Surgery Date January 30th and now I'm Nervous (plus haven't made up my mind which surgery is right for me)!

[Hollyhock 62]

Hi everybody,

It's been a long journey for me, but I finally have been assigned a surgery date for January 30th.

My metabolic problems began in childhood, like so many of you. My mother was mentally ill and there was often little or no food around. I was responsible for cooking for my family as a child, and didn't know very much about nutrition. My brothers and sisters and I were often moved back and forth across the country between my parents in unpredictable combinations. I had very little interaction with my Dad till my teen-age years. Although, I was a normal weight, he strongly encouraged me to go on 10 day fasts, eating nothing but hot Water with lemon and molasses, or else hydrogen peroxide (I refused the latter). As a result, I got into the habit of starving myself for weeks or months at a time. This lasted until my 30s when I had children. Since I needed to cook for my family and couldn't afford to be shaky or emotionally unstable (as happens when I fast), I went in the opposite direction. I had lost the capacity to feel full, so it was hard to tell when to stop eating. I was constantly hungry during pregnancy and gained tons of weight, and I kept gaining in smaller amounts after the kids were born.

About three years ago, I joined and Intensive Outpatient Program (IOP) for eating disorders. It took about four months before I could recognize myself as having an eating disorder. At first, I insisted I had a weight problem, and the eating disorder part was nothing but an excuse. But I kept going anyway, three nights each week plus Saturdays, for eight months.

I am extremely high functioning, even with the eating disorder. Ironically, I run substance abuse treatment programs, which can be a sixty to eighty hour a week job. I have been with the same guy since I was 17, and married for about 35 years. I've lived in the same house and had the same job for over 20 years. Except for the eating disorder, I'm very stable, which is part of the reason I couldn't recognize it.

The IOP was a wonderful experience that has changed my life in many ways. Three nights a week, I participated in "supported eating," which is a kind of group eating therapy designed to teach you to recognize the signs of hunger and fullness. We had to rate our hunger before eating, midway, and after eating from 1-9 and at first, I had no idea what those numbers meant. I was rating myself a 3 (normal hunger) when I was really a 1 (famished) because the only cue I could feel was being dizzy and about to pass out, or else shaking and crying. The first time I brought in my food log, the counselor asked me if I was aware I hadn't eaten for 17 hours. I thought that since I was fat, I was supposed to wait until I absolutely couldn't function before eating. After 8 months of supported eating, group and individual therapy, dialectical behavioral therapy, nutrition counseling, and movement therapy, I now know better.

(One night in particular was a real epiphany for me. We were eating at a Thai restaurant. I had missed snack and let myself get really hungry. When the food finally came, I was so focussed on eating it, that I couldn't participate in the conversation, and also it took much longer to feel full, so I overate to the point of discomfort. I suddenly realized that there was a different quality to what my dietician called "chemical" [as opposed to mechanical] hunger, and that that level of hunger actually caused me to be obsessed with food. And that I could avoid it by eating the right kinds of food every two to three hours in the right proportions.)

I have continued with less intensive counseling (DBT and nutrition only) for another year. I decided about six months ago that I have always enjoyed movement, and that because my metabolism is so slowed down and I now have knee issues, I will not be able to continue to enjoy moving unless I lose about 100 pounds. So I began looking into WLS. I found a good surgeon at the recommendation of one of my dieticians, and was cleared by my insurance to pursue WLS. I finished the psych tests, the EGD, the sleep study and a month of CPAP, and logged my food for months, meeting with the dietician. I went in for my final consult expecting to be scheduled and was extremely surprised to learn that their surgeon had quit and the program was ending. I had even begun losing a small amount of weight!!! I would have to start all over again somewhere else.

I found a new surgeon a few hours from my house. It took me a few months to get all my tests transferred. I sailed through the requirements of the new program largely because I had already completed them. I showed up at my appointments with the dietician and psychologist with Show 'N' Tell. I brought a months worth of food diaries (they were ecstatic), the cute little thermal lunch bag with my name on it that I use to carry my food for the day, and my DBT skills book and homework (even more ecstatic). I made it through what is normally a twelve month program in a month. My plan is to return to the IOP as soon as I am able to eat solid foods again (about two months after surgery), so that I have lots of support to explore a new experience of food and hunger in a group setting. I want to give myself the best possible chance of success. I hope after I lose enough weight, to go hiking with my husband in the Himalayas. (We used to hike, ski, bike, jog, and snowshoe together all the time, and our first date was backpacking.)

As you can probably tell, I'm a bit of a perfectionist...

Initially, the first bariatric program I went to offered only the sleeve. The new one offers me the choice between sleeve or bypass. I really don't have any medical condition that would indicate one over the other. The surgeon spent a good long time talking to me about it last week. He couldn't recommend one over the other. He said that if someone is diabetic or binge eats sweets or has GERD, he recommends bypass. If someone has chronic pain, or an increased risk of chronic pain, he recommends a sleeve. I don't fall into either group. I don't binge eat sweets, but I have problems with Portion Control and I eat too many sweets. He said that in my case, the sleeve might actually do a better job of cutting down on hunger, making it easier for me to turn down sweets, since it removes most of the ghrelin-producing cells; and that because I have already had an ulcer caused by H-pylori, the risk of complications with a bypass is greater than normal; and that he advises patients to avoid risks if there is no medical reason to take them. His reasoning makes sense to me. I am also hesitant to do something that disrupts my ability to absorb necessary nutrition if there is no medical reason to do so. I don't want to create a risk of osteoporosis if I don't need to. I try to avoid NSEDs because they caused an ulcer, but the day might come when I feel I need them. Finally, he says that while the average person my age, gender and weight loses 22 pounds more with bypass, even if I turn out to be average, 22 pounds will not inhibit me from enjoying most of the kinds of movement I once did. Maybe only downhill skiing. And even then, that is just the average and if I do what I am supposed to do, I may beat the average. And based on what he's seen so far, it is quite likely I will do what I need to do.

My biggest fear is that I will still find it very difficult to resist sweets after surgery. I don't usually go out of my way to find them, but people always bring them into the office. The worst time is the afternoon when I am both tired and hungry. The CPAP has helped me feel less tired, but it doesn't cut down on stress or hunger. We've been working in DBT on some alternative strategies to afternoon stress, like getting up and walking for ten minutes, or leaving work early and going to the pool, or having a co-worker straighten my hair for 15 minutes.

Anyway, as the day approaches, I'm becoming very nervous. I've tried out a bunch of Protein Drinks and discovered I like fusion the best. I just received the bariatric plate and scale I ordered online. I retired my too big Vitamix to storage and pulled out the Ninja that makes individual servings. I bought eight ice cube trays and intend to use them to freeze chicken Soup infused with flavorless Protein powder. because the dietician said that ice cubes are the perfect after surgery serving size.

I'm just really worried that I will do all of this and still won't be able to change the way that I eat, or I'll choose the wrong surgery, or it won't work. I guess what it boils down to is that I don't trust myself because of all those years I felt out of control of what I ate. The surgeon says the sleeve will correct the excess of hunger that leads me to eat too much food, or makes the wrong food appealing. What if that doesn't work?

Edited December 25, 2016 by Hollyhock

[contestador 32]

Go ahead and do it

Life changing my friend

I feel I'm born again after surgery

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[SharBear617 146]

@Hollyhock...I definately don't think you need to hear this, but I've gotta say it...for someone who has had life throw a lot of crap your way, you have managed to overcome so very much....wow.

The decision can be hard, but it has to be yours because it's so very personal. You are obviously trying to make sure you make the "right" choice, and I've no doubts you will. Seems like your gut (no pun intended!) is telling you sleeve from what you've posted. With either surgery, honestly a LOT of the work is mental, and you are going to have a good outcome as long as you remain true to what has gotten you to going down this path, which is being honest with yourself and showing that you have an amazing ability to overcome whatever life sends you. You're going to come out a winner whichever you choose, because you're already doing the mental work of this journey. Best of luck with whatever you decide, and thanks for sharing your journey to this point.

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[angelgirl15 2]

My Dr says the gastric sleeve is less invasive and I've know several people who have had the bypass and it hasn't went well with them. 1 ends up in the hospital every year like clock work for dehydration and the nutrients from what she does eat doesn't get absorbed because it goes through so fast. So for me I did a lot of research and decided on the gastric sleeve which has been great so far.

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[Tufflaw 463]

Statistically, the sleeve is less invasive than the bypass, requires a shorter surgery, and a shorter recovery time. The bypass has been around a lot longer than the sleeve, and all else being equal you will likely lose slightly more with the bypass in a shorter amount of time. Personally, after I did the research, I got the sleeve, which is also what my doctor recommended.