigue.

Things went a little pear-shaped the next morning, my first back in Canada. I chewed on my Gummy bear Multivitamin, followed by some flavoured Water with a crushed metformin. Later, a bit of cream of wheat fortified with whey Protein isolate seemed to be competing for limited space. In the middle of a Skype chat with my sister in South Africa, the cream of wheat wanted out and I hurled for the first time. How on earth am I going to get in 70 - 100 g of protein with this little stomach volume?

The summary of my food intake is protein and more protein, very, very little carbohydrates and almost no fats and sugars. I'm also on a cocktail of Multivitamins, Iron, B12 and Calcium supplements to compensate for the limitations of the new diet. Modern Multivitamins and supplements are chewable and tasty so, incorporated as Snacks, you don't even feel like being medicated.

Combating dehydration is now a way of life. I have to walk around with a bottle of Water and sip constantly between meals. As it is early days yet and I'm only now graduating to pureed foods, I have to space out my spoonfuls in order to avoid an extreme sensation of fullness and subsequent pain. Recently, I was able to finish a whole cup of veggie soup over two hours whilst watching a movie.

It now takes about 4-or-5 teaspoons of food to achieve a feeling of fullnes whereupon I start to belch. Any more hurts like hell. One more bite is like trying to stuff one more marble into an already full jar. There’s no give whatsoever. The greater curvature of the stomach is where your stretchy material resides. Mine has been removed and sealed shut with three lines of staples. My very compact stomach pouch has a valve on both it's entrance from the oesophagus and exit into the small intestine, respectively. Therefore, it is a closed container under pressure, implying no more fizzy drinks that could release carbon dioxide and cause immense discomfort. Adios beer, hello wine, vodka and whiskey on the rocks.

I’m currently paying lip service to six meals a day; I can barely manage one, and two Protein Shakes. Yesterday morning, I bravely scrambled a single egg with a tiny amount of spinach and a sliver of cheese. I got through half of it, then ate the rest several hours later. Interspersed between meals, I’m supposed to sip about 2 litres of water. What a bloody joke! I’m averaging about a litre. The only things I’m making sure I consume are the multivitamins, Iron supplement and chewable Calcium sweets. They’re like dessert. Oh, I do get to enjoy as much sugar-free jelly that I can handle and I never seem to tire of it.

Within a few weeks, there will be little external sign that I had any surgery. As the whole affair was done laparoscopically, I’m left with 5 little scars on my belly that is already mostly healed. Once fully-healed, I'm heading to the swimming pool to start exercising. I hate walking at the best of times.

Oh yes, the million dollar question; I first met the surgeon on 13 Dec and went on a pre-op diet for 10 days. I lost 10 lbs (4.5 kg) in that time. In the 24 days since, I have shed a total of 36 lbs (16.3 kg). I have been told by my dietician that it is not unrealistic to expect to shed around 75% of my excess weight over the next six months. When I started out, I was 351 lbs (160 kg). I'm now 315 lbs (143 kg). The next milestone is to break the 300 lb mark, a weight I haven't been in over a decade.

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13 January 2011

If there's one thing that I've discovered post-op, it is precisely that old habits can die easily and very, very quickly at that. There is nothing quite as drastic as once being able to virtually inhale a three-egg omelette with cheese, green pepper, mushroom and bacon and, sausage and hash browns on the side, followed by a cup of coffee, to hoping-upon-hope that the single boiled egg you're just about to tackle for breakfast won't fill you after just three bites. Such is the drastic nature of this procedure.

The sense of fullness isn't the same satisfactory one as before. Rather, it takes you by surprise. One minute you're savouring the taste of just your third spoonful, then you feel a slight burp and know you ought to stop right there-and-then. But being a man, you bravely go for the fourth and the pain hits from nowhere. The tightness in your stomach is indescribable. It feels like your chest is going to explode and you wonder why-oh-why you were ever so greedy as to dare to eat a whole fourth spoonful. This surgery is like having an electric shock device around your ankle when you're on parole. Any deviance in the eating department and you're very quickly zapped into line.

All went well the first two weeks post-op with a little heartburn to contend with. These past few days, I thought I was going to meet an untimely demise from acid reflux. How embarrassing is that? Even in my drinking heyday, I had never felt anything quite like this. Back in the day, you puked, you rinsed, you slept (not necessarily in that order) then got up, nursed the hangover and picked up where you left off. This time, the reflux was a whole new kettle of fish. Anything short of standing bolt upright had acid gurgling at the back of my throat. sleep was almost impossible. Yesterday, I finally collected from the pharmacist in capsule form a potent antacid which has proven to be the elixir for which I had been waiting. Last night for the first time in days, I got a full night's sleep and am feeling very refreshed finally.

The surgery is doing its work. I have shed 17 kg in 30 days. The last three days, there's been a slight lull from my average loss of a pound-a-day. It might be because I have been struggling to get in the dietitian's requirement of 70 - 100 g of protein per day. A single egg has just 8 g of protein. Given the minimal volume of my stomach of around 130 ml, it would be impossible to meet the protein requirement from food consumption, the equivalent of 9 - 12 eggs. The solution to the dilemma is whey protein isolate shakes that body builders use. I mix it with something called enriched milk (skim milk fortified with powdered milk for the extra protein) and knock them back in 15 g slugs. Even that requires about 5 drinks a day. As tasty as vanilla and chocolate flavour is, after a while you just want to gag. Interspersed in all this protein intake is a requirement to rehydrate constantly. Water, jelly, electrolyte drinks and more water, 2 litres minimum of the stuff per day, is what is required. There just isn't enough room for it all.

To combat the potential for malnutrition, for the rest of my life I have to take a Multivitamin and iron supplement with breakfast, then three doses of calcium supplements the rest of the day. They're all in chewable form so it feels like snacking on sweets for dessert. Also, once-a-month, I have to get a Vitamin B-12 injection.

On the plus side, I've kicked the type II diabetes that required two metformin pills a day. Which would one rather have, is the big question. There's no telling what the consequences of diabetes is, ranging anywhere from gangrene and the amputation of a foot to a stroke from high blood pressure. Yikes! By far, the nuances of bariatric surgery are a nuisance I'd rather have.

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13 February 2011

It has been so long ago that I was last under 300 lbs, I have kind of forgotten which era of my life that was. There is a selection of still-new clothing in my closet that is too tight for me so I obviously bought them when I was thinner than I am now. I have to try to recall when I bought--and almost immediately outgrew--them. Did I buy them in Canada at my favourite fashion store, Walmart, or in South Africa at my similarly popular source of bulk thread, Makro? If memory serves me right, I don't think I ever felt this 'trim' since arriving in Canada in 2004, and I certainly had one hell of a paunch during my wedding in 2000, so we may well be looking at the late 90's.

I would be lying if I didn't admit that my latest stall was getting the psychological better of me. I mean, here I am post-major-surgical-procedure to lose weight, barely able to imbibe half-a-cup of food per meal that fills me for hours, and getting nowhere near the required amount of protein, only to hover tantalizingly above 300 lbs for the last few weeks. Like everyone, I went dramatically from 351 lbs pre-op to around 305 lbs. The expectation that this kind of rate would be sustainable is rich to say the least, yet it becomes a pipe-dream for the morbidly obese. Luckily, I didn't go into the kind of depression that resulted in starvation to achieve this milestone. I stuck with the programme, sucked down Protein Shakes to make up the deficit, ate the soy sausages and even relished the chocolate-coated Protein Bars that 10 years ago would have made me gag.

My exercise regimen has included some very basic exercises because I still feel a little too weak to go for lengthy walks, let alone jog or play squash. I timed my exercise routine. It took me exactly 13 minutes (12h00 to 12h13) to do 20 reps each of the following:

squats (feet shoulder-width apart, only squatted as far as was comfortable)
crunches (lying on back, hands clasped behind head, tried bringing up head to knees, could barely get my head off the ground)
leg lifts (lying on back, palms face down under buttocks, just lift feet off ground)
cheat pushups (on my knees instead of the traditional way)
left bicep curl (using a shopping bag filled with our new duvet as a weight)
right bicep curl (ditto)
left tricep extension (ditto)
right tricep extension (ditto)
bench press (lay on bed and pushed the 'weight' towards the ceiling)
shoulder press (shopping bag as weight, standing legs slightly apart, raised 'weight' to ceiling)
left side bends (standing feet slightly apart, hands clasped behind head, lean twice to the left, then back upright, will use make-shift weight in future)
right side bends

I did these 12 exercises (so a little over a minute each on average) on a mat in the small space between the bed and the wall. My gym outfit was my boxer shorts and I went barefeet. I will continue to use my make-shift dumbbell until we find that ideal duvet cover. Who needs a gym, eh? It has now taken me longer to describe my exercise than the workout itself took. How did I find the excuses to avoid exercise in the past?

Which brings me to the topic of Constipation. What is up with that? I guess the minimal food intake is as much to blame as the lack of hydration. I have struggled to drink the suggested amount of water and am hoping that the protein shakes count as both nutrition and fluids. No doubt, the body tries to absorb as much of whatever little it is now getting and often tempers the metabolism in anticipation of famine rather than feast. So, as much as toilet humour provides endless hours of mirth in slapstick comedy, it is a serious topic when it comes to diet and weight-loss. Not having a bowel movement for two-to-three days is discomforting to say the least. The medical team knows about this and is ready to prescribe suitable 'stool softeners'. Instead, I've re-discovered prune juice.

"What does all this have to do with the scale," one wonders? Well, when you're desperate to reach certain weight milestones, like lose 50 lbs or 100 lbs, or achieve a specific weight, 300 lbs in my case, you start to become very particular about what exactly it is that you're weighing. In my mind, any food or liquid in my intestine is not part of my body weight, hence has to be expunged before the weigh-in. How ridiculous is it that I was careful not to swallow any water whilst brushing my teeth in the morning? Sometimes, the mind concocts ideas that descend rapidly from the sublime to ridiculous.

To cut to the chase, after yet another morning leaving the toilet tissue undisturbed, I stepped trepidly onto the scale and weighed in at 298.4 lbs. The sensation was overwhelming. For all intents and purposes at 05h30 on a Sunday morning, I ought still to have been in bed. But an early night and a full bladder resulted in an early morning and my usual interlude with the scale. My wife was still fast asleep so it took enormous restraint to squelch my desire to yelp.

With an enormous weight off my shoulders, no pun intended, I have a spring in my step today. At last it feels like the programme is on track again. I have regained all of the confidence in the surgical procedure that I had going into it. The overwehlming evidence of its effectiveness just from the experiences of its alumni should have been convincing enough. However, it still requires one's own adventure with it to fully come to terms with its benefits. I look forward now to tackling the next 100 lbs.

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Tuesday, 22 March 2011

I love numbers because, unless manipulated by accountants and politicians, they tend not to lie (a bold statement from a would-be-accountant).

When I first started exploring bariatric surgery as a solution to my morbid obesity, one of its wilder claims that attracted me to it was that a person could lose 75% of his excess weight within 6 months. At the time, I was 351 lb (160 kg) and felt that I needed to get down to 220 lb (100 kg). In total, that would imply a loss of 131 lb (60 kg). 3/4 of that is 98 lb (45 kg). Could I really lose 45 kg in 6 months, in other words, 7.5 kg per month? It seemed too good to be true. A 45 kg loss in weight would put me at 115 kg, a weight at which I once used to play a half-way decent game of league-level squash. As I read more about the effectiveness of the surgery, I became giddy in anticipation of becoming a veritable gazelle within just six months.

At the 3 month mark since my vertical sleeve gastrectomy, I weigh 280.4 lb (127.5 kg). I have lost a whopping 71 lb (32 kg). This implies a rate of loss of just over 22 lb (10 kg) per month. If this is sustainable for another three months, I'm on track to blitz right past the projected 6-month, 45 kg loss. It even tickles a tantalizing fantasy of shedding the entire 60 kg within 6 months. Reality dictates otherwise, however, because the initial rate of loss post-op is staggeringly high versus what it's become, hence a much larger drop in weight immediately post-op. Still, a gander at my weight graph in the health tracker shows a fairly straight line with a constant slope.

With some hesitation, I'm tempted to adjust downward my overall weight-loss expectation to around 187 lb (85 kg). Before my op, I asked the surgeon whether this was feasible and he said it certainly was. At the time I didn't believe him but now I'm not so sure.

I remember very well when I was last 85 kg. It was in 1991 when I was at my fittest ever and about to play in the B Divison at the US Open Squash Tournament in Portland, OR. In the second round, I lost a 5-game marathon to the top-seed and shed 8 lbs of water weight for my effort. Back then, I was a fairly well-oiled machine and knew intimately the effects of food on my body. A diet on a student budget, comprising instant noodles with broccoli, tuna, pinto Beans and chicken kept me in trim. Toasted sandwiches with hotdogs, cheese and mayo inevitably translated into an upward tick of the scale.

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Sunday, 27 March 2011

More on the numbers, this time regarding my recent lab tests. In summary, they're all good and a reversal of where they've been the past decade. I've moved into the normal range in just about all the important categories.

Even going back 10 years to my mid-30's, my blood sugar levels--as measured by Hemoglobin A1C and Fasting Glucose--were always a couple of points above normal though nothing worth calling out the cavalry for. Even the Urine Albumin or ACR (Albumin/Creatinine Ratio) which is a gage of the level of functioning of the kidneys, was just above normal. When my personal care physician (PCP) a.k.a. family doctor diagnosed me with Type II Diabetes, it was almost tongue-in-cheek. He said that each measure, on its own, was not worth a diagnosis of diabetes but, together, ooh, aah, maybe, why not?

"Diabetes! Take a couple of Metformin daily and see me again in three months." At the time, it sounded more like he was obliged for ethical and liability reasons to come to a conclusion of diabetes rather than any concrete proof of the disease.

Thus began three-monthly visits to the labs to test these two variables, as well as an annual visit to the optometrist to photograph the back of my eye. This was to see if excess blood sugar was causing the rupture of capillaries back there. The eyesight of diabetics deteriorates for this reason rather than from the normal decline around middle-age from retinal mal-function.

Another ominous feature of my blood was elevated pressure and high levels of cholesterol, especially the abnormally high ratio of total cholesterol to bad (LDL) cholesterol. Neither was ever high-enough to warrant medication but required a change in diet that favoured fish and chicken over red meat and, an increase in leafy greens. My dietary approach was to ignore the advice.

The PCP was vindicated in his diagnosis of diabetes. While the ocular capillaries were always intact, the blood sugar levels were not. I initially avoided the Metformin like the plague and it showed in the tests. As soon as I started taking them, the numbers came down though never into the normal range. It was plainly obvious that my body was not processing sugars normally. In fact, the endocrinologist to which my first bariatric surgeon had referred me emphatically increased my Metformin dosage from two- to three-a-day. There must have been something more compelling in the numbers that he saw leaving me feeling a little disingenuous for doubting my PCP.

It's a coincidence that my three-monthly lab date was just before my VSG. It meant that I had fresh numbers for comparison and could attribute any changes in my digits directly to both the surgery and post-op dietary changes. Prior to those pre-op labs, I had been on a high-protein, leafy-green diet to shed some weight, get my body into ketosis mode and, reduce the size of the liver and rid it of fats and sugars. Despite that, my numbers were still off the charts.

A tabular summary of the results are:

Normal Early Immediately Post-op

Range Dec '10 Pre-op Mar 2011

Glucose 3.6-5.5 mmol/l 7 (high) 6.4 (high) 5.3 (normal)

A1C 4.8-6.2% 6.8 (high) 6.6 (high) 6.0 (normal)

ACR < 2.0 2.1 (high) 0.8 (normal)

Chol. 2.0-5.2 mmol/l 4.6 (normal)

LDL 1.5-3.4 mmol/l 3.3 (normal)

HDL >0.9 mmol/l 0.9 (low)

Chol/HDL <5.0 5.1 (high)

Triglyc. <2.3 mmol/l 0.9 (normal)

BP 120/80 120/80 (normal)

I'm reasonably pleased with the results though everything could come down a notch, especially the cholesterol level.

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Tuesday, 24 May 2011

Almost 21 weeks since surgery, I find myself still picking from the hors d'oeuvres or soup section of the menu while my short, slightly-built wife has her pick of the Entrees. It's an ironic reversal that is actually working quite well for our appetites and budget. For the wait staff, however, it's enormously confusing. The order taker has to first scowl at me for declining anything to drink, not even water, then frown harder at my minimal order. I don't always feel that it's necessary for me to explain why I cannot drink 30 minutes before a meal. There is usually a progression from amusement to bewilderment as the paltriness of the order registers. "Are you sure that would be all?" I get asked whilst being physically sized up against my order. As he turns to leave, you can almost read the, "What a cheapskate!" facial expression. Initially it might be understandable that I'm too cheap to order a beer or glass of wine. But for such a big fellow to cut costs with just the cup (not even the main-course-sized alternative) of clam chowder while the lady chooses the lamb shank with potatoes and gravy is just wrong. It doesn't end there. If a different person actually brings the meal to the table from the kitchen, there is the almost mandatory politically correct query about which meal is for whom. To avoid any question of ridicule as it's obvious that the mountainous lamb shank is for the big chap and the lady is watching her figure, I find the main course heading my way. At least the order taker had time to digest the information; this poor character shakes his head almost as if we the customer got our own order wrong.

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Thursday, 26 May 2011

The converse of the non-surgical victory (NSV), something with which bariatric post-ops become quite familiar even only a few months post-op, has to be the non-surgical disappointment (NSD). In the wake of the breakneck speed at which we lose weight, start fitting into old clothes, get compliments from people and become more active, we run the danger of expecting too much too soon. Coupled with a stall at the 22-week mark, I experienced my first NSD when my scuba wetsuit proved two inches too tight. If you know these infernal things, the zipper is at the back, like those embarrassing surgical gowns. I guess if it had been wet which is when it is more stretchy, I might have been able to squeeze it shut until my blood stopped flowing. So rather than pass out, I go it the heck off and resolved to be patient a few more weeks.

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Thursday, 23 June 2011

Today is a weight-loss surgery (WLS) milestone for me. Exactly 6 months ago to the hour, I was in my ward at the Virginia Mason Medical Center in Seattle, WA recovering from my vertical sleeve gastrectomy earlier that morning. The six-month post-op period is significant in the WLS context because it is considered the 'honeymoon' period during which the most rapid rate of loss occurs, as much as 75% of the total weight needed to be reduced. Of the 70 kg (154 lb) that I needed to shed at surgery, I have kissed 49% away so my experience has been closer to average. I'm half-way there with the rest expected to take another year to come off. As a matter of fact, I reached my current weight about a month ago so my honeymoon may have ended prematurely. I seem to have entered the dreaded post honeymoon stall that is experienced by many WLS recipients.

This is not the end of the loss because my caloric intake is still miniscule. It may be the body's response to what is essentially starvation (in relative terms, of course) in which it hangs on to whatever it is fed. That's all well-and-good and I'm not panicking. I continue to get full on tiny portions. I have pushed the envelope on a few occasions with one bite too many, and paid the price in the form of extreme pain and discomfort. It's a vast change in psyche compared to the heyday of binging with a stretchable stomach. That was when I could eat through any sensation of fullness whereas now I'm alert to any signal of fullness. Around three bites into a meal, I start to notice a slight churning in my stomach accompanied often by a tiny belch. Of course, this sensation is commonplace to anyone who hasn't had surgery. It is only unusual in my case because it occurs so much earlier. At that point, most normal people would be exlaiming that they have left just enough place for dessert. I, on the other hand am good for just one more bite which, if I reserved for dessert, would be depriving myself of a crucial opportunity to ingest protein. Most of this description in any event is pertinent to meals of dense protein comprising fish, chicken, red meat or soya. A small bag of popcorn goes a longer way in which I have to allocate an entire segment of about 3 hours to indulge.

Cynics may be critical of the fear-driven disincentive to eat and they would be right. You should not be averse to food and certainly not terrified of getting full. That kind of mentality coupled with societal pressure to conform aesthetically spawns a whole range of eating disorders that include bulimia and anorexia. Overweight people such as I are often like petulant children who want our cake and want to eat it. The surgery is just the wooden spoon of discipline. So wish me luck as I tackle the next 50% over 12 months.

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Sunday, 26 June 2011

The irony of getting a question in a letter from someone named Ruth was enough to send me into paroxysms of laughter. She's not Dr. Ruth, just my friend's daughter whom I've known since the mid-80's. She wrote: "Wow, Neeven, you look so great! You must feel really good too! How has your weight loss changed your life? Ruth". To this I replied simply (yeah, right!),

"Dear Ruth

Thanks so much for the compliment. Indeed I feel good courtesy of numerous changes to my life, both psychological and physical. The most important of these has been a more optimistic outlook despite bleak circumstances. Just being able to leap out of bed with ten times more energy rather than dragging myself from under the covers is testimony to that. My mobility is vastly improved. I am walking everywhere now, back on the tennis courts with a vengeance and, after a few more lost pounds, even contemplating a squash membership. I played tennis this morning against a chap who 24 years ago used to play competitively. He tired after the first set while I was still good to go. It was a big boost to my confidence that my fitness has improved so much. I was chasing balls that I used to let fly past and taking the extra steps to better position myself without the fear of exhaustion. It is easier to get in-and-out of cars. I no longer have to shuffle in the aisles between restaurant tables and risk knocking over some poor diner’s beverage. I can see my shoelaces again and even bend down to tie them without needing a respirator afterward. From opting for the stairs, to sharing a bench with someone, to stepping aside in an elevator to allow one more person in, I’m considerably more self-confident.

It’s taking some getting used to the attention I’m receiving from friends who are noticing the difference. Those who have been with me from the beginning have continued to be tremendously encouraging and supportive. Others who see me after a very long interval struggle with the awkwardness of commenting on my physique. They want to gush at how ‘good’ I now look but suddenly hesitate at the implied suggestion that I used to be a slob. Yesterday, at Shamin’s company’s annual Summer picnic, most of her colleagues had last seen me mere weeks before I had the surgery, squeezed into my suit and wolfing down chow at the Christmas function. This time, many targeted me for conversation to inquire how I felt, what I was eating and whether I had struggled. I’ve never been coy about talking about the surgery (and neither is Shamin at work, it appears) so I was flattered that they wanted to chat and heap praise on me. I soaked it all up Stephen Colbert style, like a seasoned celebrity.

I made the mistake of not logging my body-dimensions pre-op but I guess my loosening clothing is measure-enough of what used to be. I say that tenuously because a lot of what is now too big for me, was actually once very tight for me. I used to bulge out of my jeans so my girth must have been a lot larger than the diameter of the trousers. Near the end, I couldn’t button my suit coat and the ski jacket that I wore during my Dec. ’09 visit to New York shows evidence of strain on more than a few seams. From shirt collars that used to choke me, to button holes that protested, to belts that didn’t even fit but now need new holes, there’s no shortage of evidence of my shrinkage in my wardrobe. Heck, even my feet slip into my shoes more comfortably.

By far the biggest compliment I get is from Shamin who is highly critical of my aversion to spending instead of splurging on a few pants, shirts and jackets that actually fit. I sometimes catch her giggling at how much of a clown I look like in jeans with a crotch that hangs too low, or a favorite sweater that now reveals my clavicle. My logic is that I’m just a few inches from fitting into four brand new trousers that I outgrew the instant I bought them years ago. The reality is that as good as it has been, I’m only half-way down this journey with another 80 lb of loss still to navigate. I’m going to get much smaller (how many guys actually say that with a straight face?). It will now fall off slower but fall it will (hello, still talking about the weight here...!), so I’m biding my time before incurring the expense. We’re saving in other ways. I select from the appetizer section of restaurant menus and my share of the consumption of household groceries is negligible. That is partially offset by the introduction of pricey protein shakes, Protein Bars and a cocktail of nutritional supplements to the grocery list though there’s a net saving against breakfast Cereal, candy, soda and potato chips.

My life was worsened for the sudden development of GERD post-op which persists intermittently but guaranteed to flare up by my favorite, curries. We used to prepare it spicily-enough to remove paint from a ship’s hull, whereas I can barely handle black pepper on my 4 oz steak now. I have become partial to fat-free, white-sauced foods rather than their tomato-based alternatives and, in general, just a whole lot more finicky about meals. I approach every meal with a certain trepidation. This selective eating is a two-edged sword that deprives me of the tastes I once savored, but further promotes my weight-loss.

Now do you regret asking a simple question?

Your friend

Neeven"