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May
10

Surgiversary

So now that you’ve hopefully recovered from reading about the craziness that was my life since August, as promised I’m going to attempt catching you up on key changes that have been happening ’round here.

Starting with the biggest change…literally. My first year as a postop bariatric patient. Oh boy, brace yourselves.

Stats-wise, as of my April 23 “surgiversary” I had lost exactly 130 pounds since Surgery Day and 148 from my highest recorded weight. Looking at those numbers, it’s pretty astounding. I have literally lost more than half of myself, weightwise. My BMI at the start of this journey was 47 (AKA morbidly obese). My BMI today is 20.6. Zoinks.

One month before surgery in April of 2015, this was me…

Not my cute baby...

Not my cute baby…

And this is me (with the hubby) on an April 2016 trip to D.C. …

washington_monument

*Interesting observation: I am still camera shy and prefer not to have full body photos taken…*

Last time I posted about my postop experience, I was only two months in and feeling…well…mixed up. Guys, there are SO MANY emotions tied to this experience, and it doesn’t help that as you lose weight, your shrinking adipose tissue releases stored hormones back into your circulation. All.the.feelings. All.the.time.

In the interest of avoiding a novel, I thought I’d write up sort of a “Frequently Asked Questions”-style list, based on conversations I’ve had in person and via online support groups, of the most common issues that inquiring minds want to know about. If you have additional questions, please leave them in the comments section and I’m happy to tackle them in a future post and/or one-on-one. Feel free to use the Contact Me link as well if you have a more personal question you don’t want to share.

So let’s get to it…

What surgery did you have again? My surgeon refers to it as the SIPS (Stomach/Intestine Pylorus-Sparing surgery). It’s also been called a SADI-S (by the surgeons in Spain who originally came up with the idea) and the Loop-DS. Since it is still in clinical trials, it’s pretty unfamiliar to most folks, even other health professionals. For those who are familiar with weight loss surgeries, I often explain it as a combination of a vertical sleeve gastrectomy and a very modified duodenal switch. If that previous sentence makes no sense to you, don’t worry, you’re not alone. See this post for more details about the SIPS/SADI-S/Loop-DS (plus a gnarly video). And one of the surgeons who performs this surgery has developed a helpful description as well as a handy comparison chart. There is limited data out there since it’s a new(er) procedure, but early nutritional outcomes are pretty promising.

What was the most surprising thing about your first year? I’d say it’s a tie between the sheer amount of weight I lost so quickly and the emotional ups and downs that I didn’t expect to be quite so extreme. Which are related to each other. I’m 0.6 BMI points away from being technically “underweight”. This causes its own share of stress, as I start to wonder when things are going to level out. I’ll reach an even weight for a few weeks and then drop 3-4 more pounds. I’m ready to stop dropping and maybe even take a few pounds back.

What has been the best part about your first year? Hands down, feeling like I can participate in my life again. There were so many occasions pre-op when I turned down opportunities to hang out with friends because I literally didn’t think I could keep up with them. I’d be worried about walking too much, or sweating, or chafing, or not being able to breathe if we were going dancing or headed to a concert. I chose parking spots based on the minimum distance needed to walk and dreaded anything that involved stairs. So to not worry about these things is very liberating.

What has been the most distressing thing about your first year? Definitely the unpredictability tied to eating. I can eat the exact same food two days in a row and tolerate it fine on Day One, while I’m running for the bathroom on Day Two. It’s annoying and sometimes inconvenient. My rule of thumb is never to try a brand new food in a public venue (if I can help it). Plus I’ve had to get over my fear of using public restrooms. A necessity. (TMI: This handy little product has been a lifesaver.)

Can you drink alcohol? Yes, but I’ve become quite the cheap date. 😉 It doesn’t take much to give me a good buzz and most of my favorite cocktails from pre-surgery are way too sugary now. I’ll take a small pour of wine with dinner and I’m golden. (Bonus: My migraines have been largely absent since surgery, a not uncommon and quite desirable outcome of weight loss procedures. So I can drink red wine again! This makes me very happy).

Does food taste different now? Yes and no. My palate has definitely changed. Sweets tend to turn me off completely – if it’s a really special occasion and it’s a really high-quality goodie, I’ll have a bite or two to enjoy the flavor but that’s about all I want. Which is a huge change from my days of inhaling Skittles and Pretzel Flipz in massive quantities. I tend to prefer saltier foods and umami flavors. Sushi is still my favorite food but I tend to eat the fish and veggies and leave the rice for Steve (seriously, I should take a photo sometime. It’s massive sushi roll carnage on my plate). My sense of smell is still very strong and doesn’t always agree with my sense of taste. And my eyes are still bigger than my stomach. But I also have a lot of food anxiety that I didn’t have before, so I’ll over-order for fear that I can’t find something I’ll like and then just eat bits and pieces of something.

My cousin’s sister’s aunt’s brother had gastric bypass five years ago and has gained all the weight back and then some. Aren’t you worried this will all be for naught? (Or some variant of this question….) First of all, I know the statistics, thank you. I know regain is a major concern in this community. The jury is still out on how it will affect SIPS patients because it’s a newer surgery, so we don’t have long-term data. But I know it’s easy to get complacent, especially when you are literally melting off the fat without even trying during your first year postop. It doesn’t come so easy in year two or three or ten. So thank you for sharing the regain horror story – I’ll take it as well-intentioned and move on.

Can you eat anything you want? Can I? Sure. Should I? Nope. Will I pay the consequences with my GI system? Often. This is supposed to be a tool, not a crutch. I’m learning portion control and paying better attention to nutritional information (especially sugar content). I’m certainly at the point where I can physically consume pretty much anything (in MUCH smaller quantities). Certain foods still don’t sit well and cause uncomfortable gas and bloating. I don’t technically get “dumping syndrome” the way that RNY-ers do because I still have an intact pylorus controlling gastric emptying from my stomach to my intestines. But sugar moves through me FAST and does not absorb well, and often leads to great discomfort.

So tell me more about this food anxiety? Let me paint you a picture: during a recent road trip, I called up Steve sobbing because I couldn’t figure out where to stop for lunch. Although I still consider myself a “foodie” and love to try new restaurants, this experience also causes me some distress because I don’t know how I will tolerate new-to-me dishes anymore. I tend to try splitting plates and unfortunately have had several episodes of feeling awful and crampy after a nice evening out. When it’s just me and I’m in a situation where I need to order take-out, I try to stick with foods and restaurants that I have tolerated before. But it’s no guarantee (see above re: unpredictability)

What have you done to help you recover mentally/emotionally/spiritually? This is key, folks. If you make this leap, be sure you surround yourself with people who will be there no matter what the outcome is. There is no place for negativity … this is MAJOR surgery with major physical and emotional fall-out. You need support and you need to find outlets for when it gets hard. Because it will get hard. Personally, I can’t recommend ongoing therapy enough. Most surgeons will require a pre-op psych eval. But it doesn’t stop there, and the issues that caused weight gain in the first place don’t get surgically resected with your stomach. So find a good therapist and keep going back. Plus, find a support group if you can. Most bariatric centers have a support group for their patients (I’m fortunate that I found a local one that is going to let me start coming even though I had my surgery elsewhere). At the very least, search online for supportive communities. Some of the online message boards can be downright toxic, so choose wisely (and let me know privately if you need recommendations).

I have also tremendously benefited from acupuncture. Not everyone is a believer (you know I am) and the scientific jury is still out, but when we moved to Maryland in January I found a local place and started going weekly. We focus on digestion and also talk a lot about nutrition. It has done wonders … I’ve only gone once this month due to budget constraints and I can feel a real difference when I don’t go regularly. Luckily my new employee insurance covers acupuncture, so as of June 1 I’ll be golden. (And in the meantime, I re-budgeted to go at least twice for the rest of May…it’s too important not to.)

How are you feeling today? Sigh, such a complicated question. Unfortunately I am still dealing with quite a bit of fatigue. If I don’t eat on a fairly strict schedule I get lightheaded and develop symptoms reminiscent of hypoglycemia. This makes working as a nurse/nurse practitioner quite tricky sometimes. I’m also struggling with exercise tolerance related to my fatigue, as well as some orthostatic hypotension. We’re trying to figure out if it’s just the result of massive and rapid weight loss to which my body is having a hard time adjusting, or if there is something slightly more sinister at play. My endocrinologist has had to make significant changes to my thyroid meds with the weight loss, so that could be part of the problem. And I’ve had multiple people ask me if I’m anemic because I’m so pale (I was pale to begin with but apparently these days I can come across as downright peaked.) Previous labs have never revealed severe problems, but we are re-doing a CBC this week just in case.

So all in all, it’s still a struggle. I imagine that in some ways it always will be. My relationship with my body and with food is complicated and has been for as long as I can remember. That relationship doesn’t get fixed by having my insides rearranged.

And yet, and yet …. this will always be one of the best decisions I ever made for myself. I was headed down the path of serious health complications that would likely have shortened my life and would almost certainly have led to profound disability. My overall quality of life was at an all-time low. I needed this, not because I wanted to be a certain clothing size or weight. In fact, I’ve really struggled with what it means to be a feminist who is attempting to be body-positive and yet intentionally lose a person by undergoing drastic surgery. It’s complicated. Another post for another day.

I guess the best word I’d use to describe myself today is … grateful. We all have our battles. Mine have changed as my body has changed. But I’m in a far better place now.

More than anything, I’m grateful for the most important lesson learned from this experience: Take care of yourself. Whatever that means to you, take care of yourself.

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