Though I’ve shared little about the subject on this blog, I’ve suffered from obesity for the better part of my adult life. I was always fit and trim as a child, and through most of my twenties maintained a healthy weight. It was around the age of 26 that I began to gain weight as a result of a poor diet and infrequence exercise. Hiking – a subject that I have covered here in detail – has been a great help, but like most Americans I’ve never been able to lose weight and keep it off.
By winter of 2014, I reached 260lbs, the highest I’ve ever weighed. Crucially, I’d developed two conditions co-morbid with obesity (as part of a general health status called “metabolic syndrome“): hypertension and high blood sugar. (My triglycerides were also high.) I knew that the combination of hypertension caused by obesity and diabetes was a deadly one; my life expectancy was surely lower than the statistical average for men in America.
I would look at my daughter and wonder if I’d see her graduate from college, get married, or have children of her own. River is clever and sufficiently literate about health and nutrition to know that obesity is a form of sickness. She would say that she wanted me to live to ninety, and I would flinch knowing that my weight and the ailments caused by it made that improbable.
And so it was that I decided to investigate surgical weight loss. The process itself, from an initial orientation to over a year of medical tests, visits with a dietitian, preoperative physicals, even a psychological evaluation, is a fascinating one. It’s something about which I will probably write in the future.
But for now, I’d like to discuss the immediate aftermath of my surgery – a vertical sleeve gastrectomy – and both the expected and unexpected outcomes I’ve experienced.
My surgery was on January 19. For 12 days prior, I had been on a highly restrictive diet meant to shrink my stomach and liver. My grandmother dropped me off at Hartford Hospital, and after checking in with Admissions, I was brought to the OR waiting area. A parade of patient care techs and nursing staff came through to check vitals and keep me occupied with paperwork. The anesthesiologist walked me through the risks of general anesthesia, and had me sign off on a consent form. Finally, my doctor arrived to look over all the pre-op work and see how I was feeling. This would be my final opportunity to back out of the procedure if I so desired.
I knew there were risks. Any surgery comes with them, and if you’re overweight, have diabetes, or high blood pressure, the danger increases. A sleeve gastrectomy also comes with a 0.3% chance of death, usually caused by a rupture in the stomach suture causing sepsis. But I knew this surgery was the right choice. I thought of River and the life that would be mine after all the hard work was done, and with that image I had the courage to say, “Let’s do this.”
The procedure was done in about an hour. Weight loss surgery in all forms is now done laparoscopically, a tremendous improvement on the invasive techniques required a few decades ago. (A laparoscope is a device with a camera. It’s inserted into the stomach, and the surgeon makes small incisions in the abdomen in order to complete the procedure while being able to see with laparoscope.)
I had a two day hospital stay following surgery. The staff on the OR floor – Bliss 8 at Hartford Hospital – were simply amazing. Under their diligent care, I was tested for fluid tolerances (tea, chicken broth, sugar-free popsicles, and water were all I could ingest) and monitored for complications. The ability to stand, walk the floor, pass gas, and urinate were the additional benchmarks required for discharge. Before leaving, I was given a detailed seven-week diet plan and a pile of prescription meds.
Here’s what I’ve noticed in the month since I left the hospital.
First, my blood pressure began dropping. In fact, it began to drop during the pre-op, low-carb diet. Within two days of discharge, I was getting normal blood pressure readings (<120 / <80). Often, my pressure was too low due to hypovolemia (lack of sufficient blood volume) caused by insufficient hydration. Dehydration is the primary health concern after surgery, and my post-op diet called for 64 ounces of water per day. By three weeks after surgery, my diagnosis of hypertension was rescinded and I was taken off my hypertension medication. A huge win for my health.
For two weeks after surgery, liquids were all I could consume. I mainly drank protein shakes, water, and broths. I tried a number of brands – Atkins, Muscle Milk, Isopure – but to be honest, they all taste like chalk eventually. It may sound like a brutal diet, but another immediate effect of the gastrectomy (and this might seem obvious) is that I don’t feel hungry. At all. There are times, of course, when low blood sugar triggers the notion that I need to eat in my brain, but I never feel the ravenous pangs I felt before. Two weeks on liquids was a cinch.
During the two week liquid diet, I began monitoring my glucose levels. A week before surgery, my fasting blood sugar was 136, and my A1C (a measure of average glucose levels) was 6.5. Following surgery, my blood sugar immediately began dropping – now, my fasting blood sugar is around 70-80, and post-meal it’s 95-105. Perfectly normal.
At week three, I was allowed to add mushy foods – non-fat yogurt, oatmeal, low-fat ricotta cheese, and anything that could be pureed – to my diet. I experimented with pureed concoctions like ground turkey, gravy, and spices (thumbs up), or pureed hard-boiled eggs with paprika and lite mayonnaise (thumbs very much down). In addition to 64 ounces of water, I was to consume 70-90 grams of protein each day. The protein would help with healing and help my body get used to a low- to no-carbohydrate diet. So, the mantra provided by my dietitian was “Always choose protein first.” For the short term, that meant putting vegetables and fruits aside, and eschewing carbs almost entirely.
I began to notice a few other changes in the third and fourth weeks. For example, I had a lot more energy than I ever had before. Whereas once I would only feel rested with 9-10 hours of sleep, now I feel great after 7 or 8. Of course, I was also exercising nearly every day – I’ve hiked more in the past month than in the entire autumn of 2015 – and my resting metabolism was improving – evidenced by a resting heart rate of 65-75 bpm.
I was saving a lot of money, too. I found that halving my estimate of how much food I could eat wasn’t enough; I had to reduce it to a quarter or eighth of the portion that “seemed” right in my mind. (After surgery, the size of my stomach was about equal to a banana, or to a 4oz total capacity.) So suddenly a pound of lean beef lasts a month. A can of broth lasts a week. A batch of chili using the standard recipe needs to be frozen because I can never eat all of it before it goes bad. There was, unfortunately, considerable waste as I adjusted to this new way of eating. I used to shop like a bargain hunter, you know the mindset, the most food for the least price. Now, I look for the smallest servings and the highest quality ingredients. I can afford to get better quality meats and superior organic staples. I’ve completely eliminated processed sugars from my shopping list. I’m also saving money in unexpected ways – toilet paper, for example. (I won’t be too candid here, but suffice it to say that when you eat less, you need the bathroom less, too.) I don’t need to buy antacids – heartburn is a thing of the past.
At week two, I also began taking supplements. Because of the limited capacity of my stomach, I will need to take a daily multiple, B12, calcium, iron, and vitamin D supplements every day for the rest of my life. Getting used to this routine was a challenge, so I began tracking my supplements, diet, exercise, and vitals in a daily log. It’s been tremendously useful for staying on top of my fluid and protein goals, too.
A few cognitive changes related to the weight loss took me by surprise. First of all, my tastes changed. Prior to surgery, I despised mushrooms, but now find myself liking them. Rotisserie chicken or roast chicken used to be a favorite indulgence of mine; now I get nauseous at the thought of it. Fast foods, once a bane to my health and a craving I couldn’t shake, hold no appeal. Mostly I find myself jonesing for salads, fish, and – occasionally – Cheez-Its. But without the hunger pangs, I breeze right by the chips and snacks aisle at the store and think nothing of it.
I found my anxiety decreased and my mood improved. Feeling healthier and more fit brought me an inner peace and joy like I have not felt in my life before. Prior to surgery, I set up a meditation area in my living room, complete with an indoor greenhouse and small waterfall. These, of course, helped me develop mindfulness practices that aid in keeping my grateful and happy in my life, but the diet and exercise – both tied to surgery – have made it easier still.
So, the big question: has it been worth it so far? I have to give a completely unqualified “yes.” Though I’m 47 pounds lighter, the real victory is the remission of the hypertension and diabetes, two serious health issues that I have successfully treated with the surgery. Prior to making a final decision, I went to a handful of friends who’ve also had weight loss surgery (mostly gastric bypass) in order to ask them if they were happy they had it done. The answer, from all of them, was nearly always the same: “It was best decision I ever made.”
I can now add my voice to their number, echoing their joy for the new life surgical weight loss – and their own hard work – gave them.