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Weight Loss 6 — The First Two Weeks After Gastric Bypass

on-q

When I was a kid, we used to play a game where we’d put on a blindfold and spin around a lot, getting really dizzy. Then we’d try to pin the tail on the donkey.

That moment you stopped spinning, when you realized you had to get started pinning the tail, was very confusing. Everything was spinning around, you felt like you couldn’t stand up, and although you had some general idea that you wanted to do something called “walk”, you had no idea how that was going to work out. Things didn’t work like they were supposed to. Spinning did something weird to you. You couldn’t trust your instincts.

Getting out of gastric bypass surgery is like that, only on your insides of your gut. The rest of you is zonked out of it with pain medications.

I wish there were some nicer way to say this — perhaps I could remind you of the whole point of the exercise. But any way you slice it, this sucks. It’s the “Oh shit!” time of your experience, so be prepared.

The first three days are especially bad. When I came out of the operating room, I remember the nurse asking me how I felt.

“Cold, shocky, and nauseous,” I said.

Didn’t really improve from there for a couple of days.

The weird thing was how many people told me that I was doing great. “Hey, you look like you’re doing great!” they would say. Meanwhile I felt like I didn’t know who I was anymore.

Looking in on some of the other patient’s rooms, they weren’t hitting on much either.

There are a lot of reasons for this misery. First, they give you some serious drugs to go inside ripping your guts around. That plays havoc with your emotions. Second, most people are very comfortable with their abdomen — after all, you’ve had it your entire life. Waking up post-op, you suddenly realize that everything about your stomach does not work the way it used to. That’s a pretty freaky experience. After I would do something simple like sip water, then I would burp and then wince in pain. Not fun.

Finally, for some people, this is the first time they really realize that now they’ve gone and done it — there’s no turning back now! It’s the “Oh shit!” moment.

I didn’t have any buyer’s remorse, but I was very emotionally confused about just how my new body was supposed to operate. Combine that with the drugs and it wasn’t a pleasant experience. When I went down for my barium swallow, for instance, I remember thinking that it was very likely that the exercise could end in projectile vomiting. (It did not)

You just don’t know what to expect. It’s very stressful, and it’s also very disorineting. It’s unlike anything else in life you’ve experienced.

I ran a low-grade fever the entire time I was in the hospital — between 99.5 and 101.1. To this day I have no idea why. But I remember looking at that thermometer reading and being able to picture in my mind catching pneumonia, or some other secondary infection, and then being really screwed. I found myself catastrophizing, taking events and imagining terrible consequences, even when I knew that was what I was doing.

I think the first 3 days are the worst. That’s when everything is out of whack and you’re stuck in the hospital. After I broke out from the hospital, I figured out that I was not going to die in that place. There was a tiny bit of stability. The next three days were a different story.

Once I made it home and realized that the end was not near, I spent the next three days slowly coming out of the haze and trying to get a bearing on what kind of new body I had received. Of course, the first thing to do is blog! After that, I was really unsure.

Everywhere I went, I carried around an automatic external pain pump. It wasn’t a narcotic. It just constantly sent numbing agent into the places where they cut. It was about the size of a canteen and hung around my neck. A tube from it went into a bunch of tape and then into my abdomen.

When I tried to get up from a sitting position, it hurt. A lot. The best I can describe it is that my lower abdominal muscles felt as if I had done situps to the point of complete exhaustion. I was okay walking (although pretty wobbly at first). I was okay lying down. Sitting was iffy depending on how much I moved, and moving from sitting to standing sucked quite a bit. When I was still, my lower abdominals would tighten up. Then when I went to flex them to get off the bed or move to standing, there’d be quite a bit of pain. Lots of wincing and groaning.

The big change in the second three days was that I realized that slowly, bit-by-bit, I was getting better. Yay! I wasn’t going to wake up all at once and be dancing a jig, but every day when I woke up I was a little better than before. The fever went away. On day five I was able to pull out the tubes to the pain pump. (Let me tell you, it’s a weird feeling to be pulling 3 feet of tubing from a hole in your abdomen!)

So the second three days were better than the first. Not hugely better physically, but psychologically I was able to start seeing the light at the end of the tunnel.

The next week went by quickly. Every day I would go out walking — the doctor said I couldn’t lift anything or drive, but I could walk “as much as I wanted to”. I found that the more I walked, the better everything else worked out. It helped slowly heal my abdominal muscles. It got me out of the house. It got me to begin thinking about what was coming next. If there’s one thing I can tell people who are going through this, after doing everything the doc says, be sure to get out and move. Don’t just sit on the couch.

syntha-6

From an “eating” standpoint, there wasn’t any eating going on. I’m on a liquid diet. After some experimentation, I’ve settled on a Syntha-6 shake in the morning, followed by a large glass of water. In the afternoon, another big glass of water followed by an Isopure pre-made drink. There’s also a bit of chewable and liquid medicines and vitamins. I can have sugar-free jello and popcicles if I want, and I’ve been having some off and on, but frankly it doesn’t seem worth it.

I’m just not hungry anymore. Thirsty? Sure. Nauseous? Most definitely. When I see a big meal on TV or something, I feel sick. All-in-all, I’m probably consuming around 500 calories a day.

The best I can describe it is like this: have you ever had a really bad stomach virus, where your intestines completely empty out and you have this terrible churning and bubbling in your gut? You’ll drink a bit of water and hear your stomach growl for the next 15 minutes. You may pass a lot of gas. You break out in a cold sweat. Your pulse is feeble and rapid. You’ll try a little piece of a cracker thinking “Wonder how THIS is going to go down?”

At it’s worst, that’s how I felt all of the time. Now, at the end of the two weeks, 85-95% of the time I don’t feel like that, but not always. Sipping, I can drink 20 ounces of water in 45 minutes or so. My Syntha-6 has a very small amount of sugar, though, so when I drink it I feel terrible for the next hour. (Sugar is not-so good for folks with gastric bypasses) After that I feel more energetic, because I have a tiny bit of carbs in me.

When you learn to walk, you learn that you can do certain things and certain things don’t work. This is the same thing, only with your stomach. I’ll make peace with my Syntha-6 over the next couple of weeks. It’s no bit deal — it’s nothing like what I’ve already been through. Heck, after Thursday I’m going to actually be eating meals! Woo Hoo!

On the plus side, it looks like I’m evaporating. That’s the best I know how to explain it. Daughter Katrina had me stand sideways last night and just couldn’t get over how I looked. Over the last three weeks I’ve lost over 30 pounds, and I can almost feel the pounds leaving me each day. I’m looking forward to more of that to come!

If you decide to go this route, learn all you can about the options. Know what to expect. The first little bit after surgery is going to really suck. Be prepared for it. Find something that motivates you and hang on to it. I’m still very happy for the decision I made and I’m looking forward to a really cool summer ahead, but it’s important to remember that there’s a sucky part too. This is not something you do on a whim.

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Weight Loss 5 — Roux En Y Surgery

Tuesday night Melissa and I drove the 4 hours to northern Virginia in preparation for the surgery Wednesday morning.

We were in good spirits. Being married with kids, it’s unusual to have so much time together. Since she is trying to support me in my weight loss plans, she brought along some shakes to have along with mine.

Wednesday morning I got up at 5am and went through my morning routine. It was really strange thinking that in just a few hours they were going to be doing major surgery on me. I have never broken a bone, never sprained an ankle; I’ve never stayed in a hospital a day in my life. And now they were going to re-arrange my digestive system. In the afternoon it would be all over. But for now, the waiting.

The morning of the surgery, and ready to get the show on the road!

The morning of the surgery, and ready to get the show on the road!

Since I was first in line for the cutting room, I had to show up at 6:30.

Signing in to the hospital was first-rate. Since I had already completed a medical history online, there was only a few questions to be asked and I was given an armband for identification. I went out to sit with Melissa. They even gave us a little pager to know when they needed us. Hey, this was just like going to the steak house.

After a few minutes of silence, Melissa turned to me and said, “It’s not too late. Are you sure you want to do this? Really sure?”

I thought about it. She was right: I could walk out the door right now and never have to go through whatever awaited me. I could continue eating as I had, continue enjoying my life as a fat person, and just chalk this up to a crazy idea I had one day. Good thing I didn’t go through with it.

“Yes, I’m sure. I’ve thought about it and this is what I want to do”

The pager went off.

Innova Fair Oaks is within a few miles of Dulles airport. Based on my research, it's probably one of the top 5 places on the East Coast to get bariatric surgery

Innova Fair Oaks is within a few miles of Dulles airport. Based on my research, it’s probably one of the top 5 places on the East Coast to get bariatric surgery

They took me back to the pre-op room. I was weighed. I weighed 295.5 pounds. I had lost about 16 pound in the two weeks of fasting. Not bad! Still, in the back of my head, I was thinking “why not just fast like this for another 4 months? Then you could go back to eating normally?”

But I knew that was a fool’s dream. I couldn’t stay on a fast like that for 4 months without being imprisoned, and once let loose, I’d be back up to my old weight in no time. Worse, I’d gain even more. The entire reason I was here for the surgery was that dieting was only 1) Reducing my willpower over time as I failed more and more, and 2) Making me even fatter than I would have been had I not dieted in the first place.

It’s a seductive idea, but not an honest one. Maybe for somebody who hasn’t been down as many dieting roads as I have it’d be worth another go, but this was the best choice I had, other than just sticking my head in the sand and ignoring my problem. I was taking it.

Not a bad bed, but it was really tough trying to get room service.

Not a bad bed, but it was really tough trying to get room service.

Today’s cast of characters came by and introduced themselves to me. I met my surgeon again (Only the second time I had seen him since this entire journey began back in January!), the anesthesiologist, the anesthesiologist’s assistant, my operating nurse, the surgeon’s assistant, and so forth.

Good grief. These folks needed name tags. I could never remember all of that. But they all were very friendly, saying the same things that I know they say dozens of times each week. My surgeon has mastered the “Kind smile” technique. You ask him a tough question and he just kind of smiles, tells you not to worry, and lets you know he’s on top of things.

They set up an IV and we waited a few more minutes. Then I heard somebody say “It’s almost eight, we need to get these patients moving back there!”

Somebody came over, gave me a shot in the IV, I waved at Melissa, and away I went.

They say you don’t remember a lot when you have surgery, but I remember some of it. I remember being wheeled into the operating theater. Wow! Are those places cool! They have all kinds of monitors and equipment stuck all over the place. Looked like the bridge of the Starship Enterprise. I told somebody “You guys have all kinds of cool gadgets in here. This is really neat!”

She said, “I’m going to be putting you to sleep now, Mr. Markham.”

I thought, “That’s what they think, with the tolerance I have they’ll never….”

And that was pretty much it. I remember thinking a sentence and having it cut-off right in the middle. Weird.

Then I was dreaming. I can’t remember what, but it seemed like a normal dream. I was waking up, expecting to be home on a normal day. Instead I opened my eyes and all these bozos with strange gear were standing around me and I had a tube down my throat.

I zonked out again.

When I woke up, they were wheeling me out of the operating theater and somewhere else. That’s about all I remember. Then I zonked out again.

I didn’t really wake up. I simply came to now and then for the next hour, so I have spotty memories. I was taken to the Patient Anesthesia Recovery Unit, or PACU. There was a bunch of other poor souls who also had various cuttings done to them.

My nurse seemed irate. She obviously had a headache, was tired, and used a tissue to dab at her nose. One time she stifled a cough. That’s right, my nurse in the critical part of recovery was actually sick. I couldn’t freaking believe it.

There were only a few bad parts of my entire stay at the hospital. Overall they were great, and I’d recommend them, but bad things stick out like a sore thumb. The second bad thing was getting ready to happen next.

They had no rooms, so we all had to wait in PACU until something could be done. Normally and hour or two stay, I was there almost six hours with my sick nurse. I kind of felt sorry for her. But on the bright side, she was attentive and helped me with pain medication when I needed it.

I had read that the trick to managing pain is to not let it get out of control. On a scale of 1 to 10, where 1 is no pain and 10 is the worst pain you’ve had in your life, you should do something around 3 or so. If you let it spike, you’ll end up using twice the narcotics to bring it back under control.”

Late in the afternoon, I felt the pain starting. I was pretty groggy, and even like this it did not feel good. I called the nurse and told her I had pain around a 4 or 5, and I would like some medication.

Just at that moment, however, they found rooms for us. She smiled at me and said “Don’t worry, they’ll give you a shot when you get upstairs”

It was over an hour later when I got the shot, and I found out what level 10 was like. I was in so much pain I was crying. It is a terrible memory, and I know that nobody at the hospital wanted that to happen. But it did, and I’m reporting it. It’s part of my story.

At the room, they ended up giving me a shot or two to eventually dull the pain. By that time I was off in space. I was still conscious, but heck, they could have operated on me again and it would have been fine.

Seven hours after surgery. My stomach has been inflated for the procedure, so it is even bigger than normal

Seven hours after surgery. My stomach has been inflated for the procedure, so it is even bigger than normal. I was not a happy camper.

After that experience, I made sure for the next day or so that I was assertive when I was feeling my pain starting to rise. This didn’t make my stay pain-free by any means, but it allowed me to at least feel happier about everything. (Melissa says the bad jokes were especially bad during this time)

The next morning, I was off to radiology to do a barium swallow. This is a thing where you swallow some fluid and they “check you for leaks”. Leaks are considered A. Really. Bad. Thing., so I was apprehensive.

The guy took the shot and the picture appeared on the screen. I was like “Cool! That would make a great Facebook post!” Perhaps I had a little too much of the happy pills, or perhaps I just over-share. Tough call.

He thought the idea was great and asked me if I had a cell phone. I didn’t, but Melissa did back in the room. So they called up to the room and had her come down with my camera to take a picture of me next to my x-ray.

My new digestive system. I am so proud.

My new digestive system. I am so proud.

After that came back positive — no leaks — it was one more day in the hospital. I liked most everybody I met there, but I was really happy to be going home. My surgery adventure was complete. Getting used to my new life was just beginning.

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Weight Loss 4 – The day before surgery

incentive-spirometer

The incentive spirometer is a little contraption that you take deep breaths through. It helps “pop open” your lung passages. You practice with it for a while before surgery and then every hour in recovery. It’s to help prevent respiratory problems

Almost two weeks into the fast, and I’ve lost around 16 pounds — most of which is water weight. Every day I’m practicing with my incentive spirometer. For the last three days I’m taking showers with a special kind of anti-bacterial soap that’s supposed to reduce the chance of infection.

This isn’t my first time fasting — as an experienced dieter I’ve fasted several times in the past. It always amazes me the personality changes I experience when fasting. I’m much more calm, much more unsure of myself socially. Compared to the usual roller-coaster of caffeine, sugar, alcohol, huge meals, and lack of sleep, it’s like becoming an entirely new person. Interesting. Not really sure I like this guy, though. Junkies always make more interesting artists :)

Today we drive the four hours to the hotel next to the hospital. Tomorrow at 6:30 am I head into my new future. Surgery and post-op should last 4-5 hours.

Yesterday I watched a DVD from the hospital showing what to expect. One of the things that continues to impress me is the way the team continues to provide me the same information in various formats. They’ve obviously read-up and understand that it takes many, many repetitions for things to sink in for folks.

It also amazes me that after all of that, I’ve still misunderstood some things. I am supposed to hold my breath for a few seconds after inhaling with the spirometer. Didn’t know that. I’m also supposed to wash not only my abdomen, but my limbs with the special soap. Missed that one too. I went through hundreds of pages of information in my surgery file yesterday looking for the time I was supposed to be at the hospital. Couldn’t find that one either.

Quite frankly, I don’t think we fasting folks are hitting on a lot intellectually. It’s kind of like having a light bulb on a dimmer switch. I’m still the same person, of course, but not as quick with a rejoinder and a little more prone to skip important pieces of information.

Since I’ve had the experience of having severe sleep apnea for a while,I have a couple of physical traits that I’ve noticed happen with diminished capacity. I tend to unfocus my eyes and relax them while thinking. I tend to skip over words in comments and emails — leaving out small words like “not” or “or” I spend more time researching extraneous topics on the net. (Look! Shiny!)

One other disturbing thing was that during my pre-op interview with the doc he said my endoscopy might be showing signs of Barrett’s esophagus, a condition where the stomach lining starts growing into the esophagus. It’s associated with GERD, being a white male, and having lots of abdominal body fat.

The biopsy came back “normal” though, and he only mentioned it in passing saying “Well, if it is Barrett’s, the number one thing to do to fix it is a gastric bypass”

I read somewhere that one reason not to do more testing was the number of small indicators of potential disease we all have that never actually ever happens. It would make most people paranoid freaks to know all the little things wrong with their body. Still, I need to follow up on this a year or so after surgery. If it is Barrett’s I have a 1-in-200 chance each year of it turning cancerous, and that type of cancer is a very deadly type to get. Who knows, perhaps by taking action on my weight I’m inadvertently saving my own life from a cancer I could have developed in my 50s. Strange world.

If I sound overly negative, apologies. Just mentally taking a deep breath for the changes to come. Everybody keeps asking me how I feel about the upcoming surgery. The best answer I have is “ready” I have done the research, I have weighed the options, I am aware of the risks, and I am ready. Not excited, not eager, not dreading it, just — ready.

On the flip side to all this sobering information, I was out yesterday doing a bunch of chores and realized hey, I feel a lot better being 15 pounds thinner. I am definitely looking forward to more of that feeling!

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