It's About to Get Real

Well.  Here I am.  Age 55 11/12.  Cholesterol under control for many years due to taking a pill.  Moderate sleep apnea under control of an annoying CPAP machine and mask I wear nightly.  Both knees not too bad after laparoscopic meniscus surgeries a few years ago - but certainly not suitable for running.  And my right hip in pain if I use it for anything crazy like putting on my right shoe.  Otherwise, my health is not too bad.  Heart still working OK, and blood pressure still remaining under the acceptable limits, barely.  My weight has fluctuated from 300 to 280 over the past 3 years.  Up and down and up and down.  Just in the last 3 months, I've been up and down between 290 and 300 like 4 times.  As I review this blog I've written the last 13 years, I see 18 posts tagged as having mention of dieting in them, counting this one.  I even came across this memorable graph I made in 2008, showing my progress on one of the most successful of the many diets I've been on.  Look at that cyan line, how it dives down beyond the yellow and magenta lines! 

That year I went from about 280 to about 235.  I was preparing to apply to MBA school at Duke and was really motivated.  Side note: I did get accepted, but couldn't get funding from my company to pay for it.  But that's another story.

Then there was the Diet of 2010.  Lori and I both were using Metabolic Research, which was a costly program requiring all sorts of vitamins before each meal, as well as better eating.  Here's a photo of us during that time.   I think that diet costed about $4000-$5000.  I don't have my weight during that era graphed.  But even then, my BMI was higher than it should be.  In every picture of me, I am subconsciously holding in my gut.  :-)

Back then, I tracked my weight on index cards, and in Excel.  I even made this diet summary table once.  I should update this someday!

Soon after that I guess I started using MyFitnessPal to track my data.  It collects my weight every day that I enter it in, which was manual up until I bought a scale which updates it automatically.  Check it out.  In 2012, 260.  Up to over 270 in 2013.  Down to 255 in mid 2013.  Up to 290 in 2015.  Down to 260-something in 2015.  Up to 300 at the beginning of 2017.  

Most recently, in January 2017, I joined the UNC Wellness Center and became a swimmer.   I worked out or swam about 5-6 days a week for months and really improved my muscle tone.  This picture is actually from the YMCA in August 2017, but I really was getting some shoulder muscles then.  I felt great, even though the weight loss was only down to the 260s.  I really thought at that time, that I would be able to maintain.  But eventually, the workouts became 4 days a week.  Then 3.  Then 1.  Then barely none.  Life happens.  Taco Bell beckons.  Since then, I did a beeline up to over 300 regularly in 2019.  

What a difference 3 years makes.  Here I am 2 weeks ago with Lori, visiting my mom.  

I've never had much problem losing weight, though it has become more challenging as I've gotten older.  It's keeping it off that is the challenge, as I believe it is for most people who struggle with being overweight.  In addition to the aforementioned methods involving vitamins and exercise, which I've done over the years, I've also consulted with dieticians, weight trainers, psychiatrists and even a hypnotist to help me lose weight!  They all helped - for a period.

As I wrote in a 2008 blog post The Diet of 2008, 

To me, diets are like relationships. That's why I'm so reluctant to start each diet. Why start this new diet, when the last one just didn't work out? I really thought the previous diet would be my last. I invested time into it. I loved and cared for it. I had the right intentions. But then, I fell out of diet-love. Me and the diet went our separate ways. Perhaps I made some mistakes, but the diet did too. Will this new diet be "true diet", or just a "rebound diet" started too soon after the last diet ended, and after one feel-good night of better eating and a little casual exercise? Indeed, diets are like relationships.

People say I don't look that bad.  I look OK in some pictures.  I'm not "that" much overweight.  I'm one good diet away from looking like I did in 2008 or 2012 or 2017 all over again!  I am fortunate that I carry my weight pretty well.  Not that this is about looks.  But when the photo is straight on and someone is in front of me, I can say a picture of me is not too bad, like the one with Mom up above.

But then, there's the side view and it's not flattering at all.  Here I am a few weeks ago about to attempt a solo with my band.  I don't particularly like this angle of me.  

Anyway, it's not so much about how I look, though, that is important.  It's about other "cosmetic" things, like choice of clothes.  Most shirts come in a 2XL.  But not many come in 3XL.  And even those sizes can vary in fit.  Nothing more disappointing than finding that the new 3XL shirt I like has somehow gotten too tight to wear.  

But I digress.  This is not about my vanity, but about my health.  And while my health is not too bad (yet), I don't want to cross a line and end up with heart issues or diabetes or cancer, or whatever else it is that we fat people get that leads to an early death.  I don't want to live forever, but I would like to live long enough to retire and maybe have a grandchild or three.  Plus, I want to be able to do stuff without always feeling like I am fatigued or in pain.  Ever notice that the word fatigue starts with FAT?  This stops now.

So here I am, two days away from starting the pre-op process for the vertical sleeve gastrectomy (VSG) I am having on September 4.  According to Current State of Bariatric Surgery: Procedures, Data, and Patient Management, 

Bariatric surgery comprises a group of operative procedures designed to improve weight-related medical conditions.  Bariatric surgery is the only durable and effective way for most humans to lose a significant amount of weight, and see improvement in obesity-related comorbidities. It can improve quality of life, prevent a number of cancers, and decrease overall mortality. Bariatric procedures work through several avenues, including restriction of food intake, malabsorption of food calories, an increase in metabolic rate, decreased hunger, increased satiety, and a variety of other hormonal mechanisms. 

VSG is basically where part of the stomach is removed, leaving a banana sized pouch remaining.  Other procedures involve rerouting the digestive plumbing to bypass parts of the system in order to reduce fat absorption (ie. gastric bypass).  I'm going with the more basic and less risky VSG procedure, which comprises about 59% of all bariatric surgeries.  With any surgery, there is a chance of death and complications.  But I figure there is a pretty good chance of death sooner than later if I stay on the current yo-yo dieting path I've been on for the last 30 years... which always trends UP over the long run.  Lose 20, gain 30.  Lose 15, gain 25.  Lose 40, gain 60.  And so on.  And regarding complications, I believe a lot of those are due to patients not following directions, rather than doctors screwing up.  I can follow directions when I have to.

Because my BMI was 40, I was able to qualify for this procedure with my insurance.  I have spent the most part of this year working through the various hoops Aetna requires to be approved: gallbladder ultrasound, dieticians, more psychology, lab work, upper-GI, sleep study, and then a 12 session weight-loss program.  

Holy smokes.  Look at this beached mammal observed on the coast of NC earlier this summer!  Talk about stylish!  That poor chair.

I've always thought weight loss surgery was for really huge people who just didn't have the discipline to stop eating once they passed 300, 400, 500, etc., pounds.  I choose not to let it go further than it has.  But I know the struggle is real.  I love food.  A lot of it.  And it's not all good for me.  And it's not all bad.  But I need this tool because I've tried every other avenue with success, followed by failure, time and time again.  

It's easy to think of weight loss surgery as an easy shortcut.  People get fat and don't want to do the tough work of losing weight and maintaining it.  Just go to the doctor and have a procedure and voila!  Now you look great!  Well, I am afraid it won't be that simple.  For me, I have to be on an all liquid diet the week prior.  Some larger people require 2 weeks so I'm glad I'm a 1-weeker.  I'm thinking this will be like colonoscopy prep 7 days in a row - without the cleanout!  Yikes.  This starts in 2 days for me.  The goal is to get to ketosis so that the liver will get smaller which makes the surgery go better.  

Surgery takes about 2 hours and there will be one night of recovery in the hospital.  Then, 2 more weeks of all liquid... but this time they say that I will not be hungry so hunger will be the least of my worries.  The challenge will be getting enough protein in me.  I will be on vitamins the rest of my life after this surgery, but that's better than being on cholesterol pills, heart pills, etc.  During that 2-week post-op period, I can have yogurt, vegetable juice, sugar free puddings, milk, strained soup.  I was told it's like being a baby again and you have to re-acclimate your stomach to eating.  

In weeks 3-4 after surgery, I can have pureed food, scrambled eggs, cottage cheese, pureed fruit & veggies, yogurt, tilapia.  Yummy.  Weeks 5-6 includes chopped food, pot roast, any foods I can cut with a fork, string cheese, etc.  Now we're talkin'!  After week 6, I can eat mostly regular food again, though in much smaller portions because: 1) my stomach is smaller and 2) cravings will be reduced because the lower part of the stomach is removed and is believed to somehow be involved with driving cravings.

Easy as that.  Oh, and there may be some throwing up involved, though I have read about many people who never had such issues.  This will take some getting used to.  But I can do it.

Anyway, I'm doing this.  Because I've tried everything else.  More than once.  Bariatric surgery is not a quick-fix.  It is not a shortcut.  It is a pain-in-the-ass fix that I believe will yield years of positive results.  It is a tool.  An expensive and difficult - but effective - tool.  

I've read posts in bariatric Facebook groups from hundreds of people who have had massive success with bariatric surgery, losing hundreds of pounds.  I've seen before and after pictures.  More times than not, people wish they'd done it sooner in life.  There are some people who've had issues, but those are by far the exceptional cases.  

I had to write this because I wanted to document my thought process, as I've documented many of my other life experiences.  I can't say I'm not nervous about this.  I've spent the last week visiting some of my favorite culinary weaknesses, much like a groom having a bachelor party.  Longhorn Steakhouse.  Five Guys.  Jersey Mike's.  Taco Bell.  JJ China.  Wendy's.  Cereal.  I still need to have Lori's homemade lasagne one more time.  Not forever.  But for a while.  I'm also a bit excited about getting on with this.  I'm dreading the pre-op week probably more than anything.  I expect I will be HANGRY for a few days until I get used to it. 

My procedure will be done at Rex Hospital which is part of UNC Hospital system.  I trust them and I believe I am in good hands.