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!

Update: One Month on the Minus-50 Plateau

It's been a month. Lots of good stuff has been happening.

• I'm still tracking my eating, and I feel like I'll be doing that for a long time to come. It gives me more peace of mind, and is very easy to do, so it's a very worthwhile habit. 

• I bought a whole bunch of new clothes! It feels wonderful to put them on. 


• I'm walking 5 kms 5-6 days/week, and usually once each week I walk a 7-km loop around our little town. It takes me past the bay, where there are eagles and herons, and snow-capped mountains in the distance. 


• I've discontinued one of two blood-pressure medications. I still take several other meds, and my goal has never been to discontinue any of them. But it's still a nice little perk.


• All my other bloodwork is normal -- blood sugar, liver enzymes, etc.

I'm weighing myself too often, but I'm trying hard not to obsess.

The last time I was the weight I am right now, I thought I was a fat oaf. I dieted obsessively, weighed myself constantly, hated my appearance, and was desperate to lose 25 pounds or more. 

Yet this is the weight at which my weight-loss settled. My post-surgery weight-loss gradually slowed and then stopped. So I feel that this must be my new normal weight, the weight that I can comfortably maintain.

However, the medical establishment and the weight-loss industry do not agree with me. According to BMI calculators, I am still obese. 

Now, I am not skinny. You might say I am "chubby" or "somewhat overweight" or similar expressions. But I could not rightly be called obese. 

Those same calculators say that my ideal weight is a minimum of 30 pounds less than I am now, giving a range of 30-50 pounds less! At current weight minus 30, I would be quite thin. Even if I could reach that weight (which is highly unlikely), I would never be able to maintain it. Current weight minus 50 is ridiculous. That would be my weight when I was 17 years old. 

From another perspective, the caloric intake per day needed to maintain my current weight is -- supposedly -- almost double what I am eating now. According to the information above, based on my size and what I am eating, I should be losing a pound per week. But I'm not. I'm maintaining my supposedly obese weight.

Something is seriously amiss.

I understand that being very overweight is not healthy. I get that. But the guidelines of what is supposedly healthy is conveniently aligned with the diet industry and all the other consumerism that feeds off people's unhappiness and insecurities.

When I say, above, The last time I was the weight I am right now, I thought I was a fat oaf, I can also say: today, at this weight and size, I feel great.

First Blood Tests Post-Surgery: Result!

When I began this blog, I wrote about a health scare that jolted me into taking action about my weight: I had an elevated fasting glucose level. It wasn't diabetes, but it was considered the "pre-diabetes" range.

A fasting glucose level of 7 or higher on two consecutive readings spells diabetes.

Since 2017, my fasting blood sugar readings have been between 6.3 and 6.7.

(US readers: 6.3 equals approximately 113. 6.7 = 120. The best conversion site on the internet can help! Or here's a conversion chart.)

This terrified me. I already have more than one chronic illness that requires a lot of maintenance. I can't even think about having diabetes on top of that.

I used this fear as motivation to change my eating and exercise habits, as best as I could. I drastically changed and reduced my diet, so it more closely resembled how I ate when I was much thinner.

No result. 

I also started taking supplements that are supposed to reduce blood sugar.

No result.

My frustration with this, and my seeming inability to control my hunger and stop gaining weight, led me to research bariatric surgery.

So. This week I got the results of my first bloodwork since surgery, at the three-month mark. 

Fasting glucose: 5.4 (97.2 US). Normal.

Another relevant test is the Hemoglobin A1c (HbA1c), which measures blood sugar over time. Health Canada considers a fasting HbA1c level of 4 to 7 (72 to 126 US) normal. Mine was 6.4, is now 5.9.

My liver enzymes have been elevated since around 2007. Normal ALT levels are between 10 and 55. Mine was 98, now 21. 

I was so happy to hear this!

All other readings were normal, except certain vitamin levels were very high. I am taking all the supplements recommended post-bariatric surgery, but because I'm also eating a very healthy diet, I can lower my supplement levels.

Every doctor, both when I had the surgery and with my follow-up, has said that I will no longer need cholesterol or blood pressure medication. That is typical of people post-bariatric. However, I don't expect this to be the case for me. I've had high cholesterol my entire adult life, including when I was thin, and when I was a vegetarian. 

Similarly, my hypertension (high blood pressure) has never responded to diet and exercise. My mother and my sister have the same, and they are both very slim and get a lot of exercise. My hypertension appears to be genetic. My doctor suggested continuing to monitor my blood pressure, and to note if I feel any symptoms of low blood pressure, and we could try lowering the dosage.

I'm so pleased about this and actually looking forward to my March 1 weigh-in.

I Am Considering Having the Surgery Done at a Private Clinic

I've been researching the options for having bariatric surgery done privately, outside of our public health care system. The big consideration -- actually, the only consideration -- is money. It is very expensive, far more than I should even be thinking about. 

I recently had a small surgical procedure done, and I had to be weighed for the anesthesia. I was both shocked and not at all surprised to see I have gained yet more weight. 

Shocked, because I haven't been on a scale in more than two years, so seeing the number was a shock. 

Not surprised, because this is what my body does. Despite any steps I have taken or will take, I gain weight.

At this point I feel that my weight is diminishing my quality of life. I am becoming increasingly less mobile. More and more health issues are popping up. I'm sure that surgery is my only option. But surgery in this province is easily two years away -- or more.

I could have the surgery done in another province (on the other side of the country), right away, no waiting, if I'm willing to spend an extremely large amount of money. I would have to finance it, so I'd have yet another bill to pay. We are currently paying off a short-term (no interest) loan that ends in December 2021. Financing part of the surgery would make next year's finances even tighter. Although not impossible. 

The private clinic sees people from all over Canada, and they can arrange it so there is only one trip, for the surgery itself. Tests and whatever medical prep is needed can happen locally, and consultations can be done by videoconference.

What if I have the surgery done privately, incur all that expense and debt, then the Province announces a new policy, and they clear the bariatric surgery waitlist? That would suck!

I already know I want the surgery. I don't know if I should do it financially.

I also know this is not a question anyone else can answer for me. 

After That Shock, Next Steps

It's taken me a few days to get past the shock and disappointment of learning that bariatric surgery is years away. Now I'm left with serious concerns about my health.

The RD in our local health centre showed me that the best way to reduce my blood sugar levels is to increase my exercise. And of course increasing exercise is good for so many other reasons. I'm 58 years old, overweight, and there's cardiovascular disease in my family. Enough said.

The habit itself is not the issue. An exercise routine had always been part of my life, until about 10 years ago. I'm motivated and ready to change that.

The issue is what and how.

One of my goals or desires has been to spend more time outdoors, which is not always easy when you're a bookworm and completely non-athletic like me. I love to walk and hike, and I've been trying to maximize that.

But walking is so weather dependent! I thought I would buy good rain gear and walk in all weather, but that just hasn't worked out. I just really don't like being out in the rain. Plus, for a good portion of the year, at my preferred time to exercise, it's dark outside.

I'm swimming again, but until/unless the pool in our tiny town opens early in the morning, that's only once or twice a week, at best -- and many weeks, not at all.

There is a gym in town, so that's an option.

Right now I think getting some exercise equipment for our own home is the best option. In the past, at different times we've had a cross-country machine, and a manual treadmill, which I used to rotate with swimming. I'm going to start investigating.

As far as writing this blog... I'm not sure what I'll do.

Why I'm Choosing Surgery: About My Weight and My Health

Obviously, I'm overweight. Although I'm not shockingly huge, known as "morbidly obese," according to the prevailing wisdom, I am obese.

To qualify for surgery under the public health guidelines, the BMI threshold is 40. My BMI is less than 40. However, you can qualify for surgery if your BMI is over 35 and you also have two or more health conditions that could be improved by the surgery. I do qualify for that.

That's not good, but that alone would not be enough, would not lead me to take this drastic step.

Health Scare

Two years ago, I went for some routine bloodwork, and had a high fasting glucose -- not in the diabetic range, but high enough to raise an alarm. It's sometimes called pre-diabetes. I was completely freaked out. I already have more than one chronic health condition. My life already requires a lot of maintenance. I've adjusted to all of it, but I cannot even think about adding diabetes to that list.

I used this scare as a motivation to make smarter food choices and get more exercise. At the time I was very busy, with very little time to myself, and regular exercise had really fallen out of the picture. So I did this for some months, got tested again... and there was no change. Or, there was a change but it was insignificantly small.

Now fast-forward to the present. I'm eating healthfully, I'm getting regular exercise, and I'm taking supplements that are supposed to help with blood sugar levels. My blood sugar readings after eating are normal. But my fasting levels are still in that pre-diabetes range.

Age

I'm 58 years old. I've seen a lot of information about the determinants of a healthy old age, and much can be determined by your health as you head into old age. Being a healthy senior and maintaining my independence as I age is really on my mind. There's so much we can't control. I want to control what I can.

I do eat a very healthy diet. I do get exercise -- not a huge amount, but I aim for that minimum 150 minutes per week. That's all good. But I am never going to lose enough weight, and maintain a lower weight, to significantly lower my BMI and change my health outcomes. The most I could hope for would be to stop gaining weight.

And I'd likely ruin my life while I tried. (I'm not exaggerating.)

My Diet...

I said I eat a very healthy diet. That's both true and not true.

I don't eat fast food, I don't drink soda or anything with sugar in it. I don't eat processed food.

I do eat a lot of fresh fruits, vegetables, and whole grains. I'm an omnivore, which I believe is a healthy way to live.

I don't stress eat, and I don't eat from boredom. I eat only when I'm hungry.

...And My Brain

But. There's the but. I'm always hungry. I eat, and I feel full. Ninety minutes later, I'm hungry again.

And when you're always hungry and have access to food, it's very difficult to always make good choices. I do all the things you're supposed to do. I plan ahead. I have healthy snacks on hand to help with hunger between meals. I'm the queen of healthy snacks. But it doesn't always work.

In the last 10 years, I have gained five pounds per year. And I was about 10 pounds overweight to start with.

Bariatric surgery shrinks your stomach, so that it can only accept small amounts of food. But it does more than that.

Your stomach secretes hormones that tell your brain when you are hungry or sated, and tell your pancreas how much insulin to secrete -- and a lot of other things that medical science doesn't completely understand. After bariatric surgery, those hormones are drastically reduced. It's believed this contributes to both weight loss and the maintenance of a healthy weight.