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.