Monday, July 30, 2007
July 31, 2007
So, where are we now? Well, recently I went for an Upper GI x-ray just to confirm that there isn't any narrowing at the junction of the pouch and small intestine. I will be getting the results next week. My blood pressure is 120/70! Finally, it is down where it should be. I am going to consult with my new endocrinologist as to whether or not I can start coming off of some of my blood pressure medications. Woo Hoo! Ones less pill to take!
Chris and I have joined the Toronto Central YMCA and have been participating daily in Deep Water Aquafit classes together. (By the way, my bathing suit fits again!) I am feeling a bit sore, but enjoying the exercise buzz that I get. Chris and I joke a lot while in the pool, which makes the exercise part more enjoyable. I have also been participating in a weekly Tai Chi class and really enjoying it. My energy level seems to be increasing as well. I still have to take a nap around 2:00, but generally I am feeling good.
I am having less difficulty eating. Foods like tuna, cooked vegetables, cheese, soups, pancakes, crackers, milk, poached eggs and English muffins are easily consumed. I am considering including red meats in my diet during the next week. However, I still have difficulty swallowing pills. They just kind of sit in my stomach and make me feel heavy and full. Not a very pleasant feeling.
To date, I have lost 44lbs. I am still having difficulty seeing it but I am experiencing funny little reminders that the weight is going. The other day, while I was driving, I was having difficulty depressing the clutch and had to move my seat up so that I could reach the pedals. Another fun reminder took place at the movie theater last Thursday. When I sat down in the chair, I realized that I actually had shuffle room!
Sunday, July 29, 2007
Could Fat be Catching?
by Jenny Bryan
Could a fat virus be responsible for the epidemic of obesity that is sweeping the USA and seems to be spreading to Britain? Obesity scientist, Dr Nikhil Dhurandhar thinks that it is and has some intriguing research findings to back him up. But he knows that other obesity specialists cannot believe it's that simple.
'The concept of a virus causing obesity is so far away from mainstream causes of obesity that it's going to take much more convincing and evidence simply because it's a very different idea. But we'll do it,' predicts Dr Dhurandhar, Wayne State University, Detroit, Michigan.
In the USA 61% of people are now officially classed as obese (with a body mass index, BMI, of over 30) or overweight (BMI of 25-30). The situation is scarcely any better in the UK, with about 20% of people obese and over 40% overweight.
If you look at a map of obesity in the USA, you can watch the epidemic spreading rather like a forest fire from the east coast to the west over the last 20 years. And it is this, says Dhurandhar, which suggests that there could be an infection.
It Started with Chickens …
Dhurandhar's story starts in Bombay in the 1980s with a mysterious epidemic that wiped out hundreds of thousands of chickens. The birds were found to be infected with an adenovirus called SMAM-1. Adenoviruses are very common. There are at least 40 types that affect humans and they cause about 1 in 20 cases of chest infection.
What was intriguing about the Indian chickens with SMAM-1 was not so much that they were probably killed by an adenovirus infection, but that they died plump, with a large pale liver and large kidneys. They weren't thin and emaciated as you might expect an animal with a virus to be.
Working in India, Dhurandhar deliberately infected some more chickens with the same virus and, sure enough, these birds also put on weight. He decided to pursue his research in the USA, but the US government wasn't keen on him importing a virus that had wiped out a large portion of the Indian chicken population.
Instead, Dhurandhar borrowed a human adenovirus, called Ad-36, from the US collection and set to work infecting first chickens and then rhesus monkeys and marmosets. Like the chickens, infected animals started to put on weight. Six months after they were infected, three male marmosets put on three times as much weight and doubled their body fat compared to three animals that were not infected. It was a very small study, but the results were still impressive.
It wouldn't be ethical to infect humans with Ad-36 to see if they got fat. But, as the virus does occur naturally in the human population, Dhurandhar decided to compare infection rates in people who were fat with those who weren't. He tested 500 people in three cities. Thirty per cent of obese people screened positive for the Ad-36 virus, compared with only 5 to 10% of those who were not overweight.
How the Fat Virus Might Work
Dhurandhar – and his critics – wanted to know how a fat virus might work. Dhurandhar showed that Ad-36 appeared to increase the size and number of fat cells in infected animals. In the laboratory, his experiments suggested that Ad-36 encourages pre-fat cells with the potential to become fat cells to do just that. Three times as many pre-fat cells became fat cells when they were exposed to Ad-36 compared with fat cells that weren't exposed to the virus.
As part of his studies to try and convince other obesity researchers about the importance of the fat virus, Dhurandhar turned to a set of identical twins, Christyn and Beth. Born with exactly the same genes, there was no chance that one twin was genetically more likely to put on weight than the other. Until they went to college, the twins did indeed remain a very similar weight – as do nearly all sets of identical twins. But in the two years after Christyn left home to go to college, she became two and a half stone heavier than her twin. Blood tests showed that, while Beth remained Ad-36 negative, Christen had, at some point, been infected with the virus. Did the virus make her put on weight or did she just eat more and exercise less when she went to college? Who knows, but Dhurandhar blames it on the virus.
Others Remain Sceptical
'The idea that a virus may be causing obesity seems intrinsically unlikely,' says Professor Stephen Bloom, from Imperial College, London. 'Obesity has been growing at a constant rate for about 50 years and the causes are pretty obvious. People have been eating much more and taking less exercise. Why do you need to invent some strange story about a virus?'
Virologist, Professor William Russell, from the University of St Andrews, points out that adenoviruses have never been linked with a long-term illness, like obesity. They cause short-term infections and disappear. It's important to keep an open mind but, at present, the evidence just does not stack up, he says.
A Vaccine Against Obesity?
In the USA, some scientists are more prepared to accept that viruses could be involved.
'Viruses can lie dormant for many years and we've seen the crossover of the HIV virus, for example, from animals to humans. We may be seeing a similar thing now with the obesity virus,' suggests Dr John Foreyt from Baylor College, Texas.
'We really don't know why people get fat or why people are skinny. There's so much that is unknown and that's why we need new theories and people looking at why our bodies are the way they are,' he says.
One possible hypothesis is that, in the late '70s, someone working on a chicken farm in India had the Ad-36 virus and came in contact with birds with SMAM-1. The two viruses got together, exchanged genetic material, and turned into a hybrid virus capable of infecting humans and making them fat. There is nothing, of course, to confirm this series of events, but Dr Dhurandhar now has research grants to help him develop his theories. He has his sights set on a vaccine against the fat virus, but accepts that could be some way off:
'It would be absolutely fascinating to have a vaccine to prevent at least some types of obesity virus – that's my dream,' he says.
Tuesday, July 24, 2007
Which brings me to restaurants. What an interesting place they are. As a food snob I go to all kinds, even ones that you might pass up, if you didn't know how delicious the food was. But since the surgery I have become even more fascinated by restaurants, particularly ones that have buffets and by the people who eat at buffets.
Recently, I went to a restaurant in St. Jacobs, Ontario called the Stone Crock, a fabulous place that served wonderful "home cooked" food and had absolutely brilliant service. The restaurant also offered a well set out buffet. As Chris and I sat down for dinner, I commented on how useless a buffet was for me now, since I can only eat a few ounces of food at a time. He agreed and we ordered dinner; I, a bowl of soup and he, pork schnitzel with fresh vegetables.
As we ate dinner, I began to realize that just about everybody who was eating from the buffet was overweight. I had never noticed this before. I was amazed. Couldn't these people see that by eating from a buffet they were eating past their "full signals" and were overeating? How had I not seen this behaviour in myself? Who in their right mind would do this to themselves?
Then to my horror I realized that, in fact, this behaviour was encouraged. All restaurants overfeed their patrons. What is even worse, we demand to be overfed! How many times have I gone to a restaurant and been impressed by the amount of food I was being served. Never once considering the consequences, I too would eat past my full signals and then recommend the restaurant to friends, ultimately encouraging the restaurant to continue doling out plates heaped with food.
What struck me next, is that we hunt these restaurants down. We actively seek out restaurants that give us more food for our money. In essence, instead of hunting down a woolly mammoth and gorging, we hunt down a buffet and gorge, the whole time rolling our eyes, unbuttoning our pants, and lamenting on how full we are!
I'm not sure if I am comforted or horrified.
Comforted, that we live in a country that has so much food or simply horrified that we as a society have taken to abusing food to such a degree. The more serious problem lies in the fact that once people are encouraged to overeat, society then turns its' backs on the results. We ridicule people who are fat as "lazy slobs". We say that they are people who have no will power and low self-esteem. We make fat jokes; laughing at them behind their backs and to their faces. We deny them medical benefits, access to comfortable furniture, large seats in planes, trains, buses, and movie theaters. We create public washrooms, restaurant booths and automobiles that are way to small for them to fit in. We have gyms, yoga studios and exercise programs built by, designed for, and populated by slim, fit individuals. Tell me, how is a person of size to cope with such adversity? They to turn to the very thing that made them the way they were. They eat to console, comfort, and bolster themselves. All the time recognizing that this is not who they want to be.
I don't have the answer. I can only tell you what is going on in my mind. To let you know that this was who I was just a little over a month ago. I am not suggesting that gastric bypass surgery is for every obese person. Rather, I suggest that we need to re-examine the way we use food and how we treat those who are lured by its easy availability and soothing effects.
I wanted to talk about french fries. "French fries", you ask? Yes, french fries and the fact that I will not be eating these again any time soon. As you may well know, I am at the point in my recovery that I can eat "soft solid foods"; basically everything I want except for bread, pasta, and rice as long as I chew everything at least 25 times before swallowing.
While on our vacation I decided to try french fries. We went to a little place that specialized in them and, once served, I doled out a few for myself adding some vinegar and ketchup. I ate about 6 fries, chewing well, and sipping tiny amounts of water. Now let me clarify that these were skinny chips, not long, or noticeably greasy, and when I felt my chest muscles tighten ever so slightly, I did stop eating. In all honesty, I thought that I had done well.
Chris and I left the restaurant and decided to go for a walk. "This is great", I thought. "No difficulties so far". Boy was I wrong. About 1/2 hour into our walk I began to feel like I had swallowed a lot of air and began burping. About 10 minutes later my chest began to constrict. I told Chris that I needed to sit down and we found a little bench. Things only began to feel worse and after another 10 minutes I told Chris I definitely felt like I needed to vomit and wanted to be by myself. I left him on the bench and walked to the back of a parking lot where the garbage bins were and waited. Nothing happened and after a while, and several more burps, I felt fine. I went back to find Chris and told him that maybe I had just swallowed too much air while eating, That I felt OK and wanted to resume our walk. I pondered, as we walked, what could be the cause of this discomfort? I had not overeaten, potatoes were on my list of things I could eat, and I had chewed well. The only thing I could think of was that the potatoes had been deep fried, and possible I had consumed more oil than my stomach could break down.
Not more than a minute later an overwhelming weight began to close in on my chest. Pressure from my diaphragm pressed up toward my stomach, the tightness around my chest pushed my ribs in, and I experienced a gag reflex that seemed ready to remove my own throat. I could barely stand from the pain, and immediately sat at the nearest park bench. This bench was facing a road (that, thankfully, was not well traveled), and was situated amongst nearby bushes obscuring us from view.
Chris asked if there was anything he could do and I merely shook my head and indicated how much pain I was in. Moments later I felt my stomach turning inside out and all I could do was turn away from the road, hang over the back of the bench, and watch french fries leave me. All I could think of was "Well, that was gross", and Since there was not much food to begin with, the whole process took no more than 30 or 40 seconds. Once the deed was done, I felt wonderful. Like nothing had happened. In fact, I was amazed at how good I felt. I mean, usually when one vomits there is an overwhelming body soreness and exhaustion, But not this time. All I wanted to do was clean up, and continue with our walk.
So, why am I sharing this with you? Well, I wanted you to know that this is not an easy process. That along with my many successes (as indicated by the little train at the top of my blog), I do have some setbacks. But that is all they are - setbacks and I can wipe myself off (pun intended) and get back up again. I will not eat french fries again; at least for a month or two, but eventually I will try them. Who knows what the future holds. I may never be able to eat fries again but maybe I will. That is just part of the adventure.
Wednesday, July 18, 2007
June 19, 2007
July 17, 2007
I still can't see the difference. However, I am now wearing pants that I have not worn in 3 years. My tops are a bit loose but still wearable. In fact, I went through my closet and gave to GoodWill all the clothes that had begun to fall off me. My closet is so empty!
I am not going to buy any new clothes though. I have decided rather, to buy a couple pairs of "scrub uniforms". They are cheap and easy to keep clean. That way, as I loose weight, I can replace the bottoms cheaply and still work comfortably. Once I get close to my ideal weight, then I will go on lavish shopping sprees!
Monday, July 16, 2007
Pre-pouch - I would have just eaten everything on my plate. Fundamentally, this is one of the issues that lead me to being overweight. The internal dialogue that I face follows this logic; "Well there is only a little bit so I might as well finish it off" or "Mmmmmm, this is so good I don't want to stop eating" or "You have to finish the food on your plate" or "It is impolite to leave food on your plate" or " You do not throw food in the garbage" or "There is to little to save as a leftover in the fridge so I better eat it" or better yet "Eat your food. There are starving children in Africa". Consequently, I would overeat.
Where did all this crap dialogue come from?
Some of it is cultural. Have you ever been to an Italian's home for dinner? Each special occasion dinner is at least 6 courses; soup, pasta, meat & vegetables, salad, fruit and finally dessert & coffee. At a wedding add the following courses; appetizer, seafood and a second dessert at midnight.
So if invited to such an event, one must prepare. First, you must know the secret phrases that will halt the appearance of food on your plate or you are doomed. Second, you must starve yourself for at least 24 hours leading up to the dinner so that you are really hungry and ready to eat. To survive at the dinner you do the following; put very small portions of food on your plate so that you can eat all of the first serving while maintaining some room in your stomach. You will need this room for when your "Nonna" (grandmother) inevitably tells you to "mangia" (eat). At this point even if you are still a little bit hungry, you must say that you are full. That way Nonna will only half fill your plate. Then, after the second serving of food and you are full and couldn't eat another bite, you say that you are saving room for dessert. When dessert comes you eat as much as you can and leave some in your dish so that when Nonna tells you to mangia, you can point to the unfinished dessert and say you are stuffed. The key to all this is leaving food on your plate. If you don't leave food on your plate you will be served more food. In spite of all this you will be encouraged to eat yet again because it is inhospitable to leave food on your plate, so after much protest you must finish the dessert. Then, and only then, you be left alone - for a few hours.
So in my culture I was taught that food is important to celebrations and is an intrinsic part of happiness. I was taught that eating and overeating were okay. I was also taught that refusing food was an insult to my host. Now don't get me wrong. I would never suggest that the celebrations that I had with my family were not enjoyable, because they were. I wouldn't even say that I was deliberately taught bad eating habits. I would however say that the practices of my culture did reinforce my skewed perceptions of food, and helped form my own personal bad eating habits.
Some of the dialogue comes from my childhood.
22 years of working with parents and their children have led me to one certain truth; parents have a difficult time watching their children eat. The difficulty may show through in many areas. Some children choose mealtime to practice their ability to say "no" and simply refuse to eat. Some parents worry that their children are just not getting enough food. In both of these situations eating becomes a power struggle in which both parent and child come out as the loser. What inevitably happens is that the child is constantly "encouraged" to eat, often past their internal "full signals". The long term consequence being; children may grow into adults who are no longer able to detect their personal "full signals".
For myself I was encouraged to eat all of the food given to me with "starving children in Africa" statements used as a guilt motivator. One of the more unique things that I remember dealing with, however, was competition for food. This competition was not a result of having too little food, but rather the opposite. My mother is a fabulous cook and, as a youth, there were very few things that I did not like to eat, but I came from a family of six (two sisters, one brother, myself and my parents). If I liked something that mom had cooked, and I wanted seconds of it, I had to eat very quickly so that I could have more. I believe that this is where my distorted fears of somebody taking away my food, or of not having enough food, come from, not to mention my frantic pace when eating.
Some of the dialogue is self-inflicted.
After many years of not experiencing any type of full signals other than pain, I began to work really hard at measuring out normal portions of food and waiting for full signals to present themselves. Once I started becoming sensitive to these signals again, I would on occasion still choose to eat past them, for the simple reason that the food tasted so good. It is obvious to me now that this was a chemical response to the way food made me feel, but I was still unable to cognitively override my biological desire to eat, and instead ended up fabricating justifications for my overeating.
Where does this leave me today? Well, the problem is that after 42 years of eating, I have been conditioned not to leave leftovers, but because my pouch tells me when I am, in no uncertain terms, full, I often end up with leftovers. I end up with a conflict of emotions; one side telling me to finish my food and the other side telling me that I am full and that one extra bite will just make my life miserable. The worst part is knowing that if I try to put that little bit of food in a plastic container to refrigerate it, I will have it eaten before the lid is on.
The only solution that I can think of is to throw the food out. Something which has always caused me waves of panic. Again this has roots in my upbringing. My parents were raised in Italy from 1938 – 1958, and even prior to WWII both families had limited access to food. My grandparents rationed what little they had and no one was able to eat till they were full. Neither family had access to refrigeration; consequently my grandmothers only bought enough food to prepare the meals for the day. No snacking in their houses. My father’s family lived on a farm and though their food was limited it was at least quality food. My mother’s family fared worse. Her father took ill and was not able to work. Each day all five children went without breakfast, had bread with olives or cheese for lunch and had pasta with garlic and oil at night for dinner. Today my mother’s feelings towards food are that it is sacred; a blessing and a sin to waste.
As a result, my parents, out of a need for security, store food all around the house. They have two fridges, that in my entire life I have never seen even half empty. They have a deep freezer packed with food. They have three drawers crammed with canned goods and a closet full of dry goods. There is cold room in the basement that is jammed to the ceiling with home canned goods and they have a huge garden in the back yard that they insist on planting ever year even thought they do nothing but complain about weeding it all summer long. Again, I don't place any kind of blame on my parents for their need to store food. In fact, I understand it very well. Wouldn't you store food, if you grew up without? Rather it is the result of my own skewed perspective in combination with my upbringing that has lead to my aversion to throwing food away.
To be successful, I believe that I must learn to throw my little, itty, bitty, leftovers away, in spite of my feelings. So it is toward this goal that I now labour.
Sunday, July 15, 2007
About and hour later I decided to go upstairs to check my emails and as I began to climb the stairs my pajamas, yet again, started to puddle around my feet and trip me up. As I continued to climb I mused as to why , all of a sudden, my p.j.'s were now way to long for me. I mean I was suppose to be losing weight not losing height, right?
By the time I got to the fourth floor I had realized that because I had begun to loose weight around my belly and butt, my pajamas no longer needed as much cloth to cover those areas and as a result my pajama legs had lengthened! Thus the reason why my pajamas were now too long for my legs. An unexpected result of weight loss.
When I told Shelna about this little adventure her quip was, "Baby got less back". Less back indeed!
Wednesday, July 11, 2007
Some days, eating my many small meals, is easy. My ability to measure out portions sizes is great, I don't experience panic attacks about not having enough food, the food goes down well, and I don't experience any pain. Today was not one of those days.
I woke up early in hopes of getting a jump on the day and toddled on downstairs for breakfast. For the past 4 days breakfast has been 2 oz of a broccoli and cheese frittata that I had made. Today was no different. I ate my 2 oz of frittata slowly and chewed it well. Then about 1/2 hour later, I started to drink my water and that is when the problem began. Once the water hit the pouch, I experienced terrible pain across my entire diaphragm and upper chest. I became queasy, really hot and weak. These are all symptoms that I had overfilled my pouch, but I had not done anything that I hadn't done for the past 3 days. The nausea got so bad that I actually believed that I was going to vomit and was wanting the relief that vomiting can bring. I didn't, but the pain across my diaphragm lasted for about another 1/2 hour.
Once the nausea subsided, I still had to drink my water. And, though I didn't feel nauseous, every sip hurt like hell.
Skipping to lunch, I decided to have a 1/2 cup of pureed soup. Soups have always gone down really easy and I have never experienced pain when eating pureed soup. Not today. There were no feelings of nausea, but as the soup moved into my pouch; my chest felt like it was being squeezed tighter and tighter. My diaphragm began to tense up and I developed the hiccups. (Have I said hiccups hurt?) The pain was so bad; it was actually difficult to breath.
"Alright", I said to myself, "let's shake this off with a walk". And really, I did want to go for a walk, but I guess that I was weak from not eating enough food and as the walk progressed my legs began to burn and my left knee (which has arthritis) began to ache. By the time I got home, my whole body felt like it had been hit by a bus and I was overheated to boot.
I drew a bath, sprinkled in some Epsom Salts and soaked for about an hour, cooling off and re-hydrating myself.
As you can guess, it was then time for dinner. Well the good news is that it went down well. I think my diaphragm and chest muscles relaxed in the tub. After dinner, I took a short nap, and I am actually, just now, beginning to feel like myself.
I am just really frustrated with the way my pouch sometimes responds to food. Eating has always been a pleasurable experience for me and now, it just seems like work. I mean, I know that that is part of what the surgery was suppose to do; shift the random desires of eating to eating only when needed. But this is ridiculous. I have begun to feel like it would be easier just not to eat at all and that in itself is just as dangerous as overeating. The scary part is that I know that I could do it. I mean, I never get hungry so why do I have to eat?
I know, I know. This is dangerous thinking. And I know that I will most likely not follow this line of thinking, but the point is - I am thinking it. This leads me to wondering about the underpinnings of what is happening. How can my thinking switch so easily from overeating and binging to not wanting to eat at all? Is it a result of the surgery and the few painful experiences I have had? Or is it that not eating is the flip side of overeating? Are my thoughts of not eating the same as an anorexic who denies themselves food?
I'm not sure what is going on in my head right now. I guess that this too, is part of the adventure. When I know, I will tell you.
Tuesday, July 10, 2007
If you don't take a look at the article itself, let me break down the part that I thought was most helpful; "four ways to curb your appetite".
1) Eat fiber - Unrefined foods, especially those that are high in fiber, stimulate appetite-suppressing hormones and make you feel full.
2) Brush you teeth - Take a break from eating to brush. The flavour change helps you resist eating more.
3) Be consistent - Eating breakfast and regularly scheduled meals keeps hormone levels steady and quashes hunger pangs.
4) Slow down - It takes awhile for the brain to realize that the stomach is stretching. Eating slowly gives the brain time to catch up.
These are just four small points from the article. There is much more in it and it is brilliantly fascinating!
Thursday, July 5, 2007
Tuesday, July 3 I visited my family Doctor, Dr. Cathy Andrew. She has been my family doctor for 16 years. We often joke about the complications that she has faced due to the myriad of medical problems that I present. What I really like about her is that if she doesn't know how to treat a specific problem, she refers me to a specialist. No humming and haawing. She just calls up the specialist's secretary and refers me that minute.
In regards to the gastric bypass surgery she tracks the following things; my weight, blood pressure, blood work (for my Hb1C, LDL & HDL cholesterol, triglycerides, random blood sugars, iron) and B12 levels.
At the appointment, Dr. Andrew gave me my B12 injection, and checked my blood pressure which is 130/70 (right on the money, but for a diabetic she would like to see 120/70). She ordered up the blood work and referred me to a new endocrinologist. (My regular endocrinologist, Dr. Pike, closed his office two weeks before my gastric bypass surgery, so now I have to break in a new one!)
Thursday, July 5, I saw my gastric bypass surgeon, Dr. Hagen. I had a few issues that I brought to the table, first and foremost being the pain that I have just below my sternum. It seems to be worse when I am sitting, and wearing a bra. However, it also hurts at times when I am laying down, eating, and drinking water. Dr. Hagen said that it was most likely due to the retraction of the liver during surgery. He asked me to keep track of it and inform him if it got worse.
The second issue was that one of the port sites that was used for the surgery was very sore and tender to the touch. Dr. Hagen said that that particular port site had an internal stitch in it and it was the stitch pulling that was causing it to be sore. He said in a few weeks, that too would diminish.
June 19, 2007
July 4, 2007
Now, I can't see and difference between the two pictures (except for the pink hair), but somewhere between the two, I have lost 30lbs. Chris and Shelna both tell me that my face is smaller, but like I said; I can't see it. What I can tell you is that my wedding band no longer fits. It actually fell off! So, I have put it away until I am down to my ideal weight.
Interestingly enough, people have also been asking me how tall I am. Apparently, when a person looks at somebody who is heavy, they also perceive height, and as I loose weight, I apparently appear to be shrinking. An optical illusion that is not in my favour since I am a mere 5'4" tall!
Monday, July 2, 2007
So what exactly did I have done? Specifically, I had what is called a Roux-en-Y Gastric Bypass Surgery (RYBG). The RYGB procedure reduces caloric intake by altering the gastrointestinal tract two ways: through a restrictive and malabsorptive procedure. The Restrictive part of the procedure cuts down on the amount of food you can take in by tying or stapling off a little portion of the stomach, thus creating a miniature stomach, and leaving only a narrow outlet from which the food travels into the rest of the digestive tract and out in the normal manner. The stomach is reduced from a four-pint capacity to about a half-cup, and the lower outlet of the pouch is only about ½ inch in diameter.
The malabsorptive part of the procedure, also called gastric bypass, bypasses about two feet of the small intestine, the originally twenty-foot long tube where nutrient absorption occurs. Consequently, the food travels a shorter route, and fewer calories are absorbed. The lower end of the intestine, called the Roux limb, is brought up to the little stomach or “pouch” and attached to provide material with an exit. The other cut end is sewn back onto the intestine further down, to allow bile and pancreatic secretions into the small intestine so that digestion can proceed and nutrients can be absorbed. In essence most of the stomach if bypassed, all of the duodenum is bypassed, and the pyloric sphincter (the mechanism that controls the rate of entry of food into the small intestine) is bypassed.
What are the Gastric Bypass Surgery risks?
In general, the more extensive the operation, the greater the risk of complications and nutritional deficiencies. My procedure was done laparoscopically, thus reducing my risk, though the procedure is still considered Major Surgery.
Although RYGB is currently the most popular form of gastric bypass surgery, it does carry other risks. The risk of actually dying can be up to one percent, and the risk of serious complications is as high as ten percent. The leading cause of death is pulmonary embolism caused by deep vein thrombosis (a blood clot deep in a leg vein that breaks loose and travels to the lungs where it blocks a lung artery). This is something that I was worried about. To prevent this from happening I was initially required to move my feet and legs for a minimum of 10 -15 minutes every hour. On the day after surgery I was required to actually get up and take numerous short walks. As I have stated before, walking also helps move and dissipate the gas that is used to inflate the abdominal area during the surgery, but more importantly, it helps prevent blood clots. Finally, I was given Heprian, an anti-coagulant drug that is used chiefly in the treatment of thrombosis.
Gastric Bypass post surgery risks include abdominal hernias, which are the most common complication requiring surgery, but are much more common with "open" surgery where the procedure is done manually through a large incision.
Uncommon gastric bypass surgery risks can include the rare complications of: leakage from around staples or sutures, ulcers in the stomach or small intestine, blood clots in the lungs or legs, stretching of the pouch or esophagus, persistent vomiting and abdominal pain, inflammation of the gallbladder, and failure to lose weight (very rare).
More than one-third of obese patients who have weight-loss surgery develop gallstones. Gallstones are clumps of cholesterol and other matter that form in the gallbladder. During rapid or substantial weight loss, a person’s risk of developing gallstones increases. Gallstone formation can be lessened with medication taken for the first six months after surgery.
Since the connection between the stomach and intestines has narrowed, patients can experience vomiting and nausea after eating, though these are not universal side effects and normally only afflict a minority of patients, however vomiting and nausea are very likely to occur in patients who continue to eat highly refined, high-calorie foods, including sweets. Because many gastric bypass patients have poor dietary histories, this is considered a genuine risk.
Nearly 30 percent of patients who have weight loss surgery develop nutritional conditions such as anemia, osteoporosis, and metabolic bone disease. Because the small intestine is largely bypassed, minerals and vitamins can not be effectively absorbed from food. As a result deficiencies in iron, vitamin B12, calcium or magnesium can occur. These can be avoided if vitamin and mineral supplements are taken as recommended, on a continuing, life-long basis. Of those who do develop an iron deficiency, 50 percent develop anemia, a blood disease that can result in paleness and feelings of fatigue.
To avoid this and keep nutrition under control, doctors often recommend gastric bypass patients work with a dietitian to plan meals.
Another risk to consider involves what patients won't be able to have. A common procedure for early detection of gastric cancer is endoscopy, wherein a visual examination is conducted by passing an endoscope through a patient's mouth, down the esophagus and into the stomach and small intestines. The structure of the gastric bypass makes this procedure out of the question, thus adding another potential health risk for bypass patients.
Women of childbearing age should avoid pregnancy for 18 months to two years after surgery, until their weight becomes stable, because rapid weight loss and nutritional deficiencies can harm a developing fetus.
Non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen and many arthritis drugs that contain aspirin may not be taken after this surgery.
Smoking after weight-loss surgery may cause ulcers in addition to other known health risks.
Gastric bypass reversal is complex and is only performed if medically necessary.
Benefits of Gastric Bypass Surgery
Most weight-loss surgery patients will lose between 60 to 80 percent of their excess body weight with the gastric bypass procedure. Substantial weight loss occurs 18 to 24 months after surgery; some weight regain is normal and can be expected two to five years after surgery.
In addition to weight loss, surgery has been found to have a beneficial effect on many other medical conditions such as: diabetes, hypertension, acid reflux, sleep apnea, polycystic ovary syndrome (PCOS), urinary stress incontinence, low back pain and many others. Cleveland Clinic research has shown that 80 percent of their diabetic patients had remission from their diabetes (patients’ blood sugar levels were normal without medication). In addition, many patients report an improvement in mood and other aspects of psychosocial functioning after surgery.
After gastric bypass surgery, your overall quality of life is improved. Many weight-loss surgery patients express elation on being able to do things that may seem trivial to the non-obese person, such as going to the store, playing with their children, getting in and out of a car, riding a roller coaster, shopping for regular-sized clothes … the list is endless.
Typically, weight-loss surgery is performed laparoscopically (minimal invasive surgery). Patients will often experience shorter hospital stays, smaller incisions and quicker recovery periods.
Medical conditions that may be greatly improved after gastric bypass surgery include:
High blood pressure. At least 70 percent of patients who have high blood pressure, and who are taking medications to control it, are able to stop all medications and have a normal blood pressure typically two to three months after surgery. When medications are still required, their dosage can often be lowered, without reduction of medication side effects.
High cholesterol. More than 80 percent of patients will develop normal cholesterol levels two to three months after the operation.
Heart disease. Although it can't be said definitively that heart disease is reduced, the improvement in problems such as high blood pressure, high cholesterol and diabetes certainly suggests that risk reduction is very likely. In one recent study, the risk of death from cardiovascular disease was found to be profoundly reduced in diabetic patients who are particularly susceptible to this problem. It may be many years before further proof exists, since there is no easy and safe test for heart disease.
Diabetes. More than 90 percent of Type II diabetics experience, usually within a few weeks after surgery: normal blood sugar levels, normal Hemoglobin A1C values, and freedom from all their medications, including insulin injections. Based upon numerous studies of diabetes and the control of its complications, it is likely that the problems associated with diabetes will slow in their progression when blood sugar is maintained at normal values. There is no medical treatment for diabetes that can achieve as complete and profound an effect as gastric bypass surgery — which has led some physicians to suggest that gastric bypass surgery may be the best treatment for diabetes in the seriously obese patient. Abnormal glucose tolerance, or "borderline diabetes," is even more reliably reversed by gastric bypass. Since this condition becomes diabetes in many cases, the operation can frequently prevent diabetes as well. Another recent analysis showed that 84 percent of those who underwent Roux-en-Y gastric bypass experienced complete reversal of their type 2 diabetes. Most of them stopped their oral medications or insulin before they even left the hospital, so the remission was apparently not due to weight loss alone. As a result, gastric bypass surgery is being explored as a cure for type 2 diabetes in normal weight or moderately overweight people. Recently, the RYGB procedure was used on two mildly overweight patients. Within a month post-surgery, these patients had dramatically lower fasting glucose, fasting insulin, and A1c's.
Asthma. Most asthmatics find that they have fewer and less severe attacks, or sometimes none at all. When asthma is associated with gastro esophageal reflux disease, it is particularly benefited by gastric bypass.
Respiratory insufficiency. Improvement of exercise tolerance and breathing ability usually occur within the first few months after gastric bypass surgery. Often, patients who have barely been able to walk find that they are now able to participate in family activities — even sports.
Sleep apnea syndrome. Dramatic relief of sleep apnea occurs as patients lose weight. Many report that within a year of gastric bypass surgery, their symptoms were completely gone, and they had even stopped snoring completely — even their spouses agreed. Many patients who require an accessory breathing apparatus to treat sleep apnea no longer need it after a surgical weight-loss procedure.
Gastro esophageal reflux disease. Relief of all symptoms of reflux usually occurs within a few days of gastric bypass surgery for nearly all patients.
Gallbladder disease. When gallbladder disease is present at the time of the surgery, it is "cured" by removing the gallbladder during the surgical weight-loss procedure. If the gallbladder is not removed, there is some increase in risk of developing gallstones after the surgery, and occasionally, removal of the gallbladder may be necessary at a later time.
Stress urinary incontinence. This condition responds dramatically to surgical weight loss and usually becomes completely controlled. A person who is still troubled by incontinence can choose to have specific corrective surgery later, with much greater chance of a successful outcome with a reduced body weight.
Low back pain, degenerative disk disease and degenerative joint disease. Patients usually experience considerable relief of pain and disability from degenerative arthritis and disk disease and from pain in the weight-bearing joints. This tends to occur early, with the first 25 to 30 pounds lost, usually within a month after gastric bypass surgery. If there is nerve irritation or structural damage already present, it may not be reversed by weight loss, and some pain may persist.