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.
What does it mean to be a weight loss surgery success? As I get further out from my gastric bypass, this is a question that I’ve been thinking about more and more. I’m sitting here this morning at 182 pounds, which is the upper limit of my comfortable range–usually between 177 and 182 pounds. My BMI is 24.7, which is in the normal range. (Yes, it is nice to be tall.) I’ve lost over one hundred pounds. But, most of the time? When I look in the mirror? I still don’t see myself as a success.
For all those who say that weight loss surgery is “the easy way out,” let me tell you something. It’s hard. This is, by far, the most difficult thing I have ever done in my life. There is no opportunity to stop or take a break. Thinking that my surgery is doing this all for me is laughable. At seven months out, I could easily be eating around my surgery and already be working my way back up to 280 pounds. That would be easy.
