The First of Many

The Beginning : November 2020

I honestly am not entirely sure how to start this first entry. There have been many before me who start this journey that I'm looking to start, and I'm certain there will be many after me in the years too come. But as I'm writing this, I'm reminding myself that in order to do this will take a force of will that I question I have at times, and that in order to actually be considered for help with this end goal, one of the requirements is to have a Food Journal. I haven't met with any dietitian as of yet, so I'm not entirely sure what is needed, but I figured I might as well at least start with a first entry. I suppose to gain some understanding going back a bit would be a touch helpful. I can certainly try at least. I will also warn, I ramble a bit at first as my thoughts decided to push and shove their way out to be heard.

A number of years ago, and right now being at the age of thirty-two, I'm roughly remembering when I first heard of the gastric bypass when my mother was looking into it for herself when I was, I believe, around the age of 15, though I may be a bit off with that. Oh well. My mother had started having some increasing health issues and concerns, and being on the cusp of being a young woman I was still learning just how much I should've been paying attention to things at the time. She started the process of getting a referral for the surgery that would ultimately make her stomach much smaller and help her lose the weight that was becoming an increasing concern, and hopefully be able to make sure she was around for a good long time.

After all, children should be the ones to bury their parents, not the other way around.

And so it started.

Despite the pain from excessive weight putting a strain on her joints and bones, she started walking more. Despite the fears that she had as she watched us, her children, continue to grow, she started the seemingly never ending rounds of losing the weight required before the surgeons would do the surgery. She started walking up and down the neighborhood street every evening. The smell of the cabbage soup diet that she had found became as common in our home as the smell of well worn shoes (and smelled about as appetizing). Now, I'm not saying this'll be the way for anyone who does decide to do this, as each person will have their own way of dieting, the cabbage soup diet was my mothers. The rubbing of muscles and feet became a regular occurrence as muscles strained to build strength and burn the fat that was dragging my mother down.

Oh how I wish I had paid more attention at that time for my own sake.

Time passed and as the rest of the family and I watched her fight and struggle to lose the weight needed, we watched as the pounds started to melt away. But the struggle didn't end there. Plateaus were reached when her body seemed to refuse the effort she was putting in, clinging stubbornly to each ounce it could. At this time I can't remember what that stage was called, but if I'm lucky enough to find out, I'll be adding it into my own entries here. She was assured that she was normal, and that she had to push through. Tears of frustration came, and moments of wanting to simply give up put up as much of a fight as a feral cat fighting for the last bite of food.

It was a long journey, and one not easily won.

But she did.

During a time when advancements for this kind of surgery was still being made, and the risks were even higher than they are now, she did it.

The pride her family felt for her was huge, and the relief that she would be with us for a much longer time crashed over each of us in waves. I'll be the first to admit that our family was far from perfect, and some of it's members were closer to each other than others for any number of reasons. But the relief was still there, and while her recovery took some time of course, and it wasn't any easier then the process it took to get to that point, in a way it was because my mothers goal was that much closer at hand.

Again, time passed, mom recovered, and developed a new outlook on life. The weight was staying off, she had more energy, and she felt she could finally really start experiencing some of what life had to offer that was hard to accept when you're a plus sized woman in the 1990's and early 2000's.

To say was I equal parts thrilled and jealous would be an understatement, but I didn't think much of it at that time. Never mind that I, myself, was already plus sized and in school an outcast. The pressure that came from both my peers at the time, family, and from society was immense, and many feelings of insecurities developed. But I was young, and like many at that age, I was rather stupid. While I certainly knew I didn't know everything, I very much had the frame of mind that everything would work out, and I would never end up like my mother and the struggles that she went through with her weight.

Now, at the age of thirty-two, I'm looking back and wishing I could just slap my own self at that point. I wouldn't say I regret that time, but there are definitely things I wish I had done differently. I'm fairly certain there are many in the world who feel this same way.

More time went on, and while I didn't notice a difference, my weight continued to climb, plateau, and climb again. I have learned however, not to take full blame for that happening, as the situation I grew up in, the one in which how I was raised, while decent, could have used some room for improvement.

Having been born in mid 1988, I was what I term as a fence baby. As I grew, I straddled the fence between generations, being raised by the the older generation, but being part of the generation where things started to really change in leaps and bounds. I'm going to be aging myself here a bit, and if by any chance someone is reading this, and you're my age or older, I apologize in advance, so please keep the glares to a minimum and bear with me. Who knows, maybe one of you will have a reminiscent chuckle also. To further clarify, I remember when 8 track tapes were still around, I remember when I was the remote for the television to turn it on or change the channel. I remember when you had to mess with the rabbit ears on top of the T.V to get rid of static (don't forget the foil!), and when there was only three channels to start with. The list, quite frankly, goes on for a while with this.

I, and my behind for that matter, remember when it was fine, and actually expected, to discipline your child by tanning their hide with a solid spanking (at that time it was hand, before me it was via switch, brush, or belt), or to be stuck in the corner for an extended period of time, or even sometimes sent to bed without dinner, depending on the severity of the misdeed of whatever that child had done. That's aside from any grounding that was given. Yes, I'm aware, I seem to be rambling, but I promise there is a point to all of this. Continuing on, as I grew older, more and more things came to light, including that of more children rebelling so to speak by drinking, or doing drugs, while still in their teens, and going against the warnings that parents had set forth, without seeming to get much of, if any, kind of discipline. It's not even all of the parents fault, as new laws and guidelines were put forth dictating what was or wasn't child abuse.

Again, I'm not saying all parents are bad, indeed I know there are far worse ones out there, but there are some that for one reason or another, could've used another way to help keep their children in line.

That being said, as I grew, I was in the fifth grade when the first indication that I was starting to hold onto weight became obvious. But it was brushed aside. Middle school came along, and I continued on with my education. I continued putting on weight, further drawing unwanted, unhealthy attention, from the peers that I attended classes with. As I'm sure we all know, children can be vicious, especially at school. I didn't pay much attention to the fact that when I asked for sweets or soda, I was very rarely actually told no, or given fruit instead. Soda was a standard for me as long as it was diet soda, until slushies from the nearby 7-11 convenience store was discovered. Any and all forms of candy became a staple, from candy bars to gum, to lollipops, and more, were enjoyed on a far more than regular basis. Again I didn't think much of it. I asked for it, or for some treat to be picked up on the way home, and more often than not, it was provided.

And the pounds kept coming.

Society kept going, declaring what was the in fashion, determined what the right body style was, what you should eat, who you should know, ultimately determining what "real" beauty was supposed to be. I was a teenage girl on the cusp of hormonal explosion, and this is what I was surrounded by.

But very rarely was I allowed to go to a friends house, very rarely was I able to study in peace before I was being called again for another chore, the list goes on. But still I was given treats and sweets as what some would see as a type of appeasement.

It's obviously not surprising that I developed an addiction to sugar, or a need to eat my feelings.

It took years before I realized, and confronted those responsible, that by saying yes to my constant requests for candy and sweets and soda, they saw it as a way to keep me from getting drawn into doing drugs, or being drawn into what they considered the wrong crowd. To keep an eye on me, and to keep me from something they were sure I'd do, they traded one addiction for another, one that they themselves could control. And their reasoning behind it being ok to handle things this way?

They were confident that I'd be able to lose the weight later.

Seemingly like a pesky fly, my feelings regarding what they had done was brushed aside.

So instead of being firm, and keeping sugary items to just the occasional treat or special occasion, they provided sugar to me until I felt that it was something I needed to keep myself going. They rarely allowed me to see what few friends I'd made in school outside of it, even though they were within walking distance, and continuously interrupted me when trying to study, making it difficult to focus and actually attempt to get my homework done. All to keep me away from the drugs they were sure I'd get caught up in, and they teenagers they were sure were nothing but trouble.

Looking back at it now, I see it as a form of control and manipulation, and to some extent, abuse, that many tried to explain to me it was over the years.

Now, going back to my fence comparison. I grew up in a household where when my mother was growing up, it was expected of her to have all of her homework and chores done, and dinner on the table by a certain time. But remember, that was a time roughly twenty years before I was born. By the time I came around, things had changed, and I as I sat on that fence, next to my brother and many of the others born around the same year, with a family trying to raise me they way they had been taught, I was watching cd players, i-pods, computers, dial up internet, cell phones, and more all but leap onto store shelves to be the hottest new thing. The world was racing ahead and updating how they did everything all the time. From how classes were taught, to updating the curriculum, to teaching new ways to cover the standard core classes.

Ways that were completely different from how my parents were taught and didn't know how to do so they couldn't sit down and help me.

All of these things made for further difficulties when raised in an older home.

Now, I'm honestly not trying to pull a woe is me, because I'm honestly proud of how far I've come, but I've decided to put my words, and my thoughts out there in hopes that if anyone struggling ever reads this, maybe it'll help them too.

This was also a time when if a child had trouble with studies of any kind, they were simply considered to be lazy and simply didn't want to do the work. It was beyond anyone's acceptance or understanding that their child may actually be struggling with certain classes and may be more inclined in one form of education over another. Instead it was expected for the child to do well in their classes with no argument and more often than not, to follow in their parents or families footsteps. At this time, it wasn't even considered a possibility that a child may have ADHD, autism, or anything else that messes with the childs focus.

This is something that I'm still trying to find out if I have, so I'm trying to find answers to questions I have and how to handle them.

And when some of that family were considered highly intelligent for the time when they went to school and obtained high paying jobs, the struggle becomes harder to accept for yourself and you start to believe those things that you hear your classmates say about you as you go by. It's rather hard not too.

Instead as your grades continue to suffer, and the weight continues to pile on, the family shows disappointment and confusion, and pointing fingers to find out where someone went wrong. Then the words come, the words of disappointment, and being told you'll never amount to anything, and being asked if you want to be a failure for your entire life. To add some salt and lemon to that particular wound, be told that no one would want you if you couldn't lose weight, that no one would want a heavy person.

Notice the contradictions in how they tried to keep things from being their faults at all.

This is the kind of world we live in now, and in some ways it's only getting worse.

But not for me, not any more.

While I'm not proud of the fact that I've struggled so much with losing weight and keeping it off, it took time, years, and research for me to realize that while I've always struggled with my weight, a part of it may have been my genetics. My family tree has had a number of health issues within it, one of which is obesity.

Don't get me wrong, I'm not completely blameless, I should've been able to see the signs when I was much younger and try and find a way to regulate my weight better, and my calorie intake. But it didn't happen, and now as I'm sitting here spewing word vomit across the pages, I'm starting on my own journey to be able to extend my own life beyond my struggles.

It took me years, and essentially running away at the age of 21 to another state, and trying to make a first marriage (now divorced) work, to realize that I would need to take the same route as my mother to get a surgery.

The difference this time though, is that my own mother won't be pushing me to get the surgery just so I could catch a man, no. No, I've finally made this choice for myself because I've finally found a group of friends, chosen family, that accepted me first for who I was with my weight, and still actually loved me. They would voice their concerns regarding my health, but never did they push me to do something that I didn't feel I needed to do, or was ready to do, yet. Never did I think running away to Washington State would end up being one of the best decisions I ever made. Followed quickly by divorcing my first husband and after a few years, finding my second husband, who has only ever been supportive too me.

After reading that near constant ramble and vent session, we'll move back to what is starting this journal itself. Coming to the personal decision to start the process of getting a gastric bypass surgery. The method of such that essentially shrinks your stomach, allowing you to take in less food and calories, which in turn allows you to start burning fat. After having managed to make it this far into the year 2020 without a complete nervous breakdown, I was able to come to the personal decision, for my own health concerns, to start this. As anyone knows, the year 2020 has been rather....well insane is certainly one way to put it. Between a virus that became a global pandemic, murder hornets, seemingly worse fires, fires being started by a gender reveal party (congrats, it's a baby!), election year, and so much more. My decision was one of the few things to happen that actually made sense.

Sometimes, when the world seems to be going to absolute hell, a personal choice in what could be seen as the worse time to do it, can actually be the best time. No risk, no reward right?

I had been working at an answering service company, dealing with nightly verbal abuse from customers calling in to send their messages when suddenly we're being told that we're having to work from home. While I was ecstatic, I wasn't sure how long I'd be able to mentally or emotionally continue to handle this type of job. Low and behold, I was right, and by October I was done. Instead I started on a new means of making an income, and have been happier for it, as I am able to call my own hours and start doing the work whenever I feel the need to do so, while practicing some personal discipline to make sure I stuck to meeting my daily goals to have the income needed.

Keeping holed up in my home as per the government lock down, I watched as, like dominoes, more insanity inducing things started to happen. But this is not to speak about those. This is instead to hopefully help those who struggle like I do.

With the government lock down, and working from home as directed, I found myself becoming more slack in my exercise. With going into the office, I was at least walking daily as I was one of those who caught the bus to and from work. Now, while I enjoyed the easing of some financial stress, and still doing some exercise, things changed. I found myself having an increasing hard time breathing, part of which was pushed along by my sleep apnea. I found for the times when I would go out as needed, I was having a hard time walking for any extended period of time, and would start to sweat like I had been working out for hours on end. Just going from outside to inside, or the opposite had me bracing my hands on my knees to catch my breath.

At this point, I think it's obvious I had a bit of a wake up call slam into me.

My health was deteriorating quickly, and that was something I couldn't have. Not at the age of thirty-two. I had already had two surgeries the prior year, one at the very tail end of 2018 for being unable to pass a kidney stone that had lodged itself in the kidney tract and was starting to make it back up on itself (and I thought it was cramps until I started shaking and went to the ER), and a hysterectomy at the end of January 2019 to keep my own body from trying to bleed itself dry. Some would think I'm kidding, but oh how I wish I was. If there are any who are reading who suffer from monthly cycles that go from one extreme to another, see your primary care physician, because if it was anything like mine, it can be dangerous.

Continuing on. As the year progressed, and started racing towards the end of it dragging all of us along. I noticed the difficulties I was having, and the idea of the gastric bypass, the thing my mother had gone through and started pushing me to have at such a young age, started teasing around the edges of my thoughts more and more. I was stubborn, I was determine not to have to go through it, I was still very much trying to hang onto the mindset I had had when I was younger. I would be fine, I'd be able to lose the weight on my own, I had all of the time in the world; all of these thoughts that kids ignorantly have when they still are sure they know better because it's their life. And I certainly didn't want to have to hear from my mother the next time that I saw her that she was right.

Until it was shoved home even harder how bad I had gotten when said mother came for a week visit, and while playing tourist, I was having a hard time keeping up with her and my step-dad.

The self loathing and disappointment was worse than anything my family could've given to me.

Eating a can of beans or peas, a vegetable that I absolutely loathe and can't eat (stupid gag and texture issues), would've been easier to take in than seeing myself at the point of walking around with my own family and realizing how bad I had gotten.

I wish I had paid more attention to what my mother was going through when she went through it so many years ago, and had asked more questions.

It wasn't until a bit more than a month had passed after the surprise visit, and the thoughts of getting the surgery had started steadily getting louder that I finally decided to go through with it.

This is not a decision to be made lightly, and it's a huge step to take.

So I started doing research. First I asked if my now husband, who has his own slew of medical issues, would be able to handle it if I did this surgery as during the recovery, I would need help for a few weeks at least. He immediately said he was fine with it, and while he accepted me for all of me, including my weight, he was glad I was taking into consideration my health, as it was something he constantly worried about. He'd already buried two wives due to the hand life had dealt him, he didn't want to bury another if it could be helped. Cue my hearts strings being yanked on rather painfully as I realized if things didn't change, he may very well have to do that.

After that, I reached out to one of my roommates who had also had the surgery, or at least a variation of it, and went over the experience with her. Then I reached out to another friend who had been there with me for my hysterectomy as support to myself and my husband, who had also had the surgery, and considered their in-put as well. Like any big decision, one like this is handled differently by each person, and affects each person in different ways.

Then I turned to the web to look up more information, and decided to add the general idea of the various options for something like this. For the following information, I used the following website; https://asmbs.org/patients/bariatric-surgery-procedures, if you'd like to look into it further for yourself.

To further help, I've done a slightly condensed version on here, but if you don't want to read all of the medical jargon, go ahead and skim through to the bulleted list or right after it, but even if you just skim through the information provided, you may end up with questions for your doctor or pcp. That's another thing, any questions you end up having? Write them down, no matter how much you might think of it as stupid, dumb, or silly, write them down to ask the professionals. This is your life that may be changing, so it's important you have every last detail. The well worn phrase, “There is no such thing as a stupid question?” Believe in that very strongly for something like this, no matter how small of a topic the question is covering.

Now there are four types that are well known for a procedure like this:

The Gastric Bypass, the Sleeve Gastrectomy, the Adjustable Gastric Band, and the Biliopancreative Diversion with Duodenal Switch (BPD/DS).

Also, please keep in mind, I'm not a doctor, surgeon , nurse, and someone with medical training of any kind. This is just information I gathered on my own that online sites provided. If you have questions regarding any of this, speak with your doctor or primary care provider. It should also be noted that these procedures are not like plastic surgery, and are typical meant for those who struggle with their weight, and patients have to be approved to go through with them. Any of these are options are invasive and can be risky. It's why there are steps, requirements that have to be met first with a medical team before a patient can have it happen.

Now, the first option, the Gastric Pypass, is considered the most popular one, or as the site stated, it's the “gold standard” for this type off surgery.

From the way I understood it, essentially a part of your stomach is made into a much smaller pouch, to allow for one ounce or thirty milliliters in volume, from the top of the stomach, separating that ounce size pouch from the rest of the stomach. Then a part of the small intestine is divided and brought up to connect to that new pouch, allowing whatever food is digested to bypass the full stomach with its acids and digestive liquids. By making this pouch, you're only able to eat much smaller meals, which leads to a smaller calorie intake, and allows the food to skip the part of the small intestine that would usually absorb calories as nutrients since the food is no longer going through that section. This also changes the hormones that reside in the stomach that includes suppressing hunger, promotes it, and even reverses one of the mechanisms that leads to type two diabetes.

As with any surgery, there are pros and cons. This option has significant weight loss (60-80&), it restricts how much you eat, can lead to conditions that increases energy use, has favorable changes in gut hormones as was mentioned, and has a typical maintenance of >50% excess weight loss. The flip side of that is that this option is considered a more complex operation than the Adjustable band, or the sleeve option and has the potential to result in greater complications. It can also lead to long term deficiencies in minerals and vitamins, mainly for Vitamin B12, calcium, folate, and iron. The operation can also have a longer hospital stay than the gastric band, and requires adherence to dietary restrictions, life long supplements for some vitamins and minerals and follow-up compliance.

The next option is better known as the sleeve option. This one actually has many similarities of that of the first option, but there are some differences. One of the first differences is while the gastric option creates a pouch and connected the small intestine, the sleeve turns the stomach into essentially just that. The majority off the stomach itself is removed, but no changed are made to the small intestine, the stomach itself is made smaller. Ultimately 80% of the stomach is removed. The sleeve significantly reduces the the amount of food and calories to be consumed, however the greater impact from the surgery is what it does to impact the gut hormones, as well as hunger, satiety, and blood sugar.

This option has also shown to be as effective as the gastric bypass when it comes to weight loss and improvement or remission of diabetes. It's also been found that the sleeve helps improve type two diabetes outside of the weight loss. The level of complication on this option finds a middle ground between the band and the bypass. For the pros, like the bypass, it restricts the amount of food the stomach can hold, it induces rapid weight loss, similar to that of the bypass, with a weight loss of >50% for 3-5+ years, and a maintenance of >50%. This option also requires no foreign objects, such as with the band, and no bypass or rerouting like that of the bypass. The hospital stay is seen to be two days, and has favorable changes in gut hormones, reducing appetite, and improving satiety. The other side of this particular coin though is that this procedure can't be undone, has the potential for long term vitamin deficiencies, and has a higher complication rate then the band.

The third possible option is the Adjustable Gastric Band, or AGB. This option includes a band that inflates, and placed around the upper part of the stomach, making a small pouch above the band and the rest of the stomach below it. With this device creating a smaller stomach pouch, eating smaller amounts of food will satisfy hunger while promote the sense of being full. The feeling of fullness though depends on how big the opening is between the smaller pouch and the rest of the stomach. Thee opening between those two parts can be adjusted by filling the band with a sterile saline which is injected through a port placed under the skin. Reducing the size of the opening between the two parts of the stomach is done gradually over time with repeated adjustments. There have been notions however that challenge if this is a restrictive procedure, as studies show the food passing rather quickly through the band and so the absence of hunger or feeling of being satisfied, has nothing to do with the any food in the pouch above the band. Instead, there is no malabsorption, so the food is digested and absorbed normally. From what could be seen, the band reduces hunger, which in turn helps the patient decrease the amount of calories that are ingested.

Now, due to this procedure, the pros and cons are a bit different. Yes, it reduces the amount of the food the stomach can hold, it induces excess weight loss of exactly 40-50%, involves no cutting of the stomach or rerouting of the intestines, has a shorter hospital stay, usually less than 24 hours with some locations having it as an out patient option. This procedure is reversible and adjustable, has the lowest rates of early post-op complications & mortality among the approved procedures, and has the lowest risk for vitamin/mineral deficiencies. On the other hand, this option is the slowest, and has less early weight loss than other procedures. It has a greater percentage of patients failing to lose at least fifty percent of excess body weight in comparison to the other options that are performed. It obviously requires a foreign device to remain inside the body, the band can possibly slip, or erosion into the stomach could happen, then there's the possible mechanical problems with the band, tube or port. It can cause a esophagus dilation if the patient eats too much so there's a very strict adherence to the post-op surgery that is required, including post-op follow-up visits, and this one has the highest rate of re-operation to be done.

This brings us to our last option of the procedures done to help with weight loss. It's also the most wordy. Biliopancreatic Diversion with Duodenal Switch, or much better known as BPD/DS Gastric Bypass, which is a procedure with two components. Much like the first bypass option, a small stomach pouch is created, but more of a tubular pouch rather than an ounce size. This is tubular pouch is made by removing a portion of the stomach, much like what happens with the sleeve option, then a large amount of the small intestine is bypassed, one more like what happens in the first option listed. So this procedure is a mix of the first two procedures really. This time however, the spot where the small intestine is divided is right past the outlet of the stomach, then a segment of the last portion of the small intestine is brought up and connected to the outlet of the new stomach. This allows for any food that is eaten to go through the new tubular stomach pouch and empties directly into the last part of the small intestine. This means the part of the intestine that has the bile, and pancreatic enzymes needed to breakdown and absorb protein and fat is reconnected with the last section of the small intestine, to make sure it's still mixed with the food stream.

While this procedure does initially help to reduce the amount of consumed food, over time it lessens and patients can eventually consume close to “normal” amounts of food. Also different from the other options, a significant amount of small bowel that is bypassed by the food stream.

Also, because the food doesn't mix with the bile and enzymes until much further into the small intestines, there is a significant decrease in the absorption of calories and nutrients, aka as protein and fat, as well as those and vitamins dependent on fat for absorption. This procedure is considered the most effective one for the treatment of diabetes, and like the first couple of options, this one affects the gut hormones that affect hunger, satiety, and blood sugar control.

Now for the pros and cons. On one side of the line, we have greater weight loss results than that of any of the other procedures, showing a 60-70& excess loss or great at the 5 year follow up. This option allows patients to eventually eat near regular sized meals again, it reduces the absorption of fat by 70% or more, there's favorable changes in the gut hormones to reduce appetite and improve satiety, and the one is the most effective against diabetes in comparison to the other options. Hopping on over to the other side of this particular line, we have the cons of this procedure for as pretty as it looks, it has it's faults too. This one has a higher chance of complications and risk for mortality than the other three options. This one also requires a longer stay than the band or sleeve does. There's also greater potential for protein deficiencies and long term deficiencies for number of vitamin and minerals. Just to name a few are iron, calcium, zinc, and fat -soluble vitamins such as vitamin D. For this procedure, compliance with follow-up visits, care, and strict adherence to dietary and vitamin guidelines are critical to avoid complications from any deficiencies.

I've compiled the information into a table/bulleted list in hopes to save some peoples eyes from crossing needlessly with the information given above as well. It'll have the name, the general procedures, the pros, and the cons.

Gastric Bypass

Procedure

- an ounce size stomach pouch is created from the rest of the stomach

-the small intestine is divided.

-bottom part of small intestine is connected to new pouch.

Pros

-significant long-term weight loss

-restricts amount of food able to be consumed

-possible increase in energy

-changes in gut hormones, reducing appetite, enhancing satiety

-maintenance of >50% weight loss

Cons

-more complex operation than AGB or LSG

-potential increase in complication rates

-possible long-term vitamin/mineral deficiencies

-longer hospital stay than AGB

-required adherence to dietary guidelines, life-long vitamin/mineral supplements, and follow up compliance

Laparoscopic Sleeve Gastrectomy (LSG)

Procedure

-removes 80% of the stomach

Pros

-is as effective as the gastric bypass for weight loss and improvement or remission of diabetes

-restricts the amount of food the stomach can hold

-induces rapid & significant weight loss similar to that of the gastric bypass

-weight loss of >50% for 3-5+ years

-maintenance of >50%

-no foreign objects required

-relatively short hospital stay of 2 days

-changes in gut hormones that suppress hunger, reduces appetite and improves satiety

Cons

-can't be reversed

-potential long term deficiencies

-higher complication rate than AGB

Adjustable Gastric Band (AGB)

Procedure

-an inflatable band is placed around the upper part of the stomach, making a small pouch above it, and the rest of the stomach below it

Pros

-reduces amount of food the stomach can hold

-induces weight loss of 40-50%

-no cutting of of stomach or rerouting of intestines.

-shorter hospital stay, usually less than 24 hours, with some being discharged same day

-reversible and adjustable

-lowest rate of early post-op complications & mortality of the procedures

-lowest risk for vitamin/mineral deficiencies

Cons

-slower & less early weight loss than the other procedures

-more patients fail to lose at least 50% of excess body weight in comparison

-requires a foreign device

-possible band slippage or erosion into the stomach

-possible mechanical issues w/ the band, tube, or port

-possible dilation of esophagus if overeating happens

-requires strict adherence to post-op diet & follow up visits

-highest rate of re-operation

Biliopancreatic Diversion w/ Duodenal Switch (BPD/DS)

Procedure

-has two components

-1st a smaller, tubular pouch is created but removing part of the stomach

-2nd a large portion of the small intestine is bypassed.

Pros

-results in greater weight loss than the others, 60-70% weight loss or more at 5 year follow up

-patients can eventually eat 'normal' meals

-reduces fat absorption by 70+%

-changes in gut hormones, reduces appetite and improve satiety

-most effective against diabetes compared to the others

Cons

-higher complication & mortality rates than the others

-longer hospital stay than AGB & LSG

-greater chance for protein deficiencies & long-term deficiencies in a number of vitamins & minerals

-compliance w/ follow up visits & care

-strict adherence to dietary & vitamin guidelines (critical) to avoid complications of protein and vitamin deficiencies

Now that I've bored you to what I'm sure is tears, or at least I'm sure I would be, I'll be shifting back to the actual journal aspect of this journey that I'm trying to go on.

That being said, after making the decision to start the ball rolling on this, I took a few more days to really think about it before reaching out to my own pcp to ask them for a referral, and while she got the process started on her end, she did inform me that an appointment would be needed to get some information, including the general height and weight. Yes, I know how that sounds, it should already be in the files, at least the height part. I agree. But when it comes to all of the paperwork, I'd much rather they double, triple, and even quadruple check to make sure there's no mistakes, and to have the paperwork filled out correctly. Last thing anyone would want is to go through all of this work, only to get to the surgery and it be put off for whatever reason, for however long.

Thankfully, I already know my height, a whopping average of five foot, four inches tall, and don't put me in heels as I'm likely to break an ankle! Not to mention, since I have an apple shaped body, I'd look weird even to myself and teeter all over the place if I tried. As for the weight, if you're doing a video appointment for this referral appointment as many people are with the lock down, as long as you have a scale at home, you can still get your weight. It may not be exact, but it'll be pretty close.

After facing what I consider the evil of the floor, aka the scale, right before my appointment, I found that I was rather torn on how I felt about how much I weigh.

At a towering height of 5'4” tall, the scale announced that I'm currently a grand 360 pounds.

Ouch.

The pain I felt at that had me wanting to whimper and hide under my blankets. I mean, it works for the boogeyman right?

But I didn't.

I made myself stop and think about it logically for a moment. A few years ago, when I had first been tested for sleep apnea, I had weighed in at 380 pounds. After I was approved for and started using my machine, I dropped a decent chunk of weight fast as my body and metabolism was no longer having to choose between helping to keep me breathing by prodding my brain awake so very often, or burning off what fat it could during the night. It also seemed to regulate my need to eat more as well. Unfortunately, and this one is all my fault really, after a while, I stopped using the machine that helped me breathe at night, and set myself back. Again, this was long enough ago that I was very much still in the mind set of, “Oh I'll be fine, I'm not going to go through what my mom did, I'm perfectly ok!”....uhhuh....Just as much as we are our own worse critics, we are also our own worse executors when trying to convince ourselves that we, ourselves as a person, are ok. Or at least if you're like me, and don't take care of yourself as much as you should because you care more about others, or your own friends and families, to the point of neglecting yourself.

Again, not a healthy mindset, I know, I know, I'm working on it. The habit of a lifetime and how I am naturally is not something to be easily broken.

Also, those masks can be sooo annoying to wear, but! I got the replacement equipment I need, finally attached all of it, now I just have to start using it again.

Moving on!

As I was saying, thinking of the weight I found myself at, logically, while disappointed, I could accept it. Was my weight where I actually wanted it to be? Oh hell no, not by a long shot. Did I weigh more than I wanted to? Oh definitely, and that was an anvil of self-disappointment that had me cringing on all levels. But I didn't weigh as much has I had thought I would. While I had hoped to weigh much less than I did, and currently do, my traitorous, systematically, logical brain, thought I would be much, much closer to the 400 pound mark. So I certainly didn't want to be weighing 360 pounds, but when I had thought I would be much closer to what I was sure would be a terror inducing 400 pounds, I found I was much calmer, and accepting of the 360. It ended being a middle ground that I could start from. I could work with that, move on, and start the ball rolling to lose weight and do what I needed to do to be healthier once more.

With that number firmly in my head, and knowing that my weight has a tendency to be temperamental and can seem to fluctuate at it's own will, I had the appointment with my pcp on November 5th, where we started going over what would be needed to help me lose weight, and qualify for having the surgery done.

Then we started discussing what the requirements were, and the child at heart part of me wanted to whine and throw a fit as I felt like I was back in school.

For anyone considering doing this? The following are required as part of this process.

1) Monthly meetings with your pcp (ok, not too hard, especially if I can put as many of those appointments over video instead of having to go into the actual office)

2) Keeping a food journal (ok, again, not that hard, just rather annoying to keep track of everything, but I did that with weight watchers when I was a kid, so, whatever, and I just decided to add on to it by doing this journal instead)

3) Have a psychological evaluation (I have no idea what's going to be gone over in that meeting, as I haven't had it yet, but will update accordingly, though I've been to therapists before, so maybe it's similar?)

4) 12 Dietitian Appointments. (Cue the groaning. That's right. You read that correctly. And no, I do not yet no how often that is going to be. I don't know if that's monthly, every two weeks, or even weekly)

As of right now, I could be looking at a process that'll take upwards of a year, or possibly as little as three months. Admittedly, the sooner this whole process can be completed, the better in my mind. The overall process itself doesn't appear to really be a problem, which is nice. At least for now. Because I know once I start having those Dietitian appointments, there's going to be guidelines and rules that I have to follow that I'm sure are going to make me want to cry.

Remember folks, diet starts with Die, which many feel like doing at some random stage when they're going through it.

Anyways, I had the appointment with my pcp, who is honestly a wonderful lady, and actually awesome to work with; and after getting the referrals put in, making it clear to her regarding my concerns over my health due to my genetics, and the over all increased risk to my health because of my weight alone, she did inform me that she would need to get my blood pressure, which means I would need to actually come into the office.

Blegh. That's all I could think at that announcement.

Blegh.

I'm not much of a people person. I have my friends, and I like staying all cozy in my nest with hubby where I can control my environment.

But needs must, and so I made an appointment for going into the office at the end of the month for the other things needed. While doing so, she put the referrals through to get the other paperwork processed. Of course now it's a waiting game for someone with the dietitians to call me to start those appointments, and hopefully fairly soon the psychological evaluation as well to get that out of the way. If I'm lucky, I'm hoping to make appointments with my pcp and the dietitians happen on the same day so I don't have to make multiple trips.

Yes, I'm fully aware that I sound like I'm whining, but you know what? Oh well. My journal, my rules, and as long as I keep taking the steps to reach my end goal, that's all that matters in the end.

After the initial referral appointment with my pcp, and after she sent me the list of what the steps were going to be, I gave it some more thought and decided what the hell, I might as well start the food journal now, and make it into possibly more that, who knows, might eventually be able to help someone else if they come across it.

So that's where I'm at now, and I'm hoping the journey itself is an adventure to be shared.

Thank you for reading, hopefully you'll be interested in coming back, and who knows, I might even start and advice thing like the advice columns that used to be popular in the newspapers. But that's it for now, I'll be updating with my next food journal entry as soon as I can. Bye!