Yes, I’ve finally broken through that mythical 110 pound window that’s been holding me back for two and a half years. This week, the scale started revealing strange numbers. I’d been hanging out in the 178-182 range for, well, months basically. And then on Sunday I saw 177. Then on Monday, it was 176. And on Tuesday, I saw a number I’d never seen since surgery: 175. I really couldn’t believe it. Especially since I hadn’t been doing anything particularly willful to lose weight. Sure, I’d been eating a little less; I wasn’t all that hungry these days. On Wednesday, I was a little nervous to get on the scale. Surely that 175 was a mistake, right? But, no. 174. And on Thursday, I saw 173. That puts me officially 112 pounds down from my highest recorded pre-op weight of 285, and at a BMI of 23.5.
Photo Credit: Beth Sheldon-Badore
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.
The American Heart Association issued a statement in Circulation: Journal of the American Heart Association stating the benefits of bariatric surgery for severely obese patients. This was the first statement by the AHA to focus solely on bariatric surgery and cardiac risk factors. However, it was not a full endorsement of weight loss surgery.
In the past, the AHA has presented bariatric surgery as a strong option to be considered based on the individual patient’s medical profile. In this statement, he AHA examined the serious health consequences of morbid obesity and the disappointing success found with conventional weight loss methods. The statement panel examined the current literature, which led them to conclude that, when indicated, bariatric surgery can lead to significant weight loss, as well as improvements in the comorbid conditions of morbid obesity, including diabetes, liver disease, high blood pressure, high cholesterol, and sleep apnea. Moreover, weight loss surgery can cause improvements in cardiovascular dysfunction. Finally, the statement panel also found that recent studies show bariatric surgery can prolong life in the severely obese.
According to the statement, such benefits can overcome the risks that accompany bariatric surgery, such as death and long-term post-surgical lifestyle implications.
A new device, known as Abiliti, has entered the bariatric surgery arena. It will soon be available in Germany, Spain, and the U.K., with the first implantations scheduled to take place later this week.
Photo Credit: Intrapace
You’ll remember that back in December, an FDA advisory panel recommended the lap band for less obese individuals–people with a BMI over 35 or between 30 and 35 with comorbidities. Now, the Food and Drug Administration is due to issue its decision on approving the device for this weight class. Last week, an editorial appeared in The New York Times that made some interesting points. Beth (aka Melting Mama) posted it on her Facebook, and I thought it was worth sharing.
Continue reading ‘The FDA & the Lap-Band for the Less Obese’
Tis the season for New Year’s resolutions, diet schemes galore, and recommitments to health that fizzle out by the end of January. But maybe you’ve decided that this year will be different for you. Is this the year that you’ll consider bariatric surgery? After all, if you are morbidly obese, conventional weight loss approaches, such as diet, exercise, and pharmaceuticals, have a failure rate between 95 and 97%. If you’re thinking about bariatric surgery, let’s talk.
Photo Credit: Darrren Hester (Flickr)
Photo Credit: Rebecca Bell Wilson
I look like a normal person. Most days I feel like a normal person. So, it’s an interesting conundrum. Why can’t I eat like a normal person? After all, didn’t I have weight loss surgery to be normal?
It’s a common question on weight loss surgery message boards: “How do people gain the weight back after bariatric surgery?” It’s asked as if weight loss surgery is some magic bullet that solves all the mental and physical aspects that contributed to morbid obesity. There are usually answers from individuals a few months out from surgery, claiming that it’s impossible to ever eat enough to gain back the weight. The surgery won’t let you!
Let me let you in on a little secret: this surgery doesn’t fix us.
I know I just posted about an FDA panel approving the Lap-Band for use in patients with a BMI as low as 30 kg/m2, but that’s not all they’ve been doing. Yesterday, December 7, 2010, an advisory panel voted to recommend the approval of new weight-loss drug: Contrave.
Contrave is a combination of two medications. The first is bupropion, which is marketed under the brand name Wellbutrin. Wellbutrin is used as an antidepressant and a smoking cessation medication. The second medication is naltrexone, an anti-addiction medication market under the brand names Depade and ReVia.
Allergan, the makers of the Lap-Band, has been in the news lately. They recommended to the FDA that the Lap-Band be approved for use in patients with a BMI as low as 30 kg/m2. The FDA panel voted to recommend the Lap-Band for use in these patients. The vote was 8-2.
Currently, the Lap-Band is approved for use in patients with a BMI of 40 kg/m2, or 35 kg/m2 with co-morbidities. The new recommendations would allow use in patients with a BMI of 35 kg/m2, without co-morbidities, or of 30 kg/m2, with co-morbidities.
