Sunday, May 9, 2010

Addressing all the (rude) questions about WLS

Since making the decision to have Roux-en-Y gastric bypass surgery, I've been very open about it to my family, friends, colleagues and the administration at my graduate school. I'm an open person. My closest friends know that no topic is ever off the docket.

Most importantly, being open and informing people about obesity, the struggles obese people have and choosing to have weight loss surgery were things I felt strongly about, especially with the administration at my graduate school as well as my colleagues. I'm in the health care profession. I attended a school that was like 80% physical therapist students, 20% occupational therapist students. People in those professions tend to have one thing in common: health and physical fitness. This school was full of a BUNCH of elitists.

I even heard a few people joking one day that there should be a weight limit for people attending school there. I heard a rumor about people that had an overweight or obese BMI would be required to attend the on campus gym 3x per week minimum (which we had to pay for- whether we used that gym or not). Anyhow, one of my faculty members made a very astute observation about me: On the surface, I appear strong minded, brash, confident, and determined; but once you scratch the surface, I'm not what I appear to be. Fake it 'til you make it was something I learned years ago and that's what I was living. Faking confidence but scared (and upset) that people wouldn't (or didn't) like me. They just didn't take the chance to get to know me, and I didn't give them one. I have my close group of friends who accept me as I am- fat or skinny, bitchy or loving. Just how I am, whatever that day brings.

So back on track with the topic at hand (as the title of the blog says- ramblings here folks). I'm going to address some of the questions, comments and rude things people have said to me about having bariatric surgery. And if you have a question, comment or whatever, shoot me a message or comment and I'll address it. 

Multiple people have said to me that "you've cheated" or "you took the easy way out". Yeah, who said this was easy? 
WHOEVER SAID HAVING YOUR INTESTINES CUT, STOMACH REMOVED AND INSIDES REARRANGED (or becoming a "surgically altered freak" as another blogger would like to affectionately call us). Then, all the emotional and physical issues that follow? That's not easy. I had 3 weeks of recovery, then was "given" an additional 2 weeks because someone thought I was "unable to complete the essential functions of my internship" because I almost passed out on the first day. That was embarrassing (on top of everything else). I've had to entirely change the way I think about food, but I still love food. I still want food. But seriously, this is a strict, behavior modification way of forcing good eating habits. I have to make good choices though. If I eat something that doesn't agree with my body, I puke, have dumping syndrome, reactive hypoglycemia, diarrhea or constipation (depends on the food). I can still make bad decisions, but that's the whole emotional/addictive side of food. Medications can cause low blood pressure. There's even been times I have nearly passed out while working, grocery shopping, even while cooking dinner. Yes, I have an easier time losing weight, this surgery causes malabsorption of my food intake. This includes nutrients and vitamins. I am on a vitamin protocol- for LIFE. I have to get blood work every six months- for LIFE. There are always the threat of complications, such as bowel obstructions, twisted intestines, hernias, etc. But, the risk of these complications, the need for a vitamin regimen for life, they are nothing in comparison to living as an obese person with the buckets of emotional and health problems that come with that. 

Why not eat less/exercise more/take medication? 
Do you have any idea what it takes to get approval to have bariatric surgery (of any kind!!)? I had to prove a 5 year history of obesity, had to have a BMI above 40, have an EKG with cardiac clearance, bloodwork, radiographs, pulmonary clearance, psychological testing and counseling, and follow a 6 month physician supervised diet. I had a 10 year history of obesity. My BMI was 50- which is medically classified as super morbid obesity. I followed a 6 month physician supervised diet before EVEN CONSIDERING gastric bypass surgery. I was on two different prescription weight loss medications (Adipex/phentermine and Xenical). I gained weight on that diet and on those drugs. Stress makes me gain weight, no matter what I eat, no matter what drugs you pump into my system. I've done the counseling thing on and off for years and the psychologist said I seemed to have a good head on my shoulders, a good idea of what to expect, as well as good expectations of what I should achieve with this surgery. I had no idea of the emotional changes that were to come after, though- that's another post. 

Why would you do this at this time of your life?
Why wait? Why wait 5 more years, have 2 or 3 kids by then and gain another 50lbs. Then I would have been over 300 lbs. In addition to physical discomfort, pain in my every joint at the end of the day, high blood pressure, I would have been worse off. More strain on my heart, more stress on my joints, risky pregnancies. 

Why not wait until after you have kids? Or why not have kids first, because you'll just gain it all back when you get pregnant... 
I don't plan on gaining it all back when I get pregnant. I have lost NINTY-FOUR pounds. That's a person. Yes, I expect I will gain weight when I get pregnant. I expect to even gain weight after I've gotten to goal (it's called bounce-back). I'm aware I might not get back down to my lowest weight after I have children. But losing the weight prior to pregnancy means I will be HEALTHIER when I am pregnant. I will be healthier when I have children and I will be a healthier mother. I'll tell you one thing I'm waiting for- I'm waiting until after I have kids to have my tummy tuck to get rid of all this extra skin, I'll wait for that. :) 

Don't you know RNY doesn't have good long term success? 
My response is "When did you go to medical school, get your degree, and then do residency in bariatric medicine?" RNY gastric bypass is the "gold standard" in bariatric medicine while treating obesity. See here for information about the different types of surgery. Long term results say that people with RNY are considered a success if they are able to keep off ~60% of their excess weight. So, as long as I keep off about 70 of the 130lbs they expect me to lose, then I'm successful. My personal goal started at only 100lbs. I'm down 94 so far. So I think I'm doing well. Talk to me in five years. Hopefully I don't hit 200 again. 

Why not wait until you're done with school? 
I'm done now. I made it through my final internship- and was 48lbs smaller than I was when I was on my first one. I had more energy as the weight came off. Honestly, I can't imagine how I would have been able to walk as much as I did at that internship when I was 268 lbs. Yes, I had to deal with the emotional drama, I had to deal with some complications, but I made it through. I needed to take control of my life and my weight was something that needed to be controlled. 

OMG- You'll never be able to eat X,Y,Z again? 
Um, not really. I'm not a person who will listen to "you can never eat this ever again". There's some foods I need to stay away from. I am addicted to Pepsi. Pepsi is my fri-enemy. I love it, I hate it. It's SO bad for me. But, I can eat most things- JUST smaller portions. I need to make good choices. Dinner can't consist of only macaroni and cheese, or ramen noodles. It needs to be mostly protein, with fruits and veggies. Pasta, starches and potatoes can be there or not, but the portions, SMALL and only if there's room after the important things have been eaten. Sweets- I don't need them, but I allot myself a little treat here and there. Not everyday, not anymore. Cake On the floor, sweating, nauseated, dizzy, headache. That's dumping syndrome. It's not crapping myself (though that happens for some people), but it's when the sugar from your stomach dumps into your intestine and the fluids in your system rush to the intestines basically to dilute it. Anyhow, there's some people who get severe reactive hypoglycemia and seizures, if a food did that to me, I'd stay away from it, or find a healthier version of it.

Aren't you going to miss food?
Um no. My life revolves around food. There's days I f*&^ing hate food. The thought of food makes me nauseated and want to vomit. Why? I have to count my protein, making sure I'm getting in my minimum 65-70g per day. I don't want to lose muscle mass here man- muscle mass loss=loss of heart muscle here too! I eat food, I find ways to make it work and have even started trying new things. Want to know what I hate about food? When people try to push crap into my face and get me to eat it, or offer me the same crap they know I can't eat (OVER, and OVER, and OVER). I know some people who have to log EVERY single bite they put in their mouth. They need to. Right now, I'm not at the point I need that, but I know that day is coming. That day is going to suck.

I know someone, who knows someone, that had all these problems and lost their hair/teeth, etc. Aren't you scared?
Not anymore scared than I am of having a heart attack like my dad (who died), or getting cancer like both my parents, a few aunts, and grandmother, or having a stroke in Target at the checkout like my mom.

I know someone, who ended up getting divorced because x,y,z. Does that scare you?
Um no. I have a solid relationship with my husband and we work very hard to have a good relationship. That's right. We work at it. It's not easy, there's been changes, resentment, fighting, etc. What marriage doesn't have that? All of them do. Yeah statistics aren't on my side (they aren't anyway- more than 50% people). People are more likely to be divorced after any number of life changes- death of a family member, birth of a child, illness (of self or family), surgery, graduation of college, moving to a new city, any number of life changes.  My opinion here is that the people who get divorced after having surgery had problems beforehand, they just may not have come to head until the surgery happened and the person dealing with surgery starts going through the emotional changes. It's up to them to work through those problems and decide if they still love one another enough to make it work or if they ever loved each other at all. My husband has loved me at 160, at 268, he's known me for 7 years. The lowest weight of my adult life and the highest. I'm pretty sure he's here to stay. But thanks for your concern about MY marriage.

What about when you get a job?
On my interviews, I was very forthcoming about the possibility of needing to miss occasional time from work due to medical appointments. I wasn't all "I had gastric bypass and you're gonna need to make accomodations", no, NOT like that at all. More along the lines of "I have to travel to Florida in April for an appointment that I cannot miss, and it's on a Friday". One of my interviews asked if this was going to be a frequent thing and I explained no more than every 3 or 6 months (depending on my blood work). The job I ended up taking, my supervisor was very excited for me and asked me lots of questions about it- turns out she has a friend thinking about bariatric surgery and has been thinking about it for years.  So, her acceptance of my choice to better myself led me to choose this job over other jobs I interviewed for. On another interview, well, she didn't seem all that interested in it and kind of gave that slight judgmental face. Whatever, that's why she's still looking for an occupational therapist.

What about the holidays?
What about them? My first Christmas, I learned my lesson. Don't nosh and cook. At. All. Why? Because I didn't chew that yummy ham good enough, it got stuck and I was in the bathroom yaking it up while everyone else was sitting down enjoying their Polish dinner, ham, and yummy goodness. I can have SOME of those things, I even can have one bite, and only one bite. It's called control and not wanting to have that "Post-thanksgiving coma". You're not tired from turkey, you're tired because you ate 10,000 calories, enough food for an entire week and your body is saying WTF?!?! and trying to break it down.

What about all the extra skin you're going to have?
I can't predict how my body is going to react. I can't tell you if I'm going to have batwings, a huge fat apron (aka pannus) , saggy thighs, saggy boobs (or saggier?). If I do? Well, I am going to have kids in a few years and then get a panniculectomy or tummy tuck (they are two different procedures), and get a breast lift. If I have the other stuff, well then I guess I'll just see when I get there.

What about the long term?
Well, I am not a fortune teller. So, I rely on those who have been there, done that and learn from them. I've learned a LOT from them. I read multiple blogs from other WLS'ers and they are so full of knowledge, I still feel like a newbie at 7.5 months out. Right now, despite complications, I'm happy with my choice. There's people that are years out that are mostly happy with their surgery, depending on the day or the situation or if they gained ALL their weight back.

Okay, so this is the end of this ramble. I need to publish this.
I'm sure I'll touch on a few things here and there in the future.


  1. Wow this is a really interesting post. You hear about WLS and what they do to you but not the after affects like bloodwork every six months, medications that make you pass out, "dumping syndrome", vitamins for life, etc.

    I have 2 questions for you... why not the lap band? I have a coworker that got one recently and I haven't heard her complain about "dumping syndrome" type effects yet. Second question is cost. Does insurance cover this? Do you end up having to pay thousands out of pocket? Sure all the benefits of WL make it totally worth the money but its certainly a factor and means if you want WLS you need to save up first.

  2. Well, the reason for the RNY/gastric bypass over the band is actually kind of FOR the dumping syndrome. I knew having the band, I could "cheat" around it- eating tiny portions of the foods I really shouldn't have (or grazing throughout the day). Also, there are quite a few complications with the band that I was not willing to risk. Yes, there's risk with gastric bypass (and ANY surgery for that matter), but the problems with the band outweighed the risks of RNY/gastric bypass in MY book. Also, gastric bypass shows more long term success as well as a higher percentage of overall weight loss, so for me, those were two important factors considering I had to lose more than I was expected to weigh in the end. Each person needs to weigh the choices and options, as there are more forms of WLS other than the band and RNY/gastric bypass (three other types that I researched are duodenal switch, vertical banding and vertical sleeve gastrectomy). See the thing about weight loss surgery is that people need to really start taking their health seriously and begin to put their health first. This is why vitamin supplementation is IMPERATIVE. Many people don't follow up with proper supplementation and then end up in the hospital malnourished and/or with severe vitamin deficiencies. The problem is that not all surgeons take care to really educate their patients. Overall, I did this to get healthy. So, I take my blood work and subsequent vitamin supplementation (based on my results of blood work) very seriously. I don't want to end up in the hospital. Bottom line. The side effect of medications that make me ill (and pass out) is a sucky one, but one I am willing to accept for better overall health.
    Yes, my insurance covered MOST of the cost, but I was still responsible for co-pays up to my annual max out-of-pocket expenses. Some people's policies specifically exclude any form of Bariatric surgery- it all depends on the company you get your policy from. My husband's employer covered only two forms of WLS, so those were my options at the time. Insurance covers most of my blood work, as long as the codes are put in properly. However, insurance does not cover my supplements and that can get quite expensive. Some people choose to go to other countries for their surgery and some people take out loans for their surgery. However, I was fortunate enough for my policy to cover my surgery.

  3. People can be so unfeeling! Walk a mile in my shoes.... Anyway, I think you've been brave to go on this journey - I'd love to see a post updating us on your progress!

  4. People can be rude. I haven't gone through the same thing, so I can't totally understand. I think as human beings we all have our own issues and need to be kind and tolerant of others.


Thanks a bunch for your comment love!