UPDATE page 2: I am going my bi-monthly "bariatric surgery" rumination..........

[msjones]

I've known probably 15-20 people who've had WLS surgery, some are required to lose weight first, others aren't.  Some of it is surgeon specific some of it is due to a specific set of issues.  For instance, some surgeries require the surgeon working around the liver area.  (not the lapband but most of the others), Overweight people tend to have fatty livers and it makes it harder to work in the area.  Some surgeons will require a minimal weight loss of 15-20 pounds (for the average person this isn't minimal but remember we are talking patients who have 100+ pounds to lose).  Those first few lost pounds have a dramatic affect on the liver area making it easier for the surgeon to do a good job.  So the weight loss isn't about seeing if the person can lose weight and/or keep it off, it's so the surgeon has the best chance of doing the surgery well without any leaks. 

 

Secondly the surgery affects far more than just calorie restriction.  Any WLS surgery that involves the intestine (RNY and duodenal switch), also include a malabsorption portion.  This prevents the body from fully absorbing calories from fat.  Thus a person might eat 1800 calories but the body is only able to absorb 1500 calories (I just randomly picked numbers to explain my point), the extra calories are flushed out of the body unused.  So the person eats fewer calories because of the restriction on the stomach size, then they absorb even less than that so the overall outcome is the person has far fewer calories for the body to use and thus loses weight. 

 

Thirdly, depending on the type of surgery, the hormone levels in the body are altered.  For instance in the duodenal switch the lower portion of the stomach is removed.  This is the part of the body that is responsible for the produce of gherlin (not sure of spelling), this hormone controls appetite/food cravings.  Many patient report a reduced desire for sugary foods and carbs after the DS simply because the body is no longer signaling "feed me" these things. 

 

So there are many more factors at work with WLS surgery than just restriction of food intake.

Very helpful and informative. Thanks for taking the time to explain!

(I'm guessing you have a medical background?)

[Catwoman]

Joanne, are there any support groups in your area for people who have already had the surgery, or online forums about it? If there was a local group, maybe offered at a local hospital or something, you could meet and talk with people in person about their experiences, and probably gain a wide range of opinions (both pro and con,) before you make a decision about whether or not you want to go through with it.

[BigMamaBird]

 

If you have addictions in your family, you might look into MTHFR genetic issues.  It's fairly common, and all of the fortefied processed foods have made things worse for those with that defect, which, at least for me, made me feel like I was driven to overeat.  When I learned about it after having several miscarriages I switched vitamins and started avoiding fortefied foods, and I've found that when I'm consistent with taking the right vitamins my appetite is FAR less.   People keep telling me I look thinner, but I haven't lost more than a few pounds, I'm just getting less puffy. I'm now to the point that I'm starting to think that weight is driven by biological issues, not character ones. Maybe B-vitamins aren't the issue for you, perhaps fat soluable ones are.  If I were you, I would try really hard to make sure you're getting the nutrients you need before you do anything that's dangerous and life altering.

 

I've never heard of this before and it sounds very interesting.  I'll have to check it out.  Thank you.

[Audrey]

Joanne, I think you might remember that a few years ago I had talked about my brother wanting to do WLS.  He did finally do it right before Christmas this year.  He's still in the very early stages, but he is healing well and recovering from surgery well.  It was a tough decision for him, but his complicating health issues were what put him over the fence and going for it.  His high blood pressure has become even more difficult to control over the past year and a half, and his Type 2 diabetes was also getting more erratic. 

 

However, even despite his other issues and that his weight was high into the morbidly obese range, his insurance company refused to cover it -- twice.  It took rounds of appeals to get them to okay it.  I mention this because you mention that you qualify, but do be prepared for a fight to prove that you are qualified to your insurance company.  After he was declined the first time, his doctor's receptionist told him that the insurance companies have gotten very tight on WLS in the last few years.  So... just a heads up on that. 

 

I don't really have any advice than that.  It's a hard decision, and so very personal. 

[Joanne]

What an awesome thread. Honest, encouraging, informative, and supportive.

 

I think I may be crystallizing my thoughts on the matter. I am, btw, aware I started a similar thread a while back. Could be months, could be years.

 

 

[ocelotmom]

Thirdly, depending on the type of surgery, the hormone levels in the body are altered.  For instance in the duodenal switch the lower portion of the stomach is removed.  This is the part of the body that is responsible for the produce of gherlin (not sure of spelling), this hormone controls appetite/food cravings.  Many patient report a reduced desire for sugary foods and carbs after the DS simply because the body is no longer signaling "feed me" these things. 

 

Yes, it does have beneficial physiological effects beyond just weight loss. A friend of mine who had the surgery reports that Type II diabetes is often magically reversed. Weight loss can reverse Type II diabetes, but this occurs within days of the surgery - too soon for weight loss to be the cause. That seemed to be the main thing that pushed her into the surgery.

 

This was a few years ago, and she seems to have done well with it overall.

 

One problem she has, which might be a consideration for you between the car accident and addiction issues, is pain management. Regular and high dosage use of NSAIDs are contraindicated after WLS. Because of this, she has problems with being considered drug-seeking and difficulty getting adequate pain control (for a chronic pain condition which I don't think is related to the surgery). Narcotics may be difficult to avoid if chronic pain is an issue for you.

 

I looked up someone else I knew who had weight loss surgery and discovered she died a few years ago, about 10 years after the surgery. I don't know what she died of, so I have no clue if it was related. If my guess is right (suicide, or after-effects of a previous suicide attempt), it's a chicken or the egg situation. Did chronic depression contribute to the initial weight gain in the first place, or to her decision to get the surgery? Or could nutrient deficiency have caused the depression? B vitamin deficiency, in particular, can do that, and WLS is known for causing that. Or maybe it was unrelated, or another cause (related to the surgery or not) entirely. She was young - in her 40s.

 

It does appear she kept the weight off, though.

 

Someone mentioned MTHFR, and I find that interesting. That would contribute to the likelihood of developing a clot after surgery, so I'd think it would be worth testing for prior to making a decision.

[Sugarfoot]

I don't know how to quote on my iPad, but I wanted to second (third?) genetic testing for MTHFR. It's a genetic SNP (pronounced snip) that can cause all kinds of problems. I recently found out I have the homozygous type- the worst type. I'm of Meditteranean descent, (a little over half) and it's my understanding that it's a little more prevalent in that population, but it's not uncommon in the general population. Anyone can have this problem, and lots of people do. I now take special types of vitamins and avoid certain foods. I also have some insight into the addiction patterns in my extended family. Finally, I feel better than I have in years. I'm not saying it would solve all your weight problems, but your story is compelling enough that I think it's a good idea to check it out, even if it's just to give you some info going into surgery.

 

It cost about $100 to do the genetic testing through 23andme.com

It's a saliva sample test that you mail in. It takes a couple of weeks to get results.

[Reflections]

Just to add to the discussion, there is evidence that gastric bypass success is due in part to changes in gut bacteria...

 

http://www.nih.gov/researchmatters/april2013/04152013bypass.htm

 

http://www.newscientist.com/article/mg21829115.800-gut-bacteria-swap-is-key-to-knifeless-gastric-bypass.html#.VLSVxivF9q8

 

ETA:  the second link talks of "knifeless" gastric bypass

[Catwoman]

What an awesome thread. Honest, encouraging, informative, and supportive.

 

I think I may be crystallizing my thoughts on the matter. I am, btw, aware I started a similar thread a while back. Could be months, could be years.

Joanne, I love your new avatar photo!!!

[SeaConquest]

Arctic Mama, and others with PCOS, you might be interested in this recent research on liraglutide, as adjunctive therapy with metformin, for treatment of obesity. I am going to ask my endo about it at my next visit.

 

http://www.ncbi.nlm.nih.gov/pubmed/24362411 

[melmichigan]

Arctic Mama, and others with PCOS, you might be interested in this recent research on liraglutide, as adjunctive therapy with metformin, for treatment of obesity. I am going to ask my endo about it at my next visit.

 

http://www.ncbi.nlm.nih.gov/pubmed/24362411 

Just be sure to educate yourself.  Liraglutide has a black box warning.

[LMV]

Just be sure to educate yourself.  Liraglutide has a black box warning.

 

As do Metformin and Contrave. 

[LMV]

I'm not sure if this will be helpful because although our eldest daughter had a partial gastrectomy hers was done due to cancer so the procedure was different and associated weight loss was our concern rather than goal. At the time she had the surgery, we all (us as her parents, she herself, and the physicians involved) had concerns about nutrition post-operatively.  It was one of those best of a bad set of options though because we couldn't really ignore the cancer.  What she had done was probably most similar to the old RNY procedure in terms of the gastrectomy component but the intestinal bypass was not done . As a result she has a significantly diminished stomach capacity but hasn't had the problems with additional malabsorption issues (she did have pancreatic insufficiency pre-procedure and that has persisted but now is managed quite well with creon) or significant dumping syndrome/diarrhea.  I would say that achieving adequate nutrition did require effort on her and our parts in the first year after surgery but it was just our reality so we pushed onward.  Now, she is still working with a diminished stomach capacity so she utilizes additional snacks to make up for the smaller size meals but she has just accepted that this is her life so she has to live it and she does. Her physicians and I believe that she has also stretched her stomach out some over time so she has more room to work with and this has helped (and I understand this why some of the banding surgeries often fail because it is possible for patients to increase their capacity by pushing the limits). 

 

Nutrition pieces aside the surgical recovery for her wasn't bad (but she was also an active kid with an active social life and I think she sometimes ignored pain because she just wanted to be hanging with her friends---on the positive side because of her illness she had also got really good at listening to her body by then so she also was good at going to bed early when she needed to and I think that allowed her to push some of the limits and get away with it). She was home five days after surgery and while she had accepted that she wasn't immediately going back to horseback riding or any sports she was allowed to practice her musical instruments (and even finagled some deal that she should be allowed to try before discharge because you know if it was going to be a problem shouldn't we figure it out while she was still in the hospital---so she was serenading the rest of the pediatrics floor a few days after surgery) and our house was filled with music. She did not go home with pain medicine because she hadn't been taking it in the hospital and the surgeon didn't seem surprised by that. She had learned some pain processing techniques through some modified CBT a year earlier and she did utilize those through this surgery.

 

I wish you well with your decision, Joanne.  I think you're looking at all of the angles which is good.  I would encourage you not to look at the surgery as failure or cheating but perhaps just the best option for you (if you decide it is---I don't really know enough about your specific situation to advise you).  I also think others who have advised you to look into the different procedures and look specifically into the outcomes of patients for the different procedures with your local surgeons is a good idea.  The surgeon who did our daughter's procedure did a great job and we're all very grateful to him for that.

 

 

 

 

[melmichigan]

As do Metformin and Contrave. 

True.  

 

Glucophage's black box is tied to to kidney function; it is being challenged after 20 years.  Contrave carries the black box because the Wellbutrin component is black boxed for increase in suicidal thoughts.  Liraglutide is black boxed for thyroid tumor risk.  They all carry risks, particularly to certain populations.

 

I have never heard of MTHFR.  Interesting.

[ktgrok]

This thread is  a month old, but I'm jus reading it now. I just contacted a local hosptial to start the information gathering process for surgery, most likely lap band, but not ruling out bypas. I'm lucky in that there is a "center of excellence" 45 minutes away. They do require you to meet with a psychologist first, and a nutritionist, and attend a support meeting. My insurance will require, from what i understand, 6 months of medically supervised diet first, to "prove" I really need surgery. That means meeting with a nutritionist, then follow ups for weight checks monthly, plus exercising. I have to prove I have a gym membership, for example. Only then will surgery be an option. My biggest fear is I lose just enough weight in that 6 months to not qualify for surgery anymore, but still be obese. Then in a few months be over the BMI limit again,and have ot start the 6 month process all over again. I'd be happy to lose enough weight in the 6 months to really not need surgery, but not if it's just the few pounds that puts me over the limit, you know? 

 

Also, the hospital here has you join support groups afterwards, and all meetings with the psychologist and medical team are free for a year. There is even a chaplain to discuss the spiritual side, for those that would appreciate that kind of support. And nutritionists. And cooking classes, etc. From what I understand, that kind of follow up makes a big difference in outcome. (right?)

 

I also have found several places that said the biggest factor in post op complications is how many surgeries your surgeon does a year. Higher volume means less complications. Being a Center Of Excellence is the label to look for. 

 

Our hospital also has the Da Vinci robot, which supposedly minimizes complications. 

 

That said, I'm 5'1 and 214lbs naked, first thing in the morning, no food or drink yet. So well over that by the time I'm clothed and in a doctor's office. My BMI is 40 or 41, depending if I'm wearing clothes when weighed, lol.  I have horrid acid reflux (GERD) but no hiatal hernia. I have plantar fasciitis flare ups if I exercise too much. If I try to take an exercise class my feet cramp up, even with orthotics, etc. I just have too much weight for my poor feet. I have arthritis in my toes, I think, as well. More scary to me, is that my father (I take after him) and his twin and his father all had heart attacks in their 40s. I'm going to be 39 soon. My dad has type 2 diabetes now. My Grandmother did too, before she died. I'm still ok lab work wise (well, I was last year and 20lbs ago), but how long can that hold out? 

 

From what I understand, gastric sleeve isn't a surgical option for me, because it makes acid reflux worse. Lap band and RNY bypass usually cure reflux. I lean towards lap band as RNY is so much more extreme. On the other hand, it's more effective. I'm still researching that. I want to be able to eat small amounts of normal food and feel full. Period. I don't want to want more food an hour after a normal or large meal. 

 

i do better on low carb, but sticking to it is so hard, and often the weight loss stops anyway after a few weeks to a few months. Then I'm working so hard and NOT getting any return for my effort, and I fall off the wagon. It would be a lot easier to stick with my diet if it actually resulted in weight loss!! 

 

I am looking at the post op diet, and thinking I will try to make those changes now. Mainly, no sweets, no carbonated beverages, etc. Which will be HARD. I love my seltzer and such. Hmm. We shall see. 

 

Anyway, thanks for all the perspectives!

[Seasider]

This thread is a month old, but I'm jus reading it now. I just contacted a local hosptial to start the information gathering process for surgery, most likely lap band, but not ruling out bypas. I'm lucky in that there is a "center of excellence" 45 minutes away. They do require you to meet with a psychologist first, and a nutritionist, and attend a support meeting. My insurance will require, from what i understand, 6 months of medically supervised diet first, to "prove" I really need surgery. That means meeting with a nutritionist, then follow ups for weight checks monthly, plus exercising. I have to prove I have a gym membership, for example. Only then will surgery be an option. My biggest fear is I lose just enough weight in that 6 months to not qualify for surgery anymore, but still be obese. Then in a few months be over the BMI limit again,and have ot start the 6 month process all over again. I'd be happy to lose enough weight in the 6 months to really not need surgery, but not if it's just the few pounds that puts me over the limit, you know?

 

Also, the hospital here has you join support groups afterwards, and all meetings with the psychologist and medical team are free for a year. There is even a chaplain to discuss the spiritual side, for those that would appreciate that kind of support. And nutritionists. And cooking classes, etc. From what I understand, that kind of follow up makes a big difference in outcome. (right?)

 

I also have found several places that said the biggest factor in post op complications is how many surgeries your surgeon does a year. Higher volume means less complications. Being a Center Of Excellence is the label to look for.

 

Our hospital also has the Da Vinci robot, which supposedly minimizes complications.

 

That said, I'm 5'1 and 214lbs naked, first thing in the morning, no food or drink yet. So well over that by the time I'm clothed and in a doctor's office. My BMI is 40 or 41, depending if I'm wearing clothes when weighed, lol. I have horrid acid reflux (GERD) but no hiatal hernia. I have plantar fasciitis flare ups if I exercise too much. If I try to take an exercise class my feet cramp up, even with orthotics, etc. I just have too much weight for my poor feet. I have arthritis in my toes, I think, as well. More scary to me, is that my father (I take after him) and his twin and his father all had heart attacks in their 40s. I'm going to be 39 soon. My dad has type 2 diabetes now. My Grandmother did too, before she died. I'm still ok lab work wise (well, I was last year and 20lbs ago), but how long can that hold out?

 

From what I understand, gastric sleeve isn't a surgical option for me, because it makes acid reflux worse. Lap band and RNY bypass usually cure reflux. I lean towards lap band as RNY is so much more extreme. On the other hand, it's more effective. I'm still researching that. I want to be able to eat small amounts of normal food and feel full. Period. I don't want to want more food an hour after a normal or large meal.

 

i do better on low carb, but sticking to it is so hard, and often the weight loss stops anyway after a few weeks to a few months. Then I'm working so hard and NOT getting any return for my effort, and I fall off the wagon. It would be a lot easier to stick with my diet if it actually resulted in weight loss!!

 

I am looking at the post op diet, and thinking I will try to make those changes now. Mainly, no sweets, no carbonated beverages, etc. Which will be HARD. I love my seltzer and such. Hmm. We shall see.

 

Anyway, thanks for all the perspectives!

Sounds like you have done your homework! My only input is to suggest that you look for a gym with a pool that offers water exercise class. Aquatic aerobics is much easier on the joints and the workout can be as easy or intense as you wish, based on the effort you put into it. Since you will be "ordered" to exercise, this might be a good option for you presurgery (and post, if you enjoy it as much as I do!).

[ktgrok]

Sounds like you have done your homework! My only input is to suggest that you look for a gym with a pool that offers water exercise class. Aquatic aerobics is much easier on the joints and the workout can be as easy or intense as you wish, based on the effort you put into it. Since you will be "ordered" to exercise, this might be a good option for you presurgery (and post, if you enjoy it as much as I do!).

 

My gym does have this! I do love it, although it's funny being the youngest in the pool :)

[Seasider]

My gym does have this! I do love it, although it's funny being the youngest in the pool :)

Haha! I know what you mean. One of the teachers at my old gym was 83. Her 90yo husband came to the class! Those folks could move! They had endurance skills! And it was still a great workout for me, because all I had to do was push the water a little harder, a little faster.

[SeaConquest]

Katie, before I would consider surgery, I would research the drug Victoza, which was recently approved for obesity under a different name (Saxenda), possibly combined with something like Phentermine or Dexedrine. I would exhaust the pharmaceutical options before resorting to surgery. Lap Band revisions are very common. 

[ktgrok]

Katie, before I would consider surgery, I would research the drug Victoza, which was recently approved for obesity under a different name (Saxenda), possibly combined with something like Phentermine or Dexedrine. I would exhaust the pharmaceutical options before resorting to surgery. Lap Band revisions are very common. 

 

I am looking at medications as well. i'm just not seeing great success rates with them. Seems that 5-10% of excess weight loss is considered a success. 

 

And they have similar side effects, including tumors, cancer, death, liver problems, heart problems, etc. I just don't know if that's a better risk, you know? Especially when they just "may" help you lose slightly more than a placebo.

[6packofun]

What a very difficult decision!  For me, I think the worry about complications and recovery as a woman who is getting older (BOO!) would prevent me, but you know what else would?  Losing the joy of eating food.  I want to be able to enjoy food, even as I struggle in my relationship with it.  Yes, sometimes my self-control gets the better of me, but to lose the EASE of occasionally just eating whatever I want with some good friends and not having the focus be on how *little* I get to have would probably kill me.  Emotionally, I think it would be harder for me to become *fearful* of food...this has happened to 2 people I know who have had the surgery and successfully kept it off.  They don't regret the decision, but they had no idea that food would become a BIGGER issue in their lives afterwards.  I couldn't handle that kind of stress.

 

Also, if your current picture is accurate, I think you look lovely and healthy!  I agree with whoever said that not every overweight person is UNhealthy!

[ktgrok]

What a very difficult decision!  For me, I think the worry about complications and recovery as a woman who is getting older (BOO!) would prevent me, but you know what else would?  Losing the joy of eating food.  I want to be able to enjoy food, even as I struggle in my relationship with it.  Yes, sometimes my self-control gets the better of me, but to lose the EASE of occasionally just eating whatever I want with some good friends and not having the focus be on how *little* I get to have would probably kill me.  Emotionally, I think it would be harder for me to become *fearful* of food...this has happened to 2 people I know who have had the surgery and successfully kept it off.  They don't regret the decision, but they had no idea that food would become a BIGGER issue in their lives afterwards.  I couldn't handle that kind of stress.

 

Also, if your current picture is accurate, I think you look lovely and healthy!  I agree with whoever said that not every overweight person is UNhealthy!

 

That is something I am concerned about. Although I do know two people that have had surgery, and still enjoy food a lot. One has kept off 200lbs, but is still a foodie at heart. She may even open a restaurant in the future. right now she has a food blog. she just eats small portions. 

 

The other has gained some weight back, but is still 100lbs down, and does enjoy food, but he's 10 yrs out or more, so hisgastrectomy has probably stretched out by now some. 

 

And i appreciate the compliment, that's a very recent photo. I luckily don't carry so much weight in my face as some, but the bad side of that is that it is all in my belly. Very unhealthy. And getting really uncomfortable. Heck, right now my belly keeps pressing on the stupid touchpad on my laptop, making it do things. I'm now heavier than I was 9 months pregnant with my first child. My feet hurt whenever I try to exercise. (yes, with professionally fited shoes/orthotics/etc). I'm uncomfortable driving because my belly is so close to the steering wheel. I have reflux that could cause esophogeal cancer if untreated (and has ruined my teeth), but now that I'm treating it I know I'm risking stomach cancer. (yes, I've tried natural remedies, diet changes, etc....carbs make it worse, but nothing gets rid of it, even water aggravates it when I'm unmedicated). 

 

I'm now reading that surgeons are saying that if you are obese and considering surgery for GERD (which I have been) you should just get a gastric bypass, because it is more effective in obese patients anyway, and will help with the obesity at the same time. One more thing to consider I guess. 

[Katy]

I just wanted to throw in that reversing type II diabetes isn't magical with a bypass- you literally can't eat anything with that surgery for a period of time and a bypass creates a huge caloric need because healing from that sort of surgery takes a ton of calories.  You go from burning minimal calories to burning a huge amount of calories, and when you also can't eat, your insulin level plummets.

 

 

[ktgrok]

I just wanted to throw in that reversing type II diabetes isn't magical with a bypass- you literally can't eat anything with that surgery for a period of time and a bypass creates a huge caloric need because healing from that sort of surgery takes a ton of calories.  You go from burning minimal calories to burning a huge amount of calories, and when you also can't eat, your insulin level plummets.

 

I'm not sure if that was for me or Joanne. I don't have diabetes - yet. GERD, feet issues, and a very strong family history of diabetes and early heart attacks (before 50yrs old). 

[Pamela H in Texas]

JFYI, there is no way I would even consider LapBand.  There are SO many complications on top of stinky results.  
And I had GERD and the Sleeve and have done beautifully.  

The sleeve has so many benefits and lacks the majority of the drawbacks of other surgical options.

Keep researching and best to you :)

 

[ktgrok]

JFYI, there is no way I would even consider LapBand.  There are SO many complications on top of stinky results.  

And I had GERD and the Sleeve and have done beautifully.  

The sleeve has so many benefits and lacks the majority of the drawbacks of other surgical options.

Keep researching and best to you :)

 

Thanks, the more I'm researching, the more I'm seeing poor long term results with the lap band, compared to to other procedures. Sigh. 

 

Did your Gerd get better after the sleeve, or stay the same?

[kubiac]

My aunt had multiple fainting spells and hospitalizations after a similar surgery, just FYI, but it did significantly decrease her weight/BMI and improve her overall health.

 

There is a book called Eat to Live by Dr Joel Fuhrmann that I consider transformative. If you come across it, take a look.

[Pamela H in Texas]

Katie, GERD got better, much better.  I've had maybe 3 bad moments since I had surgery (last April) and only one was really bad.  And of course, that was tied to bad choices also.  

JFWIW, I have since gone vegetarian, leaning vegan.  I really believe that high nutrients (G-BOMBS from Dr Fuhrman, but higher fruit) and not focusing on macronutrients is key.  I follow Dr. Garth Davis (a bariatric surgeon who encourages the vegan lifestyle) on FB.  Might look at Freelee the Banana Girl on  Youtube also.  

[6packofun]

I'm not sure if that was for me or Joanne. I don't have diabetes - yet. GERD, feet issues, and a very strong family history of diabetes and early heart attacks (before 50yrs old). 

 

It was for Joanne, but I think it applies to you, too!  

 

Just as an aside, I think that many of us who lose weight without surgery have to cope with the fact that our bodies are just not going to look like we envisioned them after all that hard work.  :(  This was true for me...I lost 54 pounds last year and I will just always have a smooshy belly.  But underneath?  Abs of steel, baby!  LOL  I remember getting to 145 pounds and thinking I still had 10-12 to go.  A naturally thin friend who is about 1 1/2" taller than me asked what I weighed.  I told her and said that I still wanted to lose more.  She looked sort of shocked and said that SHE weighs 144.  I had NO realistic idea of my weight, only the knowledge that I was 130 when I got married, kwim?  Things are just different now and I've become very happy with how I look.  But it is definitely a process.  I would imagine that loose skin and body shape after losing weight no matter HOW you do it will play a part in how you "see" yourself from now on.  :)

[Joanne]

The day after I posted this, I began low carb. Again. I planned, and I've eaten my body weight worth of meat and veggies since. I do limited full fat dairy. I am not counting carbs because all the carbs I eat are in broccoli, celery, spinach and I won't believe any science that suggests THAT got me fat!

 

During this time, I've had my biometrics done. My blood sugar (not fasting) was 91. My cholesterol levels were great.

 

I have lost approximately a pound a week since this post.

 

I am very, very scared about the addiction correlation. I have nearly 24 years of sobriety; too much to make a choice that might trigger or accelerate a relapse. Especially when pain has become an issue in the last 1.5 years.

 

I'm nearly 50, and ok with a pound-ish a week.

 

[T'smom]

Congrats! I think a pound a week is great!

[ktgrok]

That's great! I think part of the alcoholism issue is that it's just so much easier to get drunk after surgery, and that may trigger things? You would know better than me if that might be an issue. And pill addicitons, when you have bypass you can't have NSAIDs anymore, so I can imagine you take more narcotics, making it easier to get addicted. I don't think the other procedures limit NSAIDs soseverly. But, if you can keep the weight off another way, given your history, I don't blame you one bit for worrying about the addiction angle. I feel fairly ok taking that risk myself, but I have no addictive history, my parents and grandparents were not addicts in any way, and I plan to avoid alcohol other than a sip here and there of my husband's drinks. That said, it's something I will make sure my family is educated about, to "keep an eye on me" about. Had I a different history, I'd be more concerned. As it is my history is one of heart disease and diabetes. Sigh. 

 

It sounds like you don't need more research right now, but for anyone lurking, I did find this which was very helpful. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3470459/

 

Also, this article:http://www.nature.com/news/weight-loss-surgery-a-gut-wrenching-question-1.15560

 

In comparison, is an article on long term diet alone follow up (spoiler alert, after 6 years, none of the groups had kept off even 10lbs): http://lowcarbdiets.about.com/b/2012/10/14/some-results-from-a-truly-long-term-diet-study.htm

 

Diets and health eating are important. For some they will be enough. For others, they aren't, and we don't know why, but we know they aren't. 

[Twigs]

… During this time, I've had my biometrics done. My blood sugar (not fasting) was 91. My cholesterol levels were great.

 

I have lost approximately a pound a week since this post. …

Well done!!

 

:hurray:  :hurray:  :hurray:

[Reefgazer]

I think a pound a week is awesome!  Congrats!

 

Forgive me if you posted this somewhere already and I missed it, but if you are losing a pound a week and have those chemistry readings, how come you are considering bariatric surgery?  Especially since your photo appears to be pretty darned "normal-weight looking".

The day after I posted this, I began low carb. Again. I planned, and I've eaten my body weight worth of meat and veggies since. I do limited full fat dairy. I am not counting carbs because all the carbs I eat are in broccoli, celery, spinach and I won't believe any science that suggests THAT got me fat!

 

During this time, I've had my biometrics done. My blood sugar (not fasting) was 91. My cholesterol levels were great.

 

I have lost approximately a pound a week since this post.

 

I am very, very scared about the addiction correlation. I have nearly 24 years of sobriety; too much to make a choice that might trigger or accelerate a relapse. Especially when pain has become an issue in the last 1.5 years.

 

I'm nearly 50, and ok with a pound-ish a week.

 

[Pamela H in Texas]

Katie,  I think the real issue is that both are addictive behaviors and you still *can* drink (though in time, you still *can* eat also).  It really is a journey of mindfulness, imo.  I'm scared to death of alcohol so it isn't a direction I'd likely go regardless, but I have had to fight real food addiction issues since surgery.  They didn't just go away because my stomach is only 15% the size it used to be!  And now that I *can* eat, I *can* overeat, make poor choices, etc, I *really* have to do the mental health work on top of working out what the best diet for me is (see, that part isn't decided long term for you by surgery either).

 

Statistically, I'm much more likely to not be obese again having chosen this route. I still have to do all the work to make it where I'm healthy too :)

[ktgrok]

This addressed a lot of issue brought up here, and in other conversations. 

 

https://asmbs.org/patients/bariatric-surgery-misconceptions

[Pamela H in Texas]

I just want to share my visual results.  As I said already, the surgery was worth it for me for my HEALTH to be so much better.  My reflux is better.  My mobility is better.  My joint pains are better.  My numbers (sugar, cholesterol, blood pressure, etc) are better.  I'm just altogether better! 

 

But honestly, I wanted to look better too. I still have a ways to go, but....

 

To be quite honest, I didn't think I looked as bad as my picture from last Spring.  Obviously, I did.  And when I look in the mirror, I don't see the size 8/medium gal on the left either.  But obviously, I *am* that person whether I realize it or not yet.  

 

[Soror]

Looking great Pamela!!!

[Catwoman]

Pamela, you look AMAZING!!!! :hurray:

[ktgrok]

Wow, I wouldn't recognize you! (which surgery did you have?)

[sunflowerlady]

Pamela, you look great.

[Pamela H in Texas]

Katie, I chose the sleeve.

 

The lapband was not an option for me at all.  Not even a consideration with just cursory knowledge of a general lack of progress as well as fills and complications.  The bypass *was* a consideration briefly as my doctor felt it may be the better choice for me as there is more of a "spanking" when you mess up.  However, when I looked at pictures, I noticed that bypass people, in general, didn't look as healthy anymore.  The bypass changes the digestive system, there is absorption issues, etc.  Additionally, because I *do* believe in nutrient dense eating, I wanted to be able to go that direction which could have been more challenging, even impossible, later.  

 

I chose the sleeve because I still have each part of my digestive system, just less of the stomach.  The results by people are good.  There is *a* "spanking" (though not nearly enough 10½ months out).  The majority of the people who have the sleeve look healthy as long as they don't go too far (if your ideal weight is 130, don't go to 105!).  

Anyway, so I've lost 80 pounds.  I officially have 20 to go for my dream goal (a very reasonable number for my height). 

I will say that I think these last 20 pounds will be EXTRA challenging.  Fact is that the surgery is JUST a tool.  It doesn't do the work for me.  I still have a sweet tooth.  I still tend to overeat each meal and to snack.  I still tend to make poor choices when stressed.  I have lost only a few pounds since November :(  And I'm struggling for every good choice and messing up tons right now.  I'm back to where I started now that I *can* mess up so much.  But at least I'm doing it from a healthier place and not losing here is less of an issue than not losing at well over 200 pounds.  
 

Sorry to ramble.  Hopefully it helped someone.

Thanks for the compliments.  :)

[ktgrok]

Thank you! The sleeve is also what i'm leaning toward right now. I was concerned about reflux but the surgeon said he will fix any hiatal hernias while in there, and if I have a weak LES (will do some upper GI tests before being cleared for sx) he will do a variation on the fundoplicaiton sx usually done for reflux. He will basically leave a flap/dog ear of the upper stomach and wrap it around the esophgus to strengthen the LES, just like a normal reflux sx, but most of the stomach removed like a sleeve. 

[DawnM]

 

Note: There are three new weight loss drugs on the market that you might want to try before surgery. If you don't need surgery, great. Qsymia, Contrave, and Belviq. My endocrinologist seems to be very impressed with Qsymia, but I have no personal experience with it. He's much happier with these than the older Xenical or Meridia.

 

 

 

 

Did he say why he likes Qsymia?  I will have to go research.  

[Amy in NH]

Just to add to the discussion, there is evidence that gastric bypass success is due in part to changes in gut bacteria...

 

http://www.nih.gov/researchmatters/april2013/04152013bypass.htm

 

http://www.newscientist.com/article/mg21829115.800-gut-bacteria-swap-is-key-to-knifeless-gastric-bypass.html#.VLSVxivF9q8

 

ETA:  the second link talks of "knifeless" gastric bypass

 

I was coming to suggest looking into fecal transplant.  Gut bacteria play a huge role in ability to gain or lose weight.

[melmichigan]

I chose the sleeve.

I hope I'm remembering this correctly, but did they attribute your recent gallbladder problems to the sleeve?

[Pamela H in Texas]

Melissa, yes.  It is common to get gallstones after losing a good deal of weight.  

Many people end up having theirs removed a year or two post-wls.

I knew that was a very real possibility going in.

 

[ktgrok]

Melissa, yes.  It is common to get gallstones after losing a good deal of weight.  

Many people end up having theirs removed a year or two post-wls.

I knew that was a very real possibility going in.

 

I actually just had a gallbladder ultrasound, to make sure there were no stones prior to surgery. If there were they would remove it at the same time. There aren't, so I'll be on actigall for several months to prevent new ones forming.