Gastric Sleeve: One Year Reflection (well, close enough)

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May 14, 2019 was the day I had my Gastric Sleeve Surgery. This was performed at Good Shepherd Hospital by Dr. C (who is awesome). Like many people who struggle with their weight, this was not an easy decision. Like I had mentioned in my previous blog post (New Year: Who Dis), I researched and really looked into what any weight loss surgery would entail. My mother, years earlier, had lap-band done (different doctor from mine). And while, at first, it seemed to be working (as in, she lost weight), too many issues started coming up and she easily regained the weight (plus more) not to mention having terrible heartburn and other issues (such as vomiting on an empty stomach-Dr C. removed her lap-band this year). Lap-band was and still is touted as an acceptable weight loss surgery. There are still doctors who are willing to perform it and places that still consider it as being viable.

Lap band

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The pitfalls, however, are that lap-band has a high failure rate. According to NCBI, the failure rate is 13.2% at 18 months. That percentage goes up dramatically as time from when it was put in continue (to a whopping almost 40% at 7 years). Gastric Sleeve (and Bypass) have a failure rate of less than 5% at 2 years, with 16% at 7 years. Now, like I had mentioned in a previous blog, “failures” for Gastric Sleeve range from gaining 15 pounds to having a baby. Yes, a woman getting pregnant after having this surgery is considered a “failure” by every study that I have been able to come across and read, which I find ironic and very misogynistic considering that fertility issues (including PCOS) are considered acceptable reasons for having these surgeries. And anyone who has seen a pregnant lady can attest that most women gain at least 15 pounds, if not more, during a normal pregnancy. I feel that pregnancy after surgery should be seen as a success, not a failure. Also, gaining muscle mass (muscle weights more than fat), is also a failure. We really should, as a society, rethink the whole BMI chart as it doesn’t take into consideration body structure. The Perelman School of Medicine (University of Pennsylvania) stated in an article from 2013, that the BMI is inaccurate because it doesn’t take into consideration body mass, body shapes, bone density, overall body composition, and the basic differences between the sexes as one chart is used for both sexes, meaning that the height and weight for a petite white female will not work for a petite white male.

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So, what does this mean? Well, any good doctor will use is as a guideline, not as absolute truth (as in you MUST weight this amount). Especially when one keeps in mind the BMI chart (yes, the standard one) was invented/complied in the 1830s. Diets (as in what we eat), activity, and also heights of people have drastically changed in the nearly 200 years since it was created. There are variations of it, tailored for men, women, and children, but the basic data used still stems from this initial chart from the 1830s. See why so many of us get frustrated by this chart? Now, in all honesty, at 330 pounds and being 5’8″, I was obese. I was extremely obese. I knew it at the time and I accept this fact. But I do find it laughable that according to the chart, a healthy weight for me would be between 120 and 150 pounds. Based on my bone structure, and very wide hips, that weight range would make me look sickly. Not to mention that I would be, in Dr. C’s opinion, underweight and unhealthy. Now, my goal weight is between 165-180 (I’m shooting for about 170-175). The chart states that this weight range makes me overweight. Now, keep in mind that insurance companies still adhere to this chart and they also compile statistics for those percentages when it comes to failure and success rates of surgeries. So, I would be considered a “failure”, yet my doctor would consider me a success (FYI, he currently hails me as a success because losing over 50 pounds in the first year is a success in his eyes). So, that’s where I do take any failure rate with a slight grain of salt. Now, lap-band does have a high failure rate only in that there are so many health issues which arise with it. These range from the basic improvement of the person’s health (i.e., losing weight) to increase of heartburn symptoms and even a twisted band (yes, those things can twist and shift about in there). This doesn’t mean every lap-band surgery is going to fail nor do I believe every single one will fail. My personal opinion, based on seeing how it affected my mother and from research, the cons (such as increased heartburn, vomiting on empty stomachs, etc) outweighs the pros (weight loss). To me, this made lap-band surgery a non-viable option (and one my surgeon doesn’t do nor recommend because of these issues).

Now, Gastric Sleeve & Bypass have both fans and haters too. There are people who have written about the failure of their surgery and why they regret it. And I get it. This is not an easy decision to make and it’s not easy changing how you not only look at food, but how you eat and cook. And I do not want anyone to think I am bashing or poking fun at those who do regret this. I feel for them and I wish they had the support I have been lucky (and I feel very lucky) to have had in terms of research and making this decision. I only want to point out a few alarming issues some of these people have in common so those who read this and have questions, can be better informed. One such trend is the belief their life is going to drastically change like some pseudo Hollywood film makoever.

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Anne Hathaway in The Princess Diaries

The sad reality is that most of these miraculous Hollywood film makeovers are simply excellent makeup and costume designers who can transform a relatively attractive person (usually white and female) into being slightly to overly unattractive, in order to have a “makeover” in the film and be revealed as drop dead gorgeous. That’s not real life and while I enjoyed The Princess Diaries, I did cringe at the obvious ugly ducking to swan troupe being used. This troupe is overused and harmful to our Social Psyche. Another trend is the need to rush into having this surgery by flying abroad (generally Mexico) and having it performed there due to cost. The average cost of Gastric Sleeve & Bypass is $23-30K, Lap-Bands average around $14-16K. Compare this with the low (incredibly low) cost of $3-6K for Sleeve or Bypass and $2K or less for Lap-Band. Some sites state they can perform surgery (after receiving payment) anywhere from 4 to 6 weeks. So, if one is desperate and feeling like they HAVE to do this, waiting a month does seem like a better option than waiting 6 months to a year. I get it too because once I made the decision to go an speak to a surgeon, I really couldn’t wait to have the surgery. Yet I am so glad I was forced to wait. And I waited abut 2 months more than I should have due to a hold up (waiting on the psychiatric letter took 2 months longer than expected). Yet I don’t regret this whatsoever. I researched for at least 3 months BEFORE going to see Dr. C and continued to research after meeting him. I have two binders full of information (one was given to me by the surgeon, the other I started and is full of recipes and meal ideas, plus any information I deemed important to have on hand this way). So, while I was more prepared than most, I still wasn’t fully prepared.

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So, why Mexico? The main factor is probably based on finances. The low cost of surgery in Mexico is meant to draw in people who are desperate to lose weight. And unlike the standards set by insurance companies here in the US, Canada, and Europe, Mexican Bariatric centers will take anyone-including those who wouldn’t qualify under insurance guidelines. What? Yes, anyone. There are stories and photos of men and women who underwent surgery to lose as little as 20 pounds with no underlying medical problem. People who wouldn’t qualify because they didn’t have any of the main health issues which would deem such a surgery as being medically necessary. These factors (and this is not a definitive list, but the general accepted ones) are Diabetes (Type 1 & 2 though there seems to be more Type 2 who undergo it than Type 1), PCOS, High-Blood Pressure, Sleep Apnea, Asthma/COPD, Acid Reflux Disease, limited mobility issues, and other Endocrine related diseases. This is by no means all the health factors by which insurance companies will approve of such a surgery, but these are the basic ones that tend to help build a case for surgery. Which makes it excessively frustrating when people are choosing to undergo surgeries (most seem to get lap-band or sleeve in Mexico) to loose 20 pounds or less. Listen, these surgeries are not meant for those who just want to shed a few pounds. It shouldn’t be seen as a “quick fix” nor an inexpensive option to constantly yo-yo dieting. These surgeries are meant to help those of us who cannot (and I cannot stress this enough) lose weight through diet and exercise alone. 

Do Different People Really Need Radically Different Diets?

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I’ve been on a diet practically all of my life. I recall at the age of 8 or 9 a doctor recommending my mom start me on a diet as I was a bit too chunky for my age and height (thanks to that blasted BMI chart). I have been involved with Weight Watchers at least 3 times in my life, Jenny Craig, Overeaters Anonymous, Atkins, South Beach, Paleo, Alli (those pills you can by OTC), Slim Fast, Nutrisystem, HMR, Sensa, Mediterrean Diet just to name a few. I have had doctors lecture me about my weight. I have had nutritionists lecture me about not eating well. I could not lose it by normal means. This doesn’t mean those programs, diets, etc don’t work because I know people who are very successful on WW, and I know people who are doing well on Noom. There are people who do well on Keto and others who have been successful using Jenny Craig. The simple truth is not one plan will work with everyone and not everyone can lose weight by traditional means. We are all individuals and are all diverse. And that should be OK. As a society, we need to accept that there are other factors which lead to obesity and not just eating too many calories. 

So, yes, I do have an issue with those who seek out surgery because they think this is a quick fix and an easy way of shedding a few pounds. I take a modicum of malicious glee in how many of them regret undergoing the surgery in as little as a few hours post-op. Now, having one’s stomach butchered, not stitched correctly, and other glaringly obvious bad surgical errors (due to the rapid turn around in Mexico as they are in the business to make money, not provide healthcare) are issues which enrage me as no one should have to endure botched up surgeries. That, sadly, is a case of getting what you paid for. Surgeons in Mexico do not have to undergo the strict training (and ongoing training) that exists elsewhere. This doesn’t mean that there aren’t reputable Bariatric surgeons in Mexico. There are people, with the underlying medical conditions, who go to Mexico and have decent outcomes. It’s a case of not knowing who is going to be reputable and who isn’t. This is why I do think, until stricter standards are installed in places like Mexico, one should look for a good surgeon that is covered by their insurance. And in case people comment on here that this doesn’t help those on Medicaid and Medicare, I regret to inform you that both Medicaid and Medicare do cover this surgery as well. They use standard guidelines as to what medical conditions would qualify and go from there. 

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For those who do have medial issues, one alarming reason they flock to Mexico is they don’t want to follow the insurance (and surgeon’s) prerequisites for having the surgery. Like any basic College course, one cannot sign up for English 201 if one hasn’t had the 101 course. Think of these requirements as building groundwork. One such requirement before approving the surgery, which seems to be prevalent, is being enrolled for a minimum 6 months of physician guided diet & nutrition program. Basically, you see a nutritionist affiliated with the program or hospital every month for six months-a whopping total of 6 visits minimum. And most doctors (Dr. Nowzaradan on My 600 lb Life, for a prime example), will expect a certain amount of weight to be lost prior to getting approval. It seems cruel but there is reason for this: they want to see if you can follow directions. Many people struggle with following basic rules.Now, I have been fairly good before and currently, but I do screw up.

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One such rule I had was no soda (pop depending on the region of the US). I had my last Coke Zero in October 2018. I have not had any since. Now, if I let one go flat, I probably could tolerate it. I have bought these packets (sugar free of course) which promise to mimic the taste of soda (Root Beer, Cherry Cola) when added to water. Instead, I added the root beer (along with some root beer extract-yes, it exists) to a vanilla protein shake (and ice). It isn’t exactly like a root beer float, but it tastes similar and it satisfies that particular craving. Now, if Vernor’s could come out with a similar powder, I would be most happy (the mark of a true Michigander is whether or not you can tolerate Vernor’s Ginger Ale). 

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 I had been seeing a nutritionist for Diabetes previously and had this requirement done (in a year, I had gone from 330+ to around 300, which helped prove to the insurance company that I could adhere to a plan and was willing to change to improve my health). I was lucky that I had this recent medical history already in place. At the same time, my A1C numbers kept going up, and medication was changed from Metformin (which made me sick to my stomach the entire time I was on it, which was years) to insulin and Victozia. No lying, but the thought of daily injections scared me until I did it for a few times and felt better. While I was feeling better, I grew increasingly frustrated as the insulin went from 15 to 30 to 60 to 80 units in the span of a year. While a side effect of insulin is weight gain (and weight loss with Metformin), the opposite actually occurred in my case. My weight went down as I grew to be more active and eat a healthier diet. Yet instead of the weight loss improving the A1C, it kept getting worse. I am one of those rare people that cannot tolerate Metformin, can tolerate insulin and yet be insulin resistant at the same time (insulin resistance means you require more and more insulin to keep blood sugars in check). 

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So yes, I really did need this surgery.  I didn’t want to keep having to increase the insulin in order to keep it under control. My greatest fear was having to take 100s of units a day to stay alive. A unit is the standard way of measuring insulin and I have not found any information that this is referred to as anything else. The average insulin pen (regardless of kind) holds 300 units. I don’t know how much a vial holds, but I suspect it’s a similar amount. Yet this is a digression of the tale. I was on 80 units at the time of surgery (along with 1.8 units/dosage of Victozia), which means I needed 3 insulin pens a week. And yes, it was frightening to be on such a high dose. But, within 2-3 months of having the surgery, I was off of insulin completely. My last A1C was at 5.9 (it was 10.3 before surgery).  I currently am only on the 1.8 dosage of Victozia and I am hoping that will lessen with time. Even if I am ever completely off medication for Diabetes, I will always have to check my blood sugars, have my A1C checked, and be careful of what I eat for the rest of my life. And you know what, I don’t mind a bit.

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This surgery has given me a new lease on life. I can easily keep up with a rambunctious not yet three year old niece and will be able to keep up with her forthcoming sibling. I enjoy exercising at the gym (sadly, on hold due to COVID). I enjoy shopping for clothes for myself, a task I used to dread. I still enjoy food. God knows I still love to eat. Food is something we cannot ever stop needing, which makes obesity harder to deal with than drug addiction. One can avoid drugs and alcohol, but one can not avoid food. But know I really, and I do mean really, take a closer look at the nutritional label. Things I used to eat and thought were healthy turned out to be as unhealthy (if not more so) than things we all consider to be bad for us. Talenti Sorbet, for example, should be healthy. After all, it’s fruit that’s been blended, perhaps with some juice, and frozen. Talenti also adds over 30 grams of additional sugar. Eating Ben & Jerry’s is healthier in this instance because B&J has actual protein in it. And that’s scary, sad, and incredibly eye opening. So not only do I have to make sure I eat more protein and less carbs (basically I eat a low carb-high protein diet that is similar to KETO, but not quite), I have to look at the amount of sugar that’s included, trying to avoid harmful fake sugars (laxative effect), but also try to have a balance that includes fruit, vegetables, dairy, etc. Do I always succeed? Some days I do really well and others not so well. There are products some patients love that I cannot tolerate (taste, etc), and some that I enjoy and others don’t. And this is perfectly normal. Even though I know people who have had the same surgery, or similar, to mine, we are all still individuals with different tastes. 

The point of sharing all this is very, very simple. People, even people who have known me and my struggle to lose weight for years, think having Bariatric Surgery is a quick fx and an easy out. There are people, high profile too, who blast those of us who have undergone such a procedure. This is wrong. Bariatric Surgery isn’t like having an elective plastic surgery to do a face lift. One, for the most part, can live with having wrinkles and laugh lines. Such things do not, and I mean this wholeheartedly, DO NOT improve anything other than one’s ego and vanity. I’m not talking about plastic surgery that has to be done for medical reasons (because that does exist and valid medical reasons are VALID for a reason). Weight loss surgery is done because it improves the life of the patient who will otherwise suffer ongoing and worsening medical issues. This is a surgery which is done to save lives because it does.

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Without this surgery, I knew I would probably not live past 50 without having issues such as blindness, limb amputation, etc. Now, I feel like I can live to be 100. I am happy. My depression is better. My anxiety is better. I no longer have to take medication in order to sleep because of my anxiety. I don’t have to take medication to help the depression medication work better. I’ve gone from 3 pills for Depression to 1. Two medications for Diabetes to one. I used to take 10 prescriptions a day. Now, I take half that. I used to go through a rescue inhaler a month (at the bare minimum). I haven’t had to refill my rescue inhaler in 7 months. I still have it and carry it. But now I don’t feel chained to my asthma. So, if you are considering having this done, talk to a doctor. Reach out to the various support groups that are out there. Research, research, research. If you decide to go for it, I am happy for you. If you find you cannot, but want to try a different program to lose weight, I am happy for you. No matter what, I am happy for you because you are the one making the decision. I only want to share my experience and my reasoning. If this ends up helping one person, then I am glad.

Sources:

https://www.ncbi.nlm.nih.gov/pubmed/16839478

https://www.medicalnewstoday.com/articles/265215

https://www.businessinsider.com/bmi-is-bogus-best-way-to-tell-if-youre-a-healthy-weight-2016-9

https://www.bariatricpal.com/topic/346977-why-getting-sleeved-was-the-biggest-mistake-of-my-life/

https://www.obesityhelp.com/forums/amos/5250564/Gastric-sleeve-biggest-mistake-of-my-life/

https://www.gastricsleeve.com/forum/showthread.php?t=52900

https://www.abc15.com/news/region-phoenix-metro/central-phoenix/weight-loss-surgery-in-mexico-might-not-be-as-safe-as-advertisede

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