Weight Loss Surgery - For those of you thinknng about WLS here's my long story/ebook




KCS1
07-05-2002, 12:34 PM
How I Came to be Morbidly Obese

Unlike most weight loss surgery stories you may have heard, I havenít always been overweight. As a
teenager I weighed 118 lbs., I was the one who looked at the obese with utter disgust.(I am very ashamed of that )
Mabey God punished me for causing others pain with cruel words.

I am obese because I ate to much and exercised to little. Plain and simple, I canít make any excuses for
what I did to get up to a weight that would classify me as morbidly obese. I started weight gain with my first
pregnancy and continued with the gain with two more pregnancies. I gorged on Kentucky Fried Chicken Meals... the
whole family sized meal that included a box of chicken, side of mashed potatoes covered in gravy, a container of
coleslaw, a few buttery biscuits and let us not forget the large soda. Hey, I was eating for two right? I had little time
to lose that excess weight from one pregnancy when I would be pregnant with another. I managed to get up to 230
lbs.. throughout the three pregnancies. After my last pregnancy I had an epiphany! It didnít matter how much I ate,
my babies were all normally sized. Not one of them was the super baby that I somehow thought all that extra food
would produce. Big surprise, babies only take what they need and the leftover calories went straight to my fat stores !
I had really fooled myself into thinking that being pregnant gave me a ticket to eat (did I ever)! I subsequently dieted
my way up to my current weight, I weigh in at 280 lbs.. Sounds like something a boxing announcer would yell into
the microphone at a match, ď Here comes Boom Boom KC weighing in at 280 lbs.Ē!!!

Throughout the years Iíve tried countless varieties of diets. I have tried them all from the sensible to the down
right crazy. I had even tried to make myself throw up after eating. I couldnít do it, so I hated myself for not having
the willpower to make myself anorexic! I felt completely unworthy of anything, I loathed the way I looked and I
hated the way I felt. I would see other 24 year old women living life and looking the way I wanted to, it killed me
inside being so huge and out of control . How many of them stopped breathing in the night due to sleep apnea? They
could rollerblade and do the things I wanted so desperately to do. I was jealous of each of them to say the least! I
would see them wearing their little name brand clothes, while I was in stretch pants pushing thier maximum weight
compassity, they were so tight they made my fat legs look like sausages. I wore size 3X shirts in floral print because
thatís what they sell for people like me. I felt a constant desperation for a way out of my prison of fat.

My answer came one day sitting on the couch watching TV (like usual). A celebrity was on a popular talk
show giving testimony on a procedure she had done. Sure, I had heard about gastric bypass before, but wasnít that
for the super morbidly obese who couldnít even fit outside their frontdoor ? I had a whole bunch of preconceived
notions, which I later found to be untrue. I quickly jotted down the website that was given
http://www.spotlighthealth.com . I wasted no time to log on. I also found another helpful site
http://www.obesityhelp.com . When it comes to weight loss surgery support from friends I liked Spotlighthealth.
However, Obesityhelp highly exceeds in information on the subject. Obesityhelp is where I found information on how
to find a surgeon in my area. I also learned about which weight loss surgery procedure I wanted. ( Yes, there are
more than one) The Roux-en-Y is considered the most effective one used today and most say it produces the most
weight loss ,so that is the one I chose.


The Procedure called Roux-en-Y (RNY)

The Roux-en-Y (RNY) produces weight loss because it greatly diminishes the amount of food
the pouch holds at any one time and the surgery creates a malabsorbtion of a percent of the calories and
fat that are consumed. Donít think that you can eat whatever whenever though. People have been known
to ďbeat the pouchĒ by drinking high calorie beverages or grazing (eating throughout the day).
The procedure involves an incision, typically running between the tip of the breast bone and
the navel.The stomach is completely separated into two parts using a cutting surgical stapler and
oversewing. The upper part forms a small pouch, holding approximately 30 cc or 1 fluid ounce, which will
receive food. The lower (distal) part of the stomach is bypassed, as is the first portion of the small
intestine (duodenum and jejunum). Some surgeons choose to leave the stomach untransected or not
separated. The small intestine is cut at this point. Although food does not go through this bypassed
segment, it is still functioning. The bypassed stomach secretes its usual gastric juices, and digestive
juices from the liver and pancreas still empty into this area as before. The lower part of the small
intestine is brought up and is connected to the small stomach pouch. Food will pass through a small (12
mm, about 1/2") opening (stoma) from the small pouch into the small intestine. The end of the bypassed
section of small intestine coming from the bypassed stomach is reconnected to the lower (distal) small
intestine, forming a "Y". This allows digestive juices to empty into the portion of small intestine where
food is present. Care is taken to ensure that enough small intestine is available between this junction
and the large intestine to insure good absorption of essential nutrients. Just like any surgery weight loss
surgery isnít without risks here are some of the risks:



Risks:
Allergic reactions
Anesthetic used to put you to sleep could cause complications
Bleeding from minor or massive
Blood clots
Infection including wound, bladder, pneumonia, skin, or deep abdominal infection
Leaks from the stomach
Strictures
Bowel Obstruction
Hernia
Hair Loss
Vitamin and Mineral deficiencies
complications of pregnancy
Depression
Death

.
*note* My surgeon said 0.3% of weight loss surgery patients die (less than 1%). This figure includes the
super morbid obese and those who often have other health problems. This procedure is no more risky
compared to other surgeries requiring general anesthesia and I firmly believe the benefits outweigh the
risks,but you should ask your doctor about his take on weight loss surgery risks.The American Society of
Bariatric Surgery has a website with detailed percentages of risks. Ask your surgeon about any other
possible complications or side effects beside the ones listed


The Call

October 15th, 2001 is when I called the first potential surgeon. He came very highly recommended , but was
over 100 miles away and the waiting list was extraordinary. I requested an information packet for research purposes.
Depending on which insurance you have you may need a referral from you primary care physician just to have a
consultation. You should call your insurance company and ask if you need a referral. I highly recommend requesting
the surgeonís office to send you any forms that need attention to you prior to the appointment. Have them complete
and ready to hand over at the appointment. Also take with you a copy of your medical records, since they will need
them too. This saves time and shows that you are motivated about the surgery.

By November I had decided that traveling 100 miles wasnít a possibility. I called the second surgeon on my list
and set an appointment in December. It seemed like a long wait ,but it gave me time to get medical records together
and time to compile a list of questions for him.

Here is the list of questions that seemed relevant:

Where will the surgery be performed ?
How many gastric bypass procedures have you done?
What complications have you seen?
Have you had any patient deaths from weight loss surgery?
Will you do all of surgery? opening/cutting/closing?
Do I have any input in the size of my pouch?
Do you use staples or sutures?
When will the staples come out?
Have you ever had to re-open for leaks, etc.?
Will I need a stomach binder?
Will you tell my family how it went right away?
Can someone spend the night with me?
How long will the hospital stay be?
Do you prescribe diet/exercise prior to surgery?
Is it an especially good idea to start weight training pre/post op to prevent too much muscle
loss?
What kind of follow up care is required?
How long should my recovery take?
Besides food restrictions what other restrictions will I have after surgery?
Will anesthetist/anesthesiologist be with me alone throughout entire surgery or share time with
other ongoing surgeries?
What should my pre op diet be like?
What type of vitamins should I take pre/post op?
Is there anything else I should do to prepare for surgery?
What kind of pre op tests will I need, Who will schedule the tests, where will they be,when will
they be?Is it the sooner the better?
What is your experience with my insurance?
What can I do to make the insurance approval process go smoother/faster?
Approx. how soon after Iím approved will I have my surgery?
How many calories,fat,protein, carbohydrates minimum/maximum should I consume Post Op?
How much weight can I expect to lose? How fast?
Will I be give a list if dos and doníts post op including off limits medications?
Should I get a medic alert bracelet?
Are there any support groups in my area?
Is it true certain food/drink/medication will stretch out the pouch with gas post op?
If I am lactose intolerance will it effect my post op diet? Will the stretch my pouch?
Will there be a list nutritional supplements how do I obtain them?
What types of special things will I need when I return home? i.e......foods, vitamins, painkillers, etc..
If I feel I am not ready to leave hospital and the hospital wants to discharge me anyway, what can I
do?
Post surgery, at home, what dangerous symptoms should I look out for?(like from clots, infection,
etc.)
If Iím from out of town, what should I do if I run into complications?
(You may think of others to add to the list)
Be sure to take time to write his answers down, the list will make a great reference later. Donít worry
about his time issues, remember it is your money paying for the visit. He stands to make a bundle off
of your surgery and you should want to fully understand his explanations.

The Consultation

The consultation day arrived rather quickly. My surgeon and his staff were very friendly.They
definitely seemed pleased that I had my medical records with me. The meeting went well and was
very informative. It was in very much my favor to appear informed about the surgery. They do look at
how informed you are when they decide if you are a good candidate. He inquired my diet history.
Hereís some advice have this prepared and ready to hand over. It isnít easy remembering every fad
diet and supervised diet youíve been on off the top of your head. It is much easier to type it at home
when you have time to think. You want to include which diet it was, when and how long you where on
it, how much you lost and very important how much weight you gained back . Having this information
helps with insurance approval. He ask also asked about any obesity related problems. This is
another good thing to have prepared to hand over. This list can consist of anything physical or
emotional that you believe is due to being morbidly obese.Your list will help your surgeon know
which tests to order and it also helps with insurance approval.
Here is a sample list, yours will probably be different:

Hiatus Hernia
Poor nights sleep, I wake a lot to reposition myself
Acid reflux
Acid reflux in my sleep
Snoring
Headaches while exercising
Out of breath walking up stairs or doing mild exercise
knees burn inside
lower back pain
Feet hurt terribly when I stand or walk even short distances
Legs fall asleep when I stand or sit in one place
Trouble getting up from the floor or low furniture
I have broken wooden chairs with my weight and hurt myself.
Incontinence- I have urinary incontinence. I canít hold it for any period of time.I have accidents while coughing
& sneezing.
Infertility/hormones/Periods out of whack
Hair growth in irregular places(jawline,chin,cheeks,stomach)
Hygiene problems
Rashes/Acne in fat roll areas
Being morbidly obese has a great affect on my marriage/sex life
Depression/low self esteem
Iím very self conscious
Impedes with things that Iíd really like to do(roller blade,ride bike,be active with my family,have confidence)
Painfully cold fingers & toes from bad circulation
Iím always tired a lot and feel worn out

(Again, this is just a sample list you may have other ailments to add)

Your surgeon may ask you if you have suffered sexual abuse as a child. Iím not completely sure of why
this is asked but my gut tells me it is so he can decide whether to order a psychiatric evaluation. Many believe obesity
is due to deeper emotional problems. It is up to you if you want to be honest with him on this question. (I recommend
being honest)

Other questions you may want to have a prepared answer for:
How did you come to be obese?
Donít pull the old, ďI donít know why Iím overweight, I donít eat that much.Ē He will see right through it and
probably send to straight to a psychiatric evaluation. The reason you are overweight is basically you eat to much and
move to little...plain and simple. We all have our individual story as to how we came to be obese, and you should
include it. Try not to make it your whole excuse though. For example:
Yes, I gained weight when I was pregnant and when I was on the birth control. No, Iím not obese because of
pregnancy and birth control, Iím overweight because I ate a lot and exercised next to none.

Why do you think weight loss surgery will help you?
I have been on diets and they donít work for me. I have lost X amount of lbs. with diets ,but I never lost enough and
the weight always comes back plus some. I always felt so hungry that I couldnít stick to a long term diet. I feel
having a ďlifetime toolĒ to help me eat less is what I need to have significant weight loss. If I could lose enough
weight on my own, I would, but it just hasnít happened for me. I know weight loss surgery is my last option for a
normal life.

Please be original in your explanations. The above answers are just the ones I used, you can you them as a base for
yours if it applies to you.

Let the testing begin!
January 23rd,2002 brings the first of what seems like an endless amount of testing. The first test
was the esophagogastroduodenoscopy (EGD), it sounds scarier and more complicated than it is. An EGD
is where an endoscope (thin, flexible tube that uses a lens or miniature camera) is used to view various
areas of the gastrointestinal tract. When the procedure is limited to the examination of the inside of the
gastrointestinal tract's upper portion, it is called upper endoscopy or esphagogastroduodenoscopy
(EGD). With the endoscope, the esophagus (swallowing tube), stomach, and duodenum (first portion of
the small intestine) can be easily examined, and abnormalities frequently treated. Patients are usually
mildly sedated during the exam. I was more scared of the IV than the actual procedure. Hereís a tip for
you, make sure to use the restroom before you are sedated, I didnít and I peed my pants. Since I was still
wearing my street jeans, I had to wear hospital pants home. It was such an embarrassing situation! This
test showed me to have a mild hiatus hernia, which will resolve with the surgery.
I had a breathing test, Arterial Blood Gas and an Electrocardiogram (EKG) in the beginning of
February. The breathing test was done by a pulmonary specialist. It was easy, they issue a noseplug, it
looks and fits just like the kind for swimming. You are told to blow out as much air as you can in the given
time into a tube placed in your mouth. They root you on to keep on going even if you feel you have no
more air left in your lungs. The pulmonary lab also does the arterial blood gas on you. This one was as
bad as it sounded to me. With this test they draw a small amount of blood from an artery usually in your
inner wrist.Most people will tell you it isnít bad, but if you have crappy veins like I do then this test will be
hard to deal with. You are advised not to lift anything over 5 lbs. for an hour afterwards. The EKG was
performed by a cardiologist and was a snap. They stick these little circular pads at various key points on
your body all you have to do is lay there. The three of those tests came back normal for me.

The next test on my list was a sleep study.It was ordered because of the suspicion of sleep apnea
by the pulmonary lab. It took forever to even be able to be scheduled because the sleep lab only
accommodated two people at a time. It was mid April by the time I was able to get that done. Sure
enough, I quit breathing 105 time during the 5 1/2 hour study. I was ordered to be put on a CPAP
machine to help me stay breathing while I slept. A CPAP will help those with sleep apnea feel like new ,
since they will be able to get a full nights sleep!

Other test you may need include various blood tests, stress test, psychiatric evaluation (honestly!)
or any other test your surgeon (or insurance co.) see fit.


A New Way of Eating
Another requirement was to meet with a dietitian at the end of April. She taught me a lot about
what my new diet would consist of. I wasnít shocked, I knew there would be changes. I learned about the
different stages I would have to go through to get back to eating solid foods. There are mainly four
stages of the post op diet. Starting with clear liquids,then full liquids, next is pureed/soft foods, then
Lowfat, solid foods (permanent). I wonít mention my specific diet here as your surgeon may want you on
a completely different one. I would have to start eating slowly and planning about 25-30 minutes per
meal. I usually inhale food so this would be a big change for me. I also needed to start chewing my foods
25-30 times or until it is the consistency of mashed potatoes. This is a key rule! The opening to your new
pouch will only be about the size of your pinkie, unless you want a trip to the ER donít take any chance of
blocking up the outlet. I learned gum is on the list of canít haves. If gum is accidentally swallowed it will
block the outlet and have to be removed. Another challenge for me was to learn my ďlast bite thresholdĒ.
Unlike those with normal size stomachs if we go past our last bite threshold we will feel ill for quite a
while, not just the hour or so you would if you had a normal stomach.
The amazing this about weight loss surgery is you literally have no choice in the matter of how
much you can eat, that is why itís so successful. Another plus of the Roux-en-Y is the terrible
consequences of eating to much sugar, this is called ďdumping syndromeĒ. Dumping Syndrome occurs
when the Roux limb quickly sucks a significant amount of fluid into the bowel. This rapid filling of the
small bowel causes it to be stretched (which gives cramping). This also causes nerve responses that
cause the heart to race (palpitations) and cause the individual to become clammy and sweaty. Vomiting
or diarrhea may follow as the intestine tries to quickly rid itself of this "irritant." The next symptoms have
to do with the blood sugar level. The small bowel is very effective in absorbing sugar, so that the rapid
absorption of a relatively small amount of sugar can cause the glucose level in the blood to "spike"
upward. The pancreas responds to this glucose challenge by "cranking up" its output of insulin.
Unfortunately, the sugar that started the whole cycle was such a small amount that it does not sustain the
increase in blood glucose, which tends to fall back down at about the time the insulin surge really gets
going. These factors combine to produce hypoglycemia (low blood sugar) which causes the individual to
feel weak, sleepy, and profoundly fatigued. The bast way to avoid dumping is to avoid foods high in
sugar and fat. You will learn quickly what you can or can not tolerate. I accidentally dumped one time
and I make very attempt to avoid food that could possibly make me dump again.


It Isnít all Fun and Games (just most of it!)

Many people didnít understand my need for weight loss surgery and they would tell me I
was taking the easy way out. I didnít believe it for one minute! Gastric bypass isnít an easy way out, in
fact Iíd venture to say it is the hard way out. The first week or so after the surgery I literally felt like death
warmed over. Day by day I improved until I felt physically normal again. My recovery took about 3-4
weeks, but I didnít have my Dr.ís okay to resume normal activities until 8 weeks post operative. Your
recovery my take longer or may be shorter. The first few post operative weeks played havoc on my
emotions. I hurt and I was so tired I could barely function. I felt like I had lost my best friend and in all
honesty I had lost my dearest friend, food. I watched a lot of the food channel and sort of obsessed about
the food I couldnít have. I wasnít hungry in a physical sense, so why was I doing this? What I was feeling
was called head hunger. I was so used to turning to food for everything before the surgery and now there
was no physical way I could. Before surgery I lived to eat and now I had to learn to eat to live. I
recommend a support group for weight loss patients specifically for this reason.

I have lost 36 lbs. in just 7 weeks, I was so proud that I went shopping for a size smaller (2X) in
summer clothes. It is comforting to know for sure that the weight will come off and stay off this time. I
have a hard time fathoming that fact because of all the times I have tried before and failed. I feel so
brave for making it this far, it truly has been a journey. My dreams were within reach for the first time
in what seemed like forever. I feel my self confidence waiting to well up and spill out for all the world
to see!
Log on to http://www.geocities.com/the_new_kc for updates on my progress


Pooky2
07-10-2002, 11:04 AM
Hiya KC...

Your story was really informative and I enjoyed reading it. I have many things in common with you, with the exception I have never been a normal weight....even as a teen.

I'm so glad your complications weren't terrible and you're on your way to a new, healthy life. I hope to have your experience soon, although I still do not have a set surgery date.....hoping no later than sometime this fall....ugg!!!

Anyway, God Bless you on your new life!! I hope you continue to be well and become all that you want to be! Thanks for your inspirational testimony, too. Hopefully, it will enlighten those folks who don't know anything about the surgery or are misinformed.

Just me...Robin
Pre-285
Desired-150/160

KCS1
07-19-2002, 06:07 PM
Pooky,
I'm so glad you liked it! I hope it will help other MO people out there, whom are concidering surgery. If you need any support or have any questions please email me.
keesha@csonline.net