Challenges Well After Gastric Bypass Surgery

I have seriously neglected this blog, but I'm still living life after having gastric bypass surgery. And frankly, while I am still glad I had the surgery, I still have to deal with lots of challenges. But I am making it and still feel so much better than before the surgery. Last July was two years from my surgery. Time has helped me deal with the cravings I had for a long time after the surgery. I know some patients after gastric bypass that have been able to take up eating the same things they did before the surgery, but I can't. Oh sure, some things, I can eat again. I can eat cheeseburgers if they are made with a better quality meat. But I still can't eat sugar. I recently spent time in the waiting room of a hospital in Ohio and was tickled to find a small coffee stand and, as I have found myself extremely addicted, I ordered a sugar free hazelnut latte. I was about 4 generous sips in before I realized the barista had made me a regular hot chocolate. I was so sick that I eventually had to return to the hotel and sleep it off. I was hot and cold and clammy and nauseous. I was drained. I hadn't had to deal with that kind of feeling in a long time.

And every now and then, without rhyme or reason, something will just not sit well. Last week, I ate a "healthy" frozen dinner due to time. Whole grain pastas, balsamic cream sauce, vegetables. Sounds like a stomach friendly meal. I eat pastas, but I cannot eat spaghetti, angel hair, or vermicelli. Normally, however, rotini, bow tie, penne...these are fine, Normally. The frozen dinner had penne, but for the first time in ages, I was up until 3 am vomiting.

Also, late 2009, I had to have an urgent surgery to correct a complication that sometimes happens. When a person gains a lot of weight, it pushes the organs out and when the person loses a lot of weight, the organs don't always go back where they are supposed to, and it can cause a blockage which keeps food from didesting. I had this problem in two places. An outpatient, laproscopic surgery resolved this.

I think my biggest challenge and fear is falling back into old habits. Over the Christmas holiday, I gained 4 pounds. FOUR! But I made an effort to straighten up and get back on track. The four pounds is gone. And I'm working on a few more. At my lowest weight, I got down to 164, but I do not hope to get back down to that weight. Personally, I don't feel that is reasonable for me to think I can maintain that, but between 170 and 175 is my goal. So this year, I'm going to post more about things I learn regarding nutrition and food. It's not just about weight. It's about clean eating and health. More fresh foods, less processed. More cooking at home, less eating out. I do actually like cooking so my roommate and I spent a couple of days going through healthy cookbooks and choosing recipes we want to try. The main game plan is to actually have a menu for the week so we don't get discouraged and end up grabbing burgers in the way home from work.

I will keep this blog posted with my progress.

Return to Work

The return to work presented all new challenges and hurdles. I tried to return to work before my six week recovery period was up and found that I probably should have taken the entire time. But I had burned through all my leave time, and money was becoming a real issue. I returned to work weak and tired, but enjoying the fact that my weight loss was already very noticeable. People I had never really spoken to at work stopped me in the halls to comment. Telling people about my gastric bypass surgery became a double-edged sword and a gamble. Sometimes, people would tell me how proud they were that I had taken that step and regale me with a story of a very friend who also had a very successful surgery. Others would get tilt their head with a look that basically said, "Oh, you had THAT done..." My favorite, though, was the people who insisted on telling me about someone they knew who had the surgery and now they either looked awful, gained the weight back, or died. As if I was not already scared and emotional from coping without my familiar food crutch. Sometimes I really do wonder what goes on in another person's head when they think it's appropriate to scare someone in that way. But even those issues didn't compare to food.

My department likes to eat. Someone would normally go to a restaurant for the group and bring something back for lunch, and everyone would eat at their desk. When I first returned to work, I was still on the soft food stage of my post operative diet. I could have tuna. So almost everyday, I ate a can of flavored tuna and threw the crackers away. Crackers were carbs, and my stomach couldn't handle them anyway. I still drank my protein drinks to meet my dietary needs and a can of tuna seemed like a lot of food to me. But I would smell my coworkers' food and get that same emotional response I did at home watching restaurant commercials. Sometimes I had to just get up and leave our department for a few minutes to regroup. But I couldn't ask everyone around me to stop living their normal lives to accommodate me. Nor would the world stop eating to please me. I needed to find a way to cope. I reminded myself of the fact that I was already in need of new clothes because I was losing weight so quickly. I would sometimes walk to the bathroom and look at my newly developing figure. I took solace in the fact that my feet had already stopped swelling from the diabetes I had suffered from before the surgery. No one really knows why yet, but gastric bypass automatically reverses diabetes before the weight loss will reverse it. A lot of research is being done now to find why this happens and see if it can help people with type I diabetes. I also reminded myself that despite being worn out from the surgery, my energy level still seemed better than before. It helped some, but I still remember this time as a period of severe struggle.

The first time one of my coworkers brought a homemade cake in for a treat for the department, I went to the bathroom, locked myself in a stall, and wept. I felt ridiculous to be so emotional over food, but I had not realized just how much I relied on food for every emotion. We celebrate with food. We ease pain with food. We fill empty time with food. I would love to say that it was during this period I found a magical way to cope with this loss, but it really just took time to adapt. It did get easier with time. Not to get ahead of myself, but I will say that now, I don't get too worried about it. The smell of food will make me hungry, but I don't necessarily have to have what everyone else is having. And sugary sweets? Well, I get a little misty-eyed around the holidays and all the homemade baking, but I've learned to make some of my own sugar free desserts and tasted every sugar free cookie/candy on the market so I know what's good and not. I don't have to be deprived. Those early work days were tough, though.

I've actually heard people say they would die than do without sugary foods or fried chicken. Well, I have news, people, I am proof that you WON'T die. In fact, I live better than before. And it was a tough road, but I still enjoy food. In fact, I think I enjoy it more because I better appreciate what I can have. When you gorge on something all the time, it loses it's value. But when it's an occasional treat, you savor each bite. It's that kind of attitude that started to permeate different areas of my life as well. I started to savor and better enjoy times with friends and family. I spent more time working on my geeky WWII re-enacting hobby. I even started trying to write again. I considered trying to pick up singing again, but I found that I had real trouble with my breathing. Every time I practiced a song that required a lot of breath, I would actually get dizzy and see black spots. I mourned, but hoped that would get better in time. The point is, however, that I found that I had spent so much time eating, I had been missing out on life. I had previously had no energy to get out and do anything. I spent most of my time sitting at my computer at home chatting or playing games, but as my energy level rose, I got antsy sitting there and had to start getting out. I repeatedly tell people, I neither recommend people to nor dissuade people from this surgery, but it was right for me. I have added years back to my life. And so far, my only regret has been not doing it sooner. But I still had challenges ahead and face them today.

Finally At Home

The drive home was scary. It was excruciating mainly because I was afraid of the pain from being jostled more than it really hurt. By the time I got to my house, I was exhausted, more from the mental stress than the actual pain. But I was still ready to be in familiar settings. When I got home, I was pleasantly surprised to find that my sister and my roommate had cleaned my room for my arrival (I am shockingly messy at home). My roommate helped me get settled, and I immediately took some pain medicine. The pain meds were a combination of pain medicine and anti-nausea medicine. It also knocked me out. I put my APAP mask on (to use for my sleep apnea) and pretty much passed out.

The next couple of weeks were a medicated blur almost as fuzzy as the hospital stay but not as bad. A few important things stick out in my mind, though. My little brother and sister took turns helping me in the hospital and out. My older sister had a surgery around the same time as well, so they split their time between us. Good kids. My roommate was a life saver. She really did everything she could to make me comfortable. Everyone was great about trying to help me.

But sadly, what I remember the most about this period of time, was the misery. And I truly mean MISERY. The first six weeks after gastric bypass are critical. The body has just gone through a severe trauma and can only take a little bit of fluid at once. A very specific diet is required. There are three basic stages: clear liquids, full liquids, and soft foods. Clear liquids include thin protein drinks, broth, and water. Full liquids include soups, thicker protein drinks, and yogurt. Soft foods include mashed potatoes, oatmeal, and eggs. There were obviously other options, but these are just examples. I really wouldn't feel hungry, per se, but the urge to eat felt overpowering. I obeyed this diet strictly, however, but the mental toll became obvious quickly. I cried watching television almost every fifteen minutes because every commercial break contained ads for foods I was convinced I would never be able to eat again: subs, pizza, burgers, even fried chicken. I missed flavor and the feeling of real food in my mouth, but even drinking my protein drinks made my stomach hurt. I didn't experience too much nausea, enough to need my medicine, but not enough to be sick a lot. But my stomach did hurt. I was weak and tired from the surgery and lack of nutrients, but weight had already begun to melt away. I had already lost 11 pounds two days after being home. With the pre-op diet, that was a total of 21 pounds. I tried to prepare myself for the mental strain of not coping with food, but the reality turned out to be much more difficult than I had anticipated. I started walking up and down my street in short bursts to help deal. It helped. A couple of weeks after my surgery, my mom convinced me to stay with her for a while and that REALLY helped because it was distracting.

Weight was melting off. Before the end of July, I had dropped between 2-4 dress sizes depending on the cut of the clothing. So I struggled, but rejoiced. Hope began to glimmer. This was really working. I was really losing weight. And I had an opportunity to completely remake my life. I knew I needed to change my whole lifestyle. I needed to eat out much less. Cut out almost all fast food. Add exercise as a normal part of my routine. But I had an opportunity to change a lot more than that. I could change my whole attitude toward life. It was time to get ready for a new me and that meant no more sitting on the sidelines. It was and still is a scary thought at times, but exciting and motivating.

Waking Up to a New Life

One of my biggest fears before surgery had been the fear of having to have a regular incision. I preferred the thought of laproscopic surgery which would mean a shorter recovery time. Morbid obesity causes a condition that enlarges the liver. An enlarged liver can increase the chances of a traditional incision as it lays right over the stomach. To combat this, gastric bypass patients are placed on a pre-operative diet that resembles a "Slim Fast" diet. All refined sugar has to go. Drop two meals and substitute them with high protein drinks. One protein bar is also encouraged. Then one sensible meal is allowed. During our training session, we (weight loss surgery candidates) were given very specific guidelines as to how much protein everything should have as well as caloric intake. This meal plan is designed to shrink the liver and enable laproscopic weight loss surgery. It also helps jump start good habits to keep post-op. I tried to stick to these guidelines. I did pretty well, but I wasn't perfect. I was very good about my sugar intake, but I wasn't so great with my shakes. The night before surgery, my family took me out to an Italian restaurant (my favorite type of food), but I worried about the incision. I allowed myself one last over-the-top meal and hoped for the best.

So when I woke up in the recovery room at the hospital, I tried to talk. The nurse warned me that they had encountered trouble getting the tube to help me breathe during surgery so I shouldn't try to hard to talk yet. My first thought was, "Yay! I lived!" My next thought was, "What kind of incision was used?" When a nurse caught my eye, I moved my fingers like a pair of scissors. She laughed at me and said, "Don't worry. The doctor was able to perform the surgery laproscopically." I heaved a sigh of relief.

Now, I wondered how much pain I would be in. Still dopey from the surgery and comfortable, I wanted to see my family as soon as possible. Before I knew it, I was being wheeled up to my room for the next few days. My family was already there. Everyone commented on how good I looked. I was hooked up to an IV with fluids and a pain pump with morphine. I could push a button and administer the medication whenever I needed with an unknown-to-me limit for safety. My comfort level was decent so I visited with everyone for a while. The minute I complained of discomfort, everyone encouraged me to push the button on the pain pump before the pain got really bad. I did this throughout the day. Probably the most difficult part of the first day, though, was being unable to even drink anything. I could have nothing by mouth for a full 24 hours. At that time, I would have to have a scan done using a barium drink to see if my new pouch leaked at all. If it did, I would need to have more surgery. If not, I would begin drinking 2 ounces of fluid every hour. In the meantime, I was given flavored swabs to wipe in my mouth and suck to combat the dryness. By the end of the day, I was exhausted and nauseated. To avoid blood clots, I had to walk around the ward at least once that day. Twice was better. I am still fuzzy on some of the details of that day, but I think I walked twice. I had worked with a woman who had gastric bypass surgery and died from a blood clot. I knew I couldn't completely prevent it, but walking would help. The day was a blur of visitors and nurses and medication. The more nauseated I felt, the more I pushed the button for the morphine pump.

By the next morning, my nausea was out of control. The nurse gave me an anti-nausea medication via my IV, and I felt better very quickly. Fairly early that same morning, I was whisked down to radiology to check my pouch. I didn't have as much trouble as I anticipated drinking the barium. The surgery was a success, and there were no leaks. I was cleared to start drinking. To my horror, everything I drank made me sick. Of course, the choices were limited to water and protein drinks. But both were maddeningly painful to swallow. And now my stomach was really hurting - with nausea. The worse I felt, the more I pushed the pain pump button. By the evening, I was really miserable. The nurse gave me a short of anti-nausea medicine, but she pushed it into the IV without diluting it or slowing the push. The pain in my arm was excrutiating. The nausea also did not abate. I passed a painful, sick night.

In the morning, I got up and vomitted in the bathroom. The vomit was almost entirely blood. The doctor came to check on me with the intention of discharging me. He looked at me and asked how I felt. I burst into tears and told him about the vomitting. "I don't think you'll be going home today," he told me. Obviously smarter than me, he immediately took me off the pain pump and ordered normal pain meds for me. The difference was apparent within a couple of hours. Evidently, morphine can make you very sick. I rebounded very quickly once I stopped taking it. Everything still hurt my stomach, but at least the nausea improved. Before I knew it, it was time to go home. Panic struck again. I had not really been able to do the water or protein drinks and now time to go home. Would I be able to stand the pain without medical staff? Only time would tell.

Plotting the Course

So I made up my mind to have the surgery. Now a lot of people think that what follows is for people who are too lazy to lose weight the old fashioned way and that people who have weight loss surgery just sit back and take it easy. Look, we have all heard the stories about people who have had gastric bypass surgery (or some other form of weight loss surgery) but put the weight back on. Herein lies the quandary. Weight loss surgery is not for the feint of heart. It is a terrifying ordeal meant to help someone who faces losing years from their life without it. It is NOT a cosmetic measure. And it is NOT pleasant. Once I made the decision to pursue the surgery, my ordeal/new life/adventure began. I met with a very talented surgeon who answered my questions, explained the risks, and asked about the sordid details of my weight gain and eating habits. Answering his questions was necessary though excruciating. But the fun would not stop there. To make sure I was a viable candidate for this surgery, I would need to undergo many tests. I had to go to a cardiologist, a pulmonary specialist, and a sleep center. It had to be determined if my body could withstand this procedure. Did I mention this is not for the feint of heart?

Fear already plagued me, but the tests fed the fear. However, once I made up my mind, I really felt it best to stay the course. The cardiologist's office put me through a stress test. The pulmonary specialist put me through breathing tests I didn't even know existed. And the always fun sleep study ("We're going to hook you up to ten thousand wires...now sleep! But only on your back! Go!"). Sure. And blood work...oh the blood work. For someone like me (notoriously bad veins - deep and roll), blood work can be like some weird form of torture

After all these tests, I had to undergo a psychological exam to make sure I understood the risks and could handle the emotional aspect of the surgery. About five questions into the exam, the psychologist deemed me mentally healthy (poor, deluded woman) and decided to then just give me some coping strategies and a pep talk. Something she said really stuck with me, though. "This is the absolutely hardest way to lose weight, and don't ever let anyone convince you otherwise." I thought she needed more psychological help than I did. I mean, wasn't that the point of the surgery to make it easier? The next couple of steps convinced me that she was right.

Tests completed, training came next. A one on one session with the surgical office's nutritionist helped me to understand what my new dietary needs would be. That was an eye opener. See, someone who has gastric bypass surgery suddenly has a tiny stomach pouch and issues with absorbing all the nutrients they eat. The human body's main fuel (though not the only fuel for sure) is protein. Body builders use protein bars and shakes to build muscle and burn fat. Bariatric patients use it for the same reason, but it's more important to their health. We cannot eat enough protein with meat or normal means, but must supplement our meals with protein rich snacks (bars and shakes). Luckily, the surgical group offered some protein products at cost as a convenience and had some suggestions for other good sources. I started looking at some options in grocery stores and vitamin/health food stores. I was pleasantly surprised by the options until I started actually trying to eat them. While addicted to sugary, fried, and super fatty foods, my body did not want these options - or at least, my tastebuds didn't want them.

Next came the extended group session for training. A nurse and gastric bypass patient led us through the gory details of what would be done to our bodies and what we could expect. She carefully explained what the first six weeks would require - pain and a liquid diet. The liquid diet would start with clear liquids like thin protein drinks, broth, and water. We could then move to full liquids like soup and thicker protein drinks. After that, the gastric bypass patient may begin to eat mushy, runny solid foods like oatmeal and thin instant mashed potatoes. No problem, I thought. I probably won't feel like eating anyway with the trauma to my stomach from being cut in half and sewn/stapled back together. Check out this video: http://www.mayoclinic.com/health/gastric-bypass/MM00703. I had the Roux-En-Y method. If you can't view the video, the transcript is listed below the video. Anyway, I just knew the post op diet wouldn't be too bad. And I can be a sissy about some things, but plain old pain, I can handle. I'll describe the post-operative period in another post. It deserves it own attention.

After the training and my own research, I had nothing left to do but wait. I made the decision to have the surgery in January, 2008. In June, 2008, I found myself in the waiting room of the hospital to have a filter placed to help prevent blood clots. One month later, I sat at my desk at work and cried almost all day. I have never been so scared in all my life. Whitewater rafting, bungee jumping, hundreds of rollercoaster rides...nothing could compare. What if I stopped breathing during the surgery? What if my heart stopped? What if I developed a blood clot? What if the stomach pouch leaked or my intestines exploded? Every worst case scenario played out in my head. My co-workers and family members and friends were a true blessing that day. They all showed great patience and kindness to me. Finally, all the waiting was over. July 1st, 2008, I was plunked in a hospital bed, wrapped in a gown, and waited for my IV to be placed. I shivered uncontrollably the entire time. After six failed attempts to start an IV, the anesthesiologist finally got a small IV started. He promised to place an improved IV once I was unconscious. That is pretty much the last thing I remember from that morning. I don't remember being wheeled into the operating room the way I had remembered it from other procedures. I don't remember saying goodbye to my mom or other family and friends. I just remember being stuck 6 times to start an IV and then nothing until after the surgery.

The Decision

When a close family member of mine told me she had decided to undergo gastric bypass surgery, I panicked. I had heard so many horror stories. I feared for her life and quality of life. But her mind was made up. In the end, I chose to support her as well I could. I began learning about the surgery, it's complications, and how it worked. But I didn't spend too much time on it. She had her surgery June, 2006. She did not die. In fact, her surgery has been quite successful. Despite some complications, her quality of life has greatly improved.

In October of 2007, I weighed in at 330 pounds. My life was in a state of disarray. At 31 years old and morbidly obese in a job I really detested, my husband declared he no longer thought our marriage was working. We separated. I thought all my dreams and hopes were done - shattered. But something funny happened. When I was at my lowest point, I began to believe God had more in store for my life. And then I realized that while some dreams were done, a whole new set of dreams could happen for me. And while I had been kicking the idea of weight loss surgery around, I had not considered it a viable option as my husband was so opposed. But since we had separated, I no longer needed his approval. I had tried dieting for years, but my weight had steadily increased. I felt I had let my life spiral out of control. The time had come to make a difficult decision. With much prayer and thought, I went to the free informative seminar at a local center for bariatric excellence. I felt able to make an informed decision at that point. I weighed the consequences of not having the surgery. I was diabetic. My feet were constantly swollen. I suffered from sleep apnea. I had constant joint pain in my hips, knees, and ankles. I could only buy clothes at specific plus size stores that carried a size 30 in pants. I had not been able to buy regular-sized clothes since my first two years of high school. And I was now facing starting over alone after a divorce. I wanted to start over with a fresh start. I needed my health. I decided to have the surgery.