One Year Post-Surgery

It's coming on a full year since I had gastric sleeve surgery. It's been quite a momentous year for me.

My weight holds steady at minus 50 pounds. It fluctuates within 2 pounds in either direction, but no more than that. I weigh myself sporadically, about twice each month. When I get concerned that I'm eating too much, I weigh myself and feel reassured.

According to the charts, I've lost 70-80% of my excess weight. This is in line with what all the medical literature says about this surgery. This means, of course, that I still have excess weight. I'd look better if I was 10 or 20 pounds thinner, but I don't worry about that. This is where my weight loss plateaued and stopped, so this is my weight. Even if I could lose more weight -- which I highly doubt -- I'd never be able to maintain it. I'm not going down that road.

I frequently feel hungry, just as I always did. But now when I am hungry, I have a very small healthy snack, and I immediately feel sated. The most important thing is to not let myself get too hungry. If I wait too long to eat, I end up eating too fast, and have a lot of discomfort. 

All my health indicators have greatly improved. My blood sugar levels are normal, and I've been able to drop one blood pressure medication. 

I'm more physically active than I've been in 30 years. I walk 5K either 5 or 6 days each week, and usually once a week walk about 7-8K. It feels great. 

And, although I didn't have the surgery to improve my appearance, the change in my appearance does feel good. 

I've gotten the hang of eating in restaurants. It's a bit frustrating, because I'd like to eat more! I wish I could save all my food for the day and have it all in one meal. But that is simply not possible. So I orderly lightly, bring most of it home, and get at least another meal out of it, often two meals. Drinking wine with dinner means eating even less... but dinner is better with wine! So these are things I have to constantly navigate. 

One fun little side benefit: I feel free to eat "fattening" foods when I want to, because the portion size is automatically controlled. In the past, if I decided to eat fries or chips, I would eat a lot, with seemingly no "off" switch. Because of that, I was always struggling to completely avoid those foods. Now if I want a few fries, it's no big deal. 

In general, I feel great. I'm super happy I had the surgery, and also very happy I had it done in Mexico rather than waiting yet more years to have it done in my province.

I haven't shared this story with anyone I work with. No one asks, as it's now considered impolite to comment on anyone's change in size in any direction. Only two people have mentioned my weight loss. One person wanted to know if I'm OK, or if I'm losing weight because of a health issue. The other person is a much older woman, who I think is probably not aware of this current norm. I'm very glad I decided to be more private about this locally. I would not enjoy the attention -- or being the subject of gossip.

Thank you to everyone who has supported me through this journey. It has meant so much to me!

Recovery Day One: Time To Break Out an Old-School Cliche

Well, it's done! This morning I am thinking of that very old poster cliche, Today is the first day of the rest of your life. I've made this permanent change, and it feels daunting, but I will continue to take it step by step.

Monday night I was prepped for surgery, including an IV line for hydration and follow-up medication. Then yesterday I had visits from a whole slew of medical staff: the surgeon, the anesthesiologist, the doctor who coordinates my care, the patient coordinator who I've been emailing with, and a nurse. The dietitian even came by to say hi and tell me we will speak tomorrow.

They gave me a chest x-ray, an EKG (normal! whew!), compression stockings, and maybe some other things I've forgotten. 

Then I was wheeled off, needle, drowsiness... then I was in my room. Ta-da!

I woke up feeling like I'd done 1,000 crunches, with pain under my ribs. Apparently laparoscopic  surgery pumps you full of gas. Ouch. 

Once I woke up more fully, the doctor visited again, saying the surgery was fast (45 minutes) and easy. He told me to walk around as much as possible, as this will help the gas dissipate. Also, I have a drain (TMI?) that they will monitor, plus a breathing thingy to help facilitate deep respiration... also for gas.

So I spent the rest of the day alternating between sleeping, walking around the room and in the hallway, and having nursing staff come in and out putting various medications in my IV line -- anti-nausea, antibiotics, anti-gas, painkillers -- and giving me ice chips.

IV lines! Why wasn't this always standard?! When I was 12 years old, I had knee surgery. All painkillers and antibiotics were given by injection into my thigh. Always the same thigh. After a while, it hurt so much that I was crying, and preferred the surgical pain to the constant stabbing. It also caused nerve damage; the area was numb for nearly 20 years! Why didn't they use an intravenous line? One needle, and you're done.

I can tell that the standard of care here is very high. The staff is very methodical and deliberate, with great attention to detail. Perhaps this is a function of working in a private clinic without a huge number of patients? I don't know. But my experience in hospitals, either for myself, my partner, or anyone I've ever visited, has been that staff are very rushed, and if you don't advocate for care, it's easy to be overlooked. (Admittedly my experience is limited to New York City, where everything is always over-crowded and rushed, and the same, but slightly less, in suburban Mississauga.)

You may be wondering about a language barrier. The doctors all speak perfect English and are obviously fully bilingual. The people who seem to be the head nursing staff speak a lot of English; they also use translation apps on their phones, for both you and them to speak in. The aides don't have much English, but instead get someone for you who does. 

Everyone is friendly and so caring. It's like this in BC, too -- medical staff are unfailingly friendly and caring. I did not find this in NYC or Mississauga! I'm guessing, again, that's it's down to workload. It's hard to demonstrate caring when you're constantly rushed off your feet. 

So it's morning now. Today will be full of breathing tests, walking, drains, and other recovery business. The doc told me there are three different tests for leaks. If any are found, it's back to surgery to repair them. However, he informed me, his work never leaks. The hospital's complication rate is less than 1%, and his is zero. (Surgeons!)

To be honest, I don't know how I will be ready to travel tomorrow afternoon, but then again, that is more than 24 hours away. I already feel better this morning than I did yesterday.

One weird thing: I had an allergic reaction to one of the medications. My face and lips got swollen and puffy. No respiratory issues -- my breathing was not affected, only my face. My lips look like I tried to give myself silicone injections and didn't read the instructions. They gave me antihistamines, and will change both the nausea meds and the painkillers.

The Type of Surgery I'm Having and Why I Chose It

I don't think I've written about which type of bariatric surgery I'm having. 

There are three principal forms of weight-loss surgery. The oldest one is usually called "lap band" -- the full name is laparoscopic adjustable gastric banding. An adjustable belt is placed around a portion of the stomach, and tightened to make the stomach smaller. It restricts how much a person can eat, and it slows the movement of food to the small intestines.

The band can loosen over time, and people end up gaining back all the weight. It also did nothing to control appetite, so really, it's just a more extreme form of restricting. For these reason, it's mostly been phased out by good bariatric clinics. 

When this surgery was popular, my weight didn't qualify for surgery. But more importantly to me, I was never interested in this. I didn't like the idea of a foreign substance being introduced inside the body, without a lot of evidence about potential long-term effects. 

The second kind of surgery is the most extreme: gastric bypass. There are two kinds of gastric bypass, but they both function the same way: by re-routing how food travels through the stomach and intestines, which also reduces the hormones secreted by the stomach. 

Gastric bypass has the best outcomes, the highest percentage of excess weight loss. It also has the greatest risk of unwanted side effects, and it's more involved (and therefore riskier) surgery.

The third type of bariatric surgery is gastric sleeve. In this surgery, most of the stomach is removed, leaving a small pouch, around the size of a banana. There's no re-routing; the intestines function in the usual way.

Gastric sleeve has the advantages of gastric bypass -- small stomach, significant reduction in hunger hormones -- but the surgery is simpler, and recovery is less fraught with potentially scary side effects. 

The outcomes with sleeve are slightly less than impressive than with bypass, but overall the outcomes are still very good. 

This is what I've chosen. It seems like it's becoming the norm for bariatric surgery.