Two years ago today, I took off my requisite green, put on a hospital gown, and underwent Roux-en-Y gastric bypass. Two years ago, I was sick, sicker than a twenty-one year old should be. I had non-alcoholic steatohepatitis, or fatty liver disease. I had high cholesterol, high triglycerides, and my blood pressure had begun to creep above the normal limits. At my highest, I weighed over 285 pounds. I’m not sure how much because I began to avoid scales after I saw that number. My asthma was out of control. I was using my rescue inhaler on a regular basis, including many nights as I was lying in bed. I had upper airway resistance syndrome, a mild form of sleep apnea. I was struggling to breathe in my sleep, snoring and gasping for breath. I also had GERD, and the reflux was starting to wake me up at night.
All wired up for my pre-op sleep study, which revealed I had UARS.
So, I made the decision to pursue bariatric surgery. I actually made that decision in spring 2008, three years ago. I began reading the ObesityHelp message boards. Compulsively. I wanted to find all the information I could. My parents and I attended our first information session, with Dr. David Provost, who was practicing at UT Southwestern. My mother, a physician assistant, had heard good things about him. We walked away shocked. But not by the doctor. Instead, it was the other patients, the ones who were stunned that they would no longer be able to drink Hi-C. The ones who were more interested in abdominoplasty and liposuction than in losing the weight with bariatric surgery. We were shocked. But, we were also reassured by Dr. Provost. My decision was made. Bariatric surgery was something I wanted to pursue. Dr. Provost was my surgeon.
Me, pre-op, in Mexico. January 2007. This was taken near my highest weight. The hike up to see the monarchs was grueling.
I began traveling the long road towards insurance approval. I scheduled appointments with my primary care physician to complete the six months of supervised weight loss required by my insurance company. I gave it my best effort. As usual, I lost a bit of weight, only to find that weight again, with friends along for the ride. I had lost weight before, up to fifty pounds, but it always came back. Bariatric surgery offered the chance to change that.
Pre-Op, September 2007.
While completing the insurance requirements, I continued to research. Not only did I read books and web forums, I also read scientific studies. I saw the odds of weight loss and regain with weight loss surgery, as compared to conventional weight loss methods. I saw that even with bariatric surgery, there was a high rate of failure, but it was nowhere near the almost guaranteed failure of conventional weight loss methods. I learned that pregnancy was very possible, and safe, after weight loss surgery. I was not sacrificing my future to lose weight.
Four months into my insurance-mandated weight loss program, I received a letter in the mail. Dr. Provost was leaving UT Southwestern for a private hospital in Denton, one that was not on my insurance plan. I had to find a new surgeon. A suggestion from my gastroenterologist sent me to Dr. Joe Cribbins, a bariatric surgeon at the hospital by my house. I went to another seminar, sat through the routine questions, and had a consult with Dr. Cribbins following the intro session. He agreed with my selection of the Roux-en-Y gastric bypass. Under my insurance coverage, my choice was between the RNY and the Lap-Band, but I did not like the long-term stats of the band.
I completed the insurance requirements and submitted to my insurance company for approval. That approval came in late November 2008. Because I was a full-time student at the time, we scheduled my surgery for spring break. March 17, 2009.
My official pre-op photo, taken the night before surgery. March 16, 2009. 267 pounds.
Now, at two years post-op, my life has changed. This morning, the scale said 183, which is six pounds higher than my lowest weight of 177. My BMI is 24.8, so I’m in the normal weight category, but just barely. Several of my pre-op health conditions have been resolved. I no longer have GERD, fatty liver disease, UARS, high cholesterol, or high triglycerides. My blood pressure is normal.
Taken seven months after surgery. October 2009.
Christmas 2009, taken with my nephew. Around 180 pounds.
But that’s not to say I’m healthy. I still suffer from the depression and anxiety I had before surgery. And the malabsorption from my gastric bypass makes treating those conditions even trickier. My depression is finally back to being under control, but for almost a year, it wasn’t. I’m dealing with iron deficiency. My ferritin is still a 12, though that’s up from a 6 a few months ago. I was diagnosed with migraines with chronic daily headaches two months ago, and I’ve had a headache since November 25, 2010. I wake up with a headache, and I go to sleep with a headache. Every. Single. Day. While I no longer have fatty liver disease, my liver function tests are elevated. They returned to normal with weight loss, but the stress of my new array of medications is taking its toll on my liver. So I’m in a place where I cannot take pain medicine for my headaches. I cannot even take Tylenol. I cannot take the preventative medication that was helping with my migraines, Topamax. Not only is it processed through the liver, with a known risk of hepatotoxicity, but it also was making me acidotic. My CO2 level dropped below the normal limits. There’s no evidence that the headaches are in any way related to my gastric bypass. But the RNY has certainly made treating them more complicated. I do not have the option of simply popping an anti-inflammatory. Advil and other NSAIDs are off the table.
April 2010. Over a year post-op. Photo Credit: Rebecca Bell Wilson
At two years out, the only thing I can say for sure is that I am skinnier. I am not slowly dying of obesity-related conditions. Whether I’m healthier today is up for debate. I do not regret having weight loss surgery; to do so would not be productive. I do wish I had had the option of a vertical sleeve gastrectomy (VSG), a restrictive-only procedure that my insurance company started covering in the last year. But that wasn’t an option when I had my surgery. I’ve been successful. I’ve lost my excess weight. I’m “normal.” The RNY did it’s job. It helped me get the weight off.
November 2010. Houston OH Conference. Photo Credit: Beth Sheldon-Badore
But I’m still ambivalent. I wonder where I would be if I hadn’t had surgery. Would I have managed to lose the weight through conventional methods? The scientific research, as well as my own pre-op experience, says that is unlikely. I would likely be 300 pounds by now, and I would be killing my liver, even more so than my prescription medications are today. I would not be able to keep up with the kids I teach at work. Nor would I be able to chase my nephew around. Instead, I would struggle to breath. I would walk slowly. I would still shop at Lane Bryant.
So, life is different. I cannot say for sure that it is better, but it certainly is different. Ask me again next year.
Now, this is a rather old study. It was published in 2005. There’s a reason I haven’t written anything about it yet: it’s not very informative. Unfortunately, it gets misinterpreted a lot, so I feel it’s time to go through it and set the record straight.
Psych Meds - I've Got 'Em!
First off, this study has nothing to do with the absorption of psychiatric medications after gastric bypass. Let me repeat: the study authors did not examine absorption. At all. So, don’t get your hopes up like I did the first time I read it.
We’ll go through this step-by-step, and then I’ll give you my take on the study, and, believe me, I do have an opinion on this one!
Continue reading ‘Dissolution of Common Psychiatric Medications after RNY’
As promised, I’ve read the study I mentioned yesterday, and I’m ready to report back. I am still very excited that this study was conducted, although it does have its limitations.
Continue reading ‘Sertraline Levels in Gastric Bypass Patients’
Finally, someone with funding has run the study that I’ve been waiting for. Honestly, you would not believe how excited I was when I saw this study pop up on my computer screen. It hasn’t been published yet, but it is available online through Surgery for Obesity and Related Diseases.
Preliminary comparison of sertraline levels in postbariatric surgery patients versus matched nonsurgical cohort
Roerig JL, Steffen K, Zimmerman C, Mitchell JE, et al.
Abstract:
Background: Roux-en-Y gastric bypass (RYGB) is the most frequent bariatric procedure performed in the United States, with thousands performed. Because of the changes to the gastrointestinal tract, the potential exists for clinically significant alterations in the absorption/bioavailability of ingested medications. The purpose of the present pilot trial was to determine to what extent RYGB alters the area under the plasma concentration/time curve (AUC0-10.5) of the antidepressant, sertraline at a community research center.
Conclusion: To our knowledge, this is the first reported study exploring antidepressant pharmacokinetics after bariatric surgery. In our present trial, the AUC0-10.5 and maximal plasma concentration were significantly smaller in the subjects who had undergone RYGB than in the matched subjects who had not. Additional investigation of the effects of bariatric surgery (RYGB, sleeve gastrectomy, and gastric banding) on the antidepressant pharmacokinetic parameters is warranted.
I’ll have a full post in the next couple of days, but I wanted to share.
Bariatric surgery is often criticized as being “the easy way out.” Let me tell you first hand, there is no easy way out of morbid obesity. Sure, weight loss surgery helps you get the excess weight off faster and more successfully, but that doesn’t make it easy.
Welcome back to The Bypassed Life’s new series, “The Crazy in Us.” Today I want to talk about a serious trend in post-operative life: suicide. I’ve spoken briefly on the topic before, but it’s a topic that deserves more attention.
Basically, some research has found higher than expected rates of suicide among weight loss surgery patients. The reasons for this trend remain unclear.
Welcome back to a new series at The Bypassed Life, “The Crazy in Us.” Today I’ll be speaking about mood disorders after bariatric surgery.
The limited research that has been done on psychological functioning after surgery suggests that while many individuals experience improvement in mood after bariatric surgery, the positive changes are not universal.
Welcome to a new series at The Bypassed Life: The Crazy in Us. Over the coming days and weeks, I’ll be taking a look at the psychiatric issues that affect weight loss patients, both before and after surgery. Make sure to check back in.
The first part of the series examines the presence of psychiatric issues in the morbidly obese and in candidates for bariatric surgery. The morbidly obese individuals have a higher incidence of mood disorders.
Continue reading ‘The Crazy in Us: Pre-Op Psychiatric Issues’
Earlier this week, I posted some facts about complications after roux-en-y gastric bypass. Today, I want to tell you a little bit about my personal experience since surgery.
Down 107 pounds, but that's not the full story. Photo Credit: Rebecca Bell Wilson
Well, I’ve been on the liquid concentrate form of Zoloft for over a month now, and I figured it was time for an update.
