Five Months Post Surgery

I realized I haven't made a posting in quite awhile. My progress has been steady and I now weigh in at 103 pounds. That is a BMI of 22.3 and is in the normal weight range for my height of 4'9". I have only a few pounds to lose now before I will have to stabilize. My total weight loss is 63.5 pounds to date.

Generally speaking I feel very good. I am energetic and well. My coloring is good and I've only lost a little bit of hair. It is common for Gastric Bypass patients to experience hair loss at least to some degree. Having been gifted with extremely thick hair it is barely noticeable that I've lost any. I've tried really hard to adhere to the protein, vitamin and calcium intake requirements each day and I think it is paying off. It has been impressed upon me the importance of accumulating enough of these nutrients on a daily basis. Without them one can fall into a nutrient deficit state that can have some pretty serious ramifications. I have embraced dairy foods and meat into my every day diet as well as including everyday supplements of calcium and Flintstones children's vitamins.

Exercise is something that I work at. Now that the holidays are over I can be more consistent about it. Yesterday I did a short cardio workout followed by a short Cybex weight circuit. Today I'm going to play with my new stability ball. It is supposed to be good for core exercises. I suppose there must be some core muscles in there somewhere!

I've arrived at a place where eating is pretty easy. I know my limitations. I cannot eat much at a time so I eat a small amount 5 or 6 times a day. I can eat most things without trouble but I steer away from sugar. I can tolerate only a small amount of real sugar. A single bite is about all I can do safely. Any more than that gives me the shakes. Splenda is a great substitute and is widely available. I have found sugar free products pretty easy to come by and actually prefer that now. Interestingly my tastes have changed since the surgery. For whatever reason some things I really used to like no longer appeal to me and I sometimes crave things that I didn't like before.

Medically I am doing exceptionally well. I will be done taking Actigall in February. That was prescribed as a precaution. People who lose weight quickly often develop gallstones. So far so good. Another medication is being tapered down. If all goes well with that I'll be done with it at the end of May. In the end my goal is to only need my allergy meds on an occasional basis. I am having a liver scan soon. The prediction is that they will see a significant decrease in the size of my liver. All of the liver enzymes and blood indicators are now in the normal range so it's looking good. At 6 months post-surgery I am quite happy with my progress. I feel like I have a brand new body.

Trimmer

My Aunt Shirley took this full body picture of me a couple of weeks ago. It does show how different I look compared to where I began. It's kind of odd but I don't think my head has caught up with my body yet. What I mean is that my body is smaller but my head hasn't quite registered that yet. When I shop for clothing I still pull the large size and then when I try it on I realize that was a silly choice. Most of my shirts are now small or medium. That depends on the quality and the cut. I don't like anything to be too form fitting. I'll keep my curves to myself for now. When I look in the mirror I do see myself as thinner. In the past few weeks many people have started to ask about my weight loss. It is pretty dramatic at this point. Most people want to know my "secret to success". I say that I eat less and move more. That is the truth. My surgery is only a tool to help me stay to that path. My BMI is now 25.3 and I am on the cusp of moving into the classification of "normal weight". Maybe I'll reach that by next week.

Perception

Here I am at the beginning of September. I look at this picture and I see someone that I haven't seen in a very long time. Everyone remarks on how much younger I look now. I've made a recent observation. I've noticed that the thinner I become, the more attention I receive from sales clerks and strangers. Now, I never really thought that I was ignored before. However, it is clear to me that how people respond to me has changed. What I am not clear about is whether it has to do with them or me. Is it because I am more "attractive" to others and more aligned physically with what society deems as attractive? Or, on the other hand, is the change in me - the person, making me look happier and more approachable. That is an interesting puzzle. maybe it is a little bit of both.

It has been awhile since my last post. Now that school is in session it is harder to find a few minutes to concentrate on an update. Our first marking period ends Friday and we will have officially ended the first six weeks of school. As they say, "The honeymoon is over!".

Today I weigh 117 pounds. That is right around what I weighed in 1988 when I competed in the Empire State Games. That was 20 years ago and I was in the 118 and under weight class for women's olympic style weightlifting. I have lost a total of 48 pounds and 64.75 inches from my body. 11.5 of those are from my waist. Last weekend I bought a pair of black jeans that are petite size 4. They don't have any elastic at all. I cannot remember the last time I bought pants without any stretch to them. Of course even petite pants are too long so I took them to the tailor (my new best friend) to have them hemmed and made into straight legs instead of boot cut.

On the health front, my liver enzymes are now all within the normal range. The middle of the normal range. My blood sugars are also in the normal range and my nephrologist noted that the last blood sugar reading was on the low side of normal. I had an EKG recently which showed a lower that normal heart rate. I asked if I should be concerened and they just laughed and said no, athletes and people who are very fit always have lower heart rates. My blood pressures are dropping and so is my medication. I think pretty soon I won't need blood presure medication at all.

I am continuing to do very well. I still avoid real sugar but I have found some very good Splenda recipes. I NEVER drink anything carbonated because carbonated beverages stretch and increase the capacity of your stomach. I never knew that until I had the surgery. It is believed that carbonated beverages account (at least in part) for people over-eating when they consume soda.

I can't eat lettuce. It doesn't chew up well and it doesn't seem to move through my system well. I can eat cabbage. The only difference is that cabbage is a little thicker and easier to actually chew. My biggest daily challenge is drinking enough fluid. I used to be able to do half to three-quarters of a gallon every day. Now I struggle to drink a half gallon of liquids. The problem is that I can only drink about a half cup at a time. Being back at school I get distracted from remembering to drink. It has been challenging but now I am on the right track.

It was also difficult to start eating according to a bell schedule. I have discovered that by eating 4 small meals a day I can maintain energy and fulfill my nutritional requirements. This semester I teach 2 classes and then have a gap of 120 minutes until I teach my 3rd class. That 120 minute gap allows me 2 tiny meals: one at the beginning and one near the end. You might actually call them snacks.

It has been harder to work out with being back to work. I try to find time every day to do some physically activity. It might be cutting the grass, gardening, walking or weights. I do go to a wellness center at the hospital when I want to use the treadmill or weights.

Right now I am simply staying the course. I have a little over 10 pounds to go before my Dr. evaluates whether or not to lose any more weight. The current goal is 105. I'm sure I'll reach that before the end of 2008.

Who is this small human looking younger and healthier each and every day? It's me...It's me!!! Sometimes I cannot believe what I see looking back at me in the mirror. It is almost as if I am looking at myself 10 or 15 years ago.

Here is an update on my progress. First and foremost let's talk about my liver. My formerly very, extremely sick liver is looking pretty good. It is about 3/4 the size it was before surgery and continues to shrink. The 3 enzymes of note GGPT, SGOT and SGPT have all gone down. SGOT has dropped 15 points, SGPT dropped 52 points and GGTP dropped 51 points! That is pretty impressive and is evidence that the surgery is accomplishing the goal. While those levels are still high, they are closing in on the normal range rapidly.

My weight is now 129 and I am down 37 pounds. I haven't been at this weight in 20 years. I still have about 24 to go to reach my goal weight of 105 and BMI of 22.7. Remember, I am 4'9". Those numbers are right in the middle of the "normal" range for me. Right now my BMI is 27.9. That is classified as overweight but NOT obese by the National Institute of Health (NIH).

After doing some measuring I have lost a total of 52.75" from my body. 15 of those inches have been in the last month. Weight loss slows down after the first 4 weeks. That's because your body starts getting "real" food again and continually adjusts its metabolism. It fights to hold on to body mass as you lose so it takes more time. I am 8 weeks and 2 days post surgery and I am making really good progress.

I am making progress in what I can eat as well. Chicken, Tuna, Beef, Beans and Cheeses are staples. I always eat a lean protein with a carbohydrate. I enjoy pretzels, crackers and thin bread if is toasted to a very crispy state. This week I added fruit. So far I have tried bananas, blueberries and V8 juice. I bought a peach so that is next . Dairy products are a mainstay of my nutrition. I have to say I was never really very thrilled with that food group but I have grown to like dairy. I drink a milk-soy protein shake every day as well as having cheese, yogurt and regular Lactaid milk. Protein and calcium are the big areas of focus.

Physically I feel as if I have been re-born. Seriously. I don't think I knew how lousy I felt until I didn't feel lousy anymore. I have so much more energy and stamina now. I don't find myself constantly taking breaks from physical activity. I am consistently walking (I've even jogged 50 yards at a time a few times), mowing the lawn without stopping and I am going back to the wellness center for some alternative aerobics (like a seated stepper), beginning weight work and flexibility training. The trainer, Kevin, had me working with one of those big balance balls. I don't know who was laughing harder, Kevin or me. All I can say is that is not as easy as it looks.

My shoulder blades have reappeared and I think I saw/felt what might be a rib the other day....maybe......School starts next week. The challenge with that will be timing my eating and pacing my day to include exercise.

Solids

It's been just under 5 weeks since my surgery. To date I have lost 27 pounds. Wow! I am seeing collarbones that have been buried for years. I have lost 37.5 total inches from my body. 5.5 of those inches are from my waist. I am now walking about 4 miles a day when the weather cooperates and I have been given permission to ride my bike. I'll probably do that later this week.

In the past few days I have been introducing solid food to my diet. It has to be cut into tiny pieces and chewed thoroughly. So far I have tried roasted chicken, refried beans with cheese, pretzels, lettuce and baked tortilla chips. The lettuce was the only thing that gave me trouble. It was shredded and too stringy. I think I'll try cutting it into little squares to see if that works better. Here is an example of a meal: 2 baked tortilla chips, 1/4 cup of refried beans, 1/8 cup of shredded Mexican cheese and a tablespoon of lettuce. That used to be a small snack. The weird thing is that it takes about 15-20 minutes to eat and is more than satisfying. I'm still not really hungry but I've learned to read my body's signals when it needs fuel. Eating is now largely experimentation. I have been encouraged to try a variety of foods. The main recommendations were that the food should either be very moist or very crunchy. Those textures are easier to chew and digest. Regular bread tends to stick in the pouch and can result in having to have it extracted via the esophagus. Caution and rule following are important. I have even been encouraged to try going to a restaurant and to be sure to ask how the food is made.

Right now I am to eat 3 meals a day. In between I should drink skim or 1% milk, water or I can make a smoothie (milk, banana, splenda, ice) or have popcicles. I am allowed to flavor the milk with anything sugar free. As a former non milk drinker I have to say that I am working at that. I need to consume 1500-2000 mg of calcium a day. I have a supplement if I don't get enough in my food. I have to keep a chart each day to keep it all straight. I have to get 50-70 grams of protein each day. I have worked my way to the mid 50s.

Another encouraging sign is in my recent blood work. My liver enzyme readings have already dropped: SGPT dropped 25 points and SGOT dropped 3 points. That is really good for only a month. My Dr. said that in 6 months he'll order a CT scan to see how the size of my liver is doing. Since my abdomen isn't particularly distended my guess is that is shrinking. One of my friends commented on the fact that the whites of my eyes are now actually white instead of light yellow.

School and work are only a month away. I'm really glad that my surgery was able to be done during the summer as I will have time to fully recooperate and will be fresh to begin a new school year.

Full Bloom

Friday night was the opening for my exhibition at 171 Cedar Arts Center in Corning. I am exhibiting with Ithaca artist Stan Bowman. We both work digitally with flowers but have contrasting visions within the subject matter. The opening was nicely attended and it was good to see so many friends. I had applied for the show nearly two years ago and had a long wait after my work was accepted. The Houghton Gallery at 171 is a great space and it's very humbling to be able to show where many talented artists have gone before me.

This morning my scale showed a total loss of 22.5 pounds. The progress continues and I am feeling very, very good. My energy level is starting to return to normal although my abs still tell me when I should stop. I am now walking a couple of miles a day consistently. Sometimes I am able to do more. We've had periodic rain this week and a few walks were cut short by thunderstorms.

This week I have an appointment with my regular nurse practitioner. She will work with me to adjust my remaining medications as I continue to lose weight. She'll also keep tabs on my electrolytes and blood counts so that I don't get out of sync with normal levels. I cannot believe that we only have a week left of July. This summer is flying by.

Delicious Cream of Broccoli Soup!

Today is "move-up day". I have graduated to pureed foods. My first "meal" was one third cup of Campbell's Cream of Broccoli soup. It took me 45 minutes to eat it. Frankly I was a little bit afraid. It isn't unusual for gastric bypass patients to have their food come back up if they eat too fast or too much. Especially in the beginning. Purees are thicker than clear liquids so the whole eating process changes again.

Starting today I am to eat three meals a day. Each meal should measure between 1/4 and 1/3 cup of pureed food per meal. The texture of this food is to be runny. I used my Magic Bullet blender to bring the soup to that consistency. I cannot drink with my meals. Drinking clear liquids should be between these three mini meals. I am supposed to try to get 50 - 70 grams of protein a day. I think that can include the protein in the 1% milk that counts as clear liquid between meals. I am also now taking two Flintstones Complete chewable children's vitamins each day. They have to be taken at two separate times. Did you know that children's vitamins are more potent than adult vitamins ?

My menu has many more options for these next two weeks. I can have any cooked cereal except oatmeal as long as it is thinned with milk. Also on the approved list are: creamed soups, yogurt, any juice, pudding, fruit if it can be pureed (no seeds allowed), Slim Fast, Iced Green Tea and whey protein powder. Additionally I can now flavor my food with syrups, extracts, spices, powders, juices, melted peanut butter and Splenda. The only catch is that it should be sugar free or low sugar and contain absolutely no high fructose corn syrup.

I went from my appointment with the dietitian to the grocery store. Wegman's had these items. Variety is the spice of life and I am quite happy to have some variety both in texture and in flavor. I'm not really hungry yet but I understand the importance of eating as required.

When the dietitian Colleen weighed me this morning I was actually shocked. I have lost exactly twenty pounds. Twenty pounds in two weeks. That is just amazingly unbelievable. No wonder my clothes are already quite loose. Fortunately I do have two sizes smaller in my closet. I'll probably need to buy some new things when it's time to go back to work in the fall. I don't want to buy my whole wardrobe over and over so I plan on getting just a few pieces at a time. I did celebrate the twenty pound loss today by going to Dick's Sporting Goods and buying a new sleeveless tee shirt. I bought a medium. Slightly tight but not uncomfortable. :-)

All in all it's been a very good day. Two weeks from now I'll begin to explore my possibilities with regular food.

Losing a Chin :-)

It's Monday and I am not quite two weeks post surgery. By my scales I have lost a total of 16 pounds in the past 2 weeks. I'm not sure how the Dr.'s office scales will compare with that. Right now I'm not sure that it matters. What matters is that I have lost a lot of weight and frankly more than I expected to so soon. I think I may have also shed one of my chins.

My diet in these past two weeks has consisted of sugar free jello, sugar free popcicles, broth, 1% milk, water and flavored sugar free water. I like to think of it as the Ghandi Diet. Your basic clear liquids only fast. My body must have shed all of its physical impurities by now don't you think ? ;-) Will and I went to the grocery store over the weekend and I was thrilled to find sugar free popcicles flavored as Diet A&W Rootbeer, Diet Dr. Pepper and Diet Orange Crush. Best of all they lack carbonation. Carbonated beverages must never pass my lips again. They would stretch my new stomach and make it hold more. That is a cardinal no-no. Of course that really isn't too important to me as I have never really been a huge soda fan.

Walking has become an important part of my day. What started out as a very slow half a block has turned into about a mile at a time. I try to do that twice a day weather permitting. The weather only permitted once yesterday as it literally poured all day. The rest of the week it is supposed to be nice and sunny. The end of the week may end in a heat wave. That could be rather annoying. Thank goodness for AC. Will showed me a website called mapmyrun.com that lets you calculate your mileage for any course you might walk or run.

I sat out in the sun for a little bit this morning. It felt good to be outside. I've been spending some time on the front porch as well. I have to admit that I am starting to get a little stir crazy being home so much of the time. Fortunately I can resume driving in two days. At least then I can run errands and be more social. Right now I am bordering on being bored.

Wednesday is a big day for another reason. It is the day I start full liquids. I have an appointment with the dietitian in the morning and then I move up to that next important step. I am excited about that but a little nervous too. Figuring out how much my stomach will tolerate at a time will be a careful and slow process. However, getting to taste some new flavors will be welcome. Right now it is basically sweet or salt.

On the Mend

I am feeling quite a bit better today. Yesterday I saw the surgeon for my first post-op visit. He removed the hard plastic 10" drain tubing and the "grenade". It feels much more comfortable to have that out. That incision can now set about healing. The other five incisions glued nicely and can be uncovered now. It makes a very strange symmetrical design on my abdomen. He pronounced me right on schedule with my healing process.

Officially I have lost 12 pounds. That is amazing. After the initial huge drop it seems to be about a pound a day right now. Of course one must take into consideration that I am on an all clear and sugar free liquid diet with the addition of skim or 1% milk. Will said that I am thinner in the face and legs. I suppose the stomach will eventually start to shrink too. In one week I will meet with the dietitian and begin full liquids.

I am starting to have more energy. Will and I walked a half mile around the neighborhood this morning. The last little bit was tiring but overall I did well. It is a beautiful, breezy day in the upper 70's which is perfect for walking. We might do that again a bit later on today if I'm feeling up to it. The Dr. said walking is fine. My body will tell me if it's too much.

My parents, who have been visiting and taking care of me, left this morning to return to Florida. I am so appreciative that they were here to help. Fortunately they were here for a couple of weeks before my surgery so that we could have some fun before I was not feeling well. They left us with a clean and well-stocked house. Now that's the kind of guests to have :-) tee hee.............I love my parents, they're so good to me.

Surgery & Home Again

I'm home. I came home yesterday. I was very ready to leave the hospital and start the real healing. This picture is of Dr. Sadhasivam and I right before surgery. After surgery I didn't look too perky. I spent three days at Arnot Medical Center. I was lucky enough to get a private room on the end of a ward with air conditioning. Less noise, cool comfort and no roommate.

I ended up on the telemetry floor so my heart could be monitored. Unfortunately that meant I was not on the bariatric floor where they are familiar with bariatric patients. I'm not sure if that made a difference or not but I think that I might have left with more information if I had. I watched my blood sugars fall from the 140s to the 70s over a period of several days. I guess that is mission one accomplished. I no longer need medication for borderline type 2 diabetes. Most people who have the Roux-en-Y procedure have that result. I must say that makes it all worth it. Even the feeling terrible part, and there is plenty of that in the beginning.

Yesterday I was feeling pretty sick by the time I got home. I was nauseous which isn't too helpful when you are trying to get enough liquid into your body. Today I am quite a bit better. I have been having 1% milk, popcicles, jello, flavored water and regular water. I may try some broth today. I'm writing down how many ounces I consume so that I don't dehydrate. I'm only supposed to do a couple of ounces at a time so it is a challenge.

I weighed myself at home this morning and am down eight and one half pounds "the hard way". I would imagine that much of that is liquid since I've been on a clear liquid only diet for almost a week. My digestive tract is doing a lot of gurgling. I have a surgical drain in. It looks like a clear plastic grenade and is kind of annoying because it is in the way. That will come out when I go back to see the Dr. on Wednesday. Other than that I just have something called Tegraderm (a thin clear plastic covering) over six tiny incisions. I don't think I have any staples.

I sat outside for awhile this morning and I think I'll be napping soon. After that I'll be going for a walk. That's likely what my life will consist of this week. Everyone I know who has had this procedure says that the first week is the worst. I am so grateful that my surgeon was able to do a laparoscopic procedure and that it has been without complication.

This Will Change My Life

Here I am in two before shots. My starting weight is.......166.......I feel like I just told my deepest secret, well, maybe not the deepest one. I am a typical woman in America. I don't want people to know my weight. However, my life right now is all about just that, my weight. I just finished packing my bag for the hospital. I probably packed too much reading material. I always do. I kept it to two magazines and the book I'm reading, A Whole New Mind by Daniel Pink. It's about moving from the information age to the conceptual age. Let's just say you are in a good place if you are an artist or designer. How awesome is that? I highly recommend it to anyone who wants an honest look at how the the way we do business in the world is changing.

It's 11:15 PM and I need to go to bed. The problem is I'm not tired. I'm nervous and excited about tomorrow. I have to be at the hospital at 5:30 AM. That means getting up no later than 4:45 AM. Hopefully I can sleep at least a little. At the hospital I'll be prepared for the surgery. I'll get an IV and have compression stockings put on to keep the blood pumping. They are supposed to help keep me from getting a blood clot. I will meet with the anesthesiologist and discuss my options for post-surgical pain relief. I'd like to go with the pump but not a morphine one. Morphine makes me very sick. Hopefully they can do a different drug. Then I can just hit the button when I need a dose.

I asked my mom to take some pictures in the hospital for the blog. If I am up to it I'll jot a few notes to share when I get home. I think I come home on Saturday morning provided all goes well. Wish me luck and say a prayer.

The Dangers of Belly Fat

This picture is of the tape measure around the widest part of my waist, forty four and one half inches. Imagine that. The smallest I can remember it being was 30 inches when I was in high school. According to the University of Rochester Medical Center: Bariatric Surgery Center at Highland Hospital, a person who is 4'9" (me) should weigh between 79 - 97 pounds. Theoretically that means I should lose 69 - 87 pounds. I'd be thrilled to weigh 110. I know those numbers seem very low to those of you reading this. REMEMBER, I am the height of the average 8-10 year old. If I lose that much weight, my waist circumference should be somewhere in the twenties. I have always carried most of my weight in my belly. I have a classic "apple" physique.

Scientists have discovered that people with wide bellies are more likely to have large amounts of deep-hidden belly fat around their organs. It might be the most dangerous kind of fat and could increase a person's risk of diabetes, heart disease, stroke and some types of cancer. This fat, which is called visceral or intra-abdominal fat, is linked to high cholesterol, high insulin, high triglycerides, high blood pressure and other problems. At greatest risk of developing health problems from too much hidden belly fat are men whose waists are wider than 40 inches and women whose waists are wider than 35 inches.

I won't know until I wake up after surgery tomorrow which way my surgery was performed. My Surgeon, Dr. Sadhasivam, is going to try to do a laparoscopic Roux-en-Y gastric bypass. There is a strong possibility that he will instead do an open Roux-en-Y. Because of my belly fat, short torso and enlarged liver he may not have room to do the laparoscopic procedure.

Jello is Not a Food Group

Today the pre-surgery clear liquid diet began. I'll be on this diet until July 16th. Of course tomorrow through Friday I'll have nothing but an IV. I have a feeling that I am going to develop a very strong distaste for Jello by the time I move to full liquids. Maybe that will change after surgery when I don't actually feel hungry. Right now I feel like I could eat my arm. Today's menu included both raspberry and orange sugar free Jello, Red Punch Gatorade, popcicles, chicken broth, fruit juice and water. This is not exactly a divine dining experience. I'll just have to reflect on my Red Lobster experience last Sunday. It is most definitely better than having to take a bowel prep. I was afraid I'd have to do that and was quite relieved to find out it wasn't necessary. I can say one thing. The all clear liquid diet definitely moves anything in your system, out. I guess that it part of its purpose. I cannot have any thing at all after 9PM except two necessary medications in the morning.

An Open Book

I've decided to write this blog about my experience with the Roux-en-Y bypass procedure. I have to say that I actually kept my plans for bariatric surgery to myself for quite a long time. It is a very controversial surgery and subject. I discovered quickly that people hold very strong opinions (both pro and con) about it. There are people who truly believe that it is the lazy or easy way out. Others look at the research and cannot deny its efficacy in halting diabetes and many other weight related illnesses. Some people believe that it's just too risky. Some think it's merely cosmetic and find the numbers of people having this surgery alarming. A growing number of medical professionals believe that it provides the best chance for long term weight loss. Rather than put my personal situation up for debate I chose to remain secretive about it.

I did a lot of reading before I ever set foot in the door of the bariatric clinic. It's a very personal decision. No two people are alike. I spent a lot of time educating myself as well as consulting with physicians. For me the benefits outweigh the risks. While I am quite aware of the potential complications, I am also cognizant of the life expectancy of a person with my particular mixture of medical problems. I'm taking a calculated risk to make my life healthier, longer and of a higher quality.

Insurance coverage is tough to obtain. I sit at the bottom edge of the required BMI to obtain insurance approval. On the day I first saw the surgeon my BMI was 36. The lowest BMI possible is 35. Patients with a BMI of 35-40 must have co-morbid conditions to be approved for the procedure. I have plenty of those. Co-morbid is a pretty scary term when you think about it. Most people who qualify for the surgery are over 100 pounds over their recommended body weight. That doesn't describe me, but the term morbidly obese unfortunately does.

My entire health team was highly supportive and on board from the beginning. Their collective opinion is that my liver will return to normal size and health, the issues associated with metabolic syndrome will resolve and I will extend my life expectancy by many years. The quality of my life will be enhanced as well. That being said, it took months to jump through the necessary hoops. My insurance company has particularly high requirements to be approved for bypass surgery. I had to have a pulmonary clearance, a cardiac clearance, an endoscopy, attend support group meetings, have 6 months of medically supervised diet and exercise, demonstrate proven trials of weight loss medicines, see a social worker and a work with a dietitian. All of this had to be carefully documented. Fortunately for me the medical evidence of necessity was so compelling that I was approved for the procedure without challenge.

I think another large part of my reluctance to talk about the issue is rooted in the shame of being overweight. I certainly have bought into the concept of obesity as a character flaw. The irony is that overeating is viewed as a lack of self-control within a society that encourages that very behavior. Gluttony is also a religion-based term. It's one of the seven deadly sins so therefore there must be something immoral about it, right? That's enough to shame anyone into thinking that because they are obese they are somehow not good enough. No wonder fat people suffer from self-esteem issues.

My fear of sharing my journey came to an end this week. I'm tired of being ashamed and embarrassed by my obesity. It isn't a character flaw. It is a medical problem. I wouldn't hesitate to talk about injuring my shoulder or having the flu so why should I shy away from speaking out about my battle with obesity? Talking about this issue openly and honestly might help someone else. I certainly have been been helped by others who have gone before me.

Okay.........I am now unmasked.......and just three days away from surgery.

Today we went out to dinner at Red Lobster. I chose it as my last restaurant meal for a while. I ordered the create your own meal including Walt's Favorite Shrimp with cocktail sauce (280+30), Garlic Shrimp Scampi (110) and Steamed Snow Crab Legs with melted butter (110+200). It was absolutely delicious with a Cheddar Bay Biscuit (208), Caesar salad (260) and a baked potato with butter and sour cream (200+60+200). I had water with lemon to drink. There was absolutely no room for dessert. In fact I took about two thirds of the dinner home in a box to enjoy later.

Now let’s tally that up. That is 1658 calories if I had eaten every bite. That exceeds my daily requirements in one single meal. No wonder America is fat. Restaurants set us all up for poor eating habits. Not that I didn’t enjoy my meal. I absolutely did. I stopped when I was full. However, as part of a generation that was raised to clean their plates I had to retrain myself to not eat everything before me. Think of those starving children in Bangladesh.

Eating in a restaurant in the future will probably be somewhat stressful. I’m not sure what I might order. At Red Lobster it might be the Crab Legs with no butter. There really isn’t a lot of meat in those so it might not seem too wasteful. The other caveat in that would be that they take a long time to eat due to the cracking. It might not be so obvious that I’m eating so little. Imagine that, to be self-conscious about eating so little. That is a pretty warped thought now that I think about it.

Anyone who thinks this is going to be an easy thing is misinformed. My stomach is about to become the size of a walnut. I'll have to eat tiny bites and chew forever. I'll have to be careful to monitor my protein intake and overall nutrition. I will not be able to eat without mindfulness. One of my friends who has had the surgery has told me that what is in my head is the most important thing. The surgery is only a tool.

My Malotov Cocktail

Every day for the past several years I have started and ended my day with an extensive and expensive array of pharmaceutical wonders. Pfizer, GlaxoSmithKline, Bristol-Myers Squibb, Knoll Pharmaceuticals and many others have profited from my medical condition. I currently take 14 different medications every day. That is ridiculous. If I didn't have prescription insurance I would surely be bankrupt. One wonders how this could happen. It happened to me one medication at a time. One new problem at a time.

The smooth endoplasmic reticulum of the liver cell is the principal organ of drug metabolism, although every biological tissue has some ability to metabolize drugs (Wikipedia 2008). That's not a good thing for someone who has a fatty liver and elevated liver enzymes. When 14 medications pass through my liver every day, the drugs treating my medical problems actually contribute to the problem. How is that for irony?

Yesterday was the last time I filled my plastic weekly pill container with all of those pills. Tuesday will be the last time I take them all in a single day. After my surgery, most of those pills will no longer be necessary. That makes me very, very happy. I feel like I am shedding a skin. A therapeutic, yet poisonous skin.

The Beginning

I have struggled with my weight for most of my life. My first weight loss attempts began at age nine as did the many weight loss strategies and therapies. I have been medically and clinically supervised, educated in nutrition and exercise, tried fad diets, prescribed diet pills and have taken diet supplements. Each time I have successfully lost weight but have failed to maintain the loss despite my efforts to regulate my diet and exercise regularly.

My body conspired against me. I am 4'9" tall. At one time I was actually 4' 11". Shrinking with age surely didn't help the situation. Genetically I come from a long line of very short people. I have always been calorically efficient A.K.A. I have a slow metabolism.

Growing up, being overweight and very short, subjected me to ridicule. One of my brother’s friends actually called me “Pancake” because I was short and fat. Kids can be so cruel. For that matter so can adults. I know I heard many an unkind comment from people old enough to know better. I learned to make jokes about my body as an armor to deflect the hurt. “I’m not overweight just under tall”. Eventually fat becomes the armor. I didn’t choose to be a short fat person, I just am.

Some people think fat people are lazy. They think that if you just worked harder and ate less you’d be thin. Normal body size people don’t have a clue how wrong they are. If it were that easy we'd all be thin. They are simply blessed with good genetics and good health. They have a healthy metabolism.

Opinions on obesity are slowly changing. The United States of America is the fattest country in the world. There are more fat people now than ever. About 61% of Americans, or 127 million people, weigh too much, according to the latest government statistics. And 26%, or 54 million are obese — that is, 30 or more pounds over a healthy weight. That's up from 15% in the late 1970s. I am just one in those millions of people.

The statistics are deadly. All factors combined, obesity is a leading cause of premature death. Obesity is a risk factor for heart and vascular disease, diabetes, certain cancers, pulmonary disease, arthritis, kidney disease and depression. For me the fat represents the poor state of my health. At 46 I need to get healthy.

I have Metabolic Syndrome. What is Metabolic Syndrome?

An association between certain metabolic disorders and cardiovascular disease has been known since the 1940s. In the 1980s this association became more clearly defined and the term metabolic syndrome (also known as syndrome X or the dysmetabolic syndrome) was coined to designate a cluster of metabolic risk factors that come together in a single individual. In more current times, the term metabolic syndrome is found throughout medical literature and in the lay press as well. There are slight differences in the criteria of diagnosis - depending on which authority is quoted. Regardless, the concept of a clustering of risks factors leading to cardiovascular disease is well accepted. Generally speaking metabolic syndrome manifests in high blood pressure, hyperlipidemia, insulin resistance, type 2 diabetes and in some people a fatty liver which can lead to a condition called steatohepatitis. Simply put, steatohepatitis is an inflammation of the liver cells which causes liver damage. If unchecked, this condition can lead to cirrhosis and potentially liver failure. Metabolic Syndrome has also been associated with Polycystic Ovary Disease and high cortisol levels.

Some people only have a few of these issues, I have most. I am taking action to halt this deadly disease in its tracks. On July 2, 2008 I will undergo a Roux-en-Y Gastric Bypass. My goal is to live an active and healthy life. This is what I must do to achieve my goal. This is my story.